Estimating intrapartum‐related perinatal mortality rates for booked home births: when the ‘best’ available data are not good enough

Abstract

Objective To critically appraise a recent study on the safety of home birth (Mori R, Dougherty M, Whittle M. BJOG 2008;115:554) and assess its contribution to the debate about risks and benefits of planned home birth for women at low risk of complications.Design Critical appraisal of a published paper.Setting England and Wales. Methods Six members of a multidisciplinary group appraised the paper independently. Comments were collated and synthesised.Main outcome measures Assessment of: overall methodology; assumptions used in estimating figures; methods used for calculations; conclusions drawn from the results and reliability and consistency of data.Results Although there were some positive aspects to the study, there were weaknesses in design and an inaccurate estimate of risk. Our evidence suggests that the conclusions drawn did not reflect the results and the methodological weaknesses found in the study rendered both the results and conclusions invalid.Conclusions On the basis of our critical appraisal, the study does not contribute to the existing evidence about the safety of home birth to inform decision-making or provision of care. The limitations could have been identified by the peer review process and the problems were compounded by an inaccurate press release. Great care needs to be taken by journals to ensure the accuracy of information before dissemination to the scientific community, clinicians and the public. These data should not have been used to inform national guidelines.

Transfer to hospital in planned home births: a systematic review

“…The authors emphasised that the results should be interpreted with caution because of inconsistencies in the recorded data [30]. A critical appraisal found weaknesses in the study design and that estimates of risk were inaccurate [31]. Evers et al found an increased risk for perinatal death in women referred from midwifery care to obstetric care during labour in Utrecht in the Netherlands [32].…”

Planned and Unplanned Home Birth

“…Genel olarak bu çalışmalar, planlanan hastane doğumuna kıyasla, evde doğumun, azalmış sezaryen ve müdahaleli doğum oranları ve benzer maternal ve perinatal morbidite ve mortalite oranları ile ilişkili olduğunu bildirmiştir. Bununla birlikte, sistematik analiz için mevcut nüfus verilerinin kalitesinde ve bazı olgularda, araştırmaların metodolojik kalitesinde önemli sınırlamalar vardır (19) . Güney Avustralya'da yapılan bir araştırmada, evde doğumun, çok yüksek oranda intrapartum fetal ölümle (hipoksiye bağlı) ilişkili olduğu rapor edilmiştir (20) .…”

Home Versus Hospital Birth—Process and Outcome

“…These findings raise the notion of the intrapartum-related perinatal mortality rate, which excludes deaths caused by factors such as prematurity and congenital anomalies (45). Unfortunately, reliable estimates of this potentially valuable measure are currently unavailable (46). Among nonanomalous fetuses, the home birth PMR exceeded the hospital birth PMR by 1.0 to 2.0/1000.…”