Wednesday, December 23, 2009

homebirth with public hospital funding in Victoria

This news appears in The Age thismorning.

Home-birth boost for expectant mothers

December 23, 2009

VICTORIAN women will be able to give birth at home - with hospital back-up for the first time - under a pilot project starting at three hospitals next year. [... continued]

"with hospital back-up for the first time" NO! Victorian women planning homebirth have had hospital backup arrangements for as long as anyone in the business can remember.

with hospital/government $$$ (Mother does not pay any fee) for the first time YES

* Some women who have previously not been able to afford the cost of homebirth with a private midwife will now be able to access this service through their local hospital, if they live within reach of Sunshine in Melbourne's Western suburbs, or Casey, in Melbourne's outer South-Eastern corridor.

* Some midwives who have not been able to work independently in private practice will be able to access this service, and extend their practices, providing primary maternity care for individual women (caseload) through their local hospital, if they live within reach of Sunshine or Casey hospitals.

This homebirth service is a pilot scheme, which means the scheme will be evaluated before a decision is made to continue it or cancel it. The newspaper article (I haven't been able to find a press release from the Department yet) tells us that it's a one-year pilot, that would provide services for about 50 women at each site. That's a caseload that two midwives could easily cover, working part time for the pilot, and taking some private bookings at the same time.

"A regional health service will also participate, but the Government has yet to decide which one." - we will let readers know as soon as the news is available.

Thursday, December 17, 2009

A quiet backflip

A letter from the Health Minister, received only yesterday, has been posted on the Senate Community Affairs Committee site. Click on the image to enlarge it, or go to the committee site.

While many readers will be pleased to read this message from Nicola Roxon, that " ... I am persuaded that it is not necessary or desirable to proceed with the collaboration amendments.", there are many questions that remain unanswered in this botched attempt at maternity reform.

"However, after further consideration of the issues raised by stakeholders in relation to access to professional indemnity insurance and subsequent registration under the National Registration and Accreditation Scheme, I am persuaded that it is not necessary or desirable to proceed with the collaboration amendments to the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009."

Senate hearing today

The Senate Inquiry into the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and two related Bills is being undertaken today.

To listen to the live webcast from 9am click here or here if that doesn't work

Submissions are online

As a result of stakeholder pressure, Health Minister Nicola Roxon has informed inquirers that the amendments will not proceed. In a letter dated 8 December 2009, Minister Roxon states:
“However, after further consideration of the issues raised by stakeholders in relation to access to professional indemnity insurance and subsequent registration under the National Registration and Accreditation Scheme, I am persuaded that it is not necessary or desirable to proceed with the collaboration amendments to the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009.”

This fact has been reported on by Family First Senator Steve Fielding in a press release

The silence of the government, prepared to do a quiet backflip, and hoping that noone in the media will pay any attention, is noted.

Tuesday, December 15, 2009

19 midwifery academics speak out in Crikey

Midwives damn AMA-induced amendments to maternity reform
by Professor Lesley Barclay and Professor Sally Tracy

Senior midwifery research academics, including 19 professors and associate professors of midwifery, have signed an open letter raising serious concerns about the newly proposed amendments to Health Legislation (Midwives and Nurse Practitioners) Bill and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill.
... Crikey

Friday, December 11, 2009

Report on Stakeholder Forum

MiPP was represented at the meeting in Canberra yesterday, as a stakeholder providing input to the National Health and Medical Research Council (NHMRC) in its task of developing multidisciplinary guidance for collaborative maternity care arrangements.

The 'guidance' is to support the new legislation enabling midwives to access MBS and PBS in November 2010. I am not sure what's the difference between guidance and guidelines.

Questions put to the invited stakeholders were:
1. How does collaboration work now?
2. What does/can collaborative maternity care mean?
3. What are the essentials?
4. How do you create and maintain collaboration?
5. What are the opportunities to review and monitor collaboration?

This meeting was funded by the taxpayer through NHMRC. Celebrity host Norman Swan acted as facilitator. The 'guidance' that will be produced as an outcome of this meeting will not have any power in the laws governing midwifery practice.

Participants were seated at round tables. Places had obviously been carefully appointed. Midwives, consumers, obstetricians, academics, GPs, paediatricians, and bureaucrats were mixed and matched in an interesting way. I was positioned next to a previous head of RANZCOG, and a young female GP Obstetrician from Tasmania. Also at my table were a couple of very articulate consumers, one of whom had a delightful baby with her, the CEO of the Commission on Safety and Quality in Health Care, and a privately practising midwife from Sydney. Ann Catchlove, who was representing Maternity Coalition Victorian Branch was placed next to Dr Andrew Pesce, also known as Mr 3am.

Many conversations ensued about the questions of the forum, as well as other issues. Although the 'h' word, 'Homebirth' was not the topic of the day, it was mentioned frequently. So many people giving their time to discuss a matter that affects a tiny proportion of midwives and births.

A large Discussion Paper had been distributed for pre-reading. This document attempted to tease out the arguments, and referred to its review of the literature, without quoting references, and its 'consultation comments' some of which could have come from the DoHA tea room or corridor.

An attempt was made to identify principles that define collaboration in maternity services. The principles, which will probably be further refined, include (not necessarily in order of importance):
[comments and discussion are welcome]
1. Care must be woman-centred, culturally responsible, acknowledging a woman's right to autonomy, as well as the rights of professionals, and be coordinated according to the woman's clinical need.
2. evidence informed care appropriate to the local environment.
3. enable women to make informed decisions by providing evidence-based information, agreed to and endorsed by professional and consumer groups.
4. communication strategy
5. safety and quality framework to support all clinicians in it, including data monitoring, regular multidisciplinary audit (a process inclusive of consumers) and public reporting.
6. requires participants to respect and value each others' roles, provide support to each other in their work and provide education to meet those ends.
7. committed to joint education, trainign and ideally research focussed on improving outcomes.
8. provide to women continuity of care through pregnancy , birth and the early postnatal period as well as clear description of the roles and responsibilities of the person they identify as their primary maternity care coordinatior.

Some statements in the discussion documents were, in my opinion, plain group-speak eg "... the overarching principle that pregnancy, birth and the postantal period are normal physiological processes ..."

In many cases birth particularly, and subsequently the postnatal period, are not at all physiological. In fact, physiological births are not common in our world. The statement would have been more acceptable if "can be" replaced "are", and the document acknowledged the importance of the physiological process for health and wellbeing of mother and child. World Health Organisation (1996) states "In normal birth there should be a valid reason to interfere with the natural process."

A suggested draft definition of collaborative care is (in the discussion document)
"Collaborative maternity care involves collaboration with the woman and for the woman ..."
I disagreed with this statement. The relationship of a professional with a client, in this case, a midwife or other maternity care provider with a woman, is not collaboration. The midwife needs to collaborate with other professionals, while acting in a professional partnership with the woman. The woman has the right to disagree with the individual or collective wisdom of professional care providers, and the care providers have responsibilities to accept and respect the woman's decision. This is woman centred care. We can't place the woman as part of a collaboration with professional care providers, then place the collaboration at the centre of the care. There is no equality either in position or power in that relationship. The woman's rights and responsibilities are separate from professional collaborations.

There was no mention of the RANZCOG position that the obstetrician is the ‘designated clinical leader’ in all collaborations. The heirarchial nature of the obstetric model appeared to be overruled by the group, with the phrase "primary maternity care coordinator" being applied to the one professional person who provides care for the woman throughout the episode of maternity care, and who the woman identifies as her leading carer.

Discussion took place about the ACM National Midwifery Guidelines for Consultation and Referral, particularly with reference to the RANZCOG refusal to adopt these Guidelines. It was indicated that RANZCOG objected to what it considered a lack of consultation in the development of the guidelines, rather than the guidelines themselves. Interesting!

There was too much idealism, and too little factual reality in the room. In the discussion on continuity of carer it seemed that everyone wanted to jump on the bandwagon. Someone suggested that obstetricians, registrars, residents and even medical students would like to get to know the pregnant woman. Never mind what that would mean to the woman! How many prenatal visits would she need? Would everyone then commit to being with her when her time came to give birth, and also commit to working in harmony with her natural intuitive processes, unless there was a valid reason to intervene? I don't think so.

The facilitator had no idea of the extent to which midwives collaborate, nor did he seem interested in knowing what happened. He had an agenda - to get this mob to collaborate. And he was 'gunna' make it happen 'by hook or by crook'.

In this reform process a meeting like this one can be used as evidence of consultation with stakeholders. It can also be a box ticking exercise - yes, stakeholders have been consulted.

A further comment on insurance and practice issues can be found at Joy Johnston's blog.

Sunday, December 6, 2009


[Letters and emails, Sunday Age]
Midwives as well as mothers are facing an umprecedented attack on freedom and equity in maternity care. Nicola Roxon cannot be allowed to proceed with her plan to require, in law, a written collaborative (read supervision) arrangement between a private midwife and a doctor. Roxon's madness seems to be a special mix of listening to advice from those who have the most to win, while ignoring logic, good sense, mainstream professional advice, and the pleas of thousands of ordinary Australians.

In one way it's an extreme version of socialist health policy (the nanny state), for anyone who needs 'public' maternity care, while turning a blind eye to the absolute privilege (license to take what you want from the public purse) that has been extended to the obstetric profession for the provision of 'private' maternity care. The other provider of 'private' maternity care, the private midwife, is being bullied out of existence. The person taking responsibility for this 'achievement' is an obstetrician, who now heads the doctors' union, the Australian Medical Association.

Maternity issues don't usually get much press, but as you will see from the attached scan (click to enlarge), the Sunday Age has recognised Home Birth as THE BIG ISSUE - at least for today.

Tuesday, December 1, 2009

YOUR submissions are needed AGAIN!

To all the readers of this blog, no matter what your interest, please write to the Australian Senate (upper house of Parliament) and tell them why midwives must be free to practise MIDWIFERY, and women must be free to give birth under normal physiological conditions with a midwife in attendance.

The amendments to the legislation before the Senate will effectively prevent midwives from practising on our own authority, as it will mandate that a midwife has a collaborative arrangement with a doctor in order to practise privately.

Midwifery is a profession in its own right. Doctors do not practise midwifery, do not have any duty of care to promote and protect normal physiological processes in birth. That's what will be lost if this legislation passes.

We must all send submissions to the new senate inquiry.

For details click here.

Read through the instructions, and systematically comment on any discussion point that you consider important.

If you prepared submissions or calling cards previously you can rework these and email them to the senate committee before the cut off date 11 Dec.

Write to the Committee Secretary
Senate Standing Committee on Community Affairs
PO Box 6100
Parliament House
Canberra ACT 2600
Phone: +61 2 6277 3515
Fax: +61 2 6277 5829

Please everyone, give this priority. Your letter is important. Ask your friends and family to make submissions too.

Monday, November 23, 2009


"The Brumby Government recognises the importance of registering independent midwives in order to protect women who choose this maternity care option."

This statement appears in letters that are currently being received by people who write to the Victorian Health Minister, Daniel Andrews, with reference to the package of health 'reforms' applied to maternity services. Readers of this and linked blogs will appreciate the complexity of the changes that are only months away now, and the devastating impact these changes will have on midwives' ability to practise midwifery in our own right, and on women's ability to employ a midwife privately.

When I received a letter from Daniel Andrews with this statement in it, I paid little attention to it. I agree with statutory regulation of health professionals, including ALL midwives. The mantra, "protecting the public", can not be dismissed. Noone wants to see a health professional abuse their position of trust through either commission or omission. The various Acts and Boards that register and regulate health professionals' practice and education are an accepted and valued part of our society.

It was not until I saw another letter from Mr Andrews (attached - click to enlarge), dated 6 November 2009, in which the same sentence appears, that I considered it in another light.

It's not about registering midwives; it's about "registering independent midwives"

It's not about protecting the public; it's about protecting women who choose this maternity care option.

It's not about the general notion of statutory regulation in the public interest (which is what "protecting the public" means); it's a new level of government control in relation to "this maternity care option".

"This maternity care option" is homebirth with a privately employed midwife.

It is becoming more clear as time passes that "this maternity care option" will not exist lawfully in Australia after 1 July next year. The reform that is progressing through federal and state parliaments will not "protect women who choose this maternity care option"; it will protect the public FROM this maternity care option.

As has been demonstrated time and again, the outcomes related to planned homebirth with a midwife in this country and in other developed countries are exemplary. This fact seems to have been missed by the Minister. What is it about "this maternity care option" that he thinks he ought to protect women from? Is it the caesarean rate of under 10% for all women planning homebirth, compared with approximately 30% in the mainstream? Is it that women planning homebirth VBAC are very likely to safely achieve vaginal birth, compared with 20%-30% VBAC rates in private and public hospitals respectively?
[click here for more detail]

When the reform dust has settled it seems possible that a new hybrid "private midwife" may emerge. The Health Ministers have promised that their reform package will usher in a new era. This midwife is likely to resemble the obstetrician's handmaiden of the past: she will be required to work in collaboration with a doctor or doctors.

Collaboration with doctors is reasonable if a person (a midwife in this case) is supporting that professional in carrying out their professional practice. Collaboration with a doctor is reasonable if a doctor requires midwifery support in the care of an individual woman - as happens because doctors are far too busy to attend a labouring woman throughout the labour: that's the midwife's job.

A doctor is not educated in midwifery. It is not possible for a midwife to collaborate with someone who is not skilled in midwifery. It would be like requiring a dentist to collaborate with an orthopedic surgeon.

Readers who think I am being alarmist are welcome to leave your thoughts in the comments column. Joy Johnston

Friday, November 20, 2009

dear Ms Roxon

dear Ms Roxon
you have more than dampened expectation
you have sold out!
the agent of institutionalization
birth homogenization
increasing medicalisation
you have sold out!

you have sold out on women, responsible women,
rolling in their souls as they’re told to turn over
face to face upon the threshold of fate
in perfect season shall mothers move
instinctual as the sea, rising in swells

you have sold out on babies, innocent babies
stamped on arrival and sent to a future therapy
when life could begin with connectivity,
an hormonal shake, a firing of self
the triumphant love of making it!

you have sold out on fathers, husbanding fathers
bewildered by machines and expertly confusing jargon
men could march from history’s darkness
allied like earth to the clouds of their ladies
chest out upon a 3D engagement of the sacred

you have sold out on midwives, timeless midwives
subordinate to those with 15 minute timelines and pre-determined roads
when midwives could do the good work by just being there
‘women centred care’ is not an answer in a test
it’s what works best!

dear Ms Roxon
you have more than dampened expectation
you have sold out!
the agent of institutionalization
birth homogenization
increasing medicalisation
you have sold out!

dear Ms Roxon
our mobilization will not lie down.
the stirrups do not fit us.

[Viktor, November 2009]

Monday, November 16, 2009

birth statistics

I have looked at the new site

It’s a furphie to think that looking at the statistics enables a person to make informed decisions. The data must be interpreted and applied to the individual in order to contribute to decision making.

I do not support informal collections of birthing data. I’m happy for a site like this to link others to the sites where reliable data collections are accessible, and I’m happy for people to write their analyses of this data, but always giving reference back to the initial source. No data collection is perfect, and we need to scrutinise it carefully.

When I go to a website I am concerned about the reliability of the information and the accountability of the people who manage the site. I need to know who is behind it, and what processes the owners have committed to to ensure that the information is correct and timely. It's a huge task, with the potential to be either very useful, or to contribute to misinformation.

I’m not trying to support or bag the Victorian government for its data, but it’s not true that Victoria does not release information. If you go to you will find enough to study for as long as you have time. It’s not the simple numbers/percentages for each hospital, but it’s still very useful.

Independent midwives put our data up on this blog from time to time, and for some years we have published summaries in Birth Matters, the journal of Maternity Coalition. All midwives who send homebirth data to the government’s perinatal data collection unit receive a copy of the annual homebirth report, so you can ask any independent midwife to show you, and you can make copies. Each hospital also receives one of these reports that compares its own statistics with the data from the whole of the State.

The Victorian Maternity Performance Indicators are an amazing comparison between public hospitals – private hospitals are not given the same scrutiny, but are lumped together. We had a performance indicator analysis of planned homebirths for the past 5 years of data, and the outcomes are brilliant. Have a look at this blog.

One of the reasons the Victorian health department has not gone down the path of publishing simple outcome data is a concern that statistics can be skewed - not comparing like with like. So when the all planned homebirths in 5 years are analysed under performance indicator 'rules' the results become much more reliable and significant. This is the sort of result that should be trumpeted from the rooftops.

Joy Johnston

Tuesday, November 10, 2009

More from the rallies



Our message is clear:

Midwives and the women who employ us CANNOT ACCEPT the medical dominance over childbirth that is now being written into the laws of this country. The requirement that was last Thursday slipped into an amendment to legislation before the Senate, to require midwives to work at all times in formal collaborative arrangements with doctors as a condition of insurance, is thereby a condition of professional registration. It is very likely that this amendment will pass through the Senate without resistance.

Midwives do consult, refer, and transfer care to doctors when clinically indicated, and with the permission of our clients. This is the essence of professional collaboration.

The problem here is that when legislation makes it a legally mandated requirement for one profession to collaborate (midwives) and there is no requirement on the other profession to participate (doctors) we essentially have one hand clapping. (thans Liz for that word picture!) That will enable doctors to say which midwives can be insured, register and practice and that isn’t acceptable. It will also enable a medical veto of women’s choices that doctors do not agree with.

The passing of this legislation will effectively extinguish the right of ANY midwife in Australia from practising to the contemporary scope of a midwife's practice, as defined by the International Confederation of Midwives, and accepted internationally by health and obstetric peak bodies. This means that midwives can only exist in a restricted practice zone. Apart from concerns around workforce and professional career options, the safety and efficacy of such a model of care cannot be assumed.

We understand that our PM, Kevin Rudd, is "unmoved by protests". Until this outrageous situation has been fixed, we must continue to:

Sunday, November 8, 2009

APMA Media Release

Australian Private Midwives Association
Contact: National President Liz Wilkes 0423 580585

Medical veto impacts women’s access to care: Women Rally.

The Federal government may stall on the blocks of its first major initiative in health as the reform of maternity services hits stumbling blocks and criticism. Women will rally around Australia tomorrow to ensure choices are not lost in the wash up.

Liz Wilkes, National President of the Australian Private Midwives Association, will join women and midwives outside Kevin Rudd’s electorate office in Brisbane. Women are seeking assurances that new legislation around private midwives registration and practice will not reduce options for care.

“Midwives are educated and regulated to provide care for pregnancy, labour and birth on their own responsibility under the International Confederation of Midwives definition of a midwife,” Ms Wilkes stated “Suddenly we are told that doctors control the ship and that doctors will be able to decide who can do what.”

Legislation due before the Senate was amended on Thursday by the Government to require midwives to work at all times in formal collaborative arrangements with doctors as a condition of insurance. Doctors will be able to veto these arrangements effectively giving the medical profession the ability to control which midwives can be insured and register.

“The reform of maternity services is the first test of the Governments health reform agenda. It looks like the medical lobby may stall these reforms before they even get started.” Ms Wilkes said today “Placing one profession at the complete mercy of another for registration makes a mockery of professional regulation in this country.”

Women at the centre of the scuffle are concerned that the amendment may erode rather than expand choices as doctors make decisions about what types of care to support. Many choices such as homebirth, vaginal birth after caesarean and care in rural areas may be lost if doctors do not form the formal agreements with midwives.

“For the midwives who are currently self-employed it is no longer a matter of referring a woman who needs care to the appropriate person. Formal agreements with doctors will determine which of these educated, experienced and skilled midwives can actually register.”

Ms Wilkes added “Regulators should control midwifery professional standards, not how a doctor feels about a particular midwife. This takes midwifery back 50 years.”
Women are worried about the choices in birth and are calling on the Prime Minister to make sure that in implementing this first serious reform in health, options for choice are not lost.

Women rally at 10.30am November 9 at electorate offices of Kevin Rudd Brisbane, Julia Gillard Melbourne, Tanya Plibersek Sydney and Stephen Smith Perth.
Contacts: Liz Wilkes 0423 580585 (Brisbane and national) Marie Health 0407266004
(Sydney)Sally Westbury 0422 894 496 (Perth) Clare Lane 0416 130291 (Melbourne)

MIPP Calling Card to Julia Gillard

Deputy Prime Minister, Minister Roxon is not listening!!!

Midwives ALREADY provide safe care yet she continues to submit to the AMA demands.
MIDWIVES do not need medical supervision or permission to care for homebirthing women!

Babies born at home had similar Apgar scores to babies born in hospital. Less than 3% of babies born at home required admission to the special or intensive care nurseries compared to hospital born babies at > 15%.

Medical Observer, 6th November 2009:
"The amendments to the nurse practitioner legislation will come as welcome relief for doctors…AMA vice-president Dr Steve Hambleton, who sits on the Government’s Nurse Practitioner Advisory Group (NPAG), said the crucial amendment would ensure nurse practitioners were not supported to work in competition with doctors."
The amendments to the legislation will also apply to midwives.

The safety of women & babies is clearly not the Health Department's or the AMA's main priority. They care more about the perceived potential loss of income & loss of control over a woman’s basic right to choose how, where & with whom she gives birth.
[Calling Card prepared by Andrea Bilcliff]

Saturday, November 7, 2009


Monday 9 November 2009 from 10.30am (local time)

Rally points:

Prime Minister
Kevin Rudd’s office
630 Wynnum Road
Morningside Qld 4170

Deputy Prime Minister
Julia Gillard’s office
Shop 2, 36 Synnot Street
Werribee Vic 3030

Minister for the Status of Women
Tanya Plibersek’s office
111-117 Devonshire Street
Surry Hills NSW 2010

Perth: at 11.10am Perth Only
Office of Stephen Smith (most senior Gov member in WA)
953A Beaufort Street
Inglewood WA 6932

If you are unable to attend, please prepare your 'calling card' - a letter to Kevin, Julia, Tanya, or Stephen (or another member of the government), telling them who you are and why you can not accept maternity reform which prevents midwives from practising midwifery in their own right, and prevents women from giving birth in their homes with their chosen midwife attending them. Please email your letter to your midwife or someone else who is going to the rally, and ask them to give it to the MP concerned.

Anyone who would like their calling card to appear on this blog, please email it to


I want to encourage midwives to go to the rally, and to make sure your banners and calling cards state clearly that you are not happy with what this reform is doing to you – as a midwife.

The midwife’s livelihood is at stake, and we need to be heard. The whole profession of midwifery stands to lose our right to practising on our own authority in any setting.

Friday, November 6, 2009

Excerpts from Julia Gillard's speech to midwives in 2005

I hope you will enjoy hearing the Deputy PM saying that she is concerned that midwives have:
“limited opportunities to practise as primary carers and provide continuity of care to women”
“Unless and until the Government is shocked and shamed into realising that Australian women … blahblah”
“I believe that midwives … are key heath care professionals whose role in the care of women and their babies has yet to be fully realised in the Australian health care system”

Sounds familiar, doesn’t it! Perhaps Julia needs to be reminded of what she said before the Australian people voted Labor into office.

Joy Johnston

Midwifery By The Sea - Riding The Waves Of Change


20th October 2005

Julia Gillard

[These are excerpts from the speech]

Thank you very much for your invitation to join you here today at your annual state conference by the sea.

The best start in life

It will not surprise this audience - I'm sure you will all agree - if I now say that I see the pregnant woman as the best focus for early intervention.

Between us we could draw up an impressive list of perinatal programs that would boost the health of the mother and her baby, and improve outcomes, and give all our kids the best start in life.

Obstetric services and workforce shortages

In the middle of this is the big event - the birth.

I know that midwives - as a group and individually - have strong ideas about what should be provided in terms of birthing services.

But shockingly, it is increasingly the case that for some women the idea of having a choice of birthing services and having continuity of care throughout their pregnancy, the birth and in the post-natal period is an impossible luxury - not just unaffordable, but unobtainable in their local area.

The shortage of midwives is also a problem. The Australian Health Workforce Advisory Committee estimates a current national shortage of 1850 midwives, and this is expected to increase over the remainder of the decade.

Midwives face additional concerns about the lack of professional recognition as well as limited opportunities to practise as primary carers and provide continuity of care to women.

The need for a concerted approach

Clearly this is no time for turf warfare between doctors and midwives, but it is time for all health care professionals involved in delivering obstetrics care to mount a combined attack on the Howard Government to force them into action to address this situation.

Unless and until the Government is shocked and shamed into realising that Australian women are now scrambling to find the birthing centre of their choice, and in some cases scrambling to find any professional who will deliver their child, the situation will not improve.

It seems to me that we need a variety of solutions to fit all the circumstances that arise. There is no 'one size fits all' way to solve the problems that present so differently in metropolitan Sydney, the isolated community of Wilcannia, the growing town of Byron Bay and the multicultural suburbs of Western Sydney. The one common factor is the pregnant woman and her child - they must be at the centre of the solution.

… I believe that midwives … are key heath care professionals whose role in the care of women and their babies has yet to be fully realised in the Australian health care system.

We need to realise that potential so that mothers have real choice in their birthing experience, and their babies have the best start in life.

This is one of the best investments we can make in the future of our nation.

Thursday, November 5, 2009

Midwives/ Nurse Practitioner Amendment



Midwives/ Nurse Practitioner Amendment

The Minister for Health and Ageing, Nicola Roxon has today circulated an amendment the Government intends to introduce into the Health Legislation (Midwives and Nurse Practitioners) Bill and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill.

This amendment makes clear in the legislation something that was articulated both on introduction of the Bill to parliament and in the explanatory material tabled at that time.

Following requests for clarification, this amendment will simply clarify in legislation that collaborative arrangements with medical practitioners will be required to access the new arrangements.

The details of these requirements will be specified in subordinate legislation following the ongoing consultation with the professional groups.

These bills are a key plank of the Government’s 2009/10 Budget commitments which recognises for the first time the role of appropriately qualified and experienced midwives and nurse practitioners in our health system.

The Minister for Health and Ageing said today “I thank the doctors, nurses and midwives for their constructive engagement to date to ensure these new opportunities for nurses and midwives are implemented in an integrated fashion for the benefit of patients.”

For more information contact the Minister’s office on 02 6277 7220

Tuesday, November 3, 2009


RALLY - outside the offices of Kevin Rudd and Julia Gillard
Homebirth: My Birth, My Choice
Monday 9th November 2009 10:30am

As a result of the mess that maternity reform has become and the unclear but seemingly very poor options for homebirthing women, Homebirth Australia and Home Midwifery Association are hosting a rally outside Kevin Rudd's electorate office in BRISBANE, and outside Julia Gillard's office in WERRIBEE.

Other groups are invited to join the rally to make this the beginning of a very clear election campaign.

Homebirth: My Birth, My Choice

Kevin Rudd and the Labor Party is no friend of homebirth, not even midwifery it seems.

Kevin Rudd's electoral office
630 Wynumm Road

Julia Gillard's Werribee Office:
Shop 2, 36 Synnot Street
Werribee Vic 3030

Women, children, men, families, friends who support choice in birth, including homebirth with a private midwife.

Bring a 'calling card' to drop off, letting our Prime Minister and his deputy know that women want choice in childbirth and this includes the choice to hire a private midwife to birth at home - insured and funded. The calling card should be an A4 piece of paper (can be larger or smaller) with your name and address, concerns, experience, suggestions and a request for a response from Kevin Rudd and Julia Gillard about this important issue.

The rally and is supported by Homebirth Australia, the Home Midwifery Association (Qld) and Maternity Coalition.

More info

HBA: Justine Caines 0408210273

HMA: Kirsten Adams

Monday, November 2, 2009

Queensland passes national registration Bill

News article from the MEDICAL OBSERVER

Queensland passes national registration Bill
Elizabeth McIntosh - Monday, 2 November 2009

CONTROVERSIAL legislation that gives governments greater control over medical training standards has begun its national roll-out.

The Health Practitioner Regulation National Law Bill 2009 passed through the Queensland Parliament last week, and will now be used as a template by all other states and territories. ...

AMA president Dr Andrew Pesce said the Queensland Government had failed to take into account the association’s concerns.
“The AMA believes the Queensland Parliament is handing the other [states and territories] a flawed and ineffectual Bill,” he said.

Since it was first proposed, the national registration and accreditation scheme outlined in the Bill has generated much concern among medical groups. The AMA previously lobbied for the legislation to incorporate a ‘public interest test’ that health ministers would have to meet before altering standards, however the amendment was not supported by the Government.

The only concession given was that health ministers would have to consider the impact that any changes would have on the quality and safety of health care.

[NOTE: This is the Bill that has made professional indemnity insurance mandatory for all registered health professionals, at the centre of the threat to the very existence of private midwifery practice for homebirth. As has been discussed here and elsewhere, midwives have been granted a 2-year exemption from indemnity for attending birth in the home.]

Monday, October 26, 2009

Homebirth Awareness Week: Celebrate or Commiserate?


Monday October 26 2009

Contact: Justine Caines 0408210273

Homebirth Awareness Week: Celebrate or Commiserate?
Minister’s Weakness and Bureaucrats ignorance continues

This week marks Homebirth Awareness week. Homebirth Australia fears that this time next year Australian women will not have the option of homebirth.

“It is hard to understand the hysteria around homebirth in Australia. Our maternity hospitals are full to the brim, many of them churning women out conveyor belt style and yet this is considered safe, hardly! said Justine Caines Secretary of Homebirth Australia and mother of seven home born children.”

Mainstream Australian maternity care is not about women, women are rarely consulted in the development of services, they are the main player and yet they have been silenced by practitioners who insist they ‘know better’ said Ms Caines.

Homebirth on the other hand is different. Women make decisions about their care, they invite a midwife into their home, rather than be forced to meet the needs of practitioners and organisational convenience which happens when giving birth in a hospital” said Ms Caines

“The outcomes from homebirth are also considerably better*. Women experience more personalised care and fewer interventions, they also enter motherhood happier and more content.” said Ms Caines

Something that is considered a normal reasonable choice in the U.K, The Netherlands, New Zealand, and Canada is under threat of extinction in Australia. Bureaucrats advising the Minister do not even understand homebirth and they refuse to seek information from key stakeholders

“Asking an Obstetrician about homebirth is like seeking advice from a midwife on caesarean surgery.” said Ms Caines

“Health Minister Nicola Roxon plans to fund midwifery care under Medicare, something sorely needed. She has however excluded homebirth. She did this against all evidence and the express wishes of the women of Australia across two enquiries, one that broke a Senate record on the number of submissions received.” said Ms Caines

The question remains; Will politicians continue to be more responsive to those with deep vested interest in maternity services? It is time to step up and listen to women, the very people for whom these so called reforms are proposed.” asked Ms Caines

Also see previous posts:
More irrefutable evidence

Safe Maternity Care

Homebirths in Victoria 2007

Thursday, October 22, 2009


Saturday 28 November, at Elgar Park, Mont Albert (just off the Eastern Fwy – cnr Elgar Rd and Belmore Rd), 11am-4pm. [See Map of Melbourne]

Please check this blog by 9am that day for alternate plan if weather is unsuitable.

Midwives and our families invite the families we know and serve to join us for a picnic lunch, to celebrate life, and birth, and mothering, and midwifery.

BYO everything – food, picnic rugs, hats, chairs &tables (if you want them), games, and your musical instrument and a song if you like.

Elgar Park has toilets, playground, lots of open space, bush areas, wetlands with boardwalk, walking tracks …

Please pass this message on to others who may be interested.

More irrefutable evidence of safety in homebirth

[Note: The letter scanned has been reduced in size to fit one page, without removal of any substance. Click on the pic to enlarge it.]

A couple of months ago a request was sent to the Victorian government’s perinatal data collection unit on behalf of MIPP, requesting that a performance indicator analysis be undertaken of actual homebirth cases and planned homebirth cases (ie including those transferred to hospital) in the past 5 years of data.

For those who may not understand the principles behind performance indicator analysis, you can read up on it In essence it’s an attempt to make valid comparisons using retrospective data.

Of the approx 1000 women who planned homebirth in the 5 years 2003-2007, 170 were standard primiparae. These mothers achieved a 6.5% caesarean rate, which compares favourably with the Statewide public hospital rate of approximately 15%, and the Statewide private hospital rate of approximately 27% for standard primiparae in 2007-08 [Source: Victorian Maternity Service Performance Indicators, 2009].

The 30 women who were assessed under the performance indicator criteria for vaginal birth after caesarean (vbac) all achieved vbac! This compares with the Statewide public hospital rate of 30% and private less than 20% in the 2007-08 report.

This report adds to the already large body of evidence supporting the safety and effectiveness of private midwifery practice in Victoria.

Let’s be encouraged to stay strong in a very difficult time.

Wednesday, October 14, 2009

A breech in the system


Maternity Coalition Movie Night, THURSDAY, 5th November, 2009


A woman wants to give birth to her breech baby in a hospital. They say she has to have a caesarean section. This is an inspiring documentary about her to attempt to birth naturally against all odds.

Karin Ecker's interest in social issues has brought her international credits for her filmmaking plus photographic art. From filming European children exploring environmental issues in the Bahamas to physically handicapped people scuba diving in the Egyptian Sea, she now brings her lens to the issue of childbirth choices in Australia.

She intends to use this film as a tool to support the voice of 'woman'.

The Movie will be followed by a discussion panel including:
Dr Lionel Steinberg - Obstetrician
Joy Johnston - Independent Midwife


To get the discounted price, please pay for your spot before movie night

THURSDAY, 5th November, 2009 - 7:30 pm

Mercy Lecture Theatre (Cnr Young and Graham St)
Australian Catholic University
115 Victoria Pde Fitzroy

$10 - Pre-paid Tickets
$15 - Ticket at the door

Phone 03 8677 1881

Direct Deposit:
Mojain Pty Ltd
BSB:013313, A/C:498690669
Ref: MC11-'your name'

Please note that tickets will not be issued, but names will be held at the door

Tuesday, October 6, 2009

New Trust Fund for Indigenous Midwifery Students

New Trust Fund for Aboriginal Midwifery Students

ACM was delighted to launch this new trust fund at its recent conference in Adelaide. It is known as the ‘Rhodanthe Lipsett’ Trust, after the midwifery elder and longstanding ACM member of the same name, whose idea it was to create this trust.

The Trust aims to provide annual scholarships to Aboriginal and Torres Strait Islander midwifery students, to assist them in their study to become midwives. It is inspired by the improvements in outcomes for Indigenous women achieved in New Zealand and Canada, where care is routinely provided by midwives who are Maori or Inuit respectively.

The Trust needs to gather at least $200,000 to enable annual scholarships to be paid to eligible students. To read more visit the Trust website. Make a donation today on this secure website to help make a difference for Aboriginal and Torres Strait Islander mothers and babies.

Thursday, October 1, 2009


From the USA, Coalition for Improving Maternity Services (CIMS), together with 44 co-signing organisations, reiterated their support for informed decision-making by women in a strong statement that cites the research evidence regarding the safe choices of home birth and midwifery care.

The joint statement was released in response to a biased and sensationalized segment featured on NBC’s The Today Show. The segment, “The Perils of Midwifery” (later renamed “The Perils of Home Birth” online), which aired on Sept. 11, inaccurately implied that hospitals are the safest place for low-risk women to give birth and mischaracterized women who choose home birth as ‘hedonists,’ going so far as to suggest that these women are putting their birth experiences above the safety of their babies. Neither could be further from the truth.

For a link to the One Voice Response to Today Show (PDF), go to the CIMS site.

Friday, September 25, 2009

Bills Digest

Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009

Go to the Parliamentary Library's information, analysis and advice for the Parliament to read this
Bills Digest

Quote (page 4):
"While the review report argued that women needed comprehensive and reliable information about the range of antenatal, birthing and postnatal care, one omission in the area of birthing options that some consider it did not address in detail—homebirthing—has become the subject of considerable debate."

Wednesday, September 23, 2009

Home birthing: the fiscal nips and tucks to our health system

This article, written by Queensland Federal MP Andrew Laming, and published in Australia's e-journal of social and political debate, brings together a political and medical view of the issue. Andrew Laming was a GP/obstetrician prior to entering politics. He wrote ...

"All politics is local, and more often than not personal. Just a fraction of Australians birth at home but their fervour is at times evangelical. In Canberra’s grey rain this week, 2,000 devoted mums and midwives won a two-year reprieve from being deregistered and fined if they attend a home birth.

"But there were few cheers for Minister Roxon’s back flip. Landmark reform stemming from the recent National Maternity Services Review proposes autonomy for midwives around prescribing certain drugs and ordering tests as well as long awaited access to Medicare and indemnity cover. But for home birthing midwives, there will neither be Medicare support nor any form of indemnity protection.

"When it comes to the safety of low-risk mums birthing at home, the world’s foremost medical evidence authority is the Cochrane Collaboration. With appropriate hospital support says Cochrane, home birth and hospital mortality for low-risk bubs is comparable. Cochrane believes women have a right to choose between the two options.

"A final fillip for home births is that Cochrane acknowledges that outcomes for mums may actually be worse in hospitals. The largest of all studies was a nationwide cohort of 529,688 low-risk planned home and hospital births by de Jonge in the Netherlands. It found "that planning a homebirth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system"."
[Click here for the complete article and reader comment]

The comments are worth reading - some of them are almost amusing!
"Most big hospitals now have good birthing suites that provide as close to the home-birth experience as possible, while still having medical help close by."

"Australia is not as small in distances as New Zealand or England, where home-birthing is more common. The homes in those countries are much closer to hospitals and ambulance services should anything go wrong with the birth."

"Home births require a dedicated nurse to travel, and not be available to anyone else, and require the back up of the ambulance service. Home birthing is thus more expensive for no health benefits, and so I can understand why the funding has been withdrawn."

Read the comments in context. Please let us know what you think!

Tuesday, September 15, 2009

sexual health and intimacy after childbirth

The Murdoch Childrens Research Institute Maternal Health Study is to launch its publication, sexual health and intimacy after childbirth in October.

Midwives in Private Practice has been invited to attend the launch.

Copies of the study's 12-page brochure outlining what women had to say, in their own words, about changes to sexual health, sexuality and intimate relationships as a result of pregnancy, childbirth and parenting, are available from, or by phoning 03 9090 5204.

Thursday, September 10, 2009

Media from the rally

Jane Palmer's montage of photos and video footage.

While a crowd of 2000-3000 people wearing babies, holding umbrellas, and waving placards, gathered outside in the rain, the debate about midwifery proceeded in the House of Representatives. It has been reported that the Hansard record of the proceedings on Monday includes the mention of Midwives over 300 times!!! That has to be a record.

Here's a summary of media on the homebirth rally which has been circulated to the email lists.

Brisbane Times
The Age


The quality of the reporting from the rally was disappointing, yet it is consistent with the general apathy in the press towards physiologically normal human issues.

What other issue has engnedered a similar response: thousands of written submissions by ordinary Australians to government inquiries, and thousands of voters willing to travel to Canberra and protest outside Parliament House? The number of mothers who access private midwifery care for homebirth in this country is small - there's no denying that fact. Yet those women and families are entitled to respect, equity and safety in their maternity care. Those midwives are also entitled to respect in their professional practices.

Australia is not a totalitarian country. All statutory regulations must be in the public interest. It's clear that Nicola Roxon and her team got it wrong on the value and importance of homebirth with a private midwife. The legislation must be amended, or discarded. The partnership of homebirth and private midwifery is not an insignificant item that can be swept under the mat in a bureaucratic tidy up of maternity care. We are real people, we care deeply about birth and the whole maternity episode within life's complex continuum, and we vote.

Monday, September 7, 2009

more than 2000 people protest

News from Canberra on ABC Radio
Thousands rally for homebirthing rights

"More than 2,000 people have gathered outside Parliament House in Canberra to call for greater homebirthing rights.

"Women, men and children from all over Australia braved a rainy Canberra day to support women's rights to give birth at home. ..."

I have seen lots of pictures from the rally on Facebook

Here's A mother's blog.

[pictures from the rally will be added as they become available. Thanks to Janie, Bev and Kate for the pics so far]

Friday, September 4, 2009

Families converge on Canberra


Some are setting out today or tomorrow or Sunday to travel in their cars.

Some are flying in on Monday morning.

They are going to the MOTHER OF ALL RALLIES, Monday 7th September 2009, at 11:30 am, outside Parliament House.

They are protesting, as forcefully and publicly as they are able.


A few of the related events are:

Sunday 6th September, 2009, 6:00 –

Australian Private Midwives Association Dinner

Zeffirelli Pizza

15 Franklin St, Manuka

Monday 7th September, 2009, 10:45 -

Pre Rally Welcome

Aboriginal tent Embassy

Queen Victoria Terrance (In front of old Parliament House)

Monday 7th September, 2009, 11:30


Outside Parliament House

Monday, 7th September 2009, After the rally

Lunch for Australian Private Midwives Association

Monday, 7th September, 2009 - 6:30 - 7.30

Birth Rites Documentary Screening

Parliament House Canberra, Theatrette

The following press release is from Materntiy Coalition

Women United To Save Homebirth at Mother of All Rallies in Canberra.

Maternity Coalition members from across Australia will join thousands of others as they unite in the call for every woman to have every choice in pregnancy and birth.

The Mother of All Rallies, on Monday 7 September is in response to the limited terms of professional indemnity insurance currently on the table for midwives in private practice, which will effectively ban homebirth with a registered midwife come July 2010.

Maternity Coalition has highlighted the inequity of insurance being unavailable to midwives since 2001. Now, an indemnity solution is urgently required before the National Registration legislation takes effect next year.

Maternity Coalition's Victorian President, mother and midwife Janie Nottingham, who led Maternity Coalition’s Drive for Maternity Reform to Parliament House in 2007, will return to Canberra for Monday’s rally. “Appropriately qualified registered midwives have the skill to safely provide maternity care. Lack of indemnity for these professionals has the potential to harm mothers and babies, as the only option left to women in many areas wanting to birth outside an institutionalised setting is freebirth,” she said.

Maternity Coalition Northern Territory spokesperson Kylie Sheffield, who will make her way from Darwin to participate in the event said, "Existing state-run homebirth services in the NT are inadequate. We need to have private practice midwifery re-instated to make this an accessible choice for women and families throughout the Territory."

Maternity Coalition Queensland's spokesperson Joanne Smethurst from Brisbane, travelling to Canberra with her husband and joined by her aunty and sister, said, "The Australian Government must solve the insurance dilemma to ensure women can access registered midwives for birth in the setting of their choice. The option of homebirth with a private practice midwife must be indemnified and funded. Queensland has no state-supported homebirth programs – we rely on our private practice midwives to provide this valuable care to Queensland's expectant mothers."

Sarah Kerr, National Secretary on the road to Canberra from Townsville with her four young sons said, “To solve this problem the Federal Government needs to broaden the definitions for indemnity to include homebirth and birth on country for our indigenous mothers and babies in addition to hospital birth.”

Maternity Coalition’s National President and Wollongong mother of four, Lisa Metcalfe said, “The Federal Government must not leave women and babies without care from a registered midwife if they choose to birth outside a hospital setting. Bureaucratic oversight should not dictate women's choice. Until this problem is resolved, we are concerned that the biggest changes to maternity care we’ve seen in a century – providing midwives with access to Medicare and the Pharmaceutical Benefits Scheme – will not be effective.”

For further information about the Mother of All Rallies see Homebirth Australia’s website

Media contacts:

Maternity Coalition National President Lisa Metcalfe, Phone: 02 4268 1675 or 0437 577 576

Lisa Metcalfe
NSW President

Wednesday, September 2, 2009

MidAtlantic Conference on Birth and Primal Health Research


One step towards Utopia.
As Thomas More already knew 500 years ago, Utopia is an island in the Atlantic.

Don’t miss the


Las Palmas, February 26-28, 2010

From the prestigious symphony Hall of the Canary Islands Conference Centre (1656 seats), you’ll see the Ocean. You’ll dream of the Rebirth of the Goddess of Love, the one who was born ‘from the foams of the waves’.

In order to prepare the future, this conference will first present an overview of recent spectacular scientific and technical advances that will influence the history of childbirth.

The participation of Michael Stark, as the father of the fast, simplified, and safe technique of caesarean, will symbolise technical advances. The participation of Kerstin Uvnas-Moberg, world expert on the behavioural effects of ocytocin, will symbolise scientific advances. The need for action will be underlined by the participations of Anthony Costello, Professor of International Health, Institute of Child Health, London, and of Mario Merialdi, coordinator for maternal and perinatal health at WHO.

Invited practitioners and selected utopists will have the last word.

Everybody can actively participate in the conference by presenting a poster, by attending three of the 27 workshops, and by attending one of the two forums.


(English and Spanish editions)

The conference is open to all those interested in the future of Humanity




As everybody knows, our country - Utopia - is an independent territory.

In spite of our high scientific and technological level, we have maintained and even developed further our main cultural characteristics. In particular, we have developed our capacity to make unrealistic projects and to transcend the limits of political correctness. We shall illustrate the specific details of the Utopian with the history of childbirth.

In 2010 two local celebrities had chosen to give birth by caesarean. This is how childbirth suddenly became one of the main topics for discussion in the media. Everyone realized that every year the rate of caesareans was higher than the year before. The dominant opinion was in favour of authoritarian guidelines by the Utopian Health Organization (UHO). To face such an unprecedented situation the Head of the UHO decided to organize a multidisciplinary meeting.
A statistician spoke first. He presented impressive graphs, starting in 1950, when the low segmental technique of caesarean replaced the classical technique. According to his extrapolations it was highly probable that after 2020 the caesarean will be the most common way to give birth. A well-known obstetrician felt obliged to immediately comment on this data. He claimed that we should look at the positive aspect of this new phenomenon. He explained how the caesarean had become an easy, fast and safe operation. He was convinced that in the near future most women would prefer to avoid the risks associated with a delivery by the vaginal route. To support his point of view about the safety of the caesarean, he presented a Canadian series, published in 2007, of more than 46,000 elective caesareans for breech presentation at 39 weeks with zero maternal death, and an American series, published in 2009, of 24,000 repeated caesareans with one neonatal death. He explained that in many situations an elective pre-labour caesarean was by far the safest way to have a baby. While concluding that ‘we cannot stop progress’ a midwife’s body language suggested, that there was something the doctor had not understood.

A very articulate woman, the president of BWL (‘Association for Birth With Love’) immediately reacted to the conclusion by the doctor. She first asked him which criteria he was using to evaluate the safety of the caesarean. Of course he mentioned just perinatal mortality/morbidity rates and maternal mortality/morbidity rates. Then the president of BWL explained that this limited list of criteria had been established long ago, before the 21st century, and that a great diversity of developing scientific disciplines was now suggesting a list of new criteria to evaluate the practices of obstetrics and midwifery. This was the turning point of this historical multidisciplinary meeting.

The Professor of hormonology immediately echoed this eloquent and convincing comment. After referring to an accumulation of data regarding the behavioural effects of hormones involved in childbirth, he could easily convince the audience to conclude that to have babies women had been programmed to release a real ‘cocktail of love hormones’. During the hour following birth, he illuminated how the maternal and fetal hormones released during the birth process are not yet eliminated and each of them has a specific role to play in the interaction between mother and neonate. In other words, he added, thanks to the hormonal perspective we can now interpret the concept of critical periods introduced by behavioural scientists: some pioneers in this field had understood, as early as in the middle of the twentieth century, that among all mammals there is, immediately after birth, a transient period of time that will never happen again and that is critical in mother-baby attachment. He dared to conclude that, by combining the data he had provided with the result of countless epidemiological studies suggesting that the way we are born has life-long consequences, it was clear that the capacity to love develops to a great extent in the perinatal period. The obstetrician was gaping at him.
After such conclusions by the Professor of hormonology, the head of the department of epidemiology of UHO could no remain silent. This epidemiologist had a special interest in ‘Primal Health Research’. He had collected in particular hundreds of published studies detecting risks factors in the perinatal period for a great diversity of pathological conditions in adulthood, adolescence or childhood. He offered an overview of the most valuable studies, particularly those involving huge number of subjects. He summarized the results of his enquiries by noticing that when researchers study, from a Primal Health Research perspective, pathological conditions that can be interpreted as different sorts of impaired capacity to love (to love others or to love oneself), they always detect risk factors in the perinatal period. Referring to the comments by the president of BWL about the needs for new criteria to evaluate the practices of obstetrics and midwifery, he emphasized the need to think long term. Finally he presented the Primal Health Research Databank as a tool to train ourselves to think long term.

Then a geneticist impatiently raised her hand. She presented the concept of ‘gene expression’ as another way to interpret the life-long consequences of pre- and perinatal events. She explained that among the genetic material human beings receive at conception, some genes will become silent without disappearing. The gene expression phenomenon is influenced in particular by environmental factors during the pre- and perinatal periods. The obstetrician was more and more attentive and curious, as if discovering a new topic. One of his judicious questions about the genesis of pathological conditions and personality traits gave the geneticist the opportunity to explain that the nature of an environmental factor is often less important than the time of the interaction . She explained the concept of critical period for gene-environment interaction. The presentation by the geneticist induced a fruitful interdisciplinary conversation. The epidemiologist jumped on a question by a general practitioner to provide more details about one of the new functions of the Primal Health Research Database, which is to give some clues about the critical period for gene-environment interaction regarding different pathological conditions or personality traits.

A bacteriologist, who had kept a low profile since the beginning of the session, emphasized that the minutes following birth are critical from his perspective as well. Few people had previously understood that at the very time of birth the newborn baby is germ-free and that some hours later millions of microbes will have colonised its body. Because the antibodies called IgG cross easily the human placenta he explained that the microbes familiar for the mother are already familiar for the germ free newborn baby, and therefore friendly. If the baby is immediately invaded by friendly germs carried the mother, it is protected against unfamiliar and therefore potentially dangerous microbes. He commented that when babies are born via the perineum, it is a guarantee that they are first contaminated by a multitude of germs carried by the mother, compared with babies born by caesarean. In order to stress the importance of the question, he mentioned that our gut flora is to a great extent established during the minutes following birth: useful considerations at a time when we are learning that this intestinal flora represents 80% of our immune system.

The bacteriologist agreed when a infant-feeding adviser added that, in the right environment, if mother and newborn baby are not separated at all, there is a high probability that the baby will find the breast during the hour following birth and will consume the early colostrum with its friendly germs, specific local antibodies and anti-infectious substances. The consumption of early colostrum probably has long-term consequences, at least by influencing the way the gut flora is established.

The head of UHO was obviously happy with the progress of the interdisciplinary meeting he had organized. He asked an old philosopher, considered the wise man of the community, to conclude. The philosopher explained that we should not ignore a specifically human dimension and that we must first and foremost think in terms of civilisation. He referred to the data provided by the epidemiologist. Among the studies he presented, huge numbers had often been necessary to detect tendencies and statistically significant effects. This is a reminder that, where human beings are concerned, we must often forget individuals, anecdotes and particular cases, and reach the collective and therefore cultural dimension. From what had been heard during this meeting, it was clear that humanity was in an unprecedented situation that he summarised in a very concise way. Today, he said, the number of women who give birth to babies and placentas thanks to the release of what is a real cocktail of love hormones is approaching zero. What will happen in terms of civilisation if we go on that way? What will happen after two or three generations if love hormones are made useless during the critical period surrounding birth?
After such an eloquent conclusion the head of the UHO asked the participants their point of view about the necessity to control the rates of caesarean. Everybody, including the obstetrician, found the need for action necessary, even urgent.

This is how a second meeting was planned in order to find effective solutions.

At the beginning of the second meeting the head of UHO asked the participants if they had solutions to suggest in order to control the rates of caesareans and other obstetrical interventions. The obstetrician presented a project ‘to assess the effectiveness of a multifaceted strategy for improving the appropriateness of indications for caesarean’. Nobody paid attention. A recently graduated young doctor spoke about the need to reconsider the education of medical and midwifery students. The head of the midwifery school immediately replied that all over the world there have been many attempts to renew the education of midwives and doctors, including specialised doctors, without any significant positive effects on birth outcomes. Several participants spoke about financial incentives to decrease the rates of obstetrical intervention. The head of UHO intervened and stressed that this solution had been unsuccessfully tried in several countries, and furthermore, that the rates of c-sections were increasing in all countries whatever the health system: we should therefore look at other factors. He added that the risk would be to increase the incidence of long and difficult births by the vaginal route with an overuse of pharmacological substitutes for the natural hormones. This effect would be unacceptable at a time when the c-section has become such an easy and fast operation. The priority should be to try first to make the births as easy as possible in order to reduce the need for obstetrical interventions in general.

Unexpectedly, the turning point in the discussion occurred when a neurophysiologist - internationally known for her studies of the behaviour of mantis religiosa, a variety of praying mantis - intervened for the first time. She explained that by mixing her scientific studies and her experience as a mother, she had acquired a clear understanding of the basic needs of labouring women. In general, she said, the messages sent by the central nervous system to the genitalia are inhibitory. She understood this simple rule when studying the mating behaviour of mantis religiosa. During sexual intercourse in this species the female often eats the head of the male, a radical way to eliminate inhibitory messages! Then the sexual activity of the male is dramatically reinforced and the chances for offspring conception are increased. She had understood that the inhibitory effect of the central nervous system on all episodes of sexual life is a general rule. She had many occasions to confirm this rule and, interestingly, she understood that still more clearly after giving birth to her first baby. She is convinced that the reduction of her neocortical activity was the main reason why this birth was so easy and fast. She recalled that human beings are characterised by the enormous development of this part of the central nervous system called the neocortex. Her neocortex was obviously at complete rest when she was in established labour since she had completely forgotten many details about the place where she gave birth. She remembers vaguely that she was in a rather dark place, and that there was nobody around but a midwife sitting in a corner and knitting. She also remembers that at a certain phase of labour she was vomiting and the midwife just said: ’this happened to me when I had my second baby: it’s normal’. Although this is imprecise in her memory, she is convinced that this discreet comment with a whispering motherly voice had facilitated the progress of labour. With this experienced and calm mother figure she could feel perfectly secure. She can understand in retrospect that all the conditions were met to reduce the activity of her neocortex. She could feel secure without feeling observed, in semi-darkness and silence. So, her practical suggestion, after combining what she learned as a neurophysiologist and what she learned as a mother, was to reconsider the criteria used to select the midwifery students. The prerequisite, to enter a midwifery school of the future, would be to have a personal experience of giving birth without any medical intervention and to consider this birth as a positive experience.

The obstetrician was not comfortable with this suggestion, claiming that he had been working with wonderful midwives who were not mothers. The head of the midwifery school retorted that everybody knows good midwives who are not mothers. However her duty is to offer the guarantee that the midwives graduated in her school share such personality traits that their presence close to a birthing woman will disturb the progress of labour as little as possible. This is why she cannot imagine better criteria than those suggested by the neurophysiologist. Because this suggestion was outside the usual limits of political correctness, it was immediately considered by almost everybody as acceptable in the land of Utopia.

Then a male voice was heard from a corner of the room. It was the voice of the young technician whose role was to record the session: ‘as an outsider, can I ask a naïve question? What if the prerequisite to be qualified as an obstetrician would also be to have a personal experience of giving birth without any medical intervention and to consider this birth as a positive experience?’

At that time it was as if everybody in the room was in the situation of Archimedes shouting ‘Eureka!’…An unforgettable collective enthusiasm! It was immediately obvious for all the participants that such a project was unrealistic enough to be adopted without any further discussion and without any delay in the land of Utopia.

A committee was immediately set up, in order to organise a 15-year period of transition.

Today, in January 2031, we can offer valuable statistics, since the period of transition was over in 2024. These statistics are impressive.

The perinatal mortality rates are as low as in all countries with similar standards of living. The rates of transfers to paediatric units have dramatically decreased. There has not been one case of forceps delivery for four years. Since the priority is to avoid long and difficult labours by the vaginal route, the use of ventouse and the use of drugs are exceptionally rare. More importantly, the rates of caesareans are three times lower than before the period of transition. The rate of breastfeeding at six months is above 90%. A paedopsychiatrist has already mentioned that autism is less common than in the past. If the respected philosopher – the wise man of the community – was still alive, he would state that now, in the land of Utopia, most women give birth to babies and placentas thanks to the release of a ‘cocktail of love hormones’.

The new head of UHO and his teams are preparing articles for different sorts of international media. They have launched a ‘call for 5-words slogans’ in order to urgently spread the word in a concise and effective way. This is the selected slogan:


Published quarterly by Primal Health Research Centre
Charity No.328090
72, Savernake Road, London NW3 2JR

used with permission:
Yes, I am aware of the current legislative reforms in Australia. There are similarities with the problems they have in Brasil and the USA. Of course you can copy our newsletter to as many blogs as you want.
Warm regards

Autumn 2009 Vol 17. No2

(Free access to the Primal Health Research Data Bank)
(updated information about the ‘midatlantic conference on birth and primal health research’)