Home and away
[Home Birth : editorial]
[Prospective regional study of planned home births]
[Collaborative survey of perinatal loss in planned and unplanned home births]
[Outcome of planned home and planned hospital births in low risk pregnancies:
prospective study in midwifery practices in the Netherlands]
[Home versus hospital deliveries: follow up study of matched pairs for procedure
and outcome]
- Are home births less safe than hospital births? This week's BMJ carries four
papers reporting on the safety, professional support and patient satisfaction of
delivery at home. Despite the reservations of some GPs, home births seem to be a
safe option for women at low risk of obstetric complications.
Home birth is uncommon in the UK although possibly 10 per cent of women might be
interested in having their baby at home, says one of the papers. "More women
could almost certainly be delivered outside hospital with equal safety" says a
report by the Northern Region Perinatal Mortality Survey Coordinating Group.
At first sight, mortality figures seem to endorse the view that hospital is the
safest place to deliver. The survey reports 134 perinatal losses in 3466
non-hospital births - about four times the number of losses in hospital births.
But a BMJ editorial points out that "97 per cent (131 cases) of these perinatal
deaths at home were recorded in women who were actually booked for a hospital
delivery or had no pre-arranged plan for delivery. The perinatal outcome in
planned home births was better than for all women giving birth in the region."
Studies from the Netherlands and Switzerland both show that healthy low risk
women who wish to give birth at home have no increased risk either to themselves
or to their babies.
Planning a home birth and actually achieving one are two different things: A
study in the North of England showed that of 256 women who planned to have their
babies at home, 142 managed to do so (57 per cent). There were no stillbirths or
perinatal deaths. "Seventy four women (29 per cent) initially booked for a home
birth, later accepted hospital delivery and in only half was there a clear
obstetric reason." Many GPs were equivocal in their approach to home birth . Only
nine women (3.6 per cent of all women studied) had a home birth as well as a
supportive GP and a midwife they already knew. The 142 home births in the study
were valued as a family event - other children were present at 24 of the births.
The Swiss study noted that during delivery the home birth group needed
significantly less medication and fewer interventions than the hospital birth
group.
Contact:
Dr Gavin Young
Tel: 0176 836 1232
Fax: 0176 836 1980
Prof Chris van Weel (editorial)
University of Nijmegen,
Netherlands
Tel: 0031 24354 1862
Fax: 0031 24361 6332
e-mail: C.vanWeel@hsv.kun.nl
Prof Ursula Ackermann-Liebrich,
Switzerland
Social and Preventive Medicine
Tel: 00 4161 2676 066
Fax 00 4161 267 6190
Leukaemia linked to infection and population mix
[Effect of population mixing and socioeconomic status in England and Wales,
1979-85, on lymphoblastic leukaemia in children]
- Further evidence that childhood leukaemia might be a rare response to infection
comes in a paper in this week's BMJ.
A so-called "New Town" effect of population mixing and exposure to infection
emerged in 1988. Researchers suggested that outbreaks of infection would be most
likely when carriers and susceptible people were brought together by high levels
of population mixing. If childhood leukaemia was a response to infection, then
in high population mix settings there would be a correspondingly high incidence
of leukaemia among children whose immunity was limited. A paper by Stiller and
Boyle in the BMJ reports evidence of an effect of population mixing on the
incidence of childhood leukaemia not restricted to areas with extreme levels of
mixing.
The new study looked at childhood leukaemia in the 403 county districts of
England and Wales. There were significant trends in the incidence of
lymphoblastic leukaemia at ages 0-4 years and 5-9 years with the proportion of
children new to a district.
"For ages 0 to 4 years there were significant increasing trends in incidence with
the proportions of recent incomers in the total population and child
population..." For school age children of 5-9 years there were significant
trends with child migration. The report states "In areas with high levels of
inward migration, young children would tend to be infected earlier, producing a
raised incidence of leukaemia in early childhood...." The raised incidence of
leukaemia among 5-9 year olds in districts with a high proportion of incoming
children is consistent with the transfer of viruses at school, says the report.
A key message of the research is that population mixing even at relatively low
levels may be important in the aetiology of childhood leukaemia. Previous studies
finding increased incidence in more affluent areas may have been indirectly
observing a population mixing effect.
Contact:
Mr C.A.Stiller
Childhood Cancer Research Group
University of Oxford
Tel 01865 310 030
Fax: 01865 514 254
Smear tests
[Cervical sampling devices: editorial]
[Relation between sampling device and detection of abnormality in cervical
smears: a meta-analysis of randomised and quasi-randomised studies]
- Cervical screening in Britain is probably preventing 2000 cases of invasive
cancer each year says an editorial in this week's BMJ,. In 1994-5, four and a
half million cervical smears were examined in England, but over 350,000 (7.9 per
cent) were considered to be inadequate for making a diagnosis. Inadequacy rates
reported by 183 laboratories were extremely variable and ranged from 0.2 per cent
to over 35 per cent. Dr Peter Sasieni of the Imperial Cancer Research Fund
comments in the editorial that "such variation is unacceptable and must in part
reflect different reporting criteria."
One of the factors in the inadequacy rate is the quality of the smear taking and,
writes Dr Peter Sasieni, "there is room for improvement". A BMJ paper on cervical
smear sampling devices suggests the best devices - and combinations of devices -
to use.
Contact:
Dr Peter Sasieni
Imperial Cancer Research Fund,
London
Tel: 0171 269 3616
(ICRF Press office)
Fax:0171 269 3429
E-mail:
p.sasieni@icrf.icnet.uk
