Dutch National Data (de Jonge, BMJ, 2009/2013)
Half a million births. Fewer complications at home by every measure.
529,688 births. No increased perinatal mortality. Severe maternal morbidity (parous): 1.0/1,000 (home) vs 2.3 (hospital). Postpartum hemorrhage: 19.6/1,000 (home) vs 37.6 (hospital).
The Netherlands keeps national-level data on home birth because home birth is an established part of their maternity system, accounting for roughly 16 to 20 percent of births during the years studied. The de Jonge papers in BMJ 2009 and 2013 covered 529,688 births, drawing on every low-risk delivery in the country.
The results showed no increased perinatal mortality at planned home birth compared with hospital. The maternal morbidity numbers were better at home.
Severe maternal morbidity for women who had previously given birth was 1.0 per 1,000 at home versus 2.3 per 1,000 in hospital. Postpartum hemorrhage was 19.6 per 1,000 at home versus 37.6 per 1,000 in hospital. The Dutch system is built around the home-birth-as-default model with clear referral paths, which is part of what allows these outcomes.
529,688
Births in the dataset
1.0 vs 2.3
Severe morbidity per 1,000 (home/hospital)
19.6 vs 37.6
Postpartum hemorrhage per 1,000
0
Mortality difference
Why it matters
When a country builds the system around home birth as a normal option, half a million births of evidence shows mothers do as well or better than in hospital on every measure tracked.
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.