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The Illusion of Choice in Australian Maternity Care

by lizzi (follow)
Helping plant the seeds of positive birth. www.sproutbirthing.com.au
Birth (105)      Feminism (48)      vbac (46)     
I read it a lot. “I don’t like my doctor”; “The midwife I saw was unsupportive”; “My hospital won’t allow me to have a vbac”. What can I do about this is the question asked. And the response is generally: Change care providers. Chat to the manager and get them to assign you a supportive care provider. Get an independent midwife (IM). Have a homebirth.

Sounds simple doesn’t it? Because here in Australia we have so many options available to us – Private OB in a private hospital; Private OB in a public hospital; public hospital with obstetric or midwifery care; Group midwifery programs; Birth centres; Hospital run homebirth programs; Independent midwives who’ll support you at home OR in hospital. And if none of this takes your fancy freebirth is an option. It seems that the list of birthing options is ample enough to cover every single birthing woman’s wishes.

The choice in maternity care in Australia is a big fat illusion. Sure these options are all there. If you live in an area that provides them. Or have the money to pay for them. Or don’t have a scar on your uterus. Or have a BMI within acceptable range. Or you’re not labelled “high risk” for some other reason. Or you have a supportive partner. The women in Australia who have access to every one of these options is very very small. For the vast majority of women in Australia the choice is: Public hospital or freebirth. And freebirth is only going to be an acceptable option to a very small number of women.

Maternity room at hospital
standard maternity room, courtesy of Wikimedia commons

So let’s go back to the original question: My care provider isn’t on board for the birth I want. What can I do about it?

“Change care providers”: Oh such a simple thing to do. If you live in a town with a few different care providers! For my first pregnancy, the city I lived in had 3 private OBs operating (pun not intended) and only one taking on new clients. As one woman pointed out to me: “That’s not a choice”. And what if you do switch, only to find that the new OB is no better than the last? OR if the OB does the ole’ bait and switch on you – get you in then change their mind later? Perhaps you can’t afford a private OB, crossing that option off your list. So simply switching care providers may not be an option due to availability issues or cost issues.

“Get the manager to appoint you a doctor / midwife who will support your choices”: So you’re being seen through the local public hospital and ended up seeing a really unsupportive OB or midwife at your last appointment. One who makes you feel disheartened and unsafe. One you don’t trust. What can you do? It seems fairly simple to just get the manager to assign you an OB or midwife who supports your choices. But what if you are birthing in a small town where maybe there aren’t that many staff at the hospital? What if there is no-one at the hospital willing to support you because your birth plan goes against hospital policy? And what if the manager quite simply doesn’t WANT to go to the time and effort of finding someone truly supportive and just assigns you another random care provider – who turns out to be worse than the last? Sometimes it’s just not that simple and this often leads to the next few points.

“Hire an IM to support you”: Sounds wonderful in theory. And with medicare rebates IM’s are within financial reach of more women than before – especially if you plan to birth in hospital. But IMs are also few and far between. They are not available in every town and city. And those that are tend to book up pretty quickly! You also need to find one who has practicing rights at the hospital you plan to birth at – otherwise you are essentially paying for a doula with a midwifery qualification. And there are always issues of whether the IM will go in to bat for you against a hospital's policy - risking their relationship with the hospital and their ability to support other women to birth there.

“Have a homebirth”: What a beautiful idea. I would LOVE a homebirth. However, this requires me to find a midwife to support me in a homebirth. This can be difficult under the best circumstances, never mind if you have any risk factors. While trying to conceive my second bub I made an effort to contact some IMs in my area and ask about homebirth. I had a previous caesarean so was already considered “high risk”. The responses ranged from “I don’t service your area” to “I don’t support a HBAC, but would be happy to attend you in hospital”. The one midwife I could find who would support a HBAC, in my area, was planning leave for the 3 weeks prior to my EDD and didn’t know if she would have a back up. Not a situation I was okay with. If you can find a midwife who can and will support you to birth at home, you then have to finance this. The generally quoted cost of a homebirth is $3000 - $5000. This is a LOT of money for most of us. And it’s a huge risk to fork out all this money with the possibility that you could still end up in hospital.

Maternity room at hospital
Beautiful home water birth, courtesy of Wikimedia commons

“Have a freebirth”: If you can’t afford a midwife just freebirth! Freebirth is a beautiful option for some women. I know women who have spent their whole lives imaging their freebirth. I know some women who have freebirthed simply because they had no other choice. But freebirth is not an option many women are interested in. For a start – a lot of women will have no support for this option. Many women (myself included) will simply come to the conclusion that they can birth in hospital, with shitty care providers and increased risks WITH the support of their partner, family and doula or they can birth unassisted, at home, completely alone. Unable to tell anyone of their plans. Hoping that no-one discovers they are in labour. Unable to hire a birth pool or put anything in place. Hoping no-one decides to report them to the Department of Community Services or call an ambulance on them in the middle of it all. Worrying and wondering what the legal consequences could be if anything should go wrong. If you have the support for a freebirth, it can be a wonderful option. But it is fairly rare for a woman to have that sort of support.

So – you’ve gone through your options and come to the conclusion that all that’s really available to you is to continue your care with a care provider you don’t trust, who doesn’t trust you. You feel unsafe, disheartened, unsure, unsupported. What next? How can we prepare women for the fact that they may just have to “suck it up” and birth in a hostile environment? What can women do to help themselves and each other in these situations? How can we effect change in the birthing culture in Australia so that no woman ever need birth in a hostile environment?

Part two will be coming soon – Preparing to birth with a care provider who doesn’t support your wishes and helping change the landscape of maternity care in Australia. Please feel free to comment and share your own experiences birthing with an unsupportive care giver. Were you able to find an alternative solution? Did you have the options available to you that you wanted? What are YOU doing to help reform maternity care and birthing culture in Australia?

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I hear you. I had the caesarians, became a midwife, supported women, did homebirths and got run out of town. It is hard for the good midwives too.
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