Should I consider a home birth?
If you're a healthy expectant mother having a normal pregnancy and you have no medical or obstetrical risk factors, giving birth at home may be an option for you.
Giving birth at home allows you to labor and deliver in familiar and comfortable surroundings. You'll have more control over your birth experience than you would in a hospital, and you won't have to endure routine medical interventions.
At home, you can have as many family members or friends as you want can attend the birth, and you get to share the experience with them in the privacy of your own home, without interruptions from hospital staff. All of your caregiver's attention will be focused on you and your baby.
Giving birth at home isn't for everyone, of course. Women who are more likely to have complications during childbirth should give birth in a hospital. This includes women with:
- Medical conditions, such as high blood pressure, heart disease, or diabetes
- A previous c-section or other uterine surgery
- Pregnancy complications, such as premature labor, preeclampsia, twins (or more), or a baby in breech at 37 weeks
If you choose to have a home birth, it's important to be flexible and understand that if complications arise, you might have to transfer your care to another provider or give birth in a hospital.
You'll also need to be committed to giving birth without medication, preparing your home for the birth (including getting whatever supplies your caregiver recommends), and making plans to ensure that you have good support available to you in the days after you give birth.
Another consideration: Not all insurance companies and HMOs cover the cost of home births.
Read about health insurance during pregnancy: How to find out what's covered.
Is giving birth at home safe?
For healthy women at low risk for complications who choose skilled and experienced caregivers and have a good system in place for transfer to a hospital when necessary, a number of studies — including a 2019 meta-analysis of 14 studies — show that giving birth at home is just as safe as giving birth in a hospital.
There is also research showing that moms who planned to give birth at home (regardless of where they actually had their babies) ended up with fewer interventions, such as episiotomies, c-sections, and postpartum hemorrhage compared with a group of equally low-risk women who had planned hospital deliveries.
But home birth remains controversial in the United States. The American College of Obstetricians and Gynecologists (ACOG) states that the safest places for birth are hospitals and accredited birth centers. They contend that the hospital is the safest place to give birth because capabilities of the hospital setting and the expertise of the hospital staff are immediately available if a complication arises suddenly. Still, ACOG supports a woman's right to make a medically informed decision about delivery. The American Medical Association (AMA) and the American Academy of Pediatrics (AAP) support this position.
If you're not sure whether you have medical or obstetrical problems that would keep you from having a home birth, contact a home birth provider and share your concerns over the phone. If there are no obvious reasons to rule out a home birth, you can make an appointment for a first prenatal visit. (Request a copy of your prenatal records from your current caregiver to give to the home birth provider.)
At that visit, the home birth caregiver will do a detailed history and physical exam, as well as the usual set of lab tests. She'll continue to assess your situation throughout your pregnancy and during labor, birth, and the postpartum period.
What else can I do to make sure that my home birth is as safe as it can be?
Find a good practitioner
Look for a certified nurse-midwife (CNM), a certified direct-entry midwife (CPM or CM), or a physician with plenty of experience delivering babies at home. Ask about her education, credentials, and whether she's licensed to practice in your state.
Be sure your caregiver carries the necessary equipment and supplies to start emergency treatment if needed, such as infant resuscitation equipment and oxygen, IVs, and medication to stem postpartum bleeding. It's also critical to make sure that she has an arrangement for backup with a qualified doctor and a nearby hospital in case you need to be transferred.
Make sure your backup plan is solid
Make sure the backup hospital is relatively close (within 15 minutes) and that your transportation there is fail-safe in case something goes wrong and you need to get to a hospital quickly.
Reasons you might need to transfer to a hospital include:
- Your labor stops progressing
- You have bleeding
- You develop high blood pressure
- Your baby is breech or some other position that's not head-first
- Your baby shows signs of distress, such as a concerning heart rate or meconium staining (baby poop in your amniotic fluid)
- You decide you want pain medication (such as an epidural)
Make sure your support network is on board
It's important that your partner and any other friends or family who are involved support your decision to deliver at home and are able to voice any concerns they may have with your home birth provider. Encourage your partner or coach to ask questions at each prenatal visit.
Find a supportive doctor for your baby
Establish a relationship in advance with a pediatrician or family doctor in your community who'll be able to see your baby a day or two after he's born and is, ideally, supportive of your choice to deliver at home. (Your caregiver should be able to recommend one.)
Line up postpartum help
Arrange for extra help at home in the days following delivery. It's great if your partner can manage to take time off work to help you and to share this special time. If your partner can't (or if you want extra help), have a relative or friend come to stay for a few days, or hire a postpartum doula.
How much does a home birth cost?
The fees for home birth practitioners vary considerably from place to place and among caregivers. It's a good idea to find out not only what the home birth will cost but also what additional expenses you'd have to pay if you needed to be transferred to another provider or a hospital during pregnancy, labor, birth, or postpartum.
Some insurance carriers cover home birth, but others don't. If you have insurance through an HMO that doesn't have an in-network provider who does home births, you may be able to get the HMO to provide some coverage for an out-of-network provider, although you'll probably have to be persistent. In the United States, 68 percent of women who have a home birth pay for the birth out of pocket.
How can I find a caregiver to attend my home birth?
Try these resources:
- The American College of Nurse Midwives in Washington, D.C., can direct you to home-birth resources in your area, including a list of certified nurse-midwives. You can call the organization at (240) 485-1800 or visit its website.
- The Midwives Alliance of North America is an organization for both direct-entry midwives and certified nurse-midwives. For a list of members in your state, email the alliance at [email protected], or call (888) 923-6262. You'll find some information about home births on the group's website.
- DONA International can help you find a birth and/or postpartum certified doula to attend your birth along with your caregiver. Visit their site to locate one in your area, and to learn how to go about interviewing and hiring a doula.
- Ask a childbirth educator in your area or contact your local La Leche League.