eBMJ -- Press Releases

BMJ Press Releases, Saturday 23 November 1996
Volume 313 No 7068

EMBARGO: Friday 22 November 00.01

Home and away
[Home Birth : editorial]
[Prospective regional study of planned home births]
[Collaborative survey of perinatal loss in planned and unplanned home births]
[Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands]
[Home versus hospital deliveries: follow up study of matched pairs for procedure and outcome]

Are home births less safe than hospital births? This week's BMJ carries four papers reporting on the safety, professional support and patient satisfaction of delivery at home. Despite the reservations of some GPs, home births seem to be a safe option for women at low risk of obstetric complications.

Home birth is uncommon in the UK although possibly 10 per cent of women might be interested in having their baby at home, says one of the papers. "More women could almost certainly be delivered outside hospital with equal safety" says a report by the Northern Region Perinatal Mortality Survey Coordinating Group.

At first sight, mortality figures seem to endorse the view that hospital is the safest place to deliver. The survey reports 134 perinatal losses in 3466 non-hospital births - about four times the number of losses in hospital births. But a BMJ editorial points out that "97 per cent (131 cases) of these perinatal deaths at home were recorded in women who were actually booked for a hospital delivery or had no pre-arranged plan for delivery. The perinatal outcome in planned home births was better than for all women giving birth in the region." Studies from the Netherlands and Switzerland both show that healthy low risk women who wish to give birth at home have no increased risk either to themselves or to their babies.

Planning a home birth and actually achieving one are two different things: A study in the North of England showed that of 256 women who planned to have their babies at home, 142 managed to do so (57 per cent). There were no stillbirths or perinatal deaths. "Seventy four women (29 per cent) initially booked for a home birth, later accepted hospital delivery and in only half was there a clear obstetric reason." Many GPs were equivocal in their approach to home birth . Only nine women (3.6 per cent of all women studied) had a home birth as well as a supportive GP and a midwife they already knew. The 142 home births in the study were valued as a family event - other children were present at 24 of the births. The Swiss study noted that during delivery the home birth group needed significantly less medication and fewer interventions than the hospital birth group.

Contact:
Dr Gavin Young

Tel: 0176 836 1232
Fax: 0176 836 1980

Prof Chris van Weel (editorial)
University of Nijmegen,
Netherlands

Tel: 0031 24354 1862
Fax: 0031 24361 6332
e-mail: C.vanWeel@hsv.kun.nl

Prof Ursula Ackermann-Liebrich,
Switzerland
Social and Preventive Medicine

Tel: 00 4161 2676 066
Fax 00 4161 267 6190

Leukaemia linked to infection and population mix
[Effect of population mixing and socioeconomic status in England and Wales, 1979-85, on lymphoblastic leukaemia in children]

Further evidence that childhood leukaemia might be a rare response to infection comes in a paper in this week's BMJ.

A so-called "New Town" effect of population mixing and exposure to infection emerged in 1988. Researchers suggested that outbreaks of infection would be most likely when carriers and susceptible people were brought together by high levels of population mixing. If childhood leukaemia was a response to infection, then in high population mix settings there would be a correspondingly high incidence of leukaemia among children whose immunity was limited. A paper by Stiller and Boyle in the BMJ reports evidence of an effect of population mixing on the incidence of childhood leukaemia not restricted to areas with extreme levels of mixing.

The new study looked at childhood leukaemia in the 403 county districts of England and Wales. There were significant trends in the incidence of lymphoblastic leukaemia at ages 0-4 years and 5-9 years with the proportion of children new to a district.

"For ages 0 to 4 years there were significant increasing trends in incidence with the proportions of recent incomers in the total population and child population..." For school age children of 5-9 years there were significant trends with child migration. The report states "In areas with high levels of inward migration, young children would tend to be infected earlier, producing a raised incidence of leukaemia in early childhood...." The raised incidence of leukaemia among 5-9 year olds in districts with a high proportion of incoming children is consistent with the transfer of viruses at school, says the report.

A key message of the research is that population mixing even at relatively low levels may be important in the aetiology of childhood leukaemia. Previous studies finding increased incidence in more affluent areas may have been indirectly observing a population mixing effect.

Contact:
Mr C.A.Stiller
Childhood Cancer Research Group
University of Oxford

Tel 01865 310 030
Fax: 01865 514 254

Smear tests
[Cervical sampling devices: editorial]
[Relation between sampling device and detection of abnormality in cervical smears: a meta-analysis of randomised and quasi-randomised studies]

Cervical screening in Britain is probably preventing 2000 cases of invasive cancer each year says an editorial in this week's BMJ,. In 1994-5, four and a half million cervical smears were examined in England, but over 350,000 (7.9 per cent) were considered to be inadequate for making a diagnosis. Inadequacy rates reported by 183 laboratories were extremely variable and ranged from 0.2 per cent to over 35 per cent. Dr Peter Sasieni of the Imperial Cancer Research Fund comments in the editorial that "such variation is unacceptable and must in part reflect different reporting criteria."

One of the factors in the inadequacy rate is the quality of the smear taking and, writes Dr Peter Sasieni, "there is room for improvement". A BMJ paper on cervical smear sampling devices suggests the best devices - and combinations of devices - to use.

Contact:
Dr Peter Sasieni
Imperial Cancer Research Fund,
London

Tel: 0171 269 3616
(ICRF Press office)
Fax:0171 269 3429
E-mail: p.sasieni@icrf.icnet.uk

EMBARGO: 00.01 HRS FRIDAY 22 NOVEMBER 1996