Document Detail


Planned home and hospital births in South Australia, 1991-2006: differences in outcomes.
MedLine Citation:
PMID:  20078406     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To examine differences in outcomes between planned home births, occurring at home or in hospital, and planned hospital births. DESIGN AND SETTING: Population-based study using South Australian perinatal data on all births and perinatal deaths during the period 1991-2006. Analysis included logistic regression adjusted for predictor variables and standardised perinatal mortality ratios. MAIN OUTCOME MEASURES: Perinatal death, intrapartum death, death attributed to intrapartum asphyxia, Apgar score < 7 at 5 minutes, use of specialised neonatal care, operative delivery, perineal injury and postpartum haemorrhage. RESULTS: Planned home births accounted for 0.38% of 300,011 births in South Australia. They had a perinatal mortality rate similar to that for planned hospital births (7.9 v 8.2 per 1000 births), but a sevenfold higher risk of intrapartum death (95% CI, 1.53-35.87) and a 27-fold higher risk of death from intrapartum asphyxia (95% CI, 8.02-88.83). Review of perinatal deaths in the planned home births group identified inappropriate inclusion of women with risk factors for home birth and inadequate fetal surveillance during labour. Low Apgar scores were more frequent among planned home births, and use of specialised neonatal care as well as rates of postpartum haemorrhage and severe perineal tears were lower among planned home births, but these differences were not statistically significant. Planned home births had lower caesarean section and instrumental delivery rates, and a seven times lower episiotomy rate than planned hospital births. CONCLUSIONS: Perinatal safety of home births may be improved substantially by better adherence to risk assessment, timely transfer to hospital when needed, and closer fetal surveillance.
Authors:
Robyn M Kennare; Marc J N C Keirse; Graeme R Tucker; Annabelle C Chan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Medical journal of Australia     Volume:  192     ISSN:  0025-729X     ISO Abbreviation:  Med. J. Aust.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-18     Completed Date:  2010-03-23     Revised Date:  2010-08-20    
Medline Journal Info:
Nlm Unique ID:  0400714     Medline TA:  Med J Aust     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  76-80     Citation Subset:  IM    
Affiliation:
Pregnancy Outcome Unit, Epidemiology Branch, SA Health, Adelaide, SA, Australia.
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MeSH Terms
Descriptor/Qualifier:
Adult
Delivery, Obstetric / mortality,  statistics & numerical data*
Female
Health Policy
Home Childbirth / mortality,  statistics & numerical data*
Humans
Infant, Newborn
Logistic Models
Obstetric Labor Complications / epidemiology*
Perinatal Mortality
Pregnancy
Pregnancy Outcome
Retrospective Studies
Risk Factors
South Australia
Young Adult
Comments/Corrections
Comment In:
Med J Aust. 2010 Jan 18;192(2):60-1   [PMID:  20078401 ]
Med J Aust. 2010 Jun 21;192(12):726-7; author reply 727   [PMID:  20722097 ]
Med J Aust. 2010 Jun 21;192(12):726; author reply 727   [PMID:  20565361 ]

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