The moves to get new models of midwifery care established in New South Wales are gathering pace. Since the launch of the National Midwifery Action Plan, various projects have been developed and at last some are starting to come to fruition. It all takes a lot of time, but the end product will be very worthwhile.

Two major initiatives in Sydney look particularly promising. At Ryde Hospital, the closure of the hospital was averted and in a bold move, management overruled the objections of the private obstetricians to support a plan to turn the unit into a midwifery model of care, that will offer women a real alternative to the obstetrics that has been the norm in this area for many years. Ryde is in the same Area Health Service as Manly Hospital, and, inspired by the moves at Ryde, it now looks as though Manly will follow the lead and that they will become a Midwifery unit as well.

Considering that both of these smaller hospitals were due to close their birth services, this is a major coup. The North Shore area of Sydney (the up-market end of town) has always lagged behind the rest of the city in providing alternatives to obstetrics. Their hospitals have regularly topped the charts on the levels of interventions they inflict on the wealthy women they attract. Theirs is the last Area Health Service in the Sydney Metropolitan region to open a Birth Centre, which is appalling, given that Birth Centres have been in operation at other city hospitals for around 20 years. The first Birth Centre in this Northern region opened in August 2003 - at last.

Meanwhile, on the other side of the city, an exciting plan is about to be launched that will make home births available for women as part of the public health care system. Until now, home births have only been available in NSW if a woman could find an independent midwife and afford to pay her fee. Whilst this is still an important options for women who want to move right away from the health cares system, there is a shortage of midwives willing and able to offer this kind of service, because of the lack of professional indemnity insurance and the necessity of being continuously on call (often with little back up). There are few midwives in a position to work this way because of family commitments and burn out can be a reality.

The proposed service that will operate in the South Eastern Sydney Area Health Service will be based around the Birth Centres and utilise a more midwife-friendly service that will hopefully reduce the risk of burnout and encourage more midwives to try this way of working. For the women, they will be able to have a home birth on the public purse, making this option available to more women, not just those who can afford it.

Some concerns have been raised around the restrictions that may be placed on midwives who are recruited to facilitate these home births. No doubt there will be strict guidelines about which women will be cleared for a home birth, and given that there is no legislation that protects midwives who stay with women in the home when a transfer has been advised (as they have in the UK) this seems very sensible, if midwives are to avoid litigation. Recent history underscored these risks when a midwife in Sydney was de-registered for what was seen as the unprofessional conduct of a number of high risk births in home settings. We can’t afford to lose experienced home birth midwives in this way, so some guidelines that will give them protection and strengthen their position seems only common sense.

I well remember when the first Birth Centres were opened all those years ago. The list of exclusion criteria was pages long and women were routinely transferred for the slightest deviation from “normal”. While it could be argued that the transfer rate from some Birth Centres is still too high, the list of exclusion criteria has been relaxed and now, in some units, VBAC births are encouraged, for example, a situation that would have been unthinkable even a few years ago.

No doubt as home births become more mainstream and accepted within the community (and there is a long way to go here) the guidelines that govern their availability will be relaxed as well. The important thing is to have this option established, so that women (and midwives) can experience the joys and benefits of home birth. There seems little benefit in holding out for a more “purist” approach that revolves around independent midwifery alone, at least until the insurance situation is resolved and there are more midwives willing to offer this kind of dedicated community service. If there is one thing we can learn from the way home births are managed in other countries such as the UK, The Netherlands and New Zealand, it is that midwife as well as women friendly services are the only ones that will stand the test of time. Australia might be lagging behind in the provision of a home birth option as part of our regular national health service, but at least we can use this delay to learn from others who have more experience than ourselves, and hopefully develop a sustainable, viable and effective alternative that will give all women real choice. Posted by andrea at November 18, 2003 06:39 AM