We’ve all heard that more people started working from home during the pandemic. As it turns out, the number of people giving birth at home rose, too (albeit not to the same extent).
Per CDC data, the percentage of all US births that took place at home rose to 1.26% in 2020, up from 1.03% in 2019. That’s a 22% increase—and the highest percentage of home births since at least 1990, according to the CDC.
But there’s another pool of birthing people who are looking for something in between: They don’t want to go to a hospital, but they may not feel comfortable going into labor at home either. Those patients are turning to one of about 400 freestanding birth centers, which have doubled in number over the last decade in the US, according to the American Association of Birth Centers.
Birth centers are independent healthcare facilities that have a licensed staff and provide childbirth services. They also “were a more popular choice when there were restrictions on visitors and support people at hospitals during Covid,” said Raizy Hines, a certified doula at Doula Support Los Angeles.
Katie Martin, president and CEO of Health Care Cost Institute, a nonprofit, nonpartisan organization that compiles healthcare claims data sets, said the institute’s data does not suggest the worsening maternal mortality rates across the US influence the decision to give birth outside of a hospital, but she “can see a lot of reasons why people might be concerned about the quality of care that they’re getting and trust that they have in the hospital as a place to deliver.”
It’s hard to predict whether the home birth and birth center trend will continue in a post-pandemic world. But if it does, two healthcare economists who spoke with Healthcare Brew say it could have a negative financial effect on hospitals.
Childbirth is a “cash cow” for hospitals
Ge Bai, a professor of health policy and management at Johns Hopkins Bloomberg School of Public Health, said that childbirth is a “cash cow” for hospitals because it is such a frequently performed procedure.
“From a financial perspective, hospitals do not want to lose this service to at-home delivery,” Bai said.
But it’s impossible to calculate exactly how much hospitals typically make from childbirth and related services because hospitals don’t report revenue broken down by procedure, she said.
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Data from the Health Care Cost Institute shows that in 2020, childbirth and pregnancy made up more than 20% of hospital admissions. And Martin said that on average, hospitals are paid about $13,000 per childbirth, though there’s a “pretty wide variation” among facilities.
Childbirth is one of the lower-priced hospital admissions, whereas admissions for issues like trauma cost much more, she added.
“I think when you combine how common childbirth is with the price that is paid, it does represent probably a hefty portion of a hospital’s revenue,” Martin said.
Hospitals would be affected differently by a decrease in the number of childbirth patients depending on where they are located. Facilities in rural areas are more susceptible because they don’t have as much flexibility in the services offered, Martin said. Additionally, Bai said patient demographics also play a part, since hospitals that treat a larger senior population aren’t going to see as many childbirths as those in areas with a younger population.
Hospital execs shouldn’t sweat too much (yet)
Martin suggested hospital executives “take careful note” of the out-of-hospital birth trend. But Jill Horwitz, a professor of law and medicine at UCLA, doesn’t think hospital executives should be worried.
“If I were a hospital executive, this would not be at the top of my mind,” Horwitz said.
She added that the number of people giving birth outside of hospitals is still small and that patients with high-risk pregnancies will still choose a medical center.
Another reason? Most out-of-hospital births aren’t covered by insurance, said Tahira Ali, an independent doula who founded the company Black Nova Doula.
While the data isn’t in yet, Hines believes the initial surge in patients choosing out-of-hospital births during the pandemic is starting to shift back to pre-Covid numbers.
And though Martin said she believes a decrease in childbirth patients would have “a financial impact” on hospitals, she added that “hospitals are pretty attuned [to] what is going to have an adverse financial effect on them, and [they] are pretty good at responding.”
Do you work at a US birth center? Email Maia at [email protected] to talk about the benefits and challenges of offering services in that type of facility.