Homebirth: A Midwife Mutiny

News Article

2008-12-30T19:51:00.001+10:30

After a very busy December and a week where I decided to rest I'm back to activism and information.

Here is a great article by Dr Brett Hill To end the year.

Birthing at home or hospital?

In Australia the option to birth at home is not one that many people consider. In fact many people don’t even realise that they have that option. They have been brought up through experience, school, TV and society in general to assume that all births happen in a hospital and by a doctor. In other parts of the world, however, the choice to birth at home is much more common.
More and more we are starting to realise that birth is a natural process rather than a disease that needs to be managed. Submissions to the Federal Government’s recent maternity review confirm this. As a result people are starting to look more closely at the research around home birth, and the results may surprise you.

Don’t get me wrong: there is a place for birthing interventions. In fact if you are in a high risk group, a hospital-managed birth may well be the best option for you.

However, if you are in the vast majority of people who don’t fit that bill, then research suggests that a home birth is as safe or more than a hospital birth. In fact one large study published by the British Journal of Medicine in 2005 showed home births for low-risk pregnancies were as safe as hospital births, and had much lower rates of intervention. Of course if anything unexpected does happen, your midwife will be able to advise you what to do, and arrange for you to move to hospital if necessary.

So if you consider birth to be a healthy, natural process rather than a medical event that needs to be managed, you may wish to birth your baby at home with a private, experienced midwife.

Christmas Coffee

2008-12-19T22:15:00.001+10:30

Coffee at my house went with a swing. There were at least 30 women and hundreds of children (well it felt like)

We had lots of food.

Some of us slept through it all. My children even made some money by selling their old toys. (breast pads, cream, containers and anything else they could lay their hands on). We also got rid of a few of our kittens. Still one or two to go. If interested please email me. Obviously I can't post them!!!!!

Maternity review, push for midwifery

2008-12-11T07:06:00.004+10:30

This article came from the Australian.

MIDWIVES have warned there are high rates of "unnecessary repeat caesarean sections" in Australia to support a new push for Medicare to pay midwives.

They are calling for a national policy to reduce or stabilise the rate of c-sections in Australia within five years and calling for private hospitals and health funds, which have much higher rates of intervention than public hospitals, to join the campaign.

The reform push is a strong theme of submissions to a major review of maternity services in Australia being conducted by the Rudd Government, that also suggests post-natal care is letting down new mothers and more support is needed to help women breasfeed their babies.

Midwives have also blamed the media for the rise of the "too posh to push" myth and promoting c-sections as a "lifestyle choice" and promoting the "false" notion that a caesarean section is as safe, or safer than, a normal birth.

Citing research that suggests 60 to 80 per cent of women with a previous caesarean birth can give birth vaginally, midwives have warned just 16 per cent of women have a vaginal birth after an earlier c-section.

But obstetricians have sounded a word of caution on a small but growing number of women who want to give birth at home and suggested one reason for increasing c-section rates is older and overweight mothers.

dont you just love how the obstetricians blame the women for the increasing rate of section. It couldn't be anything to do with their practice. What a bunch of misogynists they are.

Health Minister Nicola Roxon has today released over 900 submissions to the Rudd Government's Maternity Services Review including hundreds of submissions from Australian mothers on how to improve birth services in hospitals and at home.

"The majority are from individual consumers. Their personal accounts of experiences with maternity care sound a strong note of concern that our maternity system has become too focussed on medical intervention ,'' Ms Roxon said.

Listen up Docs, the consumers are not happy, woman are getting the picture that the maternity system is focused on the medicalisation and not the woman her body and her baby.

A key recommendation of the review is expected to be an expanded role for midwives, including Medicare item numbers, which may allow them to commission blood tests or even ultrasounds without requiring clearance from a doctor.

There is an international definition of a midwife. Our role doesn't need to be expanded just accepted. Fancy commissioning a blood test or ultrasound, next we will be wanting the vote.

Another suggestion is that Medicare should pay midwives, not just doctors, to care for pregnant women to reduce rising caesarean rates in Australia and private health insurance should even cover independent midwives to care for women who want to birth at home.

The Australian College of Midwives has raised concerns about rising caesarean rates and other interventions in labour including forceps and vacuum deliveries noting research that just one in five low risk women who birthed in a private hospital acheived a vaginal birth without intervention compared with 39 per cent of public patients.

"Social induction, which takes place when women are 'sick of being pregnant' is also too common. The flow on costs for the widespread use of interventions in labour are high - both for women and their babies who are exposed to the the risks of major surgery and recovering from it,'' the submission states.

What about the social inductions that take place because the Ob has the weekend off?, Or is going on holiday and hasn't bothered to mention to the client before that at her actual due date that he will be away. This is far more common that the "sick of being pregnant" I'm sure that any woman told the risk of induction would really think twice about it.

But care for mothers after birth has also emerged as problem in the submissions with The Royal Australian and New Zealand College of Obstetricians and Gynaecologists suggesting this is one area where midwives could play and important role.

Righteo this sounds like hard work, lets get the midwives to follow it up, after all we have been paid a massive amount of money to provide continuity of care.

Doctors, midwives and breastfeeding experts should be offered direct Medicare funding to improve postnatal care in Australia to boost breastfeeding rates and reduce post-natal depression according to the nation's obstetricians.

How about you don't fuck up the birth process, that would significantly decrease the post natal depression rates. Once again the Obstetricians couldn't possibly accept that it may be down to them in the first place. We know in nature that a hindered birth causes the mother to reject the baby. What makes us so very different is we internalise the process onto ourselves as we can't just reject our off spring, and of course don't want to.

"Inadequacies in post-natal care is a constant finding of all reviews of maternity services. Direct Medicare funding of all practitioners midwives, GPs lactation consultants, psychologists/psychiatrists should be introduced,'' the RANZCOG submission states.

But obstetricians have also sounded a note of caution of rushing down the independent midwife path.

"Suggestions that independent midwives might care for women antenatally and in labour in the public system but as "effective private midifery patients is not supported,'' obstretricians said, citing "interprofessional conduct.

Lets never give women informed choice, it would be very bad for our pockets.

The Australian Institute of Health and Welfare’s Report "Australia’s Mothers and Babies 2006" released today confirms caesarean section births increased to 30.8 per cent in 2006 compared to the 2004 OECD average of 22 per cent of births.

However, the rate is even higher at private hospitals.

Dear reader
But it's not the surgeons fault!!! those shifty women and independent midwives are causing so much trouble. Interfering with our schedules, demanding what they want, expecting us to cater for their needs. It's just not on. We are the experts here, we need to be revered. We only earn so much money because we are important. Women's bodies and vagina's are so dodgy that without us they are nothing.
Love the Obs.

Lets hope that Nicola Roxon and the government are looking at the figures and listening to the women and not being lobbied by the AMA

Alternative health

2008-12-11T06:44:00.001+10:30

Here is an interesting list of links on health related sites if you are wanting more than just western medicine.

Homebirth - a GP's view

2008-12-01T21:03:00.009+10:30

I have a client who asked me to blog this for every one's information. She was horrified to receive this utterly unsolicited unwanted and unnecessary letter in the post.

When she became pregnant she went off to get her routine bloods from a GP(this won't be necessary if the maternity review grant provider numbers to midwives).

It turns out she has a negative blood group. The GP obviously not informed on rhesus status or midwifery care wrote her a letter.

"I note that you decided against first trimester screening because of concerns about radiation doses and are planning a homebirth with an independent midwife. I respect your right to make a decision about your antenatal care and birth plan but it is important that these decisions are informed."

Subtext.- I respect your right to listen to what I have to say and then totally agree with me and take up the care option that I think is the best.

"My major concerns are(1)your rh negative status and it's implications for you during this pregnancy: for your baby during this current pregnancy : and for any subsequent pregnancies:(2)a planed out of hospital birth. I would remind you that I do not offer shared obstetric care and refer all pregnant women for specialist care. There may be other investigations or procedures recommended during pregnancy about which you are entitled to be informed."

subtext.- you are rhesus negative and I know absolutely nothing about it so I will scare the pants off you so you will get another doctors opinion. Also you turned down some screening and your midwife is ok with this so she won't force you into any other test that you should have. Only a Doctor is trained to do that.

"It is recommended that rhesus negative women receive anti D at 28 and 34 weeks gestation and have their antibodies recheked. It is also important to know the baby's rhesus status at birth. I strongly recommend that you consult with an Obstetrician now to discuss this and to be reviewed so that you can be reassured as to your own and your baby's well being. rhesus negative women also require review if they have vaginal bleeding during pregnancy as treatment may be required"

subtext.- I really have no idea that an Ob doesn't deal with your rhesus status a midwife does. I do not understand that an independent practitioner does keep on top of my rhesus antibodies and offer anti D in the event of an antenatal incident. I have absolutely no clue that the local hospital test the blood brought in by midwives if the woman is rhesus negative to check the baby's blood group. I didn't bother to find out that anti D is freely available to you if you have a positive baby.

"Meeting with an Obstetrician will also enable you to be informed about the risks of a planned out of hospital birth. May be that the midwife led antenatal programme at the wCH may represent an acceptable compromise for you. Suitable pregnant women looked after by a midwife throughout their pregnancy and delivery. Delivery is at the hospital in a home like environment. The important difference is that the state of the art monitoring and specialist staff is on hand should they become necessary."

subtext.- Every woman should have a surgeon. You really should birth at the hospital because we(the medical facilty) think that's best. state of the art monitoring is very impressive to me and I have no idea what happens at a homebirth.

"I genuinely respect your right to make decisions regarding your care during pregnancy and childbirth. I cannot support your decision to pursue a home birth. My intention in writing is to advise you to meet with an obstetrician and make yourself fully informed as to the relative merits and consequences of the various options available to you. Once fully informed you can feel conformable that you have made the best and safest decision for you and baby and then relax and enjoy the rest of your pregnancy."

subtext:- Once you have decided to go to the hospital all will be well, an informed choice is really doing as we say.

Thanks Dr Cathy Dillon for providing us with confirmation that many GP's in Australia are truly uninformed in maternity services.

That's why when it comes to pregnancy and birth General Practitioners are not required. Midwives are specialist in normal and Obstetricians are specialists in complications.

Makes you wonder if the serious lobbying going on by the AMA is making the medical fraternity a little nervous.

Ranzcog lobbying lies.

2008-12-01T20:50:00.002+10:30

This busy week has prevent me keeping up with all current affairs. The Obs in Australia have been busy lobbying re the maternity review. I haven't the energy to blog this, but want to refer you to the village midwife her opinion pretty much sums it up for me. Thanks Joy for some great work both on your blog and through Ozbirth.

The week that was

2008-12-01T08:44:00.001+10:30

This week I've attended 4 births which has left my blog alone and unloved. Don't you just hate it when that happens.
Another woman is due to have her baby this week but I'm determind to find the time to complete my latest blog posts. Meanwhile I've missed commenting on some interesting news. Trust me, birth is Better!!!

Local radio and midwifery

2008-11-25T16:12:00.003+10:30

891 morning show with David Bevan and Matthew Abraham often mention maternity, even doing a newest listener slot with a new born baby. They have covered everything from Being at the Hilton to the wonderful world of caesarian but I have never really heard them ask for a real midwifery point of view. By that I mean the college of midwives or mmm, a midwife!!

This morning started with the usual letter from listener who cannot access a midwife for antenatal care in Mount Barker. This is not exactly true because you can access an independent midwife but if we are just talking public services there aren't any at Mount Barker, the only service available is a Private Ob or Private GP Ob.

The interviewed Prof Robinson from the Clinical networks, he provided no real information on midwifery and the ANF, who's brief statement included "we support midwifery care".

Nobody asked for a midwifery opinion or that of the College of midwives. Why they would ask the ANF and not ACM I don't know.

The topping was the AMA who voiced their claim that the New Zealand model of care has promoted higher mortality. This is not true and has already been shown to be AMA touting misrepresentation to try and stop the maternity review.

The actual problems they have with the maternity review as outlined in a letter to it's members from Christine Tibbet is that they will have a loss of GP Obstetricians(which are not required anyway) and potential loss of income and status. They have no actual evidence on their claims of outcomes and this has been refuted by the New Zealand college of Midwives.

How and Why are the AMA allowed to get away with such terrible slander on a public station.

I have found that Matt and Dave are medically slanted when it comes to maternity and bias in a very uninformed way. Shame on them.

After trying to get on the phone to call in and failing I got in touch with others from the college here who in turn contacted the station. You can now hear Hannah Dahlin the official spokes person from the ACM talking tomorrow at 10.3o.

What would you rather, This

OR This

Homebirth after Caesarean Breech.

2008-11-20T21:24:00.007+10:30

Here are some wonderful pictures of a home waterbirth. This woman had a section for a breech presentation with her first child. She wasn't given the option of a birth. Regardless to your feelings of breech birth there is a choice and women should be given all the information so they can make an informed choice.

You can read more about breech births from by post Breech a variation of normal and a further breech birth commentary

This pregnancy she decided to make different choices and employed me to look after her during her pregnancy.

She did lots of reading and had lots of options to take up hospital care, scans and whatever else is available to help her make decisions surrounding her birth if she decided at any time she wanted this.

She went into labour at around midnight. She decided to labour and birth at home.

She laboured well over the next 7 hours and had a lovely water birth of a frank breech who came out quickly and easily with his hand between his legs. He weighed exactly the same as her first born.

This was an easy and beautiful birth. She needed no stitches and mother and baby have speedily recovered. This is quite different from her last experience.

It is important when faced with a baby who is breech not to be cornered into a surgery that you aren't sure about. Read all the facts, not just blindly believe anything that a Dr may tell you.

I don't mean ignore risk or poo poo information, but research the actual issue not the rhetoric. Chose a care provider who can give you the care that you require in a setting that you feel is appropriate for your needs.

Press release.

2008-11-17T23:44:00.001+10:30

I have no political affilications but Love Sandra Kanck's press release of today.

SANDRA KANCK DEMOCRATS MLC
MEDIA RELEASE

Monday 17th November 2008

WE COME TO DAMN CAESAR

South Australia’s rate of 32.3% of babies being born by caesarean section - over double the World Health Organisation recommendation - is an obstetric scandal says Democrat MP, Sandra Kanck.

“The WHO guidelines recommend 5 – 15% of births as a safe level of caesareans. How then has SA managed to get it so wrong?

The WHO states:
A rate higher than 15% indicates over-utilization of the procedure for other than life-saving reasons. This is also dangerous for women's lives because of the unnecessary risk associated with any major surgical operation.

“Yet in South Australia the breakdown of Caesarean rates are 28.4 per cent for all public hospitals, both metro and country, and 43.7 per cent for metro private hospitals. The caesarean section rates in the five metropolitan private hospitals ranged from 35.1 per cent to a massive 54.8 per cent.

“Because choice in childbirth needs to be informed choice, I urge the Minister for Health to ‘name and shame’ the worst performing hospitals. Prospective mothers need to know which hospitals are performing at below World Health Organisation standards by surgically delivering more than half of all babies.

“Clearly, choosing to give birth in at least one hospital in Adelaide more than triples the risk of surgical intervention.

“Women need to know which hospitals to avoid if they do not want that option.

“And if fear of pain is a reason for choosing a caesarean, then education and the support of a midwife is a likely antidote. Women must be given information about the circumstances which might require a caesarean, and understand the risks involved.

‘It is vital that a caesarean is not seen as an option of convenience for either obstetrician or mother,” said Ms Kanck.

Coffee meeting November 2008

2008-11-14T22:16:00.004+10:30

Our coffee morning was very well attended again this month, about 25 or more women came along over the course of the morning. I enjoy getting to see all the women I love so much and meeting the new people who just come along to join us. I'm alway left with the feeling I didn't spend enough time talking with everyone, especially the women who have travelled quite a long distance or who I haven't seen for a long time.

I hope they know how much I appreciate them and how everyone coming along has built such a great community of love and support.There aren't many pictures this week as My daughter was feeling hot and bothered, it was well over 30 deg.

2 of My children. Rex and Spike

Rex and I talking while I hold a 2 week old

chilling out. Or not, in the heat

The wonderful doula Natasha Chant

These pictures really don't show just how many people were there.

Homebirth Retreat

2008-11-11T23:25:00.003+10:30

We can confirm some lovely speakers for the retreat.

Sue Cookson,Barb Glare,Julie Pratt, Roz Donellen Fernandez, Rosey Vaher,

Jenny Blyth,Jo Hunter,Jennifairy Gillet,Sonja Macgregor.

Gloria Lemay.

We have a showing of "The big Stretch"

Belly dancing, Tai Chi, Yoga, Henna tattooing with story telling.

Subjects include :

"Story Telling as a Modality for Healing and Sharing Midwifery Practice Wisdom"

“Midwifery as a Path to Personal Growth”

“Blind Spots and Belief: What We Don’t Know”

Student midwifery and homebirth

Going straight into independent practice

Calm birth

Water birth

Jiggling the Pelvis

Enlightenment and the pelvic floor.

Plus so much more, join us, it'll be worth it.

Online resources link

2008-11-06T20:27:00.006+10:30

"100+ Essential Online Resources for Midwives" (http://www.uspharmd.com/blog/2008/100-essential-online-resources-for-midwives/).

This is an interesting set of links about birth resources.

This link is worth a look http://www.little-jo-jozzy.blogspot.com/ I promised My daughter I'd post it. We have updated kitten pictures there. When I posted a link before, her hits went up and she had a few comments. She was stoked. Please go and look at our lovely kittys and post a comment for her. After all it was a birth and this is a birth blog.

JOCELYN BARRETT age 11

Collaboration story

2008-11-06T19:37:00.005+10:30

Here is a set of photos given for use on my blog.

This woman planned a vbac at home. She had calming music and was rocking on the ball.

Later she used the ball in different positions and had acupuncture from a friend and lots of support from other friends.

She also used water, She progressed smoothly and quickly.

Baby started to show signs of stress by significantly dropping his heart rate, there was also a little unexplained bleeding. We transferred to the hospital. She walked down the very steep hill at her home as the ambulance had difficulty getting up the hill and the two women paramedics would never have made a stretcher trip. This was mildly amusing although I was feeling a little concerned about the baby. The woman had not had any care by the hospital but they were more than willing to take us.

On admission It was confirmed that the baby appeared to be in severe distress and the blood loss hadn't abated. She consented to a caesarean section. Baby was a little shocked initially but soon picked up well.

After the initial concern baby went to mother and has never left. The woman will tell her own story shortly. These pictures are to show that she went into labour and stayed at home while everything was going well. Transfer was a hard decision. The hospital staff were excellent and although the decision for a caesarean was arrived at quickly, they did their best to show respect and understanding. The Registrar acknowledged the woman's good decision making and her hard choices when having to change plans. The Paeds not only understood but encouraged the skin to skin contact and nobody ever tried to change or control this.
Flinders hospital certainly deserve gratitude for a great collaboration. The Ob also remarked on this to the client.

This woman came home after 2 days at the hospital and has made a fabulous recovery along with her baby. Although all her wishes weren't realised(which made me cry lots) The control in decision making and respect given to her as a birthing woman have helped in her recovery and far outway the diabolical time she had with her last experience.

Her strength, courage and fortitude amazed me and I admire her.

It was very important that we made prints of the placenta. I made sure we kept her placenta. Here we are, Her seven year old daughter and me, having placenta fun.

Regardless to the belief of some, homebirth advocates are not anti hospital. Collaboration on occasions can be life saving. I am always grateful for the Obs skill when it's needed.
This is where the skill of the midwife in recognising a problem and the skill of the Ob/Surgeon can be used together for a great outcome for mother and baby.

Thanks to this gorgeous woman for the pictures and permission to use them. Full story to follow.

Homebirth article in A&NZ Journal of Obs and Gynae

2008-10-31T21:28:00.007+10:30

This is a great Opinion Piece even though I'm not against a womans choice to freebirth. I also believe it is a choice to birth wherever you want regardless to risk as long as you are aware of the risk and are able to make a truly informed decision.
I am always interested in a well thought out argument and I have the greatest respect for Lareen and her work.

Why planned attended homebirth should be more widely supported in Australia

Author: Lareen A Newman, BA(Hons), PhD, MPHAA
State President South Australia Maternity Coalition
Email: sapresident@maternitycoalition.org.au

Bibliographic details: Published by the Royal Australian College of Obstetricians and Gynaecologists and Blackwell Publishing.

Reference/citation details: Newman LA (2008), ‘Why planned attended homebirth should be more widely supported in Australia’, Australian & New Zealand Journal of Obstetrics & Gynaecology, 458:450-453.

Abstract: This article argues that the continuing reluctance on the part of professional and bureaucratic bodies in Australia to provide for and support planned attended homebirth for low-risk women is unfounded according to the research evidence. It also suggests that such lack of support might be encouraging some planned but intentionally unattended homebirths to occur in Australia, particularly as in recent years there appears to have been an increase in popularity in freebirth (or do-it-yourself homebirth). The article calls for RANZCOG and Australian state health departments to support planned attended homebirth for low-risk women in the face of what is now a considerable amount of evidence showing its safety, when compared with unplanned homebirth and hospital birth. The article raises a number of challenging issues for obstetricians, midwives and managers or planners of maternity services.

Keywords: Home childbirth, planned, freebirth, RANZCOG, maternity care, evidence

Note: The views in this article are solely those of the author and should not be attributed to the Maternity Coalition. The author thanks anonymous reviewers for their useful comments on earlier drafts of this article.

This article is written following the 2008 release of the American College of Obstetricians & Gynecologists’ (ACOG) revised Statement on Homebirth, in which it ”reiterates its long-standing opposition to home births”, and in anticipation of the review of the RANZCOG equivalent which is set for November this year. 1-2 The article questions the continuing reluctance on the part of professional and bureaucratic bodies involved in maternity care to provide for and support planned attended homebirth for low-risk women, in the face of the balance of the research evidence which does support its safety.

For the past fifty years or so in English-speaking developed countries such as the USA, Britain and Australia, choosing a planned homebirth has been seen by the general public as “risky”, and this picture has generally been reinforced by doctors and cultural stereotypes. This is reflected in the fact that both the ACOG and RANZCOG currently provide a blanket statement of non-support for any type of homebirth, without any discussion of the balance of the medical research on risk of maternal and infant mortality and morbidity for low-risk women, without any comparison with the risks for low-risk women of hospital birth, without differentiating whether the homebirth is planned or unplanned, and without differentiating whether the birth is attended by a qualified and experienced homebirth midwife (or GP) or is completely unattended. The ACOG Statement relies solely on what ACOG “believes” and cites no research whatsoever to support the claim that “studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous”.

By comparison, the RANZCOG Statement on Homebirth does at least cite some research evidence, although this is simply listed at the end and not discussed in the text, which is particularly disappointing for consumers of maternity care. Furthermore, despite the RANZCOG Statement being essentially against homebirth, it still lists in its references the largest yet prospective study which supports homebirth, in concluding that “planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States”. 3 The case against homebirth in Australia is also frequently supported in the general debate by the misquoting of Bastian, Keirse & Lancaster (1998) by focussing on the finding that “the death rate in Australian home births was higher than comparable births nationally and home births in other countries” yet conveniently failing to mention that “the higher perinatal death rate in Australian home births was due to the inclusion of predictably high risk births”. The authors’ actual conclusion was that “while homebirth for low risk women can compare favourably with hospital birth, high risk homebirth is inadvisable and experimental (post-term birth, twin pregnancy and breech presentation)” 4

Both the American and Australian/New Zealand College Statements therefore fail to acknowledge the balance of the research evidence that planned homebirth results in no greater mortality or morbidity for mother or infant if the pregnancy is deemed to be low-risk, if the labour/birth is attended by suitably qualified and experienced health professionals, and if the woman lives within reasonable distance of back-up obstetric services. 5-7 The latest data show that 744 women planned a homebirth in Australia in 2005, and of these 81 per cent actually birthed at home. 8 The College Statements also ignore the social and psychological aspects of birth which are important to women as consumers and which are more likely to be accommodated in the demedicalised environment of a homebirth. The ACOG statement even goes so far as to disparage consumers seeking homebirth as being “trendy”, “following fashion”, or joining a “cause celebre”. The situation is considerably more progressive in the UK, where the Royal College of Obstetricians & Gynaecologists and the Royal College of Midwives released a Joint Statement on Homebirth in 2007 which does acknowledge the balance of the research evidence which differentiates between risk levels and supports homebirth for women with uncomplicated pregnancies. 9

Despite the lack of official support by RANZCOG, two publicly-funded models of care which include an option for planned attended homebirth have operated in Australia for the past ten years in South Australia and Western Australia through a community midwifery program in each state, albeit for only limited numbers of women. 10,11 Publicly-funded homebirth also became available from 2005 (again only for small numbers of women) in New South Wales through the St George Public Hospital at Kogarah, and in the Northern Territory in Darwin and Alice Springs.12,13 A government policy or guidelines on homebirth exist for Western Australia and New South Wales. 14-15 The South Australian Government also released its first Policy for Planned Birth At Home in July 2007, 5 but at the time of writing there appears to be institutional and bureacratic resistance to its implementation through the health department and/or public maternity hospitals. The policy’s implementation would expand publicly-funded homebirth options beyond South Australia’s single community midwifery program at present.

Limited government funding and limited support from obstetricians in Australia mean that the only way most women can have a homebirth is to pay privately for the services of an independent (privately practising) midwife. For those who cannot afford this, who live in an area where independent midwives are not available or not allowed to practice, or where they have no access to an independent midwife that they consider suitable, the option to have a freebirth without professional help appears to be becoming more attractive, either to avoid the financial costs of planned homebirth or the perceived contact with medicalised maternity care for a hospital birth. Freebirth may also be attractive to women who have no access to hospital waterbirth, or to in- or out-of-hospital birth centre care (for which places in Australia, for example, are limited to less than 10% of birthing women and which have been closing down rather than expanding in recent years). 8 Data from the United Nations shows that when medicalised hospital services do not meet women’s emotional or social needs or their basic human rights then women will avoid these services, even if this means birthing at home without a qualified maternity professional and putting their own or their baby’s health at greater risk in clinical terms. 16

Recent years have indeed seen the growing popularity of the grassroots movement of freebirthing (otherwise known as do-it-yourself homebirth, unassisted birth, unhindered birth, pure-birth, solo birth, or couples birth: Wikipedia).17 A freebirth is a planned homebirth which the parents arrange to be intentionally unattended by any midwifery or obstetrically-trained health professional, even if professional care is sought during pregnancy. In this respect freebirth goes far beyond traditional planned homebirth which is intentionally attended, predominantly by midwives or GPs, and unplanned homebirth which is unintentionally unattended due to a precipitous labour “before arrival” at a hospital. There is no official data collection for freebirths in Australia. However, using South Australia (SA) as an example, about 10 births a year are registered at home for which there is no midwife’s form for a planned homebirth (note: SA births account for only 7% of the national total). 18 However, if freebirthers are attending hospital antenatal care and postnatal care and just birth unassisted at home they may be counted with the babies who are “born before arrival” at the intended hospital (BBAs). South Australia recorded 73 BBAs in 2006, while New South Wales recorded 369 in 2005. 18-19 Anecdotal evidence from consumer groups and childbirth educators since early 2007 shows that consumers are now beginning to ask about freebirth, whereas previously it was never raised. Further indication of popularity as opposed to occurrence may also be shown by Unassisted Pregnancy & Childbirth Australia (www.purebirth-australia.com) having 985 registered members, and recording an increase in website hits from just 350 a month in March 2006 to around 3000 in June 2007. 20 Freebirth has also attracted increasing attention in the popular media, with headlines such as “If you thought a homebirth was radical, prepare yourself for freebirthing.” 20-25

It can be argued that the increasing popularity of freebirth with consumers is partly a result of the lack of mainstream provision and public funding or reimbursing for planned attended homebirth for low-risk women. A brief review of freebirth websites (based mainly in the USA, Britain and Australia) and of media articles shows several reasons why women choose freebirth, and these do include the lack of independent homebirthing midwives in a particular area, the unaffordability of private-midwifery fees, and the lack of publicly-funded homebirth, as well as the belief that the set of risks associated with homebirth are no higher than the set of risks for hospital birth, which is associated with excessively high medical intervention rates (eg caesarean rates around 30% in the USA and Australia, and up to 50% for first-time mothers in some private hospitals). 21-25, 26-29 However, all that the medical fraternity in the USA and Australia appear to be doing in response to women turning to freebirth is to simply to warn of “the dangers” without any recourse to the balance of the medical evidence, and without supporting the alternative of safe, planned, attended homebirth. 30-31 In light of the already undiscerning College Statements about homebirth, consumers could well interpret such comments about freebirth as just another “cry wolf”.

This article therefore questions the continued denial of support by the ACOG, the RANZCOG (as reflected in their official Statements on Homebirth), and by various state health departments for low-risk, planned and professionally attended homebirth, because homebirth under these criteria is supported by research evidence. The continuing lack of support is causing cognitive dissonance in the minds of maternity consumers who are aware of the increasing research evidence base, particularly through their increased access to the Internet, but who fail to see this evidence reflected in the Statements and in mainstream public maternity services. It is therefore time for the Colleges and health departments to move forward and support safe homebirth (planned and attended homebirth for low-risk women) as part of comprehensive mainstream maternity care in its own right. It would also be encouraging to see this support reflected in obstetricians’ attitudes as they provide their skills as specialists in complications in friendly, accepting and accessible hospital-based services for women who transfer from a homebirth (both with an independent or hospital-employed midwife). At the same time it would also be prudent to improve the level of ongoing monitoring, evaluation and publication of clinical outcomes and consumer satisfaction associated with all models of care and places of birth in Australia so that this evidence can inform consumer choice and individual practitioner practice, as well as the future government provision of services. As Bastian, Keirse & Lancaster pointed out, such an audit would help detect patterns of avoidable problems, whilst also ensuring that women who choose to birth at home in Australia are provided with effective care and support in their choice. 4 The author looks forward with hopeful anticipation to the next version of RANZCOG’s Statement on Homebirth, which is due for review in November this year

REFERENCES

1. American College of Obstetricians & Gynecologists. Statement on Homebirths. Media Release, 6 February 2008. http://www.acog.org/

2. Royal Australian & New Zealand College of Obstetricians & Gynaecologists College Statement: Homebirths, 2006. http://www.ranzcog.edu.au/publications/statements/C-obs2.pdf, accessed 12 February 2008.

3. Johnson K, Daviss B. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 2005; 330(7505): 1416-22.

4. Bastian H, Keirse MJ, Lancaster P. Perinatal death associated with planned home birth in Australia: population based study. BMJ. 1998; 317(7155): 384-8.

5. Department of Health South Australia. Policy for Planned Birth At Home in South Australia. Adelaide: Government of South Australia, 2007.

6. Leslie MS, Romano A. Appendix: Birth Can Safely Take Place At Home and in Birthing Centres. Journal of Perinatal Education - Supplement 2007; 16(1): 81S-88S.

7. World Health Organisation. Care in Normal Birth: Report of a Technical Working Group. Geneva: WHO, 1997. http://www.who.int/reproductive-health/publications/MSM_96_24/MSM_96_24_table_of_contents.en.html, accessed 15 February 2008.

8. Australian Institute of Health & Welfare. Australia’s Mothers & Babies 2005. Perinatal Statistics Series. Sydney: National Perinatal Statistics Unit, 2007.

9. Royal College of Obstetricians & Gynaecologists & Royal College of Midwives. Homebirths. Joint Statement No.2 April 2007. http://www.rcog.org.uk/index.asp?PageID=2023, accessed 20 February 2008.

10. Nixon A, Byrne J & Church A. The Community Midwives Project: An Evaluation of the Set Up of the Northern Women’s Community Midwives Project. Adelaide: Northern Metropolitan Community Health Service; 2003. http://www.whs.sa.gov.au/pub/final_document_Evaluation_CMP.pdf

11. Community Midwifery Western Australia. Annual Report 2005-06. Fremantle: Community Midwifery WA Inc. http://www.cmwa.net.au/Downloading/Annual%20Report%20October%202006v2.pdf

12. South Eastern Sydney Illawarra Health Service. Media release: St George home deliveries, 24 April 2007, New South Wales Health.

13. Department of Health & Community Services. Media release: new beginnings for homebirth, 2005. Darwin: Northern Territory Government. http://www.nt.gov.au/health/news/2005/news_new_beginnings_for_homebirth.shtml

14. Department of Health Western Australia. Homebirth Policy and Guidelines for Management of Risk Factors. Perth: Principal Nursing Advisor’s Office;2001.

15. New South Wales Health Department. Homebirth Policy Statement. Sydney: Government of New South Wales; 2000. http://www.health.nsw.gov.au/nursing/images/cir2000-53.pdf

16. United Nations Population Fund. State of the World Population 2004. New York: UNFPA, 2004.

17. Unassisted Childbirth. Wikipedia: http://en.wikipedia.org/wiki/Unassisted_childbirth, accessed 20 February 2008.

18. Department of Health (2007). Pregnancy Outcome in South Australia 2006. Pregnancy Outcome Unit, Epidemiology Branch, Government of South Australia.

19. New South Wales Health (2007) New South Wales Mother & Babies 2005 NSW Public Health Bulletin, 18, S-1.

20. Tait A. I gave birth completely alone. Marie Claire, Feature 2007; September 5. http://au.lifestyle.yahoo.com/b/marie-claire/2379/i-gave-birth-completely-alone/?page=3

21. Boodman SG. Do-it-yourself delivery. Washington Post, 31 July 2007.

22. Gosline A. Extreme childbirth: freebirthing. New Scientist Print Edition 2007; 2585: 40-43.

23. Groskop V. Going it alone. The Guardian, 9 May 2007. http://www.guardian.co.uk/society/2007/may/09/health.medicineandhealth, accessed 15 February 2008.

24. Robotham J. Hard labour: a family’s search for maternity care. The Sydney Morning Herald 2004, 10 October.

25. Switzer R. No doctor, no midwife - women go it alone. The (Melbourne) Age 2007: 27 May. http://www.theage.com.au/news/ parenting/ no-doctor- no-midwife-151-women-go-it-alone/ 2007/05/26/ 1180205120418.html?page= fullpage#contentSwap1

26. Bornfree website, http://www.unassistedchildbirth.com/uc/whatisuc.html, accessed 20 February 2008.

27. Freebirth Q&A: http://www.birthkeeper.com/Freebirth.html, accessed 10 February 2008.

28. Shanley L K. Unassisted Childbirth. Westport CT: Bergin & Garvey, 1994.

29. Unassisted Childbirth Australia: www.purebirth-australia.com, accessed 5 January 2008.

30. Davies H. Dangers in DIY birthing: Doctors warn mums-to-be against consulting web for advice. The (Brisbane) Sunday Mail, 3 June 2007, page 19.

31. Kelland K. Freebirthers dismiss fear and bring babies home. Reuters 23 May 2007; http://www.reuters.com/article/healthNews/idUSL2148514320070523, accessed 22 February 2008.

pointless trivia

2008-10-28T23:41:00.002+10:30

I finally gave in to Tania and got a facebook account. It is extremely addictive and totally pointless. Keeping in touch has never been so bloody easy. It is providing me with light relief between blog posts.

Being Anonymous

2008-10-25T16:06:00.005+10:30

I have had an interesting and challenging week and have spent time pondering anonymous reporting'

Definition
Anonymity is derived from the Greek word ανωνυμία, meaning "without a name" or "namelessness". In colloquial use, the term typically refers to a person, and often means that the personal identity, or personally identifiable information of that person is not known

It is possible However to just remain unidentified to the person you are "telling on" (that's the term used by my children for this sort of thing)

What makes people not want to be identified? is it fear? Could the heavies be sent over? Why would someone making a complaint of any kind want to remain anonymous?.

This week part of a comment I made on a public forum ages ago was passed on . The passer didn't want to be identified but the reason for passing the message on was to try and get me to shut up. My comment was true and not that bad, trust me I say worse. I was totally willing to stand by what I said. I always am.

I have spent countless hours wondering why someone would do something so underhand. Any offers?

Candlelight Vigil

2008-10-20T22:57:00.005+10:30

Our candle vigil was very successful. Thanks to everyone for coming along and the great support. We had some German, Dutch and Danish people stop and wonder why everyone doesn't have a midwife in Australia because to them it's the norm.

The Homebirth network, Birth matters, and Joyous Birth were all represented. Also midwives from the group practice and lots of women who have birthed with a midwife.

It was the South Australian Independent Midwives regular meeting date just by coincidence, so we deferred to the vigil.

Just by chance Michael Franti (link for any heathens) happened to be passing and very supportive. Never miss a photo op!!

I sent a press release to every link that is used for these things, over 30 emails went off and not one agency appeared. This is an issue important to at least 50% of Australians. We had absolute support from all Europeans that passed as it is their right to get a midwife, but Aussies are more interested in The economic disaster that is America today. Hopefully the maternity review will be listening.

South Australian Doulas

2008-10-16T08:56:00.002+10:30

The South Australian Doulas brochure is here for anyone coming to this site who may be interested.

Homebirth and Doulas South Australia

2008-10-12T21:09:00.006+10:30

Just a few weeks ago I was at a lovely birth with a woman who had been with a private Ob since early in her pregnancy. She had felt unsettled by what he was saying over the weeks and was finding it difficult to reconcile what she wanted for her birth and what he wanted!!!

at approx 35 weeks she met a doula, Natasha from birth your way. After explaining her wishes to Natasha and saying she wished she'd made different choices, Tash made it clear that until you've birthed you can always make different choices.

I have birthed with a number of women who have chosen a doula as well as a midwife. This is always an excellent experience. Many midwives feel that doulas are not needed at a homebirth. The doulas that I have worked with have been a brilliant addition to the homebirth environment. Hopefully the women felt the same way.

Here is a great explanation of what a doula does and a list of Doulas in South Australia .

I would urge pregnant women looking at their choices to seriously consider employing a doula, especially if you are going into a system where you are unlikely to be heard.

Thanks to the doula we have all these fantastic photographs.

All Women should be offered a midwife

2008-10-12T20:53:00.004+10:30

Midwife model of care versus other care This couldn't have come at a better time for the maternity reveiw. Just in case anyone was under the impression that midwives aren't the best primary carers for women the cochrane data base, obstetric lovely that it is has back us up 100%

The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women. Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects. The main benefits were a reduced risk of losing a baby before 24 weeks. Also during labour, there was a reduced use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman's chance of being cared for in labour by a midwife she had got to know. It also increased the chance of a spontaneous vaginal birth and initiation of breastfeeding. In addition, midwife-led care led to more women feeling they were in control during labour. There was no difference in risk of a mother losing her baby after 24 weeks. The review concluded that all women should be offered midwife-led models of care.

I could resist making it nice and big. I feel like shouting.

Coffee Morning

2008-10-08T22:34:00.004+10:30

this is the new venue for our coffee mornings, SERVES YOU RIGHT and it's on Unley Road in the City of Adelaide. I was a little worried about people coming along as the weather was awful this morning and we have to be outside, however it was the best fun and lots of people came for coffee. Community is important and we have a lovely one. There were 2 lovely new faces but it's hard to tell, they look like they've been coming for ever.

Pictures were taken by my daughter Joc on Kate's camera, thank you both.

Please go to joc blog to check out the freebirth that happened in our house while we were all busy at coffee. I know she would have been safer at the hospital, especially a multip with a potentially quick labour and a multiple pregnancy. But I totally support a females right to birth in the safely and quiet of her own home.

The Invitation

2008-10-06T19:59:00.004+10:30

I hate having to feel careful when writing about all i believe in. I think that while it's always good to reflect on your practice and admit areas that need to be faced, I resent the fact people pull apart and denigrate anything they please without actually reading the words properly. Or chosing not to read the words because it suits their hideous attitudes. Even worse, insulting your very being, just because then can.

This is my favourite poem.

THE INVITATION

It doesn’t interest me what you do for a living.
I want to know what you ache for, and if you dare to dream of meeting your heart’s longing.

It doesn’t interest me how old you are.
I want to know if you’ll risk looking like a fool for love, for your dream, for the adventure of being alive.

It doesn’t interest me what planets are squaring your moon. I want to know if you have touched the centre of your own sorrow, if you have been opened by life’s betrayals or have become shrivelled and closed from fear of further pain.

I want to know if you can sit with pain, mine or your own, without moving to hide it or fade it or fix it.

I want to know if you can be with joy, mine or your own, if you can dance with wildness and let the ecstasy fill you to the tips of your fingers and toes without cautioning us to be careful, to be realistic, to remember the limitations of being human.

It doesn’t interest me if the story you are telling me is true. I want to know if you can disappoint another to be true to yourself; if you can bear the accusation of betrayal and not betray your own soul; if you can be faithless and therefore trustworthy.

I want to know if you can see beauty, even when it’s not pretty everyday, and if you can source your own life from its presence.

I want to know if you can live with failure, yours and mine and still stand on the edge of the lake and shout to the silver of the full moon, “Yes!”

It doesn’t interest me to know where you live or how much money you have. I want to know if you can get up after the night of grief and despair weary and bruised to the bone and do what needs to be done to feed the children.

It doesn’t interest me who you know or how you came to be here.

I want to know if you will stand in the centre of the fire with me and not shrink back.

It doesn’t interest me where or what or with whom you have studied. I want to know what sustains you, from the inside, when all else falls away.

I want to know if you can be alone with yourself and if you truly like the company you keep in the empty moments.
By Oriah Mountain Dreamer

Candlelight vigil

2008-10-03T09:16:00.003+09:30

Hello everyone, As many of you are aware, there is a governmental review of Maternity services happening right now. To see what’s being proposed, and to have your say by making a personal submission, go to http://www.health.gov.au/internet/main/publishing.nsf/Content/maternityservicesreview There will be a candlelight vigil being held on the steps of Parliament House to draw attention to this review and you are invited to join us in a peaceful demonstration of unity in our hope for

some positive change in the Maternity system for women across Australia. Please join us at 7pm on Monday the 20th October on the steps of Parliament house. Bring a candle and a banner if you like…some ideas for slogans would be “1:1 midwifery care for all women” “Every woman’s right – her OWN midwife” “Bring our Maternity services into the 21st Century” “Provider numbers for Midwives” “A Midwife for every woman” or feel free to make one up for yourself… Please think about coming along to support the submissions that have been and will be submitted by our consumer groups and local midwives alike. This is not a protest, it is a gathering to draw attention to the importance of this review, and we are hoping to get media coverage so the more people there the better! Taniaxxx