Volume 199 - Issue 11
Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years
Authors: Susan Ieraci and Amy B Tuteur
Med J Aust 2013; 199 (11): 742. || doi: 10.5694/mja13.10863
Published online: 16 December 2013
Published online: 16 December 2013
The safety and benefits of homebirth remain contentious
To the Editor: The analysis of publicly funded home births in Australia by Catling-Paull and colleagues1 contains some significant gaps that require clarification. Without accurate information, women may not be fully informed about their childbirth choices.
The retrospective review amalgamates data from nine of 12 homebirth programs, spanning varying periods of time. Crucial details about neonatal morbidity and mortality are lacking. The review fails to report the reasons for hospital transfer, or the causes of neonatal death. In this format, the data have limited use to inform about safety.
Significantly, the review found that the neonatal mortality rate associated with homebirths was much higher than that associated with low-risk hospital births (2.2 per 1000 births v 0.4 per 10002), and yet the authors stated that this rate for homebirths was ‘‘low’’. It is notable that the homebirth population included first-time mothers, older mothers and breech presentations — all features known to increase risk.3 However, the authors did not seek details of the deaths or make recommendations to increase safety.
Most families wish more than anything for their baby to be safe and well. Unless providers work towards improving the neonatal mortality associated with homebirth and minimising known risk factors, mothers cannot be advised that giving birth at home is safe.
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. CHDBIEIJ
- Chan A, Scheil W, Scott J, et al. Pregnancy outcome in South Australia 2009. Adelaide: Pregnancy Outcome Unit, SA Health, Government of South Australia, 2011.
- Birthplace in England Collaborative Group, Brocklehurst P, Hardy P, Hollowell J, et al. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011; 343: d7400.