The Future of Home Birth Continued
The Future of Homebirth continued
So, the plot thickens or thins, depending on your perspective!
Its easy to imagine a conspiracy theory here, or maybe its just plain bad planning and misinformation on the part of the government as they try to implement a plan that was never going to support the choice of home birth, whether they realised that or not.
In a matter of weeks the new midwifery registration process is in play (from July 1) and midwives need to buy Professional Indemnity Insurance (PII) to qualify for registration. If they don’t have it they can’t be registered, and if they practice – call themselves a midwife and do midwifery categorised activities – without being registered, they are breaking the law. The insurance products are not all ‘on the table’ and the two that are, one government, one other, range in price from $7500 to $2500. Neither cover for homebirth. The $7500 is for pre and post natal care and a hospital birth, the $2500 is just for pre and post natal care. So homebirth midwives need to buy PII to be able to register as a midwife and provide pre and post natal care and will be exempt from the need for PII for homebirths.
However, it looks like exemption from needing PII for homebirth, will only happen if the midwife’s practice is within certain ‘guidelines’ and this determines which women she is ‘allowed’ to provide care for and which women she is not. If her practice is not within these ‘guidelines’ she voids her qualification for exemption of PII for attending that homebirth, and so then is practicing outside registration requirements and conditions, which results in risking de-registration or other restrictions.
All of this has been designed with a new private midwifery care model in mind, this midwife’s role is to provide pre and post natal care in the community (in the woman’s home or the midwife’s clinic) and then accompany the woman in labour to hospital (or meet her there) for the birth. Her practice would be similar to what happens in a hospital, ie within certain guidelines that are an obstetric model of care rather than midwifery. This midwife’s fees will be covered by medicare, and all this will be in place (supposedly) by November this year. Hospitals will need to give these midwives ‘visiting rights’ similar to GPs and Obstetricians. It’s a great move, but excludes homebirth.
So, as ever, birth, and especially homebirth, is a political act. And the current situation is limiting a woman’s choice of where and with whom she gives birth – a basic woman’s right – and is limiting a midwife’s practice, making it against the conditions of her registration to attend women who fall outside the current guidelines. If these guidelines are adopted as restrictions and conditions for homebirth, then this removes the choice of a midwife attended homebirth for these women – previous caesarean, previous postpartum haemorrhage (PPH), pregnancy beyond 42 weeks, asthmatics, rupture of membranes before 37 weeks, ruptured membranes for longer than 18 hours, breech, twins, 6th or greater baby, and many others. At face value this may seem sensible, reducing risk to mother and baby, however more often than not, many of these situations or conditions do not create extra problems but are ‘managed’ in hospital in a way that often causes more problems. And many women choose homebirth to avoid the unnecessary obstetric intervention that so often accompanies hospital birth. This is the case especially for VBACs, (the evidence for the safety of VBAC exists) previous PPHs that may have been caused by mismanagement anyway and wouldn’t happen again and many others. Birth works. 85% of women are capable of giving birth normally without medical intervention, however if they are subject to unnecessary medical intervention, masquerading as safety, then what so often happens, is that the normal process is interfered with and won’t progress without further intervention. Women choosing homebirths and midwives providing that care are avoiding unnecessary intervention not rejecting what is necessary should a situation arise.
These conditions, if they are adopted, would void the rights of a woman to choose a midwife attended homebirth and the rights of the midwife to practice the internationally defined role of midwife. But maybe this will change and a woman’s rights will be honoured and a midwife’s duty of care will reign. We’ll see.
Jane Hardwicke Collings