March 12, 2009

As many of you who are regular readers of my humble little blog will know, the Maternity Services Review has been a big issue for me lately.

A couple of weeks ago, the report into the review was published, after round table forums and over 900 submissions were made. You can read the report here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/64A5ED5A5432C985CA25756000172578/$File/Improving%20Maternity%20Services%20in%20Australia%20-%20The%20Report%20of%20the%20Maternity%20Services%20Review.pdf

Some of the material in the report is, I believe, a great step forward. There appears to be a shift towards a less fragmented maternity system, collaborative care with some level of continuity, enhancement of midwife practice, more resources to ensure informed choice for parents-to-be, and a push to raise breastfeeding rates.

However, there is one thing that really disturbs me about the report. Despite the fact that over half the submissions made to the review were at some level advocating for more access to homebirth options, the report states:

“at the current time in Australia, homebirthing is a sensitive and controversial issue, the Review Team has formed the view that the relationship between maternity health care professionals is not such as to support homebirth as a mainstream Commonwealth-funded option (at least in the short term). 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.”

Whilst I personally never expected that homebirth would be funded by the public system, this still disappoints me. I feel it is inequitable that the more medicalised end of the spectrum- that is, elective caesarean- is funded by the public system, but homebirth isn’t. This is a paradigm issue. As was mentioned on the Insight episode on birth the other night, midwives come from a position of wellness, and obstetricians from a position of risk. Whilst I do not feel I am in a position to question any other mother’s choice on how to birth their baby- given that they have made an informed choice, which can be difficult in our current maternity climate, and understand and have made provisions for the extra psychological, psychical and physiological risks involved in a caesarean- there are factors that lead to elective caesarean not often considered such as residual trauma from earlier sexual assault, previous birth trauma, and a system and society that directly works against a woman’s trust in her body- I can’t see this as anything but unfair, and a quite overt way that the ‘system’ continues to value medicalisation over trust in nature.

Homebirth is seen as a risky option by many. On Monday night’s Insight program, Dr Ted  Weaver from RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) stated that a baby is three times more likely to die in homebirth. What Dr Weaver conveniently failed to add, is that this was addressing homebirths in Western Australia, in which only six babies died, and where it was found that place of birth had absolutely no impact on the outcome in at least five out of the six cases.

In fact, large studies on midwife assisted homebirth have found that homebirth is just as safe, if not safer, than hospital births in terms of mortality. When birth trauma and other morbidities are included, my personal observations of anecdotal evidence would suggest that it is a far ‘safer’ option. I have been involved with women suffering birth trauma for nearly a year and a half, and I am yet to find a woman traumatised by a homebirth (not to say it couldn’t happen, but I think it’s a telling observation).

The report cites the low levels of current homebirth as a reason for not funding it. This seems fair enough on the surface, but when you look at the possible reasons for the low level- not just a preference against homebirth, but issues such as prohibitive cost (at around $4000 a birth), low levels of independant midwives in some areas, and the controlling of said midwives by their feeder hospitals, it becomes clear that it is not simply a matter of preference.And clearly, the system is against homebirth.

The second thing that disturbs me is that not only is homebirth not to be funded, but it could very well be outlawed all together. The report recommends that all health care professionals in birthing be more regulated, and hold indemnity insurance. Since the insurance collapse of 2001, no homebirth midwife has been able to get this insurance- no insurance company will insure them. So, in leiu of some insurance company offering this insurance (and if they do, the premiums will drive up the cost of a homebirth even higher), homebirth will become illegal.

Having been through a traumatic birth experience, I now know the incredible value of a peaceful birth. Having been denigrated, ignored, and processed I know the value of being listened to, respected, and being able to make decisions about my birthing. Having been left in a room with no privacy, lights and verbal interaction that stimulates my neocortex at a time I need to limit this stimulation to birth, I know the value of a sacred and quiet birthing space.  Having been pumped full of drugs that inhibit the wonderful orchestration of hormones necessary for labour, birthing and bonding, I understand the need for an undisturbed birth wherever possible. Having lost the first few precious weeks of motherhood to guilt, shame, fear, anxiety and trauma, I look forward to a blissful babymoon next time. Having many times holding and soothing my child who is overcome with anxiety and fear because of a birth that taught him to be wary of the world, I see how birth imprints us for life.

Homebirth would afford me all the things Bodhi and I missed out on. I was looking so forward to birthing my baby with respect and in peace at home, when the time comes. Now I feel like the tide is turning against me, and instead of being able to reverently prepare my body to bear another child, conceive consciously , immerse myself in pregnancy and be open to the sacredness of birth, a great deal of my attention will be fighting the system and trying to protect myself, and my baby.

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