BIRTH AT HOME SHOULD BE AN AVAILABLE OPTION

Submission:
Australian Health Ministers’ Advisory Council National Registration and Accreditation Implementation Project Exposure Draft – Health Practitioner Regulation National Law 2009Re. Independent (Homebirth) Midwifery

I wish to draw attention to section 101 (ii) in which a registered health practitioner must not practise the health profession unless professional indemnity insurance arrangements are in force. Also to section 148 in which a person must not direct or incite a registered health practitioner that amounts to unprofessional conduct or professional misconduct, incurring penalties.Registered homebirth midwives are not covered by indemnity insurance due to the small numbers practicing and therefore it is not viable to indemnify them. The introduction of this legislation means that homebirth midwives will no longer be legally allowed to practice midwifery without insurance.Therefore a registered homebirth midwife will not be able to attend a women's birth in her home, as they have in the past. This not only affects me but every women in Australia who chooses to birth at home with a registered midwife. This will also affect families who wish to choose the continuity of care and support that a midwife provides and therefore affects unborn children.

I have had three homebirths - one in Ireland, where the government reimbursed me 80% of the fee I paid to an independent midwife, and two in New Zealand, where I was attended by two experienced midwives, and the cost of this was fully covered by the government. Regardless of whether I birthed at home or in hospital, I would have continuity of care from my self-chosen midwife, and the service would be free. This is what should be available for every birthing woman in Australia. It grieves me that my own countrywomen are being deprived of the basic rights I enjoyed in more progressive (and less sexist) countries than Australia.

If this legislation is passed, it will be a backward step for the emancipation for women in our country.

Any decent dictatorship knows the secret to absolute power is to eliminate any dissent. The essence of democracy is to have an opposition group. When this balance is destroyed, you have oppression and abuse. I believe the majority of women who birth in hospitals will be impacted negatively by rendering homebirth "unlawful", as much as the 1% who are currently somehow able to access homebirth (no thanks to the government), because destroying homebirth will destroy the last remnant of anything approximating the midwifery model of birthing care, leaving the obstetric model of birth as the only reality the majority of women have ever been exposed to. An absolute, uncontested monopoly of obstetric control over the field on childbirth, and the successful elimination of the last vestiges of the midwifery model, that currently exist in homebirth services, means the counterbalance to the obstetric view is removed. There's no checks and balance system. There's no accountability. There's no dissenting voice. There's no opposition party. North Korea shows us how much an oppressed people will worship their leaders in power when there is NO other reality allowed. That is what the women of Australia will be like when homebirth is eliminated. We will lose normal birth skills. We will lose our knowledge and confidence in what normal is. Pathologising and institutionalising birth will be our new reality. If the only dissenting voice we have left is "criminalised", it will be open season on the rest of the birthing population. Birth here will not be like birth in the UK or Sweden. It will be like birth in USA or Brazil.That is why I feel that the majority of women birthing in hospitals stands to lose as much from this misogynistic legislation as women who actually desire to homebirth. They just might not realise how much they've lost for a few decades. Don't it always seem to go, you don't know what you've lost till it's gone. Paving paradise.

We are constantly seeing and hearing reports of rising violence within our society. Where does this violence comes from?

It starts with the institutionalised violence women experience in our birthing institutions, under the medicalised, fear-based, risk-management obstetrics. Michel Odent's 'The Scientification of Love" and Dr. Sheila Kitzinger's "Birth Crisis" explain this. As a doula, I am tired of seeing the sanitised violence women and babies - and to some extent, fathers - are put through during the average hospital birth. My only clients who are treated with patience, respect and gentleness, allowed to have autonomy, allowed to labour normally and give birth under their own power, are the ones who choose homebirth. I have heard countless appalling tales of the birth trauma women sustain. There is no collection and analysis of feedback from the consumers of maternity services in Australia. Feedback from the women is not used to determine obstetric policy. We are told what is good for us and told what to do. The voice of the consumers, women, is dismissed. Our voice is muzzled. Our leaders are listening to the most powerful trade union in the country: the AMA, NASOG et al. We are not a "vocal monority". Our leaders are unaware of how the majority of women out there feel about their births. Birthing women are not offered a chance to offer feedback and de-brief after the birth with their careproviders - as they do in New Zealand, with the BIRTH REVIEW that is mandatory to offer every birthing woman. So, we don't know how women really feel. They get told they have PND when they have PTSD. If they write letters of complaint, they get fobbed off and patted paternalistically on the head. They get told, "At least you have a healthy baby."

It is evident that there is a connection between the increasing rates of corporate management of birth, and increasing violence in our society. This is not the only reasons for rising violence, of course - but it is an important starting point to addressing the problem that should not be ignored any longer.

Meanwhile the rates of intervention rise, just as we are seeing in the USA, where the AMA suceeded in achieving an absolute obstetric monopoly, and they have been allowed to persecute and prosecute midwives who are offering gentle, safe alternatives to the assembly-line butchery in the institutions. You have an entire nation of women who fear birth, fear their womanly power, and are conditioned through intimidation and fear to defer to doctors, and collude with mistrusting their bodies, their instinct and capitulating to the power-over dynamics of the institutions.

Over recent decades, we have de-institutionalised the care of orphans, the care of the mentally ill and the care of the disabled. It's taken far too long, but we know that alternatives to institutionalisation are better and more humane - and therefore, ultimately less costly, in more ways than financially, on society.

So why is the government seeking to increase the institutionalisation of childbirth?

Why shut down smaller, low-tech, low-risk rural centres and birth centres, forcing women to travel hundreds of miles to huge, impersonal centres which are run with cold efficiency, and criminalise homebirth?

This has nothing to do with "keeping the public safe". With considerable intellectual dishonesty, obstetricians - with their vested interest - are going on in the media about 'dead babies, dead babies, dead babies." In 2006, no babies died at home. None. 2000 babies died in hospital. I've read the stats, I've read the research, including the bogus research like the Bastion study. Babies do die at homebirths, babies do die in hospital.

It is time we stopped measuring what is "safe" only in terms of mortality and serious morbidity. In a modern, progressive country, that is backward. That may have been appropriate 100 years ago, but to justify the continuing damage, physically and emotionally, to mothers and babies by parading our low death rate statistics, is not good enough. Homebirths have low death rates, too. They also have one-tenth of the caesearean rates of hospital births, and twice as many intact perinuems - and far less birth trauma. But how would our leaders know? There are no statistics on how many women in our country are sustaining birth trauma, based on the DSM III daignosis of PTSD. But those of us who work in the field - at street level - we know the rates are high. We know that no one is listening to the voice of women.

Who are these people, who are driving this move to criminalise homebirth? I seriously doubt that any of them have ever seen a woman give birth normally, under her own power, unhindered. They may have seen "SVBs" - "spontanous vaginal births" in hospitals. But even the best vaginal births in hospitals are negatively impacted by such things as focus on paper work, time frames, partograms, time pressure, babies taken from the mothers to an examination table instead of straight onto the mother's skin, babies wrapped in cloth before being handed to the mother, babies being hurried to suckle, mothers being hurried to deliver the placenta, hurry hurry hurry, fear, fear, fear, control control control.

I doubt they have ever seen a normal birth. A really normal birth. Very few women in Australia other than the homebirthers are getting decent births. Gentle, safe, compassionate, humane births. Very few women in Australia other than the homebirthers have access to a birth pool of sufficient depth, continuity of care, continuous emotional support, and unrestricted freedom of movement - except for the homebirthers.

The NASOG site states that midwives should be trained in obstetrics and work for two years in a high-risk obstetric unit so that their training is similar to that of obstetricians. If, on the other hand, obstetricians were required to spend two years working with an independent midwife, attending homebirths under her supervision, then perhaps we would see "collaborative care" and a revolution in maternity services. What are our chances, do you think? Any chance of requiring that obstetricians spend two MONTHS observing homebirths? Two births, maybe?

Regardless of what anyone thinks fo the safety of homebirth, and we could all just play "duelling research papers" till the end of time, the government DOESN'T HAVE THE RIGHT TO TAKE AWAY OUR CHOICE.

It is scandalous that Australia does not provide for fully-funded, fully resourced homebirth services, to women in every area, include remote and indigenous areas. This is a wrong that the government has failed to address for too long.

To actually criminalise homebirth is completely unacceptable, and anti-democratic.

I don't think that the government is indulging in "paternalistic arrogance." I think what is behind this dictatorial move is far more sinister. What I see is a government on the back foot, intimidated by the most powerful trade union in the country, who have greedily observed what the AMA in USA have gotten away with, and want nothing less than that for themselves. With a toxic combination of arse-licking and intimidation, the AMA have the Labor government compliantly lying back in stirrups - and our government has sold out the womanhood of Australia to placate them.

It is our right to have a choice. No threats, lies, smoke-and-mirrors, and mis-information from the AMA can take this away from us.

Marsden Wagner, formerly of the WHO, has this to say:

"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.

Do not make the mistake of assuming that this legislation only affects 1% of women in Australia, and it is all right to strip 1% of voters of their human & democratic rights, because they're only a "vocal minority" (or "nutters" as Dr. Andrew Pesce dismissively said), and besides they're just women - so therefore we're safe, the vast majority of votes will never even find out that we're doing something anti-democratic and totalitarian.

If homebirth was properly funded and resourced, more than 15% of Australian women would choose to homebirth. From my conversations with my clients, I believe it would more - more like the 30% in Holland. (Perhaps this is what the AMA is afraid of. They want the monopoly. 87% of women in Nw Zealand choose their own midwife to be their lead maternity carer. Less cash for obstetricians. And that is what it comes down to. Not "safety". Greed. Control. Why? Because they can.)

What will the 70% of Australian women who would probably not choose to homebirth think about this? Are you so sure they won't mind if the democratic rights are stripped from their friends, colleagues, daughters and sisters, because it doesn't concern them? Are you so sure that the fathers of Australia won't mind witnessing the demise of democracy, just because they don't have vaginas? This is supposed to be a free country. There are people out there who like freedom, even if they don't have vaginas and don't homebirth.

This legislation will vastly limit a women’s choice to birth where and with whom she chooses. This will force women into hospital systems that over-medicalise birth or to birth at home without the support of a qualified professional midwife of their choice. After what I have seen of the inside of the average maternity suite in Australia today, I will be staying home to have my next baby. Whether or not I have one of the most experienced, highly skilled midwives in the art of normal birth that we have in Australia, by my side, and whether or not I have a back-up plan guaranteeing seamless transfer to hospital should it become prudent to do so, and whether or not my midwife can accompany me to hospital and continue to care for me - or have to dump me and the doorstep and flee to evade "arrest" .... is up to you.

I would like to draw your attention to these sobering words by Coroner Reimer in the recent case of homebirth baby death. (On radio, a spokepuppet of the AMA told how she was "charged". They forgot to mention she was acquitted, and why. And they didn't quote the Coroner of the case.)

"At the outset, it should be noted that certain pronouncements of the Federal Government of late might have a vast effect on the viability of private practitioner midwives and indeed the future of the practice of homebirthing altogether.

It seems that it is intended to legislate to make it unlawful for homebirths to take place attended by midwives, unless they are fully covered for professional negligence. It has been forecast that no insurers will be prepared to issue such policies. It seems to follow that the practice itself, by this back-door method, could in itself become unlawful.

Obviously this could have disastrous ramifications. It might have the effect of driving the practice of homebirthing "underground", which would be a dangerous outcome. History has shown that there will always be a small group of expectant mothers (and fathers for that matter) who will want to give birth in their home.

The representatives of the parents in their submission (and indeed the mother in a separate letter to the Coroner), despite the disastrous experience of this birth, argue that it is the inherent right of a mother to determine how and where she should give birth and birthing at home should be an available option. Not suprisingly the midwife's representatives also press these sentiments on the Court. It is a practice that will not go away and it is to be hoped that the Legislators take great care in drafting any proposed laws in this regard."
I sincerely hope that the Government will heed Coroner Reimer's warnings. But it seems that the Government has bowed to pressure from the powerful medical lobby and is afraid to stand up for women, and our right to choose between midwifery care (including homebirth) and obstetric care.

I am opposed to the introduction of this legislation and ask that an amendment be made to include an exemption for Independent Midwives to require indemnity insurance.

Yours sincerely,

Julie Bell

BIRTHING AT HOME SHOULD BE AN AVAILABLE OPTION.