Hi everyone, I find it interesting to read all your responses to the implementation of hospital run homebirth services. To me it really brings home the blurring of ethics, models and care provided by what I believe to be two distinctly separate models of birth care - the obstetric model and the midwifery model.
Some of you believe that women and their partners will be able to discern the difference between the two and will continue to choose a user pays homebirth service over a hospital run free homebirth service. I beg to differ, based on 5 years of observing the downplaying of homebirth services in the Northern Rivers Area (around Byron Bay) which are unsupported by local GPs, and up-playing of a low risk hospital service in this region which is fully supported by local Gps. Women enter the hospital service fully expecting and believing they will birth normally. They are led to believe this can and will happen, but sadly 34% of them will be transferred out to higher level obstetric hospitals, all with further intervention. And these transfers for all the simple things such as post dates, prolonged rupture of membranes, lack of progress, mec staining etc etc -all the sorts of things covered in the statement " midwives.. (who) will be asked to work strictly to agreed guidelines in order to obtain their insurance cover." VBAC women, breech babies, older women will all be excluded as usual. And if this hospital service was to introduce the term homebirth into their protocol, then most of the women who still birth at home in this region would initially at least, be sucked into believing they could achieve the same outcomes within this advertised model, and a free service at that. And the truth is simply that this could not ever be achieved because of the strict criteria used to control the risk level of the women allowed into the service, and the regulation and guidelines put in place to control the journey these women have through their labours. Was it only 1989 when the Australian government report said that risk levels in birth could not be effectively predetermined ?? (I've forgotten the name of the report but can locate it if required, or can any others recall the title?) Over the years, the midwifery model has been eroded to mimick the obstetric model. If we accept that only 10% of women going through Australian hospitals achieve anywhere near 'normal' birth, then why would we think that this will change dramatically if we have funded homebirths under the same narrow guidelines that decide criteria such as 'low risk'? Having one-to-one midwifery care will have to make some difference, but I am very doubtful if much will be achieved if the midwives have their hands tied by the obstetric model. I have watched up here as perfectly normal healthy women get waylaid in their birth plans by narrow guidelines and frightened doctors. And if midwifery insurance will be tied to acting 'correctly' according to obstetric models, how can a real change occur?? I would feel much happier if the guidelines were expanded to include international protocols, relative to dates, age, etc etc, and if not just academic but lots of consumer input was both asked for and listened to. I am not meaning to in any way undermine the amount of work that has gone before us to establish a different model of care in the Southern Sydney region. At the same time I do not have any answers to how to change the care received by most women in their pregnancies and birth. I simply know that the true midwifery model of care, one that starts by acknowledging everywoman's right to a normal birth, has been incredibly diminished by fear and intimidation. This includes the withdrawal of insurance. I don't believe for one minute that the guidelines as established by the obstetric model to describe homebirth practice are even vaguely reasonable. I don't have the answers, but I am watching with unease as the wholesome midwifery model of care that may never really have existed in Australia anyway, is quickly subsumed by the obstetric model and our medical profession. Midwives really need to be trained separately and stand solidly in established midwifery practice. Only then will the guidelines between the two separate modalities - those of woman centred midwifery care, and medical/surgical model of obstetric care remain clearly defined, and therefore be able to work together, for the ultimate better health of our women and future generations. To all of you, with respect, Sue -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
