As far as I know no one is saying Women cannot have ahome birth. Surely the author belives in small government, The Gov should give basic care ie Hospital birth, and if you want something different the go for it but you pay for it. I don't see what the issue is.

I agree Kenny,

Too often proponents of home birthing argue that the government is trying to prevent, or make illegal home birthing. This is not true, and the author attempt to argue this by attacking everything from hospital equipment "needles and gas, probes and clips through to forceps, extractors" to government spending. Hidden away in this argument is the true facts - "extending indemnity cover to include community midwifery will come at a cost."

If mothers choose to give birth at home, as they are freely allowed to, then the financial risk involved (insurance) should be on the patient, not the taxpayers.

The essential question is whether home birthing is regarded as a legitimate form of medical or health practice. If so, then there can be no rational reason why it should not have a Medicare number i.e. a basic fee paid by government. Personally I fail to see why a low risk mother, especially if not a primip, and where there is good, fast, ambulance access to dedicated hospital beds, should not be regarded as legitimate when carried out by a qualifed midwife under specified circumstances. I do not share Andrew Laming's rather touching belief that the shock troops of the opposition are not specialist obstetricians. The real problem however lies not in Medicare paying for the delivery but with the the cost of private indemnity which, for obstetrical practice, would be prohibitive for midwives. The only possible solution would be for the Government to assume the role of insurer...this would be a major new initiative and one that I would think politically unacceptable to taxpayers.

I agree Gorufus, the issue at hand is more a financial constraint rather than anyone telling women where they can or cannot give birth.

The problem as I see it is that the cost to insure home-birthing midwives who are practicing on their own, in the home of the pregnant woman, would be astronomical.

The home-birthing midwives are the sole person responsible for running a safe birth for that mother and baby. If anything goes wrong, and we all know that births are not always routine, then the midwife does not have the financial backing of hospitals or the health department that hospital based midwives have.

The government is never going to agree to financially back that kind of risk. Like people who want to try IVF, or have non essential plastic surgery etc, the potential home-birth mother should be prepared to pay for this extra insurance expence if they choose this birth method.

Most big hospitals now have good birthing suites that provide as close to the home-birth experience as possible, while still having medical help close by.

Australia is not as small in distances as New Zealand or England, where home-birthing is more common. The homes in those countries are much closer to hospitals and ambulance services should anything go wrong with the birth.

The medicare system is there to ensure that citizens get good safe treatment.

Home births require a dedicated nurse to travel, and not be available to anyone else, and require the back up of the ambulance service.

Home birthing is thus more expensive for no health benefits, and so I can understand why the funding has been withdrawn.

I'm shaking my head at these comments - what a load of twaddle! I wonder if any of those who have sent comments have ever come within cooee of a professionally attended homebirth? I have been to a homebirth (safe, beautiful, 'uneventful') in Melbourne early thismorning, and find this airing of ignorance almost amusing.

There is absolutely no basis for arguing that homebirth is less safe, more expensive, or wasteful of scarce resources than any other birth option. If you want to make life more safe you had better ban birth alltogether. The safest way for most women to proceed with birth is to labour spontaneously, without drugs to take away pain or to stimulate labour.

Andrew Laming, I appreciate your clear statements supporting homebirth, but your argument that excluding homebirth is about government overspending doesn't impress me. The risk profile of homebirth is extremely low. Homebirth numbers, and potential costs, are a mere drop in the government's maternity bucket. Supporting homebirth will not increase birth numbers.

But you are right saying that 'bad policy in 2 years is still bad policy'.

One point that is overlooked is that indemnity insurance has nothing to do with safety or even with compensation for those who are harmed as a result of health care.

This is an outrage! The patriarchy are still wanting to control women's bodies! It has nothing to do with money and everything to do with the misogynist abusive obstetricians interfering in women's right to enjoy their life-giving power. Men will never be able to overcome their jealousy of this power, so they soil this beautiful event with their selfish efforts to control women. It is nothing short of abuse and women need to reclaim their right over their bodies. Tampons should be GST free too! If women ran the world there would be no war either! If men had babies they would get 6 years maternity leave on full pay too!

Actually villagemidwife, I have attended a homebirth which was just a quick birth with no problems.
However, as a midwife, I have also received one of these would-be homebirth labouring mothers at our local hospital who came screaming in having had no antenatal care from a doctor and very little from the homebirth midwife!

It was a very traumatic time for us all, trying to work out what was going on, and she ended up with a caesarian and a sick baby!

That lady was one of quite a few that I have dealt with.
The problem is that many of these women think they can do it all 'natural', including financially free, and don't think they need to have a midwife visit as often as they should.

They need to live close to a hospital with a good, quick ambulance service, which many Australian women do not!

When everything goes pair-shaped, they present at a hospital in a mess.
No doubt there are plenty of wonderful homebirths, as there are awful hospital births, however I can understand why the insurance would be more expensive for a homebirth.

If ya wan to give birth your own way so be it. Wats all the talk about.
The indigenous done that for so many thousand years.
Just disappear into the bushes and do it your way and don't interupt any body else. The trouble with you is you want the best of of both, with insurance thrown in.
You are making a pig of yourself, with your native overtones.

I am astounded by the ignorance of these comments, bar Village Midwife. Suz, you may be a midwife but you have no comprehension of indemnity insurance and risk profiles for obstetrics/midwifery. The Dept of Health recently revealed while under oath that claims in obstetrics are 1.1 per 1000 births. In New Zealand where 80% of women are cared for by a midwife (with a 10% homebirth rate) there have been 5 claims against midwives in 300,000 births. The difference between 5 and 330 is considerable. The problem is not cost, the premiums would be lower, the issue is the political power weilded by vested medical interest and the fact that Nicola Roxon puts their needs ahead of Australian women.

As taxpayers we all pay for maternity care and not just public care like some claim. Taxpayers pay for private obstetric care through the Medicare safety net and the 30% priv health insurance rebate. Private health insurance offers absolutely NO CHOICE in maternity care it is anti-competitive and very costly.

Australian homebirth midwives when insured had virtually no claims. Australia's largest claim in birth negligence was from an overdose of syntocinon that caused a hypertonic uterus and like cerebral palsy. Suz you would know that the use of synto is rife in the maternity system, despite it being a very powerful and potentially dangerous drug. The case cost $11M in damages alone. Where is the responsibility for Obstetricians to curb their practice? Homebirth midwives are so scrutinised and as such have exemplary practice. If only Obstetricians were party to the same level of scrutiny.

If you think maternity is of no interest to you, you may like to know that Obstetricians increased their fees by 300% in less than 5 years. 80% of their fees are funded by taxpayers, so is a BILLION DOLLARS in indemnity insurance premium support since 2002. So when you or a loved one are genuinely sick and are denied care or endure poor care from a broken health system, remember rich obstetricians are rorting BIGTIME taking money from areas of genuine need.

Sage Femme, maybe I don't really understand the insurance problems faced by midwives or obstetricians, but I have seen many births over the years (and delivered plenty myself) that have resulted in live babies and mothers only because of the intervention of obstetricians.

I am a staunch supporter of midwife-run births of course, but we also don't want to turn all women off the idea of problem births that will need intervention to have a good outcome.

What worries me is these militant midwives and other like-minded women surging towards the 'ideal natural birth' as the only successful outcome for the modern pregnant woman.

What of all the women who really won't be able to birth naturally or safely without medical intervention? Will they be feeling less of a woman or a failure for not striving for a homebirth at all costs?

Safety and a healthy outcome for both mother and baby should be paramount for all births- not just the wishes of the pregnant woman for a natural birth.
I am all for choice of birth methods, but only if
medical help is close by, and only if it is best for BOTH mother and baby.

I wanted home birth desperately, and, being classified 'low risk' - although never having given birth before - investigated the process.
My husband could not be persuaded, so I went drug-free in hospital. My baby deteriorated very quickly, and suddenly had to be extracted with forceps, and then resuscitated. I'm glad I had more than one qualified person attending my son's birth... and I'm grateful for the inhospital support for mums too. Adds up to better breast-feeding outcomes and much more rest for Mum! You don't have to take drugs just because you're in a hospital environment.

Mmmm - I come from a similar career background as Suze and have given birth 3 times as well so can claim to have a bit of 1st, 2nd & 3rd hand knowledge.

First I believe in CHOICE.

If women who are perfectly healthy and capable of vaginal delivery can choose a Caesarean section on an appointed date with their appointed Obstetrician with Medicare backing then the perfectly healthy and capable of vaginal delivery should be able to choose home birth on same terms.

If the reader wonders who pays?/who should pay?/what are we paying for? ponder these facts:

Caesarean births are becoming increasingly frequent with more "indications" added regularly. This birth method is by far the most expensive. (Obstetricians however don't mind)

Antenatal care has become increasingly expensive over the past 3 decades. Where once a scan was performed to diagnose suspected multiple foetuses or abnormalities, it is now standard practice for 3 scans to be performed routinely through a normal pregnancy. Has this practice resulted in better outcomes for healthy mothers and babies? Not perceptively, but it charms the parents and helps pay for the Obstetricians yacht - unless it is the Public system when costs come out of the Health Care budget.

Is birth 'over-medicalised'? I would say yes. Is there a vested interest in maintaining and extending this trend? I would say yes.

Continued .....
My own experiences are now old with youngest offspring aged 25, however each was different. Being very 'conventional medicine' minded I went to hospital (large Public Teaching) quite early in my first labour and was subjected to almost every procedure available - initially without my consent eg. breaking waters on initial exam. Labour was slow, probably because I was so unsettled. Drs decided I needed a Caesarean. I refused. Several hrs later I managed to give birth 'naturally'. Was so disgusted with my experience I discharged myself next day.

Two years later I laboured at home until things were imminent then went to hospital, birthing 35 minutes later. My Dr grudgingly discharged me next day.

Three years later I had a planned home birth with a very experienced Dutch mid-wife. Cost me $300 for her services (included 2 ante-natal & 2 follow up visits) opposed to about $1200 (cost of hospital stay, Drs fees) though with no remittance from Medicare or private health fund I was in fact nearly $200 down. Got my moneys worth however. You, dear reader, got off scot free.

What we need 'culturally' and economically both in medical and social senses is a commitment to reducing unnecessary antenatal procedures and promoting minimal intervention birthing. Focus should be on providing 1st rate basics in an environment where women feel comfortable and supported with the high tech stuff reserved for what it was originally intended - the high risk situation.

This would mean having choices like "Home-style" birth suites in all Maternity facilities, wide availability of Mid-wife care and Homebirth rebate. Meantime introduce "BirthCover" the insurance for every woman and newborn with generous but capped payouts for medical misadventure.

For every other mother who wants a "high tech experience" with NO medical indications - eg. an elective Caesarean on "social" grounds (and there are a lot more of these performed, taxpayer funding included, than homebirths) then let the extra costs rest with that individual.

Now count the benefits and the savings!

Unless you are a specialist Obstetrician ... Sorry guys