Trends and Characteristics of Home Births in the United States by Race and Ethnicity, 1990-2006
ABSTRACT After a gradual decline from 1990 to 2004, the percentage of births occurring at home in the United States increased by 5 percent in 2005 and that increase was sustained in 2006. The purpose of the study was to analyze trends and characteristics in home births in United States by race and ethnicity from 1990 to 2006.
U.S. birth certificate data on home births were analyzed and compared with hospital births for a variety of demographic and medical characteristics.
From 1990 to 2006, both the number and percentage of home births increased for non-Hispanic white women, but declined for all other race and ethnic groups. In 2006, non-Hispanic white women were three to four times more likely to have a home birth than women of other race and ethnic groups. Home births were more likely than hospital births to occur to older, married women with singleton pregnancies and several previous children. For non-Hispanic white women, fewer home births than hospital births were born preterm, whereas for other race and ethnic groups a higher percentage of home births than hospital births were born preterm. For non-Hispanic white women, two-thirds of home births were delivered by midwives. In contrast, for other race and ethnic groups, most home births were delivered by either physicians or "other" attendants, suggesting that a higher proportion of these births may be unplanned home births because of emergency situations.
Differences in the risk profile of home births by race and ethnicity are consistent with previous research, suggesting that, compared with non-Hispanic white women, a larger proportion of non-Hispanic black and Hispanic home births represent unplanned, emergency situations.
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ABSTRACT: After a gradual decline from 1990 to 2004, the percentage of births occurring at home increased from 2004 to 2008 in the United States. The objective of this report was to examine the recent increase in home births and the factors associated with this increase from 2004 to 2008. United States birth certificate data on home births were analyzed by maternal demographic and medical characteristics. In 2008, there were 28,357 home births in the United States. From 2004 to 2008, the percentage of births occurring at home increased by 20 percent from 0.56 percent to 0.67 percent of United States births. This rise was largely driven by a 28 percent increase in the percentage of home births for non-Hispanic white women, for whom more than 1 percent of births occur at home. At the same time, the risk profile for home births has been lowered, with substantial drops in the percentage of home births of infants who are born preterm or at low birthweight, and declines in the percentage of home births that occur to teen and unmarried mothers. Twenty-seven states had statistically significant increases in the percentage of home births from 2004 to 2008; only four states had declines. The 20 percent increase in United States home births from 2004 to 2008 is a notable development that will be of interest to practitioners and policymakers. (BIRTH 38:3 September 2011).Birth 09/2011; 38(3):185-90. DOI:10.1111/j.1523-536X.2011.00481.x · 2.05 Impact Factor
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ABSTRACT: AIM: To determine risk factors for accidental out-of-hospital deliveries (OHD), which represent 0.5% of living births in France and are associated with poor neonatal outcomes. METHODS: This retrospective case-control study assessed accidental OHDs that occurred in the Finistère district (Brittany, France) between January 2007 and December 2009. For each OHD case, two controls were randomly selected. Outcome measures included maternal demographics, obstetric characteristics, and neonatal outcomes. RESULTS: During the study period, accidental OHDs accounted for 0.42% of all births; 76 accidental OHDs were included in the analysis. Multivariate analysis found four independent risk factors for accidental OHD: multiparity [OR 8.84 (3.22-24.29)], unemployment [OR 4.99 (1.85-13.47)], lack or poor antenatal care [OR 9.00 (2.41-33.72)], and a travel time >45 min from home to the delivery unit [OR 6.18 (1.33-28.65) versus < 15 min]. Significantly more newborns from the OHD group required admission to the neonatal unit (p = 0.04), but accidental OHD was not significantly associated with prematurity or low birth weight. CONCLUSION: Four risk factors for accidental OHD were identified. Set up of an anonymous registry of OHD cases could improve our knowledge and screening of women at risk. ©2013 The Author(s)/Acta Paediatrica ©2013 Foundation Acta Paediatrica.Acta Paediatrica 01/2013; 102(4). DOI:10.1111/apa.12156 · 1.84 Impact Factor
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ABSTRACT: IntroductionAlthough out‐of‐hospital births are still relatively rare in the United States, it is important to monitor trends in these births, as they can affect patterns of facility usage, clinician training, and resource allocation, as well as health care costs. Trends and characteristics of home and birth center births are analyzed to more completely profile contemporary out‐of‐hospital births in the United States. Methods National birth certificate data were used to examine a recent increase in out‐of‐hospital births. ResultsAfter a gradual decline from 1990 to 2004, the number of out‐of‐hospital births increased from 35,578 in 2004 to 47,028 in 2010. In 2010, 1 in 85 US infants (1.18%) was born outside a hospital; about two‐thirds of these were born at home, and most of the rest were born in birth centers. The proportion of home births increased by 41%, from 0.56% in 2004 to 0.79% in 2010, with 10% of that increase occurring in the last year. The proportion of birth center births increased by 43%, from 0.23% in 2004 to 0.33% in 2010, with 14% of the increase in the last year. About 90% of the total increase in out‐of hospital births from 2004 to 2010 was a result of increases among non‐Hispanic white women, and 1 in 57 births to non‐Hispanic white women (1.75%) in 2010 was an out‐of‐hospital birth. Most home and birth center births were attended by midwives. DiscussionHome and birth center births in the United States are increasing, and the rate of out‐of‐hospital births is now at the highest level since 1978. There has been a decline in the risk profile of out‐of‐hospital births, with a smaller proportion of out‐of‐hospital births in 2010 than in 2004 occurring to adolescents and unmarried women and fewer preterm, low‐birth‐weight, and multiple births.Journal of Midwifery and Women?s Health 09/2013; 58(5). DOI:10.1111/jmwh.12092 · 1.04 Impact Factor