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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.

Bernard Keane — Politics Editor

Bernard Keane

Politics Editor

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 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….

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