New report shows increase in perinatal deaths at homebirth in Western AustraliaA press release from the Department of Health of Western Australia celebrates declining rates of perinatal and neonatal mortality in the years 2002-2004. Despite the overall improvement, specific problems were identified:
Dr Towler [Chief Medical Officer] said the report had raised three key areas of concern - the role of socioeconomic status and smoking as risk factors for stillbirth and infant death, the continuing high mortality rate of Aboriginal babies, and the relatively higher mortality rate of babies born at term to mothers who had chosen a home birth.The unanticipated perinatal deaths at homebirth in 2002-2004 followed on the heels of unanticipted perinatal deaths at homebirth from 2000-2002. Accordingly, the Department of Health attempted an in depth review as part of its 12th Report of the Perinatal and Infant Mortality Committee of Western Australia:
There were a total of six unexpected term perinatal deathsThe Committee reached the following conclusions about homebirth:
amongst planned home births recorded in the five years Jan 2000 – Dec 04. The six deaths occurred between 38 and 41 weeks gestational age, and involved singleton pregnancies with no overt congenital abnormalities. Two deaths were antepartum and four were the result of an intrapartum complication (two stillbirths and two early neonatal deaths). Three of the deaths occurred at home and three occurred in hospital. One of the six babies delivered at home, and five delivered in hospital. Four of the six cases had low-level medical preventability scores (2 or 3) and two cases had no evidence of preventability.
The term perinatal mortality rate was 6.7 per 1,000 total births, compared with a term perinatal mortality rate of 2.1 per 1,000 total births in the planned hospital births in the same period, which was a statistically significant difference (Fisher Exact p=0.013)...
Trend data show that the proportion of planned home births has remained fairly stable at between 0.4 – 0.7% of all births over the past 15 years.
A small but significant number of women choose a planned home birth. Ideally that choice would be 'informed choice'. The current risks and benefits of home birth in Australia are not well understood, due to low numbers and lack of recent research. However, there was an increased risk of perinatal mortality in planned home births compared with planned hospital births in a large Australian study of home births where analysis of births in the four years 1985-1988 for which the most comprehensive data were available showed that in babies of at least 2500g birthweight there was a perinatal mortality rate of 5.7 deaths per 1000 births in planned home births compared with 3.6 deaths per 1,000 planned hospital births. Intrapartum death not associated with congenital malformation or extreme immaturity was three times as frequent in planned home births than it was nationwide...This report emphasizes the fact that there is NO scientific evidence that shows homebirth to be as safe as hospital birth. The report itself is yet another contribution to the burgeoning literature that demonstrates an increased risk of perinatal death at homebirth.
Advocates of home births have often quoted 'safety data' from international studies, but it is difficult to extrapolate from international data to the situation in Australia where there are differences in many respects, including training and experience of midwives, and geography. The difficulty of emergency transport services to offer safe retrievals in WA is a major consideration. Whilst there have not been any maternal deaths in planned home births in WA in recent years, there may be concern about the potential risk of maternal death, particularly due to postpartum haemorrhage in the home setting. There was a significantly increased risk of third stage complications in planned home births in WA 1981-1987.
The information presented from the WA 2000-04 analysis shows that the choice of home birth would appear to have put 'low risk' women into a ‘higher risk’ category of perinatal death,.. (my emphasis)
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