AOSTRAL1AN COLLEGE O F MIDWIVES INCORPORATED

S T O P P R E S S : Engl i sh j u d g e ru le s n o n - c o n s e n t i n g m o t h e r to h a v e c a e s a r e a n s e c t i o n to

s a v e the l i fe o f her u n b o r n chi ld .

It was reported in The Times, October 14, 1992 that surgeons at a London hospital carried out a caesarean section against a pregnant woman's wishes after being given permission to do so by the president of the English High Court, family division, following an emergency hearing.

The woman had been admitted to hospital in a serious condit ion in labour with ruptured mem- branes and the fetus in a transverse lie. The doctors considered a caesarean section was their only hope of saving the life of the unborn child. The woman, supported by her husband, refused the operation on religious grounds. The woman's life was also at risk.

The doctors contacted the court and the judge, Sir Stephen Brown, gave permission for the doctors to override the woman's wishes even though she was competent to decide for herself, on the ground that the life of the unborn child might be saved. The woman survived the surgery and remains in a serious condit ion but the baby died.

This is the first case of its kind in England but is not unknown in the United States. The decision represents a marked departure from the protection the law normally affords those who withold consent to medical treatment. The issue at stake here is whether the judiciary in Australia will follow in the wake of this decision by making similar decisions. The case also raises the spectre of pregnant woman being compelled to undergo non-consent ing treatment in any case where their behaviour puts the life of their unborn children at risk including ingestion of drugs or alcohol. To do so would be to single out pregnant women for court-approved procedures which to date in Australia and England have been limited to those who lack mental capacity or are too young to consent. It also means subjecting women to legal compulsion in a manner which could not be applied to men.

What will happen in Australia? Given the current climate in which there is a growing push to recognise fetal rights we may not have to wait too long to find out.

Judith Mair

L e t t e r t o E d i t o r

Dear Lorraine, In light of the World Breastfeeding Week and Baby Friendly Hospitals campaign and 'Future Birth' seminars I would like to suggest that there is One Step To Successful Breastfeeding that is absent from the WHO list and it is the most important; 'The philosophy and practices of birth must promote normalcy; recognise, respond to and co-operate with the natural forces of childbirth.' (Elizabeth Davis, 'Heart and Hands; A midwife's guide to pregnancy and birth,' 1987).

Some of us have experienced that when the childbearing couple and their caregivers perceive the natural forces and processes as positive and strive to utilise them, successful breastfeeding is only part of the healthy outcome, and that w o m e n thus empowered through pregnancy and childbirth do not need to be taught to mother.

I ask that the Journal of ACMI review 'The Impact Of Pregnancy and Birth Experiences On A Women's Confidence And Ability To Breastfeed"

Consequently I would ask all College Members, to become involved in fostering the development of birth options in Australia, by one or all of the following ways;

* Become informed as to the available birth options and their statistical outcomes and impacts.

* Write letters and make calls to the Ministers of Health (State and Federal) and your own MP requesting; a) Medicare rebate for pregnancy and birth care by a registered midwife (currently limited to those who can afford the full costs involved, though less per capita than the medical approach) b) funding for more Birth Centres, so that such care by midwives is an option for all healthy women who so choose.

* Share information with other groups to which you belong, for birth impacts on many aspects of the life o f present and future generations and the communi ty is ignorant of the facts, including many of our health colleagues.

* Form networks with other groups to combine the impact and co-ordinate efforts to effect the necessary change, for as in New Zealand the opposition is well established and powerful.

Yours sincerely, Denise Hynd

DECEMBER 1992 ACMIJOURNAL PAGE 21