Over the past few decades, many developed countries have experienced sharp rises in home birth rates. While the number of home births in most of these countries remains low, the trends are striking. For example, home births in the U.S. increased by almost 30 percent between 2004 and 2009. Similarly, the fraction of home births in the UK almost tripled between 1990 and 2006 and out-of-hospital births in Canada more than quadrupled between 1991 and 2009.

Despite these trends, there is still a lot of controversy among scientists and the media on the risks associated with home births. This prompted us to investigate the impact of home births on the short-term health of newborns. We found evidence that hospital births were significantly safer in terms of infant mortality but only for those women in the poorer half of the population. For richer women, giving birth at home was just as safe.

Our study used data on 356,412 Dutch women deemed to be in the low-risk pregnancy category who delivered between 2000 and 2008. The Netherlands is an ideal setting to study this question because it is the only developed country where home births are widespread: between 2000 and 2008, about 25 percent of births took place at home.

In addition, the Dutch institutional setup allows us to investigate place-of-birth effects (home versus hospital) independently from provider-effects (obstetrician versus midwife). This is because Dutch maternity care is based on a system of risk selection where low-risk women can choose between a home or a hospital birth and in both cases the delivery is supervised by a midwife without a doctor being present. In contrast, high-risk women are always required to give birth in a hospital under the supervision of an obstetrician.

The Netherlands is a country where the childbirth system is a major policy issue because the Dutch mortality rate within the first seven days of life (seven-day mortality) is one of the highest in Europe and the contribution of home births to this is hotly debated.