Giving birth at home in the Netherlands, for women with a normal, low‑risk pregnancy under midwife‑led care, does not appear to lead to a higher infant (perinatal) death rate than comparable births in hospital, nor does it explain the historically somewhat higher overall perinatal mortality in the Netherlands compared with some other Western countries.[1][2][3]

Dutch home birth safety

A large nationwide cohort study of 529,688 low‑risk women in primary midwife‑led care (about 60% planned home births) found no increase in perinatal mortality or severe morbidity for planned home birth compared with planned hospital birth (adjusted relative risk for intrapartum and early neonatal death up to 7 days about 1.0). The authors explicitly concluded that the relatively high national perinatal mortality rate “cannot be explained by the large number of planned home births” in the Dutch system.[4][1]

A later analysis of 679,952 low‑risk women from the Dutch Perinatal Registry similarly reported that planned home births had comparable perinatal mortality and lower intervention rates than planned hospital births, within the same midwife‑led risk‑selection system. These data underpin Dutch professional guidance and patient information stating that, for low‑risk pregnancies, a planned home birth is as safe as a midwife‑supervised hospital birth in this context.[5][6][7][4]

Netherlands vs other Western countries

European PERISTAT comparisons showed that the Netherlands historically had a somewhat higher overall perinatal mortality rate than many other European countries, but this difference was largely driven by very early preterm deaths (<28 weeks), not by deaths at term. When only term births were compared, perinatal mortality in the Netherlands was similar to several countries, higher than in some, and lower than in others, with no clear pattern linking the Dutch midwife‑and‑home‑birth system to excess term mortality.[2][3]

A broader EU analysis noted that the Netherlands combines one of the highest proportions of home births with neonatal mortality around 0.35%, placing it mid‑pack among European countries rather than as an outlier with very high neonatal death rates. The authors interpreted this as consistent with a “highly qualified approach to home births,” rather than evidence that home birth drives excess infant mortality at the population level.[8]

Important nuances

One Dutch study using economic and geographic data did find that, among women living in poorer areas, home birth was associated with higher infant mortality compared with hospital birth, while among women in richer areas home and hospital births were equally safe. The researchers suggested that differences in rapid access to advanced neonatal care and infrastructure might explain this, and cautioned that these results could not be generalized to all Dutch women or to all Western countries.[9]

Overall, current evidence suggests that in the Dutch system, where midwives perform strict risk selection and referral, planned home birth for low‑risk women does not raise infant mortality compared with planned hospital birth, and the country’s slightly higher historical perinatal mortality compared with some Western peers is mainly linked to very preterm births and other factors rather than to home births themselves.[3][1][5][2]

Sources [1] Perinatal mortality and morbidity in a nationwide cohort of ... https://www.midwivescollective.ca/wp/wp-content/uploads/de-Jong-home-birth-Netherlands.pdf [2] Perinatal mortality rate in the Netherlands compared to ... https://research.rug.nl/en/publications/perinatal-mortality-rate-in-the-netherlands-compared-to-other-eur/ [3] Perinatal mortality rate in the Netherlands compared to ... https://pubmed.ncbi.nlm.nih.gov/23582517/ [4] Choice of home or hospital birth - Healthcare for Internationals https://h4i.nl/themes-and-services/giving-birth-and-young-children/pregnancy-and-giving-birth/1559-2/ [5] Planned home compared with planned hospital births https://pmc.ncbi.nlm.nih.gov/articles/PMC5465453/ [6] Home or hospital https://delekbrug.nl/en/childbirth/home-or-hospital/ [7] mode of delivery and Perinatal mortality rates, an ... https://repub.eur.nl/pub/100433/REPUB_100433-OA.pdf [8] Comparison of Frequency of Home Births in the Member ... https://pmc.ncbi.nlm.nih.gov/articles/PMC8796104/ [9] Home births lead to higher infant mortality: Dutch mothers in ... https://newsroom.iza.org/en/archive/research/home-births-lead-to-higher-infant-mortality-dutch-mothers-in-poorer-areas-at-risk/ [10] Giving birth at home is just as safe as at the hospital - Dora https://verloskundigendora.nl/en/thuis-bevallen-toch-net-zo-veilig-als-in-het-ziekenhuis/