Perinatal death associated with planned home birth in Australia: population based study

BMJ 1998;317:384-388 ( 8 August )

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Perinatal death associated with planned home birth in Australia: population based study

Hilda Bastian, consumer advocate, ^a Marc J N C Keirse, professor, ^b Paul A L Lancaster, associate professor. ^c

^a PO Box 569, Blackwood SA 5051, Australia, ^b Department of Obstetrics and Gynaecology, Flinders University of South Australia, Flinders Medical Centre, GPO Box 2100, Adelaide SA 5100, Australia, ^c Australian Institute of Health and Welfare, National Perinatal Statistics Unit, University of New South Wales, NSW 2052, Australia

Correspondence to: Ms Bastian hilda.bastian{at}flinders.edu.au

Objective: To assess the risk of perinatal death in planned home births in Australia.
Design: Comparison of data on planned home births during 1985-90, notified to Homebirth Australia, with national dataon perinatal deaths and outcomes of home births internationally.
Results: 50 perinatal deaths occurred in 7002 planned home births in Australia during 1985-90: 7.1 per 1000 (95% confidence interval 5.2 to 9.1) according to Australian definitions and 6.4per 1000 (4.6 to 8.3) according to World Health Organisation definitions. The perinatal death rate in infants weighing more than 2500 gwas higher than the national average (5.7 versus 3.6 per 1000:relative risk 1.6; 1.1 to 2.4) as were intrapartum deaths notdue to malformations or immaturity (2.7 versus 0.9 per 1000: 3.0;1.9 to 4.8). More than half (52%) of the deaths were associatedwith intrapartum asphyxia.
Conclusions: Australian home births carried a high death rate compared with both all Australian births and home births elsewhere. The two largest contributors to the excess mortalitywere underestimation of the risks associated with post-term birth,twin pregnancy and breech presentation, and a lack of responseto fetal distress.

Key messages

In some countries there is a trend towards high risk home births
This study examined perinatal death rates in Australian home births, including both high and low risk births
The death rate in Australian home births was higher than comparable births nationally and home births in other countries
The higher perinatal death rate in Australian home births was due to the inclusion of predictably high risk births and prolonged asphyxia during labour
While home birth for low risk women can compare favourably with hospital birth, high risk home birth is inadvisable and experimental

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