Homebirths forced to go underground

If an Australian woman wanting give birth at home is Little Red Riding Hood, then the Rudd government is the Big Bad Wolf.

Under the draft Health Practitioner Regulation Law released last week, homebirths will effectively become illegal.

How does it work?

According to the new law, all health practitioners (such as midwives) must hold indemnity insurance in order to legally practise. Considering the government and insurance companies have thus far been unwilling to include homebirth in the indemnity scheme, therefore, any midwife that attends a homebirth (even if qualified) will be subject to a fine of AU$30,000.

Homebirths will now be forced to go underground as Australian women are being stripped of their choices in childbirth. Now, it seems that a hospital is the only sanctioned venue for birth to occur.

Australian College of Midwives executive officer Dr Barbara Vernon said the Government's intentions were obvious.

"Even though only less than half a per cent of women have home births, they should have the same rights as a woman who chooses to have a caesarean," she said. "Home births won't stop."

Vernon touches on an important contradiction. Why is that women can still elect to have caesarean births which arguably carries much risk and the small proportion of women (about 2%) who want to give birth at home cannot do so even if the birth is attended by a qualified health professional?

I think unfortunately, the tragic death of Joyous Birth founder, Janet Fraser's baby in April during a homebirth has unfairly placed the blame on the venue of birth rather than any other medical factors that could have been integral to her baby's death. It is not clear how Janet's baby died other than it suffered from cardiac arrest and could not be revived.

The small proportion of instances where homebirth goes horribly wrong pale in comparison to the staggering complication and caesarean rates that women in the developed world are continually subject to as a result of needless intervention in hospital.

Seriously, K. Rudd. Leave the business of birth to women.

On that note check this uplifting tale of homebirth...

Homebirth going underground down under

Speaking of homebirths, it looks as thought homebirth in Australia is likely to go underground as a result of new policies for health care professionals under the Rudd government. From the middle of next year, midwives will have to hold professional indemnity insurance. This is a problem because no insurance companies in Australia are yet willing to insure independent midwives so when the new regulations come into effect, it will no longer be legal for independent midwives to attend homebirths.

Although less than 1% of all births in Australia take place at home, more than 50 % of submissions to the federal Government's recent maternity services review came from women calling for greater support for homebirthing services, which according to The Australian claims up to a 10-fold greater share of births in some overseas countries such as Britain.

This is devastating and dangerous. Women who are committed to have homebirths will do so anyway and many obstetricians agree that it is much more reasonable to support midwives in the provision of quality care to women wherever they choose to give birth, rather than knowingly risk the lives of women who make choices outside the medical model.

Source: http://www.theaustralian.news.com.au/story/0,25197,25124579-601,00.html

Midwives given expanded role in new report

According to The Age, a report written by Commonwealth chief nurse and midwifery officer Rosemary Bryant, due to be released today, suggests that new funding arrangements could support the expansion of midwives' roles in Australia's failing maternity system. Under the new scheme, midwives would have access to indemnity insurance, Medicare numbers and the Pharmaceutical Benefits Scheme. Of course, many obstetricians are upset by this prospect. More than 900 submissions from health professionals, individuals, researchers, industry groups and professional organisations have been received. In submissions, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists said midwives should not be given Medicare numbers and the Australian Medical Association said independent midwifery care would jeopardise the care of mothers and babies.

The report states that midwives must meet an advanced level of professional education and experience before being given greater access.

What do we think?

Source: http://www.theage.com.au/national/report-urges-expanded-role-for-midwives-20090220-8dqz.html?page=-1

Midwifery, vindicated at last?!

According to an international review of maternity services, women who are cared for by midwives rather than GPs or obstetricians are less likely to lose their babies within the first six months of their pregnancies.

In a huge analysis of 12,000 women in 4 countries, researchers argue that women who were supported by midwives were much less anxious than those treated by other health care providers. As a result, they experienced fewer miscarriages.

Obstetricians are unsurprisingly annoyed with the findings.

The best part of the study?

Women being looked after by midwives were less likely to be admitted to hospital during pregnancy, episiotomies or require pain medication and were more likely to have vaginal births, feel in control during labour and better able to initiate breastfeeding.

As the most comprehensive study of this kind ever, the analysis also showed there was no significant difference between the women who were looked after by midwives or obstetricians when it came to foetal deaths after six months gestation, length of labour, induction, intervention, premature births and admissions to neonatal intensive care units.

For all the midwives out there, go on...say it....

WE TOLD YOU SO.

Source: http://tinyurl.com/3mb4k9

Moral panic Thursday!

I love a good moral panic. As you probably have noticed, I haven't even touched on Sarah Palin and all of this teen pregnancy tomfoolery. Rather, my attention turns to freebirthing. Yet again.

According to the Daily Mail, as a result of a midwife shortage in the UK, women are being 'forced' to have 'dangerous' homebirths. The maternity system in the UK is so overcrowded, understaffed, and apparently un-hygienic, many women have opted to have their babies at home. Dame Karlene Davis, a midwife said:

'Technology and the internet has led to people thinking they can do freebirthing. If a woman has had a positive experience then people think it’s something worth trying."

Damn that technology. Putting ideas in women's heads. Lead them not into temptation! Even though the British government is unwilling to acknowledge the midwife shortage and birth rates continue to rise in the midst of a crumbling system, I highly doubt that the majority of women in the UK are freebirthing or even homebirthing, for that fact. In most of the West, homebirthing is still rare and unfortunately, women are more willing to suffer the ills of public medical systems rather than have babies at home because they are not given the proper information nor the support to make that choice if they so desire. All of this malarky and panic over freebirthing is evidence of a resounding fear that if women give birth on their own or at home with a midwife, obstetric 'expertise' will be undermined. In Australia, the government is considering giving midwives the power to prescribe medications and to deal with Medicare as a way to cope with understaffing. And why not considering births in Oz are at the highest level since 1971? Of course doctors have attacked this proposal with more 'risk' talk saying that more babies will die if midwives have a greater role in hospitals. No wonder women in Australia and beyond are sceptical of homebirth and freebirth: doctors keep telling them they will die or their babies will die. Sure there are always risks but scare tactics will not fix underfunded and understaffed maternity systems.

Sources: http://tinyurl.com/5kf22l
http://www.theage.com.au/national/doctors-attack-midwives-proposal-20080910-4dvi.html

One-to-one midwifery care in Queensland

Good things are happening in Queensland.

Anyway. Turns out preggo women in Queensland are going to get one-to-one midwifery care from conception straight through to the first few weeks of motherhood. Seeing as some women were seeing up to 16 different midwives throughout their pregnancies and beyond, Premier Anna Bligh decided enough was enough.

'This is about delivering personal, professional and local support to regional Queensland mums and mums-to-be: from the moment they conceive right through to the early weeks of motherhood,' Ms Bligh said.

'They will have access to the same midwife, or small team of midwives, for every stage of pregnancy - someone familiar to answer their questions and support them through this very emotional time'.

Source: http://news.theage.com.au/national/new-midwifery-services-plan-for-qld-20080803-3p7k.html

The end of homebirth in America?

Well, it seems despite all of the momentum for homebirth generated by Ricki Lake is on the out in the US. The American Medical Association (AMA) adopted a resolution last weekend at their annual meeting to OUTLAW homebirth. In effect, the resolution would force American women to give birth in hospitals, again suggesting that midwives just aren't good enough compared to doctors. It's not yet clear how women would be penalised (or how anyone would find out?) if they have homebirths, however, this aggressive move is a sign of clear and present danger for the maternity system in America. As one of the largest profit generating sectors of American hospitals, ob/gyns are not willing to give up any of their cash. Similarly, the AMA is pushing for midwives to only be able to practice in hospitals under direct supervision of a doctor.

So much for constitutional rights.

Source: http://www.rhrealitycheck.org/blog/2008/06/16/bad-medicine-ama-seeks-to-outlaw-home-births

Pain-free birth just a pipe dream?

A new study says that women are kidding themselves if they think they can get through birth without pain relief. British researchers from Newcastle University reviewed 32 studies on expectations of labour pain, finding that most women who didn't want to have pain relief ended up with it.

However, what about home birth? 99% of women in America give birth in hospitals. Definitely not places which are conducive to quelling women's anxieties. 90% of births in New York hospitals are induced and epidurals are often doled out without any measures in places to help women manage pain naturally before the drugs are in place.

A 1988 U.S. study found that mothers that underwent labor in a hospital rated their pain as significantly higher than did a home-birth group. In the spirit of Sheila Kitzinger, what about accounting for those mothers that report euphoric, even orgasmic, feelings during what is supposed to be the most painful event in their lives. This study was obviously not included in the current review. More recent studies suggest that knowledge, confidence, and lower anxiety are predictive of positive childbirth. Also where is the discussion of the value of midwives? Studies show that midwives can help birthing women to find their own ability to cope.

This new review basically shuts down any positive feelings pregnant women may have in anticipating birth. Sure, it hurts and there is nothing wrong with choosing to have pain relief. However, why suggest that women are setting themselves up for failure by even thinking that they could possibly give birth drug-free?!

Source: http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/women-are-misled-into-thinking-that-childbirth-can-be-painfree-795721.html

Homebirths on the rise in the UK

Although homebirth happens in relatively small proportions in most 'Western' parts of the world (only 2.5% in all of the UK), it seems that giving birth comfortably at home is becoming increasingly more appealing. According to new research, in certain parts of the UK where midwife teams are strong, homebirths have shot up to 14.2% in places like West Somerset.

Alongside new legislation promising that by the end of 2009 all women in the UK will be able to choose how they give birth, including at home, there has been a greater willingness for women to explore their birth options with knowledgeable midwives. However, as fantastic as these new plans seem, there is still an increasing shortage of trained midwives (as in Australia) so the feasability of the scheme is significantly in jeopardy.

Nevertheless, in Wales alone, the government has set a target of 10% of all births to take place at home and this has increased the total homebirth rate overall in Wales over the last six years (even though actual figures are not close to 10%).

If you had one-to-one support from a qualified midwife, would you be more likely to consider giving birth at home?

Source: http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/huge-rise-in-number-of-home-births-796618.html

One to one midwifery changing Australian pregnancy

Just as the British government is admitting their maternity system is crumbling as thousands of midwives flee to greener pastures (e.g. Australia!) for better pay and working conditions, it seems Australia is finally doing good by their midwives and pregnant women in one of the largest trials of one-to-one midwifery care in Victoria.

It seems midwives have finally gotten the message across: when women are looked after by one midwife from the start to end of pregnancy and beyond, birth outcomes are better and the caesarean rate goes down and women are supported better postnatally. Midwives have a more manageable workload with more midwives on staff, women feel more secure having a familiar face when they give birth and there is less of a strain on the medicare system as less women are interfacing with obstetricians unless absolutely necessary. In the Victorian trial, 1,000 women are paired up with one midwife and hopefully the system of having midwives on call will be implemented more widely in Australia as it seems to work quite well in Europe and New Zealand. Now, if only the American government could be persuaded to think about the welfare of its pregnant women maybe the atrocious birth outcomes in the US would be better with a midwifery system as opposed to the heavy emphasis placed on obstetrics.

Source: http://www.theage.com.au/news/national/onetoone-midwifery-aims-to-cut-complications/2008/01/28/1201369037407.html
http://www.timesonline.co.uk/tol/life_and_style/health/article3261305.ece

Black market for midwives

I was stunned to read today in the Chicago Tribune that midwifery is outlawed in 10 states in America. Missouri is the only state where midwifery is considered a felony, but the other nine states have actually banned the practice (including Illinois from where I hail). However, there is still a thriving network (or black market) of practicing midwives in Missouri who operate through word of mouth. At least 1,000 women in Missouri give birth at home each year which is a clear sign that women are resisting and taking control of their own births. Similarly, in Illinois at least 800 babies are born each year at home (that's 2-3 babies every day!)

As most of you may already know, childbirth is still considred a medical emergency in most American states. Ricki Lake's doco, The Business of Being Born, and the forthcoming full-length feature film, Pregnant in America, could not have come at a more opportune time. Whilst 40 states do permit midwives to practice (mostly under the supervision of a doctor in a hospital), it is homebirth that has sparked the most intense debate. Missouri is now on the brink of deciding whether to overturn its ban on midwifery after a state lawmaker's wife was aided by a midwife in her pregnancy and has pushed (no pun intended!) to make midwifery legal.

I won't go into the pros and cons of homebirth here. However, this is an interesting irony:
A good samaritan who helps a woman deliver a baby in a taxi cab or in a lift is not subject to prosecution. A trained midwife, on the other hand, who helps a woman give birth at home is.

Even more surprising, there is a fantastic homebirth story in a very unlikely place: Vogue

Titled 'Mother Knows Best' (pp.304-17, 406) the author recounts her experience of homebirth in New York in the November issue with the same midwife featured in Ricki Lake's documentary, Cara Muhlhahn. Great to see a positive representation of homebirth in a mainstream fashion magazine (of all places!)

Source: http://www.chicagotribune.com/services/newspaper/printedition/sunday/chi-midwives_bdnov25,0,1653801.story

Check out the Midwives Alliance of North America for more info on safe homebirth and to find a certified midwife in your area: www.mana.org