Women’s Health
Maternal and Neonatal Outcomes by Birth Setting: Planned Home Births vs. Hospital Births Carissa Rodriguez* Carissa Rodriguez Tennessee Department of Health
Background: Home births have increased in the U.S. over the past two decades, partly due to low intervention rates and patient perceptions of birth safety. This analysis compares maternal and neonatal outcomes for planned home vs. hospital births.
Methods: Using Tennessee birth certificate data (2012–2022) and linked birth-death certificate data (2012–2021), we excluded unplanned home births, births whose status regarding intention was unknown, and births in other settings. Hospital births excluded transfers. Analyses included in-state residents, singletons, and term births (≥37 weeks). Chi-square and Fisher’s exact tests were used to assess birth outcomes.
Results: Among 673,193 births, 1.27% were planned home births. Home births had fewer interventions, including induction (0.63% vs. 39.50%), augmentation (1.16% vs. 22.65%), and perineal lacerations (0.32% vs. 1.06%), and more vaginal deliveries (99.89% vs. 67.58%; p < .0001 for all). Neonatal outcomes varied: Apgar <7 (1.63% vs. 1.33%, p=.02), seizures (0.09% vs. 0.02%, p<.0001), and ventilation (3.75% vs. 3.21%, p=.01) were higher for home births, while NICU admissions were lower (1.25% vs. 3.83%, p<.0001). No significant differences in early neonatal or neonatal deaths; infant deaths were slightly lower for home births (0.16% vs. 0.29%, p=.05).
Conclusions: Planned home births show fewer maternal interventions but mixed neonatal outcomes. Several factors contribute to favorable home birth outcomes, including reliable access to safe and timely transportation to hospitals. To ensure that newborn screening is conducted promptly for home births, the Tennessee Department of Health added home birth tracking to its Newborn Screening Dashboard. Additionally, the state is enhancing its perinatal regionalization guidelines to include standards for neonatal resuscitation training and has funding for three years of statewide perinatal telehealth projects to develop or expand telehealth services.