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


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

In This Article


The goal of our study was to categorize and describe common themes among the culture of women choosing home birth and to provide an understanding of the depth of reasons included in this very personal decision. We used Leininger's theory of cultural competence to explain the need for health care professionals to appreciate how the individual woman views her own health status.[21] Through appreciation of the insight and personal expressions shared by women, the implications for practice apply to midwives, physicians, obstetric nurses, and perhaps most importantly, to women of childbearing age whose health status is affected by the childbirth process. Midwives and physicians who attend home births can use this information to further support the necessity for continuing the home birth portion of their practice.

There is clear evidence that hospital obstetric units in the United States are not providing evidence-based maternity care, appropriate care for low-risk women, labor support techniques for pain relief, nor support for the natural ability of low-risk women to give birth vaginally without technological interventions.[26,27,34] The insight provided by the women in our study, combined with the responses from LTM-II,[26] could provide motivation for hospitals to evaluate their current practices and begin to implement protocols that better reflect current evidence-based research and women's desired preferences.

Our research can provide a framework to assist hospital obstetric nurses and physicians in providing culturally competent care to women who divert from their planned home birth when a transfer to the hospital is necessary. The women in our study were concerned about safety and interventions, not unlike the women of the LTM-II study who planned to deliver in the hospital.[26] Unlike the women in LTM-II, who reported that they did not possess the knowledge to make informed birthing decisions concerning risks and benefits of interventions,[26] many of the women in our study felt that routine obstetric interventions were not safe and made a careful choice to birth at home.

In summary, our data on "Why did you choose homebirth?" and the data from LTM-II have shown that women in the United States who have a strong desire for a natural birth without exposure to technological or medical interventions have few alternatives.[26] We know that more than 99% of births in the United States occur in a hospital,[4] and more than 90% of those women experienced interventions, even though 50% of them believed that the birth process should not be interfered with unless medically necessary.[26] Given these inconsistencies, one might be better able to understand why low-risk women who want to labor without interventions choose home birth.


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