Australian Midwifery Debate
Australian doctors claim they have a monopoly on “high-quality, evidence-based care”, with midwifery being unworthy of taxpayer funding.
Letters to The Editor, The Age, 18th July 2009
Actuarial reality
PROPOSED legislation establishing a national registration scheme for health professionals does not outlaw home birthing. Rather, the Government has simply stated it will not provide indemnity for midwives working outside established clinical settings. This does not prevent midwives from seeking indemnity privately (as doctors have to do). The difficulty, of course, is that the cost of such insurance is likely to be prohibitive … an actuarial reality in keeping with the risks of home birth.
Hospital delivery is safe, not because it is done by doctors (most deliveries are conducted by a midwife), but because of the robust systems of clinical governance and access to a multidisciplinary team that underpin it.
Monica Dux asserts (Comment, 16/7) that to give birth at home is a fundamental right of all women, when really the right we should be fighting for is that of equitable access to high-quality, evidence-based care that will ensure the wellbeing of both mother and child.
Women should be free to make their own choice about childbirth, but this choice should not be inappropriately subsidised by the taxpayer.
Dr Sharon Monagle, Mordialloc
The AMA Submission to the Maternity Services Review makes various largely unsubstantiated frightening sounding claims, such as:
- Australia is one of the safest places in the world in which to give birth. Australia’s maternal and perinatal death rates are lower than the majority of comparable countries. Any reforms to maternity services must not lose sight of or jeopardise this excellent record.
- …absence of access to (medical) services means that mothers will not have the choice of epidural anaesthesia if required, will not have the choice of emergency caesarean section if required, and will not have the choice of their baby being assisted by a paediatrician if required.
- …real risks in morbidity and mortality outcomes…
- …there is a risk that Australian women will be made to feel that they are “lesser” women if they choose to have medical specialist and hospital care for their pregnancies and delivery.
- …in-home birthing by midwives is three times more likely to lead to perinatal mortality than conventional
options even with the lowest risk pregnancies. - … there was a statistically significant 4 fold overall increased risk of a baby dying during labour in a birth centre group overall and a 7 fold increased risk of dying in labour for babies of first time mothers in the birth centre group.
So suck it up ladies – you have no options because you’re not qualified.
Letters to The Editor, The Age, 17th July 2009
Delivering right care
MONICA Dux (Comment, 16/7), it is not only a matter of a woman’s right to choose, but also of society’s responsibility to either care for a family who has lost a mother through complications of a home delivery, and/or the considerable expense of looking after a baby with a cognitive defect as a result of a complicated or prolonged delivery.
As a country doctor who for 30 years has delivered about 1000 babies in NSW, Queensland and Norfolk Island, I can look back to a number of deliveries where everything pointed to an “uncomplicated” delivery, but problems developed during or after the delivery of the baby.
In a hospital, we always have full facilities at hand — blood for a severe and unexpected post-partum haemorrhage, or resuscitation equipment for a “flat” baby. Not one mother’s or baby’s life has been lost or threatened as a consequence.
The same could not be said if the deliveries were home-based.
International studies do not support home deliveries; in fact they do the opposite. Certainly the British Government is supporting home births, but in a recent discussion with a friend, Eric Jauniaux, professor of obstetrics/gynaecology at the Middlesex and Royal Free hospitals in London, he pointed out that the Government has used a discredited report from just two years in the early 1990s to support their advice, simply as a huge cost-saving measure.
Well-conducted clinical studies from 1998-2008 show nearly a 10-fold increase in peri-natal and maternal mortality from home-based deliveries.
Dr Martin Panter, Kuranda, Queensland
Letters to The Editor, The Age, 19th July 2009
Home birth needs to go mainstream
I AM not quite sure what research Dr Martin Panter (Letters, 17/7) is referring to when he talks of “nearly a 10-fold increase in perinatal and maternal mortality from home-based deliveries”. Research of more than 600,000 births, published a few months ago in the British Journal of Obstetrics and Gynaecology, concluded that “planning a home birth 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”.
The Royal College of Obstetricians and Gynaecologists, in response, said it supported home births for low-risk pregnancies, provided there were appropriate infrastructure and resources.
Home birth is a legitimate choice for women. The Australian maternity system needs to promote this choice by providing the appropriate infrastructure and resources. Ignoring the fact that some women will choose to birth at home will not make it go away. We need to acknowledge this, and provide access to home births as a mainstream option.
Debbie Slater, vice-chairwoman, Childbirth Australia, Churchlands, WA
