Volume 199 - Issue 11
Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years
Author: Donald M Clark
Med J Aust 2013; 199 (11): 742-743. || doi: 10.5694/mja13.10887
Published online: 16 December 2013
Published online: 16 December 2013
To the Editor: The recent article by Catling-Paull and colleagues1 documents the apparently very low perinatal mortality associated with state-funded homebirth, mostly among women in Western Australia.
However, the 2007 triennial report of the WA Government Perinatal and Infant Mortality Committee (PIMC) stated that, for homebirth:
The term perinatal mortality rate was 6.7 per 1000 total births, compared with a term perinatal mortality rate of 2.1 per 1000 total births in the ...
To the Editor: The recent article by Catling-Paull and colleagues1 documents the apparently very low perinatal mortality associated with state-funded homebirth, mostly among women in Western Australia.
However, the 2007 triennial report of the WA Government Perinatal and Infant Mortality Committee (PIMC) stated that, for homebirth:
The term perinatal mortality rate was 6.7 per 1000 total births, compared with a term perinatal mortality rate of 2.1 per 1000 total births in the planned hospital births in the same period, which was a statistically significant difference.2
This led the WA Government to undertake a review of homebirths in the state, which found that:
for the years 2000–2006, the total perinatal mortality rate for babies born at term was statistically significantly different (OR 3.58; 95% CI 1.8–6.9; p < 0.001) between the planned homebirth and hospital groups. The total [perinatal mortality rate] in planned homebirths was 7.96 per 1000 births and in planned hospital births it was 2.22 per 1000 births.3
This review made a large number of recommendations to improve safety and regulation.
Nevertheless, the 2010 triennial PIMC report found that:
There was an increased risk of stillbirth and infant death in term gestation pregnancies in planned home births compared with planned hospital births in the triennium. These results were very similar to those seen in the previous triennium (2002–04). In addition, the Committee analysed deaths in planned home births that were attributed to peripartum hypoxia as a specific group for the first time in 2005–07. Significantly increased risks of death due to peripartum hypoxia (21 fold increased rate of stillbirth and 18 fold increased risk of infant death) were found in the planned home birth group.4
Catling-Paull et al1 state that the evidence surrounding the safety and benefits of homebirth remains contentious. I disagree — the benefits are contentious but the lack of safety is clear.
Competing interests
No relevant disclosures.
References
- Catling-Paull C, Coddington RL, Foureur MJ, Homer CSE; the Birthplace in Australia Study and the National Publicly-funded Homebirth. Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years. Med J Aust 2013; 198: 616-620.
- Newnham J (Chair). 12th report of the Perinatal and Infant Mortality Committee of Western Australia: Deaths 2002–04. (Report No: HP10489 Nov 07 22445.) Perth: Department of Health WA, 2007. http://www.health.wa.gov.au/publications/documents/mortality.pdf (accessed Oct 2013).
- Homer C, Nicoll M. Review of homebirths in Western Australia: undertaken for the Department of Health WA. (Report No. HP11284 Apr 09 23847.) Perth: Department of Health WA, 2008. http://www.healthnetworks.health. wa.gov.au/publications/docs/11284_HOMEBIRTH.pdf (accessed Oct 2013).
- Newnham J (Chair). 13th report of the Perinatal and Infant Mortality Committee of Western Australia for deaths in the triennium 2005–07. (Report No. HP10489 Jan 11.) Perth: Department of Health WA, 2010. http://www.health.wa.gov. au/publications/documents/perinatal/13th_report_perinatal_infant_mortality_2005-7.pdf (accessed Oct 2013).
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