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

Discussion

Previous studies have reported equivalent safety rates when comparing home and hospital births,[6,7,8,9,10,11] the demographics of women choosing home birth,[24,25] and the expectations of women choosing hospital birth.[26] Women choosing home birth in several countries were described as wanting more flexibility, choice, and control,[16,17,18,19,20] while those choosing a hospital birth have been described as being concerned about safety.[17,18,19] These findings could be misinterpreted to mean that safety is not a concern for women who choose home birth. In this study, the concern for safety was mentioned by 24% (n = 38) of women as being paramount in their decision to plan a home birth; they considered home birth to be safer than hospital birth.

Avoiding unnecessary medical interventions and interferences that are part of hospital routine were also mentioned by 24% (n = 38). Listening to Mothers II (LTM-II), a national US survey of women's childbearing experiences, found that interventions have become routine in hospital settings, including electronic fetal monitoring (94%), medications for pain relief (86%), and epidural analgesia for vaginal deliveries (71%).[26] Nearly one-third of hospital births in 2005 were cesarean deliveries.[26] LTM-II concluded that "large proportions experienced numerous labor and birth interventions of benefit for mothers with specific risk conditions, but inappropriate as routine measures."[26] Routine labor interventions experienced by women delivering in hospitals are not evidence-based and do not reflect best practice.[27] It is not surprising, then, to hear women express a desire to birth at home to avoid interventions that they may have experienced or witnessed at previous births, especially when women do not feel that their preferences would be honored.

Many of the women's responses specifically acknowledged the impact of former negative birth experiences. The hurt and frustration were apparent in their responses. Also voiced in their comments was the positive impact that their decision to have a home birth had on their families, their babies, and themselves. This echoes the findings of LTM-II, which examined research focused on the life-long implications and the impact of the birthing process on both infants and mothers.[26]

Institutions have policies and procedures intended to safeguard the well-being of the institution and those it serves. In some instances, the control of the institution comes in direct conflict with the power and control of the individual. In our study, 35 women stated that one of the issues that influenced their decision to have a home birth was their desire to have increased control of their birthing experience. Words used were: "freedom, control, autonomy, and lack of hospital-imposed restrictions" -- concepts that they felt were only available to them in their own home. In contrast, words used by women in LTM-II when describing their feelings about their hospital birthing experience were "overwhelmed" (38%) and "frightened" (33%), while only 17% described feeling "powerful" during the labor process.[26]

Thirty of the women in our study remarked that their home birth decision was based on wanting to give birth in a comfortable, familiar, peaceful setting where they would be better able to relax during labor. Many of them also upheld their belief that this relaxed state contributed to a normal progression of labor, which results in shorter labors. Extensive research supports the hypothesis that increased epinephrine levels that occur with anxiety during labor are associated with an increase in the length of labor.[28,29,30,31,32,33]

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