I had my daughter in 2006 in a hospital, with a midwife. It was a great experience. Sadly, neither the hospital nor the midwifery practice I used still allows this. At least in New York, the number of midwife options with hospitals has been shrinking dramatically over the last decade — right in line with the rising rates of c-sections. I am not pro-homebirth, but I also think low-intervention, hospital choice is a very, very good thing.

I delivered my first child in a hospital with a doctor I’d never met. Mine was on vacation when I went into labor. If it hadn’t been for my husband and a great labor nurse, I would have ended up with a c-section (his rate was the highest in the hospital). Next, I chose a nurse-midwife program at the hospital but they seemed too afraid of losing their hospital privileges. Everything had to be OK’d by the over-seeing doctor. The next four (that’s right!) were born at home with my husband and an attending midwife. It was more relaxed, less traumatic and very joyful. The midwives gave me a greater standard of care (whole person) that I ever received through the standard ob-gyn and hospital delivery methods. I just wish I’d had the courage to start with my first at home.

The authors of the study comment on possible causes of this significant upsurge as follows:
” Interestingly, the recent increase in home births in the United States began before the release of a series of documentaries and newspaper articles about home birth (footnote 16). Such a development is not without precedent. In the United Kingdom, a government-endorsed movement called Changing Childbirth has been credited with leading a growth in home births that has continued until the present. However, the home birth rate in the UK had already been increasing for five consecutive years before Changing Childbirth came into being (footnote 17). Women choosing home birth may be a harbinger, as much as a result, of increased activism related to childbirth (footnote 16).”
(I will provide the citations for 16 and 17 in a follow-up comment)

They also wrote:
“Despite these difficulties (ACOG/AMA opposition and hospital transport hostility) an increasing number of United States women are opting for a home birth. Women may prefer a home over a hospital for a variety of reasons, including a desire for a low-intervention birth in a familiar environment, surrounded by family and friends, and cultural or religious concerns. Lack of transportation in rural areas and cost factors may also play a role in the decision to have a home birth, as total costs for home birth are about one-third of those for a hospital birth.”

These are the reasons we keep hearing from women who join forces in the Big Push to work for regulation of Certified Professional Midwives, the home birth specialists — cost, access problems, religious or cultural reasons, avoidance of harmful interventions. What we are NOT hearing is that women have been influenced by celebrities who choose home birth. It is highly insulting to women to suggest, as ACOG and some OBs do, that women decide something so important as giving birth at home on the basis of People magazine or Entertainment Tonight.

I gave birth at home in January and had a fantastic birth and a very healthy baby. Home birth was absolutely the best healthcare decision I’ve ever made.

A few years ago I knew absolutely nothing about birth, but a friend of mine is a doula and she had encouraged me to see “The Business of Being Born.” It really opened my eyes and made me curious to do more research.
When I got pregnant I was seeing an OB, but after miscarrying I realized how terrible that OB’s bedside manner was. I switched to another OB and hated how I could never get all of my questions answered and it felt so cold.
At that point I convinced my husband to switch to a midwife and we explored giving birth at the St. Luke’s Roosevelt birthing center here in NYC, but read many stories from women who “risked out” of the birthing center and had to deliver at L&D. I wanted to avoid that scenario so I begged my husband to at least interview some home birth midwives with me and be open to the possibility.
He was very concerned about giving birth at home, but when we interviewed our midwife, especially in comparison to the OB’s I had, she was amazing and he was completely sold on the home birth. It helped too that a hospital is 5 minutes from our home in case we needed to transfer.

I was shocked at how well my birth went and how positive an experience it was. I also couldn’t believe how quickly I recovered from the birth (walking around right away–totally high on adrenaline and oxytocin) and how healthy my baby was.

Our decision has been reinforced many, many times after hearing other peoples’ birth stories in the hospital. I have a group of about 15 mommies that I get together with and I was the only one who did a home birth. I was also the only one who ended up with zero interventions. So many women were induced for one reason or another. I will say, I can’t imagine going through labor in a hospital without an epidural. At home I was comfortable and could move freely, eat or drink freely and enjoy the privacy of my own home which helped me cope with the pain. If I were in the hospital, confined to a bed or even one room, it would have been much worse.

Whenever I hear people say “what if something happens” or “what about such and such story where a baby died during a home birth” I tell them that things happen in hospital births and the infant mortality rate in the US is shockingly high. Since less than 1% of births are at home, that means that 99% of the babies or mothers who die in birth are dying in hospitals. And, if something were to happen at home, my midwife (a CNM) has the equipment and knowledge to know early enough that we need to transfer.

My biggest piece of advice for friends who are thinking of having children is to really, really educate themselves and to know that there are options. So many women think that they have to do it the way our mothers did it, but I know now that there’s a better way.

Home birth most certainly is not for everyone, but it is a very legitimate option for many women and I hope the upward trend continues.
Until the medical community realizes how screwed up their approach to childbirth is, I think it’s perfectly legitimate to opt out of that system.

It’s far from clear that there even was a 20% increase in planned homebirths, because the authors didn’t look at planned homebirths.

MacDorman and colleagues looked at birth certificates to determine whether a birth occurred inside or outside of a hospital. In fact, the authors used the exact same technique used in part of the Wax study, a technique bitterly criticized by homebirth advocates specifically because it failed to distinguish between planned and unplanned homebirths.

So what did the authors actually find? They discovered that in 2004 there were 23,150 births that took place outside the hospital and in 2008 there were 28,357 births. Then the authors made a leap of faith, or rather several leaps of faith. MacDorman et al. ASSUMED the ratio between planned and unplanned homebirths remained the same from 2004 to 2008. They ASSUMED that the rate of hospital transfer during planned homebirth remained the same from 2004 to 2008. They ASSUMED that the death rates of planned homebirth remained the same from 2004 to 2008.

Those are big assumptions to make about a dataset composed of very small numbers (relative the to overall number of births). It is entirely possible that some portion of the purported “increase” that they observed reflected NOT an increase in the number of planned homebirths, but an increase in the number of unplanned homebirths. It is equally possible that some portion of the purported “increase” that they observed reflected NOT an increase in the number of planned homebirths, but a decrease in the number of hospital transfers. It is equally possible that some portion of the purported “increase” that they observed reflected NOT an increase in the number of planned homebirths, but a decrease in the number of homebirth deaths. And, of course, it is very possible that a substantial proportion of the purported “increase” in planned homebirths actually reflects some combination of the three.

Finally, this purported increase, even if it is real, means that homebirths have gone back to the rate they were in 1990, hardly a year noted for a large number of homebirths.

Before we speculate on the causes of the purported rise in planned homebirth, we ought to find out whether the rate of planned homebirth actually rose.

I chose home birth with my first child in 2003 as, I would say, a result of statistical analysis. I was 23, and though homeless and jobless, I was not stupid (more Jack Kerouac than Bob Marley).

It quickly became apparent that a 1 in 3 chance of a surgical birth in hospital was a clear indication of a systemic problem. With further investigation I discovered how the rest of the world does birth. I hired the most expensive, skilled and experienced mw in town, developed a trusting relationship, and had and have the healthiest child I’ve seen since. I didn’t know anyone who had chosen this at the time, but I am grateful for my parents who watched their first grandson born in their dining room, With all the neighbors watching on as well. I hope more people will continue to educate themselves so they can do for their children what I have done for mine (I have 2 now).

My first son was born in a hospital in 2008, but it was a completely natural birth. We were already pretty convinced we wanted to go that route (drug-free, without any interventions), when we saw “The Business of Being Born”. We thought it was great – found it to be very informative, and very affirming of my desire – yes, I could do it! Unlike what most people were telling me, I was not stupid or foolish to think that I could actually manage a natural birth!
Sure enough, it was a wonderful experience! I had never felt so alive in my life! And the sense of accomplishment & empowerment that I felt after delivering my 9lb, 10oz boy was amazing. The only problem was, I really had to fight for it. I had to write a VERY DETAILED birth plan/ birth letter ahead of time, share it with my doctor & the nursing staff, and have it added to my file, and I had to sign numerous waivers to be released from most of their normal requirements. My doctor had to sign off on a hep-lock IV, so I’d be free to move around during labor, and I had to literally NOT SHOW UP to my induction appt when I went over a week late. He finally came, at 12 days overdue, but I was so glad I waited. He was perfect, and healthy, and I got the birth I wanted.
The only thing that made it better was doing it at home the second time. This time, instead of swimming upstream the whole way, I had terrific support – through both the pregnancy AND the labor & delivery. My second son (10lbs!) was born in water, in a birthing tub on my living room floor. I had a normal, low-risk pregnancy, and had already achieved one natural birth, so we were good candidates. My midwives were there, along with a birth assistant, my mom, sister and husband. The support of that “little village” really got me through, and made the experience so unforgettable. If I had it my way, I would never go back to the hospital. Homebirth is just too perfect, and too amazing. The only problem is, insurance covers 100% of a hospital birth, but only reimburses 50-60% of a homebirth, so that option ended up being much more expensive for us. We’re not sure if we can afford to do it again with #3, when the time comes. Anyone else running into this problem??