Homebirth riskier, says report

CATHY O'LEARY MEDICAL EDITOR, The West Australian Updated February 9, 2011, 2:35 am

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.

Doctors said yesterday the findings of the expert committee which investigated the deaths of unborn babies and newborns had been watered down.

A draft version obtained by _The West Australian _two months ago recommended against planned homebirths, saying the State Government funded community midwifery program should continue only if major changes were made.

At the time, two doctors on the committee quit in protest at what they said was inaction over the "persistent increased risk" to homebirth babies.

Obstetrician Donald Clark said he believed the perinatal and infant mortality committee, chaired by Professor John Newnham from King Edward Memorial Hospital, did not want to "rock the boat" with the department, which seemed keen to promote homebirths. Professor Newnham said at the time the report was due to go to the Government, prompting Health Minister Kim Hames to speak out in favour of the right of women to choose homebirth.

In the final report Professor Newnham said while death rates of babies before, during and after birth had greatly improved in WA, "such reassurance could not be found in the review of some of the cases of homebirth".

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.

But it did not recommend against the practice, instead calling for an audit of how recommendations from an earlier review into homebirths were being implemented.

Australian Medical Association WA president Dave Mountain questioned how many more reviews were needed.

"We have the evidence they are a significant risk to at-term, healthy babies, with very different outcomes for homebirth babies, so we have to wonder how long it will take for them to turn this program around and make it safer," he said.

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.

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Nephilangel08:08am Wednesday 09th February 2011 WSTReport Abuse
I find it interesting how these 'experts' are unwilling to look at the 'possibly avoidable' infant mortalities that go on in hospitals in the same time frame. I know of at least ONE personally. It all went on in hospital and the death was due to the arrogance of the staff refusal to hear the mother who knew something was wrong. Funny that these apparent professionals can't follow the obvious logic that the one who giving birth ought to know SOMETHING about what is going on in her own body.
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Caroline08:10am Wednesday 09th February 2011 WSTReport Abuse
Does the study account for the fact that the higher incidence of adverse outcomes of the homebirth babies comes from and existing preselected group of "low risk pregnancies"? Even under the existing system, any complicated high risk pregnancy would occur in hospital. Perhaps the study results are even less in favour of homebirth than we realise.
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Debbie08:24am Wednesday 09th February 2011 WSTReport Abuse
The report also says: "Some caution must be exercised in interpreting home birth data due to small absolute numbers." We are talking about 7 cases here over three years. Four births occurred in hospital, three at home. Three of the deaths were for congenital abnormalities and so not preventable: four were deemed to have some level of preventability. It does not say whether those preventable aspects occurred at home or in hospital. The Committee identified some aspects for consideration in these cases: including issues of communication and transfer. This confirms findings in a large Dutch study on homebirth in 2009 saying that support, communciation and resources are crucial to good and safe homebirth services. This is what we need to ensure in WA: a system where there is collaboration between all health professionals, and provision for good and timely transfer if required. What has not made the news, are the findings in the report that aboriginal women have significantly higher rates of perinatal mortality: now that is scandalous.
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Georgina09:19am Wednesday 09th February 2011 WSTReport Abuse
I know one of the women who gave birth to one of the babies who died and was counted in this report. She planned a homebirth. Midway through the pregnancy a scan showed a defect that was not compatible with life. Instead of terminating, she carried the pregnancy through and her daughter was eventually born in the hospital, This is counted as a 'homebirth death', which makes absolutely no sense.
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Neil11:26am Wednesday 09th February 2011 WSTReport Abuse
What @#$%. Can someone please remind the Doctors that womens bodies are designed to birth children, and have birthed Hundreds of millions of babies before there were ever such things as doctors or hospitals. Homebirths are only deemed more dangerous than hospital interventions because it threatens the income of the Ob/Gyn.
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