Sunday, November 13, 2011

ACM Position Statement on Homebirth Services 2011

The Australian College of Midwives (ACM) has released a revised Position Statement on Homebirth Services 2011, together with a 'guidance' document and literature review. To access the .pdf files, click here.
"The following Position Statement on Homebirth Services 2011 has been developed utilising extensive consultation with all submissions being considered by a Review Panel. The Review Panel consisted of nominees from all Branches (eligible midwives, private practising midwives, midwives providing public homebirth services and midwifery academics) and two representatives from the ACM Consumer Advisory Committee. It should be read in conjuntion with the Guidance for midwives regarding homebirth services 2011."
Readers of this and other midwifery blogs will know that an Interim Position Statement on Homebirth, with a guidance document and lit review were released a couple of months ago by ACM. The position statement was endorsed by the Nursing and Midwifery Board of Australia, prior to the documents being circulated in the midwifery profession for comment. The full significance of this rapid endorsement by the regulatory body, of an 'interim' document, prior to consultation with the profession, is not clear.

The new Position Statement presents a clearer position than the previous one.  One of the key stumbling blocks is what to do with women who choose home birth against the midwife's or other health service's advice.  The new statement addresses informed decision-making, informed consent, and the woman's right of refusal, and acknowledges that "some women may choose a planned homebirth when this is not recommended by a health care provider.  Women should continue to have access to midwifery care whatever they choose."

In a Croakey blog (the Crikey health blog), outspoken obstetric spokesman Dr Andrew Pesce states that:
"Until those individuals and groups which advocate for publicly funded home birth unambiguously and publicly state home birth is unsuitable for high risk pregnancies, their advocacy will remain at the fringes of the maternity system."
Dr Pesce's concluding, and tantalising statement is:
"If they [those individuals and groups which advocate for publicly funded home birth] can cross that Rubicon, they might find that they have broader support than they realise."

I say this statement is tantalising, because it appears to be suggesting that obstetricians and mainstream maternity services would, with agreed boundaries, support publicly funded homebirth.  That is happening in a variety of homebirth models, providing homebirth services for a small number of women around Sydney, Melbourne, Adelaide, Perth, Fremantle, Darwin, Alice Springs. 

I wonder if that support would extend to home birth in the care of a privately employed midwife?


Anonymous said...

But we don't want to state that "high risk women" are unsuitable for home birth, and we don't want the College stating that either! Risks are defined by the WOMAN, that's what they should be stating. It appears the ACM was attempting to appease the likes of the doctor quoted above, " bargaining' to be 'allowed' homebirth choices for the women that the medical profession deems suitable. nope. That is NOT the role of the College, in fact, it is the direct opposite of the purpose of the College of Midwives, which is to support and uphold midwifery philosophy, the basis of which is respect for the bodily autonomy of women and their choices. I am gratified that the revised document reflects this, but still somewhat rattled that MY College came up with such a revolting piece of rubbish the first time. Truly disturbing. WHAT WERE THEY THINKING???!!!!!!????!!

Joy Johnston said...

Thankyou for this comment.
The whole home/ hospital birth debate is very challenging.
I don't agree that risks are defined by the woman - the woman may or may not understand the risk profile of her own body or her baby's. Partnership with a known midwife who is able to explain and discuss any potential complication or risk is one way of enabling informed decision-making.