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• Sybille Japhary-Dobber, please understand that:

  1. Australian midwives do not get 4 years of intensive training.

  2. The patients are often hours away from a hospital.

  3. "the logistics surrounding the home birth" are compromised by distance to and availability of specialist services.

  4. "the rest of the world" is not what we are talking about here. We are talking about Australia, and our own situation.

  Your argument may work in the Netherlands with different staffing and logistics, but please compare like with like.

  Posted by J. davis 16/09/2009 12:27:19 PM

• Articles like this annoy me a lot, because it shows a profound ignorance from the writer into what is going on in the rest of the world.

  I come from the Netherlands, a European country that embraces home deliveries, and quite rightly so. Dutch midwives receive 4 years of intensive training before they can register to assist deliveries independently, therefore they have a much higher level of skills and expertise.

  Home birthing is a very safe way to deliver a child as long as the logistics surrounding the home birth are well organised.

  Speaking from personal experience, I have planned 2 home deliveries in Amsterdam myself. The first one ended in an obstructed labour, so the midwife decided at the right time to refer me to the hospital where my daughter was born after vacuum extraction. My second delivery was a smooth home-birth without any complications.

  Dr. Pesce seems to forget that hospital deliveries are associated with an increased rate in interventions like inductions, epidural anaesthesia, strong analgesia, vacuum- and forceps extractions and caesarian sections, all with their own risks and complications.

  I think the focus of the discussion should be to create a safe environment for women who want to deliver at home, with strict protocols regarding referrals to secondary care, and midwives who are trained to do the job, rather then focussing the discussion on the indemnity issue.

  Posted by sybille Japhary-Dobber 27/08/2009 1:37:03 PM

• There may be lies lies and damned statistics but the latter teach us a simple lesson: childbirth under the supervision of doctors in hospital has become steadily safer since WW2.

  The principal reason? Better care of patients with either haemorrhage or hypertension. Neither of these is always predictable and nor are they best managed in a domiciliary setting (I'm not familiar with IV Magnesium given at home!).

  How can Health Minister Nicola Roxon display the folly she has in acquiescing to the nurse practitioner/homebirth lobby? Should the Honorable Minister ever suggest that doctors must follow evidence-based best practice, it will be timely to remind her that her own coterie of advisers has cajoled her to ignore best practice and evidence in obstetrics.

  Posted by Jim Wilkinson 25/08/2009 7:37:05 PM

• Dr Pesce should, in my view, be saying plainly that homebirth is more dangerous than hospital births, as the studies show. Doctors are constantly exhorted to be advocates for their patients. We should thus be advocates for the 4 babies per 1000 that studies indicate will die because they are delivered away from medical help. By even offering home births we are putting these infants at risk. No surgeon does an operation that has 3 time the risk of a comparable, safer procedure. When homebirth litigation starts, expect the defendant homebirth midwives to be asked in court "Why did you confine this woman at home when statistics show it was 2 ot 3 times more risky? Why Nurse, please tell the court why?"

  Posted by Jim Wilkinson 25/08/2009 1:39:05 PM

• It came a full circle!

  Home was where all births took place when we lived as tribes and third world.

  Hospital birth was considered an improvement in the care for the mother and the baby and always thought as a civilized and improved status.

  Then came the fashion of home birth and the midwifes colluded with the ignorant and made it a 'sexy' thing to do.

  Leaving it as a the 'human rights' issue, doctors did not challenge these changes then.

  Now it is a case of 'giving the camel room in the tent'!

  Posted by Saratchandran 24/08/2009 5:52:44 PM

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