Trends and Characteristics of Home and Other Out-of-Hospital Births in the United States, 1990–2006

Volume 58, Number 11 March 3, 2010
Trends and Characteristics of Home and Other Out-of-Hospital Births in the United States, 1990–2006
by Marian F. MacDorman, Ph.D., and Fay Menacker, Dr. P.H., C.P.N.P., Division of Vital Statistics
Eugene Declercq, Ph.D., Boston University School of Public Health

Abstract
Objectives—This report examines trends and characteristics of out-of-hospital and home births in the United States. Methods—Descriptive tabulations of data are presented and interpreted.
Results—In 2006, there were 38,568 out-of-hospital births in the United States, including 24,970 home births and 10,781 births occurring in a freestanding birthing center. After a gradual decline from 1990 to 2004, the percentage of out-of-hospital births increased by 3% from 0.87% in 2004 to 0.90% in 2005 and 2006. A similar pattern was found for home births. After a gradual decline from 1990 to 2004, the percentage of home births increased by 5% to 0.59% in 2005 and remained steady in 2006. Compared with the U.S. average, home birth rates were higher for non-Hispanic white women, married women, women aged 25 and over, and women with several previous children. Home births were less likely than hospital births to be preterm, low birthweight, or multiple deliveries. The percentage of home births was 74% higher in rural counties of less than 100,000 population than in counties with a population size of 100,000 or more. The percentage of home births also varied widely by state; in Vermont and Montana more than 2% of births in 2005–2006 were home births, compared with less than 0.2% in Louisiana and Nebraska. About 61% of home births were delivered by midwives. Among midwife-delivered home births, one-fourth (27%) were delivered by certified nurse midwives, and nearly three-fourths (73%) were delivered by other midwives.
Discussion—Women may choose home birth for a variety of reasons, including a desire for a low-intervention birth in a familiar environment surrounded by family and friends and cultural or religious concerns. Lack of transportation in rural areas and cost factors may also play a role.
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