Objective:

To compare maternal and peri/neonatal mortality and severe morbidity in planned midwife-assisted home/FMU births with obstetric team-assisted births at the hospital in strictly defined expected low-risk births in high-income countries.

Approach:

• Study Design: Systematic review based on a Health Technology Assessment (HTA) report, preregistered and conducted in accordance with PRISMA 2020 guidelines.
• Eligibility Criteria: Included studies comparing planned midwife-assisted home/FMU births with planned obstetric unit births among women with expected low-risk births, published after 2004.
• Search Strategy: Comprehensive literature search conducted by experienced medical librarians across multiple databases, with independent screening by authors.

Key Findings:

• Planned out-of-hospital births have been associated with fewer obstetric interventions and higher maternal satisfaction.
• Conflicting results exist regarding neonatal outcomes in planned out-of-hospital births, particularly concerning peri/neonatal mortality.
• Previous reviews lacked applicability to strictly defined low-risk populations and included diverse healthcare systems.

Interpretation:

Uncertainty persists regarding the safety of planned out-of-hospital births for strictly defined low-risk populations in high-income countries.

Limitations:

• Previous studies included midwife-led hospital settings, complicating comparisons.
• Variability in definitions of low-risk births and healthcare systems across studies.

Conclusion:

A rigorous synthesis of evidence is needed to clarify maternal and peri/neonatal risks and benefits.

Sources:

• Health Technology Assessment Report