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Planned home birth

Eugene Declercq, PhD
Naomi E Stotland, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Kristen Eckler, MD, FACOG


Planned home birth is a subject of ongoing controversy. The American College of Obstetricians and Gynecologists' (ACOG) Committee on Obstetric Practice states that hospitals and birthing centers are the safest setting for birth, but they respect the right of women to make medically informed decisions about their delivery site [1]. The American Academy of Pediatrics (AAP) has taken a similar position [2]. The American College of Nurse Midwives (ACNM) [3] and the American Public Health Association (APHA) [4] have policy statements supporting the practice of planned out-of-hospital birth in select populations of women. The World Health Organization (WHO) has released a statement indicating women can choose to deliver at home if they have low-risk pregnancies, receive the appropriate level of care, and formulate contingency plans for transfer to a properly-staffed/equipped delivery unit if problems arise [5]. In the Dutch system, pregnant women without medical complications are asked to choose where they want to give birth: at home or in a short-stay hospital setting. The home birth rate in the Netherlands is the highest in the developed world, although it has declined from 35 percent of all births in 1997 to 2000 to 16 percent of all births in 2013 [6].

This topic will discuss planned home birth. Delivery at birth centers and unplanned home birth are reviewed separately.

(See "Birth centers".)

(See "Precipitous birth not occurring on a labor and delivery unit".)


Prevalence of home birth — The prevalence of planned home birth varies by country. As an example, the prevalence of home birth in Sweden is 0.1 percent compared with over 20 percent in the Netherlands [7]. For the United States, 0.92 percent of births occurred at home in 2013 [8,9].

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Literature review current through: Nov 2017. | This topic last updated: Apr 26, 2017.
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  1. ACOG Committee on Obstetric Practice. ACOG Committee Opinion No. 669: planned home birth. Obstet Gynecol 2016.
  2. American Academy of Pediatrics. Policy statement: Planned Home Birth. Pediatrics 2013; 131:1016.
  3. American College of Nurse-Midwives Position Statement on Home Birth. Washington, DC: ACNM. December, 2005.
  4. APHA. Increasing access to out-of-hospital maternity care services through state-regulated and nationally-certified direct-entry midwives. APHA Public Policy Statements, 1948 to present, cumulative Washington, DC 2001.
  5. Maternal and Newborn Health/Safe Motherhood Unit of the World Health Organization, Care in Normal Birth: A practical guide. World Health Organization, 1996.
  6. Brouwers HA, Bruinse W, Dijs-Elsinga J, et al. Netherlands Perinatal Registry. Perinatal Care in the Netherlands 2013. Utrecht: Netherlands Perinatal Registry, 2014.
  7. Zielinski R, Ackerson K, Kane Low L. Planned home birth: benefits, risks, and opportunities. Int J Womens Health 2015; 7:361.
  8. Martin JA, Hamilton BE, Osterman MJ, et al. Births: final data for 2013. Natl Vital Stat Rep 2015; 64:1.
  9. National Center for Health Statistics. VitalStats website. Birth data 2013 state and county files. http://www.cdc.gov/nchs/vitalstats.htm (Accessed on January 07, 2016).
  10. Hamilton BE, Martin JA, Osterman MJK, et al. Births: Final data for 2014. National vital statistics reports. National Center for Health Statistics; Hyattsville, MD 2015.
  11. Office for National Statistics. Births in England and Wales by Characteristics of Birth 2, 2013. http://www.ons.gov.uk/ons/dcp171778_384394.pdf (Accessed on July 25, 2015).
  12. Stichting Perinatale Registratie Nederland. Perinatale Zorg in Nederland 2013. 2014. http://www.perinatreg.nl/uploads/150/153/PRN_jaarboek_2013_09122014.pdf (Accessed on August 05, 2015).
  13. Grünebaum A, McCullough LB, Arabin B, et al. Neonatal Mortality of Planned Home Birth in the United States in Relation to Professional Certification of Birth Attendants. PLoS One 2016; 11:e0155721.
  14. Vogel L. "Do it yourself" births prompt alarm. CMAJ 2011; 183:648.
  15. Wax JR, Pinette MG, Cartin A. Home versus hospital birth--process and outcome. Obstet Gynecol Surv 2010; 65:132.
  16. Boucher D, Bennett C, McFarlin B, Freeze R. Staying home to give birth: why women in the United States choose home birth. J Midwifery Womens Health 2009; 54:119.
  17. MacDorman M, Declercq E. Trends and Characteristics of United States Out-of-Hospital Births 2004–2014: New Information on Risk Status and Access to Care. Birth 2016.
  18. Rooks J. Midwifery and childbirth in America, Temple University Press, Philadelphia 1997.
  19. Kitzinger S, May M. Homebirth: the essential guide to giving birth outside of the hospital., 1st American, Dorling Kindersley, New York 1991.
  20. Klee L. Home away from home: the alternative birth center. Soc Sci Med 1986; 23:9.
  21. McClain CS. Perceived risk and choice of childbirth service. Soc Sci Med 1983; 17:1857.
  22. Janssen PA, Henderson AD, Vedam S. The experience of planned home birth: views of the first 500 women. Birth 2009; 36:297.
  23. Lindgren HE, Rådestad IJ, Christensson K, et al. Perceptions of risk and risk management among 735 women who opted for a home birth. Midwifery 2010; 26:163.
  24. Pang JW, Heffelfinger JD, Huang GJ, et al. Outcomes of planned home births in Washington State: 1989-1996. Obstet Gynecol 2002; 100:253.
  25. Lindgren HE, Rådestad IJ, Christensson K, Hildingsson IM. Outcome of planned home births compared to hospital births in Sweden between 1992 and 2004. A population-based register study. Acta Obstet Gynecol Scand 2008; 87:751.
  26. Ackermann-Liebrich U, Voegeli T, Günter-Witt K, et al. Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome. Zurich Study Team. BMJ 1996; 313:1313.
  27. Janssen PA, Lee SK, Ryan EM, et al. Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia. CMAJ 2002; 166:315.
  28. de Jonge A, van der Goes BY, Ravelli AC, et al. Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. BJOG 2009; 116:1177.
  29. Woodcock HC, Read AW, Bower C, et al. A matched cohort study of planned home and hospital births in Western Australia 1981-1987. Midwifery 1994; 10:125.
  30. Johnson KC, Daviss BA. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ 2005; 330:1416.
  31. Wiegers TA, Keirse MJ, van der Zee J, Berghs GA. Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in The Netherlands. BMJ 1996; 313:1309.
  32. Janssen PA, Saxell L, Page LA, et al. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ 2009; 181:377.
  33. Olsen O, Clausen JA. Planned hospital birth versus planned home birth. Cochrane Database Syst Rev 2012; :CD000352.
  34. Mori R, Dougherty M, Whittle M. An estimation of intrapartum-related perinatal mortality rates for booked home births in England and Wales between 1994 and 2003. BJOG 2008; 115:554.
  35. Amelink-Verburg MP, Verloove-Vanhorick SP, Hakkenberg RM, et al. Evaluation of 280,000 cases in Dutch midwifery practices: a descriptive study. BJOG 2008; 115:570.
  36. Kennare RM, Keirse MJ, Tucker GR, Chan AC. Planned home and hospital births in South Australia, 1991-2006: differences in outcomes. Med J Aust 2010; 192:76.
  37. Hutton EK, Reitsma AH, Kaufman K. Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study. Birth 2009; 36:180.
  38. Snowden JM, Tilden EL, Snyder J, et al. Planned Out-of-Hospital Birth and Birth Outcomes. N Engl J Med 2015; 373:2642.
  39. Hutton EK, Cappelletti A, Reitsma AH, et al. Outcomes associated with planned place of birth among women with low-risk pregnancies. CMAJ 2016; 188:E80.
  40. Gyte G, Dodwell M, Newburn M, et al. Estimating intrapartum-related perinatal mortality rates for booked home births: when the 'best' available data are not good enough. BJOG 2009; 116:933.
  41. Wax JR, Lucas FL, Lamont M, et al. Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. Am J Obstet Gynecol 2010; 203:243.e1.
  42. Dowswell T, Thornton JG, Hewison J, et al. Should there be a trial of home versus hospital delivery in the United Kingdom? BMJ 1996; 312:753.
  43. Koehler NU, Solomon DA, Murphy M. Outcomes of a rural Sonoma County home birth practice: 1976-1982. Birth 1984; 11:165.
  44. Michael CA, Janssen PA, Vedam S, Hutton EK, de Jonge A. Planned Home vs Hospital Birth: A Meta-Analysis Gone Wrong. Medscape Ob/Gyn & Women's Health (online). http://www.medscape.com/viewarticle/739987. (Accessed on June 24, 2011).
  45. de Jonge A, Geerts CC, van der Goes BY, et al. Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases. BJOG 2015; 122:720.
  46. National Institute for Health Care Excellence. Clinical guideline 190: Intrapartum care: care of healthy women and their babies during childbirth. 2014. http://www.nice.org.uk/guidance/cg190/resources/guidance-intrapartum-care-care-of-healthy-women-and-their-babies-during-childbirth-pdf (Accessed on August 05, 2015).
  47. Shah N. A NICE delivery--the cross-Atlantic divide over treatment intensity in childbirth. N Engl J Med 2015; 372:2181.
  48. Greene MF, Ecker JL. Choosing Benefits while Balancing Risks. N Engl J Med 2015; 373:2681.
  49. Cheyney M, Bovbjerg M, Everson C, et al. Outcomes of care for 16,924 planned home births in the United States: the Midwives Alliance of North America Statistics Project, 2004 to 2009. J Midwifery Womens Health 2014; 59:17.
  50. Birthplace in England Collaborative Group, Brocklehurst P, Hardy P, et al. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011; 343:d7400.
  51. https://www.npeu.ox.ac.uk/birthplace. (Accessed on December 15, 2011).
  52. Schroeder E, Petrou S, Patel N, et al. Cost effectiveness of alternative planned places of birth in woman at low risk of complications: evidence from the Birthplace in England national prospective cohort study. BMJ 2012; 344:e2292.
  53. Evers AC, Brouwers HA, Hukkelhoven CW, et al. Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study. BMJ 2010; 341:c5639.
  54. van der Kooy J, Poeran J, de Graaf JP, et al. Planned home compared with planned hospital births in the Netherlands: intrapartum and early neonatal death in low-risk pregnancies. Obstet Gynecol 2011; 118:1037.
  55. de Jonge A, Mesman JA, Manniën J, et al. Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study. BMJ 2013; 346:f3263.
  56. Bastian H, Keirse MJ, Lancaster PA. Perinatal death associated with planned home birth in Australia: population based study. BMJ 1998; 317:384.
  57. Malloy MH. Infant outcomes of certified nurse midwife attended home births: United States 2000 to 2004. J Perinatol 2010; 30:622.
  58. Grünebaum A, McCullough LB, Sapra KJ, et al. Apgar score of 0 at 5 minutes and neonatal seizures or serious neurologic dysfunction in relation to birth setting. Am J Obstet Gynecol 2013; 209:323.e1.
  59. Cheng YW, Snowden JM, King TL, Caughey AB. Selected perinatal outcomes associated with planned home births in the United States. Am J Obstet Gynecol 2013; 209:325.e1.
  60. Grünebaum A, McCullough LB, Sapra KJ, et al. Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009. Am J Obstet Gynecol 2014; 211:390.e1.
  61. Grünebaum A, McCullough LB, Sapra KJ, et al. Planned home births: the need for additional contraindications. Am J Obstet Gynecol 2017; 216:401.e1.
  62. Committee on Obstetric Practice. Committee Opinion No. 697: Planned Home Birth. Obstet Gynecol 2017; 129:e117.
  63. Grünebaum A, McCullough LB, Brent RL, et al. Perinatal risks of planned home births in the United States. Am J Obstet Gynecol 2015; 212:350.e1.
  64. Daysal NM, Trandafir M, van Ewijk R. Saving lives at birth: The impact of home births on infant outcomes. American Economic Journal: Applied Economics 2015; 7:28.
  65. Ecker J, Minkoff H. Home birth: what are physicians' ethical obligations when patient choices may carry increased risk? Obstet Gynecol 2011; 117:1179.
  66. Chervenak FA, McCullough LB, Brent RL, et al. Planned home birth: the professional responsibility response. Am J Obstet Gynecol 2013; 208:31.
  67. Leone J, Mostow J, Hackney D, et al. Obstetrician Attitudes, Experience, and Knowledge of Planned Home Birth: An Exploratory Study. Birth 2016; 43:220.
  68. American College of Nurse-Midwives http://www.midwife.org (Accessed on May 19, 2017).
  69. Janssen PA, Lee SK, Ryan ER, Saxell L. An evaluation of process and protocols for planned home birth attended by regulated midwives in British Columbia. J Midwifery Womens Health 2003; 48:138.
  70. Obstetric Handbook 2003: Commission final report non Obstetrics of the Health Care Insurance Board. Diemen, the Netherlands. 2003. http://lib.ugent.be/nl/catalog/rug01:000838946 (Accessed on April 03, 2017).
  71. http://www.livestrong.com/article/534876-holistic-approach-to-strep-b-in-pregnancy/. (Accessed on November 19, 2012).
  72. Bishara RM. GBS in a homebirth setting. Midwifery Today Int Midwife 2006; :32.
  73. DeVries R. A Pleasing Birth: Midwives and Maternity Care in the Netherlands, Temple University Press, Philadelphia 2005.
  74. Blix E, Kumle MH, Ingversen K, et al. Transfers to hospital in planned home birth in four Nordic countries - a prospective cohort study. Acta Obstet Gynecol Scand 2016; 95:420.
  75. Davis-Floyd R. Home-birth emergencies in the US and Mexico: the trouble with transport. Soc Sci Med 2003; 56:1911.
  76. Declercq ER. The trials of Hanna Porn: the campaign to abolish midwifery in Massachusetts. Am J Public Health 1994; 84:1022.