Home Birth — The Facts
Want to know more about home births? Here’s the facts.
How many women have out-of-hospital deliveries?
The Centers for Disease Control (CDC) states that out-of-hospital deliveries represented 1.4% of births (more than 56,000) in 2013 (the most recent data available). 64.4% (36,080) were home births and 30.2% occurred in freestanding birth centers. This is the highest home birth rate the US has seen since 1989 when home births started being recorded. The rate of home birth has risen steadily since 2004.
Who’s having home births?
Older Caucasian mothers, aged 35 and over, are more likely to give birth at home than younger mothers. According to data compiled by the CDC, there are wide disparities in race and ethnicity for mothers choosing home births. In 2009, the percentage of home births was three to five times higher for non-Hispanic white women than for any other race. From 2004 to 2009, the percentage of home births increased for Asian Pacific Islanders and Hispanic women, and remained about the same for non-Hispanic black and American Indian or Alaska Native women.
About half of home births are to mothers having their third or higher births.
About 84% of women having home births are married.
Where are women having home births in the U.S.?
Home birth rates were highest in the Northwest region of the U.S. and lowest in the Southeast. Montana reports the highest percentage of home births with 2.5% of all births occurring at home and six other states report rates of 2.0% or more including Idaho (2.0%), Oregon (2.3%), Utah (2.1%), Vermont (2.2%) Washington (2/1%) and Wisconsin (2.0%).
By comparison, in many parts of the developing world, more than 50% of births take place at home, primarily among poor women.
Why do women have home births?
The answers to this question vary widely and include affordability and lack of insurance, desire to avoid non-essential medical interventions including C-sections, desire to have a vaginal birth after cesarean or a vaginal birth with twins or a breech baby. For many women living in rural areas, the distance to the hospital is too far. For some, the lack of healthcare providers performing obstetric services means home birth is their most reasonable choice. For women who live near hospitals with exceedingly high C-section rates, home birth may feel like the safest option.
Who delivers the babies?
Midwives attend the vast majority of home births. Certified Nurse Midwives, Certified Midwives and Certified Professional Midwives all have the skills needed to deliver babies at home, though CMs and CPMs usually have more training specific to home birth. Very few obstetricians do home deliveries and statistics are unavailable as to exact numbers.
Is home birth safe?
Many studies indicate that home birth can be a safe option for some women and their babies. For low-risk, healthy women attended by a skilled midwife and with access to a nearby hospital in case of emergency, home birth outcomes are generally excellent for mothers and babies. NPR discussed varying opinions on the home versus hospital debate in response to a British study that indicates home birth can be safer for low risk women than hospital births because there’s less risk for surgery, infection and hemorrhage. Other studies conflict however as to home birth safety as compared to hospital births.
- A 2014 study in the Journal of Midwifery and Women’s Health, evaluated outcomes for 16,924 women who planned home births at the onset of labor, 89.1% of whom gave birth at home (the other 10.9% were transferred to a hospital). Their study indicated that rates of spontaneous vaginal birth, assisted vaginal birth, and cesarean were 93.6%, 1.2%, and 5.2%, respectively. Of the 1054 women who attempted a vaginal birth after cesarean, 87% were successful. Low Apgar scores occurred in 1.5% of newborns. Excluding lethal anomalies, the intrapartum, early neonatal, and late neonatal mortality rates were 1.30, 0.41, and 0.35 per 1000, respectively. This study concluded that the low-risk women in this group experienced high rates of physiologic birth (vaginal) and low rates of intervention without an increase in adverse outcomes.
- Another study presented in 2014 at the Society of Maternal-Fetal Medicine’s annual meeting, used CDC data from 14 million infant births and deaths. They determined that babies delivered at home by midwives had a roughly four times higher risk of neonatal death (12.6 deaths/10,000 births) than babies delivered in the hospital by midwives (3.2 deaths/10,000 births). For first time mothers, rates were even higher (21.9/10,000 births). They indicated that the increased mortality risk was associated with the place of birth, not the midwives’ credentials.
This study has received a lot of criticism (including from some of the studies’ co-authors) that the type of births and data used have been misconstrued or used inaccurately, which may have negatively skewed results.