Home births are on the rise. Here's why.

Giving birth at home isn't for everyone — or even many expectant parents. But research shows that the practice is growing in popularity.

Montana recently passed laws to make it easier to give birth at home, including expanding Medicaid coverage to help with the cost. Home births accounted for 2.85% of all births in the state in 2021, making it the sixth-highest rate in the country. (Idaho is the nation's leader, with 3.6% of all births taking place at home.)

Home births in the U.S. also rose 12% from 2020 to 2021, and reached the highest level since at least 1990 during that period, according to a report from the Centers for Disease Control and Prevention (CDC). According to the American College of Obstetricians and Gynecologists, in the U.S. about 35,000 births per year take place at home.

'I wanted something different'

Ali Levine is one of those moms who opted for a home birth. She had her third child at home in September 2022, after having two hospital births. "I wanted something different experience-wise," she tells Yahoo Life. "I wanted the comfort of my home and space. I wanted my daughters to be a part of the birth and process. I wanted freedom with my body and to be natural without interventions."

Levine says she hired a certified midwife and doula in advance, and took Christian hypnobirthing and pain-free-birth courses, which she says were "very helpful." Levine says she had prodromal labor (labor that stops and starts) for a week before her son's birth, and her son's shoulder got stuck during the delivery process. But, she adds, "My team handled it immediately and all was fine."

She says her home birth was a positive experience. "All in all, it was peaceful, beautiful and such a rite of passage," she says.

Mom Angela Dube says she originally planned to have a hospital birth with her first child in 2016 but changed her mind late into her pregnancy. "At about 37 weeks along in my pregnancy, I did a hospital tour and just had a terrible gut feeling," she tells Yahoo Life. "It felt so sterile and uncomfortable, I couldn't imagine myself relaxing there. I started to feel uncomfortable about having random doctors and nurses coming in and out during my labor and realized that not knowing my caretakers was anxiety-inducing for me."

Dube, who had a second home birth in 2018, says she wanted to be comfortable at home. "I wanted to eat when I wanted to eat, not be prodded and touched at random times, and I was worried that I would have to argue with the medical professionals about my birth experience while in a challenging situation," she says. She had been working with a doula in advance of the birth and used a meditation app to help her relax.

"Both of my births were very long," Dube says. "They lasted so long that I became utterly exhausted and it was hard to keep going. Thankfully, having my doula, whom I trusted and could literally lean on for support, was able to guide me through and keep me strong, even when I was at my weakest."

Dube says it was helpful for her to not have specific expectations of how the experience would go. "Many women go into their home birth experiences wanting a fairy tale, maybe fantasizing about the perfect water birth, for example, and then they experience what childbirth really is, which can be painful, messy and unpredictable," she says.

She adds: "Going in with an open mind but having an intention helps with having realistic expectations and a successful home birth."

What's behind the rise in home births?

It's not entirely clear, although there are some theories. "Home births may be on the rise as patients are looking for alternate birthing options to suit the diverse and unique needs of their families," Cassandra Sampsell, a certified nurse-midwife at the Ohio State University Wexner Medical Center, tells Yahoo Life. "Not all families or birthing persons look similar, and often hospital policies surrounding birth may be viewed as cookie-cutter and not tailored to individual needs."

The years cited in the CDC report were also during the height of the pandemic, Sampsell points out. "Many hospitals adopted restrictions for visitation and limited the number of support people that could enter the facility during those years to help protect families, patients and staff members from the spread of COVID-19," she says. Families that wanted other options may have simply decided to have a home birth, she says.

But some of it may be related to women wanting to feel more empowered, Julie Lamppa, certified nurse-midwife at Mayo Clinic and author of Obstetricks: Mayo Clinic Tips and Tricks for Pregnancy, Birth and More, tells Yahoo Life. "Women are wanting lower-intervention birth and to have more control over their experience," she says.

Some may simply need to have home births because there are no other options, Sampsell says. "There has been an ongoing trend of smaller community hospitals needing to close their maternity units for financial reasons, which has left some women in maternity care deserts, with the closest maternity services being available more than an hour away," she says. "The reality for these women would be that if labor started at home, they may deliver en route to the facility where they are planning to birth."

What to consider before having a home birth

A major benefit of giving birth in a hospital is that medical staff are able to intervene quickly if there is a medical emergency, Dr. Christine Greves, an ob-gyn at Winnie Palmer Hospital for Women & Babies, tells Yahoo Life. "If there is an issue during a home birth, you have to get to a hospital and that can raise the risk of complications for mom and baby," she says.

"I advise against home birth," Greves says, noting that babies can die if there are complications and medical staff aren't able to intervene swiftly. "It's unpredictable what will happen in delivery," she says. "It can be 95% sheer joy but 5% terror, and there's no way of predicting what will happen."

However, there are studies that show planned home births can be safe for low-risk pregnant women. A large international 2019 study found that low-risk pregnant women who plan to give birth at home don't have a higher chance of the baby's perinatal or neonatal death compared to other low-risk women who plan to give birth in a hospital. Another study, this one from 2021, found that a planned birth at home with a licensed midwife is just as safe as one at a state licensed birth center.

If you want to have a home birth, Sampsell recommends asking "a lot of questions" before deciding to go that route. "Interviewing one or two midwives or groups of midwives would be ideal to get an idea of the range of services they will offer and protocols they have," she says. "I would strongly advise that patients ask specifically about the guidelines that the group or midwife have regarding candidacy for home birth. The guidelines should be transparent about when a patient would 'risk out' of such a low-risk setting and preexisting health conditions that would not make them a good candidate for a home birth."

Sampsell also recommends asking about neonatal resuscitation certification for a midwife. "Even in full-term, low-risk deliveries, a baby may require some intervention at birth to breathe," she says. "A delay in this care could have lasting consequences if not handled appropriately. Being certain that emergency oxygen and resuscitation equipment, as well as a trained provider, will be present is needed for safety."

Lamppa stresses the importance of doing your research before deciding on a home birth. "You need to be well informed and educated," she says. "Know your birth attendant. He or she should be a qualified provider, such as a certified nurse-midwife or physician who has the appropriate education, certification and license to practice. The provider should have a good collaboration with a local hospital and labor unit in case a transfer of care becomes necessary."

She adds that mother and baby should be "medically low-risk, have no history of cesarean deliveries and baby should be head down. Multiple gestations — twins, triplets — should always be delivered in a hospital."

Greves strongly recommends that women consider giving birth in a hospital. "Bring your comforts of home — your soundtrack, your nice pillows, your lavender scents," she says. "Make it nice, if that's what you want, but ask yourself why you want a home birth and recognize the risks if you choose to have a home birth."

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