Thursday, April 9, 2009

homebirth in the media

The recent publicity around a woman's choice to give birth at home without any professional attendant [for more links and discussion click here] has sparked various articles in the papers and television media.

A consistent omission is any attempt to define 'unattended homebirth' as distinct from homebirth with a professional midwife as primary care provider.

SMH reporter Miranda Devine, in A home birth is not a safe birth refers to "the death during childbirth of the baby of a leading home birth advocate at her inner-western Sydney home ..." The article draws attention to the government's Maternity Services Review, and it's failure to recommend support for home birth, yet fails to mention the fact that had been on the record for several weeks: that the mother whose baby died in labour preferred to be an "autonomous care-provider", without any professional attendant.

Several doctors have been reported in the "debate" on the safety of homebirth.

These doctors, who ought to know better, have quoted data that have no statistical significance, without reference to reliable research. For example, in response the ABC Unleashed 8 April, 'Mother and baby are doing well', Debbie Slater from Perth WA comments

"Dr Pesce's comment on the 12th Perinatal Mortality Report from WA:
"The statistics referred to in that report are just 6 deaths in 4 years. The report actually covers 2002 to 2004, but there weren't enough deaths in that period, so the committee went back and included those from 2000 to 2002.

"Of the 6 deaths 4 were stillbirths and 2 babies died shortly after birth. Only one baby was actually born at home: the other 5 were born in hospital, although 2 of the babies born in hospital actually died at home (stillbirths where the baby died before mum went into labour and mum went into hospital to give birth).

"All of the deaths were examined. Four of the deaths were considered to have low levels of preventability and two were considered not preventable at all.

"The WA health department at the time said:
"A preliminary review of medical records by the Department indicates that it is likely that the setting of the birth did not affect the outcome in at least five of the six deaths."

"A review of homebirths in WA was recently carried but the report is yet to be made public. I understand it is now to be released next month.

"Given that the WA Health Department has just provided additional funding to expand the government-funded Community Midwifery Programme I will surmise that the review cannot have found too many adverse findings.”

The listener to Unleashed is informed of an "Australian review of over 1.5 million births between 1985-90. This report showed a three-fold increased risk of a full term, otherwise healthy baby dying during a planned home birth ..."

The paper from which this statistic is drawn is probably that published by Bastian et al (1998), which has come under strong criticism for its methodology. Marsden Wagner (1999) pointed out that less than three quarters of the data was collected by an ‘orthodox and acceptable’ method, giving a perinatal mortality rate of 3.8 per 1000 births, comparing favourably with other homebirth studies and the general Australian rate at the time. The remainder of the data was derived from ‘unorthodox and unacceptable’ methods, which Wagner considers unreliable. The latter group had an inflated perinatal mortality rate of 20.8. Wagner suggests that conclusions drawn about unacceptable death rates from unreliable sources are not valid.

Listeners are not informed that the 'gold standard' Cochrane Review evidence is that for women at low risk of complications, there is no strong evidence to favour either planned hospital birth or planned home birth. (Olsen and Jewell 1998, Last assessed [by Cochrane Reviews] as up to date April 2006.)

In a discussion on ‘Birth Territory: a theory for midwifery practice’ (Fahy and Parratt 2006) the authors postulate that “when midwives create and maintain ideal environmental conditions maximum support is provided to the woman and fetus in labour and birth which results in an increased likelihood that the woman will give birth under her own power, be more satisfied with the experience and adapt with ease in the post-birth period.”

Joy Johnston

1 comment:

Joy Johnston said...

The following comment has been received from 'itchybnanna'.

Where is the ACCC? In what other industry would we have sellers of one service able to publicly spread skewed statistics against a competing service?

Could a car company publish a sensationalist article saying that if you buy another brand of car you will be three times more likely to die!
Could they then lobby the government successfully to make this other brand illegal?

The reality is that private midwifes are competitors in the extremely lucrative (for RANZOG members) market for births. They also threaten the absolute power such members have in most of our publicly funded birthing institutions.

I am going to make a complaint to the ACCC [] about this behavior and I urge others who feel the same way to do this too.