Women Choosing Contraindicated Home Births

Abstract

INTRODUCTION: Women with ACOG-proscriptions against home birth (twins, breech presentation, gestational age (GA) 41 weeks or more, and vaginal birth after C-section) continue to have planned home births. Designing interventions to decrease contraindicated home births require identifying venues for action and characteristics of women to target with educational materials. METHODS: Women with contraindications to home birth were identified using US birth certificates from 2011–2013. Of these women, those with planned home births were compared to those who delivered in the hospital. RESULTS: Of 3,655,027 births to women with contraindications, 21,292 (0.6%) had planned home births and 17766 (83%) of these births had GA 41 weeks or more. Among women with contraindications to home birth, 99% of women with planned home births had prenatal care compared to 99% of women with hospital births, and 64% of planned home births were paid out-of-pocket compared to 4% of hospital births (P<.001). Demographically, women with home births were likely to be married (91%), be of white, non-Latino race/ethnicity (92%), and have diverse education levels (18% non-high school graduates, 40% high school graduates±some college, and 42% Bachelor's degree or higher). CONCLUSION: GA of 41 weeks or more is the contraindication to home birth that needs public health action. Prenatal education for women with contraindications may be possible; more data on who provides prenatal care is needed. Health insurance-based interventions are unlikely to decrease home births because most are paid out-of-pocket. Educational materials should target married, white, non-Latino women of diverse education levels.