U.S. Home Births Rise And It’s Not Because of Ricki Lake


For women who choose to go through pregnancy and childbirth, the freedom to choose where and with whom to birth is not always immediately accessible. Before childbirth in hospitals became the norm, women birthed at home, under the care of a midwife. It wasn’t until the 1950s that childbirth care shifted significantly from midwives and homebirth to physicians and hospital birth. However, birth for healthy mothers and their babies does not necessarily have to be medicalized.  And because it was becoming increasingly clear that birth was drifting, quickly, from the hearts and hands of women to the more medicalized, economic model put forth by hospitals, women’s health advocates interested in natural birth created a movement.

There is nothing inherently wrong with hospital birthing, of course (written from the heart of a mother who birthed two beautiful children in a hospital birthing center). It is the focus on economics, while having lost our sense of what birth is all about by straying far away from trusting women and women’s bodies, that is the “wrong.” We now have a cesarean section rate in this country of 30 percent – one out of every three births in this country is via c-section -  that dangerously exceeds the World Health Organization’s recommended rate of 5 to 10 percent of all births. With a cesarean rate of over 15 percent, the WHO says, we’re in the realm of doing “more harm than good.”

We are not providing women with the optimal enivornments for birthing, or giving women the chance to choose where they wish to birth and with whom. There are of course many reasons for this, not the least of which is access. Women who have no health insurance are not in a position to “choose.” Pregnant women who live in a small town with one hospital that forces c-sections upon women who have had a previous c-section are not in a position to “choose.” Women who live in a state where midwifery, essentially homebirth, is illegal are not in a position to “choose.”

This cannot be what our mothers want or what we want for our mothers.

Things are looking up. According to a new report by the Centers for Disease Control (CDC) released this week, more women in the United States are opting to birth at home or out-of-hospital, when they are able, mostly out of a desire for a low-intervention birth or because of cultural or religious reasons, and sometimes because of lack of transportation.  

The report also identifies reduced costs associated with out-of-hospital maternity care as a factor in the increased demand. 

Over the last five years, out-of-hospital births (which includes home birth and birthing at a free-standing birth center) rose 3 percent and home births rose 5 percent after having sharply declined between 1940 and 1969 and then remaining static over the last few decades.

Approximately 17 percent of these home births recorded were unplanned – either because of transportation issues for women who live in rural areas or emergency scenarios.

The report acknowledges that home births were “less likely than hospital births to be preterm, low birthweight, or multiple deliveries.”

Out-of-hospital birthing, particularly home birthing, has been treated with more than a raised eyebrow by the media as well as some professional medical associations (specifically the American Medical Association (AMA) and American Congress of Obstetricians and Gynecologists (ACOG)) over the last few years.

The AMA passed a resolution in opposition to home birth stating that hospital births are the safest route for mothers and babies.

In a poorly reported segment on The Today Show a few months ago home birth was treated as a perilous fad spurred on by celebrities who birth at home with hordes of pregnant women clamoring to “do what Ricki Lake did.”

However, the report makes a point to note that in contrast to the AMA and ACOG, the organizations that represent physicians who facilitate birth in hospitals, “the World Health Organization, the American College of Nurse Midwives, and the American Public Health Association all support home and out-of-hospital birth options for low-risk women.”

As for midwives who attend home births and birth center births around the country?

The Big Push for Midwives Campaign Manager, Katie Prown, says, “Those of us who have been advocating for increased access to Certified Professional Midwives and out-of-hospital maternity care have long known that the research shows that AMA and ACOG statements about the safety of home birth and the reasons why women choose out-of-hospital delivery have no basis in the evidence,“ said Prown. “It’s great to be able to cite even more research on the safety of out-of-hospital birth and to be able to point to data showing that women in the United States do not, in fact, make decisions about where to have their babies for frivolous, selfish, or trendy reasons.”

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  • amytuteurmd

    But the homebirth rate is NOT rising.

     

    Read the actual paper and you will see. Homebirth rates in the US has been falling steadily since 1990. Yes, they recovered a tiny bit from 2004-2005, but  rates are still at the same level as 2000. A statistical blip within a long downward trend is not a “rise” no matter how much homebirth advocates pretend it is.

     

    Indeed, the purported “rise” was from 0.56% of births to 0.59% of births, paltry by any standard, and still lower than in any year prior to 2000.

     

     

  • amie-newman

    which is why I wrote about it.

    In some states, in fact, the home birth rate rose more than 10%. And while I will not debate the report in the comments section with you, I urge readers who are interested to read the report themselves for all of the facts. The link is in my post.

    The proportion is small relative to all births, yes. And the proportion remained steady in 2006 but the increase is there.

    I didn’t write the report so if you have an issue with the ways in which the CDC studies and reports on this information, please comment with them.

    From the report:

    After a gradual decline from 1990 to 2004, the percentage of home births increased by 5% to 0.59% in 2005 and remained steady in 2006.

  • amytuteurmd

    “After a gradual decline from 1990 to 2004, the percentage of homebirths increased by 5% fto 0.59& and remained steady in 2006.”

     

    Exactly! Just as I said, homebirth rates have been declining since 1990. They recovered a bit in 2005 but only back to the level they were in 2000. That’s not an “increase.”

     

    Here’s a graph of what happened:

    homebirth rate

     

    The homebirth rate has dropped by 13% since 1990. It’s hardly appropriate to describe what happened between 2004-2005 as an “increase.”

     

     

    • amie-newman

      to read the report (linked to in my post above) for themselves. Dr. Tuteur is an assertive and relentless voice for her perspectives on midwifery and out-of-hospital birth – both of which she opposes – and will attempt to debunk any and all evidence that does not support her agenda. Dr. Tuteur posts comments throughout our site repeatedly ignoring evidence and information from the CDC, recommendations from the World Health Organization, the American Public Health Association and others, and has decided for herself what information works for her and which information doesn’t.

      Other news outlets are reporting on this report as well – NPR, ABC News just to name a couple.

      However, as we’ve seen with many who oppose evidence-based studies that do not support their ideological belief systems, you’d prefer to continue to endlessly debunk the experts in matters of global public health and twist the statistics until they fit your view of the way things “should” be.

  • crowepps

    Without insurance, knowing that it costs one-third of the price is likely to be a huge incentive. In our local small town area, several OB/GYNs make it a practice to encourage the use of midwifes where appropriate by referring patients with cost issues to them, screening patients who have had an uncomplicated first birth to ensure there are no complications likely, and also by doing ultrasounds to check on the health of the fetus.

     

    This COOPERATIVE efforts is of great benefit to all the parties involved, including the overworked OB/GYNs who already have more patients than they can handle, and who must short-change the rest of their lives and their families.

  • paminpa

    I don’t really see how any doctor, who by their trade should back the science, would deliberately set out to pan homebirth.

    I am an educated woman, who by grace of luck knew of homebirth some years before having my first child.  Being a healthy woman with no chronic health conditions, I elected to research homebirth in depth when I became pregnant with my first child.  Subsequently, I had my son at home without any complications after less than 10 hours of labor and with the assistance of a lay midwife.  This midwife went on to attain her CNM and also attended my 2nd (last) child’s birth at home; this time she barely got there in time, since my daughter came after about 5 hours of labor, also with no complications.

    I have also attended hospital births as an interpreter/informal doula for several women.  I cannot begin to express my dismay at how their birth plans, which I helped them prepare, were ignored.  How the atmosphere and attitude was one of emergency, crisis…and the need to intervene.  There was also absolutely no positive communication with these women.  One woman I knew (whose birth I was unable to attend) was talked into signing papers for a C-section, papers which she later said she did not really understand, after having been at the hospital less than 6 hours, with a first child.  This woman had wanted to birth naturally.  She had no health complications, the baby had not been in distress. 

    When I have asked questions of hospital staff, as in “excuse me, nurse, but what is that I.V. for?  This mom has a birth plan on file, and she wants to birth naturally,” I have been met with surprise and a lack of staff’s having been informed.  When I have interpreted questions for one patient, her doctor, upon peering at my conversation with the mom and then hearing my interpreting of the mom’s wishes to try to walk around some more (in lieu of being made to lie down and stay immobile for monitoring – and we know the data on what that’s likely to increase the chances of) stormed out of the room loudly mumbling that “this patient is making no decisions for herself!”  Ha ha, I think the doc was just pissed that I was working with the mom to make sure the mom’s wishes were heeded, and that doc was a little steamed that it left her with nothing (read: unnecessary interventions) to do.  Because, for a regular OB GYN, there is no training in how to support a mom in birthing her child herelf. Btw, mom had her baby a couple hours later, after walking the halls until just before transition.  And several more attempts to scare her into giving in to monitoring, laying down, internals, etc.

    Oh a hospital- with all it’s OR’s and OBGYNS, trained as they are in catastropy and complications -is a wonderful place to give birth.  But only if you are one of the decided MINORITY of women who are indeed unhealthy or have certain medical conditions…

    Yeah too bad about the numbers.  But more and more women are becoming informed.  More and more women are talking to each other, and that includes on social networking sites online, where they have access to the experiences of a larger and broader range of women, and to the many  women who have given birth at home and who are telling their stories.  As are the way too many moms who tell the heartache of having interventionist, unhappy birth experiences in hospitals.

  • emjindiemama

    Women need to hear about this issue more and more.  They need to realize the trends that have overtaken what is supposed to be a natural and amazing experience.  Women need to be able to learn from trusted sources about their choices when giving birth and we all need to empowered once again.

    I had my first child when I was just 20 years old–the best shape of my life and probably the lowest risk pregnancy I will ever have.  I attended “Childbirth classes” where they taught all of us we needed to move and have active labors.  Yet when I arrived at the hospital the day my daughter was born, I had a catheter inserted, my bag of waters ruptured, and I was hooked up to 2 different monitors.  I could not move.  I could not have an active birth.  I was not informed by my Dr. that the amniotic fluid was protecting my baby by keeping the umbilical from being constricted and cutting off her air flow.  I was not asked for my consent to this procedure. Soon, I was started on Pitocin.  I was not asked for my consent, nor were the purposes or dangers of the drug explained to me.  While I was pushing, the precautionary IV I had to have in my hand was ripped out and I had to stop while they dressed the wound.  While I was lying on my back and my daughter’s head crowned, I was instructed to “wait for the Dr.”.  20 minutes later, she appeared, caught the baby and spent the next hour sewing up my 3rd degree tear from the pressure of holding the baby’s head there.  My daughter weighed 8. 6 and I was in labor for 21 hours.

    When I went in to have my 2nd child, I was still naive about how much had been taken from me in the first experience.  I tried to refuse the IV at least, but was told by the nurse that the Dr. on call (who had never come in to see me) insisted.  After my nurse made a few comments that I was “really getting through the contractions so well”, it was decided I needed pitocin again.  The pain from the forced contractions became unbearable and I asked for pain medication–something I never wanted.  When the Dr. came in to “deliver” the baby, he gave me an episiotomy.  I was never asked for permission or given any information about the cut.  My daughter was then taken from me, put under a warming lamp where the nurses shoved tubes down her throat and put drops in her eyes.  She screamed and screamed and screamed.  She weighed 9.1 and I was in labor for 14 hours.

    When I became pregnant with my 3rd child, my sister-in-law gave me a gift.  She lent me Ina May’s Guide to Childbirth.  I devoured the information and went on to read much, much more: Misconceptions, Spiritual Midwifery, Birthing From Within, The Thinking Woman’s Guide to a Better Birth, on and on.  I decided to fight for a natural birth.  First, I met with the OB I had seen since I was 16–the one who delivered my 1st child and saw me all during my 2nd pregnancy.  She told me she could not let me refuse an IV lock.  She told me I might have to have pitocin in order to have a natural birth.  She told me she wouldn’t wait to cut the cord.  I left sad and discouraged.  I decided to meet with a midwife at my hospital who said many of the same things.  I was more depressed.  In a last effort, I met with another midwife.  When I presented her my birth plan, she read it thoughtfully and talked about how everything seemed possible.

    But when I went into labor, she was not there; the first midwife was.  I had to continue to fight for the things I wanted, all while trying to concentrate on my labor.  In the end, I gave birth to my son.  The whole experience was completely natural and I was so exhilarated to be able to remember the whole thing.  Our labor was only 7 hours and he weighed 10.4.

    If I hadn’t had the guidance of my sister-in-law, I would never have been able to understand how incredible my body is– how amazing it is to be a woman and to complete that experience the way it was meant to be.  I would have thought, like almost all other women out there, that medicalized birth is the best.  I wouldn’t have known that I can tell Dr.s “no” and that I have power.

    My son had such a quiet birth and when he was out, he layed on my chest and didn’t endure the tubes or the eyedrops–he could actually look at me as I gazed at him.

    It is sad and disgusting that we are in this state in our country.  Our maternal death rate is one of the highest and our infant mortality rate is one of the highest in the industrialized world.  We are not helping women–we are making birth a dangerous experience in which women are not able to bond properly with their children and babies are born with obstacles to overcome!  No one is being helped in this system and we have to help women understand the risks and their right to choice in all areas of their medical care.

  • mwinnike

    Considering I don’t have any children yet I’m probably not the best person to weigh in on this topic, but I had to put in my 2 cents worth. Like I said I’ve not had any children but my mother happens to be a RCNM who works in a practice near where we live in Iowa. My mother has patients come to her spacifically instead of seeing the doctors in the same practice because she encourages the most natural birth possible. She’s even delivered the children of a few friends and old classmates of mine’s children. From speaking to them about it afterwards, they expressed how wonderful it was. Midwives, or at least in the case of my mother, and a few other midwives she’s trained, stay with the mother though almost the entire labor and birth. Friends who have given birth in a hospital tell me how even just the environment of being in the hospital room can increase nerves because of the unfamiliar surroundings. My mother’s average for c-sections is also well below the WHO guideline with far less complications. She also takes on many 2nd time mothers who were unhappy with their first delivery via c-section. I’m starting to ramble a bit so I’ll stop there, but I’d just like to say that in my case, I wouldn’t even consider anything but home birth/midwife birth as a first option. It’s horrible that midwives, like my mom, who has delivered thousands of healthy babies are getting such a bad name.

  • momtfh

    I am going to enjoy reading the article. I think you accurately portrayed the information after perusing the abstract and data.

    This is a great way to represent part of the entire specturm of reproductive rights – from contraception to place and mode of delivery and beyond.