Here is an article written by my friend Miriam Hannay.
The current debate on homebirth has been sidetracked by comparisons between those who choose to birth in the hospital system, those who birth at home with a registered midwife, women choosing to birth at home without assistance, and women who live in third world countries and have limited access to health care wherever they choose to birth. These comparisons are nonsensical and contribute nothing to what could and should be a reasonable and productive dialogue between all interested parties. The majority of recent reportage has been vitriolic and sometimes personal and is inappropriate in a debate that involves the choices of women during the childbearing continuum and the professionals who provide their care.
This is not a time to be emotive. It is a time to focus on evidence and fundamental human rights. The reality we all face as citizens of Australia is that in July 2010, the registration of midwives will be governed by a federal body. Our health minister has stated that under this new system it will be necessary for midwives to have indemnity insurance. For the majority of practicing midwives this requirement will be fulfilled by their employers. For those midwives who work in the hospital system and also attend births at home that requirement will compel them to choose which aspect of their career is more viable or more palatable. For midwives in private practice the choice will be to rejoin the mainstream maternity system or revoke their registration and work as lay practitioners risking criminal charges and possible incarceration by doing so.
As in any circumstance that significantly affects the practice of qualified professionals it must be asked, in what ways will this change affect those professionals and their clients? It has been mooted that the effects will be minimal given that only 0.2% of women choose to birth at home in Australia. What does it matter if those women have no access to a registered midwife to attend them at home? What does it matter if those midwives who choose to eschew the hospital system lose their registration? It matters because all women who choose to birth at home have made a decision about their health care they have an inalienable right to make. It matters because all midwives have the right to work in whatever setting they choose as long as their practice conforms to national competency standards.
While it is true that homebirth is a minority choice for women and midwives the suggestion that it is irresponsible and unsafe should be carefully examined. The evidence being presented to support this stance is either anecdotal or drawn largely from a twenty year old study with fundamentally flawed methodology. If journalists and other professionals wish to include research findings in their contributions to the current debate it would behoove them to access studies that are as recent, extensive and sound as possible. In contrast to the excessively quoted Australian study on homebirth outcomes is a New Zealand study spanning a period from 1973 to 1993 which examined 9776 planned homebirths based on data collected from home birth associations and national perinatal statistics. The researchers found no significant difference between infant and maternal morbidity and mortality between hospital and home birth. They concluded that home birth was a safe option that increased in popularity during the period covered by the study. The Cochrane Collaboration, regarded as the gold standard for reviews on medical research states in their review on planned home birth as opposed to hospital birth that there is no good evidence to support one or the other. They point out that more research is needed but that hospital birth may lead to an increase in medical interventions and subsequent complications that offer no benefit to women with low risk pregnancies.
In addition to inadequately addressing issues of safety and risk, the current dialogue fails to recognise the limitations placed on the practice of midwives and the choices of women should the proposed plan for national registration be implemented as it stands. In Australia the dominant culture supports a truncated scope of midwifery practice bound by the policies of individual institutions and clinicians. This medical model of care is in many ways unsuited to the profoundly personal nature of the childbearing experience. Only a small number of midwives work within the full scope of their professional practice however current legislation and professional standards support all to do so. The Code of Professional Conduct for Midwives in Australia states that the work of the midwife is not only defined by clinical competence but extends to encompass a woman’s personal aspirations and desires. It also emphasises the importance of the role of the midwife in supporting the individual choices of every woman in her care when those choices are informed by accurate information and a relationship of trust and respect.
In a system that requires midwives to accept a limited scope of practice it follows that women’s choices will be diminished and their needs may not be met. While no bureaucrat or politician has suggested a law prohibiting women from birthing at home, to prevent midwives from registering due to a lack of appropriate insurance effectively marginalises that choice, perhaps to a degree that many women and their midwives may find untenable. When obstetricians and general practitioners faced a similar insurance crisis, a rescue package was devised to ensure they could continue to follow their chosen career paths and provide essential care to their communities. It seems logical that our federal government should afford midwives in private practice the same respect for their professional qualifications and consideration for the women who seek out their care.
- Do you
Homebirth? Share this post with your friends - Recommend on Facebook
- Buzz it up
- Share with Stumblers
- Tweet about it
Related posts:
Wise words indeed…
Thank you for this well written piece, which explains the issues at heart so clearly.
Well said!!
Very well written. I see the growing popularity (if not understanding!!) of homebirth back in the UK and as a pregnant woman myself, cannot conceive of a suppoed 'civilised' country where this can actually be happening. Such a hugely sad day for Australian society.
well said Mim!!!!
See I too see it as a human rights issue – but I totally disagree with you and the other comments. I see it as a human rights issue for the baby. The baby has a right to have access to every emergency medical care possible. The baby is the most vulnerable person in this thing – not the Dr certainly, not the midwife, and not even the mother, they all have SOME semblance of control over their safety and actions. I would want every kid to have their right to immediate medical care and expertise fulfilled. That just can't happen if they're born at home. Its one thing when its an accident (the birth in a car on the way to the hospital) but I don't think we should be encouraging deliberately naysaying our babies' access to Drs.
Sorry but I think there's too much talk about "birth experience" and not enough about the rights of babies to care by specialists.
In making this comment before I've found the implication that is controversial in my view isn't really that the mother's "experience" isn't that important. The controversy is my assertion that midwives are not as good as Drs at medical care. You'd be amazed how defensive midwives are about their role. But I stand by it. Drs are trained in the science not just of obstetrics but the human body as a whole. Midwives may have seen a lot of births but they are still just nurses. Their role has never been to provide medical care.
Now maybe it isn't dangerous to the mother to have a non-Dr attend the birth alone. But if it were my child I wouldn't want there to be no Dr around if my baby needed one upon birth. And I wouldn't want anything less for any child. I feel we are all responsible for all children.
That is why I feel compelled to applaud the end of homebirths. Not to be mean to other women, but to protect their children.
Dear Anonymous,
May I remind you that the leading cause of maternal mortality is suicide? Actually a mother’s experience IS important. Mothers are important too!
If you understood the role of a midiwfe, certainly in New Zealand and the UK where I was born/had my babies, you’d understand they are the experts in normal birth. We’re not talking about homebirth as the only choice, or homebirth at all costs, we’re talking about women having the RIGHT to CHOSE care for their body and their baby. Many planned homebirthers transfer to the hospital for medical care if the midwife is concerned. Isn’t that great! Maternity services working holisitcally! Many more women and their families go on to have a fulfilling, safe and joyous birth in the comfort and privacy of their home.
We’re not trying to force YOU to have a homebirth, by all means, have a hospital birth if that is where you are comfortable. BUT please take your hands off my body and my baby and trust me to make the right decision for my family…unless you’re suggesting an Orwellian society is admirable?
BTW You may be interested to know research over the last couple of decades in the UK has found that planned home birth is at least as safe as hospital birth for healthy women with normal pregnancies. In addition, home birthers are half as likely to have a caesarean section, half as likely to have an assisted delivery and have a lower risk of haemorrhage. Babies born at home are less likely to have birth injuries and less likely to need resuscitation. (Chamberlain, G, Wraight A, Crowley P. Home Births The report of the 1994 confidential enquiry. National Birthday Trust Fund. Parthenon Publishing).
Kind regards
Georgina Lewis