Home Birth: What You Need to Know Before Considering a Home Birth

Sandy Wang, National Center for Health Research

home birthThere are many reasons why women consider giving birth at home or at a birthing center rather than in a hospital.  One reason is the desire to have more control over the process of childbirth, and especially the desire to avoid Caesarean sections (C-sections).

In 2013, 33% of births in the United States were C-sections, which is more than twice as high as the World Health Organization recommends (10-15%).  C-sections are major abdominal surgery, with higher risks of complications such as damage to other organs, blood clots, internal bleeding, or infection.1

In addition, women who get a C-section for their first baby face higher risks for complications in later pregnancies, such as the placenta growing abnormally, or uterine rupture close to the scar.[1]

In many cases C-sections are necessary for the health of the baby or mother, and the increased risk is justified. However, women who give birth in hospitals have been shown to receive higher rates of intervention, whether they need it or not.  For example, of first time mothers, 43% have induced labor, compared to 32% of mothers who previously gave birth.[2]

A hospital birth is a safe and favorable choice for many women, particularly those who would like the option to have pain medication or who are higher risk. And of course, being in a hospital is reassuring if something goes wrong at the last minute. However, women who are looking for a more natural birth experience often consider alternatives to hospital births.

A “home birth” is defined as giving birth in a place other than the hospital – it could be your home, someone else’s home, or a birthing center.[3] Most home births are accompanied by a midwife, but some are accompanied by a physician, family members, or medical technicians.[4] The Centers for Disease Control and Prevention recorded that U.S. non-hospital births have increased by 60% from 2004 to 2012, although the percentages are still extremely small: from 0.87% to 1.36%.[4]

A study of almost 17,000 U.S. women, found that the rates of interventions are lower for home births compared to births in hospitals, without any increase in negative outcomes.[3]  For example, the C-section rate for women who had a home birth was 5.2%5 compared to 27% for low-risk women in the U.S.[6]

Women who prefer a home birth over a hospital birth do so for various reasons.  In addition to a more natural experience, many like giving birth in a familiar place surrounded by family and friends, or a home birth may be more in keeping with their cultural traditions.[2] Researchers from Columbia University School of Nursing found that women who wanted an active role in the birth of their child and expected the delivery to be a positive experience were more likely to plan a vaginal home birth without pain medication and in the care of a midwife.[7] If you are considering a home birth, here is what you need to know.

 Is It Safe?

Home birth has been a controversial topic. The growing numbers of home births have continuously raised questions of safety, midwife licensing and training, communication between midwives and doctors, and hospital transfers just in case any problems emerge. In a 2015 study published in the New England Journal of Medicine, researchers found that for infants with planned home births (some of whom had to be rushed to the hospital), the chance of dying (2.4 infant deaths per 1,000 births) was twice as high as for hospital births (1.2 per 1,000). This difference was not quite statistically significant.[8]

Risks and Complications

Home birth is a safe option for some but can carry risks for others. Home birth is not recommended for women who are diabetic, who have chronic high blood pressure or toxemia, and are at risk or have experienced preterm labor.[9] Also, home birth is best if the baby is head down at term, you are between 37-42 weeks pregnant, have no serious medical conditions, do not have placenta previa at the beginning of labor, and have not had a prior c-section.[10] It is best to speak with your doctor and midwife so they can explain the process and answer your questions.

You also have to consider the possibility of being transferred to a hospital. Studies have shown that in the U.S., approximately 12% of pregnant women who had planned home births had to be transferred to hospitals during labor or after birth. Only 3% of the transfers were urgent; for reasons such as fetal distress or maternal bleeding after birth.  Most of the transfers were non-urgent, due to slow progression of labor, request for pain medication, or maternal exhaustion. Researchers found that first-time mothers who had planned home births were four times more likely to transfer to a hospital than women who had given birth before.[11]

What Do You Need to Do Before Planning a Home Birth?

Home birth is not for everyone, but it is an option for low-risk women who want to avoid medical interventions, want to have an active role in giving birth, want to have options of different positions while giving birth, do not want to be separated from the baby in the hours after childbirth, and want to be in a familiar environment surrounded by loved ones. Giving birth, whether at home or in a hospital, comes with risks and therefore it is also important to do your own research on home birth. Here are some tips to consider:

  • Talk to your obstetrician and/or doctor
  • If you want a midwife, interview midwives about their birthing philosophies and experiences to find a midwife that you are comfortable with and respects your views on birth.
  • Have a “plan b” just in case you need to be transfer to the hospital
  • Find a pediatrician that will be available to examine your baby right after birth

For more information about midwives and how to find the right midwife for you, click here.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

  1. Almendrala, A. (2015). U.S. C-Section Rate Is Double What WHO Recommends. Retrieved 2016, from http://www.huffingtonpost.com/2015/04/14/c-section-rate-recommendation_n_7058954.html
  2. Laughon, S. K., Zhang, J., Grewal, J., Sundaram, R., Beaver, J., & Reddy, U. M. (2012). Induction of labor in a contemporary obstetric cohort. American journal of obstetrics and gynecology, 206(6), 486-e1.
  3. Home Births in the United States, 1990–2009. (2012). Retrieved February, 2016, from http://www.cdc.gov/nchs/data/databriefs/db84.htm
  4. Trends in Out-of-Hospital Births in the United States, 1990–2012. (2014). Retrieved from http://www.cdc.gov/nchs/data/databriefs/db144.htm
  5. MANA: Largest Ever U.S. Study on Planned Home Birth. (2014). Retrieved from http://mana.org/pdfs/PressRelease1-30-2014.pdf
  6. Osterman, M. J., M.H.S., & Martin, J. A., M.P.H. (2014, November 5). Trends in Low-risk Cesarean Delivery in the United States, 1990-2013. Retrieved March 9, 2016, from http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_06.pdf
  7. “Active” Mothers Prefer Planned Home Birth, Midwifery Care. (2015, April 03). Retrieved from http://nursing.columbia.edu/active-mothers-prefer-planned-home-birth-midwifery-care
  8. Belluck, P. (2015, December 30). As Home Births Grow in U.S., a New Study Examines the Risks. Retrieved February 2016, from http://www.nytimes.com/2015/12/31/health/as-home-births-grow-in-us-a-new-study-examines-the-risks.html?_r=0
  9. Home Birth: Benefits and Tips. (2015, August). Retrieved 2016, from http://americanpregnancy.org/labor-and-birth/home-birth
  10. Dekker, R. (2012, July). What is Home Birth? Evidence Based Birth. Retrieved from http://evidencebasedbirth.com/what-is-home-birth
  11. Johnson, K. C., & Daviss, B. A. (2005). Outcomes of planned home births with certified professional midwives: large prospective study in North America. British Medical Journal, 330(7505), 1416.