Perinatal death associated with planned home birth in Australia: population based study.
OBJECTIVE
To assess the risk of perinatal death in planned home births in Australia.


METHODS
Comparison of data on planned home births during 1985-90, notified to Homebirth Australia, with national data on perinatal deaths and outcomes of home births internationally.


RESULTS
50 perinatal deaths occurred in 7002 planned home births in Australia during 1985-90: 7.1 per 1000 (95% confidence interval 5.2 to 9.1) according to Australian definitions and 6.4 per 1000 (4.6 to 8.3) according to World Health Organisation definitions. The perinatal death rate in infants weighing more than 2500 g was higher than the national average (5.7 versus 3.6 per 1000: relative risk 1.6; 1.1 to 2.4) as were intrapartum deaths not due to malformations or immaturity (2.7 versus 0.9 per 1000: 3.0; 1. 9 to 4.8). More than half (52%) of the deaths were associated with intrapartum asphyxia.


CONCLUSIONS
Australian home births carried a high death rate compared with both all Australian births and home births elsewhere. The two largest contributors to the excess mortality were underestimation of the risks associated with post-term birth, twin pregnancy and breech presentation, and a lack of response to fetal distress.
PO Box 569, Blackwood SA 5051, Australia. hilda.bastian@flinders.edu.au
H
H
Bastian
M J
MJ
Keirse
P A
PA
Lancaster
D001238:Asphyxia Neonatorum / Q000401:mortality; D001315:Australia / Q000453:epidemiology; D001724:Birth Weight; D005260:Female; D006700:Home Childbirth / Q000401:mortality*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007233:Infant, Postmature; D011247:Pregnancy; D012307:Risk Factors; D015996:Survival Rate