Coroner: Homebirth advocates need more and better education

The Australian coroner's 106 page report on the inquest into the multiple deaths at the hands of homebirth midwife Lisa Barrett goes beyond rendering findings in the deaths of the specific infants to offering comprehensive recommendations to improve the safety of homebirth. Those recommendations are based in large part on the coroner's concern over the lack of education of homebirth advocates and homebirth midwives. In particular, he recommends dissemination of accurate information:

a) The risks associated with certain types of birth, including but not limited to, twin births and breech births;
b) How those risks might be affected by a choice to undergo such deliveries within the individual’s home;
c) To dispel the notion that adverse outcomes in homebirthing cases would inevitably have occurred in a hospital setting in any event;

In other words, in confirmation of what I have written many, many times before, most of what homebirth advocates (and some homebirth midwives) think they know is factually false.

The coroner offered a variety of examples of Lisa Barrett holding views that are not supported by scientific evidence, including:

• idiosyncratic views as to risk.
• the seemingly unshakeable dogma that an adverse outcome in the homebirth setting would inevitably have occurred in a hospital setting in any event and that the professional services that are available within a hospital would not have altered the outcome.
• Ms Barrett’s tendency to contradict or deny established evidence-based opinion.
• Ms Barrett’s general position [on macrosomia] is at odds with the written material that Ms Barrett herself produced in evidence.
• Much of Ms Barrett’s evidence about the desirability or otherwise of a vaginal delivery of a breech birth in the home setting was premised on a number of questionable views that she steadfastly appears to hold.
• Neither this article [the PREMODA breech study cited by Barrett] nor any other literature that has been tendered suggests that planned vaginal delivery for a singleton foetus in the breech presentation at term ought appropriately be undertaken in the home. On the contrary, the conclusion reached in the article to which I have referred suggests that in vaginal deliveries, rigorous compliance with conditions before enduring labour is a prerequisite.
• Ms Hughes asserts that Ms Barrett told her that breech was 'just a variation of normal.'
• Ms Barrett holds the view that ‘there’s just as much risk surrounding an elective caesarean for a breech as there is surrounding a vaginal birth for a breech’.
• Ms Barrett went so far as to say that it would be impossible to tell whether a planned caesarean section would have resulted in the child being born alive. She goes so far as to suggest that the risks associated with caesarean section are higher than the risks of vaginal birth and that the risk associated with caesarean section and the morbidity and mortality of breech is the same in vaginal birth and caesarean section ... This opinion is simply manifestly incorrect. It causes me to doubt the genuineness of other assertions made by Ms Barrett ...

As a result, the coroner reached the following conclusion:

The evidence in this Inquest has demonstrated that there is a need for education of the general public in respect of the risks associated with certain types of childbirth within the home and in order to dispel what appear to be widely held myths concerning the circumstances in which these births are managed in hospital.

The bottom line is that homebirth midwives like Lisa Barrett misrepresent and minimize the risk of homebirth, misrepresent and minimize the additional risk of conditions such as macrosomia, breech, VBAC and twins. Moreover, they disseminate myths about hospital conditions and policies.

The coroner reached the same conclusions I reached long ago: homebirth advocates are not "educated" about homebirth. Rather they are ignorant of the real risks and instead are indoctrinated with falsehoods and myths, none of which have any basis in science.