The Transforming Birth Fund Birth By the Numbers 2016 Contemporary Trends in Home Birth Prof. Gene Declercq, PhD www.birthbythenumbers.org With support from: The Transforming Birth Fund As an example of the delay in releasing data, the 2010 final birth data was released in August, 2012. The preliminary 2011 data was released in October, 2012 which provides early data on teen birth rates, rates of cesareans and premature birth. The 2011 Final Data Births report was released on 6/28/2013. States will sometimes release data in a more timely way. BirthByTheNumbers.org

Is anyone having home births? Who’s having them? Who’s attending them? What’s the future for home birth?

Is anyone having home births?

Out of Hospital Birth Rates, Selected Countries, 1935-2014 Finland Japan U.S. Sources: National Vital Statistics and Birth Reports, various countries.

Percent of all births at home, or in a birthing center, United States, 1990-2014 58% Increase 2004-2014 56,313 (1.41%) 46,956 (1.13%) 35,587 (0.87%) Total home & birth center 38,094 0.96% Home 18,219 0.46% Birthing center Home births approached 1% of all births in 2014 reaching the highest level (0.96%) since recording of home births began in 1989. The proportion of births in freestanding birth centers also reached a new high of 0.46% in 2014. In all, 56,313 births occurred out of hospital in the U.S., a total of 1.41% of all births. After a slow, steady decline from 1990-2004, the number of out of hospital births began to grow after 2004, increasing by 58% between 2004 and 2014. Among population groups (not shown), out of hospital births were most common among non-Hispanic white mothers with 1.46% of their births at home and 0.7% in freestanding birth centers. In other words, 1 out of every 47 births to non-Hispanic white mothers occurred out of hospitals. Rates of out of hospital birth for non-Hispanic black and Hispanic mothers have remained steady at about one half of one percent in recent years. Home births were also strongly related to the number of times a woman had given birth (not shown). Only one half percent (0.5%) of first time mothers had a home birth, a proportion that increased with each subsequent birth, with 1.6% of mothers with 3 or more births giving birth at home. Source: NCHS Annual Birth Reports & CDCVitalStats. http://www.cdc.gov/nchs/nvss.htm BirthByTheNumbers.org

Who’s having home births? Where in the U.S. are they most common?

Percentage of births occurring outside a hospital by race and Hispanic origin of mother, United States, 1990-2014 Notes: Non-Hispanic white, Non-Hispanic black and Hispanic data exclude New Hampshire in 1990-92 and Oklahoma in 1990, as these states did not report Hispanic origin on their birth certificates for those years. API denotes Asian or Pacific Islander. Source: Birth certificate data from the National Vital Statistics System.

Home Births, U.S. States 7 States > 1.5% 5 States 1.0-1.5%

Home Births, U.S. States

Home Births, U.S. States 6 States > 1.5% 6 States 1.0-1.5%

Home Births, U.S. States

Home Births, U.S. States

Home Births, U.S. States 2014 15 States > 1.5% 10 States 1.0-1.5%

Who’s attending home births?

Percent of home and birthing center births by type of attendant, US, 2014 Doctor 3% NOTE: CNM/CM = certified nurse midwife or certified midwife. SOURCE: Birth certificate data from the national vital statistics system.

Total Births Attended by Other Midwives, U.S., 1989-2014 31,701 0.80% 15,007 0.54% Source: Centers for Disease Control and Prevention. National Center for Health Statistics. VitalStats. http://www.cdc.gov/nchs/vitalstats.htm. Accessed November 28, 2015

CNM Attendance at Home Birth, 2004-2014 Source: Centers for Disease Control and Prevention. National Center for Health Statistics. VitalStats. http://www.cdc.gov/nchs/vitalstats.htm. Accessed November 28, 2015

“Other” at home birth

Percent of home births that were planned, by care provider, 47 States and DC, 2014 NOTE: Not stated planning status excluded before percent computation. SOURCE: Birth certificate data from the National vital statistics system.

What’s the future for home birth?

If a woman wants to have her baby at home, she should be able to do so.

For any future births, how open would you be to giving birth at home?

For any future births, how open would you be to giving birth at home? Would Consider Definitely Want Race/Ethnicity

How far is this increase likely to go?

Proportion of Home Births, England, 1985-2014 Changing Childbirth

Future of Out-of-Hospital Births in the U.S. Likely to continue to grow for a time. Home birth is not likely to rise much beyond 2-3%. May be much greater potential for growth in Birth Center births if growth in CNMs. Biggest question is whether or not the U.S. will develop integrated systems of care.

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