Thursday, February 25, 2010

A challenge to the AMA

To review our previous post on the sensationalist misrepresentation of home birth statistics by the Medical Journal of Australia, click here.

The following article has been published in the British Medical Journal, 24 February 2010, doi:10.1136/bmj.c826
Cite this as: BMJ 2010;340:c826

Medicine and the Media
Science, politics, and headlines in the home birth war
Melissa Sweet, journalist, Sydney

Why did the media report new research as showing that outcomes of home births are much worse than those for hospital delivery? Melissa Sweet reports

Last month the Medical Journal of Australia published a study on outcomes of home birth that generated many media stories sounding the alarm about the safety of such births.1
Many stories focused on the study’s findings that babies were seven times more likely to die during labour in a planned home birth and in particular were 27 times more likely to die from asphyxiation. Some also did mention the finding that there was no significant difference in the overall perinatal mortality rate between planned home births and those planned for hospital delivery.

These were also all findings highlighted in the media release accompanying the journal, which made no mention of uncertainty surrounding the relative risk estimates. The confidence interval for both was wide: 1.53 to 35.87 for intrapartum deaths and 8.02 to 88.83 for deaths from intrapartum asphyxia.

Nor did the press release mention the numbers of deaths involved or the absolute risks. ...
[Unfortunately the remainder of this article is available only to subscribers]

MS holds an honorary position at the University of Sydney’s School of Public Health and moderates a health blog, Croakey, which has covered the home birth story.

1. Kennare RM, Keirse MJNC, Tucker GR, Chan AC. Planned home and hospital births in South Australia, 1991-2006: differences in outcomes. Med J Aust 2010;192:76-80.
2. Australian Medical Association. Planned home births linked to a higher risk of perinatal deaths in childbirth.
3. Pesce AF. Planned home birth in Australia: politics or science? Med J Aust 2010;192:60-1.
4. Woloshin S, Schwartz LM, Kramer BS. Promoting healthy skepticism in the news: helping journalists get it right. J Natl Cancer Inst 2009;101:1596-9.

Sunday, February 21, 2010

Community Cabinet in Ballarat

Consumer members of Maternity Coalition in Ballarat were successful in putting key questions to the Prime Minister, Kevin Rudd, who passed the questions to Health Minister Nicola Roxon.

Anyone who has not followed the process of maternity reform, who listens to this film clip, may ask what's the problem. The Health Minister has absolutely guaranteed that:
  • homebirth will not be forced underground
  • women's rights in birth will not be vetoed by the Australian Medical Association
 The spin doctors have carefully woven this web, and the Minister is well scripted.  There are clues in subsequent statements, even in this video clip.  For example,

  • homebirth will not be forced underground. Of course not! The Victorian government has announced three publicly funded pilot homebirth schemes that are connected to public hospitals.  As long as there are women who can jump through the hoops set by these pilots, and as long as there are midwives who are prepared to work in managed programs, homebirth can continue.  Anyone who lives outside the radius covered by these pilots, or whose 'risk' profile excludes them from participating in the pilots, or ... - well you're on your own.  BUT this government is NOT forcing homebirth underground.
  • women's rights in birth will not be vetoed by the Australian Medical Association.  The doctors don't want homebirth at all.  The AMA, RANZCOG, NASOG, and others consider that birth can only be safe if it happens in hospital.  So as long as women are in hospital, or in the virtual hospital in the home (under the supervision of the hospital), women's rights haven't changed. 
  • people (midwives and doctors) will be requred to work together!  The Minister put on her most paternalistic/dictatorial (Queenly, as in Alice in Wonderland) voice to make this proclamation.  She illustrated it with telling us that we will need to have backup arrangements (for homebirth).  Excuse me!  If she, or her advisors/spin folk had read even a few of the thousands of submissions made to the multiple government reviews, she would know that midwives and women planning homebirth do make backup arrangements.  She would know that the obstacles are erected by hospitals, not as a result of any unwillingness by midwives to 'work together' as she puts it.  She would know that midwives do consult with obstatricians or other doctors, and refer when appropropriate - AND that by all outcome measures we provide effective and safe primary maternity care.  What Roxon obviously does not understand is that, for many women, giving birth is a spontaneous, non-medicalised event.  It can happen in the privacy of their own home.  It is not an illness.  Only those who experience illness or complication need medical attention. 

In summary, it seems that midwives who agree to provide private midwifery services for planned homebirth will, after 1 July this year, be under a great deal of pressure to accept only those whose risk profile is totally uncomplicated.  The women who have had previous caeasarean, or grand multiparity, or multiple pregnancy, or too fat, too thin, ... - they will be expected to go straight to [hospital], do no pass go, do not [see a midwife].

[ADDED 24 Feb]
From the Hansard:

Senator McGAURAN
Rest assured that I know all about the incompetence of Minister Roxon, who has flown under the radar. It is not just this issue; a whole array of issues in her portfolio ought to be brought out.......

I was in Ballarat recently for the community cabinet—‘community cabinet’?; it was Mr Rudd’s sideshow. That was all it was. You should have seen the glum faces on all of the ministers who turned up. What a joke. In this portfolio is the midwives issue, denying women the choice to have home births. That was what dominated the community cabinet. I got a guernsey; I was there in the front row. I could not believe it. It was a sight to see the one ego on display. He really does have a big ego. You have to see it to believe it, and you are all compliant to it. It is a joke. When are you going to stand up and speak on an issue?

This Prime Minister is so frightened of the midwives issue he is not willing to meet the public outside of a controlled situation. When he had to unveil the Kevin Rudd bust in Ballarat—as many of you know, in the gardens there there are busts of every Prime Minister— he did not turn up. He left the council, the Mayor and everyone else standing
there waiting for him to appear at 11 am. He just did not turn up. He did not even ring ahead to say he was not going to turn up. Can you imagine the embarrassment and the frustration? Do you know why?
Because there were midwives protesting there waiting for him and wanting to speak to him. Of course, they have dubbed it as ‘cowardly’.
That is the portfolio I want to speak on.

Thursday, February 18, 2010

National consultations on Quality and Safety Framework for Midwifery Care

Many of Victoria's privately practising midwives, as well as maternity consumer activists, have attended meetings today with representatives of the Department of Health's Maternity Services Program (Ms Julie Jenkin) and the Maternity and Newborn Clinical Network (Dr Jeremy Oats and Ms Debby Rodgers). Similar meetings are also being held in other capital cities.

The purpose of the consultations is to develop a 'Quality and Safety Framework' which midwives in private practice will be required to agree to IF we wish to be exempt from the requirement for private indemnity insurance for attending home births. For more on the exemption, click here.

We were reassured, once again, that the government has no intention of preventing midwives from continuing their private practices. BUT the caveat is that we must comply with a framework that is yet to be declared.

Having carefully considered the draft framework, we have no confidence that we will be able to comply.

Submissions will be made to the consultation by the end of February, and we will keep our readers informed.

Please note that these comments focus on the midwife and our right to practise midwifery in the setting of the woman's choice. While it is likely that midwives will continue to practise after 1 July, we have deep concern for women whose 'risk profile' includes factors such as previous caesarean births, previous post partum haemorrhage, multiparity, breech, post 42-weeks gestation, as well as age and BMI considerations. These women are often the ones who seek out a private midwife, and who may choose to plan home birth at present. The 'quality and safety framework' appears to be a bureaucratic effort to prevent such women from accessing any care outside the hospital system.

Friday, February 12, 2010




Main Event is in Ballarat where Kevin Rudd will be - Please wherever you are in Victoria please come and join us to send a clear message to Rudd that we are now UNMOVED and will continue to fight this.

When: Thursday, February 18 from 10:00 am to 12:00 am
Place: to be confirmed

Other events will be in
Blue Mountains

(still some places being finalised, watch the websites below and register at mybirth for updates on the campaign)

Do you think Australian women, not Kevin Rudd should make decisions about their own healthcare? If so come and support us.

Visit the MyBirth website for Campaign tools & Event details
- posters to download and distribute, banners for your website/blog and register to be notified of upcoming events in your area

When having a baby do you want to make choices about your health care?

New reforms introduced by the Rudd Government were meant to increase support to women, giving them the option of choosing a midwife to care for them.

Many women have said they would love this care, especially because the care would come from 1 midwife from early pregnancy, through labour and birth and up to 6 weeks after the birth. The best part being, many midwives provide home visits! Pure Luxury.

Many Mums think this care is long overdue!

Enter the problem! The Australian Medical Association has decided that women will only be able to choose midwifery care if a Doctor agrees. This means if a doctor is not prepared to support the local midwives, then women will not have access to care.

We believe while women may seek advice and support from their doctor that ultimately they have the right to make decisions about their bodies.

There are events running in every State so spread the word!

This is for EVERY WOMEN (and their families and friends) and EVERY CHOICE, please forward this on to every person you know who supports the right to choose!

For media reports go to

Channel 7 Sunrise

Channel 7 News

Friday, February 5, 2010

The exemption

The next big hurdle for privately practising midwives (PPMs) is to ensure that we are able to access 'Exemption' from indemnity insurance for homebirth from 1 July 2010, until 2012. Without that exemption it will be unlawful to provide any midwifery services for homebirth. Midwives will be required to purchase indemnity insurance for the other parts of our practice - prenatal and postnatal. Exact definitions of what is prenatal and what is postnatal and what is 'birth' for the purposes of the exemption are yet to be found.

Does 'birth' start at the beginning of labour, and how is the beginning of labour to be defined for the purposes of the exemption? And does 'birth' end after the placenta has been birthed, or does it end at some other time?

The Federal and State/Territory Health Ministers decided at their meeting last September that midwives providing homebirth care would be given access to an exemption from the requirement to hold professional indemnity insurance for a period of 2 years subject to three conditions. The conditions are:
1. That PPMs report all homebirths according to the requirements of their jurisdiction
2. That women booking with a PPM receive written disclosure that the PPM is practising without insurance
3. That PPMs agree to a Quality and Safety Framework for midwifery care

Point .3 is the one receiving most attention, and is the focus of the face to face consultations that are being held, at which organisations are being invited to comment on the draft document.

MiPP has prepared a response which is to be presented to the consultation by several members. This response will also provide the basis for written submissions.  MiPP has gathered evidence to support our submission.

In summary, we urge the Consultation to recommend to the government
  • that the only mandatory requirement for a midwife to engage in private practice be that the midwife is registered
  • that all midwives who are currently in private practice should be eligible for the exemption
  • that midwives who choose to commence private practice during the two-year exemption period be able to proceed with fair and reasonable processes
  • that the two years of the exemption be used to review and record private midwifery practice so that any regulatory changes can be introduced in a systematic and evidence-based way 
  • that midwives in private practice be treated equitably with other midwives, and with other regulated health professionals in their ability to practise their profession privately. 

Other groups whose draft submissions are being circulated amongst members for commment are those of the Australian College of Midwives, and the Australian Private Midwives Association.

Monday, February 1, 2010

Senate Committee's findings

The Senate committee "recommends that the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 with amendments, the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-Off Cover Support Payment) Bill 2009 be
Click here for the full report

Senator Rachel Siewert (Australian Greens) in her minority report recommended that
"the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill is amended by replacing reference to ‘collaborative arrangements’ with a requirement that eligible midwives demonstrate collaborative practice and that in the definition of a participating midwife, midwives would be required to demonstrate ‘collaborative practice’ by using standardised clinical documentation for planning and provision of care. This would record specific indications of collaborative practice, in particular consultation and referral as required, with the consent of the women for whom care is provided."

ADDITIONAL COMMENTS by the The Coalition Senators
"... acknowledge the concerns of stakeholders regarding the Government’s proposed amendment to the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009. Significant concerns were originally raised about the affect of the amendment on the ability of Midwives to gain indemnity insurance and therefore be registered. The Minister has since given notice that the Government will withdraw the amendment relating to the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009. The Coalition Senators acknowledge the importance of an appropriate collaborative arrangement that provides for patient safety and confidence. Mothers-to-be and midwives have not been assisted by the Health Minister’s numerous changes in policy direction and the Coalition will reserve the right to consider the regulations that define the nature of collaborative arrangements between nurse practitioners, midwives and medical practitioners."

Australian College of Midwives' website

Keep up with maternity news, using a new listing that appears at the website of the Australian College of Midwives, which has recently been updated.

Link to the BJM

Midwives may enjoy receiving a monthly email update from the British Journal of Midwifery

To view articles click here

News articles also appear at the site
Midwives have been advising pregnant women not to have the swine flu vaccination
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