6 essential tips for a natural birth

Choosing a natural birth can be the most empowering and transformational experience in a woman’s life. In our culture, childbirth is viewed as a medical event and an emergency waiting to happen. We only have to turn on the TV and we witness birth being portrayed as a major emergency, and thank goodness those doctors were there to save the mother and baby. As well as this, when we ask our mothers about their births, we're bound to hear more horror stories. Forceps, stirrups, the dreaded episiotomy. Shaves, enemas, being bound to bed, not allowed to get up, let alone even sit up. Nothing to eat or drink. Husbands were not present. Is it any wonder that we are so fearful of birth?

Fear guides many birth experiences and results in the overuse of interventions and medications. As a result many women feel out of control and disempowered by their birth experience. It doesn’t have to be that way.

The following suggestions will help you prepare to have the best birth experience possible:

1. Understand the process of birth If you understand what is happening with your body during labour, you will have more confidence in the birthing process. Knowing that everything is as it should be, is the key to “letting go” and allowing birth to happen normally and naturally.

2. Good nutrition Good nutrition is essential to good health. The food we put in our mouths today will build the cells of tomorrow. In pregnancy, the food we eat also builds our baby, so we have an added responsibility to ensure that nutrition is optimal.

3. Exercise Birth is a physical event. Staying fit can minimise pregnancy discomforts and ease the birth process. Walking or swimming and prenatal yoga are very beneficial to the health of you and your baby.

4. Relax Your body instinctively knows how to birth your baby and it releases hormones that help you through birthing.  Fear, tension and anxiety can interfere with the natural process by inhibiting labour hormones and increasing fight / flight hormones.  I recommend Calmbirth to all women who plan a natural birth.

5. Address fears and concerns We are constantly bombarded with negative images and stories of childbirth. Over time these messages can become ingrained in our way of thinking. It is important to recognise our attitudes and beliefs and understand how they shape our experiences. Any negative thoughts or beliefs about childbirth can be explored prior to giving birth.

6. Care provider

Your choice of care provider has a great impact on the sort of birth you will have, despite points 1 - 5 above. Having a supportive care provider throughout pregnancy and birth is critical in positively influencing the outcome of your experience.

Birth is natural and women have done it for centuries. But in today’s society, a birth without preparation may not be the one you envisioned. You have all the resources available to help you prepare for the birth experience you desire.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

First time mums and homebirth

What a great choice!  Discuss your situation with your midwife for more advice. Generally, first babies are ideal for home births. Why? Most first births go really well with the care and support of a midwife.  In the hospital system, a first-time Mum stands a 25% chance of having a caesarean, a 25% chance of needing forceps / vacuum, and only a 50% chance of a normal birth.  Compare this with the chance of a normal birth at home with a private midwife (around 90%) and you can see why there is such a benefit to planning to birth your first baby at home.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

 

Continuity of care

Private midwifery is the oldest form of continuity of midwifery care.  Recent research has demonstrated that this form of care – where a woman is cared for by the same midwife throughout pregnancy, birth and the postnatal period – is beneficial for women and families. It results in increased satisfaction with the birthing experience and enhanced safety.  When multiple care providers are involved in a woman’s care, the chance of errors is high because care is provided in pieces. When a woman is cared for by one midwife, she has one point of reference, no conflicting advice, she can develop trust and a sense of security and the birth will generally proceed naturally.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

 

Why is choosing a care provider one of the most important decisions you will make in your pregnancy?

A woman’s choice of care provider for pregnancy and birth is one of the most important decisions she will make. This decision has the most important influence on how her birth will go and how she will experience her care.

Some things to consider when deciding on a care provider are:

  • What sort of relationship would you like to have with your care provider? Are you merely looking for physical check ups in pregnancy and someone to turn up for the last few minutes of the birth? Are you wanting to be cared for by strangers who do not know you or your wishes for birth / would you like to feel nurtured? Would you like to know the person who will assist you in birth?
  • How much information do you expect to receive? Are you happy with “It’s normal” in response to your questions, or do you need more information and a better understanding of your situation and progress and health?
  • Do you wish to be actively involved in the decisions made about your care or are you happy to leave all decision-making up to others?

It may take some time and energy to find the right care provider for your pregnancy and birth. It is very helpful to interview several midwives and obstetricians before deciding on the one that is right for you.

What about place of birth?

There are three options for place of birth: home, birth centre and hospital. Midwifery care is available at all three locations. Obstetricians generally work only in hospitals, however a few will attend birth centre births. Knowing where you would like to birth your baby can help you in choosing a care provider.

What should I look out for when I am interviewing care providers?

One of the most important issues to consider really doesn’t need much consideration at all. How do you feel about your care provider at the end of the initial consultation? It’s a gut feel. You can trust your gut.

You will want to ask your care provider about his/her practices to ensure that their practices are consistent with what you’re wanting for your pregnancy and birth. If waterbirth is important to you, you need to find a place of birth and care provider who can provide this. It’s best to find this out at the initial consultation stage rather than at 38 weeks.

You will also want to explore your care provider’s philosophy on pregnancy and birth to ensure that there is a match with your own.

Are there any poor reasons for choosing a care provider?

Yes! And I hear them very often. It is not wise to choose a care provider because:

  • They are close to your home / office
  • Your mother used them
  • You feel you don’t have any other choices (there are always choices; it’s not a question of resources, it’s a question of resourcefulness)
  • They are female / they are male.
  • Your GP recommended them (unless you are sure of the basis for that recommendation and you agree that they are right for you)
  • They are cheap
  • They do an ultrasound at every visit
  • They delivered you
  • It would offend Aunt Bessie if you didn’t go to Dr X
  • Although you don’t like the person, you’re sure they’ll be fine on the day (your gut is always right)

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

Pets and home birth

I am sometimes asked about pets and home birth.  I am an animal lover and I think that our pets are an important part of our families, so my views below might be a tad biased, but here goes: I find that most pets are fine during a home birth.  You'll know if your cat or dog loves the water a bit too much (so much that they'd hop in the birth pool with you), and in this case, some people prefer to have their pets in a separate room.

Dogs always seem to know what pregnancy means (ie, that a baby is on the way) and seem to be protective of the pregnant woman throughout her pregnancy.

I think dogs tend to know when labour is about to begin, and sometimes their behaviour changes very subtly.

During labour, dogs tend to be quiet and respectful, and I find that cats just tend to do their own thing.

If you have other pets, such as fish, rabbits, chickens, birds and so on - these animals tend to be fine during home births.

The main things with pets would be to ensure that they have enough water and food, and if you think they might need their own support person, to consider this ahead of time and have someone handy in case they are needed.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

Holistic midwifery care

Holistic midwifery care is care that assesses and incorporates the needs of the pregnant woman, rather than merely focusing on her pregnancy.  A midwife who is working holistically will be interested in a woman’s family, her health and medical history, her previous births, her emotional well being, any fears that she may have around birth and parenting, her work life, and her relationships. A midwife who is working holistically will tend to see women for longer appointments, around an hour each, so that there is plenty of time to get to know each other and for the woman to feel safe and comfortable and supported.

A midwife who works holistically believes in the mind-body connection.  When we consider pregnancy and birth, a holistic midwife will understand that issues in life can impact a woman’s pregnancy, and s/he will recognise when fears, uncertainty and doubt are affecting a woman’s labour.  The midwife works with the woman through her pregnancy and birth holistically to help the woman to birth naturally, safely and calmly.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

Fetal heart rate monitors - reassurance?

During pregnancy, it is very normal for women to crave reassurance that their baby is healthy.  The purpose of regular antenatal care is to ensure the health and well being of the mother and baby, but for some women, it is this period between visits with their midwife or doctor that concern starts to build.  Is the baby ok?  How do they know? Some women purchase or hire fetal heart rate monitors (dopplers) to keep track of their baby’s heart rate.  They feel that if they can hear a heartbeat, all is well and they feel reassured.  Midwives and doctors general recommend against this practice.  But why, if it provides women with reassurance?

When a midwife or doctor listens into baby with a doppler (or pinards), they are interpreting several aspects of the baby’s heartbeat, and they are putting this piece of clinical information together with the other aspects of the antenatal visit to create a complete clinical picture of the health and well being of the mother and baby.  It is simply not as simple as listening to the baby’s heartbeat in isolation and without reference to the overall health and well being of the woman.

As well, the interpretation of the baby’s heart rate and rhythm requires a degree of clinical training.  The mere presence of a heartbeat is not necessarily reassuring, and by the same token, it is very common for there to be some difficulty in locating the heartbeat and in differentiating the heartbeat from the other sounds that emanate from the uterus.

So, if midwives and doctors recommend women do not use monitors to reassure themselves of their baby’s well being, how can a woman feel reassured?

The simplest and most effective way for a pregnant woman to monitor her baby is to monitor the baby’s movements after 28 weeks of pregnancy.  A healthy baby moves, and often quite a lot!  Monitoring the baby’s movements after 28 weeks, and reporting a reduction in movements to your midwife or obstetrician is by far the safest and most effective way to monitor the health of your baby between appointments.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

Pre-labour: what to expect?

Pre-labour is a topic that has come up recently with some of the women I have cared for.  In particular, women have asked what the difference is between pre-labour and labour itself. I'll start by saying that pre-labour has many names: false labour, early labour, practice labour and prodromal labour.  I like the terms pre-labour or practice best as they describe the phase of labour (ie, before labour starts) and the purpose (practice for labour).

Many women experience pre-labour, but not all women will experience it.  For women women, the very first contraction is the start of active labour and from that point, their baby arrives very soon.  However, for most women, a period of contractions occurs as the body warms up for labour and as the baby shifts into a more favourable position for birthing.

Practice labour can last a while.  Several hours, several days, even a couple of weeks.

It is characterised by contractions that are irregular in frequency, intensity and duration.  This means that there is no pattern to the contractions that persist for more than an hour.  Some contractions will be long, while others will be short; some will be quite intense while others will be very mild; and some till come close together while others will be spaced apart.

They can feel like strong Braxton Hicks contractions or strong period pain.

They may also become more apparent when you are active, and die down when you rest.

When labour starts, there will be a regular pattern to the contractions and they will not be affected by your level of activity.

In terms of your body, practice labour is the time when your baby is moving to an optimal position for birth and it is a time when your cervix is softening, thinning and opening a little.  So we bring respect to this process, understanding that it is the key to a healthy start to labour.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

Knowing Your Midwife

For many women, pregnancy can be an emotional rollercoaster.  Many women experience excitement, joy and hope, but also fear, uncertainty and even disappointment and sadness. The relationship a woman develops with her midwife is important to a woman as she journeys through her pregnancy, birthing and in the early weeks with her baby.

It has been shown that women who are cared for by one dedicated midwife for the duration of their pregnancy, birth and early newborn period find this form of care to be highly satisfying.

It is about having one person who shares in your pregnancy, who listens as you share your fears and concerns, who shares information with you and who supports your decisions and choices.

When a woman knows and trusts her midwife, there is a shift of power towards the woman as she feels a greater sense of control over her entire experience.  She becomes aware of her choices and options, she feels confident to make her own decisions and she goes to her birth feeling confident, informed and supported.  She knows who will be caring for her on the day, and she knows that her midwife knows everything that is important to her for her birth.

There is no sense of being a number in a busy system.  There is no need to repeat yourself at every visit.  There are no lengthy waits for appointments.  Each appointment takes around an hour, so there is plenty of time to get to know one another.

Private midwifery care is an option that more and more women are asking for, although it is only accessed by a small number of women.  Yet research shows that this care model, in which a woman is cared for by one midwife from early pregnancy though to birth and post-birth care, offers numerous benefits to women and babies. These include a greater chance of a spontaneous birth without stitches, feeling in control during labour and exclusive breastfeeding with minimal chance of postnatal depression and baby blues.  Private midwifery care also means much less requirement for pain relief in labour, fewer inductions of labour and of course a much lower chance of needing a caesarean.

The care I am describing - where a woman knows and chooses her midwife – is available for both home and hospital births.  If private midwifery care is available in your area, you may decide that is what you would like.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

Care options: we don't know what we don't know.

A Queensland-wide survey has revealed that very few women say they are informed about all available options for care when they visit a GP in early pregnancy, yet typically the GP is the first port of call when a woman discovers she is pregnant.

The Queensland Centre for Mothers and Babies found that only 7.7% women report that their GP discussed with them all the maternity care options available.  This is important because the lack of options presented to women early in their pregnancy does limit their ability to make informed choices about their care.  The old saying that you don’t know what you don’t know is very true in this case!

The other concerning aspect is that often by the time a woman does discover her preferred care option, in some cases, that option will be fully booked.  for example, private care options such as private obstetrics and private midwifery are often booked by 6- 8 weeks of pregnancy.

In recent years, there has been an expansion in the range of care options that are available to women, both within the public system and private system.  Within the private system, private midwives can now provide services that are claimable via Medicare, and private midwives can request ultrasounds and pathology for women in their care, as well as prescribing the necessary medications across pregnancy, labour, birth and the postnatal period.  These are fairly major changes to the maternity care system, and women deserve to be informed of all of the options that are available to them when the first find that they are pregnant. 

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

 

My pregnancy is high risk. Can I have a midwife?

Yes, midwifery care may well be an option for you.  Your public midwifery options may be limited as public hospitals will generally steer higher-risk women towards obstetric care.  However, private midwives can care for women of all levels of risk in consultation with an obstetrician for the issues that may need obstetric input.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

How do Midwives Work?

It's a common question I am asked! When people ask me what I do, I tell them I am a midwife. The next question is usually, “Oh, so you’re a nurse?”. “Not quite”, I reply, “a midwife – I care for women though pregnancy and birth and with their new baby.” Then they really look puzzled. “That's not what an obstetrician does?" “An obstetrician is a doctor who specialises in caring for women with complicated pregnancies and births. A midwife specialises in caring for women who are having healthy pregnancies and births.” By that stage they’re well and truly confused and I start to wonder what we need to do to promote midwifery as a care option for all women.

The term midwife means ‘with woman’. Midwives work in partnership with women through pregnancy, birth and the postnatal period. Midwives can provide care to women from the time that the woman discovers she is pregnant, right up until her baby is 6 weeks old. In fact, women who experience a normal, healthy pregnancy and birth may not see a doctor at all! Eligible midwives are able to order all the necessary tests and scans during pregnancy and may refer directly to an obstetrician if their services are necessary.

Midwives provide education, clinical care, assessment, planning, support, advice and information, as well as doing all the routine checks of mother and baby.  Most importantly, though, a midwife's role is to develop a relationship with the woman and her family along the pregnancy, fostering feelings of trust, respect and safety for the woman and her family.

Midwives advocate measures throughout pregnancy and birth that promote normal birth: that is a birth without interventions. Midwives and are experienced in such things as water birth, active birth, and so on.

Midwives are also specially educated to know if anything is out of the ordinary, and they can get help from obstetricians. In pregnancy, midwives see women at intervals so that any issues that may present can be dealt with before they cause any major issues.

Women who are cared for by one midwife from pregnancy through to birth have better outcomes in terms of safety, lower rates of intervention and satisfaction with their experience. Midwives too prefer to work in this way, getting to know each family individually.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

Care providers in labour

Care providers in labour include midwives and obstetricians. 

Around 30% women in Australia will have some of their care from a care provider who is chosen by them and known to them in the private system, be it a doctor or midwife.

Around 70% women give birth in the public system, most under the care of a midwife or doctor whom they have not met before.

Why does it matter if your care provider is known to you and chosen by you?

  • It is sometimes hard for care providers to know exactly what the woman they are caring for wants in her labour: the labour may be quite advanced at the time that the woman comes in in labour, and it might be hard for the woman or her support person to verbalise what it is that she wants
  • It can be difficult for a care provider to cater accurately to each woman's needs and expectations, especially when they have not met before.  A birth plan is a good way to communicate basic wants and needs for labour, but often the more subtle issues cannot be known without the midwife and woman knowing each other beforehand.
  • Midwives often feel that labour is not the best time to be educating a woman about her choices and the pros and cons of each option, and for good reason: when labour is well established, contractions come every 3-4 minutes, leaving little time in between to discuss choices and options and work out what will be best for the woman.

If you are cared for by a private care provider who is known to you and chosen by you, you will have the opportunity in your pregnancy to discuss with them what is important to you in your birth, and they will have the opportunity to speak with you about any concerns they may have.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

How do midwives monitor the baby's heart beat in labour at a homebirth?

Midwives monitor a baby's heart beat in a home birth, as well as ensuring the health of the woman giving birth.  The usual method of monitoring a baby at a homebirth is for the midwife to use a doppler.  This portable and light-weight piece of equipment is water-proof, so the woman can be in any position and also in the bath or shower while it is in use. Current guidelines recommend that a baby's heart beat be listened to every 15 minutes in the first stage of labour, and after every contraction during the second stage of labour.

Some women are keen to avoid ultrasound, and the hand-held doppler does use ultrasound.  in lieu of this, the midwife can use a pinnards stethoscope, however this can only be used on land, so it would require the woman to leave the bath or shower so that the midwife could check on the baby's wellbeing.

If the midwife detected anything untoward in the baby's heartbeat at home, s/he would arrange for the woman to be transferred to the hospital where a CTG monitor could be used to give more information abut the health of the baby.  This is the same process that a birth centre midwife would employ.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

Choosing where to birth your baby

Where you birth your baby is a really big decision.  Over the weekend, I met with four newly-pregnant couples who came to ask me about their options for birth and the models of care that were open to them.  I was delighted to be seeing them so early in their pregnancies: this is the best time to be asking those tougher questions.  Together, we sat and talked through the various options: public, private, which hospital, obstetric care, midwifery care, public models and so on. 

Why do we place so much emphasis on where women give birth?

This is because the type of birth a woman has often depends on where she has chosen to birth her baby, and who she has chosen to provide her care. 

Where you choose to give birth can influence:

  • the environment in which you give birth: clinical environment, home-like environment within hospital, or home
  • the options that are available to you for pain relief in labour: epidural, gas, morphine, natural methods of pain relief
  • whether you can use water for labour and / or birth (NB: this is different to the availability of baths: some facilities have lots of baths, but labouring / birthing in them is not supported by policy / practice)
  • who looks after you during your pregnancy and labour: a midwife you know, who has been chosen by you; a hospital midwife you have never met before; a group of midwives from the hospital whom you may have met during your pregnancy; a hospital doctor whom you have not met before; your own private doctor; or a private doctor whom you have not met before
  • how far you have to travel in labour: no travel at all (homebirth); intra-state / inter-state (eg if the birth options that you require are not available in your local area); some travel (eg to a hospital)
  • your chance of having medical interventions (these are very unlikely in a planned homebirth, even when transfers are included in the data)
  • whether you can access specialist medical care or facilities, anaesthetists, paediatricians, obstetricians
Water birth

Water birth

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

What equipment do midwives bring to homebirths?

Typically, midwives bring a range of safety equipment and supplies to a birth. These include:

  • Oxygen for mother and baby
  • Suction equipment
  • Suture material and local anaesthetic in case of any tears (generally there are no tears) 
  • Medication to stop any excessive bleeding after the baby is born
  • Vitamin K for the baby
  • A doppler to monitor the baby’s heart beat
  • Blood pressure equipment
  • Urinalysis sticks
  • Scales to weigh the baby
  • Resuscitation equipment for the baby
  • An oxygen mask for the mother
  • A catheter in case the mother is unable to pass urine
  • General equipment such as gloves, needles and syringes, sterile water and normal saline, gauze, cotton wool, tape, cord clamps (unless the family prefer to use a cord tie) and so on. It’s quite a big kit when it’s all put together.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

Independent Childbirth Education

Congratulations to Julie Clarke for winning 4 business awards from WOMO Word of Mouth Online for the last four years.  I have referred clients to Julie since 2005 and I keep hearing wonderful reviews about Calmbirth classes with her.  For more information, call Julie Clarke at Sylvania 95446441 see www.julieclarke.com.au

 

What causes a long labour?

First, it's probably worth saying that a "long" labour is subjective. What is long for one woman may be fine for another. A woman's perception of the duration of her labour will be affected by many factors such as hunger, dehydration, tiredness, support, encouragement, the environment, interventions, being cared for by one midwife who is known to the woman and trusted by the woman, her expectations of labour and birth, her preparation for labour and birth and so on. There can be many things that can cause a labour to be longer than hoped for. These include things like:

  • First baby: first babies can sometimes take longer than second and subsequent labours
  • The position of the baby: a posterior baby can sometimes (not always) mean a longer labour.
  • The positions you adopt in labour: upright positions may speed the process of labour
  • Hydration levels: if you are dehydrated, it can cause your contractions to weaken, and this can slow the labour
  • Being cared for by one midwife: continuity of carer has been shown in research to result in shorter labours
  • Birthing in the environment that feels safest to you: home or hospital, it doesn't matter. It's about where you feel safe. When you feel safe, you will labour better
  • Feeling ready for birth and motherhood

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

Homebirth transfer rates: cause for concern?

What is a woman really asking when she asks her midwife what the midwife's transfer rate is? Women often interview several private midwives when they are choosing the right midwife for their needs. Women will ask many questions of their prospective midwife, and one of the more common questions is, "What is your transfer rate?" meaning, "what percentage of the women who book with you for homebirth, end up transferring to hospital?"

On the surface, this seems like a fair question. But what is the woman really asking? I consider that the woman is really asking, "If I book with you, what's my chance of being transferred?" and when women ask the same question of several midwives, they are most reassured by the midwife with the lowest transfer rate because they perceive that they have the lowest chance of transferring if they go with the midwife with the lowest transfer rate.

Is it a fair assumption to make, that the midwife's transfer rate, representing her previous client's outcomes, are a valid guage for the current woman's likelihood of transfer? Often I find that transfers can't be predicted at the time a woman books-in for care. If we could predict it, we'd recommend a planned hospital birth. Considering transfer rates from this perspective, a midwife's transfer rate has no bearing on the current woman sitting with her. As well as this, some transfers occur because the woman has requested it - eg a request for transfer for an epidural, but not on the advice of the midwife as the labour is actually progressing very normally. The other situation that can arise is that the midwife forsees problems occurring and makes some recommendations to avert those problems, but the woman considers the recommendations and declines to follow them. In these cases, again, the midwife's transfer rate has no bearing on each new client who interviews a midwife.

What's a "good" homebirth transfer rate?

Well, many might argue that the lowest transfer rate is the best transfer rate. You're setting out for a homebirth, right? So why go to the midwife with a "high" transfer rate?

I did some scouting around on the internet and found that transfer rates range from 10% through to 50%. The Netherlands has a transfer rate of 52%! This surprised me. In the Netherlands, 86% women start in "primary" care (midwifery care), 28% are transferred in pregnancy and 17% are transferred in labour, leaving 41% women birthing with midwifery care. Of this 41%, 30% occurred at home and 11% occurred in hospital.

The St George hospital homebirth program reported a transfer rate of 37% for its first 100 births and this was in a low-risk clientele (at the start of pregnancy). Their outcomes were excellent, however and the satisfaction of the women and midwives using / working in the service was very high.

Private midwives' transfer rates vary - anywhere from 10% to 40% in some States of Australia as well as overseas. So there's a wide fluctuation. What can we deduce from these transfer rates?

Well, with the exception of the Netherlands - which has large numbers - we can't really deduce very much at all. You never can when you're dealing with small numbers. Private midwives in Australia typically don't attend more than 25-30 births a year, and some as few as 5 births a year. One transfer in 5 births is 20%, whereas if that same midwife had attended more births without complication, perhaps the transfer rate would have only been 10%.

There are a couple of things to consider with high and low transfer rates: 1. The risk status of the women at booking 2. The midwife's adherence to safety and risk management guidelines and her outcomes.

The midwife with the lowest transfer rate might simply have a low transfer rate because she only attends very low risk women: women who have birthed without complication before, who have no health history and who have no problems in their current pregnancy.

The midwife with the high transfer rate might not be transferring willy-nilly, she might just be taking on a higher risk group of women and adopting a wait and see approach - eg, "yes, you have a family history of high blood pressure and you've had it with every pregnancy thus far, but let's try some preventative measures and see what happens this time", and continue with homebirth plans. If this woman's blood pressure went up, she would have been transferred, contributing to the midwife's "high" transfer rate. The low risk / low transfer rate midwife might not have accepted this woman for homebirth at all, hence the difference in transfer rates.

The other thing to consider with transfer rates is the midwife's commitment to safety and risk management. Some midwives may have low transfer rates because the decision to transfer is prolonged, or because risk factors are denied. Is it good to have a low transfer rate if women or babies have been compromised?

But getting back to the question, "If I book with you, what's my chance of being transferred?", this question is impossible to answer. 1. We can't tell the future. Family history and health history might shine some light on possible issues for the pregnancy, but not necessarily. We can't predict all the paths a pregnancy can follow. 2. A woman's determination to move towards - and remain in - a state of health and wellness is a life-long journey that pre-dates the pregnancy. 3. Although midwives will make recommendations with the aim of homebirth in mind, it is the woman's right to consider the advice and decline it. Declining a midwife's advice may well mean that a transfer will become necessary. 4. Midwives' statistics are only relevant to her past clients, not the client sitting with her currently. 5. For many midwives, the goal is really safety: safety for woman and baby. We strive to achieve the safest birth in the setting that can best meet the needs of our client.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

5 myths about homebirth

1. Home birth is unsafe

Numerous studies have shown that a home birth is at least as safe as hospital birth for healthy, low-risk women, who are attended by midwives, with back-up plans in place.

2. Home birth is messy.

Many homebirths occur in water, and the birth pool is simply drained after the birth and everything stays very clean!  However, if you are birthing out of the water, your midwife will provide you with a list of homebirth supplies that you will need, and this will include such things as towels, sheets and plastic to protect floors, lounges, beds, carpet and so on. Garbage bags are always available and midwives always leave the house as they found it after the birth.

3. What if something goes wrong? "I / my baby would have died if we had had a home birth!!!"

How many times do we hear hear this?  Provided the homebirth is "low risk"and there is a midwife in attendance, the chance of things going very wrong is very very small.  The important issue is to ensure that good care has been provided in pregnancy, that there are back-up plans in place and that the woman and her baby are healthy at the start of labour.  In this group of women, homebirth is at least as safe as hospital birth, for both mother and baby.

If things take a different path in the labour, the midwife is often able to manage issues with simple measures. If more complicated measures are needed, the midwife will take the woman into hospital.  Most studies show that this happens in less than 15% of home births.

Typically, midwives bring a range of safety equipment and supplies to a birth. These include: - Oxygen - Suction equipment - Suture material and local anaesthetic for tears - Medication to stop any excess bleeding after the baby is born - Vitamin K for the baby - A doppler to monitor the baby's heart beat - Blood pressure equipment - Urinalysis sticks - Scales to weigh the baby - Resuscitation equipment for the baby - An oxygen mask for the mother - A catheter in case the mother is unable to pass urine - General equipment such as gloves, a mirror, needles and syringes, sterile water and normal saline, gauze, cotton wool, tape, cord clamps (unless the family prefer to use a cord tie) and so on. It's quite a big kit when it's all put together!

4. Only hippies have home births.

This couldn't be further from the truth! The general profile of a homebirthing family goes something like this:

- tertiary educated - in their 30s - already has one child or has been researching birth for many years - works in professional or managerial industries And many are from a health background.

5. It's expensive to have a homebirth.

Costs range from $3000 to $6000 which is very little when you consider what it covers, and the fact that it is spread over about 9 months of care.  After Medicare benefits have been claimed, the out-of-pocket cost is much lower than this. 

Care includes things such as:

  • antenatal (pregnancy) care
  • postnatal care for 6 weeks
  • labour and birth care at home or in hospital
  • your own midwife being on-call 24/7 from the time you book in until 6 weeks after your baby is born
  • access to a library of books and DVDs

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.