"I came to the conclusion that I didn't need a specialist surgeon to go about natural pregnancy and childbirth"

Submission to the Maternity Services Review from Kiera Perrott

Dear Ms Bryant

I am writing to express my support for expanding women's access to midwifery care in Australia.

I recently had my first child in Box Hill, Victoria, and was unable to access the kind of care I wanted within the public system or private obstetrics route and instead chose to engage an independent midwife and birth at home at my own expense (my health insurance didn't cover these services either). I'd like to share with you some of my pregnancy, birth and postnatal story to let you know how I feel the system could be improved so that all women have the options I was fortunate enough to be able to access.


Once I had successfully conceived I went to my GP to discuss my options. My GP referred me to an obstetrician on the basis that I had private health insurance and that he was a great surgeon who would be useful if I needed a caesarean. This seems to be a common experience among my friends, but being fit, healthy, young women, the odds of us needing caesareans are low. The medical evidence suggests that care by a known midwife leads to the best outcome for mother and baby so it seems to me it would be better if GPs were referring women to the available midwifery services, which in my case includes a Know Your Midwife program at Birralee Maternity Service, Box Hill Hospital.


I made an appointment with the recommended obstetrician, but luckily his bedside manner was so poor that I came to the conclusion that I didn't need a specialist surgeon to go about natural pregnancy and childbirth. Unfortunately by the time I rang to try and get a booking with the Know Your Midwife program I was 17th on the waiting list. I made a booking with Birralee instead, but I was disappointed at the tour to discover water birth would not be an option, despite the great bathtubs, because not all midwives had the expertise and the hospital didn't have a policy supporting water birth. I was also concerned at the thought of birthing my baby aided by a midwife I might never have met before.

From my reading I was starting to realise that the best way to ensure that I could have a normal, physiological birth was to do it at home, with the support of an independent midwife who would care for me and my baby before, during and after the birth. At about 24 weeks pregnant I engaged an independent midwife and began to plan for homebirth. Fortunately my midwife was able to provide Shared Care with Birralee, so I maintained my Birralee booking in case I needed to transfer to hospital from home.


At the hospital I was offered the 20 week ultrasound but declined it because of the unknown effects ultrasound poses to an unborn baby and the cascade of interventions that can occur if something unexpected is detected. Doctors claim ultrasound is safe but there is no research that really proves this. Studies also show that despite the cascade of interventions that can occur, the outcome for the baby is often the same either way. It's staggering to consider that despite the conclusion of the Cochrane Collaboration that "no clear benefit in terms of substantive outcome measures like perinatal mortality can yet be discerned to result from routine use of ultrasound", in 1997 the Australian Federal Government paid out $39 million to subsidise pregnancy scans, compared to spending $54 million for all other Medicare obstetric costs (Buckley, S, Gentle Birth, Gentle Mothering).


I also declined Doppler ultrasound heartbeat checks. My independent midwife used a Pinard's stethoscope. While there was a Pinard on the shelf in the hospital consulting room, the hospital midwife said she didn't know how to use it, and said if I could feel the baby moving then it must have a heartbeat anyway. I also declined the Group B Strep swab, despite the hospital doctor muttering something into his desk about how sorry I'd be if my baby died.

My baby was only exposed to Doppler ultrasound during labour, when I agreed it was important to monitor my baby for fetal distress during contractions. I also avoided being offered unnecessary antibiotics by birthing at home, given that my waters broke 14 hours before the birth (the hospital apparently likes to give them after 6 hours).

At home in a space I could relax in, without unnecessary interruptions, and the aid of my midwife and a birth pool, I was able to give birth to my baby and her placenta without any need for pain relief drugs, ensuring the best start for me and my baby in terms of bonding and breastfeeding. My midwife also provided five postnatal visits over the week after the birth to ensure my baby and I were doing well, providing advice and reassurance, and saw us again at 6 weeks. Birthing at home with a known midwife who also provides follow-up care should be available to all women through the public health system.