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Peer-reviewedCC BY 4.0Acta Paediatrica (Oslo, Norway : 1992)

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

  • Carolina Herding1
  • Ulla‐Britt Wennerholm1,2
  • Anders Elfvin3,4
  • Sara Holm1
  • Karolina Linden5
  • Jahangir Khan6,7,8
  • Max Petzold6,7
  • Christina Bergh2,6
  • Petteri Sjögren6
  • Ida Stadig9
  • Ann Liljegren9
  • Ylva Carlsson2,6
1 more authors
  • Verena Sengpiel1,2
9 affiliations
  1. 1Department of Obstetrics and Gynecology Sahlgrenska University Hospital Gothenburg Sweden
  2. 2Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
  3. 3Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
  4. 4Department of Pediatrics, The Queen Silvia Children's Hospital Sahlgrenska University Hospital Gothenburg Sweden
  5. 5Institute of Health and Care Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
  6. 6Centre for Health Technology Assessment Sahlgrenska University Hospital Gothenburg Sweden
  7. 7School of Public Health and Community Medicine, Institute of Medicine University of Gothenburg Gothenburg Sweden
  8. 8Department of International Public Health Liverpool School of Tropical Medicine Liverpool UK
  9. 9Medical Library Sahlgrenska University Hospital Gothenburg Sweden
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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.

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Cite

BibTeXRIS
BibTeX
@article{herding2026maternal,
  title = {{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}},
  author = {Carolina Herding and Ulla‐Britt Wennerholm and Anders Elfvin and Sara Holm and Karolina Linden and Jahangir Khan and Max Petzold and Christina Bergh and Petteri Sjögren and Ida Stadig and Ann Liljegren and Ylva Carlsson and Verena Sengpiel},
  journal = {Acta Paediatrica (Oslo, Norway : 1992)},
  year = {2026},
  month = jul,
  doi = {10.1111/apa.70685},
  url = {https://doi.org/10.1111/apa.70685},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - 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
AU  - Carolina Herding
AU  - Ulla‐Britt Wennerholm
AU  - Anders Elfvin
AU  - Sara Holm
AU  - Karolina Linden
AU  - Jahangir Khan
AU  - Max Petzold
AU  - Christina Bergh
AU  - Petteri Sjögren
AU  - Ida Stadig
AU  - Ann Liljegren
AU  - Ylva Carlsson
AU  - Verena Sengpiel
PY  - 2026
DA  - 2026/07/20
JO  - Acta Paediatrica (Oslo, Norway : 1992)
DO  - 10.1111/apa.70685
UR  - https://doi.org/10.1111/apa.70685
AB  - 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.
SN  - 0803-5253
SN  - 1651-2227
ER  -