Abstract

Historically, most births took place at home, and babies, and much less commonly, women, sometimes did not survive the journey, contributing to a ‘taken for granted’ association between home birth and danger in the cultural imagination. In many countries, this association remains well founded; high rates of maternal and infant mortality and of injury from prolonged and obstructed labour and inability to access lifesaving interventions such as caesarean birth are a focus of global concern. In well-resourced settings, birthing people may choose home and birth centre birth to avoid overuse of these same interventions that are lifesaving when used appropriately, but that introduce new dangers when overutilised. Research undertaken in the UK, the USA, the Netherlands, Norway and Canada shows that planned home birth is as safe for women and babies at low risk for medical complications as planned hospital birth in an obstetrician-led setting. Furthermore, community births, including home birth, reduce the likelihood of intervention-related iatrogenesis during labour. This evidence is frequently contested, yet women and birthing people continue to opt for planned home birth in many higher-resource settings, and clinicians continue to support them to do so. In our chapter, we examine some of the debates about planned home birth in the USA and UK, and why it remains such a contentious issue in these nations. We focus on debates about birth setting and the appropriate provider in these contexts over the last twenty-five years, including the rise of freebirth as a response to systems failures, reflecting on what has changed during this time, and what the future might hold.