Dr. Anthony Schapell, the coroner who authored the 106 page report about the 4 preventable deaths presided over my Australian midwife Lisa Barrett, made the objective of his report crystal clear: to ensure that Australian women receive accurate information about the risks of homebirth.
The Australian College of Midwives, and spokesperson Dr. Hannah Dahlen, have chosen to deliberately misrepresent this objective. Instead of acknowledging that coroner’s recommendations restrict the autonomy of rogue midwives, they have chose to pretend that the recommendations restrict the autonomy of women to choose homebirth. Their tactics, while admirable from a marketing point of view, are unethical and betray the fact that their primary concern is themselves, not babies and mothers.
The coroner was quite clear in his condemnation of the misinformation spread by homebirth advocates including certain homebirth midwives:
… I refer to the commonly held misconception that appears to be promoted by those who advocate homebirthing in risky circumstances, that adverse outcomes that occur in a homebirth would inevitably have occurred in a hospital. There is also the misconception that twin births in hospital will inevitably involve the second twin, to borrow the expression of Dr Hannah Dahlen, being ‘whipped out within about 3 minutes’. There are other misconceptions that these Inquests have identified.
The ACM issued a statement in response:
… [T]he ACM is disappointed that there has not been a greater emphasis on strategies to prevent such tragedies as seen in these three cases.
What strategies does the ACM recommend to ensure that women receive accurate information about the risks associated with homebirth, particularly high risk homebirth?
Don’t be silly! They have no practical suggestions for that problem because they don’t see it as a problem.
Nonetheless, the ACM recognizes that opposing the provision of accurate information would be a marketing disaster. So instead, they’ve completely ignored that issue and substituted their favorite straw men. But let’s look behind their claims to see what they really mean, keeping in mind that their primary objective is to promote the autonomy of midwives.
All these women had suffered traumatic previous births in the hospital system and some sought care in birth centres but this was not made available to them.
These women should never have been delivered at home, but the only other place where midwives are autonomous are birth centers and there aren’t enough of those. Of course, none of these women were candidates for birth centers, but so what?
The recommendation to report women who are seeking to have a baby at home with risk factors is of grave concern as it may push some women further underground and lead to them not seeking any engagement with health services.
We have absolutely no evidence to substantiate this, but we are going to pretend that women who are advised that their babies will be safer in the hospital will ignore doctors, and deliver unassisted. The coroner explicitly rejected this claim, advanced by Dr. Dahlen in her inquest testimony.
The ACM finds the statement that all these babies would have certainly survived if a caesarean section was performed concerning as such certainty is not possible with childbirth.
The ACM doesn’t care about the scientific evidence, it only cares about the autonomy and employment of midwives.
Once a woman has had caesarean, complications in subsequent pregnancies are significantly increased.
And then midwives won’t be able to autonomously care for these women either.
The ACM also recognises that until private midwives are allowed clinical privileges to be able to practice in hospitals that reluctance on the part of the woman and midwife will continue to compromise safety and seamless transfer.
We will refuse to transfer patients in an effort to save their babies lives if it means that we will have to give up control of those patients.
Let’s be honest about what is going on here. The priority of the ACM is professional autonomy for midwives regardless of whether those midwives are providing accurate information and regardless of whether babies live or die. Their behavior is morally bankrupt and they ought to be ashamed of themselves.