Is It Time For A Royal Commission Into Birth?

Today Western Sydney University Professor of Midwifery Hannah Dahlen posed two questions of her social media audience in response to 2021 update of the “Australia’s Mothers and Babies” report, released by the Australian Institute of Health and Welfare last week.

The first question, “what the hell are we doing?”, comes on the back of the following 2019 statistics from the publication last week.

As of 2019, Australia’s caesarean birth rate is now 36% (and 37% for first time mothers and birth parents), up from 31.5% in 2009. As a reference point, the World Health Organisation international healthcare community recommends the ideal rate of caesarean sections to be 10-15% to optimally prevent maternal and newborn mortality. The Australian rate is also markedly higher than the average amongst other OECD (“developed”) countries of 28 per 100 live births.

The likelihood of a pregnant person spontaneously going into labour was 56% in 2009 (already pretty rubbish), and fell to 42.5% in 2019.

The likelihood of a pregnant person being induced increased from 25% in 2009 to 35% in 2019.

The likelihood of a pregnant person experiencing no labour increased from 18% in 2009 to 23% in 2019.

24% of births in 2019 involved an episiotomy.

The rising rates of intervention have not led to any improvement in perinatal death for mothers/birth parents or their babies since the year 2000, especially for those in vulnerable groups.

In light of these statistics, Professor Dahlen’s second question to her readers seems apt: “Can we ask for a Royal Commission into birth?”

Royal Commissions are major public investigations and inquiries into a matter of great importance that happen independently of the government. Recommendations are then made to the government about what should change to improve the situation.

Although there is no obligation for the government or health bodies to adopt the recommendations, a Royal Commission can be a turning point for action.

While I suspect the current government are unlikely to consider the experience of birth as a “matter of great importance” or be willing to loosen their grip of a white man’s control over anything to do with natural processes, wombs and birth canals, it would certainly be a step in the right direction.

I can almost guarantee the main answer would be “every pregnant person should have access to continuity of midwifery care and a known midwife at their birth, regardless of where they birth or the involvement of a specialist obstetric team.”

For those expecting soon, systemic change will not come quickly enough, so what can you do?

Here are my suggestions if you want to feel as ready as possible for birth in 2021/22:

1. Participate in independent birth education.
   
   Unless you partake in birth education outside the birth system, you’ll be learning more about interventions than physiological processes and how to go with natural flows. Face to face options like Hypnobirth and CalmBirth are excellent, empowering for both birthing and support person, and have the stats to back it up.
   
   Thanks to COVID-19, many independent providers offers live classes and pre-recorded courses online at lower prices which will hopefully increase access to this very important preparation.
   
   
2. Choose your birth partner wisely.
   
   The flipside of COVID-19 is that many places are only allowing one support person in to the birth suite with you. If your partner knows more about car engines than birth, this could be a problem – the birth system is geared towards policy not your preferences, and unless your support person knows how to advocate within it, it might take a lot of effort to stick to your guns.
   
   If they are not 100% on board with your plan for birth, feeling confident after birth class or don’t know their way around the Evidence Based Birth website (it’s fantastic, go dive in) you might want to consider someone else joining you for birth. It sounds harsh, but this is your birth and your body, and you can not be looking after their wellbeing while you are birthing or answering questions they should be dealing with on your behalf.
   
   If you can get a student midwife as well as your partner or get an exemption to have your partner and doula join you, that might be a good way to go. If not, I’d recommend you seriously consider whether a doula, aunty or trusted person who has given birth themselves as your sole companion for hospital birth would leave both of you with a better entry to parenthood.
   
   
3. Choose your care pathway and provider wisely.
   
   If you were like me and assumed private health insurance would be a key to having the birth you want, you’ll be sorely mistaken. Do not be fooled by “supportive” specialists and wards unable to provide their stats - private hospitals have worse intervention rates than public hospitals, and public hospitals have higher intervention rates than homebirths. 
   
   The “gold standard” model of care in Australia is called “continuity of midwifery care” – try your best to get referral to a program like that as early as possible.
   
   If you have the funds available, a private midwife can support you for all prenatal and postnatal visits and attend your birth at either home or a public hospital for around the same amount as a private obstetrician birth in a private hospital ends up being on top of your health insurance policy.
   
   If you're in Newcastle NSW or surrounds, you can read a comparison of local provider pathways I've compiled here.

I realise these are not feasible options for everyone, which is another of the great failings of the Australian birth system built like all other colonial systems on the prioritising of the privilege havers over the have nots.

You might be able to find a way around it, a provider who'll do pro bono work or the like, or you might not.

I'm sorry I don't have any answers, and decent alternative.

This is why we need that Royal Commission Professor Dahlen so rightly raised. Unless all birthing women and people have choice, there is no true choice for anyone, only execution of privilege. Our mothers, parents and our babies ALL deserve better.