The main reason is a wish to avoid overly invasive procedures during childbirth. Deliveries taking place at home tend to involve far fewer medical interventions and complications.
However, midwife-assisted home births cannot always be easily or legally arranged.
Only 27 U.S. states license or regulate professional midwives. And in the 23 states that lack licensing laws, midwife-attended births are illegal, and midwives may be arrested and prosecuted.
However, according to Time Magazine:
"Momentum appears to be growing. Of the 27 midwife-friendly states, eight began licensing midwives only in the past decade. And legislatures in 10 other states are now considering bills to institute licensing of [professional midwives] -- a fact that has not gone unnoticed by the medical establishment …
Both the American Medical Association (AMA) and the American Congress of Obstetricians and Gynecologists (ACOG) ... oppose home birthing."
If a pregnant American woman announces to her friends and family that she is planning a home birth, the first reaction is typically shock, followed by questions like:
- "What will happen if something goes wrong?"
- "Isn't it too dirty?"
- "Is that safe?"
Unfortunately, this is the product of a medical system that views pregnancy and childbirth as a disease or a problem that has to be "fixed" rather than the completely natural process it actually is.
More than 75 percent of women have normal pregnancies, and for these women a midwife may be more qualified to attend birth than an obstetrician, and giving birth at home may be preferable and safer than doing so in a hospital.
Why Giving Birth at Home Makes Sense
Most people consider hospital births to be safer than home births, but when you look at the facts this isn't the case.
Nearly all U.S. births (99 percent) occur in a hospital, yet the United States has one of the highest infant mortality rates of any developed country (6.3 deaths per 1,000 babies born). In the Netherlands, however, where one-third of deliveries occur in the home with the assistance of midwives, the infant death rate is lower (4.73 deaths per 1,000).
Maternal mortality rates also rose more than 54 percent from 2000 to 2005 in the United States, while decreasing in other developed countries.
This is likely due at least in part to the incredibly high rate of Caesarean section (C-section) in the United States. C-section is the most common operation performed in the United States, and accounts for nearly one-third of all births.
According to the World Health Organization, no country is justified in having a cesarean rate greater than 10 percent to 15 percent.
The United States' rate, at nearly 32 percent, is so high that even The American College of Obstetricians and Gynecologists admits it is worrisome. This is actually the highest rate ever reported in the United States, and a rate higher than in most other developed countries.
One study in the British Medical Journal found that a woman's risk of death during delivery is three to five times higher during cesarean than a natural delivery, her risk of hysterectomy four times higher, and her risk of being admitted to intensive care is two times higher.
Clearly C-section should be used as a last resort, and only when absolutely necessary. Yet in the United States the rates suggest they are being used far more than that. C-section rates are lower among home births, as well as midwife-attended births. At one small hospital run by the Navajo Nation, where midwives deliver most babies born vaginally, the C-section rate is only 13.5 percent.
New Homebirth Study Gives Outrageously Flawed Results
Unfortunately, a recent study by Dr. Joseph Wax that looked at the safety outcomes of home births versus hospital births gave very misleading conclusions -- and has been publicizing them in the media. What the study found was that:
- Women who delivered at home had fewer interventions such as an epidural, electronic fetal heart rate monitoring, episiotomy, and operative delivery (c-section). They were also less likely to experience lacerations, hemorrhage, and infections.
- Babies born at home had less frequent prematurity, low birthweight, and assisted newborn ventilation.
- Planned home and hospital births exhibited similar perinatal mortality rates.
All of these findings suggest that home birth appears to be as safe, if not safer, than hospital birth. However, what the authors focused their results on were the neonatal mortality rates, which are newborn deaths that occur within 28 days of delivery. For this they found that homebirths had a higher rate of death, by three times, compared to hospital births.
The problem with this statistic is that a lot can happen in 28 days after delivery, and many of these deaths were likely completely unrelated to the fact that the babies were born at home.
As Melissa Cheyney, assistant professor of medical anthropology and reproductive health, recently reported in the Huffington Post, " … congenital anomalies, Sudden Infant Death Syndrome, unsafe home environments, and poverty, can all contribute to death in the first month of life."
So the statistic is misleading to start. But the study authors also included what Cheyney calls "faulty data" in their report, such as grouping high-risk and low-risk mothers together and including babies that were unintentionally born at home. This flawed methodology lead to skewed results, and as Cheyney reported:
"As Dr. Michael Klein of the Child and Family Research Institute in Vancouver, B.C. points out, after removing low-quality studies and out-of-date statistics, the Wax study actually demonstrates no difference in outcomes between home and hospital-based delivery, even for neonatal mortality."
My Personal Biases
I have four siblings but am closest to my sister Janet who I started my medical practice with me in 1985. She was my assistant and office manager for 14 years until she got married and left to raise her children.
She has two boys who were both scheduled to deliver at home with an MD who performed home births. At 31 weeks during her first pregnancy, she developed HELP syndrome, and had to have a hospital birth. We tried IV magnesium and other vitamins in hopes of turning things around, but she was admitted to the hospital and labor was induced at 35 weeks.
That was before my epiphany of the importance of vitamin D, and it is my belief that if we had got her vitamin D levels optimized she likely would have avoided these complications.
About the only complication of the hospital delivery was the painful and unnecessary episiotomy, and also the fact that my nephew received an unwanted hepatitis B injection.
Eighteen months later, she was able to successfully deliver her second son at home with a doctor, and had an absolutely positive experience.
Homebirths Can be Difficult to Plan in the United States - But it Can be Done
In the United States it often takes a lot of diligence and determination to go against the norm and find a physician or midwife who performs homebirths. It is rare to find an obstetrician that will agree to a home birth in the United States, and while certified nurse midwives (CNMs) can legally attend home births in any state, most do not and choose to practice in hospitals instead.
Only 27 states currently license or regulate direct-entry midwives (or certified professional midwives (CPMs), who have undergone training and met national standards to attend homebirths. (You can find the legal status of CPMs in your state here.)
In the other 23, midwife-attended births are illegal, however women often end up finding a midwife on the "black market," who due to lack of any type of regulatory oversight may or may not have adequate training.
It is certainly possible to find highly qualified and trained midwives practicing on the underground market. These women often believe strongly in women's right to choose home birth, and risk being arrested and prosecuted for practicing medicine or nursing without a license to offer their services.
There are also people practicing as midwives who have not received adequate training that can also be found in this underground home birth market, so if you do go this route it's imperative that you thoroughly check out and reference the person you are working with.
A campaign is currently underway to expand state licensing of CPMs so that women who want a home birth can choose from a qualified pool of applicants, but until that happens you have a few legal options for homebirth:
- Find a certified nurse midwife (CNM) who attends homebirths in your state or in a nearby state (then travel to that state to give birth)
- Find a CPM who is either licensed by your state or in a nearby state (then travel to that state to give birth)
- Use a CNM but give birth in a hospital or birth center (a compromise)
To find a midwife in your area, try:
- Midwives Alliance of North America
- Mothers Naturally
- American College of Nurse-Midwives
- Midwifery Today
- BirthLink (Chicago area)
The bottom line is that the surgical interventions obstetricians are trained to use are often unnecessary in a normal pregnancy and delivery, and can cause more harm than good when used inappropriately.
In a healthy pregnancy, a qualified midwife, who is there to offer help, education and support during pregnancy, labor, delivery and after, is actually the safest, most qualified birth attendant, and your home may very well be the best place for you to deliver.