Safe in selected women, and with adequate infrastructure and support

Birth is an event of great importance in family life. Although pregnancy and delivery are, under healthy conditions, normal social and physiological processes, childbirth has become hospital centred in most industrialised countries. The assumption is that hospital based deliveries are safer for mother and child. Yet the Cumberlege report sees home birth as a real option,1 and the wishes of women to have home births must be viewed in that light. A randomised controlled trial would help to resolve the controversy over the relative safety of home and hospital birth,2 but conditions for a “fair” trial are difficult to achieve. Such a study would require large numbers because of the low frequency of adverse events, and the necessary environment of experienced home deliveries has virtually disappeared. In the absence of a randomised trial, observational studies are welcome, and this week's BMJ …