Assessing relative risks and outcomes of home births vs. transfers in low-risk pregnant women in Ireland: a decade-long retrospective analysis (2012-2022)

Objective: : To examine the incidence, care pathways, and outcomes of women registered for a home birth in Ireland from 2012 to 2022. Design: : Retrospective national clinical audit. Setting: : The National Home Birth Service in Ireland. Population : A total of 3,046 women who registered for a home birth between January 1, 2012, and December 31, 2022. Methods: : Home birth incidence and geographical distribution described, and multinomial logistic regression and Poisson regression used to examine factors associated with transfers and maternal/neonatal outcomes. Main Outcome Measures : Incidence of home birth registration, transfer rates, maternal and neonatal outcomes, and risk factors associated with transfers. Results: : From 2012-2022, home birth registrations increased from 3.47 to 8.22 per 1,000 maternities. However, the likelihood of home birth completion decreased due to increased antepartum transfers (18% 2012-2014 to 32% 2021-2022). Among those who laboured at home (74.4% of registrations), 19.4% required intrapartum transfers. Higher antepartum and/or intrapartum transfer risks were observed in women over 35, nulliparous, smokers, non-white ethnicities, and those with BMI ≥30 kg/m 2 . Both transfers were more frequent in preterm/post-term pregnancies and lower birth weight cases. Transferred women had increased blood loss, episiotomies, and maternal complications. Their infants had lower Apgar scores, higher resuscitation needs, and were less likely to be exclusively breastfed at discharge. Conclusions: : Home birth registrations have increased, and transfers remain influenced by maternal and pregnancy-related factors and are associated with increased risk. Understanding these factors can help improve care pathways and inform home birth policies.