Home Births on the Rise, But Still Rare

Home birth and birthing center rates have risen as more pregnant women opt for out of hospital birth

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) More moms-to-be may be opting for a new birth plan — a plan that doesn't involve the hospital. Researchers behind a new study looked at changing trends in where women are giving birth.

This new study looked at rates of out-of-hospital births in the US, often occurring either at home or at a birthing center.

The researchers found that although rates of these births are still very low, out-of-hospital births have become more common in recent years.

"Discuss birthing options thoroughly with your doctor."

This study was led by Marian F. MacDorman, PhD, of the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS).

According to Dr. MacDorman and colleagues, while almost all US births occurred outside of a hospital in the year 1900, this number dropped to only 44 percent of births in 1940 and only 1 percent of births by 1969.

Although this type of birth remains rare, Dr. MacDorman and team explained that out-of-hospital birth rates have seemed to be on the rise in recent years.

To explore this topic, the researchers looked at Birth Data Files for the years 1990 to 2012 from NCHS's National Vital Statistics System.

After analyzing the data, Dr. MacDorman and team found that out-of-hospital births started to increase in 2004, an increase which continued through the most recently available data for the year 2012.

Out-of-hospital births accounted for 0.87 percent of US births in 2004 and increased to 1.26 percent of births in 2011 and 1.36 percent of births in 2012.

Of the out-of-hospital births in the US during 2012, 66 percent occurred at home and 29 percent occurred in a freestanding birthing center not attached to a hospital.

Increases in both home births and birthing center births have contributed to the rise in out-of-hospital births since 2004. Home births increased from 0.84 percent of births in 2011 to 0.89 percent in 2012, while birthing center births increased from 0.36 percent of births in 2011 to 0.39 percent in 2012.

The researchers found that in the year 2012, out-of-hospital births accounted for 2.05 percent of births (one out of 49 births) to non-Hispanic white women.

The rates were lower among other ethnicities, with out-of-hospital births accounting for 0.81 percent of births to American Indian women, 0.54 percent of births to Asian or Pacific Islander women, 0.49 percent of births to non-Hispanic black women and 0.46 percent of births to Hispanic women.

Dr. MacDorman and team also saw regional differences in rates of out-of-hospital births, with generally higher rates in the northwestern part of the country and lower rates in the southeastern US.

In 2012 in Alaska, Idaho, Montana, Oregon, Pennsylvania and Washington, 3 to 6 percent of births were out-of-hospital births, and in Delaware, Indiana, Utah, Vermont and Wisconsin, between 2 and 3 percent were out-of-hospital births.

In contrast, the lowest rates were seen in Rhode Island, Mississippi and Alabama, where the rates were 0.33 percent, 0.38 percent and 0.39 percent, respectively.

The researchers also found that out-of-hospital births tended to have lower "risk profiles" than hospital births — meaning that fewer home births involved issues like premature births, low infant birth weights, multiple births and teen pregnancies.

It is important to note that while out-of-hospital births have increased, they are still relatively rare in the US.

Andre Hall, MD, an OBGYN at Birth and Women's Care, PA in Fayetteville, NC, told dailyRx News that his feelings on this issue are mixed.

"As an obstetrician, I am not opposed to deliveries at a birthing center due to the safety protocols they have in place. Home births concern me, however," Dr. Hall said.

"Periodically, home births that don't go well get transferred to the hospital. ... These outcomes often are not good. The problem with 'low risk' births at home is that there is no way to predict when these seemingly straightforward deliveries will take a turn for the worst. In situations like this, the outcome is often determined by the personnel and equipment in place to correct the problem," he said.

This study was published in the March NCHS Data Brief. No conflicts of interest were reported.

Review Date: 
March 5, 2014
Last Updated:
March 12, 2014