Birth & Midwifery in Australia
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Jan RobinsonJan Robinson had a career in Midwifery Education for many years then branched out into independent practice in the early 1990s, attending homebirths mostly in the southern suburbs of Sydney, New South Wales, where she lived. She now maintains a small clinical practice in the inner Sydney city area while continuing to be involved in midwifery education on a casual basis. Apart from homebirths, Jan’s current project is completing her booklet “Setting up an Independent Midwifery Practice in Australia.” She also enjoys meeting as many like-minded midwives as possible which happens when she conducts perineal repair workshops for midwives around the countryside. Jan tells us: “It is gratifying to see rural midwives beginning to take on their own ‘caseload’ and taking responsibility for providing total maternity care of healthy women.”

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Midwifery in Australia [September 2011]

Thank you for another informative article by Marsden Wagner, “Technology in Birth: First Do No Harm.” (midwiferytoday.com/articles/technologyinbirth.asp). If every obstetrician spoke the truth like he does it would be a rich world for pregnant women. I’ve suggested to Marsden that he add Australia to his comment, “The United States and Canada are the only countries in the world where highly trained surgeons called obstetricians attend the majority of normal births.” This is one of Australia’s main problems—overworked, overpaid obstetricians practising midwifery, with the benefit of a Medicare rebate for services rendered to healthy women and babies.

In May of this year I sent the following to “The 7.30 Report,” a nightly news show in Australia:

A false impression is passed on to the public. As much as midwives celebrate this new era of government health reform, midwifery cannot be one profession until the discrimination is lifted. It could well be our votes that Mr. Rudd [former Australian Prime Minister Kevin Rudd] will need to rely on in the coming election. [Australian Prime Minister Julia Gillard defeated Rudd in June 2010.]

Our profession has made great steps for midwives in the past year to reclaim midwifery, to be recognised as a profession in our own right and to be a respected voice on the world stage. Yet, Australian women who birth with midwives at home remain penalised under the leadership of the Health Minister, Nicola Roxon and the Rudd government. While access for insurance is exempt for two years, there is no insurance coverage or Medicare rebate for homebirth. All women must birth in hospital to receive these and other benefits. This is the backdoor way of denying women their right to have midwives attend them at home. How long do midwives as a profession intend to let this discrimination continue?

I also wrote the following to the governor of New York:

As a midwife of 35 years practising for the past 25 years in homebirth I write to you to express my concern about the state of New York making qualified midwives illegal. Attempts have been made to do the same in Australia. However, during some difficult times and lots of lobbying the Australian government and the Health Minister have chosen to recognise the right of women to choose midwifery services in the home.

World evidence shows that homebirth is as safe as hospital birth, if not safer. Midwives who have put their careers and life into the care and well-being of women and babies should be supported by bureaucracy with appropriate back-up services within maternity service institutions.

While governments continue to allow the medical profession to control maternity services, women will continue to suffer the trauma of major, unnecessary interventions in normal labour and birth. Midwifery will eventually be forced underground, a return to the dim, dark ages. Women will not give up seeking the services of midwives to rightfully birth at home.

I hope you will listen carefully to the women and the midwives of New York City and assist in paving a logical and sensible way of solving this problem. Institutions and doctors must morally consider why they are denying services to women and experienced midwives.

Robyn Thompson, midwife
Melbourne, Australia

Update on Australia [April 2006]

Even though Australian perinatal statistics show that privately insured women who have a private obstetrician and deliver at a private maternity hospital are six times more likely to incur a surgical birth, privately insured women mostly believe that “best care” equates with highest costs. One in every four Australian women has a cesarean section, and almost the same proportion suffers significant postnatal depression. The medical profession has eroded women’s confidence in their birthing abilities to the degree that even essentially healthy women feel they need an obstetrician present at their birth. It is not until after the first unexpected caesarean section that some women begin to question whether they could have traveled down another pathway for their birth, and they begin to explore other birth options. Unfortunately most women who have obstetricians have been convinced that their c-section was absolutely necessary, and they are easily convinced that the elective operation with the same obstetrician is the way to go with their next pregnancy.

It is very difficult for midwives in private practice to compete with obstetricians because they do not have government support to obtain Medicare provider status. Nor does the federal government assist midwives to obtain malpractice insurance as they have done with obstetricians and GPs attending births.

There is also public ignorance to contend with—the public knows lots about medicalised pregnancy services because doctors spend lots of money on advertising their services. The vast majority of pregnant women seem happy to follow the medicalised pregnancy pathway as depicted on media advertising by the Australian Medical Association. Midwifery birth options are not well identified despite midwifery organisations and consumer groups attempting to do so.

The other problem Australian midwives faces is the general apathy found amongst members of our profession who refuse to move forward and out of their comfort zones in hospital employment. Many of these midwives stay in the same job for years, never updating or looking to gain new knowledge through attending conferences or seminars. They do not belong to professional organisations nor interact with consumer groups and therefore do not ever keep abreast with what women are wanting out of today’s maternity services.

My guess is that this situation is unlikely to be reversed until lots of women who have experienced continuity of care with a midwife get up and talk about it, write about it and shout about it. The only way to rectify the situation is through public education. Only when public demand for “world’s best practice” (i.e., continuity of care with one midwife) reaches fever pitch will politicians listen and push for birth reform. At the moment there just aren’t enough mothers and midwives doing this to raise political interest; they don’t have the numbers or the money to make an impact.

However, midwives and women are beginning to work together through Australia’s peak national consumer organisation, the Maternity Coalition. The Maternity Coalition is raising monies and organising demonstrations to educate both politicians and the public about what constitutes “world’s best practice” and starting to raise the public profile of the midwife. The number of maternity reformers is gradually swelling through consumer involvement.

Jan Robinson, independent midwife practitioner
National Coordinator Australian Society of Independent Midwives
South Hurstville, NSW, Australia