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9 Comments

  1. 1
    Jennifer Doggett

    Jennifer Doggett

    Great post – congratulations too on the article in the BMJ! One of the most unfortunate consequences of the AMA/MJA’s irresponsible promotion of this research is that by trying to scare women out of homebirths (assuming that that was what they were trying to do) they will probably end up pushing some women into having a home birth who probably shouldn’t. When women looking for some objective information on this issue can only find selective and sensationalist reporting such as this, they can lose trust in any research findings and ignore evidence which actually does show them to be high-risk. And of course, another consequence for the rest of us is that we continue to pay the high cost of hospital births for all those low-risk women who could safely have a homebirth and, if given reliable and objective information about it, would choose to do so.

    Reply
  2. 2

    shell

    Thank you Doctor Bisits and others for your insight into this ‘research’

    It is no coincidence that this sensationalist study and media release happened right when the Senate was about to debate the new maternity laws. If these laws are passed, they would give Doctors veto rights over women’s birth choices – this includes a woman’s right to employ a private midwife to care for her at home during pregnancy and birth.

    I would like to ask Minister Roxon and PM Rudd:
    Private practice midwives will now be required to find Doctors to ‘collaborate’ with as required by your new maternity laws currently in the Senate – how will they be able to do this when the Head of the AMA, Doctor Pesce and the Medical Journal of Australia seem determined to demonise home birth both in professional journals and the mainstream media?

    This is despite the overwhelming international evidence which show home birth with a skilled practitioner to be as safe (and in some cases safer) than a hospital birth for many women.

    This low intervention apprach to birth has significant cost savings for the Government and the taxpayer. Why is the Federal Government not embracing this model of care which has a proven record of improving outcomes for both mothers and babies and the health budget?

    Australian women want the choice to be able to birth at home with a private midwife – over 2000 submissions to each of the recent Senate Inquiries into this legislation clearly told the Government this is what is wanted by women and their families. What will it take for them to listen to the consumer and not the Australian Medical Association (which is essentially a trade union for Doctors that exists to protect their interests)?

    It is not up to Kevin Rudd or the President of the AMA to decide how and where a woman gives birth – it is a woman’s right to decide.

    Reply
  3. 3

    Greg Angelo

    As a simple bean counter, without delving into the details of the statistical analysis, it would appear that homebirth is a more risky activity than having a birth in hospital. If medical spin doctors exaggerate the risks for commercial advantage this is to be regretted.

    However while homebirth advocates are indulging themselves with homebirth, who is looking after the interests of the unborn child? As some of the consequential but avoidable birth abnormalities require community support for the whole of the child’s lifetime, the issue is broader than “the woman’s right to decide”. A woman placing her own body at risk under such circumstances is no different from a scuba diver or downhill skier taking personal risks, but the unborn child has nobody as an advocate.

    It is therefore vitally important that mothers undertaking homebirth acknowledge the higher risks and indemnify the community, including emergency health care providers, concerning the avoidable consequences of their self focused action, by being required to formally acknowledge retention of responsibility for this increase risk exposure for both themselves and their unborn child.

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  4. 4

    shell

    Greg

    Can you please point out the source of your claims that homebirths cause “avoidable birth abnormalities that require community support for the whole of the child’s lifetime?”

    More than 40% of Australian women now have an operative birth which includes caesareans and instrumental deliveries (forceps/vacuum extraction) – these carry high risks to the baby and the mother and can be very traumatic for both.

    What these figures show is that the obstetric model is broken.

    Marsden Wagner (for 15 years a Director of Women’s and Children’s Health, World Health Organisation) is quoted as saying: “Having a caesarean birth also affects the future reproductive possibilities of the woman, because having a cesarean section means she has a decreased chance of ever getting pregnant again. And if she does get pregnant again, she is at higher risk that her pregnancy will occur outside her womb, a condition that will never result in a live baby and is life threatening for the woman. If in her subsequent pregnancies she succeeds in making it to the end of pregnancy and goes into labour, she is also at higher risk of two serious complications during the birth, both of which can threaten her own life and the life of the baby: a placenta that blocks the outlet for the baby or a placenta that detaches itself before the baby is born.”

    This is why many women choose to stay out of hospitals to birth – to avoid risky interventions that are often forced on them when they are at their most vulnerable. There are many many Australian families dealing with children today who have been permanently damaged due to medical interventions that occurred during their birth in hospital.

    Let’s please focus more on the thousands of babies dying during childbirth in the hospital system being cared for under the obstetric model instead of comparing homebirthing mothers to scuba divers.

    Reply
  5. 5

    chris

    Thank you Crikey for such intelligent coverage and discussion of this issue. It is mindblowing the way that medical “statistics” can be manipulated for individual agendas.

    I don’t think the penny has yet dropped with the government or the AMA that they will not win this war they are waging against women’s rights – because women who choose to birth at home do so because they have taken the time to do the research on what is safest for their babies and themselves. They are not passive health consumers who sit in a doctors room nodding their heads. They make informed choices and decisions. They are intelligent, motivated, confident women and their families who take responsibilities for their actions. Supporting women to birth at home with skilled, supported midwives is good for babies, good for women, and good for our groaning hospital system.

    And they are choosing to birth the way that women always have, with the assistance of skilled caregivers, other women and (sometimes) men. It is no coincidence that the word for midwife in French is “sage femme” or “wise woman”.

    Greg – perhaps you would like to speak to the fellow who rang me out of the blue the other day whose wife had the most horrendous birth experience at Blacktown Hospital. He has spent the last 4 years trying to get someone to be accountable. Listen to him, and others like him and you will no longer question why women choose to birth at home.

    Reply
  6. 6

    Justine Caines

    Dear Greg
    Where to start! As a taxpayer we have both contributed to the billion dollar (and growing) premium subsidy for Australian doctors (High Cost of Claims Scheme). Obstetricians score 80c in the dollar support, oh and after that great score they lobbied hard and reduced the common law rights of plaintiffs. So we pay to get less, what a scam. You have paid NOTHING towards homebirth insurance or poor outcomes, which their are basically NIL. 1 million dollars in claims in the insured history. Calandre Simpson however is the largest payout in med neg history and on appeal (awarded $14M lowered to $11M on appeal) was still twice that of the previous highest award. How was Calandre injured? At a private hospital under the care of a private obstetrician. The likely cause of cerebral palsy was an overdose of syntocinon (used for induction and augmentation of labour). The overdose caused the uterus to contract uncontrollably bashing Caladre’s brain in (yes nice). Oh have obstetrics been held to account for the mis-use of syntocinon? No aprox 60% of Australian women have it as an induction or augmentation agent. The majority with no clinical need. As a consumer advocate I want a safe system across the board, but this is not a level playing field. Homebirth midwives would be the most scrutinised health professionals and as such their practices are in the vast majority excellent. Women are informed and the care is 1 to 1, this removes all those ‘falling through the cracks’ issues in the hospital system where oner busy midwife runs between 3, 4 or more labouring women, hoping to catch when a normal labour turns abnormal. In the case of serious prematurity and pathology hospitals provide valuable care. For the majority of healthy women they are a case of Russian roulette. Most women and babies come out alive (gee what a bench mark), but take a look at the high rates of morbidity from medicalised childbirth. It is hard to find because no one cares enough to compile a report. As someone who has immersed themeselves in childbirth reform for 10 years I can assure you the women and often babies are being suffering high rates of iatrogenic injury. Tragically they are being lied to and believe the harm was just bad luck, rather than as a result of an intervention that in the most part was not clinically indicated.

    Reply
  7. 7

    Scott

    Does this mean I’ll be able to find a bulk-billing doctor? I don’t have a health care card, and the stats are schewed as most doctors bulk-bill concession card holders only.

    What about my Chiro or Physio? Will I they be able to bulk bill as well? What about the sky high price of dental?

    I want primary health care, so I don’t end up in hospital. I fail to see Rudd’s idea changing much.

    Reply
  8. 8

    Karen van

    Greg (March 2) – I would like to understand where your fear of homebirth has come from – do you have knowledge of homebirths gone wrong or have you researched the issue in depth???

    I did not have either of my homebirths for my own benefit – I had both of my homebirths because I wanted my babies to be born to a low risk, healthy mother, who, accompanied by qualified midwives (who between them had half a century of helping women birth in both hospital and home settings) and after extensive research and preparation around possible unforseen issues such as prolapsed cords, umbilical cord entanglement and issues of bleeding in third stage – would birth them without unnecessary medical interventions and pressure into an environment far less infested with dangerous disease than a hospital.

    I love the way homebirthing women and midwives are painted as irresponsible – we do nothing but take responsibility for EVERYTHING in terms of ensuring as best can be done, a healthy and safe place for a baby to be born. I didn’t even take panadol during my pregnancy – if a woman researches the pros and cons of taking powerful opiates during labour and makes an informed decision about her choices – I applaud her responsibility – but to take powerful drugs at a vulnerable time for the mother and baby with no idea what the impact will be on either – this scares me more and it is concerning that many women demand ‘drugs’ during labour as a matter of course without having looked into before the event.

    I have saved the community many thousands of dollars and delivered for my babies the best start I could possibly provide. How irresponsible of me…

    Reply

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