Thursday, August 06, 2009

Streaming from the Senate committee hearing

Today I and many others who are concerned about the impact of the government's legislative reforms for midwifery watched and listened to the presentations, streamed direct from the Senate Community Affairs Committee's Inquiry into the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and two related Bills. [If you follow the link you may note that only 34 of the reported 2000 submissions to the inquiry are available for public access today. My submission has not yet been posted at the site. I hope the Senators have read them.]

The people who appeared before the committee representing midwives and maternity consumer interests presented their arguments in a professional and exemplary way. Private midwifery practice and homebirth, the aspect of midwifery that has been presented as insignificant in the report of the Maternity Services Review, occupied a disproportionately large share of the time available.

I was able to listen to a few of the presentations and discussions. The Senators did seem to grasp the huge inequity in not only the proposed legislation, but also in the restrictions midwives in Australia face at present. Several speakers drew attention to the lurking shadow of unattended birth, and the expected increase in adverse outcomes as rates of unattended births rise.

I know several midwives who intend to continue as midwives for women planning homebirth after 1 July 2010; midwives who believe the moral and ethical duty of care to practise authentic midwifery for women who plan to give birth unassisted at home, outweighs the unreasonable and irrational attempts of this government to remove midwives from our private practices.

A newsletter from Homebirth Australia quotes feminist academic and homebirth mother, Monica Dux, who argued most eloquently that this struggle was simply not about homebirth, but more so that of a fundamental right for women. Her opinion piece appeared in The Age on 17 July

The assumption...that minority rights are unimportant and can be casually overridden - is both offensive and antithetical to the fundamental values of a liberal society... It is not only the rights of the minority who undertake home birth that are at stake here. This is an issue that impacts on all women.

In the past century we have seen a profound shift in the status of women, from being virtual chattels owned by husbands or fathers, to the attainment of full citizenship and (supposedly) equal rights with men. This hard-won legislative and cultural change has allowed women greater freedoms, but it has also given rise to an expectation of physical dignity, and of ownership over our own bodies, ...

The legislative squeezing-out of home birth represents a serious regression in this reform process. Given that the new laws will effectively make private midwife-assisted home birth illegal, the Federal Government is acting to deprive most women of the ability to make a fundamental choice about their own bodies; the choice to birth in a non-medicalised environment.

Giving birth under conditions that promote physiologically normal, healthy functioning of a mother's and baby's bodies is not like any other health issue. It does not require drugs or equipment or technique. The midwife's skill includes an ability to partner the birthing woman, in heart and mind and body, with the knowledge that together they can promote health.

We know that employees of legislators and health departments are reading the blogs that address the issues of maternity reform. That was stated in today's review. One Senator commented on the 'Bilby', a reference from this blog.

There is no simple way of ensuring that the needed amendments will be made before these legislative reforms become law. We must continue to draw attention to it, and demand that midwives be enabled to continue private practice, in the public interest.


Stitch Sista said...

I listened to what I could yesterday (w/o neglecting the kids too much!), some of it inspiring, and some of it quite farcical.

I also read Monica Dux's article back in July and applauded it as it said everything I believed in my heart of hearts. Even as people talk about risk, and even though that matters to me - I don't think it is necessarily relevant...what is relevant moreso is that the choice be made by a woman, not a doctor, not her partner not anyone else but the birthing woman and whomever SHE chooses to collaborate with. I feel very strongly about that.

It also concerns me that if insurance is acquired, or funding for that matter, there will be far too many caveats placed on being able to birth at home. Yet if there remains no funding, then so many women who might homebirth are still shut out, or will choose to freebirth even though they would otherwise be attended.

I have my own ideas of how the reforms should work. Something akin to a voucher for each woman to choose any care she desires. One voucher would get a birth in a hospital, or part of a private birth, or a homebirth or part of. But there would be no restrictions placed on these things and a woman could choose whichever registered care option (or none at all) if she desires.

Joy Johnston said...

Thanks for your comment Stitch Sista. The problem we face is far greater than homebirth.

I understand your concern about insurance and public funding restricting what's on offer, because of risk management protocols imposed on the care provider(s).

The key that every woman has, regardless of her risk status, and that we must value highly and remind ourselves of, is that spontaneous labour leads to spontaneous, physiological birth. There is no other pathway. And spontaneous labour is not under the control of any man-made system; not even under the conscious control of the birthing woman. She must accept the hormonally mediated processes, and harmonise her thoughts and actions with her body's intuitive activity.

buildteam said...

Hi Joy
Thanks for your comments. I appeared before the committee last week for Homebirth Access and also felt that Senators were starting to get their heads around the issues.

I agree with Stitch Sista's concern's about the risk minimisation that could occur in order to secure insurance. Do you think that what we need to argue for is the right of a midwife to practise their profession, within their scope of practice, leaving it up to them to make the decisions? My understanding is that the Obs do not have extensive restrictions placed on their practice in order to get insurance.

Women then can choose the midwife whose practice philosophy matches their own.

I would appreciate your ideas on this.

Joy Johnston said...

That's a good question: "Do you think that what we need to argue for is the right of a midwife to practise their profession, within their scope of practice, leaving it up to them to make the decisions?"

Yes! That's the essence of professional practice. If the decisions a midwife can make are determined by legislation or by lawyers and outside risk micro-managers, then the midwife is no longer acting as a professional in her/his own right.

Jo Tilly from Homebirth Access made a good point in the Senate inquiry that I didn't hear from others. Here's the transcript from the proof Hansard (pCA29)

Ms Tilly—"We note that the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009
allows the minister to restrict premises where an eligible midwife might provide care. Presumably that is with the aim of excluding homebirth, as she has said in public on a number of occasions. Obviously the minister’s
power to do this is contained in an as yet not available common form of understanding that each midwife must
provide. In the professional indemnity bills, the definition of eligible midwife also allows the minister to
develop rules that can exclude a class of persons, which could also allow the exclusion of those midwives who
are providing homebirth care.
One of the things that we would like to add to our submission is that we do not really think that those are
appropriate matters to be dealt with in regulation. They have significant public health implications for
consumers. But they also directly impact the capacity of a group of professionals to carry out their work. As you are probably aware, the Senate Regulations and Ordinances Committee principle C talks about delegated
legislation not making rights unduly dependent on administrative decisions that are not subject to independent
review. One of the things it specifically talks about is delegated legislation affecting the right to practice a trade or profession. So, in that context, it would seem pretty clear that homebirth midwives would fall into that category. As such, we are pretty concerned that these matters are looking as though they will be determined by regulation rather than being determined in substantive legislation."

I'm not sure I understand everything in that statement (I was so impressed when I heard it!), but it supports the opinion that I have formed, that the legislation must be amended in the public interest.