Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point of care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

For more information, click below.


Subscribers log in here


Planned home birth

INTRODUCTION

Planned home birth is a subject of ongoing controversy. The American College of Obstetricians and Gynecologists' (ACOG) Committee on Obstetric Practice states that hospitals and birthing centers are the safest setting for birth, but they respect the right of women to make medically informed decisions about their delivery site [1]. The American Academy of Pediatrics (AAP) concurred with this statement [2]. The American College of Nurse Midwives (ACNM) [3] and the American Public Health Association (APHA) [4] have policy statements supporting the practice of planned out-of-hospital birth in select populations of women. The World Health Organization (WHO) has released a statement indicating women can choose to deliver at home if they have low-risk pregnancies, receive the appropriate level of care, and formulate contingency plans for transfer to a properly-staffed/equipped delivery unit if problems arise [5]. In the Dutch system, pregnant women without medical complications are asked to choose where they want to give birth: at home or in a short-stay hospital setting. The home birth rate in the Netherlands is the highest in the developed world, although it has declined from 35 percent of all births in 1997-2000 to 29 percent of all births in 2005-2008 [6].

This topic will discuss planned home birth. Delivery at birth centers and unplanned home birth are reviewed separately.

UNITED STATES NATALITY DATA

Prevalence of home birth — The United States National Center for Health Statistics reports birth data based on state vital statistics records, which are determined from the Standard Certificate of a Live Birth (ie, birth certificate). Prior to 1989, births were identified as either occurring in or out of a hospital (eg, home, car, office). Since 1989, a specific category for home births was included on the Standard Certificate. Since 2003, some states have changed their Standard Certificate to identify planned versus unplanned home births and, by 2008, there were 27 states which reported planning status, accounting for 68 percent of all home births.

In 2009 (the most recent complete figures available), there were 44,121 out-of-hospital births in the United States: 29,650 were home births and 12,169 occurred in free standing birthing centers [7]. Thirteen percent of the home births were unplanned in 2008 (range 1 to 33 percent among the 27 states reporting these data). From 1989 to 2003, the overall rate of home births in the United States declined from 0.69 to 0.57 percent of births, or by an average of 0.01 percent annually. The 2009 figures represent a substantial increase in both absolute numbers and rate, reaching 0.72 percent of all births, the highest United States home birth rate since 1990 [7-10]. Almost all of the increase was attributed to births among non-Hispanic white women.

                   

Subscribers log in here

To continue reading this article you must have access through your hospital or your group practice, log in to your personal subscription, or purchase a personal subscription. For more information, click below.
Literature review current through: Apr 2013. | This topic last updated: May 14, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2013 UpToDate, Inc.
References
Top
  1. ACOG Committee on Obstetric Practice. ACOG Committee Opinion No. 476: Planned home birth. Obstet Gynecol 2011; 117:425.
  2. American Academy of Pediatrics. Policy statement: Planned Home Birth. Pediatrics 2013; 131:1016.
  3. American College of Nurse-Midwives Position Statement on Home Birth. Washington, DC: ACNM. December, 2005.
  4. APHA. Increasing access to out-of-hospital maternity care services through state-regulated and nationally-certified direct-entry midwives. APHA Public Policy Statements, 1948 to present, cumulative Washington, DC 2001.
  5. Maternal and Newborn Health/Safe Motherhood Unit of the World Health Organization, Care in Normal Birth: A practical guide. World Health Organization, 1996.
  6. Hendrix MJ, Evers SM, Basten MC, et al. Cost analysis of the Dutch obstetric system: low-risk nulliparous women preferring home or short-stay hospital birth--a prospective non-randomised controlled study. BMC Health Serv Res 2009; 9:211.
  7. Martin JA, Hamilton BE, Sutton PD, et al. Births: final data for 2009, National vital statistics reports, National Center for Health Statistics, Hyattsville, MD 2011.
  8. MacDorman, M, Menacker, F, Declercq, E. Trends and characteristics of home and other out-of-hospital births in the United States, 1990–2006. National vital statistics reports 2010; vol 58 no 11. Hyattsville, MD: National Center for Health Statistics.
  9. MacDorman M, Declercq E, Mathews TJ. United States Home Births Increase 20 Percent from 2004 to 2008. Birth: Issues in Perinatal Care 2001.
  10. QuickStats: Percentage of Births That Were Home Births, by Maternal Race/Ethnicity — United States, 1990–2009 www.cdc.gov/mmwr/preview/mmwrhtml/mm6103a6.htm (Accessed on April 06, 2012).
  11. Office for National Statistics. Birth Statistics 2008 Series FM1 No.37 February 2010. http://www.statistics.gov.uk/downloads/theme_population/FM1-37/FM1_37_2008.pdf. (Accessed on May 10, 2010).
  12. DeVries R. A Pleasing Birth: Midwives and Maternity Care in the Netherlands, Temple University Press, Philadelphia 2005.
  13. National Center for Health Statistics. VitalStats website. Birth data 2010 state and county files. http://www.cdc.gov/nchs/vitalstats.htm (Accessed on December 21, 2012).
  14. Vogel L. "Do it yourself" births prompt alarm. CMAJ 2011; 183:648.
  15. Declercq E, Macdorman MF, Menacker F, Stotland N. Characteristics of planned and unplanned home births in 19 States. Obstet Gynecol 2010; 116:93.
  16. Wax JR, Pinette MG, Cartin A. Home versus hospital birth--process and outcome. Obstet Gynecol Surv 2010; 65:132.
  17. Boucher D, Bennett C, McFarlin B, Freeze R. Staying home to give birth: why women in the United States choose home birth. J Midwifery Womens Health 2009; 54:119.
  18. Martin, JA, Hamilton, BE, Sutton, PD, et al. Births: final data for 2007. National vital statistics reports, National Center for Health Statistics, Hyattsville, MD 2010.
  19. QuickStats: Percentage of Births That Were Home Births, by Maternal Race/Ethnicity — United States, 1990–2009* http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6103a6.htm?s_cid=mm6103a6_x (Accessed on January 26, 2012).
  20. Rooks J. Midwifery and childbirth in America, Temple University Press, Philadelphia 1997.
  21. Kitzinger S, May M. Homebirth: the essential guide to giving birth outside of the hospital., 1st American, Dorling Kindersley, New York 1991.
  22. Klee L. Home away from home: the alternative birth center. Soc Sci Med 1986; 23:9.
  23. McClain CS. Perceived risk and choice of childbirth service. Soc Sci Med 1983; 17:1857.
  24. Janssen PA, Henderson AD, Vedam S. The experience of planned home birth: views of the first 500 women. Birth 2009; 36:297.
  25. Lindgren HE, Rådestad IJ, Christensson K, et al. Perceptions of risk and risk management among 735 women who opted for a home birth. Midwifery 2010; 26:163.
  26. Pang JW, Heffelfinger JD, Huang GJ, et al. Outcomes of planned home births in Washington State: 1989-1996. Obstet Gynecol 2002; 100:253.
  27. Lindgren HE, Rådestad IJ, Christensson K, Hildingsson IM. Outcome of planned home births compared to hospital births in Sweden between 1992 and 2004. A population-based register study. Acta Obstet Gynecol Scand 2008; 87:751.
  28. Ackermann-Liebrich U, Voegeli T, Günter-Witt K, et al. Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome. Zurich Study Team. BMJ 1996; 313:1313.
  29. Janssen PA, Lee SK, Ryan EM, et al. Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia. CMAJ 2002; 166:315.
  30. de Jonge A, van der Goes BY, Ravelli AC, et al. Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. BJOG 2009; 116:1177.
  31. Woodcock HC, Read AW, Bower C, et al. A matched cohort study of planned home and hospital births in Western Australia 1981-1987. Midwifery 1994; 10:125.
  32. Johnson KC, Daviss BA. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ 2005; 330:1416.
  33. Wiegers TA, Keirse MJ, van der Zee J, Berghs GA. Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in The Netherlands. BMJ 1996; 313:1309.
  34. Janssen PA, Saxell L, Page LA, et al. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ 2009; 181:377.
  35. Olsen O, Clausen JA. Planned hospital birth versus planned home birth. Cochrane Database Syst Rev 2012; 9:CD000352.
  36. Mori R, Dougherty M, Whittle M. An estimation of intrapartum-related perinatal mortality rates for booked home births in England and Wales between 1994 and 2003. BJOG 2008; 115:554.
  37. Amelink-Verburg MP, Verloove-Vanhorick SP, Hakkenberg RM, et al. Evaluation of 280,000 cases in Dutch midwifery practices: a descriptive study. BJOG 2008; 115:570.
  38. Kennare RM, Keirse MJ, Tucker GR, Chan AC. Planned home and hospital births in South Australia, 1991-2006: differences in outcomes. Med J Aust 2010; 192:76.
  39. Hutton EK, Reitsma AH, Kaufman K. Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study. Birth 2009; 36:180.
  40. Gyte G, Dodwell M, Newburn M, et al. Estimating intrapartum-related perinatal mortality rates for booked home births: when the 'best' available data are not good enough. BJOG 2009; 116:933.
  41. Wax JR, Lucas FL, Lamont M, et al. Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. Am J Obstet Gynecol 2010; 203:243.e1.
  42. Dowswell T, Thornton JG, Hewison J, et al. Should there be a trial of home versus hospital delivery in the United Kingdom? BMJ 1996; 312:753.
  43. Koehler NU, Solomon DA, Murphy M. Outcomes of a rural Sonoma County home birth practice: 1976-1982. Birth 1984; 11:165.
  44. Michael CA, Janssen PA, Vedam S, Hutton EK, de Jonge A. Planned Home vs Hospital Birth: A Meta-Analysis Gone Wrong. Medscape Ob/Gyn & Women's Health (online). http://www.medscape.com/viewarticle/739987. (Accessed on June 24, 2011).
  45. Birthplace in England Collaborative Group, Brocklehurst P, Hardy P, et al. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011; 343:d7400.
  46. https://www.npeu.ox.ac.uk/birthplace. (Accessed on December 15, 2011).
  47. Schroeder E, Petrou S, Patel N, et al. Cost effectiveness of alternative planned places of birth in woman at low risk of complications: evidence from the Birthplace in England national prospective cohort study. BMJ 2012; 344:e2292.
  48. van der Kooy J, Poeran J, de Graaf JP, et al. Planned home compared with planned hospital births in the Netherlands: intrapartum and early neonatal death in low-risk pregnancies. Obstet Gynecol 2011; 118:1037.
  49. Ecker J, Minkoff H. Home birth: what are physicians' ethical obligations when patient choices may carry increased risk? Obstet Gynecol 2011; 117:1179.
  50. Chervenak FA, McCullough LB, Brent RL, et al. Planned home birth: the professional responsibility response. Am J Obstet Gynecol 2013; 208:31.
  51. Janssen PA, Lee SK, Ryan ER, Saxell L. An evaluation of process and protocols for planned home birth attended by regulated midwives in British Columbia. J Midwifery Womens Health 2003; 48:138.
  52. http://www.livestrong.com/article/534876-holistic-approach-to-strep-b-in-pregnancy/. (Accessed on November 19, 2012).
  53. Bishara RM. GBS in a homebirth setting. Midwifery Today Int Midwife 2006; :32.
  54. Davis-Floyd R. Home-birth emergencies in the US and Mexico: the trouble with transport. Soc Sci Med 2003; 56:1911.
  55. Declercq ER. The trials of Hanna Porn: the campaign to abolish midwifery in Massachusetts. Am J Public Health 1994; 84:1022.