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.

Patronising? Definitely. 

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.

6 comments:

Rixa Freeze said...

I'm working on a post about risk and home birth an autonomy and am glad I came across your post.

FYI here are the quotes verbatim:

Prof. Euan Wallace, head of obstetrics at Casey Hospital:

"It's one of the jewels in our care provisions. We think it's fantastic. We think it's an appropriate choice, and we think it's a choice Victorian women should have wherever they live in Victoria. And it was about demonstrating to government and to the rest of pregnancy services in Victoria that it is a safe choice."

"Instead of her coming to us, our midwives go to her. Our midwife stays with her during the whole labor, and then as it's getting close to the birth, a second midwife joins her. There are two midwives with her at the time." He wants to expand the program throughout Victoria."

"In Australia, less than one=half percent of women are choosing to have a home birth, whereas in England it's 1 in 20 women who are choosing to have a home birht. I think we should rightly ask why those differences exist. For whatever reason, choosing to have a home birth in Australia seems to have a wackiness about it, and we just don't think that's right."

"We haven't done a formal economic evaluation of our home birth program, so really what you're asking is 'does women ahving babies at home save the hospitals money?' You'd expect they would."

RANZGOG spokesperson, Prof Michael Permezel:

"The reason is is there's a very small number of home births that go wrong, that would have been different had they been in hospital....The dnager of calling for more hospital birth programs [that offer home birth] is that women get the false message about how safe home birth is. It would be wrong if the availability of that program led women to think 'Ah! Which will I choose? I can go with this, I could have a home birth, I could have a hospital birth.' And treat it as if the availability of that program is implying that it's safe."

motherwho said...

I suppose he believes so strongly in his opinions that he would have no need to reflect upon them and wonder whether it might be wrong to keep women's choices a secret on the off chance they might choose something else!!! Apart from him, I thought the report was probably one of the more balanced I have seen on Aussie telly.

Joy Johnston said...

Thankyou Rixa and motherwho for your response. I have had many similar comments about the attitude of some obstetricians to a woman's ability to understand the decision making around a suitable place to give birth from others who saw the program.
The curious point to ponder is that the statements of the RANZCOG spokesman, Michael Permezel, are consistent with the position of the College. RANZCOG "does not endorse planned home births". http://www.ranzcog.edu.au/womens-health/statements-a-guidelines/college-statements-and-guidelines.html?showall=&start=1

JudyC said...

I seriously doubt that he would reflect on his words. RANZCOG are so blinkered in their belief that what they say is RIGHT. There are now many programs around Oz with either funded HB programs or several Caseload Midwifery programs working from hospitals without on site back up obstetrics. As far as I know they all have great outcomes but that doesn't equate to "evidence" for the RANZCOG.
As the song says "When will they ever learn....".

MidwifeAlex said...

I'm going to attempt to apply logic to this comment, although it appears, from your post that you may be immune.
Firstly, in a major tertiary hospital, skilled professionals don't just "go home" and leave untrained workers in their place. There are always professionals trained in emergency obstetric care available.
This differs with a homebirth situation, in that the individuals required for emergency care will not be available, should the unlikely event arise.
I agree in that women should be given a choice, although it should be an informed one. Most sane women, when provided a choice between a cozy homebirth with a risk of death, and a sterile hospital birth, with facilities equipped to prevent this nasty complication, will choose the latter. Permezel is right in not wanting to condone home births.

Joy Johnston said...

MidwifeAlex, I wonder what experience you have had with home birthing? If you are an Australian midwife, it's quite likely that you have not been the responsible professional for birth at home.
The statement by Dr Permezel, "The reason is is there's a very small number of home births that go wrong, that would have been different had they been in hospital..." could also be made for the alternative, "... there's a very small number of HOSPITAL BIRTHS that go wrong, that would have been different had they been AT HOME ..."