Death rate nearly double for night births, researchers say

Babies born at night are almost twice as likely to die as those born in the daytime, researchers say.

A study of 380,000 "low risk" babies born in hospitals in the German state of Hesse in the 1990s showed that death during labour or in the first seven days after birth was extremely rare, with only 57 children lost.

But the risk of babies dying was almost twice as high if they were born at night, defined by the researchers as being between 9pm and 6.59am.

The risk of the baby dying of asphyxia, where it is deprived of oxygen just before birth, was almost four times as high during the night.

Reporting on the research in the latest edition of the British Medical Journal, the German team, led by Günther Heller from Philipps-University of Marburg, said tiredness might be the explanation.

"It may be a result of staff's increased physical and mental fatigue during the night, when doctors in charge, at least in Germany, have usually worked through a complete day shift," they said. "Overreliance on less experienced staff may be another important reason for the higher risk."

Similar research in Scotland and Wales in the last decade produced contradictory results, and German working patterns are different to those in the NHS.

But James Drife, vice president of the Royal College of Obstetricians and Gynaecologists, said he believed the Hesse survey was highly relevant to Britain.

"I wouldn't say: 'Oh, that's in Germany, it doesn't apply here,'" he said.

"My feeling as an individual is that it rings true, that we are all actually not nocturnal creatures, and that concentration levels are not so easy to maintain as during the day.

"When you come to look at cases sometimes you find that decision making is not as switched on at five o'clock in the morning. But, having said that, the absolute levels of risk are low."

Professor Drife said he and his colleagues were not complacent, and were pushing for consultants to be present in maternity units at all times, instead of just being on call.

"This piece of research would be relevant to that and would increase the pressure on us to say, 'well, we shouldn't just have consultants there during the day: we need consultants at night'."

At present the Royal College is recommending only that the largest units, such as those at big teaching hospitals, have 24-hour consultant cover.

When babies are being born in modern hospitals in western countries, a battery of sophisticated monitors is deployed to ensure that the baby is not being deprived of oxygen. But warning signs can still be missed, and if there is a problem, decisions need to be taken very quickly.

With the spread of induced labour and birth by caesarean section, the timing of births is no longer purely up to nature.

But Prof Drife said that were it left to biology, more babies would be born during the hours of darkness - possibly an evolutionary defence mechanism to protect mother and child at a vulnerable time.