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What to Know About Home Birth

Reviewed by Melinda Ratini, MS, DO on November 22, 2022

Until the 1700s, home birth was the only option for those giving birth. Friends and family members would help with the birth, along with a midwife. In the late 1700s, doctors began to help with the birthing process because some people felt they needed the medical knowledge to make birth safer.

Then, in the early 1900s, hospital births became more popular. Hospitals offered a less painful birth with anesthesia. By 1935, just 15% of births were done at home with a midwife.

Now, just over 1.5% of births in the U.S. are done out of hospitals, either at home or at a birthing center.

Why Do People Have Home Births?

There are many reasons you might consider a home birth, including:

  • Giving birth in a familiar and comfortable environment
  • A desire to avoid medical interventions
  • Staying faithful to your religious and cultural practices
  • Having your family and friends present at the birth
  • Having more control over the birth
  • Wanting to save money
  • Lacking transportation 

How to Prepare for a Home Birth

If you choose to have a home birth, there are a few steps to keep in mind, such as:

Find a trained health care provider to assist. This is typically a certified nurse-midwife or a certified midwife. In addition, you may want to have a doula present to help out. They can come to your home and care for you throughout pregnancy, labor, and postpartum, which is after the baby is born. You can also work with them at a birthing center.

While uncommon, in some places, OBGYN doctors may be available to help with home birth.The American Academy of Pediatrics also recommends that you have a trained person present whose only responsibility is the newborn. 

Create a home birth plan. Think through the logistics of home birth, such as:

  • Supplies and equipment you’ll need before, during, and after a home birth
  • Who should be there during labor and delivery
  • Pain management
  • Birthing positions 
  • If you want to breastfeed immediately
  • Cord clamping, removing the umbilical cord, and the placenta

Write down your expectations and plan and share with your birthing partner or whoever will be there during labor. Communicate your plans clearly with your health care provider. You’ll also need a plan B if things go wrong or if you need to head to the hospital for medical attention. 

If you’re unsure about how to put a birth plan together, ask your doctor or midwife, or try to take a childbirth class during pregnancy. You can meet with coaches and other pregnant people who can share tips and advice on labor, delivery, and other birthing expectations to consider in your birth plan. 

Prepare to go to the hospital if necessary. During a home birth, life-threatening issues might pop up during labor that need immediate medical help.

If that’s the case, be prepared to head to the hospital. For this, you should:

  • Talk to your doctor or midwife about signs you need to head to the hospital
  • Have a hospital bag ready to go
  • Have transportation ready
  • Make a list of emergency contacts and choose a point person to handle communication. 
  • Try to plan a home birth within 15 minutes of a hospital with 24/7 maternity care.

If you need to head to the hospital immediately after you give birth, consider how you’ll transport the baby as well. 

You’ll need to go to the hospital if:

  • Labor becomes complicated or isn’t moving along
  • You need help with pain
  • You have medical complications like bleeding or issues with blood pressure
  • Your baby is in distress
  • You have a fever

Home Birth Risks

The risks of a home birth include:

  • Greater risk of death. The rate of infant mortality for home births is 1-2 out of 1,000, which is at least twice as high as hospital births.
  • Greater risk of neurological damage and seizures during birth. The rate of neurologic dysfunction for home births is 0.4-0.6 out of 1,000 births, which is three times as high as hospital births.

To lower these risks during home birth, make sure to work with a properly trained and licensed midwife. 

Are Midwives Licensed Professionals?

Many midwives are nurse-midwives. This means they are officially registered nurses with advanced degrees in midwifery.

In some states, nurse-midwives can only work under the supervision of a doctor. In other states, licensed or certified midwives, who are not registered nurses but have extensive midwife training, are allowed to help with at-home births.

In addition to attending home births, many nurse-midwives, and some licensed midwives, practice in doctor’s offices or other medical settings.

What Is a Doula?

A doula is someone who provides physical and emotional support to the mother before, during, and after the birthing process. During labor, they may do things like suggest positions for labor, conduct the mother’s breathing exercises, and support everyone involved in the birth.

A doula is usually available to you in the months before and after labor to answer any questions you may have and offer support. There are also postpartum doulas who support you after you give birth. They help with breastfeeding, cooking, and cleaning while you are recovering and bonding with your baby.

How Much Does a Home Birth Cost?

A home birth with a low-risk pregnancy will cost you less than a planned hospital birth. There are some home birth packages that have a global fee.

This includes prenatal, labor and delivery, and postpartum care. One large nationwide survey found that, on average, home births in the U.S. costs $4,650. But costs can vary by state and region and how much training your midwife has. For example, a certified nurse midwife has more training and might charge more than a professional midwife. 

Health insurance companies don’t usually cover home birth costs. If you’re unsure, call your health insurance provider and check if they’re able to cover certain costs like childbirth classes, midwife or doula fees, and other baby-related costs. 

Remember that things you’ll need during a home birth, such as equipment, transportation, birthing, and baby items, might be additional expenses that might not be covered in your global fee. 

What Supplies Do You Need?

For a home birth, you’ll need specific items and equipment to help you have a smoother labor and delivery experience.

A home birth, like a planned hospital birth, can be messy. You’ll need ample supplies to clean, wipe, or soak up bodily fluids during labor and delivery. This will help you maintain a clean, sanitary environment for your newborn.

In your birth kit, you’ll need:

  • A copy of the birth plan with emergency contact information
  • Up to 10 large, clean bath towels 
  • Clean pillows
  • Several clean washcloths
  • Two sets of clean sheets 
  • Sanitary pads
  • Ice packs
  • Heating pads
  • Garbage bags
  • Bucket, in case you throw up
  • Large bowl for placenta
  • Access to warm water for compress or water births
  • Over-the-counter pain medications that are pregnant or postpartum safe
  • Sitz bath or hemorrhoid cream for postpartum care
  • Access to transportation in case of emergency

For the baby, you’ll need:

  • Newborn-size baby clothes, caps, and blankets
  • Newborn or size 1 diapers
  • Digital thermometer
  • A home glucometer to check for blood sugar levels
  • Infant car seat

Make sure to have at least two meals prepared or handy for yourself, your birthing partner if you have one, and for the midwife or doula. 

Home Birth and Postpartum Care

Soon after you give birth, the American Academy of Pediatrics recommends that you have at least one trained person to care for the newborn’s needs and health. Aside from the trained medical person to take care of the newborn, speak to your close family and friends for support and help with newborn and household chores. 

Talk to your midwife about what postpartum care they offer. Your and your baby’s health will need to be closely monitored for any complications. Your midwife might come in to check on you and your baby during the first few weeks after you give birth.

Your midwife might also be skilled to coach you through breastfeeding if you choose to do it. They can also offer support, advice, information, and tips on how to care for a newborn. 

Who Qualifies for a Home Birth?

You may be a good candidate for a home birth if:

  • You have a low-risk pregnancy.
  • You are generally in good health.
  • You are pregnant with only one baby, not twins or triplets.
  • Your baby has gotten into the proper head-first birthing position and is not in the breech position.
  • You have never had a C-section.
  • You are not at risk for early labor and have never had a premature birth.
  • You do not have preeclampsia or high blood pressure.
  • Your partner supports your desire to have a home birth.
  • You understand and accept that your plan may have to change. Forty percent of first-time parents need to go to the hospital during a home birth.

Talk to your obstetrician before making your decision to be sure what is safest for you and your baby.

Show Sources

SOURCES:

American College of Obstetricians and Gynecologists: "Planned Home Birth."

BBC: “The real cost of giving birth: '$40 to hold my newborn baby.'”

DONA: "What do birth doulas offer?"

HHS Public Access: "Trends and State Variations in Out-of-Hospital Births in the United States, 2004-2017."

La Leche League International: “Skin-to-Skin Care.”

Legislative Analyst's Office: "Analysis of California's Physician-Supervision Requirement for Certified Nurse Midwives."

Mayo Clinic: "Home birth: Know the pros and cons."

Midwives Alliance North America: "Types of Midwives."

WHYY: "How did birth move from the home to the hospital, and back again?"

Midwivescare.org: “Birth Supplies List and Links for Birth Kits.”

Midwife.org: “Support After Birth.”

International Journal of Environmental Research and Public Health: “The Cost of Home Birth in the United States.”

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