Expecting mothers increasingly turn to at-home births: New research

DENVER — More pregnant people are turning away from hospital births and instead choosing their homes, according to research presented during the American Academy of Pediatrics 2025 National Conference & Exhibition at the Colorado Convention Center Sept. 26-30.

Cincinnati Children’s researchers tracked out-of-hospital births and found that the numbers doubled in the region from April 1, 2020 - December 31, 2023, compared to births from January 1, 2018 - February 29, 2020. The trend was seen most in young, highly educated mothers who were also more likely to have higher body mass index and fewer prenatal visits, according to a study abstract, “The Changing Landscape of Planned Out-of-Hospital Births.”

Research author with Cincinnati Children’s Emily Miller MD, MS, FAAP, said the American College of Obstetricians and Gynecologists (ACOG) advises against planned home births for higher-risk pregnancies. A myriad of factors contribute to a high-risk pregnancy, including maternal age, chronic illness, previous birthing issues like preterm birth, and being pregnant with multiples, she said.

“As intensive care doctors who care for critically ill infants in the neonatal intensive care unit (NICU), it is important to understand the changing landscape of where, when and how pregnant people are delivering their babies and the associated impact on infant health outcomes,” Miller said.

As rural hospitals and clinics face potential closures due to federal Medicaid cuts, Miller said it is crucial that expectant mothers consider all circumstances when deciding where they ultimately want to give birth.

“As more parents choose to deliver their infants outside of a hospital, it is important to understand associated infant health outcomes, including the risk of adverse events such as birth injury, need for respiratory support, and death, so families can weigh the potential benefits and risks, consider their individual circumstances, and ensure access to appropriate medical care if needed,” Miller stated.

The authors received financial support for this research from Cincinnati Children’s Hospital Medical Center, Perinatal Institute, Division of Neonatology.

Study author Hadi Berbari, MD, is scheduled to present the research, which is below, from 5 p.m. to 7 p.m. on Friday, Sept. 26, in the Colorado Convention Center, Four Seasons Ballroom 1 & 2. To request an interview with the authors, write to Hadi.Berbari@cchmc.org.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal. 

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

Program Name: 2025 Call for Abstracts

Submission Type: Section on Neonatal-Perinatal Medicine

Abstract Title: The Changing Landscape of Planned Out-of-Hospital Births

Dr. Hadi Berbari, Dr. Shelley Ehrlich, Chunyan Liu, Dr. Morgan Hill , Dr. Emily Miller

Cinncinati, OH, United States

Planned out-of-hospital (OOH) births are increasing within the United States, with the COVID-19 pandemic potentiating an already upward trend. American College of Obstetricians and Gynecologists recommends strict selection criteria for OOH births: absence of preexisting maternal disease, cephalic presentation, and term singleton gestation. Infants born to low-risk women choosing OOH births more frequently experience adverse neonatal events. To date, no study has examined changes in the maternal risk profile and neonatal outcomes for planned OOH births since declaration of the pandemic. We hypothesized maternal risk factors and rates of adverse neonatal outcomes for planned OOH births have increased since declaration of the COVID-19 pandemic. Study objectives are to describe the sociodemographic profiles and maternal risk factors among those with planned OOH births pre/post the COVID-19 pandemic and compare neonatal outcomes pre/post the COVID-19 pandemic.

This retrospective cohort study includes pregnant individuals and their neonates with planned OOH births in Cincinnati and surrounding areas between January 1, 2018 - February 29, 2020 (pre-pandemic), and April 1, 2020 - December 31, 2023 (post-pandemic). We extracted variables of interest from Ohio Department of Health birth certificate and vital statistics files. Maternal characteristics and potential risk factors for adverse neonatal outcomes are reported using descriptive statistics. Comparisons between groups are evaluated using Wilcoxon rank sum test for continuous variables and Chi-square or Fisher’s exact test for categorical variables

We identified 1601 planned OOH births; 1234 occurred during the post-pandemic era. The incidence of planned OOH births doubled from 1.5% pre-pandemic to 3.0% post-pandemic. As described in Table 1, women with post-pandemic OOH births had statistically significant (p< 0.05) increases in Black or Asian race, Hispanic ethnicity, obese/overweight, and completion of a high school, collegiate, or graduate degree. Statistically significant decreases were noted in mean age, white race, number of prenatal visits, and underweight persons. Neonatal characteristics, rates of adverse events, and completion of routine screenings were largely unchanged between cohorts (Table 2). Ocular prophylaxis agent and use differed between groups; more families opted against prophylaxis in the post-pandemic group. Analysis is ongoing to compare neonatal outcomes of OOH births to a matched in-hospital birth group

Planned OOH births doubled post COVID-19 pandemic, reaching 3.0% of births in our study region by 2023. Sociodemographic profiles and maternal risk factors varied between study groups; notably, younger and more educated mothers are choosing OOH births. While maternal characteristics, such as BMI category, in the post-pandemic cohort may confer increased neonatal risk, it is reassuring that despite the significant increase in OOH births, neonatal characteristics and outcomes have remained similar with low absolute rates of adverse events. Analysis is ongoing to assess the impact of an evolving risk profile on neonatal outcomes compared to planned in-hospital births.

Table 1: Maternal Characteristics of the OOH Cohort

Table 1 describes changes in maternal sociodemographic and risk profile between areas between January 1, 2018 - February 29, 2020 (pre-pandemic), and April 1, 2020 - December 31, 2023 (post-pandemic). Mothers who delivered during March of 2020 were excluded from this analysis as this was a transitional month during the pandemic.