Choices for Childbirth: Are women being sidelined again?

The current statistics around birth experience in Australia reflect a culture of inappropriate medical management of the natural process of most births. Data released by the Federal Health Minister, the Hon Nicola Roxon states that public hospitals produce a 27.1 percent caesarean section rate while private hospitals boast an astounding rate of 40.3 percent. The World Health Organization (WHO) states that the caesarean rate should be around 10-15%. So why do we, in Australia have the highest rate of medical intervention in the OECD, more than double recommended by WHO? 

Using maternal and neonatal deaths as the only measure, Australia is one of the safest places to have a baby. While some attribute this to the high rates of medical intervention they fail to include other factors that can be used to measure quality of birth outcomes. In fact increased medical intervention often leads to difficulties breastfeeding, reduced ability to bond with baby, post natal depression (15 percent of women suffer) and dissatisfaction with the birth experience. The impact of a negative birth experience on a woman and baby is grossly undervalued and can deeply affect the mother’s ability and confidence in early parenting.

In 2008, the Rudd Government initiated the, ‘Improving Maternity Services in Australia Review’. Its aim was to assess the current maternity care system and receive suggestions on how it can be improved. It stated, ‘we must recognise that pregnancy and childbirth, while requiring quick and highly specialised responses to complications, are normal physiological processes, not an illness or disease.’ 

The review successfully collected over 900 submissions from professionals and activist groups involved in maternity care as well as countless stories from mothers contributing their experiences and ideas on how maternity care could be improved in Australia.

Based on the information collected through the review, the Health Minister has made recommendations clearly in support of enhancing midwifery care in the public health system. 

The recent release of the budget includes access to Medicare and the Pharmaceutical Benefits Scheme to eligible midwives working in private practice as well as ‘subsidised medical indemnity for eligible midwives working in collaborative arrangements in hospitals and healthcare settings.’  It is still unclear however, how eligibility will be measured and to what extent midwifery fees will be subsidized.

The successful implementation of this budget policy would ensure the provision of true continuity of carer, where a woman chooses her midwife and that midwife cares for her throughout her pregnancy, birth and post natal period. 

It does however fall short of providing the option to birth at home. While a woman will be able to claim a Medicare rebate from a privately practicing midwife for all ante-natal and post-natal care, she will not be able to make a claim for services provided during a planned homebirth. In order to be financially supported by the government, a woman must birth in a hospital or birth centre.

In addition to the lack of Commonwealth support for homebirth, new legislation deems that it will be a criminal offence for any health professional to provide a service if they do not possess professional indemnity insurance.

From January 2010, midwives in private practice whom attend homebirths will, not only be excluded from any federal funding, but may also face criminal charges.

There are only a few options for publicly funded homebirth in Australia, so this policy, will effectively take away a woman’s right to choose where and with whom she gives birth. As midwives in private practice will be less likely to attend homebirths, women will be forced either to birth in a hospital or birth centre, or at home, unattended by a registered midwife. The Rudd government’s neglect in providing options for homebirth is discriminatory and fails to meet acceptable standards of duty of care for all Australian women. It puts both mother and baby at undue risk.

It would appear that according to our government it is acceptable to opt for an elective caesarian, in the absence of medical needs, but to experience a safe, intervention free birth, in the comfort and safety of your own home cannot be socially supported.

It remains to be seen whether or not the recommendations made by Nicola Roxon actually reach ground level of maternity services and it does not all end up as political tokenism. Hopefully, she can show true leadership by honouring the choice made by many women and their families to birth at home.

What you can do:

Make sure your voice is heard, contact the Maternity Action Coalition and register your support for their lobbying efforts to make prevent homebirth from being made illegal, sign on to receive action alerts and news items. You can find out what is happening in your particular region through the Maternity Coalition.

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