A year ago I wrote a candid response to the registration crisis midwives were facing as the national registration of health professionals legislation made the rounds of each State. I am sad to say that some of the somewhat satirical comments I made have now started to eventuate. This should be shocking and horrifying to anyone who values the principles of autonomy and self-determination. You now no longer have the ultimate say in what happens to your body if you choose care by a registered health professional. Your choices may be vetoed by a medical gatekeeper. Women, it seems, have less right to self-determination in birth than horses.

Women who want to home birth are now worse off than ever before. There have been recent reports in the media about women being refused prescriptions for syntocinon by midwife-wary GPs. The witch hunt is in full swing with midwives being reported left, right and centre and soon the term ‘midwife’ will only openly be used in the halls of power, where midwifery staff can be controlled and where women’s rights to self determination are vastly eroded. Pretty soon the tales about home born babies will be hushed up and a cone of silence will encase those who dare to choose this option. Women will have to join secret birthing societies in order to get the information they need to hire an underground midwife to support them so they can have, what they consider to be, a safe birth and they won’t be able to refer to these birth helpers as midwives. Doing so could mean prosecution, so instead they’ll say they were birthing unassisted with partners and “friends”. Midwives will be unable to accompany women to hospital should they need to transfer and adequate consultation with medical professionals will become impossible. Yes, the situation is dire indeed.

In the wake of all of this, I have chosen to not to have another baby. It is clear to me that none of my choices will be respected in the system. I wouldn’t be “allowed” to even use water for pain relief because of my two previous caesareans (even though I birthed my last baby naturally). I also don’t feel comfortable putting a midwife in the position of supporting me when each previous pregnancy involved complications that put me in the “high risk” category, despite the normalcy of my pregnancies in reality. I feel like my only choice is to birth unassisted at home but I’m not willing to do that either. So, that’s, that. No more babies for me.

I am extremely angry that my personal life and our family choices have been interfered with by the state to such an extent, that I no longer feel that Australia is a democracy in the true sense of the word. When a government can dictate to you that you cannot choose for a normal bodily function to happen in the comfort and safety of your own home, then that is not freedom or self determination.

The thing I find really disturbing is that there are a plethora of so-called experts who support what the government is doing and who think it is okay to deprive women of their liberty. Some have even called for homebirth to be made illegal. Excuse me? Following that reasoning, we should also make patient-choice caesareans illegal and patient-choice inductions illegal. Not that I want to compare homebirth to medical procedures but you get my drift. If they are going to control once choice, why not control them all!

So what do we do now? I have no doubt it is going to be a rough road ahead for both women and midwives who are passionate about choice in childbirth but we need to keep telling our stories, the good stories about birth. If our stories die, so will home birth.

My VBAC story

A picture tells a thousand words. For the complete story of my kids’ births visit my website: www.casmccullough.com/stories.shtml.

In 1938 Hitler outlawed home education in Germany. The idea of institutionalised schooling for children was first introduced in Germany not to improve children’s education but because the Prussian leaders of the time recognised the efficacy of spreading propaganda to children. They knew that institutionalising education would ensure a higher level of control over the children who would grow up to become the soldiers, leaders and workers of Germany’s future. At the root of Prussian rhetoric of the time were the Prussian ideals of intolerance, racism, and anti-Semitism. As we know, this propaganda campaign was so successful that it gave birth to Adolf Hitler and resulted in the torture and death of millions of people. Our family tree is littered with stars of David to reflect the number of ancestors who lost their lives in Nazi death camps, in forced-labour camps and on the front lines in Russia.

Despite its controversial origins, the idea of spreading propaganda through schools took off and is now a common and effective way to change a population’s actions and paradigms. As a public relations practitioner and a parent, I well know the value in using schools to ensure greater take up of a public education initiative. When my kids come home from school laden with goodies—stickers, posters and erasers all sporting the latest government message about wearing seatbelts, walking safely to school, saving water or brushing teeth I know that the propaganda machine is well and truly oiled and that my kids will unconsciously absorb the catchy phrases and carefully orchestrated ideals the government wishes them to internalise. Really, state-based schooling is more about control than it is about fostering an independent, thinking human being.

However there is a dark side to any movement towards controlling a population’s ideas and actions. In Germany today, because of Hitler’s anti-home education law, German families can be prosecuted, jailed and have their children removed from their care. One such family had to flee the country last year—loving parents who just wanted the freedom to educate their children as they saw best. It is hard to believe that this is possible in what is now a democratic country. However, when you see the history behind this paradigm, you can understand how generations have been influenced by one, seemingly insignificant law that impacted on a small percentage of the population.

The rights of self-determination and autonomy are inherent in any true democracy. However, as the years go by I can’t help but think that democracy is slipping away from us at an ever-increasing rate.

This blog isn’t really about home education and the propaganda machine. What it is about is showing the impact of government control on the autonomy of individuals.

The Australian Government is currently considering legislation to ensure all health practitioners are registered. On the surface, this seems like a good thing and in many ways it is. However, the dark side of this reform is that it is being used as an efficient way of controlling women’s access to homebirth midwifery. The draft legislation not only penalises midwives who dare to defy it to the tune of $30,000 plus deregistration, it also penalises women and any organisation that promotes homebirth midwifery or is seen to instigate homebirth midwifery.

As of July 1 next year, Birth Matters, the journal I have lovingly edited for the past two years, will no longer be able to legally print the beautiful photographs and stories of women. To do so would put these women and their midwives in jeopardy and may result in the Journal incurring a $30,000 fine. Any midwifery blogs about attending homebirths will disappear and our stories, our folklore will be lost.

I have no doubt that this is the intention behind this legislation, that it is designed not just to control how and where women give birth but to quash the rhetoric that supports the notion of safe and beautiful birth at home. If this legislation is passed successfully, women will be the losers. Once again our rights to self-determination will be eroded. While homebirth with a midwife has been difficult in the past ten years, it will be more so now. For instance, women who could get prescription medications from a sympathetic GP for a homebirth will now not be able to do so. If the GP does this, they could be registered and prosecuted, the woman could be reported and prosecuted and their midwife deregistered and prosecuted.

Just like the family that fled from Germany to the UK last year because they chose to home educate their children, women will flee Australia to give birth in the UK and New Zealand so that they can birth at “home” safely with a trained attendant. Even if you view homebirth as something that only affects a minority of women, is this the kind of society you want your daughters to grow up in? One which forces them to subject to government control over their basic human right to choose where and with whom they give birth? Do we really want them to submit to a “just lie down and open your legs like a good girl because we’re doing what is best for you” paradigm?

The government can’t argue away the inherent rights of women on the basis of safety. There is absolutely no evidence that hospitals are a safer place to give birth for normal healthy women. Indeed, given the stories we hear day in and day out, it is clear that what happens on the birth front is neither safe nor respectful of women’s right to autonomy over their bodies. While I welcome the opportunity for midwives to attend women privately in a hospital or birth centre, I abhor the notion that this absolves the government from protecting those women who still want to birth at home for whatever reason—cultural, spiritual, physical or social.

One thing I can guarantee, women will continue to fight for their birth rite and rights because to outlaw the normal function of their bodies at home is not only absurd but an injustice. We are entering a brave new world where secret homebirth societies will flourish and midwives will form knitting circles in jail. This fight is only just beginning. I will see you on the birth front!

There aren’t too many issues that would compel me to plan a last minute road trip to Canberra but when I read the draft legislation on registration of midwives, I realised that I had to go and be among the many mums and babies, small children and midwives doing just the same.

My passion for this cause doesn’t stem from my own experience of homebirth because I’ve never had a homebirth. My passion extends from my births, yes… but also from my anger that women’s rights are being completely eroded by this legislation. The legislation was put in place to protect consumers but what it is doing instead is putting a stranglehold on midwifery practice and ensuring it will forever be under the thumb of medical dominance.

It makes my skin crawl to think that midwives and women may be slapped with a $30,000 fine if they went ahead with a planned homebirth. And what of all the unplanned homebirths? What happens to a woman who planns a hospital birth but slips a baby out at home while her midwife is walking through the door? This legislation is unjust, and really, un-enforceable! Are they really going to fill jails with knitting circles full of wise women? It just makes no sense!

So, I am planning a trip to Canberra in September and am taking son no. 1 with me to give him insight into our democratic process. Only I don’t feel like I live in a democracy at the moment. Any government that thinks it can legislate away a basic human right cannot really call itself a democracy.

The freedom to choose what we do with our bodies is a basic human right and a basic tenet of democracy. What is happening to childbirth in Australia will force women to give birth in an institution and this may have extremely detrimental consequences for some women.

To be fair, perhaps the government should consider issuing fines to women who elect to have a caesarean for no medical reason… but then, that would be absurd wouldn’t it? So why is it any less so for a homebirth?

That the majority of people are too busy to understand the complexities and evidence behind the choice to birth a baby at home doesn’t surprise me. But it never ceases to astound me how quick people are to judge women who make this choice or who, indeed, feel they have no choice. Why do people believe what some pubescent journalist fresh out of uni says when nine times out of ten the information is at best superficial, at worst down right lies? And they certainly don’t improve their reporting accuracy as they get older…

Take the case of an opinion piece in the Daily Telegraph today http://www.news.com.au/dailytelegraph/story/0,22049,25298631-5001030,00.html.

The journalist, Fiona Connolly, claims “Home births are selfish, irresponsible, anti-reason and anti-progress.” She also has the audacity to compare birth in a poverty-stricken, war-torn Somali village with homebirth in the safe, leafy suburbs of Australia. Connolly fails to consider that women who homebirth in Australia DO have access to all the modern technology and a trained professional to assist them. Somali women in remote villages do not. I’m not really sure where the reason comes in to this argument.

What strikes me about this ill-informed piece was what was missing. What about the perinatal mortality rates of New Zealand and the UK and the Netherlands, all of which have state-sanctioned homebirth programs? Their perinatal mortality rates are not only comparable to or better than Australia’s but their intervention rates are better. Perinatal mortality rates in Australia are 10.1 per 10,000 live births. It is the same in New Zealand (despite their vastly smaller population which tends to skew statistics to look worse than they actually are). The UK’s perinatal mortality rate is 8 per 10,000 live births and the Netherlands 9 per 10,000 live births.

To support her point that all homebirthers care about are candles and home cooked meals, Connolly quotes various celebrities who have gushed over their homebirth experiences. But by pulling these quotes from the Homebirth Australia website she failed to do her homework and find out that Elle Macpherson birthed with the assistance of a private obstetrician in a birth centre. And where was the flippant quote from the great Australian thinker and journalist George Negus who’s wife Kristy was also a homebirther? Is Connolly seriously calling educated and philanthropic people like George and Kristy “selfish, irresponsible anti-reason and anti-progress?”

Another interesting nugget in Connolly’s rant is that she mistakenly believes that narcotics somehow make birth safer and that women who homebirth don’t have access to antibiotics, oxygen and oxytocic drugs. This is far from the truth. Most homebirthers are well aware of the need to obtain an oxygen tank, and oxytocic drugs from the local pharmacy prior to birth and organise this with their local GP (because midwives are prevented from prescribing these in Australia despite it being within their scope of practice). That said, most women who birth at home choose to avoid drugs and unnecessary antibiotics, not just because they want a beautiful birth experience but because they are informed and educated about the harm these can do to their babies. The fact is, we aren’t in a war torn country with no access to medical care when it is needed. Women who genuinely need antibiotics are referred by their midwife to a GP or to the hospital for treatment. But let’s not let the facts get in the way of a good homebirther-bashing.

That women have lost babies in childbirth is sad and tragic but we are not in a position to judge whether or not being at a hospital would have made any difference in any of these cases. We are also not in a position to judge whether being at home might have saved the woman who died from an amniotic fluid embolism or who’s baby’s throat was accidentally cut during surgical delivery. On mercifully rare occasions terrible things happen in childbirth in whatever environment a woman births in—be it home or hospital–but telling every woman that she should have no choice but to birth her baby in a hospital is not only irresponsible it is misogynistic and misguided.

Australia: Law et al, 2008 (AIHW)

New Zealand: NZHIS, 2006

UK: CEMACH, 2008 & NHS Information Centre 2008

Netherlands: Statline, 2008 (Statistical Yearbook 2004)

NB: It is important to note that different countries record perinatal statistics differently. The WHO standard is to report deaths from 22 weeks gestation. Most countries, however, seem to record rates from either 24 or 28 weeks. In order to present a more consistent picture, the 24 weeks has been used where possible.

A few months ago, I lost something precious, something I had worked 10 months to find and within eight weeks of gaining, it was gone. I didn’t really feel it at first. I was too numb from the entire experience. I was too raw to feel anything and submersed myself in work so as to avoid thinking about it at all. But recently, Angel has come back to haunt me in the exuberant faces and big rounded bellies of other women who are now five months pregnant with other, very precious somethings.

What has also brought this home is the fact that some people have been rather out of the loop. I had an email the other day from a colleague who asked when my baby was due and then at Christmas eve service last night at church, a kindly acquaintance I hadn’t seen for a while asked me the same thing. Put aside the fact that I don’t look five months pregnant (or maybe I do… maybe I’ve eaten way too much fudge this Christmas season), I was kinda dumbstruck and then felt rather mortified for this poor woman who asked an honest question. Her discomfort was obvious and mine too. I just willed the conversation to be over so that I could crawl into a hole somewhere far away. This Christmas, I was supposed to be sitting around on my lard-arse contentedly rubbing my swollen belly, making my mother shift uncomfortably at the dinner table over conversations about homebirth and birthing pools. Instead I just miss my Angel. I miss him/her desparately and wish he/she was here.

I am also reminded that for the better part of the last six years I have spent most of my time pleasing others, doing things to make me feel like I was somehow not such a selfish person. But the truth is, I am selfish and I’m sick of pretending to be otherwise. Recently, I wrote out a mission statement for my life. I really struggled with this because, to be honest, I don’t really know what I want or maybe I’m afraid that what I want isn’t really the right thing to want. I don’t know. All I do know for sure is that I have this vision in my head of spending long days with my children, enjoying their learning, their company and their fun. I have a vision of justice, of doing something bigger than myself, something that leaves a legacy. I also have a vision of truth…. it keeps pulling me back to the nagging thought that I should be doing something other than what I am currently doing.

I am conscious that I have set myself up to be pulled in a million different directions by others. I made a decision earlier in the year to stop putting emotional energy into the personal choices and conflicts of others outside my own family. This choice has confused some but I have to stick to it. My family’s survival, my survival depends on it. I need a full tank to be strong enough to deal with the ebb and flow of my family.

So what do I really want? For those I love to know the hope and love of God and the gift He has given us, a family that knows they are loved no matter what, to be able to make beautiful music and to see my children thrive. Everything else is somehow not so precious to me.

I don’t know if we will try to have a another baby again or not. I’m still raw and hurting from the experience of losing that something precious. But I do know that I will make some different choices in 2009. Some of these choices leave others scratching their heads but they are my choices to make. Somewhere along the line, we all have to decide to stop living life for the will and purpose of others and instead, live a life of purpose that is true to ourselves and honest about what motivates us to do what we do. It is easy to act out of brokenness, from hearts destroyed and confidence lost… it is hard to face the truth that this is what we do and step beyond.

I haven’t done the peak hour commute to and from the city for nine years but last Thursday, I had the opportunity to don some “work” clothes, park my car at the train station and get the express to Central Station.

Not a day has gone by that I’ve missed going into the city for work. I’ve been into the city on the odd day to see Wayne at work or to attend an appointment at doctor row on Wickham Terrace, but walking around, watching office employees as they went about their daily grind, seemed really surreal to me. Everyone was dressed the same and had the same look of “just get me to the end of the day so I can self-medicate” written on their faces. To think, I used to be one of them, religiously following the same routine every morning. Nine years ago, I would get my muffin from the Muffin Break shop as I waddled to work (I was pregnant) on the other side of town. I would always take the same route and would always wait in the same place when catching the train home. Routines provide some comfort in a world full of strangers.

I could tell, last Thursday that I was an unwelcome site in the train carriage, an extra person taking up a precious seat, someone they hadn’t seen before. Who is she and will she be coming back again? I wondered what I would think if a stranger wandered into my routine world like that, unannounced.

When I headed for Central Station in the afternoon, I watched as everyone grabbed their free daily paper and rushed to their platforms. On the train, I looked out the window at a view I had not seen for years, mused over how that view had changed in nine years, and secretly admired the skill in some of the graffiti lacing the walls. Most just read their papers, head down, eyes averted, until they could escape the carriage and head home.

When I got home, it was 6.30pm. Wayne, who had taken the day off so I could speak at a conference, had made me dinner and the boys were bathed and ready for bed. I had seen them last at 7am but they were happy and running around as usual. Had they even missed me?

Soon, I may be faced with the prospect of having to make this experience my own routine and it’s a daunting prospect. I love my rural home, the activist work I do and raising my boys myself. I love working a few hours a week in a paid job that doesn’t infringe on my family’s needs. I love working from home and having my lunch breaks out on the deck, overlooking the river valley. I love working in solitude and silence. The thought of having to hand my boys over to others for 12 hours of the day so I can join the daily rush, surrounded by strangers is heartbreaking for me. Can I really do this? Do I really have to? On the flipside though, I’m curious about this other world. I’m curious about whether my experience from the last nine years– doing on and off PR work and research work, some paid, some not—will be taken seriously or whether I’ll be cast into the box of “mothers trying to return to the work force” forever more.