… Under the draft laws, midwives must be insured to join the register but private insurers no longer provide cover for homebirthing and the government has also refused to subsidise professional indemnity for homebirth claims.

As a result, up to 200 independent midwives faced deregistration from July 2010 and, if they continued working, risked fines of up to $30,000.

… following a meeting of state and territory health ministers … Nicola Roxon announced a two year exemption from holding indemnity insurance for privately practising midwives who can’t obtain cover for attending a homebirth.

To take advantage of the exemption, homebirthing midwives will be required to tell women they are not insured, report each homebirth they attend and participate in a quality and safety framework which will be developed after consultations led by the Victorian government.

… “I was concerned that as an unintended consequence of the national registration and accreditation process that homebirthing may be driven underground, that that would not be a good outcome.

Health Minister Nicola Roxon announced privately practising midwives would have a two year exemption from obtaining medical indemnity cover.

… Under the deal announced today following the Health Ministers conference in Canberra, midwives will be able to keep practising homebirths provided they warn expectant mothers they do not have insurance, they follow quality and safety guidelines being developed and each homebirth is reported to health authorities.

She was referred to the hospital several days ago because of unusually sharp pains in her abdomen. There is no nurse or doctor in Msisi’s village, only a health officer with some basic medical training. Fearing the worst, he sent Msisi in a taxi on the nearly hour drive to Wayali.

She was found to be having a false labor and was treated at the hospital, but is being kept there until she gives birth. If Msisi goes home and a complication does occur, she may not be able to make it back in time.

“In the villages … If [pregnant women] are hemorrhaging they are transferred here but sometimes they die before they leave …” …

According to the most recent maternal mortality data … 578 women died in 2004 per every 100,000 live births, and that rate has increased since 1999.

World Health Organization data paints an even bleaker picture, listing the Tanzania maternal mortality rate for 2005 at 950 deaths for every 100,000 live births. In comparison, the United States had 11 maternal deaths for every 100,000 live births in 2005.

… The leading cause of maternal death in Tanzania is excessive bleeding before or after birth … Infection and high blood pressure also cause many maternal fatalities …

… “In the rural areas [it is] an average of 5 to 10 kilometers for someone to walk to the nearest health facility …” …

… the ministry is planning to have a dispensary and health officer in each village, and is upgrading some dispensaries to health clinics, which can handle minor operations. The country is also working to train more health professionals to ease the dire nursing and doctor shortage in the country.

Assistant medical officers, with three years of medical training, have had to take up many of the responsibilities of doctors in Tanzania, and perform about 80 percent of cesarean sections.

… About 53 percent of deliveries in Tanzania are attended by unskilled people, while 47 are attended by skilled health care professionals …

“… [traditional healers] are a necessary evil,” … because there simply are not enough health workers and some people only trust healers. In response the government is trying to provide some training to traditional healers, teaching them to recognize danger signs and providing them with antiseptics.

… maternal deaths are “just a part of life” and she estimates the Morogoro hospital sees as many as 20 maternal deaths in a month.

… “You could have three or four birth on one day,” Massi said. “Sometimes if they are rushing they can’t sterilize the equipment between births so that is dangerous.”

… While assistant medical officers are an important resource, Im says she gets angry when she sees women suffering with botched cesarean sections, which should be a simple operation.

Petah Kimm died in June 2006, when her blood pressure suddenly dropped just hours after giving birth by caesarean section at Nepean Hospital …

… a medical emergency team was not called when Ms Kimm’s blood pressure dropped …

… nobody had checked on Ms Kimm until two hours later, when she was already dead.

A student midwife, who had checked on Ms Kimm, had failed to notify an experienced nurse when her blood pressure dropped, the investigation found.

Nurses were also concerned about the amount of blood Ms Kimm had lost during childbirth.

Anaesthetic nurse Denise Johnston and ’scrub scout’ Rebecca Roseby both gave evidence that they noticed a “significant” amount of blood … when they were transferring her from the operating theatre to the bed.

… She had raised her concerns with Dr Ralph Nader, who had told her it was not a concern …

… she died from soft-tissue haemorrhage after the caesarean birth, and that morphine toxicity might have been a significant contributing factor.

… doctors would give evidence that the amount of morphine injected “seemed to be sufficient … in the resulting of her death”.