Consensus Statement
Central to the safety and quality of homebirth is women and midwives working together in partnership. Without indemnity insurance support, private midwives will be unable to register to provide homebirth care from July 2010. This is unacceptable.
We support:
The legally enshrined concepts of informed consent and right of refusal, to enable every Australian woman to choose, how, where and with whom she gives birth
A safe and sustainable maternity health system that supports maternity health professionals equally, enabling funding for midwifery in the public and private setting
We request:
Immediate intervention from Health Minister, Nicola Roxon to secure professional indemnity insurance for privately practising midwives providing homebirth services. Inclusion of private practice homebirth services within the Medicare Benefits Schedule.
ENDORSEMENT OF THIS CONSENSUS STATEMENT APPROVED BY THE FOLLOWING NAMED MIDWIVES:
Andrea Bilcliff
Alice Barden
Andrea Quanchi
Brenda Manning
Clare Lane
Fiona Hallinan
Helen Barrington
Helen Sandner
Jennie Teskey
Joy Johnston
Karen Heyward
Kate Larvin
Kate Wylie
Kim Cooper
Lisa Chapman
Malinda Morieson
Nicola Dutton
Seneka Cohen
Simone Sayers
Wendy Buckland
Sonya Beutel [Qld]
Robyn Thompson
Sally Westbury
Kylie Shaw Wallace
Sally McCrae
[Other names of midwives will be added as their messages of support are received. JJ]
Wednesday, April 29, 2009
Monday, April 27, 2009
Senate Inquiry into National Registration and Accreditation Scheme for Midwives
Inquiry into National Registration and Accreditation Scheme for Doctors and Other Health Workers
Terms of reference
The Senate has referred the following matter to the Community Affairs Committee for inquiry and report by 18 June 2009:
The design of the Federal Government’s national registration and accreditation scheme for doctors and other health workers, including:
1. the impact of the scheme on state and territory health services;
2. the impact of the scheme on patient care and safety;
3. the effect of the scheme on standards of training and qualification of relevant health professionals;
4. how the scheme will affect complaints management and disciplinary processes within particular professional streams;
5. the appropriate role, if any, in the scheme for state and territory registration boards; and
6. alternative models for implementation of the scheme.
Written submissions are invited and should be addressed to:
The Secretary
Senate Community Affairs Committee
PO Box 6100
Parliament House
Canberra ACT 2600
Closing date for the receipt of submissions is 30 April 2009.
The Committee prefers to receive submissions electronically as an attached document - email: community.affairs.sen@aph.gov.au.
Submissions become Committee documents and are made public only after a decision by the Committee. Publication of submissions includes loading them onto the internet and their being available to other interested parties including the media. Persons making submissions must not release them without the approval of the Committee. Submissions are covered by parliamentary privilege but the unauthorised release of them is not protected.
Following consideration of submissions, the Committee will hold public hearings. The Committee will consider all submissions and may invite individuals and organisations to give evidence at the public hearings.
Information relating to Senate Committee inquiries, including notes to assist in the preparation of submissions for a Committee, can be located on the internet at http://www.aph.gov.au/senate/committee/wit_sub/index.htm.
For further details contact the Committee Secretary, phone: (02) 6277 3515, fax (02) 6277 5829, email: community.affairs.sen@aph.gov.au.
For further information, contact:
Phone: +61 2 6277 3515
Fax: +61 2 6277 5829
Email: community.affairs.sen@aph.gov.au
Terms of reference
The Senate has referred the following matter to the Community Affairs Committee for inquiry and report by 18 June 2009:
The design of the Federal Government’s national registration and accreditation scheme for doctors and other health workers, including:
1. the impact of the scheme on state and territory health services;
2. the impact of the scheme on patient care and safety;
3. the effect of the scheme on standards of training and qualification of relevant health professionals;
4. how the scheme will affect complaints management and disciplinary processes within particular professional streams;
5. the appropriate role, if any, in the scheme for state and territory registration boards; and
6. alternative models for implementation of the scheme.
Written submissions are invited and should be addressed to:
The Secretary
Senate Community Affairs Committee
PO Box 6100
Parliament House
Canberra ACT 2600
Closing date for the receipt of submissions is 30 April 2009.
The Committee prefers to receive submissions electronically as an attached document - email: community.affairs.sen@aph.gov.au.
Submissions become Committee documents and are made public only after a decision by the Committee. Publication of submissions includes loading them onto the internet and their being available to other interested parties including the media. Persons making submissions must not release them without the approval of the Committee. Submissions are covered by parliamentary privilege but the unauthorised release of them is not protected.
Following consideration of submissions, the Committee will hold public hearings. The Committee will consider all submissions and may invite individuals and organisations to give evidence at the public hearings.
Information relating to Senate Committee inquiries, including notes to assist in the preparation of submissions for a Committee, can be located on the internet at http://www.aph.gov.au/senate/committee/wit_sub/index.htm.
For further details contact the Committee Secretary, phone: (02) 6277 3515, fax (02) 6277 5829, email: community.affairs.sen@aph.gov.au.
For further information, contact:
Phone: +61 2 6277 3515
Fax: +61 2 6277 5829
Email: community.affairs.sen@aph.gov.au
Saturday, April 25, 2009
the benefits of breast-feeding ... or the risks of not breast-feeding
The breastfeeding message can easily be understated or overlooked when midwives are focusing on promoting normal birth. Normal initiation of breastfeeding is simply part of the normal birth continuum: it doesn't need much in the way of special skill from the midwife, or any gadgets or education for the mother.
Breastfeeding is the next step in normal birth. As long as unhelpful interferences such as separation of mother and baby, or imposed times of feeding, or supplements, teats, dummies, or careless chemical inhibition of normal hormone production are avoided, the healthy newborn child and healthy new mother discover the delights of breastfeeding together: each learning their own part.
To review the process of normal initiation of breastfeeding go to http://breastcrawl.org/
From Heartwire
Breast Is Best: New WHI Data Extend CV Benefits of Breast-Feeding to Mom
Lisa Nainggolan
April 23, 2009 (Pittsburgh, Pennsylvania) — "Women who breast-fed for a year or more were less likely to develop hypertension, diabetes, hyperlipidemia, and cardiovascular disease when postmenopausal than women who were pregnant but never breast-fed, a new analysis of the Women's Health Initiative (WHI) has found [1]. Dr Eleanor Bimla Schwarz (University of Pittsburgh Center for Research on Healthcare, PA) and colleagues report their findings in the May 2009 issue of Obstetrics & Gynecology.
"We were able to show that benefits were visible in anyone with six or more months' lifetime duration of breast-feeding," Schwarz told heartwire, with those who reported a lifetime history of more than 12 months' lactation being 10% to 15% less likely to have hypertension, diabetes, hyperlipidemia, and CVD than those who never breast-fed.
... [continued]
Breastfeeding is the next step in normal birth. As long as unhelpful interferences such as separation of mother and baby, or imposed times of feeding, or supplements, teats, dummies, or careless chemical inhibition of normal hormone production are avoided, the healthy newborn child and healthy new mother discover the delights of breastfeeding together: each learning their own part.
To review the process of normal initiation of breastfeeding go to http://breastcrawl.org/
From Heartwire
Breast Is Best: New WHI Data Extend CV Benefits of Breast-Feeding to Mom
Lisa Nainggolan
April 23, 2009 (Pittsburgh, Pennsylvania) — "Women who breast-fed for a year or more were less likely to develop hypertension, diabetes, hyperlipidemia, and cardiovascular disease when postmenopausal than women who were pregnant but never breast-fed, a new analysis of the Women's Health Initiative (WHI) has found [1]. Dr Eleanor Bimla Schwarz (University of Pittsburgh Center for Research on Healthcare, PA) and colleagues report their findings in the May 2009 issue of Obstetrics & Gynecology.
"We were able to show that benefits were visible in anyone with six or more months' lifetime duration of breast-feeding," Schwarz told heartwire, with those who reported a lifetime history of more than 12 months' lactation being 10% to 15% less likely to have hypertension, diabetes, hyperlipidemia, and CVD than those who never breast-fed.
... [continued]
Tuesday, April 21, 2009
Great joy from birth at home
Published in the Herald Sun
Steve Perkin April 21, 2009 12:00am
"AT this exact moment, 18 years ago, my household was preparing for the arrival of our third child.
"With two kids already safely under lock and key, you would have thought we'd have matters under control, and maybe my wife did, but I didn't, because months earlier, she'd announced that she wanted the next child to be born at home.
[continued]
Steve Perkin April 21, 2009 12:00am
"AT this exact moment, 18 years ago, my household was preparing for the arrival of our third child.
"With two kids already safely under lock and key, you would have thought we'd have matters under control, and maybe my wife did, but I didn't, because months earlier, she'd announced that she wanted the next child to be born at home.
[continued]
Monday, April 20, 2009
Lessons from labour
ABC Unleashed has published Lessons from labour.
"The front page of the Daily Telegraph ran the sensational headline recently 'Four dead in home birthing'. The article went on to say that at least four babies had died 'during homebirths in the past nine months' and a further four babies had suffered brain damage. This was presented as 'fact' although it remains unconfirmed to date.
"The facts we have from the latest Australian Institute of Health and Welfare (published in 2008), indicate that 708 women had planned homebirths in Australia in 2006 (0.3%) and there were no deaths reported amongst these births. In this same year 2730 babies died - most of them in Australian hospitals. While we must remain committed to trying to reduce these deaths, the reality is this rate has remained unchanged for nearly 15 years, despite a doubling in the caesarean section rate. ... [continued]"
[you may leave comments after the article at the ABC Unleashed site]
Dr Hannah Dahlen is the national media spokesperson for Australian College of Midwives
"The front page of the Daily Telegraph ran the sensational headline recently 'Four dead in home birthing'. The article went on to say that at least four babies had died 'during homebirths in the past nine months' and a further four babies had suffered brain damage. This was presented as 'fact' although it remains unconfirmed to date.
"The facts we have from the latest Australian Institute of Health and Welfare (published in 2008), indicate that 708 women had planned homebirths in Australia in 2006 (0.3%) and there were no deaths reported amongst these births. In this same year 2730 babies died - most of them in Australian hospitals. While we must remain committed to trying to reduce these deaths, the reality is this rate has remained unchanged for nearly 15 years, despite a doubling in the caesarean section rate. ... [continued]"
[you may leave comments after the article at the ABC Unleashed site]
Dr Hannah Dahlen is the national media spokesperson for Australian College of Midwives
Friday, April 17, 2009
Largest study in the world confirms home birth is safe
This statement is from the Australian College of Midwives and was published in Australian Healthcare News, Thursday, 16 April 2009.
The opinion that hospital birth is safest for all women and babies has finally been overturned with the publication of the world’s largest study of planned, midwife attended home births.
The study, published in the British Journal of Obstetrics and Gynecology (April 15th 2009), included over half a million, low risk, planned home and hospital births in the Netherlands over seven years and compared numbers of babies dying and being harmed during the births. The Netherlands currently has the highest home birth rate in the western world (30%) and a caesarean section rate that is more than half Australia’s (14% vs 31%).
Over three hundred thousand women had planned homebirths attended by midwives in this study. No significant differences were found in numbers of babies dying during labour, during the first 24 hours after labour or up to seven days after birth between planned low risk birth at home, attended by a trained midwife and those who planned to give birth in hospital. There were also no differences in numbers of babies being admitted to a neonatal intensive care unit following the birth. Previous studies have been limited by small sample numbers of births and this study has now achieved adequate numbers to show differences very rare events.
We have known for many years mothers have lower intervention rates and higher satisfaction rates when giving birth at home, but there has remained a cloud over the impact on babies’ outcomes. This cloud has now been lifted. This study adds to others, which established planned home birth attended by professional midwives was safe for low risk women. It confirms that homebirth services properly networked into mainstream care are safe for babies.
The Australian College of Midwives calls on the Government to reconsider its silence over homebirth and work with health professionals to implement safe, supportive systems of care that will facilitate women’s choice of birthplace. Over 400 submissions to the National Maternity Review from consumers, the majority requesting greater access to homebirth cannot be ignored any longer.
The opinion that hospital birth is safest for all women and babies has finally been overturned with the publication of the world’s largest study of planned, midwife attended home births.
The study, published in the British Journal of Obstetrics and Gynecology (April 15th 2009), included over half a million, low risk, planned home and hospital births in the Netherlands over seven years and compared numbers of babies dying and being harmed during the births. The Netherlands currently has the highest home birth rate in the western world (30%) and a caesarean section rate that is more than half Australia’s (14% vs 31%).
Over three hundred thousand women had planned homebirths attended by midwives in this study. No significant differences were found in numbers of babies dying during labour, during the first 24 hours after labour or up to seven days after birth between planned low risk birth at home, attended by a trained midwife and those who planned to give birth in hospital. There were also no differences in numbers of babies being admitted to a neonatal intensive care unit following the birth. Previous studies have been limited by small sample numbers of births and this study has now achieved adequate numbers to show differences very rare events.
We have known for many years mothers have lower intervention rates and higher satisfaction rates when giving birth at home, but there has remained a cloud over the impact on babies’ outcomes. This cloud has now been lifted. This study adds to others, which established planned home birth attended by professional midwives was safe for low risk women. It confirms that homebirth services properly networked into mainstream care are safe for babies.
The Australian College of Midwives calls on the Government to reconsider its silence over homebirth and work with health professionals to implement safe, supportive systems of care that will facilitate women’s choice of birthplace. Over 400 submissions to the National Maternity Review from consumers, the majority requesting greater access to homebirth cannot be ignored any longer.
Thursday, April 16, 2009
Surge in home births in South Australia
The Advertiser
TORY SHEPHERD, HEALTH REPORTER
April 13, 2009
"TWICE as many women are choosing to give birth at home, the latest statistics show.
"The number of home births increased from 44 - 0.2 per cent of births - in 1997 to 107 - 0.5 per cent of births - in 2007.
[continued] "
Note: Homebirth is able to be accessed within publicly funded models in South Australia, as well as privately. The South Australia Department of Health (DoH) Policy for Planned Birth at Home in South Australia was published in 2007.
TORY SHEPHERD, HEALTH REPORTER
April 13, 2009
"TWICE as many women are choosing to give birth at home, the latest statistics show.
"The number of home births increased from 44 - 0.2 per cent of births - in 1997 to 107 - 0.5 per cent of births - in 2007.
[continued] "
Note: Homebirth is able to be accessed within publicly funded models in South Australia, as well as privately. The South Australia Department of Health (DoH) Policy for Planned Birth at Home in South Australia was published in 2007.
Homebirth Conference ECHUCA 15-16 May 2010
Please make note of the date for the HOMEBIRTH conference in Echuca May 15-16th 2010.
Previously this conference had been planned for later in the year, and the date has been changed to place the conference before 30 June. Hopefully this is still far enough away not to be an issue for people and if it is we apologise but strategically it seemed like a better option.
If anyone would like some preliminary fliers to hand out could you email me Andrea Quanchi idacq223@mcmedia.com.au
Keep an eye on the HOMEBIRTH Australia website for details in the coming months.
Previously this conference had been planned for later in the year, and the date has been changed to place the conference before 30 June. Hopefully this is still far enough away not to be an issue for people and if it is we apologise but strategically it seemed like a better option.
If anyone would like some preliminary fliers to hand out could you email me Andrea Quanchi idacq223@mcmedia.com.au
Keep an eye on the HOMEBIRTH Australia website for details in the coming months.
Home births 'as safe as hospital'
From BBC News
The largest study of its kind has found that for low-risk women, giving birth at home is as safe as doing so in hospital with a midwife.
Research from the Netherlands - which has a high rate of home births - found no difference in death rates of either mothers or babies in 530,000 births.
... [continued]
Listen to an extract of the Today program
The largest study of its kind has found that for low-risk women, giving birth at home is as safe as doing so in hospital with a midwife.
Research from the Netherlands - which has a high rate of home births - found no difference in death rates of either mothers or babies in 530,000 births.
... [continued]
Listen to an extract of the Today program
Wednesday, April 15, 2009
A question of law
The question is, how can one professional group (midwives) be excluded from practice on the grounds of no insurance being available, when the group competing for the same work (obstetricians and proceduralist GPs) receive substantial government support to purchase their indemnity insurance? When the same support for midwives has been refused? Does this not breach the terms of competition policy and monopolies supported by government funding?
This question has been sent to Damien Carrick, presenter of the ABC Radio National Law Report. It can be sent to other commentators too.
Perhaps we should also approach PILCH? with the same question, or a corresponding one from the consumer's perspective?
Australia's National Competition Policy has guided the development of laws in relation to competition, under the Trade Practices Act.
A paper 'The Trade Practices Act and the Health Sector' was presented by Professor Allan Fels, the then chair of the ACCC, in 1998. Here are a couple of quotes:
"competition policy is based on the premise that consumer choice, rather than the collective judgment of the sellers, should determine the range and prices of goods and services that are available. Or in other words that the competitive suppliers should not pre-empt the working of the market by deciding themselves what their customers need, rather than allowing the market to respond to what consumers demand."
The role of the ACCC includes "looking at health professionals' conduct to determine whether it promotes or hinders patients' interests in being able to choose among a variety of services and price options according to their needs."
I KNOW THERE ARE A FEW CONSUMERS READING THIS BLOG. CAN YOU BELIEVE WHAT YOU HAVE JUST READ? WHEN YOU HAVE RECOVERED YOUR COMPOSURE, PLEASE SEND A COMMENT AND TELL ME HOW YOU INTEND TO PROCEED WITH DEMANDING THAT CONSUMER CHOICE BE SOMEHOW INCLUDED IN THE MATERNITY CARE COMPETITIVE SCENE. THE HEALTH MINISTER AND ALL GOVERNMENT BODIES ARE SUPPOSED TO ACT UNDER THIS LAW.
********
The only way within the law that a monopoly is allowed is if the monopoly is established in the public interest. This means in maternity that midwives SHOULD ONLY be denied access to funding and registration if it can be shown that the 'public' out there are safer within the medical/obstetric monopoly of care, and by being prevented from accessing midwife led care. The medical/obstetric monopoly has the vast majority of maternity care under its belt - it just needs to mop up that troublesome minority of women and midwives who have independent minds and like to proceed without drugs and gadgets.
When someone who understands and is able to argue the law is willing to listen, we would like to talk about the legal ramifications of the current status of midwives who practise independently, and are unable to purchase professional indemnity insurance.
Thankyou for your comments.
Joy Johnston
This question has been sent to Damien Carrick, presenter of the ABC Radio National Law Report. It can be sent to other commentators too.
Perhaps we should also approach PILCH? with the same question, or a corresponding one from the consumer's perspective?
Australia's National Competition Policy has guided the development of laws in relation to competition, under the Trade Practices Act.
A paper 'The Trade Practices Act and the Health Sector' was presented by Professor Allan Fels, the then chair of the ACCC, in 1998. Here are a couple of quotes:
"competition policy is based on the premise that consumer choice, rather than the collective judgment of the sellers, should determine the range and prices of goods and services that are available. Or in other words that the competitive suppliers should not pre-empt the working of the market by deciding themselves what their customers need, rather than allowing the market to respond to what consumers demand."
The role of the ACCC includes "looking at health professionals' conduct to determine whether it promotes or hinders patients' interests in being able to choose among a variety of services and price options according to their needs."
I KNOW THERE ARE A FEW CONSUMERS READING THIS BLOG. CAN YOU BELIEVE WHAT YOU HAVE JUST READ? WHEN YOU HAVE RECOVERED YOUR COMPOSURE, PLEASE SEND A COMMENT AND TELL ME HOW YOU INTEND TO PROCEED WITH DEMANDING THAT CONSUMER CHOICE BE SOMEHOW INCLUDED IN THE MATERNITY CARE COMPETITIVE SCENE. THE HEALTH MINISTER AND ALL GOVERNMENT BODIES ARE SUPPOSED TO ACT UNDER THIS LAW.
********
The only way within the law that a monopoly is allowed is if the monopoly is established in the public interest. This means in maternity that midwives SHOULD ONLY be denied access to funding and registration if it can be shown that the 'public' out there are safer within the medical/obstetric monopoly of care, and by being prevented from accessing midwife led care. The medical/obstetric monopoly has the vast majority of maternity care under its belt - it just needs to mop up that troublesome minority of women and midwives who have independent minds and like to proceed without drugs and gadgets.
When someone who understands and is able to argue the law is willing to listen, we would like to talk about the legal ramifications of the current status of midwives who practise independently, and are unable to purchase professional indemnity insurance.
Thankyou for your comments.
Joy Johnston
Tuesday, April 14, 2009
NORMAL BIRTH Campaign in the UK
Royal College of Midwives (RCM) Campaign for Normal Birth
provides an opportunity to share good practice to promote normal birth. The Campaign aims to inspire and support normal birth practice. It’s a reminder that good birth experiences can happen despite the challenges. Interventions and caesarean shouldn’t be the first choice - they should be the last.
www.rcmnormalbirth.org.uk
'Making normal birth a reality' is the Consensus statement from the Maternity Care Working Party, in which the contributors state their shared views about the need to recognise, facilitate and audit normal birth.
The Maternity Care Working Party is an independent, multi-disciplinary body that campaigns for improvements in maternity care. It was established to raise awareness of the public health implications of the rising caesarean rate. It highlights the health and social needs of women and their families, and the contribution that woman-centred maternity services can make to the promotion of public health, ensuring that babies have the best possible start in life.
And while you are browsing the British midwifery sites, have a look at the Independent Midwives UK
These midwives also face loss of their right to practice, when the UK government brings in legislation requiring professional indemnity insurance as a requirement for registration.
provides an opportunity to share good practice to promote normal birth. The Campaign aims to inspire and support normal birth practice. It’s a reminder that good birth experiences can happen despite the challenges. Interventions and caesarean shouldn’t be the first choice - they should be the last.
www.rcmnormalbirth.org.uk
'Making normal birth a reality' is the Consensus statement from the Maternity Care Working Party, in which the contributors state their shared views about the need to recognise, facilitate and audit normal birth.
The Maternity Care Working Party is an independent, multi-disciplinary body that campaigns for improvements in maternity care. It was established to raise awareness of the public health implications of the rising caesarean rate. It highlights the health and social needs of women and their families, and the contribution that woman-centred maternity services can make to the promotion of public health, ensuring that babies have the best possible start in life.
And while you are browsing the British midwifery sites, have a look at the Independent Midwives UK
These midwives also face loss of their right to practice, when the UK government brings in legislation requiring professional indemnity insurance as a requirement for registration.
Thursday, April 9, 2009
homebirth in the media
The recent publicity around a woman's choice to give birth at home without any professional attendant [for more links and discussion click here] has sparked various articles in the papers and television media.
A consistent omission is any attempt to define 'unattended homebirth' as distinct from homebirth with a professional midwife as primary care provider.
SMH reporter Miranda Devine, in A home birth is not a safe birth refers to "the death during childbirth of the baby of a leading home birth advocate at her inner-western Sydney home ..." The article draws attention to the government's Maternity Services Review, and it's failure to recommend support for home birth, yet fails to mention the fact that had been on the record for several weeks: that the mother whose baby died in labour preferred to be an "autonomous care-provider", without any professional attendant.
Several doctors have been reported in the "debate" on the safety of homebirth.
These doctors, who ought to know better, have quoted data that have no statistical significance, without reference to reliable research. For example, in response the ABC Unleashed 8 April, 'Mother and baby are doing well', Debbie Slater from Perth WA comments
"Dr Pesce's comment on the 12th Perinatal Mortality Report from WA:
"The statistics referred to in that report are just 6 deaths in 4 years. The report actually covers 2002 to 2004, but there weren't enough deaths in that period, so the committee went back and included those from 2000 to 2002.
"Of the 6 deaths 4 were stillbirths and 2 babies died shortly after birth. Only one baby was actually born at home: the other 5 were born in hospital, although 2 of the babies born in hospital actually died at home (stillbirths where the baby died before mum went into labour and mum went into hospital to give birth).
"All of the deaths were examined. Four of the deaths were considered to have low levels of preventability and two were considered not preventable at all.
"The WA health department at the time said:
"A preliminary review of medical records by the Department indicates that it is likely that the setting of the birth did not affect the outcome in at least five of the six deaths."
"A review of homebirths in WA was recently carried but the report is yet to be made public. I understand it is now to be released next month.
"Given that the WA Health Department has just provided additional funding to expand the government-funded Community Midwifery Programme I will surmise that the review cannot have found too many adverse findings.”
The listener to Unleashed is informed of an "Australian review of over 1.5 million births between 1985-90. This report showed a three-fold increased risk of a full term, otherwise healthy baby dying during a planned home birth ..."
The paper from which this statistic is drawn is probably that published by Bastian et al (1998), which has come under strong criticism for its methodology. Marsden Wagner (1999) pointed out that less than three quarters of the data was collected by an ‘orthodox and acceptable’ method, giving a perinatal mortality rate of 3.8 per 1000 births, comparing favourably with other homebirth studies and the general Australian rate at the time. The remainder of the data was derived from ‘unorthodox and unacceptable’ methods, which Wagner considers unreliable. The latter group had an inflated perinatal mortality rate of 20.8. Wagner suggests that conclusions drawn about unacceptable death rates from unreliable sources are not valid.
Listeners are not informed that the 'gold standard' Cochrane Review evidence is that for women at low risk of complications, there is no strong evidence to favour either planned hospital birth or planned home birth. (Olsen and Jewell 1998, Last assessed [by Cochrane Reviews] as up to date April 2006.)
In a discussion on ‘Birth Territory: a theory for midwifery practice’ (Fahy and Parratt 2006) the authors postulate that “when midwives create and maintain ideal environmental conditions maximum support is provided to the woman and fetus in labour and birth which results in an increased likelihood that the woman will give birth under her own power, be more satisfied with the experience and adapt with ease in the post-birth period.”
Joy Johnston
A consistent omission is any attempt to define 'unattended homebirth' as distinct from homebirth with a professional midwife as primary care provider.
SMH reporter Miranda Devine, in A home birth is not a safe birth refers to "the death during childbirth of the baby of a leading home birth advocate at her inner-western Sydney home ..." The article draws attention to the government's Maternity Services Review, and it's failure to recommend support for home birth, yet fails to mention the fact that had been on the record for several weeks: that the mother whose baby died in labour preferred to be an "autonomous care-provider", without any professional attendant.
Several doctors have been reported in the "debate" on the safety of homebirth.
These doctors, who ought to know better, have quoted data that have no statistical significance, without reference to reliable research. For example, in response the ABC Unleashed 8 April, 'Mother and baby are doing well', Debbie Slater from Perth WA comments
"Dr Pesce's comment on the 12th Perinatal Mortality Report from WA:
"The statistics referred to in that report are just 6 deaths in 4 years. The report actually covers 2002 to 2004, but there weren't enough deaths in that period, so the committee went back and included those from 2000 to 2002.
"Of the 6 deaths 4 were stillbirths and 2 babies died shortly after birth. Only one baby was actually born at home: the other 5 were born in hospital, although 2 of the babies born in hospital actually died at home (stillbirths where the baby died before mum went into labour and mum went into hospital to give birth).
"All of the deaths were examined. Four of the deaths were considered to have low levels of preventability and two were considered not preventable at all.
"The WA health department at the time said:
"A preliminary review of medical records by the Department indicates that it is likely that the setting of the birth did not affect the outcome in at least five of the six deaths."
"A review of homebirths in WA was recently carried but the report is yet to be made public. I understand it is now to be released next month.
"Given that the WA Health Department has just provided additional funding to expand the government-funded Community Midwifery Programme I will surmise that the review cannot have found too many adverse findings.”
The listener to Unleashed is informed of an "Australian review of over 1.5 million births between 1985-90. This report showed a three-fold increased risk of a full term, otherwise healthy baby dying during a planned home birth ..."
The paper from which this statistic is drawn is probably that published by Bastian et al (1998), which has come under strong criticism for its methodology. Marsden Wagner (1999) pointed out that less than three quarters of the data was collected by an ‘orthodox and acceptable’ method, giving a perinatal mortality rate of 3.8 per 1000 births, comparing favourably with other homebirth studies and the general Australian rate at the time. The remainder of the data was derived from ‘unorthodox and unacceptable’ methods, which Wagner considers unreliable. The latter group had an inflated perinatal mortality rate of 20.8. Wagner suggests that conclusions drawn about unacceptable death rates from unreliable sources are not valid.
Listeners are not informed that the 'gold standard' Cochrane Review evidence is that for women at low risk of complications, there is no strong evidence to favour either planned hospital birth or planned home birth. (Olsen and Jewell 1998, Last assessed [by Cochrane Reviews] as up to date April 2006.)
In a discussion on ‘Birth Territory: a theory for midwifery practice’ (Fahy and Parratt 2006) the authors postulate that “when midwives create and maintain ideal environmental conditions maximum support is provided to the woman and fetus in labour and birth which results in an increased likelihood that the woman will give birth under her own power, be more satisfied with the experience and adapt with ease in the post-birth period.”
Joy Johnston
Saturday, April 4, 2009
Maternity Coalition's campain in response to the Maternity Services Review
From Janie Nottingham:
I am writing to inform you of the Maternity Coalition campain underway at present and to develop links with many of you and detail how you can become involved.
The MC website has been updated and I urge you to please go and have a look at it
http://www.maternitycoalition.org.au
Maternity Coalition believes that the implementation of the review could see a system that ranges from providing women with every choice, to a system that restricts women even further than they are restricted today. We have particular concerns about the Government's support and funding of private midwifery care and midwife-led care in public hospitals. The government has made it clear that homebirth will not be supported at this time.
Maternity Coalition has sent a letter to the Health Minister and is awaiting a response.
Our campaign asks the Government to listen and respond to women and to enable women to have all options available.
Letter writing campaign:
MC has developed a sample letter to assist when drafting your own. This is not on the web site yet but will be uploaded shortly, it is a page version of the one already distributed by Bruce Teakle - click here.
Please send a letter to Nicola Roxon and to your local federal MP (you can find your local federal member through the AEC website). Please do not cc your letters, write two separate ones (this ensures responses!).
Nicola Roxon
Minister for Health and Ageing
Parliament House
Canberra ACT 2600
Visit your Federal MP:
It is valuable to also meet with your local federal MP, make sure you see them and not just one of their staff.
Join our postcard campaign:
MC has developed a postcard campaign and has printed 10,000 copies, all of which will be sent to Minister Roxon's office. We need your help! Order your bundle of postcards to distribute amongst your friends and family. Simply attach a stamp and write your name and address (and a short message if you choose), pop it in the mail, and your postcard will join the thousands of others making their way to Nicola Roxon's office, all carrying our message - Every Woman, Every Choice. Order your postcards by emailing postcards@maternitycoalition.org.au We really need to have a state wide discussion about this and develop our approach, I am the chief distributor at present and would love a representative from each branch to come forward to liase with me to ensure we do this part well. Again this would be discussed in detail on a conference call hook up for all interested Victorians.
Organise or attend an event on our National Day of Unity and Action for Birth Reform:
A national day of action will be held on July 4, 2009. For further information, or to register your local event email campaign@maternitycoalition.org.au.
Support homebirth as an option for Australian women:
We also ask that if you feel strongly about homebirth as an option, you also support the Homebirth Australia campaign.
What else are we up to?
We are making links to other birth-related organisations and are developing a joint letter to be signed by all organisations to go to the Government. If you can help in any way with this it would be greatly appreciated, it would also be timely for us to do this within Victoria.
This is a time for women to unite to support all choices being available in birth.
Thank you for supporting this campaign.
Please stay in contact and ask for any info you require.
For Women For Midwives
Janie Nottingham
Acting Vic MC President
janie.nottingham@gmail.com
I am writing to inform you of the Maternity Coalition campain underway at present and to develop links with many of you and detail how you can become involved.
The MC website has been updated and I urge you to please go and have a look at it
http://www.maternitycoalition.org.au
Maternity Coalition believes that the implementation of the review could see a system that ranges from providing women with every choice, to a system that restricts women even further than they are restricted today. We have particular concerns about the Government's support and funding of private midwifery care and midwife-led care in public hospitals. The government has made it clear that homebirth will not be supported at this time.
Maternity Coalition has sent a letter to the Health Minister and is awaiting a response.
Our campaign asks the Government to listen and respond to women and to enable women to have all options available.
Letter writing campaign:
MC has developed a sample letter to assist when drafting your own. This is not on the web site yet but will be uploaded shortly, it is a page version of the one already distributed by Bruce Teakle - click here.
Please send a letter to Nicola Roxon and to your local federal MP (you can find your local federal member through the AEC website). Please do not cc your letters, write two separate ones (this ensures responses!).
Nicola Roxon
Minister for Health and Ageing
Parliament House
Canberra ACT 2600
Visit your Federal MP:
It is valuable to also meet with your local federal MP, make sure you see them and not just one of their staff.
Join our postcard campaign:
MC has developed a postcard campaign and has printed 10,000 copies, all of which will be sent to Minister Roxon's office. We need your help! Order your bundle of postcards to distribute amongst your friends and family. Simply attach a stamp and write your name and address (and a short message if you choose), pop it in the mail, and your postcard will join the thousands of others making their way to Nicola Roxon's office, all carrying our message - Every Woman, Every Choice. Order your postcards by emailing postcards@maternitycoalition.org.au We really need to have a state wide discussion about this and develop our approach, I am the chief distributor at present and would love a representative from each branch to come forward to liase with me to ensure we do this part well. Again this would be discussed in detail on a conference call hook up for all interested Victorians.
Organise or attend an event on our National Day of Unity and Action for Birth Reform:
A national day of action will be held on July 4, 2009. For further information, or to register your local event email campaign@maternitycoalition.org.au.
Support homebirth as an option for Australian women:
We also ask that if you feel strongly about homebirth as an option, you also support the Homebirth Australia campaign.
What else are we up to?
We are making links to other birth-related organisations and are developing a joint letter to be signed by all organisations to go to the Government. If you can help in any way with this it would be greatly appreciated, it would also be timely for us to do this within Victoria.
This is a time for women to unite to support all choices being available in birth.
Thank you for supporting this campaign.
Please stay in contact and ask for any info you require.
For Women For Midwives
Janie Nottingham
Acting Vic MC President
janie.nottingham@gmail.com
Safe natural birth under threat
MEDIA RELEASE
[prepared by a group in central Victoria]
Safe natural birth under threat
New government policy is looking to remove womens' access to private midwives. Local supporters of private midwives recently came together in a letter writing workshop and are planning further actions.
Ilana Solo says “My children were born with support from private midwifes - one in a hospital and one at home in Campbells Creek last month. The continuous support I received went far beyond the support offered by the hospital system and helped make both births safe, natural births.”
“My midwifes were with me throughout the pregnancy and stayed for the whole birth. There was no going home at the end of the shift. They also helped me for an extended period after the birth.”
Drummond based private midwife Sally McCrae believes that many women could have better birth outcomes with the support of a private midwife. She attends the births of about 25 babies each year. In her 30 years of practice, she has seen many changes.
“I spend many hours with the family prior to the birth listening to them and gaining their trust. I am able to tailor the support I give to birth each baby safely and as naturally as possible.”
“Australias ceasarean rate has doubled in the last ten years and is much higher than world health organisation reccomendations. If women are denied the choice of private midwifes, we will move one step closer to losing the skills of safe natural birth.”
Continuity of care and homebirth are nationally funded in the United Kingdom, Canada, New Zealand and The Netherlands. Studies have shown that this model delivers good outcomes for the mother and the child and reduces the risks of postnatal depression and other post birth complications.
PLEASE NOTE
This media release can be used as a template in other settings
Thursday, April 2, 2009
MIDIRS Podcasts - a new educational resource for midwives
Launching MIDIRS podcasts – the best midwifery information at a time and place to suit you
MIDIRS is pleased to announce the launch of its new podcast service, which will focus on delivering key information surrounding pregnancy, birth and the postnatal period to maternity health care professionals.
This free resource replaces MIDIRS Webinars. It aims to deliver the best maternity expertise to you at a time and place which suits.
...
In order to subscribe to a podcast, you need an internet connection and a piece of podcast software which is usually available free of charge. Once you have installed this software, it will check MIDIRS for new episodes of your chosen podcast series and automatically download new episodes for you.
...
What is available?
Categories include antenatal, intrapartum, postnatal, neonatal, professional practice, research and education, maternity services and miscellaneous and specialist topics. We have an extensive back catalogue of podcasts available from the MIDIRS archives and will be adding new ones all the time. Guest speakers have included Denis Walsh, Soo Downe, and Ina May Gaskin.
To launch our new service we have an excellent podcast from Dr Sara Wickham on the art of questioning! Sara is renowned for her inquisitive and critical approach to the consideration of various midwifery practices. Sara brings these skills to this podcast, as she helps us to consider the role of reflective practice and critical thinking in contemporary maternity care provision. Asking questions is fundamental to our daily practice and Sara demonstrates how questions are often posed while midwives work within multiple paradigms. For example, the obstetric (medical) model, where birth is only perceived as ‘normal’ in hindsight, compared to the midwifery (social) model of care with its strong focus on normality, in which pregnancy is viewed as an altered state of normal health.
What are we doing and why are we doing it? How can we view it differently and how can we improve things? If you feel the need to be inspired or re-enthused to challenge practice, then this podcast is an absolute must for you!
We hope that you enjoy our new podcast service as well as letting us know your thoughts through the reviewing facility.
| Adam McGahern | IT Manager | MIDIRS |
MIDIRS is pleased to announce the launch of its new podcast service, which will focus on delivering key information surrounding pregnancy, birth and the postnatal period to maternity health care professionals.
This free resource replaces MIDIRS Webinars. It aims to deliver the best maternity expertise to you at a time and place which suits.
...
In order to subscribe to a podcast, you need an internet connection and a piece of podcast software which is usually available free of charge. Once you have installed this software, it will check MIDIRS for new episodes of your chosen podcast series and automatically download new episodes for you.
...
What is available?
Categories include antenatal, intrapartum, postnatal, neonatal, professional practice, research and education, maternity services and miscellaneous and specialist topics. We have an extensive back catalogue of podcasts available from the MIDIRS archives and will be adding new ones all the time. Guest speakers have included Denis Walsh, Soo Downe, and Ina May Gaskin.
To launch our new service we have an excellent podcast from Dr Sara Wickham on the art of questioning! Sara is renowned for her inquisitive and critical approach to the consideration of various midwifery practices. Sara brings these skills to this podcast, as she helps us to consider the role of reflective practice and critical thinking in contemporary maternity care provision. Asking questions is fundamental to our daily practice and Sara demonstrates how questions are often posed while midwives work within multiple paradigms. For example, the obstetric (medical) model, where birth is only perceived as ‘normal’ in hindsight, compared to the midwifery (social) model of care with its strong focus on normality, in which pregnancy is viewed as an altered state of normal health.
What are we doing and why are we doing it? How can we view it differently and how can we improve things? If you feel the need to be inspired or re-enthused to challenge practice, then this podcast is an absolute must for you!
We hope that you enjoy our new podcast service as well as letting us know your thoughts through the reviewing facility.
| Adam McGahern | IT Manager | MIDIRS |
ABC 7.30 Report on homebirths
Homebirths could soon be forced underground
Australian Broadcasting Corporation
Broadcast: 01/04/2009
Reporter: Kirstin Murray
A recent review of the country's maternity services recommended the Government overhaul the power given to midwives. If the recommendations are accepted by the Health Department, some midwives could be given access to many benefits doctors have including professional indemnity insurance.
[click for Transcript]
Australian Broadcasting Corporation
Broadcast: 01/04/2009
Reporter: Kirstin Murray
A recent review of the country's maternity services recommended the Government overhaul the power given to midwives. If the recommendations are accepted by the Health Department, some midwives could be given access to many benefits doctors have including professional indemnity insurance.
[click for Transcript]
Wednesday, April 1, 2009
ANF study day on legal issues for midwives and nurses
‘Am I Responsible?’
Australian Nursing Federation (Vic Branch) Professional Day Conference gives nurses and midwives the opportunity to listen to key players in these changes and to ask questions of these leaders in nursing.
Friday May 22, 2009 at the Rydges on Swanston, 701 Swanston St. Melbourne.
The program includes:
* Magistrate/Coroner Audrey Jamieson starts the day by exploring the coronial expectations in the fulfilment of your duty of care.
* Barrister Ron Gipp examines the impact on nurses of the coronial process with a case study.
* Nigel Fidgeon, the CEO of the Nurses Board of Victoria (NBV), who explains the NBV rationale of moving responsibility for determining scope of practice to the employer and the individual nurse.
* We then put the three speakers on the spot, in a panel discussion facilitated by Philip Gardner, Partner of Ryan Carlisle Thomas Solicitors and ask them to answer the question ‘So who’s really responsible for making the decision?’ and invite you to put all the questions you have to them.
This forum aims to provide midwives and nurses with firsthand information on the coronial process, tribunals and NBV expectations relating to their duty of care. It also aims to provide insights into education and practice as a result of changes to professional regulation and government policy.
Questions: Elaine Toma on 9275 9333 or email etoma@anfvic.asn.au
To register securely for this conference click this link.
Australian Nursing Federation (Vic Branch) Professional Day Conference gives nurses and midwives the opportunity to listen to key players in these changes and to ask questions of these leaders in nursing.
Friday May 22, 2009 at the Rydges on Swanston, 701 Swanston St. Melbourne.
The program includes:
* Magistrate/Coroner Audrey Jamieson starts the day by exploring the coronial expectations in the fulfilment of your duty of care.
* Barrister Ron Gipp examines the impact on nurses of the coronial process with a case study.
* Nigel Fidgeon, the CEO of the Nurses Board of Victoria (NBV), who explains the NBV rationale of moving responsibility for determining scope of practice to the employer and the individual nurse.
* We then put the three speakers on the spot, in a panel discussion facilitated by Philip Gardner, Partner of Ryan Carlisle Thomas Solicitors and ask them to answer the question ‘So who’s really responsible for making the decision?’ and invite you to put all the questions you have to them.
This forum aims to provide midwives and nurses with firsthand information on the coronial process, tribunals and NBV expectations relating to their duty of care. It also aims to provide insights into education and practice as a result of changes to professional regulation and government policy.
Questions: Elaine Toma on 9275 9333 or email etoma@anfvic.asn.au
To register securely for this conference click this link.
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