When home births go wrong, hospitals can add to the complications

Aria BendixThu, February 26, 2026 at 10:30 AM UTC

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Maria Ibarra holding her daughter, Joy Mendoza, at her home in Lebanon, Ohio, on Jan. 27. (Madeleine Hordinski for NBC News) (Madeleine Hordinski for NBC News)

With each contraction, Maria Ibarra’s plan to deliver her daughter in her Ohio living room seemed less likely. The baby’s heart rate was slowing, her midwife said. They needed to go to the hospital right away.

Ibarra’s midwife, Meghan Nowland, tried calling the labor and delivery unit at the closest hospital from the car but had trouble reaching anyone. When a charge nurse finally answered, Nowland identified herself as a midwife and asked if the hospital would be able to admit Ibarra, whose baby had a concerning heartbeat.

But she was taken aback by the nurse’s response.

“She was like, ‘We just won’t take walk-ins,’” Nowland said.

Hospitals, by law, cannot turn away patients who show up in emergencies. But Nowland and nine other midwives interviewed said that situations like Ibarra’s arise far too often.

The Christ Hospital in Cincinnati on Jan. 27. (Madeleine Hordinski for NBC News) (Madeleine Hordinski for NBC News)

A growing number of women in the U.S. are opting to give birth at home: More than 50,000 had planned home births in 2024 (the latest data available), a nearly 71% increase from 2016. But when issues arise during labor that require a transfer to a hospital, which happens in around 10% to 15% of home births, the process can be plagued with unnecessary challenges — a result of decades of distrust between midwives and doctors.

It’s not uncommon, midwives said, to call a hospital’s labor and delivery unit when a patient needs a transfer, only for nurses or doctors to discourage them from coming or dismiss the information they relay. This forces stressful, split-second decisions with patients: Should they show up anyway at a hospital that is unwelcoming or spend precious time calling others? Is it worth a longer drive to reach a hospital more open to admitting them, when every second counts?

The resulting delays can put women at risk during their most vulnerable moments in childbirth, in some cases turning a complicated delivery into a life-threatening one.

Hospitals can be hesitant to accept home-birth patients for several reasons. Some doctors worry that they could be held legally responsible for a problem that arose at home. It can also be challenging to properly treat patients without having observed the full course of their labor. And some hospitals lack space or staff to accommodate the unexpected arrival of a woman who didn’t receive prenatal care within their health network.

Midwives said they recognize that hospitals are often busy, and doctors and nurses sometimes can’t get to the phone right away. But they expressed frustration with hospitals that are unwilling to collaborate with them — at the very least, to make contingency plans for a patient’s transfer.

Challenges with transferring patients have loomed over the practice of home birth for years, according to conversations with midwives, lawyers, midwifery patients and birth centers. Some hospital networks agreed that it’s a persistent issue, though others did not.

Data on these situations is lacking, making it difficult to know how common they are or assess changes over time. No national system tracks home birth-hospital transfers or their outcomes.

Midwife Meghan Nowland talks with patient Annie Vowell during an appointment at the Cincinnati Birth Center on Jan. 27. (Madeleine Hordinski for NBC News) (Madeleine Hordinski for NBC News)

Some midwives worry that as more women choose home births, issues with transferring patients will become more common. Discouraging home births isn’t a realistic solution, they said.

“We’re not asking the physicians to be in favor of this, but it’s a reality in their community,” said Melissa Denmark, a retired midwife who co-chairs a Washington state program called Smooth Transitions, which works to improve the transfer process.

A rise in home births

A convergence of factors has fueled the rise in home births. Some women have made the choice after negative experiences with hospital systems or because they wanted less medical intervention. The trend jibes with the views of so-called “MAHA moms” — named for their support for Health Secretary Robert F. Kennedy Jr.’s “Make America Healthy Again” movement — who favor home birth because they distrust mainstream medicine. Glowing testimonials about home deliveries have also proliferated on social media. In October, a Twitch streamer livestreamed her labor at home to nearly 30,000 viewers.

Home births became more popular during the pandemic, when hospital deliveries came with a risk of contracting Covid and few visitors were allowed. For other women, giving birth at home may be the only option, as the widespread closures of hospital obstetric units create maternity care deserts in which midwives are the only providers nearby.

“There are people that are forced into it. There are people that are doing it because culturally, that’s what their community does. And then there are people who are doing it because TikTok says this is a cool thing,” said Dr. Wendy Smith, an obstetrician-gynecologist in Portland, Oregon.

Midwives generally recommend hospital births for high-risk patients, such as those carrying twins, those with pre-eclampsia, or when a baby is breech (head up instead of down).

Ibarra, 27, said she was drawn to home birth because she wanted a calm, warm environment where every decision felt completely her own. She had read stories of Black and Hispanic women — who have a higher risk than white women of pregnancy-related complications — being dismissed by hospital staff when they raised concerns during their pregnancies.

Maria Ibarra at her home in Lebanon, Ohio, on Jan. 27. (Madeleine Hordinski for NBC News) (Madeleine Hordinski for NBC News)

“They would talk about the pain that they experienced, like they were ignored or given a cold shoulder,” Ibarra said.

To prepare for labor at home, Ibarra strung up soft yellow lights and laid a mattress on the floor of her living room. She planned to deliver in an inflatable birthing pool. In the end, she never got to use it.

The situation Ibarra encountered, a baby’s slowing heart rate, is considered a “yellow flag,” Nowland said. Although not always an emergency, it can be a sign of restricted blood flow or oxygen to the baby that, if unaddressed, can cause brain damage.

After the nurse at Ibarra’s first-choice hospital, Christ Hospital in Liberty Township, Ohio, said it didn’t take walk-ins, Nowland tried a different hospital. She reached the labor and delivery unit by phone while pulling into the parking lot.

Ibarra was admitted right away and went on to have an emergency cesarean section. Her daughter, Joy, was born healthy.

Maria Ibarra’s living room, where she planned to give birth, is now scattered with her daughter Joy Mendoza’s things. (Madeleine Hordinski for NBC News) (Madeleine Hordinski for NBC News)

The experience with Christ Hospital left her even more skeptical of such health systems, she said: “It does make me a little bit more hesitant to approach a hospital.”

The Christ Hospital Health Network declined to answer questions about Ibarra’s case but said in a statement: “In keeping with our policy and deep commitment to the community, we always welcome and accept all patients without exception.”

When transfers go wrong

Nowland had followed a commonly known set of best practices for Ibarra’s transfer. Midwives and their home-birth patients are expected to develop contingency plans about which hospital they want to deliver at, then call ahead if they need to transfer. That way, the patient can get admitted straight into the labor and delivery unit rather than the emergency room, where they can face longer waits. Once they arrive, the midwife should brief the hospital’s care team.

But it doesn’t always happen that way. Nowland said she had a patient years ago who waited an hour in the ER, her face turning green. The woman’s placenta had adhered to her uterus and she required a blood transfusion.

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Nowland and other midwives interviewed said that when they call a hospital, it’s not uncommon for staff to question their decision-making or refuse to trust what they say. Their patients are sometimes chastised upon arrival for attempting a home birth, they said.

Meghan Nowland at the Cincinnati Birth Center on Jan. 27. (Madeleine Hordinski for NBC News) (Madeleine Hordinski for NBC News)

“A lot of L&D [labor and delivery] staff will of course have to accept patients on transfer, but then treat them like they’ve been abusing their child,” said Cindy Farley, a certified nurse midwife and professor emerita of midwifery and nursing at Georgetown University.

Caitlin Hainley, a midwife in Des Moines, Iowa, said that last spring, one of her patients decided she wanted an epidural after around 22 hours of labor. Hainley called one of the closest hospitals, and after 30 minutes of waiting for the doctor to call back, they decided to start driving over.

Hainley’s phone rang midroute. The doctor questioned whether she knew how to properly assess the baby’s heartbeat, Hainley said, and insisted the patient would be better off at a hospital an hour away in Des Moines, which had more advanced critical care services for infants.

“She’s like, ‘Well, we just don’t even know anything about this patient,’” Hainley said. “And I said, ‘You know, if you don’t want this patient in your facility, I wish that you would just be upfront with me.’”

The group turned around and headed for Des Moines. By the time they got there, roughly two hours had passed since Hainley’s initial call.

“Anything could have happened in those two hours,” she said. “They don’t trust that we are giving them clear, accurate information, but I don’t know why, because it’s all documented. It’s not like I’m just somebody that decided to wear a hat and call myself a midwife.”

Distrust of midwives

Prior to the 20th century, midwife-assisted births were more common in the U.S. than hospital births. That changed after the arrival of pain medications and new surgical techniques. Over time, many in the medical field came to see midwifery as risky. Some of the messaging against midwives was also rooted in racism, targeting Black midwives in the South.

“There was a campaign that home-birth midwives were uneducated, dirty, lacked skill sets and practiced witchcraft,” said Gaylea McDougal, the central representative for the Tennessee Midwives Association.

Today, 38 states don’t allow licenses for certified midwives, who have master’s degrees in midwifery. Thirteen states don’t offer a path to licensure for certified professional midwives, who complete training and an exam but don’t need a degree. All states, however, recognize certified nurse midwives — registered nurses who specialize in midwifery.

Nowland feels for patient Annie Vowell’s baby’s feet during an appointment. (Madeleine Hordinski for NBC News) (Madeleine Hordinski for NBC News)

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.

The Cincinnati Birth Center, where Nowland offers prenatal care. (Madeleine Hordinski for NBC News) (Madeleine Hordinski for NBC News)

Eighteen states, including Ohio, require birth centers to have a formal, written agreement with a hospital that will accept their transfer patients. Although the policy is meant to protect patients in emergencies, it often prevents birth centers from opening in the first place, since many hospitals are reluctant to be party to the agreement.

Nowland has tried for years to find a hospital to enter into a transfer agreement with the birth center she runs in Cincinnati, which she had hoped would give women more options in the area. But no hospital has been willing, so the center can only offer prenatal care. It’s where Ibarra was seen during her pregnancy.

“I absolutely adored it,” Ibarra said. “I felt a level of comfort that equated to me being at home.”

For deliveries, Nowland exclusively attends home births.

A bathtub at the Cincinnati Birth Center. (Madeleine Hordinski for NBC News) (Madeleine Hordinski for NBC News)

Another model is for a hospital to operate an affiliated birth center, where the midwives are employed by the hospital network and patient records can be seamlessly shared. However, such arrangements can be less attractive to patients seeking a more alternative approach.

Some other hospitals, meanwhile, have moved to have more midwives on staff, which research has shown is associated with lower preterm birth rates and fewer maternal deaths.

Yet another solution is to strengthen the relationship between doctors and midwives, so that hospitals are more comfortable accepting home-birth patients.

Washington state has arguably done the best job at this, according to Smith, thanks to the Smooth Transitions program, which helps midwives and hospitals create joint guidelines on how to handle transfers, organizes simulations and hosts meetings where both sides can address concerns.

“There’s no villain,” said Sarah Davidson, the program’s manager. “But there’s a problem and there are solutions.”

A patient bed at the Cincinnati Birth Center. (Madeleine Hordinski for NBC News) (Madeleine Hordinski for NBC News)

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