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Published on: October 10, 2025
Maternal and Peri/Neonatal Mortality and Morbidity in Midwife-Assisted Low-Risk Birth Outside Hospital Compared to
Carolina Herding1, Ulla-Britt Wennerholm1,2, Anders Elfvin3,4
1Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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.
