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  1. 1

    Pam Harnden

    The issue that this doesn’t address is one of informed choice. I would like to remind people of the RANZCOG guidelines for standards of maternity care in Australia and New Zealand,
    “1.5 Women who have been fully informed regarding a recommended course of action, and the potential consequences of not pursuing such management, should have their decisions respected if they decline.”p.6

    I would also like to remind people of the following from the National Guidance on collaborative maternity care document published by the Australian Government NHMRC,
    “Documentation should include clear and consistent records of: information provided to the woman and indications that the messages have been understood, informed consent, responsibility and accountability for decisions, and the woman’s understanding of risk and her responsibility for her own choices and decisions about care, especially if these decisions are in conflict with professional
    advice (in such circumstances it must be clearly documented that the woman has accepted a certain level of risk).
    A woman decides who she involves in this decision-making process, be it a health professional, partner, doula, her extended family, friends or community, and should be free to consider their advice without being pressured, coerced, induced or forced into care that is not what she desires (McLean and Petersen 1996).Women have the right to decline care or advice if they choose, or to withdraw consent at any time. Therefore, if a woman declines care or advice based on the information provided, her choice must be respected (UNESCO 2005). Importantly, women should not be ‘abandoned’ because of their choice (FPA Health and Read 2006, Faunce 2008; NHMRC consultations 2009).” p.14

    The ACM therefore are the only organisation that sought to deny these rights to women and actively encouraged midwives to refuse to attend a woman in labour by issuing this ‘interim home birth statement’. I also stress it was an INTERIM statement which has now been voted on my the membership to be withdrawn. I would remind any midwife that under the law as it stands should a woman have consulted her at any time during her pregnancy that a therapeutic relationship has been established and should she then refuse to attend that woman in labour she could be prosecuted.
    The real issue is that where informed consent has taken place there is no protection for the midwife she looses on all counts. Can be prosecuted should she refuse to attend, prosecuted if she attends and struck off. I love that you wish to portray us as ‘demons’ but please stick to the real issues and quit with all the professional personal attacks.

  2. 2

    Debbie Slater

    In moving to a system that supports planned homebirth for women at low risk of complications it is important to commensurately look at how our health system supports women of ‘high risk’ within the hospital system. Many women (not all) plan a homebirth because they want the same midwife throughout their antenatal care, labour, birth and for several weeks postnatally: what they are choosing is the model of care not the place of birth per se. It is therefore incumbant on health services to step up to the mark and provide these models within hospital settings – particularly where women are unable to choose this model of care at home because of their ‘risk status’. The evidence supports these models as leading to good outcomes for women and indeed they are mandated as part of the National Maternity Services Plan. Health departments must increase provision of midwifery-led models of care within hospitals and primary care settings, and need to ensure that eligible midwives with Medicare provider numbers are able to admit the women in their care to public hospitals – something they are by and large failing to do. Medical practitioners have a part to play in this and must be willing to enter into collaborative arrangements with midwives – as Dr Pesce has already done. Health Services should also be looking at ways to reduce the primary caesarean section rate, as this plays a significant part in the increasing number of so-called ‘high risk’ women within the system – through a focus on normal birth. NSW have already taken a lead on this. Dr Pesce talks about crossing the Rubicon (which many midwives and consumers have done), but many medical practitioners have their own Rubicon to cross: that of accepting that homebirth is an acceptable place of birth for women of low obstetric risk. In my work as a consumer representative in maternity services and involved in the provision of low-risk publicly-funded homebirth service, I too often come across medical practioners who fail to support homebirth at all and, in some cases, actively make it difficult. In order for maternity services to work for women, everyone (midwives, women and doctors) has to work together in a spirit of cooperation and collaboration. This involves a bit of give and take on all sides. Only then will women be the winners.


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