Appendix A: Adverse outcomes for different places of birth

Guidance

In order to be able to count enough adverse events to be able to say that the results recorded are not just a result of chance, the Birthplace UK (2011) study used a composite definition of 'adverse outcome'. The definition includes the following outcomes: stillbirth during labour, death of the baby in the first week after birth, neonatal encephalopathy (disordered brain function caused by oxygen deprivation before or during birth), meconium aspiration syndrome, and physical birth injuries (brachial plexus injury and bone fractures). The term 'serious medical problems' has been used to describe this composite outcome in the guideline recommendations.

**Table A1 Numbers and proportions of the individual components of the composite adverse outcomes measure recorded in the Birthplace UK (2011) study**
Outcome	Actual number of babies affected out of 63,955 to 64,535 (number per 1,000)	Percentage of all adverse outcomes measured
Stillbirth after start of care in labour	14 out of 64,535 (0.22 per 1,000)	5%
Death of the baby in the first week after birth	18 out of 64,292 (0.28 per 1,000)	7%
Neonatal encephalopathy (disordered brain function caused by oxygen deprivation before or during birth): clinical diagnosis	102 out of 63,955 (1.6 per 1,000)	40%
Meconium aspiration syndrome (the baby breathes meconium into their lungs)	86 out of 63,955 (1.3 per 1,000)	34%
Brachial plexus injury	24 out of 63,955 (0.38 per 1,000)	9%
Bone fractures	11 out of 63,955 (0.17 per 1,000)	4%
Total of all outcomes included in the 'adverse outcome' composite measure	255 out of 63,955 to 64,535 (approximately 4 per 1,000)	99% (does not equal 100% because of rounding)

Each of the categories in table A1 are mutually exclusive and outcomes listed higher in the table take precedence over outcomes listed lower down. For example, if a baby with neonatal encephalopathy died within 7 days, the outcome is classified as an early neonatal death. For actual number of babies affected, the denominator varies because of missing values.