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Wednesday, 20 March 2019 12:57 pm

New Zealand homebirth figures being addressed by Ministry

THE HOMEBIRTH community in New Zealand is a small one and reasons for this range from fear and misinformation about childbirth, to a lack of detailed statistics.

The Ministry of Health and birthing organisations say they are currently addressing the issue of figures.

However, until now regular and up to date homebirth figures have been difficult to for the general public to find. 

The problem stems from the unique midwifery employment situation in New Zealand, says Wellington Homebirth Association coordinator and a trustee of Homebirth Aotearoa Jeanette Lazet.

“We have a unique system that supports women being empowered to have their babies at home as a safe and viable option, which works because we have a state-funded one-woman one-midwife system and it’s time that we had statistics to quantify the success and benefits of that model, ” says Ms Lazet.

She says registered midwives are self-employed, and claim for services completed, with amounts charged, being set by the Ministry of Health. 

In this way, data collection has in the past related to components of work rather than specific birthing details.

Homebirth Aotearoa  has been in conversation with the Ministry of Health since 2002 about this issue.

It claims the homebirths rate here is probably around 7%, but may be as high as 10% in some regions.

It hopes the new work by the Ministry of Health will result in accurate data that reflects childbirth in New Zealand.

Ms Lazet points to the United Kingdom, where specific birth details are more readily available, which means doctors have been able to promote homebirth as a safe option.

The National Childbirth Trust, a UK healthcare charity, says no difference has been found in deaths between hospital or homebirths in Britain. 

It says studies have also found women planning a homebirth were more likely to have a normal, healthy birth.

88% of women in the UK having a planned homebirth had a ‘normal’ birth, compared with 60% of planned obstetric unit births; and homebirths were found to progress better in a more relaxed environment with no time pressures, says the NCT. 

Andrea Vincent, a self-employed midwife, says that regardless of where they wish to give birth, NZ parents choose a lead maternity carer, or LMC, who provides continuity of care through pregnancy and birth the first six weeks of a baby’s life.

Most LMCs are midwives, but can also be doctors and obstetricians.

Mothers choose where to give birth: at home, in hospital, or in a primary birthing unit.

Self-employed midwives work together in small practices and are careful to take regular time off and reflect on their performance.

“Midwives have gone through a lot of growth and their role is always evolving and becoming more organised,” says Ms Vincent.
The service is free of charge and the LMC midwife coordinates his or her skills between  hospitals, nurses and obstetricians, if they are required.

Ms Vincent says one way to measure birth data in New Zealand is to look at the figures recorded by the Midwifery and Maternity Provider Organisation.

The MMPO was established in 1997 by the NZ College of Midwives to provide professional support and education.

It also manages data collection for those practitioners who use their service, which is about 50% of births.

Ms Vincent says this is the most robust data available in the country, and has been audited by Canterbury University.

The data, taken from a large sampling of the babies born each year, shows the planned place of birth, whether it is by caesarean or ‘normal’, ethnicity of mothers and geographic distribution.

Ms Vincent says in the Nelson region where she works, homebirth rates are cyclical and depend on such factors as media coverage of the issue, support groups in particular regions, and active homebirth promotion by midwives.

She questions the idea that the availability of related data would inform women’s birth choices.

“It would be interesting to have better data, but I don’t think it would change the rate of homebirths we have.”

She says women should take care to choose an experienced and skilled midwife with whom they can build a good relationship, which is more important than gauging what is happening nationally.

She says midwives are very careful not to take risks with homebirths and will often advise against one if they see fit.

“It’s all very well to say it’s a woman’s choice, but in the end they’re coming to you for your professional advice,” she says.

One group worried about the lack of Ministry of Health data on birthing outcomes is Action to Improve Maternity.

Spokeswoman Jenn Hooper describes AIM as a support group for families of children who either died or were disabled at birth, as well as advocating for an independent perinatal database that records every birth in New Zealand.

“How is a woman supposed to make a fully informed decision when there is so much we don’t know about birth in this country?” she says.

She says of particular concern is the lack of information about the birthing outcomes of women who are transferred from a primary birthing unit to a hospital, as the time spent in transit can be critical to the health of an unborn baby.

Mrs Hooper also questions the 7-10% homebirth rate proposed by Homebirth Aotearoa. 

“I don’t think it would be that high a figure, but again, proper numbers would be useful.”

She says that a 2004 Ministry Report puts homebirths at 2% nationally and she will await an up-to-date report with interest.

Rhiannon Larsen, who has given birth three times at home, says many women equate ‘homebirth’ with ‘natural birth’ and worry about not having the option of pain-relieving drugs.

“I think there’s a lot of fear because of the pain and the perceived danger to mother and baby. Natural birth really just needs to be normalised in our society.”

Ms Larsen has formed a homebirth support group in her town with a friend, but says finding new members has been difficult.
“Homebirth is not for everyone. It’s got to be a proper, considered choice. For me it’s just unbeatable,” she says.

Jasmine Purnell is a Thames mother of three children who were all born at home.

In her rural community she has found a stigma attached to the idea of homebirth, even amongst medical professionals.

Ms Purnell says the decision to have a homebirth must be an educated one, and it is important the health risks are properly assessed for mother and baby.

“I just wanted a healthy and happy baby. That was the most important thing, so I chose a good midwife who had a lot of hospital experience, in case I had to be transferred.”

Ms Purnell realised that the equipment in her local, rural birthing unit would be the same as that carried by her independent midwife to a home birth.

“It’s good not having to go anywhere once labour starts. It works well in a rural setting, providing it’s a low-risk pregnancy,” she says.

Despite the positive stories, Jeanette Lazet says homebirth still remains a little-considered option for parents.

“Often new mothers don’t even see it as a possible option, to have a birth at home in comfort and with those they love surrounding them.

“It comes down to what we are willing to create in our community, and for ourselves,” she says.

Homebirth Aotearoa is an umbrella organisation for homebirth support groups throughout the country.

Its aim she says is to empower women and their families to “really make the choice” and to realise that healthy homebirths are possible and normal.

A Ministry of Health spokesperson  says that some homebirth data is available on their website, but it only relates to specific years.

He says updated figures are due to be released in two weeks’ time.

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