The pleasures of home birth?

This study's1 stated purpose was to evaluate the safety of home births by comparing perinatal outcomes for planned home births involving regulated midwives with those for planned hospital births. However, it was not designed to detect differences affecting the most clinically significant adverse outcomes. If a study is not designed to detect clinically relevant differences, it may fail to detect a statistically significant one despite the presence of clinically important differences between the study groups.

The interpretation section states that “there are no indications of increased risk associated with planned home birth.” This is dangerously misleading: rates for perinatal mortality and assisted ventilation were both higher in the home-birth population.

Although the authors acknowledge that the rates of some adverse outcomes were too low to provide statistical comparisons, they still suggest no difference in adverse outcomes. Clearly, one preventable episode of perinatal mortality or requirement for assisted ventilation is one too many. Given that this study is not large enough to detect a clinically relevant difference in these major outcomes, the authors have no basis to make this claim.

Unfortunately, the claims have already made it into the popular press, with the CBC stating: “Home births with a midwife are as safe as births in a hospital with a doctor.” Once again, a medical publication has played a hand in misinforming the public.

Caroline McIntyre Meite Moser Division of Emergency Medicine Vancouver General Hospital Vancouver, BC