Although less than 1 percent of births in the U.S. take place at home, the number of home births jumped 20 percent over just a four-year period, according to the results of a study from the Centers for Disease Control and Prevention (CDC) and a Boston university professor. The details of the analysis were recently published in the medical journal Birth: Issues in Perinatal Care.
While home births were on the decline from 1990 to 2004, figures for the period between 2004 and 2008 show a steady increase among a small subculture of white women opting for natural birth. In 2008 alone, at least one in 98 white women gave birth at home, while an average of just one in 357 black women, and only one in 500 Hispanic women choose to have their babies in their homes. Among all races, around one in 143 births occurred at home in 2008, compared to one in 179 in 2004. Of course, some home births occur due to women residing in remote locations being unable to reach a hospital in time for delivery.
Lead study author, Marian MacDorman of the CDC’s National Center for Health Statistics speculated, “I think there’s more of a natural birth subculture going on with white women — an interest in a low-intervention birth in a familiar setting.”
Study Details
For their study, the researchers evaluated birth certificate data of more than four million live births registered in the U.S. for 2008 and previous years. Findings showed that 28,357 babies were born at home in 2008, accounting for 0.67 percent of total births, which was the highest proportion of home births since 1990.
The study revealed that the largest home birth increases occurred in Vermont and Oregon, with an average of about one in 50 births, with the rate in Alaska following closely behind. In all, 27 states had significant increases during the four-year period analyzed.
While the physician participation in home births decreased by 38 percent from 2004 to 2008, the percentage of those assisted by certified midwives and nurse-midwives has been on the rise. Doctors have become increasingly adamant in advising against home births due to the possibility of serious complications. For years, the American College of Obstetricians and Gynecologists (ACOG) has warned that home births are unsafe, especially in the cases where mothers have high-risk medical conditions. The danger of complications can be compounded by inadequately trained attendants, or lack of fast transport to a hospital if something goes wrong.
Regarding the increase in home births, George Macones, an obstetrician at Washington University in St. Louis who chairs ACOG’s Committee on Obstetric Practice stated, “From our perspective, that’s not the best thing for the overall health of babies and women.”
However, the researchers also found that during the period from 2004 through 2008, home births involving medical risks declined. Home deliveries of babies born preterm dropped by 16 percent, and by 2008, just 6 percent of all home births involved those in which infants were born prematurely. This equates to less than half the percentage born in hospitals.
Controversy
There are those who point out that at-home births avoid the potential risk of infection posed by hospitals, and also prevents unnecessary medical interventions. In addition, home births are much more economical with costs that are about one-third of those for hospital births.
The controversy surrounding the safety of home birth is only compounded by studies the yield conflicting results. MacDorman noted, “There have been some large studies done in other countries that found that home births were as safe as hospital births for low-risk women.” Yet, she also pointed out that a 2010 study published in the American Journal of Obstetrics & Gynecology found home births to be linked to a tripling of the newborn death rate. However, she did acknowledge that the research methods used for the latter study came into question after having been published.
Home births and out-of-hospital birth options among low-risk women are also supported by the World Health Organization, the American College of Nurse-Midwives, the American Public Health Association and the National Perinatal Association.
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