The trend makes the U.S. somewhat of an outlier globally. Midwives attend roughly 63% of births across various settings in the United Kingdom, 60% in the Netherlands and 43% in France. But they’re present for less than 13% of births in the U.S.
Many doctors can recount their own harrowing experiences with home-birth transfers.
Smith, the OB-GYN in Oregon, said she will never forget a patient pregnant with twins who came in after delivering the first baby at home. Pregnancies with multiples are high-risk, so the standard of care is for these births to be in a hospital. When the woman showed up, the arm of the second twin was dangling out of the birth canal, Smith said. The baby died during an emergency C-section.
“It’s when you get these emergent transfers that don’t go well that the whole feelings of bias and stigma form in a provider’s head,” Smith said. “It’s the negative transfers you remember.”
Some patients, too, have complained that their midwives discouraged them from going to the hospital, either because they overestimated their ability to treat complications or feared that hospital staff would stigmatize the patient or take invasive measures. Midwives who don’t follow state requirements for transferring patients to a hospital can be fined, sued or have their license suspended or taken away.
Gabrielle Nelson, whose son Isaac is now nearly a year old, said her midwife in Salt Lake City, Utah, encouraged her to hold out at home, even though 48 hours had passed since her water broke. The baby’s head was stuck and Nelson was in excruciating pain, so her husband insisted on a hospital transfer.
“I literally thought I was going to die,” Nelson said. “I’m just thinking, ‘I want to go to the hospital. I want a C-section if I can get it. I just need this to be over.’”
When they eventually made it to the hospital, Nelson’s blood pressure was dangerously high — a problem that her midwife could have detected earlier had she been checking it regularly, as is generally recommended. In the end, Nelson ended up delivering a healthy baby.
“There is a reason you hear so many people who work in labor and delivery who are so anti- home birth,” she said. “I’m sure things like this do have a lot to do with it.”
More than one solution
Had Ibarra lived in a different area, she may have had the option to deliver at a birth center — a facility where a staff of midwives oversees deliveries and administers pre- and postnatal care. These centers are slowly gaining popularity as a middle ground between hospitals and home births. Nationwide, around 22,600 babies were born at birth centers in 2024, a nearly 15% increase since 2016.
