The bills resulted from a review earlier in the year by Rosemary Bryant, Commonwealth Chief Nurse (a position established by Roxon), which concluded what Australian women by and large have been saying for years, that unless you’re privately-insured there’s not enough choice when it comes to giving birth, especially in a regional community. Roxon’s bills also added to the growing push for collaborative care, making midwives more central in maternity care as part of a team-based approach. It needs to be said, however, that doctors are not over-keen about the reforms.

If Roxon thought this major reform would get support from those who support choice in "birthing", she was wrong. The bills upset many homebirth advocates who wanted Medicare funding for midwives outside clinical settings like planned home births, and 'homebirth midwives to have professional indemnity cover.

Roxon’s bills established a publicly-funded professional indemnity scheme for midwives, but didn’t extend to services provided outside clinical settings where risks are much higher. Private insurers won’t provide indemnity cover for homebirth midwives because there’s too few of them to provide a premium pool, and homebirths are too high risk.
This hasn’t stopped some women suing after bad outcomes.

As Ms Bryant’s report notes, if one practitioner can’t be sued [and many homebirth midwives strip themselves of assets and require tight contracts against litigation, then some clients will try to sue other practitioners who were involved, e.g. obstetricians called in at the last minute when a homebirth has gone badly wrong. Other medical professionals are reluctant to become involved now for fear of becoming 'the litigee of choice'.

The reaction from many homebirth advocates has been extreme and Nicola Roxon has been vilified across the blogosphere and deluged with letters and emails.

Many claim that the Government is seeking to ban homebirths, when it is doing no such thing, and claim - against considerable contrary evidence - that homebirths are as safe    or safer than deliveries in clinical settings, including birthing centres.

The missing fact in the virulent attacks on Roxon and her reforms -- which the Coalition have eagerly taken up in Parliament -- is that only a tiny fraction of Australian women choose homebirths - 0.22% of all births in Australia, according to Bryant’s report. Even in New Zealand, where taxpayers fund homebirths, the rate is only 2.7%. Moreover the rate was declining rapidly in Australia even in the 1990s, when homebirth-midwife insurance was available.

No one is stopping Australian women who want homebirths from choosing them. Nicola Roxon’s bills merely continue the current approach of not providing Medicare funding for homebirths and require that midwives are either part of a professional, accredited, indemnified, collaborative care model.

What should have been hailed as a major midwifery step forward in the Australian health system - long characterised by a maternity care approach dominated by obstetricians (usually male) has been drowned out by ideological attacks from a tiny unrepresentative minority.

AGAINST THE ABOVE [midwife author]

The issue of homebirth divides the community into those who think it is OK and those  who don’t. Often, no amount of evidence, opinion, or research will convince either side.
The above view is based on two incorrect pieces of information. The first is that "no one is stopping Australian women who want homebirths from choosing them". The second is that there exists 'considerable evidence' that home births are dangerous.

To start with the first. As of July next year it will no longer be legal to have a homebirth attended by a registered private midwife in Australia. This is a fact, the reason being that the state and Commonwealth governments are implementing a National Registration and Accreditation Scheme for health professionals.

As part of this scheme a health professional must hold professional indemnity insurance in order to register to practise. Private midwives are presently unable to obtain such insurance because there is no insurance product available for them to purchase: they form too small a collective to make it worthwhile for an insurer to provide that product.

The legislation currently before Parliament proposes indemnity insurance to some midwives. It is not at all clear who these midwives will be only that they are "eligible" and that they will work "collaboratively" and that they won’t attend homebirths. Extending this legislation to cover homebirth midwives is the only realistic way that homebirth with a registered private midwife will remain an option for Australian women after July 2010.
This is why so many have written to Nicola Roxon, visited their local MPs and made submissions to the recent Senate inquiry concerning this legislation.

The second piece of incorrect information is that home birth is an inherently dangerous and high-risk option. There is a body of evidence regarding the safety of homebirthing. The most recent published study (only a few months ago), of over half a million low risk births showed that women and their babies were as safe at home as they were in hospital. Even the Australian homebirth study published over a decade ago found that low-risk women were no less safe at home giving birth.

That study did point out that the practices of unregistered midwives versus registered practitioners was the issue of concern. The fact is that flawed research from the 1970s which falsely concluded homebirths were not safe has misinformed government policy for decades.

The UK Department of Health website states that "for a healthy woman experiencing a normal pregnancy with no major complications anticipated during the birth, studies have shown that it is equally safe to be attended by midwives in the comfort of your own home as to have your baby in hospital." The Department of Health in the UK has made one of its priority targets for 2009/10 to give more mothers-to-be the opportunity to choose to give birth at home.

One could write many pages setting out the breadth of evidence that supports homebirth as an option for women but would distract from the fact that at its heart this debate is not about safety or risk or insurance. It is not a turf war about whether obstetricians or midwives should be the most important care provider for pregnant women. It is about whether all Australian women have the autonomy to make their own choices about how they will give birth -- a fundamental choice about a fundamental life experience.

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A Caesarean is meant to be a lifesaving operation rather than an operation of convenience. But figures show that many Caesarean deliveries are carried out where the threat of emergency does not exist.

The World Health Organisation recommends that the incidence of Caesarean section delivery should not exceed 10-15 per cent.

Yet in Australia, the rate is approximately 20 per cent, compared to five per cent thirty years ago.

In the 1970s the Caesarean rate worldwide remained constant at 5 per cent.

In Australia statistics vary between hospitals. However, if you are a women aged between 35 and 39 years and you are having your first baby in a hospital, you face a Caesarean rate of 40.4 per cent.

Earlier this year, British obstetrician Professor Fisk predicted that within the next ten years half of all babies would be delivered by Caesarean.

It cannot be denied that in emergency situations, Caesarean deliveries have saved lives. But where there is no emergency, there is no evidence to indicate that Caesareans reduce the possible trauma and risks of childbirth.

On the contrary, there is documentation to show that Caesarean delivery increases the incidence of respiratory distress in a newborn. It is known that the passage through the birth canal prepares the baby for independent breathing by massaging the respiratory organs and aiding the elimination of mucus from their system.

Furthermore, Caesarean delivery has a high incidence for post-traumatic stress syndrome for mothers and arguably also for babies. Many mothers need to overcome the psychological stress of missing the birth and may experience emotions of guilt.

Australia is not alone in experiencing an ever-increasing number of caesarean deliveries. In the United Kingdom, the figure is 20 per cent compared to 3 percent thirty years ago and in the United States, Caesarean deliveries comprise 25 per cent of all births.

So why the increase? There are several factors thought to influence these rising figures. In contrast, the Netherlands has a Caesarean rate of 7 per cent, thought to reflect a different clinical approach (rather than indicating a overall state of women's health).

One thought is that midwives and obstetricians have differing approaches.It is often suggested that midwives tend to take a more wholistic approach whereas the medical fraternity of obstetricians encourage more medical intervention with a view that safety is their main concern.

There is no doubt that this is largely influenced by current trends in medical litigation and it seems the paranoia about legal liability is not without foundation. A recent Senate Committee report confirmed the increase in medical indemnity premiums for all obstetricians in Australia as a further factor affecting the way births are carried out.

The increasing number of international celebrity mothers opting for elective Caesarean has been identified as having a malign influence on mothers-to-be.

In an age obsessed by body image, it has been suggested that women are following their Hollywood counterparts by rocking up weeks early to be induced, hence avoiding the final growth phase that further alters their body shape, and choosing to deliver by Caesarean section.

At London's Portland Hospital, the birthplace choice of many celebrity mothers, 950 out of 2,165 births last year were Caesarean and just 386 of these were emergencies.

Many women are misguided by being lead to believe that a vaginal delivery after a Caesarean is not advisable and in some cases not possible.

In Australia Birthrites: Healing After a Caesarean, is an organisation dedicated to helping women make informed choices relating to their birth and subsequent births. Birthrites has a particular interest in helping women heal following a Caesarean birth and supports women in their choice of a vaginal delivery after a Caesearean birth.

For further information: www.birthrites.org

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An active childbirth offers a woman about to give birth the freedom to move around and change positions throughout the labour and birth. In the early 1980s English childbirth educator Janet Balaskas brought to the fore and promoted the concept of birth as being a less of a medical condition to be dealt with on the labour bed and delivery table, and more of an instinctive response to the rhythm of labour. Since publishing her book Active Childbirth in 1983, her teachings have been incorporated into many childbirth education classes throughout the world.

Active childbirth encompasses movement and breathing techniques based on hatha yoga. The basic premise is that birth is more successful if the woman is in an upright position, either squatting kneeling or on all fours, using gravity. Preparation for labour involves stretching, pelvic floor muscle exercises and adopting “opening” exercises with help from your birth partner.

The pelvic floor group comprises those muscles between the anus and vagina that support your womb, bladder and rectum. During pregnancy, hormones, along with the added weight of pregnancy, puts extra stress on these muscles. In countries where women are accustomed to flat-foot squatting while doing their daily chores, giving birth in this position comes easily. For many western women, the pelvic floor muscles require a specific work out.

The pelvic floor group comprises those muscles between the anus and vagina that support your womb, bladder and rectum. During pregnancy, hormones, along with the added weight of pregnancy, puts extra stress on these muscles. In countries where women are accustomed to flat-foot squatting while doing their daily chores, giving birth in this position comes easily. For many western women, the pelvic floor muscles require a specific work out.

An effective way locate these muscles is to imagine you are stopping urination mid stream. These same muscles are those responsible in cases of urinary incontinence. It is this movement that tones this muscle group. In preparation for labour, practise the following movement:

• Squeeze muscles, hold tightly, and slowly count to five
• Relax for five seconds
• Then repeat

Do this exercise 10 -15 times daily.

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It is likely your medical professional will advise a hospital birth first time around where equipment and expertise are available in case of complications. Home births are usually only advised for low-risk pregnancies. If you are considering a homebirth it may be wise to check to ensure your medical insurance will cover a homebirth.

Homebirths have the advantages of providing a more private and intimate birth where your partner and family can share in the event.

You are free from hospital rules and routines and have no need to travel. You are also able to prepare your birthing environment exactly as you wish in advance. Your doctor or midwife should help you with the
necessary preparations and modifications.

Usually your midwife will bring a birthing kit and provide you with a list of what you’ll need.
You may be asked to provide a drop sheet and a large pot in which your midwife’s utensils can be sterilised.

It is advisable to organise postnatal help in advance to assist you until you have recovered and feel confident enough to cope.

The disadvantages of a homebirth include that should complications develop you may need to be transferred to a hospital. You may also find your home a busy environment after the birth as neighbours, friends and
family easily access you. Most women who have homebirths say the intimacy of being in in the home they have created provides a positive birthing experience.

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The Le Boyer birthing method was named after its founder Frederick Le Boyer, a French obstetrician who delivered thousands of babies by conventional methods before travelling to India where he studied traditional birthing methods. He then returned to France to implement what is now known as the Le Boyer birthing method of non-violent birth as detailed in his book ‘Birth Without Violence’. The baby’s entry into the world occurs in a quiet room, away from bright lights. There is no unnecessary conversation and those attending the birth speak in hushed voices. Unlike conventional birthing methods, the umbilical cord is not cut immediately. The baby is immersed in a warm bath and is then lovingly and gently massaged until it stops crying.

Le Boyer noticed that babies born this way appeared more alert, smiling and content compared to those babies born conventionally. Le Boyer’s ideas have since influenced our understanding of the possible effects a traumatic birth may have on a person’s wellbeing.

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Pregnant women find great comfort and repose in being submerged in water. Noted for its analgesic effect, many women favour water as a principal method of pain control. One woman described sitting in a tub of warm during labour as similar to "getting a shot of demerol, but without the side effects." Others have referred to a birthing pool as "a wet epidural." It seems that women are able to achieve an unequalled level of comfort in water that reduces levels of fear and stress. Water therapy can be as simple as sitting in a bath or shower at home, to booking a birthing pool at a local birthing centre or hospital. As more and more women approach labour and birth with an ideal of maintaining and managing ownership of their birth experience, water offers an alternative way to manage pain and speed labour without the necessity of medical drugs or assisted delivery. The result is often a more empowering birthing experience with less medical intervention and injury.

Top ten benefits of water during labour & birth

• promotes labour
• encourages circulation
• increases focus
• relieves pain
• promotes elasticity of the perineum
• enhances a newborn’s birthing experience
• allows freedom of movement
• provides a safe and hygienic alternative
• can reduce the need for medical drugs and intervention
• creates a positive birthing experience
• Resting in a warm tub of water facilitates the progression of labour.

Free from gravity's pull and with sensory stimulation reduced, the body is less likely to secrete the stress hormones noradreneline and catecholamines that raise the blood pressure and slow or inhibit labour. This allows the body to produce the pain-inhibiting endorphins that compliment labour. Furthermore, the increased relaxation encourages the uterus to contract more effectively.

Many pregnant women report an "energy surge" that moves through them as soon as they step into water. Sometimes the level of pain reduction is so great that women surrender themselves to the water, full dilation occurs rapidly and the baby slips out. This is quite safe as a healthy newborn will breathe only when lifted clear of the water. Oxygen continues to be supplied through the umbilical cord for a few minutes after birth. A midwife will often rest a finger on the cord so that she can feel the blood pulsating through it.

Encourages circulation

Studies show that being immersed in warm water increases venous pressure encouraging blood to return to the heart more efficiently. It enhances cardiac action and slows the pulse rate. Women with hypertension (high blood pressure) often experience a significant drop in blood pressure within 10 to 15 minutes after entering a warm bath.

Increases focus

A woman’s perception of pain is greatly influenced by anxiety. Being more relaxed physically, a woman labouring is able to relax mentally, enhancing the ability to focus.

Many women acknowledge that once they get into the water concentration is strengthened. Doctors and midwives who attend waterbirths find that the mere sight and sound of water pouring into the tub helps some women release whatever inhibitions were slowing the birth, at times so quickly that the birth occurs even before the pool is filled. Often women get in the pool with intention of using it for labour only and the birth occurs before they can get out of the pool.

Relieves Pain

The unique sensation of water counteracts the force of gravity and relieves internal pressure on the lower back and buttocks. The analgesic effect of warm water helps some women reach a state of consciousness in which their fear and resistance are diminished or removed completely.

Promotes elasticity of the perineum

Another benefit of waterbirth is the elasticity that water imparts to the tissues of the perineum, reducing the incidents and severity of tearing and the need for painful stitches or episiotomy. Surgeon and childbirth expert Michel Odent reported that in the 100 waterbirths he had attended, there were no episiotomies performed and only 29 cases of tearing, all of which were minor surface tears.

Enhances a newborn's birthing experience

It is known that drugs or synthetic hormones used during birth can affect the baby. If the mother's delivery is easy and smooth, so too is the child's birth. The baby spends less time in the cramped birth canal and is free from the fear, frustration or other painful emotions that a long and difficult labour might arouse in the mother. It is thought that water provides a gentle and less traumatic transition for a newborn entering this world.

Water recreates a womb-like environment and offers comfort after the stress of birth, allowing bodily systems time to organise. During birth babies often open their eyes. As a baby is born into water, its limbs are able to unfold with ease and lights and sounds are softer when perceived from under water. Even the touch of its mother's skin against its own tender skin is softened by the presence of water. The innate alliance human beings have with water is first apparent in babies who move toward the surface of the water before taking a breath. This mechanism remains in tact throughout the first year of life.

Allows freedom of movement

Water allows a woman in labour to frequently change her position as she feels necessary. It is easy to move in water and a woman often switches positions without a thought, allowing the baby’s rotation and descent of the head. A birthing pool offers the added advantage of being able to use the side of the pool as support. A supported squatting position encourages the knees to spread wide so that the pelvis opens fully in preparation for delivery.

Provides a safe & hygienic alternative

Waterbirthing is considered completely safe and hygienic and there is no evidence to suggest otherwise. Plastic linings are used as a further prevention of passing infections between users.
Can Reduce the need for medical drugs & intervention
Most women use birthing pools as a preferred method of pain control and have no need for analgesic medication. The analgesic effects of water negate the need for intervention with many women reporting only small, surface tears.

Creates a positive birthing experience

Overall, mothers who have given birth in water often feel exhilarated, ecstatic and euphoric. This is a positive result. Furthermore, the ease of a mother who labours and gives birth in water translates to the child.

It is believed that a mother and a baby share the emotional experiences of birth due to hormones secreted and absorbed by the baby.

Marysia recalls her feelings in her waterbirth story: “I was so ecstatic. I felt so proud. I kept saying, I did it! I did it!”

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