After falling for 14 years, the percentage of home births in the US from 2004 to 2009 rose by 29% to the highest level since data collection on this began in 1989. However, although this looks like a big surge, the overall proportion of American women giving birth at home is still low: in 2004 only 0.56% of births were at home, rising to 0.72% in 2009.

The latest statistics on American home births appears in the January 2012 National Center for Health Statistics Data Brief, from the US Centers for Disease Control and Prevention (CDC).

The increase is widespread across the country although there are large regional variations, perhaps due to differences in state laws on midwifery practice and births outside hospital.

Another reason could be because of the large differences in racial and ethnic composition among states, since the surge in home births is largely driven by a 36% increase for non-Hispanic white women. About 1 in 90 births to this group of women is now at home, which is about three to five times higher than for any other racial or ethnic group.

Women may choose to have their baby at home instead of the hospital because they want a low-intervention birth in a place they are familiar with and where they can have their family and friends with them. Cultural or religious concerns, lack of transportation in rural areas, and the higher cost of hospital births (a home birth costs about one third as much as a hospital birth) could be other reasons.

The report finds that home births are more common among women aged 35 and over, and among women with several previous children.

The report also says most American women choosing to give birth at home have a lower pregnancy risk profile than those giving birth in hospital. Compared to hospital births, there are fewer teenagers or unmarried women choosing home birth, and fewer preterm, low birthweight and multiple births occuring at home.

The authors suggest one reason could be that midwives and other birth attendants are getting better at deciding which women are less likely to have complications giving birth at home.

According to research, most home births are intentional or planned, whereas most non-home births are usually because there is an emergency, such as early labor, inability to reach the hospital in time, or because of labor complications. This appeared to be reflected in data from 26 states (covering 50% of US births), which showed 87% of home births were planned in 2009.

The American College of Obstetricians and Gynecologists (ACOG) does not support planned home births because they believe "hospitals and birthing centers are the safest setting for birth". However, in an opinion statement released in 2011, their Committee on Obstetric Practice said it "respects the right of a woman to make a medically informed decision about delivery", and women enquiring about planned births should be informed of the risks and benefits. Specifically this should tell them that although the risk is low, the most recent evidence shows "planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth".

Written by Catharine Paddock PhD