From the Los Angeles Times:
Home births in the United States increased 20% from 2004 to 2008, reaching their highest level since 1990, according to a study published online Friday in the journal Birth.
The study's authors, led by Centers for Disease Control and Prevention statistician Marian F. MacDorman, examined trends in home births by looking at birth certificate data from all 50 states. These provided information about maternal race and ethnicity, maternal age and marital status, whether infants were born prematurely, birth weight, place of birth and who attended the delivery.
While home births had declined gradually between 1990 and 2004, the team found, they began creeping back up in 2004. That year, there were 23,150 home births in the United States -- about 0.56% of total births. In 2008, there were 28,357 home births in the country, or 0.67% of total births.
The increase appears to be driven primarily by an increased interest among Caucasian women in giving birth at home, the authors wrote. In 2004, about 0.80% of births among Caucasian women were home births. In 2008, 1.02% were. The researchers calculated that approximately 94% of the increase in overall percentage of home births between 2004 and 2008 was because of this increase. According to the study, the percentage of home births among white women is three to six times higher than for any other race or ethnic group.
Also of interest: percentages of home births were generally higher in western states, and lower in the Southeast. In 2008, Montana had the highest percentage of home births -- 2.18%. Vermont was next at 1.96%, and Oregon was third at 1.91%. In all, 16 states had more than 1% home births, while 18 states had less than 0.50%.
The percentage of home births delivered by certified midwives or certified nurse-midwives increased from 15.8% in 2004 to 19.2% in 2008. The percentage of home births delivered by other midwives fell from 43.9% in 2004 to 42% in 2008. The vast majority of midwife-assisted births were planned home deliveries. The percentage of home births delivered by physicians -- most of which are unplanned home births, the authors noted -- fell from 8.7% in 2004 to 5.4% in 2008.
Article abstract:
Background: 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.
Methods: United States birth certificate data on home births were analyzed by maternal demographic and medical characteristics.
Results: 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.
Conclusion: 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)