Maternal and Peri/Neonatal Mortality and Morbidity in Midwife-Assisted Low-Risk Birth Outside Hospital Compared to Obstetric Team-Assisted Low-Risk Hospital Birth: A Systematic Review and Meta-Analysis
In brief
Planned home or freestanding midwife births raise neonatal death risk by 70%
A meta-analysis of nine high-income cohort studies found that planned home or freestanding midwifery unit births increased peri-neonatal mortality by about 70% compared with obstetric hospital births, while reducing maternal intensive-care admissions by 60% and severe perineal tears by 35%. Transfer rates ranged from 9% to 33% and cost savings vanished when emergency backup was accounted for; evidence certainty was low.
- Journal
- Acta paediatrica (Oslo, Norway : 1992) (Q1)
- Published
- 20 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Carolina Herding, Ulla-Britt Wennerholm, Anders Elfvin, Sara Holm, Karolina Linden, Jahangir Khan, et al.
- PMID
- 42478077
- DOI
- 10.1111/apa.70685
Why clinicians should know about it
- Picked for Health Policy (paper of the day, 22 July 2026).
- Picked for Obstetrics and Gynecology (paper of the day, 22 July 2026).
Abstract
AIM: To compare outcomes of planned home or freestanding midwifery unit (FMU) with obstetric unit births in high-income countries. METHODS: We conducted a systematic review and meta-analysis of systematic reviews, randomised controlled trials, cohort studies, case series, and case reports. Medline, Embase, CINAHL and the Cochrane Library were searched up to 8 April 2026 (PROSPERO: CRD42024570558). Outcomes included maternal and peri/neonatal mortality, severe morbidity, hospital transfers and health economics. Certainty of evidence was assessed using GRADE. RESULTS: Nine cohort studies (n = 1 261 312), 18 case series, and three case reports were included. All cohort studies had a risk of bias. Planned home/FMU births were associated with fewer maternal intensive care admissions (adjusted odds ratio [AOR] 0.41, 95% confidence interval [95% CI] 0.19-0.89), increased peri/neonatal mortality (OR 1.70, 95% CI 1.05-2.74), fewer severe perineal tears (AOR 0.64, 95% CI 0.45-0.93), and lower intrapartum caesarean section rates (AOR 0.29, 95% CI 0.26-0.33). Transfers occurred in 9%-33% of births. Cost savings for home/FMU births disappeared when emergency standby capacity was considered. CONCLUSION: Evidence certainty was low or very low. Planned home/FMU births may reduce some maternal complications but may increase peri/neonatal mortality, although absolute risks remain low. The cost-effectiveness of home/FMU birth remains uncertain.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.