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More Women Opting to Give Birth Outside of a Hospital

Data shows rate of births at home and in birth centers reaches highest level in 30 years; demand may actually be greater

Faculty Associate Marian MacDorman's recent study in Birth shows the increasing number of women in the United States who are choosing to give birth outside of hospitals, and the demand for nontraditional delivery options, is likely higher than current data show. Existing records indicate that one of every 62 births in the United States in 2017 took place at home or in a birth center, the most ever recorded in the 30 years of national birth certificate data available, she notes.

After a gradual decline between 1990 and 2004, out-of-hospital births increased by 57 percent from 2004 to 2017, researchers discovered. They also found that non-Hispanic white women were more likely than any other group to choose to give birth outside of a hospital: For these women, one out of every 41 births (2.43%) was an out-of-hospital birth.

Dr. MacDorman and colleagues say these figures underestimate the true number of women who choose out-of-hospital births because those who plan to give birth outside of the hospital but then are transferred to a hospital during labor or delivery are reported on birth certificates as hospital births. Meanwhile, newly available data on payment methods showed more than two-thirds of planned home births were self-paid by the mother (i.e. not covered by either private health insurance or Medicaid), compared to one-third of birth center births and just 3 percent of hospital births.

“The lack of access to payment options for out-of-hospital births may prevent many women from making these choices, suggesting demand for out-of-hospital birth is considerably higher than what the data tells us,” Dr. MacDorman said. “The question that arises from our findings is, what is happening during hospital births that is leading women to seek other options, even when that means bucking convention and paying more to deliver at home or in a birth center?”

A recent national survey of post-partum mothers showed that 64 percent would consider a birth center birth and 29 percent would consider a home birth for future pregnancies. Researchers say women who choose out-of-hospital birth do so because they feel it is safer, with lower rates of cesarean and other interventions, and because they feel more in control of their experience.

“These findings raise questions about the nature of care in the dominant model of maternity care in the US,” MacDorman said. “Many mothers are turning away from hospitals because they’re seeking a place to give birth where they feel empowered, engaged, and safe.”