Homebirths far riskier: review

An expert review of homebirths in WA has recommended against the practice after finding babies in planned homebirth are almost four times as likely to be stillborn compared with those delivered in hospital.

The draft report, yet to be released by the Health Department, warns the State Government-funded Community Midwifery Program should continue only if major changes are made, including making women wanting homebirths sign written consent accepting the increased risks.

The Perinatal and Infant Mortality Committee review of 458 homebirths from 2005 to 2007 found seven homebirth babies died. Four of them died from loss of oxygen to the brain and three deaths were considered possibly avoidable.

It said the risk of stillbirth and infant death in homebirths was almost four times higher, with a death rate of 7.81 per thousand compared to 2.03 per thousand in hospital births

Significantly, the risk of stillbirth from asphyxia was 33 times higher in planned homebirths.

The committee said that in some cases routine screening tests were not carried out during pregnancy, homeopathic medicines were used and there were delays in transferring to hospital. .

The review, which also studied 80,000 women who had hospital births over the three years, found safety recommendations from 2007 had been ignored. A preliminary review of five stillbirths in planned homebirths in 2008 and 2009 showed the recommendations "had not been adhered to".

Australian Medical Association WA president Dave Mountain said the report added to the weight of worldwide evidence of the dangers associated with homebirths.

"It is irresponsible for those who support homebirth not to acknowledge the risks and to dismiss the concerns of obstetricians as nothing more than self-interest or turf protection," he said.

Dr Mountain said it was a tragedy some homebirth babies in WA had died of peripartum hypoxia, which meant that because of complications the baby was suddenly deprived of oxygen to the brain.

"In a hospital setting an obstetrician could save these babies by urgently performing a caesarean section or delivering the baby by vacuum extraction or forceps," he said.

"These are not operative procedures that a midwife can perform."

Princess Margaret Hospital paediatric consultant Jacqueline Scurlock said there was clear evidence homebirths were riskier and she regularly attended births where babies ran into problems unexpectedly and needed emergency care.