Monday, January 25, 2010

Bev's review of politics and homebirth

Over half of the submissions to the Federal Government Inquiry into Maternity Services in March 2009 were from consumers and nearly 60% asked for greater support for, and access to, homebirth. The extreme naivety of leaving home birth off the agenda because "it would polarise the professions" has caused chaos. If you believe in the chaos theory, midwives and mothers have emerged victorious. Midwives and homebirth are now on the agenda.

Home birth families around the country have been fascinated to read the new South Australian study published in the MJA (Medical Journal of Australia) on Monday 18th January. For babies born at home there were only 2.5 deaths per 1000 actual homebirths making homebirth 328% safer for babies than birth in hospital. When the detail of the study was exposed and the data analysed correctly by experienced exponents of research analysis, the perinatal mortality for homebirth is 2.5 babies per 1000 births compared to 20.1 babies per 1000 births in hospital.So women can safely choose homebirth in South Australia.

Sophisticated high level research in the United Kingdom, Netherlands, New Zealand and Canada has already confirmed that women are more satisfied with midwife led birth. In spite of false claims by the erstwhile leaders the of the AMA (Australian Medical Association) this South Australian research study, reinforces the view of advocates for women, that home birth is now only way for women to claim back normal birth. In fact one leading obstetrician Marsden Wagner in the USA puts it more bluntly "get the Hell out of Hospital".

The other good news from the study, was that homebirth provides: a lower incidence of episiotomy (an unkind cut), higher incidence of intact perineum, less 1st. 2nd and 3rd degree tears than in hospital women, less incidence of post-partum haemorrhage, no statistical difference in babies' apgar (colour breathing) score.

The new study assessed the outcomes of almost 300,000 births in South Australia from 1991 to 2006 which resulted in approximately (8.2/1000) or 2550 baby deaths in hospital. Of the 1141 planned home births the rate was declared to be 7.9/1000 EXCEPT that 7 of these 9 births died in hospital.
The claim that the research demonstrated that baby’s had a 7 times more likelihood of dying in homebirth is false.
The attribution to planned homebirth for at least 4 of those deaths which were congenital abnormalities, is specious.
There is no explanation given for the approximately 2500 deaths in hospital.
The other false claim of "27 times more likely to die of birth asphyxia " ( lack of oxygen either before during labour or at birth) is exposed when it is clear that only one baby died for that reason at home during the selected 16 years. The mother refused to go to hospital due to previous bad hospital experience.

Caesarean surgery, removing the baby through the mother's abdomen, is taking place for one in three women and higher in Australian private hospitals. These doctor led positively reinforced decisions are nothing short of assault and battery of women. Obstetrician David Elwood from Canberra stated to Norman Swan on Health Matters on 2.11.09 "now that we manage surgically so well then there is no turning back to normal vaginal birth" he further stated that "we" set the surgery for 39 weeks. "I was up during the night recently performing a caesarian (surgery) because a woman came into labour before 39 weeks.". Even more scary another doctor Caroline de Costa from Qld stated to Norman Swan that women "now have right to choose between vaginal and abdominal birth".

Duty of care, that is, "first do no harm" seems to be missing. In Brazil the abdominal surgery rate for birth is 80%. According to recent research from South America, repeat surgery for future births, is putting women at risk of loss of fertility, haemorrhage and/or death. Recent strong causal links have been made with the high incidence of asthma. Lack of exposure to normal flora of the mother's skin and the absence of squeezing out fluid from the lung as in normal vaginal birth are stated to be the reason. High rates of psychosocial and physical illness are also linked to this surgery.

It is interesting that M. Keirse who was co-author of the South Australian study was also co-author of 3rd Edition of a Effective care in Pregnancy in which it was stated that it is inherently unwise and perhaps unsafe for women with normal pregnancies to be cared for by an obstetric specialist. The Health Minister Nicola Roxon, stated in a letter to me, that the Australian Government has recommended a review of the high rates of abdominal surgery for birth and intervention . Federal MP Darren Chester from East Gippsland spoke to me of the high regard in which he held the midwives of East Gippsland who were lead carers in their children's births. Matt Viney State MP from Warragul told me that two of his children were born at home with a midwife.

Most of the placards and speakers at the rally I attended outside the Melbourne office of the AMA on Wednesday 20th January last, called for Dr. Pesce’s resignation. The AMA were called on to ask for his resignation. The AMA as a group of medical professionals must be prepared to take responsibility for the gross distortion of facts by its leading representative

• This attempt to frighten women is an indictment on the current maternity system in Australia - it that which needs fixing - removing homebirth won’t do this.

Beverley Walker Mother of 4 Grandmother of 7.
Midwife Ethicist & Health Scientist
Lobbyist and Activist.

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