After two years working in a labor and delivery unit as a surgical tech, Carlie Smith knew she didn’t want to give birth in a hospital. Nearly every night shift she worked was the same: women were wheeled in for cesarean sections following failed 39-week inductions that their bodies and babies weren’t ready for.

But as a North Carolina resident, Smith didn’t have many options for home birth. North Carolina is one of a dozen states that doesn’t license Certified Professional Midwives, who are direct-entry midwives specializing in out-of-hospital birth. CPMs can face arrest just for practicing in the state.

So Smith went underground. She found a midwife based in Charlotte, N.C., to attend the birth of her first daughter in August 2022.

“My first birth was definitely intense. I was in prodromal labor for a week, but my actual labor was three hours,” Smith told TAC. “It was very empowering because I was the one that caught her.”

Smith is one of a growing number of women choosing home birth. The number of home births in the United States jumped nearly 20% from 2019 to 2020, according to Pew Research Center analysis of National Center for Health Statistics data. That statistic is far from a pandemic fluke. Midwives across the country say their busy schedules are evidence that women are returning to home birth.