Home births up, driven by natural birth subculture

ATLANTA – Home births rose 20 percent over four years, government figures show, reflecting what experts say is a small subculture among white women toward natural birth.

Fewer than 1 percent of U.S. births occur at home. But the proportion is clearly going up, study by researchers at the Centers for Disease Control and Prevention found. The new figures are for 2004 to 2008. Home births had been declining from 1990 to 2004.

The increase was driven by white women — 1 in 98 had their babies at home in 2008, the most recent year for which the statistics were available.

Only about 1 in 357 black women give birth at home, and just 1 in 500 Hispanic women do.

"I think there's more of a natural birth subculture going on with white women — an interest in a low-intervention birth in a familiar setting," said the lead author, Marian MacDorman of the CDC's National Center for Health Statistics.

For all races combined, about 1 in 143 births were at home in 2008, up from 1 in 179 in 2004.

Geographically, 27 states had significant increases during those four years. Montana, Vermont and Oregon had the most home births — about 1 in 50 births were at home in those states.

Alaska's rate was nearly as high, and it's clear that some home births occur because women are in remote locations and are not able to get to hospitals in time for delivery.

The increase is notable because doctors groups have been increasingly vocal about opposing home births, The American College of Obstetricians and Gynecologists has for years warned against home births, arguing they can be unsafe, especially if the mother has high-risk medical conditions, if the attendant is inadequately trained or if there's no quick way to get mother and child to a hospital if something goes awry.

Doctor participation in home births declined by 38 percent from 2004 to 2008. The percentage of home births attended by certified midwives and nurse-midwives grew, meanwhile.

Home births increasing? "From our perspective, that's not the best thing for the overall health of babies and women," said Dr. George Macones, an obstetrician at Washington University in St. Louis who chairs ACOG's Committee on Obstetric Practice.

Exactly how unsafe home births are is a matter of medical controversy, with studies offering conflicting conclusions. And some argue that hospitals present their own dangers of infection and sometimes unnecessary medical interventions.

The CDC researchers did find that home births involving medical risks became less common from 2004 to 2008. Home births of infants born prematurely fell by 16 percent, so that by 2008 only 6 percent of all home births involved preterm births. That's less than half the percentage in hospitals.

The study was done by two CDC researchers and a Boston university professor. It was electronically published Friday by a medical journal called Birth: Issues in Perinatal Care.