The results of Australia's latest Maternity Services Review are in and sadly it is doom and gloom for those of us who care about the health and safety of low risk mothers and babies. Giant steps backwards have been taken for homebirth in Australia and midwives in private practice have been put in an unnecessarily difficult position. In short; obstetricians' medical monopoly over birth has been further solidified thanks to this latest review of maternity services.
The following is an analysis of the review from a dear friend of mine who has graciously permitted me to share it here:
The following is an analysis of the review from a dear friend of mine who has graciously permitted me to share it here:
There were over 900 submissions to the review committee. 407 of them were the personal stories of women, and 53% of those were from women who'd had homebirths. In other words, over 20% of the submissions to this review were from homebirthing women, despite the fact that only about 0.26% of all births in Australia are homebirths. (I daresay there was a significant number of women who haven't had a homebirth who also made submissions in favour of homebirth. I did.)Of the 886 planned homebirths in Australia in 2006, "only" 706 actually occurred at home. An 80% success rate. Of the 9368 planned birth centre births in Australia in 2006, only 5460 births actually occurred in a birth centre. A 58% success rate...[note from sarah@ilithyiainspired; this means that actual home birth settings have greater success than so-called home-like birth settings].
As of the 1st of July, 2010, it will effectively be made illegal to practice as an independent midwife in Australia. This is because national registration requirements for all midwives will include having professional indemnity insurance, and this is not available to independent midwives. (It used to be, until 2001 when the AMA and RANZCOG lobbied hard enough to have it removed.) Because, basically, homebirth is perceived to be so dangerous. What were those stats I just quoted you?
The politics of birthwork have never been so obvious for all to see. But they're just statistics. I would like to highlight a few extracts from the review concerning homebirth, which struck me. These come directly from the review and do not leave much to the imagination with regard to the politics at play against homebirth and midwives in private practice:
1. "No adequate and reliable data is available to develop an accurate risk profile for privately practising midwives who provide birthing services".
This is incorrect. There are many studies attesting to the safety of homebirth attended by midwives in private practice, one of them was published in The British Journal of Medicine in 2005. This shows that those who made the final decisions on the review are not properly educated or familiar with the medical evidence concerning birth. This is very troubling considering they hold the power in making decisions regarding birth choices in Australia.
This is incorrect. There are many studies attesting to the safety of homebirth attended by midwives in private practice, one of them was published in The British Journal of Medicine in 2005. This shows that those who made the final decisions on the review are not properly educated or familiar with the medical evidence concerning birth. This is very troubling considering they hold the power in making decisions regarding birth choices in Australia.
2. "It is difficult for insurers to come up with a suitable premium for midwives because the provision of birthing services by privately practising midwives is perceived to be a high-risk activity" (emphasis added).
This demonstrates that the power holders on this review committee based their decisions regarding homebirth on nothing more than their uneducated opinions. Rather than researching the medical literature on homebirth, they decided to accept the perception that homebirth is risky.
3. "The Review concluded that, while homebirth is the preferred choice for some women, they represent a very small proportion of the total."
One of the reasons homebirth rates are so low in Australia is a lack of government funding for homebirth, a lack of accurate information of homebith being readily available to Australian families and the misconception that homebirth is more dangerous than hospital birth, which is owed to cultural propaganda. The review chose to base it's recommendations concerning homebirth on this propaganda and essentially make the review itself another piece of propaganda.
4. "Lack of professional indemnity cover for midwives is a barrier to the development of collaborative models of maternity care involving privately practising midwives...while a risk profile for midwife professional indemnity insurance premiums is being developed, consideration be given to Commonwealth support to ensure that suitable professional indemnity insurance is available for appropriately qualified and skilled midwives operating in collaborative team-based models."
Midwives in private practice can't work with obstetricians because they can't get insurance for their work and they can't get insurance for their work because they can't work with obstetricians. Midwives in private practice in Australia are damned if they do and damned if they don't. Ultimately obstetricians don't want them working at all and this services review has given them the solution; rendering independent midwifery illegal in the near future.
5. "Currently, privately practising midwives who provide birthing services independently of a medical practitioner."
This illustrates that the review does not recognise midwives in private practice as medical practitioners, despite the fact that midwives are the medical experts on normal physiological birth!
6. "The Review also considers that moving prematurely to a mainstream private model of care incorporating homebirthing risks polarising the professions rather than allowing the expansion of collaborative approaches to improving choice and services for Australian women and their babies."
Basically, homebirth is serviced by professionals who aren't obstetricians and by giving independent midwives government support it would enable Australian women to more easily access homebirth and therefore take away business from obstetricians. Ultimately pleasing the obstetricians and maintaing the status quo is of more importance to the maternity services reviewers than meeting the needs of birthing women and giving them choice and control over their own bodies at birth.
This demonstrates that the power holders on this review committee based their decisions regarding homebirth on nothing more than their uneducated opinions. Rather than researching the medical literature on homebirth, they decided to accept the perception that homebirth is risky.
3. "The Review concluded that, while homebirth is the preferred choice for some women, they represent a very small proportion of the total."
One of the reasons homebirth rates are so low in Australia is a lack of government funding for homebirth, a lack of accurate information of homebith being readily available to Australian families and the misconception that homebirth is more dangerous than hospital birth, which is owed to cultural propaganda. The review chose to base it's recommendations concerning homebirth on this propaganda and essentially make the review itself another piece of propaganda.
4. "Lack of professional indemnity cover for midwives is a barrier to the development of collaborative models of maternity care involving privately practising midwives...while a risk profile for midwife professional indemnity insurance premiums is being developed, consideration be given to Commonwealth support to ensure that suitable professional indemnity insurance is available for appropriately qualified and skilled midwives operating in collaborative team-based models."
Midwives in private practice can't work with obstetricians because they can't get insurance for their work and they can't get insurance for their work because they can't work with obstetricians. Midwives in private practice in Australia are damned if they do and damned if they don't. Ultimately obstetricians don't want them working at all and this services review has given them the solution; rendering independent midwifery illegal in the near future.
5. "Currently, privately practising midwives who provide birthing services independently of a medical practitioner."
This illustrates that the review does not recognise midwives in private practice as medical practitioners, despite the fact that midwives are the medical experts on normal physiological birth!
6. "The Review also considers that moving prematurely to a mainstream private model of care incorporating homebirthing risks polarising the professions rather than allowing the expansion of collaborative approaches to improving choice and services for Australian women and their babies."
Basically, homebirth is serviced by professionals who aren't obstetricians and by giving independent midwives government support it would enable Australian women to more easily access homebirth and therefore take away business from obstetricians. Ultimately pleasing the obstetricians and maintaing the status quo is of more importance to the maternity services reviewers than meeting the needs of birthing women and giving them choice and control over their own bodies at birth.
Finally, I would like to return to my friend's analysis of the review because she summarises the situation so aptly:
"The Australian Medical Association and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists are a filthy stinking lot of evil, power and money hungry parasites intent on making their near-monopoly on birth in Australia complete...Let's just get this in perspective. Homebirths with independent midwives represent ZERO POINT TWO SIX PER CENT of ALL births in Australia. Why are these doctors running so scared? Because homebirth is actually SAFE. Because if homebirth was government funded, if independent midwives weren't having to operate with nooses around their necks, and if more women caught on that homebirth is the best option, that it has the best outcomes, is the easiest and most convenient option and has the priceless, invaluable advantage of EMPOWERING WOMEN TO TAKE BACK SOME CONTROL OVER THEIR LIVES and BOOSTING THEIR CONFIDENCE AS MOTHERS, well! More women would go for it! Maybe even LOTS of women would go for it -- eventually, anyway. Now THAT is a worry for the surgeons and other powers that be who run birth (and health) in Australia, isn't it?...So here's the state of affairs: You can have a free and unnecessary C-section in a public hospital which costs the public $8000 and the government and everybody else claps and cheers and tells you not to worry because at least you got a healthy baby. About 20% of births in Australia occur like this (the C-section rate is 31% but let's be generous and say 11% of them are actually necessary)[note from sarah@ilithyiainspired: the world health organization recommends that anything above 10-15% of caesareans in any one region is medially unjustifiable, so approximately half of all caesareans performed in Australia are unnecessary] . Or you can have a beautiful, empowering homebirth with a midwife risking her integrity, livelihood and possibly even freedom to attend you, which costs you somewhere between $2500 and $4000 and everyone tells you you're a crazy risk-taker endangering the life of yourself and your baby and if you get up someone powerful's nose they might even get the Department of Child Services onto you."
See also:
Australian Government, Violating The Fortelesa Declaraion
Homebirth Underground
Maternity Review part one
Maternity Review there's more
Homebirth Ban
Medicare payments to OBs up from $77m to $211m...
Join the Facebook group "Home Birth should NOT be illegal in Australia" and find out more ideas for how to help!
Sign Homebirth Australia's online Petition to Save Private Midwifery & Homebirth Choices!
2 comments:
been waiting for this since i read nat's post. going to link this one along with hers, if that's ok with ya?
It is absolutely fine to link to this :)
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