NCHS Data Brief ■ No. 84 ■ January 2012

Home Births in the United States, 1990–2009 

Marian F. MacDorman, Ph.D.; T.J. Mathews, M.S.; and Eugene Declercq, Ph.D.

Key findings

•	 After	a	decline	from	1990	

to	2004,	the	percentage	of	U.S.	

births	that	occurred	at	home	

increased	by	29%,	from	0.56%	

of	births	in	2004	to	0.72%	in	

2009.

•	 For	non-Hispanic	white	

women,	home	births	increased	

by	36%,	from	0.80%	in	2004	

to	1.09%	in	2009.	About	1	

in	every	90	births	for	nonHispanic	white	women	is	now	

a	home	birth.	Home	births	are	

less	common	among	women	of	

other	racial	or	ethnic	groups.

•	 Home	births	are	more	

common	among	women	aged	

35	and	over,	and	among	women	

with	several	previous	children.	

•	 Home	births	have	a	lower	

risk	profile	than	hospital	births,	

with	fewer	births	to	teenagers	

or	unmarried	women,	and	with	

fewer	preterm,	low	birthweight,	

and	multiple	births.	

•	 The	percentage	of	home	

births	in	2009	varied	from	

a	low	of	0.2%	of	births	in	

Louisiana	and	the	District	of	

Columbia,	to	a	high	of	2.0%	in	

Oregon	and	2.6%	in	Montana.	

Large	changes	in	birthing	patterns	in	the	United	States	have	occurred	over	the	

past	century.	In	1900,	almost	all	U.S.	births	occurred	outside	a	hospital,	the	

vast	majority	of	which	occurred	at	home	(1).	However,	this	proportion	fell	to	

44%	by	1940,	and	to	1%	by	1969,	where	it	remained	through	the	1980s	(2,3).	

The	1989	revision	of	the	U.S.	Standard	Certificate	of	Live	Birth	provides	

additional	detail	for	out-of-hospital	births,	and	makes	it	possible	to	distinguish	

among	out-of-hospital	births	at	home,	in	a	birthing	center,	or	other	specified	

location.	Home	births	are	still	rare	in	the	United	States,	comprising	less	than	

1%	of	births,	however	they	have	been	increasing	since	2004	(3–5).	This	report	

examines	recent	trends	and	characteristics	of	home	births	in	the	United	States	

from	1990	to	2009,	and	compares	selected	characteristics	of	home	and	hospital	

births.	

Keywords: birth certificates • out-of-hospital birth

U.S. home births increased by 29% from 2004 to 2009.

The	percentage	of	all	U.S.	births	that	occurred	at	home	increased	from	0.56%	

in	2004	to	0.72%	in	2009	(Figure	1).	

Figure 1. Percentage of births occurring at home: United States, 1990–2009

NOTE: Numbers of home births are shown in parentheses after percentages.

SOURCE: CDC/NCHS, birth certificate data from the National Vital Statistics System.

0.0

1990 1995 2000

Year

2005 2009

0.2

0.4

0.6

0.8

1.0

1.2

0.67

(27,678) 0.56

(23,150)

0.72

(29,650)

Percent

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics
NCHS Data Brief ■ No. 84 ■ January 2012

■  2  ■

In 2009, there were 29,650 home births in the United States (representing 0.72% of births), the

highest level since data on this item began to be collected in 1989.

Previously, the percentage of home births had declined slowly from 0.67% of all U.S. births in

1990 to 0.56% in 2004.

In 2009, about 1 in 90 births to non-Hispanic white women were home 

births. 

There are large differences in the percentage of home births by maternal race and ethnicity, and

these differences have widened over time (Figure 2).

In 2009, the percentage of home births was three to five times higher for non-Hispanic white

women than for any other racial or ethnic group.

The percentage of home births to non-Hispanic white women increased by 14% from 1990 to

2004 and, more rapidly, by 36% from 2004 to 2009 (from 0.80% to 1.09%).

In contrast, from 1990 to 2004, the percentage of home births declined for American Indian

or Alaska Native (AIAN), Asian or Pacific Islander (API), Hispanic, and non-Hispanic black

women. From 2004 to 2009, the percentage of home births increased for API and Hispanic

women, and remained about the same for non-Hispanic black and AIAN women.

About 90% of the total increase in home births from 2004 to 2009 was due to the increase among

non-Hispanic white women.

0.0

1990 1995 2000 2005 2009

0.2

0.4

0.6

0.8

1.0

1.2

Non-Hispanic white1

Non-Hispanic black1

Asian or Pacific Islander

American Indian

Hispanic

Percent

Year

1

Data exclude New Hampshire in 1990–1992 and Oklahoma in 1990, as these states did not report Hispanic origin on their birth certificates for those years. 

SOURCE: CDC/NCHS, birth certificate data from the National Vital Statistics System.

Figure 2. Percentage of births occurring at home, by race and Hispanic origin of mother: United States, 1990–2009
NCHS Data Brief ■ No. 84 ■ January 2012

■  3  ■

The percentage of home births was generally higher in the northwestern 

and lower in the southeastern United States. 

In 2009, Montana had the highest percentage of home births (2.55%), followed by Oregon 

(1.96%) and Vermont (1.91%). Five additional states (Idaho, Pennsylvania, Utah, Washington, 

and Wisconsin) had a percentage of home births of 1.50% or above (Figure 3). 

In contrast, the percentage of home births was less than 0.50% for southeastern states from 

Texas to North Carolina, as well as for Connecticut, Delaware, the District of Columbia, Illinois, 

Massachusetts, Nebraska, New Jersey, Rhode Island, South Dakota, and West Virginia. 

The increase in the percentage of home births from 2004 to 2009 was widespread and involved 

selected states from every region of the country. Overall, 31 states had statistically significant 

increases, and only two areas had statistically significant declines (see Figure 3 and associated 

data table). 

Figure 3. Percentage of births occurring at home, by state of residence, 2009

NOTE: Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db84_tables.pdf.

SOURCE: CDC/NCHS, birth certificate data from the National Vital Statistics System.

MT

OR

ND

SD

NE

CO

TX

AR

LA

IA

MN

W I

IL IN

GA

FL

S C

VA

OH

MI

NY

PA

MD

DE

NJ

CT R I

MA

ME

NH

NM OK

MO

TN NC

KY

WV

VT

NV

AK

HI

1.50%–2.59%

1.00%–1.49%

0.50%–0.99%

Less than 0.50%

U.S. average: 0.72%

DC

MS AL

WA

C A

AZ

WY

KS

UT

ID

Most home births are attended by midwives.

In 2009, 62% of home births were attended by midwives: 19% by certified nurse midwives and 

43% by other midwives (such as certified professional midwives or direct-entry midwives). 

Among hospital births, only 7% were attended by midwives (Figure 4). 

Only 5% of home births were attended by physicians, and a previous study suggested that many 

of these were unplanned home births (possibly involving emergency situations) (6). For hospital 

births, 92% were attended by physicians.

For home births, 33% were reported as delivered by “other” attendants. “Other” may include, for 

example, a family member or emergency medical technician (3,7). Among hospital births, less 

than 1% of births had “other” attendants.
NCHS Data Brief ■ No. 84 ■ January 2012

■  4  ■

SOURCE: CDC/NCHS, birth certificate data from the National Vital Statistics System.

Figure 4. Percent distribution of home births, by type of birth attendant: United States, 2009

Other

32.9%

Other

midwife

42.9%

Certified

nurse

midwife

19.5%

Physician

4.8%

Compared with hospital births, home births are more common among older 

married women with several previous children.

One in five home births were to women aged 35 and over, compared with 14% of hospital births

(Figure 5).

About one-half of home births were third- or higher-order births, compared with 28% of hospital

births.

About 84% of home births were to married women, compared with 59% of hospital births. Percent

SOURCE: CDC/NCHS, birth certificate data from the National Vital Statistics System.

Figure 5. Percentage of home and hospital births with selected maternal characteristics: United States, 2009

0

20

40

60

80

100

Births to women aged Third- or higher-order births Births to married women

35 and over

20.8

14.2

50.1

27.9

84.0

58.7

Home Hospital
NCHS Data Brief ■ No. 84 ■ January 2012

■  5  ■

Home births have a lower risk profile than hospital births.

The percentage of home births that were preterm was 6%, compared with 12% for hospital births

(Figure 6).

The percentage of home births that were low birthweight was 4%, compared with 8% for hospital

births.

Less than 1% of home births were multiple deliveries, compared with 3.5% of hospital births.

The lower risk profile of home births suggests that home birth attendants are selecting low-risk

women as candidates for home birth (5).

0

2

4

6

8

10

12

14

Preterm Low birthweight Multiple birth

Home Hospital

SOURCE: CDC/NCHS, birth certificate data from the National Vital Statistics System.

Figure 6. Percentage of home and hospital births with selected infant health characteristics: United States, 2009 Percent

5.8

12.2

4.2

8.2

0.9

3.5

Summary

After 14 years of decline, the percentage of home births rose by 29% from 2004 to 2009, to the

point where it is at the highest level since data on this item began to be collected in 1989. The

overall increase in home births was driven mostly by a 36% increase for non-Hispanic white

women. About 1 out of every 90 births to non-Hispanic white women are now home births. The

percentage of home births for non-Hispanic white women was three to five times higher than for

any other racial or ethnic group.

Home births have a lower risk profile than hospital births, with fewer births to teenagers or

unmarried women, and with fewer preterm, low birthweight, and multiple births. The lower risk

profile of home compared with hospital births suggests that home birth attendants are selecting

low-risk women as candidates for home birth.

The increase in the percentage of home births from 2004 to 2009 was widespread and involved

selected states from every region of the country. The large variations in the percentage of

home births by state may be influenced by differences among states in laws pertaining to

midwifery practice or out-of-hospital birth (8,9), as well as by differences in the racial and ethnic

composition of state populations, as home births are more prevalent among non-Hispanic white

women (7).
NCHS Data Brief ■ No. 84 ■ January 2012

■  6  ■

Studies have suggested that most home births are intentional or planned home births, whereas

others are unintentional or unplanned, because of an emergency situation (i.e., precipitous labor,

labor complications, or unable to get to the hospital in time) (3,6). Although not representative of

all U.S. births (see “Data source and methods”), 87% of home births in a 26-state reporting area

(comprising 50% of U.S. births) were planned in 2009. For non-Hispanic white women, 93% of

home births were planned (10).

Women may prefer a home birth over a hospital birth for a variety of reasons, including a desire

for a low-intervention birth in a familiar environment surrounded by family and friends, and

cultural or religious concerns (9,11). Lack of transportation in rural areas and cost factors may

also play a role, as home births cost about one-third as much as hospital births (9,11,12).

Definitions

Home birth: A birth that takes place in a residence (home).

Percentage of home births: The number of home births divided by the total number of births

(regardless of place of delivery) times 100.

Preterm birth: Birth before 37 completed weeks of gestation.

Low birthweight: Infant weighing less than 2,500 grams at birth.

Data source and methods

This report is based on data from the National Vital Statistics System, Natality Data Files for

1990–2009. The Natality Data Files include data for all births occurring in the United States,

and include information on a wide range of maternal and infant demographic and health

characteristics (4). These data files are available for download at http://www.cdc.gov/nchs/

data_access/VitalStatsOnline.htm. Data may also be accessed through the interactive data tool,

VitalStats, at http://www.cdc.gov/nchs/VitalStats.htm.

Data on home birth began to be reported with the 1989 revision of the U.S. Standard Certificate

of Live Birth. Prior to 1989, births were reported as occurring in or out of the hospital, with no

specific category for home births.

The 2003 revision of the U.S. Standard Certificate of Live Birth added a data item on planning

status of home birth. However, due to the staggered implementation of the 2003 revision among

states, only 26 states (comprising 50% of U.S. births) reported data on planning status of home

birth in 2009 (10). The 26-state area is not representative of the overall U.S. population because it

is not a random sample of U.S. births.

About the authors

Marian F. MacDorman and T.J. Mathews are with the Centers for Disease Control and

Prevention’s National Center for Health Statistics, Division of Vital Statistics, Reproductive

Statistics Branch. Eugene Declercq is Professor, Department of Community Health Sciences,

Boston University School of Public Health.
NCHS Data Brief ■ No. 84 ■ January 2012

■  7  ■

References

1.	 Wertz RW, Wertz DC. Lying-in: A history of childbirth in America. New York: Schocken

Books. 1977.

2.	 Curtin SC, Park MM. Trends in the attendant, place, and timing of births, and in the use of

obstetric interventions: United States, 1989–97. National vital statistics reports; vol 47 no 27.

Hyattsville, MD: National Center for Health Statistics. 1999.

3.	 MacDorman MF, Menacker F, Declercq E. Trends and characteristics of home and other outof-hospital births in the United States, 1990–2006. National vital statistics reports; vol 58 no 11.

Hyattsville, MD: National Center for Health Statistics. 2010.

4.	 Martin JA, Hamilton BE, Ventura SJ, et al. Births: Final data for 2009. National vital statistics

reports; vol 60 no 1. Hyattsville, MD: National Center for Health Statistics. 2011.

5.	 MacDorman MF, Declercq E, Mathews TJ. United States home births increase 20% from

2004 to 2008. Birth 38(3):185–90. 2011.

6.	 Declercq E, MacDorman MF, Menacker F, Stotland N. Characteristics of planned and

unplanned home births in 19 states. Obstet Gynecol 116(1):93–9. 2010.

7.	 MacDorman MF, Declercq E, Menacker F. Trends and characteristics of home births in the

United States by race and ethnicity, 1990–2006. Birth 38(1):17–23. 2011.

8.	 Midwives Alliance of North America. Direct-entry midwifery state-by-state legal status.

Available from: http://mana.org/statechart.html.

9.	 Declercq ER, Stotland N. Home birth. In: UpToDate, Rose BD (Ed). Waltham, MA:

UpToDate. 2009.

10.	National Center for Health Statistics. VitalStats. Birth data for 2009. Available from: http://

www.cdc.gov/nchs/VitalStats.htm.

11.	 Boucher D, Bennett C, McFarlin B, Freeze R. Staying home to give birth: Why women in the

United States choose home birth. J Midwifery Womens Health 54(2):119–26. 2009.

12.	Health Management Associates. Midwifery licensure and discipline program in Washington

State: Economic costs and benefits. 2007.
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NCHS Data Brief ■ No. 84 ■ January 2012

Suggested citation

MacDorman MF, Mathews TJ, Declercq E.

Home births in the United States, 1990–

2009. NCHS data brief, no 84. Hyattsville,

MD: National Center for Health Statistics.

2012.

Copyright information

All material appearing in this report is in

the public domain and may be reproduced

or copied without permission; citation as to

source, however, is appreciated.

National Center for Health 

Statistics

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Vital Statistics

Charles J. Rothwell, M.S., Director

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