# Midwife-Led Home Births in Japan: A 25-Year Retrospective Analysis of Care in Accordance with WHO Recommendations Before and After COVID-19

## TL;DR

Midwife-led home births in Japan largely followed WHO guidelines for 25 years, with notable changes in maternal and neonatal factors after the pandemic.

## Contribution

This study provides a 25-year retrospective analysis of midwife-led home births in Japan, assessing adherence to WHO recommendations and pandemic-related changes.

## Key findings

- Midwife-led home births in Japan aligned with 16 of 25 WHO intrapartum care recommendations.
- Post-pandemic, maternal age and neonatal birth weight increased significantly.
- Midwife-led care supported positive perinatal outcomes and physiological birth processes.

## Abstract

What are the main findings?
Midwife-led planned home births in Japan aligned with 16 of 25 applicable WHO intrapartum care recommendations, indicating substantial adherence to international standards over 25 years.Maternal age, gestational weight gain, and neonatal birth weight shifted significantly following the COVID-19 pandemic.

Midwife-led planned home births in Japan aligned with 16 of 25 applicable WHO intrapartum care recommendations, indicating substantial adherence to international standards over 25 years.

Maternal age, gestational weight gain, and neonatal birth weight shifted significantly following the COVID-19 pandemic.

What are the implications of the main findings?
Independent midwives in Japan provide safe, evidence-based, woman-centered care, supporting physiological birth and positive perinatal outcomes in planned home births.Pandemic-related changes in maternal characteristics highlight the need for adaptable community-based perinatal support in Japan’s evolving maternity care system.

Independent midwives in Japan provide safe, evidence-based, woman-centered care, supporting physiological birth and positive perinatal outcomes in planned home births.

Pandemic-related changes in maternal characteristics highlight the need for adaptable community-based perinatal support in Japan’s evolving maternity care system.

Background/Objectives: In Japan, hospital births predominate, with home births comprising only 0.1% of deliveries. This study assessed how documented practices for planned home births attended by independent midwives align with national guidelines and WHO intrapartum care recommendations, and assess maternal and neonatal differences before and after the COVID-19 pandemic. Methods: Records of 430 low-risk pregnant women who received continuous care at a private midwifery home over 25 years were reviewed. After excluding 8 maternal and 22 neonatal transfers, 400 records were analyzed. Descriptive statistics were compared with WHO recommendations and between the pre-pandemic (1999–2019) and post-pandemic (2020–2024) periods. Results: All women experienced spontaneous singleton cephalic labors with intermittent fetal heart rate auscultation. The mean gestational age was 277.3 days and the median labor duration was 303.5 min. Labor onset was spontaneous in 83.5% of cases. Nearly half of the women had no perineal lacerations. Postpartum blood loss ≥500 mL occurred in 14.1% of cases. Family presence was nearly universal. Neonates had a mean birth weight of 3129.0 g and high Apgar scores. Skin-to-skin contact occurred in 52.9%; exclusive breastfeeding reached 93.8% at 1 month. Post-pandemic births showed higher maternal age and higher neonatal birth weight, although these differences should be interpreted cautiously due to the small post-pandemic sample. Conclusions: Independent midwives provided evidence-based, physiologically oriented care, partially aligning with selected WHO intrapartum recommendations during planned home births. Midwife-led home births may support positive childbirth experiences and favorable maternal/neonatal outcomes for low-risk women. Post-pandemic shifts underscore the need for continued monitoring and flexible, community-based perinatal support, while recognizing the limitations of retrospective, single-site data.