Adapted from author Gila Zarbiv CNM with a master’s in women’s health and a PhD candidate at Ben-Gurion University, specializing in Global Health Systems Management. As a doctoral fellow at the Israel Implementation Science and Policy Engagement Centre (IS-PEC), her work bridges research and policy to transform maternal health systems globally. The original article focused on maternal care in Israel, but the issues apply to the U.S. as well.
When media report tragic outcomes during births, those that happen at home inevitably receive more public attention than those in hospitals. Each of these cases is heartbreaking. The loss of a newborn is an unimaginable tragedy, and there are no words that can match the depth of such grief.
But what happens after the tragedy, how the story is told, matters, too. And time and time again, we see a familiar pattern: sensationalist headlines proclaiming that “a home birth ends in death.” These headlines do more than report the news. They erase context. They conflate unassisted births with planned, midwife-led home births. This kind of coverage distorts public understanding, fuels fear, and undermines informed choice. It leads to the widespread impression that home birth is inherently more dangerous than hospital birth, an impression that is not supported by evidence.
Globally, studies from countries like the Netherlands, the United Kingdom, Canada, and New Zealand have consistently found that planned home birth, with a licensed and skilled midwife, is just as safe as hospital birth for low-risk pregnancies, with fewer unnecessary interventions and higher maternal satisfaction. The World Health Organization (WHO) endorses midwife-led continuity of care, including in the home, as a safe, cost-effective model. In this approach, a woman is supported by the same midwife, or a small team, throughout pregnancy, birth, and postpartum, with care that centers her needs and preferences every step of the way.
In the U.S., however, home birth is still not treated as a legitimate, evidence-based option for most families. Although home birth is legal, as well as the establishment of birth centers, access to both remains severely limited to one’s efforts and financial resources. Current policies, insurance frameworks, societal pressures, and regulatory structures make it very difficult for families to safely and legally choose either option. Regulations for out-of-hospital care are overly restrictive. And systemic support, from financing to infrastructure, remains absent.
As a result, families who wish to give birth outside of a hospital setting are often left with no smooth, regulated, or safe pathway to do so even when they are low-risk and seeking care that is standard and respected in many other countries.
And when tragedies occur, the public response often follows a familiar and misguided pattern: headlines fuel fear, and that fear is followed by calls to restrict choice even further. But if we truly want to make birth safer, we must do the exact opposite.
We need to invest in strong midwifery infrastructure. Midwives are highly trained professionals who can provide up to 90% of the essential care in sexual, reproductive, maternal, newborn, and adolescent health. This includes prenatal care, birth, postpartum follow-up, family planning, and more. Countries that have embraced this model see better outcomes, lower costs, and greater equity. We must ensure that midwives can obtain insurance, are fully integrated into the healthcare system, and are empowered to exercise their full scope of practice, with complete autonomy and independence. We must provide women access to safe, regulated, midwife-led birth options across all settings, not just in hospitals. It also means removing the unnecessary barriers that prevent the development of birth centers, which exist around the world as safe, evidence-based alternatives to both hospital and home birth.
Choosing where and with whom to give birth is not a luxury. It is a basic human right.
A healthcare system that denies those options, or restricts access through policy, insurance, or regulation, is infringing on bodily autonomy and human dignity. The role of the system is not to control women’s choices, but to make those choices safe.
The U.S. should be at the forefront of evidence-based maternal care. We have the tools, the data, and the professional expertise. What’s missing is the policy. It is time, long past time, for our laws and systems to catch up with the evidence. We owe it to the families who give birth here every day, and to the midwives who are ready to support them.