Orgasmic Birth In Australia

Article written by Thea O’Connor | March 28, 2009 for The Australian Newspaper

Supporters of homebirth are asking why the topic is still seen as too hard to handle in this country.

WHEN Natalie Hemingway gave birth to her son 10 months ago, doing so at home seemed an obvious hoice. She had already given birth to her daughter at home three years earlier, and both of her sisters had been born at home.

“That’s what I saw when I was growing up, so birthing at home was normal to me,” says Hemingway, 27, who lives on Sydney’s lower north shore.

Homebirth in developed countries was the norm up until the past 50 years or so. In Australia today, homebirth can seem a radical choice, and the women who chose it anything from brave and alternative to misguided and loopy.

The recent federal government review of maternity services has done little to help bring the practice into the mainstream. It has inflamed an already heated debate over homebirths by stating it does not support Medicare funding of independent midwives attending homebirths. Described in the review as a controversial and sensitive issue that polarises the professions, it seems that homebirths are just too hot for Australia to handle, at least for now.

Part of the problem is that both advocates and opponents of homebirths have research evidence to support their arguments.

According to Hannah Dahlen, associate professor of midwifery at the University of Western Sydney and
spokeswoman for the Australian College of Midwives, the best available evidence comes from a large prospective study of 5000 women planning a homebirth in the US in 2000.

The results, published in the BMJ in 2005, showed that the rate of babies dying during labour or within 28 days of birth (intra-partum and neonatal mortality rate) was 1.7 deaths for every 1000 uncomplicated intended homebirths. The study (2005;330:1416-1419) said this was similar to risks in other studies of uncomplicated home and hospital births in North America.

Dahlen says it is also similar to the risk of first-time mothers having an uncomplicated birth in an Australian
birth centre (1.4 deaths for every 1000), or Australian hospital (1.9 deaths for every 1000), reported in a
population-based study of more than one million women, published in the journal Birth (2007;34:3:194-201).
When the high-risk births (planned breeches and twins) were included in the analysis of the US study, the rate was twodeaths for every 1000 births.

The highly regarded Cochrane database, which assesses the highest quality evidence available, concludes that “there is no strong evidence to favour either home or hospital birth for selected, low-risk pregnant women”. Australian research is scant and a fierce debate rages over what little there is. Andrew Pesce, president of the National Association of Specialist Obstetricians and Gynaecologists, believes we have enough evidence to worry. He points to Australian data that indicates babies have a two to three-fold increased risk of death with homebirths.

A study of 7000 planned homebirths in Australia between 1985 and 1990, published in the BMJ (1998;317:384- 388) reported that deaths occurring during labour and not due to malformations or immaturity were higher than the national average: 2.7 v 0.9 for every 1000.

Dahlen counters that this study provides low-level evidence: the study design was retrospective, it included births by non-registered midwives, it used a number of methods to collect the data, including searching newsletters for death notices, and it’s almost 20 years old.

Pesce also refers to the 12th report of the Perinatal and Infant Mortality Committee of Western Australia. It
documents a 2000-04 death rate for babies that is three times higher for homebirths. The report said the
numbers were too small to be conclusive.

A review was conducted last year, but the results have not yet been released. In December 2007 the West
Australian Department of Health stated “a preliminary review of medical records indicates that it is likely the
setting of the birth did not affect the outcome in at least five of the six deaths”.

Distinguishing the outcomes of uncomplicated births from high-risk births helps to make sense of the conflicting data. Referring to the West Australian figures, Pesce insists that even for uncomplicated births there’s a significantly increased risk. Marc Keirse, head of obstetrics and gynaecology at Flinders University, is one of the authors of the local study of 7000 women. “Most of the elevated risk came from high-risk births, such as breech and twin,” he says.

The study concluded that while homebirth for low-risk women could compare favourably with hospital birth,
high-risk homebirth was “inadvisable and experimental”.

The Australian College of Midwives supports this conclusion.

Dahlen says women should still have the right to attempt high-risk births, provided they are well informed of the risks, as well as their chances of success.

“Women wanting to give birth vaginally after a caesarean, for example, have a 70 to 85per cent chance of
success,” she says.

“I don’t know of any other area where the battle over women’s bodies is as intense as this. We have to make suremwe don’t end up with situations like those in parts of the US, where midwives are put up on criminal charges and women are arrested and taken from their homes to hospital if they are intending any birth at home the medical establishment considers risky.”

Keirse, who has also worked in obstetrics in the Netherlands, characterises the debate as a demarcation dispute. “Holland went through that in the 1970s. When midwives were granted free access to hospitals in the early 1990s, that made a big difference and contributed to improving safety rates.”

Pesce believes it’s not so much a turf war that polarises the homebirth and medical professions. “It’s because we come from different paradigms with different underlying philosophies,” he says. “We can’t even agree on what thepriorities are; what safety means, forexample.”

Britain’s Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have managed to agree. Their 2007 joint statement, which supports homebirths for women with uncomplicated pregnancies, reads: “There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe.”

Safety, the statement says, needs to encompass emotional and psychological wellbeing, not only physical safety. In the Netherlands, 30 per cent of all births take place at home.

“The culture is conducive to homebirths in Holland,” says Keirse. “It’s an accepted government policy and the midwives who conduct homebirths are considered part of the medical profession. They have rights that allow them to continue caring for their clients if they need to transfer to hospital.

“In Australia, there can be large distances between home and hospital, independent midwives have no hospital rights and they are not incorporated into the healthcare system.

“This means that training of homebirth midwives isn’t regulated, which it should be.”
One research finding that is not disputed is that homebirths result in fewer medical interventions. The US study of 5000 women found that compared with the relatively low-risk hospital group, intended homebirths were associated with lower rates of electronic foetal monitoring (9.6 per cent v 84.3 per cent), episiotomy, an incision

made to enlarge the vagina and assist delivery (2.1 per cent v 33 per cent), caesarean section (3.7 v 19.0 per cent) and vacuum extraction (0.6 v 5.5 per cent).

One of the reasons Hemingway wanted a homebirth was to avoid exposing her baby to drugs. “I also wanted to see the same person before, during and after the birth,” she says. “The biggest thing was being able to choose.

Homebirth is just another choice that should beavailable to all women if that’s what they want.”

Reprinted with thanks - Copyright 2009 News Limited.

A great kick off to 2009 was the airing of the ABC 20-20 segment January 2, 2009 http://abcnews.go.com/2020

The direct video link is: http://abcnews.go.com/Video/playerIndex?id=6569030

We are thankful to ABC, JuJu Chang and our producer Gail Deutsch for a great job of providing a glimpse into our documentary and sharing about the pleasure and possibilities that birth holds.

We are creating quite a buzz on blogs and as Lee Stranahan shares in his article on the Huffington Post

http://www.huffingtonpost.com/lee-stranahan/orgasmic-birth-the-natura_b_154934.html

“Pascalli-Bonaro says she wishes some critics who just seem to see the title would actually see the film.”

I hope that people reading here will do just that! As Sue McLean, from The Birth Circle, a screening host in Australia said:

“We just had our screening and the response was amazing!!I woke up with such a smile on my face!! Incredible turn out! We laughed, cried cheered and clapped our way thru this wonderful film. Lots of warm fuzzies in the air today!!and lots of inspired women and midwives. We will change the way birth is ‘managed’ one baby at a time.”

It is such an exciting time as together we rock the boat and create waves of change!

I am so grateful for all your support and help in this process. Together we are making a difference. It is truly a labor of love and our birth into the Prime Time Television was “orgasmic”

Choices in Childbirth: A Statement by Physicians, Midwives and Women’s Health Advocates who Support Safe Choices in Childbirth

Women’s choices for how and where they want to give birth have been consistently eroding these last few years. Whether these directives are coming from medical associations, risk management teams, or malpractice insurance providers, their impact is affecting the health of mothers and babies in a negative way.

The women’s health activist organization,Our Bodies, Our Selves,

together with maternity care professionals, advocates,and consumer groups have issued a joint statement, Choices in Childbirth A Statement by Physicians, Midwives and Women’s Health Advocates who Support Safe Choices in Childbirth, calling for health reforms in maternity care. If you agree with their proposal, please join us and add your name to the statement.

Image courtesy of Wikipedia - from an medieval woodcut - A woman giving birth on a birthchair.