Thursday, June 28, 2012


Readers of this blog are probably familiar with the historical roots of 'hysteria'; the Greek word ὑστέρα (hystera) meaning womb, the condition of the wandering womb, and recommended treatments.

"Galen, a prominent physician from the 2nd century, wrote that hysteria was a disease caused by sexual deprivation in particularly passionate women: hysteria was noted quite often in virgins, nuns, widows and, occasionally, married women. The prescription in medieval and renaissance medicine was intercourse if married, marriage if single, or vaginal massage (pelvic massage) by a midwife as a last recourse.[1]" [Wikipedia]
The Medical Dictionary that my computer's online dictionary led me to offers this information:
hysteria hys·ter·i·a (hĭ-stěr'ē-ə, -stēr'-) n.

A neurosis characterized by the presentation of a physical ailment without an organic cause, such as amnesia.

Excessive or uncontrollable emotion, such as fear.[Link]

I wish to contend here that there is a cultural hysteria in response to midwifery.  A cultural neurosis that leads to excessive and uncontrollable fear about that highly contested terrain, childbirth.

While midwives are recognised internationally as essential providers of primary maternity care, Australian midwives (and our sisters in many other developed countries) face exclusion and restriction when simply practising our profession.

Cultural hysteria with regard to midwifery depicts the midwife as someone who lacks skill in management of obstetric emergencies, events that are bound to happen, leading to a mass fear reaction.  Cultural hysteria sets up a fearful scenario, and uses that scenario to prove its point.

I don't have answers to every possible scenario, but I do know that in the State of Victoria, where I live and work, data from privately attended planned homebirth have been collected and reported on for many years, demonstrating the clinical effectiveness of planned homebirth in the care of a midwife.

The mothers who planned to give birth at home have not been uniformly 'low risk': they include births after Caesarean, mothers who are older, or who have had more births, or whose babies are bigger than average.  They are ordinary women, who just want to give birth to their babies.

The midwives have not undertaken any special courses of study: they are simply competent midwives, who seek to work in harmony with physiological processes, and who, generally, refer women appropriately when complications are suspected. 

The Victorian government’s Perinatal Data Collection (PDC) unit within the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM) publishes an annual profile that captures all planned homebirths in the state, and puts the data alongside cumulative data from hospitals and statewide totals. These reports, although retrospective, carry a high degree of reliability.

The reports over the past 20+ years have shown planned homebirth in the care of a midwife as a safe option in terms of maternal and perinatal morbidity, with many features that are considered protective of the mother’s and baby’s wellbeing and safety. 

For example, in 2008, the most recent set of published data in this series:
• 91.5% of women planning homebirth had unassisted cephalic births, compared with 55.4% state-wide.
• Approximately 5% of women planning homebirth at the beginning of labour had caesareans, compared with 19% in small ‘low risk’ (<100 births) hospitals, and 31% statewide.

When looking at the baby outcomes for the same group (2008),
• 95.6% of babies born to mothers who planned homebirth at the beginning of labour did not require admission to a hospital nursery, which is approximately the same as the rate for small hospitals with less than 400 births per year.

These data support our contention that there is safety and protection of wellbeing for mother and baby when midwives attend women for planned homebirth.

I recognise that individual cases may be held up as examples of things going very wrong in birth, whether that birth takes place in a tertiary hospital, a private hospital, the woman's home, a birth centre, or in the back seat of the car. 

There are risks associated with birth, as there are particular risks linked to any life event.

I believe that the safety and wellbeing of mothers and babies in our community is enhanced by a strong midwifery profession that is recognised as essential in effective primary maternity care.

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