Choices for Childbirth: Are women being sidelined again?

For further information about childbirth choices, contact Melissa Maimann at Essential Birth Consulting. Link

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 ... and dissatisfaction with the birth experience. The impact of a negative birth experience ... can deeply affect the mother’s ability and confidence in early parenting.

However, because these cannot be measured quantitatively, they don't "count" as much as stats around mortality and morbidity. Yes, Australia is one of the safest countries in the world to have a baby. But not when you use more qualitative measures. Our dissatisfaction with the current delivery of maternity services as evidence in the recent Maternity Services Review adds strength to the push for midwifery services that recognise women as people. I read several of the submissions. Now all, but many. And I did not read one submission from a woman who had recieved private obstetric care and wished that all women had that option. Yet I read many, many submissions from women who had benefited from private midwifery care and wished that it was an option for more women.

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.’

... 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.

... 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 ... Hopefully, she can show true leadership by honouring the choice made by many women and their families to birth at home.

The finer details of insurance and funding have not been determined at the time of this posting. Most likely, private midwifery for home birth will continue to remain an option, albeit unfunded and uninsured. Although it may be seen as discriminatory for the govt to fund most - but not all - birth choices, does the govt have a duty to do so? I thought the govt had a responsibility to provide a basic and safe level of maternity care. The changes that are proposed in the MSR will allow women to access contiuity of midwifery care for hospital birth and this represents a significant improvement on our current (woeful) services.

Melissa Maimann, Essential Birth Consulting 0400 418 448