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Dear Ms Plibersek
I attended the Face of Birth movie premiere in Sydney on Saturday night. There is a viewing at Parliament House on March 19 and I would strongly encourage you to attend it. It brings to light the inequities in our current health system with regards to women's birth choices.
I am personally concerned with the current lack of choice for women giving birth in Australia, compared with many of our overseas contemporaries. I am particularly concerned about the situation for our Indigenous sisters, who are removed from their communities and sent away to give birth in a less remote hospital. To me, this seems unconstitutional as it denies them the ability to proceed with birth rituals and the sacred connection they establish with the land while giving birth and at the time of birth. Surely this goes against the freedom of religion guaranteed in our constitution!
In my personal experience as a mother I can bring the issue to an individual level.
I and a friend who lives in the same suburb of northern Sydney both had our first children in 2006. We are both tertiary educated, working, married women, in our late 20s. We both suffered a complication in our pregnancies, with low lying placentas. Hers was a much more serious case than mine. Both of us had elective caesarian sections two weeks apart and welcomed our first children into our families, she a son and I a daughter. In each case, we are grateful for the medical advances that allowed us to birth our children safely. We were both recipients of tax payer funded health care, her through the public hospital and me through the private health fund rebate from the Government, as well as the reimbursement of ante and post natal visits with my private obstetrician.
Both of us wanted to have more children.
My friend is pregnant again. She decides, after researching her options, that she would like to have a repeat elective caesarian. She goes to our local public hospital and meets with the midwives and obstetrician. They support her in her choice, after hearing of her reasons and the careful research she has done. She has an elective caesarian soon before Christmas and welcomes her new daughter into her family. Again, her choice is taxpayer funded, as it should be.
I fall pregnant again too. As for my friend, I carefully research my options. I decide that I do not want a repeat elective caesarian as a young, healthy woman enjoying a healthy pregnancy I believe I am at a very low risk of complications and don't require high medical management. I am fully capable of assessing my options, since my daughter's birth I have even managed to complete a postgraduate qualification, so motherhood has not reduced my ability to make an informed decision! I try to look into the statistics and options in my local and private hospital and I'm discouraged at both the lack of information readily available and then appalled at the approach to management of a pregnancy and labour with my history. After much research and discussion my partner and I choose a homebirth with an independent midwife. There is no taxpayer funding for my choice for any aspect of my care, so the high cost is borne by us alone. If we did not have the means, I would have had no choice but to accept care that I see as substandard and not in line with my wishes.
Why is this?
Instead of an individual approach that takes into account my concerns and choice, at the public hospital and the private hospital I am given a list of 'requirements' that I will be subjected to as soon as I walk through the doors in labour. For no particular reason except that it's policy. I cannot be accepted into the midwife program at the hospital, because of my prior caesarian (again, no regard for my individual situation). The same is true of the closest birth centre, which at least supports my low intervention desire, even if they cannot accept my care under the current system. It is mainly because of this I choose to engage the services on an independent practicing midwife who will assist me in a home birth. Neither the public nor the private system support my right to choose my care.
I go through the same pregnancy management as most women do in the care of midwives, private or public. Except this time, every step of the way, I am given as much information as I ask for and the right to choose to accept or deny anything. It is not assumed I will follow the advice/instructions of my health care provider. My GP is supportive and provides the medication scripts I need for the two things we need at home for the birth (syntocin, in case of bleeding, and vitamin K, for the baby). I book into the local public hospital in case I need to transfer and even see two obstetricians, my private one and the one at the hospital. Both inform me that the line from the AMA is that they recommend against it, but there is no reason I shouldn't expect a good outcome. I was wished well and left alone.
I gave birth to my second daughter at home with my midwives, my partner, my older daughter and my Mum present on 4 January, two months ago. It was the most amazing, empowering and joyful moment of my life! I never knew birth could be such a spiritual event. And from a medical point of view, not only did nothing go wrong, my outcomes were far better than almost everyone I know who has given birth in a hospital setting. I had no birth trauma, no physical damage (tearing, etc), no need for drugs, no intervention (the midwife spent most of her time crocheting!), and so on. The bonding with my baby and her introduction into our family was instant and seamless. My postnatal recovery was excellent and breastfeeding established quickly. My baby is the picture of health.
So why is it that my birth, which in terms of total 'cost' in every way, is not covered by our national health system and my friend's was? Why did she have the right to choose the care that she was comfortable with and expect Government support in both a financial and policy sense, but I did not?
And while I was able to choose a home birth because I had the means to pay for it myself, why do other women who do not have the same financial stability not get the same option?
I am also given to understand that midwives' medical indemnity insurance for attending home births runs out mid 2013. So do I face the situation that any more children I may have cannot be born at home, even though we had such a successful and wonderful experience this time?
To me, it seems like an unacceptable denial of my rights as a woman and of my daughters' future rights. I look across the Tasman to New Zealand and see that women there are not denied the right to choose where and how they give birth and their Government supports both home, birth centre and hospital births in their policies and funding. So why should Australian women be denied the same right? The only obstacle I can see in Australia is the influence of the AMA and FRANCOG in preventing women from accessing what should be a basic human right - to choose the kind of care you desire for yourself and your unborn child.
Again, I encourage you to attend the movie screening on March 19. If for some reason you are unable to attend, I am more than happy to send you my copy of the DVD for you to watch personally (or you can buy it online at ...).
I hope that you can approach next year's decision with an understanding of the gravity of the choice you make for all birthing women and their families in Australia. (My partner is a big fan of yours and assures me that we are in good hands!)
Regards
Jennifer
