Calls for ‘restrictive’ home birth trial criteria to be relaxed

Ian Bushnell 15 March 2019 6

The ACT’s home birth trial should be extended under different conditions, say the Greens.

There have been only 23 births in 28 months of the three-year home-birth trial being run out of Canberra Hospital, prompting criticism that it is too restrictive and the criteria needs to be relaxed.

The Greens, which had concerns from the beginning that the trial would be too restrictive, say it should be reassessed so that it can proceed under different conditions.

First-time mothers and those living outside of the hospital catchment area are ineligible, and women are not allowed to give birth in water.

Submissions from the Australian College of Midwives (ACT) and the Primary Home Birth Midwives at Centenary Hospital for Women and Children both say the trial, which began in October 2016, is inadequate and restrictive.

The Primary Home Birth Midwives say other home birth programs are more liberal, and warn against over-restricting a service.

“When women cannot access care that meets their needs, they are more likely to look at alternative options, which may include disengaging from services altogether and free birthing. The other alternative is that we force women to seek private midwifery services which can cost them thousands of dollars out of pocket,” the submission said.

They say the trial’s catchment area is also smaller than most others and unnecessary in a city with an excellent road system and ambulance service.

The midwives fear the limitations of the trial threaten its viability as a body of evidence.

Shane Rattenbury and Ali Teate from the Australian College of Midwives. Photo: Supplied

Greens leader Shane Rattenbury said it was time to reassess the trial and consider extending it but under a more relaxed set of conditions, saying he had made contact with the Health Minister.

He said the catchment area, based on a 20-minute-or-less journey to Canberra Hospital, meant most of the northern areas of the ACT were excluded.

He said the low number of births was a clear indication that the trial was too restrictive.

“Our advice is that more women would like to have home births. They see it as a viable option, a safe option and a comfortable option,” he said.

“We need to make sure that the range of options are there for people so they can do what’s most comfortable for them and their families.”

Ali Teate, from the Australian College of Midwives, said the College backed expanding the catchment time to 30 minutes, based on the fact that this was the usual lag time for a woman in hospital going to theatre from where she had been labouring.

“If you extended it to 30 minutes that would cover most of the Territory,” she said.

Ms Teate said women had been declined the service because of where they lived and what number baby they were giving birth to, and limiting their options could lead to some birthing at home without support.

She said women who gave birth at home reported high levels of satisfaction, less rates of intervention and surgery, with outcomes similar to those in a hospital setting.

Ms Teate believed one or two of the 23 trial births required a trip to hospital but there had been no risk to mother or baby.

Canberra Health Services said the trial’s final evaluation was planned for late 2019.

“The eligibility criteria for the trial are based on general and clinical guidelines with continuous risk assessments conducted throughout the pregnancy and labour. The eligibility criteria will remain the same until the final evaluation is completed,” a spokesperson said.

“It would not have been appropriate to open the service to all Canberra women at the trial stage. As would be the case with any trial, parameters needed to be set at the start and the sample size needed to be manageable.”

The final evaluation will provide recommendations for publicly funded home birth in the ACT.

For any women interested in finding out more about home birth, there are information sessions coming up at Centenary Hospital for Women and Children Birth Suite (Building 11, Level 3). The next information session will be on Friday 29 March from 5:30pm to 6:30pm.


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6 Responses to Calls for ‘restrictive’ home birth trial criteria to be relaxed
Lucy Baker Lucy Baker 2:47 pm 16 Mar 19

Hang on -ACT Health went to a lot of trouble to introduce birthing centres that would be as close as possible to birthing at home. There are complications that don’t allow 30 minutes’ window to get to hospital. Put your baby’s life first for goodness sake!

Amy Wilson Amy Wilson 9:39 pm 15 Mar 19

Home Birth shouldn't be an option, you never know what can happen. O had a 1/10000 trauma with the afterbirth. If I was at home I would have died. I had a normal pregnancy minus the morning sickness.

    Alison Seow Alison Seow 9:48 pm 15 Mar 19

    Amy Wilson I’m very glad you are here to tell the tale 🙂

    Know that home birth isn’t free birth.

    You have highly experienced health professionals with you, trained to manage birth complications, just as you would in hospital.

    The available research is clear that home birth can be a safer option for women and babies, than a medicalised birth, as long as certain safety criteria are met.

    Jenni Zimoch Jenni Zimoch 9:54 am 16 Mar 19

    How is it 'safer' than a hospital birth?

    Iona Thompson Iona Thompson 11:14 am 16 Mar 19

    Alison Seow ... if it was touch and go in the hospital it would have been death at home. Would your “highly experienced health professionals” include a surgeon, anaesthetist and access to blood for transfusion?

    Sarah Mac Sarah Mac 9:30 pm 16 Mar 19

    Jenni there are highly regarded peer reviewed studies that prove homebirth as safe, if not safer, for low risk women. A main argument, as I understand it, is that women are not subject to possibly harmful interventions, they are also supported in a safe and known environment, which contributes to the ability to birth safely and naturally. The amazing thing about a hospital supported home birth program is the availability of obstetric support when needed, and the smoother transition from home to hospital during labour if the need arises. Continuity of care can be maintained, as well. It is not for everyone, but women and families deserve a choice and to be fully informed.

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