Considering a Home Birth? What to Know for a Safe and Healthy Outcome

Giving birth at home (called a home birth) can be a memorable and bonding experience for some families. But it may not be safe for everyone. Only a handful of people will qualify for a safe home birth without the worry of possible harm to the mom or the baby. For this reason, planned home births account for less than 1% of births in most parts of the U.S.

Here, we’ll talk about the benefits and risks of a home birth, and who might be able to safely have one.

Why consider a home birth? 

Giving birth surrounded by family and friends in the comfort of your own home may be appealing to many. Being in your own bed, not attached to monitors and IVs, seems more natural and healthier for you and your baby. 

A cesarean section, or other interventions that may speed up birth, are more likely to occur in a hospital. But with a home birth, you have the opportunity to labor at your own pace and avoid these interventions. Though this may sound ideal for some, it may also come with more risk of birth complications.

What risks are associated with home births?

In some countries, like the Netherlands and parts of Canada, many babies are delivered at home. Well-trained, hospital-supported healthcare workers (called midwives) attend these home births. This is considered an “integrated system.” Studies confirm that home births in such an integrated midwifery system are safe. A recent study in Washington state reported similar good outcomes. This was attributed to their well-integrated midwifery system.  

But only a few areas in the U.S. have such an integrated healthcare system. So we cannot generalize these findings throughout our country. In fact, for most other areas of the U.S., home births come with a higher risk of complications for both mom and baby. 

Factors contributing to this higher complication risk include:

• Lack of supplies to treat problems like bleeding, infection, or high blood pressure in the mom

• Lack of supplies to resuscitate the baby during or after a difficult delivery

• Lack of timely communication with a back-up physician during emergencies

• Lack of safe and timely transport to the hospital when needed

In the U.S., babies born at home are two times more likely to die when compared with babies born in a hospital. Studies also show an increased rate of seizures in babies born at home. These babies also have a high rate of lasting neurologic damage.

Is there a way to safely attempt a home birth?

Yes, for some people. According to the American College of Obstetricians and Gynecologists (ACOG), “hospitals and accredited birth centers are the safest settings for delivery.” But every woman has the right to make an informed decision about their delivery. As such, ACOG has offered some suggestions about how to increase the chances of a safe home birth.

Who may be a good candidate for a home birth?

As mentioned previously, at-home birth isn’t a good option for everyone. So it’s important to understand the criteria for safe home births. Home birth may be possible for you if:

• Your current pregnancy is low risk. Medical conditions (like diabetes, etc.) may need treatments not available at home.

• You have had a vaginal delivery before, without complications. This is the only way to know if your baby will fit through your pelvis. Also, an old cesarean scar can tear, causing bleeding, and the baby may not get enough oxygen.

•  Your baby is believed to be a normal size (not too small or too big). If too big, your baby could get stuck, while a small baby may need extra care.

• Your baby is head-down, making it less likely to get stuck once the head is delivered. 

• You are pregnant with only one baby (as opposed to twins). It’s difficult to know how the second baby is doing without appropriate monitors. 

• You go into labor on your own, between 37 and 40 weeks of pregnancy. Babies born too early or after 41 weeks tend to need more medical attention.

What is the role of a midwife or a doula?

Almost all planned home births involve the help of a midwife. There are different types of midwifery training and certifications. There are also different state laws based on the type of certification a midwife has. These may impact your options for a home birth. 

A doula may also take part in home births. But they are not trained to perform the actual delivery. Their role is that of a support person to you and your family during labor and delivery. 

The average charge by a midwife for an uncomplicated home birth is about $3,000. This cost will be higher if there are complications. Medicaid and many private insurances will pay for a home birth with a midwife depending on where you live. Nonetheless, more than half of those who had a home birth in the U.S. reported paying out of pocket for the birth. It’s important to check with your individual insurance carrier to understand your coverage.

What backup care is available in an emergency? 

Because labor is such an unpredictable event, emergencies can happen at any time. As such, it is very important that your midwife or doula has a doctor they can call in these situations. For instance, they will need backup if you need a cesarean delivery or if you are having too much bleeding. You also need to live close enough to a hospital that can care for you and your newborn in case of emergencies.

Should I deliver in a birthing center?

A free-standing birthing center may be a good middle-of-the-road option for some. These are birthing facilities typically run by midwives. They provide many of the freedoms of a home birth but with better access to medical resources. Birthing centers commonly partner with a nearby hospital and physician in case of emergencies.  

The average cost to deliver in a birthing center is about $7,000. This is much less than that of an uncomplicated vaginal birth in the hospital, which is closer to $12,000. Insurance will often cover these costs. But it’s always a good idea to check your insurance plan for details.

Are there any circumstances that a home birth would not be advisable?

There are some home births that have a higher chance of complications. These are all conditions that may require an emergency cesarean delivery. A home birth should not be attempted if:

• This is your first time delivering a baby.

• Your baby is a breech delivery (i.e., not head-down).

• You are pregnant with more than one baby (twins, triplets, etc.).

• You have had a cesarean delivery in the past.

Why trust our experts?

Written by:

Andrea Kemp, MD, MPH

Dr. Kemp is an accomplished board-certified physician with over 25 years of clinical experience. She completed medical school and residency training in obstetrics and gynecology in Cincinnati, Ohio.

Edited by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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