Home birth in Britain can be safe

EDITOR—Drife's assertion that hospital birth is three times as safe as planned home birth is misleading.1 Since the study groups were dissimilar it is about as helpful as saying that a man and a dog have an average of three legs. He is also wrong to say that “no recent audit of the safety of home delivery in Britain is available.” Just such an audit has been running here for 18 years.2 There has been no intrapartum death and only one neonatal (0-27 day) death in the past 15 years among the estimated 3400 mothers (0.6%) who were booked for home birth when labour started. The comparable figure for all such births in this region for these years (1984–98), after lethal malformation and babies weighing less than 2.5 kg are excluded, is 1:921 (587/540 830). That home birth has become statistically “safer” than hospital birth is not, of course, unexpected, as high risk mothers seldom press for home delivery.3

National figures also exist. The comparable figure for all booked home births in 1994–5 nationally, as established by the Confidential Enquiry into Stillbirth and Death in Infancy, was 1:1113 births (22/24 484), although this denominator includes unplanned home birth and excludes transfers in labour.4 This is similar to the rate in non-malformed births of ≥2.5 kg in these two years (1143/1 224 856, or 1:1072 births). The National Birthday Trust study, which did collect accurate denominator data during 1994, encountered two stillbirths and three neonatal deaths among the 4665 mothers still booked for a home birth at 37 weeks' gestation (1:933 births). …