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Re: OB:Home Births in AustraliaFrom: Peter Wein (p.wein@obsgyn-mercy.unimelb.EDU.AU)Wed Aug 26 19:17:07 1998
At 05:13 PM 26/08/98 -0500, you wrote: >Was wondering how many of you have read the recent (8 Aug. 1998) >Article in the BMJ titled "Perinatal death associated with planned home >birth in Australia: population based study". The conclusions state: >Australian home births carried a high death rate compared with both all >Australian births and home births elsewhere. The two largest >contributors to the excess mortality were underestimation of the risks >associated with post-term birth, twin pregnancy and breech presentation, >and a lack of response to fetal distress. > >Would be interested in peoples comments about the paper, especially our >Australian contributors. I am also interested in the fact that the BMJ >used "fetal" I thought they would have used "foetal". > >John > The authors are careful respected people with lots of epidemiological experience,and no particular axe to grind about home birth (unlike me). Comments - it shows what would be expected - if you manage delivery in an inadequately monitored environment with inadequate skills, and include in that environment women with multiple pregnancies, breech presentations and pregnancies with evidence of intrauterine hypoxia, you will kill babies. In the non-malformed infants weighing over 1,000g, the odds ratio for intrapartum death at home compared with the national figures for all births was 3.0 (95% CI 1.9 - 4.8 0 rate for home births was 2.7/1,000, national figure was 0.9/1,000) - fewer than 0.5% of births in Australia are planned home births. There were 2 deaths in 344 water births - no other information given but this gives rate of 5.8/1,000 (95% CI 0.67 - 20.8) - compared with above national figure for all births of intrapartum > 1,000 g and not malformed of 0.9/1,000! So - despite only having small number of births to manage and so being able to give them a great amount of individualized care, and having an enthusiastic care giver and care receiver - they are still killing 3 times as many babies in labour as everybody else - and occasionally kill mothers as well. As to the spelling of fetus/ fetal - the BMJ is absolutely correct - fetus is a Latin word meaning offspring - it has no 'o' in it - the 'oe' diphthong is of Greek derivation and is pronounced "oi".
-- Peter Wein Senior Lecturer Department of Obstetrics and Gynaecology University of Melbourne, Mercy Hospital for Women Clarendon Street, East Melbourne 3002 Australia Tel: +61 3 9270 2556 Fax: +61 3 9417 5406 Mobile: 0414 691690
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