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.

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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.

Physiological (natural) third stage

The third stage of labour begins once the baby has been born, and ends with the birth of the placenta. Many women are now requesting a physiological (natural) birth of their placenta.  A safe physiological third stage requires oxytocin to be produced by the mother to stimulate the uterus to contract and expel the placenta.  Generally, this requires:

  • Natural birth: without medication to induce or augment (speed up) the labour, without an epidural, without forceps, vacuum or caesarean.  So, in other words, a labour that starts on its own, progresses on its own, where the mother does not use medical forms of pain relief, and where she breathes out or pushes out her baby unassisted by forceps or a vacuum (or caesarean).  This is because these natural processes prime the woman's body to release lots of oxytocin once the baby is born, to stimulate the uterus to contract to expel the placenta.
  • An environment that supports oxytocin release: this would be a private, dark, calm, warm, quiet environment.  Not the hustle and bustle of a busy delivery suite, but perhaps a water birth setting, home birth setting, or a birth centre setting.
  • No distractions: the mother and baby should be left (but observed by a midwife) for uninterrupted skin-to-skin contact, bonding time and breastfeeding if the baby is ready for this.
  • Leave the cord!  No-one should be fiddling with the cord, checking pulsations or pulling on the cord.  So long as the bleeding is not excessive, the woman should be left and observed.

In time, the placenta will emerge.  Often the woman feels more contractions and an urge to push.  If she is upright (eg squatting, sitting on the toilet, standing or kneeling) the placenta will come on its own, or perhaps with a gentle push.  It can be supported as it emerges and collected into a bowl, ice cream container (sans ice cream) or other receptacle.  The midwife would then check the placenta and membranes to ensure that they are complete.

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.

Do obstetricians and midwives attract different clientele?

New research has suggested that women who see themselves as active participants in the birth of their first child, and prefer a collaborative role with their healthcare provider are more likely to opt for a planned home birth with a midwife. On the other hand, women who perceive their role in the birthing process more passively and are more fearful of birth are more likely to seek obstetric care for a hospital birth.

Women's answers indicated whether they perceived the Mother’s Role as active or passive, the Provider’s Role as dominant or collaborative, and the Delivery Experience as fearful and painful, or as a positive occurrence.

Women who perceived their role as active, the provider’s role as collaborative, and the delivery of the child as a positive experience, were more likely to prefer midwifery care, birth at home, a vaginal delivery and the avoidance of pain medication.

The more painful and fearful a woman expects her birth to be, the more likely she is to prefer a caesarean to a vaginal 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.

Where is the best place to try for a VBAC?

It's an interesting question!  If you're planning a VBAC, you want to maximise your chance of success by choosing  supportive environment in which to birth.

But ..... outcomes for birthing depend more on a woman's choice of care provider, and much less on the place of birth.

If we look at VBAC success rates, we can divide those rates according to choice of care provider and model of care.

According to the NSW Mothers and Babies Report (2010), which is our most recent report, on average, only 5.6% women attending private hospitals under private obstetric care have a VBAC.  94.4% women have a repeat caesarean.

NSW-wide, only 12.1% women have a VBAC: 87.9% have a repeat caesarean.  This rate has not changed very much over the past four years.

Private midwifery is unique in that the women who have previously had a caesarean and request care from a private midwife are generally not planning a repeat caesarean, so the VBAC success rates with a private midwife reflect the success rate of those women who have planned a vaginal birth.  Success rates vary from 80%-90%.  This is not dependent upon place of birth.  Women planning a VBAC with a private midwife sometimes choose to birth at home, and other times choose to birth in hospital.  Either way, the private midwifery model of care results in a high chance of successful VBAC.

I think this is a reflection on the positive, preventative and holistic care that a private midwife provides, carefully and proactively ensuring that small issues are managed before they become big issues; positively encouraging women when they feel disheartened; sound preparation for birth; birth debriefing so that the woman is emotionally-clear before she embarks on her next birth, and so on.

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 3 myths about waterbirth

Waterbirths are great, and about half of the women who birth within my practice choose to birth in water.  But when I'm out and about, I come across some interesting ideas about waterbirth ....

1. Babies may drown during waterbirths

So long as the baby is brought to the surface after birth, they do not drown during water births.

2. The midwife has to get in the tub to deliver the baby

The idea here is that the midwife gets in the tub and "pulls" the baby out.  However, midwives don't "pull" babies out; women either push their babies out, or breathe their babies out.  So we don't actually get in the bath tub / birth pool and pull.  Rather, we guide and catch, or the mother guides and catches, or the partner guides and catches.  And the baby is brought to the surface.  The only part of the midwife that goes in the pool is her hands and arms.

3. Waterbirth causes infection

Research has shown this not to be the case.

All in all, waterbirth is a great way to give birth and has many benefits for mother and 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.

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 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.

What does it cost to have a baby with a private midwife?

It's a common question asked on forums and social media, and a good question to ask.  Fees vary between different private midwifery practices, and depend on many factors. 

Sometimes, people comment that private midwifery is very expensive.  I think it is easy to form this view when people are not familiar with what goes into the cost of providing care.  Actually, when you work out an hourly rate for all of the care, it is very low.  Much of the work of a private midwife is invisible to families, so it is understandable that the cost might seem high.

I have prepared the following information to explain what goes into the cost of providing private midwifery care.  Before we start, there are a few things I'd like to point out:

  1. Private midwifery services (whether for hospital birth or home birth) are very comprehensive, and private midwives spend many hours with women and their families, one-on-one, building a relationship during the pregnancy that carries through to the birth and beyond.
  2. When a woman books with a private midwife, the midwife herself is on-call 24/7 from the moment of booking and until the baby is 6 weeks old.  This is not the same as a group practice arrangement where the midwife is on-call for 12 hours at a time and with holidays scheduled in as well as days off, or a group obstetric practice where your obstetrician works only one weekend in four.
  3. Appointments are generally around an hour long, compared with standard hospital services and private obstetric services where visits may be around 10 minutes.

So .... what exactly goes into the cost of providing care for a family?  I'll break it down to the visible costs: those that a woman can appreciate each visit; and the invisible costs: those that are incurred behind the scenes.

Visible costs

  1. Time: consultations, birthing
  2. Program handouts
  3. Library of resources

Invisible costs

  1. On-call - 24/7
  2. Travel time to home visits and births
  3. Research
  4. Professional consultation with other professionals on the client’s behalf (eg medical consultation)
  5. Office (computer, fax, copier, scanner, printer, phone)
  6. Policy development: private midwifery practices are required to have written policies
  7. Auditing
  8. Reporting
  9. Preparation of a hospital booking
  10. Referrals to medical staff if required
  11. Continuing professional development (eligible midwives are required to undergo at least 40 hours of professional development each year)
  12. Professional Practice Review
  13. Membership of professional bodies and organisations
  14. Registration
  15. Administration
  16. Data entry for auditing
  17. Care Program development
  18. Consulting room lease / purchase
  19. Insurance
  20. Postage
  21. Parking
  22. Tolls
  23. Merchant fees
  24. Stationery and printing costs
  25. Birth kit
  26. Midwifery equipment
  27. Oxygen and suction

As you can see, the service provided by a private midwife is comprehensive and does not compare easily with other maternity services in terms of continuity of care, hours of contact, follow-up and availability. When you choose a private midwife for your pregnancy and birth, you are choosing gold standard service.

Also, when midwives provide this level of service, it is impossible to book more than two or three clients each month without anticipating clashes in births and attendance for urgent issues that come up.

I think that private midwifery care is a fantastic choice for women who are after comprehensive, value-filled, smart care.  It is a model of care that is backed by international research as being gold-standard care for mothers and babies.

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.