I would tend to disagree.
There is a significant difference between something carrying an element of risk and something being inherently unsafe.
Safe maternity care isn’t about being physically in a hospital. It’s about appropriate risk assessment, skilled and experienced midwives, recognising deviations from normal physiology, and identifying when additional monitoring or medical intervention is required. Very often, complications don’t arise suddenly. There may be subtle changes in observations, or even behaviour, that prompt a recommendation for transfer. This is precisely why planned home births should be attended by qualified midwives, with pathways for escalation and transfer to hospital.
Obviously, there are occasions when serious emergencies occur suddenly, without any identifiable warning signs. In those circumstances, immediate access to hospital care can be life saving. I don’t think anyone should pretend otherwise. But neither should we pretend that being in hospital eliminates the possibility of an adverse outcome.
Labour and birth are not neatly defined periods of predictable risk. Complications can occur during the latent phase, established labour, second stage, immediately after birth or during the postnatal period. We don’t routinely admit women to hospital at term simply because labour could begin, and women planning hospital births don’t all arrive at the same stage of labour. Some will labour at home for many hours, others will arrive just before delivery, and some won’t make it through the hospital doors before giving birth. There is no magical point at which simply entering a hospital makes childbirth safe.
We actually have evidence on this. NICE guidance recognises that, for low-risk women who have previously given birth, planned home birth is associated with fewer interventions and no difference in serious outcomes for babies compared with planned obstetric-unit birth. For first-time mothers, the evidence does identify a small but important increase in serious adverse neonatal outcomes with planned home birth, and that absolutely deserves honest discussion with women who choose Homebirth.
I’m not arguing that home birth is appropriate for everybody, or that the location of birth never matters. Obviously it does. Individual risk factors, clinical circumstances, local services and access to emergency care are all important considerations.
But describing all home births as unsafe is an extraordinary oversimplification. It dismisses the evidence, the expertise of midwives, the importance of ongoing clinical assessment and, ultimately, women’s ability to make informed decisions about their own maternity care. Taking that choice away from women is simply paternalistic.