Planned home and hospital births in South Australia, 1991-2006: differences in outcomes.
OBJECTIVE
To examine differences in outcomes between planned home births, occurring at home or in hospital, and planned hospital births.


METHODS
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.


METHODS
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.
Kennare
Robyn M
RM
Pregnancy Outcome Unit, Epidemiology Branch, SA Health, Adelaide, SA, Australia.
Keirse
Marc J N C
MJ
Tucker
Graeme R
GR
Chan
Annabelle C
AC
D000328:Adult; D036861:Delivery, Obstetric / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006291:Health Policy; D006700:Home Childbirth / Q000401:mortality / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D013021:South Australia; D055815:Young Adult