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October 14, 2004
Hard labour: a family's search for maternity care

By Julie Robotham, Medical EditorPage Tools

CAPTION: From here to maternity ... Narelle Foster of Narromine couldn't find care that suited her for the birth of her daughter, Lauren. She is pictured with husband Dale and sons Timothy, left, and William.
PHOTO: Peter Morris

It was not as though Narelle Foster planned to give birth at home, 40 kilometres away from medical care and with only her husband for support. But as the arrival of her third child drew closer, the Narromine mother felt she had run out of options.

"I don't agree with unassisted birth. I did it out of desperation I suppose," said Mrs Foster, whose older children were born in Inverell under the care of a female GP with obstetrics training.

Baby Lauren arrived three months ago in the bathroom of the family home after a drug-free overnight labour. Her father, Dale, caught her and cut the cord. Her brothers, William and Timothy, slept through the event.

But the relative ease of Lauren's birth was in contrast to the stress and heart-searching the Foster family went through during the pregnancy as they sought safe maternity care that was acceptable to them.

The only private obstetricians in Dubbo, the nearest major centre, were all men - and Mrs Foster was adamant that she wanted female support during labour. Neither did any women GPs in the area deliver babies. Ideally, the Fosters would have chosen the care of one midwife throughout the pregnancy and birth. But they could not find a private midwife prepared to travel to the district. At Dubbo Base Hospital, the only service then available was the public antenatal clinic, where women are assigned to whichever doctor or midwife is free that day.

Mrs Foster booked into hospital but found its procedures bureaucratic and alienating.

"It was very, very unfriendly and unsympathetic," Mrs Foster said. As the birth approached, she felt increasingly unhappy about the prospect of giving birth in a medical environment under the care of strangers. The couple decided they would stay at home, but transfer to hospital at the first sign of any difficulty.

Claire Blizard, the administrator of Macquarie Area Health Service, which manages Dubbo Base Hospital, said the hospital had now begun to offer a "midwife companion" program. The scheme, which women can join in early pregnancy, has been in operation since June 15 - three weeks before Lauren's birth - and was "in high demand with expectant mothers-to-be", Dr Blizard said.

But Sally Tracy, Associate Professor of Midwifery at the University of Technology, Sydney, said mothers in many parts of regional NSW had no access to midwifery care and Mrs Foster's case was "an absolute indictment of our maternity services in Australia, where women really don't have a choice".

The Federal Government had chosen to give disproportionate funding to private obstetrics "without any regard for the research under their noses" that midwifery care was superior for uncomplicated births, Associate Professor Tracy said.

According to the Cochrane Collaboration, which reviews international research, "modern obstetric care frequently subjects women to institutional routines, high rates of intervention, unfamiliar personnel, lack of privacy, and other conditions that may be experienced as harsh. These conditions may have an adverse effect on the progress of labour ... This process may to some extent be buffered by the provision of support and companionship during labour."