Home Births in the U.S. Increased Again, Maintaining Pandemic Trend

Home births jumped 12% from 2020 to 2021, continuing an upward trend observed since the start of the COVID-19 pandemic and reaching their highest level since at least 1990, according to the CDC.

Home births increased from an absolute 1.26% of total births in 2020 to 1.41% in 2021, representing an increase of 6,000 births, reported Elizabeth Gregory, MPH, of the National Center for Health Statistics in Hyattsville, Maryland, and colleagues in the National Vital Statistics Report.

Last year's increase in home births follows a 22% increase from 2019 to 2020, signaling that the pandemic was a potential cause for the climbing rate, the researchers said. Prior to the start of the pandemic, the percentage of home births increased by about 2% each year.

"Home births had been rising over time, but much more slowly," Gregory told MedPage Today. She added that the researchers heard reports detailing concerns from women about giving birth in hospital settings, and wanted to assess whether this trend would be ongoing throughout the pandemic.

Eugene Declercq, PhD, of Boston University, said that it was remarkable to see an "incredible surge" in home births within the last few years, especially in the U.S. where home birth is often discouraged.

While the pandemic exacerbated the increase in home births, Declercq, who was not involved in the research, added that childbirth in home settings has trended upward for more than a decade. During this time, the infrastructure for home births has become more well-established in the U.S., with more than 30 states licensing certified professional midwives, who attend the bulk of these deliveries.

"The groundwork was laid before this. The pandemic simply pushed that trend into high gear," Declercq told MedPage Today.

Declercq said that following these increases, it will be interesting to see if home births continue to increase beyond the pandemic.

"The real question going forward is, will we go back to the old system, or will there be a longer term impact on increased numbers of home births?" Declercq said. "I wouldn't have anticipated this much of a change to begin with."

The data in this report are based on birth certificates collected from all U.S. states and the District of Columbia by the National Vital Statistics System. Both planned and unplanned home births were included in this analysis.

Overall, there were 51,642 home births in 2021, up from 45,646 in 2020 and 38,506 in 2019, Gregory's group reported.

The proportion of home births climbed in all racial and ethnic groups, the researchers found. Among non-Hispanic white women, the percentage of home births increased 10% from 2020 to 2021 (1.87% to 2.06%). This increase followed a 21% rise in the percentage of home births from 2019 to 2020.

Among Black women, the proportion of home births increased 21% from 2020 to 2021 (0.68% to 0.82%), and 36% from 2019 to 2021.

For Hispanic women, home births climbed 15% from 2020 to 2021 (0.48% to 0.55%). The percentage of home births in this group increased 30% the year prior.

While sharp increases in home births occurred among all racial and ethnic groups, "the vast majority of home births do occur among non-Hispanic white women," Gregory noted.

The proportion of home births increased in 30 states from 2020 to 2021, with increases ranging widely among states. Florida, for example, had an 8% increase in home births, while West Virginia had a 49% increase. From 2019 to 2020, 40 states had statistically significant increases in home births.

Comment