I’m pretty fed up with reading stories in the papers from those who are either pro-midwife or anti-midwife, and as a result, anti-obstertrician or pro-obstetrician. When I wrote an article recently for Mamamia.com.au, I was shocked at the amount of comments it received, many of which were telling tales about ‘horrible midwives’, and others hitting back at these comments. Some were downright nasty, and others accused me of making up the story. Yes, my article talked about a particular interaction I had with a particular midwife whose views I didn’t agree with, but that wasn’t the point of writing it.
Recently, there has been huge debate in the media about homebirths, fuelled perhaps by the tragic death of a mother in Victoria while birthing at home (reported here in The Age) and Danni Minogue’s failed home birth (which required her to be transferred to hospital – reported here).
Recent laws passed here in Western Australia regarding recognition of the unborn baby as a legal life led to statements from the WA Australian Medical Association (WA AMA)* calling for the criminalisation of mothers who insist on a home birth despite prior knowledge of pregnancy complications (reported here). This week, there was a story highlighting the lack of obstetricians available in Western Australia and suggesting that more GPs (as well as midwives and specialists) need to be trained to help cope with the growing number of births each year. This led to letters in the papers suggesting that we don’t need more doctors, just midwives…you get the idea.
The two camps seem to be divided by their philosophy of birthing as either a ‘natural’ event or a ‘medical’ event. Those who feel it is ‘natural’ blame the medicalisation of birth for causing more intervention and resulting physical and emotional trauma.
The only thing that this polarisation does is risk alienating mothers, who are often confused and vulnerable about such a major life event as having a baby, and make them feel that they have to choose between the options and wave their flag firmly in one camp. It also splits staff in both the public and private health care sectors, causing overt and covert tension between ‘nurses’ and ‘doctors’ rather than encouraging cohesive team work and coordinated care for patients.
I am a doctor and of course recognise the value of medical intervention in pregnancy. Personally I would not choose to have a home birth, but I do not believe in unnecessary medical intervention either. I have had obstetric-led care for my three pregnancies, and have been very happy with it. However, I also see a midwife at every antenatal appointment, and my two labours so far have been largely managed by fantastic midwives. I have also had potentially serious medical complications which have required medical input, but have every confidence that even if I hadn’t chosen to be managed by an obstetrician, I would have been referred to one by my midwife when the complications became known.
Perhaps it is because I am medically trained that I believe that while childbirth is natural, it was previously a major cause of morbidity and mortality of newborns and mothers, and still is in many developing countries. In 2010, Australia had a maternal mortality rate of 5.1 deaths per 100000 live births, but the rate in Afghanistan was 1575.1/100000 and Malawi 1140.1/100000 (reference here). Our access to good, integrated midwifery and medical care makes childbirth as safe as it can be.
We need — and have — great midwives and great doctors who all work towards making our pregnancies and births as safe and enjoyable as possible. Let’s stop asking people to choose and be grateful that we have such easy access to both.
*While I have been a member of AMA WA, this statement does not represent my views.
Dawn Barker - author and psychiatrist 