Births Out of Hospital Up Sharply in Last Decade.
The proportion women giving birth out of the hospital increased sharply from 2004 to 2014, with mothers who gave birth at home or at birth centers having lower obesity and smoking rates and higher college graduation rates, a new study co-authored by a School of Public Health researcher shows.
The study, in the journal Birth, found that, while still relatively small, the percentage of out-of-hospital births in the US increased by 72 percent from 2004 to 2014—from 0.87 percent to 1.50 percent. The increase came after a 23 percent decline from 1990 to 2004.
Mothers who gave birth out of hospitals had lower risks of obesity and smoking and also were more likely to pay out-of-pocket for a planned home birth—a finding that may “highlight the commitment of some women to have the type of birth that they want to have,” the authors said.
“The risk profile of mothers having out-of-hospital births has improved across the decade, and in 2014, mothers with out-of-hospital births appeared to be at less demographic risk than mothers giving birth in hospitals,” said study authors Eugene Declercq, professor of community health sciences, and Marian MacDorman, research professor of the Maryland Population Research Center at the University of Maryland.
They said the increasing proportion of out-of-hospital births suggests that “a large number of women are choosing to bypass the traditional hospital-based maternity-care system in the United States and to choose an alternative model of care.” Access to out-of-hospital options could be improved by ensuring that both state Medicaid and private insurance programs cover out-of-hospital births, they said.
Of the more than 59,000 out-of-hospital births in 2014, about two-thirds were home births, while most all the rest were deliveries at birth centers. About 88 percent of home births were planned. Non-Hispanic white women had the highest percent of out-of-hospital births and one of the largest increases in such births—from 1.20 percent in 2004 to 2.25 in 2014.
Among women delivering in hospitals, 25 percent were obese at the beginning of their pregnancies, compared with 11.8 percent of birth center births and 11.6 percent of planned home births. Among women giving birth in hospitals, 8.5 percent smoked during pregnancy, compared with just 1.3 percent of birth center deliveries and 0.9 percent of planned home births.
The rate of vaginal births after cesarean section (VBAC) was higher among planned home births (4.6 percent) than among hospital births (1.6 percent), the study found. This was perhaps a reflection of the difficulty mothers had in accessing hospitals that provide VBACs, the authors noted.
The study analyzed birth certificates for the approximately 4 million births registered in the US in 2014 and comparable data from previous years. The analysis found strong regional patterns, with out-of-hospital births being several times more likely in the Pacific Northwest than in the deep South, for example.