Planned home birth: The main factors influencing the safety and accessibility of Home Birth in Brazil: An integrative review

Abstract

Introduction: Planned Home Birth (PBD) has gained prominence as an alternative to the hospital model, especially among women seeking greater autonomy and protagonism in the childbirth process. In Brazil, access to this modality is still limited, mainly due to the lack of public policies in the Unified Health System (SUS), socioeconomic inequality, and the shortage of qualified professionals. Objective: This is an integrative literature review aimed at analyzing the main factors influencing the safety and accessibility of PBD in the Brazilian context. Methods: Thirteen articles published between 2014 and 2024 were analyzed, extracted from the Scientific Electronic Library Online (SciELO), Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS), and the Nursing Database (BDENF). Results: The results indicate that PDP, when performed by trained professionals and with adequate infrastructure, is safe for low-risk pregnant women, with positive obstetric and neonatal outcomes. However, access to this modality is largely restricted to women from higher social classes, which reveals structural inequalities in the health system. The recent regulation of the role of obstetric nurses, through COFEN Resolution No. 737/2024, represents progress, but remains insufficient given the existing challenges. Conclusion: Strengthening professional training, expanding specific public policies, and valuing humanized care are essential to democratizing access to PDP in Brazil.