Development of the evidence-based guidelines for home birth in Switzerland: Results from a Delphi process

In Switzerland, the right to a home birth is enshrined in law, and the associated costs are reimbursed by the national health insurance system. However, the conditions under which such births should occur remain unregulated at the national level, with no shared criteria for determining eligibility across the country. The aim of this project is to develop national guidelines to define criteria under which pregnant women would be ineligible for a planned home birth.

A four-phase process was conducted, combining scientific evidence and expert consensus. It began with a systematic review of international home birth guidelines, conducted across five guideline specific databases and registries, complemented by a manual search. Subsequently, the identified criteria were submitted to expert classification by experienced Swiss home birth midwives through an online survey and three regional Delphi inspired workshops. Finally, the draft guideline was circulated to all members of the Swiss Federation of Midwives (SFM) for national consultation.

The systematic search identified 262 records, of which 249 were screened and 42 assessed in full text. Nine guidelines met the inclusion criteria, from which 97 unique ineligibility criteria were extracted. Thirty Swiss clinical midwives participated in the classification phase, resulting in a four category structure distinguishing absolute ineligibility from situations requiring individual assessment. The national consultation generated 433 responses, leading to refinements and clarification of several criteria. The final guidelines comprise 97 criteria, supported by structured decision making pathways. These criteria include both medical conditions (e.g. unmanaged hypertensive disorders) and contextual factors requiring individual assessment (e.g. history of a previous baby >4500 g).

This policy initiative has led to the first nationally endorsed home birth guidelines in Switzerland. Built on scientific evidence and clinical consensus, these guidelines provide a harmonized framework to support safety and professional autonomy in midwifery practice.