Big hurdle for home births

Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448. Link

Private midwives have "yet to find" a doctor willing to engage in arrangements to gain access to Medicare rebates and the Pharmaceutical Benefits Scheme ...

The college [of midwives] is building a case against the incoming arrangements ... College members were asked to provide evidence of their difficulties in getting doctors to sign on to collaborative arrangements, in the hope of showing the new rules, which take effect from November, are unworkable.

President Hannah Dahlen pointed to the recent overturning of near-identical legislation in the United States, where "doctors were increasingly unhappy to sign contractual arrangements with midwives because they were worried about their own liability".

"Doctors are quite happy to collaborate with us, but they don't want to put their name on a document because they're worried about their own vulnerability. They're quite rightly saying 'what's in it for us'," Professor Dahlen said.

The new rules are believed to be the result of lobbying by medical groups opposed to home births.

... Nadia Szimhart ... gained access to [a] fledgling publicly funded home birth service ... and gave birth to Hana Lanceley at home on January 28.

The experience was "absolutely beautiful", but was possible only because hers was a low-risk pregnancy which met very stringent eligibility requirements - more strict than those of most private practice midwives.

Ten babies have been born through the publicly funded service since July 2009, with another six births expected by the end of 2010.

Private practice midwives are the only other option for women who want a home birth but don't meet the public system's stringent guidelines.

"The regulations being put in place are going to make it difficult because most of the doctors I have spoken to - including my GP - don't agree with home birth," Mrs Szimhart said.

The public models for homebirth have very strict entry requirements, and once accepted into the program, women must remain absolutely low risk of they will be asked to birth in hospital. Private midwifery care affords women are better guarantee of a home birth with lower transfer rates. Transfer rates for public programs range from 37% - 50% whereas private midwives have transfer rates of 5% - 20%.

Medicare funding was only meant to cover hospital birth, not homebirth. However, the catch is that doctors will not sign agreements with midwives who attend homebirths at all. This forces midwives to attend either home births or hospital births. This model does not provide for continuity of care and does not reflect the fact that along the pregnancy - birth continuum, some women will start out wanting a hospital birth and change to a homebirth later on, while other women will plan a homebirth but end up birthing in hospital.

Melissa Maimann, Essential Birth Consulting 0400 418 448