20 December 2017
To the Committee of NZCOM
Firstly we would like to express our delight at the focus of the latest issue of Midwifery News on primary birth settings. As was expressed so well in several articles across the magazine, there are multiple advantages to mothers and babies when birthing in primary settings, and significant risks when low risk women birth in hospitals. What concerns us greatly is that within this discussion on primary settings, the option of home was almost ignored, and in the context of this focus, that is concerning.
We as a consumer organisation are disturbed by what appears to be a lack of support for one of the three key place of birth options as outlined by the Ministry of Health. The HDC Code of Rights requires all expectant mothers to be clearly informed of all three options and allowed to make the decision that suits them best. We are highly concerned that this is not being done, and that many women are not aware that they have three options, or that they are being restricted in their choice by what locations the midwife prefers. We are concerned that a number of midwives are not meeting their requirements under the Code, both to provide full and clear information, that allows informed decision-making by all women regarding place of birth but also to be able to provide sufficient care and skill to meet their client’s needs. If a midwife working as an LMC is only confident enough to support a low risk birth in a hospital setting, then that is not meeting the Code of Rights requirements. We are concerned that the number of midwives who fit this description is significantly high, and we feel that the College does as well, hence the focus on primary birth in this magazine issue. Hence we request the College be more strident in assisting in the return to the norm as it used to be – midwives who are capable of fulfilling their duty under the Code of Rights and the College of Midwives’ Consensus State, and being actually able to support birth in ALL three settings, and not just paying lip service to this.
The location of home being given scant attention in the latest Midwifery News may not have been intentionally done, but it illustrates the widespread attitude of home being considered a minor option, and this seems to be an attitude that is clearly entrenched in the minds of the midwife collective. Even what was otherwise an excellent article by the President, Deb Pittam, mentions home in a subtly derogatory way, with the expression “as far as the safety of birthing in primary units or, for that matter, at home is concerned, the evidence is strong.” Home is mentioned as an afterthought. And while it is quite possible that Deb doesn’t actually feel that home is of lower standing to a primary unit (although she may, we couldn’t rightly say), the inference by a casual phrase like that is often subconsciously reinforcing midwives’ opinion of home birth as not on an equal level with either hospital or primary units. We feel compelled to point out that tacit messages like that, as well as discussions of primary/community locations where primary units are strongly pushed, and home is barely mentioned at all, will continue to reinforce these negative ideas about home birth in the minds of most midwives. The College needs to lead the charge of upholding home and primary units as equally valid, and equally excellent places for babies to be born in safe and empowering circumstances, as Deb alluded to in the opening statements of her article. The skills and expertise of a midwife experienced in true normal, physiological birth is more than sufficient to operate in both settings. It is the clients that are missing out if their choices are being restricted by where a midwife is more comfortable working.
While we acknowledge that the article on community birth by Lesley Dixon did mention home twice, in qualifying the term primary or community locations, in actual fact the angle of the entire article was clearly to promote primary units only. We request clarification on why home could not have been given priority in part of the same article. As research studies were strongly used by Lesley in her discussions, if there isn’t sufficient quality research that focuses on or includes home birth, we respectfully enquire what NZCOM is doing to rectify that. If the next issue of Midwifery News plans to give the same amount of time and attention to home birth as the primary units received in this issue, then we await it with interest and wonder why that was not stated early in the article, making it clear that home is not nearly invisible, but a primary location, the first listed in Ministry of Health information, and strongly supported by the College. As pointed out by Jacqui Anderson in her article, private providers are behind a number of primary units, and if primary units are being promoted to the detriment of home, and home not being supported in equal measure, it does begin to ring alarm bells in the minds of some as to who is profiting by an uneven support of primary locations over home.
Another situation that surprised and dismayed us, particularly when considering the focus of this issue of the magazine, was the lack of any mention of the recent national Home Birth conference held in early October. It took place before the Joan Donnelly conference, which received a full report in this issue, but not only was similar attention not afforded the Home Birth conference, but there wasn’t even a snippet mentioned in the Bulletin paragraphs towards the final pages of the magazine. We find this quite extraordinary, particularly since not only was one of the College’s senior staff a delegate, but she also contributed to this magazine issue. The natural assumption is that as a staff member, Lesley would have been required to report back on her attendance at the conference to the College, and we wonder how the speakers and topics covered, were not deemed relevant to mention in any way in this December issue. The conference was very successful, with as many as three quarters of the delegates being midwives or student midwives, and the topics presented were not only well received but things delegates wished could have received a wider audience. Our venue had a capacity of 120 and we had reached capacity and were receiving emails from people desperate to attend two weeks out.
We thank you for your consideration of our concerns, and look forward to receiving your thoughtful response as soon as possible.
Sandy McGivern-Butler, Chairperson
Lynne Carne, Committee Member
Donna Fowles, Committee Member
Holly Neilson, Committee Member
Philip Carne, Committee Member
Rose Fisher, Committee Member
Fiona Saunders, Committee Member
Bridgette Jones, Committee Member
Alix Whittaker, Committee Member
on behalf of Auckland HomeBirth Community
www.ahbc.space | firstname.lastname@example.org
Cc: Sue Claridge, Auckland Women’s Health Council
Holly Neilson, Maternity Services Consumer Council
Brenda Hinton and Linda McKay, MAMA Maternity Ltd
Auckland Region Committee, NZCOM