Interesting article this morning in the Australian. I have a few points of order but essentially it’s great to see something a little more accurate than of late.
Homebirths may have to be secret
Adam Cresswell, Health editor | /March 02, 2009/
Article from: The Australian
*HUNDREDS of women each year who choose to give birth in their homes are likely to face greater medical danger for themselves and their babies with the introduction of regulations that could force the practice underground.*
From the middle of next year, midwives will be required to hold professional indemnity insurance as a condition of practice, under the Rudd Government’s plan to streamline registration requirements for all health professionals.
No commercial insurer has been prepared to offer an insurance policy to an independent midwife since the medical indemnity and wider insurance crises of 2001. When the new regime comes into effect, it will no longer be legal for these uninsured independent midwives to attend home births. The only exception will be if the midwife is employed by one of the very few publicly funded services, thought to be fewer than half a dozen nationwide.
Although the number of women giving birth at home is tiny in Australia -just over 700 in 2006, or 0.26 per cent of all births – this represents a committed group. More than 50 per cent of submissions to the federal Government’s recent maternity services review came from women calling for greater support for homebirthing services, which claim up to a 10-fold greater share of births in some overseas countries such as Britain.
Since 2001, an estimated 150 midwives have provided homebirth services to women, at a typical cost of between $3000 and $5000, but without rebates from Medicare or private health funds, and without insurance cover that would give recourse to compensation should anything go wrong.
I am interested to know who the 150 are. I am opposed to the belief that we are struggling without a medicare rebate or a private health fund. I have never really found it a huge problem because I have good relationships with some GP’s and some Obs.
Midwifery experts, consumer advocates for homebirthing and even some obstetricians are calling for the problem to be sorted out before midwives are forced out of homebirths.
Sarah McLean, a volunteer with the Homebirth Access Sydney consumer group, is pregnant with her third baby and is planning to deliver at home. She said the prospect of losing the option of homebirth was “quite devastating”.
“It’s ridiculous to effectively make homebirth illegal, when other countries like Britain have publicly funded homebirth programs,” Ms McLean said.
This isn’t true, homebirth is free at point of contact for every pregnant woman in the UK regardless to risk as a human right. Sometimes the system may make it awkward but you can stay home and they have to give you a midwife.
Caroline Homer, professor of midwifery at the University of Technology Sydney, said the “worst-case scenario is that women would be unattended” when giving birth.
“Another scenario is that the midwives will continue to practise under other names, but there won’t be any standards of care, and no peer review or evaluation, because it will all be in secret,” Professor Homer said.
“Removing independent midwives and saying we won’t do homebirths won’t solve the problem; women will continue to have babies at home.”
Obstetrician Andrew Bisits, director of obstetrics at Newcastle’s John Hunter Hospital, said there was no reason that the federal Government should not support midwives’ indemnity costs as it already did for obstetricians and other doctors.
Between 2003 and 2006, the federal Government subsidised doctors’ premiums to the tune of $54.39 million.
“If that’s denied, you will have a number of people going underground, making these very fragile, secretive arrangements,” he said. “It’s much more sensible to be positive about it.”
We are not fragile and wouldn’t become suddenly dangerous practitioners, we just wouldn’t be registered. We are discussed like pieces of meat on a slab. I don’t think we really want insurance. I know I just want homebirth as the right of a woman to chose.
Homebirth supporters had been hoping the Maternity Services Review would solve the problem by recommending federal support for midwife indemnity.
This isn’t true either. The College of midwives have agreed to indemnity as a condition of registration. Not having insurance isn’t a problem. It doesn’t change practice, outcome or risk. The only benefactor is the company.
In the event, the report said homebirthing was “a sensitive and controversial issue” and the “relationship between maternity healthcare professionals is not such as to support homebirth as a mainstream commonwealth-funded option (at least in the short term)”. Evidence for the safety of homebirths is disputed. US research published in the British Medical Journal in 2005 found low-risk women giving birth at home with midwife supervision had lower rates of medical interventions, such as the use of forceps, and no greater risk of their baby dying either during birth or soon afterwards.
Even if homebirth was more risky (the research says it’s definitely not), it should still be the womans right to choose.
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This must be the article in the paper my husband read. He told me about it today and my response was it won’t happen BUT I am terrified of being forced to go to hospital beacause my husband won’t ‘break the law’ by having an essentially illegal homebirth!I don’t know where to turn…. any advice would be greatly appreciated.
part of me just cannot really believe this is happening, but it is…. can we stop the ball??? the idea of going into hospital is, to me… a bit like volunteering for gang rape when 9 months pregnant. no I’m not exagerating. that is how it felt.(been there three times) home birth is like making love to your partner and new child is welcomed into both your arms.(been there twice). Now that may be graphic, and I know many women are very satisfied with the medical approach to birth, if only the first time… and have no complaints with the cascade of interventions imposed from the moment you arrive. even if i am ‘informed’ and have my ‘birthplan’, i just do not feel like fighting when in labour with the ‘obstetric nurse’ who might think she is in control!
A Media push, about the irrationality of Making home birth attendants “illegal”,(as an attention grabber) might shame the government into action? I do not think the midwives can push this without getting canned/abused again with the self-interest line, but maybe it really is time for women to vote with their voices and feet.
could we have a meeting of women who are passionate about home birth, with Lisa and other midwives as speakers, and invite ‘today tonight’ or similar??? Flood the media in every state through every contact we have, using all the independant midwives that are affected, their clients, and fight tooth and nail at last? If they can fight so passively at the college for women, we can fight agressively for ourselves. I am sick of the ‘risky’ label, when I know the real risks of hospital birth. Lets get those cochrane articles out, get comments from leading members of the obstetric and hospital/govt community to respond word for word why they deny informed choice to women about maternity services. let’s get the stats from the home birthing projects that have existed,bring them out also. Mutual community ran their trial of home birthing payments to independant midwives, and it was deemed a total success (from the mouth of the agent who ran it)… it has been scrapped for lack of infrastucture to support so few women wanting it…. bulderdash, they thought that way about chiro and natropathy too 20years ago. if home birthing became widely supported,expected and requested, of course they would refund it, and midwives might even get provider no’s also! I’d like to try every avenue to make home birthing a true option for every women, without condemnation and scare mongering. How can I help?
last week, I was in despair and thought that, well at least my 6th baby will make it in before 2010… but now I am just furious that we are returning to the early 1900’s where only the Dr knew best… and every woman after me is denied home maternity care, including my daughters…. come on girls, lets make some MORE noise than ever before. after all, could it get any worse?
Hi Lisa,
I might have missed one point (having been in Australia for only 2 years): what would happen to parents who choose homebirth from July 2010 if that’s illegal?
Would they have to pay a fine if anyone discover their plans?
If anything goes wrong with bubby or Mummy, would the parents/the father go to jail for having chosen the illegal way?
As a consumer, at this stage, I don’t see what would be the difference, apart from the fact that it would be harder to find midwives doing homebirths.
Thanks Lisa.
Milie from Sydney
Looks like you may need to get geared up for a sudden increase in demand for a mobile knitting tutoring service in mid 2010.
This would probably benefit from a number of home visits over say about a nine month period, perhaps with the option of a knit-in near the end of the knitting support service period.
To encourage confidence in developing knitting skills, perhaps an unexpected visit could be agreed to at the onset. If the woman happened to be in labour at the time you could perhaps sit quietly in the corner & do some knitting.
PS: Hopefully the next step will not be going after parents on the basis of "endangering" their unborn or new-born by willfully going against the arbitrary changes.
Grant
Hi there, there would be no consequences for the parents just the midwife who would have a fine and up to 2 years in prison.
Thanks Lisa for your reply.
As a consumer, I feel very concerned by this issue – I’m planning a home birth in June for our first child with an independent midwife (and I’m passionate about home birth in general). What would happen if we want more children born at home? Go back to my country, France? At least independent miwdives have the legal right to assist home births over there, but it’s getting harder to find one. And at the moment it’s the only alternative for women who don’t need/want the hospital over there. Midwives are pushing hard to have birth centres created outside hospitals managed by themselves, when obs are just starting to create “physiological units” within hospitals managed by themselves and midwives to keep the control, and skip home birth practice…
Anyway. It does not provide any solution for Australian independent midwives, consumers and babies!
Can’t wait to meet our midwife next week to talk about this with her.
Keep the good work Lisa ;-0
What about unassisted homebirth? Is that legal in Australia? I'm in Victoria and expecting my 5th child in June, so far I haven't been able to find a midwife to attend me, so I'm thinking to try unassisted, but if I do that what's the procedure after baby is here – do I need to find a Doctor or midwife to check the baby before registration or can I just do that myself by getting the correct paperwork? My first 4 were all hospital births and so I guess that took care of a lot of the things they do straight after birth – vitamin K and Hep B immunisation, forms for registration etc. I'm just not quite sure how to proceed here and since I've stopped seeing my Doc and am searching for a midwife I have no-one I can ask right now. Probably should have done this research before I stopped the Doc visits *sigh*
Sorry to hear you can't find a midwife. have you looked at http://www.joyousbirth.info there is lots of great information there on both midwives and on freebirth. There are good forums with discussion on both too. Good luck.