Monday, March 09, 2009

A response to the Maternity Services Review

"It appears that the Reviewers have conceded to fear of extreme medical voices, over the interests of women. Hopefully the Minister, who is directly accountable to women, will be braver." [Bruce Teakle, Maternity Coalition Queensland Branch]

As anyone who has read this or other Australian midwives' blogs will understand, the Report of the Maternity Services Review recommends that the Federal government should prevent midwives from practising as private practitioners, which also means, in most of Australia, an effective outlawing of homebirth.

In response to this very real threat I feel there is an urgent need in Victoria that we work for free homebirth options, and widespread caseload, with the option of homebirth, for midwives working in the public system. (If any of the private hospitals want to join in that’s fine, but I’m not holding my breath!)

I don’t think women should have to declare ‘home’ or ‘hospital’ until they are ready. The midwife should have competence and unrestricted practice to go with the woman wherever she wants to give birth. As we have often said, it’s not about the bricks and mortar, or the curtains. The Report's language of 'informed choice' and 'access' to 'evidence based' models of care is mere rhetoric, when the recommendations of the Report announce that the very model which many of its submissions promoted and backed with significant evidence is to be summarily withdrawn.

The Report draws attention to the fact that a very small proportion of Australian women choose homebirth; that many of the submissions were from mothers who were dissatisfied with the choices available to them, and in fact had chosen homebirth or other midwife led models; and that moving to a mainstream private model of care incorporating homebirth 'risks polarising the professions' (whatever that means!). As Bruce Teakle has observed, the Reviewers "have conceded to fear of extreme medical voices, over the interests of women."

As Allison Leemen said (ABC Unleashed) "Homebirth with an independent midwife is a great model of care for lots of reasons, key among them that it provides continuity of care with a known carer - something the Maternity Services Review says it wants to see in hospital -based models. So why is it killing off the only model that reliably delivers that care?”

We must insist to our professional associations as well as to the government that homebirth is not about the marginal minority of women or midwives. Internationally homebirth is recognised as normal midwifery practice and is a safe and reasonable option for many women.

We know that many more women would want homebirth if it was free, and this has been demonstrated in the Review by the rates of homebirth being highest in NT, WA and SA where publicly funded options are currently available for some women. People do not, without strong reason, ask for something that is not available. Those who are prepared to pay for homebirth are usually well informed. Other women are on a journey of discovery when they become pregnant, and if the system offers them a reliable care option, such as homebirth, they will think about it then. Shutting down homebirth options by shutting down independent midwifery makes no sense at all. Furthermore, midwives in Victoria will quickly lose competence and confidence in homebirth practice if we are forced to cease our practices. If, on the other hand, there were publicly funded homebirth models on offer, whether or not independent midwifery continues, many more midwives could be upskilled quickly by those who are currently experienced in homebirth.

No comments: