Planned and unplanned deliveries at home: implications of a changing ratio.

Abstract

The observation that perinatal mortality among babies delivered at home has tended to increase beyond that among babies delivered in consultant obstetric units has caused alarm and prompted recommendations that delivery at home should be further phased out. With data derived from the Cardiff Births Survey the possibility was investigated that this trend might reflect a changing ratio of planned to unplanned domiciliary births. At the beginning of the 1970s deliveries at home that were planned to be so outnumbered those that were not by nearly five to one. By 1979 unplanned deliveries at home outnumbered planned deliveries. The characteristics of the mothers, the health care they received, and the outcome of delivery differed strikingly between planned and unplanned deliveries at home.It is concluded, firstly, that every year the maternity services must try to meet the various needs of about 2000 women in England and Wales who give birth at home without planning to do so; and, secondly, that the heterogeneity of births at home and in hospital will continue to obstruct the search for unbiased estimates of the risks attributable to delivery in specialist obstetric units, general practitioner units, and at home.

Home births in England and Wales, 1979: perinatal mortality according to intended place of delivery.

“…Thus if transfers had been included the perinatal mortality for all deliveries booked at home may have doubled to about 8/1000, which is still below the national figure of 14 Two hundred subjects aged 60-89 were selected for a study aimed at defining a reference range for the erythrocyte sedimentation rate in the elderly. The study extended a previous survey in subjects aged 20-65.…”

Normal erythrocyte sedimentation rate in the elderly.

“…Thus if transfers had been included the perinatal mortality for all deliveries booked at home may have doubled to about 8/1000, which is still below the national figure of 14 …”

Collaborative survey of perinatal loss in planned and unplanned home births

“…A service geared to cope with these unplanned events ought to be able to deal with a proportion of planned low risk deliveries. The estimates in table 1 are a sobering reflection of the perinatal hazards that these women face,3 4 even if the exact rates have been exaggerated by some underas-certainment of the relevant official denominator figure for all births outside hospital and are subject to uncertainty because sampling methods had to be used to aportion the overall figure.…”

“…Almost all mortality figures available nationally1 provide merely a single global figure for planned and unplanned home births, though the constituent rates differ greatly 3. The only recent figures for planned home birth in England and Wales relating to 19794 and 19935 provide an inaccurately low estimate of risk because it was not possible to account for those mothers who originally booked to have a home delivery but ended up delivering in hospital.…”