Home birth numbers have been rising recently, and more and more women are looking to skip the hospital and give birth at home.
But it’s important to know that home birth is not without its risks.
The key to pulling off a successful home birth is educating yourself so that you can be prepared for any problem that might arise.
We’ll go over everything you need to know so you can make an educated decision about whether having a home birth is the right option for you.
Pros and Cons of Home Birth
Advantages of Home Birth
- It can be more comfortable to labor and give birth in familiar surroundings: You’re used to every small detail about your house and your belongings. That can be a big advantage when you’re feeling oversized, clumsy, scared, and in pain.
- Unlimited presence of family and friends and rest in your own bed after delivery: At home, there aren’t any visiting hours. Your mom can stay as long as you want her to. And if you hate hospital beds, you’ll love getting to sleep in yours instead.
- Religious or cultural factors will be considered: You have complete control over your setting. If you want to burn candles in a religious ceremony before or even during birth, you’re free to do so at home.
- More intimate, and greater control over who is allowed to stop by and who isn’t: With a home birth, you have full control over who can attend.
- Freedom to eat and drink as desired before delivery: Think you can handle more than ice chips before delivery? At home, you can have whatever you want, within reason. Just make sure you can keep it down if things start to get dicey.
- Freedom to choose the delivery position, how long to labor, and whether to use other birthing elements: Some moms deal with labor pains by taking a warm shower, and some hospitals frown upon that. At home, you can take that shower to help, and you can have more input on your delivery position and more.
- Reduced delivery costs: It is much cheaper to deliver at home, provided everything goes smoothly.
- Optional in-home follow up and lactation support available: Your team of your midwife and doula, if you hire one, will have your back. They’ll give you the support you need, checking in on you after the birth and providing lactation support if needed.
Risks of Home Birth
- Lack of monitoring and interventions available: In a hospital, if you need an IV or a fetal heart monitor, it’s there. You’ll also get regular checks on vitals. During a home birth, emergency assistance cannot be easily provided should you need it.
- Poor insurance coverage if any: In many states, your health insurance provider won’t cover home births, or they may only offer limited coverage. If you have a high deductible though, you’d still be paying thousands for your hospital delivery, so you still might come out ahead financially by having an uncomplicated home delivery.
- No pain relief or epidural: You’re going to have to opt for a largely natural birth. There won’t be a way to get you an epidural.
- Need to be transported to the hospital if an emergency occurs: This is a factor to consider because it can mean the difference between having potentially life-saving care when you need it. It can also negate some of the advantages of home birth, like saving money.
- Issues if your midwife is unable to handle complications in time: Choose a qualified professional to improve your chances of a good outcome.
- Arranging newborn & postpartum care: You may need to handle details like arranging postpartum check-ups or filing your infant’s birth certificate on your own. These are some of the hassles you might not want to handle when you’re recovering from childbirth and wanting to bond with your new baby. It’s one advantage of using a hospital.
Home Birth vs Hospital Birth Statistics
When considering the impact and effectiveness of home births compared to hospital births, it’s helpful to consider hard facts. Here are some key statistics that may be useful to you as you weigh your options.
U.S. home births per year vs hospital births
Home births are still relatively rare in the U.S., with only 35,000 births happening at home (1). One-fourth of the at-home births are unplanned or unattended by qualified medical professionals. That represents .9 percent of births each year in the U.S.
The death rate for babies from birth to 27 days old is higher with home births than with hospital births. For hospital births attended by a certified nurse-midwife (CNM), the neonatal mortality rate was 3.2 deaths out of 10,000. For a home birth with a CNM in attendance, that number jumps to 10 out of 10,000 (2).
If an uncertified midwife is used in a home birth, that number goes even higher — to a neonatal mortality rate of 13.7 out of 10,000 births. That underscores the importance of hiring a CNM instead of a midwife with less training if you’re going to have a home birth.
Keep It In Perspective
In certain situations, such as a birth that occurs after 41 weeks gestation, the gap in the neonatal mortality rates are even more pronounced, with a neonatal mortality rate of 2.7 per 10,000 births with a CNM in a hospital setting, 10.3 per 10,000 births with a CNM in a home setting, and 21.6 per 10,000 with an uncertified midwife in a home setting.
It’s worth noting the neonatal mortality rate for home births in the study we cited may actually be higher. Any baby that was born at home and was later transferred to a hospital before dying would have been listed by CDC data as a hospital outcome instead of a home one.
Likelihood of medical interventions
One question moms may ask is if they are more likely to need interventions such as an operative vaginal delivery or Cesarean section with a planned home birth. The answer is no. Despite the higher neonatal mortality rate, the need for medical interventions is actually much lower with planned home births than hospital births.
Here are the rates for common interventions, both at home and at the hospital (3):
- Inducing labor: 48 per 1,000 births in out-of-hospital settings, compared to 304 out of 1,000 births in the hospital.
- Cesarean delivery: 53 per 1,000 births in out-of-hospital settings, compared to 247 out of 1,000 births in the hospital.
- Operative vaginal delivery (requiring the use of forceps or a vacuum): 10 per 1,000 births in out-of-hospital settings, compared to 35 per 1,000 births in the hospital.
- Labor augmentation: 75 per 1,000 births in out-of-hospital settings, compared to 263 per 1,000 births in the hospital.
The one intervention that appears to happen more frequently at out-of-the-hospital planned births than during in-hospital planned births is blood transfusions to treat hemorrhage. That happens in six out of 1,000 out-of-hospital births, compared to 4 out of 1,000 hospital births.
Hospital transfer rate
Moms may also want to know what the hospital transfer rate is for home births that can not be safely completed at home. In one review of studies of home births in Western countries, including the U.S., the rate of transfers from home to hospital at any stage of the birthing process or immediately after ranged from 9.9 percent to 31.9 percent (4).
The transfer rate was much higher for women who had never given birth before. That rate ranged from 23.4 percent to 45.4 percent throughout the studies. For women who already had children, that rate was much lower, ranging from 5.8 percent to 12 percent.
Result of home trial of labor after C-section
If you’ve had a C-section for a prior birth, it may be riskier for you to have your future babies at home. If you’ve had a vaginal birth since that C-section, you can still have a healthy outcome with a home birth though (5). You’ll have to weigh your options, considering how your prior deliveries went, as well as your overall health.
I firmly believe that every woman should be offered the opportunity for a Vaginal Birth after Cesarean (VBAC). Unfortunately, many hospitals do not provide that option.
The concern with giving birth at home is that women who have had uterine surgery have a slightly increased risk of uterine rupture, but this risk is less than 1 per 100 women (6). If your home is a far distance from the hospital or your birth attendant does not have a good relationship with a back-up physician, you and your baby’s life could be in jeopardy. It’s important to know your comfort level and to be aware of the risks and benefits.
Editor's Note:Caitlin Goodwin, MSN, RN, CNM
You’re In Charge
It’s your body and your baby, so it’s your call when it comes to the type of birthing experience you want to have. But, no matter which avenue you choose, remember, it’s your job to be your own advocate. Whether you’re being attended by a doctor, a midwife, or a doula, if you feel something is being mishandled, get a second opinion.
Find a birth professional who is well-trained in emergencies and will respect you and your family’s wishes. Unassisted birthing can have some pretty significant risks. I believe in respecting a patient’s autonomy, but please do not make this choice lightly.
Editor's Note:Caitlin Goodwin, MSN, RN, CNM
While the majority of home births are safe, they do carry an increased risk for baby mortality, so having a solid plan in place and a capable midwife is crucial.