16. Evidence-Based Selection of Birth Setting

Researchers have compared the health and well-being of mothers and babies across birth settings for many years. However, until recently, studies did not clearly differentiate outcomes from births at home or birth centers with skilled attendants from outcomes of unplanned or unattended home births. Since 2009, several large population-based and matched cohort studies have established that for people without risk factors there are significant reductions in use of obstetric interventions when labor  and birth occurs in homes, birth centers, and midwife-led hospital units, with no significant differences in adverse outcomes (1, 10, 11, 20, 21, 23). While there are some differences in neonatal outcomes across settings among women in the first pregnancy, in high resource countries the absolute risk of adverse medical outcomes are extremely small in all settings (24). As a result, Britain’s National Institute for Health and Care Excellence (NICE) recommends that providers,

"Explain to both multiparous and nulliparous women that they may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support them in their choice of setting wherever they choose to give birth.
Advise low‑risk multiparous women that planning to give birth at home or in a midwifery‑led unit (freestanding or alongside) is particularly suitable for them because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit.
Advise low‑risk nulliparous women that planning to give birth in a midwifery‑led unit (freestanding or alongside) is particularly suitable for them because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit. Explain that if they plan birth at home there is a small increase in the risk of an adverse outcome for the baby." (17)