Trends and Characteristics of Home Births in the United States

Marian MacDorman,* Eugene Declercq,** T.J. Mathews*

*National Center for Health Statistics

**Boston University School of Public Health

AMCHP Webinar on Home Births

July 11, 2013

Source of Data

• Data based on all birth certificates filed in the US each year

• Shows number of births actually delivered in each location (home, birthing center, hospital, etc.)

• Data do not identify women who planned to deliver at home but were transported to a hospital.

Long-Term Trends by Place of Birth

There have been large changes in US birthing patterns over the past century:

• In 1900, nearly all US births occurred at home.

• By 1940, only 44% of US births were born outside of a hospital

• By 1969, only 1% of US births were born outside of a hospital.

• Out-of-hospital births have remained around 1% for several decades.

• 1989 revision of the birth certificate allowed us to distinguish, for the first time, between types of out-of-hospital births (home or birthing center)

1990

1995

2000

2005

2011

0.0

0.2

0.4

0.6

0.8

1.0P

erc

en

t

23,150(0.56%)

27,678 (0.67%)

33,043(0.84%)

Number and percent of home births, US, 1990-2011

Source: Birth certificate data from the National Vital Statistics System.

Percent of home births by maternal race/ethnicity, US, 1990-2011

1990 1995 2000 2005 20110.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

Pe

rce

nt

Non-Hispanic white

Non-Hispanic black

Hispanic

American IndianAPI

Notes: Non-Hispanic white, Non-Hispanic black and Hispanic data exclude New Hampshire in 1990-92 and Oklahoma in 1990, as these states did not report Hispanic origin on their birth certificates for those years. API denotes Asian or Pacific Islander. Source: Birth certificate data from the National Vital Statistics System.

MT

WY

ID

WA

OR

NV

UT

CA

AZ

ND

SD

NE

CO

NM

TX

OK

KS

AR

LA

MO

IA

MN

WI

IL IN

KY

TN

MS AL GA

FL

SC

NC

VAWV

OH

MI

NY

PA

MD

DE

NJ

CT RI

MA

ME

VT

NH

AK

HI

<0.50%

0.50-0.84%0.85-1.49%

DC

Percent of home births, 2011

Source: Birth certificate data from the National Vital Statistics System.

1.50-1.99%

U.S. average=0.84%

2.00% or more

MT

WY

ID

WA

OR

NV

UT

CA

AZ

ND

SD

NE

CO

NM

TX

OK

KS

AR

LA

MO

IA

MN

WI

IL IN

KY

TN

MS AL GA

FL

SC

NC

VAWV

OH

MI

NY

PA

MD

DE

NJ

CT RI

MA

ME

VT

NH

AK

HI

Significant increase 13%-49%

DC

Change in percentage of home births 2004-2011

Source: Birth certificate data from the National Vital Statistics System.

Significant increase 50% or moreU.S. average=50% increase

No significant changeData not available

Percent of home and hospital births with selected demographic risk factors, US, 2011

Unmarried <20 35+ Live birth order 4+0

5

10

15

20

25

30

35

40

45

14.8

2.1

20.8

31.2

41

8.5

14.611.5

Home Hospital

Maternal age

Percent of home and hospital births with selected medical risk factors, US, 2011

Preterm Low birthweight Multiple birth0

2

4

6

8

10

12

14

5.3

3.6

1.2

11.8

8.2

3.5

Home Hospital

Pe

rce

nt

Source: Birth certificate data from the National Vital Statistics System.

Change in risk profile of home births, US, 2004-2011

0

5

10

15

20

25

30

35

3.9

22.0

33.1

20.4

7.15.3

1.12.1

20.8

31.2

14.8

5.33.6

1.2

2004 2011

Perc

ent

Maternal age

Planning status of home birth

• Important indicator of risk for home births

• Unplanned home births:

• may represent an emergency situation (precipitous labor, couldn’t get to the hospital)

• may be at higher risk for poor birth outcomes, with the birth taking place in an environment unprepared for a delivery.

• Planning status of home birth reported by 34 states and DC (67.5% of US births) in 2011

Percent of home births that were planned by maternal race/ethnicity, 34 States and DC, 2011

Total Non-Hispanic

white

Non-Hispanic

black

Hispanic Native American

Asian or Pacific Is-

lander

0102030405060708090

100

8893

34

6877 74

Per

cen

t

NOTE: Not stated planning status excluded before percent computation.SOURCE: Birth certificate data from the National Vital Statistics System.

Percent of planned home births by birth attendant, 34 states and DC, 2011

28%

48%

1%

24%

CNM/CM

Other midwife

Other

Source: Birth certificate data from the National Vital Statistics System.

Physician

Summary• In 2011, there were over 33,000 home births in the US,

comprising 0.84% of US births. The percent of home births increased by 50% from 2004-2011.

• For non-Hispanic white women, home births increased by 59% from 2004-2011. In 2011, 1 in 79 non-Hispanic white births was a home birth (1.27%).

• The increase in home births was widespread and involved states from every region of the country. From 2004-2011, 39 states had significant increases in home births, including 21 states with increases of 50% or more.

• In 2011, 88% of home births were planned (34 state and DC reporting area). For non-Hispanic white women, 93% were planned.

Summary (cont.)• Home births have a lower risk profile than hospital

births, with fewer births to teenagers or unmarried women, and with fewer preterm, low birthweight, or multiple births.

• In contrast, a higher percentage of home than hospital births were higher parity births and those to older mothers.

• The risk profile of home births improved from 2004-2011, suggesting that appropriate risk selection of low-risk women is occurring and improving.

Marian MacDorman, Ph.D.Statistician, Reproductive Statistics BranchNational Center for Health StatisticsCenters for Disease Control and PreventionPhone: (301) 458-4356Email: mfm1@cdc.gov

Questions?

Link to recent report: http://www.cdc.gov/nchs/data/databriefs/db84.pdf