My pregnant sister went to her first pregnancy check up with her GP last week. She was given a warning to book into her local hospital straight away because their quota fills up very quickly. If she misses out she will have to have her baby in a hospital outside of her local area. This could be a ½ hour drive away or more, depending on traffic. Now since she and her partner don’t have a car this in itself creates a bit of anxiety.

Auntie Jules says that pregnant sisters should be given time to decide where and how they want to have their baby. We are told that we are lucky to have options in Sydney such as the birth centre, labour ward and, for a limited time only, at home. It would be nice to be able to let the news that you are going to have a baby sink in a little before having to rush into a decision about the birth. Since we don’t live in a perfect world, I can deal with this. I have trouble dealing with what the doctor said next…”As it is, if you’re overdue you will probably be sent to another hospital anyway”. Huh?? The baby doesn’t even have an umbilical cord yet and it already has a ‘must be delivered by date’. How can it be good for a pregnant sister to have to worry about delivering her baby ‘on time’ only 7 weeks into the pregnancy?

And so begins the treadmill of hospital policy and procedure that keeps the cogs turning but rarely meets the requirements for happy, healthy mothers and gently birthed, healthy, breastfed babies.

I know how lucky we are here in Australia to have a public health care system that gives us free top notch pregnancy care and life saving medical interventions if something goes wrong. My gripe is that it is these little bits of policy and procedure that make intervention free hospital birthing a very rare event. Having to get into a car for a ½ hour drive to a hospital is not without consequence. It will often stall a labour that is progressing well. Once at hospital, this puts you on the clock and may well result in administration of artificial hormones to speed things up. The Cascade Of Intervention is a well known phenomenon in midwifery. I have even seen diagrams similar to this one below, on the wall in the hospital where I had my children.

One thing leads to another

The Cascade of Intervention- From birthinternational.com

‘Once the natural process of labour and birth has been disturbed, especially if there is no actual medical emergency, there is a significant risk that the unwelcome side effects of the treatment will make further intervention necessary to remedy the problem.’

So why then do we predispose mothers to this well known Cascade Of Intervention by giving an already anxious overdue mother the choice between:

a) Induce now so that you can birth here in your hospital of choice

or:

b) Take your chances at be sent to another hospital strapped into a car seat for ½ hour while in labour?

Based on my own experiences and those of other mothers I have spoken to, I can already get a feel for how this may play out. Sister arrives at her chosen hospital a few days over due. She may be given a choice “You could wait a few more days and see what happens, but if we are too busy here, you will be sent to another hospital. If you like we can get things started for you now”. It will be presented as a choice but if you give this choice to an overdue first time mother, chances are that she will snap it up.

And there you have it – we are on the intervention train. Take a look at the bottom of the Cascade of Interventions chart. Difficulties with breastfeeding and reduced bonding are the potential outcomes for this commonly sited as safe and routine practice of induction. Routine maybe…. but safe? I guess that depends on how you measure safe. If safe is merely the absence of death; then yes, it is safe.

The end result is very often an immobile mother with a baby who can’t latch on to breastfeed. The hospital provides them with overstretched midwives and a lactation consultant on the postnatal ward who are too busy to spend the time required to give proper breastfeeding help. You have a new mother with messed up hormones at greater risk of postnatal depression because the synthetic hormones have told her body that there is no need for her to make her own oxytocin which is absolutely vital for bonding and breastfeeding.

This seems to me to be very ineffective cost cutting. Surely the best thing for our health budget is healthy, happy mothers and babies. Surely allowing babies to arrive in their own time is a relatively simple step in giving them the best possible chance of a positive birthing experience and a gentle transition to a new life.

Now I realise this is a particularly busy hospital I am talking about, but it is a well known fact that our maternity hospitals are neither staffed adequately nor equipped for the increasing number of births with which they deal. My 3rd baby, born 9 months ago was born on a postnatal ward because all the rooms in the birthing unit were full. He had to be taken into the cold corridor of the postnatal ward for emergency resuscitation because the room I was in was too small to allow resuscitation while he was still attached to his functional placenta; his very own life support system. I could write pages about this but I think I’ve made my point; our maternity hospitals are not coping with demand.

All of this leads me to think; Why, why, why are we taking away the option of homebirth in Australia? Why are there only 3 hospitals in NSW that offer publicly funded homebirth as an option (whether they still exist and for how long we don’t know)? Why are we all but outlawing private midwifery? With a midwife present homebirth is a perfectly safe and is a much gentler way to bring a baby into the world.

If my last birth had been a homebirth, my baby would still have received the resuscitation that possibly saved his life. It would have been done in a calm, peaceful and warm environment. He would have been able to continue receiving oxygen from me while getting his act together to take his first breath. He would not have been put in a plastic box in the NICU for routine monitoring but would have been monitored by a midwife while he was getting skin to skin contact in my warm arms and adjusting to life on the other side of my belly. If he needed further medical care, he would have been transferred to the hospital. I would not have been left on my own squatting over a bed with an umbilical cord hanging out, wondering what the hell was going on with my baby. I would not have been watching my baby in a plastic box ½ hour after giving birth to him, but would have been sleeping with him in my arms.

It seems quite simple to me. Problem; unexpected baby boom putting pressure on our health care system and not enough midwives or hospital beds to support them properly.

Possible solutions:

A) Shuffle  women around to whichever hospital  has room for them at the time

B) Squeeze women into overcrowded maternity wards which are attended by overworked staff

C) Allow women the choice to have their babies in their own homes thereby taking some of the pressure off the hospitals and allowing families CHOICE on how and where they give birth.

The obvious answer from my perspective is C, so why are we now removing this as an option? We need a publicly funded,  hospital supervised home birthing program as well as private midwives with access to the mandatory indemnity insurance which will allow them to legally work.  Aside from the fact that families deserve the right to decide how and where they are going to birth their babies, our hospitals just can’t manage the workload and need to outsource.  I still don’t understand how the Maternity Services Review managed to disregard homebirth as a viable option.

Here is this week’s advice to pregnant sisters everywhere:-

  • Arm yourself with knowledge of the birthing process
  • Learn skills that will help you birth without boarding the Cascade of Intervention train.  Be ready to apply these skills even if you find yourself on the train.Get off this train as soon as possible.

Anyone interested in learning more about how the maternity services review affects homebirth and private midwifery in Australia please see homebirthaustralia.org

There is a Senate inquiry set up to get community feedback on the proposed bills which will effectively put an end to home birth as option in Australia. If you believe in keeping home birth as a legitimate legal choice for women, we need to stop the Senate from passing it. You can add your objection by sending a short email to the Senate committee. You can use this template:  http://www.pregnancy.com.au/Campaign/Senate_Submissions_Info_Sheet.doc

Anyone who would like to support the campagin to keep birth choices for Australian families can do so by signing this petition: http://www.homebirthaustralia.org/sites/sign-petition-save-private-midwifery