When I was growing up I loved babies - but it wasn’t until I got older and began reading about pregnancy and childbirth that I realized that women still have home births. I started to wonder if I could have a natural birth... at home! When I got pregnant with my first baby, I researched everything I could on birth and baby - including how to have a home birth.
A natural birth at home is a safe, gentle option for many mams. Knowing what it involves, who can have a home birth (and who can’t), and risks vs. benefits helps you decide if giving birth at home is for you. Next, choose a care provider and prepare your home, family, and body for labor! Plan how to handle labor pain and enjoy postpartum at home... and you’re ready!
As I discovered while pregnant with my first baby, women do still give birth at home - in fact, it’s becoming more popular. I went on to have all eight of my babies at home!
Here’s essential information and my top tips for a smooth home birth:
Essential Information On Home Birth
Home birth is becoming more and more popular. There are two main options for giving birth outside of a hospital: a free-standing birth center and birthing at home. While some women give birth at someone else’s home, most women who choose home birth do so in their own home.
Some believe that a home birth means a “DIY” or “do it yourself” birth, but that’s not usually the case. Some women do choose unassisted birth. But most women want an attendant and choose a skilled midwife or a doctor who attends home births to assist them.
Who Can Have a Home Birth?
I’ll be honest - this section is misleading because ultimately there are no hard and fast rules about who “can” and “can’t” give birth at home. It comes down to understanding home birth benefits and potential risks and deciding which option is right for you.
Here are general guidelines for choosing a home birth:
Who Can’t Have a Home Birth?
As I said above, there are no clear-cut rules on who “can’t” have a home birth. There are risk factors that may weigh against a home birth, but some skilled providers may feel comfortable attending you at home.
The American College of Obstetricians and Gynecologists gives recommendations for women who should not have a home birth as:
Additionally, some providers recommend against home birth for women with:
If you have risk factors or complications but still want to birth at home, I recommend discussing your unique situation with a skilled provider.
Dr. Stuart Fischbein talks about birthing choices and women’s rights during one of my Natural Birth and Baby Summit sessions - including how moms with multiples or who are planning a VBAC can decide if home birth is right for them. Click here to access the summit.
What Are the Risks of Home Birth?
Ultimately, home birth is safe because birth, especially undisturbed birth with high levels protective hormones, is safe.
Having said that, birth always comes with risks (just as most of life comes with risks). Birthing at home does mean you’re away from the hospital - some immediate interventions are not available to you:
Often the “decision to incision” time frame for cesarean section in the hospital is about the same as a home birth transfer (30 minutes).
The results I noted about correlation between home birth and neonatal death do not always play out. In areas with integrated care between home birth and need for transfer, baby outcomes are often better.
Additionally, home birth outcomes are often skewed by including unplanned home births in the results (in other words, premature deliveries at home, situations where the baby came before someone could get to the hospital, etc.).
Maternal - or mother - outcomes are generally always better at home, but it’s worth understanding studies on safety. Rebecca Dekker has a good webinar replay available on her site covering this topic.
A skilled care provider generally carries equipment for many possible complications, including resuscitation equipment for the baby and medications for excessive bleeding. Attendants can certify in neonatal resuscitation and transfer and train in handling situations like bleeding, shoulder dystocia, and more. Talk to your care provider to find out her skills, training, and protocols.
What are the Benefits of Home Birth?
Home birth has many benefits to mother and baby:
Remember - with a home birth you get to make the choices. For example, even though I birthed all my babies at home, I wanted a quiet, private birth experience. We even let my kids sleep through births (though they could generally come in if they woke up while I was in labor).
You get to choose what you want with your birth. And, if you choose to birth with a skilled midwife or doctor, you can have a birth professional present at your birth. I don’t believe that you must have an attendant and I support women choosing unassisted birth - however, if you want an attendant you can choose someone you feel comfortable with.
If you need certain interventions, like labor augmentation (Pitocin) or if you decide you want pain medications, you’ll have to transfer.
However, as we’ve seen from countries with more integrated health systems than the US (for example, the United Kingdom and Canada), transfer from home to hospital is part of a “normal” system and works very well.
When you have a skilled attendant and good provider-hospital relationships, a transfer goes smoothly and outcomes are often very good for mother and baby.
Even with the best birthing care, we know that some women need to transfer and some will need cesarean sections. A rate of around 5% is recommended, and we’ve seen that rate or lower in places like The Farm that had very strong, comprehensive midwifery care and skilled birthing families.
Because of that, transfers should be expected for a small percentage of women, and care open and comprehensive.
It’s okay if you need to transfer. And it’s okay if you’re disappointed! Of course you feel many different emotions. You can work through the experience knowing that sometimes transfers need to happen - they are supposed to be part of a healthy homebirth system.
That doesn’t always make it easier, but often the feeling of control and respect that you feel from your birth team as you decide to transfer will be empowering and ultimately helpful you.
Choosing Your Home Birth Care Provider
Your choices for a home birth care provider include doctors and midwives. Or, you can choose unassisted birth. Some women want to have a doula at their home birth for continuous labor support.
Most doctors don’t attend home births, but there are doctors who do. Some women like having a doctor on the birth team when planning a home birth after cesarean (HBAC) - or when they’re expecting multiples.
The majority of home birth attendants are midwives - some are certified by various bodies and have a formal education. Others have used an apprenticeship model and may choose not to get licensed or certified.
I’ve worked with midwives who have been attending births for decades with good outcomes who choose not to license - many midwives today are moving towards licensure. Talk to you midwife about her certifications, licenses, and training.
Ask her how she handles various situations. Ask her for her statistics. What continuing education does she complete regularly? Neonatal resuscitation and basic CPR training is done every two years. Midwives can also do continuing education on a variety of topics. Talk to your midwife about all of these things, ask for any certifications or licenses that may feel important to you, and make a decision from there.
Prenatal care for a home birth is often very different from hospital care. You won’t be offered all of the same tests (though you can generally have them done, if you desire). And your appointments will be longer and much more thorough.
Your physical health is assessed, as is your baby’s health and position. Your midwife will also talk to you extensively about diet and about your mental and emotional well-being.
She’ll talk to you about how you’re feeling about birth, how your natural childbirth classes are going, and help you talk through fears and anxieties.
She’ll also likely talk through postpartum issues so you’re prepared for a safe, healthy, and well-nourished postpartum!
Paying for Your Home Birth
Some home birth midwives don’t take medical insurance. These midwives often have payment plans and can be flexible with what you can do to pay for the baby’s birth.
Additionally, a sliding scale fee may be available to low-income clients. Some midwives also accept barters in exchange for births. I’ve heard of midwives getting fresh garden produce, hand-crafted furniture, and cozy quilts in exchange for attending a birth!
If money is a real issue for your home birth plans, don’t hesitate to talk frankly with the midwife you’re considering.
Preparing Your Home
Aside from holding my baby in my arms, this is one of the most fun parts of having a home birth!
Truthfully, you don’t have to do much to prepare for a home birth. Your home is good enough regardless of what it looks like!
However, I’ve attended a lot of births at this point and I’ve seen homes in a lot of different conditions. The mamas who have the most peaceful postpartum periods have generally spent some time before their baby’s birth de-cluttering and tidying up the home - even if it’s a tiny home <3
You can also do some planning before your baby’s birth to create a nice environment for birthing. Plan out a few playlists with peaceful or inspiring music.
Think about what kind of lighting you’d like. Low lights are usually good.
You can also consider scents - sometimes women get very sensitive to smell during labor, so any scent you choose should be something easy to move away if you decide you don’t like it.
Also plan to have healthy foods on hand. Good labor foods include:
Any food you like is a good option to have on hand, but these choices can provide quick energy during birth - which might be needed. Many home birth transfers happen when a mama just runs out of energy. That’s why resting during early labor, staying hydrated, and eating periodically is so important.
Keep the cupboards and refrigerator well-stocked overall at the end of your pregnancy - you want to have plenty to eat once baby arrives. You’ll be ravenously hungry!
Some women also like to decorate the area they’re birthing in. Inspiring birth quotes, affirmation cards, beautiful pictures, colorful scarves, etc.
Gather all of your birthing, postpartum, and baby supplies together in one place so they’ll be on hand when you need them 🙂
If you’re planning a water birth, choose where you’ll set up the tub. Have the tub on hand by around 36 weeks or so (often your midwives bring it when they come for the home visit at that point in pregnancy).
Also check to make sure you have everything you need for the tub, including hoses and connectors. My husband ended up filling the tub with buckets during not one, but two of our babies’ births!
Preparing Your Family
Many families choose to have home births because they want things to be a family affair!
You don’t have to go with that option - older children can go to grandma’s or the neighbor’s house if that’s what you feel more comfortable with.
But you can also do a lot to prepare your children for your new baby’s birth. If you have only very young older children, I recommend you have someone at the birth who is there only for them (your husband is going to be focused on you). Sometimes your birth team might have enough people to help with the children.
For my second birth I had a friend watch my oldest. For my third birth, my midwife had two attendants and one of them kept an eye on the older two. My children slept through babies #4 and #5 - and by the time #6 came along, my oldest kept everyone else settled quietly to watch his arrival. Everyone slept through #7, and #8 was again a sweet, quiet family affair.
I share my experiences just to show you that home birth can look very different. Baby #7 was a delightful, intimate birth for my husband and for me - but #6 and #8 with everyone there was also a lot of fun (and the pictures are priceless!).
You can click here to read all of my babies’ birth stories - they’re at the top of the page!
I always talked to my children about how babies were born - where they came from out of Mama’s body (the birth canal, down between the legs). I also talked to them about noises that mamas make when birthing babies - “mooing like a cow” or “roaring like a lion.” I let them watch some gentle birth videos, usually videos featuring siblings at births.
Please do take a natural childbirth class with your husband - that way both of you feel prepared for the big day 😉
Preparing Your Body
A safe, smooth home birth begins long before your baby’s birth.
Going into labor strong, healthy, and well-nourished greatly increases the chances of a successful birth for both of you. Just as athletes train and eat well before they perform, you should too!
Eat a nourishing pregnancy diet and get in lots of daily movement - plenty of protein and daily walks are a good way to start.
You should also go through natural childbirth classes. A good natural childbirth class will teach you everything you need to know about prenatal diet, exercise, and movement.
It also teaches you how to prepare for childbirth - preparing your body for birthing, different labor positions, handling contractions and pain naturally, and more.
A good class gives you techniques to use during pregnancy to minimize tearing and other pelvic floor problems, too.
It’s Go Time!
You think “this is it…
…I’m finally going to meet my baby!”
Contractions have started and feel like they may keep going - maybe they’ve developed a bit of an “edge” that the practice contractions you had during pregnancy didn’t have.
Now is a great time to check all your supplies - make sure everything is gathered together and you feel comfortable and prepared (at least as prepared as you’ll ever be 😉 ).
…go about your normal day! Early labor is time to rest, relax, and enjoy the last few hours of being pregnant. Go through your normal day - eat normally, take gentle walks or do your pregnancy exercise routine, and nap here and there.
If it’s nighttime, go through your normal bedtime routine and try to sleep!
This strategy keeps you well-fed and well-rested as you prepare for active labor. Some level of activity (like walking, your prenatal routine, light housework, etc.) also helps you keep baby well-positioned and encourages labor to get going. You can also safely make love at this time (if that feels good to you) and shower. If your water hasn’t broken, you can get in the bath.
Don’t fill up the birthing tub too early. If you’re not sure if you should or not, call your midwife and ask her thoughts. While it’s true that it takes a long time to fill a birthing tub (usually a couple of hours because you have to wait on the hot water heater to refill), you also don’t want to have the tub sitting around for a long time while you get to the point where you’re ready to get in.
Here’s a good rule of thumb: once labor is really active and you’re having to stop everything to work with your contractions, go ahead and fill the tub. If this is not your first baby and you tend to have fast labors, fill it as soon as you think labor is starting.
Call the Midwife!
If you have a midwife or doctor attending your home birth, call as soon as you think “this is it.” You may not need them to come out right away, but your care provider appreciates the notice. They may need to reschedule appointments, arrange childcare, etc.
Your midwife can also listen to your contractions over the phone and get an idea of where you are in labor just by listening to you! Don’t be afraid to ask questions, share concerns and fears, etc. When you call.
Sometimes you may not feel sure if you should call or not, but your husband might think, “it’s time to call!” I’ll admit that I’m always wishy-washy in labor… never quite sure if I should call. My husband always knows, though - so he has been the one to make the call every time! Often, trusting dad intuition is a good thing!
You can use the same rule of thumb as a mama going to the hospital - it’s probably team for your birth team to be on the way when you hit the “4-1-1” rule. Contractions are 4 minutes apart (from peak to peak), lasting about 1 minute, and this has been the case for 1 hour. If this is your second or later baby, use the 5-1-1 rule… contractions 5 minutes apart (I recommend you call your midwife as soon as you know things are moving along).
Labor Pain During a Home Birth
A huge difference between home and hospital is there’s no pain medication! You have to handle things naturally.
This is where your childbirth education class and other preparation comes in handy (I enjoy reading birth stories before each of my babies’ births - I like hearing how other mamas handled their birthing time). Use the techniques that you’ve learned during your class.
A key in early labor is not to wear yourself out. Things will get more intense. If you don’t need to stop and breath through contractions, you don’t have to do that. Just go about your normal day. If you can doze through contractions, take a nap!
This is all about conserving energy and establishing a good labor pattern.
Once things get more intense, causing you to need to stop and work with the contractions, find what works for you.
If you can do it, I recommend you choose an upright position where you can sway your hips. Find a firm surface, such as a sturdy table or the counter in your kitchen or bathroom. Bathroom counters are often slightly lower so are a good choice. I leaned into a sturdy cat tree during one of my labors :p
Lean into the counter or table during the contraction, swaying your hips and breathing through the energy of the contraction.
Once the contraction ends, you can resume your day.
A birth ball is another good choice because it offers you a comfortable place to sit along with the ability to rock back and forth or spiral your hips. A towel draped over the ball can make it more comfortable for you.
Once you get to the point where you cannot sleep through contractions, or lie down through them, or they’re taking all your attention and coming frequently, it’s active labor.
Use breathing techniques to help prepare once you feel a contraction beginning, then breathe through the contraction. Continue using breath to relax and clear the energy once the contraction ends, then rest. Click here to read more about natural birth breathing techniques.
The time between active labor contractions is a time to rest, change positions, go to the bathroom, or have a bite to eat for some quick energy.
As you get deeper into labor, this time between contractions is also when you might feel what I like to call the “labor land” feeling - it’s a lot like the time when you’re falling asleep but you’re not quite asleep (the time when lucid dreaming might happen).
A contraction beginning brings you back to awareness - really you snap into alertness. Once it ebbs away, you go back to that place. This is the time women describe as feeling “connected to all other birthing women” or particularly connected to their babies.
Even if contractions are very intense, this is a good period of time to close your eyes and really rest because it helps restore you for the next one.
The period between contractions generally shortens, even disappearing completely so that things feel “right on top of each other” during transition. Click here to read my full blog post on how to get through transition during a natural birth.
You may start shivering as your baby’s birth gets closer. This isn’t because you’re cold - rather it’s an indication of birth hormone levels peaking (especially adrenaline). Some women shiver and others do not.
Once you get through transition and into the second stage, things space out again and you can rest between pushing contractions. This is a good time to have a couple of quick bites of something sugary (fresh fruit, honey, or maple syrup are good options) to give you energy for pushing.
Home Run: Pushing Baby Out!
Your birth team has been quietly busy getting your birthing supplies set out and ready. They’ll have blue pads (”chux pads”) put down to help protect your floors. They’ll also get your bed ready so your mattress stays clean. If you’re birthing in the tub, they’ll have towels on hand to catch drips and to get you and baby dry and cozy as soon as you get out of the tub.
If you’re birthing unassisted, have blue pads and towels in a basket so they can be carried to whatever room you end up birthing in. Blue pads protect floors very effectively and can simply be thrown away after baby arrives. Towels can catch drips and help keep you and baby cozy.
Have hydrogen peroxide on hand - it takes out almost all blood stains if something drips on the floor. Add it right to the washing machine to clean towels or bedding.
You direct pushing during a home birth, but your midwife or doctor can help guide you if you feel unsure of how to push - I know that I needed some guidance with my first baby!
Being in control during pushing is one of the best parts of home birth! I chose to “catch” and bring up my own babies from my fourth baby onward, and it’s something I treasure about each of their births (click here to read their birth stories). You don’t have to do this - your midwife can catch, Daddy can catch if you’d like, etc. - but it can be a really powerful experience as a mama.
It’s also possible not to “catch” your baby. If you’re birthing while kneeling or in a low squat, your baby can slip right out onto the bed or a pile of soft towels. When mamas birth undisturbed, this is often what they do. Mother and baby both take a moment to breathe, then mothers examine their babies and bring them up into their arms.
Pushing may go quickly or may take longer - generally it’s longer of a first-time mama, and you may need to actively push. But you won’t have to push in a forced, coached position.
You’re also free to change positions to one that helps bring your baby down, if needed or desired (standing, hands-and-knees, and squatting are all good positions).
Gentle, mother-directed pushing helps reduce chances of tearing - and with a home birth you don’t need to worry about an episiotomy!
Postpartum at Home
Your birth team will get you and baby comfortable and check over both of you to make sure everyone is healthy and stable. They do frequent checks in the immediate postpartum - and give you, baby, and Daddy some time to bond quietly after the initial excitement of birth!
Your birth team also makes you something to eat - you’ll be ravenous and need energy after pushing your baby out!
A birth team usually stays for a few hours after birth, doing a newborn exam before they leave. This is a full exam of your newborn baby and checks for many health markers.
Your team will return the next day, and then generally every couple of days for the first week. They’ll check your baby and you (especially your uterus and bottom). They also help with breastfeeding and answer any questions you have.
If you have any concerns at all, call your care provider. She’ll listen to your concerns and talk things through with you, and can come out to the house if you’re worried.
Call if you have any emotional concerns, too - your midwife wants to help you feel comfortable, calm, and happy during your initial postpartum!
How do you have a natural birth at home? Childbirth is supposed to work - and generally it does! Staying healthy and active throughout your pregnancy gives you a great chance at a smooth birth. You boost your chances dramatically when you get educated about how birth works - and you prepare to handle labor at home. A good natural childbirth class covers all of this and gives you a great chance at a natural birth at home.
Can I give birth at home without a midwife? Yes, this is called “unassisted childbirth” or “free birth.” Some women choose unassisted childbirth because they cannot find a midwife, but most women choose to birth without an attendant because it’s important to them. Understand how birth works and how to keep yourself healthy during pregnancy and postpartum. Preparation for an unassisted birth is a journey. Laura Shanley talked about how to do this during one of my Natural Birth and Baby Summit sessions - check that out here.
Is it safe to give birth at home? Home birth is safe for most mothers and babies. There are some women who should not birth at home, as I outline above. However, a healthy, well-nourished mom who is prepared for labor and birth can generally have her baby at home without complications. A skilled care provider can help watch over you and your baby - your homebirth midwife or doctor knows how to watch for complications and can assist you and your baby if needed.