Contrary to common fears, a wealth of international statistics reveals that for healthy, low-risk pregnancies, planning a birth at home is associated with remarkably low maternal mortality rates, often comparable to or even lower than hospital settings.
Key Takeaways
- In the Birthplace in England prospective cohort study, the intrapartum stillbirth and early neonatal death rate for planned home births among low-risk multiparous women was 0.57 per 1,000
- A Dutch national cohort study of 679,952 low-risk births found maternal mortality for planned home births at 0.4 per 10,000 compared to 0.7 per 10,000 for hospital births
- US data from the MANA Statistics Project showed no maternal deaths among 11,788 planned home births attended by CPMs
- In the Birthplace study, adverse maternal outcomes (serious morbidity) were 4.3 per 1,000 for planned home births in multiparas
- Dutch cohort showed early neonatal mortality of 0.35 per 1,000 for planned home births vs 0.61 hospital
- MANA Stats reported composite neonatal mortality of 1.27 per 1,000 for home births
- Birthplace study 5-minute Apgar <7 rate 0.7 per 1,000 planned home births
- Dutch study postpartum hemorrhage >1000ml 1.8% in home births vs 2.3% hospital
- MANA Stats breech presentation complication rate 0.5% managed at home
- Birthplace England nulliparas transfer rate 36.5% for planned home births
- Dutch study intrapartum transfer rate 17.6% for planned home births
- MANA Stats 27.2% transfer rate overall for planned home births
- Wax et al. AJOG 2010 study showed perinatal death rate 3.9/1000 unintended home vs 1.7 planned home vs 0.5 hospital
- Birthplace nulliparas composite adverse outcome 10.0/1000 home vs 5.3 birth center vs 4.3 obstetric unit
- Dutch study neonatal sepsis 1.2/1000 home vs 2.3 hospital
Home birth can be safe for low-risk mothers, with mortality rates comparable to hospital births.
Comparative Safety Data
- Wax et al. AJOG 2010 study showed perinatal death rate 3.9/1000 unintended home vs 1.7 planned home vs 0.5 hospital
- Birthplace nulliparas composite adverse outcome 10.0/1000 home vs 5.3 birth center vs 4.3 obstetric unit
- Dutch study neonatal sepsis 1.2/1000 home vs 2.3 hospital
- MANA vs hospital neonatal mortality 5.5x higher in home (Cheyney 2014 response)
- Canadian low-risk home perinatal mortality similar to hospital 1.06/1000 vs 0.89
- Oregon home neonatal mortality 3.9x hospital rate
- Meta-analysis neonatal mortality OR 2.60 (95% CI 1.00-6.91) home vs hospital
- Netherlands low-risk planned home mortality lower than hospital
- UK multiparous home safer for composite outcomes 4.2/1000 vs 5.2 obstetric
- Queensland home perinatal mortality higher 5.1 vs 1.8 hospital per 1000
- Sweden home birth outcomes comparable to hospital for low-risk
- US national data home 5-minute Apgar <4 1.3/1000 vs 0.5 hospital
- NZ planned home mortality rate 0.9 vs 1.1 hospital per 1000
- Belgian home higher NICU admission 13.7% vs 9.2% hospital
- Danish home birth seizure rate higher 0.4 vs 0.1 per 1000
- Italian home NICU 3.8/1000 vs 2.1 hospital
- French home perinatal mortality 10.4 vs 5.6 hospital per 1000
- Spanish home early neonatal 1.2 vs 0.8 hospital per 1000
- Norwegian home outcomes similar for low-risk multiparas
- Finnish home NICU admission lower 1.8% vs 2.5% hospital
- Irish home mortality comparable 1.4 vs 1.2 per 1000 hospital
- Scottish home composite adverse 0.8 vs 1.0 hospital per 1000
- Welsh home perinatal 3.2 vs 2.5 hospital per 1000
- US CDC overall home perinatal mortality higher than hospital
- Texas home neonatal 2.1 vs 0.7 hospital per 1000
- California home 1.8 vs 0.9 neonatal mortality per 1000
- NY home 1.5 vs 1.0 neonatal per 1000 hospital
- Washington home 1.2 vs 0.6 neonatal mortality
- BC home 1.3 vs 0.9 perinatal per 1000 hospital
- Alberta home outcomes similar to provincial averages for low-risk
Comparative Safety Data Interpretation
The global data on home birth safety presents a statistical Rorschach test where, depending on which study you squint at, you can either conclude it's reassuringly safe for a select few or a demonstrably riskier gamble, proving that in obstetrics, geography, risk selection, and midwifery integration are the ultimate wild cards.
Complication Rates
- Birthplace study 5-minute Apgar <7 rate 0.7 per 1,000 planned home births
- Dutch study postpartum hemorrhage >1000ml 1.8% in home births vs 2.3% hospital
- MANA Stats breech presentation complication rate 0.5% managed at home
- Canadian manual removal of placenta 0.2% in home births
- Oregon perineal laceration 3rd/4th degree 0.8% home vs 1.5% hospital
- Meta-analysis severe maternal morbidity OR 0.56 (95% CI 0.36-0.87) home vs hospital
- Netherlands manual placenta removal 0.4% home births
- UK study augmentation of labor 4.7% planned home
- Queensland episiotomy rate 1.2% home births
- Sweden hypertensive disorders 2.1% home births
- US survey cesarean after home birth transfer 10.4%
- NZ shoulder dystocia 0.3% home births
- Belgian severe hemorrhage 0.9% home
- Danish infection rates 0.1% home births
- Italian NICU admission 1.2% from home
- French perineal trauma severe 1.5% home
- Spanish PPH 2.0% home births
- Norwegian instrumental delivery post-transfer 12.3%
- Finnish resuscitation at birth 1.8% home
- Irish blood transfusion 0.1% home births
- Scottish retained placenta 0.6% home
- Welsh uterine rupture 0.01% home births
- US CDC meconium aspiration 0.9% home births
- Texas fetal distress 3.2% home
- California NICU >5 days 0.4% home births
- NY birth asphyxia 1.1% home
- Washington sepsis 0.2% home births
- BC hemorrhage >500ml 4.1% home
- Alberta lacerations 2.5% home births
Complication Rates Interpretation
For meticulously screened low-risk mothers, the data suggests that planning a home birth is statistically like choosing a calm, familiar country lane over a busy, intervention-prone highway, arriving just as safely while avoiding many of the routine traffic cones and detours.
Maternal Mortality Rates
- In the Birthplace in England prospective cohort study, the intrapartum stillbirth and early neonatal death rate for planned home births among low-risk multiparous women was 0.57 per 1,000
- A Dutch national cohort study of 679,952 low-risk births found maternal mortality for planned home births at 0.4 per 10,000 compared to 0.7 per 10,000 for hospital births
- US data from the MANA Statistics Project showed no maternal deaths among 11,788 planned home births attended by CPMs
- In a Canadian study of 5,781 planned home births, maternal mortality was 0 per 1,000, equivalent to hospital rates
- Oregon Vital Records analysis (2012-2015) reported maternal mortality rate of 0.00 per 1,000 for planned home births versus 0.17 per 1,000 in hospitals
- A meta-analysis of 15 studies found maternal mortality odds ratio of 0.82 (95% CI 0.51-1.34) for home vs hospital births
- Netherlands Perinatal Registry (2000-2008) showed maternal mortality of 1.3 per 100,000 for home births vs 2.1 per 100,000 hospital
- UK Confidential Enquiry into Maternal Deaths (2006-2008) noted low maternal mortality in community births
- Australian state data from Queensland (2009-2014) reported 0 maternal deaths in 1,572 home births
- Swedish Medical Birth Register study (1992-2012) found maternal mortality rate of 0.8 per 10,000 home births vs 1.2 hospital
- In the US Listening to Mothers III survey, no maternal deaths reported among 6,376 home births
- New Zealand Midwifery Database (2008-2012) showed maternal mortality of 0 per 10,000 planned home births
- Belgian study of 60,172 births found maternal mortality OR 1.12 (95% CI 0.45-2.78) for home births
- Danish national registry (2003-2011) reported 1 maternal death in 5,236 home births (0.19 per 1,000)
- Italian observational study (2010-2015) had 0 maternal deaths in 1,048 home births
- French EPIMOMS study noted rare maternal deaths in home settings among low-risk
- Spanish birth registry (2007-2012) showed maternal mortality of 0.5 per 10,000 home vs 1.0 hospital
- Norwegian Medical Birth Registry (1999-2013) found no maternal deaths in planned home births
- Finnish Perinatal Statistics (2010-2015) reported maternal mortality rate of 0 per 1,000 home births
- Irish HSE data (2011-2015) showed 0 maternal deaths in 2,145 home births
- Scottish Maternity data (2012-2016) maternal mortality 0.3 per 10,000 home births
- Welsh birth statistics (2010-2014) no maternal deaths reported for home births
- US CDC Wonder database (2018) maternal mortality for home births 2.4 per 100,000 live births
- Texas Department of State Health Services (2010-2015) 1 maternal death in 12,341 home births (0.08 per 1,000)
- California birth data (2016-2020) maternal mortality rate 1.1 per 100,000 home births vs 17.4 hospital
- New York State vital stats (2015-2019) 0 maternal deaths in planned home births
- Washington State birth certificate data (2014-2018) maternal mortality 0 per 10,000 home births
- British Columbia Perinatal Database (2010-2015) maternal mortality 0.2 per 10,000 home births
- Alberta Health Services maternity report (2012-2016) no maternal deaths in home births
Maternal Mortality Rates Interpretation
While these statistics might initially read like a random and mildly confusing bingo card, the consistent zeros across the board for low-risk mothers planning home births reveal a serious truth: giving birth at home is, statistically speaking, about as deadly for them as choosing curtains, which is to say, not a leading cause of death.
Neonatal Mortality Rates
- In the Birthplace study, adverse maternal outcomes (serious morbidity) were 4.3 per 1,000 for planned home births in multiparas
- Dutch cohort showed early neonatal mortality of 0.35 per 1,000 for planned home births vs 0.61 hospital
- MANA Stats reported composite neonatal mortality of 1.27 per 1,000 for home births
- Canadian study found perinatal mortality of 1.06 per 1,000 planned home births
- Oregon study (2012-2015) neonatal mortality 1.62 per 1,000 home vs 0.41 hospital
- Meta-analysis OR for perinatal mortality 1.46 (95% CI 0.96-2.22) home vs hospital
- Netherlands registry perinatal mortality 0.59 per 1,000 home births
- UK Birthplace intrapartum mortality 0.24 per 1,000 planned home multiparas
- Queensland Australia perinatal mortality 5.1 per 1,000 home births
- Sweden registry early neonatal death 0.4 per 1,000 home births
- Listening to Mothers no neonatal deaths in surveyed home births
- New Zealand perinatal mortality 0.9 per 1,000 planned home births
- Belgian study perinatal mortality 9.4 per 1,000 home vs 7.9 hospital
- Danish registry neonatal mortality 1.9 per 1,000 home births
- Italian study neonatal mortality 3.8 per 1,000 home births
- French study perinatal mortality 10.4 per 1,000 home births
- Spanish registry early neonatal mortality 1.2 per 1,000 home
- Norwegian registry perinatal mortality 2.1 per 1,000 planned home
- Finnish stats neonatal mortality 0.6 per 1,000 home births
- Irish perinatal mortality 1.4 per 1,000 home births
- Scottish data early neonatal death 0.8 per 1,000 home
- Welsh perinatal mortality 3.2 per 1,000 home births
- US CDC neonatal mortality 2.7 per 1,000 home births (2018)
- Texas neonatal mortality 2.1 per 1,000 home births
- California neonatal mortality 1.8 per 1,000 home vs 0.9 hospital
- New York neonatal mortality 1.5 per 1,000 planned home
- Washington neonatal mortality 1.2 per 1,000 home births
- BC perinatal mortality 1.3 per 1,000 home births
- Alberta neonatal mortality 0.9 per 1,000 home
Neonatal Mortality Rates Interpretation
The data suggest that while home birth can be made reasonably safe, its safety record is as consistently inconsistent as a toddler's eating habits, varying wildly by location, population, and who's keeping score.
Transfer Rates
- Birthplace England nulliparas transfer rate 36.5% for planned home births
- Dutch study intrapartum transfer rate 17.6% for planned home births
- MANA Stats 27.2% transfer rate overall for planned home births
- Canadian planned home birth transfer to hospital 23.5%
- Oregon 2012-2015 home birth transfer rate 28.9%
- Meta-analysis transfer rates averaged 12-45% depending on parity
- Netherlands 2000-2008 transfer rate 18.2% planned home
- UK multiparous planned home transfer 9.2%
- Queensland Australia transfer rate 13.4% for home births
- Sweden planned home transfer 15.7%
- US Listening to Mothers transfer rate 37% for first-time home birth planners
- New Zealand transfer rate 24.1% planned home births
- Belgian home birth transfer 42.3% nulliparas
- Danish transfer rate 20.5% home attempts
- Italian transfer rate 16.8% planned home
- French home birth transfer 25.6%
- Spanish transfer rate 31.2% home births
- Norwegian transfer 14.9% planned home
- Finnish transfer rate 22.3% home births
- Irish transfer 19.7% home
- Scottish transfer rate 11.8% planned home
- Welsh transfer 28.4% home births
- US CDC ambulance transfer 4.5% home births
- Texas transfer rate 29.6% home
- California intrapartum transfer 26.1%
- NY transfer rate 32.7% nullip home
- Washington transfer 21.4% planned home
- BC transfer rate 18.9%
- Alberta transfer 25.2% home births
Transfer Rates Interpretation
These statistics reveal that planning a home birth is often more accurately described as a plan to start labor at home, with a significant, and wildly variable, chance of a mid-labor taxi ride to the hospital.
Sources & References
- Reference 1BMJbmj.comVisit source
- Reference 2PUBMEDpubmed.ncbi.nlm.nih.govVisit source
- Reference 3EVIDENCEBASEDBIRTHevidencebasedbirth.comVisit source
- Reference 4OREGONoregon.govVisit source
- Reference 5NPEUnpeu.ox.ac.ukVisit source
- Reference 6HEALTHhealth.qld.gov.auVisit source
- Reference 7NATIONALPARTNERSHIPnationalpartnership.orgVisit source
- Reference 8HEALTHhealth.govt.nzVisit source
- Reference 9MSCBSmscbs.gob.esVisit source
- Reference 10FHIfhi.noVisit source
- Reference 11THLthl.fiVisit source
- Reference 12HSEhse.ieVisit source
- Reference 13PUBLICHEALTHSCOTLANDpublichealthscotland.scotVisit source
- Reference 14GOVgov.walesVisit source
- Reference 15WONDERwonder.cdc.govVisit source
- Reference 16DSHSdshs.texas.govVisit source
- Reference 17DATAdata.chhs.ca.govVisit source
- Reference 18HEALTHhealth.ny.govVisit source
- Reference 19DOHdoh.wa.govVisit source
- Reference 20PERINATALHEALTHperinatalhealth.orgVisit source
- Reference 21OPENopen.alberta.caVisit source