BMJ  2008;336 (2 February), doi:10.1136/bmj.39476.584005.47

Editor's Choice

What counts?

The first 150 words of the full text of this article appear below.

Dutch obstetric outcomes topped the league tables two decades ago (about the time my wife was beginning her obstetric training). Home births were foisted on the rest of the developed world largely because they seemed to underpin the Dutch success. Yet something unexpected has happened: the Netherlands now has the second highest rate of perinatal deaths in Europe (doi: 10.1136/bmj.39472.657384.DB). It turns out that half the women who choose home births are transferred to hospital during labour because of unexpected problems. Delivering in hospital out of hours increases the risk of intrapartum and neonatal deaths by nearly a quarter.

While deaths are an unambiguous end point, Nigel Hawkes reminds us that there are usually not enough of them to use as reliable measures of the quality of care provided by individual doctors or hospitals (doi: 10.1136/bmj.39470.702627.59). So, what about less catastrophic outcomes? Hawkes quotes Richard Lilford’s opinion that . . . [Full text of this article]

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