My question is that in the statistical comparison between home and hospital births, are we comparing like with like? Surely to be able to have your child at home you must fall into a low risk group with a greater proportion of those who give birth in hospital being higher risk. I suspect that that is one of the reasons why the outcomes for home birth are more favourable. As an 'elderly primigravida' I will be encouraged to have my baby in hospital and although I love the idea of a home birth, i believe that the anxiety of doing so (in case something goes wrong) would make it a very stressful experience. That said, I have heard some horror stories of hospital births and we do need to ensure that standards are being met.

sjulians, london,

In 1989, I delivered my only child in a hospital. It was an interesting experience to say the least. In this country, it is considered the only way. However, from the start, it is impressed upon you that no drugs, immediate breastfeeding after the birth and rooming in is what is expected of you. I was in labor for over 24 hours and did not progress UNTIL I received an epidural, which relaxed me enough that my cervix was able to open. I was unable to breastfeed due to medication I was taking at the time and was made to feel subhuman by a nurse practitioner for this decision (and I am a nurse!). I sent the baby back to the nursery the night before I was discharged home so I could get the last full nights sleep I would every again have and was made again to feel subhuman by the nurses because if all the babies are rooming in then there is more downtime for them. Why would anyone want to birth in a hospital where no one really has time for them anyway?

Dena, Denver, NC, USA

I agree that home births should not be supervised by nurses, perhaps midwives might be a better bet. Dr Stuttaford really needs to check his facts more carefully, I'd also advise a reading of "Safer Childbirth?" That he doesn't seem to consider the mother's well being as of any importance is worrying.

Justine Andrews, Ryde, IW, UK,

Of course a Doctor would advocate a hospital birth....it's money in their pocket. When I first became pregnant 26 years ago, I went to a Doctor. On my first visit, she told me that because I was so small and my husband was a big person I would probably need a C-section. What a ridiculous statement! We discussed pregancy and birth and I left her office feeling very uneasy. I drove straight to the bookstore and found books on birth and midwifery(which was very rare in those days). The more I read, the more I realized how harmful and degrading it is to have a baby in the hospital. It took me over 3 months to find a qualified midwife. What a difference in attitude and knowledge. I eventually gave birth to a 9 1/2 lb son after 6 hours of labor in the bathtub. (So much for being too small to deliver a healthy child). I hope my grandchildren are born at home, if there's an emergency, they can go to the hospital, and being at home prevents all the often made hospital errors.

Theresa, Pleasanton, CA

Heard of evidence based medicine? Planned homebirths are NOT riskier than hospital births, in fact there are studies that show that all that expensive equipment sitting around waiting to be used in hospitals contributes to more intervention in hospital births, and therfore greater risk! Wouldn't it be nice if doctors (supposedly scientists) actually read some scientific studies once in a while instead of relying on purely anecdotal evidence.

Tara, Cambridge,

Also, he is quick to compare the mortality rates currenlty between developing countries and Britain now, without considering that many of the reasons for the high mortality rates in childbirth in developing countries are the same as what they were in Britain the nineteenth century. Perhaps it would be more appropriate to compare the mortality rates of the Netherlands now, where the majority of births take place at home. He puts such an emphasis on the importance of politics but I have found more and more in my dissertation that the setting up of the maternity services was much more complex than this with mothers, midwives, obstetricians all playing a role, as they do today. Hospital birth has changed the natural birth process and many unnecessary interventions do now take place. Would it be so bad to attempt to go back to a more natural provision which could actually benefit the baby and mother? He has fallen into the fear "what if" factor which obstetricians use to frighten so many.

Hannah Jones, Cwmbran, South Wales

Many people do certainly prefer to pay in order to recieve a better product and so the less expensive is less valued. This equates in my mind to the marked benefits of a homebirth versus a more expensive medically managed hospital birth, where the hospital birth wins because its more expensive! The huge benefits of homebirth for women who are assessed as low risk in pregnancy shouldnt be denied them just because someone is worried that a cheaper birth means a poorer quality! It is a worrying concept really!

Claire Mellish, Chandlers Ford, Hants

I have had six children , all in hospital usually involving a overnight stay. I believe wommen should have the choice to choose, but believe a hospital birth is safer for the obvious reasons of the medical help that is on hand,which could mean the difference of life or death for mother and child or both. My experience of coming home from hospital is that i feel compelled to start doing household chores, cooking and so forth, as the wommen giving birth in fields most probably feel compelled to start work in the fields, they are in a enviorment where they feel obligated and responsible. They could also be in an enviorment where they are at risk of domestic abuse. The hospital birth was introduced to eliminate many deaths of women and babies why take a step backwards? If the demand for hospital places fall, this will lead to the closure of many maternity units. Dr Thomas Stuttarford is right and he should know better than most.

margaret, london,

At a minimum , all women desiring home delivery should sign a release that no-one else is responsible should the child suffer brain anoxia and be retarded for the rest of its days.
Also, should abnormal position of baby occur , haemorrhage, infection , or the mother's death occur , no lawsuits should be permitted for home deliveries by next of kin.
So the mother's who wish to play russian roulette , ---go right ahead. But don't blame the medical profession when things turn sour.You can't have your cake and eat it too.

will knight, orange county, california usa

This is classic scare mongering. And mysoginistic.
It is a womans' rights to choose where she births her baby, regardless of obstetric history. If you want to talk statistics, why not read Majory Tew's book "Safer Childbirth?" No Matter how she looked at statistics, neither she nor RCOG could hide the fact that overall it is safer for the vast majority of women to birth their babies at home than in hospital.
After an unnecessary caesar due to an SHO who wanted to practice his surgical, rather than Midwifery skills, I have gone onto very calmly birth 4 babies at home. Skilled Midwives and excellent Doulas present, no doctor required.
I wonder how many people are aware that hopsitals are paid a greater premium for a caesarean delivery than they are for a home birth?
With the rise in hospital births, there is a continuing rise in families choosing to Home Educate their children. I wonder if this correlates to a rise in the knowledge that "Obstetrician does not always know best"

Caroline Spear, North Bersted, UK

As a pregnant woman looking forward to the birth of my first child, I am currently weighing up the options for the birth. I am nervous about hospital delivery, because I feel the atmosphere will be stressful to me, and because I do not appreciate the 'we know what's best for you' approach taken by doctors (my parents are both doctors and have influenced my opinion here), most notably by male doctors who can speak until they are blue in the face about medical history and statistics, but have no first hand experience of how it feels to be a labouring woman. I want control at the birth of my child, and I do not want the emergency C-Section, so prevalent nowadays, to be the back up for any problems, or when a doctor may feel a lawsuit is looming. I appreciate that the current low risk nature of my pregnancy may change, and that a hospital birth is preferable to risking my life or that of my baby, but I feel home birth is best for me, and that choice above all is what women need.

Sarah Church, Colerne, UK

Is this really evidenced based medicine?

Vickikate, Midlands,

As a student in Exeter University, since the summer of 2006 I have been undertaking extensive research into the history of the hospitalisation of births in England and Wales for my dissertation. What I find particualrly interesting about Dr Thomas Stuttaford's article is that he has fallen into the typical category of an obstetrician's thinking in that he has associated the decline of maternal and infant mortality in childbirth completely to the rise in hospital delieveries in Britain. He has also mentioned how high maternal mortality rates are in developing countries where they do not have the provison for hosptial care. However, he has completely neglected the fact that the decline in maternal mortality started to occur a significant amount of time before the rise in hospitalisation and can be linked to improved nutrition and living standards as well as things such as antibiotics to stop puerperal fever, which was one of the biggest causes of maternal mortality. Much more to say!

Hannah Jones, Cwmbran, South Wales

To suggest that home births are advised or supported without a full risk assessment and that expert care and attention is somehow rationed during a homebirth is contentious to say the least.
The statement that there is a campaign to revert to homebirths entirely supervised by nursing staff is also ill- informed. Midwives are not nursing staff, but appropriately trained experts in normal pregnancy and birth. They have the necessary skills to recognise deviation from the norm and procure the appropriate assistance when necessary.
Of course women should be able to make a properly informed decision about the place of birth for their baby- whether or not there will be a 'kindly' midwife available to support them will depend how midwives are supported and adequately renumerated in the future.
This article displays an extremely paternalistic approach to obstetrics, which in my opinion is far to prevalent.

Chris Morgan, St Mary, Jersey

My first two children were born in hospital after short labours. Whilst delivering my second child I was left alone a few times as the hospital was busy. My son's head had crowned before we could get the Midwife back. Finding myself pregnant 13 years later aged 42 and with a new husband, I requested a home birth ensuring that I had the full attention of a midwife. I had a trouble free pregnancy and after a 3 1/2 hour labour with no pain relief (second midwife arrived with gas and air after the baby), I delivered a healthy boy at home 12 months ago. Being able to bathe in my own bath afterwards, and sleep in my own bed with my husband at my side and our baby boy next to us in his crib was bliss. I understand that complications can arise, and as we were only a short trip away from the hospital, felt I was not endangering myself or my baby. It was a truly wonderful experience.

Carol Horne, Bristol, United Kingdom

I was one of the last to do home deliveries in London and I did further training in Obstetrics. I was impressed by how quickly emergencies could arise inspite of good prenatal care.
My sister wanted to have a home delivery but I managed with difficulty to persuade her to have the baby in hospital. She had a severe post delivey haemorrhage and would have probably died if she had been at home.
I agree with Dr Stuttaford that delivery is much safer in hospital

Dr J.Warner, Bath, UK

Oh for goodness sake - the available data shows that planned home births are in fact safer for women and babies, provided that no problems have been detected during pregnancy. Modern scanning allows the majority of complications to be detected early thus diverting women who need to be in hospital into hospital. Should problems arise in labour, women are swiftly transferred to hospital where medical care is available.
Please stop being derogatory about home births. When carefully chosen and with good midwife support they are wonderful. I had two of my three children at home after a disastrous first experience in hospital where the standard of care was terrible. With the rise of superbugs and a continuing decline in hygiene standards it makes a great deal of sense for women to stay at home to give birth rather than bring their child into the world in germ-filled and unfamiliar environment.

S Kilgour, Berkshire, UK