Australian Private Midwives Association: Outcomes for planned home births 2008 (Victoria)

Wednesday, December 29, 2010

Outcomes for planned home births 2008 (Victoria)

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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)

These data refer to women attended privately by independent midwives in Victoria, as the publicly funded home birth pilot program commenced in 2010. The following information has been selected from the Homebirth 2008 Profile, for interest of readers of this blog:

There were 299 actual births at home, of 344 planned home births; the total number of births in Victoria in the year 2008 was 72,206
The number of actual home births (and planned home births) has been rising steadily:
2003: 151 (183)
2004: 180 (227)
2005: 182 (218)
2006: 198 (231)
2007: 249 (298)
35.4% of women planning homebirth were mothers aged 35 years and older, compared with 20.8% in public hospitals, and 39.3% in private hospitals.
1% of all women giving birth were recorded as Aboriginal. There were no Aboriginal women who gave birth at home.
32% of women planning to give birth at home were primiparous (first birth), compared with 43% of all births.
93% of women planning to give birth at home came into spontaneous labour, compared with 37.7% statewide.
6.4% of primipara planning to give birth at home had epidural/spinal anaesthesia, compared with 34.2% in public hospitals, and 50.2% in private hospitals.
93% of women planning to give birth at home did so without any medical analgesia, compared with 26.4% of all births.
91.5% of women planning to give birth at home gave birth unassisted, with baby presenting cephalic.
86.4% of primiparous women planning to give birth at home progressed to an unassisted cephalic birth, compared with 49.7% in public hospitals, and 30.8% in private hospitals.
Four women (1.2%) who planned to give birth at home proceeded to a vaginal breech birth, compared with 0.4% statewide.
97% of the babies of women who planned to give birth at home had an Apgar score 7-10 at 5 minutes.
Fifteen babies (4.4%) of women who planned to give birth at home were admitted to Special Care Nursery. No babies were recorded as being admitted to Neonatal Intensive Care Nursery.

Of all the maternity care statistics, life, and death, are absolutes. Our society has an expectation of good outcomes for all births, particularly those which take place in homes. Midwives rightly face scrutiny if anything goes wrong.

The article copied above refers to an important question: When is a life a life?, published in the Australian Nursing Journal, Vol18 No1, July 2010, page 22. This article refers to the Coroner's involvement in investigating the birth and death of baby born at home in South Australia. The case has been reported in the public press, and the midwife has written publicly about aspects of the case.

The loss of life of a previously healthy baby in any circumstances, born or unborn, is a tragedy. The midwife's duty of care is the promotion of the wellness and safety of both mother and baby. However, there are some emergencies that can arise, regardless of the place of birth, which unfortunately lead to death or serious damage.

The homebirth statistics reported on here demonstrate good outcomes.

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WHO ARE WE?

The Australian Private Midwives Association represents midwives in private practice. The association is focused on the safety of women, the ability of women to access quality midwifery care across Australia and the partnerships between women and midwives. APMA supports women’s choice in maternity options within a framework of quality and safety and believes in women being able to access midwives in all settings. APMA unites all midwives seeking to provide continuity of care for women.

APMA strives to provide midwives in private practice with information relevant to their practice and advocacy in the political process.

Enquiries:
Joy Johnston joy@aitex.com.au
Marie Heath NSW and National 0407 266004
Clare Lane (Vic) 0416 130219

APMA POSITION STATEMENT on PLANNED HOME BIRTHS WITH A MIDWIFE

1. We support home birth with a midwife in attendance for women who have uncomplicated labours. 2. We support and adopt the International Confederation of Midwives’ (ICM) Definition of the Midwife (2011), which is foundational to all midwifery practice, including homebirth. 3. We support the right of every woman to access a midwife as the primary maternity caregiver who works in partnership with the woman throughout the episode of care, who is able to be the responsible professional in attendance at the birth either at home or hospital, and who is able to make appropriate referral and transfer of care when required. 4. We support the right of a midwife to practise privately in a fee-for-service or funded relationship with the client, or to take up employment. 5. We support only those regulatory restrictions that are able to pass the ‘public interest’ test: “How does this promote health and wellbeing in the mother and baby?” 6. We support an expectation of equity, including equal pay for equal work throughout a midwife’s scope of practice. Midwives who provide primary maternity care are entitled to the same public funding, the same opportunity to charge a fee-for-service, the same access to hospital referral, and publicly supported indemnity insurance, as medical practitioners providing the same maternity services. 7. We support processes by which midwives are able to gain experience and mentoring in order to commence and demonstrate competence in homebirth practice. 8. We support seamless and reliable processes by which midwives are able to make hospital bookings for women planning homebirth, and arrange transfer to the hospital in a timely way when needed.