In a piece in the Victoria Times Colonist a few days ago in relation to an increase in funding for home birth in British Columbia, the Hon. Dr. Margaret MacDiarmid, BC’s Minister of Health, made some very disturbing remarks.
MacDiarmid, the former president of the B.C. Medical Association, is encouraging women with low-risk pregnancies to plan their deliveries at home if that’s what they’d like, citing B.C. research published in the Canadian Medical Association Journal in 2009 as the safety standard.
As long as mothers were screened to be low-risk and assisted by a registered midwife, “there wasn’t any difference between the outcomes for moms and babies whether they were at home or in a hospital,” she said, adding it would also save the health system money.
The study she cites from 2009, Janssen et al., involved less than 3000 home births, was retrospective, and used registry data that defined perinatal mortality as mortality from any point after 20 weeks to 7 days of life. They published relative risks for perinatal mortality but not actual numbers in the original paper. After criticism the CMAJ published an on-line appendix of the actual numbers but in a sloppy manner with reversed column headings that resulted in significant edits and confusion for readers. The difficulty is, because there is no detailed information available on the seven deaths in the study, its difficult to draw conclusions since we know nothing about the circumstances that lead to each mortality.
One of the authors of this study, is our old “friend” Dr. Michael Klein who has made it his life’s mission to convince physicians and nurses that work in LDR that natural birth is “better” and that women will do better if we deny them “elective” things like pharmacologic pain relief.
I think the Minister might look at both the NHS in the UK and the situation in the Netherlands. Both have maternity systems where the majority of care is provided by midwives and where there is active policy to encourage home births…and in both cases, large prospective cohort studies have shown that outcomes in the home birth group are poorer than for those who chose hospital care (see the Birth place Study and the Netherlands Study). Home birth rates in the Netherlands are falling. Women in the UK under the NHS who are defined as “low risk” are often completely unable to access obstetrical consultants, hospital births and pain relief in labour unless they have the personal means to pay for private care. And by the way, they are HOPPING MAD about it. As they should be.
So where does that leave BC women? Well, before I get flamed too badly, let me say that I don’t think choosing a home birth after informed consent is obtained is a stupid choice or an unsafe choice or a choice that shouldn’t be tolerated. I think it is a perfectly legitimate choice. But I don’t think that saying “home is as safe as the hospital” meets any of the conditions of informed consent – an attempted homebirth results in increased risk even though the absolute value of the risk isn’t that impressive. However it is certainly not the ministry’s place to encourage any one birth plan…especially one that has small but real increases in risk and poor outcomes. That’s just irresponsible. And if the motive for doing so is to “save money” then it’s reprehensible. Homebirth won’t save anyone money as several commenters here have pointed out…you still have to fund all the back up systems to look after transfers, you still have to pay for all the complications and it would only take one catestrophic outcome (ie one child with hypoxic ischemic encephalopathy and major disability) that could have been avoided in hospital to knock out the “savings” from homebirth completely for years.
But lets drill a little deeper….why is the BC Ministry of Health (MOH) dropping a half million dollars on low-risk, predominantly caucasian, predominantly upper middle class pregant women who are all, by and large, going to do well anyway? Why aren’t they directing their scarce resources (and we keep hearing how there is no more money for health care, right?) towards those for whom the dollars would do the most good…for example, marginalized populations like pregnant teens or recent immigrants or investing in a culturally sensitive aboriginal obstetrical program?
Could it be because…..*gasp*…….predominantly caucausian, predominantly upper middle class women (and their husbands/ partners) vote? And that they generally vote Liberal?
These women don’t need extra funding. They could be charged the $350 fee for the second homebirth midwife out of pocket (charging the patient for that fee, btw wouldn’t be in violation of Canada’s Health Act) and most of them wouldn’t blink ….this is a demographic, remember, that likely spent more than that for pregnancy belly photography, doesn’t pause before dropping $200 for pre-natal yoga classes and thinks nothing of purchasing $70 curve-revealing lululemon tank tops.
No, they don’t need extra funding.
The Liberals, however, need the votes.