Wednesday, September 23, 2009

Home birthing: the fiscal nips and tucks to our health system

This article, written by Queensland Federal MP Andrew Laming, and published in Australia's e-journal of social and political debate, brings together a political and medical view of the issue. Andrew Laming was a GP/obstetrician prior to entering politics. He wrote ...

"All politics is local, and more often than not personal. Just a fraction of Australians birth at home but their fervour is at times evangelical. In Canberra’s grey rain this week, 2,000 devoted mums and midwives won a two-year reprieve from being deregistered and fined if they attend a home birth.

"But there were few cheers for Minister Roxon’s back flip. Landmark reform stemming from the recent National Maternity Services Review proposes autonomy for midwives around prescribing certain drugs and ordering tests as well as long awaited access to Medicare and indemnity cover. But for home birthing midwives, there will neither be Medicare support nor any form of indemnity protection.

"When it comes to the safety of low-risk mums birthing at home, the world’s foremost medical evidence authority is the Cochrane Collaboration. With appropriate hospital support says Cochrane, home birth and hospital mortality for low-risk bubs is comparable. Cochrane believes women have a right to choose between the two options.

"A final fillip for home births is that Cochrane acknowledges that outcomes for mums may actually be worse in hospitals. The largest of all studies was a nationwide cohort of 529,688 low-risk planned home and hospital births by de Jonge in the Netherlands. It found "that planning a homebirth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system"."
[Click here for the complete article and reader comment]

The comments are worth reading - some of them are almost amusing!
"Most big hospitals now have good birthing suites that provide as close to the home-birth experience as possible, while still having medical help close by."

"Australia is not as small in distances as New Zealand or England, where home-birthing is more common. The homes in those countries are much closer to hospitals and ambulance services should anything go wrong with the birth."

"Home births require a dedicated nurse to travel, and not be available to anyone else, and require the back up of the ambulance service. Home birthing is thus more expensive for no health benefits, and so I can understand why the funding has been withdrawn."

Read the comments in context. Please let us know what you think!

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