In a back-to-the-future twist on birth trends, California is seeing a sustained rise in the number of women choosing to deliver their babies in settings other than a hospital, a shift that accelerated as the pandemic created more risky and onerous conditions in many hospitals.
About 5,600 people gave birth outside a hospital in California in 2020, up from about 4,600 in 2019 and 3,500 in 2010.
The shift took place during a widespread “baby bust,” so the proportion of births outside hospitals rose from 0.68 percent in 2010 to 1.34 percent in 2020, according to a KHN analysis of provisional data from the California Department of Public Health. The proportion of births outside hospitals stayed relatively high — 1.28 percent — from January through July 2021.
From 2009 to 2019, the proportion of births nationwide outside hospitals rose from 1.01 percent in 2009 to 1.56 percent in 2019. Nationwide data for 2020 and 2021 is not yet available.
Births away from hospitals usually take place with the help of licensed midwives working at the homes of clients or at free-standing “birth centers.” In either setting, expectant parents typically meet with midwives several times during the pregnancy to get comfortable, express their hopes for the pregnancy and learn about the birthing process.
Intentional at-home births and deliveries at midwife-run birthing centers are typically restricted to “low-risk” pregnancies. Women giving birth in those settings generally do not have serious preexisting health conditions like diabetes or high blood pressure that could complicate their babies’ births; they are giving birth to one child — no twins or triplets; and they are not expected to undergo a breech delivery, in which the baby emerges feet first, said Erina Angelucci, a certified nurse midwife at Best Start Birth Center in San Diego.
Midwives interviewed said they’ve heard from far more women in recent years turning to home births to avoid epidurals, induced labor and other invasive procedures common in hospital delivery rooms.
“I think people are looking to be more empowered in their birth and less ‘just go along with whatever happens,’” said Shari Stone-Ulrich, a certified nurse midwife and midwife services clinical director at Best Start.
Many people want to avoid cesarean sections unless absolutely necessary, several midwives said. About 30 percent of births in California hospitals last year were via C-section, though that figure has dropped some in recent years, state data shows.
“For first-time moms, C-sections in hospitals are very high,” said Miriam Singer, 32, who gave birth to her son, Eitan, at Best Start a few weeks ago. “So, knowing that the birth center is going to work with you and understand it’s going to be a longer process and just make sure everything’s going well, you really minimize your chances of having a C-section or an emergency situation.”
Singer has three older children, ages 4, 6 and 9. Three of her kids were born in a free-standing birth center and one was born at home.
“Birth is just a very natural part of life, and it should be approached as something that is natural, and we should follow our body and listen to our body going through the process,” she said. “I find the approach maybe in the hospitals a little bit more like it’s an emergency.”
As the coronavirus swept across California, families sought births outside hospitals for other reasons. Some didn’t want to give birth in a setting where they feared contracting COVID-19. Others bristled at rules restricting when partners and family members could be present during labor.
Out-of-hospital birth rates ranged widely among California’s urban and rural counties. These births were most prevalent in Nevada County, a rustic north state community known for its bohemian enclaves and passionate home-schooling movement. About 1 in 10 mothers gave birth at home last year in Nevada County. Four other largely rural Northern California counties also saw notably high rates: Tuolumne (6.8 percent), Mendocino (6. percent), Shasta (5.4 percent) and Humboldt (5.3 percent).
The analysis also revealed racial and educational disparities between people giving birth in a hospital and those delivering at home or in a free-standing birth center last year.
Whites gave birth outside hospitals at a rate twice that of African-Americans, about four times that of Hispanics and about six times that of Asians. In addition, people with a four-year college degree gave birth outside hospitals at a rate almost three times that of people without a four-year degree, state figures show.