Wednesday, September 14, 2011

Australian midwifery's Position Statement on Homebirth

MIPP and other midwifery and maternity consumer groups are preparing our responses to the ACM Interim Positon Statement on Homebirth. See previous posts at villagemidwife and an earlier post on this blog.

It's a complex and important matter.

The ACM Interim position statement was endorsed by the regulatory authority prior to its release to the midwifery profession for comment. Having been endorsed, the Position Statement on Homebirth comes under the midwifery Safety and Quality Framework which details the requirements with which a privately practising midwife must comply in order to be exempt from requiring insurance for providing intrapartum care for homebirths. Under the national law,
284 1 (c) the midwife complies with any requirements set out in a code or guideline approved by the National Board under section 39 about the practise of private midwifery, including— (i) any requirement in a code or guideline about reports to be provided by midwives practising private midwifery; and (ii) any requirement in a code or guideline relating to the safety and quality of the practise of private midwifery.
In the interests of public protection, it is essential that midwives reject the ACM Interim Position Statement on Homebirth (IPSH), and work with the College to develop a statement that is consistent with current midwifery practice and philosophy.

The woman's decision-making role in spontaneous unmedicated childbirth - the only option in home birth - has been ignored and avoided in an apparent attempt to enforce boundaries around aspects of clinical safety.

Consider, for example, some of the evidence referred to and relied on by the College in support of its IPSH. Reference is made to both the Kennare et al (2010) paper on planned homebirth in South Australia, and the widely discredited Bastian et al (1998) [note this paper is outdated by academic standards], which included data collection by unreliable and unacceptable methods.

Midwives' comments on Kennare et al (2010) can be accessed online. I draw readers' attention particularly to a critique attributed to leading midwife academics, who are also prominent members of the College of midwives, Hannah Dahlen and Caroline Homer.

Another valuable commentary was published by midwife Caroline Hastie at her Thinkbirth blog.
Birth is as safe as life gets Dr Pesce. The therapeutic use of self as a health care practitioner is what makes both life and birth safer. As Barbara Katz Rothman says "birth is about making strong and capable mothers". Time to stop pulling the rug from under women's sense of self with all this 'turf war' rhetoric!
Since pregnancy and birth are truly natural states, and are not, per se, reliant on outside management, the woman has a basic natural right to maintain personal control over primary level decisions, including if and when she goes to hospital. The midwife is the professional care provider with the skill and the ability to attend births at home. If a position statement which is endorsed by the regulatory authority effectively restricts the midwifery profession to attending only home births that meet criteria for being at ‘low risk’ from a clinical/obstetric perspective, a significant number of women will be either excluded from making an informed decision about home birth, or they may engage the services of unregulated attendants and continue to plan home birth. Neither of these options is in the interests of the mother’s and her baby’s wellbeing.

In drawing attention to the need of all pregnant-birthing women for midwifery services, we are not promoting management of complicated births in the home. We are, rather, highlighting the importance of access for all birthing women to continuity of skilled care from a known midwife, and the importance of midwives being able to provide professional services in all settings. The partnership that is formed between a midwife and the woman enables the ongoing process of informed decision making by the woman throughout the episode of care.

Your comments on this important matter are welcome.


Emily Bennett said...

Thank you for your further exploration of the issues. Midwifery Students across Australia are coming together so that our voices may be heard too. Please check out our facebook page.!/studentmidwives

Joy Johnston said...

The Australian College of Midwives has informed members that a review panel is being established with a representative from each branch, who has knowledge and expertise in homebirth.
There will be two consumer representatives invited from the Consumer Advisory Committee to participate in the review.
The Review Panel will meet in Adelaide on Saturday 8th October 2011.
Following this review it is anticipated that a revised copy of the position statement will be sent to the Board for review/endorsement.