Research

Planned Homebirth in Australia 2013

Marc J N C Keirse, Med J Aust 2013; 198 (11): 574-575

This paper studied 1,801 planned home births conducted through nine publicly funded public hospital programs. There were 6 deaths.  NASOG acknowledges that this does represent better safety than home births conducted without collaboration with a hospital, especially for multigravida women.  However the paper has a number of deficiencies including discussion of whether these deaths could have been prevented by being in a hospital with rapid access to intervention if required.  There was no comparative data as to how similar low risk women fared actually birthing on site in the public hospital.

Reviews of home births in Australia and UK, that include some high risk home births, reveal a 3 to 7 fold increase in perinatal mortality compared to hospital birth. Low risk is often a retrospective diagnosis after the birth, as unexpected complications can develop rapidly.  As such NASOG continues to recommend birth in a hospital as the safer option.   There should also be a greater emphasis on assisting women’s requests for a lower intervention approach that is accommodated within the hospital maternity system.  Women should be advised of the risks of home birth, especially where that choice is inadvisable for those women with risk factors or are primigravidae.

Are you having a prenatal diagnosis?  Help by participating in research on the impact this has on women

Australian women are invited to participate in a study (as part of a PhD) through Griffith University entitled Prenatal Diagnosis and supportive interventions; A study on the effects of psychosocial support on women’s wellbeing after a prenatal diagnosis.  The study is opened to women who were living in Australia at the time of diagnosis, regardless of diagnosis and whether they terminated the pregnancy or carried it to term and will involve a couple of surveys and an optional phone interview. For more information, please visit.

Contact Stephanie Azri at s-azri@myoffice.net.au

Prospective maternal-request caesarean section study

Studies suggest that as many as 10,000 caesarean sections are performed at the woman’s request in Australia every year, where there is no medical reason for a ceasarean section to be performed.

The RANZCOG guidelines state that such ‘maternal-request’ caesarean sections are appropriate provided the woman receives counselling about the risks and benefits of such a delivery.  However, no study has ever been performed comparing the outcomes of a ‘maternal-request’ caesarean section with a planned vaginal birth to provide the appropriate information for counselling.

This unique study is a collaboration between researchers at James Cook University (Prof Caroline de Costa and Prof Ajay Rane) and the Australian National University (A/Prof Steve Robson).

It aims to recruit women through two websites:  www.caesareanstudy.net for women requesting a caesarean birth, and www.birthstudy.net for women who plan a vaginal birth.  Participating women (aged 18 years or older, single baby, head-down presentation, and no other complications of the pregnancy) will receive email surveys to complete before the birth, and at 6 weeks, 6 months and 18 months post-delivery.  The questionnaires will seek information about decision-making, satisfaction with birth, outcomes of the birth and baby, breastfeeding, continence, and quality of life.  The study will recruit until mid-2013 and will be the first prospective study of its type.

For more information, contact study@birthstudy.net

Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study.
BMJ 2010;341:c5639

Planned home birth death rate four times higher : WA report

Media Release, AMA November 13 2010.
The death rate among planned home birth babies is almost four times higher than those delivered in hospitals, according to a report yet to be released by the WA Health Department.