Is home birth safe?
According to the most recent and up-to-date research evidence, yes. On this page, I’ll share some of that with you. I also link to a number of articles and blog posts that I’ve written about home birth, and a book that I helped with.
But here’s a quick answer to the question of whether home birth is safe.
In 2019, a large systematic review and meta-analysis was published in The Lancet.
It looked at 14 studies including data from around 500,000 intended home births.
The authors found that, “The risk of perinatal or neonatal mortality was not different when birth was intended at home or in hospital.” (Hutton et al 2019).
So yes, home birth is safe.
And this is just one of many studies that show the same thing. The Hutton et al (2019) study was remarkable because of its size. But, as the studies on this page show, it’s not a unique finding.
Diving into the detail
If you’re the kind of person that likes the detail, here are the results of the Hutton et al (2019) study:
“Among nulliparous women intending a home birth in settings where midwives attending home birth are well-integrated in health services, the odds ratio (OR) of perinatal or neonatal mortality compared to those intending hospital birth was 1.07 (95% Confidence Interval [CI], 0.70 to 1.65); and in less integrated settings 3.17 (95% CI, 0.73 to 13.76). Among multiparous women intending a home birth in well-integrated settings, the estimated OR compared to those intending a hospital birth was 1.08 (95% CI, 0.84 to 1.38); and in less integrated settings was 1.58 (95% CI, 0.50 to 5.03).” (Hutton et al 2019).
This paper has also been discussed by Henci Goer and you can read her analysis here.
Just the latest review
The findings of Hutton et al (2019) also confirmed those of the meta-analysis conducted the previous year by Scarf et al (2018).
This systematic review and meta-analysis further confirmed the safety of home birth for healthy women, even if they are having their first baby.
After comparing data from births planned at home birth, in birth centres and in hospital, researchers found that high-quality studies found no statistically significant difference in infant mortality between the different settings, although women giving birth at home or in birth centres were more likely to have a normal vaginal birth.
In fact, women who planned a home birth were nearly three times more likely to have a normal (that is, non-instrumental) vaginal birth than women planning a hospital birth.”
The Scarf et al (2018) review was an important one because, as the authors explain in the background to their paper, there have been many debates on the subject of home birth and there exist methodological challenges which have to be taken into account.
Some of the so-called evidence that is cited on this topic is not of good quality. The review authors include some world experts on this topic, and in order to produce high-quality research they “reviewed original research from high-income countries (World Bank, 2016) using a birthplace-specific quality appraisal instrument (Vedam et al 2017a), and undertook meta-analysis of outcome data where possible.” (Scarf et al 2018).
In their summary of the findings and conclusions, the researchers noted that, “Meta-analysis indicated that women planning hospital births had statistically significantly lower odds of normal vaginal birth than in other planned settings. Women experienced severe perineal trauma or haemorrhage at a lower rate in planned home births than in obstetric units. There were no statistically significant differences in infant mortality by planned place of birth, although most studies had limited statistical power to detect differences for rare outcomes. Differences in location, context, quality and design of identified studies render results subject to variation. High-quality evidence about low-risk pregnancies indicates that place of birth had no statistically significant impact on infant mortality. The lower odds of maternal morbidity and obstetric intervention support the expansion of birth centre and home birth options for women with low-risk pregnancies.” (Scarf et al 2018).
Ongoing evidence of safety
Again, these findings aren’t new. We have long known that home birth is safe, and evidence for this comes from all over the world. I have a list of individual studies from different countries at the bottom of this blog post.
And a related question – is hospital birth safe – is also important.
What if there’s an emergency?
What happens in a home birth emergency?
Qualified midwives carry a car boot (trunk) full of equipment, and have all the skills, training and knowledge to deal with emergencies at a home birth. In many situations, there’s very little that would be done in a hospital setting that midwives (and our paramedic colleagues) can’t do at home or in the back of an ambulance on the way to hospital.
Anyone who has had or seen an ’emergency’ caesarean will know that the vast majority of these are not actually dire emergencies, needing to be carried out within minutes. Women who opt for hospital birth often find that half an hour (and sometimes longer) passes between when they are offered an emergency caesarean and when the surgery actually starts. In a home birth situation, midwives have alerted the hospital staff to our arrival, and we and paramedics are doing the same kinds of things in an ambulance that would be being done in the hospital ward.
This is illustrated by the findings of a Dutch project which researched home birth emergencies. They looked at what happened when women had excessive bleeding after birth (postpartum hamorrhage, or PPH), and the results are very reassuring.
One important caveat here is that these women in this study had trained midwives.
When women had a PPH at home, the midwives gave drugs and used their technical skills and knowledge to stop the bleeding while also arranging transfer to hospital.
Importantly, although half of the women had blood transfusions and two underwent further procedures to stop their bleeding, all of the women fully recovered.
Furthermore, even when there was a slight delay in getting women to the hospital in the 45 minutes that is seen as optimal, the outcomes weren’t any worse than if the women had been in hospital in the first place.
Turning it around: the harms of hospital
“A 2023 summary of the best available research published in the internationally recognized Cochrane Library shows that planned hospital births can do more harm than good. This applies if the pregnant woman is healthy, expects an uncomplicated birth, and the birth takes place in a well-organized health care system.” (Olsen and Clausen 2023).
It highlights that, while there is a lack of evidence from randomised controlled trials, “Evidence from observational studies suggests that planned hospital birth does not reduce mortality but may lead to more interventions, more complications, and more neonatal problems.” (Olsen & Clausen 2023).
The World Health Organization (WHO) has raised concern that the increasing medicalisation of childbirth tends to undermine women’s own capability to give birth and negatively impacts their childbirth experience. (Olsen & Clausen 2023).
You can read the Cochrance review which highlights the lack of RCT evidence and the need for a different approach at Planned hospital birth compared with planned home birth for pregnant women at low risk of complications.
Other benefits of homebirth
Many studies also confirm other benefits of homebirth.
For example, a study which looked at the experiences of more than 28,000 women in the UK and Ireland showed a significant association between home birth and breastfeeding (Quigley et al 2016).
And, when researchers asked fathers about their experiences of home birth, they described it as magical. Although several of the men had initially had reservations about home birth, they found the experience to be very positive one which gave them a new perspective on life.
For the fathers in this study, ‘the decision to have a home birth was prompted by a search for an alternative birth experience following a previous hospital birth’. But they ‘required convincing that home birth was safe and as Henry went on to say: ‘it’s only when you do research and look into it you see what the truth is.’ (Sweeney and O’Connell 2015).
As with many qualitative research studies, the data are rich, and I would encourage dads-to-be to read this paper.
‘The language the men used to describe the birth indicated how much the birth meant to them. Mark described it as: ‘Magical, magical to see life happening, to see a baby growing in your partner, coming to life, been born. . . is just, it’s mind blowing, it just puts back the magic into life.’ (174–175) Henry saw the beauty of the event: ‘There’s a beauty in life, the force of life, is amazing’. (283–284) For Barry it was: ‘that sense of awe and wonderment. ‘We’ve helped bring this child into the world together and it was just a very moving moment. . ..’ (217–218) Mike was so elated that he felt that ‘I could have jumped over the house. I was delighted at everything, feeling the cord pulsating and letting it stop before it was cut and stuff like that . . ..’ (124–127)
This joy at sharing in the birth of their child was a unique and meaningful experience for the fathers; they shared the experience of their partner and were conscious that they had contributed to the wonderment of their baby’s arrival into this world.’
A more positive experience
Home birth is also known to be experienced positively by women.
For example, a recent study in Ireland which collated the experiences of 141 participants who birthed both in hospital and at home between 2011 and 2021 found that, “Participants’ overall experience scores were significantly higher for homebirth (9.7/10) than hospital birth (5.5/10).”
“Homebirth was perceived far more positively than hospital birth experiences across all aspects of care surveyed.”
The authors concluded that, “This study provides evidence regarding the need for genuine choices for maternity care and reveals the importance of care which is respectful and responsive to divergent ideologies about birth.” (Gregory et al 2023).
In 2026, an Australian study found that, while the women who experienced homebirth evaluated this very positively, those who wanted homebirth but weren’t able to have this are incredibly frustrated at the risk management which means that it isn’t an option for everyone.
“Women described the publicly funded homebirth program as relying on respect, integrity, trust, and empowerment. Women want publicly funded homebirth to be more widely publicised and made available to more women with greater flexible inclusion criteria.” (Sweet et al 2026).
Emotional safety
Safety isn’t just a physical thing. We are becoming increasingly aware that emotional safety is important too. This links with topics such as birth trauma, and women’s satisfaction, which I discuss further below.
A good example of the evidence of the emotional safety that some women experience with homebirth can be seen in a 2026 study.
“The homebirth group perceived childbirth as less traumatic. The feeling of safety during birth was significantly higher in the homebirth group than in the hospital birth group.”
Who opts for home birth, and why?
There’s another important consideration nowadays.
In 2018, Nygaard & Kesmodel discussed why home births are gaining in popularity in some countries, looked at the evidence of safety (and why this is so hard to gather, given the current focus on over-valuing evidence from randomised controlled trials) and how professional background influences the debate.
The authors acknowledge that it isn’t just about place:
“Some studies point toward the comfort of having a known midwife present during the entire course of birth, of giving birth in a “homely” environment, and having more control and decision‐making power throughout the process as important to many women. The positive effect of continuous care has previously been well established in the scientific literature, showing that women who had continuous support during childbirth were more likely to have a spontaneous vaginal birth and shorter labour, and less likely to have intrapartum analgesia, cesarean section and instrumental vaginal birth.” (Nygaard & Kesmodel 2018).
Sadly, home birth is often not easily available in mainstream and publicly-funded health care systems. Or, if it is available, it is only on offer for those who fit into an increasingly narrow box labelled ‘low risk’.
“In a publicly financed health care system it should not be necessary for women to purchase private support in order to have a positive birth experience. If the choice of place of birth is legally up to the woman, the health care system should have the resources to accommodate this wish.” (Nygaard & Kesmodel 2018).
Things have been changing…
As a home birth midwife, I saw the profile of home birthing families change from when I began to when I retired. These days, those supporting home birth see more women whose pregnancies are not straightforward than I did in the early days of my career. Some of these women have problems or risk factors, and yet the women themselves are concerned that they will not be safe within the system.
‘Safety’ is a complex and multifaceted concept. It is not just about physicality and mortality rates; it is also related to how a person or place makes us feel. (Nadine Edwards wrote a great book on this.)
Women want care which is individualised and based on evidence, but are instead quoted policies and pathways.
Women want to know that their caregivers understand their concerns, but often feel that they are dismissed or accused of ‘caring more about themselves than their babies’.
This is untrue and unfair, particularly in the light of the potentially damaging consequences of obstetric intervention on babies.
Women who I have cared for have often been told that it is the hospital’s way or the highway and it is then not surprising that some of them come to see home birth as the only way in which they can retain any control over their decision-making and the integrity of their and their baby’s body.
Generally, these women make the decision that is right for them and their baby in full awareness of the risks and benefits that characterise each option.
Home birth and risk
So home birth isn’t just for those who manage to stay in the ‘low risk’ box.
In fact, the idea that so-called ‘high risk’ women are better off in hospital needs questioning, because this isn’t as cut-and-dried as some people think.
In the UK, the Birthplace team analysed the outcomes of women who were deemed to be at higher risk. In their data set, this was around 7% of the women who planned home birth, 4% of those who planned birth in an alongside midwifery unit (AMU), and 3% of the women who planned to give birth in a freestanding midwifery unit (FMU).
“In ‘higher risk’ women, compared with planned OU birth, planned home birth was associated with a significantly reduced risk of ‘intrapartum related mortality and morbidity’ or neonatal admission within 48 hours for more than 48 hours. The difference reflected a higher neonatal admission rate in planned OU births.” (Li et al 2015)
The women in this group also had a greater chance of having a straightforward vaginal birth without interventions:
“Compared with planned OU birth, planned home birth was associated with a significantly lower risk of intrapartum interventions and adverse maternal outcomes requiring obstetric care in both nulliparous and parous ‘higher risk’ women and a significantly higher probability of straightforward vaginal birth in both nulliparous and parous ‘higher risk’ women” (6). (Li et al 2015).
A bit more on risk
Risk can be a bit of a slippery concept, of course.
Not everyone agrees on what it means, or on what feels risky to them.
In 2005, a friend and colleague of mine, Nadine Edwards, published a book sharing the experiences of women planning home births.
One of the key things Nadine showed in her research was that the women she interviewed had very different ideas about what constituted risk and safety than the people who see hospital birth as safest and best.
This is still the case. A 2025 systematic review which looked at what safety and risk mean to women who birth at home also showed that risk means different things to different women and families.
What is risky, anyway?
Another element of this is that, as Li et al (2015) point out, although we know that there are a few situations in which women deemed to be ‘at risk’ by the maternity services may genuinely be better off in hospital (which still does not mean they have to go there, of course, and individual situations will vary), many of the conditions and situations that women are told are risky are in fact not well-researched.
Sometimes, the idea that they are ‘at risk’ is based more on opinion than research evidence. This is one reason why we really need researchers to analyse this area.
It is important to know that women who were deemed to be at higher risk and who planned a home birth in the Birthplace study did have a significantly higher risk of an adverse perinatal outcome than women who were at low risk and who planned a home birth, but it would appear from these results that the ‘higher risk’ women who planned home births had better outcomes compared with those who planned hospital birth.
It is uncertain, however, whether the increase in neonatal admissions reflects an actual difference in morbidity or is due to some other reason, for example perhaps health care providers are more likely to recommend transferring babies to a neonatal unit ‘just in case’. Women and midwives have long been concerned that intervention is more likely in hospital and that this often occurs when it is not really warranted, and this may be reflective of that.
I have looked in depth at the so-called risks faced by larger women in my book, Plus Size Pregnancy: what the evidence really says about higher BMI and birth.
Twin home birth
In 2024, researchers published the outcomes of a series of twin home births in the care of one practitioner.
“The vaginal birth rate was 91.3% (n = 63): 77.3% for primips and functional primips (no previous vaginal births) and 97.9% for multips. Six mothers (8.7%) had in-labor cesareans (1 multip and 5 primips). Rates of vaginal birth did not vary significantly by chorionicity. There were 8 transports in labor (11.6%): 2 vaginal and 6 cesareans. Average gestational age was 39.0 weeks (range 35–42). Compared to primiparas, multiparas had less perineal trauma and higher rates of vaginal birth and spontaneous vaginal birth. One twin infant and one mother required postpartum hospital transport. Of the babies born in a community setting, there was no serious morbidity requiring hospital treatment.”
The research keeps coming
Many individual studies from around the world have also evidenced the safety of home birth.
Here are a few examples:
USA
Researchers analysed two “…large (n = 50,043; n = 62,984), national community birth registries to compare maternal and neonatal outcomes for planned home versus planned birth center births” (Bobvjerg et al 2024). They note that this is the largest study to examine how the settings compared to each other in terms of health outcomes.
Combined, the two registries documented more than 110,000 births from 2012 to 2019, representing all 50 U.S. states, and the data showed no safety difference between home birth and birth center birth.
“Individuals who planned home births had a lower incidence of all types of transfers, compared with those who planned birth center births, but in one dataset only, experienced more cesareans [adjusted odds ratio (95% CI): 1.32 (1.02–1.70); 0.95 (0.88–1.03)].
Planned home birth was associated with lower adjusted odds of maternal hospitalization in one dataset but not the other [0.97 (0.54–1.74); 0.85 (0.76–0.95)], and was not associated with hemorrhage.
Neonatal outcomes likewise were either not associated with a planned birthplace or suggested home birth was safer: hospitalization [0.77 (0.53–1.11), 0.90 (0.82–0.98)], neonatal intensive care unit admission [0.54 (0.28–1.00), 0.97 (0.86–1.10)].
There was no observable association with intrapartum or neonatal death: 1.07 (0.68–1.67; only calculated once because of small numbers of events).” (Bobvjerg et al 2024).
The authors concluded that, “Planned home births are as safe as planned birth center births for low-risk pregnancies. Current guidelines advising against planned home births are not supported by these data.” (Bobvjerg et al 2024).
Australia
In 2025, a retrospective comparative cohort study looked at the outcomes of 100 Australian women who gave birth at home during the study period.
“They were more likely to have a physiological birth (p < 0.001), intact perineum (p < 0.0001), and less likely to have a postpartum haemorrhage (p < 0.0001) compared to the matched cohort of women who birthed in hospital.
There were less assisted births and caesarean section births for women who transferred from home to hospital (p < 0.0001).
No statistical differences were seen between groups for postpartum haemorrhage, and Apgar score of < 7 at 5 minutes.”
“This study demonstrated favourable outcomes for women receiving MGP who planned to birth at home compared to those women who chose a hospital birth.
This is consistent with the existing literature that place of birth makes a difference.” (Sidery et al 2025).
Spain
A 2024 study looked at maternal and neonatal outcomes in midwife-attended planned home births versus planned hospital births in Spain.
Researchers analysed data from 3,463 low-risk births between 2016 and 2018, including 2,713 hospital and 750 home births.
They found several differences between the groups, which is often the case in this type of study.
“Women choosing home births typically had higher education levels and were predominantly Spanish. They were 3.43 times more likely to have a spontaneous birth and significantly less likely to undergo instrumental births than those in hospitals.
“Home births were associated with higher utilization of non-pharmacological analgesia and a more pronounced tendency to initiate breastfeeding within the first hour post birth. stronger inclination towards breastfeeding.
“Hospital births, conversely, showed higher use of the lithotomy position and epidural analgesia.” (Alcaraz-Vidal et al 2024).
Importantly, “There were no significant differences in neonatal outcomes between the two groups.” (Alcaraz-Vidal et al 2024).
The researchers conclude that:
“Home births managed by midwives offered better obstetric and neonatal outcomes for low-risk women than hospital births. These results suggest home birth as a safe, viable option that promotes natural birthing processes and reduces medical interventions. The study supports the integration of midwife-led home birth into public health policies, affirming its benefits for maternal and neonatal health.” (Alcaraz-Vidal et al 2024).
Finland
In Finland, researchers were concerned that, “compared to in-hospital births, the long-term outcome of children born out-of-hospital, planned or unplanned, is poorly studied.”
Researchers often use hospital birth as the standard by which the safety of home birth is measured. This is curious, because hospital birth is a relatively new intervention and it was introduced without evidence of safety compared to home birth. But that’s another post.
So they looked at the outcomes of 790,136 children born in Finland between 1996 and 2013. These included planned and unplanned out-of-hospital births. Usually, it’s better to separate the two as there can be quite a difference in outcomes.
The fact that planned AND unplanned out-of-hospital births were included make the results even more interesting.
They actually found that, although on the whole there is no difference in children’s health at the age of seven, “morbidity (illness) related to asthma or allergic diseases and infections by seven years of age appeared to be lower in children born out-of-hospital.”
The paper is by Ovaskainen et al (2021) and it is freely available online.
Spain
In 2021, researchers published a descriptive study of planned homebirth in Catalonia (Spain).
“In Spain, official records show that 0.63% of births take place at home, but these records do not state the proportion of planned and unplanned home births. For this reason, official records do not enable the analysis of maternal and neonatal outcomes according to the place of birth; thus, the rate of adverse advents with respect to planned place of birth remains to be determined.”
“Catalonia is the region with the largest number of home births, and thanks to the data collected by CAHBM midwives, we know that most home births in Catalonia were planned.”
“The rates of maternal and neonatal morbidity show a high degree of safety during birthing and reflect the work of independent midwives in Catalonia. The variety of positions during the birth and the low percentages of high-grade perineal tears and episiotomies, as well as the high percentage of women who used water during birth and of babies who started feeding within an hour of birth, demonstrate that the care provided by the midwives in these planned home births in Catalonia is based on the scientific evidence and on a respect for physiology.”
The full study can be read here.
Norway
In 2020, a Norwegian study by Skrondal et al (2020) which is freely available here provided more evidence of homebirth safety.
“Planned home birth may be experienced as a very positive occurrence for nulliparous women, and the care those women in this study received contained several elements that can help to promote normal labour and birth at a time in which reducing interventions in maternity care is of importance. Their positive birth experiences gave the women confidence both in their transition to motherhood as well as in other aspects of life.” (Skrondal et al 2020).
New Zealand
Data from the New Zealand College of Midwives Clinical Outcomes Research database (NZCOMCORD) also added further weight to the evidence showing home and primary unit settings to be a safe option for birthing women and their babies (Dixon et al 2014).
Researchers analysed retrospective data from 61,072 women who were considered ‘low risk’. Eight per cent of them planned a home birth and 16.6% planned to give birth in a primary unit. As was also found in the Birthplace study in the UK (see below), those women who planned to give birth at home were more likely to be older and multiparous. But the transfer rates were considerably lower than in the UK Birthplace research. This may be due to differences in the cultures and systems of care.
Importantly, there was no significant different in perinatal mortality rates, and babies who were born at home fared better in terms of Apgar scores than babies born in secondary or tertiary hospitals.
The Netherlands
One older but important study is de Jonge et al’s (2013) study, Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study.
The authors of this research looked at the experiences of 146,752 low-risk women, of whom 92,333 (62.9%) had a planned home birth and 54,419 (37.1%) had a planned hospital birth. Upon analysing the outcomes, they discovered that, although the absolute risks were small in both groups, low risk women who planned home birth had lower rates of severe acute maternal morbidity, postpartum haemorrhage, and manual removal of placenta than those with planned hospital birth. These differences were statistically significant for women who had had given birth before.
The take-home message, although worded in the negative as is often the case with such studies, is that: There was no evidence that planned home birth among low risk women leads to an increased risk of severe adverse maternal outcomes in a maternity care system with well trained midwives and a good referral and transportation system (de Jonge et al 2013).
More recently, researchers in The Netherlands, “explored the relationship between home birth rates and increasing rates of postpartum haemorrhage (PPH) and manual removal of the placenta (MROP). Data were used from the Dutch national perinatal registry (2000–2014) of women in midwife-led care. Adjusting for place of birth flattened the increasing trends of PPH and MROP. By adjusting for place of birth, the rising trend of MROP among multiparous women disappeared. This suggests that if home birth rates had not declined, PPH and MROP rates might not have increased as much. This study supports policies of enabling women to choose home births.” “
Australia
Another useful study is Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years.
This comprises the first national evaluation of 97% of the women who chose publicly funded homebirth between 2005 and 2010. While 97% is a significant proportion of the available sample, however, the rarity of poor outcomes means that the sample size isn’t big enough to be conclusive about safety. What the evaluation shows is that 84% of the women who planned to give birth at home actually did so, and 90% of the women (which will include a few of those who transferred to hospital) had a normal vaginal birth.
Other positive outcomes included that intervention rates among these women were low. Women choosing homebirth had low rates of postpartum haemorrhage (which is particularly significant given that around three quarters of the women had physiological placental births) and third degree perineal tears and stillbirth and early neonatal death rates were also low. In other good news, 69% of the women were breastfeeding at 6 weeks postpartum. Transfer rates were high though and, although this is consistent with some other studies, it warrants further exploration.
In a related editorial, Professor Marc Kierse addresses those who may question the need for publicly funded homebirth programs, especially as only around half a per cent of Australian women currently choose homebirth, noting that, “It is a woman’s prerogative and her fundamental human right to determine her reproductive behaviour, and this includes how and where to give birth.” (Kierse 2013: 575).
Women’s experiences of planning home birth
I have had the privilege of working with Nadine Edwards for many years now, and Nadine’s PhD research turned into a book: Birthing Autonomy: Women’s Experiences of Planning Home Births: Women’s Experiences of Home Births.
Nadine undertook research in which she talked to thirty Scottish women about their experiences of planning a home birth and her book explores the themes that arose within these woman’s stories alongside some of the key issues, debates and tensions that exist in relation to modern maternity care.
I am especially fond of citing her work on how the women she talked to perceived notions such as risk and safety, which explores these concepts into a very different light from the way they are viewed by many birth attendants in the modern culture of the maternity services.
In fact, I wish that everybody involved in maternity care was made to read this book before they were allowed to practice, because in its entirety it provides one of the most compelling arguments for listening to women and ensuring that their care is woman-centred that I have ever read.
What do women want?
In 2023, a systematic review of women’s experiences of planning home birth in consultation with maternity care providers in middle to high-income countries (Gillen et al 2023) also highlighted a number of key issues in this area, including that:
- All women need accessible evidence-based information about planned home birth;
- Women need to feel supported in their plans for home birth;
- Women value the care of midwives when planning home birth;
- Fully resourced home birth services should be a prioritised service. (Gillen et al 2023)
This is an important topic. We know that there is a significant discrepancy between what women want/are asking for, and the services they are told they can access.
This is particularly the case when it comes to midwifery care, out-of-hospital settings, and interventions that are low-tech, physiology-focused, and requested by the women themselves, such as water immersion.
We know that some women’s desire to birth at home is rooted in previous poor experiences, and these researchers also found that, “Women’s prior traumatic experience of hospital birth and a preference for physiological birth motivated their assertive decision to have a planned home birth despite criticisms and stigmatisation from their social circle and some maternity care providers.”
The study also showed that, “Midwives’ competence and support enhanced women’s confidence and positive experiences of planning a home birth.”
What about freebirth?
Several studies also look at how, when home birth isn’t made available by the maternity services, some women will decide to freebirth instead. This highlights how important it is that homebirth is offered. It’s important to know that the studies cited on this page showing that homebirth is safe are looking at planned home births attended by midwives.
But I know that people are also interested in freebirth, so here are some recent papers.
An Australian study is beautifully described by its title. Birthing outside the system: the motivation behind the choice to freebirth or have a homebirth with risk factors in Australia (Jackson et al 2020, also freely available).
“The core category was ‘wanting the best and safest,’ which describes what motivated the women to birth outside the system. The basic social process, which explains the journey women took as they pursued the best and safest, was ‘finding a better way’. Women who gave birth outside the system in Australia had the countercultural belief that their knowledge about what was best and safest had greater authority than the socially accepted experts in maternity care. The women did not believe the rhetoric about the safety of hospitals and considered a biomedical approach towards birth to be the riskier birth option compared to giving birth outside the system. Previous birth experiences taught the women that hospital care was emotionally unsafe and that there was a possibility of further trauma if they returned to hospital. Giving birth outside the system presented the women with what they believed to be the opportunity to experience the best and safest circumstances for themselves and their babies.” (Jackson et al 2020)
Another Australian survey of why women choose homebirth showed that, “if a midwife was not available, half of the respondents indicated they would give birth without a registered midwife (freebirth) or find an unregistered birthworker.” (Sassine et al 2020). Unfortunately, this paper isn’t freely available, but you can see the abstract here.
We also have a freebirth information hub:
Homebirth and cost
There are lots of reasons to opt for a home birth. We know from research studies that home birth is both safe and satisfying, that it leads to fewer interventions, a higher chance of breastfeeding success, and helps to make confident parents.
A 2021 study from the USA also showed that it is also far more cost effective than hospital birth.
Anderson and Gilkison (2021) set out to estimate the cost of home birth in the USA and found that: “On the basis of a nationwide study, we estimate that the average cost of a home birth in the United States is USD 4650, which is significantly below existing cost estimates for an uncomplicated birth center or hospital birth.” “Further, we find that each shift of one percent of births from hospitals to homes would represent an annual cost savings to society of at least USD 321 million.”
No, it’s not just about money.
But it makes you think.
How to find out more
I helped a colleague with putting the evidence on safety together for a book. Homebirth: Safe & Sacred.
It was written by American homebirth midwife Kim Osterholzer. The book’s aim is to get information out to those who have questions in an affordable, readable format. It is written for a US audience, so some of the information about midwifery care is US-specific. But the stories and the evidence transcend national borders. You can find out more about the book here.
Articles
This site also contains other articles that might interest you if you’re looking for information on home birth.
If you’d like to know more about your options, or explore tools for decision making, I can help!
My book What’s Right For Me? has been written to help women and families make the decisions that are right for them.
About the Author: Dr Sara Wickham is an author, speaker, and researcher specialising in pregnancy, birth and maternity care. Her work focuses on evidence-based, woman-centred information and informed decision-making, drawing on more than 30 years of midwifery knowledge and experience.
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