Janet Fraser

Jane Austen who always comes to mind when I click on Science and Sensibility!

So I was idly looking over the admirable Science and Sensibility blog and in the categories I saw, “systematic review”. Two words calculated to stir the breast of the homebirth advocate. So just because I can, I’m sharing that very link.

systematic review

Enjoy! I did!

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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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

If your revolution doesn't include singing and dancing, don't invite me.

The Trust Birth conference is being tweeted so it’s like little live jewel bursts of glorious information coming out during the sessions! If you twitter, join in and retweet some beautiful birthing wisdom as it happens!

* And it definitely won’t be on Facebook if it involves breastfeeding.…

About 4% of babies are in breech positions at term. Of course nowadays the normal course of events is surgery. Is this safe? Realistic? Warranted? Not according to evidence, no.

“Attending births is like growing roses. You have to marvel at the ones that just open up and bloom at the first kiss of the sun, but you wouldn’t dream of pulling open the petals of the tightly closed buds, and forcing them to blossom to your time line. ” -Gloria Lemay

Lisa Barrett’s blog entry on breech. Lisa is an independent midwife in South Australia.
http://www.homebirth.net.au/2008/03/breech-variation-of-normal.html

A video of a breech birth.
http://www.homebirth.net.au/2010/01/frank-breech-video.html

http://www.aims.org.uk/

Birthing a baby by the breech at home.
Beech B. AIMS Journal, Vol 14, No 2, 2002, p4-5

Coroner’s inquiry into a breech delivery.
Beech B. AIMS Journal, Vol 14, No 2 2002 p19-20

Breech Presentation – Caesarean operation versus normal birth
Lowdon G. AIMS Journal, Vol 10, No 3, 1998, p1-4

Natural, Active Breech Birth.
Lowdon G. AIMS Journal, Vol 10, No 3, 1998, p5

Keep Your Hands off the Breech.
Cronk M. AIMS Journal, Vol 10, No 3 1998, p6-8

Why are some babies breech?
Lowdon G. AIMS Journal, Vol 10, No 3, 1998, p8-9.

Turning Point for the Breech?
Thomas P. AIMS Journal, Vol 10, No 3, 1998, p12-13

Breech on Gentle Birth archives
http://www.gentlebirth.org/archives/breech.html – overview
http://www.gentlebirth.org/archives/breechcl.html – turning
http://www.gentlebirth.org/archives/breechtn.html – turning
http://www.gentlebirth.org/archives/breechrf.html – studies

Book review on breech babies.
http://www.midwiferytoday.com/reviews/breech.asp

Ina May Gaskin on catching surprise breech babies!

http://www.midwiferytoday.com/articles/3surprisebreeches.asp

Homeopathy to turn babies in utero.
http://www.midwiferytoday.com/articles/turnbaby.asp

A great site on moving breech babies.
http://www.spinningbabies.com

A Natural Breech Birth – hospital
http://www.lalecheleague.org/NB/NBMarApr01p47.html

More than you could ever hope for from the UK midwives (I love these women!)
http://www.radmid.demon.co.uk/breech.htm

About 500 birth stories with clear descriptions.
http://www.breechbabies.com/breech%20_stories.htm

Lovely story! Home breech lotus birth! (Quick, call RANZCOG and tell them one got away!!)
http://www.birthwell.com.au/birth_stories_priya.html

Footling Breech: A Midwife’s Own Birth Story – by Veronica Wagner

In this memoir a midwife reflects on the story of her birth as a footling breech in Germany during World War II, and the homebirths that she has attended in her life. She touches on both themes, remembering not only breech births, but the role that animals have played in many births she has been involved with.

http://www.midwiferytoday.com/articles/FootlingBreech.asp

http://www.home4birth.com/pregnancy/Breech/index.html

Breech birth is not inherently dangerous if medical intervention is avoided and if the mother is allowed to instinctively choose her birth position and give birth at her own pace. It really disturbs me to not see this attitude represented at all among most people. Every suggestion made, every time you touch a woman during pregnancy, labor, and birth, every time you hint that something about her baby, her pregnancy, her labor, or her birth is not exactly as it should be, is an intervention that could lead to complications.

http://www.birthinternational.com/articles/andrea13.html

Most breech babies will turn naturally before labour. You will probably be referred to an obstetrician as these days few midwives will undertake a breech birth, even though in the past most midwives considered this within their scope of practice. There are still some midwives who are happy to assist with this variation of a normal birth, so it may be worthwhile asking around in your local community to see if you can find a willing midwife.

http://www.aims.org.uk/Journal/Vol10No3/breechCSvsNormal.htm

There are widespread fears surrounding vaginal delivery of the breech presentation and a lack of information generally available on safe vaginal delivery of a breech. There is also a lack of honesty about the risks of caesarean section and sparse knowledge of the post-caesarean difficulties many mothers encounter. These factors, together with the prevailing myths and beliefs that caesareans guarantee healthy babies, more often than not leave the woman with no option but to blindly accept the decisions made for her by her obstetrician.

If only people saw violence against birthing women so clearly.

Not content with sharing the lurve of the previous enquiries into who really owns women’s bodies  human rights Homebirth in Australia, here is the submission sent today to the next enquiry which I predict will find that women want midwives and to be in charge of their own birth and will result in the AMA’s final victory over our human rights as we lose the right to homebirth with the midwife of our choosing. Cynical? Bitter? No, just realistic.

10 December, 2009

Joyous Birth, the Australian homebirth network

http://www.joyousbirth.info/

Ms Claire Moore

Chair

Senate Community Affairs Legislation Committee

By e-mail: community.affairs.sen@aph.gov.au

Dear Senator Moore

Inquiry into Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and two related Bills

We are opposed to the amendments that have been introduced to the above bills which would require midwives to enter into formal “collaborative” arrangements with medical practitioners. To implement a situation where a medical practitioner has veto over the actions of a midwife, and consumer, is anything but collaborative. It is 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.

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.

The AMA website reads in total defiance of international example, stating that ‘Obstetricians are the most appropriate care providers for women.’ Obstetrics is the care and management of pregnancy and birth where abnormality, illness or complications have been detected. As with other specialist or surgical branches of healthcare in Australia, there should be no reason for obstetricians to be the first port of call for healthy pregnant women. As demonstrated time and again internationally, to do so only increases surgical rates and iatrogenic complications, and reduces consumer satisfaction and overall safety. For obstetricians to claim they are appropriate healthcare resources for most women is an outrageous claim unsupported by evidence or logic and clearly driven by profit.

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.

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 legislation 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.

The AMA’s propagandist methods seek to pose a false debate around safety and manufacture  a way for the community to be distracted from the real issues here – the right of women to autonomy around basic healthcare decisions. Neither obstetricians, 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 proposed amendments, 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, 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.

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 legislation would completely contradict the findings of the government’s own report in order to pander to what is in essence a trade union. Surely the provision of healthcare is to attend to the needs of the consumers not the political desires of the AMA.

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. The reviewers believe that the choice to give birth at home or in water will continue, as will the choice to have a vaginal birth after a caesarean section. Therefore, developing systems to support safe and satisfying systems of care that provide childbearing women with a diversity of options is essential.

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 government 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 both 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.

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?

Please share what you’re reading and writing, I love to have new material for eager readers and learn from all the many groovy blogs out there on the interwebz.

Image of Hannah More from http://1stangel.co.uk/art/brilliant-women-18th-century-bluestockings/

Ilithyia Inspired brings us news of the latest piece of obstetric bullshit to hit the airwaves.

iBirth? iPhone As The Latest Obstetric Intervention

Memorial Hermann Healthcare System (Houston, Texas) have been featured on Apple’s business profile website for adopting the latest in obstetric intervention technology: the iphone. Apparently the iphone and “state-of-the-art medical [applications] like AirStrip OB let Memorial Hermann’s physicians keep a finger on patients’ pulses even when they can’t be at their bedsides.”* Every obstetricians dream, a technology that enables him to intefear in birth while on the golf course!

The newest intersectional blog which gives us feminism and disability brings a truly tremendous, thought provoking learning experience for those of us who see birth, reproductive rights, human rights, women and bodies of all kinds as important. Really, you need to add this blog to your blog roll now!

Law & Order: “Dignity”, Worth, and the Medical Model of Disability

As a feminist, I am pro-choice. Abortion should be safe, legal, and accessible.

As a feminist, I look at more than whether single, individual women have access to abortion. There is a much broader reproductive justice framework that must be scrutinised, critiqued and repaired so that all women have access to informed, supported reproductive choices.

Gloria Lemay has luckily had the loan of one of Australian’s midwives in the last few weeks. Good thing you sent her back! Gawd only knows, we need her here.

Breech birth workshop in Vancouver with Lisa Barrett

I haven’t posted this week because I’ve been wrapped up in having midwife Lisa Barrett as a visitor to Canada.  If you’re not familiar with Lisa’s work, visit her blog from Australia at

http://www.homebirth.net.au/

Lisa presented a workshop on breech birth for midwives and other birth workers last Tuesday and it was an excellent review with new food for thought.  She showed a breech birth video and, then, broke the video down into still photos to show the progress of the naturally birthed breech baby coming through the diameters of the pelvis in the most efficient way possible.  In addition, there was helpful information on why some babies present breech, how to open up the pelvis with a rebozo and how to prevent problems such as entrapped arms and premature respiration.

Henci Goer, yet again, uses her incisive skills and wealth of knowledge to reveal how the surgical discourse is constantly making inroads into the reality and logic of normal, phsyiological birth. Birth politics have losers, people, they’re women and babies.

Does It? Really? “WHO Admits: There Is No Evidence for Recommending a 10-15% Caesarean Limit”

This is the title of a Medical News Today piece, actually a re-posting of a press release from a coalition of websites that promote elective cesarean surgery. The press release claims that the 2009 edition of the WHO’s “Monitoring Emergency Obstetric Care: A Handbook”  has rescinded its 1985 recommendation that cesarean rates not exceed 10-15%. Can this be true? Not so much.

In fact, not at all.

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.

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.