Wednesday, January 28, 2009

Inquiry into Public Hospital Performance Data

I became aware of this inquiry last week, and initially thought it could slip by without requiring my input. However, it occurred to me that it was unlikely that anyone else would inform the committee of the need for public hospitals to provide back-up for planned homebirths. Therefore, I realised, I had better get to work on a submission.

There are three areas, under the general topic of public hospital performance data, that the committee has asked for comment on:
To inquire into and report on
1. the capacity of hospitals to meet demand, standards and quality of care,
2. resourcing and access levels, and
3. the accuracy and completeness of performance data
for Victorian public hospitals.

Background on homebirths
Birth in the home is unusual in Australia, with only 0.2% of births being recorded as homebirths in 2005 (AIHW 2007), and a similar number being unplanned out of hospital births, known as ‘born before arrival’ or ‘bba’ births.

Most planned homebirths in Australia are attended by self employed midwives, with a fee-for-service arrangement between the woman and the midwife. The State with the highest rate of homebirths is WA, at 0.6% of births (155 births) in 2005 (AIHW 2007). In WA, a publicly funded homebirth program has been operating in Perth and Fremantle through Community Midwifery (CMWA) (http://www.cmwa.net.au ) since 1997.

Reports produced by the Victorian Government’s Perinatal Data Statistics Unit (PDCU), including the annual Hospital Profile of Perinatal Data - Homebirth Report, and the Births in Victoria Report, provide accurate and reliable epidemiological data for planned homebirths that are attended by midwives, and planned homebirths for which transfer of care to hospital took place.

A review of 440 planned homebirths in Victoria 1995-1998 (Parratt and Johnston 2001) reported that:
• Spontaneous labour rate was 96.4%
• Spontaneous cephalic birth rate 91.6%
• Transfer to hospital rate 20%
• No perineal trauma in 64.2%
• Post partum haemorrhage 5.5%
• Retained placenta 1.1%
• Four perinatal deaths in this cohort were unrelated to their risk status or place of birth.

A woman planning homebirth faces certain requirements before homebirth becomes a possibility: she needs to come into spontaneous labour at term, and progress in labour without analgesics or stimulants, so that she can give birth spontaneously. The midwife works in a way that protects the mother’s wellness, and her baby’s transition from the womb to the outside world, and has the capacity to intervene when required to protect mother and baby, in the same way as she would attend a spontaneous birth in a hospital or birth centre. Homebirth midwifery is not remarkably different from hospital midwifery for well women in spontaneous labour. The midwife’s competencies are the same. The consideration by midwives to attend homebirths is a logical step after caseloads in establishing autonomous practice.

Developed countries in which midwives attend homebirth within the usual scope of midwifery practice include the Netherlands, UK, Canada, New Zealand, and other parts of Europe and USA.

Although the number of women who plan homebirth in Victoria is small, they are a significant group, and should not be ignored.

[This post has been condensed from my submission to the inquiry. Joy]

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