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Publicly Funded Homebirth Pilot

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Patrice Hickey, President, Victorian Branch, from the Australian College of Midwives & Clinical Midwife Consultant, Sunshine Hospital, Western Health has presented at the Obstetric Malpractice …

Patrice Hickey, President, Victorian Branch, from the Australian College of Midwives & Clinical Midwife Consultant, Sunshine Hospital, Western Health has presented at the Obstetric Malpractice Conference. If you would like more information about the conference, please visit the website: http://bit.ly/10xh1iO

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  • 1. Publically Funded Homebirth PilotProject, VictoriaPatrice HickeyWestern Health
  • 2. Footer Text 2Sunshine Hospital• Western Health in Victoria• Maternity Services 4,500 for 2011• Western Metropolitan Area• Multicultural & Low Socioeconomic Community• Secondary Centre• Currently has 4 MGP teams-21 Midwifery EFT
  • 3. Footer Text 3Background• 2000 Midwifery Lead Care through the Teams• Shared Care with GP• Shared Care with GP & Midwife• Clinical Midwife Consultants• Midwifery Community/Hospital Clinics & ComplexMaternity Clinics• 2008 Caseload/ Midwifery Group Practice(MGP) – All‘risk’ model.• 2010 Home Birth Program
  • 4. Footer Text 4Pilot Program• One of two sites chosen for a research based DoHfunded pilot project into the feasibility of a publicallyfunded homebirth project in Victoria.• Detailed preparation and stakeholder engagement• Detailed CPG• One obstetrician visit mid-pregnancy
  • 5. Footer Text 5Home Birth Story• CPG – Women• Catchment• Collaboration• Numbers – Caseload Mix• Advanced Practice• Evaluation• Birth Politics• Media
  • 6. Footer Text 6• January 2010 – March 2012• 140 women booked• First woman birthed January 2010• To date (end March 2012) – 108 birthed within the programexcluding 10 transferred out for breechto private practitioners.Brief Overview of Outcomes
  • 7. Footer Text 7Outcomes cont.• n=108• Primiparous 40 (37%)• Multiparous 68 (63%)• NVB 94.4%• Elective lscs 2 (1.85%)• Emergency lscs 3 (2.77%)• Instrumental 1 (0.92%)• PPH 3 (2.77%)• Exclusive breastfeeding rate98.1%
  • 8. Footer Text 827 Transfers (any stage)4 Antenatally• 2 elective LSCS for breech• 1 APH – IOL – NVD• 1 PET – IOL – LSCS23 Intrapartum (inc postnatal)1 preterm 24 weeks8 had meconium staining – all had NVD atSunshine6 prolonged first stage: 3 NVD / 2 lscs / 1 vacuum
  • 9. Footer Text 9Transfers cont.• 3 PPH - All good outcomes• 1 4th degree tear (primip)• 1 Lack of staff• 2 RDS -mild• 1 Poor neonatal conditionMidwives not in attendance at time of delivery• Severe HIE– Died day 5– Coroner’s inquest
  • 10. Footer Text 10SummaryPlenty of interest‘Incredible’ outcomesNo hospital service in Australia can compare with anLSCS rate of <6% for nullips!< 3% overall!!!But a PNMR of 0.92%!
  • 11. Footer Text 11Continuity of Care