Home births on the rise in California

A growing number of California babies are taking their first breaths not in the florescent glow of hospital rooms, but in their parents’ bedrooms.

Although the percentage of women giving birth at home is still small, home births in the state increased by 37 percent between 2004 and 2009, from 0.38 percent of all births to 0.52 percent, according to a January report released by the National Center for Health Statistics and the federal Centers for Disease Control and Prevention.

Nationwide, the percentage of births that occurred at home jumped 29 percent during the same time period, from 0.56 percent to 0.72 percent. There were 29,650 babies born at home in the U.S in 2009.

“I think part of it is the economy driving people to have home births,” said Sue Turner, a licensed midwife in Ventura. “Maybe they’ve lost their job and don’t have health insurance, and so they’re wanting the cheaper way to go. Also, I think many people want fewer medical interventions. There’s more awareness that giving birth can be a natural experience.”

Fawn Peterson is one California woman who opted to give birth at home last year, after having three previous hospital births.

“The home birth was just easier—we didn’t have to pack bags and go anywhere, and we could enjoy the comforts of our own home,” she said. “At the hospital I would have had an I.V. and wouldn’t have been able to move around as much while I was in labor.”

She gave birth to her son, August, on the bed she and her husband, Jeff Peterson, share. Under Turner’s guidance, Jeff Peterson, “caught” August as he slid down the birth canal.

Like Peterson’s, the majority of home births are planned, but an estimated 25 percent occur because women can’t make it to the hospital in time, according to a 2010 study published in the American Journal of Obstetrics and Gynecology.

The American College of Obstetricians and Gynecologists’ recommends that women not plan a home birth, because of safety concerns and a lack of rigorous scientific study. The California Department of Public Health does not have a position on home births, said spokeswoman Anita Gore.

Studies have shown that home births can be more dangerous for babies, but may result in fewer complications for mothers, said Dr. Robert Levin, health officer for Ventura County Public Health and a pediatrician.

“In terms of the mother’s health, home births appear to be as safe as hospital births, but there is some concern that with planned home birth, there’s as much as a two-fold increased risk of neonatal death,” he said. “The neonatal death rates are still quite low, but they’re something we look at every year in California and the United States.”

The 2010 study by the Committee on Obstetric Practice found that 2 in every 1,000 newborns died during planned home births, while 0.9 in every 1,000 died during planned hospital births.

Meanwhile, 1.2 percent of women who had a planned home birth received third- or fourth-degree lacerations during the delivery, compared with 2.5 percent of women who had a planned hospital birth. Rates of maternal infection were also lower among those who delivered during a planned home birth, at 0.7 percent, compared to the 2.6 percent among those who had a planned hospital birth.

The lower complication rates among those who deliver at home could be because state laws only allow midwives to care for women with low-risk pregnancies, Levin said. Those with gestational diabetes, high-blood pressure or a number of other common pregnancy conditions that can cause birth complications typically deliver in a hospital.

In addition, 25 to 37 percent of women who have never given birth before and plan to deliver at home end up being admitted to a hospital because complications arise or their labor isn’t progressing, according to the Obstetric Practice study.

If women are considering a home birth, Levin said it’s important to make sure they select an American Midwifery Board Certified midwife, have a low-risk pregnancy and haven’t had a previous cesarean section.

The percentage of U.S. births that occurred at home declined between 1990 and 2004, but has increased sharply since, the CDC study found. Home births are most common among women aged 35 and older who have had previous children.

For non-Hispanic white women, home births increased by 36 percent, and about 1 in every 90 births for this group of women is now a home birth. Home births are less common among women of other racial or ethnic groups.

The percentage of home births in 2009 varied from a low of 0.2 percent of births in Louisiana and the District of Columbia, to a high of 2 percent in Oregon and 2.6 percent in Montana.

Turner, who also operates the Ventura Birth Center, a place where women can give birth outside of the hospital, said she’s seen her business increase 15 percent each year in the past decade. She’s typically booked about four months in advance and frequently has to turn pregnant women away.

“This week I’ve gotten calls for people due in October,” she said on March 15. “We’re halfway booked now for October.”

Giving birth at home is about a third the cost of a hospital birth, Turner said. Midwives typically charge between $4,000 and $6,000 to deliver a baby at home, whereas hospital bills often run between $12,000 and $15,000. However, only about half of health insurance companies in California cover home births, Turner said.

Other women opt for home births because they’re afraid of hospitals, or associate them with negative experiences, she said.

“Perhaps they’ve had a traumatic experience giving birth previously in a hospital, or maybe they’ve had a loved one or previous child pass away in a hospital,” she said.

Some women also chose to stay home because they want more control over their environment and birth attendants, or because they want a more traditional experience, Turner said.

“It’s so interesting to me it just seems like things go full circle this way,” she said. “For so much of history, women gave birth at home.”

In 1900, almost all U.S. births occurred outside a hospital, the vast majority of which occurred at home, according to the CDC study. This proportion fell to 44 percent by 1940, and to 1 percent by 1969, where it remained through the 1980s.

Peterson said knowing that women traditionally gave birth at home helped persuade her to do so as well — but she wasn’t opposed to being transferred to a hospital if something went wrong.

“I had nothing to prove,” she said. “I think it’s silly if someone’s high risk and she still wants to grit her teeth and stay at home. The baby’s safety is what’s most important.”

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