Are hospital confinements really more dangerous for the fetus?

A large number of publications has reiterated the observation that perinatal mortality rates in Britain are higher among births in consultant units than among those occurring at home or in other units. In this paper we show that whereas these observations are themselves undeniable, the conclusion that hospital confinements are more dangerous to the fetus is probably erroneous. To illustrate the methodological difficulties, we have used as much information as possible on the delivery intentions for a national survey of 16,668 singleton births taking place in the United Kingdom in one week of April 1970. Using these data, we show that although deliveries in a consultant unit had a three times higher mortality rate than those delivered elsewhere, this was due almost entirely to the excess mortality among transfers of women originally intending to deliver elsewhere. Consideration of the place the mother was originally intending to deliver altered the picture considerably, with mortality only 38% higher among the consultant unit group. It is pointed out that if account was taken of risk factors such as past obstetric history, marital status and social class it is likely that booking for hospital delivery may well carry a lower risk of perinatal death, but that present data collection systems combined with high rates of consultant delivery are unlikely to resolve this question.