a small but increasing number of women in the united states are choosing to give birth at home. this study indicates that they are choosing this despite challenges associated with navigating the maternity care system. home birth continues to be a contested issue within the obstetric and midwifery communities,although many studies have shown equivalent safety rates
optimal outcomes occur when home births are planned and there is a system whereby women and families can transfer to a facility when needed. true comparison of the safety of home birth cannot occur in a country without a widespread , integrated system to provide transition to hospital birth should the need arise when planning a home birth. if our goal is to promote safe birth, then barriers such as those found by these women when they tried to bridge the gap between home birth care and hospital-based providers must be removed. for women giving birth within the hospital setting, changes can be implement that will make it a more satisfying experience without compromising safe maternal or newborn care. despite spending more money per capita on birth than any other developed nation, the united states ranks 50th in the world in maternal mortality and 39th in neonatal mortality, indicating that a critical analysis of the current system is needed.
although the causes of these differences are varied, there is one issue in particular that is of growing concern : contemporary practice of maternity care in many significant areas only tangentially adheres to best practices, despite multiple efforts to encourage the widespread use of evidence-based practice