I have looked at it and have it in my files. To start with your
question about definitions, the study looked at perinatal
deaths, which investigators defined as stillbirths plus deaths
within 28 days after birth. They further broke down neonatal deaths
into deaths within the first week and late neonatal deaths. In
other words, late neonatal deaths are deaths after day
7 through day 28.
The core issue was that the still birth plus death rate in
the first 7 days (6.4 per 1000) was substantially higher than
in other large studies of planned home birth with a qualified birth
attendant conducted in the U.S., U.K., and the Netherlands (2.0-3.5
per 1000). The investigators attributed the difference to two main
factors: First, Australian midwives were caring for babies who
were not low risk (breech, twin, less than 37 weeks
gestation, 42 weeks gestation or more) in the home birth setting.
Study authors speculated that, "Overintervention and lack of choice
for women with high risk pregnancies, however, could well encourage
some to choose home rather than hospital birth. In many Australian
hospitals, women with breech presentation or twins, for example,
would only be offered caesarean section" (p. 387). (Sound like
another country we know and love?) There also appeared to be
failure of timely transfer in cases where there was meconium,
episodes of slow heart rate, or both for several hours before fetal
death. Study authors comment, "Our study highlights the need
for objective guidance on what constitutes safe practice for birth
at home" (p. 387), and conclude, "Australian women, like women
elsewhere, will continue to choose to give birth at home. They and
their infants are entitled to effective care and support in their
choice." I would add that they are also entitled
to hospital care that does not force them outside of the
hospital in order to avoid overly interventive care with its
attendant risks and unnecessary cesarean surgery.
-- Henci
