New Zealand Home Birth Association

1978 –

New Zealand Home Birth Association

1978 –

Theme: Health

This essay written by Joan Donley and Brenda Hinton was first published in Women Together: a History of Women's Organisations in New Zealand in 1993.

Update coming soon!

The twentieth century home birth resurgence arose in the early 1970s, as a reaction against the increasing medicalisation of childbirth. In New Zealand, a policy of regionalisation directed women to large, centralised, high-tech hospitals, and forced the closure of rural maternity and cottage hospitals. The home was the only place where a woman could control her birthing process.

The demand for home births grew, and in 1974 three midwives—two in Auckland, one in Christchurch—took up domiciliary contracts. Because these were with the Department of Health, rather than local hospital boards, the midwives and the women they attended were outside the control of their local obstetric bureaucracies. This independence was a key factor in the survival of the home birth option in New Zealand.

In Auckland in 1978, a small group of home birth parents formed what they initially called the New Zealand Home Birth Association (NZHBA) to make sure this option did survive. [1] Their aims were to promote planned home birth as a safe alternative to hospital birth; to support women choosing home birth, and the midwives and doctors facilitating this choice; to educate the general public, health professionals and policy makers about the advantages of home birth; to research aspects of home birth; and to promote comparative studies of hospital and home births.

By 1980, six more home birth groups had formed independently in Christchurch, Dunedin, Wellington, Manawatu, Nelson and Tauranga, with women in several other areas eager to organise. This proliferation of groups reflected an international movement instigated by women wanting to reclaim the normality and intimacy of childbirth. At the first national conference in Auckland that year, seventeen delegates from the original seven groups agreed to formalise and incorporate the NZHBA. The Auckland group had already established links with groups in Australia, where the idea of Home Birth Week originated. Held in the last week in October, it featured a wide range of locally organised activities designed to publicise and promote home birth.

Midwives group

Members of the Wellington Home Birth Association and children, July 1980. From left: Helen Staples, Jennifer Sage (midwife), Jessica McLean, with Vanessa Moon (front). Ref: EP/1980/2116, Alexander Turnbull Library.

The NZHBA constitution provided for a national executive which would rotate annually to the branch hosting the conference, and would be supported by a capitation fee on all branches. One of its functions was to speak with one voice on issues of national importance. However, the 'one voice' soon became a problem, and by 1983 several branches felt that the national structure cost too much and was not working; they preferred groups which could function autonomously. Others saw the national organisation as providing clout, accessibility and respectability.

This controversy was finally resolved at the 1985 Nelson conference, when the NZHBA was wound up and reformed as a loose grouping of autonomous Home Birth Associations (HBAs), sharing common aims and a philosophy that birth is a normal biological event, not a pathological state requiring intervention; and that home birth is based on responsibly giving birth, rather than being passively delivered, and therefore requires self-awareness, a supportive environment, and flexibility. These organisational changes had little effect on the day-to-day work of the HBAs; all worked to ensure the continued availability of the home birth option, and to retain and improve the availability of fully subsidised maternity services in general.

The essential, special nature of the partnership between birthing women and midwives was valued and nurtured by all HBAs. Between 1978 and 1988, there was an acute nation-wide shortage of domiciliary midwives, because of the very low level of remuneration, frequent difficulties with medical peers, the stress of having to be on call 24 hours a day, and the professional isolation in areas with only one midwife. The HBAs adopted various strategies, such as running active or 'natural' childbirth classes, which swelled the demand for home births, and surveying attitudes among local doctors and hospital authorities, then lobbying and educating to gain the necessary back-up support. Some HBAs fundraised to buy the required equipment, in order to ease the financial burden for midwives. In other areas an HBA formed to support a midwife who had already taken out a domiciliary contract, publicise the service, and provide information and support for women choosing it.

Save the Midwives book cover

Home-birth midwife Joan Donley (back centre) was a leading midwifery practitioner and activist. Her 1986 book Save the midwife charted the history of midwifery in New Zealand and argued for a return to midwives' independence. Reference: Joan Donley, Save the midwife. Auckland: New Women’s Press, 1986 (sourced from Te Ara).

The Nurses Amendment Bill 1983 would have placed total care of mother and baby with nurses who might or might not be midwives, and made midwifery merely a postgraduate nursing qualification, rather than a separate profession. Auckland HBA members formed Save the Midwives, to encourage midwives nation-wide to unite against the bill. Midwives and consumers together succeeded in getting the legislation revised, and the rift between domiciliary and hospital-based midwives began to heal. This battle became the first step toward the formation of the New Zealand College of Midwives in 1988.

Between 1978 and 1988, the HBAs lobbied continuously for a realistic level of remuneration for domiciliary midwives. Little progress was made until 1986, when the national conference subscribed $3000 and hired an industrial lawyer to renegotiate the old 1939 midwives' contract with the Department of Health, winning a substantial increase in fees.

The 1988 conference approved the establishment of regional Domiciliary Midwives Standards Review Committees, comprising equal numbers of health professionals and consumers; these committees reviewed annually the practice of all domiciliary midwives recommended by the HBAs. In 1990, with the HBAs' support, the New Zealand College of Midwives and a courageous Minister of Health, Helen Clark, succeeded in bringing into law the Nurses' Amendment Act, which allowed midwives to practise independently of medical supervision.

This greatly improved the availability of the home birth option. [2] By 1992 there were 27 HBAs, with a collective membership of over 2000, functioning throughout New Zealand.

Joan Donley and Brenda Hinton

Notes

[1] By August 1979, the Auckland group had formed links with home birth groups in other parts of the country and was referring to itself as the Auckland branch.

[2] The Nurses Amendment Act 1990 removed the need for midwives to register with the Department of Health before working independently in the community, and provided pay equity, via the Maternity Benefit, with GPs providing maternity care. The number of independent midwives offering home birth services increased dramatically; however, no total for 1993 was available at time of publication.

Unpublished sources

Auckland Home Birth Association records, 1978- 1992, in possession of Joan Donley, Auckland

Auckland Home Birth Association Newsletter, 1979- 1992

New Zealand Home Birth Association National Newsletter, 1978-1990

Published sources

Donley, Joan, Save the Midwife, New Women's Press, Auckland, 1986

Donley, Joan, Herstory of the New Zealand Home Birth Movement, 1978-1991, NZHBA, Auckland, 1992

Maternity Services Committee, Maternity Services in New Zealand, Board of Health Report No. 26, Wellington, 1976

Maternity Services Committee, Mother and Baby at Home: The Early Days, Board of Health Report No. 30, Wellington, 1982

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