service and she believes women with high risk factors should give birth in hospital.
But Dr Dahlen, who has spent more than 20 years working in high risk delivery wards in major hospitals, fears homebirthing in Australia is under threat.
And she’s concerned if Australia reacts to recent negative publicity surrounding homebirthing, the consequences could be dire, including potentially pushing more women into the underground freebirthing movement.
The pressing issue confronting Australia’s privately practising midwives is one of insurance. Since the collapse of HIH in 2001, no insurance has been available for privately practising midwives providing homebirthing services.
Now under national law, Australian midwives can practise in a range of settings, including homes, as long as specific registration conditions are met.
Without commercial professional indemnity insurance, the Commonwealth, states and territories have moved to provide privately practising midwives with an exemption from the requirement to hold professional indemnity insurance for providing intrapartum homebirthing services until July 1, 2013.
Australia’s health ministers will meet in August to discuss the issue and while the deadline is a year away, Dr Dahlen fears if a solution is not found soon, the uncertainty will affect women falling pregnant as soon as September.
“It’s a looming crisis,” she says.
“The crucial issue is as of June 30, 2013, if insurance is not found for midwives…homebirthing could become an illegalised practice.”
Homebirthing has recently faced a torrent of negative publicity.
The issue made headlines earlier this year when a renowned homebirthing advocate died after giving birth to her second child in her Melbourne home.
And in early June, a South Australian coronial inquest found three babies who died during or after planned homebirths would have survived had they been born in hospital by caesarean section.
The births, which all involved complications, were assisted by midwife Lisa Barrett who withdrew her midwifery registration in January last year and was acting as a birth advocate.
SA deputy coroner Anthony Schapel found the deaths “could and should have been prevented” in a more appropriate clinical setting.
Dr Dahlen, who spoke at the inquest, says the Coroner highlighted serious system and legislative flaws that contributed to the incidents, and she now fears the negative headlines could tarnish homebirthing and jeopardise the future of the birthing option in Australia.
“We must find a solution for 2013 and we mustn’t react,” she says.
“If we go and change laws based on the case in South Australia, we are changing laws on one midwife and three women, which will impact on hundreds of women and midwives.
“It’s really important not to have a reflex reaction but a measured, sensible response.
“Six or seven babies die every day in hospital. Every two weeks a mum dies in childbirth in hospital. “We have a very skewed perspective in this country.”
Australian Institute of Health and Welfare figures reveal that of the 294,540 women who gave birth to 299,220 babies across Australia in 2009, 863 were homebirths, representing 0.3 per cent of births.
The figures show there were two fetal deaths at homebirths in 2009, while there were 2,339 fetal deaths in hospitals and birth centres across the nation.
In the South Australian coronial inquest, Coroner Schapel recommended that only midwives registered under national law should be allowed to practise midwifery and “it ought to be regarded as an offence, punishable by law, for midwives to practise midwifery without registration with the Nursing and Midwifery Board of Australia pursuant to the national law”.
Dr Dahlen, who helped formulate the ACM’s position statement on homebirth services, welcomes the move but expresses concerns at one of the Coroner’s other recommendations.
That recommendation calls for new legislation to “impose a duty on any person providing a health service, including midwifery services, to report to the South Australian Department of Health and Ageing the intention of any person under his or her care to undergo a homebirth in respect of deliveries that are attended by an enhanced risk of complication, for example but not limited to, homebirths involving the birth of twins or known breech birth at term”.
Dr Dahlen says if enshrined in legislation, the move may push more women towards freebirthing, where there is no medical assistance, or intrude on the rights of women to choose their path through pregnancy and birth.
Anecdotal evidence suggests freebirthing is on the rise in Australia.
Dr Dahlen, who is involved in a large study on the movement, says while there are no statistics on how many women are choosing to freebirth, there is “no shortage” of women wanting to share their experiences.
And she says many women who have experienced previous traumatic births now want to avoid the hospital system.
“Some studies are telling us one in 10 women are coming out of childbirth with symptoms for post-traumatic stress disorder,” she says.
“That’s terrifying. We have got to look back at the system that allows this trauma in the first place.”
Dr Dahlen practises at Midwives @ Sydney and Beyond, a small group practice with six midwives, providing care in the woman’s choice of setting.
Privately practising midwife Robyn Dempsey, a colleague of Dr Dahlen’s, has attended about 400 homebirths in almost 20 years.
After completing her midwifery training at a Sydney hospital in 1990, Ms Dempsey birthed her own three babies at home, under the care of a midwife, and also launched her own midwifery practice.
Ms Dempsey says on average about 16 per cent of her birthing mothers are transferred to hospital, for either pain relief or emergency care, but no mothers or babies have lost their lives under her care.
“I think women need to have a choice of having their babies wherever they want to,” she says.
“The most amazing thing I find is working with first-time mums. They are just full of enthusiasm and watching them move from the girl and into a mother…the look on their faces of ‘look what I did’.
“It’s wonderful watching women make their own choices and showing them that they can do it and it’s perfectly safe for low risk women.”
Like Dr Dahlen, Ms Dempsey has concerns about what will happen when the deadline expires next year; for birthing women and also for her midwifery career.
“If no solution is found, I won’t be able to offer women births at home, which collapses an 18 year midwifery practice,” she says.
“It’s just really sad. The government needs to come to the party and provide us with insurance.”
Dr Dahlen says Australia should look to New Zealand where homebirthing is not outside the norm.
In New Zealand, 78 per cent of women choose midwifery care and opt to give birth either at home, at a birth unit or in hospital.
“New Zealand has got it right,” she says.
“They have got a very good clinical pathway they have developed for their midwives.
“The government has given the funding to women... saying ‘here is the package you can go and pick a midwife, a GP or an obstetrician’.
“You can have your baby pretty much wherever you want to have your baby.
“It’s a fundamental human right that a woman should be able to give birth to her baby where she wants to,” Dr Dahlen says.
“I believe that if we can birth right I feel we can get anything right. That's how strongly I believe in it.”
Note: The Nursing and Midwifery Board of Australia has removed the Australian College of Midwives’ original position statement on homebirth from the board’s website. View the explanatory note here and the board’s midwifery professional practice framework.