Quickhit: Maternity Services Review and Homebirth

Further to our thread on the Maternity Services Review, check out ABC Unleashed: Homebirth ban, by Alison Leemen

The Maternity Services Review report, released last weekend, was an attempt to delivery continuity of care and midwife-led services to more Australian women. In so doing, it has stripped that very same care and service from the only women who currently have it – homebirth mums.

The fact that it did this in the face of having received the majority of its submissions from homebirth parents is galling and speaks volumes for the way “public consultation” occurs in this country. But the fact that the report’s recommendations, if accepted by the Government and made law, would criminalise the high quality care currently delivered to women who choose to give birth at home by registered, professional, independent midwives to their clients is radical and dangerous.

Good intentions have paved the way. The MSR was established partly in response to rising birth intervention rates and widespread concern that women were being poorly served by a maternity care system that was fragmented, expensive and increasingly medicalised.

But the process became hijacked by professional lobbying, deal-making and perhaps a strange reflex of governments to favour institutionalised power over the rights of individual constituents.

The report is fairly forthcoming about this:

“In recognising that, at the current time in Australia, homebirthing is a sensitive and controversial issue, the Review Team has formed the view that the relationship between maternity health care professionals is not such as to support homebirth as a mainstream Commonwealth-funded option (at least in the short term). The Review also considers that moving prematurely to a mainstream private model of care incorporating homebirthing risks polarising the professions…”

So as long as the AMA and RANZCOG are hostile to homebirth -ideologically, not evidentially – the government is not prepared to stare them down. […]

The Review concluded that, “while homebirth is the preferred choice for some women, they represent a very small proportion of the total.” Since when has being in the minority constituted an acceptable reason for discrimination? The fact that only a small proportion of the population will need heart transplants is no reason to ban them or block public funding to them. The small minority of families who choose private education due to religious beliefs are still supported by Commonwealth funding. And of course homebirth will be unpopular when it is the only way to give birth in Australia that receives no public funding whatsoever.

Read the rest, which goes on to discuss the 2010 registration issues that may make homebirth midwifery outright illegal.

[hat tip: the Morrigan]

Categories: ethics & philosophy, gender & feminism, health, social justice

Tags: , , , , , , , , , , ,

12 replies

  1. I wonder how it is that Netherlands has one of the highest home birth rates in the (white) West and the lowest neonatal & maternal death rate.
    Could it be something to do with all those bicycle? ie active from go to whoa, grandparents still wheeling along when ours are being wheeled or stuck in the corner.
    Friends born in the UK were mostly at home up to the 60s and almost always after prima gravida.

  2. A pesky point – not only homebirthing parents have “continuity of care and midwife-led services”. I had this with both of my children’s births through the world best practice Canberra Midwifery Program run out of The Canberra Hospital.
    Please note that I am not saying this to diminish the substantial difficulties brought to bear on those who wish to homebirth, just to point out that I was able to access the “gold standard”, and that I am grateful.
    Part of the reason for my ability to access the midwifery program was knowing that I needed to book in about five minutes after we finished having sex 😉
    Any peeps in Canberra who wish to support the Friends of the Birth Centre should know that there is an AGM of the group on 25 March. I’m happy to be contacted at crazybrave@gmail.com (I’ll be going along for the first time too.)
    Hoydens, please move this etc, if too OT.

  3. Midwifery run out of a hospital is NOT the gold standard. Hospitals are run by surgeons. The transfer rate for most BCs is from 40-60% thus not only do a huge number of women not qualify in the first place for the lofty heights of this corridor of the hospital over that one with L&D in it, but 4-6 out of 10 who make it there will end up in L&D for all the normal bullshit obstetric reasons anyway -“FTP” *snort*, postdates, breech or whatever is bugging the surgeons that month.
    Let’s not confuse the crumbs of birth centres with the loaf of homebirth, however problematic may be our experiences of homebirth given it’s current political pressure. One woman, one midwife, at home, evidence based care – gold standard with outcomes to prove it.
    Leeman’s article is indeed a good one since it names the reality – AMA and RANZCOG are massive pillars supported by every media form and outlet across the country. Your discussion of the Devine reminds me of the number of times she’s worked at poisoning the air further for birthing women with an utter disregard for research or reality.
    The myths spun about birth and women’s bodies are continuous themes of patriarchy plus commerce. Unbeatable combination and one for which women, babies and communities are paying heavy prices.

  4. The fact that it did this in the face of having received the majority of its submissions from homebirth parents is galling and speaks volumes for the way “public consultation” occurs in this country.
    Yes and no – I think this was the exception, in my admittedly limited experience I usually see corporate backed lobbyists and/or wackos dominating the discourse. For instance, in the decriminalisation of abortion in Victoria last year, if the govt had gone by the sheer number of submissions, it’d have to bow to the forced-birth element.

  5. Con Su Permiso – With Your Permission (Spanish)
    What is really rankling me about this whole issue is that the MSR report has totally blown by without so much as detectable nod in the direction of the NHMRC, or the National Health and Medical Research Council, and the impact it’s activities have on maternity care.
    Practitioners and institutions are allowed to go ahead with some NHMRC approved projects without first obtaining consent from the family. Yes, that is correct, the Australian Government has approved reams of funding in known non-consensual human research related to maternity and L&D. Consent does not have to be sought in situations in which the knowledge of being a research subject would likely alter the outcome of the research. This situation is clearly in violation of human rights legislation, and constitutes forced unpaid labor on the part of the mother/baby dyad. Unless, of course, you count the baby bonus as a de facto payment for possibly being randomized into an research trial (RCT). If every institutionalized mother and baby, in the hospy or the birth center, has the possibility of being randomized, you have to pay everyone, just in case.
    There are no RCTs (Randomized Controlled Trials) in homebirth that I’m aware of. 1% of families are opting out, maybe unintentionally, of the Russian Roulette currently going on in maternity care. Research dollars account for millions on top of mundane charges. How many women would go into the hospital or birth center knowing that they would be participating in an RCT without knowledge or consent? How many more families would seek homebirth as an option if this information was more widely known? How can the government fund sexual assault in the name of research? How long until the public en masse says “No More!”

  6. Which RCTs, MrsC? Could you give some examples, please?

  7. http://www.nhmrc.gov.au/publications/ethics/2007 for the current National Statement on Ehtical Conduct in Human Research (2007) including guidelines for consent and situations in which consent may be waived.
    This includes the download “maternal.xls” which bears the title NHMRC Funded Research into Maternal Health Issues 2000-2008, found at http://www.nhmrc.gov.au/grants/dataset/_files/maternal.xls, which provides which research trials, and, who, what, when, where, and how much it cost.

  8. Second link still not working. Use search on link 1 for “labor delivery birth” and it should pop up as #4.

  9. I can’t find anything in that xls file that details a randomised controlled trial in which consent was waived. Do you have some specific examples of consent-waived Australian RCTs in maternity healthcare, to open up the discussion? I’m not having a go at you; I think it’s an important topic, but it’s not one we can discuss readily without specifics.

  10. Amphibious: – I had a Dutch midwife for my homebirth, who was trained and started her career in the Netherlands. She told me that in Holland, childbirth is treated as a natural event, not a medical emergency. Only women with complications go to hospital to give birth. I think this is the reason for the low death rates – nothing to do with the bicycles!

  11. It looks like any study which does not specifically include the words “We obtained written informed consent” would fall into the category, including clinical and therapeutic innovation trials. However, I can not be sure as I do not have access to the coding that is being used, or the applications for approval, therefore, I can only say that there is the possibility that some clinical trials involving maternity, newborns, and biological samples, are being conducted with a waiver of consent. Having a go at someone is vastly different than asking them to verify what they are spouting off about. I like your site.

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