Home Births vs. Hospital Births

Here is some data for home births versus hospital births in the US and Australia - the data cover the entire country. The article is complaining about the lack of such data for Britain...

BMJ 1999;319:1008 ( 9 October )

Letters

Data on babies' safety during hospital births are being ignored

EDITORZander and Chamberlain state that "no evidence exists to support the claim that a hospital is the safest place for women to have normal births."¹ They cite the report Where to be Born, published in 1994 by the National Epidemiology Unit.

In 1997 the Confidential Enquiry into Stillbirths and Deaths in Infancy published a survey of 19 348 deaths in Britain occurring during 1994 and 1995, including 873 deaths due to intrapartum events.² At that time 98.16% of all deliveries occurred in hospital. The chance of a normal baby dying during labour at term was 1 in 1561. The Royal Colleges of Obstetricians and Gynaecologists and of Midwives regard this risk as unacceptably high and are working to reduce it still further.

Data on home deliveries in the United States were published in 1995,³ and data for home deliveries in Australia were published in 1998.⁴ In the American study (a retrospective review of 11 788 planned home births) the intrapartum and neonatal mortality among women intending to have a home birth at the onset of labour was 1 in 500. In a prospective American study of 1404 home births in 1994-5 the figure was 1 in 400, and the authors regarded this outcome as good.⁵ In the Australian study, which included 7002 planned home births during 1985-90, the risk of intrapartum fetal death was 1 in 371.

It is disappointing that no similar recent audit of the safety of home delivery in Britain is available. The figures from the United States and Australia are, however, strikingly similar; in the absence of current data from the United Kingdom they indicate that, for a normal birth, hospital delivery is now three to four times safer than home delivery for the baby.

Women should be able to choose between home and hospital delivery. They also have a right to accurate and up to date information.

James Drife, professor of obstetrics and gynaecology.
University of Leeds, Leeds LS2 9NS j.o.drife@leeds.ac.uk

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1.	Zander L, Chamberlain G. ABC of labour care: Place of birth. BMJ 1999; 318: 721-723[Free Full Text]. (13 March.)
2.	Confidential Enquiry into Stillbirths and Deaths in Infancy. Fourth annual report: concentrating on intrapartum deaths 1994-95. London: Maternal and Child Health Research Consortium, 1997.
3.	Anderson RE, Murphy PA. Outcomes of 11,788 planned home births attended by certified nurse-midwives. A retrospective descriptive study. J Nurse Midwifery 1995; 40: 483-492[Medline].
4.	Bastian H, Keirse MJNC, Lancaster PL. Perinatal deaths associated with planned home births in Australia: population based study. BMJ 1998; 317: 384-388[Abstract/Free Full Text].
5.	Murphy PA, Fullerton J. Outcomes of intended home births in nurse-midwifery practice: a prospective descriptive study. Obstet Gynecol 1998; 92: 461-470[Abstract].