Another Birth Centre Bites The Dust?

On July 15th the Gold Coast Birth Centre was shut down by one of Gold Coast Hospital's chief obstetricians, who acted without prior consultation. The closure came just two weeks after the Australian Government introduced maternity reforms which give doctors unprecedented control over independent midwives, restricting Australian families' access to homebirth.

Australians were quick to mobilise and speak out against this affront to birth rights. It's important to note the heavy involvement of homebirthing women in this movement. While homebirthers don't wish to use birth centres, we certainly know how it feels to have our choice ripped out from under our feet.

A protest rally attended by 300-500 people caused the birth centre to be re-opened over the weekend, with talk of the centre's future to resume on Monday (see Mum-Power Reopens Coast Birth Centre).

Yet, the supposed "Mother of all rallies" attended by over 2000 people at Parliament House on a cold and wet September day did nothing to save midwife attended homebirth last year! Why? My theory is that the Gold Coast Birth centre, like the overwhelming majority of Australian birth centres, is not free-standing and (as is made obvious by the fact that one obstetrician closed it down) is ultimately under the control of hospital power-holders. Homebirth attended by an independent midwife, on the other hand, was not under the direct control of hospitals or obstetricians prior to the maternity reforms introduced on July 1st.

In conclusion, the medical power-holders are willing to tolerate natural birth in Australia, so long as they are in control of when, where and who it happens to.

Save Gold Coast Birth Centre Facebook Page

Maternity Coalition's Press Release

Hundreds March To Save Gold Coast Birth Centre

Channel 7 Television Coverage Of Protest

1 Good Reason I'm Reluctant To Support Hospital Run Homebirth Programs

Last week a homebirthing couple expecting their newborn any day received a knock at the door only to discover police officers who were sent to their home by their local hospital (see here).

Allegedly the mother was "12 days overdue". Given mainstream Australia's tendency to pin-point the arbitrary 40 week mark as when the baby should be born it is most likely that this mother was at an estimated 41 weeks and 5 days pregnant (which cannot be proven and thus we refer to these things as ESTIMATED due dates). Even still, full-term pregnancy ranges anywhere from 37 to 42 weeks, meaning she could not be "12 days overdue" until she was 43 weeks and 5 days pregnant. (It's worth noting that even these "overdue" mothers can go on to have healthy homebirths see here).

Bathurst Hospital informed the mother that they wanted to induce her at her next appointment. Having suffered a traumatic induced hospital birth in the past she opted not to attend the appointment after consulting her primary care provider: her independent midwife. According to the mother and the midwife, an induction was not medically indicated. (even when the mother asked the hospital to provide evidence attesting to their claim she required an induction they could not). The hospital's response was to bring in The State to try and scare the mother into submitting to an unnecessary procedure against her will!

While the hospital gave the couple an apology for their behaviour this hardly undoes the unnecessary harm caused by their actions. The end of a pregnancy is a sacred time for a family, a time when peace and quiet is of the utmost importance, the last thing a heavily pregnant mother needs is the stress of the state interfearing in her birth space.

This is just one home grown story that gives me all the reason I need to be reluctant to support hospital run homebirth programs. When hospitals get a whiff of even a slight variation on a textbook pregnancy or birth they swoop in to label the mother "high risk" and take away her right to homebirth. My prediction is that an increase in hospital run homebirth programs will result in a decreased number of babies born at home or an increase in last-minute freebirths (where mothers are left to "choose" between giving birth in hospital or going it alone at home). This is why it is so important that independent midwives are able to practice autonomously, not just when Obstetricians or The State give them their blessing.

Slightly Related Blog Posts
Me: Homebirth Makes It To Question Time
Gloria Lemay: Lisencing, Registering and Certifying Midwives - At What Cost?
Janet Fraser: Consumers Are Not Stakeholders It Would Seem, When Birth Is Discussed

"Mother Freebirths While Father Surfs The Web"

would have been a more apt title for Slashdot's: post entitled "Dad Delivers Baby Using Wiki":

"A Londoner helped his wife deliver their baby by Googling 'how to deliver a baby' on his mobile phone. From the article: 'Today proud Mr Smith said: "The midwife had checked Emma earlier in the day but contractions started up again at about 8pm so we called the midwife to come back. But then everything happened so quickly I realized Emma was going to give birth. I wasn't sure what I was going to do so I just looked up the instructions on the internet using my BlackBerry"

Any member of a birth support team worth their salt knows that nobody "delivers" babies. Mothers give birth to them, plain and simple. The original article from The Sun states: "And after following the detailed guide on the internet's wikiHow Emma safely gave birth to daughter 6lb 11oz Mahalia Merita Angela Smith...." crediting the healthy outcome of this unplanned freebirth to a man's ability to use a search engine when it seems rather obvious that it didn't matter whether or not he was online, that baby was coming then and there!

What makes this story interesting is that the mother had been planning for a homebirth and visited by her midwife before the labour. Surely at some point earlier in the pregnancy the father might have shown some interest in what to do at a homebirth or considered the possibility that they might have a fast freebirth (it was their fourth baby too, one would think the father would have learned how to support his wife during labour slightly before she went into it for a fourth time! But instead he spent those precious moments in front of a computer screen).

Concerning the representation of accidental freebirths in the media, Gloria Lemay notes that

"What is missed is that birthing a speedy baby without any professionals around is actually a safe process. I have read these stories for 30 years and have never seen a single one that involved a true complication."

She also notes that the majority of these stories involve two factors which help contribute to these births being uncomplicated: the umbilical cord is left alone because of a lack of clamps at the scene, which enables baby to stabilise breathing and the mother holds her newborn continuously. She says it best when she says:

"I’m sure that the newspapers will continue to write these stories with all the drama laced throughout them but, remember, birth is a healthy, normal elimination process of the body that happens smoothly, easily and quickly for some women and their babies. It’s an emergence, see?"

I like to think of birth like pooing, two elimination process as Gloria notes. But I can't imagine a fast-moving freepoo by the side of the road making it in the news and I certainly can't imagine anyone trolling the internet for tips of safe poop-before-arrival!

Related Posts:
Emergency Deliveries - Stand and Deliver
Treatment of Baby in a Hurry Stories - Gloria Lemay

iBirth? iPhone As The Latest Obstetric Intervention

Memorial Hermann Healthcare System (Houston, Texas) have been featured on Apple's business profile website for adopting the latest in obstetric intervention technology: the iphone. Apparently the iphone and "state-of-the-art medical [applications] like AirStrip OB let Memorial Hermann’s physicians keep a finger on patients’ pulses even when they can’t be at their bedsides."* Every obstetricians dream, a technology that enables him to intefear in birth while on the golf course! The site states:

"The iPhone advantage is highlighted by [applications] like AirStrip OB, which enables obstetricians to monitor different stages of labor even when they’re not by a patient’s side. Developed by AirStrip Technologies, AirStrip OB links individual mobile devices to a central AirStrip server with HIPAA-compliant authentication, giving obstetricians remote access to live views of delivery room data — including fetal heart tracings, contraction patterns, vital statistics and nursing notes."

Years ago I wrote about the pregnant robot technology Noelle, who enabled medical students to have complete control over a patient without any capacity for independent thought, discussion or to give her consent to procedures. I was concerned that by learning how to control a robot in labour, and creating and managing emergencies during the robot's birth would lead to:

"[T]he continuing (if not exacerbated) attitude within obstetrics that birthing women should be in the complete control of medical professionals and their technologies, and the belief that birth is a surgical procedure, rather than a biosocial, personal, emotional, psychological and spiritual experience, unique for each woman."

Now thanks to the iPhone medical students don't need to concern themselves with these aspects of care provision! While a marketing officer for the healthcare system praises the iphone for helping staff to: "deliver patient care in a more efficient, productive manner" in reality the iphone serves as another obstetric tool which enables doctors to detach from the women they should be serving. It helps obstetricians provide a one-size model of "care" which focuses on data from other technologies rather than on the unique needs of the individual birthing woman. "Efficiency" and "productivity" have little to do with childbirth, these are words relevant to industrial manufacturing. Someone needs to let obstetricians know that they are not manufacturing neonates and birthing women are not factory machinery!

One doctor is quoted as saying that "AirStrip OB is an absolutely indispensable [application] on iPhone”. He goes on to say:

“It fundamentally changes the way I’m able to interact with labor and delivery [note not "the birthing mother"]. In a tenth of the time, without pulling a nurse away from what she’s doing, I get all the real-time data I need at the touch of a button.”

This doctor sees human touch, eye-contact and face-to-face conversation with the birthing mother as irrelevant to his role in "attending" a birth! "All the real-time data" he needs comes from machines. And that is the crux of the issue, the iphone AirStrip OB application (and obstetrics more widely) are concerned primarily with what the doctor needs, not the birthing woman and her baby.

It will be interesting (read devastating) in the future to see what impact this technology has had on hospital birth, such as caesarean rates, narcotic use rates during birth (and for the children born, later in life), rates of postnatal depression, birth trauma and post traumatic stress disorder, as well as a range of other important considerations the obstetrical profession appear to have ignored.

I predict that like the electronic foetal monitor and the ultrasound before it, the use of the iPhone and it's applications during birth will lead to greater rates of unnecessary intervention and trauma for families.

See AirStrip Technologies Press Release Here.

*Why should obstetricians have the luxury of not being "able" to be at their patients bedsides? Pregnant and birthing women should expect nothing less than continuity of care, that means having their care provider by their side during childbirth! This is standard practice for the independent midwives who the Australian Government are legislating out of existence presently.

Homebirthing Voices Across Australian Media

Last week my daughter, an independent midwife and I appeared in our local paper. I contacted the local media to ask if they were interested in talking to some of the homebirthing families and midwives in the community about the legislative changes set to happen in 2010. This was the result;

The first article also appeared on the newspaper's website:

I was pleased with the second article. It was great to read some local women's views and experiences in the paper and to see a beautiful picture of a friend and her son. I think the article reflected the concerns of our community quite well. I was less impressed with the first article which bases it's misleading headline on a very vague quote from the health minister which promises midwives and homebirthers nothing (and stands in contrast to the ministers actions to date).

Further, the newspaper credited me with a profession that does not exist "midwife assistant." This would not frustrate me so much if it weren't for the fact that the only thing the journalist interviewed me about was the definition of a birth servant. Myself and others have written to the paper correcting this mistake and reiterating what I already told them: that a birth servant is privately hired by the birthing woman and serves her ( not the midwife) however she wishes her to.

All across Australia homebirth families and midwives have been contacting their local media and sharing their stories and their concerns about this legislation. Here are a handful that have also appeared online:

Parents labour for home births - The Age
Home-birth revolt - Sunbry Leader
Protesting the right to a home birth - Central Western Daily
Delivering security for midwives - Star News Group
Fight for right to homebirh - Geelong Advertiser
Home births to be outlawed by new maternity laws - Herald Sun
Midwife laws may force homebirths underground - Sydney Morning Herald
Homebirth defenders take protest to capital - Express Advocate

Homebirth Rally Made The News

This is the Channel 7 news report on the homebirth rally in Melbourne that aired on Tuesday night:

Quoted In An Opinion Piece About Homebirth In Australia

My "Birth Is" article was quoted in a piece in Sydney's Indi Media online news. In her opinion piece "Support for Hombirth", Helen Lobato wrote:

"Sarah, a feminist mum describes birth in our society as ‘a snapshot of our violent culture more generally. She talks of the societal crisis of drug use, explaining that the vast majority of births also involve drug use and highlights the fact that almost 100% of women give birth according to ‘expert’ advice rather than trusting themselves."

I'm flattered that someone out there read something I wrote and thought it was valid enough to include in their own writing about birth. My only minor disappoint is that I was not referenced in full, so anyone who might have wanted to read the full piece my words came from would have to do their own reserach rather than quickly referring to the references.

It's fantastic to see the issue of homebirth and government regulation of homebirth gaining attention in circles beyond birth activist blogs, forums and email lists. Thanks for spreading the word, Helen.

You can read Helen's article in full here and my article she quoted here.

Divide and Conquer: Pitting Homebirthers Against Freebirthers

An article was published in an Australian newspaper yesterday stating that four babies have died at homebirths in the past nine months. Let's put aside, for a moment, that the article didn't publish the number of babies who have died in hospital during that period, that when a baby dies at homebirth it is presumed to be avoidable and when a baby dies at hospital is is assumed there was nothing that could have been done to save him or her, let's also ignore the abhorrent fact that this article singled out one grieving mother to be the target of all attacks against homebirth, and let's forget for a moment that the article in question made reference to a study which attests to the unsafe nature of homebirth that is twenty years outdated and was not a study of planned homebirths at all, but a study of unplanned "births before arrival", and let us also forget for a moment that the same article failed to make mention of any of the many medical studies attesting to the safety of planned homebirth attended by a midwife (one study which is only four years old).

Instead, let's focus on the fact that the article did not distinguish between homebirth and freebirth. Why focus on this one aspect? Because this is the aspect that some homebirthers have highlighted on their own blogs, or in disucssions on birth forums across Australia. But mostly, because this aspect is the one that has the potential to best serve the opponents of all homebirths.

On the same day as the newspaper article was published one blogger wrote a piece "Homebirthing Vs Freebirthing: There is a Difference", the title in itself pitting two groups of homebirthing women against each other. Ultimately this piece was written as an attack on one group of consumers and their community. In the article she refers to women who freebirth as "radical fringe-dwellers" and concludes that "Freebirthers who actively shun medical assistance for their own selfish ideological positions, however, don’t help anyone. Least of all their babies."

The author's point is this; don't hate all homebirthers, just the freebirthers, women who homebirth with a midwife present are normal mothers who deserve respect, but freebirthers are members of a crazy cult and feel free to disrespect them (where then, I wonder, does this leave the women who had planned midwife attended homebirths but the midwife didn't make it in time?).

What this author fails to realise (in addition to the fact that freebirthers don't actively shun medical assistance or choose to freebirth because of ideology) is that this line of argument makes her, her own worst enemy (if she was hoping to improve the situation for women who homebirth with a midwife). I am reminded of a reworked poem on Empowering Birth Blog:

First they came for the unassisted birthers,

but I did not speak out, because I do not free-birth.

Then they came for those who birth at home with lay midwives,

but I would would not speak out, because I would not have a home-birth with a lay midwife.

Then they came for those who birthed with Certified Professional Midwives,

and I would not speak out, because I would not have a home-birth with a CPM.

And then they came for those who birthed in birth centers and with Certified Nurse Midwives,

but I would not speak out because I would not have a birth in a birth center or with a CNM.

And then they came for me,

and there was no one left to speak for me.


When the freedom of one group is under attack, freedom for all is attacked. This is why when the latest maternity services review recommended effectively making independent midwifery illegal (leaving women who want to birth at home with freebirth or nothing) freebirthers rushed to aid their fellow homebirthers, despite the fact that they don't hire independent midwives!

Homebirthers and freebirthers are not enemies. Nor are hospital birthers and homebirthers. We are all women navigating a system that we did not create, that was not created for our convenience, but for the convenience of care-providers, and we are all trying to make the best decisions for our own health and the health of our babies. To assume otherwise is to be the real fool in all this. Most of all, to pit yourself against another group of women who birth at home is to do the bidding of homebirths' enemies; dividing before concquering.

Save Private Midwifery!

Make an on-line slide show at www.OneTrueMedia.com

Sign Homebirth Australia's Petition Here!

Marsden Wagner M.D. M.S. on Australia's Maternity Services Review

When I was working on my PhD and my passion for unhindered birth was just beginning to blossom I read the work of Marsden Wagner M.D. M.S. Wagner was one of the first people to convince me that birth was safe and women's bodies work perfectly during birth! Who is Marsden Wagner? I refer to his webpage:

Marsden Wagner, born in San Francisco, his education at University of California at Los Angeles (UCLA) included an M.D., clinical specialty training in pediatrics, then in perinatology (neonatology and obstetrics) followed by two years post-graduate study with an advanced scientific degree in perinatal science. Following several years of full time clinical practice and some years as a full time faculty member at UCLA, he was a Director of Maternal and Child Health for the California State Health Department. After six years as Director of the University of Copenhagen-UCLA Health Research Center, he was for 15 years Director of Womens and Childrens Health for the World Health Organization. He is now an independent consultant.

With extensive experience in maternity care in industrialized countries, including midwifery and the appropriate use of technology during pregnancy and birth, he has consulted and lectured in over 50 countries and given testimony before the US Congress, British Parliament, French National Assembly, Italian Parliament, Russian Parliament and others. His publications, in 11 different languages, include 131 scientific papers, 20 book chapters and 14 books.

When the results of Australia's latest Maternity Services Review were published and the Australian government's discrimination against homebirth and midwives in private practice became ever clear I contacted Dr Wagner and asked him if he would be interested in writing a letter to the relevant power-holders in Australia. Within 24 hours I received the following letter along with his permission to forward it to "all those in Australia who need to see it" and to publish it here:

To all those in Australia concerned with maternity services:

Childbirth is not a medical procedure, it is a normal part of the life cycle and belongs to women and their families, not to doctors nor hospitals nor the government. There is overwhelming scientific evidence that planned out-of-hospital birth attended by a midwife is an absolutely safe choice for all low-risk pregnant women---women without any serious medical problems. To in any way limit or forbid the choice of out-of-hospital birth or the training and ability to practice of midwives willing to attend out-of-hospital births is to deny Australians the freedom to control their own lives and is to fail to honor the central importance of family values in Australia.

In the 1980’s the German organization of obstetricians and gynecologists tried to get a national law forbidding planned out-of-hospital birth. The German women rose up and fought against it, there was an international outcry and the effort of the doctors failed and since then there has been a vast effort to promote out-of-hospital birth centers, increasing from one to the present over 100 such centers, all using midwives.

In the 1990’s the Hungarian organization of obstetricians and gynecologists tried to get their government to forbid planned out-of-hospital birth. The Hungarian women rose up and there was an international outcry and the effort of the doctors failed.

In the last decade, the government of Brazil tried to lower their very high caesarean section rate through working with the doctors and hospitals. When this did not succeed, the government of Brazil started up a national network of out-of-hospital birth centers staffed by midwives which are very popular and have quite reasonable caesarean section rates.

Efforts by doctors in Australia to prevent or limit in any way the option of planned home birth attended by midwives by completely falsely claiming, without any scientific evidence, that planned out-of-hospital is unsafe, will ultimately fail as the people of Australia cannot be fooled all the time and value their freedom too highly and Australia does not want an international outcry against them and to be seen as unable to prevent unjustified medical dominance of normal family life.

Marsden Wagner, M.D., M.S., for 15 years a Director of Women’s and Children’s Health, World Health Organization.

In such dark times for women and for birth it is reassuring to know there is at least one medical expert in our corner.

To read some of Wagner's well-researched articles about birth take a look at these:

Fish Can't See Water - The Need to Humanize Birth

Marsden Wagner explores the rates of technological intervention in birth and the treatment of women during birth arguing that birth has been dehumanised. He notes that many people within the medical model of birth are so used to this model that they cannot see how inhumane the treatment of birth can be - just as a fish doesn't see the water he or she is immersed in.

Technology in Birth - First Do No Harm

Marsden Wagner offers a timely reminder that just because we have the technology doesn't mean we need to use it, and that just because technology is said to help birthing women doesn't mean it is without risks. The best way to stay unharmed in birth, argues Wagner, is to be informed.

The Active Management of Labour
Marsden Wagner critiques the pathologising of birth. He looks at the issues of control and arrogance within the maternity system, the lack of medical evidence to suggest the benefits of the active management of labour outweigh the risks, and how birthing women are kept in the dark about those risks.

Choosing Caesarean Section
Marsden Wagner takes a look at the arguments in favour of women's freedom to choose to have their babies surgically removed instead of born normally.

Australian Government , Violating The Fortelesa Declaration

The Australian Government is in the process of violating the human rights of Australian women. They are doing this through the latest Maternity Services Review which stands to extensively restrict the choices women have with regard to where they give birth and who they can hire to be their medical care provider. The recommendations of the Maternity Services Review stand in violation of The World Health Organisation's Fortelesa Declaration. In particular, article one which states:

1. The whole community should be informed about the various procedures in birth care, to enable each woman to choose the type of birth care she prefers.

And the opening statement of the delcaration which states:

Birth Is Not An Illness

These 16 recommendations are based on the principle that each woman has a fundamental right to receive proper prenatal care: that the woman has a central role in all aspects of this care, including participation in the planning, carrying out and evaluation of the care: and that social, emotional and psychological factors are decisive in the understanding and implementation of proper prenatal care.

The latest Maternity Services Review in Australia is removing the rights of Australian women by refusing to publically fund home births, thus restricting the availability of home birth to many Australian families. And forcing independent midwives to be part of a national registration scheme. This registration will include mandatory professional indemnity insurance for all midwives, the alternative is to practice midwifery unlawfully.

In order for midwives to access professional indemnity insurance they must work within a "collaborative team", however no definition of "collaborative team" has been provided. It is possible that "collaborative team" could mean not working independently (as many homebirth midwives do) in which case insurance would not be available to these midwives and their decision to attend homebirths could lead to prosecution and incaceration.

The Materntiy Services Review clearly states that these decisions were based on presumptions of risk for homebirth. No medical evidence was consulted regarding homebirth and the review goes as far as to make the outlandish claim that there is no medical evidence which they could base their judgments on.

Ultimately The Australian Government has furthered obstetricians' monopoly over maternity care and has prioritised the medical model of maternity care over the midwifery model, despite the fact that the midwifery model is the safer model for the majority of women. By further empowering the already powerful players in Australia's maternity system, The Australian Government has aggressively restricted the rights and freedoms of birthing women. Perplexing behaviour for a government committed to raising the national birth rate!

For Those Of You Who Don't Homebirth

At this time I refer to the author of Empowering Birth Blog's reinterpretation of "First They Came For The Jews":

"First they came for the unassisted birthers,
but I did not speak out, because I do not free-birth.
Then they came for those who birth at home with lay midwives,
but I would would not speak out, because I would not have a home-birth with a lay midwife.
Then they came for those who birthed with Certified Professional Midwives,
and I would not speak out, because I would not have a home-birth with a CPM.
And then they came for those who birthed in birth centers and with Certified Nurse Midwives,
but I would not speak out because I would not have a birth in a birth center or with a CNM.
And then they came for me,
and there was no one left to speak for me."

When one woman's human rights are attacked, all human rights are attacked! No one is safe when a government takes to such heavy regulation of the choices women make with regard to their bodies, their babies and their birth experiences!

What Can You Do?

You can send your letters of disgust and demand to The Department of Health and Aging:

Central Office postal address
GPO Box 9848,
Canberra ACT 2601, Australia

And your feedback to Maternity.Services.Review@health.gov.au

And The Office For Women:

Australian Government Office for Women
Department of Families, Housing, Community Services and Indigenous Affairs
PO Box 7576
Canberra Business Centre
ACT 2610

Telephone 1300 653 227
Facsimile +61 6212 9572
Email women@fahcsia.gov.au

You can also send them to the parties in opposition to the current government as well:

The Liberal Party

The Greens

The Democrats

Family First

What Women Want

(I do not endorse any of these parties. I provide links to them so that readers have access to the information required to contact political power holders in Australia in order to apply pressure to these groups and individuals to do something to change this unacceptable position Australian women and indpendent midwives find themselves in).

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 and Homebirth Choices!

Watch this space for more ideas and for information about various protests and talks you can support.

Australian Maternity Servies Review: Maintaining the Status Quo & Then Some!

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:

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.

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.

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

More on this
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!

An Ezine By Homebirthers, About Homebirth And Much More

Australian homebirth network Joyous Birth publishes an e-zine each season. You can download the first edition of JOY, from Winter 2007 from JOY's website. Each edition is based on a particular theme related to birth and includes an eclectic mix of submissions from Joyous Birth members including; personal testimonies, poems, art work, articles, recipes, as well as a section entitled "celebrate girls" with articles about and submissions from women before menarche.

The Summer 2008/9 edition of JOY is now available and explores "the unknown". This edition includes an article I wrote called "Que Sera Sera: Surrendering to Birth's Uknowns", available only in JOY.

JOY is now accepting submissions for the Autumn edition about "anniversaries". To find out more about the e-zine, how to subscribe and how to make submissions join Joyous Birth's online community.

Trust Birth, Prepare For The Staff

The Age, a Melbourne newspaper, published an insightful opinion piece concerning birth preparation titled "Homework is the mother of prevention". The author, Monica Dux, discusses an issue that sparked my interest in the politics of birth when I was working on my PhD:

"There seems to be a widespread culture of passivity when it comes to labour. Many expecting mothers do dedicate an enormous amount of time and effort to preparation, yet, in my experience, there are just as many who refuse to do adequate homework, preferring to sit back and see how things develop. It's not that these women are unsure about what sort of labour they'd like to have (almost always an uncomplicated vaginal delivery). They've simply decided that "waiting and seeing" is the only realistic approach. Why bother committing to a detailed birth plan when it will probably go wrong anyway? Perhaps other wait-and-seers are simply in denial, preferring not to think about an experience that is understandably terrifying. The end result is that they approach the business of labour with less preparation than they would bring to buying a new car."

I have often thought how ridiculous it is that so many women put little thought or preparation into the birth that lays ahead of them. But then again birth is a normal physiological function, and we don't write ourselves poo plans before going to the toilet. The reality is that during birth a woman is more vulnerable than when she is on the toilet, and as a society men and women are granted privacy and assumed to be capable of going to the toilet without assistance. Society does not extend this trust to birth. Sadly most women have more trust in their medical care providers than they do in their bodies to birth safely and efficiently. This is problematic, as Dux notes:

"Medical experts bring their own subjective values to the decisions they make and the advice they give, and these may not be the same as those of the patient. Similarly, it is naive to discount the vagaries of the contemporary hospital environment. Most of us are suspicious of large institutions such as banks and government departments because we know they are not set up in a way that always serves the best interests of individual clients. Why would hospitals be any different, particularly when so many of them are over-stretched and under-resourced?

Despite all the rhetoric about the importance of consent and respecting the patient's wishes, my experience of giving birth in a big hospital is that women are encouraged to take a passive role, to defer to both their doctor's opinion and to the institutional imperatives. If you argue, you are often told "that's just the way we do things."

Dux concludes that "To just "wait and see" when the stakes are so high is simply negligent — both for the mother's health and for her baby." And she is right. When working on my PhD I collected a number of birth stories from women who had had their trust betrayed during birth. The effects of these betrayls lasted long after the baby was born and included the breakdown of a marriage, many cases of post traumatic stress disorder, breastfeeding problems and challenges to the motherbaby bond.

It is my wish that all women were aware of these issues and possibilities before giving birth for the first time. Dux has done a great job of raising awareness. You can read the full article here.




My own writings on this and related topics:

A Matter of Trust

Doulas: Mortal Ilithyiai

Your Childbirth Options

The Wisdom of Ani DiFranco

As if the woman didn't rock enough on account of her awesome lyrics and music, take a look at her insightful words on birth and women's power:

"I was in labor for 43 hours. Pushed for five hours. It was brutal and scary and prolonged, and if I was in a hospital, they would have definitely cut the baby out of me. I thank the goddesses that I was at home with patient midwives who knew how to go the distance. The memory of pain always recedes. The memory of triumph does not....

I would definitely choose a homebirth again despite the fear mongering of this patriarchal society, which convinces women that they are incapable of having babies without the intervention of men and their machines. I look at societies where women are marginalized and oppressed their whole lives (even covered head to toe in tarps!) but are still in control of birthing practice, in a whole new way now. I mean, who is really more advanced?

To take birthing out of women’s hands and deny us the continuum of eons of wisdom and experience is to eject us from the very seat of our power. I believe that women in hospitals are prevented from being able to have normal, healthy birthing experiences because of the intimidation of being on the clock, being pressured to take drugs to make it quicker, being inhibited in their movement and activities, and alienated by a sterile, fluorescent lit, feet-in-the-air type environment.

You know the classic “performance anxiety” of not being able to pee or poo because somebody’s watching you? Multiply that by a million! A cervix is a sphincter after all!

Then to add tragic insult to injury women are numbed through their great moment of revelation. I believe the act of giving birth to be the single most miraculous thing a human being can do and it is surely the moment when a lot of women finally understand the depth of their power and connection to all of nature. You think it can’t possibly be done, you think you can’t possibly take the pain, and then you do — and afterward you look at yourself in a whole new way. If you can do that, you can do anything.

Check out the books on this subject by Ina May Gaskin. She’s one of my great heroes."

Quote from Celebrity Baby Blog (emphasis added by Ilithyia Inspired).

Pregnant Robot

The article quoted below is from http://www.knoxnews.com/news/2008/apr/24/baby-goes-beep-beep/ but this very same pregnant robot was in the news two years ago.

Robot birthing simulator is good practice for hospital

By Kristi L. Nelson (Contact)
Thursday, April 24, 2008

There was nothing mechanical about the way Fort Sanders Regional Medical Center nurses handled several deliveries in the conference room of the hospital's labor and delivery department Wednesday.

The nurses, all shift leaders, delivered with expertise and humor when the umbilical cord was wrapped around the baby, when the baby's shoulders were stuck, when the placenta was blocking the cervix, when the mother's blood pressure spiked and caused her to have seizures, and in spite of a number of other dangers.

But the patient, "Noelle," was in no position to appreciate the nurses' work. Noelle is a robot - a mannequin birthing simulator that can be programmed to deliver her "baby" with just about any kind of labor and delivery complication.

Fort Sanders Regional got Noelle and her infant companion, "Hal," a newborn that can simulate post-birth complications, about a month ago, but Wednesday was the first time nurses had trained on the robots. A representative from Noelle's maker, Gaumard Scientific Co., was on hand to help nurses learn to run the simulations.

Noelle can have a breech delivery, or a vacuum or forceps delivery, or even a Caesarean section. She can be set up with a dilating cervix in one of four sizes, and any of three vulva for postpartum stitching. She can be given an IV or intubated, and nurses can monitor hers and the fetus's heart rates, blood pressure and pulse oxygenation. She even talks (and sometimes moans, grunts and screams).

"She is fantastic," said Cathy Fry, nurse educator and clinical practice specialist. "She does more than I'd even hoped for."

Fry co-presented a grant proposal that convinced the Fort Sanders Foundation to unanimously vote to purchase the $34,000 system for the hospital's maternity department. For the past five years, Fort Sanders Regional has delivered the most babies of any Knoxville hospital; last year, 3,059 babies were born there.

Previously, nurses conducted monthly "high-risk" birth scenario drills using inanimate models. But Noelle is the first interactive device they've used during a birth scenario. And while other hospitals in the area have used birth simulators, Fry said, Noelle is currently the most advanced. She's wireless, has an internal motor and can be used in or controlled from any area of the hospital.

"These drills are usually held for situations that don't happen very often but are very serious when they do happen," Fry said. "The nurses need to be able to act automatically."

Although Noelle comes with some pre-set scenarios, Fry said, they can also be modified. Nurses can even duplicate real hospital cases to use for training.

Fry said all maternity nurses - including labor and delivery, postpartum and nursery nurses - will train with Noelle and Hal. The full-size infant simulator (which is not the plastic model baby Noelle "gives birth" to) has an umbilical stump and pulsates as a real infant does. Using internal colored lights, it even turns "blue" if it's not getting enough oxygen.

Karin Gamble, a labor and delivery nurse for 34 years, said the simulators will help not only new nurses, but old hands like herself.

"You get to actually practice in a controlled environment" to be ready for the complex case when it involves an actual patient, she said.

Ultimately what the pregnant robot helps hospital staff practice in treating childbirth like a medical drama and the birthing woman like a disaster waiting to happen, and in heavily intervening in the process. This approach to training birth attendants fosters an unhealthy distrust of a birth.

CNN reported, on 17 April 2006, that "medical schools [are] mov[ing] away from using patients" thanks to the invention of a pregnant "robot", or model, named Noelle. The model has been created to improve the current situation in the United States where "as many as 98,000 U.S. patients die annually from preventable medical errors."

http://www.cnn.com/2006/HEALTH/04/15/pregnant.robot.ap/index.html

Unsurprisingly this model woman is a white skinned, "blonde" (according to CNN) haired object. Noelle relieves medical students of the inconvenience of patient discussion, and grants them the freedom to practice medical routines that are, more often than not, unnecessary in childbirth. Noelle enables medical students to have the medicalised "birth" of their dreams: "As Noelle's heart rate increased, a nurse examined her under the sheets. An umbilical cord was visible -- not a good thing. Immediately, the nurse called a "code 777." Several more medical personnel burst into the room and wheeled Noelle off to the operating room where she gave regular birth to twins after a frenzied 20-minute operation."

The $34,000 spent on Noelle could have been better spent on educating obstetricians in normal birth, which over 80% of all births would be (Wagner 2000) if left undisturbed, setting up programs where doctors learn directly from midwives, and ensuring that they attend a certain number of home births. Noelle will not prepare obstetricians for dialogue with birthing women about their interests and desires regarding their birth experience. Nor will it prepare them for the likely situation where a woman wishes to refuse a procedure. Fundamentally, it will prepare doctors for dealing with mute women, void of opinions, who are nothing more than a series of potential surgical events. Despite claiming the model is "only one training method" according to the CNN report it is becoming "standard issue in the United States".

The majority of pregnancies and childbirths are not medical dramas, and they are not illnesses. Therefore, most pregnancy and childbirth, arguably fall outside the scope of the medical profession. Whereas a model may be of huge educational and practical benefit when preparing for heart surgery, or other procedures necessitated by the presence of an actual illness (where the patient is necessarily passive), a model, or robot, for childbirth prepares doctors for little more than an extremely medicalised "birth" involving a passive woman.

98,000 preventable deaths a year caused by the medical profession suggests medicalised reproduction is not the best option for women. A pregnant robot cannot solve the underlying problems with medicalised birth, such as the tendency to unnecessarily intervene in normal births. It simply gives doctors more opportunities to practice this flawed method on a woman who can't complain.

What we can expect from the addition of Noelle to the medical profession is the continuing (if not exacerbated) attitude within obstetrics that birthing women should be in the complete control of medical professionals and their technologies, and the belief that birth is a surgical procedure, rather than a biosocial, personal, emotional, psychological and spiritual experience, unique for each woman.