Abstract and Introduction
Approximately 1% of American women give birth at home and face substantial obstacles when they make this choice. This study describes the reasons that women in the United States choose home birth. A qualitative descriptive secondary analysis was conducted in a previously collected dataset obtained via an online survey. The sample consisted of 160 women who were US residents and planned a home birth at least once. Content analysis was used to study the responses from women to one essay question: "Why did you choose home birth?" Women who participated in the study were mostly married (91%) and white (87%). The majority (62%) had a college education. Our analysis revealed 508 separate statements about why these women chose home birth. Responses were coded and categorized into 26 common themes. The most common reasons given for wanting to birth at home were: 1) safety (n = 38); 2) avoidance of unnecessary medical interventions common in hospital births (n = 38); 3) previous negative hospital experience (n = 37); 4) more control (n = 35); and 5) comfortable, familiar environment (n = 30). Another dominant theme was women's trust in the birth process (n = 25). Women equated medical intervention with reduced safety and trusted their bodies' inherent ability to give birth without interference.
Modern hospitals have undergone tremendous technological advances and patient-focused changes over the past 50 years, culminating in facilities that offer world-class care, patient safety, and compassionate attention. In particular, maternity units have been replaced with family-centered birthing suites outfitted with the latest machines and patient amenities. Despite this safe and seemingly comfortable environment, a small but steadfast population of American women chooses to decline the hospital setting to give birth in their own homes.
Before the mid-20th century, most American women gave birth at home under the care of midwives. As the specialty of medical obstetrics grew, the percentage of hospital-based births increased. In 1940, 40% of births to white women and 73% to nonwhite women in the United States occurred at home. Total hospital births were 56% in 1940. In 1950, the percentage of hospital births soared to 88%, rising to more than 99% by 1969, where it remains today.[3,4,5] Therefore, the small percentage of the population of women choosing home birth in the United States today comprise a minority culture.
Although the percentage of home births has remained below 1% since 1960, the actual numbers are not trivial. National figures for 2005 show that 24,468 infants were born at home in the United States. The majority of women who chose home birth in the United States were white (n = 19,706) and were attended by midwives (n = 13,118).
Numerous studies have shown equivalent safety rates when comparing home and hospital births.[6,7,8,9,10,11] A recent integrative review compiled data from 28 studies undertaken between 1969 and 2000. Fullerton et al. concluded that maternal and neonatal outcomes of planned home birth receiving first-level care were favorable when compared to planned hospital or birth center births. A meta-analysis of six studies comparing the birth outcomes of 24,092 low-risk pregnant women found that perinatal mortality was similar between the home and hospital birth groups. Olsen found that the home birth group had a decreased frequency of induction, augmentation, episiotomy, operative vaginal birth, and cesarean delivery.
Despite favorable safety rates, the choice to have a planned home birth is not well supported in the United States by the government, professional organizations, the insurance industry, or society. Government regulations impede practitioners from providing home birth services by limiting licensure. All states license physicians and advanced practice nurses, but only 23 states allow licensure of nonnurse certified midwives who are more likely to attend home births. Recently, the American College of Obstetricians and Gynecologists issued a news release reiterating its opposition to home birth as stated in their 2006 Statement of Policy, which admonished physicians from practicing home birth and from providing back-up support for home birth providers.[13,14] These regulations and policies result in small numbers of home birth providers and great difficulty for women in locating a provider. Some insurance companies do not fully reimburse providers' fees for home birth. In addition, women who choose home birth are often asked questions about the perceived risk they are taking.
Studies from other countries where home birth is more prevalent examined reasons why women chose home birth. Common themes were control, comfort, freedom to move, and fewer interventions.[16,17,18,19,20] In two of the four studies, women stated that they felt safer at home.[16,20] In Turkey, although the main reason for choosing home birth was economic, almost 50% of the women stated that they feel more comfortable at home.
Given that women choosing home birth in the United States are a minority population, and that their choice to birth at home is not well supported, the aim of our study was to describe the reasons why women choose home birth.
J Midwifery Womens Health. 2009;54(2):119-126. © 2009 Elsevier Science, Inc.
Cite this: Staying Home to Give Birth: Why Women in the United States Choose Home Birth - Medscape - Mar 01, 2009.