Is the Pandemic to Blame for the Spike in US At-Home Births?

Summary

The COVID-19 pandemic has led to a significant increase in at-home births in the US, with a 22% rise in 2020, marking the highest rate in thirty years.

Abstract

The pandemic has altered birthing preferences in the US, with at-home births accounting for approximately 1% of all births historically, but surging by 22% in 2020. This increase, the highest in three decades, is attributed to fears of contracting COVID-19 in hospitals, visitor restrictions, and policies separating mothers and newborns. The CDC's National Center for Health Statistics reported that home births rose each month from March to December 2020, correlating with the rise in COVID-19 cases. The trend was observed across various ethnic groups, with non-Hispanic Black women experiencing a 36% increase, non-Hispanic White women a 21% increase, and Hispanic women a 30% increase. The phenomenon was widespread, with 40 states seeing increases, most notably South Dakota with a 68% rise. Despite the shift, the American College of Obstetricians and Gynecologists (ACOG) emphasizes that hospitals and accredited birth centers remain the safest places for delivery, citing higher risks associated with home births, including double the risk of perinatal mortality and triple the risk of infant seizures or serious neurologic disorders. ACOG advises that favorable home birth outcomes depend on careful candidate selection, qualified healthcare providers, and timely access to hospital care. The rise in home births coincides with a broader trend of increased telehealth usage during the pandemic, with a 63-fold increase in Medicare visits conducted through telehealth in 2020.

Opinions

The CDC acknowledges a direct correlation between the initial surge of COVID-19 cases and the increase in home births.
ACOG maintains that hospitals and accredited birth centers are the safest delivery settings, despite the increase in home births.
ACOG also highlights the importance of informed decision-making by women regarding their delivery settings, stressing factors that reduce perinatal mortality rates and improve birth outcomes.
ACOG suggests that successful home births require appropriate candidate selection, qualified midwifery or obstetric care, and easy access to hospital services.
The Department of Health and Human Services notes that the pandemic led to a massive increase in telehealth usage, which helped maintain healthcare access, particularly for behavioral health services.

Data doesn’t lie

Typically, at-home births account for about 1% of all births in the US. But due to fear of contracting COVID-19, visitation restrictions for family members, and in some cases, babies not being allowed to stay in the mother’s room, many are deciding against delivering at a hospital.

This is backed up with data according to the findings released Thursday, December 9, 2021, by the Centers for Disease Control and Prevention’s National Center for Health Statistics. This new data shows home births spiked in 2020, up 22% from the year before and the highest in thirty years. National Vital Statistics Reports Volume 70, Number 15 November 2, 2021 (cdc.gov)

“The percentage of home births rose each month March through December in 2020 compared with the same period in 2019,” Elizabeth Gregory, a CDC scientist and lead author of the study, stated. “The timing of the increases in home births generally corresponds with the initial surge of COVID-19 cases in the United States.”

Other findings in this study included:

For non-Hispanic White women, the percentage of home births increased 21%,

For non-Hispanic Black women, the percentage of home births increased 36%,

For Hispanic women, the percentage of home births home increased 30%.

From 2019 to 2020, the percentage of home births increased in 40 states. Increases ranged from 11% for Wisconsin to 68% for South Dakota.

American College of Obstetricians and Gynecologists released a statement, in part, saying: “Data has long demonstrated that hospitals and accredited birth centers are the safest places to give birth. Although each woman has the right to make a medically informed decision about delivery, it is imperative that women be informed about the factors that are critical to reducing perinatal mortality rates and achieving favorable birth outcomes.” ACOG Statement on Birth Settings | ACOG

Also, according to ACOG, home births are associated with more than double the risk of a baby dying between 22 weeks' gestation and seven days after birth. At-home births are at three times the risk of infant seizures or serious neurologic disorders.

In another ACOG paper, they recommended that women should be informed that several factors are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes. These factors include the appropriate selection of candidates for home birth; the availability of a certified nurse–midwife, certified midwife, or midwife whose education and licensure meet International Confederation of Midwives’ Global Standards for Midwifery Education, or physician practicing obstetrics within an integrated and regulated health system; ready access to consultation; and access to safe and timely transport to nearby hospitals.

This data also coincides with data from the Department of Health and Human Services showing “massive increases in the use of telehealth helped maintain some health care access during the COVID-19 pandemic, with specialists like behavioral health providers seeing the highest telehealth utilization relative to other providers.” The report found that the share of Medicare visits conducted through telehealth in 2020 increased 63-fold, from approximately 840,000 in 2019 to 52.7 million.