School of Nursing and Midwifery, Family and Community Health Group, University of Western Sydney, Australia.
Women Birth. 2011 Dec;24(4):148-55. doi: 10.1016/j.wombi.2010.10.002. Epub 2010 Nov 11.
In February 2009 the Improving Maternity Services in Australia - The Report of the Maternity Services Review (MSR) was released, with the personal stories of women making up 407 of the more than 900 submissions received. A significant proportion (53%) of the women were said to have had personal experience with homebirth. Little information is provided on what was said about homebirth in these submissions and the decision by the MSR not to include homebirth in the funding and insurance reforms being proposed is at odds with the apparent demand for this option of care.
Data for this study comprised 832 submissions to the MSR that are publicly available on the Commonwealth of Australia Department of Health and Aging website. All 832 submissions were downloaded, coded and then entered into NVivo. Content analysis was used to analyse the data that related to homebirth.
450 of the submissions were from consumers of maternity services (54%). Four hundred and seventy (60%) of the submissions mentioned homebirth. Overall there were 715 references to home birth in the submissions. The submissions mentioning homebirth most commonly discussed the 'Benefits' and 'Barriers' in accessing this option of care. Benefits to the baby, mother and family were described, along with the benefits obtained from having a midwife at the birth, receiving continuity of care and having a good birth experience. Barriers were described as not having access to a midwife, no funding, no insurance and lack of clinical privileging for midwives.
Many positive recommendations have come from the MSR, however the decision to exclude homebirth from these reforms is perplexing considering the large number of submissions describing the benefits of and barriers to homebirth in Australia. A concerning number of submissions discuss having had or having considered an unattended birth at home due to these barriers. Overall there is the belief that not enabling access to funded, insured homebirth in Australia is a violation of human rights. It appears that homebirth was considered by the MSR as 'too hot to handle' and by dismissing it as a minority issue the government sought to avoided dealing with homebirth as a 'sensitive and controversial issue.'
2009 年 2 月，《改善澳大利亚产科服务-产科服务审查报告》（MSR）发布，在收到的 900 多份意见中，有 407 份来自女性的个人经历。据说，相当一部分（53%）的女性曾有过在家分娩的个人经历。关于这些意见中提到的家庭分娩，以及 MSR 决定不在提议的资金和保险改革中包括家庭分娩的决定，几乎没有提供什么信息，这与人们对这种护理选择的明显需求相悖。
本研究的数据包括在联邦政府卫生和老龄化部网站上公开的向 MSR 提交的 832 份意见书。所有 832 份意见书都被下载、编码，然后输入 NVivo。内容分析用于分析与家庭分娩相关的数据。
450 份意见书来自产科服务的消费者（54%）。470 份（60%）意见书提到了家庭分娩。在意见书提交中，共有 715 次提到家庭分娩。提到家庭分娩的意见书最常讨论的是获得这种护理选择的“好处”和“障碍”。描述了对婴儿、母亲和家庭的好处，以及在分娩时获得助产士、获得连续护理和获得良好分娩体验的好处。描述的障碍包括无法获得助产士、没有资金、没有保险以及缺乏对助产士的临床特权。
MSR 提出了许多积极的建议，但考虑到大量意见书描述了澳大利亚家庭分娩的好处和障碍，决定将家庭分娩排除在这些改革之外令人费解。有相当数量的意见书讨论了由于这些障碍而在家中无人看管的分娩或考虑过这种分娩。总的来说，人们认为澳大利亚不允许获得资金、保险的家庭分娩是对人权的侵犯。看来，家庭分娩被 MSR 视为“太棘手”，政府通过将其视为“敏感和有争议的问题”而将其作为一个“少数问题”来避免处理家庭分娩问题。
