The Mayo Clinic lists some reasons parents choose planned home births over a hospital setting.

Watching the snow fall outside her bedroom window while holding her newborn, as her husband brought her a cheeseburger and an old fashioned, Hope Payton-Carrillo had no doubt that home birth was the right choice for her.

After conducting extensive research during her first pregnancy, Payton-Carrillo, 41, decided to give birth at her home in Milwaukee to ensure she could have the privacy she desired and a more comfortable recovery process.

Payton-Carrillo has now given birth at home twice.

Home birth with midwives has rapidly risen in popularity in Wisconsin and the U.S. in recent years, according to data from the Wisconsin Department of Health Services.

While the total number of births per year decreased by around 5% from 2019 to 2023 in Wisconsin, the number of home births with midwives attending has increased by about 22%, according to data from the Wisconsin Department of Health Services.

In 2023, the most recent year of data available, more than 1,800 babies were born in Wisconsin in intended home births with midwives. More than 8,800 births were attended by midwives, whether at home or in hospital settings.

While there can be increased risk with home birth in some cases, families report that it offers other benefits.

Payton-Carrillo's home birth experiences were both "empowering" for herself and "unifying" for her family, she said. It allowed her husband and daughter to be more involved in the birth process, and it created a special connection to their home.

"I feel like the pain of childbirth gets talked about in a vacuum. It's not to say that childbirth isn't painful, because it definitely is ... but it's also an experience that we're built to manage," she said. "It can be such a transformative experience."

Women turn to home birth for more privacy, comfort and autonomy

Women choose home birth for a variety of reasons beyond privacy and comfort, said Rixa Freeze, who focused her doctoral research on the history of health care and why women give birth at home.

For some, giving birth in a comfortable environment allows the body to relax and produce the necessary hormones to stimulate labor, said Freeze, who founded the nonprofit Breech Without Borders.

Oxytocin, often called "the love hormone," causes the uterus to contract in birth. Hospital settings can hinder the release of this hormone because some don't feel safe, private or relaxed in that environment, Freeze said.

Others may choose to give birth at home following traumatic hospital birth experiences where they feel their choices were not respected, Freeze said. Some want to avoid medical interventions like cesarean deliveries.

Many choose home birth because it "facilitates autonomy," which can be difficult to find in a hospital setting with stricter rules and policies that must be followed during birth, Freeze said.

"It's their house, their body and their birth, and they're the ones in charge," Freeze said. "The midwife is there just to kind of keep an observant eye out, and basically let the woman do her thing, and only step in if she's needed."

During her first birth in a hospital in Milwaukee, Aisha Wo'se, 30, said the experience was "very robotic" and she found it difficult to advocate for herself.

Entering the hospital in a rush and transferring to the labor and delivery unit caused her significant stress and stalled the progression of her labor, Wo'se said.

"It was chaotic from that moment -- like I was rushing to the emergency room because I got into a car accident and I was in critical condition," Wo'se said. "It put my body into a shock. ... I had to refocus my mind to be calm so that I can actually release the baby."

The experience left Wo'se "traumatized," and she determined that hospital birth was not right for her, she said.

Wo'se is expecting to have her first home birth this December.

Expanding midwifery could improve access to quality maternity care

Midwifery and home birth could also help to address "maternity care deserts" in the U.S., where access to health care is limited and hospitals are closing, Freeze said.

Overall, home birth can be more affordable than hospital births, although not all insurers cover the cost, Freeze said.

For her home births, Payton-Carrillo enrolled in the Bridge Program through Aurora Sinai Medical Center, which connects patients with licensed midwives for home birth.

Home birth "doesn't really get equal space from the most trusted sources, even though it's very evidence based," Payton-Carrillo said. "Things like the Bridge Program make it so much safer, but those programs are so rare."

Payton-Carrillo was introduced to the program by her midwife Sabrina Foulks-Thomas, the first African American certified professional midwife in Wisconsin.

Foulks-Thomas said the program allows for "collaborative care" between a hospital provider and a midwife for families who are planning to give birth at home. Together, they create a plan for a transfer of care if an emergency situation arises, she said.

In the event that a patient becomes too high risk for a home birth, they can be transferred to an in-hospital provider, and the midwife can act as a doula -- a birth-coach who accompanies the patient as an advocate, Foulks-Thomas said. The program only works with women with low-risk pregnancies.

Expanded access to midwifery could also help reduce Black infant and maternal mortality rates by providing families with more options for supportive environments for prenatal care and overall health education, where they feel their concerns are heard and their needs are respected, according to Foulks-Thomas.

"It's allowing us to create options for families that didn't have those options before," she said.

Public health experts have also proposed that more "respectful patient-centered maternity care" could help reduce disparities in maternal mortality. More access to midwives, doulas and providers with diverse backgrounds has been shown to improve patient experiences among minority groups, according to the CDC.

Foulks-Thomas is also serving as the midwife for Wo'se. After her bad birth experience in the hospital, Wo'se sought her out because she believed her needs would be better met.

"When you're feeling heard, you're going to be more of a proponent to take care of yourself, to educate yourself, you're going to be more empowered," Foulks-Thomas said.

How to choose the best midwife for you

When deciding whether to have a home birth, it is important to make sure your midwife is licensed, according to Jane Crawford Peterson, a licensed midwife and director of community relations at the Wisconsin Guild of Midwives.

In 2006, Wisconsin passed a law requiring midwives to be licensed, joining 37 states nationwide that require licensure. Peterson worked alongside state lawmakers to establish the rules governing home birth.

Depending on the licensure program, the training varies. In most cases, student midwives in Wisconsin must attend courses, receive hands-on training through an apprenticeship and pass a national exam, Peterson said.

"I always wanted licensure to be the answer. It's not completely," Peterson said. "It is certainly important, but ... there are people that either fall below the standard or have a personality that desires to be in charge more."

Compared to hospital births, home births carry a higher risk for perinatal morbidity and mortality if the midwife attending the birth does not "meet the gold standard for midwifery regulation," or if a patient is considered high risk due to preexisting medical conditions, according to the American Journal of Obstetrics and Gynecology.

To ensure that a midwife is the right fit for a family and has the proper training, the Wisconsin Guild of Midwives provides a list of questions on its website that families can ask their prospective midwives, Peterson said. The questions range from verifying the midwife's licensure, to what their plan is for emergencies.

Families considering home birth should treat their first meeting with a midwife as an "interview," Peterson said.

Peterson also recommends families ask their prospective midwives what they think is the most important thing to do in the first hour after birth. For example, parents may want extended skin-to-skin contact, or request other after-birth processes that can be beneficial to the baby.

"I think that's a really important question, because that tells you a lot about what you might want, and what the provider thinks is the most important, because it's considered the 'golden hour,'" Peterson said.

For Peterson, midwifery and home birth goes beyond a science -- it's the art of providing care to a family, she said.

"I saw women who were abused during their birth process, and the healing is such a privilege to watch," Peterson said. "To calmly walk them into that place and see them own that part of the process."

Alyssa N. Salcedo is a data and investigative journalist pursuing her master's in journalism at DePaul University. She can be reached at [email protected].