Health Ministry doesn't collect home birth data

Nobody knows how safe it is to have a home birth, because the Health Ministry can't tell how many women do it.

It's a data gap that's frustrating maternity providers and managers such as midwife and MidCentral District Health Board maternity adviser Cheryl Benn.

Authorities are alerted if something goes wrong with a birth, including a home birth, but nobody can put those cases in the context of how many home births went without a hitch.

The Manawatu Standard tried to get home birth figures for the past five years, broken down by district, through an Official Information Act request to the ministry. The only information provided was that there were 2222 home births throughout New Zealand in 2005, 2262 in 2006, and 1236 in the first half of 2007. The rest of the request was refused.

Data collected from lead maternity carer (LMC) claim forms before July 2007 didn't record the district where home births happened, and since then, the forms haven't asked the LMCs or midwives to state if the birth was at home.

"It's a quality and safety issue," said Dr Benn. "There is a concern ... that hospital births may be safer, but we need hard evidence to say whether that is so."

Home birthing gets good press from women who have found it a fulfilling experience, and from midwives who believe it is a safe option when there are no concerns that labour could get complicated.

Dr Benn's experience is that women who give birth in hospital are more likely to be offered interventions in labour that can lead to a cascade of other, sometimes costly, birth interventions.

"But without the numbers, we can't prove the intervention factor."

The lack of numbers has also made it impossible for the board to measure the success of its 2005 maternity strategy, which had increasing home births as one of its goals. The strategy was written just after the Clevely maternity ward in Feilding was closed, and Dr Benn was concerned to see options for out-of-hospital births retained.

In the absence of money to build a new primary birthing unit, home births were seen as a reasonable option that would be safe for low-risk mums, and probably cheaper.

While Dr Benn knows some midwives have been doing more home births, the evidence was only anecdotal that there had been a growth on the estimated 5 per cent rate when the strategy was adopted. She said improved information technology could hold the key to better data sharing.

The Standard asked the Health Ministry if it acknowledged that the lack of statistics was a problem, and if it planned to do anything about it. Senior advisor for maternity services Bronwen Pelvin replied:

"The Maternity Data Warehouse is undergoing an extensive rebuild and will be functional from May 2011. We will then be able to calculate the number of home births."

Manawatu Standard