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Homebirthing is a common phenomenon in most parts of the world, but in Australia, fears surrounding the process are threatening its acceptability.
In New Zealand, Canada, the UK and the Netherlands, giving birth at home is a reasonable choice, supported by both governments and insurers.
In Australia, however, the choice is threatened by proposals from Health Minister Nicola Roxon to leave midwives without insurance or funding to assist home births.
The curbing of that choice started last year when Ms Roxon initiated the Maternity Services Review and announced Medicare funding for midwives in the 2009 budget. In conjunction, she proposed the National Registration and Accreditation Scheme (NRAS) legislation, which would require health professionals to hold indemnity insurance so as to safeguard consumer safety.
While this looks sound on the surface, the great omission in her proposal was homebirth midwives, who were not offered funding or indemnity insurance within the proposed scheme, leaving them at the mercy of private insurers who traditionally refuse such cover. In effect, this would condemn homebirth midwives to operate illegally if they wanted to continue delivering babies.
What followed was a hefty debate between politicians, obstetricians, midwives and mothers, culminating in a 2000 strong rally in Canberra protesting the proposals. In a last minute move, Ms Roxon postponed the measure until 2010.
Homebirthing Unresolved
While this has created a temporary calm, it has not provided a solution for those women who want to home birth, nor does it address the bigger question of a woman’s right to choose the type of birth she wants.
Gary Hastie, who has delivered all four of his children at home while supporting other home birthers, believes homebirthing “is the most natural process for the woman”.
However, he has observed an increasing fear of home births, distrust of a woman’s ability to have a natural birth and a demonisation of what is, in the end, a woman’s choice. “It’s a woman’ right to choose where and how and with who she gives birth,” he said.
Nicola Roxon says she supports women having a choice, but is concerned with the consumer and ensuring a system of registration. It is “about lifting standards and ensuring that people are both registered, accredited and insured,” she said.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZOG) says they are concerned about the safety of both mother and child. In a country as vast as Australia, many women are far from hospitals, which could endanger them or their babies if complications arise during their pregnancy.
The president of the college, Dr Ted Weaver, says it is not only the size of Australia that is a problem, but also cultural differences. “The infrastructure in other countries is completely different from the infrastructure in Australia–these countries have a tradition of home birth.”
Dr Weaver said the biggest danger lies when women get transferred to a hospital after complications arise. While midwifes should work in conjunction with a hospital, he says the handovers are often chaotic. “Virtually any obstetricians that you talk to would have had experience with a home birth that has been transferred to a hospital where there have been difficulties,” he said.
Doubts are expressed too about how qualified Australian midwives are. Dr Weaver says: “Their [overseas] midwives are better trained and act along more stringent guidelines, and the selection for home birth is much more rigorous than in Australia.”
Kylie Woods, from Moss Vale in New South Wales, is a former paramedic, labour assistant, or “Doula”, and the mother of four children. She says Australian home birth midwives are no less trained or qualified to assist women in home birth, nor are the women choosing home birth any less qualified to choose what’s best for them or their child. “Most midwives will refer high risk women onto a hospital and work in conjunction with the local hospital,” she said.
“They may even book into a hospital just in case complications arise.”
Ultimately, she says, “You’ll find that women will choose whatever is in their baby’s best interest.”
But the situation is slightly more complicated than that, says independent midwife Jane Collings, who has been attending homebirths since the early 1980s.
While most high-risk women will be referred to a hospital by a midwife, there is a very small portion of these women who consciously choose home birth over a birth in hospital, even if they are considered “high risk”. “High risk” includes women who are having twins or have had a breach birth previously.
Many women, including those considered “high risk”, do not want a hospital birth, which is considered high intervention and impersonal, Ms Collings said.
“The home birth rates do not include many high risk women, but there will always be women like that and it is their choice,” she said.
Taking away the choice for low-risk women to have a home birth because of such isolated cases, however, would be disproportional, Ms Collings said. “If come July 2010, the Government does not find insurance for Home Birth, then they are saying they are not giving the support to home birthers that other birthers are getting, which is absurd and inappropriate.”
Kylie Woods believes the Government will be taking away a woman’s right to choose a homebirth if they continue on this course
“In the end, this is a human right issue,” she said. “It wouldn’t surprise me if we’ll see this go all the way to the courts.”
