Wednesday, August 27, 2008

Limited choice for rural areas - Homebirth refused

A NSW hospital refused a woman the right to have a homebirth, despite the local obstetrician agreeing to the woman's request. The obstetrician was willing to send a hospital midwife to the homebirth, however the request was rejected by the hospital.
The woman only found out by chance that her request was rejected - she states
They knew that at 37 weeks you can't fight,"Ms Caines said.

This woman who has been a maternity advocate in the region for eight years, said she was upset that women in the Upper Hunter were given fewer choices when it came to delivering their babies than elsewhere in the region.

she said.
"As a leading advocate I hold dear the fact that there needs to be benchmark of safety and quality,"

It's birth by postcode

The outcome is that this woman has now employed a private midwife for the birth, but not all women have have this option or resources to do this.
The reason the hospital gave for not allowing the homebirth was
...did not meet the criteria for a home birth because she did not have a GP who would support her and she needed to have a midwife from the Upper Hunter area.

There was no medical reason stated for the refusal of this woman's request, in fact she did have the support of an obstetrician and it made no difference to her case. This is a tragedy for women's choice.


The questions I am posing is; do our hospitals have the right to do this? and as a result of this, will the hospitals be forcing our women to "freebirth" or birth in a way that may not be safe and go it alone?

Would it not be better to find a compromise to suite all parties rather than a straight out "no"? do they think in doing this they can control women?

If we constantly refuse women their choices, women will find a way to do it? where does this leave us as a society and our duty of care?

What happened to informed choice and women taking responsibility for their own choices?
Why do we not allow women to make these choices? or are we just a paternalistic society?

Paternalism manifests in the making of decisions on behalf of clients/patients, where doctor knows best - that is the culture of our health care system - a culture which is hard to change.


Laura Jane said...

And THAT'S why women make the choice for Freebirth!

Suzanne said...

I wonder who is sitting at the top for that hospital. Is it a male doctor or female doctor? Or none of the above? Or someone who is just so keen on making money and getting more salary? This question in mind sparks off the money profit issues. Are they trying to earn back the lost profits from homebirths?

Sorry Pauline, I have no answers to your questions but I do have some rebuttal points. Also, I come from a country with a total different system as compared to here so please bear with me.

1. Isn't a specialist better than a GP?

2. Isn't it within the law context that so long as the patient is rational, he or she holds the right to decide for himself or herself. Isn't there a breach here?

3. If this hospital gets its way, wouldn't others follow? By and by, there will not be any more homebirths. (I do hope I have a choice to homebirth but its not allowed in my country. =( I was dreaming of having a bath tub delivery though.)

4. In addition to pointer 3, wouldn't the numbers for Obs decrease as their job will soon be replaced by a GP?

5. With so many restriction, I do agree where is the freedom? Isn't it just plain say and no action aka NATO (no action, talk only) since it doesn't only apply to women but the people as well.

infomidwife said...

Thanks Laura for you comments, couldn't agree with you more!

infomidwife said...

Hi Suzanne,
Thank you for your comments. I am currently away in Singapore teaching - face to face - and I will give your comments some thought and respond when I return home. Once again thanks!

Suzanne said...

Oh cool!!! Have fun teaching in SG. Make sure you visit the Lao Pa Sat for an awesome dinner of satay from Stall 7. Ask for extra peanut sauce. Its free. =) Get yourself a teh tarik (pulled milk tea) from the Uncle that sells just Teh haliah (pulled ginger tea) or Teh Terik. Its just facing Stall No. 7. Next, get a barbecued string ray with sambal chilli (if you can take spice) or just tell them however you like it. Enjoy!!!

infomidwife said...

Hi Suzanne,

Singapore was great, I had a lot of fun teaching and visiting temples, now to answer your questions:

1. There are two systems here in Australia, GP Obstetrician or a Obstetrician, they are both equally accepted and is ultimately the woman's choice however GP Obstetricians are usually in rural or outer city areas. There are fewer GP Obstetricians now due to the high premium cost of insurance.

Off course the other issue for independant midwives is, that they can not get insurance coverage and therefore should inform women that they have no vicarious liability, this puts them in a precarious position should things go wrong. The only governing body that may control independant midwives will be the Nurses & Midwives Boards of each state.

2. Consent is a major issue: every person has the fundamental right to autonomy. If a woman is of sound mind, in other words fully rational, she can decide what ever she wants/ every one of sound mind has the right to refuse medical treatment whether it is life saving or not.

3. I can not answer for this hospital, but I think there will always be independant midwives or priviate midwives, even if they are reduced in numbers. Why I say this is because there will always be women who will choose them. These women are generally well informed, well researched and sort out the independant private midwife.

I would rather see a woman (who chooses a homebirth & understands the concequences fully) be supported at home by a midwife than freebirth.

The take home message is that you can refuse medical treatment if you are mentally competant, that is your basic human right.

Suzanne said...

Paulineee!!! This is so complicated. OMG!!! Seems like the system in my country is more straightforward. If you specialise --> specialist else GP. Geez... Didn't know its so much different here. Suddenly I feel like a frog staying in a well... I give myself the credit that I'm in Gen Y. Still young and inexperience to travel around learning from different places like you. Its awesome you have a blog and I can learn things from you. Though I maybe not be in midwifery, its great to gain extra knowledge without having to spend money. =)

Here's more question for your answers:

1. If women knows its so risky, why are they still going for freebirth? Also, why are some independant midwives willing to deliver?

2. What is a independant midwives? If you plan to have baby at home, is it known as free birth? Sorry, I'm just being confuse between homebirth and freebirth.

3. Which birth has a doctor around?

I agree with you when it comes to consent and its always heart-wrenching when it comes to taking consent Jehovah Witnesses as they refuse blood transfusion. Makes things a lot difficult and risky when it comes to saving their lives. No one should be deprived of their own choice.

infomidwife said...

Ciao Suzanne, where are you from?
just to clear up a few points!
1 - Freebirth is someone who chooses to birth without any medical/health professional present and this is usually at home.
2 - An Independant Midwife is a midwife who is qualified as a midwife and works for herself - In Australia they are answerably to the Nurses & Midwives Board of the State in which they live. Currently Independant midwives do not have any indenimity insurance. These midwives usually do home births on low risk women or women who are fully informed about there risk factors and want a home birth.
3 - Any woman can choose to have a homebirth.
4 - If a woman who has risk factors wants to have a homebirth or freebirth - that is her right - the course of natual justice is the right to make autonomus decisions - if they are fully informed and understand the implications of the risks involved the woman can choose what she wants. This is everyones right, whether you like it or not, providing the woman is of sound mind. It is the same as you can refuse medical treatment even if it is life saving that is what autonomy is all about - again the catch is you have to be of sound mind, not mentally ill.

People now are very well informed and the medical / health professionals have to remember that and not be paternalistic, not do what we think is right but inform people of all the possible outcomes and let them take responsibility for there own actions. Off course you will have to document all discussions to cover yourself.

Suzanne said...
This comment has been removed by the author.

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