Home births are rising in the U.S.—especially for Black women. Here's why.

Last year when Asia Dessert was 40 weeks pregnant and felt her contractions begin, she didn’t pack her bags and rush to the hospital. Instead, Dessert, who is Black, lounged in her bed before eventually moving to a tub filled with lukewarm water in her Los Angeles backyard. A few hours later she delivered her baby near the tub, in a planned home birth attended to by a midwife, surrounded by palm trees and cacti, under a bright blue sky.

The rate of home births in the United States has increased 60 percent in the past seven years, to nearly 2 percent of all births. This is the highest level in three decades, according to a recent analysis published in the Journal of Perinatal Medicine. The most pronounced gain has been in Black women, up 36 percent in one recent year, according to figures by the U.S. Centers for Disease Control and Prevention. Experts say much of the rise stems from women’s desire to take back control over their births. But they caution that not every woman can safely choose the option.

Dessert, whose pregnancy had proceeded without complications, was inspired to deliver at home after reading books some years earlier that described home deliveries as “joyful moments where women were in control and supported by other women they knew in their community,” she says. Most home births are overseen by midwives, who tend to view birth more naturally than obstetricians, who are trained as surgeons.

Equally important was her desire to avoid the negative treatment she and other Black women often experience in medical institutions. Her mother’s complaints of pain had been dismissed by doctors for years before she was ultimately diagnosed with terminal cancer. Dessert herself felt belittled early in the unplanned pregnancy, when a clinic she went to for a pregnancy test insisted on performing additional tests despite her objections.   

Hours after an uneventful labor, Dessert easily pushed out baby Wazir, and then showered in her bathroom before being tucked with her baby into her own, comfortable bed.

“Had I been in a hospital I would not have been so relaxed,” Dessert says. “The focus here was on me and my son, rather than having to acclimate myself to people I don’t know, with lighting and temperature out of my control.” 

Concerns about mistreatment and medicalization

Greater influence over their labor and birth and among reasons women are increasingly drawn to home births, the Journal of Perinatal Medicine review found. Others want to avoid unnecessary medical interventions or a Cesarean section, which occurs in 32 percent of U.S. births, much higher than the U.S. government’s target rate of 24 percent. The COVID-19 pandemic also heightened fears of illnesses that can be contracted in the hospital. (Home birth rates rose 12 percent the first year of the pandemic.) 

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Many women of color, in particular, share Dessert’s worries about mistreatment during pregnancy and birth. Roughly 30 percent of Black, Hispanic, and multiracial women, and 19 percent of whites report feeling disrespected during this time, such as being scolded or shouted at or having their requests for help ignored. The problem is so pervasive the CDC launched a campaign, Hear Her, urging healthcare providers and family members not to ignore pregnant women’s concerns. 

In addition, more than 800 U.S. women died during pregnancy or childbirth in 2022, the most recent year statistics are available, and experts say more than 80 percent of these could have been prevented with proper care. Black women are almost three times more likely to die than white women. 

Black women who choose to deliver at home often seek out a Black midwife and/or birthing assistant (known as a doula) for added comfort, says Laurel Gourrier, a doula in Columbus, Ohio, and co-host of the podcast Birth Stories in Color. 

“Many know their chances of having a birth that is led by their voice is strengthened by a support team that has a similar lived experience, in a space they have curated and cared for,” Gourrier says. 

Longer, more patient-focused prenatal appointments

Women who opt for home birth say the experience can be different during the entirety of their pregnancy, with midwives often conducting lengthy prenatal appointments, sometimes in the woman’s home. 

By contrast, appointments in most obstetrical offices are “15 minutes, with no time for questions or suggestions or asking if you can do something differently,” says Stephanie Mitchell, a certified nurse midwife who does homebirths and is constructing a home-like birthing center in Gainesville, Alabama, after leaving a hospital-based practice in Boston several years ago. 

“These conventional systems do not value autonomy,” Mitchell says.

That was partly what drove Saige Maltz, a white woman from Boynton Beach, Florida, to birth at home last year. After Maltz learned she was pregnant following a devastating miscarriage, she wanted the next nine months to be a positive experience. She leaned toward birthing at home, an option she discovered from a social media influencer who had documented her own satisfying experience.

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Maltz’s husband was skeptical, but he changed his mind after they visited a female obstetrician for an ultrasound early in the pregnancy, which was conducted quickly and without emotional warmth. “We left there and my husband said, I feel ready to talk to a midwife,” Maltz recalls. 

A week later, Jennifer Roberts, a licensed midwife from nearby West Palm Beach, spent more than an hour at Maltz’s home, explaining what to expect during her pregnancy and birth. “My husband asked a million questions and she patiently answered every one,” Maltz says. Roberts also gave Maltz her cell phone number, which Maltz used regularly to text her questions.

Are hospital births safer?

Most of the questions pregnant women ask Roberts are about safety. 

“It does take precious minutes to get an EMS and transfer,” she says. But “situations that need such immediate care during birth are very rare,” and midwives bring emergency equipment to every birth, including oxygen and medication to stop a hemorrhage.

Experts say women should consider a home birth only if they have a low-risk pregnancy with one fetus, without diabetes or high blood pressure, and where the baby continues to grow and develop as expected to full term. The medical group the American College of Obstetricians and Gynecologists (ACOG) insists that multiples, babies in a breech position, or births in women who had a prior Cesarean section should never be done outside of a hospital. 

Not all mothers who have had a home birth meet these criteria. A detailed analysis by Shanna Cox, associate director for science at the CDC’s Division of Reproductive Health, and her colleagues found 35 percent of these women should have been disqualified, including 17 percent who had diabetes, 20 percent whose babies were small for their gestational age, and 10 percent who delivered preterm (some of these issues overlap). 

Deaths of babies among low-risk women having a planned home delivery seem to be slightly higher than comparable women birthing in a hospital, ACOG notes, although both are below one in a thousand. At the same time, women planning a home birth are one sixth as likely to have their labor induced and two and a half times less likely to have a C-section.

Home births are a good option for low-risk women who already delivered one child without incident and who live less than 20 minutes from a hospital with a delivery ward, says Jacoba van der Kooy, an obstetrician in Rotterdam in the Netherlands, a country where home births with midwives are common. But healthcare providers frequently miss risk factors, such as a too-small fetus, that increase the odds for neonatal health problems or deaths, her study found.

Also problematic is the lack of integration between midwives and emergency hospital personnel, the Journal of Perinatal Medicine analysis found. And many midwives say they can’t find obstetricians with whom they could work seamlessly throughout a woman’s pregnancy.

Mitchell says this systemic flaw is a disservice to birthing moms. “It makes sense to start with a midwifery model offering low intervention with close evaluation” and moving women to a higher intervention OB if the need arises. 

“Birth is not inherently dangerous. It has been made to be dangerous by its medicalization and industrialization,” Mitchell says.

It is difficult to directly compare home birth and hospital birth outcomes, as no adequate randomized clinical trials have been conducted. When one researcher attempted to do so in the Netherlands, prospective participants refused to deliver in a location not of their choosing and the study was cancelled. 

Barriers to home delivery

In many Western countries, including the U.S., women say they are criticized and stigmatized if they choose a home birth, including from other healthcare providers, one systematic review found.

Cost is another limiting factor. Many insurers don’t have any midwives in their network, while Medicaid, which insures 40 percent of the nation’s births, covers home births in only half the states.

Dessert was able to afford her $7,000 home birth only with financial help from a nonprofit.  

“My birth was fun, slightly chaotic, euphoric, and tough,” Dessert says, and she wouldn’t have wanted it any other way. She tells friends she delivered at home hoping that some would follow, but she says “homebirth is inaccessible to most people I know because of the money.”

For those who can afford it or whose insurance will pay, the option may be worth discussing with a medical professional.

“It’s clear women are wanting to have respectful care, low-intervention births, and more choice and control,” the CDC’s Cox says. “But we also want to balance that with risks to outcomes for the mother and the infant and support shared decision-making around where to give birth.”