Rules on patient safety hit midwives

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Homebirth supporters claim bureaucrats are restricting women's choice by stopping some midwives from managing higher-risk homebirths, particularly women who have had a caesarean delivery.

Homebirth Australia said it was aware of more than 20 recent cases ... where midwives had been deregistered or had conditions imposed on their registration because of claims they were working outside safe guidelines.

... The Weekend West is aware of a WA midwife who was ordered last week to stop providing care for planned homebirths in women at higher risk, including those who had a caesarean and wanted to have a normal birth in the next pregnancy.

The Australian Health Practitioner Regulation Agency wrote to the midwife, saying the condition was imposed by the WA Nursing and Midwifery Board because the midwife had not proved he or she could provide a safe homebirth environment for a planned vaginal birth after a caesarean.

"The board formed the reasonable belief that because of your alleged conduct issues, you pose a serious risk to persons, and it is necessary to take immediate action to impose conditions on your registration to protect public health or safety," the letter said.

... the move could force women to have unattended homebirths, putting them and their babies at risk. "We can't by stealth deregister or pose conditions on midwives which rob women of access to a registered health professional," she said.

Australian Medical Association WA president Dave Mountain ... questioned whether the health system should allow higher-risk women to exercise the choice of homebirth when there were clear risks for them and their babies.

What a huge ethical debate - largely unresolved. All women have the right to autonomy - the right to make choices, have control over what happens to their body, to accept or reject advice and interventions, to decide when, where and by whom they will be cared for, to access care - or not. It is a fundamental human right that is enshrined in law.

On the other side - the health practitioner has a duty of care to the woman and her unborn baby and is obliged to provide safe care at all times. Safety is defined in terms of what the average midwife would do, or by accepted professional standards, or by laws relating to practice. A health practitioner cannot be incited to practice unsafely: they must make a judgment and adhere to professional standards.

So where does this leave us all when the two positions collide? Although we have guidelines on what we ought to do in those situations, as we can see from the above article, they do not hold water. The consequence for now is an increase in the number of women opting to freebirth - that is an unassisted homebirth (no midwife present). I am hopeful that in time, the regulatory authorities will support midwives to support all women.