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.
SourceAvailable from: Birgit Arabin[Show abstract] [Hide abstract]
ABSTRACT: We examined neonatal mortality in relation to birth settings and birth attendants in the United States from 2006-2009. Data from the CDC linked birth and infant death data set in the US from 2006-2009 were used to assess early and total neonatal mortality for singleton, vertex, term births without congenital malformations delivered by midwives and physicians in hospital and midwives and "others" out of hospital. Deliveries by hospital midwives served as the reference. Midwife home births had a significantly higher total neonatal mortality risk than deliveries by hospital midwives (1.26/1,000 births; RR: 3.87 versus 0.32/1,000; p<0.001). Midwife home births ≥ 41 weeks (1.84/1,000; RR: 6.76 versus 0.27/1,000; p<0.001) and midwife home births of women with a first birth (2.19/1,000; RR: 6.74 versus 0.33/1,000; p<0.001) had significantly higher risks of total neonatal mortality than deliveries by hospital midwives. In midwife home births, neonatal mortality for first births was twice that of subsequent births (2.19 versus 0.96/1,000; p<0.001). Similar results were observed for early neonatal mortality. The excess total neonatal mortality for midwife home births compared to midwife hospital births was 9.32/10,000 births, and the excess early neonatal mortality was 7.89/10,000 births. Our study shows a significantly increased total and early neonatal mortality for home births and even higher risks for women ≥41 weeks and women having a first birth. These significantly increased risks of neonatal mortality in home births must be disclosed by all obstetric practitioners to all pregnant women who express an interest in such births.American journal of obstetrics and gynecology 03/2014; DOI:10.1016/j.ajog.2014.03.047 · 3.97 Impact Factor
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ABSTRACT: Objective To explore the influences on women who chose a publicly-funded homebirth in one Australian state. Design A constructivist grounded theory methodology was used. Setting A publicly-funded homebirth service located within a tertiary referral hospital in the southern suburbs of Sydney, Australia. Participants Data were collected though semi-structured interviews of 17 women who chose to have a publicly-funded homebirth. Findings Six main categories emerged from the data. These were: feeling independent, strong and confident, doing it my way, protection from hospital related activities, having a safety net, selective listening and telling, and engaging support. The core category was having faith in normal. This linked all the categories and was an overriding attitude towards themselves as women and the process of childbirth. The basic social process was validating the decision to have a homebirth. Conclusion Women reported similar influences to other studies when choosing homebirth. However, the women in this study were reassured by the publicly-funded system's ‘safety net’ and apparent seamless links with the hospital system. The flexibility of the service to permit women to change their minds to give birth in hospital, and essentially choose their birthplace at any time during pregnancy or labour was also appreciated. Implications for practice Women that choose a publicly-funded homebirth service describe strong influences that led them to homebirth within this model of care. Service managers and health professionals need to acknowledge the importance of place of birth choice for women.Midwifery 07/2014; DOI:10.1016/j.midw.2014.03.003 · 1.71 Impact Factor
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ABSTRACT: Abstract Background: The Apgar score is used worldwide to assess the newborn infant shortly after birth. Apgar scores, including mean scores and those with high cut-off scores, have been used to support claims that planned home birth is as safe as hospital birth. The purpose of this study was to determine the distribution of 5 min Apgar scores among different birth settings and providers in the USA. Methods: We obtained data from the National Center for Health Statistics of the US Centers for Disease Control birth certificate data for 2007-2010 for all singleton, term births of infants weighing ≥2500 g (n=13,830,531). Patients were then grouped into six categories by birth setting and birth attendant: hospital-based physician, hospital-based midwife, freestanding birth center with either certified nurse midwife and/or other midwife, and home-based delivery with either certified nurse midwife or other midwife. The distribution of each Apgar score from 0 to 10 was assessed for each group. Results: Newborns delivered by other midwives or certified nurse midwives (CNMs) in a birthing center or at home had a significantly higher likelihood of a 5 min maximum Apgar score of 10 than those delivered in a hospital [52.63% in birthing centers, odds ratio (OR) 29.19, 95% confidence interval (CI): 28.29-30.06, and 52.44% at home, OR 28.95, 95% CI: 28.40-29.50; CNMs: 16.43% in birthing centers, OR 5.16, 95% CI: 4.99-5.34, and 36.9% at home births, OR 15.29, 95% CI: 14.85-15.73]. Conclusions: Our study shows an inexplicable bias of high 5 min Apgar scores of 10 in home or birthing center deliveries. Midwives delivering at home or in birthing centers assigned a significantly higher proportion of Apgar scores of 10 when compared to midwives or physicians delivering in the hospital. Studies that have claimed the safety of out-of-hospital deliveries by using higher mean or high cut-off 5 min Apgar scores and reviews based on these studies should be treated with skepticism by obstetricians and midwives, by pregnant women, and by policy makers. The continued use of studies using higher mean or high cut-off 5 min Apgar scores, and a bias of high Apgar score, to advocate the safety of home births is inappropriate.Journal of Perinatal Medicine 04/2014; DOI:10.1515/jpm-2014-0003 · 1.43 Impact Factor