When I decided to have my third baby at home, I did so because I felt that a home birth with an experienced midwife would be the safest place for labor and delivery. My first two children were born in a large, Boston teaching hospital, and medical interventions there caused complications for me. My last two children were born at home, on their own time, with no interventions and no complications. You can read more about my home birth experience here.
More women are now discovering the safety and joy of a planned, midwife-assisted home birth. The coronavirus has caused expecting parents to question the safety of a hospital birth, while restrictive hospital policies, such as mask-wearing and visitor limitations, make labor and delivery in a hospital less appealing.
According to Joyce Kimball, a Certified Professional Midwife in Massachusetts, more women are considering a home birth now than they were pre-pandemic.
“My practice has seen an uptick in the interest in home birth and community birth since the spring of 2020,” says Kimball, who runs one of the busiest home birth practices in the state. “Prior to 2020, I would receive 1-2 calls per week from folks interested in non-hospital birth. Now I receive about 4-5 calls per week."
"Every month I have a full panel of clients and refer away several people a month,” she adds. This trend is occurring in midwifery practices across the country.
Many of the reasons why these pregnant mothers are contemplating a home birth now are the same as they were before COVID hit. They want a more personalized, less institutionalized birth experience. They want more control over the labor and delivery process. They want to be surrounded by a supportive birthing team, including family members, friends, and perhaps their other children, in addition to their midwives. They don’t want to be separated from their baby at any time. They may pay more in hospital co-pays and deductibles for maternity care than they would for a home birth. They recognize that for most healthy women, birth is a life event—not a medical one.
According to Kimball, COVID has increased the desirability of home birthing. She says that pregnant women may now feel more uneasy during their prenatal care, with the heightened focus on COVID protocols when consulting with their healthcare provider. They may not want to get tested for COVID in the hospital, and have to wear a mask during labor and delivery. They may not like the idea of keeping that mask on during their postpartum hospital stay, creating an artificial barrier to bonding with their baby. They may not want their newborn exposed to hospital germs, including COVID.
Prior to the pandemic, interest in out-of-hospital births was growing in the US. It is estimated that about 62,000 of the roughly 4 million US births in 2017 occurred at home or in a freestanding birth center, and the number of US out-of-hospital births increased by almost 80% between 2004 and 2017.
This rise in home births may be at least a partial reaction to the country’s dismal hospital birth record. Despite significant spending, the US has some of the highest rates of maternal mortality and morbidity of any industrialized country, especially among women of color. A 2018 USA Today investigative report concluded that “the U.S. is the most dangerous place to give birth in the developed world.”
A planned home birth with an experienced midwife, on the other hand, can be both safe and rewarding. According to a 2021 study published in Frontiers of Sociology about the rise in home births since the start of COVID, laboring women “have been continually achieving safe outcomes in private homes and freestanding birth centers with the assistance of midwives in the United States and abroad…COVID-19 has disrupted the perspective of actual safety because staying at home offers better protection from the pandemic for childbearers than sharing a hospital with disease-stricken patients.”
New hospital COVID policies may also inadvertently drive more women toward home birthing in the months ahead. For instance, FEE’s Jon Miltimore wrote recently about a hospital in upstate New York that announced a “pause” in its labor and delivery services this month due to so many of its nurses and other healthcare workers quitting over COVID-19 vaccine mandates. Some of those expecting mothers may choose to consider a home birth instead, particularly in light of recent efforts to expand home birth access in the state. Former New York Governor Andrew Cuomo signed an executive order in 2020 to allow Certified Professional Midwives to practice midwifery in the state to help alleviate the burden on hospitals due to the pandemic, but that order expired in June. Advocates have since tapped the state legislature to support the role of home birth midwives in the state.
Until the recent COVID-related executive order, Certified Professional Midwives were forbidden to attend births in New York, and some longtime home birth midwives have been arrested there for delivering babies. One of the highest profile arrests was that of Elizabeth Catlin, a midwife who has been attending home births in New York for decades, particularly in the state’s rural Mennonite community. In 2018, she was arrested and charged with 95 felony accounts for being an unlicensed midwife. Catlin is a Certified Professional Midwife, a credential recognized in 30 states but not in New York until the 2020 COVID-related executive order. Last week, Catlin agreed to a plea deal that dropped 94 of the charges against her and left her pleading guilty to one charge of practicing midwifery without a license. She will be sentenced in December.
COVID has disrupted many previously entrenched sectors, from education to healthcare. Frustrated by COVID policies in schools or fearful of virus spread, more families have shifted away from institutionalized learning and toward schooling alternatives, such as homeschooling. Similarly, more expecting parents frustrated by hospital COVID policies or fearful of the virus are turning away from an institutionalized birth toward home birthing and other out-of-hospital birth options.
Restrictive institutional policies in both education and healthcare are accelerating the growth and popularity of more decentralized choices in these sectors. Continued loosening of occupational licensing requirements, such as those impacting New York’s midwives, along with ongoing deregulation in healthcare and education, will expand choice and opportunity for parents—from where they give birth to how their children learn.