Connect
MJA
MJA

Planned homebirth in Australia

Marc J N C Keirse
Med J Aust 2013; 198 (11): . || doi: 10.5694/mja13.10625
Published online: 17 June 2013

Time to reconsider what is safe for mother and baby, and what is not

Debates about homebirth have a long tradition of producing more heat than light.1 This is not because people on opposite sides of the fence have a lack of reasonable arguments. Those opposing homebirth rightly argue that, irrespective of how well selection processes work, unexpected complications can and do arise and that several of these cannot be remedied within the home environment. Proponents, on the other hand, argue that complications are rare and that the home environment protects against undue interference in what is basically a natural process. They assert that hospital births lead to interventions that are not risk-free and are disproportionately frequent compared with the benefit that can be derived from them. Undeniably, there is truth to both sides of the debate. Both arguments boil down to an issue of numerators and denominators. As risk is everywhere, the issues are what and how much risk is acceptable and how much action is warranted to avoid that risk. Having both mother and baby to consider does not simplify matters. Essentially, this is what fuels the debate and produces the heat, because there is little light that can be shed on any of these questions.


  • Flinders University, Adelaide, SA.


Correspondence: marc.keirse@flinders.edu.au

Competing interests:

I chaired the working party that developed the Policy for Planned Birth at Home in South Australia in 2006.

  • 1. Keirse MJNC. Home birth: gone away, gone astray, and here to stay. Birth 2010; 37: 341-346.
  • 2. Catling-Paull C, Coddington RL, Foureur MJ, Homer CSE; on behalf of the Birthplace in Australia Study and the National Publicly-funded Homebirth Consortium. Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years. Med J Aust 2013; 198: 616-620.
  • 3. Hutton EK, Reitsma AH, Kaufman K. Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003–2006: a retrospective cohort study. Birth 2009; 36: 180-189.
  • 4. Birthplace in England Collaborative Group. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011; 343: d7400.
  • 5. de Jonge A, van der Goes BY, Ravelli AC, et al. Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. BJOG 2009; 116: 1177-1184.
  • 6. Bastian H, Keirse MJNC, Lancaster PAL. Perinatal death associated with planned home birth in Australia: population based study. BMJ 1998; 317: 384-388.
  • 7. Kennare RM, Keirse MJNC, Tucker GR, Chan ACl. Planned home births in South Australia, 1991–2006: differences in outcomes. Med J Aust 2010; 192: 76-80. <MJA full text>
  • 8. Li Z, Zeki R, Hilder L, Sullivan EA. Australia’s mothers and babies 2010. Canberra: Australian Institute of Health and Welfare National Perinatal Epidemiology and Statistics Unit, 2012. (AIHW Cat. No. PER 57; Perinatal Statistics Series No. 27.) http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129542372 (accessed May 2013).
  • 9. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PFA. WHO analysis of causes of maternal death: a systematic review. Lancet 2006; 367: 1066-1074.
  • 10. Keirse MJNC. What does prevent postpartum haemorrhage? Lancet 1998; 351: 690-692.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.