Collaborative survey of perinatal loss in planned and unplanned home births

Objective-To document the outcome of planned and unplanned births outside hospital. Design-Confidential review of every pregnancy ending in stillbirth or neonatal death in which plans had been made for home delivery, irrespective of where delivery eventually occurred, The review was part of a sustained collaborative survey of all perinatal deaths. Setting-Northern Regional Health Authority area. Subjects-All 558 691 registered births to women normally resident in the former Northern Regional Health Authority area during 1981-94. Main outcome measure-Perinatal death. Results-The estimated perinatal mortality during 1981-94 among women booked for a home birth was 14 deaths in 2888 births. This was less than half that among all women in the region. Only three of the 14 women delivered outside hospital. Independent review suggested that two of the 14 deaths might have been averted by different management. Both births occurred in hospital, and in only one was management before admission of the mother judged inappropriate. Perinatal loss to the 64 women who booked for hospital delivery but delivered outside and to the 67 women who delivered outside hospital without ever making arrangements to receive professional care during labour accounted for the high perinatal mortality (134 deaths in 3466 deliveries) among all births outside hospital. Conclusions-The perinatal hazard associated with planned home birth in the few women who exercised this option (<1%) was low and mostly unavoidable. Health authorities purchasing maternity care need to address the much greater hazard associated with unplanned delivery outside hospital.