PODCAST: Interview with Elizabeth Gregory on Home Births During the Pandemic

December 10, 2021

https://www.cdc.gov/nchs/pressroom/podcasts/2021/20211210/20211210.htm

HOST: Though no historical data are available, it is widely accepted that most births prior to the 20th century occurred in the home.  With the arrival of the 20th century and the advances in modern medicine that came with it, home births became far less common – as low as 0.56% of all births in 2004.  But in 2020, driven at least in part by the pandemic, home births increased 22% from 2019, to 1.26% in 2020 – the highest percentage since at least 1990.

This week NCHS has released a new report documenting the increase in home births during the pandemic.  Joining us to discuss the findings in the report is the lead author of the study, Elizabeth Gregory…

HOST: Are women who give birth at the home – and their babies – more at risk for adverse outcomes?

EG: So, this report doesn’t address the safety of home births – what it does is it examines changes in home births before and during the COVID-19 pandemic by month and by race and Hispanic origin and state of residence of the mother.

HOST: Home births have been higher in recent years than 10-15 years ago, is that correct?

EG: Home births have been increasing for the last 15 years or so.  The pace of increase had slowed from 2014 to 2019, and then there was a large increase in 2020.

HOST: The data suggest the low mark for home births in the United States occurred around 2004, is that correct?

EG: Yes that’s correct, but it’s important to note that we don’t have comparable data on home births prior to the 1989 revision of the US standard certificate of live birth.  But for 1990 through 2020 the lowest percentage of home births which was 0.56% occurred in 2004.

HOST: So even though it’s accepted that back in the 19th century, for example, most births occurred in the home, we don’t really have data prior to 1989, is that correct?

EG: So for vital statistics data, previous to the 1989 revision the question for place of birth – the response could either be in hospital or not in hospital.  We don’t really have the more detailed information about where the birth may have occurred outside the hospital.

HOST: I see.  So the pandemic would help explain the sharp rise in 2020, but what explains the higher rates since 2004?

EG: We didn’t look at what might have caused the increases for those earlier years, but we did look at when and where the increases occurred for 2019 to 2020.  So for example, in 2019 to 2020 the percentage of home births rose 22% for all women, with increases ranging from 21 to 36% for the three largest race and Hispanic origin groups.  And the percentage of home births for all women increased for each month, March through December, peaking in May, and this pattern of home births by month was also generally observed for each of the three largest race and Hispanic origin groups.

HOST: What factors related to the pandemic accounted for the big increase in 2020?

EG: So other researchers have found that some reasons included: increasing number of cases of COVID-19 in the U.S. combined with concerns about contracting COVID-19 while in the hospital… limitations or bans on support persons in the hospital… and the separation of infants from mothers suspected to have COVID-19.

HOST: What were some geographic differences we saw in 2020 as far as home births go?

EG: This report found increases in home births for the vast majority of states from 2019 to 2020.  The percentage of home births increased significantly in 40 states, with non-significant increases seen in an additional nine States and the District of Columbia.

HOST: What about race and ethnicity?  Were there similar increases in home births along those demographic lines?

EG: Historically non-Hispanic white women have been more likely to give birth at home, and this pattern continued into 2020.  However, increases ranging from 21 to 36% were seen for all of the three largest race and Hispanic origin groups from 2019 to 2020.

HOST: Any other topics in your study you’d like to mention?

EG: Yes, the report found that the percentage of home births rose for each month, March through December 2020, compared with the same months in 2019 and peaked in May.  And the timing of increases in home births generally corresponds with the initial surge of COVID-19 cases in the United States in late March and early April 2020.

HOST: Thanks for joining us Elizabeth.

EG: You’re welcome.

MUSICAL BRIDGE

HOST: December got off to a busy start with two reports focusing on children’s health, using 2020 data from the National Health Interview Survey.  The 2020 NHIS included questions on concussion, to measure both symptoms and diagnosis from a health care provider to provide a more complete understanding of the public health burden, as children with mild injuries may not see a doctor or receive a diagnosis.  On Dec. 1, NCHS released a new study on concussions and brain injuries among children in the U.S.  The new study found that nearly 7% of children in the U.S. under the age of 18 have had symptoms of a concussion or brain injury.  And 4% have been diagnosed with these conditions by a health care provider.   Boys are more likely than girls to have had these symptoms, and non-Hispanic White children are more likely than children in other race categories to have had these symptoms. 

While the report on concussions and brain injuries doesn’t have any direct correlation to the pandemic, a second report looked at dental exam visits among children in 2020 compared with 2019. It is known that in 2020, dental practices across the country adjusted their services in response to the COVID-19 pandemic, and access to dental care was disrupted for many Americans. This new study found that there was a decline in visits for dental exams or cleanings from 2019 to 2020, which likely was driven by the pandemic.  The decline was greater among younger children ages 1 to 4, as well as among lower income children and children living in the northeastern United States. 

Capping off the first week of the month was the latest quarterly provisional birth data for the U.S.  This latest release features mid-year 2021 data, and shows that fertility in the U.S. appears to be continuing its steady decline from the past several years, including a sharp decline in the U.S. fertility rate in the one year ending in mid-year 2020 compared to the same point the year before.

MUSICAL BRIDGE

HOST: This week NCHS also released data from its 2019 linked birth and infant death file.  These data are considered to be more comprehensive than infant mortality data from death certificates alone, due to the linking of the two sources of information.  As a result, much more accurate demographic and geographic data on infant mortality are available from this linked file.  However, the general “bottom line” remains the same – infant mortality in the United States continues to decline, as it has for nearly a century.

Finally, today NCHS released a report looking at trends in mortality from the leading cause of death in America, heart disease.  The new study covers most of the past two decades, with a special focus on changes by state.  The report shows that in the first decade of the millennium, 2000 to 2011, heart disease death rates declined in all 50 states and DC.  However, from 2012 through 2019, heart disease death rates fell in only half the states plus DC – and actually increased in one state (Arkansas). 

Later this month, on Dec. 22, NCHS will release its final death data for 2020, which will include the final, official number of COVID-19 deaths for the country in 2020.  Rounding out the last week of the year are several new reports, including one on emergency department visits by adults who have mental health disorders, using data from the National Hospital Ambulatory Medical Care Survey.  Two pregnancy-related reports are slated for release that week as well:  one on pre-pregnancy body mass index and infant outcomes and another on maternal and infant health outcomes among mothers with confirmed or presumed COVID-19 during pregnancy.  And last, the annual final report on drug overdose deaths for 2020 will be released, which comes on the heels of the latest monthly release of provisional overdose death numbers, running through May of 2021.


Births: Final Data for 2018

November 27, 2019

Questions for Joyce Martin, Health Statistician and Lead Author of “Births: Final Data for 2018

Q: What is new in this report from the 2018 provisional birth report?

JM: In addition to providing final numbers and rates for numerous birth characteristics such as fertility rates, teen childbearing, cesarean delivery and preterm and low birthweight, this report presents final information on  teen childbearing by race and Hispanic origin and by state, births to unmarried women, tobacco use during pregnancy, source of payment for the delivery and twin and triplet childbearing.


Q: Was there a specific finding in the 2018 final birth data that surprised you?

JM: The continued decline in birth rates to unmarried women (down 2% for 2017-2018 to 40.1 births per 1,000 unmarried women), the fairly steep decline in tobacco smoking among pregnant women (down 6% to 6.5% of all women) and the continued declines in twin (down 2%) and triplet (down 8%) birth rates.  Also of note is the decline in the percentage of births covered by Medicaid between 2017 and 2018 (down 2% to 42.3%) and the small rise in the percentage covered by private insurance (49.6% in 2018).


Q: How did you obtain this data for this report?

JM: These data are based on information for all birth certificates registered in the United States for 2018.


Q: What is the take home message for this report?

JM: Birth certificate data provide a wealth of important current and trend information on demographic and maternal and infant health characteristics for the United States.


Q: Why do you think the birth has dropped in the U.S.?

JM: The factors associated with family formation and childbearing are numerous and complex, involving psychological, cultural, demographic, and socio-economic influences. The data on which the report is based come from all birth certificates registered in the U.S. While the data provide a wealth of information on topics such as the number of births occurring in small areas, to small population groups, and for rare health outcomes, the data do not provide information on the attitudes and behavior of the parents regarding family formation and childbearing. Accordingly, the data in and of itself cannot answer the question of why births have dropped in the U.S.


Births: Final Data for 2015

January 5, 2017

Questions for Joyce A. Martin, M.P.H., Demographer, Statistician, and Lead Author on “Births: Final Data for 2015

Q: Was there a result in your study’s analysis of births in the United States that you hadn’t expected and that really surprised you?

JM: Although small, (from 9.57% to 9.63%) the rise in the preterm birth rate (births of less than 37 completed weeks of gestation) was unexpected. This rate had been declining steadily since 2007.

Also of note is the decline in the triplet and higher-order multiple birth rate, down 9% from 2014 to 2015, and a decrease of 46% since 1998. The year 2015 also is the third straight year of declines in the rate of cesarean delivery (rate of 32.0% in 2015).

The continued, large decline in the teen birth rate (down 8% from 2014 to 2015) was also somewhat surprising, although not unprecedented. From 2007 through 2014, the teen birth rates had declined 7% annually.


Q: What is the difference between this new births report and the other reports your office produced on 2015 birth data, like the preliminary data report on 2015 births and the Data Brief on teen births?

JM: The annual report “Births: Final Data for 2015” offers substantially more detail (e.g., age, race and Hispanic origin of mother, state) on key topics, than does the report on preliminary birth statistics (“Births: Preliminary Data for 2015”). The final report also includes information on topics not included in the preliminary reports such as multiple births, attendant and place of birth, birth order and birth rates for fathers.


Q: How has the number of births in the United States changed in 2015 from previous years?

JM: The number of births in the United States declined slightly in 2015 (by 9,579 births to 3,978,497) from 2014. The decline for 2015 followed an increase in births for 2014, which was the first increase since 2007.


Q: What differences, if any, did you see among race and ethnic groups, and among various ages?

JM: Of continued concern are the higher risks of poor birth outcomes as measured by levels of preterm birth and low birthweight among non-Hispanic black mothers compared with total births and other race and Hispanic origin groups. For example, in 2015 the preterm birth rate for births to non-Hispanic black mothers was more than 50% higher at 13.41% than for non-Hispanic white women (8.88%) and nearly 50% higher than the rate for births to Hispanic mothers (9.14%).


Q: Did you observe any regional or state differences in this study on births?

JM: Differences by state were observed for many of the demographic and medical/health items included in the 2015 final birth report. For example, from 2014 to 2015, the general fertility rate–which is the number of births per 1,000 women aged 15–44–declined in eight states and was essentially unchanged in the 42 states and the District of Columbia (DC). In 2015, the general fertility rate ranged among states from 51.1 births per 1,000 women aged 15–44 in Vermont to 78.2 in South Dakota.

Also, increases in preterm birth rates were limited to four states from 2014 to 2015: Arkansas, California, Nebraska, and North Carolina. Rates declined in four states: Montana, New York, Texas and Wyoming. Nonsignificant differences were reported for the remaining states and DC.


Out-of-hospital births increase

March 17, 2010

A recent report released by NCHS showed an increase in the number of home and out-of-hospital births. In 2006, there were 38,568 out-of-hospital births in the United States, including 24,970 home births and 10,781 births occurring in freestanding birthing centers. The report also found that there was a decline between 1990 and 2004 in the number of out-of-hospital births and then a 3% increase from 2004 to 2005. Similarly, there was also a decline in home births between 1990 and 2004 and then an increase of 5% in 2005. However the number of home births remained steady in 2006.

The report also compared trends in the number of home births among different racial and ethnic groups. Results found that non-Hispanic white women were more likely to have a home birth than women of any other race and ethnicity. Overall, 81% of home births were to non-Hispanic white women, compared with 54% of hospital births.

             For more, visit “Trends and Characteristics of Home and Other Out-of-Hospital Births in the United States, 1990–2006”