More risks in homebirths, doctors say

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Doctors have hit back at a leading child health researcher's defence of homebirths, saying research from Australia and overseas showed the practice is significantly more risky for the baby.

... Fiona Stanley said last week she strongly supported the use of midwives. She said she did not believe there was evidence that homebirth was riskier than a hospital delivery, provided that it was a low-risk pregnancy.

... Australian Medical Association national president Andrew Pesce said at least four studies done in Australia ... showed a significantly higher rate of death in planned homebirths.

He said it was important to compare only the outcomes of full-term healthy babies who would normally be expected to survive.

... AMA WA councillor Mike Gannon said Dutch research recently published in the British Medical Journal showed a three to four times higher risk of death in babies delivered in planned homebirths.

The study of more than 37,000 births found babies of women at low risk whose labour started under a midwife's supervision outside hospital had a higher risk of death and the same risk of admission to neonatal intensive care compared with babies of high-risk women whose labour began in hospital under an obstetrician's care.

"I strongly believe women have the right to choose what they want, but to say there is no evidence that planned homebirths are no more risky than planned births in more orthodox settings is just incorrect," Dr Gannon said. Professor Stanley stood by her comments yesterday.

It's important to separate out issues here. The Netherlands study was not about homebirth: it was about midwifery care of low-risk women versus obstetric care of high risk women, and yes, it did find that midwifery care of low risk women resulted in worse outcomes for babies compared to those babies who had been born to high risk women under obstetric care. Does this mean that midwifery is unsafe, or is it a reflection of the system of care in The Netherlands? Consider that fetal heart monitoring (with a doppler) is not standard practice in birth care in the Netherlands. Also consider that midwives do not provide one-to-one care in labour. In fact, most women do not have a midwife present for most of the labour. The women have a birth support person present who has no midwifery education. The midwife pops in and out every 4 hours, examines the woman and listens to the baby's heart beat and goes again, returning for the birth of the baby. A Dutch midwife cares for 105 women a year, compared to 20 - 40 in Australia. So now ask yourself, is midwifery care unsafe, or is the system of care unsafe?

Melissa Maimann, Essential Birth Consulting 0400 418 448