OBJECTIVE:
The aim of this population-based study was to measure the risk of adverse outcome for mother and child in planned homebirths in a Swedish population irrespective of where the birth actually occurred, at home or in hospital after transfer.

DESIGN:
A population-based study using data from the Swedish Medical Birth Register.

SETTING:
Sweden 1992-2004.

PARTICIPANTS:
A total of 897 planned homebirths were compared with a randomly selected group of 11,341 planned hospital births.

MAIN OUTCOME MEASURES:
Prevalence of mortality and morbidity among mothers and children, emergency conditions, instrumental and operative delivery and perineal lacerations were compared.

RESULTS:
During this period in Sweden the neonatal mortality rate was 2.2 per thousand in the homebirth group and 0.7 in the hospital group (RR 3.6, 95% CI 0.2-14.7). No cases of emergency complications were found in the homebirth group. The risk of having a sphincter rupture was lower in the planned homebirth group (RR 0.2, 95% CI 0.0-0.7). The risk of having a cesarean section (RR 0.4, 95% CI 0.2-0.7) or instrumental delivery (RR 0.3, 95% CI 0.2-0.5) was significantly lower in the planned homebirth group.

CONCLUSION:
In Sweden, between 1992 and 2004, the intrapartum and neonatal mortality in planned homebirths was 2.2 per thousand. The proportion is higher compared to hospital births but no statistically significant difference was found. Women in the homebirth group more often experienced a spontaneous birth without medical intervention and were less likely to sustain pelvic floor injuries.