My public comment on the draft - National Guidance on Maternity Care

or as I like to call it, Sharing the Maternity Habitat.

It's a bit long, but I've been too unwell to write anything more substantial than a tweet for ages, so I thought I'd put it up. It's terrible, but the best I could do in three hours :-\

To Whom It May Concern:

I’m an over educated mother of two having two degrees and a philosophy honours. I have been interested in reproductive autonomy ever since I had to fight to get it during the births of my two children. I have maintained an active interest ever since. My activities include writing to MPs and supporting and advising friends of their rights during their pregnancies and births. My primary reason for penning this contribution is that I believe that home birth midwives are professionals in their own right and thus should have indemnity insurance etc without the rather draconian necessity for collaboration.

Details are below. I humbly apologise for any errors of expression or formatting. I’m rather busy and vague and I was reminded of this deadline today - I only started at 9.00 pm! Obviously I feel very strongly about it if I’m willing to sweep all other commitments aside to work on it.

Reading through 1.1 Collaboration in health care, I am reminded that the hospital environment has its origins in the military and still has a rigorous ‘chain of command’ environment with doctors at the top and unquestioning nurses at the bottom. I was pleased to see your acknowledgement of the current health care culture in 2.6 Mutual trust and respect:

“For maternity care collaborations to be successful in Australia, the culture in maternity services will need to change. The current lack of trust is proving a major barrier. Trust and respect must be earned, rather than just assumed (Box 2.8; NHMRC consultations 2009).”

Collaborative care challenges that culture and you are to be congratulated on your efforts in this regard.

Summary of my points

We need to be sure that the people determining what is best evidence are capable, discerning and impartial. That is, they know how to read a paper and have some grasp of statistics.

Despite assertive wording in this document to the contrary, a power imbalance will continue between doctors and midwives. That this power imbalance remains illustrates that midwives are still not identified as independent maternity care professionals.

Private midwives must be able to enter metropolitan hospitals as the birthing woman’s chosen maternity care coordinator and be able to act with appropriate authority in this position.


Box 1.2 Point 2

“Collaboration empowers women to choose care that is based on the best evidence and is appropriate for themselves and for their local environment.”

During my experience in science I found that “best evidence” is always open to debate, and often what is best evidence is dictated by those who are perceived as more knowledgeable or experienced. In this case, the perceived voice of experience is the AMA. If the people dictating “best evidence” are doctors (well meaning, but fallible, reluctant to be sued, and an amazing number of them can’t do statistics) then there will be no improvement in maternity care and women will not be empowered because they will not be fully informed. Recently, the head of the AMA used a South Australian study to show that home birth was dangerous. If one reads the research paper it is perfectly clear that he misunderstood it, and if one removes the problematic births (premature, fatal birth defects) home births are just as safe as hospital births for normal pregnancies. We need to be sure that the people determining what is best evidence are capable, discerning and impartial. This needs to be explicitly stated in the guidelines as evidence guides risk assessment policies and it is these policies that will directly affect pregnant women.

Box 1.3

“Collaborating partners are independent maternity care professionals who are actively collaborating (i.e. not in an employee–employer relationship). Collaborating partners refer women to each other as the need arises.”

Despite your emphasis on there not being an employer-employee relationship, the power imbalance between doctors and midwives remains. A doctor will not lose insurance and Medicare access if a midwife refuses to collaborate with him/her, but a midwife stands to lose all of these things if a doctor refuses collaboration. That this power imbalance remains illustrates that midwives are still not identified as independent maternity care professionals. The power relationship is the same as that of an employer/employee in this respect.

I am saddened to see the assertion repeated here in 2.3 Awareness of disciplines and autonomy:

“Importantly, maternity care professionals should fully respect each other's professional autonomy. As regulated health practitioners, each clinician is responsible for working within and to their scope of practice, as defined by their profession, and in line with their professional and organisational codes and guidelines. Maternity care collaboration does not include one profession controlling the practice of another.”

Until midwives can access insurance etc without a collaborative arrangement, these mentions are mere lip service to the idea that one profession does not control the practice of the other.

Back to Box 1.3:

“A collaborative agreement or arrangement is an informal or formal recognition of the terms of a collaboration.”

How are midwives going to qualify for insurance etc if agreements are informal?

3.3.3 Metropolitan public hospitals - Access to Hospitals

You state that “access may be problematic at metropolitan hospitals”. This is something that must be addressed in the legislation to prevent situations where the birthing woman has chosen her maternity care coordinator, but this coordinator cannot attend the patient in any meaningful way if a transfer to hospital becomes necessary.

I note that you address some of the issues in 3.2.6 Credentialing, however, I believe that the emphasis on allowing privately practicing midwives access to hospitals should be stronger. Below I emphasise my concerns regarding outcomes if a midwife is not allowed to practise at the hospital of her client’s choice.

If a privately practicing metropolitan midwife cannot be credentialed at several hospitals then this will restrict choice of hospital for anyone she cares for and 1.2.1 Definition of maternity care collaboration:

“They support the person the woman has nominated as her maternity care coordinator, and recognise clearly defined roles and responsibilities for everyone involved in the woman’s care.”

is not remotely possible. Private midwives must be able to enter metropolitan hospitals as the birthing woman’s chosen maternity care coordinator and be able to act with appropriate authority in this position. In order to act with appropriate authority they must also have clinical privilege. Clinical privilege is something that can be established during the organisation of transfer plans.

I note this also comes up in 2.1 Women centred care and communication:

“Women have the right to decline care or advice if they choose. Therefore, if a woman refuses care or advice based on the information provided, her choice must be respected. Importantly, women should not be ‘abandoned’ because of their choice (NHMRC consultations 2009). Having a coordinator of care to provide a consistent, clear point of contact is integral to this approach (NHMRC consultations 2009).”

Again, if a private midwife has appropriate authority in a hospital setting the issue of abandonment becomes null and void. I know women who have elected not to have a private midwife because the thought of being in a hospital where their primary carer would have to leave their qualifications at the door was too daunting.

3.2.7 Hospital bookings

It is my opinion as a consumer that booking into hospital ought to be compulsory, and that the hospital should be notified of beginning of labour, particularly for a home birth. Making this compulsory would facilitate communication between home birth midwives and doctors and also act as a gesture of goodwill. Even the most belligerent OB can muster some respect for a safety conscious home birth midwife.


Again, I admire your efforts to change the culture of maternity care in Australia. But I reiterate that home birth midwives and models of care need more support than they currently get in these guidelines.

Yours sincerely,

Roxon's response to AVN and a dig at her take on home birth.

From a press conference with Nicola Roxon, the Health Minister, and Jim Bishop, the Commonwealth's Chief Medical Officer.

Question: Do you think an element in the slow take-up has been misinformation from the internet and from groups like anti-vaccination network?

Nicola Roxon: I think we've been quite clear about the anti-vaccination network's objections to any type of vaccination which is not based in any of the science or medical advice that we have.

I can't explain or predict how many people pay attention to that. I think it is irresponsible material, by and large, and I would encourage all Australians to act on the advice of the Government, of course based on the advice from the Chief Medical Officer, our specialised teams that meet to provide us with information, the very rigorous TGA process to ensure that this is safe for children, and we are satisfied of all those things and I think it is foolish for people to spread misinformation about a vaccine which can actually provide protection where we know there have been some bad consequences in paediatric situations, so for young children, and this is a way to protect against that.

Though I wholeheartedly agree with her this time, it's a depressing thought for me that she lacks credibility due to her involvement in restricting home birth. Roxon, unfortunately, appears to do none of the research herself. Rather, she seems to take as gospel anything anyone with a white coat or an AMA membership says.

For Melbournites - Birth Choices Meeting

Brief birth language...

Quite often when an unusual birth story hits the news you'll read about the hero civilian (or other non-medico) delivering the baby as though the mother was so much chopped liver. Nice to see a news article getting the labour the right way around for once!

Have an opinion on pain relief in childbirth? Not if you're a bloke you don't.

Wow, check out the backlash from girls who think they're experts on pain relief in child birth because they've had 1-5 kiddies. I'll take the opinion of a professional midwife over theirs any day, no matter what sex the midwife was. Is it possible that he's touched a nerve ladies? Sounds like those who begged for pain relief are being a bit reactionary, not to mention guilty of taking the poor bloke out of context. The idea was that women are frequently NOT educated about the side effects of strong pain relief such as epidurals (thus choice is not informed), and if it's possible to go without it's better for both mother and baby. He was not saying that women should, "just put up with the pain of childbirth" as the HS headline implies.

Response to SMH "Are home births safe?" Your Say.

Response to Your Say question on SMH.

Unfortunately, due to a lack of regulation and safety standards not all home births are safe. Preston was prepared, some are not and I'll bet it's the unprepared that skew the figures for home birth. For example, I'd call having a water birth at the top of a spiral staircase attended by a "birth attendant" with meagre medical qualifications ridiculously unsafe.

I would call a home birth with a suitably qualified midwife in attendance plus easy access to medical facilities if required very safe indeed. Safer, in fact, than most hospital environments where my need for a quiet, dimly lit, safe place to give birth is dismissed and often mocked by the white coats.

For most of us "crazy hippy home birth types" the position is a logical one: That the high rate of medical intervention we are seeing now is the result of the high rate of unnecessary meddling with what is a natural process. We believe that if the doctors interfered less, there would be less for them to do.

You can see how this position might mean a significant loss of cash for a certain powerful white coat lobby? You can see it from space.

Sadly, there is a bit of knee-jerk reacting going on with some women choosing to birth without any kind of attendance whatsoever. I believe this practice is a direct result of a public system that is letting women down. This is a difficult belief to prove.

However, the logical position I hold, that less unnecessary medical intervention (drugs to hurry labours, episiotomies, monitoring that restricts the movement of the labouring woman) would lead to less necessary medical intervention is not as difficult to prove. There are new studies appearing all the time: episiotomies, once routine are now known to heal more slowly and increase the risk of anal tears; caesarian sections are not as safe for the baby as once thought - it turns out that squeezing the baby's lungs on the way out is an important factor in the prevention of chest infections in the newborn. There are others of course.

The medical community has been misguided, ethically suspect and downright wrong before, take leeches and no hand washing between postmortems and surgery on live patients for example, not to mention the horrific error that curare was an anaesthetic. It's perfectly possible that they are wrong about home births now, the error would not be without historic precedent.

Letter to Ministers re Maternity Services Review

As usual, please feel free to use any of it as a template for your own letters. All care no responsibility etc.

Your MP's email addresses can be found here: http://apps.aec.gov.au/esearch/

and remember to CC the Minister for Health: Nicola.Roxon.MP@aph.gov.au

Dear Minister,

I’m hearing all over the media that only 1% of women “choose” homebirth in Australia. I’m sure that if homebirth were not prohibitively expensive the figure would be very different. I only “chose” to give birth in a hospital because the choice of homebirth was not available in our public health system, I could not afford a private midwife and I was not so stupid as to attempt to give birth unattended.

Though I had perfectly satisfactory birth experiences both times, (partially because I was lucky enough to experience continuity of care in family birth centres), I would have preferred to have had them at home. Had I, and others like me, had the option of homebirth readily available you would definitely find that a greater number of women would choose homebirth.

It is incorrect to say that only 1% of women “choose” homebirth. It would be more accurate to say that 1% of women were “able to have” a home birth. I am deeply saddened to read that the maternity review does not recommend that home births should be made more readily accessible to healthy women. In fact, it seems to be suggesting that homebirth would be effectively outlawed by 2010. It seems to me that this will endanger women who are not as willing as I to resign themselves to their hospital fate. These women need a safe solution, and women such as myself would deeply appreciate the choice.

Homebirth needs more monitoring, not outlawing or ignoring. Homebirth needs to be interfered with so we don’t see more tragic scenarios where women die doing it. Two examples spring immediately to mind: A woman who decided to have a waterbirth at the top of a spiral staircase with an inexperienced birth attendant who was “uncomfortable” inserting an IV that might have saved her life (Victoria), or the ignorant and unattended woman who decide to labour in filthy mud after her waters broke (Queensland). Had safety standards for homebirths been in place and enforced neither of the above women would have had to die. Though I think both women chose to give birth in ill conceived scenarios, I view their deaths as direct consequences of a health system which is letting them down with regard to birth choices.

In my opinion, midwifery attendance at homebirths ought to be compulsory and midwives who attend homebirths need to be registered as qualified to do so (homebirths require a distinct skill set and a greater depth of experience from the attending midwife). Midwives also need rigorous safety protocols with which they are bound to comply, they need idemnity insurance, and they need to be confident that they will be well received at hospitals should their clients require hospital care.

The maternity review is the perfect opportunity to explore solutions such as those outlined above. If the argument that women ought to be able to exercise more autonomy in the birth arena does not persuade you, then perhaps this notion will: These solutions, once in place, would be cheaper than maintaining a hospital environment for healthy women who do not want to attend one. Our community would also reap the rewards postnatally with less women feeling traumatised and invaded by a hospital experience they would have preferred to avoid - postnatal depression is costly to the federal government and the community.

Please consider campaigning for safe, commonwealth funded home birth in Australia. It is too late for me, but not too late for women who come after me.

Yours faithfully,


BSc/BA Hons (Philosophy)
Mother of two.

Some Reactionary Commentary on the film Orgasmic Birth by someone who read the pamphlet and checked out the website.

I must be feeling a bit better because these (very similar) articles in The Age by an Avril Moore made me a tiny bit angry. Just a little bit. A twinge.

Maybe, because I've seen the film and helped host the Melbourne screening I'm taking the whole thing a little personally.

Or maybe I'm just cross because she spouted her drivel having not seen the film.

Nope, it's neither of those things, it's this: This Avril chic is using her painful births to trump all the women who report a painless or ecstatic birth. She has blithely silenced the voices of women who report beautiful birthing experiences, dismissing their accounts and replacing them with her own. Isn't that one of the things the patriarchy is supposed to be good at? Disregarding the reported experiences of women? Telling us what it is we are supposed to be experiencing? particularly when it comes to childbirth? Tisk tisk Avril, BAD feminist, naughty!

Avril called the "natural birth community" backward when she accuses them of deferring to men. Avril complains that, "this 'woman-centred' approach to birth, all dressed up to empower labouring mothers, remains unapologetic in its deference to men" simply because one woman reported a reduction in pain when she smiled at her husband.

Wow.

Some readers may remember that I happen to know quite a bit about pain, and I'm pretty sure that what Avril knows could be stamped on a paracetamol capsule: Times New Roman, size 10 font - "Birth, it hurt when I did it!". It is not unreasonable to suppose that smiling at someone you love during labour could reduce pain. Distraction is an age-old technique for reducing pain, meditation forms part of the armoury against chronic pain and there is plenty of other evidence much of it published in reputable journals, that focussing on pleasurable things works wonders for pain. In infants, physical pain response is reduced when they are given sucrose to suck on, distraction with something nice is a time tested pain reliever for young children. If smiling at your husband distracts you and gets some happy chemicals pumping in your brain then wonderful! It's hardly what I would call deference.

She cites other examples of deference too. Ina May Gaskin dares to dedicate her first book to her husband and apparently two homebirth doctors in the 1970s were OMG! blokes! Avril, in the 1970s most doctors were blokes, you played the odds and won there, and my honours thesis would have been dedicated to my husband (if it had been dedicated to anyone) that doesn't mean he told me what to put in it.

Avril's contempt for Ina May Gaskin beggars belief given her credentials. Avril has experienced three births, Ina May has been present at over 1200 and pioneered an extremely effective low intervention solution for shoulder dystocia. Avril, 3, Ina May, 1200. I think Ms Gaskin is winning in the experience stakes. Also, as a writer, Avril should know that a book like Spiritual Midwifery doesn't run to four editions if it's full of hippie clap-trap.

If Avril had seen the film, she would have known that the women in it are a far cry from shutting up and smiling submissively at their husbands. They are not only very much in charge they are very noisy indeed, it's just not the kind of noise that we expect to hear having been fed hysterically screaming women by mainstream media. It's animal, it's beautiful, and if you heard only the sound track you might think you were listening to quality porn - for real.

I gather, Avril, you were more of a screamer? REALLY focussed in on that pain, did you? Good on you! Whatever works dear.

When it comes to birth, men can be fragile creatures.

This piece in The New York Times spoke volumes to me. It's an ordinary bloke's account of his failure to cope with his daughter's early arrival on the bathroom floor.

I don't like a great deal of the sentiment, such as his expectation of how the birth would proceed:

I had been expecting the birth to occur in an orderly fashion at the hospital: the midwife and nurses in scrubs, regular reports on how many centimeters her cervix had dilated, an opportunity to hold Leslie’s hand and wipe her brow. I had wanted to be the useful partner — and the witness. When the baby arrived, I would accept her from the nurse before placing her on Leslie’s chest, basking in the tableau of mother with newborn child.

Could his vision be any more polluted by the patriarchal myth that women need to be flat on their backs surrounded by a team of experts in order to do what most of them have been doing either alone or in the company of family members ever since we became bipedal? Does he have any idea of the history behind his desire to be the first to hold the baby? (In ancient Rome the father would be given the baby in order to see if it met his approval, if it did not it was exposed or sold into slavery.) Does he have any idea how useless (and annoying) brow mopping is? (If I had a dollar for the number of times I've seen women giggle over their husband's earnest brow mopping on Mummy Bulletin Boards... If my husband had tried that he'd have been flung across the room and possibly banished.) My guess is that our author is oblivious to both the implications behind his desire to be passed the baby and his misguided utility. I can't really blame him. He's a product of western culture, particularly American culture. So, when his wife yelled that she was having the baby in the bathroom, he did what he'd been taught to do - panic and call an ambulance. The birth of his daughter without him brought home a stark reality: he wasn't needed at all, it was quite possible he'd made things worse.

I think that unless we are careful, instead of being a participant in something wonderful, men like this one can be made to feel like irrelevant spectators. For the raw truth is, they are not needed at the birth. Natural and water birth pioneer Michael Odent goes so far as to say that male partners should not be allowed at births, that they only get in the way. I half agree.

I definitely wanted my husband there for the birth of my second, but I didn't take it for granted that my partner would be there the way I did with my first. He was very deliberately included in a team of half a dozen people and prepared appropriately for the event. The poor man, who comes from a very patriarchal home, was lectured to, shown videos, read to from books, made to be my advocate when I needed one, and given very strict instructions as to the boundaries of his role. Just like most other Australian blokes, his experience of birth was limited to movie portrayals and anecdotes from older relatives so he needed an entire re-education: history, medicine, male power and the myth of control. The man stepped up to the plate like an absolute hero and ended up catching his daughter (I was on my hands and knees for that one). He'll never forget it and neither will I.

My husband was the antithesis of the helpless, panic stricken ambulance caller. He knew what he could do, what I only I could do and exactly how he could facilitate it without getting in the way. He was amazing.

However, had he displayed a reluctance to be swayed from the patriarchal medical model he'd have been excluded. It would have been horrible and heart-breaking but I would have done it. The birth was both something I had to do, yet was also something that was happening to me - it was a tug-of-war between me, my body and a baby clamouring to get out into the world. I would never risk having someone present who might disrupt the delicate relationship I needed to establish with my body to achieve a good outcome. Husbands who panic, or who encourage their wives to accept interventions to satisfy their need to feel like "something is being done", are not capable of acting in the best interest of their wives. They'd be better off in the waiting room nursing their cigars.

To summarise, any man who believes that birth should be orderly and furthermore, CONTROLLED should definitely be banned from attending births. Most of them love their wives and want to be supportve, but their panic in the face of their helplessness is not, well, helpful.

Expectations for GREAT Maternity Services Reform - National Day of Action - November 16th

Great Expectations- National Day of Action


The recent review of Maternity Services in Australia is an historical event. Not only is it numerically significant it heralds the presence of what is most important actual Government support for much needed maternity service reform.

The Rudd government has been forthcoming in their promise to review maternity services and to improve upon them. Health Minister Roxon has publicly challenged the current medically dominated system and highlighted the need and the opportunity for enhanced midwifery care.


The timing is such that a visible presence is now required to make a really powerful impression that reform is necessary, wanted and indeed expected from the Australian public.


We have chosen the 16th of November to be a National Day of Action to support and make known our Expectations for GREAT Maternity Services Reform.


Please consider gathering in your local community or in a central capital city location to cement the support that we the women, men and families of Australia give to reform of Maternity Care provision in Australia. A picnic, candlelit vigil, or walk for reform are some ideas for gatherings that could be utilised to draw media attention, educate, show support and celebrate the pending report and recommendations.



The winds of change are blowing and this presents an incredibly exciting and celebratory chapter for all who have worked at one time or another for reform.



For further information about events …


Please call Janie Nottingham 0359 748364 or Mobile 04206 20808

Email Janie.nottingham@gmail.com

Orgasmic Birth - The Best Kept Secret

Hi all,

Just thought I'd let you know I'm passionate about womens' autonomy throughout pregnancy. There are many ways I demonstrate my passion for good births in my private life and helping my friend launch the Victorian screening of Orgasmic Birth is one of them.

Birth Attendants.info presents:

Orgasmic Birth - The Best Kept Secret
by filmmaker Debra Pascali-Bonaro

A documentary that examines the intimate nature of birth and the powerful role it plays in womens’ lives when they are able to experience it fully.

A film to touch your heart and challenge your preconceptions of childbirth, this film is a must see for mothers-to-be and professionals who support birthing women. It encourages us to view the process of labour and birth as an event that can be ecstatic, a life highlight rather than a trauma to be endured.

In Orgasmic Birth, beautiful images of labouring women ripple through the professional commentary, revealing a phenomenon that is rare in public media today — a normal labour. Safely supported by sympathetic medical professionals, doulas and family, we see women giving birth who experience a monumentous life event that is both empowering and enlightening. Orgasmic Birth is a call to women everywhere: “Women of earth, take back your birth.”

Orgasmic Birth is an educational documentary and is exempt from classification. As it contains images of birthing women, we recommend viewing by Adults Only.

Screening at The Palace Como, located at the corner of Toorak Road and Chapel Street, South Yarra (2 hours free parking in Centre).

Premiere screening on Friday 3rd October at 6:30pm ($28, includes light refreshements and features guest speakers Dr Sarah J Buckley & Rhea Dempsey)

Second screening Monday 6th October at 6:30pm ($22, light refreshments only)

Bookings Essential
Contact: http://www.birthattendants.info/orgasmic_birth.html

Yey! Let's model our birth care on the Netherlands!

Having had to fight for a natural birth in Australia, I can imagine this woman's shock at how things are done here. Poor thing. I can't imagine how angry she must have been when she was made to lie on her back.

(For those of you who think that having a baby on your back is a good idea, next time you need to poo, lie down on your back with your feet in the air and see if it's easier to push out than if you are upright...)

Women have only been having babies on their backs for the last 300 years, and all for the convenience of doctors. Doctors who get bored when nothing goes wrong and there's nothing for them to do so they invented "managed labour". Stick with midwives I say, bring in the doctors for actual pathology.

Just yesterday I heard a woman on 774 saying, "Normally in Australia the woman gets an injection to help her deliver the placenta."

"Normally"

It made me want to claw away the car interior in frustration. In a normal birth a woman does not need help delivering the placenta at all. Mother and baby snuggle, possibly breast feed, oxytocin is released, uterus contracts, placenta comes out. Why waste taxpayers money interfering with something that is, in 97% of cases (I think that's still the correct figure), perfectly ok if it's left alone?

Grrrrr.

Just one more reason our OBs are so "caesar happy".

Without making light of this woman's tragic circumstances, she is a prime example of the reason OBs in litigious societies are so gung-ho about cutting women open to get their babies out.

Losing a wanted baby is tragic in all circumstances. But it does not necessarily follow that a tragedy has to be someone's fault. Having babies has always been risky, for both mother and child, things go wrong despite the best efforts of doctors. In this case a baby died in the womb due to having the umbilical cord wrapped around its neck. When accidents such as this happen, it is natural to want someone to pay for your unhappiness. It is easier to cope if it is the fault of someone else. In this instance, believers in an interactive God have one up on us. They say it was God's doing and he had a reason, thus they move on.

Unfortunately, the rest of us tend to sue a doctor to make ourselves feel better.

As a result OBs are performing drop-of-a-hat caesarians (many of them unnecessary) because if they do that and the baby still dies they'll be able to say they've done all they can. ProLifers claim that abortions are bad for your reproductive future, well Caesarians are much, much worse. The WHO has known this for ages, Australia is still catching up.

But this women isn't complaining about an unnecessary caesarian. She is complaining about a lack of intervention. I find this, to say the least, rather frustrating.

In this case the woman is blaming the hospital for the baby's death. She thinks that if she had been regarded as high risk, if there had been more ultrasounds the problem would have been picked up.

I don't understand. An umbilical cord can become problematic in a matter of hours, did she want 24 hour surveillance of her healthy pregnancy?

True, the hospital could have been quicker, and by the sound of it they were almost criminally unsympathetic. But in this particular case it is doubtful that they could have helped even if she had been seen immediately. There is a rather large time lapse between first noticing there is a problem with your baby, going to your GP, and then traveling to a hospital. At least an hour if you're lucky and really hoofing it, and a foetus only needs to be without oxygen for a few minutes.

So why would this woman blame the hospital? (She says she doesn't, but holds them responsible, which amounts to the same thing in my opinion.) She blames them because of a myth that the medical profession has the power to guarantee us a perfect healthy baby. An ideology that states that unless you hand over the entire process to a white coat you are putting yourself and your baby at serious risk. The myth that a maximum of technological interference is a good thing for both mother and child.

When women hand over the pregnancy and birth process to a doctor (and any woman who needs a doctor to "confirm" her pregnancy comes firmly under this category) they hand over responsibility for the outcome, and get to sue if they don't like it. The natural response of doctors is to do everything they possibly can to ensure a "healthy baby outcome" usually at the expense of the physical well being of the mother.

We're stuck in a loop where parents want a healthy baby guarantee and professionals are being scared into performing unnecessary surgery to comply. Australia has one of the highest caesar rates in the world. This is a disgrace.

The only way to break this cycle is to put the responsibility back where it belongs. With parents, who need to know that some things can't be changed or avoided, and that there are very clear areas where medical intervention is helpful, and when it is not.

Until then, we'll have myopic parents placing their fate in the hands of doctors who are well meaning, but not omnipotent, and reluctant to be sued.

Trainee doctors need to witness more normal births.

When I was giving birth to my daughter I allowed a student midwife to be with me throughout the prenatal period and during the birth as part of her course requirements. She informed me that natural births were rare as hens teeth, that it was very hard for student midwives to find any. I can only imagine that the situation is as dire for trainee doctors. Though I'm sure their version of normal is a long way from mine. I do not consider a birth in a brightly lit room full of medical equipment with five or six strangers present to be "normal".... but I'm funny like that.

What follows is my two cents on a lament by a Queensland Prof. that trainees could not get in to witness normal births:

As a woman who only permitted midwives and student midwives to attend her both during her pregnancy and labour (with the exception of some routine medical tests done by my GP) I can understand why women would not want a student doctor coming in at the end for a "sticky beak".

Not only is it a moment that should, as far as the woman wants it, be deeply private; last minute attendance implies that the baby's exit is all there is to a normal birth.

However, I wholeheartedly agree that not enough trainee doctors are exposed to normal births. I think that the best way to increase exposure is to have a trainee follow the whole process with the permission of the mother.

Andy's suggestion that public patients should not be able to opt out betrays a deep disrespect for the privacy of birthing women. That kind of solution is unnecessarily draconian and implies that privacy is a privilege for the wealthy.

If someone had asked me whether a student doctor could follow me through the prenatal period and the birth I probably would have said yes (I said yes to the student midwife after all). But strangers at my birth? Not unless something has gone very very wrong.

People who blindly trust doctors with child birth annoy me.

My contribution to the noisy and emotional discussion about caesarean sections. Click on the title to go to the discussion on the Sydney Morning Herald website.

I'm amazed at the number of ill informed folk posting here. I'm also amazed at the number of people taking the issue personally. Doesn't anyone teach reason and argument at schools any more?

Most of my friends did more research into the purchase of their latest car or TV than they did into the birth of their child. It beggars belief.

For heavens sake people, get educated. Take a look at the recent medicalisation of childbirth, read the HISTORY, take into account that we have been bipedal and giving birth without assistance for 300,000 odd years, acknowledge that in some cases natural processes go wrong. Take a look at the birth stats for countries such as NZ, Canada, US, UK, Netherlands etc, compare policies, methods and outcomes. Look at the stats for our country, listen to the experiences of those around you. For heaven's sake don't get your information from Maternity Ward or *insert any dramatised birth story television show*. Find out what the World Health Organization says. Learn exactly what your rights are in this country, especially when it comes to "informed consent" as that tends to go out the window in a labour ward.

After all that, if your OB recommends surgery for your healthy pregnancy you are likely to ask for a second, if not third opinion. That is if you've opted for an OB at all (checking out the stats in Australia should tell you why most people who check the stats don't have a private OB).

If, once you've done your homework, you still want to opt for unnecessary surgery, you will have my astonished, but heartfelt respect for your well informed decision.