Women's health

In reply: We thank Fielke for his interest in our article.1 Our study used the 20th centile method of the Australasian clinical indicator report on obstetrics, conducted by the Australian Council on Healthcare Standards (ACHS).2 The ACHS defines the 20th centile as a “best practice rate” that is potentially achievable and uses it to identify and prioritise clinical areas in which research and quality improvement ...

Yuen Yi (Cathy) Lee · Christine L Roberts · Jillian A Patterson

Investment in women is central to future global development

Catherine R Bateman-Steel MB ChB, BSc, MSc

The safety and benefits of homebirth remain contentious

Susan Ieraci · Amy B Tuteur

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 ...

Donald M Clark

In reply: We agree that our retrospective review1 did not provide all the details about neonatal morbidity and mortality. There were limited data available on the reasons for hospital transfer and neonatal death. We explained these limitations in the article and have hence embarked on a wider study of birthplace in Australia.2 It was interesting to us that even in this low-risk population, there were 10 breech ...

Christine Catling-Paull · Rebecca L Coddington · Maralyn J Foureur · Caroline S E Homer

To the Editor: Despite evidence supporting the safety and benefits of influenza vaccination during pregnancy,1,2 half of pregnant women believe the influenza vaccine to be unsafe or are uncertain about its safety in pregnancy.3 Other studies report confusion among antenatal care providers about the safety of influenza vaccination during pregnancy, and cite the need for more professional education.4 To help address these safety concerns, the Western ...

Annette K Regan · Christopher C Blyth · Paul V Effler

To the Editor: I thank Cameron and colleagues for their timely report,1 particularly in the context of publicity for a new self-help book by economist Emily Oster, which questions advice about avoiding alcohol during pregnancy.2,3 I note with interest that Cameron et al’s study reports that proportionally more of the women who consumed alcohol beyond the first trimester were older and more highly educated. Oster has ...

Tracy W Soh

A newborn child’s critical illness changes his mother’s perspective on her own medical careerOn a cold Monday night in late winter, I pulled on my scrubs, packed my lunch and crept quietly into the small, cosy room my children share. My daughter was lying rumpled and skewiff in her big bed, covers thrown back, her little nappy-clad bottom in the air. I moved to the ...

Kristin J Boyle MB BS

The increasing use of psychotropic medicines has led to a need to understand the safety of antipsychotics in pregnancy.

Roisin N Worsley · Heather Gilbert · Jayashri Kulkarni

Prospective clinical outcomes and patient experiences after medical management of missed miscarriage in women treated on an outpatient basis at a single maternity hospital suggest it is safe and effective.

Scott G Petersen MB BS, FRANZCOG, CMFM · Anneliese R Perkins FRANZCOG, MB BS · Kristen S Gibbons BInfoTech, BMaths(Hons), PhD · Julia I Bertolone BNurs · Kassam Mahomed MB BS, FRANZCOG

More than 40% of women taking parental leave during their specialist training experienced negative comments about their leave in the workplace, and more than 25% reported being questioned about their intentions for future pregnancies in relation to job applications.

Caroline M de Costa PhD, FRANZCOG, FRCOG · Michael Permezel MD, MRCP(UK), FRANZCOG · Louise M Farrell MB BS, FRANZCOG, FRCOG · Anne E Coffey MB BS, FRANZCOG · Ajay Rane PhD, MD, FRANZCOG

John (known as Warwick) Newman was born on 2 February 1928 at Cullen Bullen near Lithgow in New South Wales, where his father was the mines manager. He attended Sydney Church of England Grammar School (Shore) and commenced medicine at the University of Sydney in 1948. In his second year of medicine, he developed severe type 1 diabetes and needed to take 2 years off from his course. During ...

James B Roche

Assessing the outcomes of homebirths attended by qualified professionals within a well regulated environment is an important part of shedding light on this debate.

Marc J N C Keirse MD, DPhil, FRANZCOG

To the Editor: McIntyre and Oats promote the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria for gestational diabetes mellitus (GDM) as being well reasoned.1 Derived from observational data and mathematical modelling in an attempt to provide a worldwide definition and to improve outcomes, these criteria will significantly increase the number of women diagnosed with GDM2 in health care systems that have ...

Adrian V G Taylor

To the Editor: McIntyre and Oats1 suggest that Australian medical practitioners should adopt the new International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria for the management of gestational diabetes mellitus (GDM),2 mainly because of the findings of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study.3 If adopted, a significant number of women will be diagnosed with GDM if their only blood ...

Michael C d’Emden · Narelle D Fagermo · Amanda J Love · Karin M C Lust

In reply: Taylor welcomes a strong evidence base for clinical practice, which is echoed by d’Emden and colleagues. However, their strong support for the current Australian diagnostic criteria for gestational diabetes mellitus (GDM) is surprising, given that these criteria are the product of an “Ad Hoc Working Party” report.1 This guideline, published in 1991, clearly acknowledged a lack of strong evidence and advocated criteria that ...

H David McIntyre · Jeremy J N Oats

To the Editor: Moynihan has recently suggested that gestational diabetes mellitus (GDM) is a “non-entity”1 and cited controversy regarding new diagnostic criteria, while McIntyre and Oats have defended the practice of screening for GDM.2 Robust data associate hyperglycaemia with adverse pregnancy outcomes;3 and randomised controlled trial data show a beneficial effect of screening and treatment on perinatal outcomes.4 However, it is short-sighted to consider only the ...

Mark McLean · Len D Moaven · Naswrin Moin · Jennifer A Bradford

A retrospective analysis of the outcomes for women who planned a homebirth and their babies provides the first national evaluation of publicly funded homebirth in Australia.

on behalf of the Birthplace in Australia Study and the National Publicly-funded Homebirth Consortium

The authors outline the development of obstetric training and simulation in 18th and 19th century London, and describe the historical obstetric simulators on display in Australia.

Harry Owen MB ChB, MD · Damian J McDonald BA, MA