Home births have significantly increased in the United States in the last decade. Home births that are unplanned and that are not attended by a midwife or physician are associated with higher neonatal and infant morbidity and mortality. The objective of this investigation is to assess trends in unattended home births in the United States.
We analyzed the Centers for Disease Control and Prevention birth certificate database assessing unattended home births in the United States from 2007 to 2012. Unattended births were defined as those not attended by a midwife, physician, or other doctor.
From 2007 to 2012 there were a total of 24,600,409 births in the United States of which 140,912 (0.57%) were home births. Unattended home births (n=42,061) comprised 29.8% of all home births. Unattended home births in the United States increased by 79% from 4,926 in 2007 to 8,822 in 2012 and gradually rose from 1.14 per 1,000 births in 2007 to 2.23 per 1,000 births in 2012 (P<.001). The increase of unattended home births among multiparous patients was higher when compared with nulliparous patients (82.4% increase compared with 65.0% increase; P<.001). The ratio of unattended home births in nulliparous patients nearly quadrupled between 2007 and 2012 from 0.6 to 2.1 per 1,000 nulliparous births, whereas the ratio of unattended home births in multiparous women doubled from 1.5 to 3.0 per 1,000 multiparous births (P<.001).
There is concern that unattended home births have significantly increased over recent years. Because unattended home births are associated with increased neonatal and infant mortality, further studies are needed to understand the causes of the increase and to assess interventions aimed to reduce unattended home births in the United States.