This study1 contained significant biases. The groups were not like for like2,3,4,5 because members of the hospital specialist group were shorter, more likely to have had a previous cesarean section, weighed more and were less likely to be multiparous. Hence, they were more prone to dystocia than members of the home-birth group.
As well, comparisons were made for induction of labour and epidural/spinal analgesia, but these interventions are usually unavailable during home births.3 Are the authors implying that they are available at home in British Columbia? The overall transfer rate of about 22% was high. What were the major indications for transfer prepartum and intrapartum?
This article is too biased to allow us to draw any meaningful comparisons between home and hospital births. Moreover, the conclusions are not justified by the evidence presented.6 The first step would be to compare like for like — a randomized selection of appropriate patients for home or hospital birth.1,2,3,4
Liz Okon Registered Nurse, Registered Midwife Clarenville, Nfld. M. A. Okon Physician Clarenville, Nfld.