Intrapartum death seven times higher in home births

THE risk of intrapartum death occurring in a home delivery is seven times greater than the risk associated with a planned hospital delivery, according to Australian data published in the latest MJA.

The study, which is likely to reignite debate on the practice of home birthing, also found the risk of death from intrapartum asphyxia was 27-fold higher for home births when compared with planned hospital births.

Researchers analysed perinatal data from 300,000 births in South Australia between 1991-2006, including all births and perinatal deaths. Planned home births accounted for only 0.38% of births over the 15-year period.

“Review of perinatal deaths in the planned home birth group identified inappropriate inclusion of women with risk factors for home birth and inadequate fetal surveillance during labour,” researchers wrote.

They said the safety of home births could be improved with closer fetal surveillance, better risk assessment and timely transfer to hospital when required.

AMA president and obstetrician Dr Andrew Pesce said the research sent a strong signal to the Government to better fund child birthing.

“Women [must have choices] when it comes to labour and childbirth, but they must also have access to all the evidence to ensure that their choice is an informed choice,” Dr Pesce said.

“The AMA does not support home birth because of the safety concerns for mother and baby… however, we do support expanded Medicare funding arrangements to improve patient access to midwife care within a quality framework that guarantees meaningful collaboration between doctors and midwives.”

MJA 2010; 192:76-80