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Home Births on the Rise in the U.S.

Increase in Home Births Comes as Debate Over Safety Intensifies
By
WebMD Health News
Reviewed by Laura J. Martin, MD

May 20, 2011 -- The number of women in the U.S. who gave birth at home rose 20% between 2004 and 2008, a new study shows.

Although home births represent only a fraction of the millions of babies delivered in the U.S. each year, researchers say the bump is significant because it follows a steady, 15-year decline in the practice and comes at a time of intense debate over the safety of home births.

A review paper published in 2010, for example, found the risk of newborn death was two to three times higher for babies born during planned home births compared to planned hospital births.

The review generated so much criticism that the journal that published it, The American Journal of Obstetrics and Gynecology, took the unusual step of having independent experts revisit its methods and conclusions.

In the end, the journal published a fuller explanation of the findings, but the paper was not retracted.

In January, citing the evidence from the much scrutinized review, the American College of Obstetrics and Gynecologists issued an opinion discouraging home births.

The World Health Organization, the American College of Nurse Midwives, the American Public Health Association, and the National Perinatal Association all support home and out-of-hospital births for low-risk women.

The current study will likely further fuel the discussion, since it found that home births appear to be getting safer.

From 2004 to 2008, rates of preterm births and low birth weights had dropped slightly among infants born at home, by 16% and 17% respectively.

Women Who Opt for Home Birth

The study found that college-educated white women in their 30s and 40s who have already had at least one child are the most likely to opt for home birth.

The rate of home births rose 28% among non-Hispanic white women from 2004 to 2008, a greater increase than was seen in any other racial or ethnic group. There was also a slight rise, 0.03%, among Asian mothers.

Rates of home births declined slightly among African-American women over that time period and held steady for American Indians and Hispanics.

Overall, there were 28,357 home births in the U.S. in 2008, representing 0.67% of all the babies born that year. In 2004, home births accounted for 0.56% of the total.

Why More Women Are Giving Birth at Home

Researchers who have watched the trend believe it may signal a growing desire among expectant mothers to have more control over the kinds of procedures that are used to deliver the baby, particularly cesarean sections.

"Our study is based on birth certificates, so I don't have direct data on why, but certainly we've seen a lot of discussion and interest recently in the birthing process," says study researcher Marian F. MacDorman, PhD, a statistician in reproductive health at the National Center for Health Statistics in Hyattsville, Md.

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