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Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years

Med J Aust 2013; 198 (11): 616-620. || doi: 10.5694/mja12.11665

Summary

Objective: To report maternal and neonatal outcomes for Australian women planning a publicly funded homebirth from 2005 to 2010.

Design, setting and subjects: Retrospective analysis of data on women who planned a homebirth and on their babies. Data for 2005–2010 (or from the commencement of a program to 2010) were requested from the 12 publicly funded homebirth programs in place at the time.

Main outcome measures: Maternal outcomes (mortality; place and mode of birth; perineal trauma; type of management of the third stage of labour; postpartum haemorrhage; transfer to hospital); and neonatal outcomes (early mortality; Apgar score at 5 minutes; birthweight; breastfeeding initially and at 6 weeks; significant morbidity; transfer to hospital; admission to a special care nursery).

Results: Nine publicly funded homebirth programs in Australia provided data accounting for 97% of births in these programs during the period studied. Of the 1807 women who intended to give birth at home at the onset of labour, 1521 (84%) did so. 315 (17%) were transferred to hospital during labour or within one week of giving birth. The rate of stillbirth and early neonatal death was 3.3 per 1000 births; when deaths because of expected fetal anomalies were excluded it was 1.7 per 1000 births. The rate of normal vaginal birth was 90%.

Conclusion: This study provides the first national evaluation of a significant proportion of women choosing publicly funded homebirth in Australia; however, the sample size does not have sufficient power to draw a conclusion about safety. More research is warranted into the safety of alternative places of birth within Australia.

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  • Christine Catling-Paull1
  • Rebecca L Coddington2
  • Maralyn J Foureur3
  • Caroline S E Homer4

  • Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW.


Acknowledgements: 

We acknowledge and thank the members of the National Publicly-funded Homebirth Consortium. The Chief Investigators of the Birthplace in Australia Study are: Caroline Homer, Maralyn Foureur and David Sibbritt (University of Technology Sydney); David Ellwood (Australian National University); Jeremy Oats (University of Melbourne); Della Forster and Helen McLachlan (La Trobe University); and Hannah Dahlen (University of Western Sydney). This study was part of the Birthplace in Australia Study, funded through a National Health and Medical Research Council Project Grant (2012–2015).

Competing interests:

No relevant disclosures.

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