Midwives criticise ACT government's home birth trial as 'restrictive'

Kate Reeve, with son William who was born at home, is no longer interested in the ACT home birth trial as she believes ...
Kate Reeve, with son William who was born at home, is no longer interested in the ACT home birth trial as she believes its eligibility criteria is too restrictive. Photo: Karleen Minney

Controversy continues to engulf the ACT government's home birth trial as midwives and formerly keen applicants criticise its "restrictive" eligibility criteria.

The publicly funded three-year trial will be a first for the ACT and Canberra women with low-risk pregnancies who live within a 30-minute drive of the Centenary Hospital for Women and Children would be eligible.

Applications were due to open in October but have been pushed back until November, with the first births expected in February.

Australian College of Midwives CEO Ann Kinnear supported the trial, but said there was no evidence for many of its "limitations," claiming that some violated women's rights.

First-time mothers or those who have given birth more than four times will not qualify for the trial, according to the eligibility criteria Fairfax Media has obtained, which is yet to be publicly released.

Ms Kinnear said a physiological birth the first time lessons the chance of needing a caesarean in the future, and that many other publicly funded home birth programs in Australia accepted first-time mothers.

She said national midwifery guidelines endorsed by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists claim that women have an increased risk of maternal and neonatal complications after having more than five babies, not four.

Another concern of Ms Kinnear's, shared by doula Amey Bencke from the Friends of the Birth Centre, assistant professor in midwifery at the University of Canberra Dr Sally Ferguson and home birth advocate Kate Reeve, is that water birth is not offered in the trial.

Water birth is one of the most effective methods for women who rely on non-medical pain relief and Ms Kinnear said there was no evidence that it increases the risk of harming the baby or the mother.

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The four women were equally critical of the trial's requirement to have the support of a partner to birth at home, which Dr Ferguson called a "patriarchal response". She welcomed the trial but agreed the criteria was overly restrictive and said the partner should not be in control of how the woman births.

The eligibility criteria also states that women must approve of an injection to encourage the contraction of the uterus and get the placenta out rather than allowing it to happen naturally. In healthcare, women can consent to or withdraw consent to this at any time.

Ms Kinnear called this requirement an "infringement of women's rights" and believed women should be free to withdraw consent for a procedure at any time.

These restrictions are the reasons Ms Bencke and Ms Reeve withdrew interest in participating in the trial.

"The ACT government is trying to make this look appealing but it doesn't seem to be an appropriate option for women who are interested in home birth," Ms Reeve said.

Ms Bencke, who is seven weeks pregnant, was concerned the "strict criteria" would mean some ineligible women would instead opt for high-risk free births, where no midwives are present.

These concerns are the opposite of those raised by president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, professor Michael Permezel, who said it posed unacceptable risks to women and unborn children.

He said the 30-minute catchment was not close enough for women to reach hospital in time to save them from unexpected complications that cannot always be managed by midwives at home.

"These situations are uncommon for women with an uncomplicated pregnancy, but the risk isn't so low that it wouldn't apply," he said.

The trial is expected to be used by about 24 pregnant women a year.

ACT Health was contacted for comment but did not respond by time of publication.