Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Further to the posts below on the homebirth study, the AMA has sought right of reply.
Dr Andrew Pesce … is the president of the AMA (which opposes homebirth), an obestetrician and gynaecologist, one of the reviewers of the new study, and also the author of the MJA editorial on the study.
He writes:
“Home birthing is a controversial issue in Australia and this week’s debate around the South Australian study is proof of this.
As would be expected, both sides of the debate put their cases strongly and passionately. Unfortunately the passion sometimes gets in the way of the facts and the evidence …
My editorial was primarily about the politics of home birth. Most neutral commentators have commended me on the balance of the editorial.
As AMA President, I transparently declared a potential conflict of interest based on the policy of the AMA. I presume the College of Midwives, which strongly advocates for home birth and the role of private midwives, has similarly declared its potential conflict of interest …
… The seven-fold increased risk is a statistical prediction of the most likely risk according to the data …
The overall rate of perinatal deaths was not different, but only if you ignore the fact that a larger number of women planning to give birth in hospital have risk factors and complicated pregnancies.
When adjusted for prematurity and low birth weight, the overall perinatal mortality rate for all pregnancies planning a home birth was double that of planned hospital birth …
Remeber that the study is on *planned* home birth and *planned* hospital birth, regardless of where the birth actually took place.
The study identified the same contributing factors that were found in a previous larger Australian review … poor adherence to risk assessment, lack of monitoring of foetal wellbeing and delayed response to emerging complications in home births …
If a justification is needed for the AMA highlighting the concerning results of this study, it is that home birth advocates continue to deny the higher risks of current home birth practice, and the need for adequate risk assessment and management.
… my editorial did mention the lower intervention rates, the similar rate of post partum haemorrhage and other favourable outcomes of home births found in the study.
… The AMA … supports women having choice about where they have their babies. The AMA media release stresses the need for evidence and safety …
• Dr Andrew Pesce is President of the AMA and a practising obstetrician and gynaecologist at Westmead Hospital in Sydney
Meanwhile, Croakey has just caught up with the 22 Jan issue of Australian Doctor … including details of a study of the first 100 births through the St George Hospital Homebirth Program in NSW, published in the Australian and New Zealand Journal of Obstetrics.
The story says the study has reported “reassuring outcomes” and that “a growing number of obstetricians are calling for more support for safe homebirth models despite the AMA’s resolute opposition to the practice”.
Professor Michael Chapman, who has been involved in the St George program, is quoted saying that homebirths involving experienced midwives following strict hospital transfer protocols were appropriate for a small group of low-risk women who preferred to give birth at home.
He said: “Homebirth conducted in a random disorganised manner with independent midwives and patients who are pushing the boundaries of safety have given it a bad name. But in a controlled environment, I do believe the risks are minimal.”
Update: The AMA has been in touch to advise that Dr Pesce was a reviewer on this paper as well.
Melissa Maimann, Essential Birth Consulting 0400 418 448