Thursday, December 22, 2011

AIHW report 2009

The Australian Institute of Health and Welfare (AIHW) has published its statistical report Australia's mothers and babies 2009, released: 21 Dec 2011 author: AIHW (Li Z, McNally L, Hilder L & Sullivan EA)
In 2009, 294,540 women gave birth to 299,220 babies in Australia. The increase in births continued, with 2,295 more births (0.8%) than reported in 2008. The average age of women who gave birth in Australia has increased gradually in recent years, from 29.0 years in 2000 to 30.0 years in 2009.
The full report is available at the AIHW website.

The following excerpts are likely to be of particular interest to readers of the APMA blog.

In 2009, there were 863 planned homebirths, representing 0.3% of all women who gave birth. The highest proportions were in Tasmania (1.4%) (Table 3.14). It is probable that not all homebirths are reported to the perinatal data collections.

The mean age of mothers who gave birth at home was 31.7 years (Table 3.45). The proportion of mothers younger than 20 was 1.6%, and the proportion aged 35 and over was 30.2%.

The proportion of mothers who gave birth at home who identified as being of Aboriginal or Torres Strait Islander origin was 1.7%.

Most women who gave birth at home were living in Major cities (58.6%) (Table 3.45). Of mothers who gave birth at home, one-quarter had their first baby (25.0%), and 75.0% were multiparous. The predominant method of birth for 99.5% of women who gave birth at home was non-instrumental vaginal (Table 3.45).The presentation was vertex for 98.1% of women who gave birth at home. Of babies born at home in 2009, 99.8% were liveborn. The mean birthweight of these liveborn babies was 3,646 grams (Table 3.45). The proportion of liveborn babies of low birthweight born at home was 0.9%, and the proportion of preterm babies born at home was 1.0%.
Private midwives are, and have been for many years, the main providers of homebirth care for Australian women. This report does not seem to distinguish between babies born at home in 'private' or 'public' care.

Method of birth and hospital sector

Method of birth for women who gave birth in hospitals was compared by hospital sector and state and territory (Table 3.40).

Women who gave birth in public hospitals reported higher levels of non-instrumental vaginal birth than those in private hospitals (61.5% compared with 43.4%).
Private hospital patients had higher proportions than public hospital patients of vaginal births requiring forceps (3.6% compared with 3.0%) or vacuum extraction (10.5% compared with 7.1%) (Table 3.40). Of women who gave birth in public hospitals, the highest rate of forceps deliveries was in the Australian Capital Territory (6.1%), and of those in private hospitals, the highest rate of forceps deliveries was in the Northern Territory (6.7%). Vacuum extraction was most common for both public and private hospitals in Western Australia.

Of women who gave birth in hospitals in Australia in 2009, 32.6% had a caesarean section delivery. The caesarean section rate of 42.5% for women in private hospitals was higher than the rate of 28.4% for those in public hospitals. The highest rate of caesarean section deliveries in private hospitals was in Queensland (47.9%), followed by Western Australia (41.8%) and Northern Territory (41.0%) (Table 3.40).

NOTE: Data from Victoria are not final Provisional data were supplied by Victoria for this report and limited to Perinatal NMDS data items. The numbers of mothers and babies in Victoria in Australia may change when the final data are used. Tables will be updated when NPDC data from Victoria are received. Tables in this version of the report are footnoted accordingly.

Monday, December 5, 2011

Sarah Buckley: Is homebirth safe?

Sarah Buckley comments on the question:
Is homebirth safe?
Homebirth has been in the news recently, with reports that homebirth may be unsafe. 
If you read an article that reports this, it is important to note the background of the researcher or commentator, and where the research has been published. As you may be aware, there are many vested interests in the maternity care system, including individuals and institutions who could lose much of their livelihood if homebirth became more popular.

As well as this, many of us enter the caring professions with a strong "need to be needed".

It can be confronting, especially for those with long years of training, to realise that women's bodies are superbly designed for labor and birth (as I describe in my ecstatic birth ebook), and that the vast majority of mothers and babies will birth safely anywhere, without outside assistance. (As my friend, and neonatal resuscitation teacher extraordinaire Karen Strange says, "Birth is designed to work, even if there is no-one else around")

The debate about homebirth safety is not just about home birth. It is the tip of a centuries-old argument that began when medical doctors first entered the birth room: is birth intrinsically safe, or an accident waiting to happen? Can we trust women's bodies or do we need to constantly improve them with monitoring, medicating and otherwise intervening?

This argument continues to rage in other aspects of birth: for example a recent paper argues that routine induction for all women at 39 weeks (as compared to 'expectant management') would be cost-effective and beneficial for all mothers and babies.

However, as my writing and research shows, there are many known safety factors in normal birth, and likely many more that we have not yet discovered. Without a full understanding of these factors, any attempt to 'improve' birth for healthy mothers and babies is unlikely to succeed. For example, we still do not understand the processes that initiate labor, but have identified mechanisms that switch on brain protecting factors. and that do not operate before term in other animals.

You can read more on my website about homebirth safety and benefits (and see an interview with my daughter Emma** ) and my blog post Ten things to love about homebirth.