Interesting story from the ABC. Have a look at it and then read this.
I’ve never really understood why Australia doesn’t offer many home birth services in the public system. They are available through in some states, the last time I checked, but it’s a tiny percentage and it’s not really supported.
Clearly not every woman is suitable for a home birth. They’re not. I’ve had some women suggest that they want a home birth to me, who are completely inappropriate and I have said no, gone through every bit of evidence and we have eventually come to a respectful, working in partnership decision. Just for the record, I would never put a women or baby at risk. Ever. Sometimes you must say no.
This is my definition for offering safe home births.
- A public system that has groups of qualified, experienced midwives with excellent clinical skills, an experienced manager /supervisor of midwives, regular weekly meetings to discuss case by case, excellent ongoing education, correct and appropriate equipment, risk assessment and management (read normal, normal, normal), referral to hospital care if any changes to risk throughout the pregnancy, ambulance awareness (call ins to report location and home birth occurring).
This is the norm in many countries around the world. Highly experienced midwives offering excellent midwifery care and referral if needed, supported by the system. Independent midwives work like this too ( look at NZ).
For years, I have tried to understand why this seems so difficult in Australia.
The answers I’ve got are – Well, we just aren’t set up the same as other countries. What does that even mean? Does it mean that we don’t have highly qualified midwives capable of doing the job? I think we do, although it’s worth considering that most student midwives I have ever met have never been to a homebirth or completed a year in community midwifery, to attend home-births, and learn all the antenatal and postnatal care along the way. They might get a bit of time doing that but a year would be good, with home-births included.
Incidentally to go out as a community midwife in England, you would have to have a good few years of birth suite experience under your belt along with excellent cannulation skills, suturing, advance life support and maternal/fetal emergency skills. It’s not for the faint hearted. You need to know your stuff. We can teach that with good programmes. Supported programmes.
The other comment I’ve heard is… Well Australia is too big, everything is too far away from hospitals.
I live in Brisbane… I’m like no! I don’t think that one holds up. True in regional areas it’s a bit different. Not all, I’ve worked in regional areas and there have been excellent small country hospitals with doctors, theatres and birth suites. There have been some problems with providing services in some areas for sure.
- Note to docs, get out to the countryside… there is a whole other argument about this though, it’s hard to get doctors out to regional for all kinds of reasons.
There is a lot to be said for providing midwifery led care in outback/ regional areas and I’m thinking especially about indigenous women who don’t want to travel to a metro area for a few weeks to give birth. Its culturally important that they give birth on country. Listen to THIS.
If we can provide that service for low risk pregnancies we should.
I can’t think of a reason why we wouldn’t be offering home births publically. In terms of independent midwives (those who work outside of the public system), I’ve known a few and I feel for them. I think they are completely committed to giving women access to one on one midwifery care and homebirth. Most I have met have been excellent.
I’ve met the midwife in this story but I don’t know her personally. She has transferred women in to me on a couple of occasions when I oversaw the birth suite. I found her decision making and clinical skills to be excellent, her records to be excellent and her handover to be excellent. Completely appropriate transfers. It does feel like a witch-hunt for these independent midwives and now with the insurance issue its getting even harder.
It is worth noting the comments from the obstetrician Prof Wallace, “the catastrophic events that happen in a split second happen at home and in hospital”.
Sometimes tragic events happen at home, but they also happen in hospital. It isn’t anyone’s fault. Bad outcomes happen. As he says, there is no evidence to show that less babies would die if women were in hospital.
Of course, some women would like to birth in hospital. That’s excellent and they can but unfortunately, so many women feel unsupported by the system, can’t afford a home birth midwife and so decide to freebirth without any assistance at all. This is a tricky one as I think some women will just do this anyway. In my experience having delivered hundreds of babies, most of them just come out, are fine and that’s that.
Some don’t though and need assistance with the birth, resuscitation etc. Some women bleed or have other complications. You really want someone there then. What you really want is that highly qualified community midwife I was talking about earlier. Some women want this. They want to birth at home in their own comfortable environment with an excellent midwife. I’m also not discounting excellent independent midwives for this job.
Home birth has been proven to be safe time and time again and less expensive to the healthcare system. Women would like to have the choice. A safe choice, without being judged. A choice which they may not take, may be advised not to take but work in partnership to make a decision about.
What we could go on to talk about, is the appalling state of staffing levels in our maternity departments. This is the public health crisis. We could spend all our time denying suitable women home births and going on witch hunts for midwives, or we could mention the fact that some maternity units are so short staffed that it is dangerous daily for women to birth there. I’d wager that you would be safer with a one on one community midwife than in some birth suites these days. These hospital midwives give the most excellent clinical care and are a total credit to the system, but they are consistently fearful that despite all their efforts they are not always working with a good staff to patient ratio. This is true and its dangerous.
We live in one of the most developed countries in the world but we haven’t got the system right. Fix the system, put more money into healthcare, and then bring in some good programmes for midwives and for women.
My heart breaks for any woman who makes a choice to freebirth just because they felt they didn’t have any other option.