I’ve been looking for the most recent official stats on homebirth and hospital birth mortality in Australia. I can’t find 2007 or 2008 figures, but there are 2006 figures available.
Australia’s mothers and babies 2006
The Australian Institute of Health and Welfare Perinatal Statistics Unit, Published December 2008.
Most births in Australia occur in hospitals, in conventional labour-ward settings. There were 269,835 women who gave birth in hospitals (97.3%) in 2006 (Table 3.11). A further 5,460 women gave birth in birth centres (2.0%). Planned homebirths and other births, such as those occurring unexpectedly before arrival in hospital or in other settings, were the two categories accounting for the smallest proportion of women who gave birth (2,053 women, 0.7%).[...]
In 2006, 708 planned homebirths, representing 0.3% of all women who gave birth, were reported nationally. The highest proportion of homebirths occurred in the Northern Territory (Table 3.11). [...]
Of babies born at home in 2006, all were liveborn. The mean birthweight of these liveborn babies was 3,687 grams (Table 3.34). The proportion of liveborn babies of low birthweight born at home was 0.8%, and the proportion of babies born at home that were preterm was 0.7%.
There were 2,091 stillbirths in Australian in 2006. 2,091 of these occurred in hospitals or birth centres. None occurred at home.
So really, mainstream media, really? This is the statistic you’re supremely uninterested in, while rumours get breathless finger-pointing and hyperventilating misogynistic diatribes from your right-wing talking heads*? Why is that, exactly?
And where were you, RANZCOG, when this was published? Anything to say?
Again: In the most recently available formal statistics, of over two thousand stillbirths in 2006, NONE occurred at home. Zip. Zero. Nada. Looking just at the planned homebirths (0.3% of births), you’d expect six stillbirths. Take away “high-risk” births, and you’d still expect at least several. Looking at all the births that occurred outside hospital or birth centre settings, you’d expect 15 deaths. Yet there were none.
These extraordinarily good statistics are definitely one of the signs that many of us are living in very privileged conditions. Access to C section is not the only or even the major determinant of maternal mortality. Most girls and women in Australia get enough food throughout our lives, have access to a variety of safe fresh foods and drinking water, have access to healthcare and contraception and abortion when needed (including when we’re pregnant too young), and live and birth in clean sanitary conditions. Most of us can expect to live our lives free from rickets, malaria, tuberculosis, HIV/AIDS, severe untreated anaemia or ectopic pregnancy or sepsis, genital mutilation, and violent rape with sharp objects. When preventative or emergency care is required in pregnancy or labour or the postpartum period, safe transfer and care is generally available.
Note the “generally” on all of this; there are caveats and issues in all of these categories, most notably with Aboriginal and Torres Strait Islander women and women living in remote areas. But in Australia, on average, our privilege on all of these points is better than most of the rest of the world. That privilege needs to be recognised, and must always be kept in mind. But the existence of that privilege should not be a roadblock to further improvements within Australia. “The women in Ethiopia would kill to have that C section you’re spurning!” is not a valid tactic to shut down birth activism in Australia – and it is most typically flung down as a trump card by those who show by their other actions that they couldn’t give a shit about women in Ethiopia or anywhere else, and that they are completely out of other arguments.
The current stories of “four deaths”** being bandied around in the media are hearsay presented to whip up a political frenzy. This is occurring at a time when supported homebirth is under severe threat, and the AMA and RANZCOG are working hard to defend their turf. Even if they are all true** (and the official stats will come out one day): unfortunately, stillbirth is a horrible, horrible fact of life. No matter where the birth occurs, some babies will never take a breath. Women who choose hospital birth know this. Women who choose home birth know this. I don’t believe that these decisions are made in naive ignorance of what “could happen”, though obviously no woman wants to think that it’s going to happen to her.
The only way anyone can rationally weigh up relative safety is to look at how many deaths occurred, and whether those deaths were likely to have been preventable. This is not something the court of public opinion can achieve. And then one will need weigh up the other dangers, the morbidity, and the hidden morbidity that doesn’t make it to the statistics. That’s a post for another day; suffice it to say, right now, that the stats being used right now by Australian barrow-pushers are not the only ones, they are flawed, and they have been grossly misinterpreted. (Please save the homebirth-study-wrangling comments for another post, as it’s not what this post is about. What follows is what it is really about.)
And here’s the other thing. Even if homebirth or freebirth were slightly less safe than hospital birth, which is pretty contentious, this is not a reason to restrict women’s rights to makes choices about their own bodies.
I’m going to say that again. YOUR assessment of “safety” is NOT a reason to restrict women’s rights to make choices about their own bodies. The State does not have the right to forcibly stop pregnant women from playing hockey, or driving, or smoking, or eating blue cheese or sushi, or skipping an antenatal appointment, or declining an ultrasound scan. None of these decisions warrant child protection referrals, or court trials, or jail terms. Nor does the State have the right to criminalise home birth.
There are fundamental tenets of feminism:
- The right to bodily autonomy without threat of State violence.
- The right to reproductive choice.
Choice runs in all directions. Do you support it?
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* No, I’m not going to link.
**And this is the closest I’m going to get to mentioning this. NOTE: This is NOT a thread to discuss individual women, their choices, or their private details, no matter whether those details have been published elsewhere. If you’re tempted to do this, read the last two paragraphs again before you type. Any attempts to do this will get comments deleted, and, as fair warning: my banhammer is on a hair-trigger with this one.
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If you’re looking for somewhere to donate to support reproductive justice and the health of women and infants, here are a few suggestions (you’re welcome to add your own in comments):
- The White Ribbon Alliance for Safe Motherhood
- The Edna Hospital in Somaliland
- UNICEF
the percentage of homebirths in NZ is a lot higher (I dont knwo the actual stats). 98% of births are attended by a midwife and we can choose to have a midwife and ob/gyn or a gp as our lead maternity carer for our pregnancy and 6 weeks following, our system is not perfect but homebirth is considered to be quite normal.
the NZ College of Midwives is this year focusing on every birth being a normal birth, that is with the least medical intervention necessary, this does not mean giving birth without any help, it just means not intervening unless necessary
I find it particularly revolting that they will carry on like this while removing obstetric services from rural areas (let alone remote areas that never had obstetric services). If they’re so worried about births not under their jurisdiction, maybe they should, oh, I don’t know, start by providing appropriate services to the women who actually want their services before attacking women who don’t?
*Train more obstetricians
*Train more GPs in obstetrics and anaesthetics
*Get the hell out of the private hospitals of the inner city and into rural and outer suburban areas
*Support the obstetrics staff who are already there, stressed and overworked, by providing relieving services and on-site education and training (or locums so that regional staff can go to training without leaving women with a four hour drive to hospital – and that’s just in rural Victoria, which is not that big)
In other words, they should get their house in order and provide services where they are wanted, rather than wasting time, money and good will trumping up evidence to turn women away from other choices.
They don’t want their house in order; they want more control. We don’t need to train more obstetricians. The ones that are there already are well and truly enough to do the obstetric work that actually needs doing, which is – at an educated guess – perhaps around half or less of what they’re doing now. If you want to take a purely evidence-based structural approach: what we need is a lot more midwives, and societal/legal/financial support for midwifery-led care – the gold standard according to Cochrane.
Anyone want to talk about women’s rights to bodily autonomy and freedom from reproductive force and coercion?
It is rather telling to see how much the conservative sides of media (and the doctors they interview) fear the notion of women learning for themselves dangerous knowledge from the Internet like… how to “measure the uterus to calculate the due date and how to work out if the baby is breech”. Goodness, how absurd that women might be able to do something as specialised as palpate their own bodies and interpret what they’re feeling.
In every aspect of women’s reproductive health there has always been such outrage and fear-mongering at the idea of women/girls learning about their bodies for themselves – this is the same reason why girls aren’t routinely taught about cervical fluids in order to understand and predict their own fertility. Teenagers would run amok with such information thinking they could have sex, and women would be sure to stuff up the calculations with their tiny pea-brains.
“All that matters is a healthy baby” is code for “You are an incubator and your right to bodily autonomy is less important than the contents of your uterus”. Women don’t lose the right to choose what happens to their body just because a baby is coming out of it any more than they lose it when a pregnancy begins. Unfortunately there seems to be a huge blindspot when it comes to birth, and many feminists who take for granted that access to contraception and abortion are feminist projects don’t seem to make the logical connection that so is what happens at the other end of pregnancy.
“…it is most typically flung down as a trump card by those who show by their other actions that they couldn’t give a shit about women in Ethiopia or anywhere else, and that they are completely out of other arguments. ”
It has always reminded me of the old “Eat your goddamn peas– don’t you know there are starving children in Africa?” Is it really about the world’s children who live in poverty or does it stem from an authoritarian fear of dissent and/or not feeling appreciated for the peas that were put on the table?
Jill– Unnecesarean’s last blog post..MRSA Infects 18 New Moms and 19 Newborns at Boston’s Beth Israel
Even if they are ALL true, you’ve still shown that that’s below the statistical prediction. Especially taking high-risk births into account, which is the obvious course when talking about cases that ended in death.
I’d count these two aspects as part and parcel of the same thing. If Australia is like the UK, most midwives are women, especially those in the higher levels of the profession; meanwhile, while I couldn’t say whether most ob/gyn doctors are male or female, the authority in the profession certainly tends male. So I think the distrust of the patients and the midwifery profession is the same distrust.
It’s superstition. They can’t stand the idea of such a process as pregnancy and reproduction being centred on women, because that makes it more mysterious to them. Cultish. Which isn’t to say they’ll sanctify it at the starting end, when they’re regulating whether women can control when and how it starts.
I agree that we need to make more of the bodily autonomy issue. It’s so common to read long arguments about abortion, rape, contraception, childbirth, and not see the point come up at all. Ultimately, however, it is the only point that matters, over-riding all other considerations. We need to turn it into a chant we just keep returning to whenever someone tries to distract. If you are human, you own your body.
It’s more simple than superstition. There are a couple of significant developments in human thought that this need to control women/women’s reproductive freedom can be traced back to; the desire to own private property, and the awareness of paternity. Some say the awareness of the finality of death also contributed.
When men first got onto the idea of owning land, it led to the desire to keep said land in their own family. In order to ensure that the child that came out of his woman was indeed his, all kinds of restrictions had to be placed on women, cos there was no dna testing obviously.
When society became medicalised so too did midwifery. The early medical/midwifery schools were dudecentric and inaccessible to midwives and other women, most of whom were poor and illiterate, so gradually all the wisdom and knowledge of assisting other women to give birth, began to disappear.
So this can be put down to the need of the patriarchal state to control the means of reproduction, women being those means, in order to control the distribution of land/wealth. ( de Beauvoir, S.& Firestone, S).
Now I would argue that the state also has a vested interest in making sure women continue in their role as breeders because of the need for new generations of cannon fodder for their wars over resources.
I’d really love to see childbirth return to being the domain of women only. Those in power seem to have instilled such a strong fear in women, and undermined our confidence in our own ability to deal with birth and help each other through the process. Then there is Beck’s theory of a “risk society” at play here too, as well as that old patriarchal belief that the baby’s health and safety is of more importance than that of the woman who is carrying that baby. Even though western birth is so medicalised and beyond our control, we still blame ourselves for every little problem, because society blames us for every little problem, even though so many of the medical interventions that are foisted on us, actually screw up the birth process.
The O H &S issues that the state goes on about is just smoke and mirrors; it’s about the need to control us and it won’t go away so long as we have a state/patriarchal society.
Also, we seem to forget that globally, over half a million women still die in childbirth every year.
While I agree with most of what has been said here already, I just wanted to say that I don’t think the fear of women knowing the “super secret squirrel stuff” about their own pregnancies is *only* a feminist issue. By that I mean that the doctor profession is, in general, *always* distrustful and threatened by people knowing about their own conditions. It is definitely a power issue and, while it is more acute in the case of women taking power over their own bodies, it is an issue that effects both sexes to an extent.
Excellent post and comments. Thanks everyone. One of the things that annoys me most about this argument is how the media buy into the obs argument, and don’t do the homework about the way midwifery works in NZ and UK. In Aus it’s all about about a bizzare construction of ‘risk management’ and insurance, not about safety in any real sense, and certainly not about women.
Thank you, now can you get this published in the national print media please.
*sigh*
I have had a midwife for each of my three births and am again having one for this pregnancy, I have chosen to give birth in a hospital setting due to other factors, but obstetricaly I dont need a dr to help me birth my children. the system here isnt perfect but does allow for more choice and more control for the women. the documentary by rikki Lake the business of being born shows what has happened to birth in America, its well worth watching. For me it showed that although the system in NZ isnt perfect its a darn sight better for mums than in America.
Finally! Thank you for such an articulate post. The media circus that has unfolded in the last week has been truly sickening.
Mama Thrift’s last blog post..An Ass of an Egg
Ah, a voice of reason. Love you women!
Excellent post, thank you. After the recent media frenzy, it is very refreshing to see somebody actually reading the stats and writing rationally on this issue.
[...] the way, a brilliant rebuttal can be found on Hoyden About Town so I don’t feel the need to write one of my own. Unlike Ms Devine, I can see the similarity [...]
Thanks for a sane, sensible comment on this.
In the interest of being the “side” that supports accurate information, it is probably worth recognising that some of these stillbirths would probably have been in cases of planned homebirth transferred to hospital. However, this adds it’s own complexity. As you have stated, the preventability of the death is nigh on impossible to establish. Also, there is probably no way to establish whether the interventions the may have occurred on transfer would have affected the outcomes.
yours in hope that some more sanity prevails next week…
Bodily autonomy? Maybe when offenders are prosecuted for violating consent laws. When complaints about possible violations which have gone to the HRC are then reported to the police, or are directly reported to the police, we may see some change.
My personal pet peeve is that I’m repeatedly seeing, over and over again, 39 weeks being presented as term by docs. and their media dogs. Like this little gem from msnbc.com ” When fertility treatments become frightening: Carrying multiple fetuses can increase risks for both mother and babies.” It states that “Women pregnant with one baby deliver at 39 weeks, on average.” Not without intervention, they’re not! And interventions carry material risk, and according to 2006 statistics, much more risk than no interventions at all, hence all the dead babies. I’d extend bodily autonomy to the right to having access to up to date, comprehensive, and factual information on the material risks and benefits of any procedure, which will not usually be provided before procedures, although medicos are legally obligated to do so.
The problem is though, that if bodily autonomy is achieved in the maternity system, it will spread throughout the healthcare system, and the medical system does not want that can of worms opened.
So where are the investigative reporters writing up the fact that doctors are not obtaining consent?
Oh,lauredhel, I love you. When my husband read me the original scaremongering article I said to him, I bet one of my blogs picks this up soon. Meaning you. And you never disappoint, saving me from trawling exactly the same statistics (first questions I asked: what are the stillbirth stats for hospital? And what % of home births doesthis 4 represent? I have no idea, he said,the article doesn’t say. Quel surprise, said I.). Thank you thank you thank you. It’s interesting that even the 4, if true, is under the statistical prediction, isn’t it?
I’m off topic, because you’re right,the topic is bodily autonomy. I agreed to a hospital birth with my first because my husband was SO uncomfortable with homebirth. But I did feel like it should have been entirely my choice, and that I was giving him something by agreeing to the compromise. If I feel like that about the father of the baby itself, I can’t imagine ceding to a nameless faceless ‘society’ about these things.
[...] (i.e. most of them) has hit the headlines to balance the report concluding otherwise that was given so much publicity in recent [...]