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. 2019 Jun;46(2):279-288.
doi: 10.1111/birt.12411. Epub 2018 Dec 10.

Trends and state variations in out-of-hospital births in the United States, 2004-2017

Marian F MacDorman  1 , Eugene Declercq  2
Affiliations

Trends and state variations in out-of-hospital births in the United States, 2004-2017

Marian F MacDorman et al. Birth. 2019 Jun.

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.

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Figures

Figure 1
Figure 1. Percentage of births occurring out of hospital: United States, 2004–2017
SOURCE: Birth certificate data from the National Vital Statistics System NOTE: Out-of-hospital births include those occurring in a home, birthing center, clinic or doctor’s office, or other location.
Figure 2
Figure 2. Percentage of births occurring out of hospital by race and Hispanic origin of mother: United States, 2004–2017
Notes:. API = Asian or Pacific Islander. Source: Birth certificate data from the National Vital Statistics System.
See this image and copyright information in PMC

References

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