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Midwives with Women

Northern NSW Local Health District
Project Added:
10 September 2014
Last updated:
26 September 2014

Midwives with Women

Mullumbimby Community Birthing Service (MCBS) - Northern NSW Local Health District

Summary

The MCBS is a publicly funded homebirth model of care that offers women a safe option to birth at home supported by skilled midwives. It also supports their right to choose where they will give birth.

Aim

The aim of the project was to provide women with a model of care that supports the right to choose where to deliver a baby by providing a safe birthing environment at home with the support of skilled clinicians.

Benefits

The Northern Rivers area has the highest number of women who prefer homebirth in NSW but access to a professional carer to support this choice has been limited. The model of care is based on a partnership between the woman and her midwife based on trust, honesty and authentic collaboration.

Project status

Project dates:  Trial commenced in April 2012 and evaluated April 2013.

Project status: Sustained - the project has been implemented, is sustained in standard business.

Background 

The Northern Rivers area has the highest number of women who prefer homebirth in NSW. For many of these women, there was previously limited access to a professional carer to support this choice. There is also a reported higher rate of freebirths that occur in this area.  The actual data for this choice is not available on the Statewide database and therefore cannot be quantified. However, local anecdotal information indicates families have had freebirths.

While planned homebirth can be a safe option for most low-risk women, giving birth at home without an appropriate caregiver can place both the mother and baby at risk. 

Solutions implemented

  • A risk assessment was conducted prior to commencement of the trial using the framework determined by Treasury Managed Fund and the GIO Insurers to identified controls to mitigate risk. 
  • A description of service was developed that articulated all aspects of the model of service delivery and the governance structure to monitor the process from a safety perspective. 
  • Eligibility criteria for accessing the service were developed from a clinical perspective and a physical home environment perspective including availability of electricity, water, telephone and accessibility in times of flooding (a common local occurrence in wet weather). 
  • Equipment to cover any scenario needed to be considered. Portability and weight were important considerations as the midwives had to carry it to the home. With each birth, the processes and equipment were reviewed and amended as needed by the staff as theory was translated into practice.
  • A communication and media strategy were developed to inform the health service as well as the community of implementation and progress.

Results

There were 25 women recruited to the trial with women added each month who requested a homebirth. This data was a component of the evaluation to determine the demand for the model.  

All women who participated in the trial evaluated the experience very positively in terms of their relationship with their midwife, provision of information and preparedness for their birthing experience.

The clinical outcomes were compared with an established model in metropolitan NSW. MCBS had more women achieve a normal birth, less intrapartum transfers, almost twice as many water births, half as many second degree tears, comparable postpartum transfer and equal neonatal Apgar scores of nine at five minutes.

Table 1:  Comparison of MCBS to metropolitan model - Antenatal outcomes

Antenatal outcomes MCBS MCBS % Metropolitan model %

4 16% 35% 

 

Table 2: Comparison of MCBS to Metropolitan Model - Outcomes for planned homebirth at the onset of labour

Homebirth outcome MCBS (N=21) MCBS % Metropolitan model (N=26) Metropolitan model %

Gestation (mean)

39.09


40


Primiparous

8

38

9

35

Place of birth

Hospital intrapartum transfer

Homebirth



0

21 


0

100 


3

23 


12

88 

Mode of birth

Normal

Caesarean section

Instrumental

 

21

0

 

100

0

 

21

2

 

81

8

Waterbirth 

14

67

9

35

Perineal trauma

Intact / graze

1st degree

2nd degree

Episiotomy


14

4

3


67

19

14


13

2

8


50

8

31

Apgar 9 or 10 at 5 mins 

21

100

26

100

Postpartum transfer 

1

5

2

8

 

 

References

  • de Jonge A, van der Goes B, Ravelli A et al. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG 2009; 116 (9): 1177-1184.
  • Janssen PA, Saxell L, Page LA et al. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician CMAJ 2008: 181:6-7.
  • Kennare RM, Keirse MJNC, Tucker GR et al. Planned home and hospital births in South Australia 1991–2006: differences in outcomes. Med J Aust 2010; 192: 76-80.
  • Mc Murtrtie et al. The St George Homebirth Program: an evaluation of the first 100 booked women. ANZOG 2009; 49(6): 631-636.
  • NSW Department of Health. (2010). Policy Directive: Maternity Towards Normal Birth

Contact


Executive Officer / Director Nursing and Midwifery
Northern NSW Local Health District
Phone: 02 6639 8225

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