I've talked previously on this blog about the fact that:
"Birth is not only about making babies. Birth is about making mothers - strong, competent, capable mothers who trust themselves and know their inner strength". Barbara Katz Rothman
The environment a woman finds herself in is a great mediator for how well she is able to develop that strength. A supportive environment is enabling. A supportive environment is capacity building.
Midwives have traditionally been a vital part of the woman's birth territory where ever the woman gave birth. Midwives have protected the space and provided the support, encouragement and trust in the birth process that is so integral to women feeling free to birth and mother well. Midwives stand strong with women as they bring their babies forth into the world. Many's the time I've been with a birthing woman who would glance at me as she laboured and I'd smile and nod and she would go back to her process satisfied that she was 'on track'. Those women would invariably say later, "I was feeling frightened and when I looked at you and you smiled at me, I knew I was ok".
The word 'midwife' comes from the Anglo-Saxon "mid-wyfe" which means 'with woman'. There is a long history (at least the last four thousand years has been recorded) of the way that being with women has brought midwives into conflict with 'authorities'. The Bible gives evidence that midwives have always stood with women and protected them and their infants in the most difficult circumstances and despite powerful edicts to the contrary. Exodus (1:15-22) contains "several verses recounting the experiences of two Hebrew midwives who refused to kill male infants in defiance of the King of Egypt".
And now, in Australia, women and midwives have a new challenge.
In response to political posturing by various authorities, the Australian College of Midwives has released an Interim Statement on Homebirth in an attempt to restrict where women can birth and what midwives can do. The statement, hastily drafted as it was, nonetheless was rapidly endorsed by the newly formed Australian Nurses and Midwives Board, even before the statement was reviewed by the College's members. You will note that the statement endorsed by the board does not mention the word 'interim'. What is also concerning is that the College statement references two papers whose data collection methods have been poorly regarded (Kennare et al (2010) paper on planned homebirth in South Australia, and Bastian et al (1998).
Submissions on the statement were requested by Friday 23rd September 2011 (after publication on the web). The College states it intends to finalise the statement in October this year. Many of us are not impressed by the statement as it stands because it does not position the woman as the decision maker. Midwifery ethics are all about the woman as decison maker.
You will find considered responses to the interim statement on homebirth by midwives who work in private practice on the following links.
Rachel Reed of MidwifeThinking's response
Australian Private Midwives' Association's position statement on homebirths
I was thrilled to see the clarity of thinking and recognition of women's rights in the response from the National Alliance for Students of Midwifery.
This statement from the International Confederation of Midwives on women's choices and birth territory is clear and unfortunately, not reflected in the interim statement by the Australian College of Midwives.
So here's my submission to the College for consideration in the Board's deliberations over the wording and intent of the Final Statement on Homebirth.
23rd September 2011
Re: Australian College of Midwives Statement on Homebirth: Women's Rights to a Homebirth and Their Right to a Skilled Attendant
Firstly, I want to know that my College supports women to have sovereignty over their own bodies and agency, including the right to choose where they give birth.
I also want to know that my College supports midwives to support women with their choices.
Guidelines and standards are important, however, risk status is an indicator, not a predictor and each woman has the right as an adult to be self determining. As an adult, a woman has the right to informed consent and informed refusal.
What enables women to be safest when giving birth is a known competent midwife, agency to choose to give birth where she feels most relaxed, a seamless means of transfer and acceptance at a local health service and collaboration with that service and prompt medical attention as required; the woman's chosen midwife able to continue to provide midwifery care with the support of the hospital's midwifery team.
Science is clear that when women have a perception of control over what happens to them, they have reduced levels of glucocorticoids in their peripheral circulation. Stress hormones are implicated in much of what goes wrong in labour and birth. Our role as midwives and as a midwifery organisation is to be 'with woman' and reduce stress, not create it.
As Barbara Katz Rothman said, "when there is a strong and autonomous midwifery profession, women and their babies do well".
We need to be a strong and autonomous midwifery profession. I want to feel proud of my College and our final Statement on Homebirth. The Interim statement both horrifies and embarrasses me, especially as it has been already endorsed and published by the Australian Nurses and Midwives Board - how on earth did that happen?
ACM Member and Fellow
Women's rights to sovereignty and bodily autonomy are under threat and we need to stand beside them, to ensure they have the information they need to make their choices and support those choices.
That is what 'midwife' means.
We need our College to support women’s right to choose what suits them and their families and to support us to support women. We need a strong College, so midwives can be strong to support women in their choices so they can become the strong mothers they need to be.
The Environment is everything!