It is very good to see such a useful debate on the proposed home birth services that are in the wind. I think everyone has had something very useful to offer to the discussion and here are my thoughts on some of those responses.
The reason that I raised the way home birth works in the UK is firstly because I have had a lot of exposure to its variations across the UK and therefore feel we can learn a lot from the way it works there. The fact that home birth rates are rising steadily in Britain comes down to the commitment fo the system to home birth as an option andn its availability as a free service to every woman wo wants it. Yes, some women don't get to choose their midwife but at the end of the day, research has shown that for the majority of women, it is not just the person (midwife) who matters to women but the quality of the care. As long as the midwife is caring, and the woman's needs are met, most women are happy - they realise that midwives too have lives and may not be able to be the beck and call of women 24/7. If a colleague arrives instead of the expected midwife, as long as the care remains the same women will accept this.
The remarkable outcomes achieved by the Albany midwives (43% home birth rate) is with a population of women who would not even be considered for a home birth by most services because of existing risk factors. This services does not set out to offer "home births" as such, but woman centred care. The decision about where to give birth is made during the labour, and because of the flexibility of the midwives and the service, many woman are able to elect to stay put and have an "unplanned" homebirth.
In constrast, the CMWA is working with a select group of women, who are very unlikely to have the social risks that the Albany team work with (homeless, poor, drug users, teenagers, non-English speaking etc). It could be argued that in such a select group, who start out wanting a homebirth, that a 75% home birth (or even higher) would be expected. A lower rate than this would be a cause for concern.
I agree that we should use our own home grown service in WA as a model of care for other community based programs. It is exemplary and an ideal model to follow. But it is not the only model, and there must be other choices available for women, especially those who book into a Birth Centre because they want to avoid a medicalised birth and then discover along the way that they could actually give birth at home quite safely. A hosptial based service that offers either birth centre or home births could make this a reality for many women.
I also quoted the UK experience because many people are using it as an argument to stymie the proposed program at St George, quoting anecdotal evidence rather than hard facts to strengthen their opposition. Many assumptions are being made, without investigating the facts, and unfounded fears are being used as a basis for doubting the commitment and philosophy of those striving to initiate much needed change within the system.
The bottom line is that the SESAHS has still not signed off on the proposed service and unless there is overwhelming support (and pressure) from the community (including the IPMs) for its establishment then they may well choose to spend their money not on providing an "elite" service for a relatively small number of women but on much needed services for a larger number of women in their jurisdiction.
It may not be the "perfect" service, but it is a start, and will set a precedent that can be used as a foundation for building home birth awareness in the community that will help drive change elsewhere. Most of you may not remember that 25 years ago birth centres were an unknown concept and it took a lot of community pressure to get the first one opened. It was not publicisied bcause the doctors feasred competition and it has very strict selection criteria, but it survived and spawned others. Birth Centres are now "mainstream" health care. Wouldn't it be wonderful if this small beginning led to the wider recognition of home birth as a "mainstream" option (as it is in the UK and elsewhere)?
The criteria for the operation of the service are still being discussed. At St George, the heads of both the midwifery services and the obstetric services are very supportive of home birth and are committed to evidence based care and woman-centred care. There is no reason to suspect that they will be putting highly restrictive practice policies in place - in fact it could be argued that a successful service, utilised by a good number of women will enhance their status and support their decision to take this bold step forward. If a woman meets birth centre criteria (and that currently includes VBAC for example) then she should be able to give birth at home should she wish. If the decision regarding birth place can be left until the labour itself, there is a good chance of a positive outcome all round. Instead of spreading rumours and doubts, let's get behind the proposed program and make sure it works well - for everyone's benefit.
Regards
Andrea
----- Andrea Robertson Birth International * ACE Graphics * Associates in Childbirth Education
e-mail: [EMAIL PROTECTED] web: www.birthinternational.com
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