Recent trends in out-of-hospital, home and birthing center births in the US, 1990-2010

Background: After a gradual decline from 1990-2004, the percent of out-of-hospital births increased rapidly from 2004-2010. Methods: Trends in out-of-hospital births by characteristics were analyzed using national birth certificate data. Results: In 2010 there were 47,028 out-of-hospital births in the US, up from 35,578 in 2004. In 2010, one in 85 US infants (1.18%) were born outside of a hospital; 2/3 of these at home, and most others in freestanding birthing centers. The percent of home births increased by 41% from 0.56% in 2004 to 0.79% in 2010, with 10% of that increase occurring in the last year. The percent of birthing center births increased by 44% from 0.23% in 2004 to 0.33% in 2010, with 14% of the increase in the last year. About 90% of the total increase in out-of hospital births from 2004-2010 was due to increases among non-Hispanic white women, and in 2010, 1 in 57 births to non-Hispanic white women (1.75%) were out-of-hospital births. The increase in out-of-hospital births was widespread and involved states from every region of the country. In 2010, 88% of home births were planned; among non-Hispanic white women, 93% were planned. Discussion: Out-of-hospital births have a lower risk profile than hospital births, with fewer births to teenagers, unmarried women, smokers, diabetic or hypertensive women, and with fewer preterm, low birthweight, and multiple births. The risk profile of out-of-hospital births improved from 2004-2010, suggesting that appropriate risk selection of low-risk women as candidates for these births is occurring and improving.