If only it were so.
While under no illusions whatsoever that submitting anything for consumers has anything to do with the process to dismantle homebirth, I still have to do it. We are still here, and we’re not going anywhere. This week’s treat is the new “framework” for “eligible” midwives even though as yet there’s no information on what exactly they’re “eligible” for other than the big lie of “collaboration” which is no more attractive now than it was in Paris in WWII. Am I the only one who always has the French Resistance and black berets pop into their head when this “collaboration” comes up?
Lissen carefully, ah weel say ziss ernly wernce: don't collaborate!
Of course it’s more Weasel Words because it’s nothing like what us normal peeps think of “collaboration”, it’s “doctors have the power of veto over women and midwives”. In Surgical Discourse Land that’s perfectly reasonable but out here in Reality Land, that’s appalling.
The new Nursing and Midwifery Board of Australia has a consultant drawing up their “guidelines” for “eligibility” so it’s addressed to them. Hear that? That’s the sound of futility. Oh and don’t think we didn’t notice they released this pile of crap on the Friday before a long weekend with a due date of midday Tuesday. Ah yes. Very serious about “collaboration” they are.
27 April 2010
Joyous Birth, the Australian homebirth network
http://www.joyousbirth.info/
Re: GUIDELINES & ASSESSMENT FRAMEWORK FOR THE RECOGNITION & ENDORSEMENT OF ELIGIBLE MIDWIVES
We are opposed to forcing qualified practicing independent midwives to enter into unethical and untenable regulatory agreements which remove autonomy from midwives and leave women without the basic right to directly choose their own healthcare practitioner throughout pregnancy and birth. This system is clearly designed to remove consumer-driven homebirth from Australian women in direct contravention of Australian’s support for CEDAW. It is unethical and immoral and must be abandoned.
Expecting midwives to submit to this and then further use this process to manage a spurious “collaborative” system is also without merit. Creating a situation where a series of registering bodies have veto over the actions of a midwife, and consumer, is anything but collaborative. It is simply a nonsense to refer to such methods as collaboration when they are clearly in direct opposition to the reasonable person’s understanding of such a term. Appropriate accessing of obstetric services when, and as required, by consumers and/or midwives already exists in demonstrable forms so there is no need to force this unworkable model onto unwilling participants.
Independent midwives do not need access to PBS or Medicare. Nor do we, their clients, desire that they have it. Independent midwives simply exist to offer services to the community which are unavailable in any other model of care. Women should have the right to bodily autonomy enshrined in law to prevent this kind of attack on our human rights. Before this becomes a reality it behooves bodies dealing with healthcare to put women’s human rights in the forefront of every change in policy. The Nursing and Midwifery Board of Australia must act within accepted parameters of human rights.
It is an accepted fact worldwide that midwives are the best and most appropriate careproviders for women. The World Health Organisation has made it clear that routine obstetric care for healthy women is damaging to women.
WHO’s Care in normal birth: a practical guide (Geneva, 1996) states:
Women and their babies can be harmed by unnecessary practices. Staff in referral
facilities can become dysfunctional if their capacity to care for very sick women who need all
their attention and expertise is swamped by the sheer number of normal births which present
themselves. In their turn, such normal births are frequently managed with “standardised
protocols” which only find their justification in the care of women with childbirth
complications.
Midwifery is a specialised profession which provides a distinctly different model of care to birthing women from that of obstetrics. It is not a branch of nursing but a separate profession. Nursing is the care of sick people and midwifery is the care and support of pregnant women within a social and community framework, not a medical or surgical framework. This misunderstanding is an historical confusion peculiar to Australia which has not occurred in other countries, where superior care and outcomes are plain to see.
Across Australia, the existing medical monopoly has resulted in the overwhelming majority of women undergoing routine, institutionalised obstetric services. The result has been rising rates of intervention and rising rates of infant and maternal mortality and morbidity. Australia’s perinatal data bears witness to this. This “framework” only cements the monopoly further in place with no support for consumers’ rights or genuine choices around healthcare.
What has not been accurately measured is the rate of psycho-social trauma to women and their families as a result of this medicalised approach to maternity services, and the repercussions throughout society as a result. Trauma as a result of unnecessarily managed births and no right of informed refusal is a common experience for birthing women.
Let us be reminded that the leading cause of maternal death in Australia is suicide.
This whole package of legislation including these guidelines around “eligible midwives” seeks to remove consumer-driven homebirth from Australia and force women to birth in hospitals. Many women choose homebirth because of previous experiences of the hospital system and the negative effect it has had on them, their children and their families and communities. Some women choose to avoid this by birthing their first and subsequent children at home. In any case, the drive to remove this right can only be viewed as a major insult to women and families who choose homebirth as well as those citizens who value women’s reproductive freedoms as human rights.
In New Zealand and the UK, around 80% of women choose the Midwifery model of care. It is patently obvious that when the vast majority of normal births are attended by midwives there is a reduction of infant and maternal morbidity and mortality in comparison with Australia.
Women should have the right to autonomy around basic healthcare decisions. Neither obstetricians, nor registering bodies, nor politicians, should be permitted to dictate how consumers birth their babies. Australia’s signature to the 1995 Beijing declaration makes us accountable on a world stage for this proposed removal of women’s reproductive freedoms.
The “eligible midwives” framework, if passed into law, will create a restriction of practice for midwives and will curtail the freedom of consumers to choose an appropriate model of care.
As countless surveys and reviews have found, genuine midwifery care is what Australian women want. It is holistic, inexpensive and with benefits to communities at every level. It is clearly inappropriate for midwifery in Australia to be manipulated by doctors or bodies invested in models of care hostile to consumers. This simply extends hospital-style bureaucracy across all areas of maternal healthcare and is abhorrent to women who choose homebirth precisely because it is more appropriate, more family friendly and safer than risking our care to the underfunded, interventionist hospital system.
The 2008 report, Improving Maternity Services in Australia – A Discussion Paper from the Australian Government (Canberra, 2008) states:
All facilities should offer women choice of carer and place of birth, more education and should promote midwife-led care across the continuum. An enormous obstacle is private obstetric charges, as obstetricians may be hesitant to forgo lucrative incomes of up to $9,000 per pregnancy, with some Sydney doctors reported to be charging up to $12,000 and earning collectively up to $1.4 billion per year.
It also recommends the following:
The state and national governments must shift the emphasis from a medical model of care to a social model of care in childbirth that encompasses women’s needs holistically rather than focussing on the clinical aspects of pregnancy and labour.
and
Women and families should be actively encouraged to take control of their pregnancies and be supported in their decision making.
The implementation of this pernicious and dangerous framework would completely contradict the findings of the government’s own report. Surely the provision of healthcare is to attend to the needs of the consumers not the political desires of careprovider groups? Consumers say no to this framework.
Similarly, the Review of Homebirths in Western Australia (Subiaco, 2008), undertaken for the Department of Health WA, states:
It seems apparent that the maternity systems are, for some women, too medicalised and restrictive, and do not meet their needs. It is our impression that some women, who in other models and systems would not be ‘eligible’ or recommended for homebirth, seem to be choosing this option as a surrogate means to access midwifery continuity of care and waterbirth. This issue was apparent in both metropolitan and rural areas.
This lack of choice, echoed as it is within hospitals, traumatises women, leaving them shattered and brutalised after experiencing conveyor belt maternity policies. It would be a grave error indeed to force this upon women.
The birthing women and families which are represented by this submission wish to let the Nursing and Midwifery Board of Australia know that we will not back down from challenging and protesting this attack on our human rights.
Women would be pleased to speak to this committee about their experiences of hospitals, birth trauma and homebirth. Consumers should be the bulk of those consulted in this process since it is on our bodies that the outcome will be written.
Yours sincerely,
Janet Fraser
National Convenor, Joyous Birth
Australian homebirth network
On behalf of the women and families of the Joyous Birth communities nationally.
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