0:00

You've probably heard of home birth. Maybe you've

0:02

even had one yourself. It

0:04

could even be how you were born. What

0:07

about free birth, though? Free

0:10

birthing, that's one that takes place

0:12

intentionally without a midwife or a

0:14

doctor present, sometimes called wild birth.

0:17

It appears to be on the rise in

0:19

Australia with the ABC confirming at

0:21

least 10 catastrophic incidents in

0:23

Queensland and New South Wales

0:26

only since 2022. Increasingly,

0:29

midwives in Aotearoa are

0:31

encountering the movement. I'm

0:33

going to have a quorum about

0:35

this with my guests. Professor Hannah

0:37

Dalen of Western Sydney University, co-editor

0:40

of Birthing Outside the System, The Canary

0:42

in the Coal Mine, also with us,

0:44

Alison Eddy, Chief Executive of

0:46

the New Zealand College of Midwives,

0:48

Te Ka Rete Onga Ka'i Faka

0:50

Fano Ki Aotearoa. They are

0:52

both with us now. Kia ora, Kora. Thanks for

0:54

being with us on Saturday morning. Good

0:58

morning, Susie. I think I'll

1:00

start with you, actually, Hannah, if

1:02

that's possible. What

1:05

are the influences

1:07

and the motivations that you are

1:10

seeing behind some of the

1:12

choices people are making to

1:15

have a free birth in Australia? Yeah,

1:19

this is what led to us writing this

1:21

book in 2020 and it's a compilation, really,

1:23

of a lot of the research we've been

1:25

doing over the last decade and international research.

1:27

So this is not just an Australian

1:30

problem, as you've alluded to in your

1:32

introduction, but this is something

1:34

we're seeing increasingly in, in fact,

1:36

the Western world, which is quite

1:38

interesting, but it also exists in

1:41

low and middle income countries.

1:44

And essentially, having talked

1:46

to thousands of women and done surveys with

1:49

thousands of women, what we

1:51

came up with is there's sort of

1:53

three major drivers. And the first one

1:55

is trauma. So this is

1:57

either a previous book where

1:59

women... were treated disrespectfully,

2:02

felt unheard, felt coerced.

2:05

And they feel that they cannot go back

2:07

into that system. And some of these women

2:09

have quite significant birth trauma or PTSD. The

2:13

other reason is that a

2:15

woman may be having a first baby, and

2:18

she encounters the system and feels that the

2:20

choices that she wants are not able to

2:22

be met in the system. For example, in

2:25

Australia, we have about 10 times lower home

2:28

births than you do. We don't

2:30

have many public-funded options. And

2:32

women have to pay huge

2:34

amounts of money. And so often, accessing home

2:36

birth or continuity of midwifery care, something that

2:39

you have a lot of in New Zealand,

2:42

is much rare in Australia. So they try

2:44

to find what they want in the system,

2:46

and they can't find that. And

2:48

a third reason, really, is a very

2:51

strong belief in their

2:53

bodies and in their capabilities and

2:55

in wanting to have understood births.

2:58

So those sort of capture the majority.

3:00

Of course, there are multiple little

3:02

reasons, but those are the major reasons. It

3:05

is being seen as

3:07

a phenomenon around birth, but it's

3:09

not just around birth itself, is it? It can

3:11

be a rejection of all antenatal

3:14

care, all scans, blood tests, the

3:16

whole kitten caboodle that goes with

3:18

the process of being pregnant. Yes,

3:21

this is not one story. Free

3:23

birth may include women going

3:26

and having antenatal care, in fact, and

3:28

not telling their care providers they're intending

3:30

not to come into hospital. It

3:33

may include them having absolutely nothing

3:35

and refusing all scans and all

3:37

blood tests. And we did

3:40

a big study a few years ago

3:42

looking at all of the babies born

3:44

before arrival in New South Wales over

3:46

more than a decade. And

3:49

that's babies, that's women who don't make it to

3:51

hospital often hits the headlines and everybody loves a

3:53

good story of a baby born in the backseat of

3:55

a car. But when we analysed that

3:57

and we looked at, well, was

4:00

that more likely? We found

4:02

stronger concentrations around places with

4:05

high home birth and

4:07

we hypothesized that some of these were probably

4:09

free birth where they had the baby and

4:11

they went in to perhaps get some stitches

4:13

or get the baby checked and get the

4:16

paperwork but didn't disclose that they always intended

4:18

to have the baby at home. What

4:21

about the role of doulas

4:25

and perhaps just explain for people who aren't familiar with

4:28

doulas and what their work can be? This

4:30

is something that can often

4:32

be a feature of free birth. Look,

4:35

doulas are wonderful people. It's really

4:37

important to not

4:39

malign them and to be careful that

4:42

we're talking about a

4:44

couple of different things here. So

4:46

doulas, they have some training but

4:48

it's very, a

4:50

small amount of training. It's certainly not

4:53

training them for clinical practices. It trains

4:55

them to support a woman, to give

4:57

emotional support, massage, all

4:59

of those things that women really

5:01

do value. So they are a

5:03

wonderful addition to the birth space

5:06

but a doulas scope of practice

5:08

is not to provide clinical care, not

5:10

to undertake clinical assessment and not

5:12

to be at birth without the

5:14

presence of a registered midwife or

5:17

doctor. What happens a

5:19

lot in free birth in Australia

5:22

is either they birth completely unattended

5:24

or they get a doula

5:27

or a birth keeper, they're often

5:29

called words like birth keeper or

5:31

birth attendant, to be

5:33

there at the birth and theoretically

5:36

supporting them but we're finding increasingly

5:38

they're stepping in and they even

5:40

are bringing doctors to listen to

5:43

the baby's heart and there are all sorts

5:45

of what we would classify as clinical things

5:47

being done. But this is a small number.

5:49

The majority of doulas do an incredible job.

5:53

Alison, if I can bring you in at this point.

5:56

Clearly Hearing the

5:58

description of the

6:00

situation. in Australia

6:03

from Hannah. What

6:05

sources differences. Do

6:07

we see in New Zealand and how

6:09

much of an impact is. This.

6:12

Sort of concept to see by having here. Why

6:15

has described with we do have a very

6:17

different maternity system here in New Zealand units

6:19

and publicly funded that were free leads from

6:22

this care is available in a free of

6:24

charge on we would like to think in

6:26

every community although I oversee I wait for

6:28

sausages us and protecting someone on access to

6:31

care we've around or the for the saints

6:33

have this happen at home and we also

6:35

have and the wake of mid were freely

6:37

doing it so that that have been a

6:40

community based am mean load heat non hospital

6:42

see things they will mechanics his toes so.

6:45

Although we his own with always been

6:47

aware and midwives have always been aware

6:49

of of examples of of woman to

6:51

thing to not have an attendant at

6:53

birth or is it has described also

6:55

and is pointed out the of picking

6:57

and choosing a very say speaks of

6:59

of kid is routinely offered through pregnancy

7:02

and what we're saying is is a

7:04

rise and and the said they were

7:06

getting from midwives about the number of

7:08

woman the at the a content hearing

7:10

a battle been engaged with or not

7:12

to varying degrees that had choosing this

7:14

and. This option to booth outside of

7:16

the system or to this that out in

7:18

attendance at all which has some as it

7:20

is a change for us. Inducing.

7:24

Largely the same, Sorts. Of

7:26

reasons are behind some of the choices

7:28

that women are making in New Zealand

7:30

about this, the kind of thing around

7:33

the in around birth trauma, about the

7:35

romanticization if that's the right word of

7:37

the process of birth. I

7:40

think he has kept those those that

7:42

have bloods Citigroup Inc thought or drivers

7:44

pretty well. I think they they very

7:47

much mera what our experiences here in

7:49

New Zealand I think the thing around

7:51

the yum the system choices as well.

7:53

You know that Tom that is a

7:56

real issue for woman that do have

7:58

head had heads and previous. Experience or

8:00

fum complex. They and they can't pregnancy and

8:02

they are being offered. You know, the the

8:04

standard package of care. I'm in breach Boost

8:06

As a very good example. there's a. In

8:10

the caught a strong arm drive to office

8:12

Assyrian six and routinely for every woman at

8:14

his a Breach presentation and pregnancies. We've lost

8:16

our skill with his practitioners as a result

8:18

of this and so they have a woman

8:20

want not wanting that. Oxen sometimes feel that

8:23

they have no choice but to to choose

8:25

to to give this outside of a hospital

8:27

season because I don't feel the choices are

8:29

going to. Be available to them the

8:31

choices they want. So I'm But I

8:33

think what we're seeing and I think

8:35

the change that we're experiencing here in

8:37

New Zealand seems to be the rise

8:39

of this. I'm a sort of a

8:42

phenomenon, almost almost like her. I'm. Sort

8:45

of miss like a culture or a

8:47

sort of a free booze images of

8:50

the sort of free booth community which

8:52

I think has been fueled by social

8:54

media by an international influences as his

8:57

highness describe we hearing from our colleagues

8:59

and the Uk. Across Europe that they're

9:01

also saying arise and Us and I

9:03

think this is why to factors at

9:05

play a sleazy said i'm in a

9:07

that the this that of experience we

9:09

had through clover with it was sort

9:11

of a at a rejection of them

9:13

the mainstream conventional wisdom around health care.

9:15

I think there's something going on the

9:17

earth. well. I

9:19

suppose that's a very interesting part that is

9:22

ah John of emerging right way to to

9:24

sort of look at it for certain. eight.

9:27

That sort of influence that comes from

9:29

social media can have a very large

9:31

bearing on people, especially when you can

9:34

hear an awful lot of conflicting advice.

9:36

I'm at a time that can be

9:38

into the can be quite frightening become

9:41

be. Quite hard to work

9:43

out. Who to listen to an

9:45

and what advice to take? oh

9:47

absolutely i think it's and with saying that

9:49

him away in new zealand sense and recent

9:52

times and it were not immune to it

9:54

here we're gonna we're part of a global

9:56

context because of that cause of social media

9:58

and the internet and it I think it's

10:01

very interesting to know how to address that

10:03

as well. I think

10:05

we've been thinking very much about

10:07

this as an organisation because we're

10:09

really wanting to make sure we're

10:11

positioning ourselves in a way that's most

10:14

helpful for the community and for our members. I

10:17

think the social media influences are things

10:19

that we can't alone tackle. What

10:22

we want to make sure is that our communities,

10:25

women and communities accessing maternity care

10:27

really truly understand the role of

10:29

the midwife and the way that she can

10:31

work here in New Zealand in a continuity

10:33

of care system. In a

10:36

partnership model where we build the relationship

10:38

of trust, we work really hard

10:40

to make sure that we can empower

10:42

and support women to have their choices respected

10:45

which is relatively unique throughout the

10:47

western world I have to say.

10:50

Making sure that those decisions and information are based

10:52

on correct information about how

10:54

midwives work here. Heaps of

10:56

feedback coming into us this morning on

10:58

Saturday morning on RNZ National. I'm

11:01

speaking with Professor Hannah

11:03

Darlin of Western City University and also

11:05

with us, the College of Midwives Chief

11:07

Executive Alison Eddy. Hannah,

11:09

if I can come back to you. Someone's

11:12

raised the question of the

11:15

age of people

11:18

who choose to free birth and wondering

11:20

how many of those are first time

11:22

mothers and how many have

11:24

previously had children. Is that

11:26

something that your research has been able to

11:29

draw any conclusions from? Yes,

11:31

absolutely. The majority are women who've

11:34

had babies before which

11:36

is really that pointing to previous

11:38

trauma and disappointment with the birth.

11:40

However, I've got to say I

11:42

totally agree with Alison. When

11:44

we published our book, it was the beginning of

11:46

the pandemic, it was 2020 and literally published it

11:48

the week before lockdown. So

11:50

I think the landscape has shifted

11:53

And I Think that the distrust

11:55

in medicine and also the rise

11:57

in social media influences. Have

12:00

played a big role and what

12:02

I now starting to see is

12:04

a shift in that demographic to

12:06

move first time mothers which actually

12:08

raises even greater anxiety and me

12:10

because we do know that first

12:13

time mothers can have. More

12:15

complexity or or nuns that we

12:18

need to provide them with support

12:20

around. Ah so we are seeing.

12:22

Definitely assist going on in the

12:24

in. The kind of women's and

12:27

the reasons why they are choosing.

12:29

Frida who. Oppose.

12:33

How important is it to have? A.

12:35

Goods the past experience because I guess that's

12:38

a lot. A lot of this is around

12:40

the breath itself. Which hopefully to the

12:42

go on for more than a day or so. But

12:46

how christmas it for. New

12:49

parents to has. An.

12:51

Experience that. They. Can

12:53

relate to. And that one that is

12:55

is the hopefully not traumatizing. It's

12:58

absolutely fundamental. If I were to ask

13:01

is how important is it to have

13:03

a good wedding experience and you would

13:05

say cause it's really important and birth

13:08

is a major transition. It's a major

13:10

part of life. It is supposed to

13:12

be something that brings the family together.

13:15

It's supposed to be one of the

13:17

highlights of a woman's line. and in

13:19

a large study in Australia that we've

13:21

just undertaking pull the best them study

13:24

you know we sound Twenty Nine percent

13:26

of women are traumatised by the. Birth

13:28

one in ten say they

13:30

were treated disrespectfully and collapsed

13:33

during their birth and we

13:35

now have the very first

13:37

in the world our government

13:39

inquiry happening in my state

13:41

in New South Wales into

13:43

Best for months and this

13:45

is having significant impacts on

13:47

women's mental health, on women's

13:49

health in it and women's

13:51

future choices and so. my

13:53

comment around free birth oases be

13:55

fully stop blaming women and before

13:57

we start making judge about them.

14:00

Let's have a long hard look

14:02

at a system that is not

14:04

meeting women's needs and let's look

14:06

at addressing that first and in

14:08

fact free birth would be quite

14:10

a small phenomenon, nothing like we're

14:12

seeing now. There

14:15

is some talk around obstetric violence,

14:17

now that sounds like quite

14:20

a full-on term. I suppose perhaps

14:22

let's talk about that term itself a little

14:25

bit and what role does

14:28

that play in turning

14:31

people away from the medical system?

14:35

So obstetric violence is and

14:37

this was where we found one in ten

14:39

women have said that they'd experienced obstetric violence

14:41

and obstetric violence is disrespect,

14:43

abuse, coercion. There are health professionals

14:45

against a woman. So it's really

14:47

important point out this is not

14:49

about obstetricians being violent. Obstetrics

14:52

actually covers all

14:54

of those health professionals that engage with

14:56

a woman. So includes midwives. So midwives

14:58

are also responsible for obstetric

15:00

violence but if you go

15:03

into a hospital or a

15:05

birth center or an experience with

15:07

a health provider and you are

15:09

treated disrespectfully, you

15:11

are, some women were

15:14

hit and slapped and held down

15:16

and you just imagine if you've

15:19

got a past history of sexual assault

15:21

or domestic violence or a mental health

15:23

issue you can see how that at

15:25

this very vulnerable and intimate point in

15:27

your life having that from the people

15:29

who you should be able to trust

15:32

is one of the most ultimate betrayals

15:34

and it is deeply traumatizing and when

15:37

we did our free birth research numerous

15:39

studies have come up showing that the

15:41

coercion and disrespect from health professionals was

15:44

a major part of the reason why

15:46

they ended up with trauma.

15:50

Alison if I can come back to

15:52

you and all of this. Lots and

15:55

lots of feedback coming in. One

15:57

person saying you know we need to

16:00

to ask why there is a shortage of midwives

16:02

in New Zealand, the present model simply unsustainable,

16:06

this person saying. Another person saying childbirth

16:09

mortality has gone down

16:11

significantly because of good

16:13

medical facilities, right? This

16:15

person saying that they don't understand this trend. There are

16:17

a mum of two had natural births in

16:19

New Zealand in two different hospitals with an

16:22

independent midwife. But how significant

16:24

is the

16:26

impact of medicine and

16:28

the medical system on

16:32

the outcome of mothers

16:34

and babies? Well

16:37

we in New Zealand are not immune

16:39

to the increasing medicalisation of birth

16:42

which is occurring throughout high

16:44

income countries. We are

16:46

somewhat protected compared to Australia

16:48

because our midwife re-lead system gives

16:50

us some protection around that. But

16:53

the medical legal risks and the sort of

16:55

fear that sits around birth

16:57

at a societal level can

17:00

be all pervasive in our hospitals. We

17:02

know simply the

17:05

place of birth impacts on the outcome of

17:07

birth that if you are a well woman

17:10

and you're choosing to give birth in a

17:12

midriffy lead unit or a home setting

17:14

you're far less likely to end up with

17:16

interventions than you are if you give birth

17:18

in a hospital. So yes the

17:21

system does impact on

17:24

the outcome without a doubt. But

17:26

I think what we really want to I

17:29

think emphasise is that

17:32

every woman should have access to midriffy

17:34

care during labour and birth and

17:37

that care should be nuanced around what her needs

17:39

are. That is what we want to really emphasise

17:41

and make sure that the community understand

17:43

that and that we can mitigate some of

17:45

those concerns around trust

17:49

in the system, fear of medicalisation

17:51

through good partnership based

17:53

care which is what we want every woman to

17:55

have. The

18:00

key to. Workouts

18:02

and. Because. It.

18:04

Into it does it always follow through that if it is

18:07

a. A straightforward and

18:09

you know uncomplicated. Pregnancy.

18:12

That it will always be a straightforward bus. Know

18:16

it's not. and I think that some you

18:18

a we know that midwives ten eight sleep,

18:20

we can save lives. It's literally what widows

18:23

were educated, undertake lifesaving procedures there at the

18:25

quip as equipment at home based in order

18:27

to make so that we can. I'm in

18:29

a present. those those things maturing I'm in

18:32

booth has never been safer in and New

18:34

Zealand and Australia some of the size of

18:36

places and the world to give birth, but

18:38

there's always an unknown and I'm that part

18:41

of the role of the midwife has to

18:43

be able to to to preempt. That's to

18:45

you notice that have to monitor to be

18:48

able to provide advice and to transfer to

18:50

high little seizing is needed from a hundred

18:52

ceasing so they were things it can neither

18:54

they predicted. That is the nature of this

18:57

even though it's I said in it's either

18:59

been there that with boys. Sincere and. And

19:02

as I can come much you. And

19:05

I suppose, how. How to

19:07

deal with? Free

19:09

Birthing A Red! While I

19:12

was researching for this interview

19:14

that you know people in

19:17

the free Birth community, I'm.

19:20

Saying that. People who

19:22

are within the medical system like a

19:24

suit yourself you know you will was

19:26

through the mean a place that baby

19:28

cards that. These things can

19:31

happen if you if he

19:33

birth outside the system I

19:35

significance as it in Australia

19:37

for the outcomes for families.

19:40

Children. Is. A possible

19:42

to quantify the level of risk that has been taken.

19:47

It. Is very hard to quantify the level

19:49

of risk because these are undocumented am

19:51

and even in our best as the

19:53

marriages which register all births. What happens

19:56

is if a woman doesn't given birth

19:58

in the hospital and she doesn't. The

20:00

paperwork and hospitals. All that's required

20:02

is a stacked deck or sketched

20:04

rejected declaration that says that you

20:06

know this baby came from her

20:08

and the discuss the witness. But

20:10

the bus as marriages don't keep

20:12

those documents. They basically registered the

20:14

birth so we actually don't know

20:16

the magnitude of the problems. What

20:18

we do know is that there

20:20

are pockets. For example, Ah, south

20:22

East Queensland I'm there are pockets

20:24

where we know they were high

20:26

end communities of you know with

20:28

strong natural. Beliefs and

20:31

leaning sets out bar and bay

20:33

northern rivers them Blue Mountains in

20:35

Australia. Actually don't

20:37

know the magnitude. Of the President. What?

20:39

We. Do know though is we

20:42

are increasingly series of really concerning

20:44

adverse outcomes but also women who

20:46

have labored four days we're talking.

20:48

You know three four hundred years

20:51

ago scenarios that we're having today

20:53

in Twenty Twenty Four And that

20:55

is that it's highly concerning that

20:58

we are losing the advantages and

21:00

and as Allison said, midwives are

21:02

trained to not a when the

21:04

ripples first that period but and

21:07

to keep a vigilant eye out

21:09

and to step. In when needed.

21:11

when you don't have that training

21:13

at birth, you can have scenarios

21:15

where women are laboring for days

21:17

and days and days and the

21:19

outcomes can be quite significantly pull.

21:22

Him. How

21:24

to deal with this though? Because. It's.

21:27

There are people who are feeling alienated

21:29

by the system s For whatever reason

21:32

they don't. Trust. The medical

21:34

system props have seen. Lots

21:36

of things on social media that give them

21:38

the impression that it's a good thing to

21:40

try to do. How

21:43

do you talk to them? Because. You

21:45

know? I guess. It. Is an important

21:47

time in. A. Woman's Life and

21:49

and A Family's Release. But

21:52

yet, if you know it, there's a danger. I

21:54

guess that can be. Driven underground That people

21:56

will simply as you say not tell people

21:58

that the planning on. a free breath. They'll

22:01

not mention it to anybody at all. And

22:04

that, I guess, can open you up to all sorts

22:06

of other dangers. Absolutely.

22:09

That is my greatest concern over this

22:11

is you won't eradicate it by clamping

22:13

down on it. You will drive it

22:16

underground. And the World Health Organization said,

22:18

don't ask why women won't accept your

22:20

service. Ask why you are not providing

22:23

a service that women will accept. So

22:25

let's turn the lens upon us and

22:28

let's look at what we're offering women. Let's

22:31

look at the fact that we are providing in Australia,

22:33

and I'll talk about Australia, which is my context, one

22:36

of the highest intervention rates in

22:39

the OECD. Like us, as they're in section rates

22:41

now, 38%. We

22:43

are offering women fewer and

22:45

fewer birth centers where our continuity

22:47

of midwifery care is like 14%

22:50

of models provide that compared to

22:52

New Zealand. And I think, you

22:54

know, Alison can correct me, but

22:56

you're in the mid-90s for being

22:58

able to provide that midwife-led care.

23:00

We offer, you know, women have to

23:02

pay $6,000 to $8,000 for a home birth. We

23:06

have got to fix our system and provide women what

23:08

they want. The second thing we've got to do is

23:10

we've got to train our health providers in

23:13

respectful care, which is a very

23:15

sad thing to say, but we

23:17

actually need to do respectful care

23:19

and consent training. Many health

23:21

providers do not understand the legal

23:23

framework around a woman's right to

23:25

consent or decline care. We feel

23:27

like it's our obligation to browbeat

23:29

them into what we want, and

23:32

browbeating gets nowhere, and it is

23:34

actually illegal, and we

23:36

are seeing the significant consequences of it.

23:38

The other factor that we need to look at, very

23:41

seriously, I do know we share this with

23:43

New Zealand, is we have significant workforce

23:45

shortage. So you cannot have

23:47

midwives showing compassionate care when they are

23:49

running between two and three women and

23:51

they are burned out. So

23:53

let's value them. Let's pay them what

23:56

they're valued as. Let's

23:58

make sure we have. Action and

24:00

Kind made wines and we

24:02

have them available to women

24:04

to provide one to one

24:06

woman centered. Care. So

24:09

we've fixed those three things

24:11

up. We. Would do

24:13

an enormous amount not only to reduce burst

24:15

roman but also to reduce free but and

24:18

free. But it's like the pointy end of

24:20

the you know a it is that it's

24:22

sort of this the peak. Of

24:24

this whole best format picture. Her.

24:29

Our our since tokyo little bit about.

24:32

Something that was raised around

24:34

here, the people effectively being

24:36

outside the system, and ah,

24:40

Bought the place is of that

24:42

someone's been in touch. The supporting

24:44

on to on a one saying

24:46

another great having free bus ah

24:48

those rejecting any government authority ha

24:50

a sovereign citizens then they don't

24:52

even register the baby's birth. This

24:55

person says this leads to many issues

24:57

for the child's future. I'm from. Free

25:00

medical visits, school and of course is

25:02

insistence of itself is not something that

25:04

you are. Encountering. Hear that there

25:06

are those are problems are indeed. is

25:08

that something that we. Could. Face

25:11

if we don't deal

25:13

with this space. Yes,

25:16

We have hit it says examples at without

25:18

it as fit as one of the try

25:20

this that says possibly unique to our context

25:22

here and at does raise a whole raft

25:24

of the seas beyond the base for that

25:26

for that fauna of it's harder and it's

25:29

and it's it's it's life. I think that

25:31

taking up on his points around you know

25:33

what is our responsibility and had a week

25:35

how do we addressed as nice I think

25:37

we really need to come to this issue

25:39

with no judgments on the woman and that

25:41

and the same the in the choices that

25:44

the making and assign a seed absolutely to.

25:46

the leans back upon ourselves and what are

25:48

we going to make her see this as

25:50

accessible and it i mean when we when

25:52

leah i'm talking to a midwife members we

25:54

we just about to put out of position

25:56

statements from in the consultation on this and

25:59

spent some time and sort of nuances of

26:01

waiting to get it right.

26:03

Because there's a really difficult conversation

26:05

that Hannah has described. If you

26:07

come in with the, always

26:10

I think as you said, through the

26:12

dead baby card and bringing up all the

26:14

things that might go wrong, it

26:17

can be very coercive for women who are

26:20

very reluctant to engage in the system anyway.

26:22

So it's a very careful conversation that needs

26:24

to happen to make sure that there is

26:26

truly informed consent happening around the choices of

26:28

care that women are making, without

26:31

them being framed as really trying to

26:35

sort of take away that choice and autonomy, which

26:37

is really sitting behind a lot

26:39

of the decisions that these women and their families

26:41

are making. So that's a very skilled and difficult

26:44

conversation to have. And around

26:46

that, of course, it's the midwives' medical legal risk

26:48

in making sure that she's got the right information.

26:50

If things do go wrong and she's in some

26:52

way called into account here, I'd

26:55

just like to make two other points. I

26:57

think we have very strong

26:59

and collaborative relationship with the College of

27:02

Obstetricians, RANS-COG, and we need

27:04

to take this as a multidisciplinary approach because

27:06

when there are complications and women are choosing

27:08

to be outside the system, we absolutely need

27:10

the backing and support of our obstetric colleagues

27:12

and for them to be in this discussion

27:15

in a way that's empowering and

27:17

supportive to help that

27:20

easy access into the system in a

27:22

way that doesn't reinforce the

27:24

concerns that the women have already have. So I

27:26

think that's a point I'd like to make. And

27:29

another issue that is unique to New Zealand

27:31

but also an issue in Australia is

27:33

making sure our system is culturally safe

27:35

for Māori Fāno. And we know a lot

27:38

around inequities and the way that we

27:40

provide care and the way that the

27:42

system is set up to make sure that we respect

27:44

those cultural values is also a really

27:46

important thing for us to consider in our practice

27:48

as individuals but also at a system level. A

27:51

really interesting corridor. Thank you both very much

27:54

for your time on Saturday morning. Really interesting

27:56

stuff. Loads and loads of feedback coming in.

27:58

I will get to that in just... a

28:00

moment but first of all

28:02

big me to Alison Eddy there Chief

28:04

Executive of the New Zealand College of

28:06

Midwives, Taka'a'atae'unga, Kae Faka'fano, Ke'otae'oro'a. Also with

28:09

us Professor Hannah

28:11

Dalin of Western Sydney University

28:13

and she co-edited Birthing

28:15

Outside the System, the Canary in the coal

28:17

mine