Ask an Honest Midwife: Is it OK to have a home birth in a big city?

New York CityWelcome readers to Ask an Honest Midwife! I was a licensed midwife for six years and a Certified Professional Midwife for three years. Although I am now retired from the practice of midwifery, I am here to answer your questions about home birth, birth centers, natural birth, and anything else you ever wanted to ask a "crunchy" midwife. Feel free to send in your questions. 

My inaugural question was sent to me via email. Wendi asks, 


"I live in a big city, New York. Is it ok to have a homebirth in a big city like New York where hospital access feels close and accessible?"



Dear Wendi,

Having a home birth when you are right next door to a hospital is certainly safer than having a baby in the middle of nowhere, where it might take an hour or more to get to the hospital in case of emergency! I think it’s pretty important to consider things like how long it might take an ambulance to get to you and then to get to the hospital in case of an emergency transport. I don’t live in New York City, but I’ve seen TV shows, and it looks like traffic can get pretty gnarly. At peak times, there might not be a guaranteed ambulance available. And although NYC taxi drivers are world-known for their baby-delivering abilities, you really don’t want to be in the back of a cab huffing oxygen and sitting in traffic while your midwife strokes your hair and hopes for the best.

I used to be a midwife at a birth center. We were a 15-minute drive from the closest hospital. Urgent and emergent transports were not the norm, but when they did happen, that 15 minutes did always seem long. Fifteen minutes of pain and worry feels like 15 minutes too many, even when everything turns out ok.

But let’s say you live literally next door to the hospital and you could just walk or be carried there within minutes. Is that a safe scenario for home birth? That really depends on your individual risk factors. I advise you find a Certified Nurse Midwife or obstetrician and arrange a consult. Ask them if you have any factors that would increase your risks at home birth. Some risk factors to consider include how many babies you’ve had before (first-time moms are at a large increased risk for needing transport, and women who have had several babies are at increased risk for complications such as bleeding), your obstetric history, your overall health, and any issues that have developed during your current pregnancy. If you are a truly low-risk case, then you can proceed to consider home birth.

In the United States, there are different kinds of midwives. Certified Nurse Midwives (CNMs) and Certified Midwives (CM) have university degrees and extensive hospital training. Look for one who does home births but also has privileges at a hospital. (Clarify that they don’t just take you to a hospital if need be, but can actually remain your care provider within the hospital and work as a part of the team that will take care of you.) This way, you can closely approximate the models of Canada, England, and other nations where home birth has been shown to be safer than in the U.S. Be careful to avoid midwives who do not have these particular credentials; they have less training and education, and they are a big part of the reason why American babies are many times more likely to die or suffer brain damage at home birth compared to babies in other industrialized countries.

Of course, there are always some complications that happen unexpectedly and suddenly, to even the lowest-risk women. In these cases, the minutes that it takes to get to the hospital can mean the difference between a healthy baby, and a brain-damaged or even dead one. There is no way to get your baby closer to life-saving technology (that goes way beyond the oxygen, resuscitation bag, and mouth-powered suction your midwife carries!) than to have your baby inside the hospital, where incredible doctors and nurses and equipment are just down the hall and ready to help. If having the highest possible level of safety appeals to you, talk to your care provider about ways to make the hospital birth experience as comfortable and personalized as possible. You can have the best of both worlds, a beautiful birth and all the safety that life in the 21st century provides.