Women Are Choosing Home Birth: The Infant-Maternal Health Care System in the U.S. Owes Them A Safe Option

Women Are Choosing Home Birth: The Infant-Maternal Health Care System in the U.S. Owes Them A Safe Option


In the face of increasing home birth rates and declining maternal health outcomes in hospitals, society owes it to families to ensure safe birth options, regardless of the setting.

A small but growing number of families are opting out of a maternal health care system that is falling short. According to the Lancet, the U.S. is only one of eight countries in the world where the maternal death rate is increasing. In some states, such as California, rates of maternal and newborn mortality in hospitals have risen substantially – notably and alarmingly for women of color. 

Families choose home birth for many reasons. Some opt to avoid the often unnecessary interventions associated with hospital birth (including inductions, high cesarean section rates, and NICU stays). Others do not want to leave their communities or their families and have a tradition of birthing at home for personal, religious or cultural reasons. Some families cannot afford to pay the cost of a hospital or, for those who can afford to be more discriminating in their healthcare choices, feel as if their beliefs and preferences will not be honored. An integrated health care system for families that choose home birth and the midwives who serve them is the safest option.

The debate around U.S. home birth statistics as it is currently framed is only serving to confuse stakeholders in this debate. Critics of home birth cite flawed birth certificate studies and highlight relative instead of absolute risk. The State of Oregon has recently made an important leap forward by creating a birth certificate that captures the intended place of birth as well as provider type. Early data is being collected and research completed, which provides consumers and providers with the kind of data that can be used to inform practice and decision making.

The U.S maternal health care system has an obligation to support the conditions that increase safety for home births, including access to consultation, smooth transfers of care and transport to hospital when necessary. The Home Birth Summit, which brings together obstetricians, midwives, consumers, hospital administrators and others in maternal-health care, has published Guidelines for smooth transports crafted by a multidisciplinary Collaboration Task Force, as well as Transport Forms and Scripts to ease communications.

As the professional association for home birth midwives, MANA firmly supports the rights of families to birth outside of a hospital setting, with the providers who are trained in home birth specifically and within a system that supports midwives in all settings.   

The CPM, issued by the North American Registry of Midwives (NARM), is accredited by the National Commission for Certifying Agencies (NCCA), the accrediting body of the Institute for Credentialing Excellence (ICE, formerly NOCA). The mission of ICE is to promote excellence in credentialing for practitioners in all occupations and professions. The NCCA accredits many healthcare credentials, including nurse-midwives, nurse anesthetists, nurse practitioners, and critical care nurses. The CPM credential requires extensive training and the passage of exams that assure competency and focuses exclusively on the safe provision of out of hospital birth. 

Midwifery organizations and coalitions around the country are working to secure licensure for home birth midwives in all 50 states. Licensure gives families the reassurance that their provider is competent and does not have to work under the radar. Currently, misinformation, fractured interprofessional relationships (learn more here and here) and medical monopolies prevent this safe choice for mothers and babies.

Families deserve the support of a provider that meets international standards. The International Confederation of Midwives, with input from over 100 countries’ midwifery associations including those from the United States, have created standards that are increasing safety for families globally. The International Confederation of Midwives supports the “recognition that midwifery is a profession that is autonomous, separate and distinct from nursing and medicine.” and does not expect, nor recommend, that midwives be nurses first. MANA, among other midwifery organizations, is working on continuing to meet and even exceed the recommendations of the ICM. 

Families deserve the right to make choices with high quality evidence informing their decisions. A growing body of literature (including in the United States, Canada, and ) suggests that home birth is safe for women and babies when the birthing parent is healthy, the midwife is trained and medical-back-up is available should a complication arise. One of the hallmarks of home birth midwives’ care is their commitment to providing evidence based information so that clients can make truly informed decisions regarding their care during pregnancy and birth. In a system that supports the autonomy of the family, decisions can be made based on evidence, not fear.

When the maternal health system of the U.S. can have a balanced discussion on how to fully incorporate non-nurse midwives into our system, regardless of place of birth, our families will have better access to the care providers of their choice, fewer interventions including surgical birth, and better outcomes. 


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