Homebirth, freebirth, and doulas ... a broken maternity system

The latest issue of Women and Birth, the journal of the Australian College of Midwives, contains a paper by midwife academic Hannah Dahlen and two colleagues, M Jackson and J Stevens, titled:
Homebirth, freebirth and doulas: casualty and consequences of a broken maternity system.


Students will be able to search for a copy of the article via their library access. Others could contact the College http://www.midwives.org.au/ or on facebook and request a .pdf copy. [The reference is Dahlen et al(2011), Women and Birth 24, 47-50]

The authors summarise their paper with the statement that:

"In Australia private homebirth remains unfunded and uninsured and publicly funded homebirth models are not widely available. Doulas are increasingly hired by women for support during childbirth and freebirth appears to be on the rise. The receltly released Improving Maternity Services in Australia - the Report of the Maternity Services Review (MSR) exclude[d] homebirth from the funding and insurance reforms proposed. Drawing on recent research we argue that homebirth has become a casualty of a broken maternity system. The recent rise in the numbers of women employing doulas and choosing to birth at home unattended by any health professional we argue is in part a consequence of not adequately meeting the needs of women for continuity of midwifery care and non-medicalised birthing options."

I support the authors' contention that the rise of freebirth and doulas, and the progressive marginalisation of homebirth by lack of government recognition and funding, are evidence of a broken maternity system.

Freebirth is not necessarily connected with doulas or other unregulated birth attendants, but anecdotal evidence suggests that there is considerable synergy between the two movements. Here's an anecdote from my personal experience:

A woman who chose freebirth in a Melbourne suburb had two doulas in attendance. I don't know the woman's reasons for this choice. The baby was born well, someone eventually tied and cut the cord, but two hours later the placenta had not come. It was the middle of the night. The woman's husband phoned me and asked what should be done. ...

I won't detail what I said (surprised at being woken and asked this question), but apparently the placenta was then birthed without incident, and everyone was happy and the attendants went home. When I had not heard from the mother a couple of days later, I checked her facebook site, and discovered that the placenta had come after 2 hours!

I cannot in any way condone this sort of un-professionalism by unregulated birth attendants. (I do not know the names of the doulas involved in this case) I am saddened that a mother considered it best to give birth without a midwife in attendance. I will not attempt to speak in support of a maternity system that, in complex ways, has contributed to this outcome.

I consider the Report of the Maternity Services Review to be a factor in the dystocia of the Australian maternity system. I have written about that in previous blogs.

At present independent midwives are working to do their best with the maternity system - broken as it is. We are doing all we can to obtain notation as 'eligible' for Medicare - see blogs midwivesVictoria and villagemidwife. This notation will, at least, give women in our care some rebate on our fees. There is also the expectation that hospitals will enable midwives to attend their clients privately for birth. This will change the paradigm from private midwifery being solely focused on homebirth, to a broader choice for women.

Thankyou for your comments