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

BMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7155.384 (Published 08 August 1998) Cite this as: BMJ 1998;317:384
  1. Hilda Bastian, consumer advocate (hilda.bastian{at}flinders.edu.au)a,
  2. Marc J N C Keirse, professorb,
  3. Paul A L Lancaster, associate professorc
  1. aPO Box 569, Blackwood SA 5051, Australia
  2. bDepartment of Obstetrics and Gynaecology, Flinders University of South Australia, Flinders Medical Centre, GPO Box 2100, Adelaide SA 5100, Australia
  3. cAustralian Institute of Health and Welfare, National Perinatal Statistics Unit, University of New South Wales, NSW 2052, Australia
  1. Correspondence to: Ms Bastian
  • Accepted 5 May 1998

abstract

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 data on 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 6.4 per 1000 (4.6 to 8.3) according to World Health Organisation definitions. The perinatal death rate in infants weighing more than 2500 g was 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 not due 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 associated with 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 mortality were underestimation of the risks associated with post-term birth, twin pregnancy and breech presentation, and a lack of response to fetal distress.

Footnotes

  • Funding Data collection was funded by Homebirth Australia with some support from the Consumers' Health Forum of Australia. Review of perinatal deaths and home births 1988-90 was assisted by a grant from the National Health and Medical Research Council. The AIHW National Perinatal Statistics Unit is a collaborating unit of the Australian Institute of Health and Welfare. The views expressed in this article are those of the authors.

  • Conflict of interest None.

  • Accepted 5 May 1998
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