Friday, July 13, 2012

S. Australia: Homebirth death rate 17 times higher than comparable risk hospital birth

The state of South Australia, which includes the city of Adelaide, has published it's perinatal mortality rates. The data shows that planned homebirth has a perinatal mortality rate more than 17X higher than comparable risk hospital birth.

The report, Pregnancy Outcome in South Australia 2009, is a dry recitation of birth statistics without editorial comment. The statistics are analyzed in every possible way to give a vivid picture of birth in the state. Among the ways the data is analyzed is according to place of birth and the results are surprising and distressing.

Any way you look at it, planned homebirth has a dramatically higher rate of death. The stillbirth rate is higher; the neonatal mortality rate is higher; and therefore, the perinatal mortality rate is higher. In fact, the perinatal mortality rate is more than 17 times higher than that at comparable risk hospital birth! These findings are even worse than the appalling findings from Western Australia, where the data showed that homebirth tripled the rate of perinatal death.

Surprisingly, the perinatal death rate at birth centers was also far higher than the rate at comparable risk hospital birth. Birth centers had a perinatal mortality rate 5X comparable risk hospital birth. This is completely unexpected. Birth centers should have a perinatal mortality rate lower than hospital birth because women with preexisting medical conditions and serious pregnancy complications are concentrated in the hospital group.

Since there were only a relatively small number of planned homebirths, the exact magnitude of the risk is probably smaller than 17 fold. However, the increased risk of perinatal and neonatal death is a remarkably robust finding, extending across time periods and countries and states. To my knowledge, all the existing international, national and state statistics show that homebirth increases the perinatal and neonatal death rates by at least a factor of 3. There is only one exception, a single paper out of Canada; the paper is notable for very strict homebirth criteria and a high transfer rate of greater than 20% in the homebirth group.

There is really no question that homebirth increases the risk of perinatal death. The only people who appear to be unaware of this are homebirth advocates themselves.

This piece first appeared on The Skeptical OB in October 2011.

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