Twelve studies were included and provided data on 342,056 planned home deliveries and 207,551 planned hospital deliveries. There was one randomised controlled trial, five population-based cohorts (two with matched controls), four prospective cohorts (one with matched pairs), one matched cohort and one prospective cohort.
Maternal interventions: Compared with planned hospital births, significantly fewer mothers who had planned home births had epidural analgesia during labour (OR 0.24, 95% CI 0.22 to 0.25), electronic fetal heart rate monitoring (OR 0.10, 95% CI 0.09 to 0.10), episiotomy (OR 0.26, 95% CI 0.24 to 0.28), operative vaginal delivery (OR 0.26, 95% CI 0.24 to 0.28) and caesarean delivery (OR 0.42, 95% CI 0.39 to 0.45). There was statistically significant heterogeneity in all analyses.
Maternal outcomes: Compared with planned hospital births, significantly fewer mothers who had planned home births experienced ≥3-degree laceration (OR 0.38, 95% CI 0.33 to 0.45), infection (OR 0.27, 95% CI 0.19 to 0.39), postpartum bleeding or haemorhage (OR 0.66, 95% CI 0.61 to 0.71), perineal laceration (OR 0.76, 95% CI 0.72 to 0.81), vaginal laceration (OR 0.85, 95% CI 0.78 to 0.93) and retained placenta (OR 0.65, 95% CI 0.51 to 0.83). There was no statistically significant difference between groups in cord prolapse. There was statistically significant heterogeneity for the analyses of ≥3-degree laceration, postpartum bleeding, perineal laceration and retained placenta. Four studies reported no maternal deaths, hence meta-analysis was not performed for this outcome.
Neonatal outcomes: Compared with offspring of planned hospital births, offspring of planned home births were significantly less likely to be premature at less than 37 weeks (OR 0.72, 95% CI 0.55 to 0.96), low birth weight at less than 10% for gestational age or less than 2,500g (OR 0.60, 95% CI 0.50 to 0.71) and were more likely to be delivered at 42 weeks or more. Except for the low birth weight analysis, there was statistically significant heterogeneity.
There was no statistically significant difference between groups in perinatal death rate (OR 0.95, 95% CI 0.77 to 1.18) based on 507,109 participants, but the neonatal death rate was significantly higher in the planned home birth group (OR 1.98, 95% CI 1.19 to 3.28) based on 49,802 participants; this was higher when only offspring without congenital defects were included (OR 2.87, 95% CI 1.32 to 6.25).