May 23, 2011 | 2:02 PM |

Why Home Births Are Becoming More Popular

FILED UNDER: Medicine/Science, Personal Health, childbirth

Holland has a robust tradition of home births, according to Agence France-Press. Maarten Rammeloo (depicted above) was born at home in 2007, along with a third of Dutch infants.

In the birthing world, it was big news: After a 15-year decline, home births in the U.S. rose 20 percent between 2004-2008. Though the actual numbers remain tiny — out of about 4 million births, 28,357 happened at home in 2008 — the reversal of the long downward trend is notable. So are the demographics: much of the increase was driven by highly educated white women. A full 1 percent of them decided to forgo the hospital and give birth at home, according to the new report published Friday in the journal Birth: Issues in Perinatal Care.

Boston University School of Public Health Professor Eugene Declercq, an authority on childbirth trends and one of the study authors, says he was struck by some media portrayals of these home-birthers. “They made it seem like it was these crazed, crunchy granola women,” Declercq said. “Do they even still exist?”

A widely reprinted AP story, for instance, quotes the study’s lead author, Marian MacDorman of the CDC’s National Center for Health Statistics, saying: “I think there’s more of a natural birth subculture going on with white women.”

Declercq says this “natural” subculture-y characterization misses the point. The women who gave birth at home, researchers found, were mostly white, married and in excellent prenatal health. They were, in the language of labor and delivery, low-risk. Many had a post-graduate degree. And a lot of them had already given birth to one or more children, likely at a hospital. Declercq said that while this study was conducted by analyzing birth records, not through interviews, a previous study found that the top three reasons women gave for choosing home birth were:

1. Safety.
2. Avoidance of unnecessary medical interventions common in hospital births.
3. Previous negative hospital experience.

So, it’s fair to guess that at least some of the healthy, degree-wielding, not-so-crunchy women in the recent analysis chose home birth to avoid the “cascade of interventions” — including labor-inducing drugs and surgery — they’d endured previously at the hospital.

Tina Cassidy is the modern home-birther.

A Boston journalist, Tina had a C-section in 2004 that she believes was unnecessary. She subsequently investigated alternative methods, the history of birthing trends and how other cultures and government handled childbirth. (All this research ended up in her book, Birth: The Surprising History of How We Are Born. Her next book is about Jackie Onassis, who, according to Tina, had four C-sections.) In 2008, determined to avoid another intervention-laden, surgical delivery in the hospital, Tina gave birth to her second son at home, in the bathtub.

“I was more comfortable, and felt safer there, than in a hospital,” she said. “The research shows home births are safer for low-risk women but doctors can’t seem to get that through their thick heads.”

Indeed, a number of studies show home birth is about as safe for low-risk women as hospital birth. For this reason, and others, home births are rising in places like England and New Zealand. In the Netherlands, the rates are already high: around 24%. But in the U.S. in particular, home birth remains controversial, mostly because the influential American College of Obstetricians and Gynecologists regularly pronounces its opposition to the practice.

Interestingly, the new study notes that the increase in home births in the U.S coincides with mounting ACOG opposition:

In 2007, the American College of Obstetricians and Gynecologists (ACOG), citing concerns about the safety of home births for mothers and infants, issued a policy statement opposing home birth, a statement supported by a resolution passed at the 2008 American Medical Association (AMA) annual meeting. A recent update to the ACOG statement also appears to discourage home birth. These attitudes may also be reflected in the very low proportion of planned home births attended by physicians. In contrast, the World Health Organization, the American College of Nurse-Midwives, the American Public Health Association, and the National Perinatal Association all support home and out-of-hospital birth options for low-risk women.

And while planned home births tend to be far cheaper than hospital births (some estimates put home births at about one-third the price) cost remains a barrier to increased use, experts say. That’s because many insurers don’t cover home births and every state and insurance company sets different rules. But that may change. Vermont, one of the top home-birth states, recently pased a law requiring private insurers to cover home births attended by a midwife. New York, New Hampshire, and New Mexico have similar laws, according to The Big Push For Midwives, a national organization promoting greater access to midwifery services and more widespread insurance coverage. (In addition to Vermont, Montana and Oregon had the most home births, according to the new study — about 1 in 50 — and Alaska was nearly that high.)

Tina says her midwife told her not to expect Blue Cross Blue Shield of Massachusetts to cover that 2008 home birth. But she submitted the paperwork anyway, and, lo, the insurer paid.

Readers: Tell us your home birth stories! Did a less than satisfying hospital experience drive your decisions? Or was it for some other reason?

About the author

Blogger, CommonHealth Rachel Zimmerman worked as a staff reporter for The Wall Street Journal for 10 years, most recently covering health and medicine out of the paper’s Boston bureau. Rachel has also written for The New York Times, the (now-defunct) Seattle Post-Intelligencer and the alternative newspaper Willamette Week, in Portland, Ore., among other publications. Rachel co-wrote a book about birth, published by Bantam/Random House, and spent 2008 as a Knight Science Journalism Fellow at MIT. Rachel lives in Cambridge with her husband and two daughters. View all posts by Rachel Zimmerman →

  • Quarked

    I am a 34 year old, white woman who holds a BS in Physics and a Masters degree. I currently have a 6-year old son who was born at home and have planned a second home birth for our next son, who is due in a month. After much research and discussion with my husband (who also holds a Masters in Physics and works as an engineer at a Fortune 500 company), we decided to have the original home birth. It was such an amazing experience for us, we are going to do it again. I have been attending births for the last four years, at home, in birthing centers and in hospitals and seeing what goes on in these places has just made me stronger in our decision to be at home.

    I also want to say that we only interviewed midwives in our area that were licensed (and currently maintaining their licenses) and who had attended a 3-year midwifery training program that included a hefty apprenticeship in homebirth. We did not even consider using a midwife who was unlicensed or improperly trained, nor did we consider using a naturopathic (ND) midwife who took only elective classes in midwifery, nor a nurse midwife who took only a small series of courses.Safety is a huge issue for us, the biggest thing being that we didn’t want our child and his brand new immune system being born in a hospital…which is where SICK people go for care. We wanted the least amount of exposure to antibiotic resistant viral strains as well as basic things like the flu and various bacteria that are found there. It’s well know that doctors lab coats, wedding rings and other articles are covered in germs that require a very healthy immune system to deal with. Why expose our baby to any of that when we don’t have to?Having a birth at home also means that we have one midwife plus her assistants/apprentice who will be watching me the entire time I am in labor. There is no shift change that could result in faulty documentation between nurses/staff. The midwife is paying total attention to me, watching the pattern of my labor process over time and using her technical skills, experience and intuition to monitor whether or not there is any reason that it is worth transferring to the hospital (meaning that the germ exposure outweighs any other problem she may see).The cost of a home birth is SO much lower than the bills that other family members have brought home from the hospital AND it includes all my prenatal checkups, labor and delivery as well as 6-8 weeks of postpartum care for myself and checkups for my baby that are done at home. I don’t have to take my newborn, with his compromised immune system, and transfer him to a hospital or have him around people with the common cold or other things that could be dangerous for him. Instead, I get to keep him in the comfort of our warm home and the midwife comes to us.I had cervical dysplasia with a cryotreatment when I was 16 (scarring my cervix) which prompted the OB/GYN that I saw to recommend an elective C-section for me. My midwife manually dilated my cervix at home, which was painful, but offered me the chance to have a natural birth, which is what I wanted. I labored for over 40 hours at home because my cervix took so long to dilate. I don’t believe I ever would have been allowed to do that at a hospital.I got to labor in a birthing tub in the middle of my dining room where things were safe and quiet. There were no strangers in my home, only my husband, best friend and midwives. I knew the layout of my home and felt absolutely comfortable there. I stocked up on healthy, fresh, organic snacks for myself during and after the birth, rather than having to eat preservative-filled hospital foods. I was not offered an epidural or C-section at home and didn’t have to have someone fighting and advocating against doctors about it because everyone in my home was my advocate and sincerely wanted me to get the natural birth that I desired.After my son was born in the water, I was transferred to my bed where we waited for the cord to stop pulsing before cutting it….almost 15-20 minutes, making sure that my son’s lungs got all of the blood that had been reserved for them in the placenta, thus reducing his chances of asthma or breathing related issues later in life. MY SON WAS NEVER TAKEN AWAY FROM ME AT ANY TIME. That was so important to me. Even when they weighed him, they put the little scale next to me on the bed and we still had skin to skin contact. My son was allowed to nurse immediately and there was never any worry he would be offered formula. The midwives took a lot of time teaching me how to nurse properly as well, getting him to latch on, etc…and I didn’t have to call for a special lactation consultant or coach on top of everything else. 

    We got to sleep in our own bed with our son the very night that he was born. Unlike being in the hospital, nobody continually woke us up through the night or day…we were allowed to sleep, wake, eat, use the bathroom and just BE as we chose. Again, there were no strangers in my home. People brought dinners to us and left them on the porch, except for a few who came in quietly to do dishes. 

    I feel like my first birth experience was the safest thing I could have offered to both my son and myself, it helped my husband and I become even more connected and I felt completely empowered by my experience.