Dr. Christine Vose (2003, revised 2007)

The midwifery practitioner is required to continually enhance her or his education to meet the demands of the profession. The Australian College of Midwives concurs with this, saying that midwives need to "have up-to-date knowledge, skills, attitudes and values and provide safe and satisfying care within a woman-centered framework' (ACMI, 1998, p.4) and "engage in opportunities to maintain or update skills, knowledge, attitudes and experience" (ANMC, 2006, p.7).

Apart from the need for access to on-going research based education, the midwife needs to be cognizant of the different aspects of midwifery models as they emerge and change with new research. Clearly, as aspects of care become obsolete or are radically changed in the light of new evidence, it is not enough for birth practitioners to simply provide the type of care they were originally trained to give.

THE NEW FACE OF MIDWIFERY The act of birth encompasses the full range of human experience physical, emotional and psychological (Odent, 1994). This is further expressed by Jordan (1993) who says;

"childbirth is an intimate and complex transaction whose topic is physiological and whose language is cultural…how a society defines itself in relation with the natural and scientific world correlates with that society's understanding and management of birth."

This knowledge is embedded in the values of the Natural Birth Education and Research Centre. Its practitioners see that in the event of birthing, through an exquisite aspect of woman, every parent and newborn infant on Earth is connected. We appreciate the instinctive wisdom of birth as it links all of us in nature and culture.

We understand, through society's attitudes to women and birth, we can view humanity's cultural progress and how we affect the lives of generations to come. This ontological understanding is difficult to appreciate with words because it is founded in the very essence of human being. However, awareness of this 'being' arises with the knowledge of 'doing' when assisting the birthing event and it is well supported by the Heideggarian philosophy underpinning both the curriculum and the practice of the Centre.

Our cultural progress includes the richness of both the social and medical knowledge of birth. However, in the Western world many disturbing trends for the future health of women, parents and infants have occurred because medical intervention in birth is emphasised when there is little or no adequate options for naturalistic maternity care (Hall and Bewley, 1999; Kitzinger, 2001; Kitzinger, 2002; Odent, M. 1994, McCarthy, 1996; Odent, 1994; Wagner, 1992: Wagner, 1998; WHO, 1996).

Birth was once a natural practice in the life of a community. One world-renowned obstetrician is clear in his call for the naturalization of birth based on the unequivocal scientific evidence that supports it (Wagner, 2000). Looking back to earlier times, this doctor laments over-emphasis on the medical model and says, "before 200 years ago all birth care was humanized as it kept the woman in the center and, in general, respected nature and culture"(Wagner, 2000). Countless studies by institutes, governments and community organizations support Wagner's call for the naturalization of birth and demonstrate birth environments are becoming de-humanized by increasing reliance on assumption based technologies and medical interventions (Wagner, 2000). For more than two decades, research shows that an increase in medical technology and birth interventions has "failed to detect any relation between crude perinatal mortality rates and the level of operative deliveries" (Wagner, 2000). This trend appears in developed and developing countries around the globe, as noted by Wagner (2000) who also suggests "we are now at the point in maternity care in industrialized countries where the positive effects of development and technology are approaching the maximum and the negative effects are surfacing".

In Australia over the past twenty years five major government reports into maternity services preceded the 1999 inquiry by the Senate Community Affairs Reference Committee (SCARC). Despite countless recommendations calling for a more naturalized system of maternity care in Australia, little has changed. There are two major implications of this trend. Firstly, the community-based focus of natural birth care is not available to Australian midwives during their training because there are no relevant community placements where natural birthing practices can be undertaken. The midwifery task force that reviewed midwifery and midwifery education in 1996 (NSW Midwifery Taskforce Report, 1996) concurred with this and showed there was a great need for a course such as the one being developed by the Natural Birth Education and Research Centre. This report stated, "it is unlikely that hospitals would have the resources to provide community experience unless the entire service provision model changes" (NSW Midwifery Taskforce Report, 1996, p.68).

Secondly, the situation for women, infants and parents continues to deteriorate despite a wealth of evidence that justifies the need for a naturalistic birthing option for women, and despite increased demand by women for this option (NSW Midwifery Taskforce Report, 1996). The SCARC were vocal about the lack of options for women asking for a naturalistic birth, saying that "women requesting an intervention free birth were likely to receive a much less sympathetic hearing than those requesting some form of intervention" (SCARC, 1999 Ch 9).

Each and every Australian report on midwifery services, over the past twenty years, reflects the desires of women for: • naturalistic options in birth • education programs that allow them to make informed choices • continuity of care throughout pregnancy, at birth and during early childhood development

In the case of some form of medical intervention, in almost 90% of Australian births, the 1999 inquiry found, "many appear to be almost routinely undertaken without any scientific evidence of their benefits" (SCARC 1999, Ch 6). Australian birthing outcomes also directly contradict international evidence indicating that in any given culture approximately 80% of women are physiologically capable of giving birth without medical intervention (WHO, 1997).

In contemporary Australia women are directed away from natural birth "here bodies are subjected to socially constructed medical influences to such a degree that the greatest majority are seen as unable to birth without medical intervention despite being physiologically and biologically capable of achieving this life-affirming goal" (Gulliver, 1998).

It is clear that our contemporary enactment of the ritual of birth in Australia – nearly universal institutionalization and medicalisation, involves significant costs to our economic, social and psychological frameworks. Prior to the Senate Inquiry into Childbirth Procedures (1999), reviews of maternity services have made repeated calls that support the provision of naturalistic birthing options for most women. Key recurrent themes have been echoed in these reviews since the Sherman Report was completed in 1989. Many birthing women are demanding a more central role in decision making about their care during pregnancy and birth. Some birthing women concerned with how their bodies are being affected by the medicalisation of birth and the resultant impact this has had on their ongoing relationships in the world have repeatedly called for options within maternity care. These women are calling for: less fragmented care delivery; decision making that places women in a central position: • maternity care that is supportive of natural physiological processes; • birthing care that is conducted in more home-like rather than institutional venues (Midwifery Taskforce Review, 1996).

Since these women's voices were first heard, a wealth of international research has become available validating their requests. Some women's innate birthing wisdom is now supported: "To be honored as knowledgeable, to be given consistent information, to have a known care provider, to be offered support, to be given responsibility, to be patiently cared for, to have privacy protected and to have individuality respected. These are the simple and compassionate ways a society can facilitate women birthing naturally, safely and joyfully" (Gulliver, 1998).

Northern New South Wales to date has been unable to universally offer the recommended women-centered, evidenced based options of maternity care. It is within this context that The Natural Birth Education and Research Centre Inc was conceived. Its three-fold purpose: offering evidence based, comprehensive and personalized maternity care; undertaking appraisal and exploratory research; and offering concurrent training for care providers, will begin the process of honoring women's birthing wisdom. The potential outcomes cannot be limited to considering cost effectiveness or incorporation of recommendations but in changing a culture of birthing. It has been shown that natural birthing is sought after by a large proportion of birthing parents and is not promoted in the current hospital system. Centuries of 'civilization' have resulted in a move away from community-based natural birthing practices.

The medical model of birthing practices has resulted in the loss of choices for birthing parents, with control of the process taken over by the hospitals. In NSW, Birth Centre births (in or attached to hospitals) comprised 2 % and 2.4% of all births in 2000 and 2004, respectively (NSW Mothers and Babies, 2004). One report states that 17% of women would choose a birth centre birth - if such centers were to be established (NSW Midwifery Taskforce, 1996).

Considering the current Australian situation, The Natural Birth Education and Research Centre is dedicated to ensuring that women, infants and parents are the focus of birth care. We are committed to the wisdom of community based training for all maternity carers, and to the promotion of safe natural birth culture in all media.

References ACMI (1998). ACMI Competency Standards for Midwives. Melbourne: Australian College of Midwives Inc. ANMC (2006). ANMC National Competency Standards for the Midwife: Australian Nursing and Midwifery Council; Australian College of Midwives Inc. Hall, M., Bewley, S. (1999) "Maternal mortality and mode of delivery" Lancet 354, p776,. Kitzinger, S. (2002). Birth your way. London: Dorling Kindersley. Kitzinger, S. (2001). Rediscovering birth. London: Pocket Books. Lomas, J., Enkin, M (1989) Variations in operative delivery rates, in Effective Care in Pregnancy and Childbirth, Eds Chalmers, M Enkin, M Keirse, Oxford: Oxford University Press. Odent, M. (1994). Birth reborn. Medford, N.J. Birth Works Press. Gulliver, H. (1998). Rational – designed for The Natural Birth Education and Research Centre. Wagner, M. (1992) "Public health aspects of infant death in industrialized countries: the Sudden emergence of sudden infant death." Annales Nestle 50:2 Wagner, M (1998) "The Public Health versus Clinical Approaches to Maternity Services: The Emperor Has No Clothes." Journal of Public Health Policy 19:1,25-35. Wagner, M. (2000) "Fish Can't See the Water they Swim in" Homebirth Australia Conference Paper. McCarthy, B. (1996) "US maternal death rates are on the rise". Lancet 348:394 World Health Organization. (1996) WHO revised estimates of maternal mortality: a new approach by WHO and UNICEF. Geneva, report no. WHO/RH/MSM/96.11 NSW Mothers and Babies (2004). Centre for Epidemiology and Research. NSW Department of Health. New South Wales Mothers and Babies 2004. NSW Public Health Bulletin 2005; 16(S-4). World Health Organisation (1997 or 2002) NSW Midwifery Taskforce - SCARC