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More U.S. Women Delivering Babies at Home or Birth Centers

Most tended to be low-risk pregnancies and Pacific Northwest saw greatest increase, study finds

By Kathleen Doheny
HealthDay Reporter

WEDNESDAY, March 23, 2016 (HealthDay News) -- More women in the United States are choosing to deliver their babies at home or in birth centers, a new study indicates.

In 2014, nearly 60,000 babies were born outside a hospital, the researchers said. While that is still a small minority of all births, the trend has been gathering steam in the last decade, the study authors added.

In 2004, less than 1 percent of U.S. births occurred out of hospitals, said report author Marian MacDorman. She is a research professor at the Maryland Population Research Center at the University of Maryland, in College Park.

By 2014, the number of out-of-hospital births had increased to 1.5 percent, the study found.

Women who opted for home or birth centers to deliver their babies tended to have low-risk pregnancies, MacDorman said.

The researchers looked at birth certificate data over the years from 47 states and the District of Columbia. MacDorman's team found both geographic variation and other differences between mothers who went to the hospital and those who chose to give birth at home or in a birth center.

The Pacific Northwest had the highest rate of out-of-hospital births, while the deep South had the lowest. Mothers who gave birth at home were half as likely to be obese before getting pregnant, less likely to smoke and more likely to plan on breast-feeding. They were also more likely to be college graduates, the researchers said.

Nearly 79 percent of those who planned home births and over 92 percent who opted for birth centers had a midwife help deliver the babies. Only 8 percent of hospital births had midwives deliver the babies, the findings showed.

To make home births safer, MacDorman said women should be sure they are at low-risk, have a properly trained midwife, and be sure the midwife has relationships with doctors and hospitals so the mother and baby can be transferred if necessary.

A low-risk woman would have no high blood pressure, no diabetes or other chronic conditions, MacDorman said. "About 10 to 15 percent of women who labor at home end up having to go to the hospital," she noted.

The study findings were published online this month in the journal Birth.

One expert pointed out that any birth outside a hospital can be risky.

"The bottom line is [that] any home delivery is a risk," said Dr. David Mendez, neonatologist at Nicklaus Children's Hospital in Miami.

In a hospital birth, he said, the risk of a baby dying is two in 1,000. "That number doubles with home delivery," he said.

Mendez views birth centers as a good compromise for women who want a more natural experience, because they have medical personnel on hand if something goes wrong. "Birth centers are set up for a possible emergency, but the home birth experience isn't," he said.

One major concern, Mendez said, is the number of women in the study who chose home births but wanted a vaginal birth after a cesarean delivery, known as a VBAC.

"A lot of hospitals still don't let women do a VBAC," he said. Uterine rupture, an emergency situation, is a known risk for these women.

Despite the pros and cons, Mendez said he respects a woman's right to decide where she wants to deliver her baby. Being aware of the risks, however, is crucial in making that decision, he added.

More information

To learn more about home births, visit the American Pregnancy Association.


SOURCES: Marian MacDorman, Ph.D., research professor, Maryland Population Research Center, University of Maryland, College Park, Md.; David Mendez, M.D., neonatologist, Nicklaus Children's Hospital, Miami; March 16, 2016, Birth, online

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