I was interested (and a little horrified) to read the recent coverage of the South Australian Coroner’s findings concerning 3 foetal deaths in SA, associated with home birth in ‘non-low-risk pregnancies’ (1 at least involving a breech presentation). See for example here. Soberingly + tragically the Coroner found that in each case, had the baby been born in a hospital setting it is likely they would have survived. A comparable case in WA was identified, though for jurisdictional reasons the SA Coroner did not make findings as to such case (other than to confirm the factual similarities).

The coverage demonstrates the extraordinary lengths some unfortunate misguided patients will go to, to go ‘natural all the way,’ apparently without regard to the risks taken..

Although not surprisingly, statistical comparison is controversial, neonatal death occurred less than once in 1,000 hospital births, compared with two in 1,000 home births, said an American Journal of Obstetrics & Gynecology meta-analysis published in September 2010. This suggests an absolute risk increase of 100% if birth is in the home, rather than at hospital. I suspect this risks increase is significantly greater in cases other than ‘low risk.’

The cases (once again) opens the questions of choice and patient autonomy + constraints that we, as a society, should impose upon ‘free-choice.’ This in some ways echos the issues arising in the Dingle case. The unusual and distinguishing factor for decisions in an obstetric context, is that ‘choice’ and autonomy for mother may have, as in these cases, catastrophic consequences for a person other than the patient themself, the unborn baby.

Given this, I think it clear we have an obligation to ensure that controls are placed upon ill-informed/misguided choices, to protect such children (as to which see the Coroner’s findings in relation to Ms Barrett, the home birth advocate).

It seems to me that a cut-off line should be set at which home-birth is not permitted, if a reasonable alternative in a hospital setting is available. A designation of ‘home birth contra-indicated,’ in the clearest of cases (only) should be permitted by the responsible supervising team.

I would have thought that education/information as to the risks, in most cases, will be sufficient to convince pro-home parents, to elect a hospital birth. For those stubborn or insightless enough to ignore ‘the facts,’ an appropriate avenue for directive (non-criminal) should be possible, via SAT or otherwise. I’m happy to volunteer my services to assist, if required…

ps: it should not be inferred from the above that I am ‘anti-home birth.’ Clearly in many, many cases this is perfectly appropriate and something that may be left to the parents choice in an informed process.. The concern is the no doubt small number of cases in which determination for a mode/venue of delivery is so great as to outweigh sense + place the unborn child at unreasonable risk.