Home birth without medical assistance

Published on 14 September 2016 were the findings of the Inquest into the death of NA.

The child NA died following a home birth in which no doctor or midwife was present. The inquest considered various issues including:

  • The mother’s understanding of risks to the baby, before the birth
  • Advice given by a medical practitioner
  • The role of the Department of Family and Community Services and NSW Health

On the issue of the mother’s decision as to the manner of birth, the Coroner said:

It is essential to remember that women have a right to decide how they will give birth. At common law all competent adults can consent to and refuse medical treatment, which includes prenatal care. Unless a lack of capacity or some kind of coercion is established, an adult mother has a right to birth at home, even if the prevailing medical advice deems the birth “high risk”. Until the foetus becomes a person, the relevant medical care is understood as pertaining to the mother.

All we can hope is that decisions are made with the benefit of high quality information and where necessary expert medical advice. In this case, it appears that F and P were firmly committed to a home birth or what was described by the Ministry of Health as a “freebirth” . While they were informed of the risks, they seemed unable to properly comprehend or take seriously what they had been told. It is extremely unfortunate that once the final scan had been done, they were not warned again in the firmest terms, either by the GP practice they had attended or by a worker from Community Services. It is now impossible to know if F would have changed her mind had that extra warning taken place or if she and her husband would have chosen to proceed with their original plans regardless.

In considering what recommendations can be made, it is clear that there is no easy solution. It is positive that the Local Health District is trying to address the desire for non-hospital births in the local area. This program should be supported and resourced. Counsel for the family sought a recommendation that such services be better resourced. In 2015 there was apparently capacity for only 200 women to choose this option. However, in the context of this inquest there was no evidence that the service was currently unable to meet the demonstrated need. It is likely that such a recommendation would go beyond the scope of this inquest.

Two recommendations were made by the Coroner:

1. That the Royal Australian College of General Practitioners consider developing policy guidelines to assist and support its members in advising patients in relation to requests for nonhospital births. Consideration could be given to the “National Midwifery Guidelines for Consultation and Referral”.

2. That the Northern NSW Local Health District consider implementing an information outreach program to local general practitioners about the services currently provided by Northern NSW Local Health District in relation to mothers wanting non-hospital births.

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