Long before there were hospitals to deliver in (and even long after hospitals started to spring up), women were giving birth at home — often in the same bed they themselves were born in. But with the unsanitary conditions and haphazard medical care that were the norm a couple hundred years ago, it was hardly an ideal way to give birth.
These days, 99 percent of babies in the United States are born in hospitals or birthing centers — but the home birth movement has become increasingly popular over the past decade or so.
For expectant mamas who are wary of hospital protocols and personnel, it's easy to see the appeal: No place beats home for a comfy, cozy and peaceful delivery, with your baby's arrival heralded by family members and friends who might not be allowed in a hospital delivery room.
Modern home birth can be safe if moms-to-be are considered low risk, have excellent support and have prepared themselves thoroughly with childbirth education classes. However, giving birth at home also comes with risks that are important to consider.
If you're thinking of a home birth, read on for more about the benefits, risks and costs, as well as how to create a home birth plan that works for you and your family.
Is giving birth at home right for you?
The topic of home birth can be polarizing. On the one hand, some professional organizations, including the American College of Obstetricians and Gynecologists (ACOG), are cautious about recommending it. ACOG says that while hospitals and birthing centers are the safest place to give birth, moms should have the option to give birth at home — as long as they are fully educated on the risks and benefits, especially the increased risk of neonatal death.[1]
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Yet other medical professionals, like the American College of Nurse-Midwives (ACNM), strongly support home birth and say it's a very safe alternative to a hospital birth.[2]
Experts do agree, however, that not everyone is a good candidate for home birth. According to ACOG and ACNM, as well as the American Academy of Pediatrics (AAP), you might be eligible for a home birth if you meet these guidelines:[3]
- Your pregnancy has been low-risk. That means you've had no evidence of hypertension, diabetes or other chronic medical conditions. You also haven't developed any pregnancy complications, such as gestational diabetes or preeclampsia, and you're not at risk of preterm birth. Likewise, you should have no history of a previous C-section, because there's a risk of uterine rupture with VBAC (vaginal delivery after C-section) — making it safer to deliver in a hospital or birthing center in case of complications. On that note, if you've had complications in previous pregnancies, you might be more likely to have complications this time around, making a hospital or birthing center your safest option.
- Your home birth will be attended by a physician or certified nurse-midwife. If you opt for a midwife, a consulting physician should be on call, preferably one who has seen you during your pregnancy and has previously worked with the midwife.
- You have transportation available and live close to a hospital. This way if an unexpected emergency arises and you need advanced medical assistance to protect your life or your baby's, it's a relatively quick drive away.
Additionally, ACOG and the AAP ask that you attempt a home birth only if:
- You're only carrying one baby. Multiple births have more variables — and more surprises — than single births. Because epidurals are often encouraged for moms delivering multiples, you'll need to head to the hospital. Plus, following the delivery of your first baby, you might need intervention only available at a hospital, such as a vacuum extraction, to get the second out quickly and safely.
- Your delivery is perfectly timed. That means you go into labor between 37 and 41 weeks. Any earlier or later, and you should head to the hospital, as preterm babies born before 37 weeks often need at least a few days' stay in a hospital's neonatal intensive care unit (NICU), and late arrivals — usually larger, with a wider head circumference — sometimes require to a C-section to make a safe arrival.
- The baby is properly positioned for a vaginal delivery. That is, head down. It is generally recommended that singleton, breech babies (those positioned feet- or butt-first) deliver via a C-section to protect the baby and the mother.
- Your labor is spontaneous or you were induced as an outpatient. If you're admitted to a hospital, stay put and see your delivery though there.
Home birth benefits
Among a few of the biggest benefits of a home birth include:
- It's at home. You have your comfy bed (or a birthing tub or spa), your things, your kitchen and your own bathroom.
- There are potential health benefits. Planned home births have been associated with less maternal infection, fewer maternal interventions (including labor augmentation with pitocin, operative vaginal delivery, cesarean delivery and episiotomy — though episiotomies are very rare these days) and fewer third- or fourth-degree lacerations and tears.
- It may cost less. A planned home birth might also be more affordable, as home births cost about one-third as much as hospital births cost before you factor in insurance coverage.
Home birth risks
Among these positives, however, it's important to note that there are downsides to giving birth at home:
- You will not have as many options for pain control. If there's any chance you might want an epidural or other anesthetic pain meds, you won't be able to order those at home. It's important to consider your pain threshold — and whether you think there's a chance having the option of an epidural might be comforting to you.
- You may end up at the hospital anyway. The risk of needing hospital transport is relatively high with home birth: If it's your first pregnancy, there's a 23 to 37 percent chance you'll need to be transferred to the hospital mid-labor, according to ACOG. Transports occur for a variety of reasons, including a lack of progress in labor, non-reassuring fetal status (or fetal distress), need for pain relief, hypertension, bleeding and fetal malposition. If one of these should occur, it will take longer for you and your baby to receive the necessary interventions and care.
- There's an increased risk of perinatal death. According to ACOG, planned home births are more than twice as likely to result in perinatal death (babies who die during or shortly after birth) than planned hospital births — though the risks are still low, at four in 1,000.
Keep in mind, too, that giving birth at a hospital is still considered the safest place to have a baby even during the COVID-19 pandemic.
How much does a home birth cost?
As mentioned, having your baby at home may be the least expensive way to give birth. Some insurance plans may help defray the costs, but others won't. Of course, the actual amount you'll end up paying varies according to the region where you and your midwife live.
How to have a home birth
Finding a practitioner for a home birth
If you meet all of the above-listed criteria for a home birth and are interested in learning more, you'll need to enlist either a physician or a midwife who is both certified and licensed as soon as you find out you're pregnant. Look into candidates' education, credentials and experience.
Various state and national organizations issue midwife certifications, but the AAP and ACOG only recommend midwives who are certified by the American Midwifery Certification Board. You can opt for a nurse-midwife — a registered nurse who's completed graduate-level programs in midwifery — but be aware that not all nurse-midwives perform home births. All 50 states license nurse-midwives. Direct-entry midwives (those with no nursing background) are the most likely to perform home births, but they're not licensed in every state. If your state doesn't license direct-entry midwives, seek out a nurse-midwife.
In addition, check that your practitioner has admitting privileges at the nearest hospital. If she's a midwife, ask if her consulting physician (who you should definitely meet sometime during your pregnancy) will take all home birth-to-hospital transfers.
Find out what resuscitative equipment your practitioner will bring to your home — and be sure to discuss her experience with labor and birth complications. (Has she encountered any situations, and how were they resolved?) You may also want to consider hiring a doula for extra support.
Making a home birth plan
To your midwife will meet with you to discuss any possible risk factors and confirm that you're a good candidate for home birth. You'll continue to see her for regular check-ins (like you would an obstetrician) throughout your pregnancy, and she'll help you prepare a birth plan that outlines your objectives during labor and delivery (besides birthing a healthy baby, of course).
Different midwife practices have different preferences when it comes to home birth plans, but you and your midwife can discuss where you'll labor, how you prefer to reduce discomfort and how to handle complications or an emergency. Your midwife will also let you know ahead of time what supplies to have on hand and how to best prepare your home.
Also discuss who you'd like to be present during the birth. Keep in mind that many experts recommend limiting the number of people in the room during labor and delivery. While it might seem nice to have lots of friends and family around, a crowd may just distract you from the task at hand, making labor last longer in the long run.
What should you have in your home birth kit?
There are several websites that specialize in home birth kits. These kits typically contain basic medical supplies such as sterile gloves, disposable underwear, a bulb syringe and lubricating jelly. Other items to have on hand include extra sheets, bath towels, wash cloths, cotton balls, swaddling blankets and a drop cloth or plastic sheet.
Ask your practitioner if she recommends that you have any other items on hand.
Do you need a pool for a home birth?
If your tub isn't large enough for you to labor in, you might consider purchasing one online. Birthing pools are generally less expensive to own than rent these days. These pools come with their own removable liners which can be switched out.
Birthing pools provide an excellent option for pain relief in both the first stage of labor (dilation) and in the second stage of labor (pushing), but water births do pose increased risks if the baby is delivered in the tub. The American College of Obstetricians and Gynecologists currently recommends that births occur on land, not in water.
What to do if something goes wrong during a home birth
Even a labor that seems to be progressing nicely can take a turn for the worse and the need to transfer you and your baby to a medical setting may be immediate. Your best bet: Set aside some time before you give birth to discuss your options with your midwife, and this way you'll know what to expect.
A few questions to ask your practitioner ahead of time:
- Who is their covering physician?
- Do they have privileges at the hospitals they would send you to?
- Do they have a close working relationship with the staff at that hospital?
- How far away is the hospital from your home?
- Would they go with you in the ambulance if something went wrong during labor?
- How do they plan on monitoring the labor or the fetal heart rate?
Caring for your baby after a home birth
The AAP suggests that there be at least one person present during the birth whose primary responsibility is caring for your newborn. This person should have the appropriate training, skills and equipment to perform a full resuscitation of the infant. In many cases, this person could be your midwife — assuming you don't need immediate attention post-birth. He or she will check your baby's vitals and should be able to assist with any breastfeeding problems.
You should also talk to your intended pediatrician or family practitioner well ahead of your due date so you can let him or her know your birth plans, and then get in touch again as soon as your baby is born. Your practitioner might want to see your newborn sooner rather than later, since there won't be a hospital pediatrician monitoring your baby's health.
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