There is no risk-free setting for giving birth, whether at home, a birth center or a hospital, according to a report released today by the National Academies of Sciences, Engineering, and Medicine. Each birth setting has both risks and benefits, the study committee found. 

The vast majority of U.S. women – nearly 98.4% – give birth in a hospital, but more women are choosing to give birth at home or in birth centers and should have access to an informed choice of settings, the authors said. The report calls for adequate payment and access to health coverage, and investments in the newborn and maternity care workforce, to support a range of maternity care options. 

Low-risk births that occur in birth centers have a slightly increased risk of poor neonatal outcomes, and similar to slightly elevated rates of neonatal mortality compared with hospital births, the study found. It also found increased risk of neonatal death in home births compared with births in a hospital, although the magnitude of the difference was difficult to assess given flaws in the underlying data. 

Integrating home and birth center settings into a regulated maternity and newborn care system may improve maternal and neonatal outcomes in those settings, the authors said. Hospital participation in quality improvement initiatives, such as the Alliance on Innovation in Maternal Health, and adoption of national standards and guidelines also can improve outcomes for women and newborns, they said. 

For more on how hospitals are working to advance better health for mothers and babies, visit https://www.aha.org/better-health-for-mothers-and-babies.

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