Editorials

Place of delivery and adverse outcomes

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c5560 (Published 03 November 2010) Cite this as: BMJ 2010;341:c5560
  1. Derek Tuffnell, consultant obstetrician
  1. 1Bradford Royal Infirmary, Bradford BD9 6RJ, UK
  1. derek.tuffnell{at}bradfordhospitals.nhs.uk

Risks can be mitigated by early diagnosis and referral, but no birth is without risk

Planned birth at home or in a midwifery unit is part of the choice that should now be offered to women at low risk of complications. A recent large meta-analysis of mostly cohort studies (500 000 births) showed a doubling of the risk of excess neonatal deaths for home birth from 0.09% to 0.2%—one extra death in 900 births.1 However, the risks associated with birth in different settings are still uncertain because of the confounding factors inherent in observational data. These include differences in baseline risk, the intended or actual place of birth, demographics, parity, and standards of care. One randomised trial was piloted, but it looked at only 11 women.2

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In the linked prospective cohort study (doi:10.1136/bmj.c5639), Evers and colleagues compared incidence rates of perinatal mortality and severe perinatal morbidity in the infants of low risk women who started labour in primary care (under a midwife) and high risk women who were under …

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