The Christchurch home birth story
By Rea Daellenbach
This history is not an account of all the amazing families and midwives who have contributed to establishing and sustaining home birth and home birth groups in Canterbury – although this would be a great thing to do. Rather, this is a story of the challenges faced by home birth activists and midwives as they have worked to support home birth and each other in Canterbury over the past thirty years.
The Christchurch Home Birth Support Group formed in September 1976. They began by meeting on the first Monday evening of the month. There was one midwife, Ursula Helem who would attend women who wanted to birth at home. Home birth was still funded by the government, but very few people knew that this was an option. The law stated that home births had to be supervised by a registered medical practitioner (doctor). However doctors did not generally provide support during labour so families needed to find a midwife. Midwives could claim for one antenatal visit, labour and birth care and ten postnatal visits through a government benefit.
The home birth group formed in the context of increasing obstetric control of childbirth. Small birthing units were being closed down and women, particularly for their first babies, were expected to go to Christchurch Women’s Hospital. At that time, women had their pubic hair shaved and were given an enema when they were admitted to the hospital. During labour women were not allowed to eat or drink, and fathers were not always welcome to stay with their partners. The concept of informed choice and decision-making was considered by most hospital staff to be a ‘deviant fad – and unworkable anyway’. Babies were put in a nursery after birth and brought to mothers at the feeding times according to a strict routine – and women and their babies stayed were expected to stay hospital for ten days following the birth.
In the 1970s some important changes began to happen in New Zealand. More and more people were disillusioned the way that the New Zealand ‘cradle to the grave welfare state’ seemed to idealise uniformity and devalue individual differences. Two social movements emerged during this time that provided the impetus for a growing interest in home births – the alternative lifestyle and the feminist movements.
The first home birth group was formed in Christchurch. The women joined to support each other to birth at home because most other people thought that home birth was radical and dangerous. They provided information to families about how to find a doctor and a midwife. They also supported the midwife – later midwives – who attended home births, raising money for supplies, doing administrative work and organising home birth antenatal classes.
The Auckland and the New Zealand Home Birth Association (NZHBA) formed in 1978. From its beginnings this was explicitly a political lobby group. They were more openly feminist than the Christchurch group.
The difference between the Christchurch and Auckland quickly produced tensions within NZHBA. At the 1982 conference in Dunedin, the representatives from Auckland argued that home birthers had to become more politically aware, while those from Christchurch contended that home birth required peacefully getting on with the job of birthing at home. This debate was fruitful in determining that home birth groups needed to do both – support home birth families and midwives and fight the political battles to protect the home birth option. The Christchurch Home Birth Support Group then formally became the Christchurch Home Birth Association and part of the NZHBA in 1983.
It is important to recognize how much home birth families and midwives were rediscovering what natural birth was about within the home birth movement at this time. Most midwives had learned about birth within hospital settings and had to go through a process of ‘unlearning’ . What about sterility? What if a woman was in second stage for more than an hour? What would happen if the birth of the placenta was not actively managed? Home birth midwives and women together had work out what was normal and safe and both had to take responsibility for their decisions. These powerful shared experiences laid the foundation for what is now called ‘partnership’ in midwifery in New Zealand.
However, political activism to save home birth was becoming increasingly important. Already in the late 1970s, obstetricians became concerned about the growing home birth trend. Their views were publicised in the media with headlines such as ‘Death and damage – natural birth warning’
(Auckland Star, 19 July, 1976), and ‘Home births almost a form of child abuse’ (the Press, 14 December, 1977). Also, the remuneration for home birth midwives had not been increased since 1939 and even home birth midwives who worked full-time earned less than the unemployment benefit. GPs who attended home births came under pressure from obstetricians and some were threatened with limits on the women they could book for hospital births. By the early 1980s, the Nursing Council and the Nurses Association (union) sought to subsume midwifery into nursing through making midwifery education only available as an option within the Advanced Diploma of Nursing and prohibiting midwives who were not also registered nurses from attending home births.
But working out the best political strategies turned out to be complicated for home birth activists and in 1983, conflicts between the NZHBA national committee and the Auckland Home Birth Association lead to the demise of the NZHBA (just shortly after Christchurch had joined). Within most home birth groups, the focus then became on home birth women and midwives supporting each other, running antenatal classes and ‘coffee mornings’, producing newsletters, providing library and information resources, and raising awareness about home birth in their communities. This created a strong grass-roots movement. Associations networked through sending out their newsletters to each other and organising annual conferences.
Home birth groups shared resources to ensure that any available political opportunities to lobby the government to improve access to home birth were utilised. Thus, government officials and MPs would receive letters and submissions from a number of groups and this increased the visibility of a small movement. Home birth groups pushed for more pay for midwives, for midwives to be able to provide home birth services without the supervision of GPs (who were vulnerable to pressure from obstetricians) and for the reinstatement of direct entry midwifery education.
The Auckland Home Birth Association kept statistics about home births around the country. They also started the Midwifery Standards Review (MSR) process in 1988 when obstetricians began to try to monitor home birth midwives more closely. The Christchurch Home Birth Association worked with the newly formed New Zealand College of Midwives (NZCOM) to set up an MSR Committee in Christchurch a year later. The Christchurch Home Birth Association never managed to become an official organisation such as an incorporated society after the NZHBA was dissolved, despite numerous attempts.
In 1990, with Helen Clark as Minister of Health, the Nurses Act was changed to enable midwives to attend births without medical supervision at home or in hospital, to provide care during pregnancy, to order lab tests and prescribe medications that might be necessary during the childbirth experience. Because doctors refused to enter into negotiations with the government and NZCOM over maternity payments, midwives became able to claim the same payments as doctors for childbirth services – a massive increase over what they had received before! Direct entry midwifery education was also established. Within a couple of years the position of home birth had completely changed. While there was great cause for celebration, the home birth associations suddenly became less relevant to midwives and families and the numbers of active members in most home birth groups began to dwindle.
In 1991, a new National government began to reform the New Zealand health system with the view of privatising many services that had been state owned. Home birth associations were invited to tender for government funding through contracts to provide home birth services in their regions. Some home birth activists feared that private medical providers might seek contracts for home birth services and then be able to control who could access home birth. The Christchurch Home Birth Association decided to oppose contracting and instead push for a national contract (such as we have now in the Primary Maternity Services Notice). As an alternate strategy, the Christchurch Home Birth Association supported the NZCOM initiative to establish the MMPO. However, the Christchurch Home Birth Association decided that they should at least tender to provide pregnancy and parenting classes so that families who wanted to birth at home would not have to pay for these.
Many other associations put massive efforts into tendering for home birth contracts. However, only two, the Manawatu and the Auckland Home Birth Associations were successful in getting contracts to provide a home birth services including midwifery care. The Tauranga Home Birth Association were awarded contracts from 1993-97 to provide home birth classes, post-natal home help, a separate Maori home birth group and a drop-in centre.
All the home birth groups who were interested in contracts had to form separate trusts so that the finances of the contracts would be completely separate from those of the associations. Also the government funding authorities considered the associations to be too political to be contractual entities. Thus, the Christchurch association established the ‘Home Birth Classes Christchurch Trust’. The Manawatu Association set up the ‘Community Birth Services Trust’ (CBS). They received a contract in 1995 and home birth rates in Palmerston North increased greatly. When CBS lost the contract in 2000, they managed to gain funding to establish Homebirth Aotearoa – a national collective for homebirth advocacy. Homebirth Aotearoa now has a direct contract with the Ministry of Health. Auckland was the last home birth association to establish a provider organization. This is called MAMA and member midwives can claim for home or hospital births.
For the associations most successful at contracting, the huge effort needed to continually renegotiate and run contracts seemed to drain all the energy out of their core home birth groups. These now have very few active members. While the Canterbury group also has struggled at times to maintain an active membership, it has remained one of the strongest home birth groups in New Zealand. The focus has continued to be on home birth women/families and home birth midwives supporting each other as well as publicising the miracle and wonder of birthing at home.
Rea Daellenbach has had connections with the home birth groups in Christchurch since 1980 and been a member since 1986. She completed a PhD in 1999 about the home birth movement in New Zealand.