Effects of planned place of birth on obstetric interventions and foeto-maternal birth outcomes in low-risk women in European countries: A systematic review and meta-analysis

Abstract

Background The birthplace has long been a source of scholarly debate and societal discourse, with varying recommendations over time among low-risk women. This systematic review and meta-analysis explore the intricate relationship between birthing place, obstetric interventions, and foeto-maternal outcomes in low-risk women in European countries. Methods We used our registered protocol (PROSPERO CRD42023439378) and searched seven databases. Cochrane software for systematic reviews (COVIDENCE) was used for full-text screening and extraction. Using RevMan version 5.4.1, we obtained pooled estimates of effect accounting for the level of integration and parity. Results The review includes 21 studies involving nearly 750,000 women and discovers no maternal deaths. At the same time, there is limited evidence of statistically significant differences in perinatal mortality by birthplace and parity. Women planning home births have a 76% lower likelihood of Caesarean section in “well-integrated” settings, a 29% lower likelihood of assisted vaginal birth, a 66% lower likelihood of epidural analgesia, and a 59% lower likelihood of retained placenta. In contrast, in “less well-integrated” settings, the likelihood of Caesarean sections rose by 69%, assisted vaginal births by 59%, and 3rd or 4th-degree perineal tears by 63%, and the study does reveal noteworthy trends. Conclusions The planned birthplace appears to affect the incidence of obstetric interventions among low-risk women in European countries. While perinatal mortality shows no statistically significant variation, the study highlights distinct outcomes in “well-integrated” versus “less well-integrated” settings, emphasising the importance of birthplace in maternity care decision-making.