In 2006 as a student midwife, I attended the annual Home birth conference in Geelong. The theme for that conference was “Bring birth back home”. At the time there were a lot of smaller country hospitals closing down their birthing services. Cost, availability of experienced staff etc. were the some of the reasons being cited for the rationale of these closures. As a result women need to travel longer distances to birth their babies if they chose a hospital birth. The model of maternity care is most likely have been limited to an obstetric trained GP in their local town and access to private home birth midwives would have been limited to availability and affordability. No such thing as an endorsed midwife with access to Medicare rebates back then. Choices in Maternity models of care were limited, and not much has changed.
I invited my lovely friend Rhia and wife of my former “work-wife” Claire to write a guest blog about her experiences and (lack of) maternity choices in her childbearing journey, from the perspective of someone living in Rural Victoria. This was to be a personal journal and one to complement my other blog piece “Congratulations…. You’re going to have a baby”, discussing choices in maternity care. What I got was this amazing birth story and an interesting insight into rural maternity services. Through this journey, the need to provide more options was germinated. Rhia’s wife Claire has now given women more birth choices in country Victoria through Your Birth Midwifery. To paraphrase a line from a cool kids flick - “See a need, Fill a need” (Robots).
Please enjoy the read….
Wow my first baby is six months old already this week. The time has absolutely flown by. I was warned it would, but as I’m learning, like with all things pregnancy and baby; you can hear all the warnings from all the people, but you don’t realise how true they are until you’re experiencing it first-hand. One thing that staggers me all the more about this particular milestone sneaking up on me is that it was a year ago that I was by now well into my pregnancy. That’s even more flabbergasting than how old my son is! A year ago! Already?! He was born spontaneously at 42 plus 3 weeks after a beautiful and uncomplicated pregnancy - No, nobody “let” me get that far; it was always a choice that was only ever mine to make. He wasn’t “late” - my body and my baby knew exactly what they needed to do to birth him safely and naturally. Whilst my labour went on for about 2 days solid, I was blessed to be able to spend most of it at home, in the bath and only transfer to hospital during transition, all because my beautiful wife and other mother of my child happens to be a midwife herself. Had I presented to a hospital any earlier in my labour, I am utterly convinced he would have been born by caesarean section because no medic would have been comfortable sitting on their hands for that long. As strong an advocate as I was for us, I couldn’t have coped with the intrusion into my head space for the battles I would have faced. In some ways I was lucky in my maternity care options but living in regional Victoria, I was far from able to explore the ones I most wanted. I wanted a home birth, in water. I knew that’s what my baby and I would be best suited to. We weren’t financially stable enough in my early pregnancy to be able to secure a private midwife and by the time we were, I was so close to the end that the only private, home birthing midwife within 3 hours of us who would travel to us didn’t have capacity. She tried; bless her but she simply couldn’t fit us in. I had what I considered to be the next best option with a place on the Midwifery Group Practice (MGP) at the local tertiary hospital 70KMs away, but even this had significant limitations. My primary midwife was wonderful and fully aligned to my values and needs. She understood the importance of informed, timely consent and also understood that I had done an awful lot of research (peer reviewed stuff, not Googling to back up my biases), so respected my decisions around my pregnancy. Not all the midwives demonstrated the same understanding and eventually, after being threatened with planned induction at 26 weeks by another, I opted to see only my primary midwife for the remainder. Towards the end of my pregnancy, I was asked to two separate OBs appointments. One to demand a scan to ensure my baby wasn’t breach. Although I was lured there under false pretences, so this was sprung on me. I spent 40 minutes arguing why I wasn’t getting it done. Responding to coercive threats and admonishments until I finally made an excuse to leave and think about it. The second was with another OB who had grave concerns that I was going “post-dates” at 38 years of age with an un-scanned baby. I was offered induction, caesarean, CTG, scans and an assurance that if it was down to her she would have induced me at 37 weeks because “well… why wouldn’t we? Baby’s done by then”. The reason and only reason I mention all this is because I’d anticipated these issues and this was why I’d wanted a home birth so desperately. I had a wonderful labour, I truly enjoyed it because I was well read and well prepared and had great support. I hadn’t wanted the stress of being pressured by risk aversive and controlling policies during my pregnancy. Unfortunately not being in the position to self-fund my maternity care meant this was the concession I had to make. Even an MGP program, where I had declined all OB input without medical indication didn’t protect me from the harassment that seems to be synonymous with publicly funded maternity care. If we had the opportunity again, I think I would beg and borrow the funds for a home birth and pray that there’s a privately practicing midwife with some availability in the area. Or perhaps the local maternity services will start providing home birth as a safe and viable option to low risk women in their local community? Until then, I’m off to enjoy some toothy grins and dribbly kisses. Then I’ll cuddle the baby too!
As a bit of food for thought after reading this piece, I’m just going to add this little excerpt taken from The National Guidance on Collaborative Maternity Care 2019. “A woman decides who she involves in this decision-making process, be it a health professional, partner, doula, her extended family, friends or community (see Box 2.2), and should be free to consider their advice without being pressured, coerced, induced or forced into care that is not what she desires (McLean and Petersen 1996). Women have the right to decline care or advice if they choose, or to withdraw consent at any time. Therefore, if a woman declines care or advice based on the information provided, her choice must be respected (UNESCO 2005). Importantly, women should not be ‘abandoned’ because of their choice (FPA Health and Read 2006, Faunce 2008; NHMRC consultations 2009). Several Australian states and territories have schedules that include refusal of treatment certificates as part of their health legislation3 that may help in recording decisions avoiding confusion if care is transferred, and outlines health practitioners’ obligations and protections in this circumstance (FPA Health and Read 2006; see also Section 3.2.11). Making a choice or consenting should be an ongoing process of discussion between a woman and her health providers throughout her care. Having a coordinator of care to provide a consistent, clear point of contact is integral to this approach (NHMRC consultations 2009).”
Further Reading:
Birthing outside the system: the motivation behind the choice to freebirth or have a homebirth with risk factors in Australia – Research Article: Published April 2020 - https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-02944-6
NHMRC (National Health and Medical Research Council) – Making the maternal health system better for all. https://www.nhmrc.gov.au/about-us/news-centre/making-maternal-health-system-better-all-women
Obstetric and gynaecology services in rural and remote communities in Australia – RANZCOG: https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/O-G-services-in-remote-and-rural-communities-in-Australia-(C-Obs-34)-Review-July-2017.pdf?ext=.pdf
Rural Doctors Association of Australia Position Statement - https://www.rdaa.com.au/documents/item/591
The Distribution of Maternity Services across rural and remote Australia: Does it reflect population need? Research Article: Published February 2017 - https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2084-8
Your Birth Midwifery – Endorsed Midwife Offering comprehensive at home care for your pregnancy journey and beyond (Benalla, Vic). https://www.facebook.com/YourBirthMidwifery/
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