J Perinat Med. 2025 Nov 17. doi: 10.1515/jpm-2025-0521. Online ahead of print.
ABSTRACT
OBJECTIVES: Community births in the United States – including planned home and freestanding birth center deliveries – have increased in recent years. Understanding how these patterns have evolved across racial and ethnic groups, particularly in the post-pandemic period, is essential for clinical practice and health policy. Objective: To analyze national trends in community births from 2016 through 2024 by race and ethnicity, and to discuss clinical, ethical, and policy implications.
METHODS: Birth certificate data from the CDC natality database were examined for 2016-2024. Community births were defined as intended home or freestanding birth center births. Trends were assessed overall and stratified by race/ethnicity, with relative changes indexed to 2016.
RESULTS: From 2016 to 2024, community births increased overall but diverged by group. Non-Hispanic White and Hispanic women demonstrated sustained increases relative to 2016, while non-Hispanic Black women showed an increase during the pandemic followed by decline, and non-Hispanic Asian women displayed a modest upward trend. These shifts occurred against the backdrop of declining total births in some groups, affecting proportional comparisons. International comparisons are limited by the distinctive U.S. context, where midwifery is less integrated and credentialing standards are variable.
CONCLUSIONS: Community birth patterns since the pandemic reveal both growth and divergence across racial and ethnic groups. These findings highlight the need for policy interventions to address maternity care deserts and harmonize midwifery credentialing. Clinically, professional responsibility requires fully informed consent leading to directive counseling, which should not be misinterpreted as paternalism but as an ethical duty to recommend hospital birth as the safest option while respecting patient autonomy.
PMID:41242944 | DOI:10.1515/jpm-2025-0521
