For healthy women with low-risk pregnancies the incidence of adverse perinatal outcomes is low in all birth settings. However, for those who are nulliparous the risk of an adverse outcome appears to be higher for births planned at home, a national cohort study has found. There was also a high intrapartum transfer rate. Over a two-year period nearly 65,000 women ‘attended by an NHS midwife during labour in the planned place of birth’ were enrolled in the Birthplace in England national prospective cohort study. Dr Chris Barclay, GP with an interest in O&G, Suffolk, reviews the study. He concludes: 'So, where is the best place to give birth? The answer appears to be that it depends on the presence of pre-existing risk factors and maternal preference. The outcomes in the midwifery units were very reassuring. However, the significantly higher figures for adverse perinatal outcomes and transfer during or just after labour from home to an obstetric unit in nulliparous cases opting for a home birth is food for thought.'