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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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Rod McGuinness
Guest

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

Sophie Black
Member

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

Mac Yourselfathome
Member
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… Read more »
Hugh (Charlie) McColl
Member
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… Read more »
acannon
Member

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?

paddy
Member

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!

Flicka
Member
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… Read more »
Ann Jorgensen
Member

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.

MD
Member
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… Read more »
Venise Alstergren
Member

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….

Chris Johnson
Member
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… Read more »
Ann Jorgensen
Member
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… Read more »
Julie
Member
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 –… Read more »
Lucy
Member

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?

Kathryn McCallum
Member
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,… Read more »
MD
Member
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,… Read more »
Stevo the Working Twistie
Member

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

MD
Member
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… Read more »
Ann Jorgensen
Member
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… Read more »
Freddy T
Member
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… Read more »
Chris Johnson
Member
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.… Read more »
Freddy T
Member

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.

Peter Titcumb
Member
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… Read more »
Kathryn McCallum
Member
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… Read more »
Freddy T
Member
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… Read more »
Venise Alstergren
Member

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

bpobjie
Member

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

banistersmind
Member
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… Read more »
Chris Johnson
Member

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.

Liz45
Member
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… Read more »
Sarah Stringer
Member
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… Read more »
Kersebleptes
Member

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?

rmacfarl
Member
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… Read more »
jeanne
Member
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… Read more »
john2066
Member
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… Read more »
bpobjie
Member

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

NO pregnant woman? Anywhere? Ever?

bpobjie
Member

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

petethegeo
Member

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)

MD
Member
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,… Read more »
Alison Croggon
Member
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… Read more »
Venise Alstergren
Member

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

Alison Croggon
Member

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?

SBH
Member
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)… Read more »
Julie
Member
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… Read more »
Venise Alstergren
Member

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?

Alison Croggon
Member

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.

MaxwellsDemon
Member

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?

Freddy T
Member
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… Read more »
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