Homebirthing may soon disappear

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 ›

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  1. As a young woman who is yet to have children, but would like to one day, this just makes me mad. Unfortunately I can’t put it more eloquently than that. I want to have the choice, a real choice. That the choice of a homebirth will probably be off the cards is upsetting.

    I can only hope that before I have children, probably five or six years from now, the situation is somewhat different.

    1. I’m glad you’re moved to write a comment. Maintain your rage because your knowledge and indignation will be the thing, in the end, that is the best hope for turning this around.

  2. Hi, this is a well researched article. I had no idea this was going ahead and I’m appalled. Women should have the right to choose whatever birth they want, especially since the research shows it is pretty much as safe to have a home birth as it is to have a hospital birth. I had a horrible hospital birth, only because that is what I thought everyone was supposed to do. There needs to be a shift is perception when it comes to birthing, it’s a natural event and what better place to do it than in the comfort and familiarity of your own home.

    Do you know if there is anything that can be done? Has anyone started a petition on this?

    1. Yes, there’s so much going on it seems as if this is going to slip under the radar. There has been a petition on-line which, unfortunately, has now closed. But Homebirth Australia, which is one of the links in the post, has some suggestions for action and is the website most likely, I think, to keep you informed.

      It is, I agree, a sad and unnecessary development in policy around birthing.

  3. I will birth my second child in 11 weeks time, and am going for the compromise: labouring in a Birth Centre – mainly because I’m planning to have a water birth and it’s hard to find a doula (or home midwife) with a lot of water birthing experience.

    The birth centre is attached to a hospital but is anti-interventionist and you go home withing 6-24 hours after birthing. That said, much hysteria was encountered from friends and family alike at even the mention of homebirthing and almost as much hysteria exists around water birthing (though again, statistics show it’s actually extremely low risk). I have also been consistently berated for choosing not to have an obstetrician and opting for midwife only care, despite the fact that my first child was born extremely healthy under these circumstances.

    Most of women I know who opted for doctor care in a traditional labour ward have ended up having ceasarians, but that may just happen to be coincidence.

    Midwives are experts in their field and need to be recognised as such.

    Why send a journalist in to do a poet’s job?

  4. Maxine, you stick to what you want, it’s your labour, your body and your choice. I had an obstetrician in a private hospital and I think that is why I ended up with a 46 hour labour and then a cesarean. If I was encouraged to labour without pressure in the comfort of my own home I do believe it would have turned out differently. And the nurses were just shocking, especially afterwards with breastfeeding, shoving my baby onto my breast, one nurse actually bullied me, insiting I call her when my daughter was due for her next feed and when I didn’t she told me off!

    As a society we have lost sight of what childbirth and mothering is about! It is natural, it is part of being human, but instead we institutionalise it! It’s a bloody disgrace.

  5. Well said. And yes, the birthing centres have struck a good middle ground. I wish you all the best with your birth and agree with Koraly’s comment for you to try to stay strong in regard to sticking to what you’d hope the birth to be like.

    There are stats indicating that the women you know who opted for a traditional labour ward (although traditional, it occurs to me, is the wrong use of the word here, except I know exactly what you mean) are much more likely, because of early intervention in the birthing process, to end up having a ceasarian. It’s also good for you to be cautious in thinking it may be a coincidence because stats don’t necessarily tell us about what can happen in an individual situation and, as we should stop talking about people failing to combat cancer, we should never blame women for failing to have a natural birth.

    Again, I wish you all the best for your birthing.

  6. I thought that childbirth as a ‘medical issue’ harked back to Leeches and the suppression of women through the church and bless the Internet – I found this interesting site: http://www.case.edu/artsci/dittrick/site2/museum/online/ob/index.html “For most of human history childbirth was an event mediated by midwives, who delivered women in their homes with the comfort and help of female friends and family. This began to change in the seventeenth century, with the advance of anatomical knowledge, the introduction of the obstetric forceps, and the emergence of man-midwifery, which became the field of obstetrics.” Any birthing mother who finds themselves in trouble knows that the marvels of modern medicine can save lives and increase the chance of excellent outcomes. However, chauvinism (the primary reason for taking childbirth out of women’s hands) and economics (accountable for the hideous rate of over-intervention) cannot and should not replace the wisdom of the body and the incarnating child.

    Every blessing on the births to come – I was lucky enough to have fabulous midwives and birth partners (all women) who understood, in a birthing centre so that the fears of other beloveds were allayed (very important, sometimes, the energy around the birth): it was a long, extraordinary and empowering experience.

    All power to midwives!

  7. It is wonderful to see a birthing article here.

    My son was born at home a little over six years ago with a qualified midwife. It was the best decision my partner and I had ever made. In the years after his birth I became passionately involved in the Home Midwifery Association (peak body here in Queensland) and Maternity Coalition. I coordinated homebirth support group in Brisbane for a year, was actively involved on the committee and was editor of Down to Birth for three years.

    In six years I have written countless submission to government inquiries, attended protests (including flying to Canberra last year),spoken with politicians, shared stories with hundreds of women and written articles. Sadly it seems it is all keeps slipping away. Despite the best efforts of families across Australia – we are fighting against the medical fraternity who have a powerful voice, the prestige to make what they say ‘turth’ and the money to fund a massive political and media presence. Versus women, who are trying to mother and keep their families afloat.

    SJ – you hit the nail right on the head when you mention the recommendations are very much in favour of midwifery care but dead against the purest form of midwifry care? Why are we not questioning that – the arguments that funding PI for private midwives as the potential to completely destroy the PI scheme planned is bollocks when you consider the federal government since 2002 has propped up PI for obstetricians to the tune of $1 billion. Seems they’re on the wrong side of the fence to be considered a ‘good or legitimate risk.’

    What disturbs me most about this is women are happy to hand over the sovereignty of their bodies to medical professional. Ask women to hand over their political vote and you’d incite a riot. But ask women to hand over the vote of what happens to their body and their babies and they’re more than willing to do it. Tell women handing over their political vote is best for everyone – and women will spit in your face, because they know men will never know what is best for them. Tell women they need to hand over their vote on their body at birth because their baby will die and women and their partner’s don’t give a second thought to it. This is medical propaganda of the worst sort. It is about time the medical profession fessed up… if we as a species needed medical intervention at birth, to continue on as a species… we would have died out eons ago.

    The number of women left traumatised after birth through the system is a huge flare that something is not right with the system. We are not caring for the most vulnerable in society. It is obvious your voice is only heard if you fit the government agenda… the recent Senate Inquiry and subsequent rounds of submission making, feel like an episode of ‘The Hollow Men’. It would be laughable if it wasn’t so bloody serious.

    I have been contemplating having a second child – but without the assurance I can birth at home – honestly, I would rather happily enjoy my one son than run the gammut of being unable to secure the best birthing option for our family.

    Koraly – in addition to following and supporting Homebirth Australia there is Maternity Coalition (both at Federal, State and local level)http://www.maternitycoalition.org.au/home/modules/content/?id=1 and also the political party What Women Want started by Justine Caines http://whatwomenwant.org.au/. And with an election looming, write to your local federal member and let them know you’re shocked and appalled. Let them know birth is an issue in their electrorate.

  8. The work of Homebirth Australia, Maternity Coalition and other consumer organisations over the last year has been directed towards making sure that homebirth DOES NOT and WILL NOT become illegal after the legislation takes effect. Everyone remembers the immensely successful rally last September in Canberra and much work has also gone on behind the scene. Certainly, there will be some changes for midwives to respond to, but homebirth with a registered Midwife will not be illegal. More information is available on the MC website, however a summary of the homebirth situation is below.

    Midwives need to buy PI insurance.

    Women planning a homebirth after 1 July 2010 will need to find a private midwife who has purchased insurance. As many people will be aware already, the new national health practitioner regulations require all health practitioners from 1 July 2010 to have professional indemnity insurance.

    Midwives currently have 2 choices in insurance:

    1. The insurance policy sold by Mediprotect is only for antenatal and postnatal care. It is relatively low cost (starting at under $2000/year) and does not have specific requirements regarding eligibility or collaboration. The Mediprotect website (www.mediprotect.com.au) gives some information about the policy.

    2. The insurance policy sold by MIGA is subsidised by the Commonwealth Government, and is available only to \eligible midwives\ according to the standard set by the Nursing and Midwifery Board of Australia. It is much more expensive than the Mediprotect policy, starting at $5000/year for up to 29 births/year ($2250/year if not providing any intrapartum care in private paractice) and covers births in hospital. Comprehensive information about the policy is available from the MIGA website (www.miga.com.au), including the policy document which lists requirements for \collaborative arrangements\. These requirements include the midwife’s responsibility to share certain information with a doctor or hospital.

    There may be major differences in what each of these policies cover, so it is important for midwives to carefully consider their choice.

    MIGA insurance requires \collaborative arrangements\ or \communication of a care plan\

    The requirements for \collaborative arrangements\ in the first released version of the MIGA policy were problematic, requiring acknowledgements from hospitals of intent to collaborate in women’s care, and receipt of the woman’s care plan and test results. The policy was amended in response to midwifery and consumer feedback, and now makes allowance for insurance when hospitals are not collaborative (or haven’t yet developed processes for collaboration).

    Now the minimum requirement is for midwives to send a copy of each woman’s care plan to the hospital, and confirm that the hospital has received it, and send other items of information about the woman’s care to the hospital. This is of course subject to the woman’s consent.

    An update about this is provided at the MIGA website (www.miga.com.au).

    Services from \eligible midwives\ will receive Medicare rebates

    The good news is that from 1 November 2010, there will be Medicare rebates payable for the services of eligible midwives in private practice, subject to certain conditions. Rebates for midwifery services will be paid for specific \items\ or types of visits with a midwife, in the same way as visits to doctors. Currently intrapartum (labour and birth) care at home is not rebatable, but antenatal and postnatal care for a woman planning a homebirth can be. The $ value of rebates is expected to be published soon, but midwives can be expected to usually charge more than the rebate for each service. These rebates, plus any Medicare Safetynet payments, will make care from eligible midwives significantly cheaper for women.

    Midwives will need \collaborative arrangements\ with doctors or hospitals

    The conditions for Medicare rebates include the requirement for each rebatable item of care to be provided under a \collaborative arrangement\ with a doctor. These requirements are listed in detail in the MIGA insurance policy, and are expected to become regulations to the Medicare for midwives law any day now. \Collaborative arrangements\ require midwives to gain agreement from a doctor to collaborate with them in the woman’s care. They also require women to book into a hospital, even if only as a backup plan.

    For women planning a homebirth, the collaborating doctor can be expected to be a doctor authorised by a public hospital to enter such an arrangement. We now have 4 months for health departments and hospitals to work out what this means, and how they will do it. We don’t expect it to be easy, especially to begin with, for midwives to gain agreement from hospitals on collaborative arrangements. We hope that state health Ministers and Departments work hard until November setting up policies, processes and expectations of public hospitals about collaboration with eligible midwives.

    Women may need to be a bit pushy

    While Australia’s hospital systems are learning to collaborate with midwives in private practice, there is likely to be some extra work to do. Women planning a homebirth with an eligible midwife, and wanting to receive Medicare rebates for their care, may have to approach their hospital themselves to ask them to agree to collaborate in their care. If they don’t get the right answer, they may need to escalate their efforts by asking the hospital administration to assist, and if that is unsuccessful escalating the matter further. Maternity Coalition, the Australian College of Midwives, state Members of Parliament and state health complaints agencies need to know about hospitals which refuse to collaborate with private midwives.

    In the longer run

    The establishment of private midwives as part of the health care system is a major reform. While it is currently very stressful for midwives and for many women, it will also have a big and (hopefully) positive effect on hospital culture and systems over time.

    In time, we expect that processes will be established in some places to allow women to have continuity of care from their chosen midwife for hospital birth. This will be a significant challenge for hospital systems, and there are various options for how this might happen.

    Its a complicated situation, but I hope this reassures homebirth families!

  9. Bec, I’m heartened to hear that you’re so positive about the viable continuation of homebirths in Australia and I know there’s been a huge amount of work going on behind the scenes. I would say though, that the fact that midwives have to purchase their own insurance does, in my mind, take homebirths out of our health services response and make it in many cases, not only prohibitive for midwives to practise, but for couples and women to afford to birth their child at home.

    As an allied health professional, all I have to do is pay my association fees and I receive indemnity as a matter of course. I’m not trying to be recalcitrant but as Homebirth Australia point out, if midwives are not insured – and to do this privately at, as I think you suggest, around $5,000 a year, won’t make it easy – they won’t be able to register on the national registry and if they can’t register then they can’t practise legally.

    Personally, when I had my baby I didn’t have a brass razoo to put towards his birth, nor would I have considered myself pushy. I also think it’s a great waste of the public purse and our skills not to be able to provide this service. However every concession is worth fighting for and I hope, as you do, that homebirths will continue to happen in Australia.

  10. The reason that there are Women’s hospitals ,at all,is that the perinatal mortality and morbidity rates were unacceptably high. The wherabouts of the birth place does not matter to a baby,yet is a selfish need of the parents that puts their child at risk should many of the possible complications occur. It is not adequate to say we are 5 minutes from a hospital etc etc. Floppy baby + maternal haemmorhage at home = DISASTER.
    Most of the comments here are uninformed and bordering on childish.Why put your baby unnecessarily at risk?

  11. Hi Kim, I am in agreement that we need Women’s Hospitals as they exist in the major cities in Australia. It has been a wonderful addition to health services for many reasons, including the choice they provide to women birthing. Unfortunately, their services do not extend to regional areas and nor are there enough places for every woman who would like to have her child in a birthing centre. It is also true that while a child may not care where they are born and in what circumstances, it is certainly not true that a mother should be labeled as selfish if she chooses to have a child in a home environment where she has the best chance of avoiding, episiotomies, epidurals, and a myriad of other interventions.
    This is not a frivolous debate, this is about women’s rights to have some control over their bodies. It is also a debate that is well informed by irrefutable research conducted in western countries and cited in the post.

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