I read with interest the article by Grünebaum et al. The article concludes that all women should deliver in hospital to prevent 1/625 intrapartum deaths 2007 through 2010 that occurred during home births attended by a midwife or doctor. The conclusion that these deaths could have been avoided if the women delivered in hospital is in direct conflict with the data, which found the deaths may have been antepartum stillbirths.

Additionally, the article reports several implausible outcomes:

• 1.
  

  The article claims that hospital births resulted in 0.16 stillbirths per 1000 full-term births after 37 weeks, which means the perinatal mortality rate of the United States 2007 through 2010 would have been 0.2/1000 instead of what it was: 7/1000.

  
  
• 2.
  

  The article claims an implausible high prematurity rate for 2007 through 2010 in the United States of 17% when the actual rate was 12%.

  
  
• 3.
  

  The Centers for Disease Control and Prevention reports approximately 29,000 home births per year for the years 2007 through 2010; about 62% of home births were attended by midwives. Over a 4-year period, that would amount to 72,000 home births attended by midwives, not 60,000 home births, as the article reports.

  
  
• 4.
  

  The authors fail to give a single conjecture as to what complication(s) could account for 1 in every 625 intrapartum fetal deaths at the hands of licensed doctors and midwives. The reason no guess or speculation is given is because none exists. The reported attended home birth perinatal mortality rate including antepartum stillbirths is 1/3000. The only 2 possible emergencies that have been documented to cause intrapartum stillbirth at planned attended home births of low-risk births (excluding vaginal births after cesarean and breech) is cord prolapse, which occurs at a rate of either 1/5000 or 1/10,000 at home birth due to the restriction on amniotomy; and shoulder dystocia, which may account for another 1/10,000 stillbirths at home births, because it rarely results in stillbirth, but rather birth asphyxia. There are no complications of planned home birth attended by a trained professional that could account for a 1/625 intrapartum stillbirth rate. This means that most if not all of the stillbirths were antepartum. The conclusions of this article that fetuses/newborns would have better outcomes at planned hospital births are spurious. No reference is made to the relatively poor outcomes of the women who would have delivered in hospital compared to the better outcomes at planned attended home birth.