Monday, September 14, 2009

Don't Let Litigation Rule Birth Choices

There has been a lot of media lately about “bad home birth outcomes” – both here in Aus as well as in America, and it has been distressing to say the least. These stories are inevitably extremely biased towards a medical view – that hospital is the only safe place to birth – without any fair representation of the truth. Both of the most recent stories discuss the death of a baby at home and neither story mentions that babies die in hospitals too. Neither story mentions the studies that repeatedly show that home birth is as safe as hospital birth with far fewer injuries, traumatic outcomes and higher breast feeding rates. Far happier mums and bubs all around. But it does not surprise me – I have lost all faith in the media and our legal and political systems, and I do not have much hope left for our medical system.

Let me be very clear – care in a hospital is NOT about what is in the best interests of mothers and babies. The doctors and midwives on the coal face may have very good motives, but the policy makers – those that dictate how a labour and birth will be “managed” are purely trying to protect themselves from litigation – regardless of whether it is good care or not. So long as it seems as if all technology was applied, then there is no case to answer. But there are some glimmers of hope for the medical profession – not all it seems have sold their souls and can see the dark path that birthing in Australia is descending. I would like to finish my little rant tonight (sorry, it’s late and I’ve got an early start) by quoting an Australian Obstetrician who is distressed by where things are heading. Insurance for midwives is NOT the answer – we CANNOT let litigation rule birth choices. Australian women – you need to stand up and reclaim the power of birth – YOUR BODY, YOUR BABY, YOUR BIRTH – YOUR CHOICE.

“- - - I agree with you that at the end of it all women are the "victims" of our medico legal system, when it is supposed to be helping them. [Local hospital] midwives have just been forced into doing mandatory admission CTG's in the interests of the hospitals lawyers. We argued until we were blue in the face that it won't improve outcomes for women and babies, or even reduce the litigation, but after a recent $14 mill payout they are only worried about their bottom line. - - - It is getting harder and harder to practice GOOD obstetrics and midwifery in Australian hospitals. Which is why HB midwives becoming insured is such a double edged sword. I'll bet a million bucks that any insurance company that takes on insurance for home birth midwives will have a long list of do's and don'ts for their "customers", which will reduce home birth to hospital birth in the home. And if the midwives refuse to do it they will be uninsured and de-registered and we are back where we started.”

Saturday, September 5, 2009

People power or political blindside?

Driving home from a long day of antenatal visits yesterday afternoon, I was listening to ABC News Radio when I hear that our friend Nicola had done a “back down” on the “making homebirth illegal issue”. The volume was instantly turned up as I listened to her say that she didn’t want to “make illegal” a current practice that was at present legal, and so had agreed with the State Health Ministers to give a 2 year exemption from the law to home birth Midwives.
“Wow” I thought.
And then I thought “How come I am not excited by this news? Am I so totally cynical and jaded that I am disappointed the fight is over?”
And then I heard her say something along the lines that midwives would be able to continue to practice in jurisdictions where it was allowed. Hmmm. What did that mean? What other hidden catches were there? I couldn’t wait to get home to get onto the net and discover the goss.

Additional requirements to access the exemption will include;- A requirement to provide full disclosure and informed consent thatthey do not have professional indemnity insurance.- Reporting each homebirth- Participating in a quality and safety framework which will bedeveloped after consultation led by Victoria through the finalisation of the registration and accreditation process.These provisions will only apply to midwives working in jurisdictions which do not prohibit such practice as at the date of the implementation of the scheme.”

I’m sorry, Nicola, but most of the women I work with towards an empowering birth at home do so because they are avoiding a medically controlled birth. It is their INFORMED CHOICE – after looking into things diligently – and with the biggest stakehold of all (the health and well being of mother and baby) – to forgo a medical birth. I have serious issues with the requirement to participate in a “quality and safety framework” that will be dictated no doubt by medical policy and a woman’s choice and right to autonomy over her own body (and her own birth) will be ignored. I also have serious concerns as to the practicality of the currently practicing midwives to be able to comply with all the requirements.

And why will it be led by Victoria? I’d like to quote from Home Birth Australia - - -

"We have been told by Nicola Roxon's office that this is due to Victoria leading the National Registration and Accreditation Scheme. However, we have concerns that Victoria may also lead the development of a framework within which private practice midwives will have to work, in order to be eligible for an exemption. Some members of Maternity Coalition and Australian Private Midwives Association recently attended a meeting with the Victorian Health Minister Daniel Andrews and they reported back that "The Minister summarized the implications that the current Bills before parliament will have for women and midwives. He stated that midwives cannot continue uninsured as they are and that if they wanted to work it would need to be as part of a team at a public hospital providing homebirth". He was asked whether he recognized the right of women to choose place of birth and what they would do in the instance of July 2010 if the issue is not resolved, "Well they will be faced with the difficult choice of choosing from what is available". We have grave concerns that this will be the beginning of the end for private practice homebirth midwifery.”
So in reality, the fan fare that Nicola has made on Friday is all show and no substance – a political blind side designed and timed specifically to take momentum out of the rally at Canberra on Monday.

Political agendas should have NO SAY over a woman’s body and birthing decisions and I urge you to support the rally in Canberra with an even louder voice. If you can’t attend, it is too late to purchase a virtual rally ticket (this has taken a huge amount of work and co-ordination and I thank the organisers for this possibility) – you can still make your opinion count. Tell your relatives and friends to watch for it on the news. Tell them to write letters to the paper and Federal Labour MP’s as a result. We do not want to descend back into the dark ages and we do not want women’s rights violated, and we do NOT want to have to go through all this again in 2 years when the medical lobby will have enough time to spearhead an even more detailed and deadly attack.
I also urge you to remember this is not about homebirth verses hospital birth.
This is not about midwife versus doctor.
This is about women and their right to make their own decisions regarding their own births and what happens to their bodies.
This is about how your daughter will birth –please fight for her autonomy and freedom.

Wednesday, September 2, 2009

antenatal care vs nurture

Well, according to RANZCOG – antenatal care is important – even vital – for the health and well being of women. In fact, so important that a woman I helped last year, who had to transfer into hospital for complications during the birth, was punished for having “no antenatal care”. Her baby was isolated from her, (he was separated from her for an ENTIRE night – despite his normal newborn behaviour for most of that night), checked, poked, prodded and tested all because of “NO ANTENATAL CARE”. That is what is actually written in capital letters in her baby’s chart as his number one problem. Hmmmm. I have two issues with this assertion – the first is that standard “antenatal care” actually promotes wellness in baby and mother or even that it actually prevents complications; and the second is that because this woman chose not to partake in the “antenatal care” on offer at this particular institution than it amounted to “no antenatal care”. Apart from seeing me, a privately hired registered midwife 5 times (for a minimum of 2 hours each time), her local GP 3 times, and a midwife that was employed by her doctor’s surgery 3 times, an ultrasound at 22 weeks, and complete antenatal blood screen work up at the beginning of her pregnancy, this woman apparently had NO antenatal “care” and thus “endangered” her baby. Please someone hold me back while I scream!! HOW DARE THEY IMPUNE THIS WOMAN’S CHARACTER like they have? I personally know her to be acutely aware of her own responsibility and how her own actions will affect her baby’s health and well being. She and SHE ALONE knows the best for herself and for her baby. We are currently composing letters of formal complaint about the treatment this woman received at the hands of the hospital concerned, so I have to be careful about what I say and cannot give you details of her abominable and illegal treatment. So I will rave about “antenatal care”.

“Care”?? Since when can the standard antenatal service provided by hospitals and many private obstetricians be described as “care”? In a previous blog I discussed a woman who at 36 weeks was given her first bit of dietary advice when they discovered that she was carrying a large baby. True “care” would ensure that these issues would be discussed in depth at the very first meeting. But that is not the focus of standard antenatal care - visits usually involve examining how big the mother’s uterus is growing, where the baby is positioned (ie head down or up) and listening to the baby’s heart tones. It also consists of many screening tests that women are given little if any information on the consequences of submitting to. Women are certainly not encouraged to research all that is available and consent to what they feel they need to – incompliance with any of these tests is seen as dangerous and risky behaviour and women are treated accordingly.

No, it is not ‘antenatal care’ that the medical profession seek to give women, but ANTENATAL COMPLIANCE that they seek from them - - - “You must have ALL tests that we say you should, and you need to comply with ALL protocol that we say you should, because we say so, and not because there is good evidence for it, and certainly against your own better judgement and researched opinion.”

The 3rd edition of the Collins Dictionary lists “care” with 13 different meanings or contexts in which the word can be used. Those applicable to our topic today are the following - - -
1. To have regard or consideration
2. To provide physical needs, help or comfort
3. Careful or serious attention
4. Protective or supervisory control

Now let’s see. When a woman enters the care of a GP, private obstetrician or hospital antenatal clinic does she receive numbers 1 or 2? No she receives number 4 as a priority and maybe in some circumstances number 3. The medical profession is "big brother" - monitoring size and supervising screening compliance. Standard maternity “care” is basically set up to make sure a woman has the proper screening procedures – to make sure it is a “normal” pregnancy (can’t have congenital abnormalities mucking up our peri natal statistics now can we?) as well as comply with standard protocols that have been designed for the organisations benefit – not for the benefit of the individual woman. Antenatal visits are brief – lucky to be 15 minutes long, and NO information is given in adequate amounts so that a woman can make up her own mind about anything. No care or nurture is given about a woman’s individual circumstances, and only information that is deemed “acceptable standard practice” is ever presented to women. Most women DO NOT KNOW that they HAVE a choice about the course of their “care”. I once had a doctor actually say to me in private conversation that “informed consent” with pregnant women was “impossible”. Why? Well due to the fact that pregnant women were hormonal and their perceptions were altered about what is best for their baby, “how on earth COULD they make rational decisions based on the facts” when “they were ruled by emotions”? Excuse me? Who on THIS EARTH has a bigger stake in the welfare of baby and mother than a pregnant woman and her partner????? Since WHEN does the medical profession care about the outcome of a birth MORE than a mother and father??

My aim during pregnancy is to “nurture” the women that come to me to assist them achieve their desire for a natural birth. The definition of “nurture” is as follows
1. The act or process of promoting the development of someone
2. Something that nourishes - to feed or support, educate or train

Pregnancy is a wonderful time of exploration - emotionally, spiritually and pysically. Women transform during their pregnancies and it is always amazing to watch. They carry a very deep power if it is nutured and encouraged to develop - and this changes not only their birth experience but their experience of motherhood. I do not use the terminology “antenatal visits/care” – not because there is anything wrong with the meaning of the words themselves, it has just come to imply an authoritarian/subject; supervisor/supervised relationship. The connotations these words bring up is of long waiting times, brief visits, reams of paperwork and test after test – and compliance with the system. I believe pregnant women need nurture – they need to feel cherished and important. They need individualised nurture - someone to met them where they are and walk alongside them in their journey. They also need someone with accurate information and statistics that they can discuss things with to help them come to a decision about what they do or do not think is important for themselves in this pregnancy. They need to develop a relationship with the person that they have asked to be at their birth – what will ultimately be their most powerful yet most intimate moment. They need to be assured that both they and their baby will be respected at all stages along the way. They need to feel safe. So I have “pregnancy visits” and I aim to “nurture”.

Just last week a precious mum was at the end of her pregnancy and "totally over it". She needed friendship, nurture, love and a change of scenery. So we packed the children up, got together with two other mums and went to the beach. During the hour drive there and back, we had plenty of time to discuss her upcoming birth and all that was on her mind. We swam and played and laughed and ate some yummy food. Oops - I didn't check the baby's heart tones - guess it wasn't "antenatal care" after all!