NMBA - Consult with the Homebirth community to fix your Guidelines putting us at risk
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NOVEMBER 16, 2018
Ms Tanya Vogt – Executive Officer
Nursing and Midwifery Board of Australia
GPO Box 9958, Melbourne VIC 3001
I’m writing on behalf of the homebirth community to express our grave concern at the ongoing actions of the Nursing and Midwifery Board of Australia, and the likely consequences that these will have on public safety.
As you would be aware, women have the right to make choices for their own midwifery care. This includes the woman’s right to decline recommended tests and procedures. This includes the woman’s right to make care choices against her midwife’s advice, and choices that are not considered by her midwife to be evidence based. This also includes the woman’s right to birth at home in circumstances outside the Australian College of Midwives National Midwifery Guidelines for Consultation and Referral (the Guidelines). These rights are upheld by Australian law and international human rights principles.
The Appendices of the Guidelines contain a pathway and a documentary record, which allow a midwife to continue providing care to a woman making choices outside the Guidelines. These documents contain the disclaimer that “the midwife’s continued care does not mean that she or he endorses the woman’s decision to choose a pathway of care that carries increased risk to the woman or her baby”.
It has become apparent that AHPRA and NMBA do not give sufficient regard to these rights, and to this pathway when administering the Safety and Quality Guidelines for Privately Practising Midwives and when investigating reports made against midwives who have continued to provide care to women who have made choices outside the Guidelines. It appears that AHPRA and NMBA view the continued provision of care in these circumstances as “putting the public at risk”, instead of understanding that by continuing to provide care (instead of withdrawing care to a client who declines to transfer to hospital) the midwife is acting in the public interest, and in accordance with the best ethics of her profession.
Research being conducted at Western Sydney University shows that where homebirthing women are unable to find a midwife to care for them, they will continue to birth at home without a midwife in attendance (“freebirth”). This same research also shows that around one in ten homebirths are freebirths. We know that the freebirth rate is climbing, due to the barriers many women face in accessing privately practising midwives, and also due to privately practising midwives ceasing to provide care to women with risk factors out of concern for their registration.
The central issue is: should women who make choices outside the Guidelines be able to continue to receive what care they do want from a privately practising midwife? As the homebirth community, we believe that the answer is yes. Unlike other health fields, pregnancy and birth will continue to progress, even in the absence of approval from the treating practitioner. We believe that it is more in the public interest that women receive what care they do want, rather than be pushed to freebirth due to regulatory red tape constraining the practice of privately practising midwives.
There have been freebirth deaths, and there will be more, if NMBA is unable to find a practical solution that empowers privately practising midwives to provide potentially lifesaving care to women who would otherwise withdraw from care all together.
Earlier this year, you and I spoke in relation to NMBA’s failure to consult with the public when introducing the second midwife requirement to the Safety and Quality Guidelines. This mandatory requirement continues to be opposed by the homebirth community, and has decimated privately practising midwives in regional areas, further increasing the freebirth rate, and further putting the community at risk. Fundamentally, the Safety and Quality Guidelines are deeply broken, because they do not acknowledge the woman’s legal and human rights to make choices in relation to her care, and because they do not contain a mechanism that expressly empowers midwives to continue to provide care when a woman makes a choice outside the Guidelines.
I urge NMBA to come back to the table, and work with the homebirth community to develop better guidelines that empower privately practising midwives to continue to perform their lifesaving work that benefits the whole community, without fear of disciplinary action due to their clients’ choices.
This is a public safety issue.
· Blue Mountains Homebirth Group – Lucy Johnston, Coordinator
· Darwin Homebirth Group – Michelle Harle, Coordinator
· Geelong Homebirth Association – Michelle Warwick, Coordinator
· Homebirth Access Sydney – Jodie Powell, President
· Homebirth Access Perth – Jenna Richards, Coordinator
· Homebirth Queensland – Azure Rigney, Advocacy Coordinator
· Maternity Consumer Network – Alecia Staines, Acting President
· Melbourne Homebirth Association – Catherine Wauchope, Secretary
· South Sydney Homebirth Group – Virginia Maddock, Coordinator
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