By Bailey Kennedy
Statistics released at the end of last year confirmed what many already knew anecdotally to be true. Many women had turned to home births during the pandemic.
While the absolute number of women who chose to use home birth to deliver their children was quite small — about 9,000 more women chose to give birth at home in 2020 versus 2019 — the percentage increase was notable. In South Dakota, an eye-popping 68% more women gave birth at home during the first year of the pandemic, as opposed to prior years.
The reasons for this shift were as varied as the women who made the decision to give birth in a non-hospital setting. Some women cited concerns that they were especially susceptible to COVID-19; others feared not having access to the support of family and friends if they chose to give birth in a hospital. Others, of course, had been interested in giving birth outside of a hospital prior to COVID, and would have done so even in the absence of the virus.
There is some real dispute about whether home-birth is as safe as giving birth in a hospital for women who are otherwise not at high risk for complications. While women appear to experience fewer interventions to their labor in a home-birth setting, the perinatal mortality rate may also be higher. In a statement, the American College of Obstetricians and Gynecologists has asserted that “unplanned home birth is especially unsafe,” while suggesting that women would be better off giving birth at hospitals or birth centers.
It’s worth noting that some in American midwifery or birthing center circles have alleged that they are being suppressed by physicians who see them as competitors. Many of the United States’ peer countries have normalized home births to a greater degree than the United States. In the U.K., for example, while home birth is still relatively rare, it occurs with nearly twice the frequency as home births within the U.S.
While there may be some increase in risk for women and their infants when women chose home births, it is clear that some women prefer to give birth at home rather than in a hospital setting. Giving birth, for many women, is a deeply traumatic experience, with up to 45% of new mothers reporting that they have experienced birth trauma. With this in mind, policies should be encouraged that allow women to have the greatest possible degree of autonomy over their pregnancies and births, even if this means allowing for some small relative increase in risk. But, as of now, many policies seem designed to lead women to give birth in a hospital with an obstetrician, whether or not that would be their natural preference.
Insurance policies are a factor that complicates a woman’s decision to give birth at home. Although home births are significantly less expensive than hospital births, they are not often covered by insurance policies. About two-third of homebirths are paid for by the patient, rather than by the insurance company. For patients who are already struggling financially, this might make homebirth impossible. Those who are looking to provide at-home or out of hospital midwifery services may also find themselves challenged — some states do not provide an official license for midwifery. Regulatory hurdles limit opportunities to practice for midwives.
It’s fair for insurance companies to want women to choose birth methods that are perceived to be of the lowest risk. But other values come into play as well when women are deciding what they want their births to look like. A broad vision of reproductive health would include a world in which women are able to choose how, where, and with whom they give birth — even if that means having a baby outside a hospital.