Women who plan home births recover more rapidly from childbirth, but there is a higher risk of their child dying, an international study suggests.
US analysis of more than 500,000 births in North America and Europe found death rates for babies in planned home births were double that of those in planned hospital births.
But the risk was still low, at 0.2%.
UK doctors said the evidence needed to be taken into account, but a midwives' body questioned its relevance.
The research, published in the American Journal of Obstetrics and Gynaecology, examined studies on the relative safety of planned home and hospital births from around the world.
Researchers looked at data from nearly 350,000 planned home births and more than 200,000 planned hospital deliveries.
Crucially, it looked at where the woman had planned to give birth, rather than the actual birthplace.
The researchers argued that the safety of home births may have previously been overplayed by the fact that when there are complications and a woman is rushed to hospital, any adverse outcome is recorded as a hospital birth.
Rates of home birth vary across the developed world. In the Netherlands a third of women deliver at home, while in the US around one in 200 women do so.
The researchers described their findings of a doubling of the risk of neonatal mortality among those planning home birth as "striking", because it is often those with the lowest risk of complications who do not need to deliver in hospital. When researchers took out babies with congenital abnormalities, the risk was threefold.
When deaths occurred among the home birth group, they were overwhelmingly attributed to respiratory problems during birth and failed attempts at resuscitation.
Overall these problems have been decreasing in recent decades, which is thought to be down to greater medical intervention, including more liberal use of ultrasound, electronic fetal heart monitoring, the induction of labor and cesarean delivery.
But the lack of medical intervention may explain why the mothers who planned a home birth tended to end up with fewer tears or lacerations, fewer cases of postpartum haemorrhage and fewer infections.
But the researchers suggested these benefits did come at a cost.
"Women choosing home birth, particularly low-risk individuals who had given birth previously, are in large part successful in achieving their goal of delivering with less morbidity and medical intervention than experienced during hospital-based childbirth," said lead author Dr Joseph Wax from the Department of Obstetrics and Gynaecology at Maine Medical Center.
"Of significant concern, these apparent benefits are associated with a doubling of the neonatal mortality rate overall and a near tripling among infants born without congenital defects."Source