Home Birth to become Illegal?

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.

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… ]

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.

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.

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.

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…

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.

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

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’.

Well said GnT

Maybe it’s just Australian women who can’t give birth at home safely then. New Zealand and British women must just be better at it.

Insurance companies have teams of highly paid actuaries to calculate the risk of everything. It might not always be fair (for example under 25 men having to pay more for car insurance, when an individual might be a very good driver) but it is always based on sound statistical analysis. If insurance companies won’t cover home birth, it is probably because the risk is too high.

Homebirth advocates always trot out statistics to show how safe homebirth is. Funny, because the other side also use statistics to prove it’s not. Lies, damn lies and all that. I find it hard to believe that insurance companies “can’t be bothered doing their risk assessment work properly”. This is their business, and if they could make money from premiums and not pay out because it was a genuine low risk, they’d do it.

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.

Instead of seeing an us against them fight, I would like to see women be able to give birth in an environment they feel comfortable in while providing all the medical support they may need.

it doesn’t matter if people waive their right to sue – the new legislation makes it illegal for a midwife to practise outside of a hospital.

so you can only have a homebirth with unqualified people around you.

I notice lots of calls here for equal rights of women to choose the place of their birth, but what about the rights of the child being born? Are they not entitled to enter this world in a place where all risks are minimized and immediate care is on-hand if needed? I have known several women who have had complications while giving birth in hospital and have been grateful for the medical staff and facilities on-hand to assist.

Sure, its a womans choice whether to go to hospital, but if one considers how the birthing mortality rate has decreased over the decades of medical birthing assistance, part of me wonders if its really worth the gamble with both your and your unborn childs life.

Not my point at all Granny. I have seen enough births to know when it goes pear-shaped, it goes pear-shaped quickly. I am not advocating for all births to be delivered by a doctor, far from it, but I am advocating for all births (were possible) to take place at a location that, when or if something does go wrong, both mother and baby are given the best chance current health care practices can provide.

sb14 said :

If people want to have babies at home in this day and age, that is fine. They should, however, wave their rights to litigate against the midwife, and promise not to burden the health care system with the of care of their profoundly disabled child arising from severe birth asphyxia

Yes, because cerebral palsy never results from hospital births. Nearly all births in Australia are hospital births, therefore nearly all the cases of birth asphyxia resulted from a delivery in a hospital.

But that’s okay, because they were born in hospital. And a doctor did it. And only doctors should have obstetric insurance. Because they are doctors.

http://www.abs.gov.au/ausstats/ABS@.nsf/2f762f95845417aeca25706c00834efa/d37892d01d1832c3ca2570ec000ace6e

64% of neonatal deaths occur from situations arising during the perinatal period. A home and a midwife are not equipped to deal with an acute event involving a neonate.

If people want to have babies at home in this day and age, that is fine. They should, however, wave their rights to litigate against the midwife, and promise not to burden the health care system with the of care of their profoundly disabled child arising from severe birth asphyxia

Part of the insurance problem is that the insurer is basing their risk assessment on a predominantly obstetric-led model in Australia with under 1% home births, where we have 11 incidents (death or permanent injury) per 10,000 births (based on Dept of Health statistics). In New Zealand, 80% of births are in a midwife-led model and over 6% are home births, and they have only 0.83 incidents per 10,000 births. If indemnity insurance for midwives were risk assessed using midwifery incident statistics, we would find that insurance is much cheaper than the insurance company leads us to believe. I personally suspect that they can’t be bothered doing their risk assessment work properly because we will still have a very small number of home births with a midwife even with insurance.

ACT Greens included a review of home birth access in the ACT in their 50-point agreement with the ACT ALP for Stanhope to keep his Chief Minister’s job. They have raised questions about home birth in the Legislative Assembly on a number of occasions, support the home birth rally, and have written to Katy Gallagher’s office requesting an information session run by ACT Health for care providers and consumers on how this new legislation will affect home births in the ACT. Rachel Siewert (federal Greens) has also requested amendments to the legislation to clarify the legal situation – don’t know how the amendments will go at voting time, and it still doesn’t resolve the indemnity insurance that is at the heart of the problem.

The federal Liberals have not yet stated a party position on this issue that I am aware of. However, Senator Gary Humphries is hosting a screening of the film Birth Rites at Parliament House on Monday night. This is a really interesting doco, comparing the birthing situation in Canada’s remote indigenous communities to West Australia’s Kimberley region indigenous community.

If the Government had the will, they could resolve the indemnity insurance issue. They did it in 2001 for the doctors, why not do it in 2010 for the midwives?

but Im sure plenty of hard core homebirthers would be willing to have a home birth attended by a qualified and experienced midwife Without Insurance. (if offered the choice of that , or a hospital birth)

the point of this law is that qualified midwives are not allowed to practice outside of a hospital. So choice is completely removed.

As for ideal birth – I’d like a birth centre, followed by a private hospital or hotel stay for a week with midwives in attendance.

While we’re on the subject of people’s ‘rights’, what about the right of the soon to be born child to have the best available medical care (i.e. hospitals, doctors etc) right there when they are born.

Nurses aren’t doctors, no matter how ‘experienced’ they are. Anyone who thinks otherwise is delusional. Those same delusions lead to people thinking homebirth is just as ‘safe’ as hospital birth.

This ‘pro-choice’ argument is moot when only 50% of the ‘rights’ are being considered

Well, it’s all a bit silly really. If other countries can make it work, how is it that this country can’t? Even New Zealand can do it!

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.

Exactly. This issue is a direct consequence of medicolegal issues that have dogged the industry for years. Reform of insurance (across the board) may find a path for midwives to attain cover. Until that happens, though, I suspect insurance will present an impasse to the issue at hand.

Where do the Greens and Liberals stand on this? Presumably the Greens would be pro home birth – after all, it is about a woman’s right to choose, and it is more ‘natural’. And what have the Liberals said? (C’wealth, not local)

Labor doesn’t have a senate majority, after all. And I don’t believe Rudd would go to a double dissolution on this issue (I would like to see him try – ha, ha).

This is very sad, perhaps we should stop women from voting next. That will make it easier to get legislation like this through.

As for the update: “government has changed its mind”, my reading of that article isn’t a backdown at all. They are basically saying lets hide the issue for two years at which point it’s all set up in law and people start getting prosecuted.

Medicare funding for midwives should extend to home births.

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.

Just got this email from Homebirth Australia, organisers of Monday’s rally:

Dear homebirth supporter

This afternoon we were sent through a joint communique from Australian Health Ministers.

Below is an excerpt from the communique

Homebirth

Health Ministers agreed to a transitional clause in the current draft National Registration and Accreditation Scheme legislation which provides a two year exemption until June 2012 from holding indemnity insurance for privately practising midwives who are unable to obtain professional indemnity insurance for attending a homebirth.

Additional requirements to access the exemption will include;

– A requirement to provide full disclosure and informed consent that
they do not have professional indemnity insurance.

– Reporting each homebirth

– Participating in a quality and safety framework which will be
developed after consultation led by Victoria through the finalisation of the registration and accreditation process.

These provisions will only apply to midwives working in jurisdictions which do not prohibit such practice as at the date of the implementation of the scheme.

ABC News link

Homebirth midwives get indemnity exemption

This only makes our rally even more necessary. An exemption for 2 years just isn’t good enough. Do we REALLY want to go through all this again in 2 years time? It’s simply a bandaid solution and will be the demise of private practice homebirth midwifery. This bandaid will take us past Nicola Roxon’s term of office, therefore in 2 years time it could be someone else’s problem to deal with and it could be someone who we will yet again have to heavily lobby and educate so that they can be up to scratch with the issues at hand.

So what does this give us?

A framework that must be abided by in order to be eligible for exemption from insurance, which is led by Victoria. We have been told by Nicola Roxon’s office that this is due to Victoria leading the National Registration and Accreditation Scheme. However, we have concerns that Victoria may also lead the development of a framework within which private practice midwives will have to work, in order to be eligible for an exemption. Some members of Maternity Coalition and Australian Private Midwives Association recently attended a meeting with the Victorian Health Minister Daniel Andrews and they reported back that “The Minister summarized the implications that the current Bills before parliament will have for women and midwives. He stated that midwives cannot continue uninsured as they are and that if they wanted to work it would need to be as part of a team at a public hospital providing homebirth”.

He was asked whether he recognized the right of women to choose place of birth and what they would do in the instance of July 2010 if the issue is not resolved, “Well they will be faced with the difficult choice of choosing from what is available”.

We have grave concerns that this will be the beginning of the end for private practice homebirth midwifery.

On radio this afternoon Nicola Roxon alluded to the fact that during the 2 year exemption, data would be collected and hospital based programs could be developed or a suitable indemnity product found. This gives us absolutely no confidence or guarantee and we are exceedingly worried that this will be the death knell of homebirth.

We have no insurance, yet again dismissing consumers of homebirth as so small in number that it doesn’t really matter.

We have no funding, yet again financially disadvantaging women who choose to birth at home with a midwife.

Our message at the rally remains very clear.

ALL WOMEN – EQUAL RIGHTS

See you in Canberra

Warm regards

Homebirth Australia

AMA is a very powerful lobby group and has a great deal of influence over the government.
Insurance may be one reason, though again I see doctors wanting to reign thing in again.
Talk to anyone who works at Medicare and ask them how much time they spend keeping the doctors happy in that agency vs service delivery.

The draft legislation does change the professional standards that apply to midwives.
As part of this legislation, there is now an advisory group drafting regulations that will determine eligibility for midwives. The advisory group doesn’t include representation from independent midwives attending home births.

When these changes take effect – whether in 2010 or 2012 – it WILL become illegal for a midwife to attend a birth at home. An exemption is not a solution – it just postpones the effects of the problem.

barking toad said :

If mums-to-be don’t want to use the facilities of a hospital with all the facilities available should there be a problem, then I have no difficulty with their decision.

Provided they are prepared to accept the consequences if there should be a problem, whether they have a mid-wife at home or not. The option to blame someone else and resort to legal action should be denied.

I’m all for personal choice. And personal responsibility.

the women aren’t sick, though, toad, so assuming some utility for medical intervention when, de facto there is no need for such is a fallacy. responsibility is the key, but assuming a midwife can only practice her/his qualification in a hospital fails utterly to understand the role and qualifications of a midwife.

just as any person who, not being sick before hand, an ambulance and other medical assistance is logically due rendering in the event of complications in a home birth, and these complications rarely arrive in a second unforeseen when the progress of the birth is being cared for by a trained birthing specialist (ie a midwife)

so there should be absolutely no case for a midwife to be barred from practising in any specific location and all due medical assistance should be as forthcoming if required as say an elderly frail person falling in a home, a child experiencing an allergic reaction to a bee sting, a hale person having a stroke or cardiac arrest… whatever.

if you, toad, are genuinely “for personal choice” then you would do well to lend all your support to the rally on monday.

You know, I am all for the power of a midwife. The main thing I would like to see is midwives being permitted admission rights for their patients in private hospitals for low risk births. Can someone please tell me why the hell we need a bloody overpriced obstetrician to sign us up for a hospital birth? Yeah, yeah, I know the arguments about what happens when something goes wrong. But, if you don’t need an obstetrician, why the hell should you pay for one when you just want the damn private room in the private hospital – or even a hotel for that matter with some midwives in attendance?

As for you home birthers…why would you want to clean up the frigging mess? Please tell me that!

As far as I can tell none of the proposed midwifery bills would have made home births illegal, nor imposed criminal or civil penalties on a registered midwife who attends a home birth.

A registered midwife who fails to comply with a condition of registration (such as holding an indemnity insurance policy for home birth practise) does not commit a crime or break the law.
There is a pre-condition when a midwife applies for registration that she hold “appropriate” insurance coverage – but the bill did not really explain what that means. I could not find anything to suggest that the insurance cover be comprehensive. It is possible that a midwife who occasionally attends home births is able to be registered because she is insured for most of her work (I don’t know for sure – someone might like to correct me).

What is clear, however, is that unregistered practise by a registered midwife may be regarded as behaviour that breaches professional standards (ie, there may be disciplinary action taken by the professional standards board). The draft legislation bills do not change the professional standards (though they mirror what goes on at state and territory level).

Professional standards in the medical professions are self-regulating in much the same way as lawyers professional standards. Lawyers can make mistakes, act negligently, unethically, or even illegally without necessarily being struck off the practice rolls by the law society. I imagine it’s similar for health practitioners, including midwives.

Whatever it is, we are not talking about home births being illegal. At best, the proposed laws might make home births impractical because of the uninsured risks.

All the bill did is not extend medicare insurance to cover a home birth. This means that in practical terms home births are uninsured (public or private). Yes, it’s a condition of registration that a midwife hold an insurance policy but her registration is not lost if she practices outside her insurance coverage.

This means that the midwife carries the risk if something goes wrong during a homebirth she is involved in. This may mean that fewer midwives practice home births (because of the risk involved). But it is not because the practice is illegal.

PS – as for the merits of excluding home births from private insurance coverage, it is probably just as stupid as insurers refusing to provide home contents insurance to tenants who live in share houses (many insurers still refuse to insure share houses, or charge live a wounded bull for the privilege).

steveu said :

Here we have the AMA at work again. Proof positive that they are one of the most powerful lobby groups in the country.

Since when is Medicare legislation and national registration for healthcare professionals the fault of the AMA? I know it’s fun to tar-and-feather the AMA for everything that goes wrong in healthcare, but this issue is more to do with the fact that midwives, under new legislation, won’t be able to practice if they’re not registered, and in order to be registered, they need insurance, which nobody is willing to pony up –> vicious circle. The AMA doesn’t control midwife rego (indeed, it’s been fairly negative towards the whole issue of national registration after Roxton brought it into being), nor does it pull the insurance pursestrings (Governmental or private sector).

True, no doctor in their right mind would practice without medical indemnity insurance (regardless of specialty), and in the past, payouts associated with birth and babies have been astronomical, which leads to considerable annual overheads for any doctor who chooses to be involved in childbirth. From a purely pragmatic point of view, it’s not surprising nobody is rushing in to offer cover to midwives (or anyone else, for that matter) who attend home births. It’s unfortunate that medicolegal issues are consequently obstructing medical choice – but there you have it.

Roxon hasn’t backed down. She’s just giving a two year exemption, so homebirth becomes illegal from 2012 (after the next election) instead of 2010. Big deal. It still doesn’t resolve the indemnity insurance issue that is the cause of the future illegality.

And yes, we will still turn up on Monday. A press release offering a two year “don’t worry, we won’t charge you with anything” exemption issued on Friday afternoon is not a solution.

this just in: Govt backs down on homebirth legislation – here is the link from the SMH: http://news.smh.com.au/breaking-news-national/govt-backs-down-on-homebirth-legislation-20090904-fb8p.html

UPDATE: THE Federal Government has backed down on controversial legislation that would have seen homebirthing effectively made illegal. sorce: news.com.au

It seems Nicola Roxon has caved on this at the last minute.

http://au.news.yahoo.com/thewest/a/-/breaking/5913365/homebirth-mothers-win-reprieve/

I wonder if all the hundreds of women and babies will still turn up on Sep 7 – lots of plane tickets re alrady booked.

If mums-to-be don’t want to use the facilities of a hospital with all the facilities available should there be a problem, then I have no difficulty with their decision.

Provided they are prepared to accept the consequences if there should be a problem, whether they have a mid-wife at home or not. The option to blame someone else and resort to legal action should be denied.

I’m all for personal choice. And personal responsibility.

This legislation WILL make it illegal for a midwife to attend a homebirth.
It will be illegal to practise as a midwife without indemnity insurance.
There is no insurance for home births.

Women have been paying privately for home birth (with no Medicare reimbursement like GPs or obstetricians get) for years, and would continue to do so – but they won’t even legally be allowed to pay out of their own pocket anymore.

So how does this affect Canberra women? No home birth. Full stop. We have one registered homebirth midwife in the ACT who will no longer be allowed to attend the birth, the Birth Centre doesn’t do home birth. As happened in 2008 when we had no registered homebirth midwife in the ACT, there will be some women who choose to freebirth rather than go to hospital. This is not a good situation when the woman would have preferred to have a qualified professional attend.

It’s an even bigger issue if you’re in a rural community with a local midwife, but no hospital unless you’re willing to drive for hours on bumpy country roads. Or for indigenous women in remote communities, where entire generations have been born in city hospitals hundreds of km’s away from their local community support network.

Bottom line: it’s a woman’s right to choose who her care provider is. I’ll be at the rally on Monday because I believe in the principle of taking responsibility for your own choices.

can a midwife apply for medical indemnity insurance if they are in, say, a regional site where an ambulance or, indeed a hospital is too far for the mother to travel safely to? Does medical indemnity insurance only apply to doctors? what if the doctor is also a midwife?

i dont know why you would want to have a baby at home. i am giving birth for the second time in 11 weeks and i want to be near any available care as soon as I (might) need it. why would you put yourself or your baby at risk because you want to be at home? there are too many things that can go wrong in a very short period of time. how do you know that you are ‘low risk’ until you are actually in labour? I know plenty of people who have had dream pregnancies and suddenly have very serious complications during labour and birth. not to mention the baby or mother may need sudden care after being born. midwives are great, I used the CMP for both my pregnancies, but I want the added security of having specialist care on hand if needed. if anything, they should be looking into expanding the midwifery program so more people can access that if they want a less intrusive form of childbirth.

I will be there.

When I chose to have my homebirth it was because the hospitals had made it awful enough and disempowering enough one time too many. I couldn’t face giving birth in a hospital again, and I am eternally grateful that my midwife agreed to accept me as a patient.

What this legislation does has the effect that women will no longer be able to choose to birth at home in safety. This is appalling, and is no choice at all for most women.

It removes choice. It disempowers.

Why should Australian women have less rights and less choice than women in other nations?

The only way i can think of is if a midwife is not able to practice unless s/he has insurance and will not be able to obtain insurance, outside the govt scheme, for home births. Thus they are not ‘illegal’ in a technical sense, but in a practical sense the midwife will not be able to provide that service.

I think that’s the issue at stake, DTC — that there is no private indemnity available for midwives to take up. Also, that homebirths would not be subsidised by Medicare either, so even if private insurance could be obtained, homebirth would be very expensive.

Just to note that private obstetrics indemnity insurance runs between $80 000 and $120 000 per annum for obstetricians working in hospitals with full paediatrician/neonatal intensive care back up. This is primarily because of the profound and long term consequences of even short periods of oxygen deprivation (asphyxia) during the delivery — the enormous pay-outs tend to be where lifetime care will be required.

Well this makes perfect sense; legislating to make an already overwrought health and hospital system even more overwrought. The home birthers enjoyed one-on-one care with qualified midwives in the comfort of their own homes. Now the majority of home birthers, without safe supervision, will be forced to go to hospital; placing more strain on the limited services. Those that do choose to give birth at home now face far greater risks, without a qualified midwife on hand to monitor the birth and manage the situation if things go wrong. Very sensible legislation indeed.

Do home births end up costing the tax payer more money or less? Say 10% (of home births) need medical intervention – do these costs outweigh the costs saved by not having all home births in a hospital? If they don’t, surely it is the taxpayers interest to encourage MORE homebirths….

Hospital policy is aimed at getting you out the door asap – so wouldn’t it be better to do more home birthing?

Here we have the AMA at work again. Proof positive that they are one of the most powerful lobby groups in the country.

In the ACT midwives are currently not insured to attend home births, although they were up until some years ago. However, this does not mean you can’t have a home birth, whether by choice or circumstances. Some ambos around town will tell you stories about delivering babies around Canberra at people’s homes because the baby couldn’t wait till mum got to hospital. In summary, as I understand it, the proposed legislation wouldn’t make home births illegal, it just wouldn’t allow for a midwife to attend, which is already the position in the ACT.

Doesnt the legislation extend professional indemnity insurance subsidies to midwives, except that it doesnt subsidise the premium in respect of home births? As I understand it at the moment, midwives have no insurance cover.

Which seems to me to be:

– better than the current position because the midwife receives a subsidy not previously received /has insurance cover for some of his/her activities that could not previously be obtained; and

– in no way makes homebirths illegals.

Now you can argue whether, as a policy decision, homebirths should be singled out. But I dont see how it makes them illegal.

Then again, I scanned the legislation but saw nothing about home births, so presumably that detail is somewhere else. The only way i can think of is if a midwife is not able to practice unless s/he has insurance and will not be able to obtain insurance, outside the govt scheme, for home births. Thus they are not ‘illegal’ in a technical sense, but in a practical sense the midwife will not be able to provide that service.

(and let the debate rage over ‘home birth safety’. . .)

PBO said :

I would like to see how this would be enforced. If a lady goes into sudden labor at home and gives birth, is she then in breach of the law? Making something that has occured for thousands of years illegal will have some interesting results.

No, that wouldn’t be against the law. What would be against the law would be for a registered midwife to attend this birth.

Pregnancy is overrated! I would like to see children created in big fish tanks from genetic information taken from random members of the public (without their consent or knowledge).

It’s not that homebirth will be illegal, it’s that midwives cannot attend because they will not be covered for indemnity by medicare. Who’d want to walk into that sort of a situation.

So it’s more a case of, homebirth = you are on your own.

It is only illegal for a midwife to attend. Most homebirths up to now have had a midwife.

Homebirth by yourself is called ‘freebirth’.

I predict ambulance births will be a lot more common, as people plan to homebirth alone at home, then freak out and call an ambulance.

PBO said :

If a lady goes into sudden labor at home and gives birth, is she then in breach of the law?

No, that won’t be in breach of the law.

But if she plans to have the birth at home and wants to give birth with the help of a midwife, then that would be illegal. Midwives will only be eligable for insurance if they are working in a hospital or similar facility. The midwives who attend homebirths are mostly Independent Midwives and thus not attached to a hospital, therefore not able to access insurance.

I would like to see how this would be enforced. If a lady goes into sudden labor at home and gives birth, is she then in breach of the law? Making something that has occured for thousands of years illegal will have some interesting results.