15% of individuals who plan to give birth at home or at a birthing center end up being transferred to hospitals, and this group had the highest rates of medical interventions and adverse outcomes.
November 26, 2025 | Erin Bluvas, bluvase@sc.edu
A recent study led by Ph.D. in Epidemiology candidate Marion Granger Howard and published in JAMA Pediatrics (the highest-ranked journal in the field) compared the health outcomes of planned hospital births vs planned community births (i.e., births that were intended to take place at home or at a birthing center). The researchers found that individuals who planned community births and actually delivered in those settings experienced lower risks of adverse health outcomes. However, those who planned community births at the onset of labor but then transferred to a hospital had increased odds of medical interventions and negative outcomes.
“Understanding the prevalence of certain perinatal outcomes in different delivery
settings is important for pregnant people as they assess the benefits and risks associated
with hospital births compared to community births,” Howard says. “Unfortunately, it
can be difficult to parse out the experiences and health outcomes for birthing individuals
and infants in these different settings because most states do not distinguish between
planned hospital births and births that began at a community location and then transferred
to a hospital for the actual delivery.”
This nuance is important because misclassifying these transfers as hospital births conceals the overall risk from pregnant people who may be planning a community birth. Community births – which have increased in recent years due to obstetric care deserts, increased health care costs, and patient preferences – have already been linked with poorer health outcomes, according to prior research. Despite documented increases in community birth rates, the actual prevalence may be even further underestimated due to the misclassification of community-to-hospital transfers.
It’s important that pregnant people know about the health outcomes associated with different birth settings, so they can make informed choices. At the state level, it’s critical that states establish legislation and robust oversight for birthing centers, midwives, and other providers involved in community births to safeguard the health of both birthing individuals and their infants.
Oregon is the only state that tracks the planned birth location at delivery onset – not solely the place where the birth actually occurs. This additional measure benefits Oregon families in two ways.
First, it allows a more accurate estimate of the number of planned community births, which is important for capturing delivery trends. By having a better understanding of the desire for community births, Oregon has been able to implement policies to help protect birthing individuals and infants, such as midwifery licensure requirements.
The second benefit is the ability to examine planned hospital births and transferred deliveries separately, which better represents the nuances of these birth experiences. By examining birth certificate records linked with hospital data, Howard worked with her advisor, epidemiology associate professor Nansi Boghossian, and their co-authors to determine whether planned community births were associated with adverse health outcomes.
Analyzing nearly 350,000 births that took place between 2012 and 2020, the team found that more than 95% of births were planned and completed at hospitals and nearly 5% were planned community births. Among the planned community births, close to 50% took place at home, more than 35% occured at birthing centers, and nearly 15% were transferred to hospitals. Notably, births that required hospital transfer had the highest rates of most adverse outcomes (e.g., fetal death, lower APGAR scores, NICU admissions) and medical interventions (e.g., ventilation, c-section). These patterns remained consistent even after adjusting for relevant clinical and demographic factors.
“These findings highlight the need to counsel patients and inform policymakers about the risks associated with planned community births, particularly when transfer to a hospital may be required,” Howard says. “It’s important that pregnant people know about the health outcomes associated with different birth settings, so they can make informed choices. At the state level, it’s critical that states establish legislation and robust oversight for birthing centers, midwives, and other providers involved in community births to safeguard the health of both birthing individuals and their infants.”
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