Model of planned home birth care in Brazil: A scoping review

Key findings from this study

This research indicates that:

• Planned home birth in Brazil operates outside formal health regulation despite growth in demand and international evidence of safety.
• Nurse-midwife and midwife autonomy and expertise are central to safe planned home birth delivery in the Brazilian context.
• National protocols, standardised guidelines, and hospital service integration are absent, creating barriers to legitimacy and sustainability.

Overview

This scoping review examined the scientific literature on planned home birth care provided by nurse-midwives and midwives in Brazil between 2012 and 2023. Brazil lacks formal regulation and national guidelines for home birth, unlike England, Canada, and the Netherlands. Hospital births account for 99.3% of deliveries in Brazil, yet planned home birth has emerged as a growing alternative outside the formal health system.

Methods and approach

A scoping review following JBI Reviewer's Manual methodology searched eight databases and national thesis repositories between January and February 2024, with updates in December 2024. Inclusion criteria specified nurse-midwives and midwives as the population, childbirth care models as the concept, and planned home births in Brazil as the context. Thirteen studies published between 2012 and 2023 were included, involving 124 nurse-midwives and one midwife.

Results

The review identified seven major finding categories: care process, team composition, materials, protocols, good practice indicators, evaluation indicators, and professional experience. Planned home birth practice in Brazil remains largely outside formal health system integration despite international evidence supporting its safety. The expansion of this care model demonstrates nurse-midwife and midwife autonomy in managing physiological processes, yet significant structural barriers persist.

Key barriers to establishing planned home birth as a regulated service include absence of national protocols, difficulty accessing supplies, and poor integration with hospital services. The findings illustrate a gap between existing practice and formal recognition within Brazil's public health infrastructure. Professional expertise and care coordination among nurse-midwives and midwives represent the primary mechanisms enabling safe deliveries in this context.

Implications

National policies and standardised clinical guidelines are essential to legitimize and strengthen planned home birth care in Brazil. Development of such frameworks would establish accountability, ensure consistent safety standards, and enable systematic integration with hospital services for emergencies. Formalizing this care model could expand access while maintaining the physiological approach that characterizes current practice.

Systematic regulation would address current supply chain vulnerabilities and create pathways for professional recognition and liability protection. Evidence from England, Canada, and the Netherlands demonstrates the feasibility of integrating home birth into public health systems while maintaining safety outcomes. Brazil's policy framework must balance support for nurse-midwife and midwife autonomy with institutional accountability and clinical standardization.

Scope and limitations

This summary is based on the study abstract and available metadata. It does not include a full analysis of the complete paper, supplementary materials, or underlying datasets unless explicitly stated. Findings should be interpreted in the context of the original publication.