Trends and Characteristics of Home Births in the United States Marian MacDorman,* Eugene Declercq,** T.J. Mathews* *National Center for Health Statistics **Boston University School of Public Health AMCHP Webinar on Home Births July 11, 2013

Source of Data Data based on all birth certificates filed in the US each year Shows number of births actually delivered in each location (home, birthing center, hospital, etc.) Data do not identify women who planned to deliver at home but were transported to a hospital.

Long-Term Trends by Place of Birth There have been large changes in US birthing patterns over the past century: In 1900, nearly all US births occurred at home. By 1940, only 44% of US births were born outside of a hospital By 1969, only 1% of US births were born outside of a hospital. Out-of-hospital births have remained around 1% for several decades revision of the birth certificate allowed us to distinguish, for the first time, between types of out-of- hospital births (home or birthing center)

Number and percent of home births, US, Source: Birth certificate data from the National Vital Statistics System.

Percent of home births by maternal race/ethnicity, US, Notes: Non-Hispanic white, Non-Hispanic black and Hispanic data exclude New Hampshire in 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.

MT WY ID WA OR NV UT CA AZ ND SD NE CO NM TX OK KS AR LA MO IA MN WI IL IN KY TN MS AL GA FL SC NC VA WV OH MI NY PA MD DE NJ CT RI MA ME VT NH AK HI < 0.50 % % % DC Percent of home births, 2011 Source: Birth certificate data from the National Vital Statistics System % U.S. average=0.84% 2.00% or more

MT WY ID WA OR NV UT CA AZ ND SD NE CO NM TX OK KS AR LA MO IA MN WI IL IN KY TN MS AL GA FL SC NC VA WV OH MI NY PA MD DE NJ CT RI MA ME VT NH AK HI Significant increase 13%-49% DC Change in percentage of home births Source: Birth certificate data from the National Vital Statistics System. Significant increase 50% or more U.S. average=50% increase No significant change Data not available

Percent of home and hospital births with selected demographic risk factors, US, 2011 Maternal age

Percent of home and hospital births with selected medical risk factors, US, 2011 Source: Birth certificate data from the National Vital Statistics System.

Change in risk profile of home births, US, Maternal age

Planning status of home birth Important indicator of risk for home births Unplanned home births: may represent an emergency situation (precipitous labor, couldn’t get to the hospital) may be at higher risk for poor birth outcomes, with the birth taking place in an environment unprepared for a delivery. Planning status of home birth reported by 34 states and DC (67.5% of US births) in 2011

Percent of home births that were planned by maternal race/ethnicity, 34 States and DC, 2011 NOTE: Not stated planning status excluded before percent computation. SOURCE: Birth certificate data from the National Vital Statistics System.

Percent of planned home births by birth attendant, 34 states and DC, 2011 Source: Birth certificate data from the National Vital Statistics System. Physician

Summary In 2011, there were over 33,000 home births in the US, comprising 0.84% of US births. The percent of home births increased by 50% from For non-Hispanic white women, home births increased by 59% from In 2011, 1 in 79 non-Hispanic white births was a home birth (1.27%). The increase in home births was widespread and involved states from every region of the country. From , 39 states had significant increases in home births, including 21 states with increases of 50% or more. In 2011, 88% of home births were planned (34 state and DC reporting area). For non-Hispanic white women, 93% were planned.

Summary (cont.) Home births have a lower risk profile than hospital births, with fewer births to teenagers or unmarried women, and with fewer preterm, low birthweight, or multiple births. In contrast, a higher percentage of home than hospital births were higher parity births and those to older mothers. The risk profile of home births improved from , suggesting that appropriate risk selection of low- risk women is occurring and improving.

Marian MacDorman, Ph.D. Statistician, Reproductive Statistics Branch National Center for Health Statistics Centers for Disease Control and Prevention Phone: (301) Questions? Link to recent report: