The issue of homebirth is up there with abortion — it divides the community into those who think it is OK — and those who don’t. Sometimes no amount of evidence, opinion, or research will convince either side.
Bernard Keane’s article in Friday’s Crikey is based on two incorrect pieces of information. The first is that “no one is stopping Australian women who want home births from choosing them”. The second is that there exists “considerable evidence” that home births are dangerous.
Let’s start with the first. As of July next year it will no longer be legal to have a home birth attended by a registered private midwife in Australia. This is not “wingnuttery” or the collective delusion of home birth advocates across the country, it is simply a fact. The reason is that the state and Commonwealth governments are implementing a National Registration and Accreditation Scheme for health professionals.
As part of this scheme a health professional must hold professional indemnity insurance in order to register to practise. Private midwives are presently unable to obtain such insurance because there is no insurance product available for them to purchase: collectively they form too small a pool to make it financially worthwhile for an insurer to provide that product.
The legislation currently before Parliament proposes indemnity insurance to some midwives. It is not at all clear who these midwives will be only that they are “eligible” and that they will work “collaboratively” and that they won’t attend home births. Extending this legislation to cover home birth midwives is the only realistic way that home birth with a registered private midwife will remain an option for Australian women after July 2010.
This is why so many women (and men) across Australia have written to Nicola Roxon, visited their local MPs and made submissions to the recent Senate inquiry concerning this legislation.
The second piece of incorrect information is that home birth is an inherently dangerous and high risk option. There is a body of evidence regarding the safety of home birth. The most recent published study (only a few months ago), of over half a million low risk births showed that women and their babies were as safe at home as they were in hospital. Even the Australian home birth study published over a decade ago found that low risk women were no less safe at home giving birth.
That study did point out that the practices of unregistered midwives versus registered practitioners was the issue of concern. The fact is that flawed research from the 1970s which falsely concluded home births were not safe has mis-informed government policy for decades.
The UK Department of Health website states that “for a healthy woman experiencing a normal pregnancy with no major complications anticipated during the birth, studies have shown that it is equally safe to be attended by midwives in the comfort of your own home as to have your baby in hospital.” The Department of Health in the UK has made one of its priority targets for 2009/10 to give more mothers-to-be the opportunity to choose to give birth at home.
One could write many pages setting out the breadth of evidence that supports home birth as an option for women but that distracts from the fact that at its heart this debate is not about safety or risk or insurance. It is not a turf war about whether obstetricians or midwives should be the most important care provider for pregnant women. It is about whether all Australian women have the autonomy to make their own choices about how they will give birth — a fundamental choice about a fundamental life experience.
In this country we accept that a woman has a right to choose an abortion. But as of July next year we won’t accept that a woman has a right to choose to give birth at home attended by qualified and registered caregivers.
There is also an underlying horror that home birth women are daring to ask the Government to look at funding their birth choices. This is simply a matter of fairness. Women who give birth at home are the only women in Australia whose birth choices receive no funding at all. At the opposite end of the birth spectrum a woman can have a non-medically indicated elective c-section under the care of a private obstetrician and her choice will be funded.
This choice will ensure that she can use up even more of the taxpayers money by being guaranteed to have more intervention, a longer hospital stay, possibly more postnatal morbidity and potentially her baby going to a neonatal special care unit. The Government will contribute towards the costs of all the specialists who will need to be involved in her care — an obstetrician, a back-up obstetrician, an anaesthetist and a paediatrician.
Additionally in the event of her obstetrician negligently causing her or her baby an injury she can take legal action because the Government has supported the insurance premium payments for her obstetrician and will reimburse the obstetrician’s insurer for the costs of high claims. The cost nearing the billion dollar mark. The Department of health and ageing recently stated that Australian obstetricians faced adverse events at the rate of 1.1 per thousand. In New Zealand where midwives care for 80% of women the adverse incident rate with a midwife has been 5 in the last 300,000 births. This makes Australian data 66 times higher. C’mon the taxpayer has footed a billion dollars in premium support.
Home birthing women are not asking for any special treatment from the Government. They are simply asking that they still be able to choose to home birth with registered midwives after July 2010 and that the Government treat them in the same manner as it treats all other women giving birth. Bernard Keane calls it “wingnuttery”, we call it equity.