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Home Births Are On the Rise—Here's What You Need to Know

home birth illustration

Verywell / Madie Goodnight

Key Takeaways

  • Home births are on the rise during the COVID-19 pandemic as hospitals have imposed restrictions during delivery in the interest of safety.
  • There is debate around the safety of home births, and some women are better candidates for this option than others.
  • There's always a risk of unanticipated complications, so talking with your doctor well in advance is crucial.

In the United States, less than 1% of births happen at home. But in the past year, hospital deliveries have looked quite different.

With a focus on COVID-19 safety, most hospitals have limited the amount of support allowed in the delivery room, mandated induction of labor, and isolated babies from mothers that show symptoms of the virus. This has pushed many women to reconsider their birth plan.

Midwives and doulas guide women through pregnancies and deliveries at home. These specialists have seen an uptick in demand for their services during the pandemic as more women are shying away from hospital deliveries and opting for home births.

While the American College of Obstetricians and Gynecologists recommends hospitals and accredited birth centers as the safest environments to give birth, every woman has the right to make informed decisions about her birth plan. If you're considering a home birth, here's what you need to know.

The Benefits of a Home Birth

Under the best circumstances, a home birth offers a more comfortable birthing experience for both mother and child. But this option is appealing for a number of reasons.

Research has shown that home births involve fewer maternal interventions like cesarean delivery, operative vaginal delivery, labor induction or augmentation, regional analgesia, episiotomy, and electronic fetal heart rate monitoring. They also involve fewer major perineal tears.

There is also evidence that low-risk pregnant women giving birth at home aren't more likely to develop complications than they would at a hospital. But some women are better candidates for home births than others.

Kimberly Langdon, MD and retired OB-GYN, recommends home birth as a safe option for women who've experienced at least one vaginal birth without needing an epidural and without complications like maternal diabetes or high blood pressure, shoulder dystocia, forceps or vacuum delivery, or postpartum hemorrhage.

Fadwah Halaby, APRN, CNM

It’s so natural to our bodies... and if you’re healthy and low-risk and your mind is in the right place, then it’s a very natural choice.

— Fadwah Halaby, APRN, CNM

In her career as a nurse practitioner with a specialty in midwifery, Fadwah Halaby, APRN, CNM, has assisted more than 1,600 women give birth. As a home birth advocate, she practices what she preaches: She delivered her six children at home.

Halaby's midwifery practice in Florida, Midwife 360, has seen business triple amid the pandemic. But she points out that women have been birthing their children at home since the beginning of time, and only the past 100 years or so has it been common practice to give birth in a hospital.

“It doesn’t make sense that natural, healthy, low-risk births take place in the hospital in the first place," Halaby says. "It’s so natural to our bodies... and if you’re healthy and low-risk and your mind is in the right place, then it’s a very natural choice.”

Understanding the Risks

There are risks associated specifically with home births. Research from ACOG says the risk of stillbirths and infant deaths within the first month of life doubles when a baby is delivered at home. The risk of neonatal seizures triples.

"The biggest risk is that there is fetal distress that does not resolve, and an emergency Cesarean section must be done," Langdon says.

It's possible that unanticipated complications will arise during a home birth that would require transfer to a hospital. For this reason, it's recommended that giving birth within 15 minutes of a hospital is key for the safety of both mother and child.

Fadwah Halaby, APRN, CNM

Every woman deserves a doula, especially with home births. Doulas are very helpful to the client and to the midwife.

— Fadwah Halaby, APRN, CNM

Home Birth Accessibility

It's important to note that the increase in home births during the pandemic has been mainly among non-Hispanic White women, according to the American Academy of Pediatrics.

Black communities, which are disproportionately affected by COVID-19, are often left behind when it comes to adequate medical care, in general. The same is true for pregnant women. In fact, in the U.S., pregnancy-related deaths (death of the mother during childbirth or in the following year), affect Black women three times as often as White women.

Inequity within the health care system and a failure to listen to the needs of Black individuals has fostered a lack of trust in these systems. However, whereas a home birth could be a viable option for women who aren't eager to give birth in a hospital, access to home birth care for Black women is more limited.

All women deserve the same care and attention necessary for a safe birth. This requires a deep examination of discriminatory policies and gatekeeping within maternal health care.

Preparing for a Home Birth

If a home birth feels right for you, it's important to speak with your doctor or midwife well in advance to discuss potential risks and flesh out your birth plan. Halaby recommends hiring a doula in any birthing scenario.

"Every woman deserves a doula, especially with home births," she says. "Doulas are very helpful to the client and to the midwife."

Consulting with a potential doula early on is crucial to determine whether they're a good fit for you and your birth plan. This introduction can provide important details on a doula's level of experience. Ask questions about their transfer rate and what kinds of instances they've transferred to a hospital, as well as what backup arrangements looks like.

With a home birth, having a backup plan is absolutely necessary. Developing this with your providers will help prevent future surprises, provide peace of mind and optimize a safe and healthy delivery of your child.

What This Means For You

Research shows home births are a safe option for low-risk pregnant women, but unanticipated complications can arise. Talk with your health care providers to determine whether a home birth is right for you.

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Article Sources
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  1. American College of Obstetricians and Gynecologists. Planned home birth. committee opinion no. 697. Obstet Gynecol. 2017 Apr;129(4):e117-e122. Reaffirmed 2020. doi:10.1097/AOG.0000000000002024

  2. Hutton E, Reitsma A, Simioni J, Brunton G, Kaufman K. Perinatal or neonatal mortality among women who intend at the onset of labour to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analysesEClinicalMedicine. 2019;14:59-70. doi:10.1016/j.eclinm.2019.07.005

  3. Kaiser Family Foundation. Racial disparities in maternal and infant health: an overview. Published November 10, 2020.