Restricted birthing practices
From 1 February, 2014 it is an offence for any person in South Australia, other than a medical practitioner or midwife registered under the Health Practitioner Regulation National Law, to carry out a restricted birthing practice.
This restriction does not deny a woman the choice of whether her baby is born at home or in a hospital. Nor does it deny a woman the choice to have a support person present throughout her pregnancy to provide emotional or social support.
While the focus is on the three stages of labour and child birth this does not detract from the importance of antenatal and postnatal care also being provided only by registered practitioners. This will ensure that a woman will be able to make an informed choice about birthing options and the health and wellbeing of their baby.
A restricted birthing practice is defined under the legislation as an act that involves undertaking the care of a woman by managing the three stages (or any part of these stages) of labour or child birth.
Why restrict birthing practices?
The restriction on birthing practices to a registered medical practitioner or midwife is in response to the recommendations of the Coronial Inquest published on 6 June 2012 (PDF 787KB) into the unrelated deaths of three babies who died at the time of, or very soon after, their births between 2007 and 2011. Each of these babies died after complications that were experienced during their delivery by way of planned homebirths.
The restriction on birthing practices will ensure that only those registered practitioners that hold the necessary education and training and that practise within accepted professional standards can provide these services. This will ensure the safety of the woman and her baby during the three stages of labour and child birth.
Health Practitioner Regulation National Law (South Australia) Act
Under section 123A of the Health Practitioner Regulation National Law (South Australia) Act 2010 a person must not carry out a restricted birthing practice unless the person is:
- a medical practitioner registered under the Health Practitioner Regulation National Law; or
- a midwife registered under the Health Practitioner Regulation National Law; or
- a student who carries out the restricted birthing practice as part of an approved program of study for the medical profession or nursing and midwifery profession; or
- is acting under the supervision of a registered medical practitioner or midwife and is acting in accordance with any standards, codes or guidelines issued by the National Board established for the relevant profession; or
- is acting under the form of delegated authority transferred or conferred by a midwife that is recognised by the Nursing and Midwifery Board of Australia and is made in accordance with any standards, codes or guidelines issued by the Board;
- is rendering assistance to a woman who is in labour or giving birth to a child, or who has given birth to a child, where the assistance is provided in an emergency.
Failure to comply with these requirements attracts a maximum penalty of $30,000 or imprisonment for 12 months.
Activities constituting a restricted birthing practice
On 6 February 2014 the Minister for Health and Wellbeing gazetted the following list of activities that may be taken to constitute the management of the health and wellbeing of the mother and baby (PDF 2.4MB) during the three stages of labour or child birth:
- assessing the risk level at the onset of labour and ensuring the resources provided are appropriate to the level of risk
- timely referral of care in the event of complications developing during labour
- management of obstetric and neonatal emergencies
- monitoring the fetal heart rate during labour through auscultation or electronic fetal monitoring according to accepted guidelines
- monitoring maternal observations (heart rate, blood pressure, temperature) during labour according to defined protocols
- assessing the need for pain relief and appropriately responding to requests for pain relief
- observing for, and assessing vaginal loss
- performing an abdominal palpation to assess fundal height, the position and engagement of the fetus in relation to the pelvis, size of the fetus and presenting part
- assessing by vaginal examination the degree of dilatation of the cervix
- assessing by vaginal examination for signs of obstructed labour including cervical oedema, caput, moulding of the fetal head and progress of the labour
- manually, or visually, managing the birth of the baby in a manner that minimises the risk of sequelae including birth asphyxia or perineal trauma
- manually, or visually, managing the third stage labour (delivery of the placenta and membranes) according to accepted guidelines
- clamping the umbilical cord and supervision of the cutting of the umbilical cord
- checking for completeness of the placenta and membranes
- assessment of membranes or liquor when membranes have ruptured
- assessing the perineum with recognition of the degree of perineal injury according to accepted classifications and determining whether there is a need for perineal suturing
- assessment of the neonate’s transition to extra-uterine life and determination of the Apgar scores at 1, 5 and 10 minutes
- examination of the newborn for presence of congenital abnormalities and general condition
- performing neonatal resuscitation as indicated in the circumstances