28 June 2010 Main Posts Homebirthing may soon disappear SJ Finn When a friend told me that two of her children had been homebirthed and she was thinking of having her third in a hospital, it was the answer that a friend of hers gave which made me sit up and take note. ‘What makes you think going to hospital will make the birth any easier?’ the woman had replied. At the time, I was pregnant too – hence the conversation – and contemplating my choices for my own ensuing act of birthing. My problem, I thought, was that if I went to hospital the professionals around me – ones I most likely had never met – would, by their mere presence, cause me to hand over all decision-making to them. I’m going back a few years, mind you, when hippies were considered worth listening to and wonderful books about thriving American communes existed, books full of stories of homebirths. Most importantly I began to understand that each birth is different and if I wanted to get some idea about how the birth of my child would proceed, I should ask my mother about her birthing experiences. The problem was that my mother, who’d had five children, remembers nothing of any of the births. What she could tell me was that her feet were strung up in stirrups for all five and she was ‘out to it’ on drugs. Oh, and I – the only one of all my siblings – was pulled into the world by forceps. There are, of course, reasons for wanting medical intervention when it comes to births: death of either a mother or a child, complications, even prolonged and protracted pain is not part of the plan. However, the question is, given our affluence and understanding of the physiology of birth, whether we want to stop women who go through normal gestation being able to decide where and how they want to birth their child. Sadly, if new recommendations before the Federal Government are adopted, from July 2010 it will become illegal for midwives to provide private homebirth services to Australian women. This is because all health professionals are required to move to a National Registration Scheme by July 2010. A prerequisite of this scheme is professional indemnity insurance and such insurance has been unavailable to private homebirth midwives since 2001 on the grounds that the pool of people requiring it is too small. It was hoped that the Federal Maternity Services Review would recommend this policy be changed. However the Review’s report has recommended against the government offering indemnity insurance for private homebirth midwives. If the recommendation is taken up midwives will be unable to register themselves on this national list and since it’s illegal to practise midwifery without such registration (and the offence carries a jail term), homebirths, legally midwife-supported homebirths that is, will become a thing of the past. The review’s antagonistic stance towards homebirth is perplexing. Firstly because the majority of the 960 submissions it received explicitly supported homebirth. Secondly, studies have shown that homebirth with a qualified midwife is as safe as birthing in a hospital. And thirdly, the Review ostensibly supports a midwifery-driven model as opposed to an obstetric one. The review, for instance, recommends culturally appropriate care for Indigenous women, better support for pregnant and postnatal women, and more collaborative relationships between caregivers. All these things can be achieved by supporting private homebirth midwifery. As to the evidence of safety, in 2009 in the Netherlands a study conducted over seven years of 530 000 low-risk births – almost a third of which occurred at home – found no differences in rates of death and serious illness for mother or child whether at home or in hospital. In another large-scale study in the US and Canada, 5000 planned homebirth outcomes for mothers and babies were the same as for low-risk mothers giving birth in hospitals – with a fraction of the interventions. This is backed up by a study released in 2007 by the Cochrane Institute that showed benefits for women in midwife-led care include fewer hospital admissions, fewer epidurals or need for pain relief, fewer surgical cuts to the perineum, fewer forceps and vacuum births. Significantly, this research showed fewer babies dying before 24 weeks gestation under midwife care and found, similarly, that none of the other major complications of pregnancy and birth were any different. Summing it up best perhaps, the World Health Organization points out that midwifery care helps avoid situations where the normal physiological process of birth is treated as a medical procedure, which ‘interferes with the freedom of women to experience the birth of their children in their own way, in the place of their own choice … ’ On a personal note, both my friend and I were lucky to manage to have our babies at home. I say manage because even then, when midwives were insured, it wasn’t just a matter of booking one in or deciding on a whim that that’s what we wanted to do. Having a homebirth in Australia then, and now, goes against popular practise and demands a lot of consideration and careful planning. I was in country Victoria at the time. The birth of my son was my midwife’s first homebirth and finding her, someone who had practised midwifery for fifteen years and had aspirations to do homebirths, was like finding a needle in a haystack. She came from a town seventy kilometres away and it was by luck, really, that we even met. It was my GP who (bless him) only became useful when we needed someone to take a few photos after the fact, that, in terms of this post, had the most interesting story to tell. A consciencious man, he’d borrowed some equipment from the local hospital – a mobile humidicrib and several other items. He did his rounds at the hospital every morning but techniqually was not employed there, so, in light of this, the hospital threatened to sack the nurse who had, reluctantly I might say, handed over the items to him. I never met this nurse who was understandably upset and furious with the doctor for putting her job in jeopardy. As a consequence, no other homebirths took place in that local community (as far as I know) for years. Now the Federal Maternity Services Review are suggesting the same for the nation. While homebirth is not for everyone, those of us who wish to protect our right to choose to birth our children in that way must now wait for the government to decide on our behalf. It’s scary to think that for all our advances individuals may lose control over a profoundly important and normal aspect of existence. Scary, especially for those of us afraid of medical intervention in any form, to contemplate having to submit ourselves to the realm of medicine for something that’s supposed to happen; that is the reason, after all, we’re all here. SJ Finn SJ Finn is an Australian writer whose fiction and poetry has been widely published in literary magazines and Australian newspapers. Her latest novel is Down to the River. She can be found at sjfinn.com. More by SJ Finn Overland is a not-for-profit magazine with a proud history of supporting writers, and publishing ideas and voices often excluded from other places. 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