 Just before I hand over to our speaker for today, I'd like to introduce Ella to you. Ella Kurtz is a midwife and a PhD candidate from Canberra in Australia. Her particular areas of interest are the power dynamics of maternity care provision and women's rights at birth. And one of our committee, Deborah Davis, is one of her supervisors. So without further ado, let me hand over to Ella. Hello, everyone. It's nice to see that you're here. I'm interested to look at your questions. As I'm going along, please feel free to ask anything at any time. Or even if you just relate to anything. Oh, I'm just hearing that it sounds not great. Let me just suggest that. Okay, let's try this. Can anybody, how's this sounding, everyone? A little bit clearer or feel not loud enough? Much better. I'll do a little bit more. Much better. Okay, let me know how that's going. So I wanted to tell you a little bit about me and the motivation presentation to start out with. So yes, I am a midwife and I'm a PhD student now. And I'm not surprised that Deb Davis is here now, but she'll work her high. And just over a year ago, I gave birth to my second child at home. My interest in home birth grew out of my work as a midwife. As I began to see how the mainstream systems, a lot of women in Australia had their babies in, really seemed to hinder the physiology of birth. Then just recently when I experienced home birth myself, I gained a very personal understanding of what a good option my birth can be for women. But that's another story. So for this piece of research from my PhD, I wanted to explore why so many people in Australia seem to be against home birth or maybe just uncomfortable with the idea of it. Even more research on the area shows home birth to be quite a good maternity option for women for a number of reasons. I thought looking at the media might be a good approach to understand what people think about home birth and why. Because I have noticed that the media gave a lot of attention to any home birth fatality and described home birth in a really negative way around any incidence of the fatality. But at the same time, I didn't really notice any media reporting or perhaps very little, minimal media coverage of hospital fatality, even though I was sure that the numbers for hospital fatality in childbirth were likely to be a lot bigger than home birth fatality. Seeing as the home birth rate in Australia is at the 1%. So just from numbers alone, there would have to be more hospital fatality at childbirth than in home birth. So first to the research, home birth for low risk women are tended by a constant increase for a network within response to maternal care services is a viable option with boy outcomes for women and their babies. I guess it's important to note that a lot of evidence that we have talks about the physical safety of home for women and babies at home birth. Yes, that's right, Cheryl. And so these studies are trying to show that the physical safety for both mothers and baby is equal to the physical safety of those women and babies in the hospital, especially for the low risk population as the tumor is pointing out there. But that home birth can actually be quite protective and perhaps one could argue even safer for women in terms of emotional safety that must be a bit. But yes, in this moving analysis, focusing on the safety of a physical outcome that's not home and baby and both can do staying alive. So even though this research says that home birth is a viable option, home birth often evokes very emotional responses. And there's a cult of belief that home birth can contribute to a damaged or dead baby. So that remains a really widely held view, which continues to drive the anti-home birth debate. And Australian midwife and swole Hannah Darwin suggests in one of her articles that more research about the benefits of home birth won't end the home birth debate because the polarization the debate produces is too powerful. So in a maternity care world in which evidence-based practices are more natural, this idea is really interesting to me because it really seems to shine a light on, I guess, the space between the evidence, which is in this case based on our scientific understanding of birth and how that works and our belief. And that's up theorists who say that people often form ideas based or more, I should say more easily form ideas based on emotions rather than facts and logic. So onto our next slide. So you might be interested in what the sex in Australia are. That was the first thing I was actually looking to, starting out on this media analysis because I didn't really know what they might be. And I discovered we don't have a precise measure or comparison at this stage in Australia, although in Australian birth they said it is underway, which will mimic the UK birthplace study. What we do know at this stage is that the instance of home birth mortality is collected but not released because the instance is so low that individuals could be identified in the data. So they're not able to release it. And also from some retrospective studies in 2013, 2014, but there's no specific difference in stillbirth and early need for deaths between birth and giving birth in hospital or at home. So I guess it's good to think about thinking about what the research done here at home is, why even are we giving birth in hospital? It was probably such an assumption. Many of us take the ground. We don't even think about why that's the practice that we currently use. And there's some thought that hospital birth would introduce to aid the learning opportunities for healthcare providers that were training. Yes, that is definitely a big issue here in data collection. And I've read a few interesting articles that kind of work on the premise that when we're trying to get good steps around home birth, it's really hard to measure that because it's kind of conform on just with apples. Yeah, it's hard to track exactly how the home birth is carried out, how planned it is and what kind of backup and skill retention it has there. But yeah, that's a really important point in thinking about the statistics. Yeah, so the idea was that the hospital perhaps was introduced to aid learning opportunities for training so that healthcare providers were more easily inefficient to learn. There was a group of women in the hospital at the same time who were not aided with the latest training. And it might kind of surprise to you all perhaps know this, the rate of cancer has surprised me to learn that early hospital perinatal mortality rates were really high because due mainly to improved forceps used and also this rate of purple fever between women because of practitioner ignorance about germ transmission like hand washing practices and the use of unsterilised equipment. But around at this time women were responsible for bringing fever into the hospital with them while they were catching them in hospital and the idea that hospitals increased perinatal deaths didn't enter wider cultural ideology or mindset. The relocation did coincide with the general advancement in population health outcomes and life expectancy. The advancements which at the time were likely thought to be due to innovation I guess you could say from the medical profession. But today we understand that it probably wasn't the medical improvement that helped these outcomes, but non-medical improvements like great access to food or housing and sanitation which were probably more effective in combating the poor health outcomes associated with that period this time. Oh wow that's very interesting, interesting point things to put up. So yeah, there's just a couple of the kind of cultural beliefs which underpin this common assumption we have in Australia that is the best place to have a baby because it's the safest place to have a baby. Which I think is a very strong point for most people. Probably fine, fine. So in order to get some information out of these media articles to kind of see what they were constructing I guess you could say about home birth. I use critical discourse analysis. There's probably good information about that. Morphodology, they're on the screen if you haven't heard of it all. Encountered it very much before. Because it was a good methodology to use because as a vehicle for a cultural belief the media reflects but also creates cultural norms of birth, of everything that needs birth. And this is done through the way words are used and how they portray events, how they tap into ideologies, cultural, mind-fed and ideas that we have about the way the world works. So probably especially in this area which I, as I mentioned before, evokes a very emotional response in people, the media is really able to contribute to a particular way of doing birth as normal and common sense in other ways as well. So as I started looking into media articles I discovered that there had been one woman had died. This is just in Australia by the way, this is just in our business area. And so one woman had died at a home birth in 2012. That was the only maternal mortality in 30 years. So there hasn't been anything but for 30 years before then too. So actually I chose this year to search for media articles because I was really interested to see what would come through in the media and how the media would counter this and how they would report it. After a little bit of deliberation with my supervisors, we decided to find articles through a Google search. So find the news articles through Google rather than university database or online technical databases in order to get a rough sketch or a rough outline of what the general Australian population might be reading about on birth. So I had two search terms. The first was my birth death in 2012 and the second hospital death in 2012 and the underscreen was a little bit of information about what came out of that search. So I want to run through the main themes that came out when I was coding these articles that came out of the search. So the first thing that was just seen to saturate all the articles was the criminalisation of home birth but it was something more legal. So this was done in a few ways of the language, which give you an example. Home birth was described as a major crime, criminal offence and midwives who were deregistered but who perhaps took practice or perhaps lived in a murky area in a way or before this much. They were described as escaping the law and that was seen to be a disembowelling. Mostly it was the health professionals who had midwives and nearly all of these articles were about independent midwife, not a public with undefended model. So it was the independent midwife who was targeted and described as breaking the law. So the woman and all her family wasn't really described as being more breaking the law but there's other stuff that wouldn't come to later. So these midwives were deterred from renegade and outside of the law. In contrast, hospital mortality was described differently. This is how they're sad and unfortunate and an incident to learn from. So something that would take note of what happened to them through possible processes. For example, communications between doctors or not, I think, as long as doctors but whoever staff were around could be including communication assistance or that kind of thing. So it was kind of an individual attack on any care provider and it was something that they did to include next time. So the next thing that came up was the midwife being seen as, I guess, a bad person. Yeah, I guess, or maybe a little bit, not a nice of being a witch but has some more positive connotations as well. So she was kind of dearly legitimised. A number of attacks to her personhood and possession. Just very nice, I'm not sure. Well, that's a good question. Who was driving the criminalisation message? I guess, in these media articles, note is one reported at a certain angle on what they want to say about whatever incident that happened. I guess a lot of though that came through was what coroners have said, so the legal system. And that came through quite strongly in a lot of articles that the coroner said this, the coroner said that. So yeah, I guess, reflecting those legal systems. Sometimes doctors, they may believe that they're criminal as much but they would say that, yeah, in their opinion, they'd like to have something in their mind or yeah, leading to this idea that the midwife was ignorant which is part of this character assassination actually. Yes. So, there were character flaws ascribed to home birth midwives. I have a couple of examples here. In one text, a midwife, who kind of almost pretends to be having a dangerous power over a woman, has been described, this is later, by his wife with brainwashed and having a birth at home by the midwife and also apparently this woman was hurt to play with the help of her death in this article in finding that the midwife wouldn't help her in her final moments which I think paints are very strong and I'm also seeing. So that was kind of the thing why it's been dangerous I guess. Also, the midwives were, the way they were described, they were made to seem like they were very ignorant. So, for example, that they committed a horrifying catalogue of errors or that the care they provided felt in short of the standard they expected or that they needed a greater level of assistance to probably manage the complications. And actually in a kind of a proverbial setting, one midwife describes why she has practiced in a certain way using some evidence to say this is why she has practiced in a particular way in spite of some evidence. And the coroner, I guess, doesn't agree with her opinion. And so in this situation describes her views on birth as idiosyncratic and rejects part of the evidence she put forward to supporting the claims. Yes, so in contrast, there isn't that character assassination for hospital death. So a little bit similar to the last slide that I showed you, they were attributed to unfortunate circumstances. And yes, I should have been better from the beginning. Okay, so here's then how the women were presented. So I guess some of the ways women were described were to tap them into cultural values that we have around women. Kind of status quo, gendered stereotypes, even as emotional or not quite rational were drawn on to I guess undermine women's decisions around birth that's why they had chosen this option. The main one was that they weren't well educated or they weren't educated enough, which I guess, you know, probably in this room we know that's probably not true, that was even that, which is my birth would actually know and have done extra research about it to back up their decision in that society that didn't come for a condo. But yeah, that was presented that women didn't know and that they should have thought outside made it for advice or they needed better education and yeah, that if they had known more they would have chosen a different option, which could be true for some women, which I'm sure it wouldn't be quite the same. And then I guess it's taken into account another idea about women too. I guess there was a way to describe women's choice behind birth that women were choosing it in kind of a frivolous way. So their desire to, for example, birthing gently was entered in quotes to make that kind of thing absurd and frivolous. And another woman who describes why she chose homebirth is to avoid unsafe elements of hospital birth factors is a little line written about saying many women opt for homebirth because they think they're a relaxed, familiar environment and would rather avoid a hospital as though, you know, it's just inconvenient for a woman to go to the hospital rather than that she's making a wrong choice. Yes, I agree, doesn't my option. Yeah, so these kind of approaches to illegitimise a woman's choice behind birth. Yes, this is one of my favourite lines in an architecture where we contend that the choice to have a really lovely spontaneous birth at home which is written in quotation marks at heart is only justified if it expresses a future charge to be at risk of a horrible disability and this is just not the case. Another thing that came out was the assumption that death could be prevented in hospital. That was a really overwhelming thing and came through most of the articles in the home-death articles that if this baby had been born in hospital the death could have been prevented by the baby would have survived the pregnancy state. In contrast, when it came to hospital death in one text the coroner said the woman should have been able to do the same at the regional hospital ultimately I'm unable to determine whether the baby would have survived if she had been delivered earlier. Which is just very in contrast to the way all of the home-death would have been described as definitely preventable if they had been managed in hospital. I just thought interesting to include here one mother whose baby did die at their home birth a little snippet of her what she says comes through in one text and she says maconium aspiration would have happened no matter where the birth took place and there would not have been her taking place at the hospital. So I guess that's feeding into the idea of what I was finding in the media analysis that she's kind of questioning the dominant assumption that also both can prevent every new woman's death. Jane that made a sound that maybe she forgot this. Unfortunately. So I guess this is the last thing and a little bit of all the other things that came into this and this kind of if the assumption that death is currently in hospital is matched by the assumption that home birth isn't our publicity. So that was kind of coming from all of the other themes. But to report in the media that home birth isn't safe which doesn't really reflect what we know the research to say it all but that doesn't make it into the articles into any of these articles that I saw. So for example the safety of home birth is a subject of frequent debate and many experts have called for a ban on birth and technique. So that line that was in one of the texts that I guess that is true that it's often a frequent debate but it kind of suggests that there isn't any positive research about home birth because it's like we've got it all kind of taken a tone that women who give birth outside of a hospital outside of a clinical setting always put themselves in new forms so kind of a blanket statement and other texts urge professionals to encourage women to live up in a safe clinical setting and also practice safe research. Once again all those things feeding to if I did birth and home is true. So by looking very carefully at the way the media presents childbirth or childbirth mortality, deaths in childbirth both at home and in hospital for this analysis they've been very careful about which words were chosen and what they created, why they were chosen and what values they were taken into. As well as noticing this real absence of what the science is about home birth in the media representation. I started to think that the debate wasn't perhaps it wasn't just about the place of birth, it wasn't just hospital or home but more about kind of deeper things going on and that maybe that maternity care providers who work outside the hospital most of these articles described very much written mainstream options on maternity care just by just by existing just by being there they're suggesting also another version of maternity care possible and I guess for any of us who do have the assumption or the value that hospital is the one placed with birth, for one maternity care with the existence of another option can be uncomfortable and threatening because it does kind of force us to think something about what we think about maternity care rather than just being able to perceive the assumption that we would like to have about it. So I guess it's in a way as easy for us to maintain our grip on our own reality by just shutting that other option out and rejecting it and saying that it's wrong, which I think is really what's happening in this kind of debate that the one side is really just rejecting the other side right out because it's kind of uncomfortable and threatening and questioning things that people would rather not question about their values and ideologies there's more going on too I can't remember anything else So these are a few things that I wanted to review this to recap I guess the analysis made me think more about how maternity care is probably based option on emotive thinking rather than scientific evidence even though we don't hold that to be the case if you ask people I'm sure people would say that it's based on scientific evidence Yes, so if there are any questions and we've probably had a similar experience you know just thinking that there's something happening for yourself or By the way I do want to say to probably those that I have some references throughout I haven't included them if anyone's interested in explaining those I can get into your area Thank you Ella that was a really interesting insight into the research you've been doing and opened my eyes about quite a lot as well especially as I have a young grandson and my daughter is going to have a baby at the end of the year so it'll be interesting to see how that plays out so has anyone got any questions for Ella if you have then please put your hand up that's a great question yes and I wish that I had a good answer for that maybe someone in this room has a good idea I guess talking about is good but sometimes I find it hard to even talk about it I feel like in this room probably everyone's very receptive to hearing this information but it'll be hard to talk about it if you really have a different mindset I'm interested to hear what everyone else thinks about how we can change these kind of cultural ideas just reading your comment yes I just want to point out different from Australia and New Zealand I haven't worked in New Zealand as my wife I've been doing it the whole day but I always hear like I do I've been it's really more progressive than Australia in these ways but at Deb you might have some interesting insights into that the way they structure there the legal type of things that's right sorry Ella I was just going to say they do have a different compensation scheme there which is a no fault kind of compensation scheme but I don't think that's at the bottom of the differences I think they're much more behind choice informed choice as an ocean and the way you have your baby because it's funded by the government whether it's home or hospital there's less kind of emotion in it it's a sanctioned choice to have your baby you know a government sanctioned choice to have your baby at home I think that government sanctioning is very important isn't it and I can see that even what I can counter up because we know how publicly funded is not being highly taken up but it is sanctioned by the government which makes it almost beyond the reproaches that these people are facing in a strange way oh that's really a pretty to hear that Karen do you think that why are the midlife shortages at the right end or is that just an over present kind of thing and should we go into your comment too I think you're really right that it does show who has the power to define terms and I guess when you find yourself on the other side of that power it's not always that nice I remember Okina as you came alive I can't remember her name right now unfortunately I saw her at a conference venting at a conference in Australia she came to visit that was when Gillard was Prime Minister and I guess probably for any Australians who remember that choice received a lot of negativity in the media just I guess don't even have a sound like just the way she looked or what she said things or everything she thought was wrong and this UK Midwife was saying that she thought compared to the UK Australia was really behind in accepting women in positions of power which I guess maybe relates to home birth too because that's very much yeah women's choice for power in the private sphere yes I think that's interesting Chris about the cultural differences I think that's probably goes into a lot also not many private positions in the New Zealand I didn't know that is that why is that because we seem to have so many in Australia or in the UK too hmm also it doesn't feel good to be compared to the US it's sorry for them I'm from the US here but also only okay not many at all yeah I guess what you're showing in the chat is that there is so many things like all into this kind of cultural branding isn't there so being free or yeah there's so many different factors oh wow that's great Linda also there's a lot of interesting things out there 90ish well 90ish independent big lights well intended you say now I think that seems really ahead of the game too that private position rights isn't as big in New Zealand I feel like in Australia people really are interested in making sure and I can't really understand why but it does seem like you ought to get a better deal in the public system yes and that's right Deb so private doctors yeah they have something at stake they'll lose money in my face so it's never as interesting to kind of legitimise private and lucrative of course what do you mean with your commentary that just that midwives need to practice in kind of a midwifey way rather than a medical way or something else that you wouldn't need to that we have midwives need to really recognise the door to the earth and Chris actually I wonder if in the UK just thinking about what this midwife said I wonder if you had a lot of content with home birth but yeah if you just generally on the street season or people that you meet if you feel like people are more comfortable with home birth than they are here yes that's why 100% physiological birthing which I think is a really great part of home birth that it does have so much scope for physiology it really doesn't allow that to happen I think probably better than most hospitals I'm trying to think of birth and just allow physiological birthing so I think they do better but I think 100% of it's the best yes that does sound good when you just bring that up a bit yes so maybe in terms of journalists and networking would be good if someone really camp yeah what kind of a campaign together to get some more positive birth stories around I know that freebirth is a really big issue that we're facing in Australia now because it's very hard to get private home birth access yeah so that's a golden position to be in isn't it birthing is a little just going to work for you and there's no one else to cover you yeah that's a good point Sheila and I think just speaking for us in camp right here as maybe you haven't mentioned before we now have a publicly funded model home birth running through our first centre and there hasn't been too much uptake at all which is a little bit worrying the powers that be for me it's a little bit worrying here's the powers that be just like oh well we don't women don't want that but I think you'll write that if there's kind of that culture of free around birth which I think we do have then of course I know there isn't going to be a good option or it takes time to talk about those things doesn't it and maybe it takes longer than nine months or women to hear new information about birth and what they can do yeah so yeah so what hmm that's interesting about women in New Zealand too yeah I just always get the phone that New Zealand's like a lot more progressive in terms of everything culturally in terms of inclusion and equality and yes they wouldn't leave their refugees anywhere I would take them thanks Chris so just now last few minutes yeah any more pressing things and things you want to talk about or have questions about oh that's interesting Carol just really oh that's it thank you Carol for that that's really interesting yeah that's true I've always liked lots of geography to work with in the trade thank you everyone for coming here today I'm going to your interesting discussion points well I'm actually not sure if we will publish this time what's your timetable Ella what was that please sir so what's your time when you're hoping to complete your your phd well I guess from the middle of the year I'm doing it part time so I think I'll have two more years part time okay yeah it's already been four years or so yep so even though it's still two more years it doesn't seem to be 100 things well I just I'd like to echo what everyone else has said which is to say thank you very much that was a really interesting presentation really engaging judging by the level and quality of the questions so thank you very much thanks very much