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

Problem As planned home birth becomes more common, understanding transfer pathways and outcomes is essential. Background National data on planned home birth remain limited across Europe. Ireland's national home birth service enables evaluation of trends, transfers and outcomes. Aim To examine the incidence, care pathways and outcomes of women registered for a home birth in Ireland between 2012 and 2022. Methods Retrospective national clinical audit of 3046 women registered with the National Home Birth Service. Home birth incidence was described, and multinomial logistic and Poisson regression analyses examined factors associated with transfers and maternal and neonatal outcomes. Findings Home birth registrations increased from 3.47 to 8.22 per 1000 maternities. However, antepartum transfers increased from 18% to 32%, reducing the proportion of women who completed a home birth. Among women who laboured at home, 19.4% required intrapartum transfer. Transfer was more likely among women aged ≥ 35 years, nulliparous women, smokers, women of non-White ethnicity, those with BMI ≥ 30 kg/m², and in preterm or post-term pregnancies. Women requiring transfer experienced greater blood loss, more episiotomies and maternal complications. Their infants had lower Apgar scores, were more likely to require resuscitation, and were less likely to be exclusively breastfed at discharge. Discussion Increasing home birth registrations were accompanied by higher antepartum transfer rates. Maternal and pregnancy characteristics associated with transfer may inform referral pathways and service planning. Conclusion Home birth registrations increased over the study period. Understanding factors associated with transfer may improve care pathways, support informed decision-making, and strengthen integrated home-birth services.