Prevalence of Home Births and Associated Risk Profile and Maternal Characteristics, 2016–2018

Abstract

OBJECTIVE: To estimate the prevalence of pregnancies that meet the low-risk criteria for planned home births and describe geographic and maternal characteristics of home births compared with hospital births. METHODS: Data from the 2016–2018 Pregnancy Risk Assessment Monitoring System (PRAMS), a survey among women with recent live births, and linked birth certificate variables were used to calculate the prevalence of home births that were considered low-risk. We defined low-risk pregnancy as a term (between 37 and 42 weeks of gestation), singleton gestation with a birth weight within the 10th–90th percentile mean for gestational age (as a proxy for estimated fetal size appropriate for gestational age), without prepregnancy or gestational diabetes or hypertension, and no vaginal birth after cesarean (VBAC). We also calculated the prevalence of home and hospital births by site and maternal characteristics. Weighted prevalence estimates are presented with 95% CIs to identify differences. RESULTS: The prevalence of home births was 1.1% (unweighted n=1,034), ranging from 0.1% (Alabama) to 2.6% (Montana); 64.9% of the pregnancies were low-risk. Among the 35.1% high-risk home births, 39.5% of neonates were large for gestational age, 20.5% of neonates were small for gestational age, 17.1% of the women had diabetes, 16.9% of the women had hypertension, 10.6% of the deliveries were VBACs, and 10.1% of the deliveries were preterm. A significantly higher percentage of women with home births than hospital births were non-Hispanic White (83.9% vs 56.5%), aged 35 years or older (24.0% vs 18.1%), with less than a high school-level of education (24.6% vs 12.2%), and reported no health insurance (27.0% vs 1.9%). A significantly lower percentage of women with home births than hospital births initiated prenatal visits in the first trimester (66.9% vs 87.1%), attended a postpartum visit (80.1% vs 90.0%), and most often laid their infants on their backs for sleep (59.3% vs 79.5%). CONCLUSIONS: Understanding the risk profile, geographic distribution, and characteristics of women with home births can guide efforts around safe birthing practices.

United States community births increased by 20% from 2019 to 2020

“…27 The proportion of births that were VBACs was notably higher among planned home than among hospital births. Given continued restrictions on hospital access to vaginal birth after cesareans, 28,29 women denied a hospital VBAC may ultimately choose to have a VBAC in a community setting, 25,30 though our data do not permit us to identify the reason for a community birth.…”

Geographic variation and factors associated with under-five mortality in Ethiopia. A spatial and multilevel analysis of Ethiopian mini demographic and health survey 2019

“…This is because home delivery increases the death of under-five children due to a higher risk of intrapartum and postpartum complications. These complications include exposure to common vaccine-preventable diseases if there is absence of vaccination, and a lower likelihood of attending prenatal and postpartum visits [ 10 , 34 ].…”

Use of privacy‐preserving record linkage to examine the dispensing of pharmaceutical benefits scheme medicines to pregnant women in Western Australia

“…Births taking place in a non-hospital setting are likely to be low-risk, potentially with few comorbidities and typically good overall health. 29 Factors associated with medication use in pregnancy were generally consistent across medication risk category and trimester, with the were more likely to be dispensed a medication during pregnancy compared with mothers aged 30-34 years, they were less likely to be dispensed a medication with known risk during pregnancy. Similarly, while young mothers were less likely to be dispensed a medication during the first trimester, they were more likely to be dispensed a medication during the third trimester compared with mothers aged 30-34 years.…”