home birth home birth a home birth is a birth that takes place in a residence rather than in a hospital or a birthing center. they may be attended by a midwife, or lay attendant with experience in managing home births. home birth was, until the advent of modern medicine, the de facto method of delivery. the term was coined in the middle of the 19th century as births began to take place in hospitals. homebirth multiple studies have been performed concerning the safety of home births for both the child and the mother. standard practices, licensing requirements and access to emergency hospital care differ between regions making it difficult to compare studies across national borders. a 2014 us survey of medical studies found that perinatal mortality rates were triple that of hospital births, and a us nationwide study over 13 million births on a 3-year span (2007–2010) found that births at home were roughly 10 times as likely to be stillborn (14 times in first-born babies) and almost four times as likely to have neonatal seizures or serious neurological dysfunction when compared to babies born in hospitals, while a 2007 uk survey found that perinatal mortality rates were only slightly higher in that country than planned hospital births for low-risk pregnancies. higher maternal and infant mortality rates are associated with the inability to offer timely assistance to mothers with emergency procedures in case of complications during labour, as well as with widely varying licensing and training standards for birth attendants between different states and countries. etymology the word combination "home birth" arose some time in the middle of the 19th century and coincided with the rise of births that took place in lying-in hospitals. since women around the world left homes to give birth in clinics and hospitals as the 20th century progressed, the term "home birth" came to refer to giving birth, intentionally or otherwise, in a residence as opposed to a hospital. history and philosophy although the fact humans give birth is universal, the social nature of birth is not. where, with whom, how, and when someone gives birth is socially and culturally determined. historically, birth has been a social event. for the most of humankind history of birth is equivalent to history of home birth. the hypothesis exists that birth was transformed from a solitary to social event early in human evolution. traditionally and historically, other women assisted women in childbirth. a special term evolved in the english language around 1300 to name women who made assistance in childbirth their vocation – midwife, literally meaning "with woman". however, midwife was a description of a social role of a woman who was "with woman" in childbirth to mediate social arrangements for woman's bodily experience of birth. birthing on country birthing on country is a traditional birthing practice that constitutes giving birth on the land where the mother was born as well as her ancestors. it is a culturally appropriate practice that coincides with spiritual tradition. it offers support to women and their families by continuing the birthing process in the community among the women and children. it is largely practiced by aboriginal women, in countries such as australia, canada, new zealand and the united states. the belief is that if a child is not born on country they lose their connection to the land and their community. birthing on country can happen in rural areas as well as birthing in cities. in australia in the northern territory of australia, the prescribed steps advocated by the government is that, in rural areas, a woman at 37 weeks gestation must leave "country" and fly to the nearest city. if an adult, she flies alone with no family members. she will wait in accommodations until she goes into labour. after birth she and the baby are flown back to "country". types home births are either attended or unattended, planned or unplanned. women are attended when they are assisted through labor and birth by a professional, usually a midwife, and rarely a general practitioner. women who are unassisted or only attended by a lay person, perhaps a doula, their spouse, family, friend, or a non-professional birth attendant, are sometimes called freebirths. a "planned" home birth is a birth that occurs at home by intention. an "unplanned" home birth is one that occurs at home by necessity but not with intention. reasons for unplanned home births include inability to travel to the hospital or birthing center due to conditions outside the control of the mother such as weather or road blockages or speed of birth progression. american home birth factors many women choose home birth because delivering a baby in familiar surroundings is important to them. others choose home birth because they dislike a hospital or birthing center environment, do not like a medically centered birthing experience, are concerned about exposing the infant to hospital-borne pathogens, or dislike the presence of strangers at the birth. others prefer home birth because they feel it is more natural and less stressful.: 8 in a study published in the journal of midwifery and women's health, women were asked why they chose a home birth; the top five reasons given were safety, avoidance of unnecessary medical interventions common in hospital births, previous negative hospital experiences, more control, and a comfortable and familiar environment. one study found that women experience pain inherent in birth differently, and less negatively, in a home setting. cost is also a factor. the estimated average cost of a home birth in the united states in 2021 was $4,650, compared with $13,562 for a vaginal hospital birth. in developing countries, where women may not be able to afford medical care or it may not be accessible to them, a home birth may be the only option available, and the woman may or may not be assisted by a professional attendant of any kind. some women may not be able to have a safe birth at home, even with highly trained midwives. there are some medical conditions that can prevent a woman from qualifying for a home birth. these often include heart disease, renal disease, diabetes, preeclampsia, placenta previa, placenta abruption, antepartum hemorrhage after 20 weeks gestation, and active genital herpes. prior cesarean deliveries can sometimes prevent a woman from qualifying for a home birth, though not always. it is important that a woman and her health care provider discuss the individual health risks prior to planning a home birth. trends home birth was, until the advent of modern medicine, the de facto method of delivery. in many developed countries, home birth declined rapidly over the 20th century. in the united states there was a large shift towards hospital births beginning around 1900, when close to 100% of births were at home. rates of home births fell to 50% in 1938 and to fewer than 1% in 1955. however, between 2004 and 2009, the number of home births in the united states rose by 41%. in the united kingdom a similar but slower trend happened with approximately 80% of births occurring at home in the 1920s and only 1% in 1991. in japan the change in birth location happened much later, but much faster: home birth was at 95% in 1950, but only 1.2% in 1975. in countries such as the netherlands, where home births have been a regular part of the maternity system, the rate for home births is 20% in 2014. over a similar time period, maternal mortality during childbirth fell during 1900 to 1997 from 6–9 deaths per thousand to 0.077 deaths per thousand, while the infant mortality rate dropped between 1915 and 1997 from around 100 deaths per thousand births to 7.2 deaths per thousand. one doctor described birth in a working-class home in the 1920s: you find a bed that has been slept on by the husband, wife and one or two children; it has frequently been soaked with urine, the sheets are dirty, and the patient's garments are soiled, she has not had a bath. instead of sterile dressings you have a few old rags or the discharges are allowed to soak into a nightdress which is not changed for days.: p156 this experience is contrasted with a 1920s hospital birth by adolf weber: the mother lies in a well-aired disinfected room, light and sunlight stream unhindered through a high window and you can make it light as day electrically too. she is well bathed and freshly clothed on linen sheets of blinding whiteness... you have a staff of assistants who respond to every signal... only those who have to repair a perineum in a cottar's house in a cottar's bed with the poor light and help at hand can realize the joy.: 157 midwifery, the practice supporting a natural approach to birth, enjoyed a revival in the united states during the 1970s. ina may gaskin, for example, sometimes called "the mother of authentic midwifery" helped open the farm midwifery center in summertown, tennessee, in 1971, which is still in operation. a movement termed 'pushing for midwives' intensified during the 1990s and early 2000s in the united states, when the public organized to request legislation that would formally legalize midwifery a consumable service. however, although there was a steep increase in midwife-attended births between 1975 and 2002 (from less than 1.0% to 8.1%), most of these births occurred in the hospital. the us rate of out-of-hospital birth has remained steady at 1% of all births since 1989, with data from 2007 showing that 27.3% of the home births since 1989 took place in a free-standing birth center and 65.4% in a residence. hence, the actual rate of home birth in the united states remained low (0.65%) over the twenty years prior to 2007. home birth in the united kingdom has also received some press since 2000. there was a movement, most notably in wales, to increase home birth rates to 10% by 2007. between 2005 and 2006, there was an increase of 16% of home birth rates in wales, but by 2007 the total home birth rate was still 3% even in wales (double the national rate). a 2001 report noted that there was a wide range of home birth rates in the uk, with some regions around 1% and others over 20%. in australia, birth at home has fallen steadily over the years and was 0.3% as of 2008, ranging from nearly 1% in the northern territory to 0.1% in queensland.: 20 in 2004, the new zealand rate for births at home was nearly three times australia's with a rate of 2.5% and increasing.: 64 in the netherlands, the trend has been somewhat different from other industrialized countries: while in 1965, two-thirds of dutch births took place at home, that figure has dropped to about 20% in 2013, which is still more than in other industrialized countries. less than 1% of south korean infants are born at home. research on safety in 2019, a meta-analysis examined perinatal and neonatal mortality of planned home birth among low-risk women in well-resourced countries, with research eligible for inclusion encompassing approximately 500,000 intended home births. the study concluded that the risk of perinatal or neonatal mortality was not different when birth was intended at home or in hospital. in 2014, a comprehensive review in the journal of medical ethics of 12 previously published studies encompassing 500,000 planned home births in low-risk women found that neonatal mortality rates for home births were triple those of hospital births. this finding echoes that of the american college of obstetricians and gynecologists. due to a greater risk of perinatal death, the college advises women who are postterm (greater than 42 weeks gestation), carrying twins, or have a breech presentation not to attempt home birth. the journal of medical ethics review additionally found that several studies concluded that home births had a higher risk of failing apgar scores in newborns, as well as a delay in diagnosing hypoxia, acidosis and asphyxia. this contradicts a 2007 uk review study by the national institute for health and clinical excellence (nice), a british governmental organization devoted to creating guidelines for coverage throughout the uk, which expressed concern for the lack of quality evidence in studies comparing the potential risks and benefits of home and hospital birthing environments