Home Birth Statistics 2026: Safety and Outcomes

CDC's final natality data counted 55,266 home births in 2023, about 1.5 percent of all U.S. births. The share has climbed for two decades: 0.56 percent of births in 2004, 1.03 percent in 2019, 1.26 percent in 2020, and 1.41 percent in 2021, which NCHS described as the highest level since at least 1990. It reached 1.5 percent in 2022 and held there in 2023.

Rates vary widely by state. In 2023 the highest shares were Idaho at 4.7 percent, Montana at 3.9 percent, and Hawaii at 3.4 percent, with Pennsylvania and Wisconsin both at 3.3 percent. The lowest were Louisiana at 0.3 percent, then Nebraska and New Jersey at 0.5 percent.

Midwives attended 41,220 of the 55,266 home births recorded in 2023. Physicians attended 1,567, and the remainder were recorded under other or unspecified attendants. The safety and outcome statistics in this guide come from studies of planned home births attended by trained midwives, so they do not describe unplanned or unattended home births.

The Hutton 2019 systematic review and meta-analysis in eClinicalMedicine pooled 14 studies covering roughly 500,000 intended home births. Its stated conclusion: the risk of perinatal or neonatal mortality was not different when birth was intended at home or in hospital. Among first-time mothers in settings where home birth midwives are well integrated into health services, the odds ratio for perinatal or neonatal mortality against intended hospital birth was 1.07 (95% CI 0.70 to 1.65). In less integrated settings the estimate was 3.17, with a confidence interval from 0.73 to 13.76 that is too wide to draw a conclusion from.

The largest U.S. cohort is the Midwives Alliance of North America Statistics Project. Cheyney and colleagues analyzed 16,924 planned home births from 2004 to 2009. Excluding lethal congenital anomalies, the intrapartum fetal death rate was 1.30 per 1,000, the early neonatal death rate 0.41 per 1,000, and the late neonatal death rate 0.35 per 1,000. When higher-risk women were removed from the sample (multiple gestation, breech presentation, trial of labor after cesarean, gestational diabetes, or preeclampsia), the intrapartum death rate was 0.85 per 1,000.

The Birthplace in England study followed 64,538 low-risk births. Its composite measure of perinatal death and intrapartum-related newborn illness occurred at a weighted 4.3 per 1,000 births overall. For first-time mothers the rate was 9.3 per 1,000 for planned home birth against 5.3 per 1,000 in an obstetric unit, an adjusted odds ratio of 1.75 (95% CI 1.07 to 2.86). For mothers who had given birth before, there were no significant differences by planned place of birth. Interventions during labor were substantially lower in every non-obstetric-unit setting.

The overall U.S. infant mortality rate was 5.52 deaths per 1,000 live births in 2024. That figure covers all births at every risk level, so it is not a like-for-like comparison with a screened low-risk home birth population.

The companion meta-analysis to Hutton 2019, published by Reitsma and colleagues in 2020, pooled 16 studies covering roughly 500,000 intended home births and looked at maternal outcomes. There were no reported maternal deaths across those studies. Controlling for parity in well-integrated settings, women who began labor intending to give birth at home were less likely than women intending hospital birth to have a cesarean (odds ratio 0.58), an operative vaginal birth (0.42), epidural analgesia (0.30), an episiotomy (0.45), a third or fourth degree tear (0.57), oxytocin augmentation (0.37), or a maternal infection (0.23). For postpartum hemorrhage the pooled result showed intended home birth was either less likely (odds ratio 0.66) or no different, depending on which studies could be pooled together.

In the MANA Stats cohort, 1.2 percent of women who gave birth vaginally had a third or fourth degree perineal laceration and 49.2 percent gave birth over an intact perineum. Blood loss over 500 mL was recorded for 15.5 percent of vaginal births, higher than rates reported elsewhere. The authors flagged their own figure as probably unreliable because it rests on visual estimation of blood loss, and questioned whether 500 mL is the right threshold in a population that rarely receives active management of the third stage. There was one pregnancy-related maternal death in the 16,924-birth sample.

U.S. maternal mortality overall fell from a pandemic-era peak of 32.9 deaths per 100,000 live births in 2021 to 22.3 in 2022, 18.6 in 2023, and 17.9 in 2024. Those are national figures across all births and all risk levels. NCHS does not publish maternal mortality by planned place of birth, so no U.S. home birth maternal mortality rate exists to quote.

Transfer rates depend heavily on parity, meaning whether you have given birth before. In the MANA Stats cohort of 16,924 U.S. planned home births, 89.1 percent of women gave birth at home, an overall intrapartum transfer rate of 10.9 percent. Split by parity, that was 22.9 percent for first-time mothers and 7.5 percent for mothers who had given birth before. The Birthplace in England cohort recorded higher rates for planned home birth: 45.0 percent of first-time mothers and 12.0 percent of mothers who had given birth before were transferred, counting transfers both before and after delivery. First labors are longer and more likely to stall, which is the pattern behind the gap in both datasets.

The documented reasons skew toward labor management rather than emergency. In MANA Stats the single most common reason was failure to progress (752 transfers, 40.7 percent of intrapartum transfers), followed by desire for pain relief (281, 15.2 percent), fetal distress or meconium (185, 10.0 percent), and malpresentation (118, 6.4 percent). In Birthplace in England, 35.1 percent of first-time mothers planning home birth transferred before delivery and 8.9 percent after; for mothers who had given birth before it was 6.4 percent before and 5.2 percent after.

A practiced midwife will be able to give you her own transfer rate broken down by parity, her most common transfer reasons, and her receiving hospital relationships. Ask for those numbers directly rather than working from national averages.

Home birth cohorts record far lower intervention rates. In MANA Stats, 93.6 percent of women had a spontaneous vaginal birth, 1.2 percent an assisted vaginal birth, and 5.2 percent a cesarean, counting transfers that ended in cesarean. Across all U.S. births the cesarean rate was 32.4 percent in 2024, and the low-risk cesarean rate (first birth, single baby, head down, at term) was 26.6 percent in 2023.

Episiotomy was recorded for 1.4 percent of vaginal births in MANA Stats. Only 4.5 percent of the whole MANA sample received oxytocin augmentation, epidural analgesia, or both. CDC recorded augmentation of labor for 20.9 percent of all U.S. births in 2023. Reitsma 2020 put the pooled odds of epidural analgesia at 0.30 for intended home birth against intended hospital birth, and episiotomy at 0.45.

Midwives at home births generally listen to the baby's heartbeat with a handheld doppler or fetoscope at intervals rather than monitoring continuously. National data comparing continuous electronic monitoring rates between home and hospital births is not published, so treat any specific percentage quoted for that comparison as unverified.

CDC's 2023 natality tables record 41,913 of the 55,266 U.S. home births to non-Hispanic White women, about 76 percent, against roughly 50 percent of all U.S. births that year. Non-Hispanic Black women accounted for 4,012 home births and Hispanic women for 5,164.

MacDorman and Declercq compared out-of-hospital births with hospital births using revised birth certificate data and found lower prepregnancy obesity (12.5 percent against 25.0 percent), lower smoking during pregnancy (2.8 percent against 8.5 percent), and higher college graduation (39.3 percent against 30.0 percent). They also found 67.1 percent of planned home births were self-paid, against 31.9 percent of birth center births and 3.4 percent of hospital births. NCHS has reported that home births are more common among women aged 35 and over and among women with several previous children.

Parity runs opposite to what most people assume. In the MANA Stats cohort, 22.3 percent of planned home births were to first-time mothers and 77.7 percent to women who had given birth before.

On motivation, the most-cited peer-reviewed source is small. Boucher and colleagues surveyed 160 U.S. women who had planned at least one home birth and coded 508 statements about why. The most common themes were safety (38 mentions), avoiding medical interventions the respondents saw as unnecessary in hospital births (38), a previous negative hospital experience (37), more control (35), and a comfortable, familiar environment (30). Those are counts from one small survey, not national rates. If you see percentages presented as national data on why families choose home birth, they are not coming from CDC, which does not collect that information.

In MANA Stats, 479 newborns (2.8 percent) were admitted to a NICU in the first 6 weeks. CDC recorded NICU admission for 9.8 percent of all U.S. births in 2023. Neither figure is adjusted for risk, and the home birth cohort is screened for low risk, so the gap between them is not a clean measure of setting.

Low 5-minute Apgar scores, meaning below 7, occurred in 1.5 percent of newborns in the MANA Stats sample. Among the 1,850 newborns born in hospital after an intrapartum transfer, 3.7 percent had a 5-minute Apgar below 7 and 2.1 percent scored below 4.

Birth injuries are rare in both settings, and reliable head-to-head U.S. numbers are not published. Birthplace in England folded brachial plexus injury, fractured humerus, and fractured clavicle into its composite outcome alongside stillbirth after the start of care in labor, early neonatal death, neonatal encephalopathy, and meconium aspiration syndrome. That entire composite occurred at a weighted 4.3 per 1,000 births across settings in the cohort. Separate home-versus-hospital clavicle fracture or brachial plexus rates for the U.S. are not in the published literature, so any figure you see quoted for those is unsourced.

These numbers describe planned home births with trained midwives among women screened as low risk. The MANA Stats authors treated multiple gestation, breech presentation, trial of labor after cesarean, gestational diabetes, and preeclampsia as higher-risk categories and analyzed them separately, and the numbers changed when those pregnancies were removed. Whether you fall inside or outside low-risk criteria is a conversation for you and your care provider, not something a national average settles.

Statistics also cannot capture individual circumstances: your specific risk factors, the quality of your local hospital, or your midwife's transfer protocols. A 30-minute transfer time is not the same situation as a 5-minute one, and national statistics do not break outcomes down by geography.

The data shows what happened on average across tens of thousands of births. Your birth will be one specific experience, not an average. Use these statistics as baseline information, then factor in your health history, your midwife's experience and transfer relationships, and your own read on the tradeoffs of any birth setting.