MOST IRISH first-time mothers opt for the epidural … But reducing the pain levels doesn’t necessarily mean a more satisfying birth experience …

The HSE report involved a study of … women who had babies in the Midwifery-led Units (MLUs) … despite having fewer epidurals, 83 per cent of women in the midwife-led units expressed satisfaction with their pain relief, compared with 68 per cent of women in the consultant-led unit.

… midwife-led care was as safe as consultant-led care, resulted in less intervention, gave birthing mothers greater satisfaction and was more cost-effective.

… the epidural was very effective in complicated labours, for example where the birth was being induced or sped up.

However, in normal pregnancy … three forms of care reduced epidural use: one-to-one care in labour given by a midwife; access to water immersion, … and access to self- hypnosis or hypnobirthing.

“When those three forms of care are widely available for women, we see quite a low rate of epidural, even in first-time births. These forms of care are available in birth centres and in home birth situations … ”

… the downsides of epidural use … included an increase in forceps or vacuum delivery, a lengthening of labour and an increased need for oxytocic drugs to induce labour.

“Research on women’s satisfaction with labour has found that the one-on-one support they got from the midwife was a much more important part of the actual experience than the experience of pain. Paradoxically, a lot of women talk about a high level satisfaction along with a high level of pain.”

“The Government amendments to their Midwives legislation are unnecessary and give doctors too much control over midwives practice” … “… any requirement that midwives must work in formal collaborative arrangements with doctors as a condition of insurance will further restrict women’s choices”.

Diagnosed with spastic quadraplegic cerebral palsy, she has severely delayed mental development as well as learning difficulties and is now reliant on 24 hour care.

Her mother Carolyn had a caesarean section with her first child but doctors … did not tell her that there was a chance the womb would rupture during a normal delivery.

Lawyers for the Joyce family … claimed Alice would have been born healthy if delivered by caesarean …

… Her father … said: “Although it sounds like a large sum of money it is needed to fund Alice’s around the clock care and ensure she gets as much out of life as her disabilities allow.

… A court ruling today is expected to award Alice a lump sum payment of £2,250,000 plus annual payments until she is 16 of £95,000 pounds and £185,000 after that for the rest of her life.

The case was funded through legal aid, without which the family would not have been able to afford legal costs to prove negligence or the experts needed to prove her complex needs.

… Chief nurse and director of patient care standards Sarah Watson-Fisher said: “We would like to express our sincere apologies to Alice and her family for the errors in the care given at the time of her birth …

Midwives provide comprehensive prenatal care for mothers with low-risk pregnancies who plan to deliver at home or at a birth center … they give pregnant women a safe alternative to a hospital delivery, saving taxpayers a considerable amount of money.

In August 2007, officials at the state Department of Health hired a private consultant to weigh the costs and benefits of midwifery in Washington. The goal … was to compare out-of-hospital births with traditional in-hospital births and determine whether there was a benefit to continue the state’s midwife license and disciplinary program.

The consultants found that the cost savings of delivery with a midwife — for both public and private insurance — amounted to $2.7 million in a two-year budget cycle. That’s about 10 times the cost to operate the state’s midwife program. The independent analysis found that savings to the state’s Medicaid system alone amounted to almost a half-million dollars.

The report also looked at cesarean-section births billed to the state subsidized Medicaid program, and found that 12.9 percent of deliveries with a licensed midwife attending resulted in a C-section compared with 24 percent of in-hospital births without midwifery care. C-sections are expensive and sometimes medically crucial. But they also have become the most frequent surgery in the United States and, when performed unnecessarily, are an undue cost to taxpayers.

Looking at the study findings, there can be no doubt that having the midwife program in place saves tax dollars.

The consultants also looked at the latest national research on the safety aspects of home deliveries and found that planned home births for low-risk women using midwives had a lower rate of medical interventions and a similar mortality rate with low-risk women who delivered in a hospital.

… the consultants also found that the risk for cesarean section is lower for women under the care of a licensed midwife as compared with women who did not receive prenatal care from a midwife … women using a midwife were less likely to have an underweight newborn.

… the average cost for a home delivery for a midwife was $1,000. The cost for a vaginal delivery attended by a physician in a hospital averaged $3,171, increasing to $5,798 for a C-section.

It is a popular belief that pregnancy and motherhood affects a woman’s memory, causing them to become more forgetful and absentminded. But research … finds no evidence that pregnancy or motherhood affects women’s brain power.

… Four areas of cognition were assessed: cognitive speed, working memory, and immediate and delayed recall …

The researchers found no significant differences in cognitive change for those women who were pregnant during the assessments and those who were not …

Dr Maurice Lichter, an obstetrician with more than 30 years’ experience, told the Victorian Civil and Administrative Tribunal yesterday that he packed Piyanat Siriwan’s uterus with gauze about 90 minutes after she delivered a healthy baby girl … because she was bleeding heavily.

After the procedure … he left the … mother in the care of anaesthetist Dr Emlyn Williams … for more than an hour because he expected they would closely monitor her and report any further bleeding to him.

… when he returned to Mrs Siriwan … he was angry and appalled to find that she had deteriorated and no one had contacted him.

… Dr Lichter … decided that she needed an urgent hysterectomy and asked Dr Williams if he would help perform the procedure at the hospital.

”… (Dr Williams’) response was something like, ‘No this is the wrong place …we need to have an intensive care unit for her recovery,”’ …

Dr Lichter did not believe he could find another anaesthetist to assist, so transferred Mrs Siriwan … Dr Lichter took more than an hour to arrange the transfer and by the time Mrs Siriwan was in the ambulance … she had lost an estimated four litres of blood …

Doctors … performed an emergency hysterectomy about six hours after she gave birth, but Mrs Siriwan died a short time later.

Dr Williams told the tribunal that he did not refuse to perform the hysterectomy, but advised against it being done at South Eastern Private as it did not have the right resources, including an intensive care unit.

”If he (Dr Lichter) told me the patient would die if we didn’t do it, then I would have given her the anaesthetic,” he said.

Dr Lichter said that if a similar case presented in future, he would try to perform a hysterectomy sooner or transfer the patient to another hospital for the procedure faster …

The Medical Practitioners Board of Victoria has accused Dr Lichter of failing to manage Mrs Siriwan’s condition appropriately. It has alleged that he should have monitored Mrs Siriwan himself and that he did not give appropriate orders to others caring for her in his absence.

The board has also alleged that Dr Lichter should have performed a hysterectomy and that his decision to transfer her to another hospital was inappropriate.

… Such an arrangement is unprecedented internationally, and would restrict midwife access and fragment care, says Professor Barclay.

“This can effectively institute medical control over individual women’s access to Medicare funded midwifery care,” she writes

… midwifery is strongly evidence based … showing that outcomes for women receiving continuity of care from known midwives were better than for women who received fragmented care from multiple midwives and doctors.

… mothers should only have a C-section for medical reasons, according to the authors of the World Health Organisation study.

Women who chose a caesarean over a natural birth were 10 times more likely to be admitted to intensive care and suffer severe bleeding.

… “I do get women who ask for a C-section, often because they’ve got a pathological fear of childbirth, fears of pelvic floor problems in later life or have been sexually abused earlier in life, so they choose to have a C-section to avoid any genital tract trauma which would remind them of what’s happened.”

Dr Kliman said Epworth Freemasons had about 20 mother-requested caesareans out of 3500 deliveries a year.

“I tell them it is not necessarily an easy way out,” he said.

“They have risk of haemorrhage, infection and more discomfort after the procedure.”

Vice-president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Michael Permezel, said …”If a woman said, ‘I want a C-section’ and had no understanding of the risks, I think most doctors may decline the request,” Prof Permezel said.

The package, called “Getting it right at the very beginning”, has been shortlisted for the “Research into Practice” category of the 2010 Royal College of Midwife Awards.

… “Not only have we had very positive feedback from the women who received the care, but midwives have also seen the benefits.”

11 per cent gave birth without any pain relief and 21 per cent used paracetamol to take the edge off the pain … and more women used natural pain relief like a birthing pool or bath.

Of the group that received the care package, 73 per cent had a normal birth, without any clinical interventions. The Caesarean Section rate was 13.5 per cent.

This compared with a 37.5 per cent normal birth rate for the women who didn’t have the early targeted support, and a Caesarean Section rate of 37.5 per cent.

The care package is a set of six proven actions which work in harmony to benefit the outcome of the labour and give women a positive birth experience.
* L – Look and Listen;
* A – Assess maternal observations;
* T – Time;
* E – Encouragement;
* N – Non-pharmacological pain relief;
* T – Telephone

… controlled ovarian hyperstimulation (COH) drugs — used to stimulate a woman’s ovaries to speed the maturity and multiply the production of eggs — accounts for four times more live births than assisted reproductive technologies (ARTs) such as in vitro fertilization.

“Many people have focused on the role of ARTs in multiples and have not fully appreciated that fertility drugs alone are responsible for one out of every five multiple births,” … “COH drugs are widely prescribed, and some health care professionals … are not aware of the serious risks of fertility drugs to women and their babies. There is a very high possibility of multi-fetal pregnancy resulting from use of these drugs, and that brings a high risk of prematurity and lifelong health problems for the babies as a consequence.”