In the United States, access to qualified homebirth providers varies by state, city, and community, and consistent, evidence-based guidelines for intrapartum management at home are not available. This article examines the similarities and differences in midwifery management of the intrapartum, postpartum, and neonatal course between planned homebirths and planned hospital births. Characteristics of qualified attendants, essential medical supplies and equipment, methods for maternal and fetal surveillance, and common intrapartum indications for transfer are discussed. Unique features of management of the healthy woman and baby in the home are described, as well as the process of consultation and/or referral for collaborative or medical management. Current evidence for the management of fetal intolerance of labor, meconium stained amniotic fluid, prolonged labor, postpartum hemorrhage, and the unstable newborn is discussed in the context of homebirth practice. Aspects of homebirth care that require cultural competency and affect the informed consent process are included. Homebirth practice may provide opportunities to increase the congruence between espoused midwifery philosophy and actual practice.