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Homebirth is NOT popular among American women; it's a fringe practice. Most women have no interest in anything that raises the risk of perinatal death. Homebirth is deeply unpopular among obstetricians; most of us abhor anything that increases the risk of perinatal death. Homebirth is anathema among neonatologists for the same reason.

Homebirth is popular among MIDWIVES; (it represents 100% of the income of American homebirth midwives, and it is represents professional autonomy for others). The question we ought to address is not why some women choose homebirth; it's why midwives promote homebirth as safe when it is manifestly increases the risk of death.

The NEJM paper indicates the risk of homebirth death is underestimated. Yes, some women will choose it anyway, but some women will refuse to vaccinate. We don't spend our time trying to make refusing vaccination safe; we educate our patients on the deadly consequences of their choice; that's what we should do here, too.