Out-of-hospital births at highest point since 1975

According to a recent report from the NCHS Data Brief, out-of-hospital births, while still rare, are on the rise and at their highest level since 1975. If the number of out-of-hospital births continues to increase, changes to resource allocation, clinician training, and healthcare costs are expected.

The report from the Centers for Disease Control and Prevention, National Center for Health Statistics looked at births from 1990 to 2012. Out-of hospital births had been on the decline for most of the studied period, 1990 to 2004, with 0.87% of all births occurring outside of a hospital. However, the number of births occurring in a setting other than a hospital has been on the rise ever since, with 1.26% out-of-hospital births in 2011 and 1.36% in 2012. In 2012, 66% of out-of-hospital deliveries happened in the patient’s home, while 29% occurred in a freestanding birthing center. The other 5% occurred in some type of medical setting, such as a clinic or a doctor’s office.

Non-Hispanic white women have out-of-hospital birth rates 2 to 4 times higher than any other groups, with 1 in 49 births occurring outside of a hospital. However the increase in these births isn’t limited to only non-Hispanic white women. Hispanic (from 0.44% to 0.46%) and Asian or Pacific Islander (0.49% to 0.54%) women also saw increases from 2011 to 2012. During the same time period, increases in out-of-hospital births among American Indian and non-Hispanic black women were statistically insignificant.

Out-of-hospital births were found to typically have lower risk profiles than hospital births. Among hospital births, 11.6% were preterm or less than 37 completed weeks’ gestation, compared with 4.4% of those that occurred out-of-hospital. However, more births to women older than age 35 occurred out-of-hospital (19.0%) than in-hospital (14.9%). Potentially promising is that the risk profiles for out-of-hospital births declined from 2004 to 2013.

The increased number of birthing centers is one potential reason for the rise in out-of-hospital births, with the number going from 170 centers in 2004 to 248 in January 2013. States with laws beneficial to midwifery practices also have seen higher rates of out-of hospital births;  in 6 states (Alaska, Idaho, Montana, Oregon, Pennsylvania, and Washington), rates are over 3%.

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