Murphy J F, Dauncey M, Gray O P, Chalmers I
Br Med J (Clin Res Ed). 1984 May 12;288(6428):1429-32. doi: 10.1136/bmj.288.6428.1429.
The observation that perinatal mortality among babies delivered at home has tended to increase beyond that among babies delivered in consultant obstetric units has caused alarm and prompted recommendations that delivery at home should be further phased out. With data derived from the Cardiff Births Survey the possibility was investigated that this trend might reflect a changing ratio of planned to unplanned domiciliary births. At the beginning of the 1970s deliveries at home that were planned to be so outnumbered those that were not by nearly five to one. By 1979 unplanned deliveries at home outnumbered planned deliveries. The characteristics of the mothers, the health care they received, and the outcome of delivery differed strikingly between planned and unplanned deliveries at home. It is concluded, firstly, that every year the maternity services must try to meet the various needs of about 2000 women in England and Wales who give birth at home without planning to do so; and, secondly, that the heterogeneity of births at home and in hospital will continue to obstruct the search for unbiased estimates of the risks attributable to delivery in specialist obstetric units, general practitioner units, and at home.
有观察表明，在家分娩的婴儿围产期死亡率相较于在产科专家病房分娩的婴儿有上升趋势，这引发了人们的担忧，并促使有人建议应进一步逐步淘汰在家分娩的做法。利用来自加的夫出生情况调查的数据，对这种趋势是否可能反映计划内与计划外家庭分娩比例的变化进行了调查。20世纪70年代初，计划在家分娩的数量几乎是意外在家分娩数量的五倍。到1979年，意外在家分娩的数量超过了计划在家分娩的数量。在家计划分娩和意外分娩的母亲特征、她们接受的医疗保健以及分娩结果存在显著差异。得出的结论是，首先，每年产科服务必须努力满足英格兰和威尔士约2000名计划外在家分娩妇女的各种需求；其次，在家分娩和在医院分娩的异质性将继续阻碍对专科产科病房、全科医生诊所和在家分娩所致风险进行无偏差估计的研究。
