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 “I think it speaks to some women’s growing discomfort with the
standard hospital-based system of childbirth in the U.S,” said lead
author Marian F. MacDorman of the Maryland Population Research
Center at the University of Maryland in College Park.
“Currently, it seems difficult for women wanting a natural birth to
be assured of having that experience in the hospital, where one out
of every three U.S. births are delivered by cesarean section, and
where induction rates and other interventions are very common,”
MacDorman told Reuters Health by email.
She and her coauthor Eugene Declercq used data from 47 states and
the District of Columbia, from 2004 to 2014, to compare in hospital
and out-of-hospital births.
During that period, out-of-hospital births rose from less than 1
percent to 1.5 percent of U.S. births.
Of the nearly 60,000 out-of-hospital births in 2014, 38,000 were
home births and 18,000 took place at birth centers. Almost 90
percent of the home births were planned.
That year, one in every 44 births to a non-Hispanic white woman in
the U.S. took place outside a hospital.
Only 13 percent of mothers who gave birth out-of-hospital were
obese, compared to 25 percent of those in hospital. Mother who gave
birth out-of-hospital were also less likely to smoke and more likely
to have graduated from college.
Two-thirds of planned home births were self-paid, that is, the
mother paid out of pocket for pregnancy and delivery care, compared
to less than half of those in birth centers and less than five
percent of those in hospitals, as reported in the journal Birth.
Home birth can be very safe if the healthcare system at large
supports it and integrates it with other options, MacDorman said.
“The finding that more women are able to choose to have the type of
birth experience that they want to have seems positive to me,” she
said. “I think it is of concern that so many doctors seem to be so
opposed to out-of-hospital birth that they won’t examine ways to
make the home to hospital transfer a smoother and safer process.”
The current study did not include data on mortality. According to
MacDorman, something goes seriously wrong only very rarely, in less
than one percent of births in or out of the hospital. Most high
quality international studies have found that the risk of stillbirth
and early infant death is not higher for out-of-hospital than for
hospital births, she said.
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“Overall the numbers are still very small and it will be interesting
to see where it goes in the next few years but I believe it will
never be a large percentage of women who opt for out-of-hospital
birth,” said Ruth E. Zielinski, a midwife at the University of
Michigan School of Nursing who was not part of the new study.
Out-of-hospital births tend to involve less intervention, like
cesarean section, and have higher patient satisfaction, MacDorman
said. “Midwives that attend out-of-hospital births generally screen
clients, so that only low-risk women attempt an out-of-hospital
birth.”
High-risk women should give birth in a hospital, MacDorman said.
“Other factors that improve patient safety are having an experienced
and properly trained midwife who has an existing relationship with
an obstetrician or hospital in case a patient develops
complications,” MacDorman said.
Certified professional midwives who do many out-of-hospital births
are only licensed in about half of U.S. states, she said. Another
barrier to giving birth at home may be insurance coverage, as most
women with planned home births had to pay out of pocket for the
costs of their pregnancy and delivery care, she said.
“If both private insurance companies and Medicaid would cover the
costs of pregnancy and delivery care for out-of-hospital births,
this could substantially improve access to this birthing option, now
clearly of interest to an increasing number of women,” MacDorman
said.
SOURCE: http://bit.ly/1pFFkOx Birth, online March 16, 2016.
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