A home birth is a birth that takes place in a residence rather than in a hospital or a birthing center. They may be attended by a midwife, or lay attendant with experience in managing home births. Home birth was, until the advent of modern medicine, the standard method of delivery in the vast majority of births. The term was coined in the middle of the 19th century as births began to take place in hospitals.
Multiple studies have been performed concerning the safety of home births for both the child and the mother. Standard practices, licensing requirements and access to emergency hospital care differ between regions making it difficult to compare studies across national borders. A 2014 US survey of medical studies found that perinatal mortality rates were triple that of hospital births, and a US nationwide study of over 13 million births on a 3-year span (2007–2010) found that births at home were roughly 10 times as likely to be stillborn (14 times in first-born babies) and almost four times as likely to have neonatal seizures or serious neurological dysfunction when compared to babies born in hospitals. Alternatively, there is research coming out that suggests that there is actually no significant difference in perinatal mortality rates between home and hospital birth and some even suggest that there are benefits such as less complications and fewer interventions. Higher maternal and infant mortality rates are associated with the inability to offer timely assistance to mothers with emergency procedures in case of complications during labour, as well as with widely varying licensing and training standards for birth attendants between different states and countries.
thumb|A young woman giving birth in bed at home.
Etymology
The word combination "home birth" arose some time in the middle of the 19th century and coincided with the rise of births that took place in lying-in hospitals. Since women around the world left homes to give birth in clinics and hospitals as the 20th century progressed, the term "home birth" came to refer to giving birth, intentionally or otherwise, in a residence as opposed to a hospital.
History and philosophy
Although the fact humans give birth is universal, the social nature of birth is not. Where, with whom, how, and when someone gives birth is socially and culturally determined. Historically, birth has been a social event. For the most of humankind history of birth is equivalent to history of home birth. The hypothesis exists that birth was transformed from a solitary to social event early in human evolution. Traditionally and historically, other women assisted women in childbirth. A special term evolved in the English language around 1300 to name women who made assistance in childbirth their vocation – midwife, literally meaning "with woman". However, midwife was a description of a social role of a woman who was "with woman" in childbirth to mediate social arrangements for woman's bodily experience of birth.
Birthing on country
Birthing on country is a traditional birthing practice that constitutes giving birth on the land where the mother was born as well as her ancestors. It is a culturally appropriate practice that coincides with spiritual tradition. It offers support to women and their families by continuing the birthing process in the community among the women and children. It is largely practiced by aboriginal women, in countries such as Australia, Canada, New Zealand and the United States. The belief is that if a child is not born on country they lose their connection to the land and their community.
In the United States
There was an increase in the percentage of home births from 2004 to 2009. Since 2009, Montana had the largest increase when it comes to home births with a percentage of 2.55 percent. Oregon and Vermont was close together when it comes to home births with percentages of 1.96 percent and 1.91 percent. The other five additional states which are Idaho, Pennsylvania, Utah, Washington, and Wisconsin, they all had an increase of home births with a percent of 1.50 and above.
When it comes to the Southeastern states which are Texas, North Carolina, Connecticut, Delaware, the District of Columbia, Illinois, Massachusetts, Nebraska, New Jersey, Rhode Island, South Dakota, and West Virginia, they all experienced a lower percentage of home births with only a percentage of 0.50 percent.
Since the percentage of home birth increased from 2004 to 2009, it went to widespread which involved states regions, and countries. While two areas saw significant decreases, 31 states saw rapid increases when it comes to home births.
thumb|Homebirth State Data 2009 Map
In Australia
In the Northern Territory of Australia, the prescribed steps advocated by the government is that, in rural areas, a woman at 37 weeks gestation must leave "country" and fly to the nearest city. If an adult, she flies alone with no family members. She will wait in accommodations until she goes into labour. After birth she and the baby are flown back to "country".
Types
Home births are either attended or unattended, planned or unplanned. Women are attended when they are assisted through labor and birth by a professional, usually a midwife, and rarely a general practitioner. Women who are unassisted or only attended by a lay person, perhaps a doula, their spouse, family, friend, or a non-professional birth attendant, are sometimes called freebirths. A "planned" home birth is a birth that occurs at home by intention. An "unplanned" home birth is one that occurs at home by necessity but not with intention. Reasons for unplanned home births include inability to travel to the hospital or birthing center due to conditions outside the control of the mother such as weather or road blockages or speed of birth progression.
Factors
Many women choose home birth because delivering a baby in familiar surroundings is important to them. In a study published in the Journal of Midwifery and Women's Health, women were asked why they chose a home birth; the top five reasons given were safety, avoidance of unnecessary medical interventions common in hospital births, previous negative hospital experiences, more control, and a comfortable and familiar environment. One study found that women experience pain inherent in birth differently, and less negatively, in a home setting.
Cost is also a factor. The estimated average cost of a home birth in the United States in 2021 was $4,650, compared with $13,562 for a vaginal hospital birth. In developing countries, where women may not be able to afford medical care or it may not be accessible to them, a home birth may be the only option available, and the woman may or may not be assisted by a professional attendant of any kind.
Some women may not be able to have a safe birth at home, even with highly trained midwives. There are some medical conditions that can prevent a woman from qualifying for a home birth. These often include heart disease, renal disease, diabetes, preeclampsia, placenta previa, placenta abruption, antepartum hemorrhage after 20 weeks gestation, and active genital herpes. Prior caesarean deliveries can sometimes prevent a woman from qualifying for a home birth, though not always. It is important that a woman and her health care provider discuss the individual health risks prior to planning a home birth.
Trends
Home birth was, until the advent of modern medicine, the de facto method of delivery. In many developed countries, home birth declined rapidly over the 20th century. In the United States there was a large shift towards hospital births beginning around 1900, when close to 100% of births were at home. Rates of home births fell to 50% in 1938 and to fewer than 1% in 1955. However, between 2004 and 2009, the number of home births in the United States rose by 41%. In the United Kingdom a similar but slower trend happened with approximately 80% of births occurring at home in the 1920s and only 1% in 1991. In Japan the change in birth location happened much later, but much faster: home birth was at 95% in 1950, but only 1.2% in 1975. In countries such as the Netherlands, where home births have been a regular part of the maternity system, the rate for home births is 20% in 2014. Over a similar time period, maternal mortality during childbirth fell during 1900 to 1997 from 6–9 deaths per thousand to 0.077 deaths per thousand, while the infant mortality rate dropped between 1915 and 1997 from around 100 deaths per thousand births to 7.2 deaths per thousand.
One doctor described birth in a working-class home in the 1920s:
This experience is contrasted with a 1920s hospital birth by Adolf Weber:
A 2002 study of planned home births in the state of Washington found that home births had shorter labors than hospital births. In North America, a 2005 study found that about 12 percent of women intending to give birth at home needed to be transferred to the hospital for reasons such as a difficult labor or pain relief. A 2014 survey of American home births between 2004 and 2010 found the percent of women transferred to a hospital from a planned home birth after beginning labor to be 10.9%.
Both the Journal of Medical Ethics and the NICE report noted that the use of caesarean sections was lower for women who give birth at home, and both noted a prior study which determined that women who had a planned home birth had greater satisfaction from the experience when compared with women who had a planned birth in a hospital.
In 2009 a study of 500,000 low-risk planned home and hospital births in the Netherlands, where midwives have a strong licensing requirement, was reported in the British Journal of Obstetrics and Gynaecology. The study concluded that for low-risk women there was no increase in perinatal mortality, provided that the midwives were well-trained and that there was easy and quick access to hospitals. Further, the study noted that there was evidence that "low risk women with a planned home birth are less likely to experience referral to secondary care and subsequent obstetric interventions than those with a planned hospital birth." The study has been criticised on several grounds, including that some data might be missing and that the findings may not be representative of other populations.
In 2012, Oregon performed a study of all births in the state during the year as a part of discussing a bill regarding licensing requirements for midwives in the state. They found that the rate of intrapartum infant mortality was 0.6 deaths per thousand births for planned hospital births, and 4.8 deaths per thousand for planned home births. They further found that the death rate for planned home births attended by direct-entry midwives was 5.6 per thousand. The study noted that the statistics for Oregon were different for other areas, such as British Columbia, which had different licensing requirements. Oregon was noted by the Centers for Disease Control and Prevention as having the second-highest rate of home births in the nation in 2009, at 1.96% compared to the national average of 0.72%. A 2014 survey of nearly 17,000 voluntarily reported home births in the United States between 2004 and 2010 found an intrapartum infant mortality rate of 1.30 per thousand; early neonatal and late neonatal mortality rates were a further 0.41 and 0.35 per thousand. The survey excluded congenital anomaly-related deaths, as well as births where the mother was transferred to a hospital prior to beginning labor.