Baby steps as hospitals delvery a helping hand to home-birth push

[ummAadam]

I found this on another forum, I hope its ok that I post it here.

Baby steps as hospitals deliver a helping hand to home-birth push




Midwives working away from labour wards are to be covered by insurance under a pilot scheme, writes John Elder.

Within the next few days, Chloe Lee will give birth to her second child at home, under the care of veteran midwife Robyn Thompson. If at some point during labour Ms Thompson thinks something is amiss, Mrs Lee is happy to head to hospital. "I trust Robyn . . . and I'm happy to access hospital care if there's a true medical need," she says.

Mrs Lee is not a zealot, but she is sceptical that a new plan to establish hospital-run home births can provide the same standard of care as a private midwife.

Under a State Government pilot program to be established at two Melbourne hospitals, midwives assisting home births will be covered by their hospital's indemnity insurance.

The scheme offers something of a reprieve to home birthing, which is threatened by planned Federal Government changes requiring all registered health workers to be covered by indemnity insurance.

The changes, to be introduced from July 10 next year, will effectively outlaw home births performed by independent midwives, who have been unable to access indemnity insurance since the industry crashed in 2001.

Some fear that the changes will force home births underground or encourage some women to go it alone, a practice known as free birthing.

It is believed that the pilot scheme, due to begin early next year, will use in-house midwives and independent midwives under contract. If the pilot is successful, the Government says it may expand it to other hospitals throughout the state.

The program appears similar to those already established in other states, where home births are restricted to low-risk pregnancies and exclude women who have previously had a baby by caesarean section.

Despite her scepticism, Mrs Lee welcomes the trial. "I think it's great that more women are getting access to all the choices available for having their babies," she says. "Having publicly funded home births is going to provide for women who can't avoid to have a home birth privately."

But there are concerns that some independent midwives may not want to be affiliated with a hospital-based program because their working methods may be compromised.

Fiona Hallinan, an independent midwife who has protested against the Federal Government's changes, says she doubts the scheme will attract sufficient staff to get off the ground. "I don't say I wouldn't work in the system again," she says. "But once you work with a hospital system, midwives often don't have a voice in how that practice is run."

Ms Hallinan says safety will be paramount. "[The hospitals] will have stringent systems in place because no one wants a front page with a dead baby . . . But that will exclude many women from taking up this option."

Victorian Health Minister Daniel Andrews says the pilot program will give families greater choice and give women more control over their birth experience.

The Australian Nursing Federation has applauded the scheme.

State secretary Lisa Fitzpatrick says a large number of independent midwives also work in hospital maternity wards, which will help make the scheme viable. "We're supportive of . . . what we see is a collaborative model," she says.

About 166 Victorian women give birth at home under the care of an independent midwife each year.


Source: The Sydney Morning Herald

[bon]

This sounds great in theory, but as that independent midwife said - the midwives who work within the program will not have a choice in how it is run. Ultimately the decision as to whether a woman will be approved for homebirth or not will rest with an OB - and I am willing to bet that very few women will meet the criteria. If you have had complications with past pregnancies(no matter how small) you might as well forget it. Overweight? Not gonna happen. OB thinks your baby might be "too big"? Sorry lady, no home birth for you. Had a baby in the past that was over 9lb, even if you birthed it vaginally with no problems? Too risky anyway. And if you are one of those women who are told that homebirth within that system will not be available to you, that's it. You are then left with having to give birth in hospital (which, if you wanted to do that, you would have gone with in the first place) or give birth at home, alone. Not very much in the way of choice if you ask me.

[Mayaness]

I love how they had to insert the word 'zealot' - there was no need, not even in a negation of the term! How stupid. It's like going into a restaurant, asking for the vegetarian menu and stating you're not a 'zealot'.

[Kitt3n]

it simply will not replace the experience and level of care as you get with a private midwife

getting there, but not good enough

[Kate07]

Originally Posted by ummAadam

Under a State Government pilot program to be established at two Melbourne hospitals, midwives assisting home births will be covered by their hospital's indemnity insurance.

Anyone know which two Melbourne hospitals?

it simply will not replace the experience and level of care as you get with a private midwife

A public funded homebirth system may have issues, but i don't think you can have a blanket statement that midwifes working in the public system can not be as experienced or caring as one that is privately funded.

Not all midwifes working in the public system would want to work with homebirthing women, but those who do (most probably) would be committed to the cause for ALL women who choose home to give birth, regardless of ability to pay.

[Mayaness]

I don't think of it as a homebirth experience, because it's got so many strings attached. It will happen at home, just not with the unconditional support and lack of attached hospital agenda that a private middie provides. To me, that's part of what homebirth is about - a midwife who is not under pressure to refer as soon as there's any sign of when an Ob would want to butt in (which is usually much sooner than medically necessary for these hospital-based homebirth programs - liability, mainly). Let's face it. I empathise heaps with middies who will take these caseloads especially if they believe in great care, because they will constantly have in their minds their job security if they cross over too much into the best interests of the birthing woman - it will not be an enviable position. Imagine a middie who is experienced in frank breech who knows she can never practice it without risking her livelihood because the hospy would come down on her so hard?
It's at-home-birth, it's not 'homebirth'. Private midwives have experience dealing with birthing situations at home that midwives from hospitals don't see because the situations get referred away from them in wards and FBC's.

[Kitt3n]

Originally Posted by Kate07

A public funded homebirth system may have issues, but i don't think you can have a blanket statement that midwifes working in the public system can not be as experienced or caring as one that is privately funded.

oh that's nto what I mean hun - I would expect that if you were to have a homebirth through the hospital it would be the midwife that was allocated to you and/or was on shift at the time when you were in labour, as opposed to interviewing midwives yourself and choosing the one with whom you had the best connection.

Not to say that hospital midwives are bad for the job or anything like that - of course they are perfect! Just that extra step .... personal step IYKWIM....

we interviewed 2 midwives and were supposed to interview a third but we felt so comfortable with the second we cancelled the third interview.....

[Lisa]

I agree 100% with what Bon wrote... as I am going through a publically funded home birthing service/birthing centre.

I had to see an Ob to get approval. He has said no to me having a home birth based on the fact that my BMI is higher than the recommended BMI for this service, I had a baby over 9lbs in the past and this baby is apparently bigger. No home birth for me
It is very disappointing to find out 5 weeks before your baby is due that you can't have the birth you've been planning all along. I also feel discriminated against and abandoned. If I knew then what I now know, I would have forked the money out for an independent midwife at the very beginning.
If I fell into the impossible idea of pregnancy perfection that is expected from the publically funded home birth service I would say I was happy with what was offered to me but sadly they seem to forget to mention the fact that the home birth option isn't available for a lot of pregnant women.... just the select few.

Kitt3n - With the service I have been going through, I had a phone conversation with my assigned midwife at the beginning of my pregnancy, then I met her face to face. I have met the other midwives through the centre too and at any stage throughout my pregnancy I am able to change midwives. I have been more than happy with my midwife and she has been the only one I have seen. She is also the one who will be attending the birth of my baby along with another who will be on shift at the time.

[Mayaness]

Oh, Lisa - that makes me so mad! And I'm just thinking that if, right from the start, they give you a list of all the things that could possibly preclude you from having the hospy-based homebirth that may present themselves much further down the track of the pregnancy, you wouldn't exactly have a peaceful pregnancy for worrying about developing any of the 'risk' factors (a PM can very well deliver a baby that's over 9 pound!). Either that or you'd spend the money on a PM just in case. It's not an ideal scenario by any stretch.
So, whilst it's supposed to open the doors for 'many women', it really doesn't - it only opens them up to the narrow definition of who is eligible for a birth centre birth...if not narrower.
It's a 'gift horse' that definitely needs a dentist.

[Lisa]

Originally Posted by Mayaness

Oh, Lisa - that makes me so mad! And I'm just thinking that if, right from the start, they give you a list of all the things that could possibly preclude you from having the hospy-based homebirth that may present themselves much further down the track of the pregnancy, you wouldn't exactly have a peaceful pregnancy for worrying about developing any of the 'risk' factors (a PM can very well deliver a baby that's over 9 pound!). Either that or you'd spend the money on a PM just in case. It's not an ideal scenario by any stretch.

My thoughts exactly. In regards to my BMI & the fact that my first DS was over 9lbs are also issues that could have been addressed from the get-go and technically I could/should have been denied earlier than 5 weeks before my due date.
As for the thought that this baby may be over 9lb and therefore considered a risk is stupid... as is the fact that my first DS's birth weight even comes into the equation considering my DS1 & DD have a different father to my DS2 and this baby. It is all really flawed and just shows that the Ob's and the hospital big wigs are still in control of how you birth your baby in the end and to quote the Ob I saw that is "under the care of the hospital and given a home like birth experience"