Home births in the United States are rare, but on the rise. According to the National Institutes of Health, between 2004 and 2017 (the most recent year stats were available), home births increased 77%; that means one out of every 62 births in this country take place outside of a hospital setting.

Many of those home births may be unplanned — think of comedian Seth Meyer's baby, who was born in the lobby of his apartment building since his wife didn't make it to the hospital in time. And while few would choose willingly to do it that way, it's easy to see why some families would plan for a home birth (inside the home or apartment, thank you very much). There's something comforting about the idea of giving birth in familiar surroundings, and not having to worry about coming and going from the hospital — especially now, when the new coronavirus threatens hospitals and staffs. Still, there are big risks involved with home births that need to be considered before one is planned. Here's how to tell if home birth is right for you.

First, find out if you should rule out a planned home birth right off the bat.

All birth decisions should be made thoughtfully with input from both patients and their healthcare team. "Anyone with a pregnancy complication or a medical condition during pregnancy should have an honest discussion with their provider about the risks and benefits of home birth in their particular situation," says Rachel Urrutia, MD, assistant professor of general obstetrics and gynecology in the UNC School of Medicine. But it's also helpful to know that there are some risk factors that make women bad candidates for planned home births from the outset.

According to the American College of Obstetricians and Gynecologists (ACOG), women who are giving birth to multiples, have had prior c-sections, or are managing fetal malpresentation (breach births, etc.) should not consider having a planned home birth.

And then there are certain factors in a woman's medical history that might indicate it'd be better to give birth in a hospital or birthing center. According to Leslie Fehan, MS, CNM, WHNP-BC, a certified nurse-midwife at VCU Health, women who have medical conditions who are not well controlled should probably consider other options first.

These include infections like HIV or hepatitis, psychiatric conditions, cardiac disease, diabetes epilepsy, hypertension, diabetes, and thromboembolic disease, along with a history of stillbirth, postpartum hemorrhage, or babies getting stuck during a previous vaginal birth. She also recommends heading to a hospital or birthing center if the baby has a condition that requires close monitoring, such as a birth defect, abnormal growth rate, premature labor, or problems with the amniotic fluid.

Home birth also presents certain risks to newborns and mothers.

ACOG recommends that every woman considering home birth be aware of an alarming statistic: "Although planned home birth is associated with fewer maternal interventions than planned hospital birth," the organization writes in its committee opinion on home birth, "it also is associated with a more than twofold increased risk of perinatal death, and a threefold increased risk of neonatal seizures or serious neurologic dysfunction." The organization admits that these risks can be somewhat mitigated if the patient works with a certified nurse-midwife and has ready access to a hospital if things go wrong.

The American Academy of Pediatrics (AAP) concurs with ACOG's opinion that hospitals and birthing centers are the safest place to give birth. "Infants born at home are cared for outside the safeguards of the systems-based protocols required of hospitals and birthing centers," it says. "This situation places a larger burden on individual health care providers to remember and carry out all components of assessment and care of the newborn infant." This includes procedures that are automatically done to all newborns in hospitals, like monitoring for strep, glucose screening, and administering eye drops to ward off conjunctivitis, among others.

Plus, there's always a chance that something could go wrong that would require a mom or baby to be transferred to a hospital. "For a healthy woman, the risk of a complication in labor or birth is small, but it does exist," Fehan says. "Babies can be intolerant of labor and need to be born quickly. When babies are stressed at birth, mothers can hemorrhage and lose a lot of blood very quickly."

And with the percentage of women giving birth at home being so small, the transfer to the hospital doesn't always go so smoothly — the United States just doesn't have the infrastructure in place to support home births. "Here, the relationship between home birth attendants and hospitals and hospital birth attendants is complicated and strained, which might be expected to cause a higher risk of adverse outcomes," Dr. Urrutia says.

There are other, less dire reasons for women to be transferred to a hospital during a home birth, such as pain management or stalled labor. This may be a disappointment for expectant mothers who had their heart set on giving birth naturally at home.

Women who have home births enjoy having control over their environment.

So, with all of these downsides, why would an expectant mother choose home birth? For healthy women who have given birth at home, the situation offers many advantages. "From what we know," Dr. Urrutia says, "advantages of a home birth include a lower chance of medical interventions, higher satisfaction levels with the birth, and a higher level of control with the birth process and who can be present, plus possibly less of an infectious disease risk — which has not been studied or proven — possibly higher rates of breastfeeding, and possibly lower rates of hemorrhage and perineal lacerations."

The higher level of satisfaction may have to do with the fact that families have greater control over home births. "Home is a protected space," Fehan says. "Women are surrounded by familiar things and people in the comfort of their own home. They don't have to move from one place to another — the care provider comes to them. No one would be involved in their care they didn’t invite in." Plus, there's a convenience factor in not worrying about who is will drive to the hospital, who has the car seats to take the infants home, and so on.

There are lots of myths about home birth that confuse what it actually is.

From the level of pain to how it's cleaned up, there are a few persistent misconceptions about what home birth actually entails.

A home isn't sterile enough to give birth in. You actually don't need it to be. "Birth is not a sterile process," Dr. Urrutia says. You need clean surfaces to give birth on, clean linens, and sterile supplies to cut the umbilical cord or repair the perineum, but you don't need the entire house to be sterilized.

Home birth hurts less (or more) than a hospital birth. Childbirth hurts, no matter where it happens. Hospitals have pain management tools like epidurals, but moms may feel more comfortable laboring at home in familiar surroundings. It's a matter of personal preference.

Home births are messy and always involve inflatable pools. There's definitely an image of home birth involving lots of fluids. In practice, you can give birth in your bed, and the clean up isn't all that intense. "Just like any birth, paper chux pads are used to capture blood and fluids," Fehan says. "Usually at home, the bed is covered with a shower curtain and a sheet on top. These can either be cleaned or discarded."

There's also a cost associated with a home birth.

Like anything that's healthcare-related in this country, the cost of a home birth isn't cut-and-dried. "Some insurance can cover providers that are in-network, or else there is a fee-for-service option," Fehan says. "There are many variations throughout the country dependent on provider type: physician, certified nurse midwife, certified professional midwife, and so on. Insurance coverage varies by provider, and varies state to state."

But don't expect a big check from your insurance company. "In most states, insurance does not cover home births," Dr. Urrutia says. "However, the total costs would likely be lower than those for a typical hospital birth. That being said, if a hospital transfer is needed, additional costs will occur from that."

The new coronavirus shouldn't be the reason to decide on home birth.

COVID-19 is a huge concern, and either the fear of picking up the virus at a hospital or the worry that a hospital might prevent a partner from missing birth might cause an expectant mother to choose to birth at home instead. This is a mistake.

"Do not make this decision out of fear of coronavirus," Dr. Urrutia says. "Make an informed decision about what is best for your family. The risks of contracting COVID-19 in the hospital appear to be quite low given the precautions that we've all put in place. We are all working on minimizing the number of people in the hospital and in your room and are working very carefully to separate sick people from those who are well. So far, there have been no reports of people contracting COVID-19 on labor and delivery while giving birth. There is also no proof that birthing at home would reduce the risk of COVID-19."

"Women should only choose home birth if they would have chosen home birth prior to COVID-19," Fehan says. The decision should be made based on your health history, your values, and your ability to make your environment optimal for home birth.

Have the safest home birth possible.

If you're considering a planned home birth even after weighing the risks, there are some ways to make the process safer.

  • Make sure you're a good candidate for home birth, and don't have the risks mentioned above that make home birth inadvisable.
  • Find a properly trained provider. Ask lots of questions, and look into references and training. If you plan on working with a midwife, check for someone certified by the American Midwifery Certification Board.
  • Plan to have two providers attend the birth — one focused on you, and one focused on the newborn — in case both of you become in distress at once.
  • Most importantly, sure there is a plan and a process for a hospital transfer should the need arise.