[ozmidwifery] another from the Australian...

[Tania Smallwood]

http://www.theaustralian.news.com.au/common/story_page/0,5744,16475238%255E23289,00.html   Midwife care gets seal of approval Adam Cresswell September 03, 2005 MIDWIVES could be blamed for just three of 51 deaths linked to birth centre care in an international review - an error rate so low it proves midwife-led care is safe, a leading expert has stated. An analysis of six studies included in the review found that, contrary to claims by leading obstetrician Andrew Pesce this week that the review showed midwife care increased baby death rates by 85 per cent, the outcomes were very good. Kathleen Fahy, professor of midwifery at the University of Newcastle, said the original data contained in the six trials included in the Cochrane review found that of the 51 deaths of babies born to the 7691 women booked into birth centres, 31 were stillbirths due largely to unavoidable factors such as congenital abnormalities or extreme prematurity. Of the remaining 20 deaths that occurred after babies had been born alive, eight were due to extreme prematurity, three to congenital abnormalities and six were either clinically unavoidable deaths or due to care that took place after the mother was transferred to hospital. "Out of a total of 51 deaths among 7691 births, in six of them midwives were said to have made some level of error. Three of these happened after labour began," Professor Fahy told a midwives' conference in the NSW city of Newcastle yesterday. "I think this is an absolutely fantastic outcome for midwife care."             The Cochrane review was cited by Dr Pesce this week as evidence that midwifery-led birthing centres, two of which are operating in NSW, were unsafe. Many obstetricians are opposed to stand-alone midwife units, which do not offer specialist medical services on site, on the grounds that dangerous situations can arise unexpectedly, even among women previously assessed as being low-risk. In such situations, the life of the mother or baby can be at risk if transfer to a fully equipped hospitals takes too long. But Professor Fahy told the conference, organised by the division of obstetrics and gynecology at the city's John Hunter Hospital, that midwife units were being unfairly scrutinised and the safety of conventional hospital births was far from perfect. "Medical care cannot deliver on its promise to make births safe, and I think we should be very careful not to make promises to the public we know we can't deliver on," she said. British obstetrician Richard Porter, director of maternity services at the Royal United Hospital in Bath, southern England, said midwife-led birthing services in his home town - some a 50-minute ambulance ride away from hospital facilities - were hugely popular and were not only proving safe but also reported much lower rates of surgical interventions. "There's nothing second-rate about midwife-led units," he said. "That's such an important message for communities - there's no need for anybody to be half-hearted about this." Dr Pesce, a consultant obstetrician at Sydney's Westmead Hospital, said an analysis of negligence claims filed with the doctors' insurer, United Medical Protection, showed a disproportionate rate of claims from women who had been cared for in rural hospitals. He warned midwives they would begin facing medical litigation, and urged doctors and midwives to lobby governments to introduce a long-term care scheme to pay for the care of babies born with brain damage.