Jennifer Tow has posted that "stastically homebirth is safer".  Safer than
what??  When mortality statistics are brought into the question, homebirth
can bring with it a significantly increased risk (in Australia at least).
Yes I agree that homebirth can bring many benefits particularly regarding
bonding and early initiation of breastfeeding but I think we need to be very
careful with the "facts" that we are presenting and give parents the risks
as well as the benefits involved.  Bastian H; Keirse MJ; Lancaster PA   in
BMJ 1998 Aug 8;317(7155):384-8    when looking at all the home births in
Australia over a 5 year period  from 1985-90 demonstrated a different
conclusion.  Are there any similiar comprehensive studies in other parts of
the world?

"OBJECTIVE: To assess the risk of perinatal death in planned home births in
Australia. DESIGN: Comparison of data on
planned home births during 1985-90, notified to Homebirth Australia, with
national data on perinatal deaths and outcomes
of home births internationally. RESULTS: 50 perinatal deaths occurred in
7002 planned home births in Australia during
1985-90: 7.1 per 1000 (95% confidence interval 5.2 to 9.1) according to
Australian definitions and 6.4 per 1000 (4.6 to
8.3) according to World Health Organisation definitions. The perinatal death
rate in infants weighing more than 2500 g was
higher than the national average (5.7 versus 3.6 per 1000: relative risk
1.6; 1.1 to 2.4) as were intrapartum deaths not due
to malformations or immaturity (2.7 versus 0.9 per 1000: 3.0; 1. 9 to 4.8).
More than half (52%) of the deaths were
associated with intrapartum asphyxia. CONCLUSIONS: 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.".
Marian Rigney RN

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