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Speaker 1: Already and this is the daily This is the daily

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Speaker 1: ohs oh, now it makes sense. Good morning and welcome

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Speaker 1: to the Daily Ours. It's Wednesday, the fifth of November.

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Speaker 1: I'm Emma Gillespie, I'm Sam Kazlowski. Health experts have joined

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Speaker 1: forces to call on the government to introduce national legislation

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Speaker 1: that would make it illegal to give birth without a

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Speaker 1: doctor or midwife present. It comes after several recent deaths

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Speaker 1: linked to a practice known as free birth. Today we

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Speaker 1: are going to explain what that means, where this push

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Speaker 1: for regulation has come from, and what experts, advocates and

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Speaker 1: lawmakers are saying about it.

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Speaker 2: And this is a really interesting story. It's been in

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Speaker 2: the headlines for last couple of weeks and well due

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Speaker 2: for an explainer on it. Before we get into the details, though,

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Speaker 2: of what health experts are calling for, can you explain

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Speaker 2: what free birth actually means.

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Speaker 1: Yes, So, a free birth is the intentional practice of

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Speaker 1: giving birth without a registered healthcare professional like a midwife

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Speaker 1: or a doctor present. So it's a birth outside of

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Speaker 1: a traditional maternity context.

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Speaker 2: Right.

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Speaker 1: It might happen at home, but a free birth is

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Speaker 1: different from a home birth. That's a really important distinction

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Speaker 1: to make. A home birth is a planned birth at

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Speaker 1: home with a registered healthcare provider. So, just to be

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Speaker 1: really clear, home birth involves a qualified midwife or doctor

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Speaker 1: attending the birth at someone's home, whereas a free birth

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Speaker 1: is when someone chooses to give birth without any registered

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Speaker 1: medical professional at all.

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Speaker 2: And give me a sense of how common free births

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Speaker 2: are in Australia at the moment.

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Speaker 1: Well, they aren't tracked nationally, which makes it how much

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Speaker 1: tricky yeah to put an exact number on it, But

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Speaker 1: the peak bodies for obstetricians and midwives, as well as

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Speaker 1: various state specific health bodies say that there has been

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Speaker 1: an increase in free births, particularly since COVID nineteen.

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Speaker 3: What we do know is that they are rare.

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Speaker 1: Ninety seven percent of births in Australia happen in hospitals.

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Speaker 2: Wow, okay, So between free births and home births, we're

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Speaker 2: talking about a general pool of about three percent.

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Speaker 1: Yes, exactly, but there is a lot of nuance within

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Speaker 1: that three percent, you could say. The latest available national

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Speaker 1: data shows that there was a one hundred and thirty

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Speaker 1: percent increase in home births between twenty nineteen and twenty

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Speaker 1: twenty three. Again, home births not free births, and an

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Speaker 1: average of fourteen percent of those required a mid berth

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Speaker 1: hospital transfer. So something happened, something went wrong, there was

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Speaker 1: some medical complication. As I mentioned, though this doesn't include

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Speaker 1: free births. But I think those numbers on the popularity

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Speaker 1: and risk levels of home births give us a bit

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Speaker 1: of an insight into the kind of non traditional birthing

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Speaker 1: options in Australia and the interest or growing interest in them.

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Speaker 2: So talk me through some of the risks that experts

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Speaker 2: say are associated with free births. So those unassisted births

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Speaker 2: at home.

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Speaker 1: Yeah, these are considered the highest risk environments to give

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Speaker 1: birth and according to the Department of Health, free birth

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Speaker 1: can increase the chance of multiple health problems for both

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Speaker 1: mother and baby, with risks including excessive bleeding, tearing complications

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Speaker 1: if the baby doesn't start breathing, including long term health

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Speaker 1: issues or even death. Without a midwife or doctor present,

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Speaker 1: birth complications and specific emergency challenges can go undetected.

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Speaker 3: Right, that is really critical. What may seem okay.

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Speaker 1: In one minute may turn into something that is extremely

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Speaker 1: dangerous the next.

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Speaker 2: Or even a couple of hours later.

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Speaker 3: Well exactly hours or days later.

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Speaker 1: The World Health organization states that around fifteen percent of

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Speaker 1: all pregnant women will develop a potentially life threatening complication

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Speaker 1: that calls for skilled care. Some will require major interventions

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Speaker 1: to survive, and of course that intervention is only possible

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Speaker 1: with medical professional care. Tragically, we have seen several deaths

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Speaker 1: linked to free births. A twenty twenty four ABC investigation

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Speaker 1: identified seven babies and one mother who died during or

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Speaker 1: after free births across parts of New South Wales and

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Speaker 1: Queensland in the space of eighteen months.

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Speaker 2: So we know what can go wrong in a free

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Speaker 2: birth context, but I think it's important to understand why

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Speaker 2: someone would choose that path. What data or research is

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Speaker 2: there around why people would pick a free birth route.

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Speaker 3: Yeah.

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Speaker 1: Absolutely, I think it is really important to mention that

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Speaker 1: this is an incredibly personal decision for a lot of

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Speaker 1: expectant mothers and families. There are a lot of opinions

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Speaker 1: in this space, and you know, ultimately practitioners want there

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Speaker 1: to be some level of choice, but they want those

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Speaker 1: choices to be prioritizing the safety of babies and expectant mothers.

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Speaker 1: According to health experts, though many women choose free birth

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Speaker 1: after experiencing a previous traumatic birth in hospital. So research

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Speaker 1: does show around one in three Australian women do experience

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Speaker 1: birth trauma, and some of those women end up finding

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Speaker 1: the hospital environment, you know, overly clinical. They feel they

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Speaker 1: don't have autonomy over their own bodies during childbirth. They're

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Speaker 1: left with physical or psychological scars that lead them to

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Speaker 1: consider non traditional options for birth. There was a new

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Speaker 1: South Wales inquiry into birth trauma that received thousands of submissions,

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Speaker 1: mostly from others who said they were ignored, belittled, denied

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Speaker 1: the opportunity to give informed consent to certain procedures or medications,

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Speaker 1: So that paints a bit of a picture as to

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Speaker 1: the why. And cost is also a major factor. Publicly

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Speaker 1: funded home birth programs do exist, but they're not widely available.

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Speaker 1: There are limited spots and that might lead some families

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Speaker 1: to consider free births as well.

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Speaker 2: And what you're alluding to there, it sounds like, is

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Speaker 2: the idea that there are some systemic issues in the

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Speaker 2: maternity system that are driving some of these choices right.

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Speaker 1: Exactly, And many experts, including some midwives duelers, they argue

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Speaker 1: that this rise in free births is exactly what you've said, Sam,

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Speaker 1: a sort of a symptom of a broken system. So

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Speaker 1: the Australian College of Midwives has said that while they

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Speaker 1: don't support free birth, they do support home birth with

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Speaker 1: qualified professionals and they respect a woman's choice. If a

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Speaker 1: woman chooses free birth and then requires care, they should

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Speaker 1: receive non judgmental care.

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Speaker 2: And one of the words you mentioned just then is

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Speaker 2: worth talking about in itself, a duela. Can you classify

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Speaker 2: what a doula is and how they fit into this discussion.

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Speaker 1: Yeah, so the free birth discussion is not one you

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Speaker 1: can have without talking about duelers. I don't think this

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Speaker 1: is a birth support person who's essentially contracted by families

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Speaker 1: privately and they provide emotional, physical, informational support to someone

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Speaker 1: during pregnancy, during labor itself and after birth. But duellers

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Speaker 1: are not medical professionals. They're not trained to provide clinical

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Speaker 1: care or to respond to medical emergencies. Some duelers around

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Speaker 1: the country are members of various health bodies that have

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Speaker 1: their own mandatory codes of conduct and ethics, but the

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Speaker 1: duller industry is by and large and unregulated one. There

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Speaker 1: is no mandatory accreditation. Right to call yourself a duller

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Speaker 1: and to sell your services to expectant families.

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Speaker 2: So let me just kind of take stock of where

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Speaker 2: we are. We have a system in Australia where largely

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Speaker 2: women are giving birth in a hospital setting and at home.

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Speaker 2: There's home births and free births, the big difference being

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Speaker 2: if there's a registered professional in the tendence or not.

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Speaker 2: Exactly why are we talking about this on the podcast

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Speaker 2: today with all of that context in mind.

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Speaker 1: Yeah, So that increase in free births and also in

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Speaker 1: complications has prompted calls from two peak.

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Speaker 3: Bodies within medicine.

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Speaker 1: We've got the Royal Australian and New Zealand College of

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Speaker 1: Obstetricians and Gynecologists or RANDSCOG yep RANSCOG is what I

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Speaker 1: will call them from now, and the Australian College of Midwives.

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Speaker 1: They have released a joint statement calling on the government

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Speaker 1: to overhaul birthing outside of the system.

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Speaker 3: That's another term you hear talking about free births.

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Speaker 1: They want legislation to ban free births and to regulate

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Speaker 1: this space. And one of the most recent high profile

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Speaker 1: cases leading up to this moment you may have seen

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Speaker 1: online some commentary about this. It involved an ossie nutritionists

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Speaker 1: and wellness influencer her name was Stacy Hatfield. She gave

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Speaker 1: birth at home to her first child in September. She

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Speaker 1: was transferred to hospital shortly after the birth due to

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Speaker 1: an unforeseen and extremely rare complication according to her husband,

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Speaker 1: where she later died. So that kind of follows this

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Speaker 1: groundswell of interest conversation about this kind of maternity care

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Speaker 1: in a sty and is really kind of the driving

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Speaker 1: force behind this latest wave of conversation.

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Speaker 2: I've definitely seen more conversations about this play out in media,

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Speaker 2: probably since the end of the pandemic where this trend

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Speaker 2: really did start to emerge, but it's clear we're talking

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Speaker 2: about it today because of those comments. What did the

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Speaker 2: health experts call for and what did they propose in

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Speaker 2: a bit more detail.

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Speaker 1: Yes, So that statement from RANSCOG and the Australian College

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Speaker 1: of Midwives has urged federal, state and territory health ministers

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Speaker 1: to one introduce and pass legislation which quote expressly restricts

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Speaker 1: labor and birth management to appropriately trained registered practitioners that

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Speaker 1: is obstetricians and gynocologists GPS midwives. They also want a

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Speaker 1: ban on unlicensed or unregulated practitioners from undertaking the management

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Speaker 1: of labor and birth that would include duelers. They want

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Speaker 1: regulatory frameworks across all states and territories to be aligned.

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Speaker 2: So a national system there.

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Speaker 1: Exactly to ensure that we're and receive the same protections,

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Speaker 1: the same level of care regardless of where they're giving

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Speaker 1: birth and for they want quote, transparency, accountability and safety

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Speaker 1: in birthing services to be promoted. In their statement, the

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Speaker 1: groups said that while choice and model of care are important,

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Speaker 1: such choice must operate within frameworks that ensure safety, quality

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Speaker 1: and accountability.

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Speaker 2: So they're not calling for the end of home births specifically,

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Speaker 2: they're calling for the end of free births and the

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Speaker 2: profession of a dula being allowed to practice in Australia.

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Speaker 1: Yeah, well, I mean under this framework dulas could still practice,

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Speaker 1: but they couldn't be the person that is calling the

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Speaker 1: shots right in a home birth, registered or qualified doctor

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Speaker 1: or midwife would need to be present as well as

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Speaker 1: a douller.

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Speaker 2: And are there any states where this type of scheme

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Speaker 2: is currently being already enforced?

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Speaker 1: Yeah, we actually have an example with South Australia. This

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Speaker 1: is the only state or territory with legislation like this, right,

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Speaker 1: but it is a criminal offense there for anyone unqualified

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Speaker 1: to provide clinical care during labor or childbirth. This has

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Speaker 1: been the case in South Australia for more than a decade.

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Speaker 1: So they introduced that legislation in twenty fourteen, and that

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Speaker 1: followed a coronial inquiry into the deaths of three babies

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Speaker 1: who each died separately after complications during home births.

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Speaker 2: And just to tease out that nuance there, because I

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Speaker 2: think it's really important so that South Australian law correct

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Speaker 2: me if I'm wrong. But is that saying that a

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Speaker 2: duela can still be at a birth, just not delivering

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Speaker 2: clinical care, which would mean kind of leading the way

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Speaker 2: in which the birth plays out. Is exactly kind of right,

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Speaker 2: So it's not saying the duellers can't be involved.

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Speaker 1: Yeah, none of these conversations are about kind of dismantling

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Speaker 1: the duela industry altogether. It's about saying, Okay, you might

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Speaker 1: want to work with a duela to support you through

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Speaker 1: your pregnancy and your birth, sure, but a qualified medical

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Speaker 1: person must be in the room when you are delivering

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Speaker 1: a baby.

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Speaker 2: Got it, okay? And so one of the recommendations there

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Speaker 2: was about national system and unifying state and territory laws

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Speaker 2: that will inevitably involve the federal government. Has the government

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Speaker 2: said anything about an idea of a national framework, so.

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Speaker 1: At the time of recording, we haven't yet heard a

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Speaker 1: response from the federal government or Health Minister Mark Butler.

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Speaker 1: It is I guess a bit confusing here because state

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Speaker 1: and territories ultimately make these decisions about birth, trauma and

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Speaker 1: maternity care. So this really would require a bit of

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Speaker 1: an overhaul of those processes and states and territories working

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Speaker 1: together with the federal government to commit to changes.

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Speaker 3: Some changes already underway.

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Speaker 2: You know.

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Speaker 1: We've got states like New South Wales where there are

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Speaker 1: several recommendations being implemented relating to trauma informed maternity care,

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Speaker 1: expanded midwife access in rural areas. Queensland as well is

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Speaker 1: trialing public home birth programs, So some momentum has kind

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Speaker 1: of started to gain a bit more traction, But it's

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Speaker 1: that uniform national conversation that these peak health bodies are

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Speaker 1: calling for with urgency.

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Speaker 2: So I guess from here and we kind of wait

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Speaker 2: for a response from the federal government. We keep track

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Speaker 2: of some of those state and territory activities as well

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Speaker 2: and see if there is movement in this space, and

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Speaker 2: I know that it can be quite a divisive topic,

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Speaker 2: especially i've seen in comment sections on social media, and

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Speaker 2: thank you for taking us through that in a way

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Speaker 2: that that makes a bit more sense.

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Speaker 3: Thank you for having me, Sam.

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Speaker 2: And that's all we got time for you on today's

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Speaker 2: episode of The Daily Os. We're going to be back

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Speaker 2: in the afternoon with some of those afternoon headlines, but

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Speaker 2: until then, have a great day. My name is Lily

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Speaker 2: Maddon and I'm a proud Arunda Bunjelung Calcuttin woman from

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Speaker 2: Gadigol Country. The Daily Os acknowledges that this podcast is

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Speaker 2: recorded on the lands of the Gadighl people and pays

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Speaker 2: respect to all Aboriginal and Torres Strait Island and nations.

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Speaker 3: We pay our respects to the first peoples of these countries,

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Speaker 3: both past and present,