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Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3263 (Published 13 June 2013) Cite this as: BMJ 2013;346:f3263

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Re: Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study

Since the authors did not specify that either of the women who died of causes unrelated to childbirth was in the homebirth group, it seems safe to assume that they were both in the hospital group.

Therefore, it appears there were 3 maternal deaths attributable to pregnancy in the entire study, 2 in the homebirth group and one in the hospital group, for a death rate of 2/100,000 in each group. The only one that appears to have been potentially preventable was the one that occurred in the homebirth group. Therefore, the homebirth group had one death that was potentially preventable in the hospital, while the hospital group had none.

The study is underpowered to determine whether there is a statistically significant difference in the death rate between the two groups, but the fact that even one woman in the homebirth group died of a potentially preventable cause means that there is no basis for concluding that homebirth is as safer or safer than hospital birth among the women in this study.

It is deeply distressing that the authors submitted a paper about maternal homebirth safety and excluded the most important information. Without it, the paper is fundamentally misleading.

It is even more distressing that a press release touting the authors' unsupported conclusion was sent out and reprinted around the world, giving the false impression that homebirth is as safe as hospital birth.

Competing interests: No competing interests

25 June 2013
Amy Tuteur, MD
obstetrician
self-employed
Boston, MA USA