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Birthing outside the system
S10 publicly-funded homebirth programs, and the benefits to the women and their families who access them. doi:10.1016/j.wombi.2011.07.045 B2.2 Choosing freebirth in NSW: An exploration of expectations and experience Shari Bonnette a,∗ , Alex Broom a , Caroline S.E. Homer b a b
The University of Queensland, Australia University of Technology Sydney, Australia
Background: Planned homebirth without professional assistance, otherwise known as unassisted birth or freebirth, is increasing in Australia. While there are no official statistics gathered in Australia to confirm occurrence or rise in freebirth, in 2006 the creation of dedicated discussion space for freebirth in popular online web forums, such as Essential Baby and Bub Hub, indicates increasing prevalence. Anecdotal evidence of freebirth in Australia suggests cost and accessibility to professional health care services are not primary factors for women choosing freebirth, but rather are value derived; a desire to be autonomous and responsible agents as experts of self in birth; recognising birth as a natural cycle, and maintaining birth as private, sacred and an intimate time shared as a couple or family. Aim: There is no sociologically informed Australian research and limited international research on freebirth. A significant gap exists in our understanding of couple’s expectations and experience of freebirth and how information and decisions made in pregnancy inform the freebirth outcome. Method: Qualitative in depth interviews were conducted with couples from rural and regional NSW who chose freebirth. Two interviews were undertaken; the first interview pre-birth in the final three months of pregnancy to ascertain the couple’s expectation of freebirth and the second interview approximately four months post birth to determine whether the freebirth experience was consistent with expectations. Conclusion: This presentation will report on preliminary findings of couples expectations and experience of freebirth in rural and regional NSW, including reasons underpinning the use of freebirth vis-à-vis the dominant medical model of childbirth. doi:10.1016/j.wombi.2011.07.046 B2.3 Birthing outside the system Melanie Jackson University of Western Sydney, NSW, Australia Scientific evidence demonstrates that homebirth for lowrisk women attended by registered midwives, is just as safe as a hospital birth. Scientific evidence and health policy however, considers homebirth unattended by a health professional, otherwise known as ‘free-birth’, and for higher risk pregnancies, as unsafe and does not support this choice. Women who pursue a free-birth or high-risk homebirth represent a minority group that chooses to birth ‘outside the
Abstracts system’ and there is very little research about what is behind their decision making process or their motivations, furthermore, there is no existing Australian research. This study aims to investigate what motivates and influences women to birth outside the system and choose a free birth or high risk homebirth. A Qualitative approach using a Grounded Theory Methodology is being used to recruit participants, collect and analyse data and present the findings. Data collection for this research has commenced and preliminary findings will be ready to presented at this conference; this project is due for completion in 2013. It is hoped that the information that is discovered throughout this research project will educate health professionals about why women choose to birth outside the system and will serve to provide insight as to why women do not engage mainstream services which may assist maternity care providers to review their services to provide a more acceptable service to these women and the greater community. doi:10.1016/j.wombi.2011.07.047 B2.4 With woman: A genealogy of Australian midwifery practice Elizabeth Newnham University of South Australia, South Australia, Australia This paper uses some key ideas of French theorist Michel Foucault to examine how midwifery knowledge and women’s experiential/embodied knowledge have been subjugated by a dominant medical discourse. This Australian midwifery ‘genealogy’ spans the two centuries from colonial days to the present repercussions of the Federal government’s 2009 Report into Maternity Services, and shows how the medical profession and the state have influenced where and how women give birth, and where and how midwives may practise. In an era of expanding medical technology and contracting resources, the defence of a woman-centred midwifery model of birth—–particularly in light of the centralising and depersonalising tendencies of the medical/hospital model—–is imperative. Documenting a genealogy illuminates the contingent nature of the present. Centrally, the paper also discusses the ‘problematisation’ of issues by government, and the way policy documents are framed. This paper will focus specifically on the development of the South Australian Department of Health Birth in Water (2005) policies and Birth at Home (2007) policy, and how the writing of these policies help to constitute these activities as ‘risky’ even as they legitimise them as ‘alternative’ birth practices. Within these social policy parameters, women self-regulate their behaviour in socially acceptable ways, yet they are encouraged to see themselves as autonomous and informed decision-making agents. Finally, looking to the future, despite the recent apparent gains for midwifery, many hospital-linked birth centres currently still operate within medical parameters, and the future of private midwives is uncertain. A viable alternative may be to introduce free-standing birth centres. The paper highlights the need for an Australian maternity system that provides real choice and plurality, by locating women at the centre of maternity services, and that seeks to arrive at a model
The University of Queensland, Australia University of Technology Sydney, Australia
Background: Planned homebirth without professional assistance, otherwise known as unassisted birth or freebirth, is increasing in Australia. While there are no official statistics gathered in Australia to confirm occurrence or rise in freebirth, in 2006 the creation of dedicated discussion space for freebirth in popular online web forums, such as Essential Baby and Bub Hub, indicates increasing prevalence. Anecdotal evidence of freebirth in Australia suggests cost and accessibility to professional health care services are not primary factors for women choosing freebirth, but rather are value derived; a desire to be autonomous and responsible agents as experts of self in birth; recognising birth as a natural cycle, and maintaining birth as private, sacred and an intimate time shared as a couple or family. Aim: There is no sociologically informed Australian research and limited international research on freebirth. A significant gap exists in our understanding of couple’s expectations and experience of freebirth and how information and decisions made in pregnancy inform the freebirth outcome. Method: Qualitative in depth interviews were conducted with couples from rural and regional NSW who chose freebirth. Two interviews were undertaken; the first interview pre-birth in the final three months of pregnancy to ascertain the couple’s expectation of freebirth and the second interview approximately four months post birth to determine whether the freebirth experience was consistent with expectations. Conclusion: This presentation will report on preliminary findings of couples expectations and experience of freebirth in rural and regional NSW, including reasons underpinning the use of freebirth vis-à-vis the dominant medical model of childbirth. doi:10.1016/j.wombi.2011.07.046 B2.3 Birthing outside the system Melanie Jackson University of Western Sydney, NSW, Australia Scientific evidence demonstrates that homebirth for lowrisk women attended by registered midwives, is just as safe as a hospital birth. Scientific evidence and health policy however, considers homebirth unattended by a health professional, otherwise known as ‘free-birth’, and for higher risk pregnancies, as unsafe and does not support this choice. Women who pursue a free-birth or high-risk homebirth represent a minority group that chooses to birth ‘outside the
Abstracts system’ and there is very little research about what is behind their decision making process or their motivations, furthermore, there is no existing Australian research. This study aims to investigate what motivates and influences women to birth outside the system and choose a free birth or high risk homebirth. A Qualitative approach using a Grounded Theory Methodology is being used to recruit participants, collect and analyse data and present the findings. Data collection for this research has commenced and preliminary findings will be ready to presented at this conference; this project is due for completion in 2013. It is hoped that the information that is discovered throughout this research project will educate health professionals about why women choose to birth outside the system and will serve to provide insight as to why women do not engage mainstream services which may assist maternity care providers to review their services to provide a more acceptable service to these women and the greater community. doi:10.1016/j.wombi.2011.07.047 B2.4 With woman: A genealogy of Australian midwifery practice Elizabeth Newnham University of South Australia, South Australia, Australia This paper uses some key ideas of French theorist Michel Foucault to examine how midwifery knowledge and women’s experiential/embodied knowledge have been subjugated by a dominant medical discourse. This Australian midwifery ‘genealogy’ spans the two centuries from colonial days to the present repercussions of the Federal government’s 2009 Report into Maternity Services, and shows how the medical profession and the state have influenced where and how women give birth, and where and how midwives may practise. In an era of expanding medical technology and contracting resources, the defence of a woman-centred midwifery model of birth—–particularly in light of the centralising and depersonalising tendencies of the medical/hospital model—–is imperative. Documenting a genealogy illuminates the contingent nature of the present. Centrally, the paper also discusses the ‘problematisation’ of issues by government, and the way policy documents are framed. This paper will focus specifically on the development of the South Australian Department of Health Birth in Water (2005) policies and Birth at Home (2007) policy, and how the writing of these policies help to constitute these activities as ‘risky’ even as they legitimise them as ‘alternative’ birth practices. Within these social policy parameters, women self-regulate their behaviour in socially acceptable ways, yet they are encouraged to see themselves as autonomous and informed decision-making agents. Finally, looking to the future, despite the recent apparent gains for midwifery, many hospital-linked birth centres currently still operate within medical parameters, and the future of private midwives is uncertain. A viable alternative may be to introduce free-standing birth centres. The paper highlights the need for an Australian maternity system that provides real choice and plurality, by locating women at the centre of maternity services, and that seeks to arrive at a model