Canadian Data (Janssen, CMAJ, 2009)
Home birth had the lowest death rate of all settings.
12,972 births. Home had the lowest death rate: 0.35/1,000 vs 0.57 (midwife-hospital) vs 0.64 (physician-hospital). 68% fewer EFM, 59% fewer assisted deliveries, 38% fewer hemorrhages.
The Janssen study used British Columbia provincial data on 12,972 births to compare three planned settings: midwife-attended home birth, midwife-attended hospital birth, and physician-attended hospital birth. Perinatal death rates were 0.35 per 1,000 at home, 0.57 per 1,000 with midwife in hospital, and 0.64 per 1,000 with physician in hospital. The home setting had the lowest death rate of the three. Interventions told the expected story.
Home births used 68 percent less electronic fetal monitoring, 59 percent fewer assisted (vacuum or forceps) deliveries, and 38 percent fewer postpartum hemorrhages requiring intervention. The Canadian system, like the Dutch, integrates midwives into the public system with clear referral pathways.
12,972
Births in the study
0.35 / 1,000
Home perinatal death rate
0.64 / 1,000
Physician hospital rate
68%
Less EFM at home
Why it matters
When the system supports midwife-attended home birth, the death rate ends up lower at home than in hospital, while the intervention rates drop substantially.
This is one finding from the research library behind How to Birth a Mother. Everything here traces back to a study, a dataset, or a systematic review.