Dear Andrea, (Jo and Justine)
To begin I am really concerned as a midwife and as a homebirth mother at the tone of this letter and feel I want to respond to some comments that have been made.
It is really important that these questions are asked in order to have thought through as many possibilities as we are able, to end with the best solution. I welcome and encourage all of us to think about this move to hospital based homebirth. With this in mind I would like to raise my own personal perspective and concerns.
Why are we modelling a service based on a UK model when we have a model that works here in Western Australia?? (I would be greatly distressed if our services homebirth rate was 43% I do acknowledge that given their high risk setting this may be adequate but the women that will be using this service will be screened as low risk.)The Community Midwifery Program has a homebirth rate of 72%!! Why is no-one looking to our own home grown homebirth service?
To hear that a hospital based caseload midwife is no different from an independent midwife is a surprise to me. There great differences about an independent midwife who employed by a women and a hospital based midwife who is employed by a hospital. The greatest difference is who we work for.
Surely a safe midwifery practice has it own guidelines for consultation and transfer? The possibility that this service is being set up to be guided/supervied by obstetrics is of great concern? (We have seen how this fails in birth centres that have high transfer rate in a medical climate that seems to wish our great birth centres to fail) Why not midwifery guidelines? A midwife should have midwifery guidelines. These do not automatically agree with obstetric guideline but does not mean that she is taking risks with the women's health! For example some midwives support VBAC at home.. this does not agree with obstetric guidelines but does not put a woman's health at risk or risk the midwives legal safety!!
'
The big advantage of the hospital based home birth service is that it will
be free. Women who cannpt afford a private practitioner will not be
excluded from having a home birth as happens now. THe people involved in
setting up this service have vast experience of home birth in the UK and
elsehwere and are dedicated to providing the best woman-centreds care they
can. They wouldn't want anything else!
We need this propject to go ahead, and quickly. At the moment we have no
homebirth service that provides safety for the woman in terms of insurance
and this is a worry for both women and their midwives. Let's all support
this model rather than be trying to pick holes in it before the facts are
known and it has even had a chance to be tried and tested! There are some
very dedicated midwives out there who are trying to create the best birth
options for women and they need out support "
I would like to point out that 'we' do have a free homebirth service that is community based, supported by state and federal funding and fully insured. We do have in now in Western Australia.
Why are we not looking to our own. We have a model that has been tried and tested in Australia. Why are 'we' not looking to our own for information and support.
The Community Midwifery Program has worked long and hard to maintain autonomous practice whilst working within agreed guidelines to provide free homebirth services.
What political campaign is happening that we may end up with a hospital based homebirth service instigated by imported experts, supervised by obstrtic experts rather than the community based model established by local activist and midwives which is driven by midwifery models of best practice and women's needs.
So there it is… my personal perspective.
I am supportive of government funding of homebirth but not at any cost.
Sally Westbury
Homebirth Mother/Activist since 1984
Homebirth Midwive since 1992
