Babies born outside hospitals

Geneva in 2061

Most babies in Geneva are born in calm, homely birth centres run by midwives in every neighbourhood, or at home for families who choose it. Birth is treated as a natural event rather than a medical procedure, at its own pace and on its own day of the week. Skilled emergency care is always within a few minutes for the rare births that need it.

Geneva today

• One birth in three in Switzerland is by caesarean section (34% in 2023), which places the country among those with the most caesareans in Europe. Geneva’s rate is lower, at 29%, down 4.2 points in ten years (same source).
• Half of all births now take place under epidural anaesthesia, against 38% in 2014 (same source).
• Hospitals record about 30% more births on weekdays than at weekends, because most planned caesareans and inductions are scheduled during the week. In birth centres, births are spread evenly over the week (same source).

Where it is already done

• England studied almost 65,000 low-risk births in the Birthplace study. Births planned in midwife-led units were as safe for the baby as births planned in hospital obstetric units, with substantially fewer interventions and caesareans. For second and later babies, planned home births were equally safe. For first babies, a planned home birth carried a higher risk for the baby (9.3 against 5.3 adverse outcomes per 1,000 births), so birth centres are the safer choice for first-time mothers.
• The Netherlands has a long tradition of home births: they accounted for 35% of births in the 1990s and still for 13% in 2015, within a system where healthy women are cared for by independent midwives.
• The World Health Organization recommends waiting at least one minute before clamping the umbilical cord. The blood that keeps flowing from the placenta improves the baby’s iron stores for up to six months after birth; in the studies reviewed, babies whose cord was clamped early were more than twice as likely to be iron deficient at three to six months.

A Pattern Language

Related patterns from the book A Pattern Language by Christopher Alexander and colleagues (1977), a classic of architecture and town planning.

• 65 Birth places: Alexander and his colleagues argue that birth belongs in a homely setting rather than a hospital ward: small birth places organised around the mother and her family, supported by midwives.

How far along

Done somewhere A city or country already does it. Geneva only needs to adapt it.

The path to 2061

Milestones proposed for discussion.

1. 2027Geneva publishes yearly figures on place of birth, inductions and caesareans, and every pregnant woman is informed about all her options, including birth centres and home birth.
2. 2031Midwife-led birth centres are available across the canton, each linked to a hospital for fast transfer, and fully covered by health insurance.
3. 2041Half of low-risk births take place in birth centres or at home; induction and caesarean rates fall steadily.
4. 2051Births are spread evenly over the week again, following their own rhythm rather than hospital schedules.
5. 2061Babies in Geneva are born in calm, homely places, with emergency care within minutes for the rare births that need it.

What moves it

Human needs it serves

Open questions

• How can births outside hospital be made as safe as possible for first babies, where planned home births carry a higher risk?
• Why is labour induced so much more often in Geneva than elsewhere in Switzerland?
• How many more midwives will Geneva need, and how will they be trained?

Sources

1. Federal Statistical Office: Births 30% more frequent on weekdays than at weekends, press release (12 May 2025, in French)
2. National Perinatal Epidemiology Unit, University of Oxford: The Birthplace cohort study, key findings
3. DutchNews: Home births out of favour with Dutch mums; just 13% stick with tradition (February 2017)
4. World Health Organization: Optimal timing of cord clamping for the prevention of iron deficiency anaemia in infants

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