Let’s cut to the chase: the answer is yes and no, depending on your source of information.

Who is saying no? In America, that would be hospitals, the American College of Obstetrics and Gynecology, and studies like a recent unpublished one from the University of Texas, presented at a May 2009 conference. The authors claim the risk of neonatal death at home is around 0.1 percent, compared to .06 percent in hospitals.

Now, who is saying yes? Organizations like Citizens for Midwifery, the National Association of Certified Professional Midwives—and a new study from the Netherlands published in the British Journal of Obstetrics and Gynaeology, which found no difference between mothers and babies in death rates of mothers or babies in 530,000 births. (A study published in 2005 in the British Medical Journal that investigated over 5,000 births in the U.S. and Canada, also found home births with low rates of medical intervention to be safe for low-risk women.)

How can the answer be both yes and no? Why wouldn’t everyone be on the same page when it comes to the safety of birth, for both mother and child? Let’s look at the new study from the Netherlands first.

That study found that home birth was as safe as hospital birth for low-risk women—news that was perhaps not met by surprise given that roughly a third of Dutch women opt to give birth at home. The BBC reported that British physicians met the news with measured enthusiasm, emphasizing that women needed to be counseled on possible emergencies; still, the Royal College of Obstetricians and Gynaecologists supports home births “in the case of low-risk pregnancies provided the appropriate infrastructures and resources are present to support such a system.”

It’s a different story when it comes to official support in the U.S. Even though 26 U.S. states license certified professional midwives to attend home births, the American College of Obstetrics and Gynecologist does not have a similar stance as the RCOG. “The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births,” reads the organization’s Statement on Home Birth, released last year. “While childbirth is a normal physiologic process that most women experience without problems, monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies.”

What did ACOG think of the Netherlands study? The organization referred me to Dr. Erin Tracy, an attending physician at Massachusetts General Hospital and assistant professor at Harvard Medical School.

“I agree with the American College of Obstetrics and Gynecology’s and the American Medical Association’s position that the safest place for a delivery is in a hospital,” she said.

While she says that home birth should not be “criminalized,” that practice is “potentially dangerous.” The Netherlands study isn’t really applicable to the U.S., she says, because the research took place in a country where significantly more women choose to have home birth, leading to a greater support system for home birth, including more efficient back-up transportation to hospitals.

She has heard “horror stories” of home birth from her colleagues, and is concerned that midwives, who are not required to attend the same amount of schooling as an obstetrician, won’t be able to recognize emergency situations in time. It’s true that most babies having home birth will have good outcomes, she says, but things can go wrong very quickly.

“I focus on the nature of obstetrics and the complications that are unpredictable but devastating,” she says. “The individual mother’s birth experience is important…but patient safety is our focus.”

Proponents of home birth say that safety is their focus, too—and that home birth is far more safe than obstetricians realize.

“We all eat food everyday,” says Susan Hodges, president of Citizens for Midwifery, who steadfastly refers to birth as a normal, every day bodily function. “Every once in awhile, someone chokes on the food…but we don’t say that you can’t eat a meal unless you’ve got a trained doctor sitting next to you in case you choke.”

In hospitals, she says, it usually takes around 30 minutes “from decision to incision” in an emergency—the same amount of time that it takes to get to a hospital from home in most places in the country, she says.

And if midwives are in good standing at a hospital (a common occurrence, she says), she can very quickly get back-up transportation. Midwives who are trained in national certification processes recognize disasters quickly aren’t going to put anyone at unnecessary risk. “Midwives screen the mothers,” she says. “If someone comes in with a medical condition that is a problem, the midwife will say that home is not the best place to give birth.”

Hodges says that routine medical intervention—like artificial induction and epidurals—in hospitals can actually lead to more danger, such as sudden fetal distress, uterine rupture or umbilical cord prolapse.

“Obstetricians will say, ‘everything can look good but can be a disaster in seconds,’” she says. “Obstetricians have not seen normal birth…obstetricians today for the most part have never seen a normal birth. They’ve seen women on drugs, and their experience in seeing disasters is in mothers confined and on drugs…it’s not because birth is intrinsically dangerous for lots of women, it’s because women are suffering complications from drugs.”

And that aforementioned University of Texas study? Since it hasn’t been peer-reviewed or published, it’s hard to know anything other than the fact that researchers haven’t proven a causal effect, says Hodges. When a baby dies during birth, it is “a rare event,” she says, and you’d need huge numbers to even detect it. (To read Hodges’ remarks on a similar study performed in Washington State that found babies born at home more likely to die, read here.)

“I think many obstetricians truly believe that birth outside the hospital is dangerous because they’ve been taught that,” she says.

But Tracy says that doctors only have their patients’ best interests at heart.

“Patients have stopped trusting doctors, but we have a lot of training and read the literature,” she says. “One of the most discouraging things for obstetricians is that it’s become an issue of women’s choice and empowerment, with the implication that doctors are against that, which is the farthest thing from the truth.”