ROBERT SIEGEL, HOST:
Here's a question that's been at the center of a long, emotional debate. How safe is it for a woman to give birth outside of a hospital? The New England Journal of Medicine is now reporting the results of a big, new study that has some answers to that question. Here's NPR's health correspondent Rob Stein.
ROB STEIN, BYLINE: Samanda Rossi gave birth to her third son just before Christmas, and like his two brothers, Tate was born at home.
SAMANDA ROSSI: He had a really, really peaceful, loving introduction into the world. And I was grateful for him that he had such a gentle journey.
STEIN: Most American women still have their babies in a hospital, but the number of women who are giving birth at home or in a birthing center has been increasing dramatically. Many, like Rossi, went to avoid getting a C-section or other medical procedures, but Aaron Caughey of the Oregon Health and Science University says there's been a big question about how safe that is.
AARON CAUGHEY: Tens of thousands of women are choosing to deliver out of hospital, so the fundamental question that we're trying to address was to identify the risks of attempting an out-of-hospital birth.
STEIN: So Caughey and his colleagues studied almost 80,000 low-risk pregnancies in Oregon in 2012 and 2013, and the results were clear.
CAUGHEY: For women who intend to deliver out-of-hospital, the risk was about four per thousand of the baby dying either before labor, during labor or in the first month of life. In women who chose to deliver in-hospital, that risk was about two per thousand, so about half.
STEIN: Now that might make giving birth anywhere but in a hospital seem pretty scary.
CAUGHEY: But in the grand scheme of things, there are definitely those individuals who consider that a relatively small risk.
STEIN: And the study also clearly shows there are some real benefits of trying not to give birth in a hospital. Those women were much less likely to get their labor induced with drugs or have their babies delivered with forceps or a C-section.
CAUGHEY: It does support this idea that women are in some cases getting what they desire.
STEIN: So Caughey hopes the new study will help each woman decide for herself whether that risk is worth the possible benefits. Other experts agree. Michael Greene heads obstetrics at the Massachusetts General Hospital in Boston. He says this is the best evidence yet about the risks of giving birth inside or outside a hospital.
MICHAEL GREENE: That's the wonderful about having this data. It lets every woman decide what is most important to them. Is it most important to them to have a - for example, a spontaneous vaginal delivery and avoid a cesarean section or avoid an instrumented vaginal delivery? Or is it most important to them to have the least potential risk of coming away without a baby?
STEIN: One group that is pushing for more states to legalize midwives welcome the new study. Steff Hedenkamp is the spokesperson for that group. It's called The Big Push for Midwives.
STEFF HEDENKAMP: This study is consistent with other literature that shows that the absolute risks are low. And this is pretty remarkable given that in the United States, midwives - certified professional midwives - are not integrated into many of our states' healthcare systems.
STEIN: For her part, Samanda Rossi, the mom we met at the beginning of the story, thinks any risk she faced by giving birth at home were outweighed by the benefits of staying away from a hospital.
ROSSI: There are certain risks that I would have going to the hospital, and there are certain risks that I may have an increased risk of at home, but I have to, as a mother, choose which risks I'm most comfortable with.
STEIN: But Rossi says Tate is probably going to be her last child, so she won't face that choice again. Rob Stein, NPR News. Transcript provided by NPR, Copyright NPR.