School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia.
Centre for Quality and Patient Safety Research, Western Health Partnership, Melbourne, Victoria, Australia.
Aust N Z J Obstet Gynaecol. 2022 Oct;62(5):664-673. doi: 10.1111/ajo.13518. Epub 2022 Mar 23.
Rates of homebirth in Australia remain low, at less than 0.3% of all births.
To report maternal and neonatal outcomes of ten years of a publicly funded homebirth service, 2009-2019.
Retrospective analysis of clinical outcome data including neonatal outcomes of women who requested a homebirth at a large metropolitan health service in Victoria, Australia. The primary outcomes included: maternal outcomes (mortality, transfer to hospital, place and mode of birth, perineal status, type of third stage of labour, postpartum haemorrhage), and neonatal outcomes (mortality, Apgar score at five minutes, birthweight, breastfeeding initiation, significant morbidity, transfer to hospital).
Referrals for 827 women were reviewed; 633 remained eligible at 36 weeks gestation, and 473 (57%) birthed at home. Compared to women who did not, women who had a homebirth were significantly more likely to be multiparous, have a normal vaginal birth and an intact perineum, less likely to require suturing and less likely to have blood loss of more than 500 mL. Compared to infants not born at home, infants born at home were significantly less likely to require resuscitation, more likely to be of normal birthweight and exclusively receive breastmilk on discharge. There were no maternal deaths and one neonatal death of a baby born at home before the arrival of a midwife.
The outcomes for women accepted into the publicly funded homebirth program suggest appropriate triaging and case selection. A publicly funded homebirth program, with appropriate governance and clinical guidelines, appears to be a safe option for women experiencing low-risk pregnancies.
澳大利亚的家庭分娩率仍然很低，不到所有分娩的 0.3%。
报告一项公共资助的家庭分娩服务十年的母婴结局，2009-2019 年。
对维多利亚州一家大型大都市卫生服务机构要求家庭分娩的妇女的临床结局数据进行回顾性分析，包括新生儿结局。主要结局包括：产妇结局（死亡率、转院、分娩地点和方式、会阴状况、第三产程类型、产后出血）和新生儿结局（死亡率、5 分钟时的 Apgar 评分、出生体重、开始母乳喂养、显著发病率、转院）。
共审查了 827 名妇女的转介情况；在 36 周妊娠时，633 名妇女仍符合条件，其中 473 名（57%）在家中分娩。与未在家中分娩的妇女相比，在家中分娩的妇女多为经产妇、阴道分娩正常且会阴完整、需要缝合的可能性较小、出血量超过 500ml 的可能性较小。与不在家中出生的婴儿相比，在家中出生的婴儿需要复苏的可能性较小，更有可能出生体重正常，出院时只接受母乳喂养。没有产妇死亡，一名在家中分娩的新生儿在助产士到达之前死亡。
被纳入公共资助家庭分娩计划的妇女的结局表明适当的分诊和病例选择。在适当的治理和临床指南下，公共资助的家庭分娩计划似乎是低风险妊娠妇女的安全选择。
