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Homes, hospitals and births: new research

Further to her previous post, Justine Caines comments on a new study of births in the Netherlands:

“A lot changes in a week! Yesterday a study of all births in the Netherlands was released.

This paper found home birth was as safe as hospital birth.  The survey size was a whopping 529,688 births.  This figure is close to 2 years of Australian births.

The study found with well trained midwives and good transfer to hospital as necessary, homebirth was a safe option.

This raises issues on what we are doing wrong in Australia.  We have a Health Minister who wants to reform maternity care but is being held back by the powerful medical lobby.

At the same time we have women taking the huge step to birth alone at home rather than face the abuse or trauma previously experienced in the hospital system.

Where are Australia’s homebirth midwives? Oh, they are facing the chopping block.  For 7 years medical practitioners have had their indemnity premiums supported by the taxpayer but privately practicing midwives have been denied any assistance. Private midwives also cannot access Medicare funding and could face de-registration with planned national registration requirements come July 2010.

At the same time the Medicare safety-net has blown out (largely due to a 300% increase in payments to obstetricians).  This issue matters to the hundreds of thousands of women who will give birth each year in Australia.

As the highest volume area of health it should matter to all Australians, because in its current broken state it is negatively impacting many other areas. It’s time for Minister Roxon to put women and their families first.”

Here is the abstract of the new study:

Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births
A de Jonge,a BY van der Goes,b ACJ Ravelli,c MP Amelink-Verburg,a,d BW Mol,b JG Nijhuis,e J Bennebroek Gravenhorst,a SE Buitendijka

TNO Quality of Life, Leiden, the Netherlands b Department of Obstetrics and Gynaecology, Amsterdam Medical Centre, Amsterdam, the Netherlands c Department of Medical Informatics, Amsterdam Medical Centre, Amsterdam, the Netherlands d Health Care Inspectorate, Rijswijk, the Netherlands e Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands
Correspondence: Dr A de Jonge, TNO Quality of Life, P.O. Box 2215, 2301 CE Leiden, the Netherlands. Email ankdejonge@hotmail.com
Accepted 26 February 2009. Published Online 15 April 2009, An International Journal of Obstetrics and Gynaecology.

Objective: To compare perinatal mortality and severe perinatal
morbidity between planned home and planned hospital births,
among low-risk women who started their labour in primary care.

Design: A nationwide cohort study.

Setting: The entire Netherlands.

Population: A total of 529 688 low-risk women who were in
primary midwife-led care at the onset of labour. Of these, 321 307
(60.7%) intended to give birth at home, 163 261 (30.8%) planned
to give birth in hospital and for 45 120 (8.5%), the intended place
of birth was unknown.

Methods: Analysis of national perinatal and neonatal registration
data, over a period of 7 years. Logistic regression analysis was
used to control for differences in baseline characteristics.

Main outcome measures: Intrapartum death, intrapartum and
neonatal death within 24 hours after birth, intrapartum and
neonatal death within 7 days and neonatal admission to an
intensive care unit.

Results: No significant differences were found between planned
home and planned hospital birth (adjusted relative risks and 95%
confidence intervals: intrapartum death 0.97 (0.69 to 1.37),
intrapartum death and neonatal death during the first 24 hours
1.02 (0.77 to 1.36), intrapartum death and neonatal death up to
7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care
unit 1.00 (0.86 to 1.16).

Conclusions: This study shows that planning a home birth does
not increase the risks of perinatal mortality and severe perinatal
morbidity among low-risk women, provided the maternity care
system facilitates this choice through the availability of well-
trained midwives and through a good transportation and referral
system.

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