Not addressing the root cause: An analysis of submissions made to the South Australian Government on a Proposal to Protect Midwifery Practice

BackgroundReports of unregulated birth workers attending birth at home, with no registered midwife in attendance (freebirth), have become more frequent in Australia in recent years. A Coronial Inquiry (2012) into the deaths of three babies born at home in South Australia resulted in a call for legislation to restrict the practice of midwifery to registered midwives. A Proposal to Protect Midwifery Practice in South Australia was issued as a consultation paper in January 2013.AimTo report the views of those making a submission to the Proposal to Protect Midwifery Practice in South Australia.MethodsThirty submissions to the South Australian Government were downloaded, read and thematically analysed.FindingsTwenty-five (81%) submissions supported the legislation, 5 (16%) opposed it and 2 (6%) were neither for nor against. Support for the proposed legislation was strong, however the underlying root causes that have led to the rise of UBWs attending homebirth in Australia were not addressed. Recommendations called for all stakeholders to work with women to develop a better framework of care that respected and met their needs and choices whilst safeguarding maternal and neonatal health.ConclusionsThe Proposal to Protect Midwifery Practice may promote greater protection of midwifery practice however, Private Indemnity Insurance (PII), collaborative agreements and power struggles associated with the medical domination of childbirth continue to marginalise homebirth and prevent women from accessing the care they want and need. These unresolved issues represent the root causes for UBWs attending homebirth; hence the proposal is only a partial solution.     

An Australian doula program for socially disadvantaged women: Developing realist evaluation theories

ProblemVolunteer doula support has achieved favourable outcomes for socially disadvantaged women around the world. There is limited explanatory understanding of how, why and when doula support programs improve outcomes.BackgroundA community organisation is providing free doula support for women experiencing socioeconomic disadvantage in Melbourne, Australia. The program aims to complement the mainstream maternity care system, to promote equity in women’s care, and experiences of pregnancy, birth and early parenting. This program is the first of its kind in Australia and has not previously been evaluated.AimTo develop hypothesised program theories for the realist evaluation of an Australian doula program.MethodsAs the first stage of a realist evaluation, three key informant interviews and rapid realist review of literature were conducted in December 2017 - January 2019.FindingsSeven theories were developed in four categories: critical elements of implementation (Attracting and activating the right doulas, and Good matching); outcomes for women (Being by her side, and Facilitating social connection), outcomes in maternity care system (Complementing or enhancing maternity care, and Doula as a witness — demanding accountability in others), and outcomes for doulas (Doulas as beneficiaries). These theories were framed in accordance with a realist understanding of causation, as Context – Mechanism – Outcome (CMO) configurations.Discussion and conclusionThe development of theories from multiple sources of evidence provides a strong theoretical base for program evaluation. The theories hypothesise how, why, for whom and when the doula program works. Subsequent stages of the evaluation will test and refine the theories.