Statcast Number 18 Transcript

Marian MacDorman, PhD, a statistician with the CDC’s National Center for Health Statistics, discusses her new study on trends in home births and other out-of-hospital births in the U.S.

MACDORMAN: After a very gradual decline between 1990 and 2004 there was a 5% increase in the percentage of home births in 2005 in the U.S. and that increase was sustained in 2006

ANNOUNCER: Statcast… March 3, 2010…

ANNOUNCER: We’re here with Dr. Marian MacDorman of the National Center for Health Statistics. Marian is a statistician with the Reproductive Statistics Branch at NCHS and she has just authored a new study on out-of-hospital births in the U.S.

Marian, how common is it for a woman to deliver a baby outside a hospital?

MACDORMAN: In 2006, there were about 38,500 out-of-hospital births in the United States, representing nearly 1% of the 4.3 million live births in the United States that year. Of those out-of-hospital births, about 2/3, or nearly 25,000 births occurred at home, while 28%, or nearly 11,000 births occurred at a freestanding birthing center.

ANNOUNCER: What exactly is a freestanding birthing center?

MACDORMAN: It is a birthing center where women go to give birth, but that is separate from a hospital.

ANNOUNCER: OK, so What are the some of the most significant findings in your study?

MACDORMAN: After a very gradual decline between 1990 and 2004 there was a 5% increase in the percentage of home births in 2005 in the U.S. and that increase was sustained in 2006

ANNOUNCER: This study goes back to 1990 – do we have any earlier estimates to compare to the most recent data?

MACDORMAN: At the beginning of the 20th century, the vast majority of births were out-of-hospital or home births. By 1940, 44% of births were out-of-hospital births. This percentage dropped to about 1% from 1970 onwards.

ANNOUNCER: Midwives seem to be playing a bigger role in home births. Can you elaborate?

MACDORMAN: About 61% of home births in 2006 were delivered by midwives; of these ¼ were delivered by certified nurse midwives and ¾ by other midwives.

ANNOUNCER: Are there any theories as to why home births are less likely to be preterm or low birthweight?

MACDORMAN: Home birth practitioners try to select the lowest risk women as candidates for home birth. Women with higher pregnancy risks are recommended for hospital birth. .

ANNOUNCER: Montana and Vermont had the greatest proportion of home births of any state, and those are very rural states. But so are Nebraska and Louisiana, which had the fewest proportion of home births. Any ideas why Nebraska and Louisiana might have fewer births in the home?

MACDORMAN: We’re not really sure, but it might have something to do with the popularity of home birth in different regions of the country. Home births seem to be more common in some of the Western states, and less common in the south. Differences in state laws surrounding home birth and midwifery practice might also play a role. For example, some states license and recognize direct-entry midwives while other states may not.

ANNOUNCER: Any other things to add?

MACDORMAN: Some home births are planned home births which are generally low risk births. Others are unplanned home births, most likely involving an emergency situation with higher risks.

ANNOUNCER: Our thanks to Marian MacDorman for joining us on this edition of “Statcast.” “Statcast” is a production of the Public Affairs Office at the National Center for Health Statistics.