Despite planned home birth having the potential to provide a psychologically and physically safe birth environment, home birth is unusual within most highly-resourced countries. Women are not always provided with the opportunity or autonomy to birth at home. Additionally, amongst the small numbers of women who do birth at home, minoritised and marginalised communities are underrepresented. To explore if an 'active offer' concept may provide a useful approach to offering planned home birth. This was a sequential multiple methods study, to explore the use of the active offer concept within the context of planned home birth. Initially, non-participant observations of seven birth planning meetings with low risk women and their community midwives were undertaken, followed by individual semi-structured interviews with all participants in order to explore how home birth was integrated within low-risk women's experience of pregnancy. The second phase used focus groups with previous maternity services users and community midwives to develop ideas for the design of a complex Active Offer of Planned Home Birth intervention. An Active Offer of Planned Home Birth comprising of 'Creating the Conditions' and 'Positive Reinforcement' stages is an intervention that midwives can use to increase the ability of all women to make informed decisions about whether they wish to birth at home. This could serve as a powerful approach in reducing the current inequality in access to home birth. This is the first research to develop an active offer in the context of planned home birth. The proposed intervention provides a structured way for midwives to offer and support home birth decision making. Further research to test and refine this intervention should now be undertaken.

Out-of-hospital births represent a small but growing proportion of deliveries in the United States. Although many of these births are planned and supervised by a midwife, deliveries that occur outside the labor and delivery suite present risks to both the birthing person and newborn. National organizations such as the American College of Obstetrics and Gynecology and the American Academy of Pediatrics generally caution against planned home births, but they do provide recommendations to reduce risk, including careful selection of appropriate candidates, presence of qualified clinical practitioners, and quick and reliable access to a higher level of care. Unplanned births in the community requiring responses from emergency personnel or emergency department births also present challenges for health care practitioners and departments that have limited experience with such cases. This review summarizes strategies to prepare for and manage these births, emphasizing care of the neonate.

Background/Objective: In Spain, 99% of births occur in hospital settings, and planned home birth is neither funded nor regulated by the Public Health System. Despite growing interest in this birth option, qualitative evidence exploring the experiences of women who opt for a planned home birth after a previous hospital birth remains scarce, particularly in contexts where this practice is not integrated into the healthcare system. This study aimed to explore the perceptions and experiences of Spanish women who opted for a planned home birth following a previous hospital birth, focusing on the reasons that motivated this decision and the care received during the process. Methods: A qualitative descriptive design was employed. Semi-structured interviews were conducted between July and December 2025 with 19 women who had experienced a planned home birth in Spain after a previous hospital birth. Data were analysed using inductive thematic analysis following Braun and Clarke's approach. The study adhered to the Standards for Reporting Qualitative Research (SRQR). Results: Three main themes emerged: (1) motives related to choosing a planned home birth, including negative hospital experiences characterised by loss of autonomy, medicalisation of birth without consent, and fragmented care; (2) seeking a physiological and humanised birth, reflecting women's desire for empowerment, control, and a transformative experience, alongside barriers such as lack of professional support and financial burden; and (3) the need to increase visibility and establish regulation, highlighting demands for professional training, dissemination strategies, and integration of planned home birth into the Public Health System to ensure equitable access. Conclusions: Women who opted for a planned home birth after a hospital experience reported highly positive and empowering outcomes. However, the absence of regulation, professional support, and public funding creates significant inequalities. Integrating planned home birth into the Public Health System, educating healthcare professionals, and developing strategies to increase the visibility of planned home births are essential to guarantee women's right to choose where they give birth.

Model of planned home birth care in Brazil: A scoping review.

Background/Objectives: In Japan, hospital births predominate, with home births comprising only 0.1% of deliveries. This study assessed how documented practices for planned home births attended by independent midwives align with national guidelines and WHO intrapartum care recommendations, and assess maternal and neonatal differences before and after the COVID-19 pandemic. Methods: Records of 430 low-risk pregnant women who received continuous care at a private midwifery home over 25 years were reviewed. After excluding 8 maternal and 22 neonatal transfers, 400 records were analyzed. Descriptive statistics were compared with WHO recommendations and between the pre-pandemic (1999-2019) and post-pandemic (2020-2024) periods. Results: All women experienced spontaneous singleton cephalic labors with intermittent fetal heart rate auscultation. The mean gestational age was 277.3 days and the median labor duration was 303.5 min. Labor onset was spontaneous in 83.5% of cases. Nearly half of the women had no perineal lacerations. Postpartum blood loss ≥500 mL occurred in 14.1% of cases. Family presence was nearly universal. Neonates had a mean birth weight of 3129.0 g and high Apgar scores. Skin-to-skin contact occurred in 52.9%; exclusive breastfeeding reached 93.8% at 1 month. Post-pandemic births showed higher maternal age and higher neonatal birth weight, although these differences should be interpreted cautiously due to the small post-pandemic sample. Conclusions: Independent midwives provided evidence-based, physiologically oriented care, partially aligning with selected WHO intrapartum recommendations during planned home births. Midwife-led home births may support positive childbirth experiences and favorable maternal/neonatal outcomes for low-risk women. Post-pandemic shifts underscore the need for continued monitoring and flexible, community-based perinatal support, while recognizing the limitations of retrospective, single-site data.

Midwifery Provision of Home Birth Services.

The choice between home birth and hospital birth remains a topic of considerable discussion within contemporary obstetrics. The choice of birth setting and the characteristics of women opting for home birth vary across different regions of the world. In developed countries, hospitals are the default place of birth, whereas in developing countries, childbirth more often occurs at home. One of the most important criteria for comparing home and hospital births is the safety of both the mother and the newborn. The comparison of home and hospital births among low-risk women shows similar neonatal safety, with lower NICU (Neonatal Intensive Care Unit) admissions and intervention rates in home births. Mothers delivering at home experience fewer cesarean sections, episiotomies, and postpartum complications. However, outcomes vary regionally, with U.S. studies reporting higher neonatal risks in planned home births. Transfer to hospital rates range from 10-30%, mainly due to slow labour. VBACs (Vaginal Birth After Cesarean) at home are associated with lower cesarean rates but higher non-urgent transfers. Postpartum outcomes, including breastfeeding success, are superior after home birth. Evidence suggests that, in integrated systems, home birth can be a safe and informed choice.

SummaryBackgroundThe safety of out-of-hospital birth in the United States remains contested. A neglected methodological issue is the selective nonreporting of 5-min Apgar scores, which may conceal adverse outcomes and bias safety comparisons. This study examined whether Apgar score missingness differs systematically by birth setting and whether such “informative missingness” alters risk estimates.MethodsWe conducted a population-based analysis of 3,066,021 term, normal-birthweight, midwife-attended singleton births in the United States (2016–2023). Birth settings included hospitals, freestanding birth centers, and planned home births. Missing 5-min Apgar scores were quantified, and deterministic sensitivity analyses modeled the impact of varying assumptions about unrecorded low scores (<4 and <7). Hospital births served as the reference group.FindingsFive-minute Apgar scores were missing in 0.13% of hospital, 1.9% of birth-center, and 3.1% of home births. Severe compromise (Apgar <4) occurred in 0.17%, 0.20%, and 0.26%, respectively. When half of missing scores were imputed as <4, adjusted odds of severe compromise increased to 7.7 for home and 4.9 for birth-center births vs. hospitals.InterpretationThis study evaluates documentation integrity of US births. Selective nonreporting of 5-min Apgar scores at out-of-hospital births introduces major bias, distorting apparent safety of out-of-hospital births. Complete and enforceable outcome reporting is essential for scientific validity and ethically sound informed consent.FundingNone declared.

Objective: to explore the experiences of Amazonian women with planned home birth (PHB). Method: qualitative study with 20 women from the state of Pará (Northern Brazil). Semistructured interviews were conducted between August 2021 and February 2022, fully transcribed, and analyzed using content analysis in ATLAS.ti 8.0. Two categories emerged: (1) the PHB experience; and (2) home birth and the break with the hospital-centric model. Results: birth was described as a ritual involving the body and care practices such as water birth, relaxation and massage, and upright birthing positions. PHB was associated with fewer unnecessary interventions and greater body awareness, strengthening women’s agency in the act of giving birth. Conclusion: the PHB experience was characterized as satisfactory, marked by autonomy and decision-making power in care, and supported by a social network chosen by the woman to preserve control over the care process.

INTRODUCTIONIn Spain, midwifery students receive limited education on and remain unfamiliar with the physiology and safety of planned home births. The aim of the study was to explore midwifery students’ experiences of clinical training in planned home birth and how to improve the quality of care based on identified barriers.METHODSA descriptive qualitative study was carried out. This research was conducted at the Nursing Faculty of the University of University of Almeria, involving 13 midwifery students. Data were collected using semi-structured interview between December and April 2025. Data were analyzed using thematic content analysis and themes generated that addressed the research objective.RESULTSA total of 13 midwifery students enrolled in the education program. Two main themes were developed that reflect the meaning patterns constructed through the data analysis: 1) ‘Attend a planned home birth’, with the subthemes ‘Fear of giving birth outside delivery’, ‘The unknown physiological process’ and ‘Recognizing stereotypes around the naturalization of birth’; and 2) ‘Promoting resources that integrate planned home birth’, with the subthemes ‘Learning as a catalyst for change’ and ‘The need for institutional support’.CONCLUSIONSThe results reveal the need to integrate content about planned home births into midwifery curricula. High-fidelity simulation can help bring planned home birth to midwifery students and midwives with a dynamic, safe, and reflective approach, ensuring optimal care for women who choose a planned home birth. Additionally, the results identify resources that could promote the visibility of planned home birth attention within academic, clinical, and social environment.

Objective: to discuss the perceptions of women who sought a planned home birth regarding the blessing tea ritual. Method: descriptive, cross-sectional study with a qualitative approach, carried out through semi-structured interviews with eight mothers who had a blessing tea with the planned home birth team in Recife/PE, Brazil. Data collection took place between February and March 2023. Data analysis was supported by the IRAMUTEQ software and Descending Hierarchical Classification analysis was used. Results: the classes combined were: "Spirituality and strengthening interconnections"; “Care rituals as a strengthening moment for labor and birth”; “The search for planned home birth and care rituals amid the medicalization of childbirth”. Conclusion: the blessing tea ritual helped the participants to have greater emotional and spiritual preparation for labor and birth.

Enablers and barriers to practice planned home birth for midwives in Spain: A qualitative study.

Depending on risk profile, pregnant women can freely choose their preferred birthplace, especially in the case of a normal pregnancy. In addition to obstetric maternity units in a hospital, options may include out-of-hospital births (such as births at home or in a freestanding midwifery unit. To our knowledge, there is no study comparing the outcomes of peripartum transfers from different places. Between 2020 and 2021, all births transferred internally from the AMU of the University Hospital of Leipzig (n=74) were retrospectively analyzed and compared with births transferred from external (home or an FMU; n=72). The main outcome measures were morbidity and interventions. 86.1 % were transfers from an FMU and 13.9 % were transfers of planned home births. There were significantly less spontaneous vaginal births in planned OH births (55.6 %) compared to planned AMU births (73.7 %, p<0.001). For the FMU births, we found a significantly higher rate of caesarean section (20.8 %, to 6.6 %, p<0.001) and postpartum neonatal transfers (8.3-4.1 %, p=0.025). The duration of labor was significantly longer in transferred OH (p<0.001). In case of an intrapartum transfer, there was a decreased likelihood of spontaneous vaginal birth and increased likelihood of secondary caesarean section compared to internally transferred AMU births. Furthermore, OH transfers were associated with a higher morbidity. Hence, pregnant women should be given an informed choice of birthplace, including the likelihood of intrapartum transfer. Out-of-hospital deliveries are associated with a higher rate of adverse perinatal outcome.

Background: The term born before arrival (BBA) encompasses the birth of any infant at ≥20 weeks of gestation and &gt;400g birth weight before arrival at the hospital or birth centre setting. These exclude planned home births attended by a health professional. Objective: The main objective of the study was to evaluate the born before arrivals, its occurrence, maternal and early neonatal complications in two highly turn over maternities in Yaoundé. Methods: We conducted a retrospective case-control study at the Yaounde Gynaecology Obstetrics and Paediatric Hospital and the "Centre d’Animation Sociale et Sanitaire" at Nkoldongo district health service. We collected retrospective data for a period of five years beginning from January 2017 to January 2022 inclusive. We reviewed files of all the deliveries that occurred in the two hospitals during that period. From these files, we identified BBAs as cases and every file of a hospital delivery that occurred after the BBA was selected as control. Results: There were 6.4%. deliveries that occurred before arrival to the hospitals. There was a significant association between the level of education and born before arrival (p&lt;0.001). Women who were educated were less likely to deliver before arriving the hospital. The mean gravidity and mean parity were high and statistically significant among women who delivered before arriving the hospital 3.61 ± 1.84 vs 2.94 ± 1.94, (OR=1.194, 95% CI 1.042-1.368, p= 0.010) and 3.00 ± 1.43 vs 2.38 ± 1.65, (OR 1.257, 95% CI 1.070-1.477, p=0.005). The birth interval among women who delivered before arriving the hospital was shorter and statistically significant 38.42 ± 1.82 vs 54.58 ± 2.41, OR 0.984, 95% CI 0.971-0.998, p=0.024]. Hospital deliveries were more associated with live newborns (P=0.019) and a higher birth-weight (P = 0.002). Conclusion: BBAs had adverse maternal and neonatal outcomes.

Introduction: Planned Home Birth (PHB) and humanized childbirth are approaches that prioritize the reduction of unnecessary interventions and respect for women's autonomy, in line with international guidelines for safe and woman-centered obstetric care. Objective: To investigate the effectiveness of Brazilian public policies in implementing PDP and humanized childbirth, with an emphasis on the contribution of obstetric nursing to improving maternal and child outcomes. Methods: An integrative literature review was conducted, covering scientific articles published in the last 5 years, as well as normative documents from the Ministry of Health, using databases such as PubMed, SciELO, and LILACS. Inclusion criteria were studies that addressed public policies, PDP practices, and the role of obstetric nursing, totaling 11 publications selected through critical analysis and thematic categorization, complying with the inclusion and exclusion criteria. Bardin's data analysis was performed, generating three thematic categories. Results: A summary of the 11 selected articles was presented, demonstrating that public policies, such as Rede Cegonha and Projeto Parto Adequado, showed a significant reduction in cesarean section rates and an increase in maternal satisfaction. It was observed that obstetric nursing plays an essential role in prenatal care, planning, and PDP assistance, promoting evidence-based protocols. However, limitations include insufficient specific training and inadequate infrastructure for safe home care. Conclusion: Brazilian public policies favor the dissemination of PDP and humanized childbirth, reinforcing the need for investments in obstetric nursing training and the expansion of structural resources to ensure safe, humanized practices and qualified care.

Home birth, as an element of maternity care, has been the subject of considerable debate regarding its safety and efficacy. Recent evidence suggests that for low-risk, multiparous women, planned home birth can be as safe as hospital birth, with reduced intervention rates and enhanced overall birth experiences. Additionally, economic assessments indicate that home birth represents a cost-effective alternative in specific contexts. However, in many high-income countries, including Saudi Arabia, home births remain rare due to prevailing socio-cultural attitudes, health system policies, and perceptions regarding the safety of home deliveries. This qualitative phenomenological study aims to explore the factors influencing the decision to choose home birth among reproductive-age women in Al-Madinah, Saudi Arabia. Semi-structured interviews were conducted with 25-30 participants to gather in-depth insights into their attitudes, beliefs, and experiences regarding home birth. The study findings highlight the interplay of cultural beliefs, socio-economic status, and prior childbirth experiences in shaping the preference for home delivery. Furthermore, the study sheds light on potential enablers, including improved midwifery services and health education, which could facilitate greater acceptance of home birth in Saudi Arabia

Abstract AimsRates of community births, including home and birth center births, have steadily increased in recent decades. Safety outcomes of community births have primarily been compared to hospital births. This study compares maternal and infant morbidity between birth centers and home births in the United States.MethodsWe identified planned home births and birth center births in 2016–2021 using the Centers for Disease Control and Prevention National Vital Statistics System. We used propensity score matching to compare each birth center birth to the most similar home birth, with outcomes including maternal and neonatal adverse events recorded on the birth certificate.ResultsWe identified 262 954 community births (42% in birth centers; 4% involving maternal or infant morbidity). After propensity score matching, we analyzed outcomes in a sample of 97 759 pairs of birth center births matched to planned home births. In the matched sample, maternal and infant morbidity was more likely in birth center births than in home births (odds ratio [OR]: 1.13, 95% confidence interval [CI]: 1.08–1.18). This difference was primarily due to higher maternal morbidity at birth centers (OR 1.57, 95% CI 1.44–1.71), with the largest difference seen for severe perineal trauma. Overall infant morbidity did not differ significantly between the two settings.ConclusionsIn the United States, planned birth center births have higher rates of maternal morbidity than planned home births, mostly due to higher rates of severe perineal trauma. These data could support informed choice of community birth settings for patients considering home birth or birth at a birth center.

Emergency ambulance services attend a wide array of medical and trauma patients. Infrequently, this includes imminent or out-of-hospital births (OOHBs). This scoping review explores emergency ambulance clinician involvement with OOHBs, and patient and clinician experiences with birthing in the out-of-hospital setting. Scoping review using the Joanna Briggs Institute framework and 'participant, concept, context' criteria. CINAHL, Embase, Medline, Web of Science and Wiley Online were searched until 20 February 2024. Articles discussing an unplanned OOHB, or a planned home birth with complications where an emergency ambulance was required, were included. Two reviewers independently determined inclusion using Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews guidelines. A data extraction tool summarised findings for descriptive synthesis. 63 articles were included. 36 articles involved retrospective research. 38 articles were published since 2015, with USA (n=17) and Australia (n=13) the highest contributors. Risk factors for OOHBs were varied, with maternal age or being multigravida/multiparous often cited. 99 complications were described, ranging from relatively minor ailments (ie, nausea and vomiting) to life-threatening situations such as maternal or neonatal cardiac arrest. Common management/interventions reported were assisting with birth, maternal intravenous cannulation and medication administration.Birth parents, partners and clinicians all describe OOHBs as anxiety-provoking but joyous when a healthy neonate is born. The OOHB experience is enhanced for patients when clinicians communicate well, while those who appeared inexperienced increased patient anxiety.OOHBs experience many challenges to optimal care, categorised as 'emergency ambulance clinicians desiring additional education and training', 'communication and collaboration difficulties', 'environmental issues', 'technology and aids' and 'other' limitations. OOHBs are rare events requiring expert assistance to optimise patient outcomes. There remain significant challenges to unplanned OOHBs; ongoing training and skill competency is required to improve patient safety and clinician confidence. Further research investigating patient outcomes and experiences is recommended.

Objective: Women may choose home birth to avoid medical interventions such as episiotomy, as midwife-assisted births involve fewer interventions and support the physiological birth process. The aim of this study is to examine perineal outcomes (episiotomy and perineal injury) in planned home births and the associated factors. Methods: This descriptive study was conducted between August 2021 and January 2022. The sample consisted of 159 women. The data were collected by using the Personal Information Form and Satisfaction Scale (Visual Analog Scale-Satisfaction). Results: Participants preferred home birth for reasons such as preserving privacy, avoiding IV oxytocin use, having their spouse present during labor, and preventing episiotomy. Intact perineum was observed in 33.3% of participants, while 17.0% underwent episiotomy, and 51.6% experienced perineal injury requiring suturing. Multiparity and flexible sacrum positions were associated with a higher rate of perineal integrity, while multiparity was also linked to a higher risk of perineal injury requiring suturing. Participants received midwifery support during home births and reported high levels of satisfaction with the care they received. Conclusion: The rate of episiotomy and perineal injury was low in-home births. These results show that women's preference for home birth enables them to avoid medical interventions. Midwives and nurses are recommended to provide pregnant women with the necessary information to help them determine a safe place for childbirth.

Background: Although home births provide personal and intimate experiences, they pose potential risks that may be better managed in hospital settings. The safety of home birth remains highly debated, with no consensus on its safety or potential adverse events, and its adoption varies widely across the world. In Italy, the Italian Society of Neonatology opposed this practice, resulting in one of the lowest home birth rates in Europe (approximately 0.1% of total births). This study evaluated the impact of planned home births on neonatal health, with a focus on severe complications requiring intervention in the pediatric emergency department (PED). Methods: Cases were collected from patients admitted to IRCCS Istituto Giannina Gaslini Children's Hospital between January 2022 and December 2024. The analysis focused on neonates born at home, who required emergency care for life-threatening conditions. Results: We identified five cases, with an incidence of approximately 0.65 per 10,000 PED visits and a complication rate of 15-30% for all planned home births. Factors contributing to unfavorable outcomes include lack of advanced medical equipment, timely diagnostics, and comprehensive postpartum screening. Thus, while proponents argue that home births can provide a more comfortable and personalized experience, concerns about safety and associated risks persist. Conclusions: This study aims to highlight the necessity of adopting hospital-level neonatal care protocols for home births, particularly during the critical first 48 h of life, to mitigate risks and ensure optimal neonatal outcomes.