What is the Future of Having a Home Birth in Australia?

Question:
Will I be able to have a midwife legally attend my homebirth after July 2010?

Answer:
Maybe.
The Government has granted ‘eligible’ home birth midwives exemption from the compulsory requirement for Professional Indemnity Insurance (PII) that will come into place in July next year ( from July next year midwives need PII to register and so practice legally and as it stands right now there is no available PII for midwives). So according to that exemption ‘eligible’ midwives will be able to attend home births, within a ‘still to be’ designed ‘framework’, without PII and not be breaking the law. The Government is currently in the process of deciding who an ‘eligible’ midwife is and what the ‘framework’ is. There is lots of speculation about the framework, it will probably be based on the medical model of risk and exclude certain women from home birth. How far this exclusion goes remains to be seen, it will undoubtedly exclude breech presentation, twins, most probably VBAC (Vaginal Birth After Caesarean), and may even exclude first babies.

This PII exemption for home birth midwives is being seen by supporters of home birth as a move of home birth from one ‘too hard basket’ into another. Some midwives are glad about it because it enables them to continue practicing the way they currently do without strict rules about who can have a home birth or not (although the ‘framework’ may have a big effect on that) and others are unhappy with it because they feel all women deserve the protection of PII. This has also been the feeling from Consumer Groups – home birth mothers and fathers active in the political arena, as they ask – why should we be the only group of birthing families with out the protection PII offers everyone else?

The big picture of what’s going on is that the Government is at the drawing board figuring out how to implement the recommendations from the National Maternity Services Review that was done last year. Eventually what will happen will be access to midwife care under medicare for Australian women. This is a wonderful thing and brings Australia up to speed with other developed countries with maternity care services that work well. At the moment, however, it feels like home birth has been the bargaining tool that the powerful medical lobby groups have said ‘no way’ to and so its exclusion was used to get agreement with an increased role for midwives (which absolutely needs to happen to improve our maternity care services).

So, big answer to a simple question that is actually so complex and has within it the potential infringement of a basic human right, a woman’s right to choose where and with whom she gives birth. The relatively small numbers of women choosing home birth in Australia has been another reason used to try to ‘sweep it under the carpet’. However we know from other developed countries that when home birth as an option is more accessible (government funded, midwives available in all areas) the choice is taken up by more and more women (NZ home birth rate is 7%, Holland 30%). The question as to whether home birth is a safe option or not has been answered with a big ‘yes’  by many scientific studies over the last couple of years, so what stands between you having a midwife ‘attend’ your home birth legally after July 2010 is the current Government’s decision about who an ‘eligible’ midwife is and what the ‘framework’ for acceptable home birth women will be.

For more information about home birth, to stay informed of this process and to know what you can do to save your choice, visit www.homebirthaustralia.org

ADDIT
There have been new developments in the Government’s definition of “eligible midwife” – the latest addition being that the midwife must work with a GP or Obstetrician. How this will play out remains to be seen, however many folk know that doctors who support home birth are few and far between. And this development in the Government’s policy will put an end to private home birth midwifery as we currently know it.

So: Will I be able to have a midwife legally attend my homebirth after July 2010?
Only if the midwife works with a doctor and if you fall within the criteria of the potentially medically defined framework that the Government is still deciding on.

A sorry state of affairs.

Best wishes and love,
Jane