About five generations ago almost all births took place at home. In the 1900s, with increased safety and presence of medicalized healthcare, a dramatic shift encouraged pregnant people to deliver with obstetricians in a hospital setting. Today 98.4% of people in the US give birth in a hospital, but there is growing interest in birthing at home! The rate of home births increased by 77% between 2004–2017 with a similar rise in the number of deliveries in birthing centers. In this post, we will explore the differences between homebirth and hospital birth, the benefits and risks of each, and factors to consider when deciding which option is best for you.

It should be noted that this post will be exploring planned home births. As we know, babies do have their own timelines that do not necessarily adhere to our best laid plans resulting in the occasional unexpected and unattended homebirth.

Homebirth: What is it and how does it work?

Homebirth is when a pregnant person gives birth in their home, assisted by a trained birth attendant like a midwife or doctor. The provider brings all necessary equipment and supplies to the home for childbirth including fetal monitoring tools, fetal resuscitation equipment, and medication to intervene in the setting of a postpartum hemorrhage. There is often a fear that homebirth providers have insufficient training in obstetrical emergencies or have no equipment to adequately address these concerns. Trained birth attendants are able to address most obstetrical emergencies for infant and mother at home including neonatal resuscitation, postpartum hemorrhage, shoulder dystocia, though not to the fullest extent that a hospital team would be able to.

Why do some people opt for homebirth?

Homebirth is often preferred by pregnant people seeking out low-intervention labor in a setting that feels familiar and safe. Most providers who attend home births also perform prenatal care at the pregnant person’s home, making home visits over having the pregnant person come into an office or clinic. This relationship does allow for a unique bond between the provider and pregnant person.

What are the benefits of a homebirth?

• Greater control over the birth experience in a homebirth, particularly in consideration of time, freedom of movement, freedom to eat/drink
• Increased options in how they would like to deliver including waterbirth
• A feeling of safety of being in their own private space for childbirth, often times allowing for faster labors
• No limit on how many individuals can be in the birthing space, allowing for more family (and even kids!) to be involved in the delivery
• Lower rates of medical intervention including epidurals, episiotomies, and cesarean sections
• Reduced risk of hospital-acquired infections
• Reduced cost compared to hospital birth without medical insurance

What are the potential risks of a homebirth?

• Delay in access to emergency medical care in the event of a complication or emergency such as hemorrhage unremitting to an initial round of medication, cord prolapse, or an unresponsive newborn that requires neonatal resuscitation beyond what can be achieved at home
• Limited access to pain relief options in homebirth, including epidurals and other medical interventions
• A two-fold increase in perinatal death compared to hospital birth, although the absolute risk is still very low
• Most medical insurance does not cover the cost of homebirth and consider homebirth midwives out-of-network providers. Some insurances will reimburse the cost of prenatal and delivery care after the pregnant person has paid the provider up front, including some Medicaid plans.

Oula’s midwives currently do not attend births at home. To learn more about delivering at home in New York City, check out NY Homebirth.

Who is a good candidate for homebirth?

• It is imperative to note that not all pregnant people are good candidates for homebirth, though many are! While each provider’s evaluation criteria for what deems someone “low risk” enough to deliver safely at home can vary, a few common considerations include:
• A term pregnancy, between 37 to 42 weeks
• A single gestation pregnancy (in other words, not twins or triplets)
• A baby who is head down
• A placenta not covering the cervix at the time of labor
• No ongoing chronic medical conditions such as high blood pressure or diabetes managed with medication, clotting disorders
• No history of a previous C-birth

Hospital Birth: What to expect and how it works

In the United States, the default location for pregnant people to deliver will be in a hospital. Deliveries in a hospital will be attended by midwives and/or obstetricians. Read more about Midwife vs. OB-GYN: What’s The Difference? and But What Actually is a Midwife?. Most hospitals also have quick access to a nursing team, neonatal team and NICU (neonatal intensive care unit), pediatrics team, an anesthesia team, a surgical team and an operating room. Hospitals can offer a wide range of medical interventions including pain medication (epidurals), inductions of labor, and the ability to perform operative vaginal deliveries (OVD) and C-births. Read more about Types of Births: Differences & Benefits. While most pregnant people may not even consider an alternative option to a hospital birth, those that choose it intentionally often do so because of the reassurance of immediate access to emergency medical care and the availability of medical interventions to manage pain and complications.

What are the benefits of a hospital birth?

• Immediate access to emergency medical care at the hospital in the event of a complication or emergency, including need for cesarean section
• Immediate access to the neonatal intensive care unit
• Access to a wide range of medical interventions to manage pain and complications
• Lower risk of perinatal death compared to homebirth
• Less risk of secondary complications to an obstetrical emergency such as hemorrhage, cord prolapse, or shoulder dystocia

What are the risks of a hospital birth?

• Higher rates of medical intervention in a hospital setting, including epidurals, episiotomies, and cesarean sections
• Increased risk of hospital-acquired infections
• Increased cost compared to homebirth without medical insurance
• Restrictive hospital policies that may hinder a pregnant person’s feeling of autonomy including visitor policies, eating/drinking, movement, delivery positions

How to improve the hospital birth experience

The movement around reclaiming autonomy in labor and birth has been a growing force within the last few decades. It was in fact the impetus behind what started Oula; creating an evidence-based, personalized pregnancy experience that combined the best of the midwifery model of care with contemporary obstetrics. Delivering in a hospital can sound sterile and structured, but it is possible to bring the beautiful elements of homebirth into the delivery room. Read more about What does it mean to have a hospital birth at Oula?

How to decide between a homebirth or hospital birth

How do I decide what’s the right place for me to have a baby? When deciding whether to give birth at home or in a hospital, consider the following:

• What does having a “natural” and holistic birthing experience look like for you?
• Do you have any medical conditions or risk factors that make a hospital birth a safer option?
• How would you feel about not having immediate access to high-level emergency care incase of an emergency?
• How would you feel about having only one or two support people in the delivery room with you (this can include a doula)?
• What type of pain management would you like access to?
• Are you located near a hospital with a good reputation for obstetric care? Likewise, do you know a homebirth provider in your area that is properly trained and is currently attending deliveries?
• Do you have a supportive partner and family members who can help you during labor and delivery?
• How much is a homebirth vs. hospital birth? What does your insurance coverage look like for a delivery in a hospital? Does that change if you chose to get an epidural? Will your insurance cover/reimburse for a home birth?

Home birth vs. hospital birth: Which one is for you?

The decision of where to give birth, either at home or in the hospital, is a personal one that should be made after careful consideration of the risks and benefits of each option in the context of your unique pregnancy. Explore all of your options early into your pregnancy and ask lots of questions.