One of the biggest decisions you’ll make about your baby’s birth is where it will happen. Hospitals are still the “default” choice in the United States, but there has been a small resurgence of home births. Let’s take a look at what you need to know to make the best decision you can about whether or not a home birth is right for you.
Estimated reading time: 10 minutes
Table of contents
- Home Birth: By the Numbers
- Why Choose Home Birth?
- Why Not Choose Home Birth?
- Who is Not a Candidate for Home Birth?
- How to Plan for a Home Birth
- The Takeaway
Home Birth: By the Numbers
While recent years have shown an increase in the numbers, only around 1% of babies are born at home (1). Still, this is an increase of 77% in less than two decades. The practice is on the rise, and there’s a good chance that you know someone who has chosen to deliver their little one at home.
Another statistic that you may be interested to know is that over a third (up to 37%) of first-time moms who attempt a home birth end up needing to transfer to the hospital, though this number drops to around 9% for moms who have had a baby before (2). However, it may be reassuring to know that most of these transfers are for non-emergency reasons, such as baby’s positioning, labor taking too long, or a desire for pain relief. Still, emergency situations do happen (around 3% of transfers are urgent), and there should always be a contingency plan in place.
How Safe Is It?
The statistic that parents-to-be tend to ask about most often is how safe home birth is. The answer, by the numbers, is that about 1 in 1,000 babies die during or just after hospital birth and that number is about 2 in 1,000 in home birth (2). That statistic is interpreted differently by different parents. Some focus on the ratio — twice as many babies die in home birth versus hospital. Some focus on the actual number — two tenths of a percent is still a small number. Only you can decide what these numbers mean in your overall consideration of the options.
Why Choose Home Birth?
If you know that you’d like a natural birth that’s free of unnecessary intervention, you might consider whether the best choice is simply to deliver in the place where most interventions aren’t even available. And if you look solely at the angle of intervention-free birth, the numbers would affirm that a person is least likely to have an assisted delivery or c-section if they give birth at home. Delivering at home means that you won’t feel pressure to consent to interventions.
Comfort in Your Environment
Delivering at home means that you can labor in your own space, rest in your own bed, and feel less “on display” than you might in an outside environment. You also get to choose who is there. This means cutting down on unnecessary people (having perhaps just a midwife and assistant or doula rather than a doctor and a team of nurses). Or it can mean including more people (having your other children around or being supported by more family and friends than the hospital allows).
You’re in Control
In theory, you are the one in control of your own birth, no matter where you choose to deliver. However, there are things like hospital policies that you can’t alter. Some may feel like the doctor is the one “in the driver’s seat” if you don’t have a good relationship with your caregiver. At home, you don’t have to consent to continuous fetal monitoring, there are no restrictions on when you can eat and drink, you don’t have to let your baby out of your sight, etc.
Why Not Choose Home Birth?
No Immediate Access to Medical/Emergency Care
The biggest reason that women decide against home birth is that there isn’t immediate access to doctors and equipment if something goes wrong. If mom or baby show signs of distress, a midwife will transfer to a hospital. However, in an emergency or urgent situation, it is important to act as quickly as possible, and some women feel the safest being already at the hospital and attended by a physician so that no time is lost in the transfer process.
May Be Difficult to Find a Certified Midwife
Home births are typically attended by midwives, but there are different types. There are Lay Midwives who do not have a formal licensure or certification, Certified Professional Midwives, and Certified Nurse Midwives (CNMs). Typically CNMs do not attend home births. They work in birth centers and hospitals. Most often, Lay Midwives and Certified Professional Midwives attend home births.
You may not have access to the type of midwife you want, either because there isn’t one close to you or because your state regulates what types of providers can legally attend a birth. This is too complex a topic to address in this article, but I encourage you to learn about midwife certifications. MANA (Midwife Alliance of North America) explains it well in their article Types of Midwives. Also, learn about the Legal Status of Midwives in your state.
Read More: Learn about the various types of midwives and birth providers in Physicians & Midwives: Difference Betwee Midwife & OB GYN
Limited Pain Relief Options
A person who is considering a home birth might know that she doesn’t want an epidural. However, sometimes plans change even after the best of planning and preparation. If you find that labor is more intense than you anticipated, if your labor drags on and you’re exhausted, or if the pain is making you feel panicky and out of control, etc. then you may decide that the best option for you is to get an epidural. If you’re at home, this requires a transfer to the hospital.
For most people, home birth is the most expensive option. This is because most people are covered by either private health insurance or Medicaid, and home birth is not usually covered. So while delivering at home may be cheaper if you’re comparing the full cost, most people don’t have to pay the full cost of a hospital birth due to insurance. Typically, moms are expected to fully pay for home birth expenses out of pocket including midwife, any needed supplies, etc. A home birth usually costs between $3,000 and $9,000, depending on where you live.
Who is Not a Candidate for Home Birth?
There are some cases when a home birth is not recommended. These are situations in which you’re more likely to require the support of doctors and equipment that is only available in a hospital. These situations include:
- high blood pressure or preeclampsia
- diabetes (gestational, Type 1, or Type 2)
- baby is not head-down
- previous c-section
- pregnant with more than one baby
- high BMI
- abnormal scans
- previous preterm labor
- placenta previa
Most experts also advise that you should not give birth at home if you live more than 15 – 20 minutes from a hospital with 24 hour maternity care.
How to Plan for a Home Birth
Choose the Right Midwife
Interview potential midwives, and make sure you find out about their certifications, experience, and relationships with local medical professionals and facilities. Choose a midwife who shares your birth philosophy and whose personality feels like a good fit.
Round Out Your Care Team
Plan who will be there in addition to your midwife. Many midwives have assistants who come with them so that there is an extra set of trained hands. Some women may choose to add a doula to the birth team.
Additionally, the American Academy of Pediatrics (which does not recommend home birth but provides guidance on it) says. “Two care providers should be present at each delivery. At least one should have primary responsibility for the newborn and appropriate training, skills and equipment to perform full resuscitation of the infant according to the Neonatal Resuscitation Program.” (3) Following this recommendation means ensuring that there is someone there to care for mom and someone else to care for baby, in case both need attention immediately following delivery.
Have a Transfer Plan
When you interview midwives, find out what their transfer plans are. Ask what situations would require transfer, if she has an established relationship with a local obstetrician and facility, and ask her to go over exactly what would happen if you needed to transfer.
Make a Birth Plan
A birth plan is a good thing to have whether you deliver at home, in a hospital, or in a birth center. It makes you think ahead of time about what you want, and then allows you to have a physical copy of those preferences so that your providers can be on the same page as you from the beginning. And talk about your birth plan in your prenatal appointments; don’t just show up with it when it’s go-time.
Find a Pediatrician
Your baby will need to be seen within 24 hours of her birth. Pediatricians do daily rotations at hospitals, but if your baby is born at home, you’ll need to be sure that you have a plan for getting an appointment in the first day of your little one’s life.
Know What You Need to Purchase
Find out what your midwife will bring when she attends your birth, and ask what you need to buy ahead of time. In most cases, a midwife will bring:
- Oxygen in case mom or baby need it
- IV and fluids
- Protective sheets/mats for the delivery surface
- Sterile gloves
- Medication to slow hemorrhage
- Peri bottle for cleaning your perineal area
- Bulb syringe for suctioning baby’s airway
- Suturing equipment
She also may have massage supplies, labor tools (like birth balls or birth stools,) and things like herbal tinctures and essential oils. Find out exactly what your midwife will bring and what you need to supply on your own.
Pain Relief Plan
There’s no way around it… Childbirth is hard work. You may know that you don’t want an epidural or narcotic medication, but you still need to create a solid plan for coping with labor pain. The best thing you can do is take a high-quality natural childbirth class that teaches a variety of ways to cope with contraction pain. Also, talk to your midwife about options like TENS units, that may provide some relief without medication.
There is no single right answer when it comes to deciding where to deliver your baby. Each parent or set of parents must weigh the information on their own and make the best decision for their own family. Ultimately, only you can decide what is best for your baby and your birth. Wherever you choose to deliver, the exciting news is that your little one will be here soon. Congratulations!
Kopa Birth’s online birthing classes allow you to prepare for a natural hospital birth from the comfort of your own home, 24/7. Enroll today in our free online childbirth class and start preparing for your natural birth!
- MacDorman, M. F., & Declercq, E. (2019). Trends and state variations in out-of-hospital births in the United States, 2004-2017. Birth (Berkeley, Calif.), 46(2), 279–288. https://doi.org/10.1111/birt.12411
- Planned home birth. Committee Opinion No. 697. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;129:e117–22. Retrieved athttps://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Planned-Home-Birth?IsMobileSet=false
- Wyckoff, A. S. (2021, August 14). AAP does not RECOMMEND home births, but offers guidance. American Academy of Pediatrics. https://www.aappublications.org/news/2020/04/20/homebirths042020.