The Pregnant Woman’s Homebirth Bill of Rights and Responsibilities
There will always be an element of risk in birth whatever the choice of birthplace. However, safety in childbirth is intrinsically related to the mother’s emotional, psychological and physical well-being during labour. This, in turn, is influenced by the choices which are made during pregnancy, choices which should enable a woman to give birth at ease with her environment, her attendants and herself.
No professional, however well-meaning, will have to live with the consequence of the outcome of labour and birth as long or as intimately as the consumers to whom they offer their services. The choice of birth professional is possibly the most important choice a woman will make during her pregnancy. There is no place for paternalism in the practice of obstetrics although at some stage of labour the decision may be made to place the management in the hands of the professional. However, domiciliary obstetrics is the ‘art of invisibility’ and without complications a woman gives birth herself, supported and aided by her midwife.
This most important choice of birth professional should be made after long and careful evaluation of the practitioners available. It is especially helpful to talk to as many clients as possible and get a clear picture of the mode of practice. Every woman gives birth in her own individual style and will feel easier if her practitioner’s style suits her own. Some homebirth midwives collect statistics of the incidence of complications which occur within their practice, such as caesarean sections, episiotomies and tears for on-going review of their own work.
Expertise in decision making is based on a firm grasp of the possible options, their consequences and their relative risks. This is only possible within the context of a mutually trusting and warm relationship. The complexities of birth and death call for hard logic, love, courage, deep conviction and intuition.
Childbirth thus becomes a shared adventure between parents and professionals. The rights and responsibilities of all concerned should be thoroughly discussed and scrupulously observed. In this way, the self-esteem and autonomy of women, whether as birth-giver or midwife, will be enhanced whatever the physical outcome of the birth.
The arduous and often unrecognised role of the homebirth midwife has become politicised because of the support midwives give women in their efforts to regain autonomy in birthing. She and her family often suffer considerable personal and economic hardship as she may work outside the mainstream of obstetrics due to lack of peer support. With the widespread misconceptions about the safety of homebirth, her professional status is in jeopardy if anything goes wrong. However skilled she may be, deregistration and loss of a career is a constant insecurity in the face of social hostility to her chosen mode of practice.
Homebirth Australia has produced this Bill in the hope that it will protect and be of help to the parents, babies and midwives who make homebirth possible in this country. - Jan Pilgrim
The Pregnant Womanʼs Homebirth Bill of Rights.
1. The pregnant woman has the right to choose her place of birth.
2. The pregnant woman has the right to choose her birth practitioner and to be fully informed of her practitionerʼs qualifications and experience.
3. The pregnant woman has the right to choose who will be present at her birth and the right to refuse entry or to ask anyone to leave her place of birth.
4. The pregnant woman has the right of access to literature and information about birth and particularly homebirth.
5. The pregnant woman has the right to know her practitionerʼs methods and techniques of birth.
6. The pregnant woman has the right to know the approximate costs which will be incurred under her practitionerʼs care.
7. The pregnant woman has the right to expect that any information she gives her practitioner will be confidential and not divulged to anyone else without her permission.
8. The pregnant woman has the right to comprehensive antenatal care including access to standard tests and procedures related to the well-being of mother and child.
9. The pregnant woman has the right, prior to the administration of any drug, medication, procedure or test, to be informed by her practitioner of any direct or indirect effects, risks or hazards to herself or her unborn or newborn baby.
10. The pregnant woman has the right to determine for herself whether she will accept the risks inherent in a proposed therapy, drug, test or procedure.
11. The pregnant woman has the right to choose how she gives birth and to be treated with dignity and consideration at all times so that she feels free to follow her instinctive reactions during birth.
12. The pregnant woman has the right to ancillary medical support when needed.
13. The pregnant woman has the right, if transferred to hospital, to be treated with respect and courtesy and to be accompanied by her practitioner and support persons of her choice.
14. The pregnant woman has the right, if transferred to hospital, not to be separated from her baby except for valid medical reasons.
15. The pregnant woman has the right to comprehensive postnatal care including support for the establishment of breast-feeding, assessment and care of her newborn baby, and information about relevant screening tests and registration of birth.
16. The pregnant woman has the right to be informed if there is any known or indicated aspect of her or her babyʼs care or condition which may cause her or her baby later problems.
17. The pregnant woman has the right of access to her and her babyʼs records and to receive a copy of her notes when desired.
18. The pregnant woman has the right, in the vent of an unexpected outcome to her pregnancy or birth, to receive all the additional support and services that she needs.
19. The pregnant woman has the right to complain and to receive satisfaction from her practitioner.
As the pregnant woman has rights, so she also has responsibilities.
The Pregnant Womanʼs Homebirth Bill of Responsibilities
1. The pregnant woman is responsible for learning about the physical and emotional process of labour, birth and postpartum recovery.
2. The pregnant woman is responsible for learning about good antenatal and birth care so that she may choose the best possible arrangements which suit her individuality and circumstances.
3. The pregnant woman is responsible for learning about her practitionerʼs methods including evaluation of statistics of past cases and talking with other clients.
4. The pregnant woman is responsible for her own emotional and physical well-being during pregnancy.
5. The pregnant woman is responsible for attending her antenatal appointments and informing her practitioner if she is unable to attend.
6. The pregnant woman is responsible for her own psychological preparation for homebirth in a society which may be unsupportive or even hostile, especially if the pregnancy results in the death of a baby.
7. The pregnant woman is responsible for meeting her practitionerʼs requirements for preparation for homebirth.
8. The pregnant woman is responsible for informing the practitioner of any relevant physical, emotional or psychological information which may affect the outcome of her birth. These may include intake of drugs, medications, herbs, allopathic, naturopathic, psychological or alternative therapies and the obstetric, sexual or psychological history of herself or her relations, friends or partners which are affecting her attitude towards birth and parenting.
9. The pregnant woman is responsible for providing a suitable birth place and environment for her newborn.
10. The pregnant woman is responsible for making any alternative arrangements for her birth and for booking into hospital.
11. The pregnant woman is responsible for making mutually agreed upon birth plans with her practitioner in advance of labour.
12. The pregnant woman is responsible for choosing a suitable support person or persons for her birth and for ensuring they are emotionally and psychologically prepared for their role at her birth.
13. The pregnant woman is responsible for being assertive enough to dispense with any person who is not supporting her during her labour.
14. The pregnant woman is responsible for ensuring her support people can carry out her preference if she is unable to express them during labour.
15. The pregnant woman is responsible for the psychological and emotional preparation of siblings for the birth.
16. The pregnant woman is responsible for the choosing of individual support people for siblings.
17. The pregnant woman is responsible for acquiring information about breast-feeding and care of the newborn.
18. The pregnant woman is responsible for arranging domestic support for herself and her family during the postnatal period.
19. The pregnant woman is responsible for obtaining information regarding the cost of her care and making arrangements for payment.
20. The pregnant woman is responsible for evaluating the quality of care she has received and making any dissatisfactions she may feel known to her practitioner.