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Friday, December 31, 2010

listing of sites for Australia's maternal and perinatal statistics

National
AIHW National Perinatal Statistics Unit
The most recent general report is Australia's Mothers and Babies 2008

ACT
Maternal and Perinatal Health Series 45

New South Wales
2007 Mothers and Babies

For 2007, there were 144 planned homebirths across NSW with 31 planned homebirth/hospital admissions, so a transfer rate across the state of 21.5%. The highest homebirth rate was North Coast NSW (Port Macquarie to Tweed Heads) with 44 planned homebirths but it also had the highest reported transfer rate of 25.5%. This rate included the Natural Birth Education and Resource Centre (now closed) which registered its births as homebirths and transfer as homebirth transfers, not birth centre births.

There were also 490 babies Born Before Arrival (BBA) which may include some babies who were born unassisted but went to hospital for their paperwork.

Queensland
Perinatal Statistics Queensland

Northern Territory
Mothers and Babies 2006

Western Australia
Perinatal Statistics in WA 2007

South Australia
Pregnancy Outcome in South Australia 2008


Tasmania
[report not found at http://www.dhhs.tas.gov.au/ ]

Victoria
Publications of  the CCOPMM
also, see Maternity and Neonatal Performance Indicators.
Further summaries of home birth, and discussion at this blog.

Wednesday, December 29, 2010

Outcomes for planned home births 2008 (Victoria)

    Click on picture to enlarge



The two pages copied above are from the Victorian government's perinatal data statistics unit, which is part of the Consultative COuncil on Obstetric and Paediatric Mortality and Morbidity (CCOPMM). The publication is:
Hospital profile of maternal and perinatal data
Homebirths for the year 2008


Each hospital receives a copy, and homebirth data are aggregated into a virtual 'hospital' for statistical purposes.

These data are not published on the internet, but are sent to each Victorian maternity hospital, and to independent midwives who provide the data.

This report, for the first time, "reports on all births that were planned to occur at home, regardless of whether they actually occurred at home or in hospital. Previous Profiles reported only on outcomes for achieved home births. This new format will provide more useful information, for example for informing women who are considering homebirth." (page 2)

Saturday, December 18, 2010

Survey on prescribing courses for midwives

The following message has been forwarded by Liz Wilkes, a leader in APMA and Midwives Australia

Re: Prescribing courses for midwives

From 1 Nov 2010, Eligible Midwives are able to prescribe certain medicines under the PBS. One of the requirements to become an Eligible Midwife is the completion of a “program of study or equivalent — prescribing” meeting the requirements of the Nursing and Midwifery Board of Australia (NMBA).

The Department of Health and Ageing (DoHA) has asked NPS: Better choices, Better health to undertake a project to look at the feasibility of prescribing courses for midwives to prepare them for this additional role. As part of this project, we have designed the following survey to help us better understand the perspective and expectations of potential students of prescribing courses. Below is some information about the survey.

What is the purpose of the survey?
The purpose of this anonymous survey is to consult prospective students who may be thinking of undertaking a prescribing course to fulfil one of the requirements in becoming an Eligible Midwife. We encourage you to complete the survey if you are currently practising as a midwife, or you have a midwifery degree and you are planning to practice as a midwife. This information will be invaluable to the Department of Health and Ageing and NPS in considering how best to support and assist midwives and/or potential course providers in the future. The idea of a survey came from the project reference group comprising representatives from the NMBA, the Australian Council of Nursing and Midwifery, and the Australian College of Midwives, as well as representatives from groups with expertise in prescribing education and drug therapy education.

Why has the survey come to me?
We are seeking to understand the perspective and expectations of potential future students of prescribing courses. This is an emerging area of practice and it is important to gain as much information as possible to assist midwives and/or potential course providers.
The Australian Private Midwives Association has kindly agreed to assist us by sending the survey to its members.

Who should complete the survey?
We invite all currently practising midwives, or those with a midwifery degree who are planning to practice as a midwife to complete the survey. Feel free to pass on the survey to relevant colleagues. We ask that each person only completes the survey once.

How do I access the survey?
Please click on this link
(http://www.surveymonkey.com/s/nps_midwives_survey_students) and you will be taken to the survey directly.

What is the timeframe for completion?
The survey will take approximately 15 minutes to complete. The survey is open from now until 10 January 2011. We would appreciate it if the survey could be completed as soon as possible.

What will happen to the findings from the survey?
The data will be collated and analysed by NPS, and the findings will be reported to DoHA.

Who do I contact for further information?
If you would like further information, please contact Dr Michelle Koo, Manager, Educational Design and Support, NPS on 02 8217 8742 or via email at mkoo@nps.org.au.

Who is NPS: Better choices, Better health?
NPS is a not-for-profit organisation funded by the Australian Government of Department of Health and Ageing to enable better decisions about medicines and medical tests. For more information, visit www.nps.org.au

Thank you and kind regards,
Dr Michelle Koo
Manager
Educational Design and Support team
Innovation and Learning

Thursday, December 16, 2010

A GP practice withdraws collaboration

click to enlarge

The letter copied above, with the name of the doctor who wrote it blocked out, was sent to this blog by its recipient. This letter was written by one of the GPs in Bendigo who, in the past, had been willing to support women choosing homebirths.  The main 'support' received in such cases is that the doctor orders routine blood tests and investigations, and facilitates access to the blood bank for women with Rhesus Negative blood to receive prophylactic Anti-D.  One would wonder what 'Duty of care' this doctor perceives is appropriate for these women once this facility is no longer available?

The writer makes reference to a paper comparing planned home births with planned hospital births, published in the American Journal of Obstetrics and Gynecology 2010, by Joseph R. Wax and colleagues.
[Maternal and Newborn Outcomes in Planned Home Birth Vs. Planned Hospital Births: A Meta-Analysis, Wax JR, Lucas FL, Lamont M, et al., Am J Obstet Gynecol 2010]

Using various statistical analyses, this author claimed that there is a three times higher neonatal mortality rate of babies in the planned home birth group than in the hospital birth group. This paper has a familiar ring to it: readers will recall the AMA publication of Kennare et al's retrospective analysis of data from South Australia, and the outrageous conclusions made by the authors. For links and comment, go to the MIPP blog.

A voice of reason has been published by Medscape Ob/Gyn & Women's Health, a respected online medical review site.

Medscape convened a 'Roundtable' in Ob/Gyn & Women's Health,
Experts Argue the Continuing Home Birth Issue
Perspectives on the Joseph R. Wax and Colleagues Home Birth Study in AJOG


The following excerpt is copied from Section 6: Eugene Declercq, PhD

After a long decline,[10] the number of home births has started increasing in the United States. ... Four years do not make a trend, but the rate of home birth is the highest it has been since 1994 and the total number of home births (26,667) is the highest since 1991.

It is in this context that we confront numerous problems faced by researchers trying to resolve the question of safety of home birth. Limited space prevents a full discussion of the barriers to such research, but 3 important ones are:
  1. Design. The gold standard -- a randomized trial -- is not feasible because women will not let themselves be randomly assigned to a given birth site. To argue that the safety of home birth can only be established by a randomized trial presumes that home births are unsafe. Because a randomized trial is impossible, then logically home birth can never be shown to be safe.
  2. Measurement. Because our focus is on planned home births, how do we define such births to make sure we exclude accidental home births (eg, precipitous labor) and include home births that result in transfers to the hospital? Current US data systems do not facilitate such tracking, although some US studies have tried to address this problem as have several recent studies from other countries.
  3. Statistical power. Because planned home births typically involve healthy women, poor outcomes are rare, and hence very large samples are needed to identify differences.

These limitations are among the constraints that Wax and colleagues[1] tried to overcome with their meta-analysis of studies that met certain criteria. The dearth of appropriate studies resulted in inclusion of some studies that are old (data from the 1970s),[25] studies that inferred rather than documented planning status, and studies that were primarily from other countries (only 2 of the 12 were US-based). The decisions that have drawn the most criticism have involved the largely unexplained inclusion and exclusion of certain studies. The inclusion of data from Pang and colleagues' study,[26] done in Washington state, drew fire because it was the source of most of the reported neonatal deaths and it could only infer planning status, which was defined as "home births of singleton newborns of at least 34 weeks' gestation [with] a midwife, nurse or physician listed as either the birth attendant or certifier..." The difficulty with that definition is seen in a recent 19-state study of births occurring at home in which planning status was indicated.[27] In that study, I and my colleagues found that 87% of the unplanned home births occurred after 34 weeks and 69% of the home births attended by physicians were unplanned. In addition, 22% of the planned home births were attended by "other" attendants; these would have been excluded by Pang and colleagues.[26] This means that Pang and colleagues probably both erroneously included physician-attended full gestation home births in the planned home birth category and excluded "other" attended planned home births. In fairness, our study was published in the same month as Wax and colleagues' study and years after Pang and colleagues' study, but one cannot now claim that the potential problems with selection bias simply cancel each other out.

Of greater consequence was Wax and colleagues' exclusion of the largest study of planned home births ever done: that by de Jonge and colleagues[7] in the Netherlands, with more than 300,000 planned home births. Wax and colleagues' decision to use neonatal mortality at 28 days as their primary outcome unfortunately led them to exclude that study, which reported on perinatal and neonatal mortality up to 7 days. After controlling for confounders, de Jonge and colleagues reported no added mortality risk in planned home births. The size of their study overwhelms that of Wax and colleagues' meta-analysis and was the basis on which the meta-analysis found no difference in perinatal mortality. Perinatal mortality, which includes fetal deaths, would seem a more appropriate outcome measure. Neonatal mortality is also widely used, but how important is the distinction between 7 and 28 days? Over the past decade in the United States, about 80% of all neonatal deaths up to 28 days have occurred in the first 7 days. Apparently, de Jonge and colleagues are now examining their data out to 28 days. Would anyone seriously suggest that such a great concentration of home birth-related deaths occurring between 7 and 28 days would alter their core finding of no added risk? If de Jonge and colleagues find no difference at 28 days, Wax and colleagues' meta-analysis would also most likely find no overall difference in neonatal mortality. What happens then -- are their findings withdrawn? Does the journal publish a retraction, even after it made Wax and colleagues' article an "editor’s choice"?

Currently under way is the Birthplace in England study, another large, well designed study of home, birth center, and hospital births. The fact remains, however, that the debate over home birth will not be resolved by this or any study, no matter how well designed. At its core, the home birth debate is ideological, centering on 2 diametrically opposed perspectives on birth held by groups that generally do not communicate with each other and unfortunately often hold each other in disdain. Perhaps the question we should be asking is not what is right or wrong about any study on this topic. Rather, why are increasing numbers of US women who are experienced in birth (80% with parity 2 or higher) choosing to reject hospital-centered systems of maternity care that so many well-meaning clinicians want to make better?

Saturday, December 4, 2010

First MEDICARE MIDWIFE Birth

Congratulations to Liz and the family of baby Eli.

The Chronicle [Toowoomba, Qld] article announces:

Baby Eli is an Australian first

Baby Eli may wonder what all the fuss is about but he really is a very special little boy.

The third son of Stacey and David Silver is the first to be born under the care of Australia’s first Medicare eligible midwife, Toowoomba resident, Liz Wilkes.

Medicare payments for midwives were introduced on November 1 as part of National Health reforms.

Ms Wilkes along with others, has established the new clinic My Midwives in Toowoomba.

The clinic will employ 5 midwives, mentor midwifery students and provide outreach services. ...