Posted by Melissa Maimann on Sep 3, 2010 in
Birth,
Midwifery,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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I was irritated to read this on the NASOG website. NASOG is the National Association of Specialist Obstetricians and Gynaecologists. My irritation lies in the fact that the obstetricians are concerned that with changes to the medicare safety net, the cost of private obstetric care will force it out of the price range of most families and that it will therefore cease to be a viable option (ie, fewer women will be able to access private obstetric care), yet the maternity reforms will have the same impact on midwifery care whereby access to midwifery care will be at the discretion of an obstetrician and fewer women will have access to private midwifery care. Many double standards exist in the article:
Australian women being denied the choice of a doctor during birth
The current changes to private midwifery practice, requiring the midwife to have a signed collaborative agreement with an obstetrician (without the requirement of the obstetrician to sign such an agreement) will result in Australian women being denied the choice of a midwife during birth.
We believe every Australian woman should be entitled to choose a specialist obstetrician or GP.
Likewise, every Australian woman should be entitled to choose a midwife. Around the world, midwives provide affordable, safe and effective care to women and families.
What choices do Australian women currently have?
A woman can:
choose a private obstetrician or GP to deliver her baby in either a private or public hospital;
attend the public health system and be assigned to a midwives or doctors clinic, however, women cannot choose the doctor present at the birth, or
share care between a general practitioner and a public hospital antenatal clinic, however women cannot choose the doctor present at the birth.
Nowhere is the option of private midwifery care mentioned. The author of this article also fails to disclose that midwives attend the majority of births in the public system, not doctors. Within the public system, while women cannot choose the doctor who *might* be present at the birth, in some cases they will know the midwife who will attend them. Private midwifery practice, which delivers virtually 100% continuity of care – the midwife you book with is almost 100% likely to attend the birth – is not even mentioned in this part of the article. If continuity was the concern of the author, surely the model that delivers the greatest continuity would have been mentioned?
The article goes on to say:
In fact doctors are not always present at births in the public hospital.
Shock Horror!! Births happen without a doctor’s presence! Of course, we’re not in there performing caesareans: obstetricians perform these operations. But hey, only about 15% women should need a caesarean; this rate is lower with private midwifery care. So for the vast majority, midwifery care is provided for the entire labour and birth. And the sky doesn’t fall in.
The bottom line is you cannot choose care by an obstetrician in Australia, unless you can afford it. This is hardly supporting a fair choice for women.
Likewise, women cannot choose private midwifery care unless they can afford it AND unless the obstetrician has agreed. And this is hardly supporting a fair choice for women.
How much does private obstetric care now cost? The average out of pocket expense for women to have the care of an obstetrician is around $2,000. Private health insurance does NOT cover this amount. The Medicare safety net used to cover up to 80%, until the current Government placed significant caps on the amounts paid to women for Obstetric care in 2009.
How much does private midwifery care now cost? The average out of pocket expense for women to have the care of a private midwife is around $2,500 – $6,000 (depending on many factors). Private health insurance might cover some of this cost.
Collaboration is the buzz word of the day and it seems that the same issues affecting private midwives are also affecting private obstetricians. What if we lobbied the Government together to make private maternity care more affordable for more women? What if, together, private obstetricians and private midwives were able to attend every woman who was privately insured in a private hospital, private birth centre or private homebirth system? Maybe the pressure on the public health system would abate and women would have safer and more satisfying birth experiences with continuity of care.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Sep 2, 2010 in
Birth Click here for details of these exciting workshops for pregnant women.
Tags: birth
Posted by Melissa Maimann on Sep 1, 2010 in
Birth,
Caesarean Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
… c-sections now account for one third of all births, and … a big reason for this increase is the over-use of labor induction.
•Almost half of women wanting vaginal births were induced.
•Women who were induced were twice as likely to have a cesarean birth as moms whose labor starts spontaneously.
•Of the c-sections done after induction, half were performed before the cervix had dilated to six centimeters, “suggesting that clinical impatience may play a role.”
•A third of first time mothers had c-sections.
•C-sections upon maternal request (those done for non-medical reasons) account for only 9% of c-sections.
•Attempts at VBAC are less likely to result in vaginal birth than previously thought. Few women are offered the option of VBAC.
… what can you do about all this if you are pregnant and want a vaginal birth? Here are a few ideas:
- Talk to your care provider … about his or her rates of induction, c-section and episiotomy …
- Educate yourself about labor induction …
- Stay home in early labor …
- Choose a midwife if you’re opting for a natural birth
- See an experienced independent childbirth educator for childbirth education classes
- Ask questions
- Read, read, read
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Caesarean, Complicated pregnancy or birth, hospital birth, intervention, Public and private hospitals
Posted by Melissa Maimann on Aug 31, 2010 in
Caesarean Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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Medical experts point to a disturbing trend of expectant mothers who are choosing to deliver their babies for non-medical reasons before 39 weeks of pregnancy. Research published in the July 2010 issue of Obstetrics & Gynecology reveals just how prevalent elective deliveries are in the U.S. In that study of 7,804 women giving birth for the first time, labor was induced in 43.6 percent of the women, and 39.9 percent of those were elective inductions.
A startling number of first-time mothers – 92 percent — believe it’s safe to deliver a baby before 39 weeks, according to a recent UnitedHealthcare survey of 650 insured, first-time mothers …
… “Unfortunately, many expectant mothers are not aware of the risks associated with early elective C-sections and induced labor. Expectant mothers may believe that at 36 weeks they have completed their nine months of pregnancy, but Mother Nature’s formula for healthy babies is actually 40 weeks,” Dr. Groat says.
… babies born electively by C-section at 37 weeks were twice as likely to have health problems, usually respiratory in nature, than babies born at 39 weeks or later. Infants delivered preterm are at an increased risk of developing chronic lung disease, cerebral palsy, learning disabilities and behavioral problems.
“The results of recent studies stress the importance of educating expectant mothers on the risks associated with elective deliveries prior to 39 weeks. These early-term births can result in the newborn’s admission to the Neonatal Intensive Care Unit, which increases the baby’s hospital stay and health risks,” …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Caesarean
Posted by Melissa Maimann on Aug 30, 2010 in
Caesarean Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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A test which could stop women labouring for hours in the hope of a “normal” birth only to end up with a Caesarean section has been developed in Sweden.
Researchers have established that when high levels of lactic acid are measured in the amniotic fluid, it is unlikely the mother will deliver vaginally.
Measuring this acid could help decide whether to end a difficult labour and opt for a Caesarean earlier.
The test is being rolled out in a number of European hospitals.
Prolonged labours which end up in a Caesarean section are seen by many as the worst of all worlds.
In the UK, despite the mantra “too posh to push” more than half of Caesareans are emergency rather than elective procedures, in which the mother frequently undergoes a long and painful labour before an urgent operation is deemed necessary to protect the health of both her and her baby.
… the uterus produces lactic acid as other muscles do when they work hard, but that when it reaches a certain level the substance starts to inhibit contractions.
… The hormone oxytocin is usually administered in cases of slow labours to stimulate the uterus into contracting, but not all labouring women respond to it.
… the test should help doctors establish which women may go on to deliver vaginally, as low levels of lactic acid suggest the uterus could still produce the contractions needed to push out the baby.
“But a high level of lactic acid in the amniotic fluid indicates that the uterus is exhausted. To stimulate this kind of labour with an oxytocin infusion would be like asking a marathon runner to run an extra 10,000 metres after he or she has passed the finish line.”
He says the system of testing, which has already started in hospitals in Sweden, Norway and Belgium, should reduce the number of Caesareans for women who may not need them and accelerate them for those that do to “avoid the risk of complications from a long birth and limit unnecessary suffering” …
What is not considered here is the option to rest a tired woman – and then let nature re-commence the labour when the mother and baby are well-rested. There is no questioning of the idea that once labour commences, it must accelerate and lead to the birth of the baby and placenta within a certain time frame. For many reasons, some women will pause in their labours. It might be that they’re tired, hungry, bub isn’t in an optimal position, or a uterus that has worked hard and needs a rest. Resting, re-fuelling and waiting for nature to take its course – provided all is well with the baby – is a reasonable approach to a labour that is progressing slowly. I doubt that this test will reduce caesarean rates; rather I fear it will increase the caesarean rates.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Caesarean, Complicated pregnancy or birth, hospital birth, Public and private hospitals
Posted by Melissa Maimann on Aug 29, 2010 in
Birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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AN Australian mum has made headlines worldwide after cuddling her tiny baby back to life.
The grieving mother had given up hope of saving newborn Jamie, after doctors pronounced the tiny boy dead.
While Jamie’s twin sister, Emily, was delivered safely, doctors worked for about 20 minutes to get premature Jamie to breathe before declaring that he couldn’t be saved.
… “I unwrapped Jamie from his blanket. He was very limp. I took my gown off and arranged him on my chest with his head over my arm and just held him. He wasn’t moving at all and we just started talking to him.”
Ms Oggs said she and her husband, David, had given up saving Jamie, who was born at 27 weeks and weighed less than 1kg.
… after about two hours of being hugged, touched and spoken to, little Jamie miraculously showed signs of life.
“Jamie occasionally gasped for air, which doctors said was a reflex action,” Ms Oggs said.
“But then I felt him move as if he were startled, then he started gasping more and more regularly.
“I gave Jamie some breast milk on my finger, he took it and started regular breathing.”
… “A short time later he opened his eyes. It was a miracle,” Ms Oggs said.
“Then he held out his hand and grabbed my finger.
“He opened his eyes and moved his head from side to side. The doctor kept shaking his head, saying, ‘I don’t believe it’.”
The Sydney mum spoke publicly to highlight the importance of skin-on-skin care for sick babies.
The technique, known as kangaroo care, is often used in neo-natal wards and is thought to promote a more stable temperature, better breathing and weight gain …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Complicated pregnancy or birth, hospital birth, Public and private hospitals
Posted by Melissa Maimann on Aug 28, 2010 in
Home birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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I live for the day that we have these headlines here in Australia!
The number of women who give birth to their children at home in Wales has more than doubled in less than a decade …
Since 2002 … they have risen from 604 to approximately 1,395 last year.
There has also been a rise in women giving birth in midwife-led units.
… the assembly government has encouraged healthy women with low-risk pregnancies to have their babies out of hospitals.
In 2002, maternity services in Wales were asked to reach a 10% home birth rate by 2007, making it the only nation in the UK to have a target.
Midwives say that while it was a very ambitious aim and many areas have not managed to reach it, it has helped transform the choice in maternity services.
On average, 4% of births in Wales last year were at home, which is higher than the UK average of 3%.
Laura Williams gave birth to her daughter Megan at home in Porthcawl, Bridgend county, on 5 November, 2009.
… “I wanted to be in a more comfortable environment – I liked the fact that with a home birth I could use my own shower and sit on my own sofa.
“As it was, I had a fantastic birth at home. I borrowed a friend’s pool and was really relaxed. The midwife even cleared everything up afterwards – I saw no mess.
… “I also think the fact I was at home and relaxed helped my recovery from the birth – the next day I was up and about and even popped to the shops.”
… “Midwives are continuing to work towards it because many see the benefits home births bring.
“They are cost effective in that women don’t need to stay in hospitals.
“And for the mother, there is less risk of medical intervention, the birth is well planned, she is in a relaxed environment and often doesn’t have to leave other children.”
… Rather than staffing a large obstetric unit at a hospital, which midwives have to do in more populated areas, they can “focus on staffing women’s needs”, she said.
… The issue of home births has been in the headlines recently after medical journal The Lancet said mothers-to-be should not be able to opt for them if they put their babies at risk. Under UK law women can override medical advice.
It came after research published in the American Journal of Obstetrics and Gynaecology suggested home births were more risky than hospital delivery.
But the Royal College of Midwives said the research was “flawed”, and the assembly government insisted that only women with low-risk pregnancies were encouraged to have their children at home.
The chief nursing officer for Wales, Rosemary Kennedy, said: “It is for midwives and other health professionals to explain to pregnant women the birthing options available to them, and decide on the most appropriate option after considering their medical history and preferences.”…
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, Home birth, midwife, Midwifery, Midwifery services, women's rights
Posted by Melissa Maimann on Aug 27, 2010 in
Caesarean The “Emergency” Caesarean. Watch it until the end. It’s priceless!
Posted by Melissa Maimann on Aug 26, 2010 in
Birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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The hormone oxytocin has come under intensive study in light of emerging evidence that its release contributes to the social bonding that occurs between lovers, friends, and colleagues. Oxytocin also plays an important role in birth and maternal behavior, but until now, research had never addressed the involvement of oxytocin in the transition to fatherhood.
A fascinating new paper reports the first longitudinal data on oxytocin levels during the initiation of parenting in humans. They evaluated 160 first-time parents (80 couples) twice after the birth of their first child, at 6 weeks and 6 months, by measuring each parents’ oxytocin levels and monitoring and coding their parenting behavior.
… At both time-points, fathers’ oxytocin levels were not different from levels observed in mothers. Thus, although oxytocin release is stimulated by birth and lactation in mothers, it appears that other aspects of parenthood serve to stimulate oxytocin release in fathers.
… this finding “emphasizes the importance of providing opportunities for father-infant interactions immediately after childbirth in order to trigger the neuro-hormonal system that underlies bond formation in humans.”
The neuroscientists also found a relationship between oxytocin levels in husbands and wives. Since oxytocin levels are highly stable within individuals, this finding suggests that some mechanisms, perhaps social or hormonal factors, regulate oxytocin levels in an interactive way within couples.
Finally, the findings revealed that oxytocin levels were associated with parent-specific styles of interaction. Oxytocin was higher in mothers who provided more affectionate parenting, such as more gazing at the infant, expression of positive affect, and affectionate touch. In fathers, oxytocin was increased with more stimulatory contact, encouragement of exploration, and direction of infant attention to objects …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: birth
Posted by Melissa Maimann on Aug 25, 2010 in
Caesarean Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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In order to minimize the risk of infection in mothers, women giving birth to babies by caesarean section should routinely receive antibiotics an hour before the surgery, according to a new recommendation issued Monday by a national doctor group.
Currently, women who undergo caesareans often receive antibiotics as a precaution against infection to the abdomen and uterus—but usually only after the delivery, when the umbilical cord is clamped, because of concern for the baby’s safety.
Some pediatricians worry that antibiotics administered to the mother will reach the newborn and suppress the baby’s blood bacterial count, potentially masking a serious infection in the baby unrelated to the caesarean section.
The American Congress of Obstetricians and Gynecologists examined several large, recent studies that administered antibiotics to mothers before and after caesarean deliveries. The group concluded there was no evidence of greater risk to the babies when mothers received antibiotics before surgery. Yet there was an increased benefit for the mothers in receiving the antibiotics before surgery.
… Some 8% to 10% of women who have a scheduled caesarean will acquire an infection, as will about 30% of women who have a caesarean delivery after labor has begun, because of greater exposure of the inside of the uterus to bacteria from the vagina …
In newborns, the prevalence rates for sepsis … is estimated at less than 1% of live births.
While the maternal antibiotic appears to neither help nor hinder a newborn’s chances of getting sepsis, doctors have worried that in babies who have the bacterial infection, antibiotics administered to the mother before the c-section will suppress bacteria in the babies’ blood test, resulting in a failure to detect the sepsis infection.
Some doctors, however, question whether the existing research adequately addresses the question of harm to the baby.
Concerns about masking babies’ infections are largely theoretical … While the antibiotic does cross over from the mother to the baby through the placenta, and while it could mask the blood culture, there are usually other clinical signs that a baby is sick …
But while such a change in practice could make caesarean deliveries safer, it “comes nowhere close to eliminating all the risks of a c-section,” … vaginal delivery is still the safest for mom and baby.”
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Caesarean
