The Royal Women's Hospital Family Birth Centre: The First 10 Years Reviewed
Authors: Stern C. , Permezel M. , Petterson C. , Lawson J. , Eggers T. , Kloss M. 
Published: February 2008

EDITORIAL COMMENT: Results of obstetric practice are conventionally assessed by consideration of perinatal and maternal mortality rates, rates of intervention in labour (induction, epidural analgesia), rates of operative procedures for delivery (episiotomy, forceps, Caesarean section) and rates of postpartum complications (retained placenta, postpartum haemorrhage). Other important considerations are physical and emotional morbidity and whether or not the woman and her partner are pleased with the birthing experience and their birth attendants. The editorial committee wishes to request readers to provide information concerning the long‐term emotional results of the male partner's decision to be present at the birth of his child since such data is not available and yet is relevant to the advice given to women regarding the partner's role during parturition. This paper reports a marvellous perinatal mortality rate for births in a birth centre. Indeed the editor makes the prediction that this figure of less than 1 death per 1,000 births for women accepted for delivery in a Birth Centre, including those with intrauterine death diagnosed when the woman was admitted in labour, will stand as a record, since this rate is less than 10% of that for the state of Victoria as a whole (9.7 per 1,000 births in 1990). The results according to the method of delivery are also exemplary. It should be noted however, that 19 fetal deaths in utero occurred in the 889 women excluded from the group because of antenatal complications, and the authors do not provide information regarding neonatal deaths in this group or the number, if any, of these women admitted in labour with an intrauterine death. The data provided indicates that the perinatal mortality rate in the 5,365 women initially booked for delivery in the Birth Centre was at least 4.3 per 1,000 (23 in 5,365).

Authors' Response: In addition to the 4 perinatal deaths in patients who presented to the Birth Centre in labour, and the 17 intrauterine deaths listed in table 4, there were 15 other deaths (9 stillbirths, 6 neonatal deaths) in the patients excluded antenatally i.e. the perinatal mortality rate for the original series of 5,365 women was 6.7 per 1,000 births.

Summary: In reviewing the first 10 years experience of the Royal Women's Hospital Family Birth Centre (FBC), we examined the outcomes of pregnancy and labour in a group of women who requested alternative birthing care and who were identified antenatally as being a ‘low‐risk’ population. This study is a retrospective analysis of 5,365 women booked with the birth centre between 1980 and 1989. Over 16% of women developed antenatal complications precluding further care there, while a further 16% developed complications in labour requiring transfer out to conventional labour wards. Thus 67% of those originally booked delivered in the FBC. The instrumental delivery rate was 11%, and the Caesarean section rate was 4%. Of the women who delivered in the FBC, 3.1% had a postpartum haemorrhage and 1.8% required manual removal of placenta. Approximately 4% of babies born in the FBC required some resuscitation, and 0.8% needed admission to the neonatal nursery. Two perinatal deaths occurred in women admitted in labour to the FBC with a live baby, whilst 2 other women presented in labour with a fetal death in utero (perinatal mortality 0.89 per 1,000).