Homebirth Policy WA
Pauline Costins (Eligible Endorsed Midwife) RN: RM: Juris
Doctor
1
Discussion points
2
!  Maternity services plan
!  History of homebirth in WA
!  Publicly funded Homebirth in WA
!  Inclusi...
3
Objective of the homebirth policy
4
!  “working together across Western Australia.A Policy
Framework is to improve care pr...
Background
5
!  2008 – Review of homebirths in WA
!  Highlighted that women have a right to choose a
maternity care option...
Definition
6
!  This policy defines homebirth as “ a planned event where
the woman chooses to give birth at home, with car...
WA Homebirths
7
!  Approximately 200 women have a homebirth
!  0.06 – 0.8% of all births
!  Transfers
!  Pain relief
!  Ob...
8
http://www.health.wa.gov.au/publications/documents/perinatal/WA_Mothers_Babies_2010.pdf
Who provides homebirth
9
!  Publicly funded by
!  Community midwifery program (CMP) North Metropolitan
Area Health Service...
Who should have a homebirth?
10
!  Inclusion Criteria
!  Is over 18
!  Has the capacity to give informed consent
!  Lives ...
Inclusion criteria
11
!  Cephalic presentation – 37 – 42 weeks
!  Has current Ambulance Cover
!  Suitable home environment...
Exclusion criteria
12
!  Previous obstetric history
!  Caesarean section
!  Postpartum hemorrhage
!  Shoulder dystocia
!  ...
Exclusion criteria
13
!  Medical history
!  Pre-pregnancy BMI < 18 and > 35
!  Any significant medical condition
!  Uncorr...
Care pathways for pregnancy and
homebirth
14
!  Antenatal Care
!  Terms of Care agreements
!  Three times during pregnancy...
Terms of care - agreement
15
Care pathway
16
!  Intrapartum
!  Two health professionals must be present for the birth
!  Providing immediate support an...
Care pathway
17
!  Postnatal
!  Care of the mother after birth
!  Care of the baby after the birth
A decision that is inconsistent – with this
policy
18
!  The woman has the right to rescind consent at any time and
the de...
Appendix 6
19
Planned Hospital Care
20
!  If the birth is planned to take place in the hospital maternity
support.
!  the obstetrician r...
Consultation referral and transfer
21
!  Risk factors
!  Antenatal factors
!  Intrapartum factors
!  Postpartum factors
Transfer to hospital
22
!  Consent process
!  How to transfer
!  Urgent ambulance assistance
!  Non-urgent ambulance assis...
Refusal to transfer
23
!  Clinical situation has varied from normal
!  The client must be referred to the Terms of Care
Do...
Roles
24
!  Primary midwife
!  Support midwife
!  Doula
!  Receiving hospital
Professional and legal requirements -
midwife
25
!  Experience
!  Competencies
!  Continuing professional development
!  I...
Essential equipment for a homebirth
26
Food for thought
27
!  Autonomy v Paternalism
!  Human Rights
!  Convention of Elimination Discrimination Against Women
(C...
Legal issues
woman midwife
28
!  Consent v Cohesion
!  Language used – fear
based
!  Right to refuse treatment
!  ‘born al...
Human Rights and CEDAW
29
!  Right to privacy
!  Freedom from discrimination
!  Article 2: Country duties (CEDAW)
!  Artic...
Case study 1
30
!  Normal pregnancy
!  Booked for a homebirth with private midwife
!  No Medicare
!  Collaboration with te...
Case study 2
31
!  Booked with private midwife for hospital birth continuity
of midwifery care.
!  Previous large baby 4.2...
References
32
!  Women's and Newborns Health Network – Policy for Publicly
funded homebirths including Guidance for Consum...
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Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers

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Pauline Costins Juris delivered the presentation at the 2014 Obstetric Malpractice Conference.

The Obstetric Malpractice Conference is only national conference for the prevention, management and defense of obstetric negligence claims.

For more information about the event, please visit: http://www.informa.com.au/obstetricmalpractice14

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Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers

  1. 1. Homebirth Policy WA Pauline Costins (Eligible Endorsed Midwife) RN: RM: Juris Doctor 1
  2. 2. Discussion points 2 !  Maternity services plan !  History of homebirth in WA !  Publicly funded Homebirth in WA !  Inclusion criteria & Exclusion criteria !  Decisions inconstant with the policy !  Referral pathways / Transfer to hospital !  Women’s right to choose and refuse !  Convention Elimination Discrimination Against Women (CEDAW) – Human Rights !  Legal issues !  Case Study
  3. 3. 3
  4. 4. Objective of the homebirth policy 4 !  “working together across Western Australia.A Policy Framework is to improve care provision of pregnancy and in childbirth”
  5. 5. Background 5 !  2008 – Review of homebirths in WA !  Highlighted that women have a right to choose a maternity care option that suits them !  Develop systems that support safe and satisfying systems of care !  Provide a diversity of options for women
  6. 6. Definition 6 !  This policy defines homebirth as “ a planned event where the woman chooses to give birth at home, with care provided by a midwife”
  7. 7. WA Homebirths 7 !  Approximately 200 women have a homebirth !  0.06 – 0.8% of all births !  Transfers !  Pain relief !  Obstructed labour
  8. 8. 8 http://www.health.wa.gov.au/publications/documents/perinatal/WA_Mothers_Babies_2010.pdf
  9. 9. Who provides homebirth 9 !  Publicly funded by !  Community midwifery program (CMP) North Metropolitan Area Health Service !  Midwifery Group Practice, Bunbury Hospital WA Country Health Service (WACHS) !  Private fee paying home birth service !  Private / independent Practicing Midwives or !  Eligible / Endorsed midwives (Medicare Provider number)
  10. 10. Who should have a homebirth? 10 !  Inclusion Criteria !  Is over 18 !  Has the capacity to give informed consent !  Lives within a geographical boundary no further than 30 mins from a maternity service !  Regular antenatal care from first trimester !  Booked into a homebirth program by 35 weeks of pregnancy !  A singleton pregnancy
  11. 11. Inclusion criteria 11 !  Cephalic presentation – 37 – 42 weeks !  Has current Ambulance Cover !  Suitable home environment !  Clean running water & electricity !  Vehicular access !  Hygienic sanitation !  Working phone
  12. 12. Exclusion criteria 12 !  Previous obstetric history !  Caesarean section !  Postpartum hemorrhage !  Shoulder dystocia !  Retained placenta requiring manual removal !  Perinatal death at term or a normally formed infant
  13. 13. Exclusion criteria 13 !  Medical history !  Pre-pregnancy BMI < 18 and > 35 !  Any significant medical condition !  Uncorrected female genital mutilation !  Social determinates of health !  Domestic violence !  Alcohol and or drug dependency !  Other considerations !  Will not accept blood and blood products !  Previous baby with GBS neonatal sepsis !  Newborn or child at risk of harm
  14. 14. Care pathways for pregnancy and homebirth 14 !  Antenatal Care !  Terms of Care agreements !  Three times during pregnancy !  At enrolment !  28 weeks !  36 weeks
  15. 15. Terms of care - agreement 15
  16. 16. Care pathway 16 !  Intrapartum !  Two health professionals must be present for the birth !  Providing immediate support and clinical assistance in emergency situations !  Collegial team spirit among midwives !  Improved documentation at births !  Safe working hours !  Consultation !  Attention and surveillance
  17. 17. Care pathway 17 !  Postnatal !  Care of the mother after birth !  Care of the baby after the birth
  18. 18. A decision that is inconsistent – with this policy 18 !  The woman has the right to rescind consent at any time and the decision made needs to be acknowledged and supported. !  Go through appendix 6 “In the course of labour or urgent situations when the steps for discontinuing care have not been undertaken or completed, as stated in this policy and the letter of withdrawal, the midwife may not refuse to attend the woman. Equally where a woman refuses emergency transfer of care in the course of active labour, the midwife must remain in attendance. Documentation of the ongoing consultation with the obstetrician/specialist throughout the labour and birth is essential.”
  19. 19. Appendix 6 19
  20. 20. Planned Hospital Care 20 !  If the birth is planned to take place in the hospital maternity support. !  the obstetrician remains the primary care giver. !  The woman is to make her own way to hospital and meet their midwife at the hospital. !  It is understood that the Homebirth Program midwife will not attend the woman at home if the woman believes that she is in labour but will direct her, or her support person that the midwife will meet here at the hospital. !  Establish if an Ambulance is required and advise the woman or support person that one will be called for her if necessary.
  21. 21. Consultation referral and transfer 21 !  Risk factors !  Antenatal factors !  Intrapartum factors !  Postpartum factors
  22. 22. Transfer to hospital 22 !  Consent process !  How to transfer !  Urgent ambulance assistance !  Non-urgent ambulance assistance !  Private vehicle transfer
  23. 23. Refusal to transfer 23 !  Clinical situation has varied from normal !  The client must be referred to the Terms of Care Document !  Consult with another midwife & share the information with the client and support people !  Document !  Still declines !  Request second midwife !  Notify on-call hospital !  If an emergency situation is anticipated call an ambulance
  24. 24. Roles 24 !  Primary midwife !  Support midwife !  Doula !  Receiving hospital
  25. 25. Professional and legal requirements - midwife 25 !  Experience !  Competencies !  Continuing professional development !  Indemnity insurance !  Documentation and record keeping !  Reporting, evaluation and audit !  Clinical incident reporting
  26. 26. Essential equipment for a homebirth 26
  27. 27. Food for thought 27 !  Autonomy v Paternalism !  Human Rights !  Convention of Elimination Discrimination Against Women (CEDAW) !  Fetal rights v Maternal rights !  Consent v Cohesion !  Language of Fear
  28. 28. Legal issues woman midwife 28 !  Consent v Cohesion !  Language used – fear based !  Right to refuse treatment !  ‘born alive rule’ !  Contributory negligence !  Scope of practice !  Competence !  Ethics !  Collaborative care !  Criminal code – s290 !  Negligence
  29. 29. Human Rights and CEDAW 29 !  Right to privacy !  Freedom from discrimination !  Article 2: Country duties (CEDAW) !  Article 3: Equity (CEDAW)
  30. 30. Case study 1 30 !  Normal pregnancy !  Booked for a homebirth with private midwife !  No Medicare !  Collaboration with tertiary hospital !  Booked back up hospital at 20 weeks !  ? Small for dates at 30 weeks refer to hospital post ultra-sound scan for review and plan !  Individualised Growth chart – within normal limits !  Progress as normal !  Labour commenced !  Problem second stage !  Progressed to birth
  31. 31. Case study 2 31 !  Booked with private midwife for hospital birth continuity of midwifery care. !  Previous large baby 4.2kg, shoulder dystocia and 2litre hemorrhage. !  Booked at local hospital !  Required tertiary hospital care !  Client refused care of tertiary hospital !  Negotiations !  Terminated contract with private midwife !  Free-birthed
  32. 32. References 32 !  Women's and Newborns Health Network – Policy for Publicly funded homebirths including Guidance for Consumers, Health Professionals and Health Services (Revised October 2013). Government of WA Dept of Health 2013. !  Preparing for the First Birth: Mothers’ Experiences at Home and in Hospital in Australia. Hannah G. Dahlen, PhD, RN, RM, BN (Hons), M(CommN). Lesley M. Barclay, RN, RM, BA, MEd, PhD. Caroline Homer, RM, PhD. J Perinat Educ. 2008 Fall; 17(4): 21–32. !  Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years. Christine Catling-Paull, Rebecca L Coddington, Maralyn J Foureur and Caroline S E Homer, on behalf of the Birthplace in Australia Study and the National Publicly-funded Homebirth Consortium. Med J Aust 2013; 198 (11): 616-620. !  http://www.health.wa.gov.au/publications/documents/perinatal/ WA_Mothers_Babies_2010.pdf

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