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Statistics-truth or dare Dr Pesce?

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Home birth families around the country have been fascinated to read the new study published in the Australian Medical Journal this week which in fact supports their belief that homebirth is safe for mothers and babies.

The new study assessed the outcomes of almost 300,000 births in South Australia from 1991 up to 2006.

Only 1,141 of these were planned homebirths and they were found to result in a similar overall rate of child deaths compared to planned hospital births (7.9 deaths per 1,000 planned homebirths compared to 8.2 deaths in planned hospital births).

For babies born at home the news is even more encouraging. There were only 2.5 deaths per 1,000 actual homebirths making homebirth at 328% safer for babies than birth in hospital.

The study also proves what homebirth advocates haven long known. The outcomes for mothers and babies are vastly improved by choosing to birth at home.

The study says:

Rates of intervention such as caesarean section and instrumental delivery were lower in the planned home birth group.

  • No measurable increase in rate of postpartum haemorrhage for planned home birth group.
  • No statistical difference in Apgar scores for liveborn infants between home and hospital birth.
  • Women who gave birth at home or planned to were more likely to have an intact perineum
  • Women who planned a homebirth had a seven time lower episiotomy rate than planned hospital birth.

For a long time now we have heard the rumours of a new home birth study that Dr Pesce had hidden under his hat, waiting to release it at the perfect moment. Reportedly it showed a baby had seven times more chance of dying at a homebirth but a close inspection of the research reveals these claims as false.

When we look closely at the research what we find is that the study is based on 1,141 planned homebirths. This includes women who were planning to birth at home but ended up birthing in hospital. This decision could have been made during the pregnancy or during labour. There are nine deaths reported in the planned homebirth group and seven of these occurred in hospital. Of the two babies who died at home, one had congenital abnormalities that would have meant the outcome would have been the same wherever the birth occurred and only one death is a stillbirth at home.

Many studies of this kind exclude babies with congenital abnormalities but this study has chosen to leave those in. There is no explanation or investigation of the thousands of babies who died in hospital during the same period who are conveniently left out of the study.

What is most concerning about this study is the way it has been presented as proving homebirth unsafe, even ‘deadly’ according to one headline when if we read it closely the opposite is actually true.

When we look at the claim that a baby has 27 times more chance of intrapartum asphyxiation what we see is that only ONE baby of all these babies suffered from this and yet this claim of there being a 27 times higher risk of death to a baby from intrapartum asphyxiation at a planned homebirth is made from this ‘research’.

Family experience the bliss of a natural home birth
The use of ‘research’ like this to push a political agenda by the AMA is unethical and dangerous. Dr Pesce says in his editorial “health policy makers should focus on evidence based decisions rather than political ones.” Yet it is he who has taken this flawed study and aggressively pushed the AMA agenda to the media to further their own political aims. The AMA does not want the Government to fund and indemnify private midwives as this is a threat to their own business and client base.

When we look at the real evidence and see the truth about birth statistics from the perinatal data reported across Australia what we find about homebirth is in 2006 not a single baby died at a homebirth and in 2007 there were 3 fetal deaths at homebirth. In 2007, 870 planned homebirths, representing 0.3% of all women who gave birth, were reported nationally. There were 2174 fetal deaths in Australian hospitals/birth centres in 2007. There were 3 fetal deaths at home during planned homebirths in 2007. Of babies born at home in 2007, 99.7% were liveborn. In 2006, 708 planned homebirths, representing 0.2% of all women who gave birth, were reported nationally. There were 2091 fetal deaths in Australian hospitals in 2006. NO BABIES DIED AT HOME DURING PLANNED HOME BIRTHS IN 2006.This does not sound like the frightening 27 times more chance of a baby dying of asphyxiation or 7 times more deadly that this study and the headlines claim.

The three most well recognised international studies on homebirth have shown home birth to be safe and is some cases, safer for babies and mothers. In the Netherlands they studied 529,688 low-risk planned home and hospital birth. 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.

A Canadian study of over 12,000 births showed planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.

A study of over 5000 births in the USA and Canada showed women who intended at the start of labour to have a home birth with a certified professional midwife had a low rate of intrapartum and neonatal mortality, similar to that in most studies of low risk hospital births in North America. A high degree of safety and maternal satisfaction were reported, and over 87% of mothers and neonates did not require transfer to hospital.

An economic analysis found that an uncomplicated vaginal birth in hospital in the United States cost on average three times as much as a similar birth at home with a midwife in an environment where management of birth has become an economic, medical, and industrial enterprise.

Birthing women and babies deserve so much better.

“The safety of mothers and babies must come first in any debate,” Dr Andrew Pesce said yesterday and we completely agree. This study and many others actually show that it is safer for mothers and babies to be born at home.

We call on the AMA and RANZCOG to stop their scare mongering for political and financial gain and look at how to improve the safety of mothers and babies during birth in ALL settings. Women will continue to home birth as they have done for centuries and the medical establishment must provide willingly the support and backup for those women and their chosen care providers, their private midwives.

It is unacceptable that the President of the AMA, himself an obstetrician has chosen to take this study and use it for his own political gain. We call for Dr Pesce’s resignation as he has breached repeatedly his professional oath, ‘First do no harm.’

The authors of this study say themselves “Although it is not anticipated that large numbers of women will opt for homebirth, women’s autonomy in choosing reproductive behaviour is a fundamental human right enshrined in Australian law.” It is the Governments responsibility to uphold that law, despite the increasing pressure and scare campaigns from so-called ‘professional’ bodies such as the Australian Medical Association, which is a trade union for Doctors and exists to protect their interests.

Any family who has been blessed to have their child born peacefully at home knows what an outrageous lie these headlines are. We all vote and we won’t forget the decisions this Government chooses to make about our basic human rights, Kevin Rudd and Nicola Roxon.

For more blogs written by Michelle and interesting birth information please visit mybirth

6 Comments on “Statistics-truth or dare Dr Pesce?”

  1. Emma Parsons says:

    Michelle, thanks so much for bringing this to my attention, I am about to hopefully have my second home birth and am also thinking of starting a UK based web resource for mums needing info to help make decisions around natural and home birth, having seen so many friends go through unnecessary stress and intervention at the hands of the hospital.
    This article has just confirmed my thoughts, many thanks
    Emma

  2. BEV says:

    I’m confused. Where does everyone get the info and how do you know it is flawed? If it is flawed you have the right to have it retracted haven’t you? Wouldn’t anyone at risk be giving birth in a hospital anyway and so you would have more traumatic births and/or deaths in hospital because of this. My daughter was so healthy and so was the baby until she went into labour and the baby’s heartrate slowed until almost stopped. An emergency c section saved him. What would have happened if she wasn’t in a hospital? Why do midwives seem to hate doctors so much? It’s funny because even though a lot of women gave birth at home back in the day a lot of them DID die and I know oldies that wish they had access back then to the medical we have now!! I don’t know anyone who remembers being born, so I could have been born inside of a volcano for all I remember. I also know the midwives I have met and had deliver 2 of my 3 were lovely as were the ones my daughters have dealt with. As for how much it costs, the workers (like my husband) have their wages levied on the amount they earn so if anyone should complain it’s them. Where would we be if it was users pay? As for letting women choose what they want and all the supposed support for mum’s what a load of………..
    My daughter rang a community centre to ask if she could come down to see if she was doing something wrong with feeding her baby. If you breastfeed you can call in anytime but if you bottle feed you need to make an appt. It didn’t matter to them she was distressed and it showed me that unless you follow beliefs like you have written about then you are somehow not up to par. That turned me right off. Not everyone is hippified but that doesn’t mean they are unfit. What would be good is a midwife birthing centre in all hospitals and a work ethic where both show respect to the other. At home births??? Forget it. The last thing I want to look at is housework that hasn’t been done sitting in a plastic pool thing. How is that tranquil? A rockpool surrounded by a private beach maybe. With a full medical team. And a loaded epidural. If that makes me a terrible mum then I dare anyone to tell my kids that.

  3. Linda says:

    I always find it interesting when some people hear or read anything pro home birth, they take it as a personal attack to their choice of birth.

    I understand that the point being made in this article is that this is a choice that should be available to women if they so choose. I read no criticism or calls of “bad mother” to those choosing the hospital route.

    Bev, you are right in saying that due to good care we have bought the maternal death rate down, what I think is interesting to note though is that this is mainly because of good prenatal care, e.g. identifying problems before the women goes into labour. We are now able to identify which women need high levels of care and which don’t.

    When problems come up in any birth there are warning signs, at a homebirth this is picked up straight away because the midwife remains with the women. This might take a lot longer in a hospital where the doctors and midwives are attending to multiple women at one time. This gives the hospital time to prep the operating room or a home birthing mother time to get to the hospital.

    You also make a comment that you would never consider a home birth because of safety, but speak of epidurals as a golden choice. I have worked in maternity care for many years and can assure all those reading my post that epidurals have many risks and are responsible for more emergency caesareans than any other intervention. The world health organisation has many studies to back this claim.

    Maybe the use pain relieving drugs, including an epidural was the cause of your daughters emergency caesarean?

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