Monday, February 11, 2013

'free birth'

Birth is, and probably always will be, a contested territory.

An unknown number of women have made the choice to 'free birth': to give birth without professional attendance.  This phenomenon is happening in Australian communities, at the same time as the independent/homebirth midwifery profession is undergoing increasingly demanding levels of regulation from statutory bodies and by way of professional expectations set by our peers. 

While any competent individual has autonomy for their own actions and their own bodies, the issue becomes more complex when that body is a woman's body, which is carrying an unborn child.  And although courts in various countries have upheld the right of a woman to refuse, for example, caesarean surgery that is intended to protect the life of the child, there are many subtle forces that direct a woman in to compliance with social norms.  

Why 'free birth'?
... access? 
Women who proceed with a plan for 'free birth' are not necessarily unable to access a midwife privately to attend homebirth, although this is sometimes the case. 
... cost?
the cost of private midwifery services for homebirth may be prohibitive.
... belief?
the woman who has formed a strong belief that the presence of any qualified person (ie midwife) will inhibit her ability to proceed naturally with birth, considers that she is better off without any professional attendant.
... objection?
A woman may object to some practice, such as listening to the fetal heart sounds, that a midwife may consider to be a basic requirement for safe practice.
... substitution?
an unregulated birth attendant may be willing to act in supporting the woman, and guiding her through her birth, effectively substituting for the midwife.

Whatever the reason, each woman / each situation, is unique.

Here is a hypothetical example.
Ms A and her partner have had two children previously.  Baby #1 was born in hospital, after a long and painful labour, in which Ms A had augmentation of labour, an epidural, and a forceps birth. 

Ms A felt traumatised after that birth, and in her second pregnancy decided that she wanted homebirth.  The midwives who attended her in labour were unhappy with her progress, and recommended that she transfer in labour to hospital.  Baby #2 was born in hospital: a big baby; and another difficult birth. 

Ms A reflected on her experience, and believed that the midwives were fearful, and that she would have been better off without them.  She therefore chose 'free birth' for her third child, and invited two friends who worked as doulas to be with her to support her for the birth.
Ms A's complex process in choosing 'free birth' included her belief that the presence of midwives for baby #2 had inhibited her progress, and the availability of a substitute for professional attendants.

In recording this hypothetical example, I would like to be very clear that I understand that Ms A made choices and decisions that she believed would be in the best interests of herself and her baby. 

The issue of 'free birth' was addressed in a Victorian ABC TV story 7.30 report last Friday.

Several of the people interviewed for this story were asked if they supported the recent recommendation by the South Australian Coroner that it should be an offense for a person to attend birth without having the qualification of midwife or doctor.  The response from Hannah Dahlen, on behalf of the Australian College of Midwives, included a statement that the answer to 'free birth' is not to be found in cracking down, to 'exterminate' its practitioners, as it will only be driven underground.

I concur with this.  Although the events that led to the recommendation by the SA Deputy State Coroner are tragic, I do not consider that legislation to protect midwifery practice in South Australia would or could achieve the desired aim of improved public safety.

The choice that some women make, to give birth to their babies at home, takes into account individual social preferences and reasons. Since birth at home is the outcome of a spontaneous physiological natural process, there is no legislation that can control who a woman consults in pregnancy, or who is with, or not with, a woman who is labouring or giving birth spontaneously.

A woman’s right to self-determination in making decisions such as where she gives birth, and with whom, will not be controlled or altered by legislation designed to protect midwifery practice.

It is my belief that the government’s support for the regulated midwifery profession, with funding for homebirth programs, protection of the full scope of private midwifery practice including hospital visiting access, and education for the public in maternity choices, will result in greater protection of public interest than the proposal to protect midwifery practice.

Joy Johnston


Sarah @ Ilithyia Inspired said...

Great post, Joy, especially the final paragraph, succinct and I believe accurate.

Annie Sprague said...

Thanks Joy for the link. I can't watch it here; ABC iView won't work in Bali. You will have to tell me when I get home.