Birth by the Numbers just released the newest video in their occasional video series and this time Dr. Eugene Declercq and his team are providing valuable information about current home birth trends in the United States. I have been a huge fan of Dr. Eugene Declercq and his team ever since I watched the original Birth by the Numbers bonus segment that was found on the Orgasmic Birth DVD I purchased back in 2008. You may also be familiar with Dr. Declercq's work as part of the Listening to Mothers research team that has brought us three very valuable studies. From time to time I have shared on Science & Sensibility the valuable and up to date resources on the BBTN website that are helpful to both the birth professional and the consumer. The site is filled to the brim with useful information, videos, slide presentations and blog posts. Find all of our posts on Birth by the Numbers resources here.

Observations when examining home birth trends

• 58% increase in the number of home and birth center births in the period of 2004 to 2014. In 2014, over 56,000 births took place out of the hospital.
• Since 2004, there has been a rapid increase primarily in the number of white non-Hispanic mothers choosing home birth.
• By 2014, there is a significant number of states who have home birth rates over 1%, primarily clustered in the Northwest, some of the Midwest and in Maine,Vermont and Pennsylvania.
• In 2014, Certified Professional Midwives (CPM) attend almost half of all out of hospital births. Certified Nurse Midwives/Certified Midwives (CNM/CM) attend just about one quarter of the out of hospital births. 27% of births were attended by "Others" which probably indicates situations where home birth midwifery is illegal or alegal. Dr. Declercq assures us that the "Others" are not taxi drivers!
• In 2014, 98% of CPM attended home births were planned to be at home, and 99% of CNM attended home births were planned to occur at home.
• When mothers who had just had a hospital birth were queried - almost 2/3 of them said they either strongly agreed or agreed with the statement that a woman should have the right to have a baby at home if they want to.
• When these women who had just had a hospital birth were asked "In a future birth, how open would you be to giving birth at home?" 29% of the women replied that they either definitely would want or would consider having a future baby at home. Very interesting results considering every woman asked had just given birth in the hospital.
• Non-Hispanic Black mothers were most likely to be open to giving birth in the future at home.

After viewing this new video on home birth trends, I asked Science & Sensibility contributor Christina Gebel, MPH MCH, who is a member of the Birth by the Numbers team, as well as a childbirth educator and doula, to answer some questions about these fascinating results.

Sharon Muza: Why is the information in this new video important?

Christina Gebel: This information is important because it not only reflects on mothers' current attitudes towards home births but also, indirectly, gives us information on how mothers are feeling about their hospital birth experiences. As Gene pointed out in the video, when women were asked if they thought mothers should be able to have their baby at home and whether that was something they would consider for their next birth, the mothers asked these two questions were moms who had delivered in hospitals. To have a significant percentage of mothers say they would consider having their baby at home after having delivered in a hospital is a chance for us to speculate why they answered that way: Did they feel their care in hospitals was unsatisfactory? Is there something that having a baby at home could offer that hospitals can't provide? We don't know, but the results are interesting. 

SM: What should hospitals and hospital providers be strategizing around regarding these trends?

CG: Again, if I were a hospital, I would be asking myself why almost a third of my patients would definitely want or seriously consider having a baby at home. They should be strategizing around getting to the root of that consideration. Are there aspects of hospital birth that need to be improved, or should hospitals be striving to offer a more home-like experience with more flexibility? No organization wants to hear that a third of their consumers would consider getting services elsewhere next time. To me, that should be a strong motivator for hospitals to seriously consider these data.

SM: What do you think has been the biggest influence on this trend?

CG: Certainly provocative films like the Business of Being Born propelled the conversation forward about the current state of maternity care in the US and why we should have a critical eye toward care with the goal of improving services as well as the experience of mothers giving birth. Another force was the overall empowerment of women around maternity care. Mothers no longer want to feel like passive participants in their birth, and feeling out of control or feeling like their desires are on the periphery of hospital policy or the standard of care might be causing women to seek out a place with more autonomy, like home. 

SM: Where is the greatest opportunity for growth and increase in the number of out of hospital births? Is this likely to be found with our mothers of color? 

CG: The data that was presented about preferences for non-Hispanic Black women is compelling. This is something that the BBTN group, in particular, is interested in. It could be that NHB women are having the poorest experiences in our maternity care system and are empowered to deliver at home next time for that reason. The biggest opportunity here could be things like setting up birth centers in predominantly NHB neighborhoods that are staffed by midwives of color. It could also mean having more home births in the NHB community. That would require that the midwifery community make a concerted effort to diversify their workforce to actively recruit NHB midwives, whether they are CNMs or CPMs. 

SM: What important takeaways should childbirth educators be sharing with the families they work with?

CG: CBEs should, always, be a source of non-biased non-judgmental information for the families they serve. Giving women information about home birth and listening to the reasons why women would consider homebirth are both crucial in supporting women in their decision to give birth at home. CBEs should watch videos like this and stay updated on the current trends so as to best serve their families. 

What trends are you seeing in your communities? Are the families you work with exploring the out of hospital birth option? Are they changing from a hospital birth to an out of hospital birth after taking classes? What are your predictions as to future trends in out of hospital births in your community? Let's discuss in the comment section below.

Published: July 14, 2016

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