Home Birth Rates Are the Highest in 30 Years, the CDC Reports

Home births are at their highest level in 30 years, according to new data released by the Centers for Disease Control and Prevention (CDC).

Among the nearly 4 million births in 2021, almost 52,000 took place at home, stated the report, which was published in November 2022. That's an increase of 12 percent from 2020, following a 22 percent increase from 2019 to 2020.

The rise in home births was seen across ethnicities, increasing by 21 percent for Black pregnant people, 15 percent for Hispanic pregnant people and 10 percent for white pregnant people in 2021.

What's behind the rise?

Report author Elizabeth C.W. Gregory, M.P.H., wrote that the reason behind the surge isn't known, but pointed out that it coincided with the COVID-19 outbreak.

"With the increasing number of cases in the United States, concerns about contracting

COVID-19 while in the hospital, limitations or bans on support people in the hospital, and the separation of infants from mothers suspected to have COVID-19, interest in giving birth at home

Increased," the report stated.

According to Eugene R. Declercq, Ph.D., a professor of community health sciences at Boston University School of Public Health who was not involved in the study, home births have been on the rise since well before the pandemic.

"Home births have been increasing since 2004, and the pandemic only accelerated a long-term trend," Declercq said. "The increase began as the national cesarean rate was surging over 30 percent."

Kristi L. Watterberg, M.D., a professor emerita of pediatrics in the neonatology division at the University of New Mexico who also was not involved in the study, has some other theories on why more mothers are electing to give birth in their homes. Watterberg speculated that cost, plus a distrust of the medical industry, might be fueling the surge.

"But I think a prime driver is a desire to have more control and a more family atmosphere," she added.

What are the risks of home births?

The known risks associated with home births far outweigh any potential advantages, according to Joshua A. Copel, M.D., professor of obstetrics, gynecology and reproductive sciences, and of pediatrics, at Yale School of Medicine.

"Emergencies such as postpartum bleeding happen unpredictably and suddenly in obstetrics and are difficult to manage at home without the resources to resuscitate the baby," Copel said. "We also see newborns that don't breathe properly at birth on occasion who require more than stimulation to come around. In either example, the time to get an ambulance and transfer to a hospital can worsen the situation."

Watterberg agreed that the possibility of delay in critical interventions for unanticipated problems makes home births risky.

"The risk is, again, small but real, and the further the woman is from an appropriate delivery hospital, the more likely that one of these events could be disastrous," she said.

What to know if you're considering a home birth

The American Academy of Pediatrics (AAP) doesn't recommend home births, citing a two- to threefold rise in infant mortality. However, the organization acknowledges it is up to the parent to decide, and if a person does plan a home birth, it's critical to have no preexisting or maternal disease, meet a stringent list of requirements and do so in the presence of two trained medical professionals with the proper equipment.

Copel emphasized that anyone with prior cesarean births, especially more than one or with a vertical or "classical" incision on the uterus, should not consider home births.

"[People with prior cesarean births] have a higher risk of uterine rupture in labor, which can be catastrophic for both patient and baby," he said.

"It is true that birth, a normal process, can be overmedicalized in hospitals, and we as a profession do too many cesarean births," Copel said. "Our challenge—and we need to work with our patients to achieve it—is to bring the home atmosphere to the hospital, while having all the resources for the rare emergency just out of sight."