Secret report damns safety of model home birth service

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A leading midwifery service specialising in home births was investigated over concerns that it had ten times the normal rate of babies born with serious complications such as brain damage ...

The Albany practice, an independent group in South London held up as a model for the midwifery sector, had its contract with the NHS terminated after an inquiry into alleged poor practice over 30 months.

... Parents ... marched to the Department of Health yesterday to protest at the termination of Albany’s contract ... They claimed that it was a flawed analysis that had been withheld from the public.

The Government has sought to increase midwife-led and home birth NHS services to address the over-stretched maternity sector.

Women are supposed to be offered the choice of a home birth, but only 3 per cent of births take place at home ...

The report ... reveals that the hospital identified 11 cases of hypoxic ischaemic encephalopathy (HIE) ... in the two and a half years ...

... "[King’s] identified the number of admissions of term infants with serious complications ... was comparatively ten-fold greater amongst women under the care of the Albany Group Practice than women cared for by other King’s midwifery group practices or by hospital midwives”.

The report ... concludes that “risk factors for a poor outcome in pregnancy were being overlooked by Albany midwives”, and that home births were sometimes being encouraged when not medically appropriate.

However, it does not recommend the termination of the service ...

Supporters of the Albany consider the hospital’s actions an attack on independent midwifery ...

Statisticians and clinicians shown the report also raised concerns about its methodology and the use of HIE as a guide to the quality of care. ... they suggested that it was based on “bad science”.

Questions have also been raised as to why the inquiry remains confidential and why it was not carried out in conjunction with the Care Quality Commission, the health regulator.

Professor Alison Macfarlane ... said the report did not include proper assessment of birth rates ... or additional risk factors ... “They haven’t attempted to look at it statistically. There are no rates per babies, only numbers, so you cannot compare like with like.

... Mavis Kirkham, Professor of Midwifery at Sheffield Hallam University, said the report was “bad science and fundamentally flawed” for reasons including the problems with diagnosing HIE.

She pointed to the lack of acknowledgement of success rates, with Albany’s mortality rates for infants at 4.9 per 1,000 compared with the wider borough of Southwark’s 11.4 per 1,000.

The Albany investigation was prompted by the death of Natan Kmiecik one week after he was delivered at the hospital by Albany midwives. Lawyers for his mother ... claimed that proper procedures were not followed because Natan’s heartbeat was monitored only by a small hand-held device so she could have a water birth.

A hospital spokesman said the report underlined the need for closer monitoring of midwifery and denied claims that it reflected an aversion to home births ...

“While the report reinforced our view of the excellent relationships formed between Albany midwives and their expectant mothers, it also highlighted serious shortcomings in terms of non-compliance with [hospital] trust policies and risk management procedures, particularly during labour and with newborn babies,” he said.

“We felt this was an unacceptable level of risk for our patients and were unhappy with the nature of the contractual arrangements. Therefore a decision has been taken to terminate our contract with Albany.”

... “the report should be made public so all those involved — not least the mothers — know why this action has been taken,” ...

Melissa Maimann, Essential Birth Consulting 0400 418 448