Australian women who wish to give birth at home should be supported in their choice if they are at low risk of complications, says Flinders University’s Professor Marc Keirse.
Professor Keirse, Head of the Department of Obstetrics and Gynaecology at Flinders, has written an editorial on home births for the latest issue of the Medical Journal of Australia.
Responding to a research paper on Australian home births also published in the MJA, Professor Keirse said that the low intervention rates reported in the new study are consistent with studies in other countries, and support the viability of planned home births for women at low risk of complications.
He said polarised opinions and a lack of local data has previously seen the debate over home births generate “more heat than light”.
Professor Keirse, who chaired a South Australian policy working party on planned home births in 2006, said that there is a vast difference between properly governed homebirths and those that create occasional headlines.
He said while it is true that unexpected complications can and do arise around labour and that several of these cannot be remedied within the home environment, good planning and management is the key.
“There is nothing wrong with timely referral from home to hospital when the need arises during either pregnancy or labour,” he said.
He said that the greatest risk to the health of the mother in home births is that of haemorrhage after birth. Professor Keirse said that this contingency could and should be largely addressed by increasing the administration rates of hormone-based prophylactic drugs shown to reduce blood loss.
Professor Keirse said that with very few women opting for home births – around .05 per cent – the provision of public funding has been questioned.
“However, it is a woman’s prerogative and her fundamental human right to determine her reproductive behaviour and this includes how and where to give birth,” he said.
“The issue is how to accommodate the autonomy of pregnant women in as safe a manner as possible for both mother and baby.”
Great article, and fantastic to now see a turn around in the attitude surrounding a woman’s right to choice.
It was disappointing to read the comments on the active management of third stage though.
Physiological third stage in low risk women is completely appropriate for physiological labour and birth.
The PPH rate in the study referred to for home was 2%, with 74% having a physiological third stage; compared to a PPH rate of around 6.3% of PPH in hospital where active management is almost universal.
The original study cited also does not say what degree of PPH the 33 women had, or more importantly, if the women who had PPHs did so in the home setting after a normal vaginal birth or after transfer to hospital following medical interventions such as caesarean section, assisted vaginal delivery or manual removal of placenta, where the risk of haemorrhage is increased.
It would be interesting to see in what settings and under what conditions the bleeds occurred before making conclusions about third stage management in low risk physiological births.