Friday, February 27, 2009

Home birth: the unheard horrors

Thankyou everyone who has sent messages of support and concern for the midwives who face loss of our livelihood because we are unable to access professional indemnity insurance.

If you have been following this blog I hope you will see that I have attempted to present issues in independent practice, and homebirth which is the main practice terrain for independent midwives, in an unbiased way.
Yes, I am outraged.
Yes, I am wondering how I will make a living next year.
I'm not really old enough to retire; my superannuation savings have been disappearing at an alarming rate; and I don't think I would be strong enough to work shifts in hospitals.
My heart would break anyway, even if the arthritis in my knees and back could be managed.

But today a letter in The Age has brought the debate to a new low level. It's such an outrageous letter that I will take the trouble to copy it into this blog, and I will place my comments in [BOLD - AND YES, I AM SHOUTING!]:

Home birth: the unheard horrors
I WISH to object to Alison Leemen's criticism of the Federal Government's maternity review (Letters, 25/2) and her claim that the Government is "criminalising home birth". The Government is sensibly responding to the overwhelming data that in Australia, home birth is three times as risky for both the mother and her baby. [THIS IS SIMPLY NOT TRUE. THERE IS NO SUCH DATA. ALL MIDWIVES ATTENDING HOMEBIRTHS SEND THE DATA TO THEIR STATE OR TERRITORY'S PERINATAL DATA COLLECTION UNIT, AND WOMEN WHO TRANSFER FROM PLANNED HOME BIRTH TO HOSPITAL ARE ALSO REPORTED ON.]

There is no way that even a "skilled and qualified" midwife working on her own in a home is able to deal with the sudden and often life-threatening complications that can occur in childbirth. [THE WOMAN WHO GIVES BIRTH AT HOME IS A WELL, STRONG WOMAN, WHO COMES INTO SPONTANEOUS LABOUR, PROGRESSES WITHOUT STIMULATION OR ANALGESIA, AND GIVES BIRTH PHYSIOLOGICALLY. BOTH MOTHER AND BABY ARE PROTECTED FROM MANY OF THE SUDDEN AND POTENTIALLY LIFE THREATENING COMPLICATIONS SIMPLY BECAUSE THEY ARE NOT RECEIVING THE MEDICAL INTERVENTIONS/INTERRUPTIONS/INTERFERENCES THAT ARE COMMON IN HOSPITALS] Compare this with a team of professionals, including a team of midwives and more experienced doctors, being immediately available. [A TEAM HEADED BY DOCTORS BECAUSE IN MOST CASES THE BIRTH HAS BEEN MEDICALLY MANAGED FROM THE START. MOST DOCTORS WOULD NOT HAVE A CLUE HOW TO BEGIN WORKING IN HARMONY WITH WOMEN'S AND BABIES' WONDERFUL BODIES IN BIRTHING]

A woman has the right to give birth at home, but she takes an increased risk and legally she must be advised about this. We see the avoidable disasters after attempted home birth daily in hospitals [I THINK THIS IS A GROSS EXAGGERATION AND WOULD LIKE TO SEE THE ACTUAL FIGURES FOR THE ALBURY-WODONGA HOSPITALS. THE MIDWIVES I KNOW IN THAT AREA ARE RESPECTED MIDWIVES, AND SINCE THERE ARE ONLY ABOUT 200 HOMEBIRTHS IN VICTORIA ANNUALLY, AND ONLY ABOUT 20% OF PLANNED HOMEBIRTH WOMEN GO TO HOSPITAL, I DON'T KNOW HOW DR MOURIK SEES WOMEN DAILY. WE KNOW THAT THERE ARE NO GURARNTEES EVER IN BIRTH. WE SEE AVOIDABLE DISASTSERS AFTER ATTEMPTED HOSPITAL BIRTH TOO]. These women do not go to the media with their horror stories to warn other women; we only hear if it goes well.”

Dr Pieter Mourik, obstetrician, Wodonga

&^&^&^&^&^&^&

It is likely that some of the misinformation about risk in Australian homebirth relates to a publication in 1998 in a respected journal by Bastian, Keirse and Lancaster (reference given below). Methodological criticism of the study by Wagner (1999) illustrates 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.

References:
Bastian H, Keirse MJNC, and Lancaster PAL 1998. Perinatal death associated with planned homebirth in Australia: population based study. British Medical Journal 317(7155):384-388.
Wagner M, 1999. Critique of BMJ Article. Homebirth Australia Newsletter No 52, 53 April p.18.

2 comments:

Sif said...

Yes, but he has "Dr" in front of his name, so he MUST know what he's talking about, right? He'd be one of the "more experienced doctors" he referred to in his letter...

Joy Johnston said...

You're right Sif. “Trust me, I’m the doctor”.

Here are some solid facts:
The review of 440 planned homebirths in Victoria 1995-1998 that Jenny Parratt and I published in the ACM Journal (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.


The numbers are small, and we cannot draw strong conclusions from these figures alone. Since then the PDCU has been publishing the stats for planned homebirth, both those who birthed at home and those who transferred. There is no picture of dire consequences.

Joy