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Federal

Aug 24, 2009

We're not homebirth wingnuts, we just want equal treatment

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, writes Homebirth Australia's Justine Caines.

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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.

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37 comments

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37 thoughts on “We’re not homebirth wingnuts, we just want equal treatment

  1. Kathryn McCallum

    Thanks Justine for telling it like it is.

  2. JaneShaw

    Whether you are in favour of home births or not, no one could argue that this article has any wingnuttery in it. Well done on producing a calmly informative piece.

  3. Greg Angelo

    It appears that the problem in this case is not the government preventing home births, but the requirement for the claimed technical specialists involved to carry appropriate indemnity insurance. It would appear that these simple solution to this problem is for the advocates of home birth to underwrite personally the insurance indemnity necessary to enable registered midwives to deliver at home. On this basis, registered midwives could obtain the insurance necessary to provide their clients with the necessary means of redress should they make an actionable mistake, and the cost of such redress would be borne by the advocates.

    On this basis the risk of this potentially risky procedure would be borne by the advocates of this practice and not by the community as a whole. If the home birth process is as safe as the advocates claim it is, it should not be difficult for a dedicated group of supporters to pledge the necessary financial support to convince an underwriter to manage the risk.

  4. MD

    Good article Justine, clears up a few things including several of my own misconceptions about the situation. It seems that the problem has come about due to the collision of two changes, one being the changes to the medicare schedule to include more allied health items (including midwifery) and the other being changes to the system for registration. One provides more “choice” while the other appears to be having the unintended consequence of taking it away.

    However, you are still asking for special treatment. What you are asking for is the Government to pay for liability insurance for one group of health professionals, working as private contractors, to make house calls. This is unique in the whole health system. The question is not whether it is special treatment you’re asking for, it’s whether that treatment is deserved. Are you lobbying the insurance industry with the same vigour asking them to provide an appropriate insurance product?

    And once again, you’re comparing apples with oranges – the overall rate of adverse events with all obstetric patients vs the rate of adverse events with (by definition) low risk patients are not comparable. If you look at the adverse event rate in specialist women’s hopsitals they are higher than in other hospitals. Why? Because of the fact that these centres are dealing with all the high complexity, difficult, high risk births. Adverse events do not mean mistakes!

    Home birth is safe, as long as you select the right mums and the midwives are good at what they do. You’ve convinced me. Now go and convince the insurers.

  5. Kindred

    Thank you Justine for so clearly and intelligently setting the record straight. Women simply must maintain the right to birth where and how they want, and social, beaurocratic structures must bend to that right, not the other way around.

  6. Ann Jorgensen

    Greg – you’re a genius! What a sensible and well-thought out response to the problem. While we’re at it, the Government should also cease all of the insurance premium and claims support that it provides for obstetricians. Those that advocate for hospital birth can put their money where their mouth is. After all if its as safe as they claim it is, it shouldn’t be difficult to convince an underwriter to manage the risk without the millions of dollars currently being spent by the government to prop up the system.

  7. Tony Blackmore

    Home birth may be a nice idea for some; but take heed of this:

    My daughter had a totally normal pregnancy and everything went normally until a few moments after the birth. Partner and mother were smiling and my daughter had the baby in her arms and then it came – a massive hemorrhage and unconsciousness.

    Fortunately it was in a maternity hospital, a crash team arrived within the minute and my daughter survived.

    A home birth and we would have had a death.

    Tony Blackmore

  8. james mcdonald

    Greg and MD: If what Justine says is true that “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”, then do you have any suggestions how to to “convince” the insurers to cover midwives outside hospitals? Easy, just set up a co-op with all the millions they have lying around and tell the insurers that if a payout is really high they won’t have to pay it. Great, that’ll work!

  9. Evan Beaver

    Yes it was a good article. Clear and rational.

    Some of the commenters would do well to remember that ‘the plural of anecdote is not data.’

  10. Monica Kane

    Justine thank-you for providing a balance to Bernard’s article. I was disappointed in reading his polemical piece. I normally enjoy his work.

    Through a holistic approach women and families must have the right to choose where they birth. I do not feel the need to lecture others on the benefits of homebirthing. I trust that people can weigh up the information and access suitable medical advice in deciding their place and plan for birth. I expect society to allow me the same right.

    As Justine pointed out the government framework ensures the insurance (as it should,) of professionals in this field. Except midwives operating from home. This exclusion is potentially creating discrimination.

    Justine you have provided a well informed argument and I hope Bernard acknowledges your contribution to this discussion. However if information or balance was his objective, he would have asked an agency spokesperson in the first place.

  11. Karl Fitzgerald

    As someone who has enjoyed the benefits of midwifery with the birth of our first child, I’m shocked at this development.

    One wonders what the new President of the National Association of Specialist Obstetricians and Gynaecologists (NASOG), Dr Hilary Joyce has to say about this? As the forst woman elected as the head of this peak body, will she stand up for the rights of women to choose?

    Did her predecessor allocate a % of funds towards lobbying for enhanced monopolistic control of this very private issue? The <a href=”http://www.crikey.com.au/2008/11/19/maternity-health-reform-has-harmed-women-but-not-obstetricians/”profits delivered per baby are assured to raise eyebrows.

    One wonders what Roxon is thinking re the health of our already over-burdened hospital system….

  12. Nadia David

    Thanks Justine for making the points I imagine a few people would like to in response to Bernard’s article. Home birth as an option clearly isn’t about just settling in and having your baby at home without any consideration of your personal situation, your pregnancy, your baby and the risk factors those three things throw up. You would be mad, and so would any midwife/practitioner, to support and attend the home birth of a woman with risk factors. I have never heard any home birth proponent suggest such a thing.

    And that is where you’re going a bit astray MD. Home birth advocates have never talked about wanting anything but low risk births to happen in a home setting. They only talk about home birth as an option for women with low risk normal pregnancies where the likelihood of something going wrong is at its lowest. As Justine said, the point is that home births are AS SAFE as hospital or birth centre births, provided the pregnancy is low risk and normal.

    Greg you’ve got a few issues with your idea. I’m an advocate for giving women the option to have a home birth but I sure as hell won’t be signing up to indemnify all home birth practitioners! I’m not a member of any group or organisation, and I think you’d find that any Australian organisation supporting the option of home birth for women would be very much a non-profit outfit. No money there mate.

    Far better if the big insurance companies provided the insurance for private midwives and offset the cost the way they always do, through the premiums most of us pay through the nose for. I’d rather pay an extra $1 a month for women to have access to registered, insured midwives than be forced to have their baby in a hospital when they are really uncomfortable with that. Remember, the individual woman still has to fork out serious bucks for a private midwife anyway…it’s not something Medicare covers. At least, not yet!

    This isn’t about making women have babies at home. It’s about options. I am pregnant and looked at birthing options in depth before making a decision about how I’d LIKE to have my baby. It isn’t home birth and I fit into the low risk normal pregnancy category. I just think women should have more options instead of being pushed into care and birth options they really aren’t comfortable with. Ask any midwife about the adverse effects having your baby in a setting you don’t want to be in has on the birth. Higher caesarian and other medical intervention rates, higher forceps use, greater risk of serious tearing, longer labour. It just seems we keep pushing the birthing model most likely to result in medical intervention and this isn’t a model supported by great outcomes for mothers and babies. Australia’s caesarian rate is twice that of other Western countries and clearly fails UN targets for desirable women’s health targets in relation to childbirth.

    Home birth is an option as deserving of support as elective caesarian. Let’s look at ways to provide that support instead of just writing off anyone who advocates for home birth as a ‘wingnut’ hippy earthmother-type who must be half-mad for wanting the least invasive option available. Believe it or not, perfectly sane women prefer to have a midwife who’s committed to their birth and there for the whole shebang than an obstetrician who just pops in after their game of golf to catch the kid before taking off to the opera!

  13. corbie68

    I find it disturbing that nothing is being done to support women’s options in this matter, I’m not a wingnut hippy either Nadia and if I ever got pregnant I doubt I would go the home birth option, but still to deny women the right to that option over a bunch of technicalities is a serious health policy oversight at best.

  14. Chris Johnson

    Thanks Justine for your article. One question before I comment – where does Joyous Birth fit into the home birth process?

  15. hozozco

    My wife and I planned a home birth last year. In the end we needed to transfer to the hospital and narrowly avoided a caesarian. So I’ve managed to see both sides (from the male perspective anyway).

    Our privately employed midwives (we had 2), were competant and professional (if totally uninsured). We also encountered an excellent obstetrician who worked hard to facilitate a ‘natural’ (non-caesarian) birth.

    I’m a Nurse and I can appreciate how dangerous hospitals are. They’re full of over-worked, often very tired Nurses/Midwives/Doctors that can really do some nasty things to you if you’re not careful (I’m now in admin and part of my duties involve looking at the adverse event reports)!

    Our decision to have a home birth was made after a wide review of the literature and discussions with a range of health professionals.

    My wife and I did not seek additional funding for the birth (though I can see plenty of arguments for this), nor are we asking the government to wear the insurance costs. However, we do think the effective outlawing of Homebirths from July next year is an outrage.

    I’m also personally insulted by Bernard Keane’s label of ‘wingnut’.

  16. pwnerous

    Thanks Justine – good article.

    I’m in favour of less hospital resources for mothers who don’t want or need them; done safely of course. There were good arguments as to why that should happen.

  17. Justine Caines

    Dear MD
    Thanks for your considered comments. I acknowledge that comparing total obstetric data with midwifery data is not comparing like with like, but I used it because the difference was so huge. The NZ incident data alone assists us to argue midwifery and homebirth risk. Yes as total volunteers we do brief insurers. This is a difficult proposition when the largest Australian based insurer is owned by Dr’s.

    Regarding the comments that we are asking for special treatment. Currently the Premium Support Scheme covers private practice medicine. The High Cost of Claims Scheme provides further assistance for the high cost areas of obstetrics and nureosurgery. Procedural GP’s and Specialist Obs have their insurance subsidised for childbirth. We are simply asking that midwives be eligible for the same cover for the same event.
    Formula: Once the premium exceeds 7.5% of gross income 80c in the dollar is funded by the taypayer. We are simply calling for a similar support package. If we focus on insurers not owned by medicos we may have a chance! Insurers have commented that they are not caught up in the place of birth, just the systems in place.
    A recent Senate Inquiry revealed that little if any work has been done by the Department of Health see
    http://www.aph.gov.au/hansard/senate/commttee/S12303.pdf

    Alarmingly Senior bureaucrats suggested come next July former Registered midwives should just change their title and continue to practice. In anyone’s book this is not sound, why have health practitioner registration at all.

    As Nadia said we are a community group with no funding (little chance of ever attracting it) working as volunteers around children. 10 years of activism has assisted me to refine the arguments and confidently present to Ministers and senior policy makers. I hope we will see some sense from DOHA soon then perhaps I can get back to baking muffins!

  18. Chris Johnson

    I’m assuming Roxon’s National Registration and Accreditation Scheme for home birth industry professionals is designed to ensure equal treatment for women and their unborn in addition to providing both with maximum protection. Registering midwives in accordance with the Scheme’s criteria promotes opportunities for the same insurance indemnity offered to other allied health professionals such as pharmacists, psychologists etc. The US home birth guru Marsden Wagner says “midwives take care of normal pregnant women, while hospital-based obstetricians take care of complicated, high-risk pregnancies.” Regulation of the home birth industry would establish guidelines for healthy and high-risk mums including those with extreme emotions regarding birth. Some of those expressed on the site Joyous Birth easily fit the ‘wingnut’ tag and have ended in tragedy.
    http://nhsblogdoc.blogspot.com/2009/04/did-your-rapist-wear-mask-and-gown-home.html As Justine says the home birth debate is much like the one we had on abortion. The latter is now far more safe and available than ever. With midwifery fostered and endorsed as a health profession home births would become part of mainstream good health practice.

  19. KerryMcG

    Dear Bernard
    Your standard of journalism has been a delight. You’ve been switched on enough to see what’s really going on in ALP Qld and other areas when most journalists have been recycling press releases.

    But you’ve been sold a pup on the homebirth issue.

    Arne Garborg explains it nicely when she said: “It is said that for money you can have everything, but you cannot. You can buy food, but not appetite; medicine, but not health; knowledge, but not wisdom; glitter, but not beauty; fun, but not joy; acquaintances, but not friends; servants, but not loyalty; leisure, but not peace. You can have the husk of everything for money, but not the kernel.”

    The midwifery legislation not only lacks the kernel, it outlaws the knowledge management and political base that has led the government to consider the husk. It is poor law for a government and machinery fixated on the short-term, when births have impacts on the long-term, and parenting choices affect political choices and every child is born.

    Please look more carefully at this with your heart and head engaged.

    You state: “drowned out by the ideological attacks of a tiny and wholly unrepresentative minority.” I ask you to check whether the percentage of adults who are members of political parties is about the same as the percentage of women giving birth at home. And while the party membership turns over every three years, the homebirthers turn over every nine months? Using spurious maths here, wouldn’t it mean that the homebirth minority is LARGER than the political member minority who decide on ideology of our nation?

    Think carefully about this one please. Remember, EVERY SINGLE PERSON is born.

  20. gef05

    @ Chris Johnson

    Awesome. That site you linked to is quoting Andrew Bolt.

    Game Over.

  21. Damien

    No-one has yet given me a convincing reason why midwives for homebirths should be exempt from holding professional indemnity insurance.
    O&Gs do indeed have government assistance to subsidise their insurance, but as a non-procedural GP, I get no subsidy at all.

    Picture this possibility: One day in my consulting room a flustered midwife rushes in asking for help. I run across the road to attend a woman in labour, whom I’ve never met, with a severe unexpected birth complication. An ambulance is called and I help as much as I can with my limited resources, but a disabled infant results.
    Add in an ambulance chasing lawyer and a Santa Claus judge. Who are they going to chase for multi-million dollar compensation? The uninsured midwife with few assets, or the doctor with the big income?
    I doubt my insurer would cover me for obstetric complications (I have only non-procedural cover) and attending the patient establishes a “duty of care” so I cant claim a Good Samaritan exemption.
    The result would be my bankruptcy. Far-fetched- yes. Impossible- no.
    I don’t care how, but get insurance or get off the playing field.

    BTW everyone, it’s Caesarean , nor caesarian.

  22. Chris Johnson

    Apologies to GEFO5. Here’s the link that disturbed me. http://www.joyousbirth.info/articles/janetsfreebirth.html

  23. john2066

    Good article. Lets not forget the real reason home births/midwives are being banned – the greedy medical profession. They will stop at nothing to make sure all medicare rebates go to themselves, and make sure that everything has to go through their hands. Despite all the evidence home births are safe.

    Naturally there are chronic shortages at all levels of medical specialists – because they keep it that way. Recently it emerged of obstetricians taking 2 million dollars a year – yes 2m a year -out of medicare.

    As usual the media slobbers all over the doctors. And as for miranda devine, well, she preaches free markets, but like all conservative commentators falls over herself to side with and gush over Australia’s most powerful trade union – the AMA.

  24. Dom Padden

    When “home births are good” hits my ears I normally hear “modern scientific medicine is rubbish”.

    That annoys me, of course. One, because there are good reasons that the average lifespan of a human has almost double in the last 120 years or so (in western society, anyway), and it’s not due to the rise of alternative medicine. Two because it got rid of smallpox and almost got rid of polio. Three because my wife and I are certainly only alive today due to scientific medicine, so I take it personally. Four because by then I’m not really listening, as you can tell.

    That was a good article, and my normal reaction of “oh, you want us to go back to when all the women died horribly after 40 hours of labour and infections” has been tempered.

    Now that we have a greater understanding (compared to 120 years ago) of what causes problems in childbirth, then sure, let’s go with the choice option. It seems that the evidence is that home birth (for low-risk cases) is just as safe as hospital birth, “provided the maternity care system facilitiates this choice through the availability of well-trained midwives and through a good transportation and referral system”.

    Do we have a maternity care system that facilitates that? It seems not. Will it cost heaps more to have one? I’m not so sure. Is it worth a go? I think so. I’m happy for some of my tax dollars going to find out.

    Have we banned home births, as some are claiming? No. Women had no choice for all of human history until a relatively short time ago, then they had the hospital choice, they still had the home birth choice, now we are essentially taking away the trained midwife option, which seems to be critical to the safety of the process (apologies for calling it a process).

    I’ll start giving home-birthers the benefit of the doubt, and hope that they stop giving my wife a hard time for choosing hospital births (seriously, they did). Assuming it is really all about equity, of course, as Caines claims, not pushing the cause of home births over hospital births. Those that give women who choose a hospital birth a hard time are just rude, and not at all in search of equity. They do exist, and they are wing-nutters indeed.

  25. Angie

    It’s really surprising to me that you can choose to have an elective c-section in this country whic costs thousands of dollars, but you can’t choose to have a planned and supervised homebirth.

    Obviously hospitals are equipped with every medical convenience, but the realilty of childbirth is that for many women, these medical conveniences are not wanted or needed to safely deliver their babies.

    I say this too as a mother of two who has had 2 c-sections. So while I personally wouldn’t have been able to have a homebirth for medical reasons, I strongly support the rights of women to choose their birth option and to have the choice of doing so with every safety measure and support.

    I wish the government would put it’s energy into coming up with some kind of insurance for doctors and midwives to attend homebirths and a register of some kind for hospitals to be aware of homebirths and to be prepared in case they are needed.

    I distinguish here between homebirth and free birth – the latter being birth at home without any medical support whatsoever. I do not support free birth, which I believe accounts for many of the tragic stories we hear in the media.

  26. petethegeo

    I still hold that it should be the right of the patient to sign away rights to litigation in the event of a misshap (except in the case of gross negligence) we had such forms for hangliding instruction and they saved a sport that the insurance companies were going to shut down due to denial of service….
    Hm. Interesting that we could even get insurance, let alone a right to sign a waiver, I would think there are fewer hanglider pilots in Aus than home-birth advocates and I’m sure the miss-hap rate (per capita) in hangliding is a lot higher.

  27. Venise Alstergren

    MONICA KANE: Bernard Keane did ask for an agency spokesperson prior to writing his article. If you had taken the trouble to read his comment properly you would have seen words to the effect that on Monday Justine Caines of Homebirth will be putting the official point of view.
    It is a shame that it was necessary to wait until Monday before a well reasoned and calm comment was to be made.
    Frankly, I was appalled by the tone of so many of the comments, especially those coming from the supporters of home birthing. Seldom have I heard/read so many pompous, arrogant, bordering on self-justifiably vicious comments. One woman was so gruesome and so far up herself that I decided then and there to be a one hundred percent supporter of hospital births. And you need people like me to fund the scheme-I am a taxpayer, and a voter, after-all. And you need money for your scheme to get off the ground.
    I am a refugee from the political section of Crikey. I can only say that the ugly comments of some of your supporters, would not only be not be printed in this section, the writers would probably be invited to cease commenting in future.

  28. rmacfarl

    A well-reasoned and welcome response. I have a question though… Are there guidelines for homebirth which would stipulate when a transfer to hospital is mandatory to protect the health of mother and/or baby (e.g. pre-37 weeks gestation, pre-eclampsia, breach birth, complications during labour, etc.)? And if not, wouldn’t it be best to establish such, and clearly communicate these to all. I repeat my earlier comment: ultimately, whatever the means, the end we all want is both a healthy mother and a healthy baby…

  29. Justine Caines

    Dear Venise
    Bernard asked for no such comment. I called him on Friday afternoon to discuss the inaccuracies of his piece and it’s overall tone. Bernard challenged me to a response, to prove to him I was not a ‘wing-nut’. I provided the published response and also a critique of the Maternity Services Review outlining the inaccuracies of it, as Bernard had quoted data from it.
    Venise currently OUR taxes fund a very expensive obstetric dominated maternity system. Despite a rising caesarean and other intervention rate, the perinatal death rate has remained fairly static, the cerebral palsy rate has not improved. Anecdotally we know there is considerable maternal morbidity (often with very serious consequences). There is no reported data because it would seem no one cares to collect it. Let’s place the same level of scrutiny on all maternity health providers, rather than assume that if one is part of the establishment then they are above reproach.

  30. Monica Kane

    Justine thank-you for your clarification regarding an opportunity to respond to Bernard’s article.

    Venise, your right, I didn’t ‘take the trouble’ to read all the comments as at the time I read Bernard’s piece there were no comments. I did not look again until reading Justine’s piece on Monday. Regardless, Bernard could easily have sourced a balanced response. There are many options aside from a youtube video. It appears either purposeful or lazy. Either is not the writing I expect when reading something by Bernard.

    In regards to the tone in many of the comments, I agree. At times the debate has gone extremely off topic and is unhelpfully emotive. However, we are talking about profound experiences for all people, regardless of their birth option/ choice.

    In addition, when commenting on the tone of others, it may be worth re-reading your own responses Venise. Here’s one, “when you…read some of the garbage written by this po-faced right-to-birthers brigade, you will realize Birthing at Home IS the new religion. All the same holier than thou attitude…” So yes, there have been absurd comments on both sides of this debate.

    Despite this Justine’s article has also generated informed and thoughtful discussion. I hope this continues to encourage debate, inform and provide the balance needed.

  31. ST

    There comes a time when the benefit of technical ‘improvements’ is outweighed by the iatrogenic harm produced. Childbirth is at risk of being caught at this tipping point. Has the pendulum swung too far?

    At beginning of the 20th century, there was widespread concern about the physical deterioration of the British people. One in 10 infants died before they were a year old, and many of those who survived reached adult life in poor health. During 1902, reports in the British national press claimed that up to two thirds of the young men who volunteered to fight in the Boer War in South Africa (1899 to 1902) had been rejected because of unsatisfactory physique. The stock of good healthy children who would grow to become soldiers to defend their country was noticeably reaching alarming levels in the UK.
    This was one of the many reasons why women were encouraged to seek medical surveillance during pregnancy and from here the move towards giving birth in hospital reached a relentless crescendo.
    It is not often recognised that the move to hospital for birth was important for several reasons other than the safety of birth itself.
    After the Second World War, apart from seeing women as production units – needing to produce a product that would be of benefit to the nation, doctors in training required a large pool of women and babies as ‘teaching fodder’ – and homes were not considered ‘appropriate’ surgical environments for the teaching of the surgical specialty of obstetrics. In addition to this it was deemed equitable that all women should be provided with what was considered the ‘best’ care – very often women who required medical help were not able to access it – so the move to hospital for all women in the UK was advised by their Department of Health, (see the Peel Report, UK 1970). Australia has historically followed both the UK and the US in policies and practices around childbirth and obstetrics.
    With the introduction of antibiotics, better nutrition and adequate housing after the Second World War, the health of mothers and babies began to improve noticeably. The improvements happened in parallel to the move to hospital for birth and consequently it was easy to attribute improvements to the new way of managing birth in hospitals. However, it is possibly more correct to assume that the introduction of antibiotics and the availability of good food and shelter have had more to do with health outcomes of our population than the increasing rates of caesarean section for example.

    The education of women and subsequently (predominantly) female professions such as midwifery and nursing has improved exponentially in the past century. Consequently the option of giving birth with a midwife who has had an excellent education in all aspects of health and physiology and has gained skills in both neonatal and adult resuscitation, has now come of age. In addition to the knowledge required to assess the progress of pregnancy and labour with appropriate understanding of when to refer or consult, midwives in Australia have an excellent set of national guidelines to advise them when this should occur in a timely manner.

    To give birth in hospital for healthy women has possibly become an anachronism. Women deserve to be able to choose whether they want to join the ‘conveyor belt’ management necessary to process the numbers of women presenting in many large teaching hospitals. Certainly there are many intelligent men and women who would prefer to give birth in the privacy and comfort of their own homes. There is no need for hysteria and shroud waving. Most families will only have one or two children these days. The event is profound and celebratory – therefore women deserve to be able to choose to give birth where they feel most safe and secure. This may be hospital – it may be at home.

  32. Venise Alstergren

    Monica Kane: Nevertheless BK DID say The Home Birthing Association will be commenting on Monday. You merely had to scroll through the piece to find it in comment form. If, as it sounds, you are a spokesperson for this organization you should not only have gone to the trouble to research anything I may have said, far more important to have researched something the author of the piece may have said.
    I’m disappointed that you didn’t enjoy my calling some of your organization’s madder commenters as being po-faced, if anyone personified that description it was the dolorous and tasteless woman, singing that appalling song.
    As for calling the movement another form of religion. If you study the emergence of any religion you will find the exactly the same extremism being expressed in these pages.

    Thank you to you, and to Justine Caines, at the very least you were as polite to me as you were able to be. Which makes you both almost unique amongst the rest of you. Political Correctness; the words have been intoned by some of your readers. Sometimes I wonder if it is a sign of high-mindedness or, rather has it produced large groups of blamers, together with tiny- minded and self-righteous bigots.

    I am not accusing either of you as being in the above paragraph.

  33. Monica Kane

    Venise, firstly I would like to clarify that I am not a spokesperson for the organisation. Had I been, I would have declared this.

    I believe in women’s rights and I am a homebirth advocate (based on experience). This does not mean I think all women should have homebirth nor do I believe it to be a superior choice.

    There is a huge difference, as I am sure you understand, between advocacy and religion. Although your comments were not directed at me, I don’t feel the comparison is accurate, in fact it is merely reductionism.

    I agree with your point that some pro-homebirth people do not articulate themselves well and in doing so the message is lost. With democracy comes a range of voices and a range of expressions. Please do not stereotype homebirth advocates. As with most stereotypes it is not an accurate or helpful representation.

    There is also the notion of ‘freebirthing’ which I do not advocate and is not relevant to this debate. This debate is regarding proprosed legislation for professional midwives attending low risk home births to be insured.

  34. Alison Croggon

    Venise, I can’t but notice that you don’t offer others the same courtesy that you demand from them.

    I have to say the various women who were – quite reasonably – objecting to their being characterised as “wingnuts” for choices they made with care, deliberation and after rational research didn’t seem holier-than-thou to me. Anyone who researches pregnancy and childbirth is acutely aware that many things can go wrong in the best of circumstances. Tragically, mothers and babies die in childbirth (as often in hospital as in homebirth situations) and nobody wants that outcome in any circumstance. That should be taken as read. It’s not “extremist” to say that homebirth with proper professional care ought to be a choice open to any woman, and it’s certainly not the same as claiming that every woman ought to have a homebirth whether she likes it or not.

    Nothing teaches you more about the folly of making plans than having children. No reasonable person would dream of condemning a woman for making her own careful choices (or for circumstances over which she has no control) whether it’s for a hospital birth or an alternative. And characterising an entire debate by its extremists while ignoring the facts is just unfair and dishonest.

  35. Veronica

    It disturbs me that deciding whether to have your child in a hospital or at home has become an issue about ‘women’s rights’. It is so perverse as to be stupid. Surely what every woman wants, first and foremost, is to deliver their child safely – that is, deliver the child in a manner that is safe for both mother and baby. Now when someone has an acute illness such as pneumonia for example, we do not argue about whether the person should be treated at home or in a hospital. We accept the logic that the hospital is most appropriate place for treatment because clinical staff are available round-the-clock to assist if the person takes a turn for the worse. Why is it not the same for childbirth?

    There are those who argue that childbirth is a perfectly natural experience and should not be thought of in the same way as disease; therefore, there is no reason why women shouldn’t give birth at home. Yes, childbirth is a natural experience, one in which prior to recent times many women and children died. It can be dangerous, even for those births that are deemed ‘low risk’. A friend of mine had a low-risk birth – right up until the moment it was discovered the baby had the umbilical cord wrapped around its neck and was in danger of having the blood flow to its head cut off.

    It makes logical sense therefore, to give birth in a place in which such issues can be dealt with – like a hospital. So why do people advocate the view that it is an infringement of women’s rights to only provide such services in a hospital?

    I think it is an insidious perversion of feminism. The argument goes that childbirth is a women’s issue and women should decide how they want to do it – and if they want to eschew all the benefits of 21st century medicine, then so be it. We are standing up for a woman’s right to choose a backward, primitive way of giving birth because this is a women’s issue and women must maintain control over their turf. We must assert the ‘ancient wisdom’ of mothers which men cannot take away from us. Bollocks. Women don’t need to hoard the turf of childbirth; doing so maintains the distinction between ‘women’s issues’ and real issues.

  36. greg wood

    I only saw this today but really had to comment.
    I’ll be a Dad soon, my beautiful wife and I have discussed the choices we have and are choosing a home birth with an independent midwife. We thought through it all carefully, spoke with friends who have had home births and hospital births and made an informed decision. We are funding it ourselves and are really happy with our decision. What I don’t get is the people that harp on about ‘tax payers money’ if a transfer to hospital is necessary? How inconsiderate and inhuman. We all deserve the right to health care and we all deserve the right to healthy birth choices. As a non-smoking vegan (yes throw me in the liberal wingnut category if you like!) I currently subsidise the healthcare of smokers, of the thousands of people who due to poor dietary choices need heart surgery, diabetes care etc. What it comes down to is choice, the data speaks for itself, home births are safe and the bonding/breast feeding rates are significantly higher. As a bloke I absolutely support 100% a women’s right to reproductive choice, be it birthing options or abortion options. This is not an ‘insidious perversion of feminism’ as the above wingnut states, it is choice, safe, healthy& informed choice. cheers

  37. Gender-Equity

    Readers
    I thank the earlier evidenced based comments regarding the topic of Home Births and Maternal Care. I would like to see more competition, choice and time series research on maternal care in Australia. I would also like to see the debate widened, as the current maternal care environment in Australia is too restrictive, outdated, expensive and not of world’s best practice.

    Pregnancy: More choice and competition amongst obsteticians. The choice to be cared for by a dedicated midwife for the term and birth. Greater flexibility in work practices for parents to be.

    Birth: bring back water births and baths in hospitals and birthing centres.

    Breast-feeding:
    -Still too few employers have feeding rooms to allow breastfeeding mothers to continue to feed their infants when returning to work.
    -Still too few public places have dedicated feeding rooms and change tables.
    -Too few workplace agreements have lactation breaks in their contracts yet the International Labour Organisation recommends 2 x 30 minute lactation breaks within a 8 hour working period to be in an employment agreement.
    -Expand the number of breastmilk banks in our country to assist premature and sick infants.

    Child care:
    -Employers (govt, public, private, not-for-profit) to invest in childcare arrangements (occasional and long-care). The long waiting lists and expense of child care is a disincentive for many working parents to return and to stay in employment or formal study. Allow for greater choice in child care provider. The same rebates to apply for in-home care by a registered child care worker.

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