If I had a penny for every time someone's asked me this question, or looked at me with slight disapproval in their eyes and remarked, "you're brave!" I am writing this apologia not because it injures my pride to be thought foolish and not to belittle hospital birth, but because I think most people really do want to know why and because I have a lot to say on the subject ;)
ALSO (because this is the internet): These are my own reasons for wanting to birth at home. I only care about how other women birth in as much as I want them to feel happy with the outcome. Beyond that, do what you want ;)
(1) Homebirth is as safe as hospital birth for low risk women, supported by a trained birth attendant (in my case, midwives). There have been a number of quality studies done over the years, which have compared the two and consistently found this to be the case. In some of these studies, home birth has actually been found to be safer!
(2) The reasons are quite simple to understand once you step back and look at the difference in how a birth unfolds at home vs. in the hospital. A huge proportion of routine procedures carried out in the hospital, are not evidence based practices for safe birth. For example: amniotomy (breaking your water), continuous electronic fetal monitoring, routine vaginal exams (each one increasing the risk of infection), restricting eating and drinking, IV fluids, arbitrary timelines, coached pushing etc. All of these individually and collectively, have an impact on the safety of a birth and on a mother's ability to cope with the intensity of labor.
(3) Pain medications and those used to speed up labor can cause problems of their own. Many times when a baby goes into distress and it's heart rate is causing panic and results in a scary emergency c-section - Pitocin (synthetic Oxytocin) is the culprit. It causes unnaturally powerful contractions, which are not only difficult for a mother to bear, but also rough on the baby. There's another thing we term the "cascade of intervention," which is very real and if you google it, there's a great clip from the documentary "The Business of Being Born," which illustrates how this happens. I am not sure that in a hospital environment, I would be able to avoid pain medication. I also do not want to have to fight with anyone when I'm in labor, over whether or not things are progressing along a timeline that has no evidential basis.
(4) When left to her own devices, a woman will stand and move and pace during labor (much like other mammals, if you've ever watched animals give birth). This actually feels very satisfying. Just like when you have other discomforts in your body, you intuitively know how you need to move, because physically it feels right. A birthing woman is also VERY sensitive to interruption. Strange environments and people, as well as disruptions to the natural flow will slow things down and make the most intense phase of labor much more painful and difficult to cope with. This reality is completely disregarded in a hospital setting (unless you have some rockstar nurses on duty and a Dr or midwife who goes way above and beyond).
(5) Eventually birth becomes painful, but it's not JUST pain! Birth is actually pretty trippy between contractions. At home, I have people around me who make me feel safe and cared for and they stay with me the whole time. I can focus on the one thing that I need to focus on and this makes the pain totally bearable for the most part.
(6) My favorite part of having my babies at home, is the way that they are welcomed into the world! A midwife's gentle hands catches them and they get to acclimate to extrauterine life, where they feel safe and warm - right next to the heartbeat that's been their constant companion for as long as they've existed.
(7) Final comments: Most potential issues in a birth, can be identified long before they become an emergency. In cases where a truly unforeseen emergency does arrive, midwives are trained and equipped to deal with it until transfer can happen. Since no one wants this (especially the midwife, who's livelihood relies on safe mothers and babies), midwives are extremely attentive to the health of both mother and baby (often more so than would be the case in a hospital, where emergency treatment is a click away).
I have kept this as short and succinct as possible. I literally could write a book on my reasons, so if you have any questions, or want to see any references, just ask!
Mishka Brownley lives in Fredericksburg Va, with her husband and three children. She has worked with expecting and new families for the past ten years, supporting them through education in birth, breastfeeding and the joy of motherhood. She runs an online directory and community for local mothers at Birth + Baby Fredericksburg.