Maggie banks home birth in new zealand - challenges and choices - yesteryear and today

Home Birth in New Zealand: Choices and Challenges,
Yesteryear and Today

Well-behaved women rarely make history

Laurel Thatcher Ulrich

The title of this conference is about the present and future, and focuses on how today’s choices
influence tomorrow’s parenting. I am going to start my talk by drawing a little on my doctoral
research 1 which was an herstorical work on the midwives of the Domiciliary Midwives Society of
New Zealand (Incorporated). This society was formed by the midwives primarily so they, rather than
the New Zealand Nurses Association, could lobby and represent themselves in pay negotiations, but
it also had an educative and support role for domiciliary midwives. Domiciliary midwives practised in
home birth before the return of midwifery autonomy in 1990. Those of us who work only in home
birth are known now as home birth midwives.

So, I will condense 7 years of work into a few paragraphs to give a very brief overview of home birth
in Aotearoa New Zealand to start with. My reason for doing that is that looking back at what has
influenced us up till this point gives a context for where we are today and can help us make sense of
today’s world and, perhaps, may help us deal with that which will exist in the future. 1

After that I will go on to look at a couple of the many challenges that exist for women birthing in
New Zealand, and I will finish up with a story that speaks to the power home birthing has to change
the culture of birthing and parenting in families.

This paper will be on the Home Birth Aotearoa (www.homebirth.org.nz) and Birthspirit
(www.birthspirit.co.nz) websites next week if you want to follow up on the sources of information
that I have used.

So where did it all begin?

It can be difficult to imagine in 2011 but approximately 5 generations ago, all women birthed at
home and almost all were attended by goodly or kind neighbours rather than midwives, doctors or
nurses. This was the case until the early 1900s when midwives of the St Helens hospitals or midwives
from some hospital boards provided services for what they called ‘outdoor cases’ or ‘home
confinements’. These services continued to be provided at least until the late 1930s but the
attendance primarily revolved around birth with minimal antenatal and postnatal care.2

In 1938, the passing of the Social Security Act introduced what is known as our ‘from cradle to grave’
welfare system, part of which provided for all women to have their babies in hospital without
charge. The services were now funded through taxes. One of the many benefits supporting that

A paper presented by Maggie Banks (PhD, RM, RGON)
Home Birth Aotearoa Conference: Today's Choices, Tomorrows Parents - bridging hearts, homes and humanity.
Okurukuru Winery, New Plymouth, 28-30 October 2011

welfare system now provided payment for midwives (and medical practitioners) to provide
domiciliary confinement or home birth.
The then governing body of all health services was known as the Board of Health. As it had predicted
and intended, the already dropping number of home births decreased further and by 1973 home
birth numbers were at an all time low of thirteen births for the whole country.3 The number of
domiciliary midwives had also declined progressively and, by 1973, there were only eight throughout
the whole country and these mainly provided only postnatal services.
However, this period of the early 1970s was the beginning of a time of tremendous social change
with the rise of the feminist movement. Women were starting to take hold of their right to govern
their own bodies. By 1974, the women’s movement was starting to focus on health issues and
hospital midwives were being challenged to “change their attitudes…from a hospital/sickness
orientation and…play a large part in humanising maternity services”.4 Women started to demand to
be treated respectfully in childbirth as they were no longer prepared to accept the humiliation that
many were been subjected to in the hospital system.
1974 would mark the start of the home birth resurgence as one Christchurch midwife (Ursula Helem)
and two Auckland midwives (Carolyn Young and Joan Donley) commenced full domiciliary practice 5
to meet the demands of women.
By the 1977 United Women’s Convention, delegates were urged to consider themselves ‘consumers’
rather than clients or patients. Home birth was, as Joan Donley, the mother of modern home birth,
said, “an idea whose time had come”.6
2
In 1978 the first Home Birth Association and a Home Birth Support Group were formed in Auckland
and Christchurch, respectively, and the consumer movement would grow over the next decade to
have branches throughout New Zealand. Today the home birth movement is supported by Home
Birth Aotearoa as the national organisation representing the many local associations throughout the
country.
Home birth numbers climbed and in 1986 these had grown to number 534 for the year.7 However,
the number of domiciliary midwives grew more slowly – there were 17 by 1980 attending births in
the greater Auckland area, Hamilton, Palmerston North, Wellington, Lower Hutt, Nelson and
Christchurch.8 The reason for this slow grow was financial - domiciliary midwives could not afford to
practice. For a 40 hour week, domiciliary midwives received less than half of that which one would
receive through the Unemployment Benefit.9 They would continue to earn much less income than
hospital-employed midwives until the change to the Nurses Act which happened in 1990. If it had
not been for the families of the home birth movement who dropped off boxes of vegetables, kept
their cars on the road, provided child care and paid for them to go to conferences (and many other
things), many domiciliary midwives would not have been able to continue to practice prior to 1990.

So what was home birth all about then and now?

Home birth philosophy was, and is, simple – it centres around the fact that when well women who
are lovingly supported in their own healthy homes by family, friends, and known and trusted
caregivers, the act of giving birth seldom requires medical intervention or hospitalisation. For the


home birth midwife it is about promoting, supporting and protecting the continuum of a healthy life
event rather than using the interventionist practices and drugs common in New Zealand’s hospitals.
For the woman it is about having a nutritious diet, a healthy life style and breastfeeding the baby,
and about exercising her rights of responsibility for herself and her baby. Simplistic as it sounds, this
is the core of home birth – health, wellbeing and women taking control of what happens to them,
and midwives supporting them to do so.

Home birth is every woman’s choice - however, not all women are informed of that choice as they
are guided to birth in hospitals with their first babies.

If there is one thing that I would like you to take away from this address it is that planning to birth
at home with your first baby if you and your baby are well, is an essential step to avoid the
medicalisation of birth that persists in New Zealand.

We can see that heavy impact on women and babies through a continuously escalating Caesarean
section rate.

Caesarean section

In 2004, the overall Caesarean rate was nearly 24 percent (23.7). Just over 61 percent (61.13) of
women birthing for the first time in New Zealand birthed normally 10 - and this ‘normal’ birth figure
includes all the well women with a normal length pregnancy (up to 42 weeks gestation) who
received the common interventions that medicalised birth attendants regularly use, such as, using 3
drugs to induce or speed up labour, breaking the waters, administering ‘gas’, narcotics and epidural
anaesthetics (all of which enter the system of the baby), and cutting the perineum – just to mention
a few things.

While we don’t know what the so-called ‘normal’ birth rate is for first time mothers for 2010, the
rate for all women is just under 65 percent (64.8), and the Caesarean rate has risen to 25 percent
(15,145 women).11

What is clear in New Zealand is the Caesarean rate has, for the last 12 years at least, remained over
twice that which the World Health Organisation recommends as appropriate, and is between 8 and
10 times higher than midwives embedded in home birth practice cite of their statistics (2-5 percent).

Home birth in hospital

There is no such thing as ‘home birth in hospital’. The environment for birthing needs to be an
environment of privacy, intimacy and familiarity, the very same intimate space and atmosphere
conducive to lovemaking, as the hormonal interplay of labour and birthing is exactly the same as
that of lovemaking. For those who promote home birth in hospital, I would suggest they try to make
love in a hospital. I am sure the lack of locks on the doors, the ever-present potential for a stranger
to enter the room, the clinical obstetric bed, the antiseptic smells and the sound of emergency bells
ringing out will dampen the strongest ardour.


Home birth support

Home birth is supported today by the Ministry of Health and the New Zealand College of Midwives.
It is not supported by the professional body of obstetricians.12 Fortunately, that doesn’t matter as
much today as it did in yesteryear. While it has always been a woman’s decision to make, today her
right to control her health care is supported by the Health & Disability Commissioner’s Code of
Rights, and midwives do not need permission from doctors to provide home birth services as they
did from 1971-1990. But it is disturbing to see robust scientific evidence continues to be ignored and
poor quality evidence continues to be cited by RANZCOG as its rationale for opposing home birth.

Ongoing medicalisation of childbearing

Women who plan to birth at home can still be exposed to the progressive medicalisation of
childbearing as they go through the hoops of various test choices. Probably the most common of
these is ultrasound scanning in pregnancy.

In 1974 there were only 2 ultrasound machines in New Zealand – one in Auckland and the other in
Christchurch. This procedure was seen by the then Department of Health’s senior obstetric advisor
to be of value in only very few pregnancies.13

The Ministry of Health’s most up-to-date Report on Maternity from 2004 tells us that only 9 percent
of women go through pregnancy without scanning and that over one third of women will have 3 or
4
more ultrasound examinations; this data excludes those who have scans in hospital or who pay for
them themselves.14 It also excludes those who have scans each time they see their obstetrician Lead
Maternity Carer.

This escalation of scanning over the last years is not about increasing unwellness. It is being used as
a tool to identify the imperfect baby with recommendations for surgical abortion (politely named,
termination of pregnancy). This culling of babies is not based on an acceptance of diversity but is
centred on the health dollar and resource allocation. While a 2010 Cochrane review15 appears to
negate the idea that scans have a detrimental effect on children's physical or intellectual
development, the machinery used is progressively more powerful and used more penetratingly.
Investigations as to whether higher and repetitive exposure creates the same cellular disturbance in
unborn babies that occurs in experimental animals 16 are lacking, and the ‘safe’ maximum of the
temperature elevations that occur during the procedure have yet to be determined.17 I have geared
my ‘Challenge’ for discussion later around the use of ultrasound, specifically the use of Dopplers to
listen to baby’s heart beat in pregnancy and labour so this issue is explored more.

To finish my address I would like to tell you a simple story about the power home birth has to bridge
hearts, homes and generations. It is about a woman I will call Adele.


Adele’s story

Adele came to home birth when she was pregnant with her 6th baby. She had experienced 4 of those
‘normal’ births that I spoke of previously – waters broken artificially, episiotomies, babies’ umbilical
cords clamped and cut immediately and injections to make the afterbirths come. With her second
baby, forceps were also used to turn and pull out her 6lb 5oz (2481gm) baby. During one of the
times that Adele’s placenta was being pulled out, the cord was pulled off and she was transferred
from the rural birthing unit to the obstetric hospital where her placenta was scraped off the wall of
her uterus by the obstetrician’s hand once Adele was put to sleep with a general anaesthetic.

She was philosophical about these births; she had trusted her caregiver (a General Practitioner) to
not intervene unnecessarily but this trust had not been honoured.

Adele was valued in her church community and, as an elder, she would be called upon to talk to the
young women of the church about birthing and mothering.

Adele had discovered La Leche League and she was a committed breastfeeder. Over time she began
to question the impact on breastfeeding of the interventions – all of which prevented immediate
latching and in-arms mothering, and the effects of the drugs on her baby made early breastfeeding
difficult.

According to the obstetric thinking of the Referral Criteria, she was too old, had too many children,
and she had a history of retained placenta, all of which meant that she was supposed to birth in the
obstetric hospital for any other births. 5
I would be Adele’s midwife for the next 5 planned home births and I was happy to support her
knowing she would avoid the problems which her previous caregivers had bestowed upon her.

Adele’s children were always present for labour and birth.

For one of these births I was called to Adele’s place in the early evening as she was in labour. After
having stowed my gear in the wash house, I was ushered into the kitchen where there was a flurry of
washing being folded, a small wet child was being tickled as he was dried and dressed, and Adele
was dishing up the dinner. She gave me a quick smile and an instruction to sit up at the table; it was
time for dinner. Adele’s labour was almost imperceptible but clearly her hawk-eye gaze over the
family proceedings was not as it normally was as she missed the sliding of numerous peas onto my
plate by one of the two little boys between whom I was sandwiched. While I had a clear
understanding of what a midwife’s role is during labour, this little boy also saw that it included
making this most hated vegetable disappear, and to do so without complaint. My wink assured him
he had an ally.

Following the dinner, some people did dishes, others ushered the remaining small children into the
shower and the birth pool was filled. One of the older children was tasked with keeping the younger
ones from falling into the pool as they strained to splash and swirl in the deepening water.

There was a point where Adele disappeared and this was my cue that, having seen to all outstanding
family matters of the day, and having started the viewing in the lounge of a video rented for the
occasion, she was now into the business of birthing in the back room.


Adele and her husband Syd were in the birth pool. Over the next little while, Adele’s labour built
until her urge to push saw her bearing down. Syd, in front of her, was in the prime position to lift her
baby out of the water and into her arms which he did after Adele’s minimal pushing. In those last
few moments before the birth, a call went out for all the children to gather around to witness the
birth of their sibling, and they stampeded into the room. Tanya, a daughter in law, was individually
summoned by Adele; as Adele said, “she needs to know how babies should be born so she can do it
herself”.

The birth was greeted with great joy and the baby was examined from head to toe by his siblings.
The movie soon beckoned, and all the children drifted back to the lounge.

The placenta was born and left to float in an ice cream bucket on the surface of the water until the
umbilical cord was clamped and cut by Syd before Adele left the pool. The baby, who remained
continuously in arms, was put to the breast and commenced breastfeeding, nourishment that would
be ongoing for some years.

The exposure of these children to birth at home did not take the family by storm; after the first, it
was their family norm. The births of further siblings became the interlude between the scenes of a
high adventure movie that was rented for each birth.

But it did have a profound effect on the choices that this extended family made as 4 of these
children (now adults), or their partners, have since planned home births for their collective (to date)
9 children. In each case the choices made were different from those that their parents had made
when they themselves were being born. One of these births in particular speaks volumes about how 6
home birth can shape parenting – one which gave birth to a father.

David appeared at my home one evening saying he wanted me to meet his fiancé, asking me what I
was doing in eight months time. (I had come to recognise this question as an announcement of a
pregnancy and that it was intended that I would be the midwife.) It was actually a re-meeting of his
partner as I had attended her mother some years previously.

The understanding that this teenaged couple brought to pregnancy, birthing and parenting belied
their youth, none more so than David’s preparedness for the birth and the early days of
breastfeeding. On entering the home when called in labour I was met by the warmth of the house,
my birth pool all ready for use, towels over an airing rack above a heater ready to flip into action,
many tempting morsels for his partner in labour, sipper bottle to the fore and offered regularly, and
the dishes were being done.

As the labour progressed, he helped his partner into the pool, getting in himself to receive their baby
when the birth was imminent. After he had caught their baby and placed her in her mother’s arms,
he was onto his next activity. The towels were warmed, a snack was made for his partner and the
bed was straightened up ready for use. As the midwife, my role was one of patient and quiet vigil –
or as an unknowing observer might interpret – I did nothing but listen a few times to the baby.

David’s support of his partner continued to ensure that over the first week of her babymoon she did
nothing but rest, eat and care for herself and their newborn. In the second week he supported her to


gradually take on the running of the home in preparation for his return to work. These things this
boy-man had learnt came through home birthing.

In closing

Home birth is not just about place of birth and avoiding all the routine interventions of medicalised
environments and practitioners. It is also about creating or recreating families who are strong and
knowledgeable who are then able to hand down that knowledge to their children.

Some of us gain that knowledge by our own birthing, and others, like myself, do so through the
women we attend and, importantly, also hand it on to our children.

The American birth activist Suzanne Arms once said (and I paraphrase): if we want to create a non
violent world then we must start with the way babies are born.

My experiences as a home birth midwife over more than two decades have repeatedly shown me
that birth can be gentle and that home is the birth space for bridging hearts and humanity.

Thank you.

References 7
1. Maggie Banks, ‘Out on a limb: The personal mandate to practise midwifery by midwives of
the Domiciliary Midwives Society of New Zealand (Incorporated), 1974-1986.’ [PhD thesis].
Victoria University of Wellington, Wellington, 2007. Available at www.birthspirit.co.nz.
2. Adelheid Wassner, Labour of Love: Childbirth at Dunedin Hospital, 1862-1972, Adelheid
Wassner, Dunedin, 1999, p. 47. A register of ‘Outdoor Cases’ of the Batchelor Hospital in
Dunedin documents 200 cases up until August 1934. The last birth on the register was
recorded as ‘Case no. 1499’; New Zealand Nurses Association, Report on Community Health
Nursing in New Zealand, Wellington, New Zealand Nurses Association, 1980, p. 3.
3. ‘Number of home delivery figures by health district and year’, Table, c.1978, in Department
of Health, ‘Self-employed midwives (domiciliary): the Department’s responsibilities’, Paper,
March 1979, DoH, ‘Board of Health – Maternity Services Committee, 1978-1979’, ABQU 632
W4550, 29/21 (49879). Held at Archives New Zealand, Wellington.
4. Maureen Marshall, ‘Women as Healers’ in Women '74: Proceedings of the University
Extension Seminar, 14-15 September 1974, Hamilton, University of Waikato, 1975, p. 96.
5. ‘Home delivery and post natal care by Health District…’, Table, c.1978, in Department of
Heath, ‘Self-employed midwives (domiciliary): the Department’s responsibilities’, Paper,
March 1979, DoH, ‘Board of Health – Maternity Services Committee, 1978-1979’, ABQU 632
W4550, 29/21 (49879). Held at Archives New Zealand, Wellington.
6. Joan Donley, Herstory of the NZ Home Birth Association, Joan Donley, Auckland, 1992, p. 3.


7. ‘Home birth statistics 1987’, c.1987, DMS, ‘Home birth statistics, DMS/00 11’. Held at Wise
Woman Archives Trust, Hamilton.
8. Data source: ‘Numbers of (A) Home Confinements and (B) Domiciliary Midwives in Each
Health Area, 1977-1980’, in Maureen Laws to Tony Cochrane, Letter, 10 June 1981, DoH,
‘Board of Health – Maternity Services Committee, 1982-1983’, ABQU 632 W4415, 29/21
(54816). Held at Archives New Zealand, Wellington.
9. Allison Livingstone to Dr Claudia Scott, Chairperson, Health Benefits Review Team,
Submission, 28 May 1986, DMS, ‘Correspondence, re Maternity Benefits, DMS/00 4/18’.
Held at Wise Woman Archives Trust, Hamilton.
10. Ministry of Health, Report on Maternity 2004, Ministry of Health, Wellington, 2007, p. 33.
11. Ministry of Health, Maternity Snapshot 2010, Ministry of Health, Wellington, 2011. Available
at www.moh.govt.nz.
12. Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Home births
(C-Obs 2), 2009. Available at www.ranzcog.edu.au/.
13. Professor JL Wright, ‘Standards of ante-natal care’, Therapeutic Notes No. 137, Department
of Health, 30 September 1974.
14. Ministry of Health, Report on Maternity 2004, Ministry of Health, Wellington, 2007, p. 25.
15. M Whitworth, L Bricker, JP Neilson, Dowswell T, ‘Ultrasound for fetal assessment in early
pregnancy’, Cochrane Database of Systematic Reviews 2010, Issue 4. Art. No.: CD007058. 8
DOI: 10.1002/14651858.CD007058.pub2.
16. NI Vykhodtseva, K Hynynen, C Damianou, ‘Histologic effects of high intensity pulsed
ultrasound exposure with subharmonic emission in rabbit brain in vivo.’ Ultrasound in
Medicine & Biology, 1995, 21(7), pp. 969-979.
17. Charles C Church, Morton W Miller, ‘Quantification of risk from fetal exposure to diagnostic
ultrasound’, Progress in Biophysics and Molecular Biology 2007,Volume 93, Issues 1-3, pp.
331-353.


Maggie banks home birth in new zealand - challenges and choices - yesteryear and today

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (10)

Ähnlich wie Maggie banks home birth in new zealand - challenges and choices - yesteryear and today

Ähnlich wie Maggie banks home birth in new zealand - challenges and choices - yesteryear and today (17)

Mehr von Active Birth Taranaki

Mehr von Active Birth Taranaki (6)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Maggie banks home birth in new zealand - challenges and choices - yesteryear and today