Obstetrician/MP fighting for home birth rights

I didn’t have a home birth, one of my children was born in a birth centre and the other one in a mainstream hospital but I absolutely support the right for other women to choose home birth if they so desire.

Here is Andrew Laming MP (federal member of the House of Representatives and also an obstetrician) feeling as bewildered as I am to find a conservative needing to argue against the progressive side of politics for home birth rights in Australia.

[ETA transcript - ~lauredhel]

Transcript from Hansard:

HEALTH LEGISLATION AMENDMENT (MIDWIVES AND NURSE PRACTITIONERS) BILL 2009/MIDWIFE PROFESSIONAL INDEMNITY (COMMONWEALTH CONTRIBUTION) SCHEME BILL 2009/MIDWIFE PROFESSIONAL INDEMNITY (RUN-OFF COVER SUPPORT PAYMENT) BILL 2009 . Second Reading , Thursday, 20 August 2009

Mr LAMING (1:53 PM) —Few in this chamber will not be cheering that finally we have indemnity to support the great work midwives do for mothers around this country. But a very strange thing happened as this legislation, the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and the cognate bills, took shape. As midwives working in the community who do homebirthing were off to do their day’s work, this government managed to slip a bit of rancid ham into the legislative sandwich and serve it up to the midwives, saying: ‘This is what we’re doing for homebirths. We’re going to make registration contingent on your no longer doing homebirths. If you contemplate a homebirth, there will be a $30,000 fine.’ There is no plan to put that on the Medicare safety net, is there, Treasurer? No way. You are attempting to snuff out homebirths. We would be the first country in the world to do it. That is a dreadful shame.

The government should have had this worked out long ago. The evidence speaks strongly to this. The Cochrane database tells us that there is no evidence that homebirths in a proper, hospital-supported arrangement cannot be achieved. We have the evidence from de Jonge and from Olsen. There has been meta-analysis in Denmark. A study of 529,000 Dutch mums has been recently published, as has Symons in the British Medical Journal and there are other sources. If it is done properly, if high-risk mums are taken out of the study and we look at the ratios, we know that there is no significant difference in outcomes.

You can talk to Hofmeyr, who authors the Cochrane collaboration, who says there is no difference in danger for low-risk mums to deliver at home or in a hospital. In fact, Cochrane, which is the gold standard for medicine, goes another step and says that, where a homebirthing service can be supported by a hospital arrangement, mums should be given the choice. But in this Labor legislation I see homebirthing being snuffed out. I can see lots and lots of people in the gallery, many of whom would never choose homebirth, but there are a proportion who would. For those mums out there, I am telling you: this side of the chamber is standing for your choice to do it in a safe environment with appropriate hospital support.

Let us be completely frank about this. Not everyone is going to choose a homebirth. But, in every country in the world bar this one, it can still continue. In the Netherlands, something like a quarter of all births are done at home. Look at the history of midwifery. You can go right back through five centuries. There was a time when homebirth was safer than being in hospital. Back in the 1750s, when they opened the doors of hospitals to mums of lower socioeconomic background—and the other side of the chamber should be listening to this all of a sudden—it was actually more dangerous to go to hospital for a birth because of the lack of antiseptic measures. There was a time, in 1854, in Vienna when 13 per cent of mums died in hospital childbirth compared to two per cent with homebirthing.

Obviously times have changed and technology has moved on, but here is one chance to stand up for homebirthing. What has happened? It has been snuffed out through this sneaky legislation. There is an evolving habit on the other side to sneak nasty bits into the centre of legislation and make it difficult to vote against. But, mums of Australia, you need to know, if you are even contemplating a homebirth, that that choice is about to be removed. We have looked at risk. There is no greater risk. We have looked at finance—after all, actuarial analysis will tell you if it is or is not going to cost a fortune to indemnify home midwifery. Will the government release those figures? It is a big ‘n-o’. There is no chance of that. We cannot even look at what it would cost to indemnify home deliveries. This is for women who ask for home delivery and professionals who want to provide it.

A funny thing happened on the way to work today. Someone turned to me and said, ‘Hang on, so it’s your side of the chamber, the conservatives, arguing for harm reduction so that there can be trained midwives at homebirths, and it is the Labor Party fighting against that, with zero tolerance for homebirths?’ I said, ‘That’s right.’ They said, ‘That’s a bit strange; isn’t it normally the other way round, with drugs?’ I said: ‘That’s right. Illicit drugs are illegal. There is nothing illegal about homebirthing, but it’s about to become that way under this lazy government.’

I do not know what the Minister for Health and Ageing has been up to, but she is developing this habit of turning up here with Treasury bills to save money in the guise of health reform legislation. That is right. Here comes a health bill but the real intention of it is to cut the guts out of health funding, save money for Treasury and start to pay for this Prime Minister’s wobbly, wobbly $106 billion spending of the last six months. To take it out on mums who simply want a home delivery is a disgrace.

You need to look at the choice, the quality of care and the fact that these home deliveries are done by committed professionals. This legislation is snuffing that out, closing it down. What are you going to do? Are you going to achieve a complete elimination of homebirths in this country? N-o. Are you going to drive it underground? Probably. Are you going to take away the qualified midwives by denying them registration if they turn up to a home delivery? Y-e-s. So what are we left with? We are left with further marginalisation of homebirths, less support for homebirths and worse outcomes in a global context where home deliveries can be done safely. Health Minister, you have had plenty of time to get this right. This did not pop up on you yesterday. You have been lobbied consistently by those who support homebirths.

In my electorate of Bowman, homebirths will be snuffed out. I am telling you, sneaking this rancid stuff into the middle of ALP legislation, sticking a bit of ALP dill on the top and trying to pass it off as a revolution in health care is a complete disgrace. It is not too late. I am asking this government to take another look at this legislation. It is time for you to support midwifery, whether it is at home or in a hospital. They are the same women, Health Minister, that need these services. They are no different. Some of them just have a birthing plan that involves delivering at home. Why don’t you allow professional midwives to support them? Do not deny the midwives registration. Do not fine them $30,000. That is a complete disgrace. We are the only country in the world doing it. It is in the context of saving money. When it comes to health, that is an extraordinary shame. On behalf of every woman who chooses to deliver at home and every family who would like to see that happen, I say: why should you run them down? Why should you snuff them out in the guise of health legislation that is mere penny-pinching? This is something that should be changed right now. It is not too late. Make an amendment and allow homebirths to continue in this country.

The SPEAKER —Order! It being 2.00 pm, the debate is interrupted in accordance with standing order 97. The debate may be resumed at a later hour and the member will have leave to continue speaking when the debate is resumed.

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