- The number of home births continues to increase in the United States.
- Experts say the COVID-19 pandemic and dissatisfaction with hospital care are two of the factors behind the rise.
- They say home birth has its benefits, such as control over the process, but it also has risks, such as lack of medical care if an emergency situation arises.
- Experts say medical check-ups during pregnancy are important whether a person is giving birth at home or in a hospital.
While most babies in the United States are born in hospitals, a small but growing proportion of pregnant people are choosing to give birth at home.
Earlier this month, the Centers for Disease Control and Prevention (CDC) reported that the percentage of home births rose from 1.26% in 2020 to 1.41% in 2021. This represents an increase of 12%, to the highest level reported since at least 1990. The CDC found an even greater increase in home births from 1.03% in 2019 to 1.26% in 2020.
Experts suggest that COVID-19-related factors may help account for the recent bump in home births, but other factors have also played a role.
“COVID probably accounts for part of that recent increase, but the home birth rate in the United States had already doubled in the decade and a half prior. So COVID extended what had been a pretty notable upward trend,” Eugene R. Declercq, Ph.D., a professor of community health sciences at Boston University School of Public Health in Maryland, told Healthline.
“Now that the rate of home births has reached 1.5 percent, the big question [is] will it stay that high or will it come down as concerns about COVID in hospitals goes down. My guess is it will come down some but not all the way,” he said.
Fears of COVID-19 in hospitals
Risa Klein, CNM, the director of midwifery at Lenox Hill Hospital in New York, NY, agrees with Declercq that COVID-19-related factors have likely contributed to the rise in home births in recent years.
Klein told Healthline that she’s heard from many pregnant people who were worried about the risk of contracting COVID-19 in hospitals.
“I had more phone calls than I can remember, of women crying, begging me to deliver their baby at home, fearful they and their unborn baby would have unquestionable exposure to COVID and possibly die if they delivered in the hospital,” she said. “In each case, I urged them to find a hospital in their area and gave them education about the safety of hospital birth, especially COVID precautions that were being implemented and followed for safety.”
Klein described some of the measures that hospitals have been taking to protect pregnant people and newborns from COVID-19, including having healthcare providers wear full personal protective equipment during interactions with patients, swabbing patients and partners for COVID-19, and requiring masks for all.
These measures have been implemented to increase the safety of childbirth in hospitals during COVID-19, but not all pregnant people are aware of them.
In some cases, hospitals have also restricted the ability of family members or support people to attend childbirth or visits afterward. Although this may help alleviate some people’s concerns about COVID-19 exposure, others may be uncomfortable with such policies.
“A lot of the 2020 and 2021 increases in home births are probably related to COVID either directly or indirectly. Directly, in that people might have been afraid to go into hospitals. Indirectly, because a lot of hospitals set up policies that people found uncomfortable around not being able to have their partner or not being able to have a doula with them,” said Declercq. “Some mothers who didn’t want to be isolated may have opted for home birth.”
Dissatisfaction with hospital-based care
Other factors may also have contributed to the increases in home births — not only during the COVID-19 pandemic but also in years prior to that.
“People seek home birth for many reasons, with or without a pandemic,” said Klein. “Some reasons include feeling emotionally safe, fear of hospitals, fear of becoming a statistic for maternal and infant interventions and morbidity and mortality, and fear of separation of mother and baby.”
“Having less intervention, monitoring, drugs, and disturbances from well-intentioned staff, including nurses and residents, are also on the list,” she added. “Many people want to be heard, have privacy respected, or have their older siblings at the birth, and hospitals in their area may not allow children at birth.”
Declercq noted that most people who have a home birth have already given birth previously, usually in a hospital. Dissatisfaction with their experiences in the hospital may have influenced their decision to give birth at home.
He pointed to a 2019 study that found that 28% of women who gave birth in a hospital reported experiencing mistreatment in maternity care, compared with 5% of those who gave birth at home. Women with low socioeconomic status were more likely to report mistreatment.
When Declercq and colleagues conducted their own survey of women who had given birth in a hospital, they found that 11% definitely wanted to give birth at home in the future and another 18% would seriously consider it.
“When I give grand rounds at hospitals, I cite that and raise the question of what are you doing that’s causing so many women to think, ‘I’d rather give birth at home than come in here again?’,” he said. “Part of this is about the way women feel they’re treated in hospital births, so for those who might be opposed to home birth, one of the things I would suggest is that they focus on better treatment of women and more independence for women in hospital births.”
Weighing the benefits and risks
Giving birth at home may give some people a greater sense of control over the birthing process, but it does come with risks, particularly when complications from childbirth develop.
According to the National Academies of Sciences, Engineering, and Medicine, home births have the potential to be as safe as hospital births for low-risk women. However, having an integrated and regulated system, well-qualified and knowledgeable providers, and seamless transfer between birth settings is essential. This helps ensure that if something goes wrong during home birth, the person can be quickly transferred to a hospital for care.
“In some places in the United States, midwives have been able to make arrangements for home birth with a local hospital, but in some areas, that’s not the case,” said Declercq. “In some places, it’s difficult to have hospital backup for home birth. That’s in contrast to countries like England, where you actually go and register for home birth at a hospital, and it’s part of the system.”
Klein warned of the risks of hemorrhage, blood pressure changes, seizures, and other potentially life-threatening complications that may occur during pregnancy, sometimes with little warning.
Managing such complications requires specialized treatment, equipment, and teams of healthcare providers that are not readily available in home birth settings.
“Minutes matter when a mother or newborn may require resuscitative measures, which are reliably found in hospitals with experienced NICU teams, operating rooms, physicians, and anesthesiologists to manage,” Klein said.
“The fact that an emergency could arise for mother or newborn, with irreversible medical consequences, demonstrates that all pregnant people need to receive sound counseling as to which location they should birth in, so they can make an informed, sound, and safe decision, pandemic or not,” she added.
Planning for safe childbirth
To learn more about the potential benefits and risks of home birth, pregnant people can speak with a qualified healthcare professional. The risks of a home birth may be higher for some people, compared with others.
“From the onset, a pregnant person must be evaluated by a healthcare provider and know their health status. They need to learn if they are healthy and low risk, for only low-risk people would be considered appropriate for a home or out-of-hospital birth setting,” said Klein.
Some medical conditions such as high blood pressure, diabetes, heart conditions, lung conditions, and blood coagulation disorders may raise the risks associated with childbirth. Klein said that people with these conditions or those who plan to give vaginal birth after having a previous Cesarean section should always give birth in the hospital.
“The only way to mitigate risks would be to deliver in a hospital where life-saving measures for mother and newborn can be utilized immediately, with skilled operating room and NICU team members ready to help and intervene 24/7,” she said.
If a person is at low risk for complications and plans to give birth at home, they should still attend regular check-ups with a qualified healthcare professional to receive prenatal care during pregnancy. This can help them identify any complications or risk factors for complications that might develop.
They should also find a qualified and licensed healthcare professional to support them through the home birth process and prepare for potential emergencies that might arise.
“[Have] a backup plan for hospital transfer that makes sense, meaning a physician group is ready to accept the patient should there be an emergency,” Dr. Jessica Taylor Goldstein, a family physician and associate professor at the University of New Mexico in Albuquerque, told Healthline. “And reasonable guidelines for when to transfer.”