Staying Home to Give Birth: Why Women in the United States Choose Home Birth

Debora Boucher, CNM; Catherine Bennett, RNC, BSN; Barbara McFarlin, CNM, PhD, RDMS; Rixa Freeze, PhD, MA

Disclosures

J Midwifery Womens Health. 2009;54(2):119-126. 

In This Article

Results

Sample Characteristics

One hundred and sixty of the original respondents met inclusion criteria for this analysis. The mean age of the study participants was 35 years (range, 20-65 yrs). Most respondents planned a home birth in the recent past: 82% (n = 132) occurred within 5 years of the survey, and the overall mean was 3 years. The majority of the women in the sample were white and married. One-third of the women described themselves as homemakers or stay-at-home mothers. At the time of the survey, 32% worked as professionals; six of the 51 professionals identified themselves as health care practitioners. Other occupations represented were service workers and management. More than half of the women possessed at least a college degree and many also held advanced degrees. Respondents resided in 36 of the 50 states, with 28% residing in Illinois, 6% in Colorado, and 6% in Maryland. A complete list of the characteristics of the study sample is displayed in Table 1 .

Themes

Responses to the study question "Why did you choose homebirth?" were numerous. Most of the 160 respondents stated several reasons for planning a home birth (mean, 3; range, 1-11). Descriptions of the 26 common themes and the coding rationale are found in Table 2 . The frequency distribution of coded themes is displayed in Figure 1. The five most frequently identified themes will be discussed in this paper: "safety and better outcomes," "intervention-free," "negative previous hospital experience," "control," and "comfortable environment." Nine out of the 30 respondents who mentioned "comfortable environment" also mentioned "trust in birth"; therefore, the "trust in birth" theme will also be discussed.

Figure 1.

Number of responses for each of the 26 themes that emerged from analysis of the question, "Why did you choose home birth?"

Safety and Better Outcomes. Twenty-four percent (n = 38) of the respondents reported that their reason for planning a home birth was their belief that home was the safest place to give birth and allowed the opportunity for better health outcomes. The following comments exemplified these beliefs:

"We felt [that] homebirth was the safest option for us."
"Later, I learned about the risks of homebirth vs. [sic] hospital birth, and felt that in my situation I had a far better chance at a good outcome at home."

Only three of the 38 women who listed safety and better outcomes as a reason for choosing home birth also reported a negative previous hospital experience. Seven of the 38 women reported that it was better for the baby's health to birth at home.

Professionals represented the largest occupational group that reported safety and better outcomes (n = 14), and four of the professionals were health care practitioners. Other occupations represented in this theme were homemakers (n = 11), service (n = 5), management (n = 4), students (n = 2), and sales (n = 1). Most of the women had attended college (n = 36), and many had completed a bachelor's degree (n = 14) or higher (n = 12).

Intervention-free. The other most frequently identified theme involved the use of labor and delivery interventions. Twenty-four percent (n = 38) of the respondents discussed their desire to avoid medical interventions, routine procedures, and interferences that are common in hospitals. Some women described specific interventions that they would like to avoid, and other women referred to interventions that occurred during a previous hospital experience that they were hoping to avoid:

"No: monitors, IVs, drugs, laying on my back, family pushed away, baby taken away, baby given sugar water..."

Some women focused their comments on avoiding interference in the birth process:

"I believe birth ... proceeds best when uninterfered with."

Twenty-four percent (n = 9) of the respondents who mentioned safety as a reason for choosing home birth also stated that they preferred their birth to be intervention-free. Women who expressed both safety and intervention-free themes shared this typical responses:

"I realized that *my* [sic] home...[is] a safer environment for my babies than a hospital room. ...As far as I am concerned, lower intervention means higher safety for both mother and baby."

Negative Previous Hospital Experience. Another theme that was frequently mentioned (n = 37) was a negative previous hospital experience:

"In my first birth experience, I felt bullied, robbed, cheated, and fearful in the hospital environment... I could not use my voice in the hospital and my doctor did not listen anyway. I was a passive patient, instead of an active participant."

Many chose home birth after observation of someone else's negative hospital experience:

"I had seen such bad experiences through family and friends of mine with hospital births that I really wanted to do a homebirth."

Control. Many women (n = 35) wrote about wanting control of their birthing experience. They expressed a desire to be the primary person making decisions and choices regarding treatment and care:

"To create a situation where I had a great deal of freedom and control over the birth process...without the restriction imposed by hospital policies."

Comfortable Environment. Giving birth in an environment described as comfortable, calm, peaceful, loving, or familiar was a theme that was mentioned as a priority to many of the women (n = 30) in this study:

"I wanted to bring my baby into a peaceful and familiar environment surrounded by love and support."

One-third of the respondents in this group (n = 9) also expressed the eighth most common theme, "trust in birth." They remarked that birth would proceed more normally in a home environment than in a hospital environment. We include this theme because of the frequency of its occurrence within this group's statements:

"I knew [that] I'd feel more comfortable at home and I would therefore labor better."

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