The American numbers, with the people behind them
About 3 deaths per 10,000 with a nurse-midwife in a hospital; about 10 per 10,000 at a home birth with the same credential. That second figure is keyed on where the baby was born, not on where the birth was planned.
Disclosure first. Almost every American study in this topic is co-authored by the doctor whose name is on this guide. He has published on this subject for more than a decade and is a known critic of planned home birth. That is a reason to check his numbers, not to hide them, so every figure below is printed with the count of babies and the count of births it came from.
And one warning that belongs in the same breath as every American figure in this topic. These come from birth certificates. A woman who plans a home birth, transfers in labor and gives birth in hospital is counted in the national data as a hospital birth, so the outcomes of transferred women are credited to the hospital group. That bias runs in favor of planned home birth. The next topic sets out what happened when one American state fixed it.
The clearest table in the American literature comes from a 2016 re-analysis of national birth records. It covers babies born at term, as single babies, weighing at least 2,500 g, with no recorded birth defect. It is keyed on where the baby was actually born and who attended, not on where the birth was planned; the intended and unintended split only became analysable in the 2009 to 2013 files.
| Group | Deaths in the first month, per 10,000 | Deaths / births |
|---|---|---|
| Hospital, certified nurse-midwife | 3.2 | 356 / 1,096,555 |
| Home, certified nurse-midwife | 10.0 | 18 / 18,389 |
| Home, uncertified midwife | 13.7 | 60 / 43,604 |
The same study splits those figures by whether it is your first baby, and the pooled rows above hide the split. Per 10,000, with a certified nurse-midwife in both settings:
| Certified nurse-midwife attending | First baby | Later baby |
|---|---|---|
| Hospital | 3.3 (141 / 432,018) | 3.2 (213 / 658,272) |
| Home | 17.6 (7 / 4,044) | 7.3 (10 / 13,980) |
A later topic in this stage calls the parity split the single most important thing in it. That is true of the American data too, and this is where you can see it: the gap for a first baby is wider than the pooled figures suggest, and the gap for a later baby is narrower. Note also that the first-baby home cell rests on 7 deaths, which is why the box below matters.
Say the numbers out loud in the units you actually think in. Ten per 10,000 is roughly one in a thousand. Thirteen point seven per 10,000 is roughly one in 730. Three point two per 10,000 is roughly one in 3,100. Those rates are printed as the study published them, rounded, and the counts beside them divide out slightly differently, so treat all three as approximations. They are all small numbers. They are also different from each other.
The authors of a companion study state their own absolute difference in words, which is better than leaving you to subtract: The excess total neonatal mortality for midwife home births compared with midwife hospital births was 9.32 per 10,000 births, and the excess early neonatal mortality was 7.89 per 10,000 births.
That is roughly 9 additional deaths per 10,000, or about 1 per 1,000.
A later analysis of 2010 to 2017 records found 13.66 per 10,000 for all planned home births against 3.27 per 10,000 for hospital births with a nurse-midwife. The counts behind those rates are 242 deaths among 177,156 planned home births, and 745 deaths among 2,280,044 hospital nurse-midwife births. The same analysis found 9.48 per 10,000 for planned home births with a nurse-midwife specifically. That figure was published with an odds ratio of 2.90, but the confidence interval printed alongside it in the journal repeated the point estimate rather than giving a range, so no interval for it is given here. The published figure could not be relied on.
Unplanned home births, in that same analysis, ran at 27.98 per 10,000, roughly double the planned rate. Planned and unplanned are not the same event.
An independent group, using every American term single birth in 2008 (2,081,753 births, of which 12,039 were planned home births), reported two other measures: a 5-minute Apgar under 4 in 0.37% of planned home births against 0.24% of hospital births, and a neonatal seizure in 0.06% against 0.02%. Their own summary is worth having in full: Planned home births were associated with increased neonatal complications but fewer obstetric interventions. The trade-off between maternal preferences and neonatal outcomes should be weighed thoughtfully.
Neonatal mortality rates at home births were not significantly different in relationship to professional certification status of the birth attendant, whether the delivery was by a certified or an uncertified birth attendant.
"Is that figure about planned home births, or about every birth that happened at home?"
"What is the same number for a hospital birth with a nurse-midwife?"
"Which study are you getting that from, and what year does it cover?"