Trends in characteristics of women choosing contraindicated home births

Kelly B. Zafman 1 , Joanne L. Stone 2  and Stephanie H. Factor 2 , 3 , 4
  • 1 Icahn School of Medicine at Mount Sinai, New York, NY, USA
  • 2 Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Maternal-Fetal Medicine, New York, NY, USA
  • 3 Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1130, New York, NY 10029, USA
  • 4 Icahn School of Medicine at Mount Sinai, Department of Medicine, Division of Infectious Disease, New York, NY, USA
Kelly B. Zafman, Joanne L. Stone
  • Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Maternal-Fetal Medicine, New York, NY, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
and Stephanie H. Factor
  • Corresponding author
  • Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Maternal-Fetal Medicine, New York, NY, USA
  • Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1130, New York, NY 10029, USA
  • Icahn School of Medicine at Mount Sinai, Department of Medicine, Division of Infectious Disease, New York, NY, USA
  • Email
  • Search for other articles:
  • degruyter.comGoogle Scholar

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.

  • [1]

    Wax JR, Lucas FL, Lamont M, Pinette MG, 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.

    • Crossref
    • Export Citation
  • [2]

    Snowden JM, Tilden EL, Snyder J, Quigley B, Caughey AB, Cheng YW. Planned out-of-hospital birth and birth outcomes. New Engl J Med. 2015;373:2642–53.

    • Crossref
    • Export Citation
  • [3]

    Grünebaum A, McCullough LB, Arabin B, Dudenhausen J, Orosz B, Chervenak FA. Underlying causes of neonatal deaths in term singleton pregnancies: home births versus hospital births in the United States. J Perinat Med. 2017;45:349–57.

    • PubMed
    • Export Citation
  • [4]

    American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 697: planned home birth. Obstet Gynecol. 2017;129:779–80.

    • PubMed
    • Export Citation
  • [5]

    Grünebaum A, Chervenak FA. Out-of-hospital births in the United States 2009–2014. J Perinat Med. 2016;44:845–9.

    • PubMed
    • Export Citation
  • [6]

    American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 476: planned home birth. Obstet Gynecol. 2011;117(Pt 1):425–8.

    • PubMed
    • Export Citation
  • [7]

    Johnson KC, Daviss B-A. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 2005;330:1416–9.

    • Crossref
    • PubMed
    • Export Citation
  • [8]

    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.

    • PubMed
    • Export Citation
  • [9]

    Wasden SW, Chasen ST, Perlman JM, Illuzzi JL, Chervenak FA, Grünebaum A, et al. Planned home birth and the association with neonatal hypoxic ischemic encephalopathy. J Perinat Med. 2017;45:1055–60.

    • PubMed
    • Export Citation
  • [10]

    American College of Obstetricians and Gynecologists. ACOG statement on home births. ACOG News release, 2008. Available from http://www.cfmidwifery.org/pdf/ACOGPRnr0206082cfm.pdf.

  • [11]

    MacDorman MF, Declercq E, Mathews TJ. Recent trends in out-of-hospital births in the United States. J Midwifery Womens Health. 2013;58:494–501.

    • Crossref
    • PubMed
    • Export Citation
  • [12]

    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.

    • Crossref
    • PubMed
    • Export Citation
  • [13]

    Krans EE, Davis MM. Strong start for mothers and newborns: implications for prenatal care delivery. Curr Opin Obstet Gynecol. 2014;26:511.

    • Crossref
    • PubMed
    • Export Citation
  • [14]

    Partridge S, Balayla J, Holcroft CA, Abenhaim HA. Inadequate prenatal care utilization and risks of infant mortality and poor birth outcome: a retrospective analysis of 28,729,765 US deliveries over 8 years. Am J Perinatol. 2012;29: 787–94.

    • Crossref
    • Export Citation
  • [15]

    Care PP. Evidence-based prenatal care: Part I. General prenatal care and counseling issues. Am Fam Physician. 2005;71:1307–16.

    • PubMed
    • Export Citation
  • [16]

    DuBard CA, Massing MW. Trends in emergency Medicaid expenditures for recent and undocumented immigrants. JAMA. 2007;297:1085–92.

    • Crossref
    • PubMed
    • Export Citation
  • [17]

    Vinikoor LC, Messer LC, Laraia BA, Kaufman JS. Reliability of variables on the North Carolina birth certificate: a comparison with directly queried values from a cohort study. Paediatr Perinat Epidemiol. 2010;24:102–12.

    • Crossref
    • PubMed
    • Export Citation
  • [18]

    DiGiuseppe DL, Aron DC, Ranbom L, Harper DL, Rosenthal GE. Reliability of birth certificate data: a multi-hospital comparison to medical records information. Matern Child Health J. 2002;6:169–79.

    • Crossref
    • Export Citation
  • [19]

    American Academy of Pediatrics. Policy statement on planned home births. Pediatrics. 2013;131:1016–20.

  • [20]

    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.

    • Crossref
    • Export Citation
  • [21]

    Grünebaum A, McCullough LB, Sapra KJ, Arabin B, Chervenak FA. Planned home births: the need for additional contraindications. Am J Obstet Gynecol. 2017;216:401.e1–8.

    • PubMed
    • Export Citation
Purchase article
Get instant unlimited access to the article.
$42.00
Log in
Already have access? Please log in.


or
Log in with your institution

Journal + Issues

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.

Search