All About Home Birth

If you’re pregnant, you have some choices about where to birth your baby. In the United States, most babies—nearly 99% according to the American College of Obstetricians and Gynecologists—are born in hospitals. The remaining just over one percent of births (about 62,228 in 2017, according to a study by Marian MacDorman and Eugene Declercq published in 2019) happen at home or in freestanding birth centers. If home birth is something you’re considering, read on to learn more about its safety, what kind of care provider to look for, and what to expect during your home birth.

Is home birth safe?

Planned home birth—where you’ve been seen for prenatal care throughout pregnancy by a licensed care provider and are considered low risk, meaning you are without any significant pregnancy or health complications—is safe. In a meta-analysis (a type of study where researchers analyze data from lots of different studies) published in 2019, Eileen K. Hutton, a midwife and researcher at McMaster University, and her colleagues found that there was not a difference in mortality for either the birthing person or the baby whether the birth was planned to be at home or in a hospital.

There is still some controversy about the safety of home birth, so if it’s something you’re considering, it’s important that you look carefully at your specific situation, and discuss it with your partner and care provider. Things that might make homebirth less safe include: a previous cesarean birth, high blood pressure, gestational diabetes, a baby who is not head down as your due date approaches, and a home environment not conducive to birthing a baby.

What kind of care providers attend home births?

Unplanned home births usually end up also being unassisted, meaning you don’t have a trained professional there to help. If you’re planning a home birth, though, you’ll likely get prenatal care from, and have your birth attended by, some kind of care provider. Depending upon where you live and what sort of care providers are licensed to do home birth in your state, you may have choices in your type of care provider.

While a handful of physicians do home births in the US, midwives are the most common type of care provider at home births. There are three types of midwives that attend home births—although some states license some types of midwives and not others—in the US: certified nurse midwives, certified midwives, and certified professional midwives. Certified nurse midwives have a registered nurse license, a graduate degree in nurse midwifery, and have passed an exam to become licensed as an advanced practice nurse. Certified midwives are not licensed nurses, but they receive the same midwifery training as certified nurse midwives and take the same certification exam. Certified professional midwives may attend a midwifery training program and must receive clinical training from a more experienced, licensed midwife.

If you are interested in finding a home birth care provider, start with recommendations. Facebook groups, online reviews, and searches are a good entry point. Once you’ve identified some options, interview them. Ask them about their statistics (how many births they attend, how often births transfer from home to hospital) and see whether you connect with them. If you’re going to have someone into your home to help you welcome your baby, it’s a good idea to for it to be a person that you trust, have confidence in and get along with.

What to Expect at Your Home Birth

At your home birth, you will get to choose what to eat and drink and when. You might buy or rent a birth tub to labor in or give birth in or take a shower in your own shower. You can wear what you want. You can move around as much as feels good to your body. Anyone that you want to be at your birth can be. Your midwife should have everything that they need with them in case of any emergencies and have a plan in place if you or your baby need to go to the hospital at some point. After your birth, your midwife will check you and baby while you relax in your own bed with your partner.

Abby Olena
Dr. Abby Olena has a PhD in Biological Sciences from Vanderbilt University. She lives with her husband and children in North Carolina, where she writes about science and parenting, produces a conversational podcast, and teaches prenatal yoga.

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