Setting a new standard for cluelessness, Australian midwives are proudly presenting the results of a publicly funded homebirth program, a program that has a homebirth death rate 5X higher that of term hospital birth.
I received a iPhone photo of the poster that include this chart (sorry for the fuzziness):
The accompanying message says it all:
I am attending the national PSANZ (Perinatal society of Australia and new Zealand) congress here in Adelaide and thought of you when I saw this poster
The authors seem to be blissfully unaware that their “rates” are anything but low given that this is a carefully selected low risk group at term. These deaths do not include those from rogue homebirth midwives such as LB nor freebirths. The publicly funded homebirth program has strict criteria including exclusion of women with any risk factors such as multiple births, preterm births, VBACS, breech. The births are managed by 2 properly trained midwives who also work in hospital and so quick referral and transfer is a given. !!!
Things that I noticed (I’m sure you will see more!!) are …
6 deaths in low risk pregnancies at term!!!!
0.7 % of IUGR missed
2.7% of the babies ended up in the nursery!!!!!! 9 babies had SIGNIFICANT morbidity
In the abstract they have the following conclusion further demonstrating their absolute ignorance:
“This study evaluates a substantial proportion of women choosing to have a publicly-funded homebirth in Australia. However, the sample size does not have sufficient power to determine safety. More research is needed on the safety of different birthplaces within Australia”
Interestingly they left this conclusion off the poster! Perhaps they didn’t want to embarrass themselves.
The poster is Publicly-funded Homebirth in Australia: outcomes after 5 years by Catling-Paull et. al. (Here’s the full size iPhone photo of the poster.)
According to the authors:
Homebirths account for a very small number of births in Australia. In 2010, only 0.5 per cent of all women … chose homebirth.
Currently, there are at least 15 publicly-funded homebirth programs [run by 13 directors] in Australia …
The programs accommodate women who are at low risk of medical or obstetric complications. Midwives are usually selected to work within the programs after … advanced obstetric emergency training, cannulation and suturing skills.
What did they find?
During the 5 years of the study, there were 1807 women who intended, at the start of labor, to give birth at home. 83% had a homebirth, 52% in water (I have no idea why they mention this except to check women’s performances against the midwifery ideal.) The transfer rate was 17%. The C-section rate was 5.4% and the neonatal death rate was 2.2/1000. That’s more than 5X the rate of 0.4/1000 found in a 2009 report on birth in South Australia.In addition, 2 babies suffered hypoxic ischemic encephalopathy (brain damage due to lack of oxygen).
And that probably undercounts the deaths and complications because reporting was voluntary and only 9 of 13 program directors responded. Nonetheless, the authors conclude:
There was a low rate of caesarean section, postpartum haemorrhage and third degree perinatal tears as well as low rates of stillbirth and early neonatal death in this sample of women and babies.
It’s absolutely mind boggling that Australian midwives appear to be completely unaware that the neonatal mortality rate for term births in Australia is approximately 0.4/1000. They are boasting about a death rate of 2.2/1000, nearly 5X higher than the expected death rate.
The findings of the study are not surprising. They confirm what we already know: homebirth increases the risk of neonatal death by a factor of 3 or more. The only surprising thing about the study is that the authors are cheerfully ignorant about the meaning of what they found.
Corrected to reflect the fact that I mixed up stillbirths and early neonatal deaths, thereby reporting the death rate at Australian homebirth as lower than it is.
