Background: A home birth is a birth that takes place in a residence rather than in a hospital or a birthing center. Objective: To study intrapartum maternal and fetal complication of home birth versus hospital birth. Method: This was a cross-sectional, prospective hospital-based and community-based study, conducted at Ad-Damer Teaching Hospital. The study sample was 700 women fulfilled inclusion criteria of the study. The study sample included 327 delivered at home and 373 delivered at hospital. Data was collected using a questionnaire filled with women after taking informed consent. Results: The most common socio-demographic differences, women delivered at home aged > 39 years 123(37.6%), 160(78.9%) illiterate, and 254(77.7%) from rural areas, while women delivered at hospital the common age was 20 – 29 years 283(75.9%), mostly had secondary education 138(37%) and 216(57.9%) from urban areas (P value < 0.05). women delivered at hospital 215(65.7%) were referred to hospital. The causes of refer to the hospital were obstructed labor 73(36.3%) prolonged labor 63(29.3%), postpartum hemorrhage 44(20.4%) and retained placenta 30(14%). Among women delivered at home maternal complications were reported in 247(75.5%) compared to 71(19%) of the women delivered at hospital. The common postpartum complication in women delivered at home were postpartum hemorrhage 44(24.4%), delay of second stage of labor 31(9.5%), retained placenta 30(9.2%) and cervical tear 28(8.6%). These complications reported in 11(2.9%), 18(4.8%) and 4(1.1%) respectively of the women delivered at hospital (P = 0.011 < 0.05). Alive babies (bedside mother) were 261(79.8%) for the women delivered at home compared to 353(94.6%) in women delivered at hospital. Neonatal intensive care admission 51(15.6%), deaths 15(4.6%) in the babies of women delivered at home compared to 18(4.8%) and 2(0.5%) of the women delivered at hospital (P = 0.014 < 0.05). Conclusion: The study concluded that home birth was significantly associated with maternal complications such as postpartum hemorrhage, retained placenta and obstructed labor. In addition, fetal deaths and admission to neonatal intensive care unit was significantly common among women delivered at home than in women delivered at hospital.