Birth centres and the national maternity services review: Response to consumer demand or compromise?
Introduction
‘Women desire homebirth, they desire birth centres and they desire hospital birth. More importantly though, we deserve them (Consumer)’.
In September 2008 the Commonwealth called for public submissions in response to a Discussion Paper aimed at improving maternity services and expanding the range of birthing options available.1 Over 900 submissions were received by the Department of Health and Ageing – the majority (54%) were from consumers. The Department of Health and Ageing also conducted a series of ‘invitation only’ roundtable forums with a range of organisations and individuals. On the 21st February 2009, Improving Maternity Services in Australia – The Report of the Maternity Services Review (MSR)2 was released.
One of the recommendations in the MSR was that when the National Maternity Services Plan is developed ‘consideration be given to the demand for, and availability of, a range of models of care including birthing centres’2 p. 57. It was unclear if this was in response to an overwhelming request for access to birth centres in the submissions received by the Commonwealth or whether it was a compromise for the decision not to include homebirth in the maternity service reforms being proposed.
This paper set out to examine what was said in the submissions to the MSR about birth centres. It occurred to us in examining the responses to the MSR that there was far less support for birth centres than homebirth. A previous paper examined what was said about homebirth in 60% of the submissions to the MSR.3
Section snippets
Background
In Australia in 2007 around 6400 women were reported as giving birth in a birth centre, which represents 2.2% of all women giving birth.4 The proportion of women giving birth in a birth centre has changed little in 10 years (1.9% in 1997).5 This could be due to a decline in the number of birth centres in the past ten years with five less birth centres operating in 2007 compared to 1997.6 There is also some evidence that birth centres are becoming more conservative in their admission criteria.
Method
This is a qualitative descriptive study that examined the 832 submissions made to the MSR that are publicly available on the Department of Health and Ageing website. The submissions were downloaded from the Department of Health and Ageing website and analysed using content analysis. While over 900 submissions were received some contained confidential or sensitive information that meant they could not be made public.
After multiple readings of transcripts for mentions of birth centre, a coding
Discussion
The MSR recommended improving women's access to and availability of birth centres; and States and Territories were asked to expand this option for women. It would seem from this data however, that once again the choice for women to give birth in a familiar place such as home, has been denied by authorities that feel they know best in terms of safety and recommend birth centre as compromise. The recommendation does not appear to reflect the views expressed in the submissions to the MSR. Only 24%
Conclusion
Birth centres appear to be a compromise position in the MSR between the strong demand for homebirth and requests for more midwife led, non-medicalised options for birth. On the whole women also saw birth centres as a compromise between the medicalised hospital based system and unfunded, unsupported homebirth. However it appears women felt this was not an acceptable position to be put in and that ‘everything should be on the menu’ when it came to birth choices. The MSR appear to see expanding
Ethical statement
Ethics approval was sought but not deemed necessary, as these are now publicly accessible documents. Extracts/quotes from the submissions are included, however names are not used and if a hospital or individual is referred to this has been removed. If the quote came from a consumer, or professional etc. this noted at the end of the quote.
Acknowledgement
To the University of Western Sydney for providing funding for the study through the Internal Research Grant Scheme 2009.
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Two decades of Birth Centre and midwifery-led care in South Australia, 1998–2016
2021, Women and BirthCitation Excerpt :The physical environment of a BC is highly desirable as it represents a home-like environment with a known midwife where in today’s fear-based medicalisation of birth, a woman may feel reassured being within a hospital while having the greatest opportunity for a normal physiological birth [22]. Women’s birth preferences in SA mirror those found in other studies; that women (and men) prefer maternity care that allows for mutually respectful relationships predominately with one carer from pregnancy to post-birth [20,23]. The cohort of women who choose BC care have been reported as having a demographic profile similar to those who choose private obstetric care in Australia; higher socio-economic status, older, and more likely to be born in Australia [24].
Birth models of care and intervention rates: The impact of birth centres
2020, Health PolicyThe development of midwifery unit standards for Europe
2020, MidwiferyRegulation of unregistered birth workers in Australia: Homebirth and public safety
2018, Women and Birth