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Planned Out-of-hospital Birth

Coverage GuidanceApproved11/12/2015
Prioritization ChangesApproved11/12/2015


Next Steps

The Evidence-based Guidelines Subcommittee will continue discussion at its 6/6/2019 meeting.


A new coverage guidance on this topic is under development. ​The Evidence-based Guidelines Subcommittee discussed the initial draft at its 4/4/2019 meeting.


​Additional sources:

Bachilova, S., Czuzoj-Shulman, N., & Abenhaim, H. A. (2018). Effect of maternal and pregnancy risk factors on early neonatal death in planned home births delivering at home. Journal of Obstetrics & Gynaecology Canada: JOGC, 40(5), 540-546.
Bailey, D. J. (2017). Birth outcomes for women using free-standing birth centers in South Auckland, New Zealand. Birth, 44(3), 246-251.
Birthplace in England Collaborative Group. (2011). Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ, 343, d7400. doi: 10.1136/bmj.d7400.
Blix, E., Kumle, M. H., Ingversen, K., Huitfeldt, A. S., Hegaard, H. K., Olafsdottir, O. A., . . . Lindgren, H. (2016). Transfers to hospital in planned home birth in four Nordic countries - A prospective cohort study. Acta Obstetricia et Gynecologica Scandinavica, 95(4), 420-428.
Bolten, N., e Jonge, A., Zwagerman, E., Zwagerman, P., Klomp, T., Zwart, J. J., & Geerts, C. C. (2016). Effect of planned place of birth on obstetric interventions and maternal outcomes among low-risk women: A cohort study in the Netherlands. BMC Pregnancy & Childbirth, 16(1), 329.
Bovbjerg, M. L., Cheyney, M., Brown, J., Cox, K. J., & Leeman, L. (2017). Perspectives on risk: Assessment of risk profiles and outcomes among women planning community birth in the United States. Birth, 44(3), 209-221.
Catling-Paull, C., Coddington, R. L., Foureur, M. J., & Homer, C. S. (2013). Publicly funded homebirth in Australia: A review of maternal and neonatal outcomes over 6 years. Medical Journal of Australia, 198(11), 616-620.
Cheyney, M., Bovbjerg, M., Everson, C., Gordon, W., Hannibal, D., & Vedam, S. (2014). Outcomes of care for 16,924 planned home births in the United States: the Midwives Alliance of North America Statistics Project, 2004 to 2009. Journal of Midwifery & Women's Health, 59(1), 17-27. doi: 10.1111/jmwh.12172. Epub 2014 Jan 30.
Christensen, L. F., & Overgaard, C. (2017). Are freestanding midwifery units a safe alternative to obstetric units for low-risk, primiparous childbirth? An analysis of effect differences by parity in a matched cohort study. BMC Pregnancy & Childbirth, 17(1), 14.
Cox, K. J., Bovbjerg, M. L., Cheyney, M., & Leeman, L. M. (2015). Planned Home VBAC in the United States, 2004-2009: Outcomes, maternity care practices, and implications for shared decision making. Birth, 42(4), 299-308.
Davies-Tuck, M. L., Wallace, E. M., Davey, M. A., Veitch, V., & Oats, J. (2018). Planned private homebirth in Victoria 2000-2015: A retrospective cohort study of Victorian perinatal data. BMC Pregnancy & Childbirth, 18(1), 357.
Davis, D., Baddock, S., Pairman, S., Hunter, M., Benn, C., Anderson, J., . . . Herbison, P. (2012). Risk of severe postpartum hemorrhage in low-risk childbearing women in New Zealand: Exploring the effect of place of birth and comparing third stage management of labor. Birth, 39(2), 98-105. doi: 10.1111/j.1523-536X.2012.00531.x. Epub 2012 May 17.
de Cock, T. P., Manniën, J., Geerts, C., Klomp, T., & e Jonge, A. (2015). Exclusive breastfeeding after home versus hospital birth in primary midwifery care in the Netherlands. BMC Pregnancy & Childbirth, 15, 1-8.
de Jonge, A., Geerts, C. C., van der Goes, B. Y., Mol, B. W., Buitendijk, S. E., & Nijhuis, J. G. (2015). Perinatal mortality and morbidity up to 28 days after birth among 743,070 low-risk planned home and hospital births: A cohort study based on three merged national perinatal databases. BJOG: An International Journal of Obstetrics & Gynaecology, 122(5), 720-728.
de Jonge, A., Mesman, J. A., Mannien, J., Zwart, J. J., van Dillen, J., & van Roosmalen, J. (2013). Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: Nationwide cohort study. BMJ, 346, f3263. doi: 10.1136/bmj.f3263.
Edqvist, M., Blix, E., Hegaard, H. K., Olafsdottir, O. A., Hildingsson, I., Ingversen, K., . . . Lindgren, H. (2016). Perineal injuries and birth positions among 2992 women with a low risk pregnancy who opted for a homebirth. BMC Pregnancy & Childbirth, 16(1), 196.
Eto, H., Hasegawa, A., Kataoka, Y., & Porter, S. E. (2017). Factors contributing to postpartum blood-loss in low-risk mothers through expectant management in Japanese birth centres. Women & Birth: Journal of the Australian College of Midwives, 30(4), e158-e164.
Grigg, C. P., Tracy, S. K., Tracy, M., Daellenbach, R., Kensington, M., Monk, A., & Schmied, V. (2017). Evaluating maternity units: A prospective cohort study of freestanding midwife-led primary maternity units in New Zealand-clinical outcomes. BMJ Open, 7(8), e016288.
Grunebaum, A., McCullough, L. B., Arabin, B., Dudenhausen, J., Orosz, B., & Chervenak, F. A. (2017). Underlying causes of neonatal deaths in term singleton pregnancies: Home births versus hospital births in the United States. Journal of Perinatal Medicine, 45(3), 349-357.
Grunebaum, A., McCullough, L. B., Sapra, K. J., Arabin, B., & Chervenak, F. A. (2017). Planned home births: The need for additional contraindications. American Journal of Obstetrics & Gynecology, 216(4), 401.e401-401.e408.
Halfdansdottir, B., Hildingsson, I., Smarason, A. K., Sveinsdottir, H., & Olafsdottir, O. A. (2018). Contraindications in planned home birth in Iceland: A retrospective cohort study. Sexual & reproductive healthcare: Official journal of the Swedish Association of Midwives, 15, 10-17.
Halfdansdottir, B., Smarason, A. K., Olafsdottir, O. A., Hildingsson, I., & Sveinsdottir, H. (2015). Outcome of planned home and hospital births among low-risk women in Iceland in 2005-2009: A retrospective cohort study. Birth, 42(1), 16-26.
Hitzert, M., Hermus, M. A., Scheerhagen, M., Boesveld, I. C., Wiegers, T. A., van den Akker-van Marle, M. E., . . . e Graaf, J. P. (2016). Experiences of women who planned birth in a birth centre compared to alternative planned places of birth. Results of the Dutch Birth Centre Study. Midwifery, 40, 70-78.
Hollowell, J., Li, Y., Bunch, K., & Brocklehurst, P. (2017). A comparison of intrapartum interventions and adverse outcomes by parity in planned freestanding midwifery unit and alongside midwifery unit births: Secondary analysis of 'low risk' births in the birthplace in England cohort. BMC Pregnancy & Childbirth, 17(1), 95.
Homer, C. S., Thornton, C., Scarf, V. L., Ellwood, D. A., Oats, J. J., Foureur, M. J., . . . Dahlen, H. G. (2014). Birthplace in New South Wales, Australia: An analysis of perinatal outcomes using routinely collected data. BMC Pregnancy & Childbirth, 14, 206.
Hutton, E. K., Cappelletti, A., Reitsma, A. H., Simioni, J., Horne, J., McGregor, C., & Ahmed, R. J. (2016). Outcomes associated with planned place of birth among women with low-risk pregnancies. CMAJ Canadian Medical Association Journal, 188(5), E80-90.
Hutton, E. K., Reitsma, A. H., & Kaufman, K. (2009). Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: A retrospective cohort study. Birth, 36(3), 180-189. doi: 10.1111/j.1523-536X.2009.00322.x.
Janssen, P. A., Saxell, L., Page, L. A., Klein, M. C., Liston, R. M., & Lee, S. K. (2009). Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ, 181(6-7), 377-383. doi: 10.1503/cmaj.081869. Epub 2009 Aug 31.
Johnson, K. C., & Daviss, B. A. (2005). Outcomes of planned home births with certified professional midwives: Large prospective study in North America. BMJ, 330(7505), 1416. doi: 10.1136/bmj.330.7505.1416.
Kataoka, Y., Masuzawa, Y., Kato, C., & Eto, H. (2018). Maternal and neonatal outcomes in birth centers versus hospitals among women with low-risk pregnancies in Japan: A retrospective cohort study. Japan Journal of Nursing Science: JJNS, 15(1), 91-96.
Kennare, R. M., Keirse, M. J., Tucker, G. R., & Chan, A. C. (2010). Planned home and hospital births in South Australia, 1991-2006: Differences in outcomes. Medical Journal of Australia, 192(2), 76-80.
Laws, P. J., Xu, F., Welsh, A., Tracy, S. K., & Sullivan, E. A. (2014). Maternal morbidity of women receiving birth center care in New South Wales: A matched-pair analysis using linked health data. Birth, 41(3), 268-275.
Li, Q., Jenkins, D. D., & Kinsman, S. L. (2017). Birth settings and the validation of neonatal seizures recorded in birth certificates compared to Medicaid claims and hospital discharge abstracts among live births in South Carolina, 1996-2013. Maternal & Child Health Journal, 21(5), 1047-1054.
Li, Y., Townend, J., Rowe, R., Brocklehurst, P., Knight, M., Linsell, L., . . . Hollowell, J. (2015). Perinatal and maternal outcomes in planned home and obstetric unit births in women at 'higher risk' of complications: Secondary analysis of the Birthplace national prospective cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, 122(5), 741-753.
Li, Y., Townend, J., Rowe, R., Knight, M., Brocklehurst, P., & Hollowell, J. (2014). The effect of maternal age and planned place of birth on intrapartum outcomes in healthy women with straightforward pregnancies: Secondary analysis of the Birthplace national prospective cohort study. BMJ Open, 4(1), e004026.
MacDorman, M. F., & Declercq, E. (2016). Trends and characteristics of United States out-of-hospital births 2004-2014: New information on risk status and access to care. Birth, 43(2), 116-124.
Monk, A., Tracy, M., Foureur, M., Grigg, C., & Tracy, S. (2014). Evaluating Midwifery Units (EMU): A prospective cohort study of freestanding midwifery units in New South Wales, Australia. BMJ Open, 4(10), e006252.
Nethery, E., Gordon, W., Bovbjerg, M. L., & Cheyney, M. (2018). Rural community birth: Maternal and neonatal outcomes for planned community births among rural women in the United States, 2004-2009. Birth, 45(2), 120-129.
Nove, A., Berrington, A., & Matthews, Z. (2012). Comparing the odds of postpartum haemorrhage in planned home birth against planned hospital birth: Results of an observational study of over 500,000 maternities in the UK. BMC Pregnancy Childbirth, 12, 130. doi: 10.1186/1471-2393-12-130.
Oian, P., Askeland, O. M., Engelund, I. E., Roland, B., & Ebbing, M. (2018). Births in Norwegian midwife-led birth units 2008-10: A population-based study. Tidsskrift for Den Norske Laegeforening, 138(10), 12.
Quigley, C., Taut, C., Zigman, T., Gallagher, L., Campbell, H., & Zgaga, L. (2016). Association between home birth and breast feeding outcomes: A cross-sectional study in 28 125 mother-infant pairs from Ireland and the UK. BMJ Open, 6(8), e010551.
Rowe, R., Li, Y., Knight, M., Brocklehurst, P., & Hollowell, J. (2016). Maternal and perinatal outcomes in women planning vaginal birth after caesarean (VBAC) at home in England: Secondary analysis of the Birthplace national prospective cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, 123(7), 1123-1132.
Schroeder, L., Patel, N., Keeler, M., Rocca-Ihenacho, L., & Macfarlane, A. J. (2017). The economic costs of intrapartum care in Tower Hamlets: A comparison between the cost of birth in a freestanding midwifery unit and hospital for women at low risk of obstetric complications. Midwifery, 45, 28-35.
Schuit, E., Hukkelhoven, C. W., van der Goes, B. Y., Overbeeke, I., Moons, K. G., Mol, B. W., . . . Kwee, A. (2016). Risk indicators for referral during labor from community midwife to gynecologist: A prospective cohort study. Journal of Maternal-Fetal & Neonatal Medicine, 29(20), 3304-3311.
Snowden, J. M., Tilden, E. L., Snyder, J., Quigley, B., Caughey, A. B., & Cheng, Y. W. (2015). Planned out-of-hospital birth and birth outcomes. New England Journal of Medicine, 373(27), 2642-2653.
Sprague, A. E., Sidney, D., Darling, E. K., Van Wagner, V., Soderstrom, B., Rogers, J., . . . Walker, M. C. (2018). Outcomes for the first year of Ontario's birth center demonstration project. Journal of Midwifery & Women's Health, 63(5), 532-540.
Stapleton, S. R., Osborne, C., & Illuzzi, J. (2013). Outcomes of care in birth centers: Demonstration of a durable model. Journal of Midwifery & Women's Health, 58(1), 3-14. doi: 10.1111/jmwh.12003. Epub 2013 Jan 30.
Stephenson-Famy, A., Masarie, K. S., Lewis, A., & Schiff, M. A. (2018). What are the risk factors associated with hospital birth among women planning to give birth in a birth center in Washington State? Birth, 45(2), 130-136.
Suto, M., Takehara, K., Misago, C., & Matsui, M. (2015). Prevalence of perineal lacerations in women giving birth at midwife-led birth centers in Japan: A retrospective descriptive study. Journal of Midwifery & Women's Health, 60(4), 419-427.
Thornton, P., McFarlin, B. L., Park, C., Rankin, K., Schorn, M., Finnegan, L., & Stapleton, S. (2017). Cesarean outcomes in US birth centers and collaborating hospitals: A cohort comparison. Journal of Midwifery & Women's Health, 62(1), 40-48.
Tilden, E. L., Cheyney, M., Guise, J. M., Emeis, C., Lapidus, J., Biel, F. M., . . . Snowden, J. M. (2017). Vaginal birth after cesarean: Neonatal outcomes and United States birth setting. American Journal of Obstetrics & Gynecology, 216(4), 403.e401-403.e408.
van der Kooy, J., Birnie, E., Denktas, S., Steegers, E. A. P., & Bonsel, G. J. (2017). Planned home compared with planned hospital births: Mode of delivery and Perinatal mortality rates, an observational study. BMC Pregnancy & Childbirth, 17(1), 177.
van der Kooy, J., Poeran, J., e Graaf, J. P., Birnie, E., Denktass, S., Steegers, E. A., & Bonsel, G. J. (2011). Planned home compared with planned hospital births in the Netherlands: Intrapartum and early neonatal death in low-risk pregnancies. Obstetrics & Gynecology, 118(5), 1037-1046. doi: 10.1097/AOG.0b013e3182319737.
van Haaren-ten Haken, T. M., Hendrix, M., Smits, L. J., Nieuwenhuijze, M. J., Severens, J. L., e Vries, R. G., & Nijhuis, J. G. (2015). The influence of preferred place of birth on the course of pregnancy and labor among healthy nulliparous women: A prospective cohort study. BMC Pregnancy & Childbirth, 15, 33.
Wasden, S. W., Chasen, S. T., Perlman, J. M., Illuzzi, J. L., Chervenak, F. A., Grunebaum, A., & Lipkind, H. S. (2017). Planned home birth and the association with neonatal hypoxic ischemic encephalopathy. Journal of Perinatal Medicine, 45(9), 1055-1060.
Wiegerinck, M. M., van der Goes, B. Y., Ravelli, A. C., van der Post, J. A., Klinkert, J., Brandenbarg, J., . . . Mol, B. W. (2015). Intrapartum and neonatal mortality in primary midwife-led and secondary obstetrician-led care in the Amsterdam region of the Netherlands: A retrospective cohort study. Midwifery, 31(12), 1168-1176.
Wiegerinck, M. M. J., van der Goes, B. Y., Ravelli, A. C. J., van der Post, J. A. M., Buist, F. C. D., Tamminga, P., & Mol, B. W. (2018). Intrapartum and neonatal mortality among low-risk women in midwife-led versus obstetrician-led care in the Amsterdam region of the Netherlands: A propensity score matched study. BMJ Open, 8(1), e018845.


​The members recieved an orientation to this topic at the February 7, 2019 meeting.


​HERC reviewed the rescan report and recommendation from EbGS and requested that a new Coverage Guidance be developed on this topic in light of new evidence presented.

EbGS will be oriented to this topic at its February 7, 2019 meeting. Initial review of the draft coverage guidance is currently planned for the April 4, 2019 EbGS meeting.

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