In the Birthplace research the authors used a combined
measurement to assess safety for babies. The combined
measurement was made up of all of the following:

• stillbirths during labour and early neonatal deaths
(within 7 days of birth), and
•conditions associated with trauma (harm) at birth, the
baby becoming distressed or being deprived of oxygen
during labour.

These conditions and evidence of distress
or birth asphyxia were ‘signs’ or a ‘clinical diagnosis’ of
neonatal encephalopathy, meconium aspiration syndrome
(this can involve complications caused by the baby inhaling
meconium, passed from their bowel into the amniotic fluid
surrounding them while in the womb), brachial plexus injury
(injury to the nerves that control the muscles of the fingers,
hand, arm, and shoulder, including Erb’s Palsy), and a fractured
humerus (the bone of the upper arm connecting the shoulder
to the elbow) or clavicle (collar bone, connecting the shoulder to the chest).

There were 250 primary outcome events and an overall
weighted incidence
of 4.3 per 1000 births (95% confidence
interval 3.3 to 5.5). Intrapartum
stillbirths and early
neonatal deaths accounted for 13% of events,
encephalopathy for 46%, meconium aspiration syndrome for

30%, brachial plexus injury for 8%, and fractured humerus
or clavicle for 4%.

Source: Birthplace in England Collaborative Group. Perinatal
and maternal
outcomes by planned place of birth for healthy
women with low risk
pregnancies: the Birthplace in England
national prospective cohort study
BMJ 2011;343:d7400.