Intended for healthcare professionals

Rapid response to:


Study shows higher rates of neonatal mortality with planned home births

BMJ 2010; 341 doi: (Published 02 July 2010) Cite this as: BMJ 2010;341:c3551

Rapid Response:

Homebirth versus elective caesarean risks

The findings in this study, that planned home birth increases a
baby's (albeit very small) risk of dying compared with a hospital birth
plan, has received a great deal of media attention, and numerous medical
professionals and birth groups have spoken out to defend home birth
legitimacy and advocacy in the UK.

Surely then, particularly in light of studies such as this one
published in Canada last year, 'Caesarean section on maternal request:
risks and benefits in healthy nulliparous women and their infants' by LS
Dahlgren et al, which found that an elective pre-labour caesarean delivery
in a nulliparous woman at full term "decreased the risk of life-
threatening neonatal morbidity compared with spontaneous labour with
anticipated vaginal delivery", it is time to review current attitudes
towards caesarean delivery on maternal request.

This Canadian study included almost 40,000 births, and even though
the comparison used breech presentation as a healthy elective caesarean
surrogate (which is arguably a more complicated delivery than a cephalic-
presenting fetus) to compare with the healthy onset spontaneous labour
group, the caesarean group's babies still had better outcomes.

Similarly an American study, also based on intent to deliver and not
just actual delivery, 'Maternal Outcomes Associated with Planned Vaginal
Versus Planned Primary Cesarean Delivery’ by EJ Geller et al, found that
planned caesarean delivery had less chorioamnionitis (2.2% versus 17.2%),
postpartum hemorrhage (1.1% versus 6.0%), uterine atony (0.6% versus
6.4%), and prolonged rupture of membranes (2.2% versus 17.5%) for the
mother but a longer hospital stay (3.2 versus 2.6 days). There were no
differences in transfusion rates.

If a healthy woman's maternal request to give birth at home is
acceptable, then given the (two examples of) improved outcomes cited
above, her request for a prophylactic caesarean delivery at 39+ weeks
should be acceptable too.


Competing interests:

Competing interests: No competing interests

05 July 2010
Pauline M Hull