Friday, June 19, 2009

talking about homebirth

Thismorning I was woken by someone from ABC Radio 774 (the Melbourne local radio) at about 6.30. Would I speak to Red Simon about homebirth being outlawed?
They called back, and Red wanted to know about homebirth. In the next few minutes (cut short mysteriously by the phone line going dead) I was able to reassure him of the safety of homebirth.
Red sounded genuinely surprised that 30% of Dutch babies can be born at home in this century. I think he was wanting to paint a picture of homebirth being a vestige of a bygone era, that some of us are reluctant to part with. He told me his wife went to three different hospitals to have her three children, so that she could check out the cuisine. He asked me if my children were born at home. No - I didn't know about homebirth then. I learnt about homebirth from reading professional literature. It was the evidence that convinced me.

News articles discussing the future of homebirth have appeared in several papers thismorning.
Daily Telegraph (Sydney) informs us that "HOMEBIRTHS will become illegal under tough new laws that prevent women using midwives to have children outside hospitals. The move is set to drive homebirths underground, with expectant mothers and their babies at risk."
A similar article in Adelaide Now identifies "the draft Health Practitioner Regulation National Law, released last week, [under which] a midwife cannot be registered unless she has insurance."

For more detail, please go to the MiPP blog.

It's not true that *all* homebirth will be illegal after 1 July 2010, when the Health Practitioner Regulation National Law, which mandates professional indemnity insurance as a condition for registration, is set to come into effect.

Homebirth programs that are operated by hospitals and health authorities will be able to continue. The option that will become illegal is private arrangements between a woman and a midwife. That means midwives like me, and an estimated 150 others, will be out of work, and all the women who want to arrange homebirth privately will be denied that choice.

Depending on your perspective, here are some ideas. I present them as questions, because each person with an interest in homebirth will have to make the best decision they can when the time comes.

After 1 July next year:
Will a midwife agree to provide midwifery care 'underground', and ask the parents and anyone else involved to keep quiet about their role?
Will a midwife who continues 'underground' cease any reporting to governement authorities such as Registry of Births, Deaths and Marriages, and perinatal data collection units?
Will a midwife who continues 'underground' ask for cash payments, and cease reporting income to the Tax Office?
Will a woman who wants homebirth need to arrange her own documentation of the birth - either by statutory declaration, or by arriving at a public hospital with her baby, and stating that the baby was 'born before arrival'?
Will a woman who wants homebirth and who experiences complications at home need to go to hospital without her midwife's referral or support?
Will all the women who want to plan homebirth find doctors who will attend them at home?

The doctor issue is worth thinking about. It might sound like competitive rivalry for me to bring doctors into this discussion, but the fact is that independent midwives compete with doctors to be the primary carers for pregnant/birthing women. (it's a very unlevel playing field, but that's another issue!) While the midwife offers continuity of care throughout the pregnancy and birth, the local GP offers a variety of fragmented models of 'shared care', ensuring that the woman receives care from a midwife who is a total stranger in labour. The stranger-midwife is also a feature of models in which an obstetrician is the primary care provider.

There are doctors who support homebirth; some have given birth at home themselves, while others will agree to attend homebirths. Melbourne doctor Peter Lucas is well known and appreciated for his homebirth practice.

Doctors have indemnity insurance, so they will be able to continue practising after 1 July next year. Some have insurance that covers 'procedures' - including childbirth, while others are more restricted in what they are able to do. Doctors fees are rebatable through Medicare, and the Medicare Safety Net enables the doctor to charge a fee that he/she considers appropriate, knowing that the client will be able to get a lot of it back from the public purse.

Women could, en masse, require attendance at home from doctors for home births if midwives are not able to be called. Of course the doctors might refuse to attend, but what is their duty of care in such a situation?

Another question: will public hospitals set up homebirth services that will provide the required professional care for all the women who at present would book with an independent midwife? Will the hospitals provide employment (and indemnity) for independent midwives?

These questions are all in my mind. What will I do? How will I advise women who ask me? (And, from a practical point of view, How will I earn enough to keep food on the table?)


midwife said...

All these questions are in my mind too Joy. I really don't know what I will do next year!

Anonymous said...

After experiencing the intimate and fantastic care of a private midwife, I'm not sure I will settle for anything less.

However, going underground may cement the reputation of home births as a "radical" choice, which is already a common reaction from the general population.

The situation is not ideal, and I wish there was a way we could lobby to improve it. Until then, I will enjoy and appreciate your wonderful care as much as I can!

Joy Johnston said...

I think you have expressed the wishes of many women vidalocura - the care of a private midwife has suited you well, and you are not interested in anything less.
But in any society the choices that we have are defined by laws set down by government, and the Australian government - the previous Liberal one, as well as the current Labor one - have agreed that it's in the public's interest to require all health professionals to have indemnity insurance.
The 'decision' that midwives providing homebirth independently should not be indemnified, and consequently outlawing privately attended homebirths is a decision of the current Health Minister, Nicola Roxon. She needs to hear from every person who cares, and she needs to change that decision.

Stitch Sista said...

I am just so so sad about this. I do not plan to have any more children, but I absolutely would be having them at home if I did...I would prefer a midwife...but what can one do?

I will be at the rally in Canberra in September, and I will write to Nicola Roxon. Although I'm not convinced it will make a difference if only because homebirthing women were already so obviously disregarded in the review.

hearwritenow said...

Like vidalocura, my wonderful midwives set a precedent that no hospital or birth centre could hope to come close to. My homebirth 5 months ago was one of the best experiences of my life, and I'm distressed that the option of repeating the experience in a few years' time may be taken away from me.