Tuesday, January 6, 2015

More Utah Women Giving Birth Out of Hospitals

(Salt Lake City, UT) – At the dawn of the 20th century, nearly all Utah babies were born at home. By 1969, only one percent were, as hospitals became the go-to place for moms to deliver. Fast-forward to 2014 and the trend is changing again, with nearly 3,700 babies, or 10 per day, delivered either at home or in a freestanding birth center according to statewide birth certificate data. 

The Maternal and Child Health Bureau at the Utah Department of Health (UDOH) partnered with Utah physicians and midwives to issue a new report to examine these trends, identify opportunities to improve data collection, and address potential areas for improving outcomes.  Using vital records data, the report reviewed out of hospital (OOH) births that occurred in Utah between 2010-2012. The report is available by clicking here.

“As more Utah women are choosing out of hospital births, it is critical that we identify and address issues that impact maternal and neonatal safety, including provider qualifications, provider-to-provider communication, and timely hospital transfer,” said Erin Clark, Maternal Fetal Medicine Physician at the University of Utah Health Sciences Center and one of the report’s authors. 

Between 2010 and 2012 a total of 139,958 full-term babies were born in Utah. Most of those births (136,625) occurred in hospitals under the care of a physician or certified nurse midwife. The remaining 3,693 births occurred as planned OOH births. The report examined the trends and characteristics of these births and found:
Utah’s OOH birth rate doubled between 1990 and 2012
2,595 births occurred at home, while 1,098 occurred in birthing centers
More than two-thirds of the births were attended by unlicensed midwives
Other births were attended by Licensed Direct-entry Midwives, unlicensed midwives, Certified Nurse Midwives, and naturopathic physicians

The report also compared women who deliver in hospitals to women who choose OOH births and found women choosing OOH births:
Tended to be older, white and non-Hispanic, married, and of rural residence
Were at a healthier weight prior to pregnancy, had five or more prior births, and were more likely to have paid for their deliveries out of pocket
Were more likely to have no prenatal care (home birth 1.9% vs. hospital 0.3%) or inadequate prenatal care (home birth 39.1%, birth center 30.5%, vs. hospital 14.9%)
Were less likely to begin care in the first trimester (home birth 52.9%, birth center 48.5%, vs. hospital 75.3%)
Had fewer overall complications, with the exception of higher rates of premature rupture of membranes (more than 12 hours), precipitous labor (less than 3 hours) and prolonged labor (more than 20 hours)

Additionally, the neonatal death rate among Utah babies delivered at home was found to be more than double that of babies born in hospitals, which mirrors findings from a recent national analysis. 

“Unfortunately, we are limited in our ability to further analyze data by birth attendant or to rigorously assess outcomes in this analysis by the relatively small numbers in the out of hospital birth cohort during the study period,” said Lois Bloebaum, director of Maternal and Child Health Quality Improvement at the UDOH and one of the report’s authors.

Bloebaum went on to say, “While the neonatal mortality rate among home births was significantly higher (95% C.I. p=.05), future analysis will indicate whether this finding is of concern or an artifact of small numbers.  We were also unable to calculate the neonatal mortality rate among birth center births at this time due to small numbers.”

Several recommendations have been identified based on this analysis, some of which include more precise collection of data on this topic. Changes to the Utah Birth Certificate have already been made and changes to the Utah Fetal Death Certificate are in process to enable more precise data collection. The Maternal and Child Health Bureau is also working collaboratively with Utah midwives and physician partners to improve communication and reporting among in-hospital and out of hospital providers when a transfer to a hospital becomes needed.

                                                                      # # #
Media Contact:
Lois Bloebaum
Utah Department of Health
Bureau of Maternal and Child Health

The mission of the Utah Department of Health is to protect the public's health through
preventing avoidable illness, injury, disability and premature death, assuring access to
affordable, quality health care, and promoting healthy lifestyles.

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number 1 B04MC28130¬01¬00, Maternal and Child Health Services ($5,777,200.00 FROM: 10/01/2014   THROUGH: 09/30/2016) 0.00% was financed with nongovernmental sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government