Do you have complete say over what you do with your body?
The Maternity Services Review report, released last weekend, was an attempt to deliver continuity of care and midwife-led services to more Australian women. In so doing, it has stripped that very same care and service from the only women who currently have it - homebirth mums.
The fact that it did this in the face of having received the majority of its submissions from homebirth parents is galling and speaks volumes for the way "public consultation" occurs in this country. But the fact that the report's recommendations, if accepted by the Government and made law, would criminalise the high quality care currently delivered to women who choose to give birth at home by registered, professional, independent midwives to their clients is radical and dangerous.
Good intentions have paved the way. The MSR was established partly in response to rising birth intervention rates and widespread concern that women were being poorly served by a maternity care system that was fragmented, expensive and increasingly medicalised.
But the process became hijacked by professional lobbying, deal-making and perhaps a strange reflex of governments to favour institutionalised power over the rights of individual constituents.
The report is fairly forthcoming about this:
"In recognising that, at the current time in Australia, homebirthing is a sensitive and controversial issue, the Review Team has formed the view that the relationship between maternity health care professionals is not such as to support homebirth as a mainstream Commonwealth-funded option (at least in the short term). The Review also considers that moving prematurely to a mainstream private model of care incorporating homebirthing risks polarising the professions..."
So as long as the AMA and RANZCOG are hostile to homebirth -ideologically, not evidentially - the government is not prepared to stare them down. In the next paragraph, the Report notes the existing small-scale state-funded public homebirth schemes, with no evidence that such models were polarising, or that they were being undermined by a poor relationship between maternity health care professionals, or that there were any justifiable safety concerns. But the MSR is not engaging with the evidence, it's playing politics.
The public consultation process is made farcical when over half the submissions are lightly dismissed without reasons of substance. Such deal-making reveals a government prepared to bend to the powerful medical lobby even against the weight of public submission and international evidence.
The Review concluded that, "while homebirth is the preferred choice for some women, they represent a very small proportion of the total." Since when has being in the minority constituted an acceptable reason for discrimination? The fact that only a small proportion of the population will need heart transplants is no reason to ban them or block public funding to them. The small minority of families who choose private education due to religious beliefs are still supported by Commonwealth funding. And of course homebirth will be unpopular when it is the only way to give birth in Australia that receives no public funding whatsoever.
The report notes that in countries where homebirth is publicly funded - New Zealand and the United Kingdom, for example - homebirth rates are ten times those in Australia.
But the MSR report goes further than merely continuing to deny homebirth funding. It becomes dangerous when it takes a back-door route to criminalisation of homebirth.
Under the proposed new National Registration and Accreditation Scheme, to apply to midwives from July 2010, midwives must have professional indemnity insurance to obtain registration. This is not currently the case - hospital insurance schemes cover their employed midwives; homebirth midwives work uninsured. The report notes that this latter situation is unacceptable. Homebirth consumers and midwives agree and have repeatedly sought Federal assistance in obtaining appropriate insurance.
But the report, while recommending Commonwealth-supported professional indemnity for midwives in collaborative team-based models, withholds such support where homebirth is concerned, since "it is likely that insurers will be less inclined to provide indemnity cover for private homebirths and, if they did provide cover, the premium costs would be very high."
Neither evidence nor logic support this. The reason insurers have not offered coverage to privately practising midwives since 2002 is not the risk profile of midwives. It is that the pool of homebirth midwives shrank to an uncommercial size during the insurance crisis in 2002 - which was caused by astronomical compensation payouts against obstetricians, not midwives.
Everyone in the industry suddenly became uninsurable, yet the then government's bailout package, under the Premium Support and High Cost of Claims Schemes, saved only GPs and obstetricians. So midwives had to work uninsured or give up their practice. Unsurprisingly, many quit attending homebirths. Even if the risk profile of homebirth practice did make premiums too high, that would only put midwives in the same boat as GPs and obstetricians, who receive substantial government support under these schemes.
The simple, obvious answer is to extend the schemes to midwives.
Instead, by cutting midwives loose on insurance, the government is effectively outlawing homebirth, since by mid-next year uninsured midwives will be unable to obtain registration, and unregistered midwifery is a criminal offence. There is no surer way than this to make homebirth unsafe.
Consumers rely on registration to ensure that they are choosing a skilled and professional carer. To remove this indicator of quality away from consumers, not on the basis of professionalism but on the availability of a suitable insurance scheme, puts women at risk. More women will birth unattended.
Women are entitled to choose where they give birth and with whom. They are entitled to refuse treatment and to choose it. They are entitled to give birth in a hospital, a birth centre, a home or under a tree if that's what they want to do. Research shows that a woman is safest birthing in the environment where she feels safest. And to make it illegal for a woman who chooses to birth at home to access appropriate care is surely not the intention of this government.
However you feel about homebirth, whether you'd want it for yourself or not, the removal of a woman's right to birth where she chooses is indefensible and should be a matter of grave concern to all women, just as if women were denied access to breast cancer treatment, epidurals, or condoms.
The government can't ban homebirth any more than it can ban sex, but by banning professional, registered midwives from attending homebirths, it greatly increases risk.
Not funding homebirth is just bad policy: cost-ineffective to Australian taxpayers and unfair to Australian women. But making homebirth illegal is paternalistic, internationally isolated and dangerous.
Homebirth with an independent midwife is a great model of care for lots of reasons, key among them that it provides continuity of care with a known carer - something the Maternity Services Review says it wants to see in hospital -based models. So why is it killing off the only model that reliably delivers that care?
Giving birth at home with a highly skilled and qualified midwife is not new or radical.
Outlawing it is.
Written by Alison Leeman
Also, a reminder of where you can write and show your support for all our rights.
The Hon Nicola Roxon,
MPMinister for Health and Ageing