Family Matters

Why Home Births Are on the Rise

The key to a successful planned home birth? Flexibility.

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Catherine Ledner / Getty Images

Nine years ago, my neighbor and I were pregnant at the same time. I was expecting my first child, she her fourth. One day, I returned home from work to find a blue bow on her lamppost. My husband and I grabbed a congratulatory bottle of wine and headed over. We rang the doorbell, and Angie answered, perky as ever.

“Um,” I stuttered, completely confused. “I thought you had your baby, but I guess I was wrong.”

“He’s upstairs,” she responded. “Want to come see him?”

Her home birth hadn’t fazed her one bit. A trained labor and delivery nurse, she’d delivered her son herself that morning; that afternoon, she drove to pick up her girls from school. Clearly not a typical case, but statistics released Thursday by the Centers for Disease Control and Prevention (CDC) indicate that home birth is on the rise.

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Although the total number of home births is still tiny, the percentage has risen by 29%, from 0.56% of births in 2004 to 0.72% in 2009. Home births are most common for white women who are not Hispanic, accounting for 1% of deliveries — 1 in every 90 babies. Moms ages 35 and over are more likely to choose home birth than younger women, according to the CDC.

Attitudes toward home birth seem to vary geographically. Louisiana mothers and those in the District of Columbia were least likely to deliver at home, while home births comprised 2.6% of Montana deliveries. In many ways, it’s a return to yesteryear. In 1900, nearly all babies were welcomed at home. By the 1940s, however, the proportion had dropped to 44%. In 1969, it hovered at just 1%. And now, the rate is the highest it’s been since the CDC began keeping detailed records in 1999.

The rising trend reflects women’s desire to return to “what is normal physiologically,” says Saraswathi Vedam, who chairs the American College of Nurse-Midwives’ committee that oversees home birth. “There is an increased interest in everything about healthy living.”

Home births are not a rejection of modern health care, says Vedam, who notes that planned home births — not the “oops, the baby’s coming and I can’t make it to the hospital” kind — involve a qualified birth attendant who brings oxygen, equipment for monitoring fetal heart rate and for resuscitation, if necessary, as well as medications to stop bleeding. Only women who’ve had healthy, uneventful pregnancies and have no underlying medical complications are good candidates.

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Not every home birth goes according to plan. The most common reason for transfer to a hospital is failure to progress, in which labor simply stalls or doesn’t proceed as expected. “Home birth is an ongoing assessment,” says Vedam. “We’re not talking about making a decision about where you’re going to give birth and sticking to it. If your risk profile changes, then you change the plan and go to the hospital.”

Dr. George Macones, an obstetrician at Washington University in St. Louis and chair of the American College of Obstetricians and Gynecologists’ committee on obstetric practice, says where to give birth should be a decision left up to each individual woman.

A study published in 2010 in the American Journal of Obstetrics & Gynecology found that planned home births involved less medical intervention — fewer epidurals, episiotomies and infections and less emphasis on electronic fetal heart rate monitoring — but they were associated with three times the number of infant deaths. “Keep in mind that the absolute risk is still incredibly low,” says Macones. “But obstetrics is a risky business sometimes.”

Is there a middle ground? Birthing centers nearby or adjacent to hospitals — where women can experience a calmer, less invasive birth while remaining close to a hospital in case of emergency — could be the solution. “That’s the best of both worlds,” says Macones. “It’s a very nice, quiet, more natural experience, but if something happens you could literally be wheeled underground to the hospital.”