Leading obstetrician
Andrew Pesce said yesterday that a review by the international
Cochrane Collaboration - considered the best source of evidence for
medical claims - found that home-like settings for births were
associated with "modest benefits".
Dr Pesce said these benefits included higher rates of
breastfeeding, more satisfied mothers and slightly higher rates of
spontaneous vaginal childbirth (as opposed to surgical deliveries).
However, the Sydney-based Dr Pesce - who is also secretary of the
industrial lobby group the National Association of Specialist
Obstetricians and Gynaecologists - said the review, published late
last year, also found babies born in home-like settings such as
midwife-run centres ran an 85 per cent higher risk of death around
the time of childbirth. However, the overall rate is still very low
- about eight babies in 1000 live births in 2002, according to the
Australian Bureau of Statistics.
Dr Pesce also said studies that midwives sometimes used to back
up their safety claims were scientifically inferior, usually because
their subjects were not randomised - an accepted technique to remove
bias.
"Everybody says it's been shown to be safe - but it's not. It's
been shown to be reasonably safe, but without question there's a
worry about increased risk of perinatal mortality," he said.
"There's a positive effect (of birthing centres), but it's a lot
lower than you would be led to believe by people who advocate this
model."
Kathleen Fahy, professor of midwifery at the University of
Newcastle, said Dr Pesce was using the Cochrane deaths data "to
imply that something is significant when it isn't".
"What's going on here is a desire to prevent midwives from
practising their profession, and using safety to do so," she said.
Sally Tracy, associate professor of midwifery practice
development at the University of Technology Sydney, said she had
recently finalised a study using data from more than 1million
Australian births, which would be published shortly in a major
medical journal.
Although prevented under medical journal requirements from
discussing the findings before publication, she said the results
were positive for midwife centres.
In an article to be published next month in NASOG's newsletter,
Dr Pesce - who also represents obstetricians and gynaecologists on
the Australian Medical Association's federal council - said the
Cochrane review looked at the results of six different trials,
together involving 8677 women.
The review found birth centre care was associated with "modest"
reductions in some medical interventions, such as episiotomies -
where a cut is made in the perineum to assist birth and prevent
uncontrolled tearing.
However, Dr Pesce wrote that the study found higher perineal
lacerations in midwife care, so the overall rate of injury in that
area was similar.
"In summary, there is now good-quality evidence of higher risk of
perinatal death in birth centres, with only modest reductions in
some medical interventions," he wrote.
