Andrea, I am a little confused, you seem to have switched from talking about a homebirth service run from RHW to one run from St.George, or am I getting my wires crossed?
cheers Jo At 8:41 +1100 1/12/03, Andrea Robertson wrote: >Hello everyone, > >It is very good to see such a useful debate on the proposed home birth services that >are in the wind. I think everyone has had something very useful to offer to the >discussion and here are my thoughts on some of those responses. > >The reason that I raised the way home birth works in the UK is firstly because I have >had a lot of exposure to its variations across the UK and therefore feel we can learn >a lot from the way it works there. The fact that home birth rates are rising steadily >in Britain comes down to the commitment fo the system to home birth as an option andn >its availability as a free service to every woman wo wants it. Yes, some women don't >get to choose their midwife but at the end of the day, research has shown that for >the majority of women, it is not just the person (midwife) who matters to women but >the quality of the care. As long as the midwife is caring, and the woman's needs are >met, most women are happy - they realise that midwives too have lives and may not be >able to be the beck and call of women 24/7. If a colleague arrives instead of the >expected midwife, as long as the care remains the same women will accept this. > >The remarkable outcomes achieved by the Albany midwives (43% home birth rate) is with >a population of women who would not even be considered for a home birth by most >services because of existing risk factors. This services does not set out to offer >"home births" as such, but woman centred care. The decision about where to give birth >is made during the labour, and because of the flexibility of the midwives and the >service, many woman are able to elect to stay put and have an "unplanned" homebirth. > >In constrast, the CMWA is working with a select group of women, who are very unlikely >to have the social risks that the Albany team work with (homeless, poor, drug users, >teenagers, non-English speaking etc). It could be argued that in such a select group, >who start out wanting a homebirth, that a 75% home birth (or even higher) would be >expected. A lower rate than this would be a cause for concern. > >I agree that we should use our own home grown service in WA as a model of care for >other community based programs. It is exemplary and an ideal model to follow. But it >is not the only model, and there must be other choices available for women, >especially those who book into a Birth Centre because they want to avoid a >medicalised birth and then discover along the way that they could actually give birth >at home quite safely. A hosptial based service that offers either birth centre or >home births could make this a reality for many women. > >I also quoted the UK experience because many people are using it as an argument to >stymie the proposed program at St George, quoting anecdotal evidence rather than hard >facts to strengthen their opposition. Many assumptions are being made, without >investigating the facts, and unfounded fears are being used as a basis for doubting >the commitment and philosophy of those striving to initiate much needed change within >the system. > >The bottom line is that the SESAHS has still not signed off on the proposed service >and unless there is overwhelming support (and pressure) from the community (including >the IPMs) for its establishment then they may well choose to spend their money not on >providing an "elite" service for a relatively small number of women but on much >needed services for a larger number of women in their jurisdiction. > >It may not be the "perfect" service, but it is a start, and will set a precedent that >can be used as a foundation for building home birth awareness in the community that >will help drive change elsewhere. Most of you may not remember that 25 years ago >birth centres were an unknown concept and it took a lot of community pressure to get >the first one opened. It was not publicisied bcause the doctors feasred competition >and it has very strict selection criteria, but it survived and spawned others. Birth >Centres are now "mainstream" health care. Wouldn't it be wonderful if this small >beginning led to the wider recognition of home birth as a "mainstream" option (as it >is in the UK and elsewhere)? > >The criteria for the operation of the service are still being discussed. At St >George, the heads of both the midwifery services and the obstetric services are very >supportive of home birth and are committed to evidence based care and woman-centred >care. There is no reason to suspect that they will be putting highly restrictive >practice policies in place - in fact it could be argued that a successful service, >utilised by a good number of women will enhance their status and support their >decision to take this bold step forward. If a woman meets birth centre criteria (and >that currently includes VBAC for example) then she should be able to give birth at >home should she wish. If the decision regarding birth place can be left until the >labour itself, there is a good chance of a positive outcome all round. Instead of >spreading rumours and doubts, let's get behind the proposed program and make sure it >works well - for everyone's benefit. > >Regards > >Andrea > >----- >Andrea Robertson >Birth International * ACE Graphics * Associates in Childbirth Education > >e-mail: [EMAIL PROTECTED] >web: www.birthinternational.com > > >-- >This mailing list is sponsored by ACE Graphics. >Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- Jo Bourne Virtual Artists Pty Ltd -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
