Home Birth to become Illegal?

Jazz 4 September 2009 65

[First filed: September 04, 2009 @ 12:14]

Its not often that we run issues of national interest here on RiotACT but because we love Riot’s and this one in particular affects womens choice and I think its worth wider discussion.

The Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and two related Bills (Currently midway through debate in the House of Representatives) if passed without amendment, will intersect with Commonwealth law regarding the National Registration and Accreditation of Health Professionals and effectively make private homebirth practice unlawful, once enacted after July 1 next year.

To save you the onerous task of wading through the Bills, in a nutshell, the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and the two related Bills enable Medicare funding, access to the Pharmaceutical Benefits Scheme and professional indemnity premium support for midwives.

Medicare funding for midwifery care is long overdue. But what the Bills put forward will mean that funding for homebirth will be excluded from any indemnity arrangement. Effectively making it impossible for a woman to be able to have a home birth attended by a registered midwife.

By doing this Australia is totally out of step with nations such as the United Kingdom, Canada, The Netherlands and New Zealand. These nations support the rights of women to choose homebirth and fund a registered midwife through their national health scheme. In New Zealand and the U.K in particular, women have a legislative right to choose homebirth.

Recent studies have shown that planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention than hospital births with the same rates
of mortality so it would suggest that home birth for low risk women not only safe, it is cheaper, since there is less intervention.

To protest the effective removal of homebirth as a birth option, the “Mother of all Rallies” is being held from 11.30am on Monday 7 September 2009 outside Parliament House in Canberra.

If youre on Facebook you can find some more details of the rally here. And further information on home birth choices is available on the save homebirth website here

UPDATE : Seems that the government has changed its mind and is now backing down on plans to push the legislation through.


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65 Responses to Home Birth to become Illegal?
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astrojax astrojax 7:54 pm 07 Sep 09

good upon you, granny! ; ) how was the rally overall? i heard on triple six a woman from melbourne who was having contractions as the rally was underway! she said in reply to the question of what she’d do if she went into later stages of labour that there were a few hundred midwives in close proximity, so she rekkun’d she’d be fine!

quokka wrote: I fail to see the direct link between “fear and apprehension as a result of misinformation” and maternal haemorrhage. and noting something about african statistics…
africa’s statistics doesn’t compare with western world stats – like apples and oranges, really.

and the captain raised the issue of one in ten being risky

well, first up, one in ten is risky, yes, and those ten percent require hospital facilities for their whole labour, perhaps even part of their pregnancy. that’s not at issue. good, professional advice through pregnancy will identify most of those to start with, so that number is drastically reduced.

and the reason africa is comprehensively different from australia and western countries also lies in that idea, that good midwifery support during pregnancy should identify a good deal of those with the likelihood of complications and put them in the ten percent [and so into a medically-supported model of birth] before any attempt at home birth. then, the by-definition ‘healthy’ mothers can choose to birth at home with appropriate, qualified midwifery support – to say again, the ‘fear and apprehension’ can be removed through appropriate advice and information about the physiology and other aspects of birth allowing women to understand that their bodies, if healthy (the 85-90% of cases), will happily, normally and – importantly – safely birth their child.

it is predominantly fear – through [mis]understandings of the birth process that are actually physiologically flawed (ie the usual false assumptions about the birth process) – that will cause the mother to work against the natural processes and bring about a greater degree of risk.

now, i am not advocating that all, or even most, mothers should – and should want to – birth at home, just that the process is not, contrary to much of the mindset cultivated through misinformation abounding in our culture, inherently risky, when the mother and her pregnancy (and her foetus) are healthy. what i argue is that, more women [and governments, etc] understanding these processes better will allow more mothers to be healthier through labour and there should be no reason to deny them – through litigating against their critical support services (midwives) – the choice to birth where they feel most comfortable (which, through understanding the physiology, is the key).

if insurance companies what to lower their risk they should be investing in a great deal more understanding – education and truth – for all participants in the birth process (women, men and the medical profession) and they will find they actually save money… but will they listen to commonsense?

and btw, good points, deeza, and no, thumper, they’re not: it is approaching libelous to suggest parents who want to birth their child at home are stupid…

Anna Key Anna Key 7:47 pm 07 Sep 09

sepi said :

Anna Keys – the legislation does prevent midwives from legally attending homebirths. Nicola Roxon said last night that this was an unintended consequence of the legislation.

No it doesn’t. It prevents them acting professionally as a midwife without indemnity insurance, and this applies in any location, not just home births.

Granny Granny 3:17 pm 07 Sep 09

I was at the rally. I have never felt so proud to be a woman.

sepi sepi 2:14 pm 07 Sep 09
sepi sepi 1:57 pm 07 Sep 09

Anna Keys – the legislation does prevent midwives from legally attending homebirths. Nicola Roxon said last night that this was an unintended consequence of the legislation.

I wonder how the homebirth rally went this morning – it would have been pretty wet and miserable at parliament house at 11.30. Nothing on any news sites as yet.

deezagood deezagood 10:41 am 07 Sep 09

Thumper said :

I think anyone that has a home birth is bloody stupid.

However, I respect a womans right to do it and think that it is the womans (and partners) choice to do so.

And so, Roxon and her social engineering can get stuffed. Fight the good fight.

It isn’t stupid Thumper. The families who choose to homebirth have, through the pregnancy, built up a bond with their chosen midwife. That midwife knows the Mother’s full medical history, any health issues etc… The midwife who attends the birth remains with the mother, every minute, through the laboring process; giving the maother her full, undivided, uncomprised attention. If anything goes wrong, the midwife is trained to see the early signs, quickly assess the situation, and either manage the situation themselves or gets the Mum straight to hospital.

I gave birth twice, in private hospitals. Both times, the maternity wards were franticly busy – I was lucky if I saw a midwife once an hour. I was completely unattended for 95% of the time during both labors, with staff only attending me at the ‘business end’ of the birth. My highly paid O.B. didn’t even make it to the second birth.

All any woman wants is for her baby to arrive safely; Mothers don’t make the choice to home-birth because they are making a statement or because of their political agendas. No mother would deliberately place a higher risk on their child’s birth. They choose home birthing because they believe that it is the safest, most carefully supervised/monitored and best way for their babies to enter the world. I wasn’t confident enough to give birth at home, but I admire and respect the women/families who do. Their baby, their choice.

Granny Granny 9:37 am 07 Sep 09

Many common modern obstetric practices not only have no evidence base but lead directly to the appalling 30% national caesarian rate where the World Health Organization deems a 10% rate to be acceptable practice. Hardly an outcome to be proud of. Unsurprisingly, some women want better than this.

captainwhorebags captainwhorebags 8:11 am 07 Sep 09

1 in 10 chance of requiring medical assistance sounds risky to me. Not saying it’s unnatural, just that there is an elevated risk around childbirth.

I agree that trained midwives should assist and be able to secure medical intervention, but when the time comes for my wife and I, I don’t think I’d like to hear “well the ambulance said they were on the way, must be stuck in traffic” if she starts to have severe problems. And whilst her rights are paramount, I don’t think she or I will know best about what problems can be handled locally and what requires medical intervention. We’re just not trained for it.

Say what you want about “medicalisation of this natural phenomenon” but the mortality and morbidity associated with pregnancy and childbirth is nowhere near what it was 100 years ago – or still is in the developing world.

Your rant sounds just slightly militant to me, and I guess that’s what annoys me about the whole debate – from my point of view (ie, outsider) it looks like various advocacy groups trying to “own” the birthing process and control access to various resources.

But please don’t think I’m in favour of banning homebirth, far from it. It’s a personal choice for each mother (and father, if he’s involved).

Anna Key Anna Key 7:33 am 07 Sep 09

The OP and other hype around this is a severe misinterpretation of the Bill. A midwife, practicing independently, needs indemnity insurance, same as a doctor or physiotherapist. This is to cover them in 20 years time when a parent (or lawyer) decides to sue. The insurance companies must have a good reason for not offering it ie the risk is too great. If they could make a profit out of it, they would.

It’s not banning homebirths, it’s not stopping midwives going out and finding a suitable insurance product.

sb14 sb14 11:59 pm 06 Sep 09

Astrojax said:
and the bottom line to all this is that well trained midwives should assist this process and be able to secure medical intervention when it is needed and requested by a well informed mother and there is no reason at all to presuppose this should be in any specific location

And how do you suppose this medical intervention be delivered in the home? Should the obstetrician leave the dozen other birthing mothers to attend to this woman? Should the anesthetist and theatre team delay the emergency list to set up a theatre in the mother-to-be’s house? Should the neonatologist leave the 20 odd critically unwell neonates to attend to the baby? Realism, a blessing and a curse.

Quokka Quokka 11:23 pm 06 Sep 09

astrojax said :

what causes many of the complications of birth is fear and apprehension as result of misinformation which means the woman’s instincts are overridden and cause her to fight against what is natural because she is too often told that what is ‘medical’ is normal when what is medical is ‘intervention’ and actually unnecessary

Uh, what? The maternal mortality rate in sub-saharan Africa is 920 per 100,000 live births with haemorrhage being a leading cause of these deaths. I fail to see the direct link between “fear and apprehension as a result of misinformation” and maternal haemorrhage. Unfortunately many of these women have probably died from conditions that would have been treatable with appropriate care, not because they were misinformed. The bottom line is that childbirth can potentially be quite a dangerous event for both mothers and infants, but that the risk can be reduced considerably by access to appropriate services. This does not mean that births should necessarily require the involvement of an obstetrician, but that immediate access to emergency treatments should be available if required (e.g., antibiotics, anticonvulsants, resuscitation equipment, C-sections)

This link provides some quite useful info on maternal mortality rates worldwide.
http://www.childinfo.org/files/progress_for_children_maternalmortality.pdf

For what it’s worth the infant mortality in Africa is also quite high (83 per 1000 live births). I don’t particularly want to harp about mortality rates in Africa, however I do think it is useful to see the figures in an area in which births tend to occur fairly “naturally” with low levels of medical interventions.

astrojax astrojax 9:27 pm 06 Sep 09

captainwhorebags said :

I’m sure there are cases of negligence, but I’d like to think that if people weren’t so eager to play the lawyer card then astronomical indemnity insurance premiums wouldn’t be an issue.

Astrojax: I agree with what you’re saying that a pregnant woman is not sick, however they are about to undergo a risky procedure that has a significant likelihood of complications occuring. Childbirth is of course a natural process that has been going on for millenia, but it was also a leading cause of death in healthy women for a long long time.

That being said, I’m pro choice for women, as long as they are aware of the risks involved and plan accordingly.

no! women aren’t “about to undergo a risky procedure…” the medicalisation of this natural phenomenon is what has the potential to make birth ‘risky’ – some 90% of human births can take place with no medical intervention (not to say that medical assistance shouldn’t be on standby should it become necessary): it is a natural mammalian response and the woman’s body is well equipped to birth offspring. what causes many of the complications of birth is fear and apprehension as result of misinformation which means the woman’s instincts are overridden and cause her to fight against what is natural because she is too often told that what is ‘medical’ is normal when what is medical is ‘intervention’ and actually unnecessary

the planning for birth should, of course, involve close medical monitoring to ensure the health of the woman and the foetus is ongoing and should also involve understanding when intervention might be required – because you’re right, that otherwise the risks of death to woman and/or child are certainly present in such a situation – but to assume antecedent to the birth event that medical intervention will be required negates the natural functioning of the normal mammalian birthing response.

and the bottom line to all this is that well trained midwives should assist this process and be able to secure medical intervention when it is needed and requested by a well informed mother and there is no reason at all to presuppose this should be in any specific location, hence any mandating that birthing need happen in a hospital is a reprehensible violation of the right to choose and so someone ought to nuke this government and all who agree with them on this issue [well, ok, so that rant may be a little too much… ; ) but i have just returned from a natural birthing course and have been researching and discussing this issue now for some time… ]

gun street girl gun street girl 7:16 pm 06 Sep 09

Quokka said :

GnT said :

The truth is, birth is risky. It may be ‘normal’ and ‘natural’, and women have been doing it for millenia, but it’s also true that millions of babies and mothers have died in childbirth and the reason our maternal and child mortality rate is so low is because of medical care.

Exactly, birth may be “normal” and “natural” but so are death and disability. Birth remains a risky business. In Africa, according to Unicef data, women can have a lifetime risk of up to 1 in 7 of dying during pregnancy or from a birth-related cause, usually from conditions that could have been managed with appropriate emergency health care (e.g., haemorrhage and hypertensive disorders such as pre-eclampsia). Fortunately in Australia the lifetime risk of death from a similar cause is about 1 in 13000 thanks largely to better levels of maternal physical health and better access to appropriate perinatal care. However, it would be a grave error of judgement to assume that a birth without appropiate support is “safe” just because it is “natural”.

It sounds awful to say this, but death is a relatively cheap outcome, as far as indemnity insurance goes. Death of a baby and/or mother, whilst utterly horrific, doesn’t incur as big a bill as ongoing payments (over a lifetime) for the social and medical upkeep of a mother and/or child who is damaged as a result of medical mishap. Being cold-hearted pragmatists, insurers aren’t as concerned about people dying; rather, they’re worried about somebody surviving with a devastating disability for which they have to foot the bill. Not without reason: an MDO went to the wall quite recently on the back of a few record payouts related to obstetric cases.

I am sure that insurance companies are well aware of the inherent risk of child-birth and the increased susceptibility of assisted home birth to negligence-based litigation in the event of adverse outcome to mother or child if it is argued that such an outcome could have been avoided by higher levels of support such as would be available at a clinic or hospital. Obstetricians are probably also not insured to perform home births for the same reason…

I’m not sure about where the indemnity insurers stand on obstetricians performing home births (certainly, an obstetrician would be very exposed if a birth went pear-shaped in a home environment). At the very least, I imagine it would add a few zeroes on the end of an already large annual insurance bill.

gun street girl gun street girl 6:53 pm 06 Sep 09

emd said :

There are a lot of women who have put a lot of work into informing themselves of their options, educating themselves about the risks for each option, and would still like to have their baby at home. Doctors are not infallible, and they are not gods. They are human beings who can inform us of our options and risks, but it is not their role to make the choice.

Doctors aren’t making the choice for you in this issue. It’s Government and insurers standing in your way. Please try to avoid blaming the wrong party – there’s enough “us and them” as it is.

captainwhorebags captainwhorebags 6:21 pm 06 Sep 09

I’m confused, hopefully someone can clear this up for me:

If a midwife helps deliver a baby via homebirth, are they actually committing a criminal offence? Do they face legal action? Or is it that the college of midwives will de-register them?

Or, is it that they don’t get assistance from Medicare or help with insurance bills?

And, if a woman delivers her child at home, is she breaking the law? The title of this post suggests that this is the case…

Any clarification would be appreciated.

Quokka Quokka 5:57 pm 06 Sep 09

GnT said :

The truth is, birth is risky. It may be ‘normal’ and ‘natural’, and women have been doing it for millenia, but it’s also true that millions of babies and mothers have died in childbirth and the reason our maternal and child mortality rate is so low is because of medical care.

Exactly, birth may be “normal” and “natural” but so are death and disability. Birth remains a risky business. In Africa, according to Unicef data, women can have a lifetime risk of up to 1 in 7 of dying during pregnancy or from a birth-related cause, usually from conditions that could have been managed with appropriate emergency health care (e.g., haemorrhage and hypertensive disorders such as pre-eclampsia). Fortunately in Australia the lifetime risk of death from a similar cause is about 1 in 13000 thanks largely to better levels of maternal physical health and better access to appropriate perinatal care. However, it would be a grave error of judgement to assume that a birth without appropiate support is “safe” just because it is “natural”.

I am sure that insurance companies are well aware of the inherent risk of child-birth and the increased susceptibility of assisted home birth to negligence-based litigation in the event of adverse outcome to mother or child if it is argued that such an outcome could have been avoided by higher levels of support such as would be available at a clinic or hospital. Obstetricians are probably also not insured to perform home births for the same reason…

emd emd 4:09 pm 06 Sep 09

There are a lot of women who have put a lot of work into informing themselves of their options, educating themselves about the risks for each option, and would still like to have their baby at home. Doctors are not infallible, and they are not gods. They are human beings who can inform us of our options and risks, but it is not their role to make the choice.

The fact that there is statistical evidence that a variety of birth care models are safe should stand as evidence that we need all options to remain legally accessible to women, so they can work out what’s best in their own circumstances. If all the evidence pointed to one model being safe and the others being unsafe, there would be no need for discussion.

If we can respect a woman’s right to request elective caesarean surgery without medical need, adding to the risk of death and injury, why not allow home birth? Both choices are taken up by a very small minority of women.

miz miz 2:50 pm 06 Sep 09

I would have loved a home birth if it had been an available option. I was lucky enough to get into a birth centre for two of my babies but the third was in a labour ward. Staff were great but, to be honest, it was far more stressful.

While birth centres are a reasonable compromise, actually, home would have been much, much better. And it’s almost impossible to get a place in the birth centres these days.

Holland have a high incidence of home birth and it’s as safe as hospital births (and far more pleasant for mothers):

http://www.smh.com.au/lifestyle/lifematters/midwife-home-birth-as-safe-as-hospital-says-study-20090416-a8wu.html

Clown Killer Clown Killer 8:08 am 06 Sep 09

As a man I suppose that I am free to speak with the liberty of one who does not actually have to bear a child into this world.

Focussing on the outcome might hlp with perspective. What do you really want from this? Is the whole thing about bringing a new life into the world – your child: another person that you have created with love and nurtured inside you? Or, is it about your right to choose? Is it about bragging rights? Is it about making a statement about the sort of parent you aspire to be?

Will you be able to hold your child in your arms – no matter what the outcome – an say ‘it was worth the risk’.

sb14 sb14 1:59 am 06 Sep 09

Well said GnT

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