Pushing for Birth Reform

By Bruce Teakle

Birth groups all over the country are campaigning for reform of Australia’s birth care services. With the crisis in current care systems, the National Maternity Action Plan helps us all sing the same song towards change. We are on the threshold of a rare opportunity to achieve reform.

Having been born at home myself, it seemed perfectly natural, when my wife Erika became pregnant, that she should choose to birth at home. It was a choice some people seemed uncomfortable with, but in practice it was a fairly simple matter of choosing a midwife we were comfortable with, and finding the money to pay her fee. The care we received before, during, and after the birth was excellent, helping to make an experience that was wonderful and empowering for all of us.

The idea that there was a political dimension to birth did not occur to me or Erika until we received a letter from one of our midwife’s other clients in July 2001. The letter told us that a few weeks earlier, while our midwife was overseas teaching, her home was raided by a government investigator and some police. Thirty client files and some video tapes had been taken by the state nursing regulator to help prepare a case against our midwife for ‘giving care to a woman during birth’ without being a doctor or registered midwife.

This was very upsetting to us, and to many other families. Once we got past the initial anger, the news served to make it clear to us that unless we became active politically, midwifery care at home would soon be completely unavailable in Queensland.

So a group of us got together and formed the Birth Action Group, with the purpose of cooperating with the existing birth groups and organising a political effort to retain access to informed choice in birth care.

At the same time as we were taking our first unsteady steps into the complex world of birth politics, other things were happening which were feeding the movement for birth reform. Most public was the loss of professional indemnity insurance for midwives in private practice. Midwives who were employed privately by women wanting woman-centred care in hospital or at home are still unable to get insurance, and most have ceased private practice.

Doctors too, were in trouble with insurance, especially obstetricians, putting birthcare issues into the media again.

Steeply rising rates of medical intervention in birth, partly influenced by the obstetrician’s fears about legal liability, also raised pressure on consumer groups to push for reform.

Queensland’s caesarean rate went from under 24% in 1999, to over 29% in early 2002. These figures can be compared to a caesarean rate of under 10% in the Netherlands, which has world best outcomes.

Consumers who had experienced the satisfaction of midwifery models of care in birth centres or at home were really under pressure all over Australia. They have been joined by increasing numbers of women who are unhappy with their experiences of high intervention birth care, and would like access to a model of care which supports their natural ability to birth.

While the systems of birth care seemed to be in free fall, cranky consumers were preparing to respond. One particularly switched on group of mothers realised that achieving change was more likely if the many birth groups could sing from the same score. Even more clever, they decided that the way to do this was, instead of trying to get everyone to join the same group, they would write up a policy proposal that could include the aims of the  diversity of people in the birth movement. The policy proposal was titled the ‘National Maternity Action Plan’ (NMAP).

The NMAP team found a suitable home within the Maternity Coalition, which already had a role as a national ‘umbrella body’ for the birth movement. Email lists were collected of interested people and groups, and soon draft NMAPs were zipping around the email networks of mothers and midwives, generating feedback and editing to ensure that the NMAP fitted as broad a support base as possible.

On 24 September, 2002 the National Maternity Action Plan was launched in the capital cities of Australia. The different launches reflected the diversity in supporting groups and the differing situations in the various states. Some launches were held in parliament houses, with the sponsorship of Green Members of Parliament. Some were rallies in public spaces with mobs of Mums. Media coverage was very satisfying.

The impact of the NMAP on policies with real world effects has yet to really start. Political support is gradually gathering. The Australian Greens have made the NMAP part of their policyplatform. On the day after the launch, the Australian Senate voted in favour of a motion by Meg Lees supporting the NMAP. Labor, Green and Democrat senators voted in favour, while Coalition senators voted against. While this is only a symbolic action, it has implications for future support from Labor governments, if we follow up with ongoing pressure from consumers.

Although mothers with young children often feel intimidated by the health system’s complexity, and cynical and powerless about the political processes, consumers are the people who can be truly powerful in achieving change.

For anyone who wants to see reform of Australia’s birthcare services, now is a very exciting time, and any effort you make to have your say to your political servants will be a valuable part of a greater movement.


Why does it matter?

While most women will only spend a few hours of their life actually pushing out a baby, the associated processes of pregnancy and parenting are hard to match in the scale of their importance on a woman’s life.

Birth experiences have profound influences on women and babies, physically and psychologically, and this has long lasting effects on women and their relationships with their children. Hard scientific evidence shows that the type of care a woman receives has a big influence of what sort of birth experience she has. There is also increasing evidence that there are longterm psychological consequences of birth trauma for babies.

Underlying much of the current push for reform of birth care is the belief that empowering women in their birth experience is a necessary element of a just and sustainable society.


What’s in the National Maternity Action Plan?

The NMAP uses the Community Midwifery Program in Perth, Western Australia, as a model for reform of Australia’s birth care system.

The Community Midwifery Program is a government funded midwifery care service, which has been operating since 1996 and provides free care to women in the Perth area. A team of midwives operate out of their own clinic, and give care to women in their own homes. Women are able to birth in hospital or at home with the care of their own CMP midwife.

The CMP is managed by a community based committee which has a clinical advisory group. This keeps it responsive to community expectations, and helps it to escape the accusation of being ‘run by doctors, for doctors’, which is often made of hospitals.

For more information about the Community Midwifery Program see

The NMAP proposes that community based midwifery care of this type is available to all Australian women, whatever their chosen place of birth. It has been endorsed by a huge list of organisations and individuals.

The NMAP is available from the Maternity Coalition website: www.maternitycoalition.org.au

While you’re there take a look at the fantastic list of groups and individuals who have endorsed the NMAP.


Model of Care: The Key to Better Birthing

The idea behind the push for birth reform, and the National Maternity Action Plan, is that the environment in which women birth, especially the philosophy and approach of caregivers, has a big effect on the outcomes. This is strongly supported by scientific research.

The medical model, currently dominating in Australia, emphasises the potential for disaster and the need for the technologies of rescue.

While there are certainly situations in which medical intervention is necessary, the evidence shows that giving all women such medically focussed care leads to worse rather than better outcomes.

In one Brisbane private hospital, for example, only 40% of women succeed in pushing out their own babies. Nearly 50% of births at this hospital are by caesarean. These figures cannot be explained by the type of women seeking care there — privately insured women tend to be healthy and well educated. Nor can they be explained by women’s request for caesareans — the available evidence shows that fewer than 1% of women prefer a caesarean without a medical reason.

In contrast, midwifery models approach care quite differently, describing their philosophies as, ‘wellness approach to pregnancy’, or ‘woman centred’.

Midwifery models tend to involve the mother in choosing her caregiver, and spending a lot of time with her midwife in antenatal visits, often in the mother’s home.

Medical care is then seen as a resource to be drawn on when needed, with the midwife trained to recognise situations beyond her scope.

‘Continuity of Care’ is a key ‘model of care’ element. In birth care this means that mothers have a single chosen practitioner for most of their antenatal, birth, and postnatal care, preferably with a known backup carer. In current Australian medically focussed birth care, women usually receive their antenatal care from a different doctor or team of midwives from the ones in birth or postnatal care. For most women this means birthing in the care of strangers, and a different group of strangers after each change of shift.

Best practice models of care are able to dramatically reduce the need for medical interventions, and the harm that often results. Home birth midwives often achieve caesarean rates (after transfer to hospital, of course) of under 5%, and whole countries, such as the Netherlands, are able to achieve caesarean rates under 10% through the use of midwifery based maternity care.


What you can do
Improving Australia’s birth care system requires our politicians to hear from mothers about what sort of care they want in birth. Historically, only health bureaucrats and doctors have set the agenda, and consumers have been left out. What is now necessary is for women’s stories to be heard.

• Contact your own member of parliament and tell them, by letter, email or in a visit, what your experience with birthcare has been, and what you would like from the birthcare system. A guide to contacting your politician about birth reform is available at: http://www.acegraphics.com.au/articles/bruce01.html

• To find who your MP is, phone the Australian Electoral Commission (in your white pages), or, in New South Wales, go to: www.parliament.nsw.gov.au/prod/web/phweb.nsf/frames/members

• If you write to your own state MP, they will contact the state Health Minister about concerns raised in your letter.

• Joining one of the many consumer birth groups is a good move too, to keep yourself better informed and supported.
Groups include:
Maternity Coalition www.maternitycoalition.org.au
Home Midwifery Association www.homebirth.org.au
Friends of the Birth Centre (Brisbane) www.fbc.org.au
Healing from Caesarean www.birthrites.org
International Caesarean Awareness Network www.ican-online.org
Ace Graphics: www.acegraphics.com.au/index.html


Published in byronchild/Kindred, issue 5, March 03