The Labor Government's threatened ban on home births is moving closer to reality.
Health Minister Nicola Roxon should be congratulated for offering the patients of hospital-based midwives access to Medicare and the Pharmaceutical Benefits Scheme.
Where to give birth, and who attends, is a medical decision. If a pregnant woman is competent and informed, it is her decision to make.
But she stands condemned for denying women the right to be cared for by a midwife at home.
From July 1 next year, the requirements of a new registration scheme mean independent midwives – long denied medical indemnity insurance – will be fined $30,000 if they practice without it. This finishes their ability to work outside the hospital system.
Roxon's decision is unjust and unreasonable, and should be overturned.
Where to give birth, and who attends, is a medical decision. If a pregnant woman is competent and informed, it is her decision to make. Australian law allows patients to choose who will treat them and where, and even to refuse interventions – like transfusions – that medicos deem life-saving.
This means that even if evidence showed that hospital births were life-saving, pregnant women could still refuse them.
Given that the evidence shows no such thing, this right seems even stronger.
A recent article in the British Journal of Obstetrics and Gynaecology looked at 529,688 cases and found no difference in the health of babies born at home to low-risk women and those born in hospital. Another large study found that the only difference in outcomes favoured home birth, which produced babies with higher Apgar scores, and showed home births were less likely than hospital births to result in unnecessary and risky medical interventions, such as induced and augmented labour, forceps delivery and caesarean sections.
Some say that because pregnant women are deciding for two, they can and should be stopped from making medical decisions that others – doctors and politicians – believe are not in their or their foetus's best interests.
This argument is bogus but even if it had legs that wouldn't take you far in the home birth debate. Because even if established legal principles are violated and pregnant women are treated like two separate people – a mother and her child – the law says the mother has the right to make medical decisions for the child. This includes decisions about what manner of birth is most likely enhance their child's health.
To override the mother's right to decide for her child, we'd have to prove that, unlike most parents, she didn't have her child's best interests at heart, or was mistaken about the safety of home birth. To claim the latter we'd need evidence that, as I've already shown, is lacking.
Roxon needs to take the views of doctors on the safety of home birth with a grain of salt. They are a vested interest and should be treated that way.
She also needs to get wise to the pitfalls of her plan. Denying independent midwives registration won't stop women from birthing at home. It will simply increase the risks they take doing so. It will be backyard abortion all over again – complete with shonky providers, death and suffering – except this time it's backyard birth.
The mantra that birth is simply a normal part of a woman's life is rubbish. It is an extraordinary event that most women will face just a few times. They need medical guidance, in the form of proper pre-natal care to know if home birth is a safe option for them.
Professional, experienced, independent midwives can offer this advice, and a safe and secure environment for low-risk women who birth at home.
Discuss this topic in the Homebirthing forum.