Birth and Delivery · Birth Setting and Provider
RRM Academy Synopsis
Out-of-hospital births reached 1 of every 62 US births in 2017
A national analysis of US birth certificate data from 2004 to 2017 found that out-of-hospital births rose from 0.87% to 1.61% of all births. In 2017, about 1 of every 62 US births occurred outside a hospital. About 68 out of 100 planned home births were paid for out of pocket, against about 3 out of 100 hospital births.
Key Findings
- Out-of-hospital births numbered 35,578 in 2004 and 62,228 in 2017, after a decline from 1990 to 2004. Their share of all births rose from 0.87% to 1.61%.
- Home births rose by 77% between 2004 and 2017, moving from 0.56% of all births to 0.99%. Birth center births more than doubled their share, from 0.23% to 0.52%.
- Alaska had the highest 2017 share of out-of-hospital births at 7.88%, with Pennsylvania at 3.53%. Alabama (0.43%), Louisiana (0.46%) and Mississippi (0.54%) were among the lowest.
- In 2017 the preterm share was 11.8% for hospital births, 1.5% for birth center births and 2.1% for planned home births. Pre-pregnancy obesity was 27.3%, 13.0% and 13.2% for the same groups.
- Women paid out of pocket for 67.9% of planned home births, 32.2% of birth center births and 3.4% of hospital births. In 29 states, the figure for planned home births exceeded 70%.
Interpretation
The report is a descriptive analysis of national birth certificate data, which cover about 3.9 million US births each year. Women who planned a home or birth center birth had lower rates of teen births, smoking and obesity. The authors describe these traits as linked to poor pregnancy outcomes. They suggest that state differences in insurance and Medicaid coverage may explain part of the regional pattern. They note that a planned home birth moved to a hospital during labor is recorded as a hospital birth.
RRM Context
Restorative reproductive medicine takes a holistic view of women's health across the lifespan. The view includes pregnancy and birth. Payer data of this kind show how often insurance, Medicaid or the woman herself pays for each birth setting in each state. Access to maternity care belongs within that picture.
Abstract
Background
Out-of-hospital births have been increasing in the United States, although past studies have found wide variations between states. Our purpose was to examine trends in out-of-hospital births, the risk profile of these births, and state differences in women's access to these births.
Methods
National birth certificate data from 2004 to 2017 were analyzed. Newly available national data on method of payment for the delivery (private insurance, Medicaid, self-pay) were used to measure access to out-of-hospital birth options.
Results
After a gradual decline from 1990 to 2004, the number of out-of-hospital births increased from 35 578 in 2004 to 62 228 in 2017. In 2017, 1 of every 62 births in the United States was an out-of-hospital birth (1.61%). Home births increased by 77% from 2004 to 2017, whereas birth center births more than doubled. Out-of-hospital births were more common in the Pacific Northwest and less common in the southeastern states such as Alabama, Louisiana, and Mississippi. Women with planned home and birth center births were less likely to have a number of population characteristics associated with poor pregnancy outcomes, including teen births, smoking during pregnancy, obesity, and preterm, low birthweight, and multiple births. More than 2/3 of planned home births were self-paid, compared with 1/3 of birth center and just 3% of hospital births, with large variations by state.
Conclusions
Lack of insurance or Medicaid coverage is an important limiting factor for women desiring out-of-hospital birth in most states. Recent increases in out-of-hospital births despite important limiting factors highlight the strong motivation of some women to choose out-of-hospital birth.
