Janet Fraser

Weep as you read about VBAC in the US (and not too far off what it’s like here) Childbirth without choice

It would seem perfectly natural that a woman could give birth naturally if she wants to. Guess what? She can’t.

An increasing number of hospitals in this country are refusing to offer women the option of delivering the way nature intended, if she had a cesarean section the first time around (and guess what — chances are she has because the 31% of all births are now C-sections — up 50% in 10 years).

I wrote an article in this week’s issue of Time magazine called “The Trouble With Repeat Cesareans” on the subject of women’s diminishing patient’s rights. I won’t repeat the story here, since you can link to it here, but will give some of the back story for those who want more:

Finally a breastfeeding product I can advertise!

Tru-Breast is here! Huzzah!

The Risks of Cesarean Section
A Coalition for Improving Maternity Services Fact Sheet
© 2010 Coalition for Improving Maternity Services. Permission granted to freely reproduce with attribution.
1500 Sunday Dr Ste 102, Raleigh, NC 27607 | Tel: 919-863-9482 | www.motherfriendly.org

Cesarean section is the most common major surgical procedure performed in the United States. The Coalition for Improving Maternity Services (CIMS) is concerned about the dramatic increase and ongoing overuse of cesarean section. The surgical procedure poses short- and long-term health risks to mothers and infants, and a scarred uterus poses risks to all future pregnancies and deliveries. For these reasons, CIMS recommends that cesarean surgery be reserved for situations when potential benefits clearly outweigh potential harms. The cesarean rate can safely be less than 15 percent84 and 11 percent or less in low-risk women giving birth for the first time,28 yet, in 2007 the U.S. cesarean rate was 32 percent.30 When cesarean surgery rates rise above 15 percent health outcomes for mothers and babies worsen,5 and increasing numbers of scheduled cesareans are contributing to the rising number of late-preterm births.2,6

Cesarean rates have been rising for all women in the United States regardless of medical condition, age, race, or gestational age,52 and while the number of first cesareans performed without medical indication is increasing, no evidence supports the beliefs that these elective cesareans represent maternal request cesareans or that the rise in elective first cesareans has contributed significantly to the overall increase in cesarean rates.52 Elective first cesarean at physician request may, however, play a significant role,39 and the rise in elective repeat surgeries, which has climbed by more than 40 percent in the last ten years, certainly does.64 Although 70 percent of women or more who plan a vaginal birth after cesarean (VBAC) can birth vaginally and avoid the complications of repeat cesarean surgeries,28 almost all women today have a repeat operation because most doctors and many hospitals refuse to allow VBAC.20,35,54

A cesarean can be a life-saving operation, and some babies would not be born vaginally under any circumstances; however, it is still major surgery. Women have a legal right to know the risks associated with their treatment and the right to accept or refuse it.14 CIMS encourages childbearing women to take advantage of their rights and to find out more about the risks of cesarean section so they can make informed decisions about how they want to give birth.

What are the potential harms of cesarean surgery compared with vaginal birth?
Health outcomes after a cesarean may be worse because medical problems may lead to surgery. This fact sheet, however, is based on research that determined excess harms arising from the surgery itself. In other words, women with a healthy pregnancy who have a cesarean rather than a vaginal birth are at increased risk for the following complications as are their babies:

Potential Harms to the Mother
Compared with vaginal birth, women who have a cesarean are more likely to experience:
• Accidental surgical cuts to internal organs.53,60,72
• Major infection.43,48
• Emergency hysterectomy (because of uncontrollable bleeding).38,48,83
• Complications from anesthesia.28
• Deep venous clots that can travel to the lungs (pulmonary embolism) and brain (stroke).28,48
• Admission to intensive care.58
• Readmission to the hospital for complications related to the surgery.18,28
• Pain that may last six months or longer after the delivery.19 More women report problems with pain from the cesarean incision than report pain in the genital area after vaginal birth.19
• Adhesions, thick internal scar tissue that may cause future chronic pain, in rare cases a twisted bowel, and can complicate future abdominal or pelvic surgeries.19
• Endometriosis (cells from the uterine lining that grow outside of the womb) causing pain, bleeding, or both severe enough to require major surgery to remove the abnormal cells.27
• Appendicitis, stroke, or gallstones in the ensuing year.18,46,47,50 Gall bladder problems and stroke may be because high-weight women and women with high blood pressure are more likely to have cesareans.
• Negative psychological consequences with unplanned cesarean. These include:
o Poor birth experience, overall impaired mental health, and/or self-esteem.12
o Feelings of being overwhelmed, frightened, or helpless during the birth.20
o A sense of loss, grief, personal failure , acute trauma symptoms, posttraumatic stress, and clinical depression.37
• Death.12,22

Potential Harms to the Baby
Compared with vaginal birth, babies born by cesarean section are more likely to experience:
• Accidental surgical cuts, sometimes severe enough to require suturing.1,28
• Being born late-preterm (34 to 36 weeks of pregnancy) as a result of scheduled surgery.6
• Complications from prematurity, including difficulties with respiration, digestion, liver function, jaundice, dehydration, infection, feeding, and regulating blood sugar levels and body temperature.25,26 Late-preterm babies also have more immature brains,63 and they are more likely to have learning and behavior problems at school age.25,26
• Respiratory complications, sometimes severe enough to require admission to a special care nursery, even in infants born at early term (37 to 39 weeks of pregnancy).28 Scheduling surgery after 39 completed weeks minimizes, but does not eliminate, the risk.31,32
• Readmission to the hospital.25
• Childhood development of asthma,3,78 sensitivity to allergens,61 or Type 1 diabetes.11
• Death in the first 28 days after birth.51
Potential Harms to Maternal Attachment and Breastfeeding
Failure to breastfeed has adverse health consequences for mothers and babies. Breastfeeding helps protect mothers against postpartum depression, Type 2 diabetes, high blood pressure, heart disease, ovarian and pre-menopausal breast cancer, and osteoporosis later in life.36,71 Breastfeeding helps protect babies against ear infections, stomach infections, severe respiratory infections, allergies, asthma, obesity, Type 1 and Type 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis (a severe, life-threatening intestinal infection).15,36
• Women who have unplanned cesareans are more likely to have difficulties forming an attachment to their babies.23
• Women who have cesareans are less likely to have their infants with them skin-to-skin (cradled naked against their bare chest) after the delivery.20 Babies who have skin-to-skin contact interact more with their mothers, stay warmer, and cry less. When skin-to-skin, babies are more likely to be breastfed early and well, and to be breastfed for longer. They may also be more likely to have a good early relationship with their mothers, but the evidence for this is not as strong.16,57
• Women are less likely to breastfeed.21,44

Potential Harms to Future Pregnancies
With prior cesarean, women and their babies are more likely to experience serious complications during subsequent pregnancy and birth regardless of whether they plan repeat cesarean or vaginal birth. The likelihood of serious complications increases with each additional operation.28
Compared with prior vaginal birth, prior cesarean puts women at increased risk of:
• Uterine scar rupture. Planning repeat cesarean reduces the excess risk, but it is not completely protective.8,49,55,75
• Infertility, either voluntary (doesn’t want more children) or involuntary (can’t have more children).7,12,56,70,74,79,80
• Cesarean scar ectopic pregnancy (implantation within the cesarean scar), a condition that is life-threatening to the mother and always fatal for the embryo.67
• Placenta previa (placenta covers the cervix, the opening to the womb), placental abruption (placenta detaches partially or completely before the birth), and placenta accreta, (placenta grows into the uterine muscle and sometimes through the uterus, invading other organs), all of which increase the risk for severe hemorrhage and are potentially life-threatening complications for mother and baby.17,28,85
• Emergency hysterectomy.42,53
• Preterm birth and low birth weight.6,40,65,73,76
• A baby with congenital malformation or central nervous system injury12 due to a poorly functioning placenta.
• Stillbirth.28,29,40,65,76

Cesarean Surgery and Pelvic Floor Dysfunction
Cesarean proponents claim that cesarean surgery will prevent pelvic floor dysfunction, but it offers little or no protection once healing is complete and no protection in later life.12 Moreover, risk-free measures such as engaging in exercises to strengthen the pelvic floor or losing weight can often improve or relieve stress urinary incontinence (loss of urine with pressure on the pelvic floor such as with exercise, laughing, sneezing, or coughing).9,12
• Cesarean surgery does not protect against sexual problems,4,33,41 gas or stool incontinence,10,59 or urge urinary incontinence (loss of urine after sudden need to void).10,13,24,62,82
• Cesarean surgery does not protect against severe stress urinary incontinence.62,82 As many as one more woman in six having vaginal birth may experience stress urinary incontinence of some degree, mostly minor, at six months or more after birth.10,13,24,62,82
• Perhaps one more woman in twenty having vaginal birth will experience symptomatic pelvic floor prolapse (muscle weakness causes the internal organs to sag downwards).45,66,77,81 With three or more vaginal births, this number may be as high as one more woman in ten.66 However, many other factors, including smoking, hysterectomy, hormone replacement therapy, constipation, irritable bowel syndrome, and urinary tract infections are also associated with pelvic floor prolapse.

Cesarean Section, Care Providers and Place of Birth
To reduce the risk of cesarean surgery, CIMS encourages women to seek providers and hospitals with low cesarean rates (15% or less) and those that support VBAC. Women can access this data from their state health departments. They can also access hospital-specific cesarean rates and rates for other birth interventions for several states at www.thebirthsurvey.com and a listing of hospitals that do or do not support VBAC from the International Cesarean Network at http://ican-online.org/vac-ban-info.

Healthy women at low risk for complications should also know that choosing midwifery care or giving birth in a birth center or at home can lower their risk for cesarean section.68,69 Having a doula reduces the likelihood of a cesarean as well.34

This fact sheet was co-authored by Henci Goer, BA and Nicette Jukelevics, MA, ICCE.
© 2010 Coalition for Improving Maternity Services. Permission granted to freely reproduce with attribution.

This fact sheet is endorsed by the following organizations (as of Feb. 2010). Academy of Certified Birth Educators, Birth Matters Virginia, BirthNet of Albany NY, BirthNetwork National, Birth Network of Santa Cruz, Birth Works International, Childbirth Connection, Choices in Childbirth, Citizens for Midwifery, DONA International, International Childbirth Education Association, Lamaze International, The Lawton and Rhea Chiles Center for Healthy Mothers and Babies, Midwives Alliance of North America, National Association of Certified Professional Midwives, North American Registry of Midwives, Perinatal Education Associates, Reading Birth and Women’s Center, The Tatia Oden-French Memorial Foundation, toLabor: The Organization of Labor Assistants for Birth Options and Resources.

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81. Uma, R., Libby, G., & Murphy, D. J. (2005). Obstetric management of a woman’s first delivery and the implications for pelvic floor surgery in later life. BJOG, 112(8), 1043-1046.
82. van Brummen, H. J., Bruinse, H. W., van de Pol, G., Heintz, A. P., & van der Vaart, C. H. (2007). The effect of vaginal and cesarean delivery on lower urinary tract symptoms: What makes the difference? Int Urogynecol J Pelvic Floor Dysfunct, 18(2), 133-139.
83. Whiteman, M. K., Kuklina, E., Hillis, S. D., Jamieson, D. J., Meikle, S. F., Posner, S. F., et al. (2006). Incidence and determinants of peripartum hysterectomy. Obstet Gynecol, 108(6), 1486-1492.
84. World Health Organization. (2009). Monitoring emergency obstetric care: A handbook. France: World Health Organization.
85. Yang, Q., Wen, S. W., Oppenheimer, L., Chen, X. K., Black, D., Gao, J., et al. (2007). Association of caesarean delivery for first birth with placenta praevia and placental abruption in second pregnancy. BJOG, 114(5), 609-613.

About the Risks of Cesarean Section

A Checklist for Expectant Mothers to Read During Pregnancy

Birth is a normal, natural, process and the vast majority of women can have safe, normal, vaginal births. There are health conditions where a cesarean birth is necessary for the well being of the mother or her baby. However, more and more mothers these days are giving birth by cesarean section for non-medical reasons. A cesarean poses risks as well as benefits for mother and baby, and should not be undertaken lightly. This educational material is provided by the Coalition for Improving Maternity Services (CIMS) to help all expectant parents become better informed about the risks of cesarean section.

To give the expectant mother time to reflect on this information and consider the impact of cesarean surgery on her health and the health of her baby, care providers are encouraged to introduce and discuss this evidence-based information throughout pregnancy and no later than at 32-34 weeks. The expectant mother is encouraged to take the form home, read and initial the statements, discuss the information with her partner, and raise any questions or concerns she may have with her care provider. The form may then be placed in her chart.
Expectant Mother’s Name: _________________________________________________
Care Provider’s Name: ____________________________________________________
A cesarean section is an operation by which a baby is born by making a cut in the mother’s lower abdominal wall (abdominal incision) and a cut in her uterus (uterine incision). I understand that a cesarean operation may be more dangerous than a vaginal birth for my baby and me.
POSSIBLE PROBLEMS FOR ME WITH A CESAREAN AS COMPARED TO A VAGINAL BIRTH:
1._____ I am more likely to have more blood loss and a longer recovery time.
2._____ I am more likely to have accidental surgical cuts to my bladder, bowel, or gastrointestinal tract.
3._____ I am more likely to have a serious infection in my incision, uterus, or bladder.
4._____ I am more likely to have thick scarring (adhesions) inside my abdomen that may cause chronic pain years after my cesarean. This scarring can make any future abdominal operation I may need more difficult.
5._____ I may have uncontrolled bleeding and need an emergency hysterectomy (removal of the uterus) if the bleeding cannot be stopped.
6._____ I am more likely to have complications from anesthesia.
7._____ I am more likely to develop serious and life-threatening blood clots that can travel to my lungs (pulmonary embolism) or my brain (stroke).
8._____ I am more likely to be admitted to intensive care.
9._____ I am more likely to need to return to the hospital for complications from the cesarean operation.
10._____ I am more likely to feel pain and/or numbness at the site of the operation for several months after my surgery.
11._____ I am less likely to breastfeed successfully. I may lose out on the health benefits of breastfeeding for myself, including: weight loss, reduced risks of cancers, heart disease, diabetes, and osteoporosis.
12._____ I am less likely to have a satisfactory birth experience. I am more likely to have emotional problems such as post-partum depression and post-traumatic stress. Many women experience a profound sense of happiness after a normal birth that flows naturally into bonding with the baby and breastfeeding.
13._____ I am more likely to die.

POSSIBLE PROBLEMS WITH A CESAREAN FOR ME WITH A FUTURE PREGNANCY AS COMPARED TO A VAGINAL BIRTH:
14._____ I am more likely to have trouble becoming pregnant again.
15._____ I am more likely to have complications in a future pregnancy due to the scar in my uterus. If the new placenta attaches over my previous scar, it is more likely to cause serious problems, including: serious bleeding, placenta coming in front of the baby (placenta previa), placenta growing into or even through the wall of the womb (placenta accreta), miscarriage, or pre-term birth.
16._____ I am more likely to have a baby with a congenital malformation, central nervous system injury, or low birth weight due to problems with the placenta.
17._____ I am more likely to have a stillbirth.
18._____ I am more likely to require major surgery to remove cells from the lining of my uterus that may grow outside my womb (endometriosis).
19._____ Since it is difficult to find a physician or hospital supportive of a vaginal birth after a cesarean (VBAC), I am more likely to have a repeat cesarean for the birth of all my future children, although a vaginal birth after a cesarean birth is usually safe. Each additional operation I have increases the odds for complications.
20._____ Research shows that having a cesarean will not protect me from urine, gas, or stool incontinence in the future, or from future sexual problems.
21._____ I may not be able to get healthcare coverage since some insurance providers consider a cesarean to be a pre-existing condition.
POSSIBLE PROBLEMS FOR MY BABY:
1._____ My baby is more likely to be born prematurely if the cesarean surgery is performed anytime before labor begins. A premature baby is more likely to experience the following:
• -admission to the intensive care nursery
• -trouble breastfeeding, digesting food, and regulating body temperature
• -developing jaundice
• -brain development problems and difficulties in learning in school
2._____ My baby is more likely to face complications from anesthesia and postpartum pain medication.
3._____ My baby is more likely to be accidentally cut during surgery.
4._____ My baby is more likely to have breathing difficulties since labor contractions clear the lungs.
5._____ If I agree to a scheduled cesarean, it is normally best to wait for labor to begin before performing the operation.
6._____ My baby is more likely to have difficulty breastfeeding. My baby is less likely to benefit from skin-to-skin contact with me and is less likely to get the health benefits from breastfeeding including: reduced risk for asthma, allergies, respiratory infections, Type 1 diabetes, childhood leukemia, and SIDS (sudden infant death syndrome). If I do have a cesarean, I can request special care to help me and my baby breastfeed successfully before I am discharged from the hospital.
I have read and discussed this information with my care provider.
Expectant Mother’s Signature: _______________________________ Date: ________________
Care Provider’s Signature: __________________________________ Date: ________________
This information is provided for expectant mothers and their care providers by the Coalition for Improving Maternity Services (CIMS). CIMS strongly recommends that cesarean surgery be reserved for situations when potential health benefits clearly outweigh the risks. Please see the The Risks of Cesarean Section, a CIMS Fact Sheet for the references that support this form, available as a free download from www.motherfriendly.org

Head over to The Angry Black Woman to read a huge link fest on reproductive justice.

Wow. Just wow.

Further wowing to be had from Helen Razer who offered us some great tips on Vajazzling in time for International Women’s Day. Oh and a slamming for some playwright or other, whose work I once enjoyed. Onya, Helen.

I’m in danger of becoming a groupie. I was already wildly grateful for her work but after a morning of reading about pole dancing being a sport, how Australia lacks women in parliament, and how women aren’t too fussed by the unspeakable misogyny of Tony Abbott (and neither are men), it was such a relief to read something that actually acknowledged women as human and deserving of human rights.

Go forth and enjoy.

The NIH VBAC Consensus Conference: Will It Pave the Road to Hell with Good Intentions?

We rightly should applaud any effort that helps women and clinicians decide between planned VBAC or repeat cesarean but lament any attempt to curtail a woman’s right to refuse surgery, be it on clinical or nonclinical grounds. VBAC is a right, not a preference, a right, let me add, not abrogated by the clinician’s opinion of its wisdom. It does not matter if you, me, and everyone on the planet were to line up and say to a woman VBAC is a bad idea in your case, she still has the right to say “no” to surgery. Clinicians and institutions must be brought to accept their ethical and professional obligation to provide best practice care to every woman wanting planned VBAC. If the conference fails in this task, then whatever it accomplishes, it will fall short of its duty to childbearing women with previous cesareans.

What are you reading and writing? Here’s a few of the things I’ve found to be good reads lately.

Breastfeeding children and women a “low priority” – Western Australian parliament

Remember the protests in Perth last year about Premier Barnett’s party failing to bring WA into line with the rest of Australia with laws protecting breastfeeding families from harassment? In which Barnett insisted that there would be no need for a law if only women were “courteous” and “modest”? Even after a woman was ejected from a restaurant for merely asking for a more private place to breastfeed; even after a woman was follower and questioned in her workplace by police for expressing milk behind a curtain in a parenting room? In which Barnett pouted that any change to the law would be merely “symbolic” as far as he was concerned?

The GroundSwell Project: social change and global conversations about death, dying and bereavement

The GroundSwell Project is a not-for-profit organisation committed to developing innovative programs that engage young people in community arts projects and global conversations about death, dying and bereavement in order to contribute to social change.

The abortion doula

Before I became a doula, I was pro-choice because I grew up in the rural Midwest and saw how abstinence only education, coupled with limited access to abortion, exacerbated class disparities in my hometown. Since I’ve become a doula, my views on abortion have become more immediate and nuanced. The decision to have an abortion is never an easy one. No one makes choices about their reproduction on a whim; I trust the decisions that women make because they are hard-fought. I hope that my continuing work as a doula and as a reproductive justice organizer honors each of the women that I have met in the hospital waiting room.

My Ob said what?!

“Oh for God’s sake why didn’t somebody give this woman an enema?” -OB to woman birthing in 1969.  She still remembers these words to this day.

Today there were yet more rallies across Australia to draw attention to the immoral legislation currently before Parliament which seeks to remove women’s human rights and criminalise independent midwifery.

Maternity Coalition have put together a document which explains clearly the changes to the legislation and what they mean. My rage is hard to put into words because how many ways can we say “Human rights, that’s all we want!” in the face of this blatant oppression?

A statement I wrote on behalf of Joyous Birth, one of the rally supporters was also read out today in Victoria.

We are heading into a dark place for women in this country, a place not previously considered possible by most people and even now many of us struggle to grasp the full implication of these ill considered laws.

This is not about risk, or lobby groups, this is about our lives, our families and our wider communities on whom the impact of birth is everpresent. As we constantly hear from every corner, our hospital system is in crisis. It is a system designed to manage sickness in sick people. It is anachronistic to think that this can also serve the needs of healthy women experiencing a normal part of their lives or the needs of families to gain appropriate support around birth and parenting. Birth is a social event, not a medical emergency. It is performed by women, it is not delivered by doctors. It is a normal part of the continuum of human existence, both everyday and extraordinary each time we birth. Forcing women to engage with any system which does not meet their needs is false economy predicated on a philosophy that we are not entitled to decide for ourselves.

There is no other primary healthcare provider in this country who is treated like a second class citizen in the way independent midwives experience. The furphies promoted by the government, opposition and particularly the press are designed to sway public opinion with half truths and obfuscation. Homebirth has been a path for women in this country since before it had a name and yet now our right to decide for ourselves where and with whom we birth is being removed from us by law. I am not an incubator. I am a woman, a human being with basic human rights to self determination and the right to decide how I will approach my own healthcare and what happens to my body and my children. I want my family to flourish not simply survive in a system where more than one in three women will experience major surgery instead of birth.

The ripple effect of how our hospitals impact on birthing women is a serious problem in our society. Birth trauma is unspoken, unnamed, ignored and women are leaving our hospitals distressed and unsupported. This is not birth, this is delivery. Birth belongs to women, not bureaucrats, nor careproviders, simply to women. Laws which are clearly aimed at removing immediate and appropriate access to the only careproviders suitable for most women are untenable and immoral. We can vote but we can’t achieve genuine reproductive freedom.

The government has left us with no choice here despite every other mode of birthing being supported. We don’t seek special treatment, we simply seek the fulfilment of human rights and the right to bodily integrity. The lobby groups which have achieved this victory for a misogynist and wealthy special interest group should feel ashamed at their dash to control women’s bodies and births into which they have no business intruding. Surgeons for surgery, women for birth, midwives to support those who choose them. It’s a simple enough equation. 99% of births wasn’t enough for you?

We stand together today on the brink of this disaster, watching our human rights disappear into a vortex of rhetoric and false promises but we are not duped. We are not going away, we cannot support a system in which we, our daughters and our granddaughters are not recognised as sentient beings but relegated to handmaiden status. Stand strong, put women first and birth will follow. Justice and logic are on our side and we are proud to stand shoulder to shoulder with other women and men who seek nothing more than simple births where women and babies are honoured.

You can read the MC document below. Sorry about the crappy formatting, I thought getting it here was more important than fixing that up.

Australia’s National Maternity Consumer Advocacy Organisation

Doctors to gain veto powers over midwives and birth choices

On 5 November the Government announced that the “Medicare for midwives” Bills would be amended
to require midwives to have “collaborative arrangements” with “medical practitioners” before being
eligible for professional indemnity insurance or Medicare rebates:

Doctors must approve each midwife!s entry to private practice:

•
Midwives will be required by Commonwealth law to have “collaborative arrangements” with
“one or more medical practitioners” before being eligible for Commonwealth-subsidised
professional indemnity insurance (PII).
•
PII will be a prerequisite for a midwife to enter private practice, under new national registration
laws, being enacted state by state.
•
Doctors will be able to unilaterally withdrawal from collaborative agreements with a midwife,
rendering her uninsured, and legally unable to practice in a private professional capacity.
•
This legally mandates medical control over midwives’ ability to register and work in private
practice.
•
This will be set in Commonwealth law, which can only be changed by Commonwealth
Parliament.
•
These provisions are contained in the Health Legislation Amendment (Midwives and Nurse
Practitioners) Bill 2009.
Doctors must approve women!s access to Medicare rebates for midwifery care:

•
Midwives will also be be required by Commonwealth law to have “collaborative arrangements”
with “one or more medical practitioners” before their services are eligible for Medicare rebates.
•
This allows medical control of individual women’s access to midwifery care.
This is potentially defacto “parallel regulation” of the midwifery profession:

•
Medical practitioners will control the registration status of midwives, despite their being a
discrete, separately regulated profession.
•
Medical professional organisations could set guidelines for collaborative arrangements,
potentially forming defacto regulatory standards for midwifery endorsement and practice.
This gives doctors right of veto over women!s choices in birth care:

•
Any model of care – women’s choices in birth care – using private practice midwives, or
developed under the Commonwealth’s new arrangements, will be subject to medical control or
veto.
•
This gives medical practitioners unprecedented control over women’s choices and access to
care.

The proposed legislation is anti-competitive:

•
One group of providers will be able to control consumer access to another group of providers
of the same business service, e.g. antenatal care.
“Collaborative arrangements” may be legally restricted to privately practicing doctors:

•
The amendments do not specifically include hospitals as able to form collaborative
arrangements with midwives. They require medical practitioners to be “of a kind or kinds
specified in the regulations”.
•
It is unclear whether a hospital, health service district or authority may be included within the
definition of “one or more medical practitioners”, but it appears unlikely.
•
Doctors who are employees of public hospitals can’t make “collaborative arrangements” as
employees of the hospital they work for. They work for the hospital, attend their workplace
when rostered on and collaborate in line with hospital policies.
•
A range of very serious consequences would flow if these arrangements were restricted to
privately practicing doctors. Consequences could include:
o
No new midwifery models in public hospitals.
o
No private midwifery practice.
o
No homebirth care from midwives in private practice.
o
Practice midwives in private obstetricians rooms could be the only viable model of
private practice or Medicare-funded midwifery.
The amendments do not improve “safety” or “continuity” for Australian mothers:

•
Midwifery is a profession with standards, guidelines and codes of practice developed to ensure
the safety of midwifery care in any setting.
•
Doctors, who are trained in a different skill-set, do not have the expertise to safely control
midwifery practice.
•
Continuity of care has been a fundamental goal of the midwifery reforms. These amendments
make this continuity much more difficult to deliver.
•
No provision is made in the amendment specifying that collaborative arrangements will be
based on patient safety or continuity of care. Medical practitioners will have veto on their own
terms.
This brief represents the best information available to Maternity Coalition on 9 November 2009. We
are actively seeking ongoing clarification and dialogue with Government in order to ensure women and
families have access to accurate information.

For full text of amendments go to:

http://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;adv=yes;db=;group=;holdingType=;id=;orderBy=priority,title;page=7;query=Dat

aset%3AbillsCurBef%20Dataset_Phrase%3A%22amend%22;querytype=Dataset_Phrase%3Aamend;rec=11;resCount=Default

For more information contact: Bruce Teakle 07 3289 0231, teakle@maternitycoalition.org.au

Who homebirths?

Welcome to a new series of entries. A series of activism, humour, love and community. This is a series for those who have birthed at home, those who would like to, those who support homebirthing women and anyone with a love of family and community. It is a safe place for women who birth at home to share their stories about why they chose homebirth, what it means to them, and anything else that helps us make sense of this anti-birth world.

This is for all women who birth at home.

It is not about careproviders, although many of the stories will include midwives, doulas and even some doctors who support women to birth at home. Careproviders are also welcome to share why they choose to work independently and support women to birth at home but the focus is on women, and their families who choose homebirth regardless of who supports or attends their births.

janet (at) janetfraser (dot) id (dot) au

Homebirth. A basic human right.

This series is to debunk myths around homebirthing populations but also to keep a record of our homebirthing. Please feel free to share in any way you like but here are a few things to maybe answer or think about while you’re composing your response!

Did you homebirth your first baby or subsequent babies?
Have you used a publicly funded homebirth scheme in any country in the world?
Have you experienced hospital or birth centre birth?
Have you experienced trauma around birth?
How old were you when you were birthing at home?
With what ethnicity do you identify?
Have you had a caesarean? More than one?
Have you had a breech homebirth?
Do you identify as disabled/temporarily ablebodied?
Have you had a midwife-attended homebirth?
Are you in a relationship?
Are you single?
How did you pay for your homebirth?
Do you work at home or in the paid workforce?
Does your family have a history of homebirthing?

VBAC is an endangered species.

This is not really surprising since vaginal births of all kinds are endangered and it only makes sense that having created a birthing monster of cuts and scars, Dr Frankenstein would be unwilling to let the monster go use it’s body in some way that silly old evolution intended.

But surely, I hear you cry, surely MY surgeon is different!** She supports my vbac hopes! Her secretary said she was great for VBAC so I had no need to ask further! No doubt someone whose wages are paid by Dr Frankenstein would be utterly objective and truthful in their comments to me, the potential paying client!

So yes, she supports me to birth vaginally so long as we’re both healthy.

Well gee that’s a relief! Here was me thinking you hoping for a VBAC would mean your surgeon would refuse to slice and dice if you got genuinely ill. Phew.

She supports me to VBAC so long as I go into labour before 38 weeks.

Oh nice. So long as you gestate shorter than about 95% of women, you’ll get a bit of a go at labour! Yay! Send out for pizza! Oh but not in labour, because you’re not allowed to eat in case you need surgery.

She supports me to VBAC if this baby is smaller because the last one didn’t fit through my pelvis.

Ah excellent. Of course she’s forgotten to say size estimates are a crock, and she’s totally forgotten that your pelvis works perfectly. I didn’t see you come in with a wheelchair, or on crutches, or with a pelvis so misshapen you can barely walk and your nearest relatives lived in London’s East End prior to WWI.

I was hoping for a vbac but at 36 weeks my surgeon tells me my baby is too small.

Hang on, I thought small was good? And you know, at 36 weeks most babies are small because they haven’t finished growing. Your baby may have another six weeks in it’s growth plan, do you know otherwise?

My surgeon supports me to VBAC, I just have to have a little more monitoring in labour.

Are you aware that “a little more monitoring” is actually going to be you with a bed strapped to your back, monitors wrapped around your belly, probably a scalp monitor shoved through your vagina and screwed into your baby’s head thus preventing you from moving around and actually birthing? Are you aware that evidence does not support this? You will also have a cannula stuck in your vein making it impossible for you to use one hand. Good thing you’re strapped down and don’t need to hold onto anything, hey? At least there won’t be much difficulty moving you about when it comes time to wheel you into theatre for your life saving surgery! What a comfort…

My surgeon said I gave it my best shot, I laboured for X hours and I was tired so I would never have been able to push my baby out anyway.

Ah yes. It’s a good thing birth normally lasts about 30 minutes so no one’s ever tired by it. You know, no one rushes up to marathon runners and says, “Hey you look really tired, just grab a cab to then end. It’s ok, you gave it your best shot, don’t worry about it!” And I often see footballers being carried off the field so they don’t get too exhausted, poor things. And of course your surgeon’s trusty crystal ball would have told them exactly how long your labour was going to be, so that was easy to predict. And since you never get to sleep again in your whole life, you would never have caught up on any sleep. One could argue that we have lots of time to sleep, but only one chance to birth a baby but one wouldn’t want to upset anyone with logic, hey?

My surgeon said that my scar was hanging on by a thread so I should never attempt to VBAC again!

Golly gosh, Batwoman! Hey how come there was no sign of imminent rupture with all that monitoring? How come your baby has Apgars of 9 and 9? Although it’s gut has been irretrievably altered, but let’s not mention that.

And sadly, my surgeon informed me that my uterus was paper thin so that’s another reason I will have to have “elective” surgery next time!

It’s the simple things which say the most, isn’t it? Get a normal household type balloon for kiddie parties and the like. Study it closely. See how thick it is at this resting state? Now blow it up, watch it change colour and get thinner as the same amount of rubber stretches to take on a large amount of air. See that? It gets thinner. Now see what else? Look down, look at your amazing body with all it’s muscles, tendons, bones and ligaments and remember that pregnancy is a normal use of your body and all those things are keeping your uterus firmly in place. They’ve held your baby through a long gestation, constant workings of the muscle as it tones for labour. If you don’t doubt your lungs can breathe and your gut can digest, give your amazing uterus some credit too.

** Far be it for me to point this out, but there’s a basic contradiction in going to a surgeon to avoid surgery, isn’t there? Do I go to a plumber and hope she won’t fix my pipes? Do I go to a mechanic and ask her to look at my car but not recommend any mechanical alterations?

Do you really want a VBAC, or are you pretending so you can humour those boring people around you who have all those “facts” about how it’s better for you? Are you just really scared because you know, in our birth-hating world it would surprising if you weren’t and I have immense compassion for you.

You know, it’s ok to have fear, but you’re not going to avoid a hole in your uterus by having surgery. In fact, you’re going to guarantee your uterus has more than a hole, it will have a big slice that someone will put their hands in and rip open. If you want to keep your uterus intact, you will stop hoping, start planning and make some better decisions about models of care.

Pick a surgeon, don’t be surprised when you get surgery.

~ we love homebirth ~

How will you birth after July 2010?

Homebirth Awareness Year 2008

Some blog deliciousness to get us all thinking more about the current draft legislation to outlaw homebirth midwifery in Australia.

http://allthatsazz.blogspot.com/2009/06/important-message-from-your-security.html

Warning warning feminist yumour ahead!

Important message from your Security Minister

Homebirthers may try to convince you that our actions are infringing on their human rights. This is an outrageous accusation given that half of all humans are men and don’t give birth. This is not a human rights issue, it’s a women’s issue, one that few women care about. Women can vote, drive, marry or not, go to university, wear pants and have group sex with rugby players, the majority of women are happy with their lot. The remaining “women” are an outspoken minority who are struggling to find a husband on account of their lack of hair on top and wild bushes everywhere else. Your government is currently drafting legislation against these terrorist ugos too.

Lisa at her Midwife Mutiny blog shares some letters and thoughts on the current draft legislation.

http://www.homebirth.net.au/2009/06/college-of-midwives.html

http://www.homebirth.net.au/2009/06/exterminate.html

http://www.homebirth.net.au/2009/06/national-forum.html

http://viv.id.au/blog/20090625.5487/homebirth-to-become-illegal-in-a-year/

Homebirth to become illegal in a year

I’m fucking disgusted. As parts of the USA move toward a system of underground abortion provision through the threat of terrorist force, we’re moving toward a system of underground homebirth midwifery through the threat of State force. Anyone who thinks this is a good thing, raise your hand. All those with your hand raised, go have a glass of wine and feel ashamed of yourselves. All those without your hand up: write to Roxon and your federal MPs and Senators, please.

http://feminamist.wordpress.com/2009/06/25/womens-bodies-on-the-line-in-australia/

Din of Inequity draws the only logical conclusion between attacks on abortion and attacks on homebirth as the same crap to control women.

Women’s bodies on the line in Australia.

It may seem like a storm in a teacup to people who are anti-homebirth, but the legislation will effect us all. Homebirth has been an anchor that has upheld the normal, natural process of birth, an antidote to the over medicalisation of birth and a counter to the spiraling caesarian rates. But going beyond birth, this is about bodily autonomy, about a woman’s right to the self determination of her health care needs, it is about our personal sovereignty. Any whittling down of our rights reduces and endangers us all.