To compare perinatal mortality and severe perinatal morbidity between planned home and hospital births among low risk women who commenced labour within the primary care system.

A Dutch nationwide cohort study, descriptive.

Data from national perinatal and neonatal registries over a period of 7 years were used to compare perinatal mortality and morbidity among women with a low risk for a complicated delivery who planned to give birth either at home or in hospital. Analysis was according to ‘intention-to-treat’. Logistic regression analysis was used to control for differences in baseline characteristics.

A total of 529,688 low risk women received primary midwife-led care at the onset of labour. Of these, 321,307 (60.7%) intended to give birth at home, 163,261 (30.8%) planned to give birth in hospital and for 45,120 (8.5%) the preferred place of birth was unknown. In the total study population, there were 345 intrapartum and neonatal deaths up to 7 days (7 per 10,000) and 975 admissions to a neonatal intensive care unit (18 per 10,000). No statistically significant differences were found between planned home and planned hospital births in intrapartum death (adjusted relative risk (RR): 0.97; 95% CI: 0.69-1.37), intrapartum death and neonatal death during the first 24 hours (RR: 1.02; 95% CI: 0.77-1.36), intrapartum death and neonatal death up to 7 days (RR: 1.00; 95% CI: 0.78 to 1.27), or admission to a neonatal intensive care unit (RR: 1.00; 95% CI: 0.86-1.16).

Choosing for home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, providing there is a maternity care system in place for this, with well trained midwives and an adequate system for transport and referral.