Discussion of Midwife-led birthing units - AMA's Dr Andrew Pesce on the Today Show

It's an age‑old debate. Are you putting your child at risk by choosing to give birth outside of hospital?

An international study has raised questions about midwife‑led birthing units, pointing to a higher death rate.

We're discussing that now with obstetrician, Dr Andrew Pesce. Good morning.

DR ANDREW PESCE:

Good morning, Leila.

MCKINNON:

And also Professor of Midwifery at Newcastle University, Professor Kathleen Fahy.

PROFESSOR KATHLEEN FAHY:

Good morning, Leila. Good morning Andrew.

LEILA MCKINNON:

Doctor, tell us about your concerns arising out of this Cochrane Study conducted in the US.

DR PESCE:

The Cochrane Study wasn't conducted in the US. It was conducted all over the world.

The Cochrane Review is an analysis of the existing literature of high-level evidence of research into effectiveness of medical care.

The study found six studies, which had looked at comparison of outcomes of conventional care in hospital labour wards, versus the outcomes of care of women giving birth in birthing centres where midwives were the only care‑givers.

And there were some advantages in terms of lower interventions for the women who had midwife care, in that for every 100 deliveries, about three women had - three more women had a spontaneous delivery, but it's worrying that it found an 83 percent increased risk of a baby dying during or immediately after childbirth.

MCKINNON:

83 percent?

DR PESCE:

83 percent.

MCKINNON:

Professor Fahy, that sounds worrying. What's your response?

PROFESSOR FAHY:

It does sound worrying and I think it's really important that we think about what safety is. There's no such thing as absolute safety and currently in Australia under medical care about eight babies die per thousand pregnancies.

In the birth centre group in the Cochrane Review the baby death rate was about 6.6 per thousand births. This means that if the woman chose birth centre care - I'll just finish - she had a 99.3 percent chance of having a normal birth…

MCKINNON:

But the study…

PROFESSOR FAHY:

…beg your pardon, having a live birth.

MCKINNON:

The study found that by not being in the hospital the death rate was quite significantly higher. Do you dispute that?

PROFESSOR FAHY:

I don't dispute the figure but I do dispute what it means, because the figure includes all premature births, all abnormal babies and it includes the 50 percent of babies that were transferred to medical care in plenty of time for doctors to do something, and they still died.

MCKINNON:

Dr Pesce, I understand that you don't have any problem at all with the work that midwives do and that there are many advantages to having midwives. It's the fact they are not in a hospital that concerns you?

DR PESCE:

Yes, I think this has become relevant because in NSW especially, because of difficulties with workforce, a shortage of obstetricians, a shortage of midwives, we're having to look at different ways of delivering safe maternity services to the women of NSW.

And some time ago the Government has made a decision that rather than trying to concentrate deliveries in places where we can get the best perinatal outcomes, that they're allowing centres to remain open, without specialist medical back‑up.

And I don't mean just obstetricians. I mean anaesthetists, paediatricians and other specialist services and access for immediate emergency delivery, if that's required.

And I suppose the reason why we've brought this to light is that this paper especially shows that we can't just take for granted that the outcomes will be as good as what we're getting now.

If we do increase that level of care in an off‑site non‑major hospital birthing centre there's a risk - an 83 percent risk in this study and this study was written by a midwife, not by an obstetrician, and she herself said there were worries about the increased risk of perinatal mortality.

So I think it is very very important that instead of just rushing headlong into what seems to be an easy solution of keeping birthing centres open without all of the appropriate facilities, that the governments involved look very very closely at how they can deliver the best possible care to women and babies of Australia.

MCKINNON:

Thank you, Dr Pesce. Thank you Professor Fahy, in Newcastle.