take care
Alphia
August 20, 2005 Saturday Travel Edition
SECTION: REVIEW; Health; Pg.
29LENGTH: 891 words
HEADLINE: Midwifery is safe, and access a right
SOURCE: MATP
BYLINE: KATHLEEN FAHY
BODY:
ALICIA (not her real name) wanted to give birth in a private and safe environment attended by a known midwife. She is young and healthy. This makes her an ideal candidate for one-to-one midwifery care where a known midwife provides all maternity care for Alicia and her family. Midwives are qualified and licensed to provide antenatal, labour and post-birth care on their own responsibility. Normal, healthy women who have straightforward pregnancies do not need to be under the care of doctors.
But Alicia and her partner, Paul, couldn't find a midwife to provide her care either at home or in a hospital.
Why not?
Because women who want to claim maternity care as a Medicare rebate must use a doctor. Thanks to this monopoly, virtually all pregnancies are managed by doctors, even though this is completely unnecessary. Another reason that Alicia couldn't hire a midwife is that midwives have been excluded from the network of taxpayer subsidies and safety nets provided by the federal Government for doctors' professional indemnity cover. The issue of Medicare rebates and indemnity insurance cover for midwives are matters of professional competition.
It can be safely predicted that doctors will resist midwives being given access to Medicare. Doctors will claim, or imply, that somehow midwives are unsafe. As a midwifery researcher, however, I know that midwifery care is safe, and I know doctors cannot produce research evidence from randomised controlled trials to the contrary.
Why did Alice and Paul want a midwife as their maternity care provider? According to them, it was because they wanted to feel in control of what happened to Alicia and the baby. They disagreed with the medical model of birth that thinks in terms of the bodies of women and babies. In the medical metaphor, the womb, pelvis and baby are thought of as either inert or mechanical. For doctors, the body is thought of as able to function independently of the brains and emotions of women and babies; but Alicia knows that this is not true.
Alicia and her partner understand that giving birth is a deeply private, even a sexual function. That is why other primates birth in private. The medicalised environment is full of strangers who come and go and touch the woman. The birth environment that medicine creates is dominated by stainless steel, artificial light, airconditioning, hard floors, surgical lights and a hospital bed with a rubber-covered mattress. Machines are frequently attached to the woman to constantly monitor the baby's heart. This immediately suggests that maybe something is or will go wrong in a perfectly normal process; thus fear is created. In this environment, the woman needs to lie still so the machines that are attached to her work well. Not surprisingly, the woman becomes uncomfortable, is fearful of strangers and fearful for the baby, she is scared to make a noise and scared to make trouble.
Women cope by using an epidural anaesthetic to block sensation below the waist. The outcome of such labours is frequently complications for the woman and the baby (BMJ 2000;321:137-141). Women who have surgical interventions and who don't get to actually give birth have higher rates of depression, guilt, regret, loss of self-esteem, feelings of violation, and dissatisfaction with care -- sometimes to the point of outright hostility.
Midwives pay a lot of attention to creating the right environment for birth. It is crucial to understand that birthing where the woman and midwife know each other helps the women feel emotionally safe enough to be uninhibited in labour. When women choose to birth unaided they usually experience a great sense of their own strength and empowerment.
Labouring without feeling safe is like driving a car with one foot on the pedal and one on the brake; thus fear leads to prolonged labour and unnecessary medical interventions. Fear is damaging to labour because adrenalin is produced and that disrupts the normal hormonal regulation of the process.
Is midwifery care safe? Should the government allow access to Medicare for midwifery managed birth?
Yes, absolutely!
All women are entitled to financial support to cover the costs of childbirth and doctors shouldn't have a government-mandated monopoly. In terms of safety, the research demonstrates that midwifery-managed care, for women who are healthy and have straightforward pregnancies, there is no statistically significant difference in the outcomes for the babies. Research shows, however, that midwifery-managed birth is safer for women than birth under the direction of doctors (Cochrane, 2001, 2005).
The Australian Medical Association and the Royal Australian College of Obstetricians and Gynaecologists both oppose independent occupational status for midwives. Midwives are safe, effective and cost-effective providers of childbirth care and they should be supported by the government via Medicare rebates and indemnity insurance.
Women would then be free to choose their maternity care providers without financial penalty. As adult citizens, women should have the right to choose. As professionals, midwives should have the right to provide maternity care to the full legal scope of their practice.
Kathleen Fahy is professor of midwifery at the University of Newcastle and president of The College of Nursing
LOAD-DATE: August 19, 2005
At 07:53 PM 21/08/2005, you wrote:
Unfortunately not available electronically, but titled Midwifery is safe, and access a right what a wonderful comment on womens rights and the sad state of affairs here in Australia where most midwives do not, and are not allowed to work truly as midwives, encompassing the full extent of our legislated practice guidelines. She challenges Doctors to provide research evidence from randomized controlled trials to prove that midwifery care is not safe, and states that doctors shouldnt have a government mandated monopoly on provision of care for pregnant women. She goes on to say that women should be free to choose their maternity care providers without financial penalty, and that as professional, midwives should have the right to provide maternity care to the full legal scope of their practice.
Three cheers for Kathleen Fahy!
Tania
PhD. Candidate
School of Applied and Human Sciences
Bankstown Campus, University of Western Sydney
UWS Locked Bag 1797
South Penrith Distribution Centre
NSW 1797 Australia
Phone: 02 97726628
Fax: 02 97726584
