Perinatal mortality: is home a safer place?

Area of Science:

• Obstetrics and Gynecology
• Public Health Policy
• Medical Statistics

Background:

• Current policy mandates births in consultant obstetric units.
• These units have shown higher crude perinatal mortality rates.
• The reasons for these higher rates are often attributed to various risk factors.

Purpose of the Study:

• To analyze the impact of consultant obstetric units on perinatal mortality rates.
• To challenge the assumption that these units inherently provide safer births.
• To propose a policy change based on statistical evidence.

Main Methods:

• Statistical analysis of perinatal mortality rates.
• Examination of risk factors associated with births in different settings.
• Review of data from consultant obstetric units versus other settings.

Main Results:

• Consultant obstetric units exhibit higher crude perinatal mortality rates.
• The assumed risk factors do not fully explain the elevated mortality in these units.
• Reversing the policy is indicated as a means to lower mortality.

Conclusions:

• The policy of centralizing births in consultant obstetric units may be counterproductive.
• A shift away from this policy could lead to an immediate decrease in perinatal mortality.
• Further investigation into risk factors and alternative birth settings is warranted.