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Out-of-hospital births increasingly popular among Utah women

Out-of-hospital births now account for 2.7 percent of Utah’s 50,000 annual births, with an average of three to four each day.
Out-of-hospital births now account for 2.7 percent of Utah’s 50,000 annual births, with an average of three to four each day.

SALT LAKE CITY — The number of women choosing to give birth outside hospitals each year has doubled since 1990, according to a recent Utah Department of Health study.

Out-of-hospital births now account for 2.7 percent of Utah’s approximatley 50,000 births each year, with an average of three to four each day.

Women overwhelmingly choose to give birth in a hospital, but the new report, prepared by the Utah Department of Health in partnership with Utah physicians and midwives, is a starting point to identify trends and look for areas to improve birthing outcomes.

"As more Utah women are choosing out-of-hospital births, it is critical that we identify and address issues that impact maternal and neonatal safety, including provider qualifications, provider-to-provider communication, and timely hospital transfer," Erin Clark, maternal fetal medicine physician at the University of Utah Health Sciences Center and one of the report's authors, said in a statement.

Between 2010 and 2012 there were 139,958 full-term babies born in Utah. Of those, 2,595 births occurred at homes and 1,098 occurred in birthing centers, according to the report.

Certified nurse midwife Rebecca Williams said one-room birthing suites, which first appeared in 2007, are often seen as a more “legitimate” hospital alternative than home bedrooms.

“Culturally, they have a much safer feel (than home births),” Williams said. “Although that’s not necessarily true, I think it explains their popularity.”

Still, traditional home births remain significantly more common than birthing center deliveries at 70 percent of Utah’s out-of-hospital births. Home births are equally popular among urban and rural women, though women who choose to give birth outside hospitals tend to live in more rural areas overall.

Southwest Utah leads the state in out-of-hospital births at 6 percent of total deliveries; the Weber-Morgan and Tooele County health districts have the lowest number of out-of-hospital births at 1.1 percent each.

Although the Department of Health study did not look at women’s reasons for choosing to give birth outside hospitals, lead author Lois Bloebaum said the department is planning to study the topic further in upcoming focus group tests.

“I think the biggest reason is a desire on the part of women to feel more empowered for their childbirth experience,” said Bloebaum, director of maternal and child health quality improvement at the Utah Department of Health.

Williams cites the emotional connection between midwives and their patients as a driving factor in the rise of out-of-hospital births.

“When I attend my patients’ births, it’s like being a family member. I know them personally and am very invested in their success,” she said. “Many of those women and babies remain close friends of mine."

The cost of giving birth may also help drive women toward hospital alternatives. An average delivery without complications costs about 60 percent less outside of a hospital than it would within one, according to the American Pregnancy Organization.

Although the health department study indicated higher than average neonatal mortality rates for out-of-hospital births, Bloebaum said the sample size suggests caution in drawing any conclusions.

“We had very small numbers from a statistical standpoint, so we’re exercising caution in making any sort of statement about (neonatal mortality),” Bloebaum said. “The one recommendation that we’re making as a result of this report is that we want to make sure women choosing out-of-hospital births are … educating themselves about the experience and credentials of their midwives."

Email:, Twitter: allisonoctober