Birth, a Human and Political Issue!

The Costs of Maternity Care.
The “Face of Birth” documentary shows that many well educated Australians see home birth as the ‘personal’ choice which has become political. Medical spokesmen who dominate Australian media pronouncing home birth dangerous and not a human rights issue, have thwarted any government initiative to equitably support this womens’ choice. The film explores some stories and the research behind those who are seeking equitable government and community support of home birth rather than maintain unquestioning and monopolistic support for hospital based maternity care in Australia (or elsewhere).

The Royal College of Midwives and National Childbirth Trust try to promote maternity issues, such as the provision and information around place of birth for healthy women, as a public issue at every UK election and in between them! Similarly other concerned ‘brits’ have created informative web sites such as the UK Birth Choice and an online petition to inform and engage the average ‘punter’ to change this situation. This online petition explains the financial, as well as the short and long term social costs to Britain of failing to promote and support out-of-hospital birth options for healthy women; it states that if “just another 10% of women chose to have their babies in a Midwife Led Unit (MLU) we could save more than £12 million a year, or more than 3 times that if they had their baby at home.”

Here in New Zealand, it is mostly Home Birth Aotearoa women and their supporters who  see place of birth as an issue here, as home birth has been a funded birth option since 1990, yet during this time the level of home birth has only risen from less than 1% to about 5%. Waikato journalist Sarah Tennant, in an Oh Baby article last year said “There’s no denying it, planning a home birth is risky. Not for the baby, but for your reputation.”  Sarah’s article explains common factors in going to hospital which can block effective birthing hormones as the basis to some New Zealand “Home Truths”. She makes references to 3 New Zealand and several overseas studies which show that home birth is safer for healthy women, as those at home compared to hospital, are less likely to end up with “Cesarean sections, episiotomies, epidurals or analgesic pain relief and babies with low Apgar scores”.

All of these interventions can result in separation of a baby from its mother  for ‘observation’ in a special care nursery, and other adverse consequences for both mother and baby.  Sarah’s article ends by saying “a familiar relaxing environment does not pit your interests against the baby’s – its good for both of you.”  This is because following a natural birth both mother and baby are bathed in the highest levels of oxytocin; the hormone of love, altruism and human connection. Thus the type of birth a baby has can influence all relationships which that person will have through-out their life. This conclusion is backed by research findings that there are growing numbers of short and long term negative consequences for babies surgically delivered, as well as those separated from their mothers after birth. So home, or out-of-hospital birth should be promoted as a means to promote healthier families and a healthier society everywhere!

Like the aforementioned petition an Australian study has found that “The relative cost of birth increased by up to 50% for low risk primiparous (first time) women and up to 36% for low risk multiparous (second or more babies) women as labour interventions accumulated. An epidural was associated with a sharp increase in cost of up to 32% for some primiparous low risk women, and up to 36% for some multiparous low risk women.” Thus regardless of the country a huge amount of money can be saved, as well as the health of mothers and babies improved by a campaign to move the births of healthy women out of hospitals and into home or primary birth units (birth centres out side of NZ) under the care of midwives, this need has been recognised by the Royal College of Obstetricians. This is also the findings of the latest review of the international Cochrane data base which Science Daily’s report of was titled “Birth is no reason to go to hospital.”  The conclusions for this review are based on human rights, ethics and results from the best available scientific studies.

Meanwhile questions are growing about the social and financial impact or costs of wide spread use of technologies and testing in pregnancy such as ultra-sound and  HIV testing. A high human cost of the rising rates of hospital birth interventions is having a post-birth hysterectomy – there were 33 in 2007 NZ statistics. Post-birth Hysterectomies are one of several rarely mentioned risks and, or consequences of a previous Cesarean delivery. These hysterectomies can eventuate as the placenta in a subsequent pregnancy is prone to embed in the scar tissue, the embedding may be to the extent that surgical removal of the womb is the only means to stop bleeding after delivery of the baby; some women have died due to this complication of a previous caesarean. Reducing the cesarean section rate is another area where the health of mothers and babies can be improved whilst also saving limited health budgets, and an area which is a national target in the UK but not in New Zealand!

Where are those concerned for babies or mothers in New Zealand?
Each of the afroementioned interventions involves, and results in the need for increased monitoring and care by staff; staff which limited hospital budgets can have problems providing. These budgets are further stretched by growing amounts of medical equipment used in the extra monitoring and interventions; equipment which is most often imported from overseas contributing to New Zealand’s trade deficit. However these items do not appear to be the expenditures DHBs seek to reign-in, (along with the interventions) rather development or maintenance of primary maternity units which consumers want are one target. Is this because current funding structures between DHBs and the Ministry of Health mean that there are incentives to maintain the numbers of healthy women birthing and having Cesarean sections in secondary and tertiary hospitals, because maternity funding is absorbed into the overall hospital budget? A 2011 AUT article claims that if Elective Cesarean Section for NO medical reason was self-funded, as is elective cosmetic surgery in New Zealand, then $9 million per year at one hospital alone could be saved[1].

It was consumer outrage over posible family dislocations due to a proposed down-sizing of the Whanganui Maternity Unit that stopped this effort to rationalise local maternity services. Perhaps a consultative campaign by the DHB or MOH which informed New Zealanders about the human costs of healthy women birthing in secondary or tertiary hospitals and, or a midwifery led effort to promote, support and protect  natural birth may have seen another public response?

 The proposal of some Waitakere women for a Community-managed Parenting-Birthing unit, raise questions about health providers using every opportunity to lead by example, to make tangible differences in their community’s health. For example these ‘westie’ women included community gardens in the grounds as part of their proposal’s wish list; this idea is consistent with the international Incredible Edible movement. Such a proposal contrasts with current sub-contracting of hospital catering on the basis of cost efficiencies, which can under valuethe importance of nutrition to health, even during childbearing. For example breastfeeding women should be encouraged and able to have  foods known to support and increase human milk production, like oatmeal for breakfast  regardless of short term costs as longer breastfeeding durations rates have many benefits for both mothers, their babies and our communities.

These are some of the reasons why the Maternity Manifesto is seeking the support of all political parties and everyone who is concerned about women-centred, evidence-based and more cost effective alternatives to the rising intervention rates that are a consequence of 84% (2007) New Zealand births occuring in secondary or tertiary hospitals. The manifesto also seeks support for issues such as a Human Milk Bank and MotherBaby Unity of Sick Newborns which was the subject of a previous parliamentary enquiry [2], and the Full Implementation of the WHO Code on the Marketing of Breast Milk Substitutes which continues to be a voluntary requirement for formula companies 20 years after New Zealand became a signatory to the code. All the evidence suggests that the options sought will bring better maternity care outcomes plus more efficient use of limited health resources as outlined in the Maternity Manifesto.

[1] Ballard, S. ‘The Price of the Slice” AUT Newsletter Summer 2011

[2] Petition 2005/31 of Jessica Haussmann and 2,478 others, Report of the Health Committee, April 2007 NZ House of Representatives

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Trust children. Nothing could be more simple, or more difficult. Difficult because to trust children we must first learn to trust ourselves and most of us were taught as children we could not be trusted. — John Holt
No other natural bodily function is painful and childbirth should not be an exception. — Grantly Dick-Read
I can promise you that women working together - linked, informed and educated - can bring peace and prosperity to this forsaken planet. — Isabel Allende
We need to have their hearts before we can open their minds. — Dr Gordon Neufeld
Birth is not only about making babies. Birth is about making mothers – strong, competent, capable mothers who trust themselves and know their inner strength. — Barbara Katz-Rothman
Nothing in life is to be feared it is only to be understood. Now is the time to understand more so we can fear less. — Marie Curie
A loving heart is the truest wisdom. — Charles Dickens
All change is not growth, as all movement is not forward. — Ellen Glasgow
The greatest joy is to become a mother; the second greatest is to be a midwife. — Norwegian proverb
Without deviation from the norm, progress is not possible. — Frank Zappa