It is long overdue, a position statement on Homebirth for Australia from the ACM, well done: since 1987 RANZCOG has had an endorsed position statement that opposes homebirth: Since 2007 there has been a joint statement from the RCM & RCOG supporting homebirth for low risk women:
Now the ACM has an interim position statement that supports homebirth for the woman who has a 'low risk'; which is in line with the current Australian Legislation: The ACM cannot contradict the regulatory authority which created the Quality and Safety Framework.
This brings me to the Introduction of the Statement; yes 'women have the right to choose where and how they wish to give birth'..... as I have discussed before in previous blogs...women always have this choice...what they don't have is the right to a midwife to support that choice...because of how the legislation is set-up here.... for women that are in a 'risk category' a midwife needs to consult and collaborate with an obstetrician and this does not happen.... certainly not in WA....this is not from a lack of trying from private practice midwives / independent midwives to collaborate with doctors; As a privately practising midwife I have tried to no avail to get doctors to collaborate; they do not answer emails, letters phone calls. I have had some success with one doctor however the doctor is reluctant to put anything in writing.
A midwife owes the woman a duty of care to provide a safe environment and work within the defined scope of practice...very few obstetricians will support a homebirth for any risk category....and here we have a quandary; unlike the UK that supports midwives to support women in whatever choices they make.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
(RANZCOG) does not endorse Home Birth.
In Australia about 0.2% of women deliver their babies at home. However this may be an underestimate, as it is unlikely that all babies born at home are recorded in perinatal data collection statistics.
Whilst mindful of a women’s right to personal autonomy and decision making, RANZCOG
cannot support the practice of Home Birth due to its inherent risks and the ready availability of safer birthing practices. Where a woman chooses to pursue Home Birth, it is important that this is an informed choice, considering all the benefits and possible adverse outcomes.
RCOG and Royal College of Midwives joint statement
The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman's likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.
The ACM is the professional body for midwives and I urge midwives to comment on the Position statement: contact the college and express your point of view, do you agree with it? How would you change it? give a balanced view:
Send submissions by email to email@example.com or by post to PO Box 87, Deakin West ACT 2600. Only submissions with identified senders and a return address will be considered, you have until 23rd September 2011.
As for me I've read lots of comments on the Statement and the guidance document, one comment that keeps appearing is that a scarred uterus is a 'new concept' or 'new rule'.... this is nothing new.... a scarred uterus has always been considered 'high risk' I suppose what is new is the terminology of a scarred uterus...but the concept is old...
My objection with the Guidance Document is the fact that as a private practising midwife we are required to consult with an obstetrician prior to or at booking-in: this is an unrealistic expectation; I am usually booking a woman at anywhere from 8-12 weeks: I would prefer a booking visit with the obstetrician at 20 weeks to discuss the plan of care: The Woman is encouraged to attend this appointment with her midwife and create a plan of care...if the woman chooses a different pathway this also needs to be discussed and a plan made to facilitate this choice: this is clearly documented and all parties sign the document understanding all the risks associated with it: however I am not sure that this will be enough to protect the midwife in a court of law: What we need to be working towards is a continuity of care model...supporting high risk women to birth in hospital with her private midwife having visiting rights to all hospitals.
Remember please to send your comments to: firstname.lastname@example.org