title: An estimation of intrapartum-related perinatal mortality rates for booked home births in England and Wales between 1994 and 2003.
abstract: OBJECTIVE
  The objective of this study was to obtain the best estimate of intrapartum-related perinatal mortality (IPPM) rates for booked home births.
  
  
  METHODS
  A population-based cross-sectional study.
  
  
  METHODS
  England and Wales.
  
  
  METHODS
  All births in England and Wales, including home births (intended or unintended) occurring between 1994 and 2003.
  
  
  METHODS
  All IPPM data were derived from the Confidential Enquiry into Maternal and Child Health. Denominators were derived by using unintended home births and transfer rates from home to hospital, from previous studies, with sensitivity analyses. IPPM rates were calculated for the three following subgroups: (a) the completed home birth group, (b) the transferred group and (c) the unintended home birth group.
  
  
  RESULTS
  IPPM rate.
  
  
  RESULTS
  The overall IPPM rate for England and Wales improved between 1994 and 2003. However, data to obtain a precise estimate of IPPM rate for booked home birth were not available. The average IPPM rate for all births in the study period was 0.79 per 1000 births (95% CI 0.77-0.81), and the estimated IPPM rate for booked home births was 1.28 or 0.74 per 1000 births, depending on the method of calculation (range 0.49-1.47). The IPPM rates for the completed home birth group appeared to be lower throughout the study period compared with the unintended home birth groups. Those women who had booked for a home birth, but later needed to transfer their care for a hospital birth, appeared to have the highest risk of IPPM in the study period.
  
  
  CONCLUSIONS
  The results of this study need to be interpreted with caution due to inconsistencies occurring in the recorded data. However, the data do highlight two important features. First, they suggest that IPPM rates for home births do not appear to have improved over the study period examined, even though rates did so overall. Second, although the women who booked for home births and had their babies at home seemed to have a generally low IPPM rate, those who required their care to be transferred to hospital did not. Women who book for home births should be offered comprehensive evidence-based information about the potential benefits, risks and uncertainties associated with their choice of birthplace by the healthcare professional responsible for supporting their decision. It is of considerable concern that the data recorded nationally in England and Wales do not provide accurate information about when and why a transfer from home to hospital booking occurs and about their outcomes.
authors.affiliation: National Collaborating Centre for Women's and Children's Health, London, UK. rintaromori@gmail.com
authors.forename: R
authors.initials: R
authors.lastname: Mori
authors.forename: M
authors.initials: M
authors.lastname: Dougherty
authors.forename: M
authors.initials: M
authors.lastname: Whittle
mesh_terms: D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006700:Home Childbirth / Q000401:mortality* / Q000639:trends; D006801:Humans; D010360:Patient Transfer / Q000706:statistics & numerical data; D054238:Perinatal Mortality / Q000639:trends; D011247:Pregnancy; D014852:Wales / Q000453:epidemiology