Dangers of Home births

In 2012 the Coroner’s Court held an inquest into the deaths of three babies involved in home births. The deaths were in relation to a breech baby, a macrosomic baby and the second born of twins. It was found that the planned home births each involved an increased degree of risk, being risks that were identified well before the deliveries took place and risks that ought to have been manageable in a hospital.

In other words, the Court said that the deaths could and should have been prevented. It was found that the babies’ deaths could have been prevented if they had been born in a hospital.

Experts during the inquest said that the second born of twins is at an increased risk of complication during the course of his or her delivery. Once the first twin has been delivered, the risks to the second twin increase the longer the duration between the deliveries. If that period exceeds 20 minutes, there is an increased risk of the placenta separating and the second twin experiencing foetal distress. If enough of the placenta separates, the baby will become deprived of oxygen (hypoxia) which can result in brain damage. The longer the period, the more likely it is that the placenta will separate and hypoxia will occur.

Home birth settings are simply not equipped for intervention if the period between twin deliveries is prolonged. This is one of the reasons it is recommended that twin births should occur in a hospital setting with facilities for emergency caesarean section.

SA Health Guidelines

Following the inquest, SA Health published updated guidelines in relation to planned home births. The SA Health guidelines state that women should only have a home birth if they have an uncomplicated pregnancy, where there is a single baby (not twins, triplets or more) and where the baby is not in the breech position.

The guidelines acknowledge there are unacceptably high risks for planned home births involving situations including:

  • twin pregnancies;
  • pregnancies outside term (outside of 37 to 41 weeks); and
  • breech presentations.

All births carry risks, with some situations involving greater degrees of risk for the mother and her baby.

Women who plan a home birth should be aware that plans to give birth at home may need to be reconsidered at any time, depending on changes conditions during either pregnancy or labour.

If complications are experienced during a home birth the possibility of compensation can arise if the mother was not referred to hospital for management in some circumstances. Legal advice from a specialist in medical negligence should be obtained in such cases.