Until birth and death do us part

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

They are two of the most natural and common occurrences in the world - birth and death - and coincidentally how we manage both of them has come under fresh scrutiny in a matter of months.

We can agree from the start that few things in life are more predictable - people reproducing, in good times and in bad, and at the other end of the spectrum, every life coming to an end, no matter how much we fight it.

Yet they are not as straight-forward as they seem. They raise controversial issues, from rising caesarean rates and debate about the risks of homebirth, through to calls for voluntary euthanasia for the terminally ill.

And they raise important questions about how much should we intervene in these two most basic of events at the start and end of life.

In particular, what is the role of medical professionals in both?

A few months ago the euthanasia debate was reignited in WA when Greens MP Robin Chapple sought to push a Voluntary Euthanasia Bill through State Parliament. It did not get the backing it needed and some senior WA doctors even threatened to quit medicine or boycott the laws rather than support legalised euthanasia.

In a candid moment, Health Minister Kim Hames admitted he once administered a potentially lethal dose of morphine to a terminally-ill patient but believed he stayed within the law and denied it was a form of euthanasia. He was making the patient more comfortable, not assisting in a death.

Interestingly, some doctors claimed the legislation was incompatible with their responsibilities as doctors and queried why they should have special authority to end a life, by virtue of a university degree and the ability to draw up a syringe.

Only weeks after the euthanasia debate went on the back burner again, the issue of how we manage childbirth and promote the various options for women also hit the headlines, when some doctors complained about a WA Health Department website.

The Australian Medical Association claimed the site provided a link to the Community Midwifery WA website which had misleading information about homebirths. The department defended its support of midwives but the information was modified to appease doctors.

But last week there was more controversy. Leading WA child health researcher Fiona Stanley waded into the homebirth issue, defending its safety record and calling on obstetricians to relinquish more low-risk pregnancies to midwives.

That in turn prompted the AMA to warn about the higher risk of death and complications in babies born from planned homebirths.

Meanwhile, a retired WA obstetrician has quietly self-published a book, Too Many Caesars, Not Enough Joy, which laments the overmedication of childbirth.

Like many of his colleagues, Ralph Hickling has seen plenty of babies born and has not tired of the wonder of a new life coming into the world.

But over the years before Dr Hickling retired from practice in 2002, he became increasingly concerned about the rising caesarean rate, and the medical domination of the whole management of pregnancy and childbirth.

Dr Hickling says childbirth has been taken over by consumerism. He says that if an obstetrician in 1960 was told that in 50 years time the caesarean rate would be more than 30 per cent, he or she would have been incredulous.

He is a strong supporter of Community Midwifery WA ...

"Childbirth, when all is said and done, remains very much women's business and that means women not only distinct from men (but) also from doctors and scientists, politicians and bureaucrats," he says.

Dr Hickling, who has four children and 11 grandchildren, including one born at home, defends the right of women to choose less orthodox places to have their babies.

"If there are more risks if you have baby at home instead of hospital, they're certainly within what should be the discretion of the woman herself and it's not right to deprive her of that choice," he says.

Perth GP and health commentator Joe Kosterich sums up the recent debate on birth and death, arguing it says a lot about how people want to "come and go".

He says wherever possible most people want to be surrounded by family and friends, and not machines and depersonalised care.

Melissa Maimann, Essential Birth Consulting 0400 418 448