Two key factors contribute to a successful home birth: a mother who is at low obstetric risk and the possibility of a seamless transfer to the hospital in case of medical necessity. Because of eligibility requirements for home birth in the Netherlands, Dutch mothers who choose that route tend to be at lower risk from the start than their American counterparts. Dutch women who have had C-sections, for example, are not candidates for home birth, while in the U.S., previous C-sections are a major reason women choose to labor at home. Yet according to ACOG’s 2008 statement, attempting VBAC at home is especially dangerous, because it puts the woman at risk of uterine rupture during labor, with no immediate access to necessary medical equipment or expertise.

In the Netherlands, moreover, midwives are fully integrated into the health care system and obstetrics practices, making transfers to hospitals routine. In the U.S., where 1 out of 200 women gives birth at home, midwives can be and have been arrested for bringing their patients to hospitals in states that do not license CPMs.

So it is no surprise that a large 2009 Dutch study showed home birth to be safe. What that means for women elsewhere is less clear, however, and results of various U.S.-based studies tend to conflict. “Research in this area is desperately needed, particularly for women in the United States,” says Wax.