We thank Ms Snyder for her Letter to the Editor concerning our most recent publication.

Ms Snyder correctly states that birth certificates only include live births and not stillbirths, and we clearly state that difference in our publications.

We agree with Ms Snyder on 2 important points. First, most planned home births in the United States “are attended by unqualified individuals.” Second, in the United States “the rates of adverse outcomes [from planned home birth] are likely much higher due to the exclusion of fetal death reports.” This is but another component of the clinical reality that, because adverse outcomes in planned home births transferred to the hospital are likely attributed to hospital births, the outcomes of planned home birth are even worse than documented in our papers. An improved birth certificate that included more information on hospital transfers from planned home births would help in elucidating this important information.

We thank Ms Snyder for reinforcing the main finding of our papers: planned home birth has increased risks of serious adverse perinatal events that can be prevented by planned hospital birth.