Miscellaneous

Question 1

Home birth - epidemiology

Answer 1

In Australia, in 2021 0.6% of women who gave birth was outside the hospital including home birth.
In NZ 4% of births at home in 2019
In 2nd quarter of 2020 (coinciding with the 1st lockdown) increased to 7%, then came down to 4% by end of 2020.

Question 2

Home birth - key considerations

Answer 2

• Health practitioners providing service - obstetricians (GP or specialist) and/or MW
• Meet eligibility criteria as specified in guidelines of their local hospital program
• MW provider - relationship with obstetrician for consultation & referrals
• Established pathways for referral to hospital in event of complications - pathways must include - booking at hospital, plans for rapid/safe transfer, timely notification to hospital of an evolving situation, handover at time of T/F

Question 3

Benefits for planned home birth for low risk women (no risk factors for adverse preg outcomes) and their evidence

Answer 3

Benefits for mother:
* Increased likelihood of unassisted vaginal delivery
* Increased likelihood of intact perineum
* Reduced likelihood of severe perineal trauma
* Reduced likelihood of CS
* Reduced likelihood of instrumental birth

Benefits for baby:
* Small reduction in NICU admission in the systemic review, but little to no reduction in Australian national data
* Little to no increase rate in stillbirth or early neonatal death
* No harm for baby were identified for individual neonatal outcome
* (little or no increase in perinatal morbidity and mortality in cohort of women without identified risk factors for adverse preg outcomes regardless of parity – grade of evidence: low)

Evidence: systemic review and retrospective cohort studies analysis

Question 4

Home birth - rate of intrapartum transfer

Answer 4

Intrapartum TF is common
TF rate were not reported in the systemic review or Aus national data
Safer care VIC stated range of TF 14%, being ~ 34% for Nullip, and ~ 6% for Multiparous.
(1 in 3 in nullip, 1 in 17 for multi)