Leading obstetrician slams ACT government home birth trial

A leading obstetrician has criticised the ACT government's home birth trial, saying home births would never be as safe ...
A leading obstetrician has criticised the ACT government's home birth trial, saying home births would never be as safe as those in hospital. 

A leading obstetrician has warned the ACT's first publicly-funded home birth trial will put expectant mothers and unborn children at risk.

The caution came as applications for the three-year trial of publicly-funded home births opened last week.

Only Canberra women with low-risk pregnancies who live within a 30-minute catchment of the Centenary Hospital for Women and Children would be eligible for the trial, which is expected to involve about 24 women a year.

But the president of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Professor Michael Permezel, said the trial posed unacceptable dangers.

"Being within 30 minutes is still not sufficiently close to reach essential services that are unexpectedly needed so that the baby and mother are not put at risk of permanent injury or even death," Professor Permezel said.

"These situations are uncommon for women with an uncomplicated pregnancy, but the risk isn't so low that it wouldn't apply to these women."

He believed births given at home would never be as safe as those in hospital.

"No pregnancy can ever be guaranteed as low risk due to unexpected complications such as post-partem haemorrhage, which occurs in about 6 per cent of all pregnancies and cannot always be managed by midwives at home," he said.

A 2013 study published in the Medical Journal of Australia, which examined five years of data from 2005 to 2010 from nine home birth programs in Australia, found the rate of stillbirth and early neonatal death was a low 1.7 per 1000 births (excluding deaths due to expected fetal anomalies).

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There was also a normal vaginal birth rate of 90 per cent.

These figures compare with a stillbirth rate of 6.4 to 7.8 per 1000 births in low risk women who do not have home births, the Australian Institute of Health and Welfare reports, although it is unclear if this includes expected fetal anomalies.

Low risk women who give birth in hospitals have of normal vaginal birth rate of 63 per cent.

Births given under the care of a midwife in ACT account for between five and 10 births per year, according to ACT Health.

But while this sample is too small to accurately determine local trends, the national rate of home births has doubled in the past four years.

Sally Ferguson from the Publicly Funded Birth at Home ACT action group and an assistant professor in midwifery at the University of Canberra defended the government's home birth trial and disagreed it would increase danger.

"There are reasons why when women are supported by known midwives throughout their pregnancy and birth at home, their likelihood of a normal birth increases and the likelihood of caesarean decreases," she said.

"Almost all of the women I talk to who have had a terrible experience giving birth in the hospital have felt out of control and haven't been given choices."

She said many women feel more at ease and trusting of known midwives in a familiar environment, which in turn reduces their risk of complications.

"If we could take well women out of busy maternity hospitals, it would be better for the busy maternity service and the well women," she said.

An ACT Health spokesperson said the home birth trial's rigorous eligibility criteria, ongoing risk assessments and requirement of two midwives present at each birth would ensure the safety of participating women and their unborn children.

"Home birth is supported by the Australian College of Midwives and all ACT Health midwives are highly trained health professionals who work in close collaboration with obstetricians and neonatologists," the spokesperson said.

The first births in the publicly funded trial are expected in February.

ACT Health Minister Simon Corbell previously said the ACT had been one of the few jurisdictions without such a service.