Historical Trends in Home Birth
Up to the early twentieth century most women gave birth at home assisted by a midwife (usually female) or a family physician (usually male), but by 1920 less than 15% of births in the United States were attended by midwives (Borst, 1995). In 1940 the percentage of American women giving birth at home fell to 40%, and further down to 1% by 1969 (MacDorman et al., 2012). The reasons for this shift are many and are widely discussed, but the importance of this change is clear. Positive or negative, the medical industry now has the power over when and where and who controls birth. This has led to much medical advancement and has saved lives, but it also has drawbacks. Women considering home birth are rejecting the maternity care establishment as an industry, and they may wish to have more control over their experiences of childbirth than the medical system allows for. This is where midwives differ from doctors. Where the midwifery model is based on the normalcy of childbirth and the ability of the woman—alongside her midwife—to make informed decisions regarding her birth, the medical model places the obstetrician at the center of the process and decision-making as he “manages” the birth (Simkins, 2011).
The Midwives Alliance of North America (MANA) supports home birth as a safe choice for low risk clients as evaluated by a Certified Professional Midwife (CPM). Women might choose a home birth for many reasons. One of these may be her level of comfort in her home environment. A hospital is bright, foreign, and sterile while the home is warm and familiar. A woman can decide exactly whom she wants in attendance at her birth. She may incorporate her children and family members into the experience or limit their visitation to after the birth. In a study done in Canada researchers found that “when a woman gives birth at home, care providers and all others present become guests in her home, whereas in hospital, the woman is the guest in an unfamiliar environment” (Murray-Davis et al., 2012). Jouhki interviewed ten women in Finland and came up with a short list of factors that influenced their decision to plan a home birth: previous birth experience, considering birth to be a natural process, increased autonomy, home environment, intuition, desire to choose the birth attendant, mistrust of medicine, and able to have baby’s siblings present at the birth (2011). These are common reasons why a woman might seek to plan a home birth, but all reasons are valid and there may be deeper emotional motives for the desire to give birth at home.
One issue surrounding the emotions of a home birth is the possibility of transfer to the hospital. Planning a home birth is just that—a plan. Know that you and your midwife will also come up with a transfer plan, and that she will most often suggest transfer before the situation is emergent.
Borst, C. G. (1995). Catching babies: The professionalization of childbirth, 1870-1920. Cambridge, Mass: Harvard University Press.
Jouhki, M. (2012). Choosing homebirth – the women’s perspective. Women and Birth,
MacDorman, M. F., Declercq, E., & Menacker, F. (2011). Trends and characteristics of
home births in the United States by race and ethnicity, 1990-2006. Birth: Issues in
Perinatal Care, 38(1), 17-23.
Murray-Davis, B., McNiven, P., McDonald, H., Malott, A., Elarar, L., & Hutton, E.
(2012). Why home birth? A qualitative study exploring women’s decision making
about place of birth in two Canadian provinces. Midwifery, 28(5), 576-581.
Simkins, Penny. (2011). Into These Hands. Traverse City, MI: Spirituality and Health Books.