Saturday, February 02, 2013
I wonder if he reflected on what he said?
Today I want to look at the words of an obstetrician who was interviewed for an ABC TV story 'Call for wider availability of home birthing' on the 7:30 report last night.
The professional body representing obstetricians, RANZCOG, strenuously opposes homebirth, and appears to have no interest in opening pathways for midwives to have visiting access for clinical privileges in hospitals - public or private. The midwife's place is working in hierarchical maternity care models in hospitals. The obstetric dominated maternity care has no place for the sort of midwifery that I have practised for the past 2 decades: private midwifery practice in which I have a small caseload of 2-4 births per month. Most of the mothers in my care are planning homebirth. Others are planning to give birth at the hospital, and I become the primary carer working within a larger team, and a sort of 'event manager' during the hospital stay.
Back to the 7:30 report.
Two obstetricians were interviewed. Euan Wallace is director of obstetrics at Southern Health, the large network that covers Monash Medical Centre, as well as Casey, Dandenong, and Sandringham hospital maternity units. Dr Wallace spoke of the (publicly funded) homebirth program within Southern Health as "one of the jewels" in the program. He compared the relative rarity of homebirth in Australia, less than 0.5% of all births, with the UK: that in Australia homebirth seems to have a "wackyness" about it! His heavy Scots accent suggests that his life experience is less insular than many of his obstetric colleagues. He called homebirth an appropriate choice for certain women, and a choice that women should have, wherever they live in Victoria.
The other obstetrician, Michael Permezel, spoke on behalf of RANZCOG. It is his comments that have left me wondering if he has reflected on what he said. In short, he said women can't be given the responsibility to make a choice about homebirth.
RANZCOG does not support homebirth because, he said, there are a few nasty things that can happen at home that would be better managed in hospital. By some amazing stroke of [un-]logic, it follows that if homebirth was offered, women would get a false message about the safety of homebirth. That it would somehow give out a wrong message, leading women to imagine that availability of the program implied safety. [This is not a verbatum quote, but it's very close.]
Readers of this blog are probably mostly people who have heard all this before, and who do not think that women who choose homebirth are deluded or intellectually impaired.
In a brief response to the RANZCOG position as stated by Prof Permezel, I acknowledge that there are occasions when unpredictable events can quickly escalate into the need for emergency obstetric or neonatal medical treatment. This is not a homebirth issue: it's a life issue. It's something that maternity hospitals face every night when their operating theatre staff go home. Even the big tertiary centres face the possibility of doctors and midwives being unskilled when a woman presents in spontaneous labour with a breech baby.
Women who sit down in my office to discuss homebirth are not ignorant; are not holding onto false notions about the safety of homebirth. They are usually very well informed, and are making plans that give them the best options that are available to them. These women, and I, the midwife, are deeply offended by the suggestion of this obstetrician that they somehow don't have the capacity to weigh the risks against the benefits of different options.