Consumers are not stakeholders, it would seem, when birth is discussed.

What should I do?
Nothing dear, you’re not qualified.

Welcome to how homebirth will look at your place – if you’re allowed to have one.

Some homebirth advocates (Wingnuts, Bernard, in case you don’t know what an Advocate is) met with the minister and learnt some interesting things. I quote from the report done up by Homebirth Access Sydney:

We asked the Minister for a commitment that consumers would be part of the discussions and agreement of a framework of practice or protocols. The Minister stated that she would not include consumers in this process and that it would be negotiated with the professional bodies.

Got that? Doctors and midwives (only certain midwives, not the ones who actually support homebirth) are going to make the decisions about where I get to give birth. Not me, not other women whose bodies are up for discussion, just Professionals. I guess they’re Qualified, right? Sure they’re qualified, they’re qualified to provide a service to those women who require or request their services. Just like a plumber, builder or other tradesperson. If I need plumbing or building done, I’m happy to hire a builder. If I need surgery, or care from a midwife, I’m happy to hire them.

But here’s the clincher: as a sentient, adult, woman I, and only I, will make the decisions about my own healthcare.

Could it get more basic? I’m a human with the basic human right to bodily integrity.

The minister thinks maybe the South Australian guidelines around  homebirth would a nice starting point.**
http://www.health.sa.gov.au/PPG/Portals/0/planned_home_birth_policy_SA.pdf

It’s quite a treat. It opens with this:

The woman should be aware that all births carry an inherent risk, with some situations involving greater degrees of risk for herself and/or her baby. She may need transfer to a health unit if complications arise. It is the woman’s responsibility to seek information about all aspects of giving birth at home.

The woman must be aware that plans to give birth at home may need to be reconsidered at any time, depending on changes in the woman’s or baby’s condition during either pregnancy or labour. Moreover, the woman must have given signed informed consent for a planned home birth. The Planned Birth at Home information brochure has provision for the woman to sign her consent.

The Department of Health policies First Stage Labour in Water and Birth in Water also must be followed if a woman also decides to use water for pain relief and have a water birth at home.

The Chief Executive Officer of the health unit providing planned home births must advise the Department of Health’s Insurance Services of that intention. This advice must arrive before starting the service to ensure compliance. There must be an annual report to the Department of Health of the number of home births undertaken in each financial year.

Of course in the interests of parity, all women who turn up at their local maternity hospital are called upon to sign a piece of paper which documents their acceptance of the risks of birthing in a hospital (higher rates of neonatal mortality, higher rates of complications, likelihood of surgery with excessive rates of morbidity and mortality, likelihood of PTSD and PND) and that they are solely responsible for researching madly the risks of that birthplace, right? Uh yeah. As if.

It includes this too:

The woman’s wishes for childbirth should be respected within the framework of safety and clinical guidelines. The autonomy of pregnant women is protected in both law and jurisprudence, and it is the duty of health professionals to accommodate that autonomy in as safe a manner as possible for both woman and baby.

The United Nations states that the human rights of women include their right to have control over, and to
decide freely and responsibly on, all matters related to their sexual and reproductive health (United Nations
1995).

Obviously all that can be read and interpreted any way you like. In Australia it means “You have this list of options we deem suitable because no one with a vagina could ever make their own sane, safe decisions.”

A woman can be supported to give birth at home only if she fits the criteria for a low-risk, singleton pregnancy at term, and the qualified practitioners are confident and competent to assist.

No, here’s the thing you don’t get: any woman has the right to choose for herself where she wants to give birth and with whom. Low risk is bullshit. Asking surgeons to define who’s allowed to give birth is insane. Unless you’re all about controlling women and then it makes perfect chilling revolting sense.

Leaving aside the guff in the middle but which even uses the totally discredited Bastian study, then we get to this bit:

It is inevitable that some women planning to have a home birth will need transfer to a
health unit after labour has started, even with a careful selection process during pregnancy
(Davies et al. 1996; Wiegers et al. 1976; Parratt & Johnston 1998). This transfer is more
likely to happen for women giving birth for the first time than for women who have given birth
before. Where such transfer occurs in a timely fashion and in a spirit of cooperation, it
typically has no negative effect on the woman’s birth experience (Davies et al. 1996;
Wiegers et al. 1998a).

Crock, all crock. Transfers are traumatic because people who believe documents like this are valid, treat homebirthing women and their midwives like shit on their shoes in the hospital. Of the many women I’ve known who’ve transferred over the years I’ve done this job I can name a handful who were treated well, not abused, sneered at, raped, punished. I can tell you the many midwives who’ve transferred with clients who were happy with the care they’ve received and yet some third party arsehole in the hospital has made a baseless complaint about the midwife and resulted in her deregistration.

It’s not homebirthers and midwives who need to co-operate. It’s the staff in hospitals under the misguided apprehension that they have the right to punish women who choose not to birth with them.

Now here’s some more chilling stuff:

The qualified practitioners, in facilitating a planned home birth, will:
5.1 be aware of the possible benefits, hazards and contraindications including the current
literature about giving birth at home;
5.2 be aware that they have a duty of care to the woman, but also and separately to the baby;
5.3 inform the woman of the Department of Health policy on Planned Birth at Home, the
precautions necessary and the contraindications;
5.4 provide the woman with the information brochure on Planned Birth at Home and be
confident that the woman has read it;

Get that bit? Babies cannot be trusted to their mothers, we need to have the practitioners deemed appropriate by the state making decisions on behalf of the baby, not a parent. A foetus is not a person. It does not have legal personhood in this country – yet. But when we start saying that careproviders should be looking out for babies separately from their mothers, we head down that road in a de facto manner. Chilling. Obviously perfectly fine in the minds of all the tossers who don’t get that a vagina doesn’t make you a dunce or a danger to your babies.

CONTRAINDICATIONS
The qualified practitioner will conduct a careful screening to ensure that the woman’s condition is
suitable for giving birth at home, that she has no fetal or maternal contraindications, and that she
has the capacity to make informed consent.
6.1 The prerequisite for a home birth is that the woman should have an uncomplicated singleton
pregnancy with a cephalic presentation between 37 and 42 weeks of gestation (259 to 294
days).
6.4 The following conditions preclude a woman giving birth at home.

Obstetric history—previous:
caesarean section;
postpartum haemorrhage in excess of one (1) litre;
shoulder dystocia;
baby requiring intensive or prolonged special care;
perinatal death.

Medical history (as identified in the SA Pregnancy Record):
any significant medical condition;
alcohol or drug dependency;
female genital mutilation.

POLICY – PLANNED BIRTH AT HOME
- 8 -
Current pregnancy:
body mass index >35 or maternal weight greater than 100 kg;
antepartum haemorrhage;
abnormal placentation (including placenta praevia);
hypertension and/or pre-eclampsia;
gestational diabetes;
suspected intrauterine growth restriction or small for gestational age;
suspected fetal abnormalities that require paediatric attention at birth;
polyhydramnios or oligohydramnios;
pre-labour rupture of membranes (see 6.4); and
post-term pregnancy (42 completed weeks; that is,294 days).

Most of us give birth at home in order to avoid being dictated to about how we can birth. This list is just the same hospital bullshit that sees all the normal women in hospitals get fucked over. Evidence based practice? Sorry? What’s that?

During labour:
need for continuous fetal monitoring;
evidence of infection or maternal temperature >37.6° C;
lack of engagement of the fetal head;
meconium-stained liquor;
fetal heart rate abnormalities;
intrapartum haemorrhage;
absence of progress in established labour;
active first stage labour in excess of 18 hours.

Home environment:
more than 30 minutes travelling time from the support health unit;
lack of easy access (in case transfer during labour is warranted);
lack of clean running water and/or electricity;
lack of cleanliness and hygiene;
domestic violence;
recreational drug use.

6.3 Situations may arise at or after birth that require referral to a health unit; these include:
retained or incomplete placenta;
postpartum haemorrhage;
third or fourth degree tear;
Apgar score < 7 at 5 minutes;
neonatal respiratory problems;
neonatal convulsions;
congenital abnormalities;
low birthweight (< 2,500 gms).

So it’s a hospital at home, ok? Got that?

And don’t try lying about anything because you have no right to privacy. If you can’t produce your medical record to demonstrate that you haven’t been sliced or lost a baby previously, you don’t get a homebirth anyway. And if you don’t have the record they’ve all been assiduously writing on when you’re in labour they want to transfer you to the hospital then too.

The absence or otherwise non-availability of the woman’s SA Pregnancy Record during
labour constitutes a contraindication for giving birth at home.

Of course midwives, those professionals qualified to offer care to pregnant women can’t be trusted to know anything about women so this is essential too:

The woman should be advised to have a general medical examination from a general
practitioner of her choice before deciding on a home birth to eliminate previously
undiagnosed disorders; this assessment should occur early in pregnancy.

I’d laugh if it wasn’t going to degenerate into a weep. Since when do GPs know anything about pregnancy? Since when?? And yet the actually qualified practitioners – midwives – who do know about pregnancy are only allowed on a woman’s case once she has the all clear from a GP. G stands for General, not specialist.

It is advisable that a woman intending to have a home birth is booked with a health unit in
early pregnancy. In the event of complications during pregnancy, labour, birth or the
postnatal period, transfer to a health unit may be necessary.
7.6 The woman’s chosen general practitioner and booked health unit should be informed of the
woman’s decision to have a home birth.

You know what? It’s no one’s business but mine where I plan to birth. No one’s. Fucking nanny state.

Pharmacological pain relief is not available during labour at home. The qualified practitioners
should ensure that the woman is aware that transfer to a health unit is necessary if
pharmacological pain relief is required.

No shit, Sherlock. It might come as news to you but that’s one of the many reasons women birth at home. Because people who think labour is an illness aren’t there to force “pain relief” on us. Pain relief causes injuries to women and babies. Do some goddam research like homebirthers do!

The woman should be advised of the need to reassess her suitability for home birth later in
pregnancy and again after the onset of labour.

So you could go your whole pregnancy thinking you’re having a homebirth and then get forced into hospital if you don’t fulfil all their ridiculous criteria at the last minute. Nice. Classy.

7.10 The woman should be referred to her general practitioner or an obstetrician if medical
complications arise during the woman’s pregnancy. If the qualified practitioner is a midwife,
the ACMI National Midwifery Guidelines for Consultation and Referral (2004) should be used
as a reference.

Again with the GPs? Who have what training in pregnancy and its complications??

7.11 If a woman chooses to continue with plans for a home birth contrary to the advice of either of
the qualified practitioners, the situation should be documented and formal notification should
be distributed to all support practitioners and the booked health unit.

Yes here’s the nitty gritty. Punishment for noncompliance. No privacy, no right to make your own decisions about your birth and your baby.

7.12 The qualified practitioner should visit the woman’s home before 37 weeks into the
pregnancy to ensure that the home is a safe environment for a home birth. The qualified
practitioners should meet the support persons who intend to be present during labour, at this
time or at any other time before the onset of labour.

More nitty gritty now. They get to visit your home and vet it (presumably if you can raise children in it, you can birth in it, right? You probably got up the duff in it but they haven’t started policing that just yet.), they get to vet who YOU want from your own goddam family there! Why isn’t everyone outraged at the paternalistic invasion of women’s privacy right there?!

7.14 The woman should have a bag packed in case a transfer is required.

Oh noes! How will the world ever survive if a labouring woman turns up in a hospital without a nightie in a plastic bag? FFS. The level of nannying is fucking astounding. Will there be reports tabled if silly women don’t pack a nightie and demonstrate their nightie packing capacity to Big Daddy?

8.3 When labour assessment occurs at home, the qualified practitioners must ensure that the
woman is informed of her progress in a timely fashion that enables informed decisionmaking;
this should include:
8.3.1 reassessment that the woman’s condition is suitable for birth at home; and
8.3.2 informing the woman and her family, where necessary, on options for care for
example, if transfer to a health unit is advised and whether this should be in a car or
an ambulance).
8.4 The qualified practitioners are responsible for informing the booked health unit both when
the woman is in labour and also when she has given birth.

So a labouring woman is going to have regular vaginal exams which disrupt labour and prove nothing about progress so the midwives can report on her and her faulty body to everyone within cooee. Then everyone gets reported for “successfully” or otherwise, managing to squeeze out a baby under these hospital conditions too. Fark. Nothing’s ok about any of this.

Here we go into really really scary territory again:

8.12 It is difficult to predict outcomes of pregnancy and birth, and complications can occur
quickly. If a woman chooses to continue with plans for a home birth when the qualified
practitioners have advised against it, the qualified practitioners should document the
situation, formally notify labour and delivery suite at the booked health unit and the obstetric
consultant on call. The qualified practitioners may continue to provide care but should be
aware of the separate duty of care to the baby.

Actually reputable sources and millenia of evolution can tell you that in unhindered birth instant complications are rare but that’s by the by.

The baby, is the baby of the woman. You do not get to make separate care arrangements for my children as if I cannot be trusted to make the best possible, safest, evidence based decisions for my child. You just don’t get to do that. As a parent I have the right to decide how my baby is treated once they’re earthside and prior to that, they are in MY body and I will make ALL the decisions, thanks. Foetuses do not have legal personhood. De facto rubbish this is.

The woman must be offered an oxytocic injection immediately after delivery to reduce the
risk of haemorrhage.

Quick point but actually this is also bullshit. But the studies done obviously have no bearing on the policy. I’m not researching it for you, try google.

9.9 The qualified practitioners are no longer responsible for the woman’s care after transfer to a
health unit, but it is advisable that one of the qualified practitioners , who attended labour at
home, remains involved with the woman’s care until after the baby is born.
9.10 If disagreement arises with the woman about transfer of her or her baby when complications
occur, either qualified practitioner should document the situation and formally notify the
appropriate staff at the booking a health unit. It is advised that the qualified practitioners
have the woman record in writing her decision not to accept their advice.

Ah so once you transfer, all this Collaborating still means squat because your midwife has no practicing rights in the hospital. You’re signed over to total strangers at this point without anyone giving a shit about the relationship you may have inadvertantly forged wth your midwife through the last nine months of constant testing and bullshit. And yes, everyone’s up to running off a quick written memo when they’re refusing to take a baby to hospital who isn’t sick but has somehow fallen outside the hospital guidelines being forced upon you in your own home.

Ok this is just dumb:

2.1 Giving birth at home is not a common practice in Australia and adequate documentation,
therefore, is of the utmost importance.

WHY? What the fuck purpose does the constant reporting on women serve? Oh yes that’s right it controls us. Have these people never heard of the perinatal data which is collected in every state and territory of Australia? Homebirth is actually documented there as lodged by attending midwives. So why do they keep saying it must be documented thus leading a reasonable person not up with this stuff to start thinking it’s not documented? Silly question? More smoke and mirrors?

12.2 The safeguarding of documentary evidence is of even greater importance for practices that
are relatively rare than for those that are common; therefore:

12.2.2 the non-availability of a SA Pregnancy Record and its information at the time of
labour and birth must be seen as a contra-indication for home birth and is an
indication for transfer to a health unit (see 6.6);

Do I really need to tell you why this is ridiculous? How about healthcare as a reason to transfer? Not just noncompliance?

I’ll leave you to read their listed sources. Unsurprisingly most are old and from the surgical school of decision making. The 2005 BMJ study rates a mention but most of the work is getting on for a decade from when this document was produced in 2007.

Why is this so? I’m sure you can work it out.

And do enjoy the checklist at the end and imagine it being applied to women who birth in hospitals, as opposed to those who have take away hospitals as per this document.

If this is our future, I’m scared for women. I’m heartbroken. I’m deeply angered that our basic human rights are not even considered.

Our bodies. Our births. WTF don’t you get?!

This youtube presentation explains the impact on birthing women of the personhood of the foetus as is supported in many states of the US.

** Since writing this the minister has actually decided that she’s going to make it a. someone else’s problem by putting a hold on some parts of the legislation for the next two years and b. that someone in another state, Victoria, will be responsible for the new guidelines that are meant to make homebirth “safer” ie bring women under closer obstetric and governmental control like the meatsocks for foetuses that we really are.

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