Homebirth: What Is It, How Safe Is It & Who Is It For

Quick Links: Judy Discusses Homebirth (video) | The Midwife’s Role | Why Home Birth? | Homebirth StatisticsPain Management | Who is Eligible? | Homebirth Costs | NYC & Long Island Homebirth Midwifery

Highlights

Here are some highlights from this page:
  • Women have been giving birth at home with midwives since ancient times, but the trend changed with the advent of modern medicine. Hospital births were touted as the only safe way to give birth.
  • By 1980, only 1.1% of births took place at home and this statistic remained largely unchanged for the next 40 years.
  • In 2022, the CDC reported a 12% increase in home births, with the current rate being 1.51%.
  • Most women who choose homebirth also choose to give birth under the care of a licensed midwife, who practices under the midwifery model of maternity care.
  • Midwives are experts in normal, physiological birth. The midwifery model of care is holistic and integrates the emotional and physical well-being of the mother to ensure the best outcome for both mother and baby.
  • Midwives are trained to handle emergencies and are equipped with tools to intervene if needed.
  • Homebirths are chosen for reasons like personal autonomy, avoiding unnecessary interventions, and wanting a natural and more intimate birth experience.
  • Homebirth is safe under the auspices of a qualified midwife
  • The largest home birth study in the US (2004-2009) conducted by Midwives Alliance North America (MANA) showed:
    • 89.1% of women completed their homebirth successfully
    • 93.6% gave birth vaginally, regardless of hospital transfer
    • 87% success rate of those attempting vaginal birth after cesarean (VBAC)
    • 97.7% success rate of breastfeeding at 6 weeks
    • Low intrapartum and neonatal fetal death rate overall (2.06 per 1000 intended home births)
    • Low rate of low APGAR scores
    • 5.2% cesarean section rate (compared to 32.1% in the US)
    • Less than 5% used Pitocin or epidural anesthesia
  • Pain management during labor:
    • Hypnobirthing: a form of antenatal education where the mother learns the physiological process of labor and utilizes breathwork to remain relaxed
    • Waterbirth: birthing in a pool or bathtub of warm water
    • Other methods of pain management: movement, different laboring positions, counterpressure, and acupressure
  • Candidates for home birth: healthy, low-risk women (single baby, head down at term, no serious medical conditions, spontaneous labor, etc.)
  • A woman who feels safe in her environment will have her best birth according to Ina May Gaskin’s book Ina May’s Guide to Childbirth.

Since the beginning of time, women have been giving birth at home under the auspices of midwives. As modern medicine evolved, childbirth gradually transitioned from the community to the hospital. Women thought this model would lead to a safer, pain-free birth experience.

Western medicine promised just that. But the medicalization of childbirth led to new issues.  In the 1960s and 70s, medical doctors extinguished the pain of childbirth by essentially knocking women unconscious with the use of “Twilight sleep.” Women became passive participants in the birth process and unnecessary interventions increased.

These interventions opened the door for infections and other unintended consequences, including increases in instrumental delivery, cesarean sections and maternal morbidity and mortality. Even with the transition to the epidural and moderate anesthesia and continuous fetal monitoring, complications continued to increase.

Despite the rise in complications, the trend towards hospital birth continued. It was touted as the only safe way to give birth. By the 1980s, only 1.1% of births took place at home.

This statistic stayed stable for the next 40 years. In November 2022, the CDC reported that homebirth rates have risen by 12%. The current homebirth rate is 1.51% – the highest rate since 1990.

Judy Ribner Certified Nurse Midwife - Holistic Midwifery New York - NYC and Long Island Homebirth Midwives (17)
Judy Ribner, DNP, CNM of Holistic Midwifery New York

Midwives – Keepers of Birth

A woman’s desire to give birth at home does not  mean a rejection of safety. In fact, modern medicine has made midwives the authority in normal pregnancy and birth. With the integration of certain aspects of Western medicine, homebirth is safer than ever.

Most women who choose homebirth do so under the care of a licensed midwife. Although there are midwives who practice in a medical setting under the medical model of maternity care, community midwifery care is different.

Homebirth midwives practice under the midwifery model of maternity care.  The midwifery model of care is holistic, integrating the emotional and physical well-being of the mother to ensure the best outcome for the mother-child dyad. Mother and baby remain together after birth without separation.

Midwives are experts in normal, physiological birth and recognize that childbirth is a natural, female-centered process. Labor is supported and remains uninterrupted, except when cautious intervention is medically warranted. Midwives are trained to recognize a deviation from normal and will take the appropriate steps when needed.

Judy Ribner, DNP, CNM, Malki Schuler, MSN, CNM, C-EFM, LCCE, Rachel Cohen, MSN, CNM, Julia Steinrueck, MSN, CNM and Alicia Richter, RN, SNM of Holistic Midwifery New York, a New York City and Long Island Home Birth Midwifery
Holistic Midwifery New York Team

“The midwifery model of care is based on the fact that pregnancy and birth are normal life events. The midwifery model of care includes: monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle; providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support; minimizing technological interventions, and identifying and referring women who require obstetrical attention. The application of this woman-centered model has been proven to reduce the incidence of birth injury, trauma, and cesarean section.”

-(Copyright © by The Midwifery Task Force) [Ina May Gaskin]

Why Choose Home Birth?

If you haven’t traversed the natural birth world for long, modern home births can sound quite radical. Many people assume that it’s illegal. So, what attracts expecting mothers and their partners? Honestly, there is a myriad of reasons that home births are chosen.

Personal autonomy is perhaps the number one reason that babies are born at home. Once a mother steps into a maternity ward, she surrenders her autonomy to the whims of her providers. Unless she finds a sympathetic team, to have her wishes honored she will be forced to fight a war against universal hospital policies throughout her labor.

Even if mothers create a birth plan, they are susceptible to redirection by hospital staff at the first sign of stalling labor.

Holistic Midwifery New York - NYC and Long Island Homebirth Midwifery

Many women wonder if midwives are prepared to handle emergencies. While a valid concern, it may be comforting to know that they are certainly prepared! Should the need arise, midwives arrive equipped with numerous tools to be cautiously invoked. They are trained in CPR, neonatal resuscitation, treatment of hemorrhages, stitching tears, IVs, herbal and physical methods of augmenting labor, and more.

Midwives are also versed in all of the recommended prenatal screenings to monitor for abnormalities. General screenings include blood work, gestational diabetes testing, Group B Streptococcus (GBS) testing, regular blood pressure checks, urine analysis, and fetal doppler heart rate checks. Midwives can also order ultrasounds through imaging centers. However, the mother can typically decline these screenings with informed consent.

Along with the recommendation of herbal medicines, midwives are authorized to prescribe pharmaceutical medications for pregnant mothers, not limited to treatment for morning sickness. Should a medical concern arise, many midwives have close working relationships with other medical professionals and can collaborate as needed. In short, midwives are capable, passionate, educated professionals.

Mothers birthing in a hospital significantly increase their chances of medical intervention. In the United States, 31.73% of births were induced in 2020. Most inductions are initiated with Pitocin, an aggressive imitation of the hormone oxytocin. Pitocin has many negative consequences, including a possible correlation to a 32-35% increase in postpartum depression. During labor, Pitocin causes contractions to come on much stronger and more painful, often leading to unwanted epidurals and an increased risk of perineal tears. The intensity of contractions can also cause fetal stress, and a stressed baby increases the risk of cesarean section. This scenario is called a “cascade of interventions” and happens daily in maternity wards across the nation.

Women often wonder how to have an intervention-free, unmedicated birth in the hospital. If you desire an unmedicated birth, then the best advice is to stay home. At the risk of sounding contentious, it can be said that a mother who manages to have an unmedicated birth in the hospital does so in *spite* of the hospital – not with its help.

Homebirth offers a way to avoid unnecessary interventions. When mothers birth at home, their body, baby, and labor are honored by their birth team. Midwifery teaches that babies are incredibly intuitive and know when they need to be born. The mother’s body is not on a timeline, so if labor stalls and all is well, Pitocin won’t be administered.

At home, we encourage our laboring mothers to move, eat, and drink. Delivering a child is perhaps the most athletic event of a woman’s life, so we encourage nourishment and hydration to keep the body sustained. Instinctual movement and laboring positions work with gravity and the body to help the baby descend into the birth canal. We will never force a mother to labor on her back where gravity’s effects are minimized, and the pelvis cannot open.

Home Birth with Judy Ribner, DNP, CNM and Malki Schuler, MSN, CNM, C-EFM, LCCE of Holistic Midwifery New York
Homebirth with the midwives of Holistic Midwifery NY

Pain medications are never pushed. If a mother decides she needs an epidural (there are times when epidurals are warranted and can promote relaxation so the body can open), then hospital transfer is always an option. There is no judgment for a request to transfer.

Mothers can invite anyone (or no one!) to be present in their birthing environment, even other children. There is access to all the familiar comforts of home. Hospital microbes are avoided. 

Delayed cord-clamping and instant skin-to-skin time are encouraged, mothers can keep their placenta, and parents are never compelled to circumcise or administer Vitamin K and antibiotic eye ointment to their newborn.

The birth team will help the mother clean up afterward, do her laundry, and get her snuggled in bed with her baby. Arguably most importantly, the baby is born sober into a warm, comforting environment, granting peace in their very first breaths. What a welcome into the world!

Homebirth Statistics – Is Home Birth Safe?

The short answer is yes! Homebirth is safe. For the number lovers out there, we’ve included some statistical data. The following are excerpts from a study of planned home birth with skilled midwives between 2004 and 2009. Almost 17,000 low-risk women were included. This homebirth study is the largest in the U.S. to date and was conducted by the Midwives Alliance North America (MANA).

  • 89.1% of women completed their homebirth successfully
  • 93.6% gave birth vaginally, regardless of hospital transfer
  • 87% success rate of those attempting vaginal birth after cesarean (VBAC)
  • 97.7% success rate of breastfeeding at 6 weeks
  • Low intrapartum and neonatal fetal death rate overall:
    • 2.06 per 1000 intended home births (includes all births)
    • 1.61 per 1000 intended home births excluding breech, VBAC, twins, gestational diabetes, and preeclampsia
  • Low rate of low APGAR scores
  • Primary reason for hospital transfer was “failure to progress.” Transfer for urgent reasons, such as “fetal distress” was rare.
  • 5.2 % cesarean section rate
  • Less than 5% used Pitocin or epidural anesthesia

Pain Management During Labor

Because there are no anesthesiologists or operating rooms at home, epidurals are unavailable during a home birth. This is actually one reason why many women choose homebirth. Since there is no access to epidurals, they avoid the temptation to request one. But never fear! Mothers don’t have to experience these sensations unmitigated. There are alternative methods of relief to ease discomfort during labor.

Hypnobirthing

One popular method, called hypnobirthing, involves mindset practice. In her book, Hypnobirthing: Practical Ways to Make Your Birth Better, Siobhan Miller describes hypnobirthing as the psychology of birth. Essentially, it is a form of antenatal education where the mother learns the physiological process of labor, which allows her to work with her body to instinctually set the stage for a smooth delivery. (Siobhan Miller)

Hypnobirthing also utilizes breathwork to remain in a headspace of relaxation and peace rather than tension and fear. Perhaps the largest benefit is that hypnobirthing is accessible. It can be practiced anywhere a woman is giving birth since it relies solely on the mother’s mindset and breath.

Waterbirth

Another popular practice is to birth in a pool or bathtub of warm water. If access to a large enough bathtub is not available, Holistic Midwifery NY offers access to birth pools.

For some women, warm water is a soothing environment and has been likened to pharmaceutical pain relief. Other women may prefer to move freely on land and/or labor in the shower.

The use of a pool is a personal preference and one that each woman should explore on her own.

Beautiful, serene births happen each day, both in the water and out.

Other Methods of Pain Management

There are various other ways of managing labor sensations. These techniques can be used on their own or in conjunction with hypnobirthing and water birthing. Some methods include movement, different laboring positions, counterpressure, and applying acupressure to certain points on the body.

Who Are Candidates For Home Birth?

Delivering a baby at home is not for everyone. It would be irresponsible to suggest otherwise. Generally speaking, the best candidates for a home birth delivery are healthy, low-risk women. According to studies in Canada, low risk means that a woman meets the following criteria:

  • Pregnant with a single baby
  • Baby is head down at term
  • Labor occurs between 37 and 41-42 weeks pregnant
  • No serious medical conditions including but not limited to the following: kidney disease, heart disease, blood clotting disorders, type I diabetes, gestational diabetes managed with insulin, preeclampsia, or bleeding
  • Absence of placenta previa at onset of labor
  • No active genital herpes
  • No thick meconium
  • No prior C-section
  • Spontaneous labor
Home Birth with Judy Ribner, DNP, CNM and Julia Steinrueck, MSN, CNM of Holistic Midwifery New York
Labor and Natural Birth in Birth Pool at Home

This list is not exhaustive. There may be exceptions to the conditions mentioned above, such as a history of C-section. If you meet some of the listed criteria or are concerned about another condition, we would love to schedule a consultation before you rule out a home birth delivery.

But here’s the thing. These are simply medical criteria to ensure that your body is healthy enough to birth without intervention. Approaching birth from a holistic perspective, there are other states of being to consider. A woman who desires to have her baby at home should trust in her body’s inherent wisdom to do what it was biologically designed to do. There may be times when the decision to give birth out-of-hospital is met with opposition. The only way to counter this is to be unapologetically confident and informed in your decision.

In Ina May Gaskin’s book Ina May’s Guide to Childbirth, Gaskin suggests that a woman who feels safe in her environment will have her best birth, no matter where the birth takes place. So as a mother, your goal should be to birth where you feel most safe and confident. If you feel safer at home, then follow your instincts! You are on the right path to home birth. If you feel safer in a hospital, then that may be a better place for you to deliver your child.

Without going into too much detail, together the mother’s body and baby share constant communication during labor. Their silent messages stimulate hormones that initiate and facilitate the process. When a mother feels safe and secure, these hormones course through her body and orchestrate all the necessary openings, contractions, and relaxations that allow a newborn to slip into the world. But if a woman is fearful or agitated, her body will secrete hormones that delay, or even inhibit, birth. This reaction is for her protection and the protection of her child. So, make sure that wherever you choose to give birth, you are safe, relaxed, and comfortable! (Ina May Gaskin)

Educate yourself so that you feel confident in whatever decision you make. Low confidence leads to fear, which opens the door to a cascade of interventions, including artificial induction to cesarean sections. Guard your heart, guard your birth, and follow your instincts.

 

Cost of Home Birth in the United States

When looking into home birth as an option, the presumed cost may be cheaper than a hospital birth, as hospitals are often associated with significant costs due to the wealth of medical equipment involved. However, the considerations surrounding cost and home birth include subsections of charges which still makes the price of home birth significant enough to make home birth something that will require reflection.

The price of a home birth can be significantly impacted by health insurance and whether your health insurance coverage will cover the expenses associated with having a home birth. For those who do not have insurance, the cost of home birth will be significantly higher due to out-of-pocket midwife costs.

A study conducted by the Department of Economics and Business at Centre College in Kentucky showed an average cost of $4,650, including those fortunate enough to have insurance coverage contributing to the overall cost figure. While this statistic is still a substantial amount of money, it pales in comparison to the figures that impact those who deliver in the hospital, with an average total hospital birth costing roughly $18,865 before insurance, according to a study from the Kaiser Family Foundation. However, for those with insurance coverage, the out-of-pocket cost reduces to an average of $2,854.

So what makes home birth expensive? Most importantly, the cost of midwifery care can be substantial, especially if not covered by insurance. These skilled professionals can be hard to come by and in high demand depending on where you live, and they typically charge a flat rate that ranges between $3,000 and $9,000, according to Parents.com. Also, additional costs associated with home birth should include an awareness of the possibility of a transfer from midwife care to hospital care, which can significantly increase the price of a planned home birth.

 

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Though birthing at home is not for everyone, the rate of home birth satisfaction is high – much higher than the satisfaction rate for hospital births.

Giving birth at home is a gift for you and your family.

At Holistic Midwifery NY, we believe that where you decide to give birth is one of the most important decisions you’ll ever make. We’ll be with you every step of the way.

For a deeper dive into everything homebirth, please see the Resources section of our website, Resources – Holistic Midwifery NY.

References

Ina May Gaskin. Ina May’s Guide to Childbirth. New York, Ny, Bantam Books Trade Paperbacks, 2003.

‌Miller, Siobhan. Hypnobirthing. Hachette UK, 4 Apr. 2019.

Robertson, Ashley. “The History of Hospital Births in the U.S.” Evidence Based Homebirth, 5 Aug. 2019. Accessed 19 Jan. 2023.

‌“Home Births in the U.S. Increase to Highest Level in 30 Years.” Www.cdc.gov, 14 Nov. 2022. Accessed 22 Jan. 2023.

Homebirth Study One-Page Fact Sheet.” Midwives Alliance of North America, 30 June 2016.

NVSS – Birth Data. 2019.

WHO Statement on Caesarean Section Rates.” Www.who.int.

Dekker, Rebecca. “What Is Home Birth?” Evidence Based Birth®, 10 July 2012.

Simpson, Kathleen Rice PhD, RNC, CNS-BC, FAAN. Trends in Labor Induction in the United States, 1989 to 2020. MCN, The American Journal of Maternal/Child Nursing 47(4):p 235, July/August 2022. | DOI: 10.1097/NMC.0000000000000824

Pitocin linked to postpartum depression and anxiety: New research. BellyBelly. (2022, August 4). Retrieved January 22, 2023.

Induction of labour – what are the risks of being induced? BellyBelly. (2022, July 27). Retrieved January 22, 2023.

Amanda Krupa, MSc. “This Is How Much It Costs to Have a Home Birth in America.” Parents, Parents, 7 May 2020.

Twitter, Matthew Rae, et al. “Health Costs Associated with Pregnancy, Childbirth, and Postpartum Care.” Peterson-KFF Health System Tracker, 13 July 2022.

Anderson, David A, and Gabrielle M Gilkison. “The Cost of Home Birth in the United States.” International Journal of Environmental Research and Public Health, U.S. National Library of Medicine, 1 Oct. 2021.

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