Homebirth: Patient choice & lack of information

Health Care Complaints Commission v Sheldrick [2016] NSWCATOD 105 unfortunately provides another midwifery conduct decision in respect of home birth issues, including allegations as to:

  • Homebirth as private practitioner involving pre-term pregnancy;
  • Failure to fully inform patients of risks of homebirth;
  • Failure to appropriately recommend medical care and transfer to hospital; and
  • Failure to recognise and respond to compounding and escalating risks in prolonged breech labour during homebirth.

At [97] – [98] the Tribunal commented:

In both cases, the midwife proceeded with a homebirth in very unsafe circumstances, did not convey to the patients and their partners the scope or gravity of the risks they faced, did not consult with any other midwives or obstetricians who may have either a) provided advice to the midwife or b) provided advice to the patients; and did not recommend transfer to hospital and medical care in terms that reflected such risk. Characterising these homebirths as a patient’s choice misrepresents the patient’s knowledge base in making that (uninformed, or not sufficiently informed) decision, and misunderstands the role of the professional in explaining risk and recommending safe practice.

The collected competency and ethics documents of the Midwifery profession make it clear that a midwife must recognise and act within her/his own knowledge base and the guidelines and standards set by the profession, and that s/he should refer to specialist medical care when the needs of a woman or her baby fall outside of this scope. Beyond her failure to be well aware of, and to adhere to, such professional guidance, the practitioner’s proven and admitted conduct in these complaints demonstrated that she was either unaware of her own limitations, or unprepared to take appropriate action as a result.

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