25 responses to “ACM homebirth statement”

  1. frillypants

    I suppose that a ‘scarred uterus’ covers many types of scarring??? Not only c-section? Sneeky!

  2. virginia

    I think it is very sneaky what ACM have done. I also thought it was positive when reading the homebirth position statement, though at the back of my mind i kept thinking “yeah but what is their definition of ‘low risk’?”, then was appalled when i read the miwives guidelines.
    i think they were trying to be quite deceptive by saying scarred uterus instead of VBAC which is the term by which people are more familiar with. i have not had a prior caesarean but theoretically i have a scarred uterus from having a laparoscopy to remove a dermoid cyst from my ovary. so there goes my right to homebirth too! this is just going from bad to worse.

    1. chris

      Having had a laparoscopy to have a dermoid cyst removed from your ovary does not mean that you have a scarred uterus…..I think what ACM are trying to include here are surgeries to the uterus, for example, a myomectomy.

  3. Sheila Vaughan

    Thanks Lisa. I am so pleased I handed in my registrations and now can be with women at home as their birthplace of choice. I am glad I have passed by the hurdle of fear I hadof the system. I fear no more, even more so, since this statement has been made, the logical choice, the only choice for me has been to become a bith attendant or ‘traditional birth Maia’.

    Thanks Lisa for being such a strong advocate, strong leader and strong role model for women giving birth. Here’s to human rights and womens rights. Love Sheila, Wollongong, NSW, Australia oxoxox

    1. Sara

      The same words keep going round and round don’t they? There seems to be this patient persistence on the part of the regulatory authorities and the professional bodies that if the same (completely non-evidence based) message is explained to us enough times in slightly altered phraseology, we who have been a bit dumb to that message will ‘get it’ eventually. When in fact we do get it – we just don’t agree with it, and actually what we want is a shift in mindset to one that recognises women as the leader and owner of their own birth, and the maternity services as just that – services…to serve her.

      I too have come to the decision that to support women properly (ie, without constantly wondering if there is a latent fear of reprisal deep in me that is affecting my decision-making and my behaviour), I need to shed that identity and hand back my midwifery registration. And having made that decision, I feel freer, more optimistic and more able to fulfil my vocation than I have since, well, forever to be honest.

  4. Pioneer_Mama

    Its not sneeky… its downright deceptive!
    How can Tracy Martin claim that freebirthing is NOT a total abandonment of women!? What a load of tripe!

    If I have a IMW that is willing to support my wishes (Which the ACM claim to do!) then why is it that I can’t have her and all that she brings (Oxytocin, Oxygen, etc) if I have a scar, or twins, or breech, or pre 37 weeks (Like 36!) or post 42 (Like 43!) weeks!? They are still babies. It is still my vagina they are coming out! Seeing as my “risk” of Uterine rupture or ANYTHING else is so so soooooo low it is hardly worth mentioning, shouldn’t I just be provided with the same care as the women who don’t have these conditions placed on them?

    If Tracy Martin TRULY believes in VBAC (as she says she does…) and truly supports women’s informed choice, why doesn’t she just leave them the hell alone!? I think someone needs to out her and her true motivations… Perhaps start looking at why she claims VBAC is Soooooo safe, but then heards all the women in WA through her NBAC clinic (which mind you she got a BIG FAT cheque to start up in the first place!) for fear that they will explode if on their own turf. Could it be embarassment that when her NBAC clinic is compared to HB it dismally doesn’t meet up to the success rates achieved at home? I spose if there is no competitor to be compared with the crappy public hospital rate of success looks pretty darn good…

    But lets not forget… some women won’t birth in hospital no matter what dirty tricks you employ. If she wants to have the blood on her hands of the small minority that do HBAC and the tiny, infentismal amount who may have a complication that could have been solved by intervention from a trained MW (How can it be outside their scope if they are trained to deal with it!? What type of MW’s are ACM supporting if they aren’t able to support VBAC!?), then so be it… But do the ACM really want to be signing off on this as it won’t be her hands, but all the hands that raise in support of passing this guideline as is…

  5. Hannah

    I’m not sure which is better, the juxtaposition of the ACM’s “midwives and women, working together” logo with Tracy Martin’s quotes, or the shit scooping at the end. Fantastic work, as always Lisa.

  6. DragonMumma

    As always, they say one thing with the one hand, while really hiding the knife behind their backs with the other! Its like people saying that they love the idea of outreach programs, community health centres, nursing homes, child care centres … BUT OH GOD NOT IN MY STREET!! As long as its not something THEY have to do (and therefore can suck up to the Powers That Be and eat the crumbs from their table) they don’t care about those women who will suffer because of this. As long as THEY get want THEY want, screw those women who want Rights!

  7. Naomi Waldron

    Thanks Lisa. I’d like to encourage your readers to write to ACM. You need to include your full name and address to have your submission counted. As I mentioned on your post on Vexacious Reporting, there is a Facebook campaign, Save HBAC in Australia. We object strongly and loudly to ACM’s guidance document, particularly the contraindications to homebirth. How dare ACM say that they support women’s right to choose where and with whom they want to birth, and at the same time, outlaw homebirth after caesarean. To everyone who wants to choose where they give birth- Object strongly to ACM, and get involved.

  8. Naomi Waldron
  9. Beverley Walker

    Thanks Lisa
    Don’t read on if you have given up hope.

    I suggest that we write in our hundreds to the ACM – because at a meeting in 2010 AGM they claimed no one wrote to them against their actions which were undemocratic on that day.

    I stated at that meeting that the members of ACM were not consulted or told about their Secret Meeting in Canberra in which the ACM representative spoke for the 5000. That meeting literally condemned us to mediocre Medicare rebate. They claim they did not hear from anyone against what the Board had chosen to do. To my knowledge no official survey went out.

    Is there some way we can send letters but at the same time record who is sending them with their member number and publicly know how many of us do? One letter signed by hundreds cannot be victimised. Membership loss may be the outcome but is that what would be in the ACM’s best interests? Individuals can write but then victimisation and bullying seems to be themodus operandi of some in our profession. I have had recent reports of those who complained about an out of date University lecturer marked the individuals down in their exams. I am a former Union delegate and exceutive Board member, Collective bargaining or combined total numbers of signatures can make a difference. What about a letter to the major Newspapers with prominent women signing it?

    Surely Home birth is important enough to have similar International qualification like the International Board Certified Lactation Consultant. I have suggested this to some that this could be a higher standard eligibility for home birth Practitioners required by a separate Academic body at University Level. University qualifications when stamped with their approval do trump some organisations.

    Another question on a positive note is that if an overwhelming majority of midwives members of ACM denounce this change the board may be wanting this to occur so that the Board has to listen to its members. We need the evidence. I do not have the know how to set this up but happy to put my name to it – – if I lose my membership – I will not be losing the right to practice midwifery education about birth and breastfeeding I am a scientist and ethicist my point being I have other qualifications to speak. I know that with IBCLC and breastfeeding expertise I can still practise. Gaining a PhD is another way to trump others. Our predecessors feminist women fought long and hard to gain entry in to University – not very long ago.

    That is my point about members of ACM letting the Australian College of Midwives know they are not happy. However individual letters can be ignored . A combined letter signed by hundreds cannot be ignored. At last count there were 5000 members. I sat back and waited for a reaction – because silence has been all that I wanted up till I came on tonight. I have been alarmed but alert/ Proactive again and again. I have already made my anger felt. I was aware of an enormous recent change in the structure of the ACM board which did not appear I believe – strange to say – to be on the side of home birth midwives. It is up to the women – midwives as usual appear to have no right to a voice in their own practice even where their profession is concerned . We do have time to organise before the end of September. I stated at the beginning that this is a global witch hunt by the medical profession. But when your own shaft you then it becomes civil war. WE do not nee that or any overt evidence of a split in opinion. My submission about collaboration was that the word means, according to the Macqaurie Dictionary, co-operation with treachery. This outcome has been demonstrated world wide.

    We have lost to my regret many fine midwife activist, midwives from practice and some walking away from home birth. I believe it is due to fatigue and despair with the actions of midwife against midwife. I feel disappointed in the lack of professionalism and willingness to demonstrate a combined duty of care to improve the health of women and our future children. It isthe hardest job to stand out from the crowd to prevent the current carnage in hospitals. Our home birth advocates in the UK tell me that THE HORRORS IN HOSPITAL AND THE CONSTRAINTS ON THE HOSPITAL MIDWIVES ARE WORSE THAN EVER. Yours as usual mother midwife and lobbying activist. Beverley Walker

  10. Claire

    I’m a bit confused as to what ‘consulting’ actually means. Does that mean the midwife has to go and visit an OB, and tell them that she’s got a ‘high risk’ woman? Or that the midwife & mum have to go together? Neither of those make any sense!!

    And it sounds like the ACM is actually encouraging those ‘high risk’ women to have unassisted births, rather than birth with an experienced midwife! Who is this woman in charge of this college? She is putting women’s lives at risk!!

    And so much for respecting women’s choice. If a woman can’t choose where and with whom she births, where does it end? So she has to give birth in a hospital. Does she have a choice of which one? Why? If what she wanted before didn’t matter, why should it now? And what if they want her to have a c/s, but she doesn’t want one. Does she get a say then? What if she doesn’t turn up to the appointment they made without her permission? Can the police fetch her and take her to the hospital for endangering her child? Can she be forced into having that c/s? Why not? If she doesn’t have any choice over her own body, she doesn’t have any choice over her own body.

    They need to make up their minds as to whether pregnant women are just vessels carrying around precious cargo, and therefore have no say in how this cargo will arrive; Or if they are women, who have rights over their own bodies.

    If they want “each woman and her family [to] have the right to expect that the care she receives is provided by appropriately skilled attendants, and is safe” Maybe they just need to make sure that each homebirth midwife is skilled enough to deal with any, and/or all variations of normal, rather than just ban who can have them.

  11. comadrona

    Cynical old me says we are wasting our breath and time with our turncoat, fearful “representative body”. I don’t think I’ll be sending in my $200 + next year to have them collude with the NON-EVIDENCE-BASED crap that is being trotted out here. I’ve just attended a lovely HBAC and I’ve had one myself. I want my daughters and their peers to have that right too. What the medical model is ignoring is the hard-core evidence that a VBAC is no riskier than a primip. Are they going to outlaw primips birthing at home too? BTW I don’t think we are far away from court-ordered Caesars, like they have been doing in the US.

  12. Meg

    this makes my blood boil.
    Here is my letter to the ACM, just sent.

    Dear ACM

    I have just read your guidelines and as a consumer I am appalled, though not surprised.
    It is very clear that although you say you respect women’s right to choose, that you have no intention to actually support women’s right to choose.

    “Decisions about homebirth suitability are based on the judgment of the midwife in consultation with the woman. Women’s evaluation for the appropriateness of homebirth is a complex process involving interviewing, antenatal, intrapartum and postnatal observations, opportunities for the woman to alter identified risk factors (e.g. diet, smoking), the midwife’s risk assessment, and the woman’s motivation to cooperate with agreed care.”

    YOU ARE WRONG – the woman must exercise her own judgement.

    The role of the mid wife is to be ‘with woman’. Not in front of, not leading, at her SIDE.

    WHY are you placing so many constraints on women’s choice? We don’t want to be in hospital not because we’re crazy, but because we do not believe it’s the safest place. There is extensive evidence to support this opinion. And yet your ‘guidelines’ make it impossible for midwives to support women who make choices contradictory to your own opinion. I guess they are just not ‘MOTIVATED” to ‘cooperate’ with “agreed care”.

    There are thousands of us out here, who have suffered terribly in the hospital system, and who now face the terrible choice between an unsupported birth at home and re-traumatisation at the venue of previous births. This is no choice at all.

    Here are my suggested guidelines:

    1. Practice evidence-based care

    2. Present women with factual and thoroughly evidenced information about the relative risks and benefits of every option. And I mean morbidity and mortality to BOTH parties. AND I mean relative information about benefits and options too.

    3. if you need to cover your own asses, then get the woman to sign off a statement that she has received information about relative risks and benefits and is exercising her right to choose what happens to her and her child. Your obligation is to inform and support, the woman’s right is to choose. This includes a choice of whether to consult other practitioners.

    4. Trust women to make sensible decisions on behalf of themselves and their children. How many women do you really think will make choices that endanger themselves, when confronted by evidence of danger? If the meaning of evidence is in doubt (eg: opinion on HBAC, Breech), then the woman must choose without fear of coercion, and on her own behalf, not making decisions to protect her midwife’s standing with a professional body.

    4. Stay with the woman, no matter what she decides. Supporting women’s choices means BEING THERE. By walking out, you remove my preferred choice – birth at home, with a midwife I choose, who is registered, trained, and able to facilitate transfer to hospital if that’s what’s needed. If women cannot find a midwife to help them at home except someone underground, then surely this places women and babies at very high risk if a situation needing transfer arises.

    I will probably never have another child because I am infertile, and though I would love another baby one of the reasons we have decided not to try again is that I am worried about what would happen to me if I did fall pregnant. Because under your rules, I may not find a midwife to support me at home, and I could not go to hospital. after my experience as a homebirth mother who chose to transfer to hospital, I will NEVER think of hospitals as ‘safe’ again.

    If these ‘guidelines’ go ahead, expect to hear more from me.

    1. Danielle

      I’d be curious to hear what response you get from this letter.

  13. Andrea

    Thanks for the great article, Lisa. This is another example of loaded language being used to sugarcoat excrement. I’ve heard AMA representatives appropriate home birth language by speaking of the ‘rights of women’ blah blah, then ending with a ‘provided there’s no risk’ statement. They can dominate and misrepresent an argument by using one word… risk. Looking at what you’ve highlighted from The College of Midwives statement, the biggest, nastiest dog whistle is the word ‘safe’. Our rational argument for the importance of a woman to birth in a safe and appropriate environment for her, is then appropriated, twisted to mean the opposite, and then sold back to us with added extras.

  14. Alexandra

    Disgusting. The ironic think is that most of those who choose to home birth would still choose to birth at home on their own than be forced to birth in a hospital if they were their options. Essentially they have said that you either birth our way or you don’t deserve any support! I’d rather not have the support of someone who doesn’t have the same values as me, thanks very much! They’re not the ones who have to raise the child who was pulled out with forceps, born by caesarian, drugged up on pain relief medication, born into a stressful environment or touched by someone other than their mother in the first few moments after they were born.
    Isn’t the role of a midwife to support a woman through pregnancy & birth, not to tell her what she is & isn’t allowed to do? Great representative body!
    In regards to “It is not the midwife’s obligation to stay with her. She should not get herself in that position in the first place”… if the pregnancy is ‘low-risk’ but something were to happen during the birth and the midwife suggests transferring to a hospital, to which the woman doesn’t agree, does this mean the midwife is supposed to leave? That would be more neglectful than staying with her!! And I’m sure that if the midwife were to leave, ACM would still find a problem with it!
    They will be receiving my letter. Worth a shot.

  15. Anna

    Hi SA Birthy people, I am in the process of writing a letter to the ACM re thier statment on homebirth and Independent midwives. Its been suggested that the letters get emailed to the president of that organisation, but i’m concerned that if it goes direct to an email that it might get ignored or quickly deleted? Is it possible to send a hard copy letter? Also, I have some questions: does anyone know where to find REFERENCED stats for: 1. What is the chance of a natural vaginal delivery of a breech baby in SA hospys? 2. What is the % chance of carrying twins to term and having a viginal birth in SA hospys? 3. What is the % chance of ending up with an emergency C-sec (via the ‘cascade of interventions’) if you are induced for going post-term? 4. where are the studies to show pre-term babies do well at home with kangaroo care as opposed to premmy baby wards? Any links would be appreciated. Also, for those too busy to write letters, what about a petition? Maybe a nice list of full names and addresses of people who think thier position is crap would make an impact? …could be put at TBP…

  16. Ann

    Anna the email address as per Lisa’s post is info@midwives.org.au. This is where you need to send your response. By all means post it too if you want but it needs to go to that email in order to be considered.

    Everyone who has an interest in these issues needs to send comments to ACM at the above address. A petition will be readily dismissed. If you care write a comment – it doesn’t need to be long or particularly professional. It just needs to express your concerns with the documents. If people don’t have time to comment they need to make time!!

  17. Danielle

    Maggie Banks made an interesting comment during her workshop in May. “It is mandatory to consult, but that does not mean the woman MUST do what the consulting person tells her to do”. Basically, she suggested that if you send a woman for consultation, you have done what is legally required as a midwife. I would be interested in a lawyer’s take on all of this… they are the ones that would be argueing for (or against) any action a midwife would take on such cases!

    1. Lisa Barrett

      Actually it’s not mandatory for the woman to consult, don’t forget the statement is for midwives, it is mandatory for the midwife to tell the woman to consult and consult herself if the woman refuses. Also if the woman does not listen to the midwife, then the midwife should back out of care. Blow the lawyers the College of midwives should not be used as a body for policing midwifery.

      1. Danielle

        Yes, I don’t think I said it clearly. It is mandatory for the midwife to consult but you cannot make the woman go.
        I would still be curios to see that if you got legal advice prior to a birth, if that would protect the midwife when the doctors decide to start reporting them even when there is a positive outcome? Food for thought?
        I would hate to see Australia go like the USA where there are “unlicensed” midwives just because of regulatory bodies that are stringent and unmalleable. In some cases, that could be more dangerous if there were people who believed themselves to be skilled birth attendants but were actually not very skilled or experienced.

  18. Beverley Lawrence Beech

    Obstetricians are experts in abnormality, so what possible value is their view of a normal birth at home and other midwifery issues? One does not ask a neurologist to give an expert opinion on gastroenterology so why are obstetricians allowed to give an opinion on midwifery. It is time they confined themselves to their area of expertese.

  19. Kylie

    Thank God I moved to NZ (from Australia) and had my first baby here (12 weeks ago). The first time I saw a Dr of any description was when my midwife recommended a consult after I had been in labour for some time and had developed a fever and baby was showing signs of distress. Even ‘during’ my emergency C-Section I felt like a woman giving birth not a surgical patient. Our midwife was awesome. The Kiwi system is awesome – from it’s midwifery care to it’s theater teams. Australia could learn a lot.

  20. Lucy Brady

    In all of this talk I cannot see any concern for the wellbeing of the foetus. The baby has no say in the birth management plan but any sensible person would realise that a high risk delivery should take place with all the resources that the modern health system can provide. Who wants to see newborn babies put at unnecessary risk?