Hannah Dahlen
Western Sydney University
Hannah Dahlen is a Professor of Midwifery in the School of Nursing and Midwifery at the University of Western Sydney (UWS). She is also the Higher Degree Research Director. Hannah has had national and international success with grants. Hannah has published more than 120 papers and has given papers at over 500 conferences and seminars with half of these being invited keynote addresses. Hannah has strong international collaborations. She is co-founder of the international research collaboration EPIC (Epigenetic Impact of Childbirth). In November 2012 she was named in the Sydney Morning Herald’s list of 100 “people who change our city for the better”. She was named as one of the leading “science and knowledge thinkers” for 2012 due to her research and public profile. Hannah has a strong profile in the profession of midwifery. She is a past National President of the Australian College of Midwives and she sits on several peak National and State committees. Hannah currently supervises 11 higher degree students, mostly investigating women’s birth choices. Hannah is an endorsed Eligible Midwife working in a private midwifery group practice Midwives@Sydney and Beyond in NSW.
Background: There is evidence that the rate of babies Born Before Arrival (BBA) may be increasing within Australia due to the closure of maternity units and geographic distances to places of birth. The BBA rate in New South Wales (NSW) is not known and the associated factors for BBA are not elucidated. The effect of “freebirth” (a birth not attended by any health professional) has not previously been investigated within this setting as a potential factor in the occurrence of BBA, and the freebirth rate appears to be rising. Our aim was to determine incidence, associated factors, outcomes and geographic occurrence of BBA in NSW.
Method: A linked population data study involving population-based surveillance systems was undertaken for the years 2000-2011 in NSW Australia comparing women who underwent BBA when compared to women who birthed in hospital/birth centre settings. Comparisons were also made in reference to geographical occurrence of planned home birth events and intervention in a previous birth.
Results: During the time period there were 1 097 762 births and a BBA rate of 4.2 per 1000 births (n=4945). The BBA rate changed from 4.2 to 4.8 per 1000 births over time. Neonates were more likely to be premature, of lower birth weight, be female, and/or be admitted to a special care nursery or neonatal intensive care unit. Women in the BBA cohort were more likely to be in the lowest socio-economic decile, multiparous, have higher rates of smoking and more likely to suffer a postpartum haemorrhage requiring transfusion than the non-BBA cohort. BBA more commonly occurred in geographical areas where the distance to a maternity unit is greater than two hours drive and in coastal regions where there is also a high rate of homebirth. Women who had more than one BBA in the time period however were more likely to be of higher socio-economic status.
Discussion: BBA occurs more frequently in multiparous women of lower socio-economic status, unless women have several BBA’s. There potentially is an effect of geography on the occurrence of BBA, as geographic area of high homebirth and BBA co-exists, indicating that freebirth followed by an unplanned transfer to hospital may be occurring.
Conclusion: More research needs to be done examining the drivers behind BBA
Ethical approval was obtained from the NSW Population and Health Services Research Ethics Committee, Protocol No.2010/12/291.
Nil Funding
The results will be available at the conference and are currently under review for a publication
Preferred presentation mode oral
The identification and examination of relevant outcomes relating to labour and birth
