The coroner has just released a 106 page report on his investigation into four separate homebirth deaths presided over by Lisa Barrett. Though the language is measured, the conclusion is scathing. Each of the four deaths investigated by the coroner:
… involved planned homebirths each of which in differing ways are said to have involved an enhanced degree of risk to the unborn infant, being risks that were identified well before the deliveries took place and risks that ought to have been manageable in a more appropriate clinical setting. In other words, it is said that these deaths could and should have been prevented.
The coroner did not believe Lisa Barrett’s contention since giving up her midwifery registration she has been working as a “birth advocate,” not a midwife:
To my mind, Ms Barrett’s evidence that she was a mere birth advocate, not performing the duties and responsibilities of a midwife, has to be rejected.
Moreover, the coroner rejected many of the oft made claims of homebirth advocates. He considered and dismissed the claim that strict regulation of midwives would result in more unassisted homebirths.
I am aware of the contention that the strict regulation of privately practising midwives in the homebirth environment might have the effect of driving those women who are intent on undergoing a homebirth underground as it were, thereby leaving them without professional assistance or support. I have given careful consideration to this issue. It is difficult to gauge the legitimacy of such a contention when regard is had to the fact that the contention is mostly supported by evidence that is anecdotal in nature and, secondly, when it is possible that one of the reasons that women are prepared to undergo homebirths that are attended by enhanced risk, such as the homebirth of twins, is the availability of unregistered privately practising midwives who are not regulated …
He also categorically rejected the classic homebirth claim that the babies would not have survived a hospital birth:
… I refer to the commonly held misconception that appears to be promoted by those who advocate homebirthing in risky circumstances, that adverse outcomes that occur in a homebirth would inevitably have occurred in a hospital. There is also the misconception that twin births in hospital will inevitably involve the second twin, to borrow the expression of Dr Hannah Dahlen, being ‘whipped out within about 3 minutes’. There are other misconceptions that these Inquests have identified.
In fact, he thinks that homebirth advocates, far from being “educated” about the risks of homebirth, believe myths promulgated by other homebirth advocates:
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.
In light of the findings in these 4 preventable neonatal deaths, the coroner recommends
1. Prohibiting the practice of midwifery by an unregistered midwife such as Lisa Barrett.
2.Reporting anyone planning a high risk homebirth.
3.Mandating a consultation by an obstetrician before any high risk homebirth.
4. And more education of women contemplating homebirth:
That education in the form of written advice distributed generally to the public be provided in respect of the following matters concerning homebirths:
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;
d) To dispel the notion that the second born of twins would inevitably be the subject of immediate intervention following the delivery of the first twin;
e) As to the need and desirability of epidural pain relief and whether such is mandatory or not in certain birthing environments within a hospital;
Ironically, Lisa Barrett has done more to strengthen regulation of homebirth than homebirth opponents ever could have managed; she has convincingly demonstrated the dangers of homebirth, the irresponsibility of many homebirth midwives, and their preference for myth over scientific evidence. Perhaps some good may come of her gross malpractice that resulted in the entirely preventable deaths of 4 babies.
addendum: Australian TV report highlights the main findings of the coroner’s report.