Articles > Australian Women's Birth Choices

Every Woman’s Birth Right    by Tracy Reibel PhD

 

 

It is the firm belief among those of us who strive for reform of Australia’s maternity services that every woman has the absolute right to choose how she gives birth, with who, and where and that to enable this every health professional has an absolute responsibility to support her choices.

 

Unfortunately, this is not reflected in practice and is a difficult right to exercise within the current system of care provided to childbearing women.

 

Research clearly demonstrates that the best circumstances for a woman to achieve not only a good outcome for herself but also for her baby rest in the care she receives during pregnancy but more importantly during childbirth. When a woman has come to know and trust her carer during her pregnancy, and that same carer is present during labour and birth the woman is highly likely to feel supported in her birth journey. The World Health Organisation has determined that for normal birth a midwife provides the most appropriate care. As most women will experience normal pregnancy and birth it follows that primary care should be provided by midwives unless there are clinical indications that require specialist intervention.

 

Very few women of the 250,000 who give birth in Australia each year choose to be the manager of their own pregnancy and birth experience primarily because there are limited choices to make. The current system is heavily biased towards care from either general or specialist obstetricians with less than one percent of women having access to primary midwifery care.

 

If we are going to provide childbearing women with a better system of care it is important to consider some of the factors currently contributing to women giving birth in the company of strangers and the impact this has on them and their families during the highly personal and intimate experience of childbirth.

 

To begin, despite the supporting evidence, women are not given the choice of continuous primary care by a midwife but instead are automatically directed into the medical model overseen by specialist obstetricians. This is an unsuitable use of health professionals, particularly in an era when all health services are stretched beyond their limits. It also means that women are less likely to receive care suitable for their individual circumstances and be more likely to have to travel outside their communities to access care.

 

Secondly, because maternity services in Australia are located within the acute health services sector this emphasises the medical approach making it more likely that pregnancy and childbirth will be viewed as a medical condition, or even an illness, rather than a normal physiological life event. A more creative approach to funding allocation acknowledging maternity services as a distinct primary health care area would enable the implementation of primary midwifery care services in most locations across Australia, relieve the burden on hospital resources, and return services to communities where they have been closed due to a lack of general or specialist obstetricians.

 

Thirdly, the birth industry is very lucrative and there is strong resistance among those who benefit from it to support reform of maternity services. Ironically though, fewer medical practitioners are undertaking the specialisation of obstetrics and within a relatively short period of time there will be a critical shortage of obstetricians. Little engagement has been undertaken at a planning level to address this situation even though maternity services are currently dependent on their availability. 

 

The complex array of social, political and economic conditions currently shaping maternity services ensure that childbearing women do not receive the most appropriate care for their individual circumstances within a reasonable distance of their homes, that midwives are not able to engage in their full scope of practice, and, that taxpayers are contributing to a costly and largely ineffective system.

 

In too many cases, women are alienated from the care they have entered into in good faith. For many of these women, their birth experience will not meet their expectations and for some the trauma of childbirth will stay with them for life. While it could be said that this is the risk of childbirth and that not everyone can have a good experience this does not acknowledge the profound implications of childbearing on the lives of women and how trauma can, in many cases, be averted. Having a live, healthy baby is not the only outcome of childbirth. We should also strive for a physically and emotionally healthy mother.

 

For those women who do choose to exercise their birth rights they often need to go to extraordinary lengths to find a health professional who absolutely supports their choice and encourages them every step of the way. This may involve running the gauntlet of family, friends and health professionals attempting to actively dissuade them from their choices. Even when they achieve what they have sought – a positive and empowering birth experience – their achievement may be labelled as lucky.

 

It is a sad but true situation that in twenty first century Australia, most women are under the impression that the medical profession is the expert when it comes to pregnancy and childbirth. This can be the only explanation for so many women handing themselves over to these practitioners, often with little understanding of the system they have entered into.

 

Until reform of maternity services is firmly on the agenda in this country, we are unlikely to see change. For this to happen more women need to be involved in taking a proactive step towards a better deal in maternity care and claim her birth right – to give birth how she chooses, with who and where.

 

Childbirth educators play an important role in informing women about the importance of choosing their primary care health professional very carefully. Does the carer have a good record in normal births and what is their attitude towards pain and pain relief? Is the carer conversant with alternatives to drugs to assist with pain relief, such as water or being ambulant? Does the carer acknowledge that normal birth is the best outcome for both the mother and the baby in the majority of circumstances? Women need to be wary of a health professional who immediately begins a conversation about labour and birth within the context of risk.

 

While options are limited in most states of Australia at present, there are strategies that birthing women can take to achieve their goal of normal birth even within the highly medicalised system that exists. Childbirth educators can support women to make decisions about their care and continually reinforce that woman are the central focus of birth. Such reinforcement during pregnancy will enable women to enter the labour and birth journey with confidence.

 

While each birth of a child is a miracle, the ordinariness of this event within the context of the physiological process that enables normal birth has been lost in the technology of modern life. While some women and/or babies will clearly benefit from intensive medical surveillance, we must question whether this should dictate the care received by the majority. Childbirth educators can be leaders in assisting more women to achieve a happy and healthy birth outcome.

 

Tracy Reibel PhD

Co-author of the National Maternity Action Plan (2002), a Churchill Fellow in 2003 investigating maternity systems overseas, and a member of the National Executive of the Maternity Coalition.

 

The Maternity Coalition is national umbrella organisation with branches in all states and territories (except Tasmania). The primary aim of the organisation is to achieve reform of maternity services to include the option of primary care from a known midwife for the childbearing continuum wherever possible. Maternity Coalition welcomes new members from both the community and professionals working in the area of maternity care.