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Trends in characteristics of women choosing contraindicated home births

Kelly B. Zafman, Joanne L. Stone and Stephanie H. Factor

Abstract

Objective:

To characterize the American College of Obstetricians and Gynecologists (ACOG) contraindicated home births and the women who are receiving these births in hopes of identifying venues for intervention.

Methods:

The National Center for Health Statistics (NCHS) birth certificate records from 1990 to 2015 were used. “Planned home births” were defined as those births in which birthplace was coded as “residence” and birth attendant was coded as “certified nurse midwife (CNM)” or “other midwife”. Contraindicated home births were defined as “planned home births” from 1990 to 2015 that had one or more of the ACOG risk factors for home births, which include vaginal birth after prior cesarean delivery (VBAC), breech presentation and multiple gestations.

Results:

A review of trends in contraindicated home births from 1990 to 2015 suggests that they are increasing in number (481–1396) and as a percentage of total births (0.01%–0.04%, P<0.001). There has been an increase in the proportion of college-educated women (31%–51%, P<0.001). Most women receive prenatal care (>95%), which is most frequently initiated in the first trimester. The majority of home births were paid out-of-pocket (65%–69%).

Conclusion:

The increasing number of contraindicated home births in the United States requires public health action. Home births are likely a matter of choice rather than a lack of resources. It is unclear if women choose home births while knowing the risk or due to a lack of information. Prenatal education about contraindicated home births is possible, as almost all women receive prenatal care.


Corresponding author: Stephanie H. Factor, MD, MPH, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1130, New York, NY 10029, USA and Icahn School of Medicine at Mount Sinai, Department of Medicine, Division of Infectious Disease, New York, NY, USA, Tel.: +212-824-7385, Fax: +212-849-2564

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Article note:

Presentation: Related abstract presented at The American College of Obstetrics and Gynecology Annual Clinical and Scientific Meeting on May 14, 2016 in Washington, DC, as a poster presentation.


Received: 2018-01-25
Accepted: 2018-03-19
Published Online: 2018-04-12
Published in Print: 2018-08-28

©2018 Walter de Gruyter GmbH, Berlin/Boston

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