Planned Home Birth and the Role of Specialist Nurses in Maternal and Obstetric Care: A Rapid Literature Review of Maternal and Neonatal Outcomes

Abstract

Abstract. Introduction: The increasing medicalization of childbirth in high- income countries has prompted renewed interest in planned home birth as an alternative for women with low-risk pregnancies. International evidence suggests that home birth may be a safe option when integrated into organized healthcare systems and attended by qualified professionals. Specialist nurses and midwives play a central role in ensuring safety, quality of care, and continuity across birth settings; however, their specific contributions in planned home birth require further synthesis. Objective: To systematically review the evidence on maternal and neonatal out- comes associated with planned home birth and to examine the role of specialist nurses in maternal and obstetric health in delivering care, promoting safety, and ad-dressing challenges in this setting. Methods: A rapid literature review was conducted following PRISMA guidelines. Searches were performed in PubMed, CINAHL, and Web of Science for studies published between 2021 and 2025. Observational, qualitative, mixed-methods studies, and randomized controlled trials addressing planned home birth attended by nurses or midwives were included. Outcomes of interest comprised maternal and neonatal outcomes, quality of care, professional contributions, and systemic challenges. Methodological quality was assessed using the AMSTAR-2 tool. Results: Seventeen studies from Europe, North America, South America, and Aus- tralia were included, predominantly involving women with low-risk pregnancies. Planned home birth attended by specialist nurses or midwives was generally asso- ciated with maternal and perinatal outcomes comparable to planned hospital birth, alongside significantly lower rates of obstetric interventions, including cesarean section, instrumental delivery, episiotomy, epidural analgesia, and labor augmen- tation. Maternal morbidity was reduced, particularly among multiparous women, with no consistent increase in maternal or neonatal mortality. Specialist nurses contributed to quality of care through comprehensive risk assessment, support of physiological birth, continuity of care, informed decision-making, early identifi- cation of complications, and timely referral to hospital services when required. Key challenges included limited integration into public health systems, regulatory barriers, variability in transfer protocols, and sociocultural resistance to home birth.