NEW YORK (Reuters Health) - A planned home birth is as safe as a planned hospital birth, provided that a well-trained midwife is available, a good transportation and referral system is in place, and the mother has a low risk of developing any complications, new research shows.

"Low-risk women should be encouraged to plan their birth at the place of their preference, provided the maternity care system is well equipped to underpin women's choice," Dr. A. de Jonge, from TNO Quality of Life, Leiden, the Netherlands, and co-researchers note in BJOG: An International Journal of Obstetrics and Gynaecology.

Data regarding the safety of home births in low-risk women are lacking, due in part to the fact that studies with very large sample sizes are needed to assess relatively rare adverse outcomes. Moreover, assigning women randomly to home or hospital births, which would make for a better study, is not possible ethically because women usually want to choose their place of birth, the authors explain.

The present study, an analysis of more than a half million low-risk planned births, was conducted in the Netherlands. Low-risk meant that women had not given birth via cesarean section before, had not had complications of delivery on previous births, and were between 37 and 42 weeks of pregnancy at delivery.

The group included more than 300,000 women who wanted to give birth at home, more than 160,000 who planned to give birth in the hospital, and more than 45,000 with an unknown intended place of birth.

The numbers of maternal and fetal deaths in both the home and hospital birth groups was very small, and essentially equal, as was admission to a neonatal intensive care unit.

"As far as we know, this is the largest study into the safety of home births," the authors note.

The findings, they conclude, indicate that with proper services in place, home births are just as safe as hospital births for low-risk women.

SOURCE: BJOG: An International Journal of Obstetrics and Gynaecology, August 2009.