Snapping point

Do you have one? Mine apparently is when I have to wait and wait and wait. FUCK will SOMETHING just resolve, PLEASE?? Or I may have to take up a hermitage.

• I am awaiting a client birthing. This one is not one of the things I'm remotely anxious about. It'll happen sometime this month, and I'm used to that - the being on call, the being prepared and not going too far from home but still getting on with my life. It's lovely to pack a bag each morning when I go out, with my camera, two lenses, 3 batteries, nappies etc for Sally and some snacks. Exciting even!

On the other hand, the following items are driving me insane with the waiting:

• UniSA continues to demonstrate that they can't organise their way out of a wet paper bag. With a map. And a headlamp. And a trail of breadcrumbs. I have placement in a matter of weeks and after busting my hump to get my paperwork updated so I could put preferences in two weeks ago, I still don't know where I'm going. Placements were supposed to be out last week. But still nothing. And no response to my polite, friendly, chatty emails. I therefore also don't have a roster for placement. So I can't work out meals, childcare, cars, transport, whether we can billet someone
• I don't have my training package from the ABA yet. Apparently it was posted to me in early December. I have been chasing it for 3 weeks now and *now* someone tells me this detail, revealing that it is likely to have been lost and therefore offering to send me another one. I have a training day on Saturday that will now be pointless as I don't have ANY work to do for the subject we're discussing.
• Virgin Mobile have told TheHusband that he can have an iPhone4 in 10 days. I've been waiting for 4 weeks to be told when they'll even have stock of them. I am pissed at this. My phone is unreliable, frustrating and still on a plan so I'd rather stay with Virgin than move and have to pay out my contract. So I ask for an upgrade so I can stay with Virgin. Sure, that's fine says Virgin but we'll let you know when they're in stock. TheHusband calls yesterday and gets a different story. I call today and get told the same story as before. I am pissed at this because it's either a) one of us being lied to or b) him getting different treatment as he's male. Not sure which makes me angrier. I have a loan phone for the meantime but want it resolved.
• I am waiting on pay for work I've done over the past few weeks, as a casual for two universities. Pay for these is notoriously fickle.
• I have a court date for settlement of my injury claim, on the 22nd. But I'm waiting for an appointment with my lawyers. And for that date to come around as well.

Sigh. What I need in the meantime is a massage, someone to clean my floors, bathroom and toilet, a fairy to sort out the spare room, something to resolve some time soon, and some sleep.

Or just someone to cheer me on. And bring me wine.

More about yesterday's post - that AJOG article

Which can be read here.Just a short point while I eat dinner. The exclusions for this study:

To identify a low obstetrical risk population, we excluded multiple gestations, preterm deliveries <37 weeks, smokers, women with pregestational or gestational diabetes, chronic hypertension, hypertensive disorders of pregnancy, or prior cesarean. Demographics included maternal age, race, education, and timeliness of registering for prenatal care. Maternal morbidity measures in this low-risk population included chorioamnionitis (clinical diagnosis of chorioamnionitis during labor made by delivery attendant, usually includes 1 of the following: fever, uterine tenderness and/or irritability, leukocytosis, fetal tachycardia, any maternal temperature 38°C [100.4°F]), fetal intolerance of labor (in utero resuscitative measures, eg, any of the following: maternal position change, oxygen administration to the mother, intravenous fluids administered to the mother, amnioinfusion, support of maternal blood pressure, and administration of uterine relaxing agents; further fetal assessment includes any of the following: scalp pH, scalp stimulation, acoustic stimulation; operative delivery is operative intervention to shorten time to delivery of the fetus, eg, forceps, vacuum, or cesarean delivery), prolonged labor (labor that progresses slowly and lasts for >20 hours), precipitous labor (labor that progresses rapidly and lasts for <3 hours), and meconium staining (staining of the amniotic fluid caused by passage of fetal bowel contents during labor and/or at delivery that is more than enough to cause a greenish color change of an otherwise clear fluid). Newborn morbidity included assisted ventilation (infant given manual breaths for any duration with bag and mask or bag and endotracheal tube within the first several minutes from birth, excludes oxygen only and laryngoscopy for aspiration of meconium), assisted ventilation >6 hours (infant given mechanical ventilation [breathing assistance] by any method for <6 hours, includes conventional, high-frequency, and/or continuous positive pressure), birth injury (defined as present immediately following delivery or manifesting soon after delivery, includes any bony fracture or weakness or loss of sensation but excludes fractured clavicles and transient facial nerve palsy; soft tissue hemorrhage requiring evaluation and/or treatment, includes subgaleal [progressive extravasation within the scalp] hemorrhage, giant cephalohematoma, extensive truncal, facial, and/or extremity ecchymosis accompanied by evidence of anemia and/or hypovolemia and/or hypotension; solid organ hemorrhage, includes subcapsular hematoma of the liver, fractures of the spleen, or adrenal hematoma), neonatal intensive care unit (NICU) admission (admission into a facility or unit staffed and equipped to provide continuous mechanical ventilatory support for a newborn), seizures (seizure is any involuntary repetitive, convulsive movement or behavior; serious neurologic dysfunction is severe alteration of alertness, such as obtundation, stupor, or coma, ie, hypoxic-ischemic encephalopathy, excludes lethargy or hypotonia in the absence of other neurologic findings, excludes symptoms associated with central nervous system congenital anomalies), 5-minute Apgar
score <7, and birthweight <2500 g.

 Way to go for reinforcing lots of "risk factors" not supported by research. And why exclude fractured clavicles and transient facial palsy?

Shame on you, Auntie

On Stateline last week, there was a snippet about calls to change laws over stillbirth investigations (link is to video with sound). In a shocking example of "jouranlism", the story went from a woman who wanted her interuterine fetal death at 28 weeks (I'm guessing there - she said "7 months") investigated for some kind of explaination, to a beat up about homebirth. The woman's horrible experience had NOTHING to do with homebirth - she was under the care of a hospital and birthed there.

The tenuous bow that seems to have been drawn between these two stories was that one woman had her baby die in her pregnancy, and another had her baby die during birth, and that latter woman was birthing at home. The case of the latter woman has now rocked the entire concept of "life" because the assistant coroner seems to have an axe to grind about homebirth.

The findings of the case make for interesting reading (go on, read it - it's only 14 neatly formatted and well spaced pages). The assistant coroner seems to have ignored eminent experts in the area of cardio-thoracic medicine and has decided that something akin to the heat left in a boiled kettle, now constitutes life. Instead of leaving the Spencer-Kock family to grieve and live their lives, the decision has been made that their baby was in fact alive at some point and therefore is a "person" under the law and so the coroner has jurisdiction to investigate the death and make recommendations under other laws, like criminal law, against people involved.

This is a scary, scary path to go down. Life has to begin somewhere, just as it has to end somewhere. Funnily enough, the definition of life and the definition of death aren't the same thing - one can be dead but a teeny bit alive as is the case of organ donors. But the line in the sand has always been that "signs of life" be seen in a baby - heartbeat, breath, movement, crying, reaction to stimulus. If these are absent, and the baby is stillborn (oh how my heart aches to write that), then no investigation can be held, no charges laid, no blame attributed. This is a two-edged sword, no doubt - but it also means that until that baby is apart from its mother and is alive, it is not a person. Augh it's confusing and I'm sure someone has been offended by the way I've put it.

Anyway Lavender, as the president of the AMA in SA, then claimed in the Stateline article (yes I was getting back to my point) that homebirth is 7 times more likely to result in a baby's death, which is (a) not true, (b) not supported by any research the whole freaking world over, and (c) not what the recent Flinders University research said. The "data point" that Lavender is referring to ERRONOUSLY is the one I've previously blogged about and kind of indicates that not only is he an idiot, but he also didn't bother reading the study and only read the press release.


Add to that recent beat ups about homebirth being more dangerous with triple the neonatal (first month - hardly a lot to do with homebirth) death rate, which is hard to comment on as the actual study doesn't come out until September, and there is a lot of attack on the process from many sides. Add to that changes here in Australia to registration and insurance for midwives and you have a very muddy water from which to sup. I'm sure there's a line there about babies and bathwater but meh, I can't be bothered.

What I can be bothered with though is to say to the ABC - shame on you for such appalling and upsetting and shallow "journalism". You didn't check the facts, you didn't bother getting any other side of the story, you didn't stop to question what agendas might be being wheeled through your "story" and you certainly didn't bother to notice that a story about stillbirth suddenly turned into a witchhunt for homebirth.

And you didn't stop to think about what this means. Let's say that all stillbirths from 28 weeks onwards get investigated. That is a lot of deaths, firstly, because not all pregnancies end in a live baby. So the coroner is now overwhelmed with them. And what if the parents do not want an investigation? What if the answer is that someone is to blame, that something could have been done, that something could have changed the course of events? How would that help the family? Instead of supporting them, financially and socially, they'll be dragged through the courts. The coroner could then autopsy babies, which means that parts of their bodies can be kept for analysis.

And the funny thing is that hospitals, where 98% of births occur, will suddenly have to be party to many more inquests. And for what?

------------------------------------------------------------------------------------------------------------

From Medscape Medical News

Less Medical Intervention for Home Birth Linked to Increased Neonatal Mortality Rate

Laurie Barclay, MD

July 2, 2010 — Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate vs planned hospital birth, according to the results of a systematic review and meta-analysis reported online first July 1 and will appear in the September 10 print issue of the American Journal of Obstetrics & Gynecology.

"The American College of Obstetricians and Gynecologists does not support home birth, citing safety concerns and lack of rigorous scientific study," write Joseph R. Wax, MD, from Maine Medical Center in Portland, and colleagues. "We sought to systematically review the medical literature on the maternal and newborn safety of planned home vs planned hospital birth."

Selection criteria for the meta-analysis were English-language peer-reviewed publications from developed Western nations, in which maternal and newborn outcomes were reported by planned delivery location. The investigators calculated summary odds ratios with 95% confidence intervals for these outcomes.

Compared with planned hospital births, fewer maternal interventions were associated with planned home births, including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative delivery. Women who delivered at home had lower rates of lacerations, hemorrhage, and infections, and their offspring had lower rates of prematurity, low birth weight, and assisted newborn ventilation.

Perinatal mortality rates were similar for planned home and hospital births, but neonatal mortality rates were significantly higher with planned home births.

"Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate," the study authors write.

Limitations of this study include those inherent in the included studies, self-selection of women for home birth, and insufficient data for some outcomes.

"Future research needs to be directed at identifying contributors to and reducing the apparently excessive neonatal mortality among planned home births," the study authors conclude. "Data regarding maternal mortality, maternal and newborn readmission rates and indications, and newborn neurologic injury are insufficient for evaluation and comparison.... Ideally, the results of such work will contribute to an obstetric and newborn best practices model benefiting women and children regardless of chosen birth location."

The study authors have disclosed no relevant financial relationships.

Am J Obstet Gynecol. Published online July 1, 2010.

Planned home and hospital births in South Australia, 1991–2006: differences in outcomes

The Medical Journal of Australia has released a paper and is claiming wildly increased rates of deaths among home births in South Australia. Read the synopsis - complete with 27 times higher! 7 times higher! bad APGARs!! - and then read the study and LOOK at the contradictions. It is appalling that this stuff ever gets published. And what's with the random throwaway inclusion of SIDS in there? I don't even begin to understand that inclusion...

Edited to add: and interviewed for on NewsRadio!!
Mon 10:45 - Babies are seven times more likely to die during a homebirth labour than a hospital labour -- according to a new study ... (audio)
Mon 10:50 - Homebirth advocates have accused the AMA of conducting a scare campaign ... (audio)

So let's take it apart as Joy has done, just for kicks - cause we all know that the "dead baby" card is a winner, regardless of the facts. Lisa has written a great summary of this as well.

• Although presented as research, it is not - it is a report on the statistics that were available. In research terms, this is the lowest of the low and has no control for biases and no statistical power which is interesting as I am (a) hopeless with statistics and (b) unschooled in them. The conclusions drawn are not backed up by solid numbers so are no better than opinion which is interesting because if you listen to the above interview (first one) the guy is not actually saying what is being reported. He clearly says that homebirth is safe.
• The planned homebirths that are reported are confounded three ways - no one can tell whether they were under the care of a registered and experienced midwife, or were unattended births, or under the supervision of a hospital-based program; the "planned homebirth" number is ~1000 and the actual number is ~300 so we're not talking about actual homebirths - just those that at the first antenatal appointment said they'd like one; and lastly - the way statistics are gathered changed during the time period reported.
  
• The title tells us something - it was about planned hospital and planned homebirths, at time of booking. This is a LONG way from the actual outcome, some 8-9 months later and the study author clearly states that they are unable to separate planned homebirths to actual homebirths out. Lots of planned homebirths don't eventuate for lots of reasons, and not all of them have anything to do with the pregnancy or maternal health. Having filled in the form that is being used here, I can tell you - the midwife looks at the Handheld Record and writes something down. No discussion is entered in to about the whys and wherefores of what changed those plans.
  
• There are probably only 2 situations in all those years where someone's baby died and it was at home and they planned to be there. 2. In 16 years. 1 had known high-risk indicators as it was a twin pregnancy. So we're down to 1 surprise death. In 16 years. That's pretty good odds.
  
• There is no way to look at such a rare outcome of intrapartum death with a small sample. Someone else has pointed out that with those odds you'd need 10,000 births at home to demonstrate this. I'm not a statistician so can't comment on those.
• I've listened to an interview with the author and he does say quite clearly that homebirth is a safe option as long as the woman is prepared, is assessed for risks, and is close to a hospital.
• I agree with Hannah Delaney (as Joy quoted her): I find it amazing that in a broken system, with uninsured midwives with no rights in hospitals, the death rate is actually no different.
  
• The intervention rates are STARKLY different - c-section 9.2% in planned homebirth vs 27.1% in hospital births, episiotomy rates of 3.6% in planned homebirth vs 21.7% in planned hospital births (one sixth the rate!!!!! And CLEARLY shown to be a bad idea anyway. 3.6% is also for the "planned homebirth" women, 70% of whom birthed in a hospital so is not "of women who birthed at home" but includes a large number of women who were perhaps treated the same (ie were likely to have a 21.7% chance of an episiotomy anyway) so the actual % would be lower still).
• Lisa's comments about PPHs got me thinking: that the comparison of post-partum haemmorhage is ridiculous enough to call the whole thing in to question. The numbers are similar once the authors took out the know reasons for PPH in hospitals (episiotomies, induction and augmentation, surgery etc) and so the author concludes that oxytocic drugs are used with the same gay abandon at home as they are in hospitals. Um - no. You the author firstly don't ask if drugs are used, so you can't make that conclusion from the stats. And further you clearly have NO idea how homebirth works and that the calm nature of birth, along with skin-to-skin immediately, breastfeeding, bonding, known care provider and so on decreases the risk of PPH. Even something as simple as keeping the room warm is said by people such as Odent to help. And perhaps because you took out all the confounding factors that are iatrogenic to the birth process in hospital, and found the same number, there is always going to be a background level of PPH and that nothing can be done to avoid a small number of them. It comes down then to how they are managed.
  

Women will always choose this and my concern is that this is going to go even more underground than it already is. I've heard women saying now that these changes make them LESS likely to hire a midwife to birth at home. Not less likely to have a homebirth but less likely to be attended by a registered, trained and competent professional. They are saying they are more likely to freebirth or just hire a doula for comfort. This is going to make the outcomes worse, not better, and probably not change the numbers.

The authors state that ‘women's autonomy in choosing reproductive behaviour is a fundamental human right enshrined in Australian law'. It is about autonomy. Others have said "The excess mortality continues to be found in high-risk women and women need to be informed of this risk." but are missing the point - that even when informed of the risk, some women would rather birth at home and not go to a hospital. And there are some practitioners who will take on those at high risk.

This does give me pause for thought about my own practice. What risk appetite do I have? As a beginner practitioner, I am prepared to go with some known knowns - breech, grand multip, reasonable distance from a hospital - but not twins, or pre-term, or probably a few others. The unknown unknowns I am trained to deal with and know that I have a whole heap of midwives at my phone-tips to call and discuss with, and I can't assess those beforehand so just need to keep up my training and skills and calm to deal with them.

Lastly - this is about the babies. Think of the children!! But there is no measure made of the maternal mortality, and only a very crude analysis made of maternal morbiditiy. No measure of maternal satisfaction.

Hoyden About Town said:
"If this study had shown a substantial increase in fetal deaths with home birth, this would still not be a reason to place legal restrictions on reproductive choice. It would not be a reason to imprison women in hospital by State force, and it would not be a reason to stop women from making informed decisions about our own bodies. They are our bodies, and until a fetus is born, we get the final say in what happens to us."

And therein is the crux of this - it is about the women and their bodies. The fetus does NOT exist legally until it takes its first breath. So what we are talking about it restricting the rights of roughly half the population. Sure, they are rights that a lot won't exercise, and choices that many of them will never make but - just like I have the choice to smoke - I have the choice about where I have this baby.

Jars

I seem to have an opinion on everything but today's is on jars.

I made lemon butter today (the Australian Woman's Weekly recipe but similar to this one from Best Recipes) and used some of the jars that I've been keeping to store it in for Giftmas presents and for eating as well.

But I used a variety of jars and had a variety of experiences with getting the labels off them. The worst offender was Beerenberg which is a shame as the jars are a great size, especially the little sample-sized jars. The labels just would NOT come off - not with soaking, not with a bread knife, not with swearing, no way and no how. So that jar will be for home use I guess!

It is frustrating when things like this are put in the way of reusing so that I can just do something here without adding to the pile of crap associated with modern living or get into the "is recycling worth it" debate...

But I do have lemon butter now!

How does it go?

blah blah blah state of the world etc etc and btw i'm pregnant

congrats. where are you having it?

at home

oh

is that safe?

well yes - i have a private midwife and am well supported with my husband and friends

oh

but it's not safe to do it at home! think of the children!!!

************************************

I have to bite my tongue because:
(a) it's none of your business where I have my baby
(b) not safe based on what? Have you looked at the research? Because in making an informed decision, I have done a lot of research. Have a look at Wikipedia or a recent Canadian Medical Association Journal article for easy understanding:
Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.
(c) not safe compared to what?
(d) still none of yur business
(e) I don't think that FOR ME, birth in a hospital is normal, natural or safe and to have a normal vaginal birth in a hospital without unneccesary interventions is a miracle rather than the norm and those interventions cause problems. There are lots of potential downsides to birthing in a hospital - they're used for treating sick people, there is little to no continuity of care or carer, there are clocks everywhere, they are a business and fast turnover is of the essence, the definition of normal is very narrow and anything outside of it is scary to care providers, and the outcomes are no better for all the interventions.
(f) I am a fit young healthy woman and have no need to hire a surgeon for a natural life process, I have hired a professional and expert in normal birth, and am quite prepared for a natural birth, "pain" and all.
(g) There is no pain free way of giving birth, and I am prepared to work with the sensations rather than against them, so don't need to plan my pain relief now beyond having a spot for a birth pool and knowing that we have unlimited hot water.

Same goes with having ultrasound scans, or blood tests, or xrays, or pelvimetry, or combinations thereof.

Informed choice does not mean agreeing with you.

I don't have to agree with you and you don't have to agree with me.

How do I marry these opinions with being a student in the health care system though? I am quite capable in a professional capacity to offer you choices (or are they decisions between two options? A topic for another post I think), discuss them with you, note which you've chosen and go from there. It is none of my business what you do with your body or baby, except from a point of view of a professional discharge of my duties. When in a traditional care situation (hospitals) I can't care for the outcome of your pregnancy from anything other than a professional point of view, because I would burn out. And if I believed in ethical practice, which I do, I also believe in autonomy and the right to self determination in health care. And by the time I see people on a postnatal or labour ward, they've made their decisions and chosen their care path and it is none of my business to judge those decisions. I don't have to agree with yours and you don't have to agree with mine.

And yes, I could just say "local hospital" or "random doctor" and lie about where I'm birthing, to avoid these conversations and having to justify myself. Instead I just smile and say "I've hired a private midwife to undertake my care" and leave it at that. Which is hard and harder at the moment when I'm in a private hospital on placement. I just try to choose who I discuss these things with.

************

And the upsides of birthing at home? Here are 10:

1. I know where stuff is, and so does my hubby. That means we have some of the power back in this situation cause mw Julie will have to ask where things are!
2. The house is colonised with our bugs already. I doubt there's anything nasty hanging around (dust bunnies not counted here).
3. I don't have to go home after giving birth.
4. I don't have to be alone unless I want to be.
5. I don't have to ring a bell and wait for anything or anyone.
6. There are no machines that go ping. Except for the microwave.
   
7. There is not going to be a trip in a car in labour.
8. I get the absolute and final say over who is going to be at my birth.
9. I will not be up on a bed at a convenient height for my birth attendant.
10. My babe will be born where they were conceived.
11. I don't have to have a change of care provider mid-labour, or explain my birth plan, or decline drugs, scans, CTGs, vaginal exams, etc etc, at every turn.
    

You're doing it wrong bitches

Ok so if I sign up for something that requires me to attend the gym every week for 12 weeks if I want a refund on my fee (incentives, I has them), and afterwards I find out that to get a refund I have to put my name on a list and get contacted for it to be processed (and I do that), and you DON'T CONTACT ME for a month, I'm going to be PISSED when I turn up to the gym and get told:

1. there has been a note on the system since the end of May stating that I needed to provide them a copy of my receipt;
   
2. that I should have contacted them to follow-up despite them not having a direct number for me to contact;
3. that there is no record of me signing up for the program;
4. and that it was entirely ridiculous that I was annoyed, given that MidwifeA managed to have hers sorted out a week after filling in the SAME FORM

given that the woman that was talking to me didn't at any point say "wow I'm really sorry - can I check we have the right number for you?".

A petition

I wanted to draw your attention to this important petition that I recently signed "Save Private Midwifery and homebirth choices".

I really think this is an important cause, and I'd like to encourage you to add your signature, too. It's free and takes less than a minute of your time.

Thanks!

------------------------------

Why is this so important? I can hear you thinking that

• you've had your babies so this doesn't affect you
  
• or alternately, babies aren't for you
  
• people who birth out of hospitals are nuts
• midwives who work in the community are hippies
• why on earth would you not want to birth in a hospital?
• obstetricians are the best
• there are perfectly free options available
• why would you want to pay $3k+ for something that you can get through private health insurance?
• why would you want pain during birth when you can go to hospital and have it "painfree"
• who cares about women's choices when my sister/next door neighbour/best friend would have died if she'd birthed at home?
  

I'm not here to debate this with you, except to say that I have different views on all of these things from the mainstream and so do other women, and just as you don't have to agree with abortion, or homosexuality, or voting Liberal, or putting sugar in your coffee, or driving to work rather than catching a bus - you would probably fight tooth and nail for the RIGHT of other people to do these things.

What I am here to say is that women have the right to a birth with an educated attendant. The recent proposed changes to the legislation regarding midwives goes like this:

• there will be a register of midwives (which is actually a HUGE deal as it is the FIRST TIME EVAH that midwives will NOT be classed as nurses!!! Yay!!! Now take another 20 years to get over people assuming that I'm a nurse)
• it will be a national register, rather than a state-based one
• to be on the register, I will need to show that I have insurance that indemnifies my practice

Why is this insane?

1. How do you propose that I register when I finish my degree? If by registering I am saying that I have insurance, then how do I get a job that requires me to be registered or be eligible to be registered in order to apply? It's a chicken-and-egg problem - I need a job to show that I have insurance, but I'd need the job and insurance to get registered. This is not the situation at the moment. And makes it insane if I chose to do something like an Honours year, or take a year off.
   
2. How do you propose that I register if *gasp* I don't WORK as a midwife, for an employer? What if I'm also a nurse and I'm working in sexual health or an abortion clinic, as a NURSE, and there is no way in hell my employer indemnifies me to practice as a midwife? Even though I am staying in touch with my midwifery skills through my job (there is a gap between the absolute letter of a position's description and the reality), I am not able to register as a midwife.
   
3. Alternately - what if I don't work for an employer? What if I am an independent practitioner? I am unable to get insurance, through no fault of my own, as there is no insurance option available. Ergo I won't be able to register, or work as a midwife as it's a controlled term and without registration I can't call myself a Midwife.
4. The insurance will not cover out of hospital services.
   

What does this mean?

• That I am wasting my time studying for a degree that I won't be able to use because I do not want to get a job just to register. I will get a job in a hospital to pay the bills, and I am realistic about the speed at which I'll be able to build a practice, but I don't want to have to get a job just to register to practice.
  
• It, if possible, get worse. Let's say we were trying to make OS#1 (offspring #1) right now. That'd be a due date of March 2010. If it's next month (July) that'd be April 2010, August (May 2010) and September (June 2010). No problems. Lots of registered midwives for me to choose from. If we waited until October 2009 though - bam July 2010. I am left with the option of choosing a hospital birth, or going it alone at home. Yes - going it alone. Because I won't be able to employ a midwife to do that. That would risk a $30,000 fine for me, and one for her for good measure. I kid you not - it would be enticing a professional to work outside the scope of her practice. Which also means that I will not be able to practice in a homebirth setting. It will essentially be ILLEGAL for me to do so. And for you or I, or your sister, housemate, best friend, daughter etc to do so.

I can think of no other situation where something that has been shown to be as safe, or safer, than the mainstream option, is going to be illegal in a sneaky way. Or alternately where the way I choose to practice will be restricted.

I understand that many obstetricians and doctors would love nothing better than to have midwives return to being glorified obstetric nurses and not jump or squeak without their permission. I get that homebirth scares the crap out of women who are told that birthing in hospital is safe, easy and guaranteed not to leave you with a dead baby or lifelong issues (bwahahahahahaha - excuse my while I laugh at the ridiculousness of that idea). I appreciate that birth is scary and unknown and complicated sometimes but for the most part, it is a normal life process and the experts in this process are the midwives.

What made me so upset last night that I swore at the acting president of our national body, and cried in a meeting, is that the people in charge just. don't. GET. it. My future dreams are being offered up as the sacrificial temple virgin so that the other great things can go through. Because it affects so few women (and the VAST majority of midwives are women, though not 100% of them) then it is seen to be OK to give something up in the negotiations that are happening. To be told that something has to give, and in this case it is homebirth, and that I should consider the glass half full rather than half empty, makes me despair at the future I face. The people who are "negotiating" this are at the end of their careers and are doing work in the political upper eschelons because they are experienced and amazing - but they also need a smack up the side of the head for even being party to this process.

Where are the industry-wide protests? Where are the rolling strikes? Where are the midwives demanding freedom to practice, regardless of whether they agree with the practice or not? I'll tell you where they are - they are secretly glad that something like this will stop the "craziness" that they consider happens when a midwife walks with a woman who doesn't fit a low risk model of care - someone with twins, or a breech baby, or a medical condition, or obstetric history, or something other than being 22 years old, in perfect health and with a pelvis like a bucket.

My options are now looking like being to go overseas to practice how I want to. I've had one offer from Washington, and one from Waikato - any further?

Today Nicola Roxon introduced two Bills to Parliament.

1) Health legislation amendment (midwife and nurse practitioner) Bill 2009
This Bill is about accessing Medicare and PBS, there is nothing currently written in this Bill that discuses eligibility - there is no comment within it at present that states anything about homebirth. However, in her speech today she openly stated that there will be no MBS for Homebirth.

2) (and this is the clincher) Midwife Professional Indemnity (Commonwealth contribution scheme) Bill 2009
This Bill excludes midwives from providing intrapartum homebirth care.

THIS IS A SAD SAD DAY FOR THE WOMEN OF AUSTRALIA!

C.F. the Homebirth Australia’s media release and a poster for the Sept 7th rally in Canberra– we know of 100s of women who will be attending from all over the country – we need 1000s so print it out, pass it on and email it around! You can register your attendance on our facebook page

Australia is going to be the laughing stock of the Western world – what a tragedy! Our new website will be going live by tomorrow morning (I hope) – for regular updates go to www.homebirthaustralia.org

Cheers

Jo Hunter
National Convenor
Homebirth Australia