Since 1996 CMWA has worked to ensure birthing families in Perth have access to a publicly-funded homebirth service. The Community Midwifery Program has grown from 75 births in the first year to almost 300 in 2008/09. CMWA's current focus is to ensure that pregnant couples are well-informed about their birth choices and that they are empowered to make decisions that reflect their own needs, concerns and aspirations, whatever they may be. We provide workshops, information and support for all birthing women and their families, whatever their choices may be.
The availability of birth choices for families is subject to a number of external factors. These include political and financial pressures, and the willingness and ability of service providers to create woman-centred maternity care options. In contemporary western society birth is largely viewed as a risky process, rather than a normal life event, and so it is no surprise that less than 1% of women in WA choose to birth at home. We have included some hot topics below with latest updates - do not hesitate to contact us if you would like any further information.
Having the choice to birth at home is a controversial issue and
subject to political will. Since CMWA was established in 1996 to
provide women in WA with access to publicly-funded homebirth, the
service has benefited from significant bi-partisan support at both
state and federal levels. From 75 births in 1996, 226 in 2008, the
Community Midwifery Program (CMP) is poised to support more than 350
women to birth at home in 2010.
The growth of homebirth in WA is in alignment with the state's new maternity framework "Improving Maternity Choices: Working Together Across WA"(2007) and comes as a result of CMWA's close and productive partnership with WA Health in the management and governance of the CMP. The federal government's National Maternity Services Review was released earlier this year which is more ambiguous about the benefits of homebirth though it clearly recommends significant change toward creating more woman-centred care.
CMWA monitors state and federal health policies as they impact on homebirth. We also play an active role in keeping ministers, health bureaucrats and the media updated on the needs and aspirations of the WA birthing community. If you wish to know more about homebirth in WA please contact us at CMWA
Insurance for midwives
Directly affecting the availability of homebirth is the issue of Professional Indemnity Insurance. Since 2001, midwives have not had access to insurance to cover their practice in the community. Hospital-based midwives are covered by their hospital's insurance arrangements. To continue to offer our publicly-funded homebirth service, CMWA negotiated with WA Health for the CMP midwives to become direct employees of the state in order to access insurance. Our midwives are covered, and our homebirth service carries on despite any federal or state changes.
For midwives in independent practice, they have had to practise without insurance since 2001. Recent federal legislation has been released requiring all registered practitioners, which includes midwives, to have insurance to practice. In the 2009 Federal Budget Nicola Roxon announced that there would be "a Government-supported professional indemnity insurance scheme for eligible midwives" . However it has transpired that independent homebirth midwives are not covered to provide care for a woman birthing at home - they are covered to provide antenatal and post natal care, and can care for the birthing woman in hospital. Midwives in private practice now have a 2 year period where they can continue to practise, pending further developments on insurance, and clarifying what collaborative arrangements with other care providers will need to be in place.
Continuity of Care
CMP's homebirth program works on a caseload basis. This means
that each woman is allocated a midwife, and 2 backup midwives for her
care. Because of the uncertain nature of when babies will come, having a
backup is essential for the woman and baby's care and safety, although
in most cases the woman can birth with her primary midwife. This model
supports continuity of care where the woman will know her midwives
before going into labour. Continuity of care throughout pregnancy and
birth has been proved to increase satisfaction levels for women and
their families, decrease the need for drugs for pain relief during
labour and reduce the level of medical interventions while labouring.
Currently in WA continuity of care is only available through planning to birth at home either with the Community Midwifery Program or with an independent midwife. Women often birth with a familiar midwife at KEMH's Birthing Centre but generally this ideal does not continue if transfer to hospital is required. The need to increase access to continuity of care models was highlighted in the 2009 'Review of Homebirths in Western Australia', - Recommendation 24. CMWA advocates for continuity of care for all Western Australian women, no matter what level of risk they may experience during pregnancy or birth.
Vaginal Births after caesarean (VBAC) are on the increase in WA due to information about the safety of this option being more widely available. A great source of support, information and research on VBACs is available on the Birthrites website. CMWA is currently unable to offer woman seeking a VBAC a place on the Community Midwifery Program. As CMWA's vision is for 'safe, respectful, empowered birth choices for all women' we recognise the importance of expanding the options for VBAC women. CMWA encourages women to submit an application to the Community Midwifery Program as it contributes to the data necessary to evidence demand for a VBAC service.
We offer a VBAC information session, as well as a Positive Caesarean session on the second Tuesday of the month at 10:30, alternating between the two. Check our workshops page for latest details and you can always contact our midwife Monday to Thursday on 9430 6882 if you would like to know more about VBACs or would like further support. See also our Birth Choices information page including a link to King Edward Memorial Hospital's Next Birth After Caesarean (NBAC) clinic.
Birthing you baby in water is generally not an option available
to women except in the homebirth evironment. Have a look at our page
in the Birth choices section. A review of the WA Department of Health's
waterbirth policy was recently completed and is being implemented
across the public hospital system. In practise that can mean that
birthing pools are used for the 1st stage of labour when the woman is
dilating to assist with pain-relief, on the understanding that the woman
must be out of the pool in order to birth her baby. Make sure you ask
the hospital what their waterbirth policy is. You can purchase a
birthing pool for your birth by contacting Simply Birth.
The film 'Birth Rites' (Jag Films 2000) is a powerful documentary that highlights the plight of Aboriginal women living in remote Australia who are forced to leave their communities to birth due to the lack of maternity care. options This practice has continued throughout remote and rural Australia for over 35 years and has had far-reaching, negative effect on the health and well-being of Aboriginal woman, and their families, communities and cultures. The documentary contrasts the situation in Australia with the incredible success of an Inuit-run Maternity Centre in far-northern Quebec in Canada. In the early 90's, in an area far more remote than any Australian community, the Inuit midwives of Povungnutik succeeded in returning birth to their lands and with stunning outcomes for women and babies, and the community at large. Although almost 10 years old 'Birth Rites' remains current in terms of the continued dislocation of birth and the almost universal disempowerment of pregnant women in rural and remote Australia. In urban WA, unfortunately Aboriginal women have rarely accessed the support of the CMP.
On the up side, at WA Health's Public Health and Ambulatory Care Unit workhas received funding and is developing an Aboriginal Maternity Group Practice model of care. This initiative is being developed and coordinated by Aboriginal Health professionals Lesley Nelson and Cheryl Hayward, with the support of Clinical Midwifery Consultant Karen Kruit. WA's 2007 Maternity Care Framework and the recently released federal Review of Maternity Care in Australia, both stress as their key priority the need to address the health and well-being of Indigenous mothers and babies. As with the Inuit example mentioned above, it is through the empowerment of women to make decisions about their own maternity care that fundamental change will come. To loan a copy of 'Birth Rites' contact your local library (if not available request a copy be purchased through www.jagfilms.com.au) or from CMWA.