The controversy about whether or not women should give birth at home is moot. In the United States today, home birth is a choice women are already making in increasing numbers. The real question we need to answer, so women have evidence-based information to make decisions with, is: What conditions make home birth a safe option?
Studies of large numbers of women who planned home births show which pregnancy-specific conditions are best managed in a hospital. A few examples include evidence of fetal growth restriction, breech presentation, multiples (i.e. twins) and premature labor. Women who have significant psychiatric conditions, substance abuse problems or certain chronic illnesses could also have a difficult labor, perhaps best managed in a hospital setting.
In Britain, women are actually advised to have children at home or in a birth center, rather than a hospital, when the pregnancy is low-risk.
But, the question of safety also implicitly asks “How often do emergencies occur?” and “How likely is it that the mother or baby will die?” In fact, the majority of labor and birth complications are non-emergencies. There is usually time for the woman or infant to be transferred to a hospital and cared for safely. Life-threatening emergencies that are not predictable are extremely rare — although they do occur both at home and in the hospital at roughly equal rates.
In Britain, the national health service actually advises healthy women that it is safer to have children at home, or in a birth center, rather than a hospital, when the pregnancy is low-risk.
Still, in the U.S., the home birth process could be improved with more advanced, integrated systems to streamline transfers into hospitals when complications appear after labor starts or the infant is born. The presence of a qualified provider is also necessary to ensure safety during labor and birth: women should have greater resources to help them evaluate their providers.
Finally, while access to correct information is important for expecting mothers, so is their choice. If transport policies are in place and a qualified midwife has an arrangement with a hospital, home birth is as safe or safer than birth in hospitals that over-rely on cesarean sections and other surgical interventions.