Home Births Increased 20% From 2004 to 2008

Emma Hitt, PhD

May 23, 2011

May 23, 2011 — From 2004 to 2008, the percentage of US births taking place at home increased by 20%, according to a new study from the Centers for Disease Control and Prevention.

The greatest increase was from non-Hispanic white women, the study finds.

Marian F. MacDorman, PhD, from the Division of Vital Statistics at the Centers for Disease Control and Prevention’s National Center for Health Statistics in Hyattsville, Maryland, and colleagues reported their findings online May 20 in Birth.

According to the researchers, from 1989 to 2004, the percentage of home births remained lower than 1 in every 140 births, declining slowly from 0.69 of all births in 1989 to 0.56 in 2004. However, in 2005, the US rate of home births increased notably for the first time since 1989, to 0.59%, a figure that remained steady in 2006.

Dr. MacDorman and colleagues compared data from 2008 with data from 2004 to examine the nature of the increase and the factors that may have caused the increase.

The researchers analyzed maternal demographic and medical characteristics of US birth certificate data on home births. In 2008, 28,357 home births took place, which represented a 20% increase from 2004 — from 0.56% to 0.67% of US births.

According to the researchers, among non-Hispanic white women, for whom greater than 1% of births occur at home, the increase was 28%, which may have driven the overall rise.

Furthermore, the risk profile for home births has been lowered: The percentage of home births of infants who are born preterm or at low birthweight has decreased substantially, as has the percentage of home births that occur to teenage and unmarried mothers.

The percentage of home births from 2004 to 2008 increased significantly in 27 states, 4 states demonstrated a decline (Nevada, Arkansas, Pennsylvania, and Vermont), and 18 states and Washington, DC, had no change.

The states with the highest home birth rates (1.50% - 2.19%) in 2008 were Montana, Vermont, Oregon, Alaska, Pennsylvania, and Wisconsin.

The investigators also found that the percentage of home births delivered by certified nurse-midwives or certified midwives increased by 22%, from 15.8% of home births in 2004 to 19.2% of home births in 2008. In contrast, the percentage of home births delivered by physicians dropped from 8.7% in 2004 to 5.4% in 2008, a decline of 38%.

"The decline in the percentage of home births delivered by physicians may be an indication of an improved risk profile, as most physician-delivered home births are unplanned," the authors note.

As in previous years, about one third of home births were delivered by a husband or family member, emergency medical technician, or taxi driver.

It is interesting that "this increase in home births in the United States occurred in the context of increasingly public physician opposition to the practice," Dr. MacDorman and colleagues note.

According to the researchers, in 2007, the American Congress of Obstetricians and Gynecologists issued a policy statement opposing home birth on the basis of safety reasons. A recent update to the American Congress of Obstetricians and Gynecologistsstatement also appears to discourage home birth. "These attitudes may also be reflected in the very low proportion of planned home births attended by physicians," the authors note.

"In contrast, the World Health Organization, the American College of Nurse-Midwives, the American Public Health Association, and the National Perinatal Association all support home and out-of-hospital birth options for low-risk women."

Birth. Published online May 20, 2011. Abstract

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