Turbulent times

A lot has been happening in the world of homebirth and midwifery. Many will have read the articles about homebirth, freebirth, midwives and maternity care that are appearing in our papers on a daily basis.

I have not posted for a couple of weeks now, for three main reasons: one I have been really busy with my practice which has not been this busy for about two years. Second, I attended the Australian College of Midwives National Conference - the ACM worked really hard to deliver an excellent conference that was appreciated by all. I had the fantastic opportunity to meet midwives from around Australia and share ideas, discuss practice and talk birthy things. I was pleased that the conference was in Sydney, because as those of you who know me will know, in my non-midwifery life I rescue and care for injured and orphaned native birds, and so I was able to make a trip home most days of the conference to feed everyone at home. They were hungry but they all survived! I digress. The third reason for not posting was that the recent issues have made me re-assess things like responsibility, accountability, safety, choice, control, autonomy, beneficence, informed decision-making and many other issues. I have no answers to report. Just lots of reflection.

Midwifery and maternity care are going through turbulent times and as professionals and organisations, I feel that we have done a major disservice to women that they feel safer birthing at home - with or without a registered midwife - in the presence of risk factors - because they so strongly believe that the hospital system will not enable them to birth in the manner of their choosing. It is a sad reflection on the health system and the professionals who work within it. Women who cannot access midwifery care because they are planning a VBAC. Women who are told that if they insist on birthing vaginally with twins, they must accept continuous monitoring, induction, epidural and birth in stirrups for twin two. Women whose only option is to birth in a hospital that is two hours from their home. We have all heard the stories.

My biggest disappointment is the lack of midwife admitting rights. We are one year into the maternity reforms on November 1 this year. We have eligible midwives with Medicare provider numbers, ordering tests and working with doctors to provide safe care to women and babies - yet we cannot access hospitals to provide this care. I well understand that there are a lot of hurdles to be overcome with midwife admitting rights, and life has taught me that nothing in life is impossible.

The release of the homebirth position statement - which I fully support as an evidence-based and safe way to provide care - combined with the lack of midwife admitting rights, is disastrous for women and midwives. Higher risk women are forced into a position of birthing in hospital without their midwife if the midwife complies with the position statement but has no admitting rights - otr else freebirthing, potentially with disastrous consequences. Overnight, this change occurred and women are fuming.

It is impossible to believe, but an eligible midwife who crosses all the "T"s and dots all the "I"s will suffer incredibly in terms of restriction of clientele, however if she were to remove her name from the register - something that I understand is very easy to do - she may do just as she pleases with no accountability, regulation or practice standards. Midwives are placed in the untenable situation of a dwindling practice, or unregistering and having a flourishing practice. Until admitting rights are in place, midwives will have no place to birth with their higher-risk clients. This situation does not see the Government supporting midwives or women. It is creating a disaster.

The various politics of homebirth and midwifery has created an enormous rift between midwives. It seems that there are the bunch who have elected to become eligible, forge ahead with collaborative arrangements, push for admitting rights and accept the increased regulation that is upon us as our profession matures. The other group opposes the increased regulation and restriction of choice, supports midwife- (or non-midwife)-attended homebirth for any woman who wants it and really wants things to just go back to how they used to be, before insurance became mandatory. Many midwives sit comfortable in the middle of this debate. It is sad to watch such division and animosity amongst midwives. We seem to lack a capacity of saying, "We don't share each other's vision and we have made different choices, but we are midwives and we will support each other". As one midwife said to me, "We are each doing the best we can for the women we care for and we're making the best of a rotten situation".

I know 2012 will be better than 2011. Who knows? Maybe it'll be an historic year where for the very first time, women will birth on their own terms, with their chosen midwife, at home or in hospital. I wonder how many women will insist on homebirth in spite of significant risks, if they are able to birth in hospital with their own midwife and in the manner of their choosing.

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