Around 4 million children are born every year in the United States. Notwithstanding modest variations from year to year, that number has remained largely unchanged since 1990. Out-of-hospital births, on the other hand, have increased substantially over the last decade. The rise in non-hospital deliveries has sparked widespread debate, in both medical and parenting circles. Are home births, and deliveries in birthing centers, safe?
As Non-Hospital Births Rise, Debate Rages Over Risks
In 2004, fewer than 1% of babies were born outside a hospital. In 2012, the last year for which we have federal data, around 1.36% of live birth took place in the home or non-hospital birthing centers. While these numbers are still extremely small, the increase represents a rise from approximately 34,800 out-of-hospital births to around 54,400 births, a jump of more than 56%.
Demographic factors paint a more nuanced picture. While more than 2% of white women chose to give birth in non-hospital settings in 2012, less than half of one percent of black women did. Similarly low rates of non-hospital birth have been observed in Hispanic women
Home Birth Safety Statistics
Home births in particular have created significant controversy over the years, especially after researchers from Cornell University linked the practice to a four-fold increase in the risk of infant death. Published in 2013, the study also found that babies born outside of hospitals are nearly 4 times as likely to experience neonatal seizures or severe neurological symptoms. Reviewing data from over 13 million births, the study remains the largest one of its kind.
Crucially, the researchers attempted to control for whether women were attended by physicians or midwives. In the end, the credentials backing an attending healthcare worker didn’t matter. “It’s all about location,” Cornell obstetrician Dr. Frank Chervenak told the University’s medical publication. “When a complication does arise, what’s needed is access to a team of skilled specialists with the training and technology in place to handle emergency procedures. In a home, none of these options are available.”
Using smaller sample sizes, researchers have found similar results elsewhere. In a 2015 study of 80,000 pregnancies in Oregon, planned out-of-hospital births increased the risk for infant death by around 2.4 times. Nearly 4 of every 1,000 babies who were set for delivery in non-hospital settings died immediately before, during or within one month of labor, compared to fewer than 2 in 1,000 babies delivered in hospitals. The encouraging take-away is that infant death is relatively low no matter the birth setting.
It should be noted that all of the births studied in Oregon, both those in hospitals and those outside hospitals, had been classified as low-risk pregnancies. To arrive at an accurate comparison, the researchers filtered through the data gathered from hospitals, eliminating high-risk pregnancies from their sample. This reflects a fact that extends nationwide, one that health researchers find heartening: few high-risk pregnancies are being delivered outside of hospitals.
In fact, the proportion of non-hospital births classified as high-risk has been dropping dramatically. In 2004, for example, teen mothers accounted for 4.3% of the year’s out-of-hospital births. That proportion had decreased to 1.9% by 2012. Preterm births also declined over the same time period, from around 6.7% to 4.4%, indicating that women who could benefit from the more rigorous safety measures available in hospital settings are receiving the care they need.
Low-risk pregnancies are, by definition, less risky than high-risk pregnancies. Thus it shouldn’t be a surprise that the children delivered in non-hospital settings are less likely to require obstetric intervention, including the use of forceps, vacuum extraction or emergency cesarean section. Needless to say, this reduces the risk of mechanical forms of birth injury.