Homebirth riskier, says report

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The Health Department has ordered an independent audit into homebirths in WA after finding they are riskier than claimed but stopped short of wanting them banned.

... The committee investigated seven deaths in planned homebirth deaths from 2005-07, finding three were possibly avoidable. It found the stillbirth rate in homebirths was almost four times that of hospital births, while the risk of stillbirth from asphyxia was 21 times higher in homebirth babies.

... WA chief medical officer Simon Towler defended the program, saying only low-risk pregnancies could use the service and more changes were being made to improve homebirth safety. He said midwives needed to get informed consent from parents who would be given the findings from the committee's report.

This article does sound alarmist, however we need to take a closer look before jumping to conclusions such as homebirth being unsafe.

The study looked at planned home births. That is, planned at the start of pregnancy. Not necessarily a planned home birth at the onset of labour which is a more accurate measure of safety. For many reasons, a woman may plan a home birth at the start of her pregnancy, but for many reasons she may decide - in the pregnancy - to birth in hospital rather than at home. For the most part, this will be because of issues such as high blood pressure, pre-term labour, bleeding in pregnancy, gestational diabetes and so on. So if the measure taken is "planned home birth at the onset of labour" this would have automatically reduced the number of deaths in the "planned home birth" arm of the study.

Four of the seven deaths were considered potentially avoidable. The other three babies had congenital abnormalities and had no preventable medical factors. Of the four babies whose deaths were considered to be potentially avoidable, some issues were identified as contributing to the death:

Absence of some routine screening tests in pregnancy Delays in transfer from home to hospital Poor communication In one case, a woman declined to follow medical advice

Only three out of the seven babies were born at home; the others were born in hospital.

Rather than making a blanket statement that home birth is unsafe, it is more helpful to make a qualitative statement around homebirth understanding that it is safe for low-risk women who are attended by an experienced midwife, who have ready access to a hospital if this is needed, and who have had screening tests that are standard practice. Once it is evident that a transfer needs to occur, the midwife needs to recognise this and make the necessary arrangements. Once in hospital, effective communication and respectful dialogue between the woman, midwife and hospital staff are helpful in providing a safe and positive outcome.

Home birth is a wonderful experience for the woman, baby and family. I hope that this report stimulates discussion rather than hindering women's access to safe home birth services.

Melissa Maimann, Essential Birth Consulting 0400 418 448