Home births are not justified in Australia

EDITOR—Bastian et al report the risk of perinatal death associated with planned home birth in Australia.1 I have been criticising the role of home births in Queensland for the past two years, as chairman of the Queensland state committee of the Royal Australian College of Obstetricians and Gynaecologists. In Queensland a registered midwife can (and they do) go into independent midwifery practice after the basic 12 months' training and 20 normal deliveries. Although the College of Midwives has rigid criteria, they are neither enforced nor policed. No one mentions maternal mortality or morbidity.

In two years in Queensland I received reports of one maternal death (a second death was admitted to me by the Queensland state president of the Australian College of Midwives) and one near maternal death requiring hysterectomy and dialysis for three weeks. I was assured that the two maternal deaths were due to amniotic fluid emboli, so would have been unavoidable even in hospital, although I have no records of results of postmortem examinations to prove this. During the same period I documented eight perinatal deaths (to my personal knowledge) out of a total of 400 deliveries by home birth. Queensland also has home birth practitioners who have no insight into their own limitations or what is termed low risk, accepting women pregnant with twins (to deliver in the mountains, and who required helicopter evacuation), with …