Babies delivered at home have a higher mortality rate than babies delivered in the hospital, a new study reports, but the rates are essentially the same when a doctor or trained midwife is in attendance at the home births.

The study, reported in the American Journal of Public Health, looked at 4,054 home births in Missouri between 1978 and 1984.

Among planned home births, there were 17 deaths, about double the number expected in a sample of that size based on projections from comparable cases. Nearly all the extra deaths occurred in births attended by people with little or no medical training. These include midwives not certified by the American College of Nurse-Midwives or the Missouri Midwives Association, and "others," such as fathers, paramedics, chiropractors or family friends.

The neonatal mortality rate for babies delivered at home by skilled attendants was almost the same as for babies delivered in the hospital, though researchers cautioned that the numbers -- five deaths -- were small.

An accompanying editorial in the journal by Dr. Warren H. Pearse, executive director of the American College of Obstetricians and Gynecologists, noted the complexity of the issue and called the Missouri study "a valiant and largely successful effort to wade into this morass and emerge with data."

An estimated 30,000 planned deliveries -- about 1 percent of all births -- occur outside hospitals each year in the United States. But at least 100 times that number, Pearse said, are born to women who lack adequate prenatal and birth care.