PLANNED HOME BIRTHS LINKED TO A HIGHER RISK OF PERINATAL DEATHS IN CHILDBIRTH

Conducted by Prof Marc Keirse, Professor of Obstetrics and Gynaecology at Flinders University, SA, and his co-authors, the study examined perinatal data on all births and perinatal deaths in SA between 1991 and 2006.

The study is published in the latest edition of the Medical Journal of Australia.

Prof Keirse said that while the data showed that planned home births had a perinatal mortality rate similar to that of planned hospital births, they had a sevenfold higher risk of intrapartum death and a 27-fold higher risk of death due to intrapartum asphyxia (lack of oxygen during childbirth). This was despite the finding that women with recognised risk factors, such as nulliparity, Indigenous status, lower occupational status, and residence outside metropolitan areas, were less likely to plan a home birth.

The study also found that low Apgar scores were more frequent among planned home births, and use of specialised neonatal care, as well as rates of postpartum haemorrhage and severe perineal tears, were lower among planned home births, but these differences were not statistically significant.

Prof Keirse said perinatal safety of home births might be improved substantially by better adherence to risk assessment, timely transfer to hospital when needed, and closer fetal surveillance.

“Integration of home birth practitioners into the health system with supervision and backup may help to dissuade women from undertaking high-risk home births and reduce avoidable adverse outcomes,” he said.

In an accompanying editorial in the MJA, Dr Andrew Pesce, obstetrician and gynaecologist, Clinical Director of Women’s Health at the Sydney West Area Health Service, and Federal President of the Australian Medical Association, writes that given the accumulated evidence on planned home birth practice in Australia spanning 30 years, facilitating and funding home births in an autonomous setting would be contrary to the principles of evidence-based health administration.

He emphasised the importance of outcomes of planned home births to be carefully monitored, and strategies adopted to minimise the risk of adverse outcomes.

“Those who argue that planned home birth in Australia can be safe will have to show this on the basis of

The Medical Journal of Australia is a publication of the Australian Medical Association.

^{The statements or opinions that are expressed in the MJA  reflect the views of the authors and do not represent the official policy of the AMA unless that is so stated.}

CONTACT:  

Prof Marc Keirse                                 (08) 8178 0116
Dr Andrew Pesce via AMA Public Affairs             0419 494 761/0427 209 753