Keep the Home Fires Burning
I knock on the door to Robyn’s home, remembering the many times I knocked here before. Robyn answers the door with her usual smile. Her petite form hides the strength she has inside. She welcomes me into her lounge to wait, and returns to her rooms as she is seeing some new clients at the moment. I can hear her calm words and infectious laugh from the room down the hall.
Robyn Dempsey was my midwife for the swift water birth of my son, born at home on Mother’s Day 2005. She calmly helped me to birth my little man (10 pound 7 ounces) into the world, watched by his big sister. There is nothing as intimate and beautiful as a homebirth. Being able to get straight into your own warm bed afterwards, feeling like you have just birthed a whole new universe and cuddle your precious baby is bliss.
The Australian Federal Government is currently debating legislation that would effectively make it extremely difficult, if not impossible for Australian women to access the services of a private midwife like Robyn. I ask her to explain the current situation, “With these new legislative changes, what they are expecting of us is… we have to have a collaborative arrangement with a doctor in place in order to register. However the AMA has always said (and this has been said in media statements by them), that they do not agree with homebirth. How on earth are we all to find a doctor who will collaborate with us? We already seek advice from other practitioners (medical or other) when required. If doctors have the final say on if a woman can give birth at home or not, then many women who are currently birthing at home without problem, will be ‘required’ to birth in hospital. Do they honestly feel that women will move into the system? I think not, more likely women will choose to birth without a midwife, at home, and this could be far more dangerous. We can’t practice without registration. We will also need indemnity, which is looking a little more hopeful, there maybe something for May next year.”
Robyn has been a midwife since 1990 and in private practice since 1995. She has been ‘catching babies’ at home for nearly twenty years. “I’m a registered nurse and registered midwife, but will drop my registration as a nurse next year (I haven’t used it for 20 years).” She helps between 20 and 50 mums each year to bring their babies into the world and over the years has “caught 300 or so.”
Her consulting room in her home is comfortable and welcoming with a single bed and posters on the wall displaying the stages of babies development whilst in the womb. The eyes of babies she has helped into the world smile down from their photos on the walls. Robyn has a card stuck up on the wall, “Change creates growth.” There are many families around Sydney who are grateful to Robyn (and other midwives like her) for the role they played in their children’s birth.
Robyn finishes with her clients, comes and slips off her shoes and settles on the sofa. I begin by asking her why do women choose a homebirth? She says there is a lot of reasons. Sometimes they have had a bad experience with the hospital before and so they really want something different this time or maybe they felt abused by their previous birth experience in hospital. “You could say stereotypically vegetarian, natural health, not ‘hippie’ but that is how mainstream society sees it…so it just seems natural – we’ll have our babies at home because you don’t feel the need to go to hospital. Hospital is where sick people go.” Robyn feels that often it is educated people who are choosing to have their baby at home, “because they know and they read and they can understand that it is kind of a dangerous thing to have your baby in hospital.”
Robyn is fulfilling a role that women have performed throughout history in helping women to give birth in their home. It is only in the last few hundred years that birth has become a medicalised event to be managed in hospital with machines and technology and predominantly male doctors. A World Health Organisation publications states, “By medicalising birth, i.e. separating a woman from her own environment and surrounding her with strange people using strange machines to do strange things to her in an effort to assist her, the woman’s state of mind and body is so altered that her way of carrying through this intimate act must also be altered and the state of the baby born must equally be altered. The result it that it is no longer possible to know what births would have been like before these manipulations. Most health care providers no longer know what ‘non-medicalised’ birth is.”
If you give birth in Australia today, you have a 30 per cent chance of having a caesarean and only a 62 per cent chance of having a normal vaginal birth. If you birth in some private hospitals, there is 50 per cent chance your baby will be born by caesarean. Robyn says the World Health Organisation recommends a ten per cent Caesarean rate.
I ask her what impact she feels a caesarean birth has on the mother. She says “This is major surgery, so the woman is going to have substantial pain after delivery. This makes breastfeeding and handling baby more difficult. The drugs required to keep mum mobile and pain free, effect both mother and baby. Making baby more sleepy, and once again this has an impact on breastfeeding. Mum’s pain may be for up to a year. Some women report numbness or discomfort in the scar for longer than that even. It is recommended that post surgery women don’t drive for 6 weeks, or do major housework. They have an increased chance of infection, the also have an increased chance of another c-section. Having a c-section may cause women to feel anxious about birthing vaginally next time, but this could also be mixed with fear of undergoing surgery again.”
I ask her if there are any births she won’t take on at home. She won’t take on smokers as she feels they are not respecting their bodies or their babies by continuing to smoke. She prefers not to do twins or breech at home (A breech baby is born in the bottom or feet first position.) Robyn calmly says “they invariably pop out unexpected…which popped out last week.” A baby born last week was a surprise breech.
A breech baby born at home is a rare event indeed. In most hospitals, it is standard to automatically deliver breech babies by caesarean. Robyn says if she had known it was a breech baby, she would have recommended her birthing in hospital and they would have pressured her to have a caesarean. As Robyn says “It’s not viewed as something you should be doing – breeches at home. But if it’s a surprise – what can you do. But I think it is good to do them because it is going to happen and you might as well have the skills.”
Birth can be an unpredictable event. I ask Robyn how she copes with the weight of the responsibility of having the life of the baby and mother in her hands. “I have all the same first line management at home as they have in the hospital. What this means is, I have oxygen, suction, resuscitation equipment for mother and baby, IV therapy, and drugs for haemorrhage. I also have the skills and knowledge to know when to use them. The beautiful thing about giving birth at home is, there are no other interventions. No induction drugs, no narcotics, no epidurals etc, these interventions are often the very thing that causes the problems, therefore, problems are rarely seen at home.”
Robyn talks about the ten per cent of women who plan a home birth end up transferring to birth in hospital. “Most of those would be first time Mum’s running out of puff. So it is not going to be an emergency or anything. It just means that they have had enough. Labour isn’t perhaps what they have expected or it’s longer than they have expected…or that they feel that they can’t do without an epidural or whatever. And then there are the less common things that I transfer for which are the emergency things such as haemorrhage or sick baby.”
Can she get a feel for how a woman is going to birth as she gets to know her throughout the pregnancy? Robyn tunes into the woman in the last four weeks. She “starts to get a feel for what’s going to happen….if we’re going to transfer. It’s an esoteric thing you know – you can’t really put your finger on it. You just know.” Robyn smiles and remarks, “If you go in to a woman’s home and it is as neat as a pin and there is not a thing out of place, you think OK this woman’s got a lot of control issues. And that woman will take a long time to birth. The woman that is a little more relaxed with the house work will probably birth a lot easier. But everybody’s different…. If they worry about little things during the pregnancy they often take a long time to birth. I mean you can spend your time with me talking about bra sizes and what pram you should buy. Or you can spend your time talking about the issues and how you are feeling and the stuff that’s in your heart that you really have to get out. More important than what pram to buy. What pram to buy tells me that you are going to be labouring for a long time. It’s because you are not focusing on where you need to be. You are in your head. But that’s OK – they’ll get through eventually.”
Many midwives find the pressure of being on call 24/7 takes a heavy toll on their families and their marriages. Robyn feels her job has a big impact on her family. “You need a really strong husband. You need a man that isn’t threatened by you because I’m obviously a very strong woman. I’m not meek and mild… And the “I’m leaving for a birth now you have to look after the kids” – and I may not be back for a week. You know they have to be able to cope by themselves and I’m lucky my husband is really good with that.”
Robyn feels the future of choice around childbirth for women is not looking good. “The current changes around legislation may significantly reduce a woman’s right to choose where and with whom she births. For new midwives coming into private practice, there is much uncertainty. They have completed their training, but new rules will require that they have further years experience before they can practice. What other profession demands this? If they wish to go into private practice, (offering women homebirth) the new rules have made it impossible for midwives to offer homebirth, therefore, there is no one to learn from in order to gain experience.”
And what is her future as a home birth midwife? “If the new legislation comes into place, I may not have a future from July 1st, 2010. I refuse to treat women in a disrespectful way as seen in the hospital system. Women are intelligent, and quite capable of making safe choices for themselves and their babies. If I am not able to register and practice privately, offering homebirth, then I have decided to train as a homeopath.”
Does she feel as if she was born to be a midwife? “I do actually. I think that was it – that was my calling. That was who I am supposed to be,” she says passionately without hesitation. “It’s like those that devote themselves to God – it’s a calling. It’s bizarre but I can’t not do it.”
Profile by Michelle Meares