To evaluate recent trends of out-of-hospital births in the US from 2009 to 2014.
We accessed data for all live births occurring in the US from the National Vital Statistics System, Natality Data Files for 2009–2014 through the interactive data tool, VitalStats.
Out-of-hospital (OOH) births in the US increased from 2009 to 2014 by 80.2% from 32,596 to 58,743 (0.79%–1.47% of all live births). Home births (HB) increased by 77.3% and births in freestanding birthing centers (FBC) increased by 79.6%. In 2014, 63.8% of OOH births were HB, 30.7% were in FBC, and 5.5% were in other places, physicians offices, or clinics. The majority of women who had an OOH birth in 2014 were non-Hispanic White (82.3%). About in one in 47 non-Hispanic White women had an OOH in 2014, up from 1 in 87 in 2009. Women with a HB were older compared to hospital births (age ≥35: 21.5% vs. 15.4%), had a higher live birth order(≥5: 18.9% vs. 4.9%), 3.48% had infants <2500 g and 4.66% delivered <37 weeks’ gestation. 4.34% of HB were patients with prior cesarean deliveries, 1.6% were breech, and 0.81% were twins.
Since 2004 the number of women delivered out of the hospital, at home and in freestanding birthing centers has significantly increased in the US making it the country with the most out of hospital births among all developed countries. The root cause of the increase in planned OOH births should be identified and addressed by the medical community.
Brouwers HA, Bruinse W, Dijs-Elisnga J, de Miranda E, Ravelli A, Tamminga P. Netherlands Perinatal Registry. Perinatal Care in the Netherlands 2013. Utrecht: Netherlands Perinatal Registry, 2014.
Cheng YW, Snowden JM, King TL, Caughey AB. Selected perinatal outcomes associated with planned home births in the United States. Am J Obstet Gynecol. 2013;209:325.e1–8.
Johnson KC, Daviss BA. Outcomes of planned home births with certified professional midwives: large prospective study in North America. Br Med J. 2005;330:1416.
Wax JR, Lucas FL, Lamont M, Cartin A, Blackstone, J. Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. Am J Obstet Gynecol. 2010;203:243.e1–8.
Grünebaum A, McCullough LB, Sapra KJ, Brent RL, Levene MI, Arabin B, et al. Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009. Am J Obstet Gynecol. 2014;211:390.e1–7.
Brocklehurst P, Hardy P, Hollowell J, Linsell L, Macfarlane A, McCourt C, et al. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. Birthplace in England Collaborative Group. Br Med J. 2011;343:d7400.
Commissie Verloskunde van het CVZ. Verloskundig Vademecum 2003. Diemen, the Netherlands: College voor Zorgverzekeringen, 2003.
Janssen PA, Saxell L, Page LA, Klein MC, Liston RM, Lee SK. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. Can Med Assoc J. 2009;181:377–83.
Cheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, Vedam S. Outcomes of Care for 16,924 planned home births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. J Midwifery Womens Health. 2014;59:11–27.
Grünebaum A, McCullough LB, Brent RL, Arabin B, Levene MI, Chervenak FA. Perinatal risks of planned home births in the United States. Am J Obstet Gynecol. 2015;212:350.e1–6.
ACOG Committee Opinion No. 476: Planned home birth. ACOG Committee on Obstetric Practice. Obstet Gynecol. 2011;117:425–8.
American Academy of Pediatrics: Policy Statement Planned Home birth. Pediatrics. 2013;131:1016–20.
Macdorman MF, Declercq E, Mathews TJ, Stotland N. Trends and characteristics of home vaginal birth after cesarean delivery in the United States and selected States. Obstet Gynecol. 2012;119:737–44.
Cox KJ, Bovbjerg ML, Cheyney M, Leeman LM. Planned Home VBAC in the United States, 2004–2009: Outcomes, Maternity Care Practices, and Implications for Shared Decision Making. Birth. 2015;42:299–308.
de Jonge A, Geerts CC, van der Goes BY, Mol BW, Buitendijk SE, Nijhuis JG. Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases. BJOG. 2015;122:720–8.
Chervenak FA, McCullough LB, Brent RL, Levene MI, Arabin B. Planned home birth: the professional responsibility response. Am J Obstet Gynecol. 2013;208:31–8.
Buekens P, Keirse MJ. In the literature: home birth: safe enough, but not for the first baby. Birth. 2012;39:165–7.
Grünebaum A, McCullough LB, Brent RL, Arabin B, Levene MI, Chervenak FA. Justified skepticism about Apgar scoring in out-of-hospital birth settings. J Perinat Med. 2015;43:455–60.
DiGiuseppe DL, Aron DC, Ranbom L, Harper DL, Rosenthal GE. Reliability of birth certificate data: a multi-hospital comparison to medical records information. Mat Child Health J. 2002;6:169–79.
Northam S, Knapp TR. The reliability and validity of birth certificates. J Obstet Gynecol Neonat Nurs. 2006;35:3–12.
The Journal of Perinatal Medicine is a truly international forum covering the entire field of perinatal medicine. It is an essential news source for all those obstetricians, neonatologists, perinatologists and allied health professionals who wish to keep abreast of progress in perinatal and related research.
01 Jan 1973
Eduardo Bancalari, Joseph Chappelle, Frank A. Chervenak, Vincenzo D'Addario, Mehmet R. Genc, Anne Greenough, Amos Grunebaum, Justin C. Konje, Asim Kurjak M.D., Roberto Romero and Ivica Zalud, MD PhD