Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years

• Published in: Medical journal of Australia 2013-06, Vol.198 (11), p.616-620
• Main Authors: Catling‐Paull, Christine, Coddington, Rebecca L, Foureur, Maralyn J, Homer, Caroline S E
• Format: Article
• Language: English
• Subjects: Adult; Apgar Score; Australia - epidemiology; Birth Weight; Female; Financing, Government - statistics & numerical data; Home Childbirth - economics; Home Childbirth - statistics & numerical data; Hospitalization - statistics & numerical data; Humans; Infant Mortality; Infant, Newborn; Obstetric Labor Complications - epidemiology; Postpartum Hemorrhage - epidemiology; Pregnancy; Pregnancy Outcome - epidemiology; Retrospective Studies; Women's health
• ISSN: 0025-729X; 1326-5377
• DOI: 10.5694/mja12.11665

Objective: To report maternal and neonatal outcomes for Australian women planning a publicly funded homebirth from 2005 to 2010. Design, setting and subjects: Retrospective analysis of data on women who planned a homebirth and on their babies. Data for 2005–2010 (or from the commencement of a program to 2010) were requested from the 12 publicly funded homebirth programs in place at the time. Main outcome measures: Maternal outcomes (mortality; place and mode of birth; perineal trauma; type of management of the third stage of labour; postpartum haemorrhage; transfer to hospital); and neonatal outcomes (early mortality; Apgar score at 5 minutes; birthweight; breastfeeding initially and at 6 weeks; significant morbidity; transfer to hospital; admission to a special care nursery). Results: Nine publicly funded homebirth programs in Australia provided data accounting for 97% of births in these programs during the period studied. Of the 1807 women who intended to give birth at home at the onset of labour, 1521 (84%) did so. 315 (17%) were transferred to hospital during labour or within one week of giving birth. The rate of stillbirth and early neonatal death was 3.3 per 1000 births; when deaths because of expected fetal anomalies were excluded it was 1.7 per 1000 births. The rate of normal vaginal birth was 90%. Conclusion: This study provides the first national evaluation of a significant proportion of women choosing publicly funded homebirth in Australia; however, the sample size does not have sufficient power to draw a conclusion about safety. More research is warranted into the safety of alternative places of birth within Australia.