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."

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!

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 hmhf@mcri.edu.au, or by phoning 03 9090 5204.

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.

ABC
SBS
SBS
Brisbane Times
Sunrise
The Age
yahoo

ninemsn

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.

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]

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.

HOMEBIRTH WITH A PRIVATE MIDWIFE MUST NOT BE MADE UNLAWFUL.


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

RALLY

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

http://www.homebirthaustralia.org/mother-all-rallies


Media contacts:

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

Lisa Metcalfe
NSW President

MidAtlantic Conference on Birth and Primal Health Research

GRAN CANARIA

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


Don’t miss the

MIDATLANTIC CONFERENCE ON BIRTH & PRIMAL HEALTH RESEARCH

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.

Visit:

WWW.WOMBECOLOGY.COM
(English and Spanish editions)

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

SPREAD THE WORD!

CHILDBIRTH IN THE LAND OF UTOPIA - Michel Odent

CHILDBIRTH IN THE LAND OF UTOPIA
JANUARY 2031
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:
ONLY UTOPIA CAN SAVE HUMANITY!


PRIMAL HEALTH RESEARCH

A NEW ERA IN HEALTH RESEARCH
Published quarterly by Primal Health Research Centre
Charity No.328090
72, Savernake Road, London NW3 2JR
michelodent@googlemail.com

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
Michel


Autumn 2009 Vol 17. No2

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