Q for a Midwife.

[Livinthedream]

I was just wondering, (and it is purely just that) what do the majority of Midwifes think about homebirthing? (with them in attendance, not free birth)
I can totally get that most would be PO'd about not being able to get insurance and, effectivly the decision being made for them.
BUT, if they could be indemnified, would most midwifes be happy to attend home births?
Thanks

[Oorki Galoorki]

are you asking HB midwives or hospital midwives?

i know in my circles HB midwives do not want insurance at all they want the choice to practice at the full extent of their profession with out having to be under the rules of the insurance companies.
any other profession is not ruled by the insurance.. they get to choose what how and when they practice.

as a consumer though(currently)
there is no way i would ever sue my mw. EVER.
every decision that is made with a HB midwife is MINE there is NO coersion, there are no dead baby threats.
everything is consented for unlike in hospital

[meow]

I think you'll find midwives vary in their philosophies. I know midwives who employ obs for their births- so clearly they don't value their own profession? I'm guessing these midwives are happy working in hospitals and wouldn't want to attend HBs regardless of 'legal protection'.

[Schmickers]

I think it varies. It is important to understand that midwives are tsught by other midwives, they learn from on the job training - if they have come up through their training with others who are anti-homebirth, they will probably share those views as well.

[Livinthedream]

as a consumer though(currently)
there is no way i would ever sue my mw. EVER.
every decision that is made with a HB midwife is MINE there is NO coersion, there are no dead baby threats.
everything is consented for unlike in hospital

Thankyou for your relpy OG, but i have to question, do your DP and family share the same ideals?, what if something happens to you?
It is totally OT, but often times it is not the injured one sueing, it is the family. What if you are no longer capable of expressing your views?.
Thankyou for answering my Q everyone, I didnot realise that there was such a division among MW's on the topic.

[meow]

I'm not OG but I feel completely the same way. I guess I trust my midwife and I know she would never do anything to cause harm to myself or my baby. If she is unable to prevent injury happening to us then I don't feel anyone could have IYKWIM so I don't feel any need to sue.

I just chatted to my H about your question and he said he doesn't care about that side of things because he trusts me so he therefore trusts HB and our midwife as I've chosen our care for this birth. He does concede that not being able to sue for negligence is a choice we have made by not going to hospital but he doesn't think it's a big enough factor. In the case of gross negligence he thinks he possibly would 'sue' or follow up a negligence complaint not for the sake of money, but rather to avoid the same incident occuring to someone else (ie. to try and get the midwife deregistered if necessary).

[Oorki Galoorki]

my husband feels the same because he is in on the decision making too..
My MIL (who was with us last time) i doubt would sue.. its not her thing itms..
we have nothing to do with my family so it doesnt even matter about them.

[Livinthedream]

Thing you have to remember Meow, is that long term hospitalisation/palliative care, in any decent sort of facility is unbelievably expensive.
Physio and rehab and those sorts of things often are not covered by medicare.
I truely, truely am not trying to debate HB, I guess I can understand the other side, of the worst case scenario and get why insurance is so important.
It actually is protecting you too.
It does suck, that at trained proffesional cannot get insurance, i hope it gets re assesed, it would seem to me that 10 HB should cancel out (plus some) of the cost of 1 "go wrong" and I am pretty sure that rate of "go wrongs" is nothing like 1 in 10.
Would be interested to know the rate of "go wrongs" if anyone knows it?

[Oorki Galoorki]

what do you consider a go wrong?
i know my midwife had a 2% cs rate(obviously after transfer) over her 10 yrs of working as an IM(not annual rate). i dont see why you should worry about the "go wrongs" when they happen everyday in hospitals.
there are LOTS of events that happen in hospital that dont happen at home.....

[meow]

HB midwives can't get insurance because their collective pool is so small- certainly not because its not good insurance sense IYKWIM. The safety of HB is so high and the incidence of something going wrong so low that they are certainly insurable.

I'm aware ongoing medical care would be expensive but I can only see that happening in a HB for something that is natural (ie. baby born with disability) rather than something involving malpractice. HBs don't involve all the procedures that cause incidents, as happens in hospital. If something was going badly we would transfer to hospital anyway and in that case if they muck up a c-sect or something then sure, we'll be covered for that libility.

Just to clarify the point I made about this being my choice- I don't want to give the impression that my H is not involved or against the idea. He's all for it- he's just pretty laid back about it is all. The decision went something like this:
Me: I want a HB
Him: Okay
Me: Maybe I shouldn't have a HB- it costs so much
Him: I think you should have the HB
Me: Yay we're having a HB! I want this midwife
Him: Okay

[Livinthedream]

OG, I was thinking about the whole "go wrong" issue, and what I would consider a "go wrong" to be, I mean, if you need a CS, you are going to need one whether you are HB or hosp right?
I guess the reason I started this thread was because I must be one of the few people who is pretty much ambivalent about the whole issue. And I wanted to know why there was no insurance (didnt realise not all middies supported HB)
If you want to HB, then hell, good luck to you, I really cant see why you shouldnt be allowed, even free birth for that matter, I mean, its probably not always the greatest idea, but so long as you are prepared to live with the consequences of your actions, then why not?
For me, after having 1 bubs, I certainly wouldnt be scared to HB, but i dont know if it would be my preffered option.
Meow, LOL your DH sounds like mine, he wouldnt mind either way, though, I lost a ton of blood last time and I am pretty sure he was glad that of the hosp staff to clean up that mess. LOL

[Oorki Galoorki]

but are you happy to live with the consequences of a hospital birth? are you happy to be forced in to induction, forced to have VEs, forced to a C/S.. this is what happens in hospital there is a HUGE risk of all these happening compared to a homebirth.
babies die any where. there are very few occasions where a baby has to be out under 30 minutes (average time for an "emergency" cs to be prepped) but dont forget it is the midwives who notice problems anyway.. not doctors.. due to the fragmented care in hospitals it takes longer for problems to be picked up compared to one on one care in a HB..

[PollyA]

Thing you have to remember Meow, is that long term hospitalisation/palliative care, in any decent sort of facility is unbelievably expensive.
Physio and rehab and those sorts of things often are not covered by medicare.
I truely, truely am not trying to debate HB, I guess I can understand the other side, of the worst case scenario and get why insurance is so important.
It actually is protecting you too.

I'm not sure what kind of injury you are thinking but actually all of these things are free in the public system. WIth the exception of head injuries (which would be very unlikely at a HB) the public health system provides many of these services. In fact up to 6 months after birth at King Edward (or with Community midwives at home) you can access free specialised women;s health physio.
Children with disabilities are also well taken care of by the public system at no out of pocket cost. there are costs in terms of the time it takes to attend appointments and often it stops parents from going back to work but as another poster said this would be unlikely to be related to place of birth anyway.

What kind of long term care were you thinking? for baby or mum? From what kind of adverse event? Usually the midwife, as a trained professional, will recognise something is wrong and transfer to your back up hospital anyhow, where the people involved are insured.

I personally would like to see more government supported home birth services such as Community Midwifery Program in Perth, the midwives on this program are indemnified or insured by the hospitals who see the women as needed and take over care if necessary. This is similar to the UK and NZ system.


It is sad that Australia is becoming like the USA, very litigious, someone must be blamed when things go wrong. I have a healthy respect for birthing, as i do for the sea. It is awesome, but it can be dangerous. And if it goes pear shaped I would like a good captain (midwife) to take the wheel and steer us into calmer waters. A good homebirth midwife has a foot in the home, where everyone stays if things go as planned (like they usually do) and one in the hospital should they need to transfer...as will happen occasionally. Like OG said, time to theatre is not immediate, even if you are in hospital. they can get ready with word from the midwife at a house, just as they can from word from a midwife in hospital.
ANyway, thats my 2cents worth.

[meow]

but are you happy to live with the consequences of a hospital birth?

Exactly. Babies and mothers are at much higher risk in hospital due to the interventions than they are home anyway.

[Mildez]

As a middy I am all for homebirths but not freebirthing.

Livinthedream is right. After 30something days in hospital unless your in intensive care or something you do have to start to pay and it is not covered by medicare. It includes includes rehab, palative care etc basically anything deamed as chronic illness over acute. Its based in your income or a percent of your pension so depending on your financial circumstances your amount you pay changes. It doesn't apply for premmie babies etc as they are classed as acute.

You also have to remember 99.5% of babies are born in hospital or birthing centre compared to 0.25-0.5% at home. I know a woman who had a HB for twins as the hospital told her they did not support her having a VBAC. She almost lost her life, lost her ability to conceive again and both her babies. And that went on the hospital statistics although she was transferred mid rupture to hospital from home. It seems to me that homebirth statisics only show the positive outcomes, the ones that are born at home and don't take any responsibility for the negative ones that then occur in hospital from transfer when things aren't going smoothly. Homebirths are only going to get good statistics when anything really wrong then gets transferred to hosital.

I recently read (and don't know how true it could possible be) that almost 50% of planned homebirths are transferred to hospital. Statistics from homebirth often says the number of transfers to hospital but not then the outcome as then its the hospitals responsibility who then cops the slack for poor outcomes and intervention. Yes there is alot of intervention but your looking at over 99% of Australias population. In the last 20-50years we have seen such a huge reduction in SBs, diasbility and maternal death and that is due to intervention. Was it 1 in 10 women died during childbirth and 30% of babies 100years ago? We now live in a time when its not acceptable for things to go wrong and when it does someone has to be blamed. Sort of getting of the topic of HomeB vs Hosbirth but working in the hospital setting sometimes intervention is neccessary to ensure a healthy baby or mother physically even if not mentally.

[Mildez]

Livinthedream if I were an IM I would be happy to attend homebirths. I'd prefer them over hospital births anyday. Although I must admit there would be a few very select women I wouldn't be happy to attend a HB for knowing the chance of a positive outcome at home would be unlikely. I'd be happy for breech, VBAC etc. I wold probably still support their decision although have to be honest that I was very concerned that the birth would not go well at home and document that I did not support it. I wont mention it on here incase a friend reads it and knows I am thinking of her situation recently.

[HotI]

but are you happy to live with the consequences of a hospital birth? are you happy to be forced in to induction, forced to have VEs, forced to a C/S.. this is what happens in hospital there is a HUGE risk of all these happening compared to a homebirth.

And very little chance of successfully suing the hospital if these happen, or if disability results from the actions or non actions of medical staff.

[meow]

I recently read (and don't know how true it could possible be) that almost 50% of planned homebirths are transferred to hospital.

You probably read it in all the recent trash that has been quoted in the papers lately. It's not true at all. The ob who said is quoting birth centre transfers rates saying "50% of first time mothers transfer to hospital" when discussing HB. 50% of first time mothers who are home birthing do not transfer. IMs have their transfer rates and it is less than this.