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Federal

Aug 21, 2009

Home birth wingnuts shouting down major steps forward for midwifery

No one is stopping Australian women who want home births from choosing them, writes Bernard Keane.

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On the morning of 24 June this year, Nicola Roxon entered the House of Representatives and proudly introduced three bills that amounted to a revolution in midwifery in Australia. Midwives have been able to access some limited Medicare items since November 2006, but Roxon’s bills would dramatically extend Medicare and Pharmaceutical Benefits Scheme funding to midwifery and nurse practitioner services.

The bills were the product of a review early this year by Rosemary Bryant, the Commonwealth Chief Nurse (a position established by Roxon), which argued what Australian women have been saying for years — that unless you’re a privately-insured patient, there’s not enough choice when it comes to giving birth, especially if you live in a regional community.

Roxon’s bill also gave effect to the growing push for collaborative care, making midwives more central in maternity care as part of a team-based approach.

It can’t be said that doctors are particularly enthusiastic about the reforms, which is usually a good sign.

But if Roxon was thinking this major reform might have attracted support from proponents of choice in “birthing”, as it’s now called, boy was she wrong. The reforms deeply offended homebirth advocates, partly by failing to extend Medicare funding to midwives providing services outside clinical settings like planned home births, and partly by requiring midwives providing homebirth services to have professional indemnity cover.

Roxon’s bills established a publicly-funded professional indemnity scheme for midwives, but it correctly doesn’t extend to services provided outside clinical settings where risks are much higher. Private insurers won’t provide indemnity cover for home birth midwives because there’s too few of them to provide a premium pool, and home births are too high risk.

This hasn’t stopped some women suing after bad outcomes. As Bryant’s report notes, if one practitioner can’t be sued — and many home birth midwives have stripped themselves of assets and required strict contracts to prevent litigation — then patients will try to sue other practitioners who have been involved — like the obstetricians who have been called in at the last minute when a home birth has gone horribly wrong. In such circumstances, other medical professionals are reluctant to become involved for fear of becoming the litigee of choice.

The reaction from homebirth advocates has been little short of hysterical. Roxon has been vilified across the blogosphere and deluged with letters and emails. One blogger, perhaps not understanding the meaning of the word, called Roxon’s failure to publicly fund homebirth “socialist”, which would make it the first socialist reform Miranda Devine has ever supported. While not all homebirth advocates are as extreme as Joyous Birth, which uses the term birth rape, there’s plenty of wingnuttery out there.

Including perhaps the ultimate nightmare of earnest Youtube songs:

Much of the debate has defaulted to the claim that the Government is seeking to ban homebirths, when it is doing no such thing, and the claim — at odds with considerable evidence — that homebirths are as safe or safer than deliveries in clinical settings, including birthing centres.

There’s a flatearther tone to such arguments, which might come as a surprise to women in developing countries who face far higher rates of maternal and peri-natal death — or for that matter to our ancestors.

But the missing fact in the froth-mouthed attacks on Roxon and her reforms — which the Coalition have eagerly taken up in Parliament — is that only a tiny fraction of Australian women choose home births – 0.22% of all births in Australia, according to Bryant’s report. Even in New Zealand, where taxpayers fund homebirths, the rate is only 2.7%. Moreover the rate was declining rapidly in Australia even in the 1990s, when home birth midwife insurance was available.

No one is stopping Australian women who want home births from choosing them. Roxon’s bills simply continues the current approach of not providing Medicare funding for home births and requires that midwives are either part of a professional, accredited, indemnified, collaborative care model or they’re not.

What should have been hailed as a major step forward for midwifery in the Australian health system — for too long characterised by a maternity care approach dominated by obstetricians (and usually male ones) — has been drowned out by the ideological attacks of a tiny and wholly unrepresentative minority.

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66 comments

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66 thoughts on “Home birth wingnuts shouting down major steps forward for midwifery

  1. Rod McGuinness

    And you guys are seriously wondering why only 30% of your subs are female. Good luck with that.

  2. Sophie Black

    Broad church, Rod, see First Dog on the Moon today for an entirely different perspective…

  3. Matthew Rodd

    OK. So this article wasn’t nearly as inflammatory (sp?) as your tweeting this morning. What women are looking for is choice in child birth. A lot of mothers are starting to feel they are being pushed into C-sections. Australia has one of the highest medical intervention rates in the world for child birth. You can argue about reduced Infant Mortality Rates all you like, but the fact remains that whilst we have over a third of all child births resulting in c-sections, women are going to feel aggrieved, and the (mostly male) medical profession leaves itself wide open to the criticism that it is trying to control child birth for the sake of convenience. The adherence to home-birth by some women is as a result of previous trauma during a previous clinical child birth and the feeling that they lost control of the ‘birthing experience’. And not once do you mention the feelings of mothers in this article.
    Because whether you like it or not, child birth is a deeply emotional experience.

    Writing that was really cathartic.

  4. Hugh (Charlie) McColl

    I don’t think it helps this struggling ‘debate’ to start with a headline including “Home birth wingnuts…”, to give it to a bloke who is most comfortable with a politically loaded gun and then to let Bernard cut loose on the tiny female homebirth minority without the slightest attempt to find one reasonable debating point from their side.
    Sure, there are extremes around (30% c-sections seems pretty out-there) but the concept of home birth is not weird, is not inherently dangerous (especially in the urban setting) and I doubt it is limited to those who have had a trauma with previous clinical child birth.
    Also, I seem to recall Minister Roxon keeping the option open of continued research on insurance options for homebirthing midwives. Hopefully, the door is not fully closed and Bernard is not the decision maker.

  5. acannon

    I can understand why people would want childbirth to happen at home – it’s home! It’s comfortable, quiet, and there aren’t a bunch of strangers running around peering at your private bits. Can we investigate ways to enable this to happen safely for those who wish it, instead of just calling each other morons?

  6. paddy

    Pretty unpleasant stuff today Bernard.
    Not your finest hour on the keyboard. 🙁

    All too reminiscent of the sort of lazy journalism and trash talking that characterise the Bolter and his ilk.

    Lift your game man and come up with some decently reasoned arguments.
    That whole article just screams “I want more hits”.

    It’s a bit disappointing when Crikey goes for the “never mind the quality, let’s revel in the “flamewar”. 🙁

    Not Happy!

  7. Flicka

    I rarely comment on Crikey articles. I am one of your minority female readers, btw, who’s right in the middle of her child-bearing years. But I’m going to jump in and say thanks to Bernard Keane for bringing some logic to a topic that is usually reserved for emotional reasoning (which isn’t really reasoning after all) and breathless hysterics.

    The statistics about the dangers of home births and peri-natal deaths DO EXIST and there’s a reason why insurance publications consistently recognise that it’s safer to have a baby in a birthing centre/birthing clinic/hospital than on your bedroom floor. It’s ridiculous to suggest otherwise. Whether or not the reasons behind Roxon’s bills are based on a fear of litigation rather than fear of loss of life- you can’t fight the evidence. There’s no point saying that it would be nicer and more female-friendly to have a baby at home: it might be, but that’s not the point.

    And by the way- you don’t need to lose all your female autonomy if you have a baby in a hospital or a birthing centre. You just need to be comfortable speaking up for yourself and asserting what you want, within reason. I was fairly sure that was what feminism was about.

  8. Ann Jorgensen

    Sophie, an obscure cartoon vs a 700 word rant containing significant factual errors isn’t really the “broad church” I expect at Crikey. I want informed comment on the issues not this drivel. How about getting someone who actually knows what they’re talking about to write about this since Bernard Keane is clearly incapable of putting aside his own prejudices and reporting on the facts.

  9. MD

    This is informed comment. He is reporting on the facts. OK, it’s a opinion piece, not just straight reporting but that’s what Crikey is on about. The point he is trying to make is that the homebirth lobby is prone to make outlandish statements and use emotive terms to overstate the importance of homebirth to the community overall. Certainly the high Caesarean rate in Australia is an issue, but homebirth is not the opposite of C-Section! The vast majority of women in Australia CHOOSE to deliver in hospital. Those that deliver at home are mostly fine, just as those that deliver in the desert, in the middle ages or in the stone age were mostly fine. The question is (as Bernard alludes) what happens when it doesn’t go well. Remember that the homebirth group is a highly selected population. They are all low-risk pregnancies and outcomes can’t be compared by superficial comparisons with in-hospital deliveries which are by their nature a more mixed group. So you need to take emotion and politics out of the equation and have the debate on merit. In this circumstance midwives (and obstetricians for that matter) can be viewed as either advocates or rentseekers, depending on your point of view. Why shouldn’t they be viewed as critically as other rentseekers?

    The other issue I have is with the constant reference to the “mostly male” medical profession making decisions “for” women. In obstetrics and GP the mix is currently about 50-50 between male and female doctors at present. The balance is swinging dramatically and quickly – of the current trainees in medicine in general 55-60% are female, and of the current obstetric trainees over two thirds are female. In 10-15 years it will be hard to find a male doctor working in this field. Then you’ll need to find some other reason that you don’t like the advice they’re giving you…

    Ultimately this debate should be about the safety of mothers and babies and based on evidence, not an ideological debate based on gender politics. The AMA and most of the midwives groups see eye to eye on most of these issues. The current debate is a fringe issue and arises from one small group wanting to be treated differently at public expense.

  10. Venise Alstergren

    HUGH (CHARLIE) MCCOLL: I come in peace.
    You may find that Bernard didn’t write his own heading. Sometimes a specialist who does only headings can be employed. Mind you, it does have that BK ring of confidence….

  11. Chris Johnson

    Since when did insurance companies hand out life policies to tight-rope walkers? If you use an unlicensed tradesman to build the family home you pay for the fall-out. So isn’t this debate about much the same? Improving birth options within the health system for the majority of users shouldn’t be interpreted as cracking down on a handful of people who prefer in this case to birth outside it. No one is preventing births from taking place at home or in the backyard swimming pool as long as liability for the outcome is accepted by those seeking the alternative. Directing taxes towards improved birth facilities in public hospitals where most births take place and where there’s a concentrate of medical and allied health professionals seems more constructive than handing out Medicare rebates to a minority opting for makeshift delivery rooms. We’d all prefer to be tucked up in our own environment when in need of family support but if we can’t offer the luxury to millions of ageing Australians it seems a bit rich to pander to .22% of our population. Our health system is begging for a revolution but there’s a national budget that can only go so far. Using taxes to install and upgrade facilities for the majority of birth experiences seems more logical and realistic to me. Wingnuts or selfish sods – take your pick Bernard.

  12. Ann Jorgensen

    Flicka putting an assertion IN CAPITALS does not actually make it correct. Where are the statistics of which you speak? Probably in the same place as the “considerable evidence” that Bernard Keane claims supports his wingnuttery.

    Rather than detail all of the studies which clearly demonstrate the safety of planned home births, I will refer you to the review of the Cochrane Collaboration – an internationally recognised database of evidence based medicine.

    The Cochrane Review “Home versus Hospital Birth” (Olsen O, Jewell D, 2006) concluded that:
    “The change to planned hospital birth for low-risk pregnant women in many countries during this century was not supported by good evidence. Planned hospital birth may even increase unnecessary interventions and complications without any benefit for low-risk women.”
    This quote is taken from the Cochrane review abstract and plain language summary of the paper, available at http://www.cochrane.org/reviews/en/ab000352.html . Accessed 4 Aug 2009.

    As a policy lawyer with a first class honours degree in law and another in political science, I don’t consider myself a wingnut. I chose to have my second child at home because my first birth experience in a hospital showed me that hiring my own midwife and giving birth outside of the hospital system was my best chance of actually getting evidence based care.

  13. Julie McNeill

    I didn’t like the homebirth wingnuts label either – If you were a woman preparing herself for how she was going to give birth in the best way personally for her and her baby you wouldn’t be so derogatory.
    I had my babies in the mid-1980’s in the Queen Vic birth centre in Melbourne. It was the best balance of being in a non-clinical setting with a mid-wife, but if anything happened specialists were at hand.
    I chose that because the local doctor said he was in charge and wouldn’t let me give birth in whatever position I wanted – the first baby came with me on the floor on all fours, head in a bean bag. I didn’t go to the Royal Womens because when I went there It was like cows waiting in a cattle yard to go into a cubicle.
    I wish every woman could have the sensitive, warm and skillful mid-wife relationship I had in a comfortable setting. I’ve been shocked at how little has been given to women to be empowered with well-funded birthing choices in this momentous time of life.
    Roving mid-wives would be great for those regional and rural women who can’t get to a hospital in a hour during early labour! The small amount of women who want an insured skilled mid-wife to assist in their pregnancy and childbirth ought to be applauded for making a noise about their passionate desire to have their children at home.

  14. Lucy

    Let’s say I need an my wisdom teeth removed. Best-case scenario, I would like to have said procedure at a spa resort somewhere in Greek Isles, with plenty of Ouzo to aid my recovery. I feel that such an environment is in better accord with my spiritual needs than the dreary, unsunny, and patently ouzo-free hospital room that those… those BUREAUCRATS in Canberra think is perfectly acceptable. Now, according to the home-birth logic, don’t I deserve that choice? And shouldn’t the government fund me?

  15. Kathryn McCallum

    Wow. Yesterday you were wondering where all the women readers are. You have it seriously wrong on this one. I’m on your 21-day trial and I’m thinking twice.

    I’ve had two planned homebirths – the first with a transfer to hospital, the second all at home. At all times my baby and I were safe and sound in the care of an experienced midwife. I’m a journalist too, and so I am relentless when I am searching for information. My research during my first pregnancy convinced me that for my normal, low-risk pregnancy home was safe and I was way, way, way less likely to experience the level of intervention that is normal birth culture in hospitals today.

    The WHO recommends a C-section rate of somewhere around 10 percent might be needed to keep mums and bubs safe – Australia’s rate is three times that and in certain hospitals half the women who go in to have a baby end up with surgery.

    Half.

    Some women are fine with that but I was not.

    MD, the public expense of a planned homebirth under midwife care is so far less than the public expense of an unnecessary c-section that I don’t know where to start.

    This debate certainly should be about an evidence-based approach to caring for mum and babies. And there should be an evidence-based approach to all the interventions that are sometimes – but usually not – required during birthing.

    If you really want to know why women should have the right to homebirth, read this article by Marsden Wagner, former head of Maternal and Child Health for the European Office of the World Health Organisation:

    “Fish can’t see water: The need to humanize birth in Australia”
    http://www.birthinternational.com/articles/wagner03.html

    It’s got all the info you need to really understand this issue. To pick just a few of the issues out of it, according to the WHO:

    “At least 80% of all women are capable of a normal birth without intervention but we see in Table I that among low-risk Australia women having their first birth in private hospitals only 18% are judged by doctors as capable of a normal birth without serious intervention. Over half of low-risk Australian women having their first baby are judged by doctors as incapable of initiating their own labour: 47% of low-risk primips in private hospitals in Australia have spontaneous labour. These figures are truly shocking.

    That half of low-risk primips in private hospitals in Australia have an epidural block for labour pain can only mean two things: doctors and hospitals increase labour pain; women are not told the truth about the risks of epidural block. ”

    On homebirth safety:

    “It is unbelievable that obstetric organizations in some highly industrialized countries such as the US still have the same official policy against home birth which they wrote in the 1970’s. At that time planned home birth was not separated from unplanned precipitous out-of-hospital birth which, of course, had high mortality due to preemies born in taxis, etc. Then when scientists separated out planned home birth, it proved to have perinatal mortality rates as low or lower than low risk hospital birth. A large scientific literature documents this, including when the home birth practitioner is a nurse midwife[28] or when it is a direct entry midwife[29-31]. A meta-analysis of the safety of home birth, published in 1997, conclusively demonstrates the safety of home birth and includes an excellent review of the literature.[32]

    …In spite of all attempts by doctors to stamp out home birth, it has never disappeared and now is showing clear evidence of making a slow but sure comeback in a number of countries including Great Britain, Denmark, US, Japan (Birth Houses). And of course the great thorn in the side of anti-homebirth doctors has always been and still is The Netherlands where planned homebirths have never fallen below 30% with birth outcomes such as maternal and perinatal mortality rates comparable to Australia. ”

    Look at the evidence Bernard, there’s plenty more in Wagner’s article: planned home birth under midwife care for a normal pregnancy is NOT high risk as you claim.

    C’mon Crikey, get real.

  16. MD

    Ann I don’t consider you a wingnut either, despite your qualifications. The Cochrane paper is an important review but remember that the line you’ve chosen has a couple of important qualifiers “may” and “low-risk”. It only applies to low-risk pregnancies, not all pregnancies. It is also important to note that it is a meta-analysis of papers from many countries, some of which have vastly different health systems to Australia. When you look at the evidence for higher risk pregnancies (or for post delivery adverse events such as massive post partum haemorrhage) then you’re safer in hospital. As I said above, if all goes well homebirth is fine. If not, it’s a problem. Hospital based care in Australia is far from perfect and can be improved. That doesn’t automatically make homebirth the best option.

    However, that whole discussion is a distraction and frankly a different debate. The article is not about home vs hospital birth. It is about how far we provide state funding to midwives. The government’s reforms provide a lot more incentive to use homebirth than is currently in place. To demand more, as some people are doing is counter-productive and (as Bernard mentions) misses the point of the debate anyway. The issue is of risk and how we choose as a society to address that risk. You chose to hire a midwife. Should we have hired the midwife for you? What if things had gone wrong? Who would you have sued? What if the midwife was unable to get insurance? Should the government step in and compensate you? They are already establishing a publicly funded indemnity program for midwives in the clinical setting, but have stopped short of home birth. Why? If insurance companies won’t take on board the risk, why should the government?

    If all patients were prepared to accept the risk and remove all threat of litigation then there’s no problem – the midwives could practice away to their heart’s content and all would be well with the world. But then the lawyers wouldn’t be very happy either, would they…

    This policy is a win for the homebirth lobby and (more significantly) a win for midwives overall. I personally believe it’s a win for prospective mothers too and provides some balance and fairness in terms of where health dollars are spent. The choice has been strengthened, it’s unreasonable to expect the government to do everything.

  17. Stevo the Working Twistie

    Look at the YouTube clip peoples. “Wing-nut” is being kind.

  18. MD

    Sorry, just an addition, Kathryn I actually agree with you, although I think you’ve misunderstood me with this sentence: “public expense of a planned homebirth under midwife care is so far less than the public expense of an unnecessary c-section that I don’t know where to start.”

    Absolutely, and I agree with you. I wasn’t making a case for hospital delivery being better value but you need to compare apples with apples – an uncomplicated homebirth vs an uncomplicated hospital birth vs an uncomplicated birthing centre birth, not a caesarean. Then take into account the complication rate and the relative cost. It’s all been done and based on my reading the cost-benefit equation stacks up pretty well for midwife-based care and I’m a big fan of it. Midwives are definitely cheaper and in most situations better (how many doctors do you find saying that!) Obstetricians have a role to play when there are problems and are pretty good at it most of the time.

    But that’s not the same as demanding the government pay for midwife indemnity insurance – they don’t pay for dentists or doctors to have indemnity for work done in the patient’s house, why should midwives be special?

    It’s not about the ‘right’ to homebirth, it’s about who pays for that right.

  19. Ann Jorgensen

    I’m sorry MD but you appear to be missing a key part of the story here. As of July next year it will not be possible to have a home birth attended by a registered midwife. This is because the National Registration and Accreditation Scheme is being introduced and it is a requirement of that scheme that a health professional has professional indemnity insurance. There is no professional indemnity insurance product available for private midwives to purchase. This really has very little to do with risk and a whole lot to do with the small pool of midwives needing that insurance. What is being asked for here is that the Government extend the proposed indemnity insurance arrangements for midwives to those doing home births.

    Home birth midwives have been operating without professional indemnity insurance since 2001. So home birth clients have already had to “accept the risk and remove all threat of litigation” -something most have readily accepted.

    In terms of whether the government can do everything, I would be quite happy at this point in time simply for it to still be possible for me to pay for my own registered midwife to attend my home birth after July 2010.

    I do however think it is extremely unfair that the government funds the choice of a woman to have a non-medically indicated elective cesarean (a minority choice carrying with it risks) but not my choice to have a home birth (another choice made only by a small number of women). My first birth in a private hospital cost myself, my private health insurance and the Medicare system many thousands of dollars. My home birth cost me about $1000 more than the amount I was out of pocket for for my first birth. Medicare and my private health insurer were not troubled for a cent. At the same time a hospital bed was made available for someone that genuinely needed it and my chances of having expensive intervention in my birth were significantly reduced.

  20. jane

    Yes MD it is all about who pays!!
    There are plenty of models for women to chose. Far more than other areas of health care.
    And it is about taking responsibility for your actions.
    As one of those women, that some seem to think did not have a good birthing experience, that is I had a c-section, I beg to differ.
    Without it I would be dead, and my baby long before me.
    It wasn’t about me and my experience, it was all about a live and healthy baby.
    And as for complications, sorry guys, I can go to the gym and not pee my pants! My perineum is intact!!
    Cheers

  21. Chris Johnson

    Kathryn – if Roxon’s aim is to provide ideal environments within a hospital or registered birthing centre isn’t that better use of the tax dollar? You say you were transferred to hospital because the midwife I presume wasn’t adequately trained to perform a C-section so ambulance and emergency resources would have been used and on stand-by. Any wonder the Opposition has a hernia over abuse of tax-dollars. It’s like private school education. If you want the frills then pay for it yourself. I prefer my tax dollar to be spent for the greater good not frittered away on idealistic notions. Have a home birth but pay for it yourself. As I said in my comment we have millions of elderly people desperate for home comforts sitting in nursing homes or ‘care facilities’ that are more like Belsen. If we’re pandering to anyone why not our lonely, bewildered and under-nursed aged.

  22. Bernard Keane

    A couple of things. Yes, I didn’t christen the column but I have to plead guilty to using the term “wingnut” on Twitter so I can’t claim innocence in that regard.

    To the people who have linked this to the recent Crikey debate about female readership: what if the same views had been expressed by a female contributor? And how does an article urging that an historic initiative promoting and funding midwifery is being endangered by the focus on homebirth represent any sort of misogyny? Moreover as Sophie, who edited today’s edition and suggested I tackle the issue stated above, First Dog, who for those who don’t know is a bloke, was expressing diametrically opposite views to me, and I’ll wager more people look at his cartoons than read my pieces.

    And hopefully on Monday there’ll be a piece from the Home Birth Association responding to my arguments and giving the other side of the story – and the rational one at that, not the wingnut types who we all know are out there. I’m looking forward to that piece.

  23. Bernard Keane

    Oh and for those who are claiming I’m some sort of opponent of reproductive rights: fuck off.

    That’s the only reply you’re entitled to for such a ridiculous statement.

  24. jane

    Bernard, unfortunately some women feel as though the birthing process is all about them.
    Bad luck for the dad and baby.
    This being the case, you can’t win.
    One such charmer once asked me did I feel less of a woman because I did not push a baby out!!
    And finally, when I look at the child at school with bad cerebral palsy who fits all the time, I do hope this child’s mother enjoyed her home birth experience.

  25. Peter Titcumb

    Bernard

    Much of the content of your article is simply incorrect. Statistics in Australia show home birth is no greater risk than a hospital birth.

    Any midwife assiting at a home birth after 2010 will be risking a fine of up to $30,000 if the midwife does not have professional indemnity – – there is no professional indemnity coverage available for private home birth midwives.

    The number of home births may be only a small percentage of total births, but it is about choice, and they way women are treated by many hostpital by so called professionals.

    Learn about a real home birth midwife at http://www.bithing.net.au

    Peter
    (webmaster of http://www.birthing.net.au)

  26. Kathryn McCallum

    Chris – I paid for my home birth out of my own pocket with not a cent from the taxpayer. My midwife was highly qualified and I did not require an ambulance or emergency services. Birth is not really like on the TV dramas. If you want to understand why, read the article I mentioned by Marsden Wagner. Again, if you are concerned about cost, the cost of fully supporting homebirth, as they do in the Netherlands and a number of other countries with excellent maternal and baby health results, is far less than hospital birth.

    I fully support providing better hospital and birth centre environments with midwife-led care. I do not believe everyone should birth at home. It is not about judging other womens’ experience or dictating where they should birth. I believe birth care should be based on evidence, and women have the right to choose.

    And it is about babies and dads too. The studies mentioned in Wagner’s article show excellent results for babies. And all the home birth dads I have met were overwhelmingly happy with it.

  27. jane

    Statistics are very interesting and the homebirth lobby manipulate the data!!
    They compare home birth to hospital birth rates stats. Yes the hospital stats are the same but you are not comparing apples with apples. Hospital stats include high risk women as well, so in reality a lot of the numbers you see if only the low risk women were included, would show a very dramatic and disturbing increase in complication rate with homebirths.
    I can hear the hysterical screams now!!!
    Show me the stats that show low risk women in a hospital setting have the same complication rate as home births, not your manipulated numbers.
    And lucky you Kathryn, that you were safe, birth is a lottery as history shows us. Have a quick walk around your local cemetary, we have progressed a long way.,

  28. Venise Alstergren

    ROD McGUINNESS: Which of the two publications has the greatest number of subscribers?

  29. bpobjie

    What two publications, Venise? Don’t think Rod mentioned any other publications?

  30. banistersmind

    The reason why there is such an aversion to home births by medico’s is because, ultimately they don’t want to get sued. And the reason why medicos don’t want to shift more autonomy towards midwives in this country is because, again they don’t want to get sued. The problem with midwives in this country is that they are, increasingly, becoming an ideologically driven group of professionals with a political axe to grind which has little to with the women they are caring for and more to do with positioning themselves as a profession with more pull than the doctors and specialists who at the end of the day are the ones that get carpeted when shit goes pear shaped. Consider this – midwives go to university for a base course of 18 months in some cases and dont even have to be a Registered Nurse when they enter training. Compare this to an Obstetrician who may do a decade of study – and thats before they even get near a labour. Home births are frought with risk that cannot be managed if things go wrong. Midwifery is a profession more concerned with pushing a quasi feminist agenda than the welfare of mother and baby. Ladies – what would you rather? Give birth to your child in a home environment where the risk ratio is far greater and your midwife may (repeat MAY) be ill equipped to deal with a medical/obstetric emergency or would you rather give birth in a controlled environment where any contingency can be dealt with promptly by a medico who has at least a decades worth of training on a midwife?

    And before you write this off as a sexist rant – just to let you know – I am a Registered Nurse.

  31. Chris Johnson

    Strewth! Read this – http://www.joyousbirth.info/articles/janetsfreebirth.html
    “I relished the soft splat of placenta dropping into a salad bowl before I climbed out of the pool”. It sounds a lot like border obsession from someone euphoric on hormones unfit to make rational decisions about a new born’s welfare let alone their own. The home birth brigade needs to put considerable distance between their mantra and the above if its cause celebre wants credibility.

  32. Liz45

    Wow! As a woman who gave birth to her three sons in the 60’s, this is an interesting and refreshing debate. The 60’s were a horrible time for all concerned in my view – that is the public hospital system; the isolation of not having your husband/partner with you at all, and being forced to spend a week in hospital away from your other children – with my 2nd son, I’d left an almost 1 yr old at home – I cried when I had to go to the hospital; not because I didn’t want my new baby, I didn’t want to leave the other one.

    You were treated as though you were ill, not to mention deaf, dumb, blind and stupid, and a female ‘nazi’ was usually in charge of the maternity ward – no getting out of bed, no babies in the room, couldn’t even visit your baby with your husband. I hated every minute of it, particularly with my first one, no real help to breast feed or anything, separated from your baby without explanation – what a miserable time – often spent in tears!

    In 1969, when my 3rd child was born, the old ideas were beginning to change. Now, there are always exceptions, but it’s heaps better. I was a bit of a risk case, so home births would probably have not been an option, but I really only wanted to go where my baby and I would get the best care, and experts if need be. Thankfully, it wasn’t necessary, but with pre ecclampsia with my last, it could have been life threatening.

    I feel, that as long as the woman is healthy, there are no perceived complications, and the baby is also fine, I can’t see why home birthing can’t be an option, but I do understand the problem of the health budget, as it’s just growing all the time. People can be saved from medical problems they would’ve died from only a few years ago, and transplants and keeping premmie babies alive is improving all the time; but there is a cost, and like most things in life, decisions have to be made with the majority in mind. We also live in a time, when some people would sue over a crack in the footpath; insurance companies get jumpy, and sometimes unforseen tragedies occur. The main issue at hand for labour and delivery is the health of both mother and baby/ies. The bonding and nurturing comes naturally to most, and in a warm and friendly environment (with a midwife who you’ve come to know and love)must be the best outcome. It’s also much better for dads to be involved these days, and I know how much it meant for two of my sons to be at the birth/s of their children.

    If I do have a pet hate, it’s the insistence by some (doctors, journalists etc) that doctors deliver babies? In most cases, the mother delivers, while midwives/doctors etc ASSIST? I suppose it could be argued, that with a c-section the obstetrician delivers, but?
    The one thing I did totally on my own, and some want to deny me of that achievement? I was in labour(rangeing from hours to minutes?) I pushed the babies out – ME?
    Drives me nuts!

  33. Sarah Stringer

    Question: Would I prefer to give birth in a controlled environment where any contingency can be dealt with promptly by a medico or in a home environment where the risk ratio is far greater? Answer: I would prefer to give birth in an environment where I am in control, where the services I require are immediately available at exactly the moment that I need them and where these services are delivered in a fully informed manner so that I understand all of the consequences of the choices that I make.

    Unfortunately the hospital system does not provide any user of its services with this standard of individualized care. Hospitals are wonderful institutions for providing basic health care in an extremely efficient and effective manner and there is no doubt that hospital systems and procedures save lives. However if I would like more individualized care during my pregnancy the only way of obtaining this type of care is by obtaining the services of an obstetrician, a GP who provides obstetric services or an independent midwife. All of these individual services cost extra but they differ in their relationship with acute care services when birthing mothers experience difficulties.

    Obstetricians and GPs provide their services to women who give birth in hospitals and therefore when difficulties arise there is a medical team who already know how to work together to respond to the emergency. Independent midwives currently operate outside the hospital system but it is my understanding that the plan is to bring independent midwives into the hospital system and give them the same ability to provide services to pregnant women as obstetricians and GPs, which can then be refunded through the medicare system. As a result independent midwives working in the hospital system will be able to obtain indemnity insurance and after July 2010 only midwives with indemnity insurance will be able to be registered. After July 2010 independent midwives who work outside the hospital system and support women to give birth at home will be outlaws.

    This will be a social disaster if independent midwives find themselves once again metaphorically “burnt at the stake”. Therefore I hope that there will such a surge in demand for midwifery services in the hospital system that all independent midwives will find their services contracted. Likewise I hope hospital bureaucrats and doctors are able to tolerate a .22% rate of women birthing at home because they do not reach the hospital in time.

    PS Is the title of this article inferring that people with minority views suffer from mental illness?

  34. Kersebleptes

    If home birth is safe, then insurance companies providing indemnity insurance for home birth would make a profit, which is the purpose of such organisations.

    They won’t provide it. So are these mercenary organisations wilfully foregoing profit that is there for the taking, or might they be aware that it is not quite the attractive bet that some make it out to be?

  35. rmacfarl

    I think it’s unfortunate that some important messages are being lost in the rather hysterical headline and language in this article, and as a result there’s an excess of passion in the replies to it. The message which has been lost in the ranting is that for home-birthing, there is no change. The option is still open to people as much as it was before, and just as before the government will not provide indemnity insurance for practitioners. When it comes down to it, this is based on a calculated, objective assessment of the level of risk of an adverse outcome without rapid access to medical intervention in the event of a problem.

    Both my children were to have been born in the ’90s in a midwives’ birthing centre in a public hospital. Both arrived early, under 5 pounds in the old money, and under hospital rules my wife was transferred to the hospital. Both were delivered normally and are now healthy teenagers (well-adjusted doesn’t count at this age! 🙂

    The ultimate payback from birth is the chance to raise and love a child into adulthood. Some children aren’t breast-fed. In the 19th century the children of entire classes were seen and not heard. And yet most children grew up sufficiently well-adjusted to lead normal lives in society, and to have normal, healthy relationships with their parents. On the other hand, many mothers and infants died in childbirth, and still more children died in childhood.

    For the home-birth proponents, the practice is a lifestyle choice. Fine. Many women have negative memories of excessive medical interventions, and desire to exercise over their experience. Also fine. But it is inescapable fact that 20th century medicine has dramatically reduced the frequency of death and serious complications. The government continues to view the risk in home birth as too great for it to fund the practice. Alternatives are available which allow women to retain a high degree of control over their own experience, while having access to high levels of medical intervention at short notice when it is required.

    My key point is: regardless of the birth experience, a healthy baby heals all scars. Ultimately, that’s the outcome we all want: a healthy mother, and a healthy child. Isn’t it?

  36. jeanne

    As an educated, informed young woman I chose to have a homebirth for our first baby because it just felt and sounded better than going to hospital. When a pregnant couple choose homebirthing they actually( in my experience) educate themselves about the whole pregnancy, birthing process. No pregnant woman would ever deliberatly put themselves or thier unborn child at risk, to insinuate that women choosing homebirths are risk takers is an insult to our intelligence.
    I now have had two more children all born at home perfectly.
    The thing is women have been making and birthing babies for thousands of years, I repeat thousands of years, population Earth forever expanding, and over these thousands of years they have birthed at home, in mud huts, in the desert, in the jungles, in the special birthing caves where women have done what women do best, BIRTH without men anywhere, since when did men know how to give birth?
    I’m quite sure us Australian women do not want some politician suddenly tell us that we can’t choose where to birth. Excuse Me!!
    The whole legistlation that Nicola Roxon has been doing is definatly a plus for midwives. Homebirthing simply needs to be included as well, thats all, and if homebirthers are such a small percentage why not include it?
    Truth be told if more women actually really listened to homebirth stories and let go of their fears, more and more women would be having homebirths.

  37. john2066

    The real story here is the greed of doctors. Its recently emerged that obstetricians were making over 2m a year each, yes thats each, just out of medicare. This is a result of the disastrous ‘safety net’ where they just raised their fees to soak up the extra cash.

    The doctors will squeal like stuck pigs to stop anyone else, such as midwives, getting any sort of medicare rebate, using their usual bait of ‘safety standards’ when in fact home births are safe; and many treatments can and should be provided by nurses.

    This closed shop of multimillionaires – Australia’s most powerful union – has to be taken on now. The way they deliberately restrict specialist numbers to keep their incomes high is a national disgrace.

  38. bpobjie

    “No pregnant woman would ever deliberatly put themselves or thier unborn child at risk”

    NO pregnant woman? Anywhere? Ever?

  39. bpobjie

    I suppose I could relate the two marvellously positive experiences we had with hospital births, but probably nobody’s interested.

  40. petethegeo

    As a taxpayer I have no-more objection to paying for a woman’s choice to birth at home than I do paying for a woman’s choice to undergo a c-section, (yes people, some c-sections are elective)

  41. MD

    John, that’s utter bullshit. A very small number of obstetricians make that kind of money – most of those that do are fertility specialists and that is their gross, not net income from which they pay for the operation of their business, which in that particular sector is extremely expensive. Australia needs a thorough overhaul of what is rewarded through medicare and to what extent, but to deliberately misinterpret the situation the way you are is just ridiculous.

    I am not an obstetrician, but I have met a few greedy doctors (I’ve met a few greedy nurses, lawyers, teachers, politicians, builders, engineers etc too). However most of the doctors I know work long hours, put up with 15 years of study, make huge personal, professional and financial sacrifices to do what they do. And most of them worry about patient outcomes first and making money second. And most importantly in my experience most doctors aren’t against homebirth – they are just cautious about the risks involved.

  42. Alison Croggon

    What a depressingly ignorant article, Bernard. And insulting too.

    I am far from a wingnut. I am one of the majority of women who experience no problems in pregnancy. I have three children: one I had in a birth centre (at the Royal Women’s), and with the other two I employed an experienced, competent midwife. My second child arrived a month early and so my midwife took me immediately to hospital (which is, of course, always a back up plan) where I delivered in a labour ward – which is no place for a woman to give birth, on a table five feet high, in horrible light, with no facilities except aneasthetic to deal with pain. Although I had been booked in, in case I needed to be there – a standard procedure in home birth – there was an enormous row over whether MY midwife was allowed to attend me. My final child I had at home, which was by far the best.

    I am no hippy, nor a flat earther. I made informed, responsible decisions, I did my research into the risks and benefits, and I made sure that I had all the back-up I needed. No responsible mother or midwife would endanger either her own health or her baby’s, and I had no desire to do that. But I did have very real concerns about the effects of intervention (the effects are well documented) and I was terrified of something happening to my body without my consent, which as any woman will tell you is a common problem in hospitals. One example being unnecessary episiotomies that take months to recover from – if at all – some women have permanent damage from this operation. (The reason given for pre-emptive episiotimies is that it prevents tearing: I never tore, and it’s also well documented that because episiotimies cut through all layers of tissue and muscle, the effects are worse than most tearing). My midwide gave me one-to-one care all through my pregnancy and daily ante-natal care after my baby was born. This care was first class, and was far better and more intensive and personal than what I experienced in hospital. I know both I and my children benefited from this, and I still figure the (non-Medicare covered) money I spent was the best decision I ever made.

    The thought that my daughter might not have this choice if she were pregnant now saddens me beyond measure. And yes, that would be the default effect of that legislation, since in the Catch-22 situation that now holds, midwives who did provide homebirth – and the women who employ them – would face punitive fines and jail sentences. The Netherlands would be looking at us in disbelief.

    Btw, those who claim that statistics on the mortality rates of home birth vs hospital are not comparing like with like are plain wrong. Those that compare low-risk births in both places demonstrate that home birth with appropriate back up is a totally safe practice. Or at least as safe as giving birth in hospital.

  43. Venise Alstergren

    ALISON CROGGON: You don’t think you use the ‘I’ word too much?

  44. Alison Croggon

    For a woman talking about her personal experience, you mean? Or are you saying that my personal experience of home birth irrelevant to this debate?

    What pronoun would suit you better?

  45. SBH

    I wonder if there would be as much heat in this argument if mothers and fathers could access clean safe welcoming birthing centres rather than have to go to really unfriendly hospitals and if the people who did the helping were midwives.

    I got real lucky and all three of my kids were delivered by midwives with no doctors needed or involved. 2 & 3 were at the birthing centre at the royal womens. Those women were sensational, warm, helpful, smart, debunking bullshit advice from hospital doctors (no doctor ever told us what happens if an induction fails for one) but its a scarce resource.

    Why aren’t there many many more all over the place. And how come there are so few female ob/gyn? The responsible college should spend some time in the room of mirrors and have a red hot look at itself.

  46. Julie McNeill

    Again, the ALP comes into power and has to modernise everything. Thanks to Nicola Roxon maternity services are getting the attention and more up to the standard that all of us women commenting here, have been frustratingly waiting for so long – and for the greatest number of women.
    My two babies were born in 1984&6, and I thought by now birth centres would be everywhere! I’m just hoping that the passionate discussion and new legislation will see that my two daughters now all grown up will have the opportunity to have as good support and environment as I had for them. (And no tears either!)…..
    In deed, when her little head finally came out, I had a thought that I wanted to be a mid-wife. It must have transferred, because that little girl is now an RN training to be a Mid-wife!

  47. Venise Alstergren

    ALISON CROGGON: “I am no hippy, nor a flat earther. I made informed, responsible decisions, I did my research into the risks and benefits and I made sure I had all the back-up I needed.” (6 ‘I’s)

    Not being a hippy, nor a flat earther, and having taken the trouble to do the necessary research into the risks and benefits of home-birth, I then made sure I had the appropriate back-up. (2 ‘I’s.)

    Satisfied?

  48. Alison Croggon

    Venise, I don’t know what your point is, though it looks like totally off-topic snark. But if you knew anything about editing and general style rules, you’d know that active tense is always preferred over passive, as it’s more direct. It’s better to read, for a start.

  49. james mcdonald

    Bernard K, this is a really downmarket article in which you cited some pro-homebirth bloggers who sound stupid or loony, and from this you try to claim that all pro-homebirth advocates by association are stupid or loony. The merits of the whole issue judged by the debating skills of its least articulate proponents.

    I mean really, is that how we do rational debate?

  50. jane

    Hey Alison, appropriate back up??
    I’ve been your back up when it all falls apart. It consists of you coming through the doors with someone screaming failed home birth CRASH section NOW!!!! Then I have no time to assess you, just ask any allergies, anything I should know!!
    Tube goes through cords I shout NOW!! and I pray you have not got any anaesthetic problems I don’t know about. Blue baby comes ou,t bit of CPR and off to the Neonatal unit.
    That’s your back up, public hospital staff ripped away from other duties to save the life of your baby.
    It’s not a nice experience for us.
    Yes Bernard they are loony.
    That’s the facts, but they never listen, they just know better.

  51. Alison Croggon

    Jane, thanks for your courteous reply, which perhaps demonstrates why women so often fear that their concerns will be dismissed and belittled in hospital.

    I had a competent and highly experienced midwife, who at that time had delivered around 500 babies. I trusted her more than any doctor I saw. I went to hospital with my second child – to a booked bed, btw – because she wished to avoid the scenario you describe. That is, as soon as there was even the remotest risk of complication, I was near medical equipment. As it happened, it was a straightforward birth with no complications, so good for all of us.

    So no, you weren’t my back up.

    I assume that in hospital births that turn into an emergency, staff are also taken away from other duties to save the life of a baby. Do they resent that too?

  52. james mcdonald

    Slightly off suject, but Vernice Alstergren, can you help me determine if this sentence has a bit of a problem? “James while John had had had had had had had had had had had a better effect on the teacher.”

  53. Dommi

    What a silly little man you are. If you actually did your research you would find that homebirth is at least as safe as hospital birth, with lower rates of intervention and postnatal depression and better rates of breastfeeding and bonding. The evidence is clear.

    What do you know about birth anyway, based on this article you clearly have no idea and have no likelihood of getting one in the future. Do your research and educate yourself and maybe you will learn something, which I think would do you a lot of good.

    The medical profession is available if we need it and should be available to all of us, whether we’re a perfectly healthy woman electing to cut our baby out of our body or delivering as nature intended in our choice of setting with whom we choose.

  54. Dommi

    Well said Alison Croggon! 😉

  55. joel betts

    To think that people in society like this have a voice is scary. I thought the whole premise of Crikey was to attack the ball, not the player…..yet Bernard refers ‘wingnuts’ and ‘froth mouthed attacks’ to get his hollow point across. It’s blatantly puerile and actually goes against what I thought Crikey was about.
    I support women choosing to give birth at a hospital…and equally, I support women who choose to give birth at home. I am a man who wasn’t born at home, and I don’t have children who were born at home…so my support of homebirth isn’t based on my own experience. It’s based on the belief in choice, equality and common sense – principles that seem to be completely lost on people like the writer of this article. This is a hideous excuse for an article, and Crikey should raise its standards again.

  56. Venise Alstergren

    ALISON CROGGONB aka The ‘I’ monger: You have by your deft and judiciously incisive writing, not to mention your eloquence, and your charm; have been an inspiration for those ladies wishing to have insurance cover whilst accessing non-conventional birthing methods.

    Now that you’ve had more space than most of us could ever dream of, could you please desist from clogging up my Crikey e-mails. There are, after all, many other and, IMHO, more important things happening in this world.

  57. Veronica

    Right on Bernard.

  58. Scoogsy

    Bernard, I’m a big fan of your articles. I’m also a fan of your ability to pick apart and get to the real issues surrounding public policy and changes to legislation. Especially when it’s dealing with particularly sensitive issues like child birth and the often knee-jerk response by those who may be affected.

    This article came across as confusing and ultimately, pretty opinionated and “rant-like”. Sometimes these articles come off, sometimes they don’t.

    Justine Caines wins this round mate.

    Dust yourself off, take the critisism on board and get back to it.

  59. jane

    Oh Alison, I am so glad you know it all!! Yes call me all the names you like I have been SPAT on by 2 failed home births hence my bitterness. As you know EVERYTHING you would know that in a hospital setting doctors, keep a close eye on what’s happening in all the delivery areas. When an emergency occurs we have time to reorganise our duties. We don’t have to abandon patients at short notice as we always get some notice that things might go bad. Failed home births in my experience never ever call in before hand, they just come flying through the door, in a drastic shape. Your comments are offensive and disgusting to those of us who work hard to deliver a good service. YOU know nothing of the dedication of both doctors and nurses.
    You guys are so naive, watch the fitting failed home birth child with me, convince me you are right. Sorry you are wrong on every level. However I know I can never convince you. I apologise to the future home birth babies, I could not save you from your irresponsible parents.
    Go rant ladies I am still wiping the spit off my face. Yes “hello I am your anaesthetist” warrants the spit every time. If I did not care about people I could not care if you gave birth in a tree. That’s my problem, like so many other professionals I care-do you deserve it?
    Thank god I don’t go there, its too dark.

  60. Alison Croggon

    Jane, I’m sorry if you’ve had a traumatic time (although as I said, that wouldn’t have been me: my midwife collaborated with an obstetrician throughout my pregnancy, and my non-emergency hospital admission was properly organised). I still don’t know why a home birth emergency is any different from a hospital birth emergency, or why it’s necessary to be particularly rude to mothers who, for very real and responsible reasons, would prefer to give birth at home.

    No, I don’t know everything, and nor do I presume to. But perhaps this recent sober and careful Canadian study, which compared all equivalent-risk births in British Columbia, home birth and hospital, between 2000-2004, might suggest I’m not talking through my hat. It shows there were no fatalities in any home births, and that perinatal mortality figures were basically the same (apparently lower in home births, but apparently that’s statistically insignificant). However, the incidence of birth injuries – tearing, infant birth trauma (brain haemorrhage, fractures etc), meconium aspiration etc – was strikingly lower – around 75 per cent – in home births. Please go and read it.

  61. jane

    Alison I retired shortly after.
    I could not tolerate these women who having failed their home birth chose to be so violent to me. You don’t understand how hard we all work for no thanks and such vitriol. I remember with great fondness the midwives with many thousands and thousands of births who would weep at the tragic home birth horrors that would come through the door. I trusted these women more than anybody I have ever met.
    The midwives you have lie to you. I speak to you with absolute honesty. It is not about you and your baby, it is about them and power.
    I gave up after the spitting even though I thought I was really good at my job.
    The wise old women told me it was a lie.
    I hope you listen to me and them.

  62. Alison Croggon

    I really don’t know the circumstances of which you’re speaking, Jane, and I don’t understand what led to them. They do sound less than ideal, and I wonder how much those situations might have been avoided by co-operation between hospitals and midwives. And, as I said, I’m sorry you feel such bitterness.

    Typifying home births by the worst circumstances makes as much (or more properly, as little) sense as doing the same for hospital births, where things also can go tragically and horribly wrong. Why is it ok if it’s in hospital? The case of Calandre Simpson, whose $13 million record insurance payout in 2001 changed the whole medical insurance picture, involved not a home birth but a hospital birth. Her cerebral palsy, as you might recall, was caused by her obstetrician.

    Countless studies (including the one to which I point you, which is conducted by several doctors, is very thorough, studies a large population of women over several years, and has very clear and credible results) have shown that home births conducted by properly qualified midwives are as least as safe as hospital births. I’d say that a 75 per cent reduction on birth injuries in home births is one big figure, and given the parity in mortality rates, rather reverses the question of responsibility.

    In any case, I’m bowing out of this one now since, as others have pointed out, I’ve said quite enough.

  63. Venise Alstergren

    Jane: I just happened to be passing through and I see that the ‘I’ monger, Alison Groggon is still barking on.

    In an earlier comment I made the point that religious fundamentalism has much in common with women who think they’ve reinvented the wheel; in this case home birthing. Both beliefs require a total lack of sensitivity, humour, compassion, logic, and iron clad beliefs.

    Despite the roar of the minority in the comments section. I am left with a question. Jane, I am asking you. Why is is difficult to get insurance cover for home birthing? I imagine it’s because they know the odds against a safe home-birthing procedure. Would that have anything to do with it?

  64. Alison Croggon

    Venise, maybe you’re scarred, like that woman in Seinfeld, by having a name that rhymes with an intimate body part. But it doesn’t excuse your rudeness, nor your “total lack of sensitivity, humour, compassion, logic, and iron clad beliefs”. Ciao.

  65. Venise Alstergren

    Alison Croggon: Every time you make another comment you set back your cause. All because you have to have the last word. And when the words come out people shrug and think WTF?

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