Written by Jo Hunter yesterday 24th June 2009
Today Nicola Roxon introduced two Bills to Parliament.
1) Health legislation amendment (midwife and nurse practitioner) Bill 2009
This Bill is about accessing Medicare and PBS, there is nothing currently written in this Bill that discuses eligibility - there is no comment within it at present that states anything about homebirth. However, in her speech she openly stated that there will be no MBS for Homebirth.
2) (and this is the clincher) Midwife Professional Indemnity (commonwealth contribution scheme) Bill 2009
This Bill excludes midwives from providing intrapartum homebirth care.
THIS IS A SAD SAD DAY FOR THE WOMEN OF AUSTRALIA!
Here is the press release from Homebirth Australia
Deaths will increase with new announcements
Homebirth Australia today slammed the exclusion of homebirth from insurance schemes for midwives announced by the Health Minister Nicola Roxon in parliament today.
"Effectively two pieces of legislation will outlaw midwives providing homebirth care from July 2010" said Justine Caines, mother of seven and secretary of Homebirth Australia.
"Women will continue to homebirth, but will now do so without the assistance of a qualified professional." said Ms Caines. "The result will be an increase in deaths for mothers and babies, this is certain. It is absolutely impossible to understand the government's position on this, other
than to say that they have bowed to political pressure from medical lobby groups."
The National Maternity Service Review received submissions from hundreds of women wanting access to homebirth services. The vast majority of homebirth services are provided by private practice midwives. Removing this option is likely to end access for most women to homebirth.
Ms Caines called on all ALP members to declare their view on a woman's right to self determination of her health care needs. "If the ALP is so hell bent on preventing women from accessing homebirth as an option I ask all ALP members to publically state their position on this. It appears that having a Health Minister who is a woman, a recent mother, and a lawyer understanding consumers' rights, is not proving to be an advantage for women. Removing women's rights to the point where we are back providing care in dark alleys or in back rooms is ridiculous in 2009."
Thursday, June 25, 2009
Friday, April 17, 2009
Homebirth IS safe - in case you didn't know....
Hopefully the following study will encourage the ACM to vigorously defend the position and interests of Independent Midwives. I would be great if opinion could finally sway to consider HB as being 'mainstream' rather than 'radical fringe'...
MEDIA RELEASE
The opinion that hospital birth is safest for all women and babies has finally been overturned with the publication of the world's largest study of planned, midwife attended home births.
The study, published in the British Journal of Obstetrics and Gynecology (April 15th 2009), included over half a million, low risk, planned home and hospital births in the Netherlands over seven years and compared numbers of babies dying and being harmed during the births. The Netherlands currently has the highest home birth rate in the western world (30%) and a caesarean section rate that is more than half Australia's (14% vs 31%).
Over three hundred thousand women had planned homebirths attended by midwives in this study. No significant differences were found in numbers of babies dying during labour, during the first 24 hours after labour or up to seven days after birth between planned low risk birth at home, attended by a trained midwife and those who planned to give birth in hospital. There were also no differences in numbers of babies being admitted to a neonatal intensive care unit following the birth. Previous studies have been limited by small sample numbers of births and this study has now achieved adequate numbers to show differences very rare events.
We have known for many years mothers have lower intervention rates and higher satisfaction rates when giving birth at home, but there has remained a cloud over the impact on babies' outcomes. This cloud has now been lifted. This study adds to others, which established planned home birth attended by professional midwives was safe for low risk women. It confirms that homebirth services properly networked into mainstream care are safe for babies.
The Australian College of Midwives calls on the Government to reconsider its silence over homebirth and work with health professionals to implement safe, supportive systems of care that will facilitate women's choice of birthplace. Over 400 submissions to the National Maternity Review from consumers, the majority requesting greater access to homebirth cannot be ignored any longer.
MEDIA RELEASE
The opinion that hospital birth is safest for all women and babies has finally been overturned with the publication of the world's largest study of planned, midwife attended home births.
The study, published in the British Journal of Obstetrics and Gynecology (April 15th 2009), included over half a million, low risk, planned home and hospital births in the Netherlands over seven years and compared numbers of babies dying and being harmed during the births. The Netherlands currently has the highest home birth rate in the western world (30%) and a caesarean section rate that is more than half Australia's (14% vs 31%).
Over three hundred thousand women had planned homebirths attended by midwives in this study. No significant differences were found in numbers of babies dying during labour, during the first 24 hours after labour or up to seven days after birth between planned low risk birth at home, attended by a trained midwife and those who planned to give birth in hospital. There were also no differences in numbers of babies being admitted to a neonatal intensive care unit following the birth. Previous studies have been limited by small sample numbers of births and this study has now achieved adequate numbers to show differences very rare events.
We have known for many years mothers have lower intervention rates and higher satisfaction rates when giving birth at home, but there has remained a cloud over the impact on babies' outcomes. This cloud has now been lifted. This study adds to others, which established planned home birth attended by professional midwives was safe for low risk women. It confirms that homebirth services properly networked into mainstream care are safe for babies.
The Australian College of Midwives calls on the Government to reconsider its silence over homebirth and work with health professionals to implement safe, supportive systems of care that will facilitate women's choice of birthplace. Over 400 submissions to the National Maternity Review from consumers, the majority requesting greater access to homebirth cannot be ignored any longer.
Saturday, April 11, 2009
Thank you, thank you, thank you!!!
Sending out a big THANK YOU to all those in my network who have referred me, as a Student Midwife, to their friends, family and colleagues.
I am now well on my way to filling my [University dictated] quota for Follow-through experiences for 2009.
A special thanks to Bec and Jasper and Anna, Andrew, Angus, Addie and baby (still un-named divine tiny 2 day old boy) for inviting me to participate in the most wonderous experience that is BIRTH!!
If anyone who resides in TOWNSVILLE and is due to birth in October or November is interested in learning more about the Student Midwife program, please feel free to send me a message or leave a comment.
I am now well on my way to filling my [University dictated] quota for Follow-through experiences for 2009.
A special thanks to Bec and Jasper and Anna, Andrew, Angus, Addie and baby (still un-named divine tiny 2 day old boy) for inviting me to participate in the most wonderous experience that is BIRTH!!
If anyone who resides in TOWNSVILLE and is due to birth in October or November is interested in learning more about the Student Midwife program, please feel free to send me a message or leave a comment.
Sunday, March 15, 2009
My first follow through experience
I'm still waiting to speak to the Mum to get her permission to publish details, but I was so very honoured and thrilled to be invited to a birth this morning. It was a caesarean in the end (undiagnosed breech with ROM @ 40+2), so a bit of an unexpected outcome for Mum, but her and baby are doing well. I, of course, cried again at bubbies first cry. It's just a joyous feeling I wonder if it will ever go away. In a way I hope not, but I don't want to be a blubbery mess everytime I deliver a baby.
Wednesday, March 11, 2009
Birth Choices - Petition to save MIPP and homebirthing options
It doesn't matter where you actually would choose to birth, it doesn't matter if you would choose and Obstetrician and c/s in a private hospital over an independent Midwife in your home. If you believe in human rights, free choice and in particular a woman's right to choose where and how and by whom then we'd love for you to use your voice.
http://www.ipetitions.com/petition/australianhomebirth/
http://www.ipetitions.com/petition/australianhomebirth/
Tuesday, March 10, 2009
Maternity Services Review
As a Midwifery Student and obviously as a future Midwife it is hard to NOT be political. So for all my fellow students here is an easy to read article by Bruce Teakle - Maternity Coalition President. It discusses the main issues of the Maternity Services Review and discusses why independent midwives (MIPP's) could become an illegeal practice.
The Maternity Services Review Report: no more homebirth?
Bruce Teakle 8 March 2008
The recently released report of the Federal Maternity Services Review proposes some promising reforms. It could, if implemented in the most positive spirit, bring huge breakthroughs in many areas of maternity care.
The Report recommends improving women’s access to midwifery care and information about pregnancy and birth. It proposes culturally appropriate care for indigenous women, better support for women in pregnancy and postnatally, and more collaborative relationships between caregivers.
Its ultimate goal for Australian mothers is “safe, high-quality and accessible care based on informed choice” (page iii).
Australia has waited a long time for the reforms proposed in the Review. However, there is a dark side to the Report.
The Report proposes an end to women’s access to midwifery care for homebirth, except possibly within state-run services. If the Report’s recommendations are followed, homebirth midwifery could become illegal in 2010 with the introduction of National Registration of health caregivers.
The full Report can be downloaded from this website:
http://www.health.gov.au/internet/main/publishing.nsf/Content/maternityservicesreview
Below are some key points, with quotes from the Report, to help women who want to lobby for their right to access safe, legal homebirth in Australia:
1. Women choosing homebirth are a trivial minority:
A strong point is made of the small number of homebirths which occur in Australia:
P16: shows a graph of declining numbers of homebirths in Australia from 1991 to 2006.
P16: “Homebirths account for a very small number of births in Australia. In 2005, homebirth accounted for 0.22 per cent of all births in Australia,28 compared with 2.7 per cent in England and Wales,29 2.5 per cent in New Zealand,30 and 0.6 per cent in the United States.” 31
P20: “New Zealand maternity data for 2004 found that, while 4.5 per cent of mothers had planned a homebirth, only 2.5 per cent actually experienced a homebirth.”
The reasons for the small Australian numbers are not explored, in particular the great difficulty most Australian women have accessing information or care for homebirth.
No comparison is made with other minority choices, such as caesarean section on request, and there is certainly no consideration of banning these choices.
The Reviewers acknowledge the high number of individual submissions from women who desired greater access and funding for homebirth. Despite this, it appears the Reviewers have been more responsive to the input of those who want to control women’s choices.
2. Homebirth will not be retained as a choice for women:
The Report is very clear that it does not support reforms which increase or fund women’s access to homebirth:
Pp20-21: “In recognising that, at the current time in Australia, homebirthing is a sensitive and controversial issue, the Review Team has formed the view that the relationship between maternity health care professionals is not such as to support homebirth as a mainstream Commonwealth-funded option (at least in the short term). The Review also considers that moving prematurely to a mainstream private model of care incorporating homebirthing risks polarising the professions rather than allowing the expansion of collaborative approaches to improving choice and services for Australian women and their babies.”
P21: “While acknowledging it is a preference for some women, the Review Team does not propose Commonwealth funding of homebirths as a mainstream option for maternity care at this time. It is also likely that professional indemnity cover support for a Commonwealth- funded model that includes a homebirth setting would be limited, at least in the short term. It is likely that insurers will be less inclined to provide indemnity cover for private homebirths and, if they did provide cover, the premium costs would be very high. Indemnity issues for midwife care more broadly are considered in Chapter 6.2.”
The Report proposes Commonwealth support for Medicare and indemnity insurance for midwives, but only working in non-homebirth practice. Midwives working outside these restrictions would not be able to legally practice, due to impending reforms:
P53: “For privately practising midwives, it is not currently a requirement in most jurisdictions to have professional indemnity cover in place before registration is granted. However, this situation is expected to change under the proposed new National Registration and Accreditation Scheme.”
The consequence of all this is that homebirth practice by private midwives (most homebirth care) would not be insured, and would be illegal under national registration laws, scheduled to take effect in July 2010.
State-run homebirth services (currently operating in NT, NSW, SA, and WA) might also be forced to close, if non-homebirth maternity services attract Commonwealth funding (through Medicare for midwives) but homebirth services do not.
3. Scientific evidence does not inform the recommendations regarding homebirth:
Although some reference is made to scientific evidence on some issues in the report, no reference is made to evidence regarding the outcomes of homebirth. It appears that medical opposition alone informs the Review’s position:
P21: “The Review also considers that moving prematurely to a mainstream private model of care incorporating homebirthing risks polarising the professions rather than allowing the expansion of collaborative approaches to improving choice and services for Australian women and their babies.”
4. The safety of women birthing without a caregiver can be overlooked
P21: “Of concern to the Review Team is the number of submissions and other evidence that suggests a small number of Australian women are choosing homebirths without the support of an appropriately trained health professional. Accordingly, as with any other maternity care model, the Review Team considers that appropriate standards, monitoring and evaluation should be integral components of any service involving homebirth.”
Women choosing to birth at home without a trained caregiver will not be helped by “standards, monitoring and evaluation”, because they are outside the system. The Review Team appear not to understand that these women are within neither a “maternity care model”, nor a “service involving homebirth”.
Maternity Coalition’s experience is that most women birthing at home without a trained caregiver do so because they are unable to access midwifery care at home, and unwilling to use hospital-based services. It is frequently a choice made in desperation. The way to help these women is to provide them access to a high standard of midwifery care in their preferred venue.
The Reviewers overlook the likelihood that the loss of homebirth midwifery care will push more women into unattended homebirth. This would ensure an absence of standards, monitoring or evaluation of any homebirth outcomes.
5. Medical extremists will become more cooperative if they are given a veto on women’s choices
The proposed reason for preventing homebirth midwifery is that it “risks polarising the professions”. The implied strategy seems to be for Government to restrict midwifery practice, against scientific evidence, against the principle of women’s informed choice and against the safety of determined homebirthing women. The presumed intention – for less collaborative doctors to become more respectful of the evidence, principles of informed choice, and women’s perspectives on safety; seems a highly unlikely outcome. The Reviewers reinforce a subordinate position for midwives relative to doctors by proposing to restrict midwifery practice in line with the prejudices of less collaborative doctors. This undermines the relationships they hope to enhance.
The Government must make it clear that the needs, interests and autonomy of women come first. Healthcare policy and services should not be corrupted by the prejudices of health care professions, which prosper on taxpayer funds.
Fear or leadership?
The Minister, Nicola Roxon, is aware that significant modernisations of the healthcare system have historically been met with protest, threats, and predictions of disaster by extreme medical voices. Reforms of Australia’s maternity care system will always provoke this sort of reaction. Those reforms include normalising midwives’ access to public funding and insurance, and women’s access to options including homebirth.
It appears that the Reviewers have conceded to fear of extreme medical voices, over the interests of women. Hopefully the Minister, who is directly accountable to women, will be braver.
Speak out now!
The Review Report has been prepared by Department of Health staff, to advise the Minister for Health, Nicola Roxon. The Minister will decide which of the Department’s advice she will take. If there is enough community outcry about the proposed loss of homebirth, the Minister may decide to act in the interests of choice.
Every Australian has a Federal Member of Parliament (MP), whose job is to represent their interests. Every person who cares about maintaining homebirth choice should contact their Federal MP, preferrably by both letter and with a personal visit.
To find contact info for your MP:
Go to http://apps.aec.gov.au/esearch/ and enter your locality in the “Search Federal Electorates” window.
In the next window, click on the name of your electorate for more information.
On the electorate page, click on “profile and map”.
For contact info for your MP (“Current Member Details”), click on the “Parliament of Australia Website” link.
Write to your MP and tell them how important it is to you that women can choose homebirth. Ask them to contact the Minister for Health on your behalf. Recognise the good sides of the Review, and expect them to help you.
Meet with your MP. Phone their electorate office and ask for an appointment, to talk about the Federal Maternity Review. Take some friends from the same electorate. Tell them why women should have choice.
Your MP is expecting a letter or visit from a mother, not a professor. Tell them why birth and choice are so important to you. Talk about scientific evidence or policy processes if you want, but you are the expert about your own story.
The Maternity Services Review Report: no more homebirth?
Bruce Teakle 8 March 2008
The recently released report of the Federal Maternity Services Review proposes some promising reforms. It could, if implemented in the most positive spirit, bring huge breakthroughs in many areas of maternity care.
The Report recommends improving women’s access to midwifery care and information about pregnancy and birth. It proposes culturally appropriate care for indigenous women, better support for women in pregnancy and postnatally, and more collaborative relationships between caregivers.
Its ultimate goal for Australian mothers is “safe, high-quality and accessible care based on informed choice” (page iii).
Australia has waited a long time for the reforms proposed in the Review. However, there is a dark side to the Report.
The Report proposes an end to women’s access to midwifery care for homebirth, except possibly within state-run services. If the Report’s recommendations are followed, homebirth midwifery could become illegal in 2010 with the introduction of National Registration of health caregivers.
The full Report can be downloaded from this website:
http://www.health.gov.au/internet/main/publishing.nsf/Content/maternityservicesreview
Below are some key points, with quotes from the Report, to help women who want to lobby for their right to access safe, legal homebirth in Australia:
1. Women choosing homebirth are a trivial minority:
A strong point is made of the small number of homebirths which occur in Australia:
P16: shows a graph of declining numbers of homebirths in Australia from 1991 to 2006.
P16: “Homebirths account for a very small number of births in Australia. In 2005, homebirth accounted for 0.22 per cent of all births in Australia,28 compared with 2.7 per cent in England and Wales,29 2.5 per cent in New Zealand,30 and 0.6 per cent in the United States.” 31
P20: “New Zealand maternity data for 2004 found that, while 4.5 per cent of mothers had planned a homebirth, only 2.5 per cent actually experienced a homebirth.”
The reasons for the small Australian numbers are not explored, in particular the great difficulty most Australian women have accessing information or care for homebirth.
No comparison is made with other minority choices, such as caesarean section on request, and there is certainly no consideration of banning these choices.
The Reviewers acknowledge the high number of individual submissions from women who desired greater access and funding for homebirth. Despite this, it appears the Reviewers have been more responsive to the input of those who want to control women’s choices.
2. Homebirth will not be retained as a choice for women:
The Report is very clear that it does not support reforms which increase or fund women’s access to homebirth:
Pp20-21: “In recognising that, at the current time in Australia, homebirthing is a sensitive and controversial issue, the Review Team has formed the view that the relationship between maternity health care professionals is not such as to support homebirth as a mainstream Commonwealth-funded option (at least in the short term). The Review also considers that moving prematurely to a mainstream private model of care incorporating homebirthing risks polarising the professions rather than allowing the expansion of collaborative approaches to improving choice and services for Australian women and their babies.”
P21: “While acknowledging it is a preference for some women, the Review Team does not propose Commonwealth funding of homebirths as a mainstream option for maternity care at this time. It is also likely that professional indemnity cover support for a Commonwealth- funded model that includes a homebirth setting would be limited, at least in the short term. It is likely that insurers will be less inclined to provide indemnity cover for private homebirths and, if they did provide cover, the premium costs would be very high. Indemnity issues for midwife care more broadly are considered in Chapter 6.2.”
The Report proposes Commonwealth support for Medicare and indemnity insurance for midwives, but only working in non-homebirth practice. Midwives working outside these restrictions would not be able to legally practice, due to impending reforms:
P53: “For privately practising midwives, it is not currently a requirement in most jurisdictions to have professional indemnity cover in place before registration is granted. However, this situation is expected to change under the proposed new National Registration and Accreditation Scheme.”
The consequence of all this is that homebirth practice by private midwives (most homebirth care) would not be insured, and would be illegal under national registration laws, scheduled to take effect in July 2010.
State-run homebirth services (currently operating in NT, NSW, SA, and WA) might also be forced to close, if non-homebirth maternity services attract Commonwealth funding (through Medicare for midwives) but homebirth services do not.
3. Scientific evidence does not inform the recommendations regarding homebirth:
Although some reference is made to scientific evidence on some issues in the report, no reference is made to evidence regarding the outcomes of homebirth. It appears that medical opposition alone informs the Review’s position:
P21: “The Review also considers that moving prematurely to a mainstream private model of care incorporating homebirthing risks polarising the professions rather than allowing the expansion of collaborative approaches to improving choice and services for Australian women and their babies.”
4. The safety of women birthing without a caregiver can be overlooked
P21: “Of concern to the Review Team is the number of submissions and other evidence that suggests a small number of Australian women are choosing homebirths without the support of an appropriately trained health professional. Accordingly, as with any other maternity care model, the Review Team considers that appropriate standards, monitoring and evaluation should be integral components of any service involving homebirth.”
Women choosing to birth at home without a trained caregiver will not be helped by “standards, monitoring and evaluation”, because they are outside the system. The Review Team appear not to understand that these women are within neither a “maternity care model”, nor a “service involving homebirth”.
Maternity Coalition’s experience is that most women birthing at home without a trained caregiver do so because they are unable to access midwifery care at home, and unwilling to use hospital-based services. It is frequently a choice made in desperation. The way to help these women is to provide them access to a high standard of midwifery care in their preferred venue.
The Reviewers overlook the likelihood that the loss of homebirth midwifery care will push more women into unattended homebirth. This would ensure an absence of standards, monitoring or evaluation of any homebirth outcomes.
5. Medical extremists will become more cooperative if they are given a veto on women’s choices
The proposed reason for preventing homebirth midwifery is that it “risks polarising the professions”. The implied strategy seems to be for Government to restrict midwifery practice, against scientific evidence, against the principle of women’s informed choice and against the safety of determined homebirthing women. The presumed intention – for less collaborative doctors to become more respectful of the evidence, principles of informed choice, and women’s perspectives on safety; seems a highly unlikely outcome. The Reviewers reinforce a subordinate position for midwives relative to doctors by proposing to restrict midwifery practice in line with the prejudices of less collaborative doctors. This undermines the relationships they hope to enhance.
The Government must make it clear that the needs, interests and autonomy of women come first. Healthcare policy and services should not be corrupted by the prejudices of health care professions, which prosper on taxpayer funds.
Fear or leadership?
The Minister, Nicola Roxon, is aware that significant modernisations of the healthcare system have historically been met with protest, threats, and predictions of disaster by extreme medical voices. Reforms of Australia’s maternity care system will always provoke this sort of reaction. Those reforms include normalising midwives’ access to public funding and insurance, and women’s access to options including homebirth.
It appears that the Reviewers have conceded to fear of extreme medical voices, over the interests of women. Hopefully the Minister, who is directly accountable to women, will be braver.
Speak out now!
The Review Report has been prepared by Department of Health staff, to advise the Minister for Health, Nicola Roxon. The Minister will decide which of the Department’s advice she will take. If there is enough community outcry about the proposed loss of homebirth, the Minister may decide to act in the interests of choice.
Every Australian has a Federal Member of Parliament (MP), whose job is to represent their interests. Every person who cares about maintaining homebirth choice should contact their Federal MP, preferrably by both letter and with a personal visit.
To find contact info for your MP:
Go to http://apps.aec.gov.au/esearch/ and enter your locality in the “Search Federal Electorates” window.
In the next window, click on the name of your electorate for more information.
On the electorate page, click on “profile and map”.
For contact info for your MP (“Current Member Details”), click on the “Parliament of Australia Website” link.
Write to your MP and tell them how important it is to you that women can choose homebirth. Ask them to contact the Minister for Health on your behalf. Recognise the good sides of the Review, and expect them to help you.
Meet with your MP. Phone their electorate office and ask for an appointment, to talk about the Federal Maternity Review. Take some friends from the same electorate. Tell them why women should have choice.
Your MP is expecting a letter or visit from a mother, not a professor. Tell them why birth and choice are so important to you. Talk about scientific evidence or policy processes if you want, but you are the expert about your own story.
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