Interview with Elizabeth Gregory on Home Births During the Pandemic

HOST: Though no historical data are available, it is widely accepted that most births prior to the 20^th century occurred in the home.  With the arrival of the 20^th century and the advances in modern medicine that came with it, home births became far less common – as low as 0.56% of all births in 2004.  But in 2020, driven at least in part by the pandemic, home births increased 22% from 2019, to 1.26% in 2020 – the highest percentage since at least 1990.

This week NCHS has released a new report documenting the increase in home births during the pandemic.  Joining us to discuss the findings in the report is the lead author of the study, Elizabeth Gregory…

HOST: Are women who give birth at the home – and their babies – more at risk for adverse outcomes?

EG: So, this report doesn’t address the safety of home births – what it does is it examines changes in home births before and during the COVID-19 pandemic by month and by race and Hispanic origin and state of residence of the mother.

HOST: Home births have been higher in recent years than 10-15 years ago, is that correct?

EG: Home births have been increasing for the last 15 years or so.  The pace of increase had slowed from 2014 to 2019, and then there was a large increase in 2020.

HOST: The data suggest the low mark for home births in the United States occurred around 2004, is that correct?

EG: Yes that’s correct, but it’s important to note that we don’t have comparable data on home births prior to the 1989 revision of the US standard certificate of live birth.  But for 1990 through 2020 the lowest percentage of home births which was 0.56% occurred in 2004.

HOST: So even though it’s accepted that back in the 19th century, for example, most births occurred in the home, we don’t really have data prior to 1989, is that correct?

EG: So for vital statistics data, previous to the 1989 revision the question for place of birth – the response could either be in hospital or not in hospital.  We don’t really have the more detailed information about where the birth may have occurred outside the hospital.

HOST: I see.  So the pandemic would help explain the sharp rise in 2020, but what explains the higher rates since 2004?

EG: We didn’t look at what might have caused the increases for those earlier years, but we did look at when and where the increases occurred for 2019 to 2020.  So for example, in 2019 to 2020 the percentage of home births rose 22% for all women, with increases ranging from 21 to 36% for the three largest race and Hispanic origin groups.  And the percentage of home births for all women increased for each month, March through December, peaking in May, and this pattern of home births by month was also generally observed for each of the three largest race and Hispanic origin groups.

HOST: What factors related to the pandemic accounted for the big increase in 2020?

EG: So other researchers have found that some reasons included: increasing number of cases of COVID-19 in the U.S. combined with concerns about contracting COVID-19 while in the hospital… limitations or bans on support persons in the hospital… and the separation of infants from mothers suspected to have COVID-19.

HOST: What were some geographic differences we saw in 2020 as far as home births go?

EG: This report found increases in home births for the vast majority of states from 2019 to 2020.  The percentage of home births increased significantly in 40 states, with non-significant increases seen in an additional nine States and the District of Columbia.

HOST: What about race and ethnicity?  Were there similar increases in home births along those demographic lines?

EG: Historically non-Hispanic white women have been more likely to give birth at home, and this pattern continued into 2020.  However, increases ranging from 21 to 36% were seen for all of the three largest race and Hispanic origin groups from 2019 to 2020.

HOST: Any other topics in your study you’d like to mention?

EG: Yes, the report found that the percentage of home births rose for each month, March through December 2020, compared with the same months in 2019 and peaked in May.  And the timing of increases in home births generally corresponds with the initial surge of COVID-19 cases in the United States in late March and early April 2020.

HOST: Thanks for joining us Elizabeth.

EG: You’re welcome.

MUSICAL BRIDGE

HOST: December got off to a busy start with two reports focusing on children’s health, using 2020 data from the National Health Interview Survey.  The 2020 NHIS included questions on concussion, to measure both symptoms and diagnosis from a health care provider to provide a more complete understanding of the public health burden, as children with mild injuries may not see a doctor or receive a diagnosis.  On Dec. 1, NCHS released a new study on concussions and brain injuries among children in the U.S.  The new study found that nearly 7% of children in the U.S. under the age of 18 have had symptoms of a concussion or brain injury.  And 4% have been diagnosed with these conditions by a health care provider.   Boys are more likely than girls to have had these symptoms, and non-Hispanic White children are more likely than children in other race categories to have had these symptoms.

While the report on concussions and brain injuries doesn’t have any direct correlation to the pandemic, a second report looked at dental exam visits among children in 2020 compared with 2019. It is known that in 2020, dental practices across the country adjusted their services in response to the COVID-19 pandemic, and access to dental care was disrupted for many Americans. This new study found that there was a decline in visits for dental exams or cleanings from 2019 to 2020, which likely was driven by the pandemic.  The decline was greater among younger children ages 1 to 4, as well as among lower income children and children living in the northeastern United States.

Capping off the first week of the month was the latest quarterly provisional birth data for the U.S.  This latest release features mid-year 2021 data, and shows that fertility in the U.S. appears to be continuing its steady decline from the past several years, including a sharp decline in the U.S. fertility rate in the one year ending in mid-year 2020 compared to the same point the year before.

MUSICAL BRIDGE

HOST: This week NCHS also released data from its 2019 linked birth and infant death file.  These data are considered to be more comprehensive than infant mortality data from death certificates alone, due to the linking of the two sources of information.  As a result, much more accurate demographic and geographic data on infant mortality are available from this linked file.  However, the general “bottom line” remains the same – infant mortality in the United States continues to decline, as it has for nearly a century.

Finally, today NCHS released a report looking at trends in mortality from the leading cause of death in America, heart disease.  The new study covers most of the past two decades, with a special focus on changes by state.  The report shows that in the first decade of the millennium, 2000 to 2011, heart disease death rates declined in all 50 states and DC.  However, from 2012 through 2019, heart disease death rates fell in only half the states plus DC – and actually increased in one state (Arkansas).

Later this month, on Dec. 22, NCHS will release its final death data for 2020, which will include the final, official number of COVID-19 deaths for the country in 2020.  Rounding out the last week of the year are several new reports, including one on emergency department visits by adults who have mental health disorders, using data from the National Hospital Ambulatory Medical Care Survey.  Two pregnancy-related reports are slated for release that week as well:  one on pre-pregnancy body mass index and infant outcomes and another on maternal and infant health outcomes among mothers with confirmed or presumed COVID-19 during pregnancy.  And last, the annual final report on drug overdose deaths for 2020 will be released, which comes on the heels of the latest monthly release of provisional overdose death numbers, running through May of 2021.