Out-of-hospital births in California 1991-2011

Area of Science:

• Maternal and Child Health
• Demographic Trends in Healthcare
• Reproductive Epidemiology

Background:

• Out-of-hospital births represent a small but significant proportion of all deliveries.
• Understanding trends in out-of-hospital births is crucial for public health planning and resource allocation.
• California, a populous state, provides a valuable dataset for analyzing birth trends in the United States.

Purpose of the Study:

• To investigate the frequency and characteristics of out-of-hospital births over a 20-year period in California.
• To identify trends and changes in out-of-hospital birth rates, including preterm births and vaginal birth after cesarean.
• To analyze demographic factors associated with out-of-hospital births.

Main Methods:

• Analysis of birth certificate records for all deliveries in California from 1991 to 2011.
• Assessment of out-of-hospital birth frequencies by year, parity, gestational age, and maternal race/ethnicity.
• Statistical evaluation of trends and changes in out-of-hospital birth characteristics over the study period.

Main Results:

• A total of 10,593,904 deliveries were analyzed, with 46,243 (0.44%) occurring out of hospital.
• Out-of-hospital births decreased from 0.54% to 0.38% annually between 1991 and 2004.
• Rates increased from 0.41% in 2005 to 0.61% in 2011, with a decline in preterm out-of-hospital births (7.2% to 5.0%) and an increase in vaginal birth after cesarean (1.2% to 4.2%).

Conclusions:

• Out-of-hospital birth rates in California exhibited a biphasic trend: a decline followed by an increase.
• The characteristics of out-of-hospital births, including preterm rates and VBAC frequency, also showed notable changes.
• These findings highlight evolving patterns in childbirth choices and practices in California over two decades.