The only certain way of answering this question would be a randomized
controlled trial (RCT). This could have been done in the 1950s but such a
trial of home versus hospital was not suggested. Such a suggestion has now
been made but it would require 500,000 women in a trial to answer the
safety question. This is patently impossible so we make do with data that
may suffer from the bias that women choosing home birth may be different
from women choosing hospital, however well one may try to match them.
Nevertheless, one can look at the outcomes in relation to place of birth.
One of the first to do so was Marjorie Tew, a statistician working at
Nottingham Medical School. In her large-scale and detailed study, she
analysed data from the 1970 British Births Survey and compared perinatal
death rates in different places of birth (Tew, M. (1980). Place of birth
and Perinatal mortality. Journal of the Royal College of General
Practitioners, 35). She recognized that one would expect more "high-risk"
deliveries in hospitals than at home. Tew attempted to control for this by
using both antenatal and labour prediction scores to categorize expected
risk ....
Tew found that babies were more likely to survive if born in a GP or at
home, rather than in hospital, at all levels of risk scores. Only at the
very highest level of risk were the better results at home and in GP units
not statistically significant.
Tew had great difficulty finding a medical journal which would publish
these results, as they went against medical "wisdom." It is possible that
Tew's results may show that prediction scores do not foretell problems.
They were not, however, her scores but were provided by obstetricians.
Tew's results have not been refuted and the 1970 survey data do not support
the then prevailing view that hospital was safer. Tew has displayed great
courage over the years, initially being one voice crying in the wilderness;
she can now take pride in her part in getting people to question that
prevailing view.
-Geoffrey N. Marsh and Mary J. Renfrew (eds), Community-based Maternity
Care, Oxford University Press, 1999
Reprinted from Midwifery Today E-News (Vol 2 Issue 21 May 26, 2000)
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