More People Are Giving Birth at Home. Why, and Is It Safe?
BU expert says it can be—but so are hospital births
Although just a small percentage of people give birth at home, the number of home births has tripled in recent decades. Photo via iStock/oatawa
More People Are Giving Birth at Home. Why, and Is It Safe?
BU researcher Eugene Declercq, who catalogs birth data, says it can be—but so are hospital births
For the past two decades, home births have been rising in the United States, almost tripling between 2004 and 2024. Although most pregnant people still give birth in hospitals, some experts have suggested a growing distrust of the US medical system is feeding the trend.
One of those tracking the rise in home births is Boston University’s Eugene Declercq. On his website, Birth by the Numbers, he catalogs national and local birth data, as well as international statistics, to share up-to-date, accessible information with researchers, policymakers, journalists, clinicians, and prospective parents. According to the latest National Center for Health Statistics data shared on the site, 1.5 percent of births in the US happened at home in 2024. That’s as the country leads the developed world in maternal deaths.
Declercq, a BU School of Public Health professor of community health sciences, says 12 percent of home births are unplanned, typically because of rapid labor or other unexpected medical issues. “Outcomes of planned home births are generally very good, while the results of unplanned home births are mixed,” he says. Federal birth certificate data don’t identify when planned home births had to shift to a hospital, “but studies have suggested these occur in 10 to 14 percent of cases.”
The Brink spoke with Declercq about birth trends and whether opting to deliver at home is cause for concern.
Q&A
with Eugene Declercq
The Brink: Why did the trend of hospital births start reversing in 2004?
Declercq: Two factors probably played a role.
First, 2004 was in the middle of a rapid surge in cesarean sections in the US. Between 1996 and 2009, cesarean rates increased by more than half, from 20.7 percent to 32.9 percent of all births. Public concern grew about the level of interventions in hospital births. Between 2004 and 2024, the proportion of home births almost tripled, from 0.56 percent to 1.54 percent of all births.
Second, the primary attendants at home births are certified professional midwives (CPMs), who attend about three in five planned home births in the US. In the early 2000s, they became more active as a profession, lobbying to reform laws that had limited their ability to attend home births. Now, 38 states have some form of licensing or regulation of CPMs, providing infrastructure for those interested in a home birth.
The Brink: Is distrust of the medical system fueling at-home births? Are certain people more likely to give birth at home?
Studies of why women choose home births generally find that the decision is about control of the environment in which their baby is born. Notably, 82 percent of those having planned home births had already had a baby. Most of those having home births have already experienced a hospital birth. In a survey we conducted of women who had recently given birth in a hospital, we asked, “For any future births, how open would you be to giving birth at home?” More than one in four either definitely wanted (11 percent) or were open (18 percent) to having a home birth in the future. For a significant proportion of women giving birth at home, their experience in hospital was their motivating factor.
While rates of home births to non-Hispanic Black mothers have increased rapidly in recent years, US home births are predominantly among non-Hispanic white mothers, who account for 84 percent of all planned home births. Among non-Hispanic white mothers in 2024, 2.3 percent of all births are now planned at home, compared to 0.4 percent among non-Hispanic Black mothers.
The Brink: Given the high maternal mortality that your site documents, is a distrust of the medical system by pregnant people well-founded?
Despite the concerns that advocates, including me, have with the performance of the US maternal health system, it is important for prospective mothers to know that birth remains extremely safe in the US. The current pregnancy-related mortality rate in the US—18.7 per 100,000 births—is higher than comparable countries and not improving as fast as it should. But pregnancy-related deaths remain very rare, involving less than 700 deaths out of more than 3,600,000 births.
The current efforts sowing distrust in the medical system may have contributed to the current rate, but it’s not the driving force. The number of home births surged by 40 percent during the pandemic as people feared going into, or had trouble accessing, hospitals. Interestingly, after COVID faded, the number of home births continued to increase slightly, suggesting as people became more familiar with the option, demand increased.
The Brink: What do we know about the safety of giving birth at home?
It is a difficult question to answer, because randomized trials of place of birth are clearly unethical. The evidence suggests that home birth can be a safe option in places where there is screening, communication, cooperation between home and hospital settings.
Countries that have successful home birth systems—the UK and the Netherlands—have screening protocols for who is eligible for home births. When a difficulty necessitates a move to the hospital, transfer is handled as seamlessly as possible. Difficulties can arise when higher-risk births are at home, particularly when parents choose home birth because they can’t get the care they seek, such as a vaginal birth after a cesarean. The key is the establishment of an integrated maternity care system, where parents have the option of a birth at home, a freestanding birth center, and a local hospital, or high-risk academic medical center, as needs and interests dictate.
Home birth will never become the dominant mode of birth. After the UK integrated home birth into their system in the 1990s, rates rose to around 3 percent and have hovered between 2.5 to 3 percent since. However, in an integrated maternity care system, home birth can be a viable option for those seeking family-centered, low-intervention, community birth.
