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Are Australian women’s birthing rights now perched on a slippery slope?

Hannah Dahlen, Associate Professor of Midwifery, University of Western Sydney, writes:

On the 6th June the South Australian Deputy Coroner released a report into the deaths of three babies in South Australia who died under the care of a midwife who is no longer registered, and as we know the coroner has a very important role in making recommendations to prevent adverse events in the future.

The coroner identified some serious system and legislative problems that contributed to these incidents and made some potentially important recommendations, along with some potentially concerning ones.

The potentially positive recommendations are that the practice of midwifery should be permissible only in the case of registered midwives under National Law as this ensures accountability and the meeting of standards that protect the safety of the public. Midwives who are registered are regulated and have to abide by practice codes and standards and follow the Australian College of Midwives National Guidelines for Consultation and Referral, which the coroner commended in his report.

The Australian College of Midwives also has a position statement on homebirths to guide midwives practice in this area.

However, what is most concerning is the recommendation that legislation be introduced that would “impose a duty on any person providing a health service, including midwifery services to report to the South Australian Department of Health and Ageing the intention of any person under his or her care to undergo a homebirth in respect of deliveries that are attended by enhanced risk of complications.”

The concern with this is twofold. Firstly, it may in fact push some women further underground and lead to them not seeking any engagement with health services at all and this will be a significant disincentive to safety and secondly, it could lead to a serious intrusion into the rights of women to determine what happens to their bodies during pregnancy and birth.

Doctors will be tempted to report anyone intending to birth at home, as they generally espouse that no birth is normal except in retrospect and midwives will be forced into a situation of turning in their colleagues and their clients. How far will this McCarthyism potentially go and who gets to determine what is acceptable and what is not when it comes to women’s choices? What next, court ordered caesareans?

The USA has shown us the slippery slope we perch on when fetal rights supersede women’s, with court ordered caesareans, arrests and prosecutions (38 USA states now have fetal homicide laws and these laws are increasingly being used to target women who sit on the fringes of what we would consider acceptable behaviour).

Women’s right to control what happens to their bodies during pregnancy and birth may be enshrined in law but this right is frequently violated in practice. To step into this and attempt to regulate a woman’s body has serious ramifications and undoes hard won battles our feminist forbears fought for and the unintended consequences should give us cause for sober reflection.

Where do we stop once we start and who controls what is acceptable behaviour and what is not and who has the ‘rights’ and who does not and what is risky and what is not?

If you are thinking surely not, or only in America, then consider this: In March this year the WA branch of the AMA called on the State Government to extend recently proposed foetal homicide laws to include applying penalties to women who choose to have a homebirth when there are risk factors in the pregnancy or where they drink alcohol and/or take drugs.

The AMA WA went further saying in essence midwives should be prosecuted as well as they were obviously misguiding these women. Inexplicably they added that they had been reassured that the proposed laws would not impact on women’s right to have an abortion and thus reassured were seeking to criminalise homebirth mothers and/or their midwives. It seems ironic that the same people that defend a woman’s right to choose abortion deny her right to choose her place of birth.

Next into the debate predictably came the Right to Life Association that called for the proposed WA foetal homicide laws to be extended to criminalising abortion, and so it went on. As all the parties bickered over the bone of women’s rights versus fetal rights and most of the feminists remained eerily silent, as they often do when it comes to birth, the question we seem unable to ask is once again is why would women take the ‘risk’ of having a baby at home when they have significant risk factors? Do these women love their babies less or do they fear our health system more?

For the vast majority of women their baby is their number one priority. When they make choices that are not always in the best interests of themselves and their baby one should ask why?

When nearly 1:10 women in some studies are reporting Post-Traumatic Stress Disorder <> following childbirth then we have a problem. While 1:10 maternal deaths are due to suicide, then we have a problem.  We have a worrying rise in freebirth (planned birth at home with no professional in attendance). If women are avoiding our system isn’t it incumbent upon us health professionals to work together with women to fix the problems?

As I have written before, homebirth is safe for low risk women attended by competent registered midwives who are well networked into a responsive health service. Where a woman has significant risk factors it is much less safe and hospital is the best place for them to give birth in.

But let us consider this reality in our country .

There has been no insurance for private midwives providing homebirth services since the collapse of HIH in 2001, so there are fewer privately practising registered midwives, leaving unregulated health workers to fill the gap. Privately practicing midwives are not allowed clinical privileging rights to practice in hospital like their medical colleagues.

And on July 1st 2013 if a solution is not found for privately practicing midwives when the Safety and Quality Framework for Privately Practising Midwives Attending Homebirths runs out, then midwives could potentially be disciplined and lose their registration for attending a birth at home. If we were trying to create the ‘perfect storm’ when it comes to homebirth then perhaps we have succeeded in this country.

In 2005, the WHO challenged health practitioners not to ask, “Why women do not accept the service that we offer?” but to question, “Why do we not offer a service that women will accept?

Let’s stop calling for ‘legislating’ against women’s choice or bullying them into submission and let’s start trying to understand why that choice is made and put in place responsive sensitive maternity care systems that cater for the individual and see birth as more than a medical event.

If we can do this we won’t have to erode women’s rights and we can pull ourselves back from the top of this slippery slope we are currently perched on in this country.

 

Comments 2

  1. Amy Tuteur, MD says:

    Dr. Dahlen’s chief pre-occupation appears to be maintaining the autonomy of rogue midwives like Lisa Barrett. That position, of course, is rather ugly, so instead, Dr. Dahlen chooses to pretend that the coroner’s recommendations will infringe on women’s autonomy.

    The coroner investigated midwife Lisa Barrett’s attendance at 4 separate preventable perinatal deaths. The coroner found that Barrett had assured women that it was safe to undertake homebirth when all the scientific evidence indicated the opposite. The coroner recommended measures that would ensure that women receive accurate information about the real risks of homebirth.

    Contrary to Dr. Dahlen’s arguments, which the coroner detailed and explicitly rejected in his 106 page report, this is NOT about women’s right to have a homebirth. It is about women’s right to receive ACCURATE information about risks. The coroner’s recommendations do not restrict the autonomy of women; they restrict the autonomy of rogue midwives.

    Dr. Dahlen is attempting to scare women into believing that regulation of midwives will hurt them by taking away the choice of homebirth.

    Dr. Dahlen is attempting to avoid the real subject, incompetent and negligent midwives who give women false information about the risks of homebirth.

    Dr. Dahlen and the ACM have failed to offer even one practical suggestion in how to avert future perinatal deaths at homebirth.

    Dr. Dahlen and the ACM should be deeply ashamed that they apparently feel professional autonomy of the rogue members among them is more important than whether babies live or die.

  2. courtney susan says:

    While I adore my son, I still refer to his birth 10 years ago as the most horrific and traumatic experience of my life – and I have been assaulted by clients and bitten by rottweilers in the variety of jobs I’ve held over the years, so this is a big call.

    I know now that I suffered post traumatic stress disorder for a significant period of time (years) following my son’s birth. I had to endure a 3rd degree tear that was facilitated by an episiotomy to which I did not consent, an infection of this tear that took 7 weeks and additional surgery at 6 weeks to heal (during which the local anaesthetic didn’t work and I got to feel the doctor burning flesh from my perineum), impacted bowels and I have been left with on-going stress incontinence.

    When I unexpectedly fell pregnant at 40 years of age last November, I instantly started investigating my care options for a home birth. I will not willingly enter a hospital ever again in my entire life, and even having to undergo a straight forward keyhole emergency appendicectomy almost 2 years ago caused me great psychological stress.

    I was diagnosed with Graves disease (hyperthyroidism) at 7 weeks pregnant, and while this is being successfully managed with medication, and my baby show no signs of ill effects from my condition/medication, my pregnancy has been labelled ‘high risk’ by the medical profession. The specialist treating my thyroid condition is trying to push me into a hospital birth with a cast of thousands, despite there currently being no medical indication of any complications for either myself or my baby for the birth.

    I did go to an ob/gyn on the advice of my GP for this pregnancy, and he recommended that I have an elective caesarean to avoid another perineal tear, when my tear last time was caused my medical malpractice and medical intervention. I was stunned that he would recommend a major operation with a definite wound and a 20% infection rate over a natural birth with a small risk of a perineal tear!

    My husband supports my homebirthing decision as he understands that the implications of me going to hospital to give birth will pose far more risk to mine and my baby’s health, than would giving birth at home under the care of our trained and experienced midwife.

    If homebirth is forced underground, I can assure you that it would not stop me from giving birth at home. I would rather take a chance on having an unassisted homebirth than to attempt another hospital birth.

    I am a tertiary educated professional woman with a science background, and I believe that I have weighed up all of the benefits/risks in quite a logical, scientific way and I have chosen homebirth as the best option for both myself and my baby.

    A one in three caesarean rate in Australia is completely unacceptable and is putting women and their babies in harm’s way unnecessarily. I consider this to be medical negligence and abuse of the vulnerability of birthing women. The doctors always have the ultimate guilt/blackmail drawcard in that they imply that you are risking your baby’s health if you make birthing decisions that are contrary to their narrow-minded recommendations.

    Please do not restrict options for birthing women and their babies/families – birth rights are human rights.

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Cultural determinants of health
Digital platforms
Elections and budgets
Federal Budget 2019-20
Federal Budget 2020-21
Federal Budget 2021-22
Global health and climate change
2019-20 climate bushfire emergency
asylum seeker and refugee health
Climate emergency
disasters
Ebola
extreme weather events
flooding 2011
global health
NHS
NZ Election 2017
WHO
health
Healthcare and health reform
abortion
adverse events
aged care
allied health care
Australian Medical Association
cancer
cardiovascular disease
child health
Choosing Wisely
chronic diseases
co-payments
Cochrane Collaboration
complementary medicines
conflicts of interest
death and dying
diabetes
digital technology
disabilities
e-health
emergency departments and care
Equally Well
euthanasia
evidence-based issues
general practice
genetics
health & medical marketing
health and medical education
health and medical research
Health Care Homes
health ethics
health financing and costs
health reform
health regulation
health workforce
HIV/AIDS
hospitals
HRT
infectious diseases
influenza
international medical graduates
journal articles
LGBTIQ
medical marijuana
Medicare Locals
men's health
mental health
MyHospitals website
National Commission of Audit 2014
National Health Performance Authority
naturopathy
NDIS
NHMRC
non communicable diseases
nurses and nursing
oral health
organ transplants
out of pocket costs
pain
palliative care
paramedics
pathology
Pharmaceutical Benefits Scheme
pharmaceutical industry
pharmacy
Pregnancy and childbirth
primary health care
Primary Health Networks
private health insurance
quality and safety of health care
rural and remote health
screening
sexual health
social media and healthcare
suicide
surgery
swine flu
telehealth
tests
TGA
trauma
women's health
youth health
Indigenous health
#CTG10
#NTRC
Acknowledgement
cultural safety
Indigenous education
Lowitja Institute
NT Intervention
social and emotional wellbeing
Uluru Statement
WA community closures
News about Croakey
PIJ Commissions 2021
Public health and population health
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
air pollution
alcohol
consumer health matters
COVIDwrap
environmental health
Fetal Alcohol Spectrum Disorders (FASD)
food and nutrition
gambling
Government 2.0
gun control
health communications
health impact assessment
Health in All Policies
health inequalities
health literacy
human rights
illicit drugs
injuries
legal issues
marriage equality
Media Doctor Australia
media-related issues
nanny state
National Preventive Health Agency
obesity
occupational health
physical activity
plain packaging
prevention
public health
public interest journalism
road safety
sport
sugar tax
tobacco control
transport
vaccination
violence
Web 2.0
weight loss products
Royal Commission
Social determinants of health
discrimination
education
justice
Justice Reinvestment
NBN
Newstart
poverty
racism
social policy
Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017