More women opt for home births despite high costs

The vast majority of children in the United States are born in a hospital, but the number of planned home births has gone up significantly in the past few years. At the root of this growing trend is the desire for pregnant women to have their voices heard, but that does not mean home births are accessible to everyone.

Taking back control

Compared to the number of hospital births in the United States, home births are still relatively low. Still, over the past seven years the rate of planned home births has increased by 60% to nearly 2% of all births. The number of home births reached 46,918 in 2023, the highest in three decades and up from 29,592 in 2016, according to a recent analysis published in the Journal of Perinatal Medicine. 

The trend "positions the US as the leading developed country in terms of home birth prevalence," the analysis' authors said. While home births are trending upward in general, Black American women have had the most significant growth. Between 2019 and 2020, the number of Black women having home births went up 36%, according to data from the U.S. Centers for Disease Control and Prevention.

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The analysts found that much of the rise "stems from women's desire to take back control over their births," said National Geographic. Others want to avoid unnecessary medical interventions or Cesarean section, the Journal of Perinatal Medicine review said. The Covid-19 pandemic also "heightened fears of illnesses that can be contracted in the hospital," National Geographic added. For Black women in particular, a home birth could be a welcome alternative in a country where they are three times more likely to die during childbirth than white women.

For many, the fear of mistreatment by medical professionals outweighs worries they might have about the risks of giving birth outside a hospital. The CDC found that mistreatment during maternity care is so prominent that roughly 20% of women reported experiencing it. Looking at the data from a racial perspective paints an even bleaker picture. Around 30% of Black, Hispanic and multiracial women reported feeling disrespected while receiving maternal care, including being scolded or yelled at or having their requests for help ignored, compared to 19% of white women experiencing the same treatment.

Some Black women who deliver at home seek a Black midwife or doula for added comfort, Laurel Gourrier, a doula and co-host of the podcast Birth Stories in Color, said to National Geographic. Taking the lead in their birth plan is "strengthened by a support team that has a similar lived experience, in a space they have curated and cared for," Gourrier said.

An expensive barrier to home birth

Home births may be more popular, but the cost can be a barrier depending on the state and whether a mother has insurance. On average, home births can cost about $4,650, according to one study, but the price varies and can be much higher. Some insurers cover some of the costs of home birth, but many do not have midwives in their network. Medicaid covers 40% of births nationally, but it only covers home births in about half the states.

Having a home birth was "fun, slightly chaotic, euphoric and tough," new mother Asia Dessert said to National Geographic. She was able to finance her $7,000 home birth with the help of a nonprofit called The Victoria Project. And while she hopes to inspire her friends to follow suit, "homebirth is inaccessible to most people I know because of the money."

In a northwest Iowa birth center where the demand for services has spiked, most of the women seeking a home birth are "white, insured and well-informed," according to Kari Ney, a certified nurse midwife and a member of the Midwifery Care Team at Promise Community Health Center in Sioux Center. A home birth would be preferable for many of her Spanish-speaking and Latino patients, but many of them are insured through Medicaid, which does not cover home births in the state. "Even at our lowest nominal fee that we have — which is like $500 — it's still a barrier," Ney said. The services are too expensive for the uninsured, so "the majority of our clients are the insured population."