I am convenor of a support group that supplies women with information and support about birth choices after a c-section. We are basically a pro-VBAC group, but we do realise that c-sections can be necessary and do save lives. We support informed birth choices for all women and their babies, and their right to have a positive c-section if that is their choice of delivery.
It is in this role of supporting women that I have raised the question of the restrictive guidelines for women entering a local birth centre attached to a major women's hospital.
This birth centre's many guidelines seem harsh and contradictory, especially considering that it is attached to the hospital and is approximately 100 metres from the emergency department. Some examples of these guidelines are: a woman is not eligible to use the centre if she has any previous uterine scar (including previous c-section), epilepsy or seizures, a malignant disease, parity 5 or more, previous severe preeclampsia or eclampsia in most recent pregnancy, previous poor obstetric outcome (e.g., stillbirth, etc.), retained placenta, etc.
All women *must* sign a form prior to being accepted into the birth center that says they will receive oxytocic administration immediately after delivery. This is a prerequisite to acceptance. Similarly women are also denied admittance if they have refused routine oxytocic administration for third stage management at a previous birth.
These are only some of the many guidelines involved, and I find most of them excessively restrictive when considering the close proximity to an extremely technologically up to date hospital. They seem to question the mother's ability to make the right choices in relation to the birth of her child and deny her involvement in the decision making process. Instead of providing guidance and support for the mother in making good decisions about her labour and birth, they provide rigid guidelines for health professionals that severely restrict her autonomy and personal rights.
I will be questioning some of the many guidelines, including those mentioned above, during a meeting with the hospital at the beginning of February. I need to find out how other birthing centres' guidelines/restrictions compare with the above guidelines, especially birthing centres located within Australia.
I raise these questions in the hope that consumer-friendly guidelines will be adopted that will safely support women by honouring and respecting their right to make informed decisions in regard to the birth of their children while offering emotional support. If I can provide evidence of current policies in similar establishments nationally, then this will help me present a better discussion in support of consumer's needs.
Women make an informed choice when they apply to birth in a birth centre, especially when trying to avoid the technology that may have surrounded a previous birth experience. This technology, which may have been 100% necessary during previous birth experiences may be the exact reason they will be denied admittance to the birth centre for a subsequent birth experience. This denial occurs even with no presentation or indication of a similar or related problem in the subsequent pregnancy. These policies must be questioned and updated according to the latest studies and research available in order to provide evidence-based care.
If these women were given the option of being accepted into a birth center after being individually assessed rather than judged on their past record of obstetric outcomes, the secure and positive atmosphere they are given may provide the emotional healing they crave, along with the safety that is their right.
My request is that you supply me with other current birth centre guidelines so I can compare them to those above. I look forward to hearing from you and thank you in advance for any help you can provide. Please email me at birthrites@edsite.com.au and I will email you my postal address so information can be sent to me directly.
-Jackie Mawson.
Convenor, Birthrites: Healing After Caesarean Inc.
Reprinted from Midwifery Today E-News (Vol 2 Issue 1, Jan 7, 2000)
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