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Are Home Births Safe?

Are home births safe? Most people don’t think so. But I’ve dug into the research and found the facts, and I am confident that home births are not only safe but also a great option for most women, most of the time. This blog post explains exactly how and why.

mother and baby in birth pool at home

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I had my first baby at home, unmedicated, and I loved it.

A lot of people call me brave. But that’s not why I did it. And it’s not even really true, to a large degree. If it were a dangerous thing or a scary thing or something I knew nothing about, it would have required bravery.

But I went into it fully aware of what I was choosing and confident that it would be a good thing. So it wasn’t bravery; it was a no-brainer.

Who This Blog Post is For

Before I get into it, let me say: if you’re not open to the idea that home births could ever be a good idea, no one and no statistic or fact is going to be able to convince you.

And if that’s where you’re at, I won’t judge you. Your life and experience is different from mine and I’m sure you have your reasons. If that’s you, this blog post probably isn’t for you.

But if you’re thinking that maybe, just maybe, hospitals aren’t the only – or the best – option, but you aren’t sure exactly what you think yet, let me shed some light on the subject for you. This blog post is for you.

Ina May and Some Statistics

Before we jump in, I want to show you some statistics. In order to do that, I need to tell you about Ina May.

Ina May Gaskin, often called “the mother of authentic midwifery,” founded a self-sustaining community in Tennessee in 1971. It’s called “The Farm.”

She and her friends taught themselves how to deliver each others’ babies (with a friendly doctor as mentor and medical liaison). They’ve since become the most sought after midwives in the country.

Ina May’s motivation was her first birth experience in the hospital which she did not like at all. All her efforts were focused on providing a better way for women to give birth.

Statistics Compared

Every birth on The Farm is a home birth attended by certified professional midwives. Their birth statistics are published online for all to see. And they are astounding.

Here they are compared to numbers from the US as a whole (where nearly 99% of births are in the hospital).

First, look at the comparison in numbers of c-sections, twin vaginal births, postpartum hemorrhaging, and more:

bar graph showing stats about home births at The Farm vs US Births

And here’s a comparison of mortality (death) and morbidity (sickness) rates:

table showing stats about home births at The Farm vs US Births

(Links to sources for these numbers are at the end of this blog post.)

Those numbers would be incredible even if we were looking at just one year at The Farm. But those charts compare DECADES of births at The Farm to just one typical year in hospitals.

It’s absolutely amazing what the midwives at The Farm have achieved.

Hospital or Home

Not everyone is going to give birth in a village in Tennessee. But women all over the world will choose to give birth at home with midwives.

For the purposes of this blog post, I’m generalizing “home birth” to include all births outside of the hospital. That means births in birth centers, in homes, or anywhere else.

I am also categorizing care providers into two general categories. First, those who attend births in the hospital, which I’ll simply refer to as OBGYNs. And second, those who attend births outside of the hospital, which I’ll refer to as midwives.

Yes, some midwives work in hospitals. But usually those who do practice in much the same way as OBGYNs (multiple patients at a time, using medications to manage labor, etc).

So when I talk about midwives in the rest of this article, I’m talking about home births. And when I talk about OBGYNs, I’m talking about hospital births, even those attended by certified nurse-midwives.

Defining “Safe”

Home births are often seen in a negative light, to say the least. Most people believe home births are unsafe. 

So are they?

Well, I would begin to answer that by asking a follow-up question: what do you mean by “safe”?

Are we talking about physical safety – like avoiding emergencies?

Are we talking about emotional safety?

Or are we talking about long-term effects on your well-being?

“Safe” as in mom and baby are alive is obviously the baseline goal for any birth.

But what about “safe” as in how a woman feels during labor and how she is treated? What about “safe” as in if you’re going to end up with complications, or even a surgery, that may not have been necessary? What about “safe” as in how your first birth could affect your second and all the rest?

How you give birth matters. It will affect you, physically and mentally, for more than just those hours you’re in labor. So let’s make sure when we say that we want mom and baby to be safe that we’re talking about the whole picture.

The Fundamentals

With that perspective as a backdrop, there are a few fundamental things every person should understand about the differences between hospitals and home births.

1. Obstetricians are surgeons.

Obstetricians, also called OBGYNs, are the primary care providers for most pregnant women in America. And while they do provide care to women in all stages of pregnancy and life, their primary training is in surgery.

Obviously, that’s going to change how they see things.

It’s not that surgery is always a bad thing. Sometimes it can be life-saving! But it’s not always the best solution. 

What Heart Health and Birth Have In Common

To illustrate this, let’s leave the world of pregnancy and consider heart health.

Nutrition plays a huge role in the human body’s ability to function properly and recover from injuries.

When a person eats poorly (lots of fried and processed foods, not a lot of fruits and veggies), their blood has high levels of cholesterol. That extra cholesterol often gets left on the inside walls of arteries rather than being discarded as waste.

If this poor diet continues for years and years, the cholesterol can build up and clog the arteries. And when arteries are clogged, that person has a higher risk of stroke, heart attacks, and even death.

A surgeon may help someone with clogged arteries by performing a coronary bypass surgery. Most of the time, however, the body can resolve the clogged artery if given a better diet to work on.

It is the same with pregnancy and birth.

While OBGYNs can perform a c-section if things go wrong, care providers with an understanding of nutrition and the importance of other preventative measures (i.e. midwives) will be able to provide a safe pregnancy and birth experience to women without having to rely on surgery.

2. Most home birth transfers are not because of emergencies.

Despite what most people believe, the majority of planned home births end well and never require a hospital. What’s more, the times when birthing mothers do transfer to a hospital despite planning on a home birth are rarely because of emergencies.

Learning from 215,000 Women

In 2014, a group of researchers performed a meta-analysis (a study that looks at other studies) which encompassed the birth experiences of more than 215,000 women.

They found that the most common reason for transferring to the hospital during planned home births is slow progress in labor.

Usually that just means labor has been going on for longer than expected. And because labor has been so long, the mother is probably exhausted and could benefit from a little help in the form of Pitocin and an epidural.

Even in the study with the highest number of transfers because of slow progress in labor, only 9.8% of women were transferred.

Transfers because of fetal distress (danger to the baby) are uncommon. In the study where it happened most often, only 3.6% of moms were transferred because of it.

Transfers because of postpartum hemorrhaging for mom or respiratory problems in the baby were both next to none (0.2% and 1.4%, respectively, in the studies with the highest occurrence).

Finally, transfers because of emergency situations, only happened 5.4% of the time at most.

In three of the eight studies that reported emergency transfers, the rate was 3.4%. In three others, the rate was 1 or 1.8%. And one study reported no emergency transfers at all.

So, to summarize, transfers for any reason are relatively uncommon, and transfers for emergencies are even rarer.

First-time Moms vs Multiparous Women

Note: Women giving birth for the first time have higher rates of transfer than do women who have given birth before (called “multiparous”). Still, many women (like me!) give birth to their first child at home and most have no complications.

3. Emergencies in hospitals often happen because mom is in the hospital.

It may seem like a bold claim to say that birth complications often happen because women give birth in hospitals, but it’s true.

Around 31% of US births follow a labor begun by artificial induction. And anyone who spends time around birthing people – whether in the hospital or out – will tell you that a laboring woman who gets induced is more likely to have other interventions as well.

This phenomenon is called the cascade of interventions. Not every woman will experience this cascade, and for those who do, it may look slightly different person to person. But there’s a specific, common element of it that I want to point out. I call it The Fetal Distress Cycle.

The Fetal Distress Cycle

This is how the fetal distress cycle goes:

A woman is nearing or is past her estimated due date so her doctor recommends an induction. She decides to move forward with it. So on the scheduled day, she goes to the hospital and gets an IV containing Pitocin, which stimulates contractions to begin.

(The same applies if her labor begins spontaneously but she receives Pitocin at a later time during labor.)

Pitocin is widely known to make contractions longer, stronger, and closer together. Those three things make contractions more painful so after a little while the woman asks for an epidural.

Epidurals often slow labor down because they interfere with normal hormonal processes in the body. When labor slows down, the doctor increases the amount of Pitocin mom is receiving to speed it back up.

But more Pitocin means more pain, so mom asks for the epidural to be upped, too.

Now, that all might sound good and fine because the one takes care of the other. But let’s think about the baby. 

What About the Baby?

Mom can’t feel the contractions, but her baby certainly can.

The increased pressure caused by the Pitocin combined with very little, if any, time in between contractions restricts the flow of blood and oxygen to the baby. That causes his or her heart rate to drop.

The monitors attached to mom pick up on that.

When the doctor sees the output from the monitors, he tells mom that the baby is in distress and recommends an emergency c-section. Mom agrees, the OBGYN performs the surgery, and the cycle ends, just not in the way mom probably hoped.

To be super clear, this cycle doesn’t happen every time a woman gets Pitocin or an epidural. But too often it does. And that means that far too often, emergency c-sections are happening that could have been avoided altogether.

Hemorrhaging

In addition to the fetal distress cycle, two other emergencies that are relatively common in hospitals can be linked to things that only happen in hospitals.

The first is hemorrhaging. Hemorrhaging is when a woman loses too much blood. Though there are many causes of hemorrhaging, one factor is prolonged use of high doses of Pitocin, like happens in the fetal distress cycle explained above.

When the uterus is exposed to that much synthetic oxytocin, it becomes desensitized. When it becomes desensitized, the uterus doesn’t contract and shrink after birth like it should. And when it doesn’t shrink like it should, you bleed more.

Breathing Problems

In addition to emergency c-sections and hemorrhaging, breathing problems in your baby sometimes happen because of routine procedures or medications used in the hospital. 

What are these routine things that can lead to breathing problems? Opioids, induction, and c-sections.

Opioids

You’ll usually hear opioids called by brand names like Fentanyl, Demerol, or Stadol. Opioids are commonly used to help minimize pain during labor. Unfortunately, they also affect the flow of oxygen to your baby.

If oxygen is restricted for too long, your baby can develop birth asphyxia, which can have both short- and long-term consequences.

Induction and C-sections

Even if opioids are not used, babies born after an induction or by c-section often have more respiratory issues, especially if the c-section is elective and happens before labor begins.

There are three main reasons for this.

The first two have to do with a baby’s lungs.

First, elective c-sections or scheduled inductions often happen around 39 weeks of pregnancy. Because due dates are just estimates, a scheduled c-section or induction may inadvertently lead to a baby being born prematurely, based on their size and development.

And a baby’s lungs are some of the last organs to develop.

Second, if labor begins and progresses spontaneously, an unborn baby experiences surges of hormones that, among other things, prepare their lungs for life outside the womb.

The third reason c-sections can lead to more breathing problems is that babies born by c-section don’t experience the “fetal heimlich maneuver.”

This “maneuver” is just a fancy way of saying that the pressure of being pushed out through their mother’s vagina efficiently expels amniotic fluid from a baby’s lungs and airways. 

The fetal heimlich maneuver is far more effective than suctioning out a baby’s nose and mouth with a device. So a baby born by c-section is more likely to have fluid left in their airways.

4. Births attended by midwives, especially at home, have better outcomes.

Multiple studies have shown that women cared for by midwives — especially those planning a home birth — have better birth outcomes. Those improved outcomes include fewer interventions (induction, episiotomy, etc), lower likelihood of a c-section, and less tearing, to name only a few.

Women who give birth at home also have lower rates of postpartum hemorrhaging, retained placentas, and infection.

Planned home births often result in higher satisfaction with the birth experience, too.

5. Midwives know when to refer to an OBGYN.

Midwives are well-educated and highly qualified to attend births as the primary care provider. That said, midwifery is meant as care for women who are low-risk.

Midwives who know their stuff know when a woman is high-risk and therefore needs different care than she can offer. (For context, only 6-8% of births are high-risk, though.)

Most midwives only accept low-risk clients. And experienced midwives know that emergencies requiring transfer to the hospital are preceded by warning signs well in advance if you know what to look for.

This is why I don’t recommend an unassisted home birth (sometimes called “freebirth”). Though most of the time birth will proceed safely and without complication, having a midwife there who knows the warning signs of an emergency can literally be the difference between life and death.

How to Prepare for a Safe Home Birth

Now you know that the myths that circle about home births are unfounded. “But, still,” you might be thinking, “what if I’m one of those people who ends up with complications that couldn’t have been foreseen?”

Well, first, if you have a good midwife, she will likely be able to recognize an emergency long before it becomes life-threatening, like we just talked about.

But you don’t have to wait and just hope that things go well. You can do a lot to set yourself up for a successful home birth because a safe home birth starts long before labor begins.

Eat Well and Exercise

One of the best things you can do to ensure a good home birth experience is to take care of your body during pregnancy. If you eat well and exercise regularly, your body will be better prepared for the intensity of labor. 

For example, if you’ve been eating a nutrient-dense diet and staying hydrated, you’ll be healthier and you’ll have more energy. That means even a long labor won’t wear you out quite as fast.

And if you’ve been exercising regularly, your muscles will be both strong and flexible which will help you to get into positions that help birth proceed more effectively.

In addition to general health and fitness, you can work on toning your pelvic floor.

Tone Your Pelvic Floor

The pelvic floor is a group of muscles that spans from your pubic bone to your spine and forms the base of your core. The pelvic floor is important during birth because it provides a sort of springboard for your baby’s head as he or she exits the birth canal. 

The difference between a toned pelvic floor and one that’s weak is like the difference between a paper towel roll and a sock. 

If you were to drop a bouncy ball down both the paper towel roll and the sock (with the toe cut off) at the same time, which would allow the ball to pass through easier? The paper towel roll!

The less toned your pelvic floor, the more likely it is that your baby’s progress will slow or stall and the harder it will be to push effectively. 

Work to Encourage Optimal Fetal Positioning

Finally, you can be intentional during pregnancy about encouraging optimal fetal positioning. Ideally, your baby settles into a head-down position as you near the end of pregnancy. It’s even better if his or her nose is pointing toward your spine. 

This position – called cephalic occiput anterior – is best because it makes it easier for your baby to navigate their way through your pelvis and come out smoothly during birth.

If your baby is posterior, meaning their nose is pointing toward your belly, labor is often more painful (which may lead to more hospital transfers because of wanting an epidural).

If your baby is positioned with their butt or feet down, that is called “breech.” Most OBGYNs will only deliver breech babies by c-section. Some midwives will attend breech births at home. Breech vaginal births are controversial because complications (like dystocia and cord prolapse) are slightly more common, as compared to a cephalic vaginal birth.

The Verdict: Are Home Births Safe?

So are home births safe?

Yes. For most women, most of the time, a planned home birth is a safe option.

Let’s recap why.

First, when talking about safety, there’s more to it than just if a mother and baby are alive after birth. Safety also includes emotional well-being and any long-term consequences that come as a result of birth.

In addition to broadening the definition of “safe,” it’s important to recognize that some complications that happen in hospitals happen because a mother is at the hospital.

And contrary to common belief, emergencies rarely happen at home. Most hospital transfers are because of non-emergency situations.

Part of the reason birth is safe at home is because midwives attend those births, not OBGYNs. OBGYNs are trained as surgeons so they are less likely to provide the kind of preventative care that decreases the likelihood of complications.

Midwives also achieve better birth outcomes.

Finally, in the case of an emergency, a good midwife knows how to spot the warning signs and will transfer a mother to the hospital if necessary. 

Conclusion: Don’t Let Fear Win

Now, after all that, here’s the reality of it all: I could write everything I know and present every reason I can come up with to try to show that home births are not only safe but also a good idea for a lot of women.

But even that wouldn’t change one simple thing – the fact that the American culture surrounding birth is one of fear.

That’s really what I’m up against here: decades and decades – maybe even centuries – of fear. (And that fear, in part, is fueled by incomplete information and inaccurate statistical reports.)

I could list all the reasons people are afraid and all the claims people make and try to explain them away. I could find quotes and stories that illustrate my points. But none of that would matter.

Because what matters is each mother and each baby. Because truth is truth and it is available to those who seek it.

Faith > Fear

Though I have strong opinions, I don’t pretend to ignore that sometimes births end very sadly – and that applies to all births, both at home and in the hospital. And I would never encourage anyone to do anything that I believed had a high likelihood of ending in the loss of a life.

But I truly believe that, when properly prepared for, labor and birth are inherently safe and have the potential to be uncomplicated and effective, even at home. 

Some people argue for hospital births saying that no woman would want to be part of that small percentage of births where either the mother or the baby dies. And of course that’s true. But is that really the best way to make decisions? 

Choking could happen any time you eat. But does that mean you shouldn’t eat? Of course not. And there are things you can do to minimize your chances of choking.

Birth is the same.

What it comes down to is that life is better lived in faith, not fear. And ultimately, “if [we] are prepared [we] shall not fear.”

Until next time,

Allison

Want to Share Your Story?

If you’ve already had a home birth, I’d love to hear about your experience in the comments! And if you want to share your story with a community of women who could benefit from your positive experience, I’ll publish your home birth story on my site. If you want to share, contact me here or reach out to me directly at allison@givebirthgivelife.com.

READ MORE:

5 Questions to Ask Yourself Before Choosing a Home Birth

Home Birth Prep: 7 Steps to Make Sure You’re Ready

Home Birth Myths: Busted

Sources for Statistic Comparisons:

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2 Comments

  1. Thank you for this article, it helped me remember not to live in fear bit faith.

    I had a home birth in 2020. Everything was fine all through pregnancy and labor, but my baby was gone to Jesus just minutes before birth. Nothing could have changed that outcome, not even an emergency c-section.

    This lead me to have a hospital birth in 2021, which I had with a hospital midwife who was great but it just wasn’t the same. Fast-forward to 2023 and I had a second hospital birth, this time the midwife was not on call and I got stuck with an OB for labor and delivery. It was not a good experience, I left feeling traumatized and helpless.

    I read your article as I think on the future. My husband and I love children, and God has been gracious and filled our home with 2 girls we adopted along with 2 more biological. I know God has put it on our hearts to have a large family and I struggle with now what to do for our future labors.

    God is good and I’m positive He helped me find this article when I needed it. There is a birthing center being built 15 minutes from our home and I believe God will help us when the time is right to go there instead of the hospital next time.

    Thank you for the encouragement but also for pointing to the Savior who holds our tomorrow’s ❤️

    1. Wow! Thank you for sharing your story, Moriah! I am honored to have helped on your journey of hope. Prayers for you and your family❤︎

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