AUSTRALIAN COLLEGE OF MIDWIVES
Advocacy Update
26 August 2005 2nd Release
MEDIA RELEASE Friday, August 26, 2005
Midwife-led Birth Centres are Safe
Recent allegations by the Australian Medical Association (16 August 2005)
that birth centres pose an increased risk to babies are inaccurate and
misleading Professor of Midwifery, Dr Kathleen Fahy said today.
"As a midwife and researcher of many years I am concerned that a national
body would be so loose with the truth. The AMA cited a systematic review
of
the research literature which was published in the influential Cochrane
Review and falsely claimed that there was a difference in outcomes for
babies. In fact, although there was a slightly higher death rate for
babies in the groups allocated to birth centre care, the review concluded
that this difference was not statistically significant" Fahy said. "It is
normal practice to only claim a difference between groups when that is
statistically significant" she said.
What the AMA did not say was that the Cochrane review found major positive
outcomes for women and babies that were statistically significant.
Allocation to a home-like setting as the planned place of birth decreased
the likelihood of women needing narcotic drugs or anaesthesia in labour.
It
also increased the rate of normal labour and birth. In addition, women
were
more satisfied with their birth care and they were more likely to
breastfeed.
"The only published research which has investigated the causes of
perinatal
deaths in a birth centre was in Sweden (Gotvall et al.2004). This study
showed that
for birth centre women who commenced labour at term (the baby was mature
but
not more than 2 weeks overdue) and who had a live baby at the beginning of
labour, only 3 babies died out of 3256 over 10 years."
"Of those three deaths one was due to infection (group B) which can't be
blamed on midwifery management. One death occurred five hours after
transfer to medical care and should not be blamed on the birth centre as
there was plenty of time for the doctors to do a caesarean but they
delayed."
"This leaves one death out of 3256 where the actions of the midwife could
possibly be criticised for failing to transfer a woman when an abnormal
heart sound was detected. This death rate compares favourably with the
death rate for normally formed, fully grown babies where the care has been
under medical control in standard hospital services" Professor Fahy said.
A recent study of all births in Australian birth centres over several
years,
currently in press with a reputable international journal, will confirm
the
safety of Australia's birth centres, she said.
Midwives are qualified and licensed to provide antenatal, labour and
post-birth care on their own responsibility. "Normal healthy women do not
need to be medically controlled in their labours and births and the
literature shows that births centres are a popular, safe and viable choice
for birth" Professor Fahy said.
"Instead of trying to take away a service women value, it would be more
appropriate if doctors organisations focused on supporting the provision
of
good quality obstetric and medical care for the 10-15% of women who can
benefit from their care."
"Rather than attacking midwives, doctors need to work closely and
respectfully with midwives. That means collaborating on good referral and
transfer polices and practices for women who do choose birth centre care.
It means receiving the woman and her midwife respectfully and sensitively
when a transfer is necessary."
"Such genuine collaboration between midwives and doctors is the real key
to
ensuring we collectively provide the best possible care to women and their
babies." she said.
Kathleen Fahy is Professor of Midwifery at the University of Newcastle.
Media contact: Professor Kathleen Fahy 0404
087
449
Dr Barbara Vernon,
0438 855 529
Executive Officer, Australian College of Midwives
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