Home Births in the U.S. on the Rise

CDC Reports 29% Increase in Home Births From 2004 to 2009

By Denise Mann
WebMD Health News

Reviewed by Laura J. Martin, MD

Jan. 26, 2012 -- Are home births in again?

Home births declined from 1990 to 2004, but jumped by 29% from 2004 to 2009. Even with this increase, the overall percentage of women giving birth at home remains low. In 2004, 0.56% of births occurred at home, and 0.72% in 2009.

"This is a fairly rapid increase over five years and it is fairly widespread, with increases in almost all states," says researcher Marian F. MacDorman, PhD. She is a statistician at the National Center for Health Statistics in Hyattsville, Md.

Montana and Oregon had the highest percentage of home births in 2009. The lowest rates were seen in Louisiana and Washington, D.C. "It seems like the beginning of a trend," MacDorman says. The findings appear in the CDC's National Center for Health Statistics Data Brief.

The American College of Obstetricians and Gynecologists (ACOG) and the American Medical Association do not support planned home births because they find the practice risky.

Why the uptick?

The new study did not look at why more women are choosing home births. "Some women are fed up with the medicalization of child birth, with the rise in C-section, and inductions of labor, and all the stuff they do," MacDorman says.

Some may credit Ricki Lake. The former talk show host and Dancing With the Stars contestant got many people to think and talk about home births in her documentary, The Business of Being Born, and its follow-up DVD series, More Business of Being Born.

Lake chose, and filmed, the home birth of her son during the first movie.

Who's Choosing Home Births?

According to the new study, home births are more common among non-Hispanic white women, women aged 35 and older, and women who have had several children previously. About one in every 90 births for non-Hispanic white women occurs at home. The percentage of home births is three to five times higher than for other racial and ethnic groups. In fact, non-Hispanic white women in large part drove the increase in home births from 2004 to 2009.

In 2009, most home births (62%) involved midwives. Just 5% of home births were attended by doctors, and 33% involved someone else, such as a family member or an emergency medical technician.

Some home births are planned. Others may occur in an emergency situation, such as when the woman was unable to get to the hospital in time. This affects who was present. Only certain states differentiate whether the home birth was planned or not on a birth certificate.

Most women who choose home births are considered at low risk for pregnancy-related complications. Midwives and others may be getting better at determining which women can safely chose a home birth, MacDorman says.

Home Birth Not for Every Pregnancy

Saraswathi Vedam is the chair of the Home Birth Section of the American College of Nurse-Midwives' Division of Standards and Practice. She is also the director of the Division of Midwifery at the University of British Columbia.

She is on the front lines of this home-birth movement. "One would hope the rise is in planned home birth among healthy women with good risk profiles," Vedam says.

Home birth is not for every woman or every pregnancy. Women who wish to have a home birth should be full term, not have any blood pressure issues during pregnancy, and should be well nourished. The baby should be growing well and ideally have its head facing downward.

"There should be nothing about the pregnancy that would suggest she will need interventions in the hospital," Vedam says.

The large variations in the percentage of home births by state may be influenced by differences in state laws pertaining to midwifery practice or out-of-hospital birth, according to the study.

Women interested in home birth should do their research, and make sure that the provider has access to a hospital if they change their mind.

Not Everyone on Board

Based on his own experiences, Gene Burkett, MD, is not sold on home births. He is a professor of obstetrics and gynecology at University of Miami Miller School of Medicine in Florida. "The downsides are that when something goes wrong, such as an abnormal fetal heart rate, you have to respond in a manner that gets the patient delivered immediately," he says.

Things can go wrong, they can go wrong quickly, and this is not always predictable.

"Even with careful selection, one can get into difficult situations which demand immediate delivery, and you must have some way to deal with that rapidly," he says.

A compromise between the hospital and home may be a birthing center. "These can be unobtrusive, but not too far away from a hospital," Burkett tells WebMD.

ACOG states that planned home births do carry a two- to three-fold increase in the risk of newborn death, compared with planned hospital births. Former ACOG President Richard N. Waldman, MD, says that "it's important to remember that home births don't always go well, and the risk is higher if they are attended by inadequately trained attendants or in poorly selected patients with serious high-risk medical conditions such as [high blood pressure], breech presentation, or prior cesarean deliveries."

ACOG believes that hospitals and birthing centers are the safest place for labor and delivery. That said, the group encourages women who decide to deliver at home to take full advantage of prenatal care.


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SOURCES: Gene Burkett, MD, ob/gyn, University of Miami Miller School of Medicine, Miami.Saraswathi Vedam, chair, Home Birth Section, American College of Nurse-Midwives, Division of Standards and Practice; director, Division of Midwifery, University of British Columbia.Marian F. MacDorman, PhD, statistician, National Center for Health Statistics, Hyattsville, Md.NCHS Data Brief, Jan. 23, 2012.News release, ACOG.

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