Thrush in pregnancy

Thrush is a very irritating fungal infection that affects the vulva and vagina.  It is very common in pregnancy due to the hormonal changes of pregnancy, and occurs in many pregnant women.  While there are a few things that women can do to minimise or prevent it, once a woman has it, it can be difficult to treat without medication.

Some suggestions for preventing thrush include:

  • Wearing cotton, breatheable underwear
  • Minimising your intake of sugar and sweet foods, including limiting fruit to two pieces per day
  • Avoiding soap and washing with water
  • Avoiding wearing tight jeans
  • Wiping from front to back after using the toilet
  • Eating natural yoghurt

If thrush is a concern, treatment is available over-the-counter from the chemist.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Nausea in pregnancy

Morning sickness (all day sickness ...) is one of the most common symptoms in pregnancy.  It usually begins at around week 6 and resolves by about week 12-14, however for a few women, it remains for the whole pregnancy (and improves after the baby is born, thankfully!)

There is a lot that women can do to relieve morning sickness, and if all else fails, there are some effective and safe medications that can be prescribed by your midwife or doctor.

Some women experience nausea only, while others experience vomiting, too.  Sometimes this is only once or twice a day, however other women have a complication called hyperemesis gravidarum, which is a more severe form of vomiting that often requires hospitalisation for fluids and medications to treat the vomiting and prevent dehydration and electrolyte imbalances.

Nausea in pregnancy is actually a really positive sign, as it indicates high levels of pregnancy hormones that help to sustain and develop a healthy pregnancy.  That said, if you are fortunate to experience no morning sickness, please don't take that to be a bad sign: you probably have other pregnancy symptoms such as bloating, breast and nipple tenderness and tiredness.

Managing morning sickness day-to-day

Morning sickness can be difficult to cope with day-to-day, but there are many things that you can do to make things easier.  Most commonly, extra rest and more frequent, carbohydrate-rich snacks will be very helpful in keeping nausea and vomiting at bay.

Spicy, hot foods will make morning sickness worse, as will large, heavy meals.  Many women cannot eat protein-based foods without an increase in morning sickness, and instead prefer carbohydrate-based foods.  Go with what your body needs.

Vitamin B6 and ginger supplements can also be helpful, as can peppermint tea, homeopathic remedies, acupressure, reflexology and acupuncture.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Carpal tunnel in pregnancy

Carpal tunnel syndrome is a tingly, numb and painful sensation in the wrists and hands that develops usually in the third trimester (28+ weeks).  It is common in pregnancy and occurs when there is swelling around the nerves in the wrist.  Usually, women who have carpal tunnel syndrome will have swelling in their lower legs and feet as well.

Carpal tunnel gets better within 6-12 weeks after the birth of the baby, along with other body swelling. 

If you have carpal tunnel, you may find it difficult to grip things and do anything which requires fine movements of your hands and fingers.  You may find that you drop things easily and that you have lost the strength in your hands and wrists.

I usually recommend that women with carpal tunnel see a chiropractor or osteopath as there is sometimes an underlying skeletal issue that makes the carpal tunnel worsen, and relief can be almost instantaneous with chiropractic or osteopathic care.

There are also exercises that women can do to relieve the sensations.  These include squeezing a small ball, massage of the hands and wrists, and making circular movements of the hands.  These exercises encourage fluid to move away from the hands and wrists. Stretching exercises can also be helpful.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

 

About due dates

Due dates can be calculated using the last normal menstrual period or through ultrasound.  If the last normal menstrual period is being used to calculate the due date, there are a few conditions that must be met for this to be considered an accurate input to the due date:

  1. The last period needs to have been a normal period
  2. The women must have had three normal cycles since ceasing breastfeeding or the oral contraceptive Pill
  3. The last three cycles must have been regular

If these conditions are not met, the date cannot be calculated using the last normal menstrual period, and so the due date would then be based on an early pregnancy scan.

When should an early pregnancy scan be attended?

The earlier the scan, the more accurate the estimate of the due date.  I usually refer women for dating scans at 7 weeks of pregnancy, however they can be performed any time between 7 and 12 weeks for the purposes of dating.  The earlier in pregnancy,  the more accurate the date.  There is very little to be gained from doing a scan prior to seven weeks as there is less chance of the baby having a heart beat, and so a good chance that the scan will need to be repeated.

An early pregnancy scan can be reassuring and exciting for parents.  Studies suggest that when the due date is taken from a good-quality, early pregnancy scan, there are fewer inductions for women going overdue.  In other words, due dates that are derived from dating scans tend to push back the due date when compared with pregnancies that are dating from the last menstrual period.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Your skin during pregnancy

There are many changes that can occur in a woman's skin during pregnancy.  These can include stretch marks, pigmentation of the skin, a brown line on the abdomen and sensitive skin.  We think this is related to the hormonal changes that occur during pregnancy, and hence, most of the changes that occur during pregnancy disappear after the baby is born.

Some skin changes, such as stretch marks and pigmentation, are thought to run in families.  While there are numerous good products on the market for stretch marks, there is a good chance that you will develop stretch marks - despite using these products - if your Mum or sisters had them. 

Nutrition, exercise and good health prior to pregnancy are thought to increase elasticity of the skin during pregnancy and reduce stretch marks.

Chloasma

Chloasma is dark, patchiness of the skin.  It is caused extra melanin in the skin during pregnancy.  Sunblock is recommended to protect your skin.  Chloasma usually resolves 6 weeks - 3 months after the birth of the baby. 

Linea Nigra

Linea nigra is a verical line that appears down the centre of your abdomen, crossing your belly button.  It is a darkened area that occurs due to the hormonal changes in pregnancy, and again, it resolves after the birth of the baby. 

Stretch marks

Stretch marks can appear during pregnancy at any stage, but usually they develop in the third trimester.  The third trimester (28-40 weeks and beyond) is usually the period of time where there is rapid and large weight gain, and so the skin sometimes doesn't have sufficient time to stretch without causing stretch marks.  Normal weight gain in pregnancy is 10 - 14 kg, and the bulk of this weight gain occurs in the third trimester, so you can appreciate that this causes the skin to stretch rapidly.

There is very little that can be done to prevent stretch marks, as they are largely a function of genetics and weight gain in pregnancy.

Women who lead a healthy, active life leading up to pregnancy (ie, good nutrition, exercise and healthy weight) generally have fewer stretch marks.  Limiting weight gain in pregnancy to no more than 10-14kg can also minimise stretch marks.

Good nutrition and sensible exercise during pregnancy, as well as a high-quality stretch mark cream can help to minimise stretch marks.

Sensitive skin

Many women experience sensitive skin during pregnancy, and this can be made worse by using soap.  Some women find that pre-existing skin conditions worsen during pregnancy, while other women experience an improvement in skin conditions in pregnancy.  To minimise sensitive skin, find a soap that does not cause sensitivity and use  good-quality moisturiser after every bath or shower and after washing your hands.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Prenatal Testing

Many women are now choosing the 10-week blood test rather than the 12-week nuchal translucency scan. The 10-week blood test is a new blood test that is a more accurate screening test for chromosomal abnormalities than the NT scan. It is so new that the blood is actually processed overseas …. in the US! The test does not carry a Medicare benefit, so parents are out-of-pocket for the full cost of the test, which is around $500-$600. The results are 99% accurate.

The new blood test reduces the need for amniocentesis / CVS which carry a small risk of miscarriage. The test may be used in place of the NT scan or to confirm a high-risk NT result (without needing an amnio). Additionally, it can be performed from 10 weeks. If the blood test comes back positive, the woman would still be advised to have an amnio as the blood result is not 100% (it is 99%+), but the blood test does reduce the number of amnios needing to be performed. Many women coming through this practice are now opting for this test. 

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Fish in pregnancy

Fish is a really healthy food to eat. It is rich in protein, healthy fat and minerals. It contains the sort of fat that can help to lower bad cholesterol, and increase good cholesterol.

It also contains omega-3 fatty acids which are important for the development of the baby's central nervous system.  Some women have commented that they don't like fish, and have asked if a fish oil supplement is a reasonable alternative.  I think that if it's a supplement or nothing, then a supplement is good, but there's no substitute for the real thing, so where possible, eat fish and avoid the supplements.

Although fish is a great food source, you need to be careful about which fish you choose. Bigger fish, such as shark, eat smaller fish.  They also live longer than smaller fish.  Therefore, over their lifetime, they accumulate more mercury than what a smaller fish would accumulate, and this can be harmful for the developing baby when we eat bigger fish.

Small amounts of salmon or sardines every day is very beneficial to your developing baby.  It does not need to be a large serve; the important thing is to have a steady stream of nutrients and fatty acids to your baby.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Independent childbirth education classes: a midwife's perspective

Women who book with me for care will know that I am a firm advocate of independent childbirth education classes.  Why do I feel that these classes are so important?  It’s not that I believe that women need to be taught how to give birth, because I know that women's bodies are designed to birth babies, and for the most part, women birth their babies without any help from anyone else.  Yet I still believe these classes are important ... vital, even. This is because all pregnancies and births involve choice.

And to exercise our choices responsibly, we need to have knowledge.

It is that simple.

If we do not know what choices we have, we do not have any.

If we are aware of our choices but lack any information about the implications of each path, we may not make responsible choices that lead us to a healthy birth and baby.

We have choices around care providers, place of birth, testing in pregnancy, interventions in birth, type of birth, methods of feeding a baby, postnatal care issues and early parenting choices.

Labour and birth and early parenting are not the times to be learning new information for the very first time: these are times in our lives when we are not in a state to take in new information and assimilate it.  This learning is best done in pregnancy, so that the time we get to labour, birth and baby, we are already aware of our options and our preferred choice.

Independent childbirth education classes cover more than basic hospital classes, in my opinion.  They will teach you everything from late in pregnancy to labour, birth and caring for your new baby.  They will provide all of the content of hospital-based classes and much more: more time, more resources and more attention.

The couples I have worked with over the years have been delighted with the classes they have attended, coming away feeling relaxed and calm, confident and knowledgeable.  They have helped enormously with birth planning and preparing for birth and baby, and with choices and decision-making.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Top tips for a healthy pregnancy

Folate Folate is a B vitamin that is found in food.  Folate helps to produce and maintain new cells - especially important during early pregnancy when the baby is developing.  Folate is found in green, leafy vegetables, citrus fruit, beans and peas.  As well as dietary sources of folate, it is recommended that women take an additional supplement of folate in the form of folic acid.  500 mcg daily is recommended for women from 3 months prior to pregnancy, until three months into the pregnancy.

Alcohol and smoking

Both are best avoided in pregnancy,  Alcohol crosses the placenta and directly affects the baby.  Alcohol can cause miscarriage, premature birth, stillbirth, a small baby and fetal alcohol syndrome.  Smoking reduces the amount of oxygen that is available to your baby, and can cause low birth weight.  As well as this, there are many chemicals present in cigarette smoke that can be harmful to a growing and developing baby.  Smoking can increase the chance of a miscarriage and preterm birth.

Sleep

Rest and sleep are really important in pregnancy.  Early pregnancy, especially, is often a time of tiredness and fatigue, and in general, the first trimester is easier when you are well-rested.  Some women will need an afternoon nap or sleep-ins on the weekend to get through the first trimester.  Likewise, the third trimester is also a time when some extra ZZZZZs are need.

Exercise

Exercise is great during pregnancy!  Any exercise that you have been doing consistently prior to pregnancy is safe during pregnancy, but it is a good idea to run this past your care provider.  Contact sports, high impact exercise and vigorous sports may need to be avoided.  The best exercises are walking and swimming, and some women also like to do pregnancy yoga and pregnancy pilates.  These are both very gentle.

Exercise has numerous benefits to you and to your baby:

  • Maintenance of a healthy weight
  • Reduction in the risk of gestational diabetes and high blood pressure
  • Promotes more restful sleep
  • Stress management
  • Improved sleep
  • More energy to get through your day
  • A shorter labour, perhaps with fewer interventions

Healthy diet

A healthy diet is the foundation of a healthy pregnancy.  A healthy diet can help to prevent gestational diabetes, high blood pressure and obesity.  Every mouthful of food helps to grow a healthy baby.  You want to give your body the best nutrients, frequently throughout the day (ie, several small meals throughout the day), to allow your baby to develop healthily.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Midwifery care after baby arrives

The focus of midwifery care is often thought to be about birth, however, after the birth, the focus rapidly shifts to the brand new baby who has joined the family.   I wanted to share some insights into postnatal midwifery care as an important (and perhaps under-valued) aspect of the care of a woman and her family.

DSC01662.JPG

Once a baby is born, new parents can be thrown into an enormous sense of responsibility, combined with a very steep learning curve. A midwife helps the mother and family make this transition to parenthood. A midwife is there to help with breastfeeding, teach practical baby care and also to provide the necessary checks of mum and baby to ensure that the normal recovery process is underway.

I provide my clients with extensive postnatal care because I know it can be a challenging time for a new family. I visit the new baby and mother at home every day for the first week. After that time, families can choose to see me in my rooms or I visit them in their home. There are two visits in the second week, and then week 3, 4 and finally discharge at week 6.

We do all sorts of things: I attend the baby's newborn screening test (Blood spot test), I check the mother and baby to ensure that they are both recovering, we talk about breastfeeding and ensure that the baby is feeding well, we monitor the baby's output to be sure that the baby is getting sufficient milk for his/her needs, I attend the Vitamin K drops for families who choose to give their babies Vitamin K drops, and we do lots of education about postnatal care, postnatal depression, what to expect with a new baby in the first few weeks, expressing milk, safe sleeping, adjusting to parenthood and so on.

Over time, I have increased the care that I provide to my clients and the feedback from my clients has been that the current visiting schedule has enabled them to feel confident, safe and secure with their new baby. Much of this stems from the extensive preparation that my clients do in their pregnancy, and that most have a drug-free, natural birth. This seems to help with the baby's adaptation to newborn life.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Home birth: how messy is it?

Homebirth generally isn’t messy at all.  Many women birth in a birth pool and any bodily fluids are easily contained.  Towels and plastic sheeting come in handy and are strategically placed to catch any mess.  And midwives are very good at leaving the house as it was found.  Plastic bags collect any garbage, the placenta is collected in a bowl or container, and sheets and towels can be washed.  All in all, a homebirth is nowhere near as messy as people think.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Birth positions

The best positions for birth are usually the positions that are the most comfortable for the woman at the time.  These are usually also the positions that will assist the baby into a good position to be born.  The positions you use will have an effect on your sense of control and how you experience your labour.  Generally, women who are able to move around as they need to, will experience labour more positively and as less painful, than women who are confined to the bed.

Women usually need to move through labour, and from a physiological perspective, this makes sense as the baby needs to make several movements through the mother's pelvis to be born.  So in this way, the mother's movements through labour and birth assist the baby to descend though the pelvis and be born.

There are many positions that women will naturally adopt in labour, such as:

  • Standing
  • Leaning over a bench or couch
  • All fours positions
  • Kneeling positions
  • Walking
  • Lying on your side

Because gravity helps the baby’s head to descend deeply into the pelvis, upright positions are generally better for aiding progress in labour while also reducing pain. This is because upright positions work with the body in labour, rather than against it.

Many women choose to birth in the water because the sensation of being in water combined with the lack of gravity makes them feel more mobile and able to position in the best way possible to help the baby move through the pelvis.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Early pregnancy: what you may feel

I am often asked by women what they might expect to experience in early pregnancy.  Here's a guide below.  The symptoms below are some of the more common symptoms that women experience.  It's always best that women contact their midwife or GP early in pregnancy to arrange for a pregnancy test and a dating scan if needed.  Eligible midwives are able to order all of the necessary tests and scans and no referral is needed.

Late period This is a common sign of pregnancy, and it is the one that it most often found first.

Morning sickness Some women experience this, while other women do not. Some experience it as a later sign of pregnancy.

Sore, tingly breasts This can also be one of the earlier signs of pregnancy and it can feel similar to premenstrual breast tenderness.

Tiredness Tiredness is a common pregnancy symptom in early pregnancy.

Changed tastes or strange tastes and off-putting smells Some women will have a strange taste in their mouth, like / dislike food that was previously disliked / liked, and may be put off by smells that were previously quite ok.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Successful VBAC

How to have a successful VBAC?  First and foremost, I think that we really need to work to minimise the number of women who ever need to have a VBAC by minimising the number of primary caesareans.  I think that preventing the first caesarean would be the best place to start. Evidence suggests that this is best done with continuity of carer: that is where a woman is cared for by one person throughout her pregnancy, birth and new parenting experience. Ideally, a woman will have her own midwife and obstetrician so that she has complete support and confidence.

Assuming the woman is well supported and goes on to have a caesarean, in my practice, women find it really helpful to discuss exactly what happened (as best as we know) and why as this helps women to make sense of their experience. It can be helpful to draw diagrams, use a model doll and pelvis to visually show the position of the baby in the woman's pelvis, review the notes that were taken through the labour and answer all of her questions. The other really vital thing is to let her know that she can absolutely plan a vaginal birth next time, provided that there are no "absolute contraindications", ie things like a placenta praevia which make a vaginal birth very unsafe for the mother and baby. These things are rare and for the most part, women who have had a caesarean with their first baby can very safely plan a VBAC with their next pregnancy.

Now to the next pregnancy ... a planned VBAC. It's important again that the woman has continuity of carer, and preferably this care will be from one midwife and one obstetrician. It will give the woman reassurance and confidence to know that her care will be from two people who know her and understand her wishes.

I have found that women who plan a VBAC need lots of time to talk and debrief their last experience. It's not uncommon for women to feel that their body is broken, that it doesn't work, that they are incapable of birthing their baby. They may feel a range of emotions: frustration, anger, disappointment, hurt, fear, powerlessness and perhaps distrust. Talking through these emotions goes a long way to paving a clear emotional path for a successful VBAC. I always recommend to my clients that they attend a Calmbirth (R) course and that they read, read and read. The more knowledge a woman has, the more confident she feels and the more relaxed she will feel going into labour - and all of this is really important for a successful VBAC.

In labour, active birth is emphasised - upright positions, movement and so on. We use a form of monitoring that means women can still labour in the bath or the shower. It doesn't interfere. Hydration and nutrition are important for maintaining fluid and energy levels. Waterbirth is a great option, but land births are great too. I find most women birth their babies in an all-fours or kneeling position and these positions are best for helping the baby move down through the pelvis. Spontaneous pushing is preferred, where the woman pushes according to her body's cues - and I find that this reduces the chance of tearing. The baby's entrance should be smooth and gentle and straight into its Mother's arms.

Following a successful VBAC, women often feel triumphant and amazing. In time, sometimes other emotions surface - things like anger (directed at self or others), guilt (perhaps feeling that the last baby didn't experience the calm birth that the current baby has experienced), regret (if only I had done xyz ...) and so on. Sometimes it's helpful to write these feelings down and talk so someone trusted - a friend or family member for example.

And as a final note, there is no such thing as a "failed" VBAC. VBAC is not about the destination, it is about the journey. It is about the courage and determination and the innate ability of a woman to make the very best choices that she can make at the time. Sometimes a caesarean is the best way for the baby to be born safely, and we honour the journey and the wise decision making.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Choosing your care provider

A woman’s choice of care provider for pregnancy and birth is one of the most important decisions she will make. This major decision is the major influence on her birth outcome: whether it will be caesarean, successful VBAC, epidural, natural birth and so on. 

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?
  • Are you after a care provider who will be known to you when you give birth?  If so, how well would you like to know that person?  Is it important that you have met them just once, or do you want them to have provided all of your care during your pregnancy?
  • How important is it to you that your wishes are respected during birth?
  • How much information would you like to receive during pregnancy?
  • 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?
  • 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

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.  Knowing where you would like to birth your baby can help you in choosing a care provider.

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)
  • They are female / they are male. Plenty of female obstetricians are more interventionist than male obstetricians.
  • Your GP recommended them (unless you are sure of the basis for that recommendation)
  • 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

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Pregnant? No private health insurance? Your options explained.

Many women believe they need to have private health insurance to be treated as a private patient.

For many, the terms "public" and "private" are discussed in relation to birth, and "public" tends to mean giving birth in a public hospital, while "private" means giving birth in a private hospital. 

However, being treated as a public / private patient really has very little to do with the location of the birth.

Public patient

Being a public patient means you do not pay for your care (we pay indirectly through our taxes), your care providers are employed by a hospital to provide your care, and you generally cannot choose where and with whom you give birth.

Private patient

Being a private patient is the opposite of this: it means that you pay for your care, your care provider is not employed by the hospital (they are in private practice); and you can choose who cares for you and where you give birth.

So where does private health insurance come into it?

Private health insurance is a way of funding your in-hospital care, ie, the birth.  It pays for the cost of accomodation in the hospital, pathology attended in hospital, and for your care provider's services.  It does not cover the cost of out-of-hospital services such as consultations with your care provider leading up to your birth and for postnatal consultations, although you can generally claim a part of the cost of your care provider through Medicare.

So do you need to have private health insurance to be a private patient?

The short answer is no.  Private health insurance does not cover the cost of any consultations during pregnancy, it does not cover the management / care plan fee of the midwife or obstetrician, and it does not cover the cost of the postnatal consultations.  All that a private health fund will cover is the cost of in-hospital care.

Provided that you are able to fund the cost of your in-hospital care, you can choose to give birth within the private system.

If you are choosing to birth in a public hospital as a private patient, the fees for in-hospital care are generally very affordable: you're only looking at paying a few hundred dollars extra, in most cases.  Of course, if you choose to give birth as a private patient in a private hospital without health insurance, this can be very costly, extending into the thousands of dollars.  But to be a private patient n a public hospital without health insurance is actually do-able for most families.

There are other options, too, with some women choosing to be private for their pregnancy care and postnatal care, while giving birth as a public patient under the care of hospital staff; this model of care is shared care.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

 

 

 

Collaborative Midwifery Care

For over three years, I have provided an exciting model of care, being collaborative care.  It was launched in the private sector for the first time in Australia in 2010.  Many families have now benefited from this collaborative model of private maternity care which enables women to have care with a private midwife (with Medicare funding) and also know the Obstetrician who will be available for the pregnancy, labour and birth if complications arise.   The service supports all kinds of births from home birth to water birth, natural birth in hospital, VBAC, twin and breech births and maternal-assisted caesareans. 

We’ve received really positive feedback

Women book with me early in their pregnancy.  This allows women to build a sense of connection, trust and continuity.  A special program of care, called The Essential Birth Program, ensures that women feel well-prepared, informed and confident at the end of pregnancy.  They feel empowered to make smart decisions in labour, they are not fearful of birth, and they almost always achieve what they wrote in their birth plan.

Birth care is provided initially at home and then we move to hospital where I provide full midwifery care. The birth is attended by me, with the obstetrician attending if needed.  We create an intimate, calm, peaceful experience and facilitate a gentle and safe birth.

After we have welcomed the baby and birthed the placenta, women generally stay in hospital for a few hours before returning home where daily home visits are provided by me for the first week.  Of course, if there are any issues, women are welcome to stay in hospital longer, but generally I find that women feel more comfortable in their own homes, in their own beds. I visit at home every day for a week and continue care for 6 weeks.

Private Health Insurance is not needed.

I’m really excited about this model of care because it meets the needs of women so perfectly:

  • Women having their first babies, maybe feeling unsure of what to expect
  • Women who previously experienced discontinuous and fragmented care from care providers who were unknown to them
  • Women who are planning a natural birth but perhaps with a more challenging pregnancy
  • Women who want a home birth / birth centre birth but with a known obstetrician available if needed
  • Women who really desire a sense of control over their birthing experience

This is a new way of working for both midwives and obstetricians and is a really supportive and nurturing way to practice. There is a huge potential for professional growth and learning. The most positive element, however, is the radiant smiles on the faces of the women who have birthed with us and the babies who have received a safe and gentle start to life.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Birthing with a Midwife

In Australia, all babies are born with the help of a midwife. This is true whether you're giving birth in hospital, birth centre, at home or in an operating theatre. The question is really - what are the benefits to having a midwife as your primary care provider? 

Midwives as primary care providers for women

Midwives generally have a firm belief in pregnancy and birth as natural processes that women can do.  In other words, they believe that a woman's body is perfectly designed for pregnancy and birth.  They look for what's right in the pregnancy and birth, while always being mindful of risks.  Midwives help to keep pregnancy and birth normal by focusing on the important preventative measures such as nutrition, lifestyle, health and well being.

Midwives use a holistic, or biopsychosocial model of care. What this means is that you're not just a pregnancy or a birth to a midwife.  Your midwife will be interested in your life, your family, your interests and so on, as well as your health and medical history.  She will take all of this information into account when making recommendations and giving advice.

Midwives are less likely to intervene with induction of labour, episiotomy, frequent perform vaginal examinations, breaking your waters and so on.  So your labour is able to progress naturally. 

Women are usually very satisfied with midwifery care. They feel supported, safe, empowered and confident. They feel they can trust their midwife and that their wishes are respected. Women feel more comfortable to write a birth plan and discuss their hopes and preferences for their pregnancy and labour when they see a midwife.

So, what does this mean for birth and babies?

Well, there are lots of positives! When you have a midwife as your primary care provider, you can expect:

  • choice of birth place (hospital, birth centre, or home)
  • a much lower chance of caesarean 
  • lower chance of episiotomy
  • less likely to be induced
  • less likely to need pain medication in labour
  • less likely to have your waters broken
  • you will be listened to and respected
  • your birth plan will be respected
  • you will be able to build trust with the midwife who will help you in birth
  • you will be less likely to have an assisted birth (eg forceps)
  • you will have a lower chance of postnatal depression
  • you will be less likely to have a traumatic birth
  • baby will be more likely to breastfeed successfully
  • you will most likely view your labour as being very positive

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Birthing at home

Homebirth provides a familiar and safe environment for birthing. This helps to keep stress hormones low, and positive birth hormones high, and can therefore make the birth easier and less painful.

Women choose a homebirth because they believe in their body’s ability to birth normally and naturally, wish to involve their partner and other children, or prefer to minimise the chance of intervention in their labour. And because let's face it: pregnancy and birth are normal, healthy and natural experiences. We don't go to hospital to experience other normal, healthy and natural bodily experiences such as food digestion, urination, menstruation, defecation .... we trust that our bodies work, and that these processes work too.  Provided that a woman's pregnancy is healthy and that labour starts at term with a healthy baby, home is a safe place to give birth and to be born.

Women choose homebirth for many reasons:

  • To experience fewer complications in labour
  • To reduce the chance of unnecessary interventions
  • To use less pain medication
  • To lower their chance of a caesarean from about 30% to around 5%
  • To remain in comfortable and familiar surroundings
  • To have a baby who has fewer problems after the birth
  • To increase their success with breastfeeding
  • To avoid time limits being imposed on labour and birth
  • To experience antenatal and postnatal visits with their own midwife of choice
  • To provide a gentle birth for their baby
  • To involve other siblings and family in the birth
  • To have choice and control in how they give birth
  • To minimise birth trauma
  • To receive care from the same chosen midwife from early pregnancy through to birth and six weeks postnatal
  • To benefit from having more choices available
  • To benefit from sound education and birth preparation
  • To have a great birth!

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.