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Although common in nonindustrialized nations, home birth is rare, comprising 1.5% of all births in 2016 in the United States (MacDorman & Declercq, 2016). The remaining 98% of births occur in hospitals. Most home births are managed by a midwife, a health care professional, usually a nurse, who specializes in childbirth. Midwives provide health care throughout pregnancy and supervise home births. One review of 50 studies found that the use of midwives, whether as part of a home birthing plan or as part of a plan to birth in a hospital setting, is associated with reduced neonatal mortality, reduced preterm birth, fewer interventions, and more efficient use of medical resources (Renfrew et al., 2014).

Is a home birth safe? A healthy woman, who has received prenatal care and is not carrying twins, is unlikely to encounter problems requiring intervention—and may be a good candidate for a home birth (Wilbur, Little, & Szymanski, 2015). Although unpredictable events can occur and immediate access to medical facilities can improve outcomes, studies from Europe indicate that home birth is not associated with greater risk of perinatal mortality. However, home birth is far more common in many European countries than the United States (20% in the Netherlands, 8% in the United Kingdom, and about 1% in the United States) (Brocklehurst et al., 2011; de Jonge et al., 2015). The few U.S. studies that have examined planned home birth compared with hospital birth have found no difference in neonatal deaths or Apgar scores, and women who have a planned home birth report high rates of satisfaction (Jouhki, Suominen, & Åstedt-Kurki, 2017; Zielinski, Ackerson, & Kane Low, 2015). Cultures vary in their approach to birth, as discussed in the Lives in Context feature.