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There's Been A 20% Spike In Home Births In The US, But Why?

More women are giving birth at home, but why?

A 20% spike in US home births between 2004 and 2008 has got the major news outlets buzzing. There are headlines at MSN, USA Today, ABC News and Slate among others.

The U.S. Centers for Disease Control and Prevention (CDC) found that 28,357 births– or .67% of all births–took place at home in 2008. This is 20% more than in 2004 and the highest percentage of home births since 1990.

“The recent increase is a surprise in that it reverses a longstanding trend,” said Marian MacDorman, a statistician with the National Center for Health Statistics.

Given the ferocity with which the home birth debate circulates online, one would think that more than a fraction of one percent of women were actually doing it. Still the increase is considered significant. Of particular note is the increase in home births among white woman: 1 in 98 white women give birth at home– this represents a 28% spike since 2004. Only 1 in 357 black women, and 1 in 500 Hispanic women, give birth at home.

Montana, Oregon and Vermont have the most– about 1 in 50–babies born at home. The study also suggests that the risk profile for home births has gone down. They saw fewer babies born at home prematurely, with low birth weight or to teen or unmarried mothers.

Why has there been this spike, especially among white woman? The researchers pointed to a number of reasons, including women’s desire for fewer interventions in birth. This means fewer inductions, fewer episiotomies, less invasive/continuous monitoring, more options for pain-coping than just medication, and a reduced chance of cesarean section. These days many of my students–I’m a childbirth educator–come into class asking right away how they can “avoid an unnecessary induction” or “an unnecessary c-section.” Childbirth educators have been talking about these things for a long time, but seeing students raise the issue themselves is a relatively new phenomenon. It seems there’s a genuine concern with the way birth is handled in hospitals.

Some reporters and commentators have raised the question of whether the spike in home births can be attributed to the  Ricki Lake-produced documentary, “The Business Of Being Born.” In 2007, both Pushed by Jennifer Block and “The Business Of Being Born” came out. The former is a serious investigation into the crisis in maternity care in the US, the later is the now infamous critique of America’s “over-medicalized” birth culture. These polemics opened the eyes of an educated, curious pregnant population to the fact that home birth might not be a completely ridiculous, bat-crazy idea but a real option. They also made pregnant consumers aware that hospitals do not necessarily have their best interests at heart.

Women might also give birth at home after a particularly dehumanizing and/or  risky hospital birth where lots of things were done to them without their total understanding and/or consent.

I think it helps women decide to have a home birth if they know (and trust) someone who has done it herself and who enjoyed it. This a big step in demystifying the experience.

Of course, the choice is controversial. Established US medical organizations such as the American College of Obstetricians and Gynecologists maintain that the hospital is the safest place to give birth. But various other organizations, including the World Health Organization, the American College of Nurse-Midwives, the American Public Health Association and the National Perinatal Association, all support home birth for low-risk pregnancies. Research has shown that non-Hispanic white, college-educated women are a lower risk population than African American and Hispanic women, when it comes to pregnancy and birth.

What do you think? Do you know more women who are giving birth at home? Also, I’m really curious to know if you did have a home birth, what helped you decide to go this direction? Was it Ricki Lake? Was it a friend? A bad hospital experience? The fear of a bad hospital experience?  Was it religion? Or rigorous statistical analysis?

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