According to the 2010 through 2012 Centers for Disease Control and Prevention birth certificate data records analyzed by Grünebaum et al, the risks of home births were shown to be significantly increased compared to a hospital delivery in the United States. However, there is an inherent flaw in the data chosen to emphasize the dangers of unqualified midwives performing vaginal deliveries in homes. Birth certificates are administered to live births as determined on the state level. By solely using birth certificates in the analysis, the babies born without signs of life have fetal death reports filed and are not included in the analysis.

The American Congress of Obstetricians and Gynecologists acknowledges that 75% of home births are attended by unqualified individuals. With no practicing obstetricians or certified nurse midwives in nearly half of counties in the United States, women are forced to either drive long distances for care or resort to lay midwives to assist in their deliveries. It would not be surprising if the actual rate of negative outcomes was much higher than in hospitals, which could be corroborated if fetal death reports were also considered. This is also contingent on the filing of these fetal death reports. If a delivery is attended by a lay midwife, it is the responsibility of the midwife to report the fetal death. Yet, this reporting could negatively impact business or could easily be overshadowed by the mourning process. Ultimately, while the risks of delivering at home are increased even under ideal circumstances, the rates of adverse outcomes are likely much higher due to the exclusion of fetal death reports.