June, 2009&#58;

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There were nearly 158,000 potentially avoidable childbirth-related injuries to women and their infants in 2006, a significant decline from 2000 …

… Between 2000 and 2006, the rate of potentially avoidable injuries during vaginal childbirth without the use of instruments, such as forceps, declined by 30%, according to the report. The injury rate declined by 21.3% for vaginal childbirth using instruments and by 16.7% for women undergoing caesarean sections.

… rates of injury were higher when instruments were used during childbirth. …trauma to the woman during vaginal delivery with the use of instruments occurred 160.5 times per 1,000 discharges, compared with 36.2 times when instruments were not used. The report said that the most common injuries to women were perineum tears, which are avoidable in many cases. Traumatic injury to infants during childbirth — such as broken collarbones, head injuries and infections — occurred 1.6 times per 1,000 discharges.

…. Women giving birth in high-income areas had 44% more injuries during vaginal delivery than their counterparts in low-income areas.

… The report found that women covered by Medicaid were less likely to be injured during childbirth — 127 injuries per 1,000 deliveries — compared with women with private insurance plans — 185 injuries per 1,000 deliveries. However, the rate of injury for infants covered under Medicaid was higher — 1.7 per 1,000 deliveries — than those under private plans — 1.5 per 1,000 deliveries.

New Leader of Australian Obstetricians Welcomes Government’s New Maternity Plans With a But…

Jun 29th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

Australia’s peak group of specialist obstetricians and gynaecologists today pledged to work with the Federal Government on the introduction of legislation that promotes the role midwives play in assisting specialist doctors in delivering healthy babies.

The new President of the National Association of Specialist Obstetricians and Gynaecologists (NASOG), Dr Hilary Joyce said that specialist doctors want to support the work of good midwives in hospitals and within collaborative practices.

“A strong collaborative model of patient care will ensure the safest and most equitable access to treatment for every Australian woman and her baby, and continue Australia’s marvelous obstetric safety record” said Dr Joyce.

However, Dr Joyce said that Australian women and their babies would fare even better if the Government also overturned a proposed budget measure that will adversely impact on every woman who seeks choice, access and affordability for her pregnancy care.

Dr Joyce said enhancing the ability of obstetricians and midwives to work together via the Medicare Benefits Schedule may be appropriate but any positive outcomes for mothers and their babies could be undermined by the proposed winding back of the obstetric safety net for patients.

“If this increased financial burden means women can no longer afford private obstetric care, they will inevitably be forced to go over to the public hospital maternity services which are already overwhelmed and barely coping with the increased birth rate of the last five years,” Dr Joyce said.

… NASOG applauds the Government announcement that it will not endorse midwives practising alone outside clinical settings

Excuse me while I vomit. Seriously. Private obstetric care should be funded, even though only 20% women actually need it. Private midwifery care (homebirth) – the sort of care that about 80% women could have – should not be funded?? This doctor opposes legislatory changes that reduce choice for obstetric care, yet in the same breath, she applauds changes that reduce choice for midwifery care.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Newborn Weights Affected By Environmental Contaminants

Jun 29th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

Recent epidemiological studies have revealed an increase in the frequency of genital malformations in male newborns (e.g., un-descended testes) and a decrease in male fertility.

The role played by the growing presence in our environment of contaminants that reduce male hormone action could explain this phenomenon.

… the birth weight of males is higher than that of females due to the action of male hormones on the male fetus. If the exposure of pregnant women to environmental contaminants that diminish the action of male hormones has increased over the years, one would expect to see a decrease in the sex difference in birth weight.

This is exactly what a new study … shows …

… the investigators effectively show a sustained decrease in birth weight differences between boys and girls, which supports the hypothesis of growing endocrine disruption related to environmental contaminants …

“Our study underlines the importance of probing the impact of environmental contaminants on the health of mothers and fetuses and on the reproductive potential of future generations,” …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Stillbirth rates falling, but not in Australia

Jun 28th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

A DROP in stillbirth rates in the UK has given experts hope that a reduction in stillbirths can occur in Australia and New Zealand.

Stillbirth rates in the UK have dropped for the first time since 2000 – from 5.7 per 1000 births in 2002-2004, to 5.2 per 1000 births in 2007.

However, a lack of improvement in Australia’s stillbirth rates in 20 years “is of grave concern”, International Stillbirth Alliance (ISA) chair Vicki Flenady said in a statement on Saturday.

… In one third of those deaths, stillbirths occur unexpectedly in what is an otherwise healthy mother and baby and no cause of death is determined.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Hospital’s Oxytocin Protocol Change Sharply Reduces Emergency C-Section Deliveries

Jun 28th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

The modification of the oxytocin infusion protocol at a large university-affiliated community hospital nearly halved the number of emergency cesarean deliveries over a 3-year period …

As oxytocin utilization declined from 93.3% to 78.9%, emergency cesarean deliveries decreased from 10.9% to 5.7% …

Other birth outcomes improved as well … significant declines in emergency vacuum and forceps deliveries and a sharp reduction in neonatal ICU team mobilization for signs of fetal distress …

“More and more data are showing us that we are using too much oxytocin too often,” …

… The most profound changes were in emergency deliveries, including caesarean deliveries, vacuum deliveries … and forceps deliveries …

Did I read that right? 93% women had oxytocin, and this was reduced to 79%? That’s extremely high! WHO says the combined induction and augmentation rate should not exceed about 10%. How is it that 93% women “needed” oxytocin? How would these women have felt if they knew that 86% of them did not actually “need” that oxytocin infusion?

Melissa Maimann, Essential Birth Consulting 0400 418 448

Malpractice Suits Contribute To Rise In Caesarean Surgery

Jun 27th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

Many doctors believe that the increase in caesarean section births in the U.S. over the last decade has been fueled by three main factors — fear of malpractice lawsuits, a decrease in vaginal births after c-sections and rising rates of obesity … According to the Times, 31.8% of U.S. births were c-sections in 2007 … making c-sections the most commonly performed procedure in the nation’s hospitals.

… c-section births … [represented] only 4% of U.S. births in 1965. … c-section rates began to increase when it was believed that many cerebral palsy cases were the result of infants being deprived of oxygen during traumatic vaginal deliveries, which led to malpractice suits against doctors. …

… Whereas doctors in the past were more likely to use techniques such as vacuum extraction or manually turning an infant during a difficult birth, doctors today automatically opt for a c-section …

… 76% of U.S. obstetricians reported at least one litigation event, with an average award of $2.3 million for negligence in childbirth.

An increase in obesity and a decline in VBACs also have driven the rise in c-section births … VBACs have declined from nearly 30% in the 1990s to 7.9% in 2005, which some doctors say is a result of fear of litigation because of the chance for rare but serious complications during birth. Similarly, obesity puts women at an increased risk for gestational diabetes, delivering prematurely or having larger infants, which can make birth more risky …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Australian Medical Association To Work With Government On Nurse Legislation

Jun 26th, 2009

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I wonder how many midwives are working with this legislation to provide input? What comes out of this for me as I read it, is that the medical profession is scared of competition from midwives and is seeking to control the profession.

The Australian Medical Association will work with the Federal Government to ensure patients benefit from the introduction of new prescribing rights for nurse practitioners and midwives.

Legislation will be introduced into Federal Parliament today to grant nurse practitioners and midwives prescribing rights under the Pharmaceutical Benefits Scheme (PBS) and the ability to perform a broader range of procedures subsidised by the Medicare Benefits Schedule (MBS).

“We have been assured by the Government that nurse practitioners and midwives will work collaboratively with medical practitioners to deliver quality care and ensure patient safety under the new arrangements,” AMA Federal President, Dr Andrew Pesce, said.

… “There is an enormous amount of detail to be worked through in this process …

Breast-Feeding Boosts Child’s School Performance

Jun 26th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

Children who were breast-fed do better in high school and are more likely to go to college than their bottle-fed siblings, researchers report.

… “We compare sibling pairs — one of whom was breast-fed and one of whom was not, or siblings who were breast-fed for different durations — and find consistent evidence that breast-fed children have higher high school grade point averages and a higher probability of attending college,” …

… “If you’re breast-fed, your high school GPA goes up substantially, and the likelihood that you go on to college goes up,” Rees said.

For every month you are breast-fed, your high school GPA goes up about 1 percent and your probability of going to college goes up about 2 percent, Rees added.

… “An array of health benefits is convincingly associated with breast-feeding, including a reduced risk of both infections and obesity in the breast-fed child,” Katz said. “Less certain, but long suggested, is enhanced cognitive development in breast-fed children as well.” …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Access For Pregnant Women To Medicare Funded Midwifery Care On The Way: But not for homebirths

Jun 25th, 2009

… Heath Minister Nicola Roxon has today introduced the first bills to legislate giving women access to Medicare funding for expert midwifery care.

It doesn’t. Expert midwifery care is provided by the minority of midwives who provide continutiy of care – eg for homebirths. Women, as a whole, will not be able to access this care because few midwives provide it.

“This is historic legislation for childbearing women and their families” said Dr Barbara Vernon, Executive Officer of the Australian College of Midwives.

Yep – it is. For the first time in Australian history, women are denied the right to have amidwife-attended homebirth. Great step forward!

“From November next year, women will be able to choose the care of a midwife to provide their pregnancy care in the community, follow the woman into hospital to provide her labour and birth, and follow her home again afterwards to provide the vital professional support in the early weeks of caring for a newborn baby”.

So long as the woman births in hospital.

The government’s bills will pave the way for women to receive Medicare rebates for private midwifery care, as well as providing for Pharmaceutical Benefits Scheme rebates for relevant tests and drugs. One bill will specifically support eligible midwives to access professional indemnity insurance for their care.

… Midwives, working collaboratively with GP obstetricians, will help meet women’s need for local care.

Collaborative care has not been defined and most likely there will be several hoops for midwives to jump through in order to access MBS and PBS and insurance. I wonder if the current midwives who work independently of the hospital system will be eligible.

“This national legislation recognises for the first time that midwives make a valuable contribution to maternity care in their own right.

Actually, it doesn’yt. It places midwifery fairly and squarely under obstetric dominance. It affords midwives some rights that they already have in hospital, provided they work with a doctor and ensure that their clients follow the obetetric rules. The new laws place midwifery subservient to obstetrics. Imagine if GPs were only able to practice provided they worked in a collaborative team with a nurse, pathologist, radiographer etc? Imagine if an obstetrician was only able to practice if they worked collaboratively with a midwife, referring all women to the midwife if the woman is low risk and healthy?

Midwives who provide Medicare funded care will work collaboratively with doctors and other health professionals to ensure the individual needs of each woman and baby are fully met.

The needs of women will only be met when they have the final say. What if the woman declines a cosultation with the onstetrician? What if the woman makes an intelligent decision not to have certain tests? Will the midwife be able to support her? The midwife will cease to be “collaborative” if the woman does not comply. So is this an attempt to use an acceptable (to the woman) person (ie, the midwife) to coerce women to have tests, consults and care that she does not want, or perhaps need? I can’t help but this it’s the govt’s way of using midwives to assert control over women.

…“These reforms will not only give women greater choice than they currently have, they will also give most midwives more choice about how and where they provide care to women, thereby helping to reduce stress and loss of midwives to the maternity care workforce.”

So long as it is within the confines of the hospital and so long as the woman and midwife play by the rules of the hospital. I doubt a doctor will work collaboratively with the midwife if the midwife’s clients decline synto for the third stage, decline routine induction, decline a diabetes screen, or insist on having a VBAC. If the midwife is no longer in a collaborative team, she no longer has insurance (and therefore registration) or access to PBS and MBS.

This is perhaps the only part I agree with:

“The only dark cloud in these historic reforms is that they will not provide for women who choose to give birth at home under the care of a midwife. There is mounting international evidence that the option of birth at home is safe for low risk women. ACM is concerned that the rise in unattended homebirths will only get worse unless the government extends its proposed indemnity scheme to ensure healthy low risk women can continue to choose homebirth with competent networked midwives.”

This has all come out of the maternity services review, in which 53% of respondents were women who demanded homebirth services to be provided by midwives. Is the govt listening? Does anyone really care?

False Test Results Seen in Group B Strep (GBS) Screening

Jun 25th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

A massive effort to test pregnant women for a deadly germ they can spread to their babies has yielded a bad surprise — a high rate of wrong test results that led some infants to miss out on treatment.

… the test missed more of the infections than would normally be expected. If the mothers had tested positive for the Group B strep bacteria, they would have been given antibiotics during labor to cut the chances of infecting their infants.

Group B strep is a common bacteria carried in the intestines or lower genital tract, and can be spread to babies during delivery. It’s harmless to most adults but in newborns can lead to blood infections, pneumonia, meningitis, mental retardation or hearing and vision loss, and death.

It is a rare problem which occurs in less than 1 in 3,000 births … the Centers for Disease Control and Prevention and doctor groups … recommend routine tests of all pregnant women.

No one is suggesting the screening program is a failure … infant infections from Group B strep … dipped another 27 percent.

… 250 infants out of nearly 7,700 were born with the infection … And the antibiotics seemed to be very effective …

But Schrag and others acknowledged that the false negatives were a disappointing surprise.

… the researchers calculated that they would see 44 to 86 cases of false negatives involving full-term infants. But the final study showed 116 cases — or about 60 percent of the infected full-term infants in the study were born to mothers who had been tested and mistakenly found clear of the infection.

The rest of the infected full-term babies were either not screened or were born to mothers who tested positive.

Timing may be an issue. It’s recommended [to screen women] at 35 to 37 weeks into the pregnancy … But Group B strep infections can come quickly …

The article goes on to speak of a new vaccine!!!! These days, it seems there’s a vaccine for everything.

A good point was raised by an obstetrician who mentioned that since group B strep is normal vaginal flora (present in 25% – 30% women at any given time), and since on only 1 of 400 colonized women is there a neonatal infection, the real question should be, “What is wrong with that one baby out of 400 that gets sick?”

Another aspect of care is the risk facor approach, which involves no routine screening, and offering antibiotics to women who fall into certain risk groups that are known to be associated with Group B Strep infection.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Caesarean Rates so high even doctors are concerned

Jun 24th, 2009

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For further information, contact Melissa Maimann at Essential Birth Consulting.

The number of … Florida babies born by cesarean section is rising so fast that even some obstetricians say surgical births are out of hand.

… 43 percent of Broward County births and 41 percent in Palm Beach County were done by C-section … Florida, at 39 percent, ranked second highest behind New Jersey.

… cesareans cause … more complications … than do natural births, and they pose increasing risks with every subsequent pregnancy …

“Absolutely, something has to change,” … “The C-section rate is three times higher [than 20 years ago], yet babies are not healthier. It’s not helping.

… C-section rates vary sharply. A few South Florida doctors deliver three-fourths of their babies by cesarean, and a few do almost none … About half the births at Holy Cross Hospital in Fort Lauderdale and Palms West Hospital in Loxahatchee were by C-section, yet others do two-thirds naturally.

There are medical malpractice fears. Obstetricians and hospitals … order C-sections for any irregularity before or during labor … Almost no doctors let women try natural birth after a prior C-section …

Doctors also may push mothers to C-sections if the labor drags on for 12 hours, if drugs fail to induce the baby or if the baby is big …

… Doctors contend they are under pressure to deliver surgically. If they don’t and something goes wrong, they are sued. As a result, almost no doctors do natural delivery for breech or multiple births.

“If there’s any untoward event, the first thing they ask is, ‘Why wasn’t there a C-section?’” … “If there’s any doubt, there’s no incentive to take a chance.”

… “The philosophy is, you will never be sorry you did a C-section, but the reverse is not always true.”

… Babies born by cesarean are more likely to go to intensive care … Surgical births … risk infections and anesthesia reactions. And mothers who have repeat C-sections are more prone to have abnormal placenta growth that causes bleeding and complications.

The first cesarean is now the key decision … “Patients have the conception that C-section is a simple surgery … “Every subsequent surgery for C-section has more risk. “About 95 percent of Florida women who have cesareans will deliver every other baby that way. Most doctors and hospitals refuse to perform … VBAC, saying the stress can cause uterine rupture, a complication in less than 1 percent of births.

… Nermarí Broderick said her doctor pushed her toward a cesarean even though she didn’t want it and had no medical risks. So she had two sons at a natural birth center.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Mothers and babies at risk: Access to qualified midwives for homebirth under threat

Jun 24th, 2009

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The following is a media release from the College of Midwives about homebirth being illegal after 2010:

Private midwives will no longer be able to attend homebirths under new national laws proposed for registering health professionals to have effect from 1 July 2010.

… One of the requirements … will be that all health professionals have professional indemnity insurance …

… Access to indemnity for private midwives ceased in 2001 following the collapse of HIH and September 11, which caused insurers to reassess their liabilities.

“The national registration laws will require a midwife to be indemnified for all areas of her practice. This will effectively make it impossible for a midwife to legally care for women planning homebirth, because there is no professional indemnity available for homebirth care” said Dr Barbara Vernon, Executive Officer of the Australian College of Midwives.
“This is devastating news for private midwives, as this policy threatens to throw them onto the unemployment queues” Vernon said.

… “It is essential that women who choose to give birth at home have access to experienced midwives. The widely reported tragic death in March of a baby born at home without a midwife or doctor in attendance is testimony that unattended homebirth is dangerous.”

“Midwives have knowledge and skills that ensure women who labour at home can do so safely. They closely supervise the labour to ensure that everything is proceeding normally, and can arrange for timely transfer if they are not. They also have skills and equipment to perform life saving emergency care in the unlikely event of a mother or baby need urgent transfer.”

“The Australian College of Midwives is gravely concerned that if midwives are prevented from providing professional care to women planning homebirth, that some women will proceed to birth at home anyway, unattended. Any attendant they might have would not be a regulated health professional like midwives are, accountable to competency standards, codes of ethics and conduct, and required to maintain professional knowledge and skills. This is a retrograde step”.

Health Minister, Nicola Roxon is set to introduce legislation to federal Parliament soon that will assist private midwives to access professional indemnity insurance. This assistance will be for midwives who become eligible to provide Medicare funded care to women in the community for pregnancy and postnatally and for labour and birth in a hospital.

I have no doubt that access to MBS and PBS will be next to impossible, and that it will be for midwives who are currently working in continuity of care models in hospital. There will be additional educational components involved in accessing PBS. It’s not a case of issuing midwives with script pads. There is no suggestion of what will constitute an “eligible” midwife for purposes of MBS and PBS, and “collaborative care” has yet to be defined. Until this is clear, really we don’t know what we’re up against.

I think it’s great if we can write scripts, order tests and if our clients can access MBS for our services. But if this is not something that is accessible to all midwives unon registration, then it will only service to create yet another level of midwife and further divide the profession.

Study To Follow Pregnant Women To Better Understand Causes, Early Signs Of Autism

Jun 23rd, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

NIH and the advocacy group Autism Speaks are enrolling 1,200 pregnant women who have other children with autism spectrum disorders to participate in a large study that aims to identify early signs of the condition and its possible causes … Women who participate in the study … will be monitored throughout their pregnancies, and their infants will be monitored until age three …

The study will focus on women who already have one child with an autism spectrum disorder because such women have a higher chance of having another child with the condition. … “By studying families who are already affected by autism, we feel we have the best chance at learning how genetics and environmental factors could work together to cause autism.” ….

Melissa Maimann, Essential Birth Consulting 0400 418 448

Don’t cut the cord, says mum

Jun 23rd, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

WHEN Cher Sievey gave birth to her baby daughter Ophelia she decided to do things a little differently.

Not only did she choose a homebirth without a midwife but she chose not to cut the umbilical cord.

It’s a practice known as Lotus Birth, when the placenta and cord remain attached to the baby until the cord detaches naturally, usually after three to five days.

Cher, 28, and her partner Will Thielker live in Brimscombe with their older daughter Aurora, five, and 13-month–old Ophelia. They will be moving to Wales at the end of the month to establish an Instinctual Living Retreat focusing on pregnancy and birth.

“Lotus Birth allows babies to receive all of their blood, oxygen and nutrients through what is known as the placental transfusion …

“There is iron-rich blood in the placenta that the baby doesn’t access until after the birth. When Aurora was born her cord was cut after 30 seconds, so she didn’t receive all her blood volume.” ….

Melissa Maimann, Essential Birth Consulting 0400 418 448

Pregnant or breastfeeding? Eat more oily fish

Jun 22nd, 2009

For further information about nutrition, contact Melissa Maimann at Essential Birth Consulting.

Lunk

… [Pregnant women] should be eating more oily fish to boost their intake of omega-3 fatty acids …

“… women in pregnancy and lactation should aim to have a regular intake of these long-chain omega-3 fatty acids that you find in oily fish … ” …

“It’s a small change in lifestyle that can major effect on long-term health,” Prof Koletzko said.

… women who had a recommended omega-3 intake during pregnancy could cut their risk of premature birth by 30 per cent.

… for “high risk” women who’d had previous premature births, their risk was reduced by 60 per cent.

A British study … also showed flow-on benefits for the child.

“If the mother had eaten more fish and seafood during pregnancy, then there was a marked advantage for IQ development until age eight years,” Prof Koletzko says.

“Fine motor development, and social behaviour, were all beneficially affected.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

Babies are healthier when they choose their birthdays

Jun 22nd, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

Elective term delivery at 37 and 38 weeks’ gestation is associated with higher neonatal morbidity than at 39 weeks’ gestation.
Preterm delivery (<37 weeks’ gestation) is associated with significant neonatal morbidity and mortality ...

... Six percent of infants ... born after elective induction of labor required admission to neonatal intensive care units (NICUs), 70% within the first 24 hours. Among planned elective deliveries, infants born at 37 and 38 weeks had significantly higher rates of NICU admissions than those born at 39 weeks (17.8% and 8.0% vs. 4.6%, respectively).

... The authors conclude that elective delivery before 39 completed weeks’ gestation is inappropriate and that women with unfavorable cervix dilation who undergo elective induction of labor should be warned about the increased risk for cesarean delivery.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Acupuncture for Indigestion in pregnancy

Jun 21st, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

A small study … reports that acupuncture may be beneficial in easing symptoms of indigestion which are very frequent in pregnant women. … Between 45 and 80 percent of women are reported to experience those symptoms.

… women in the acupuncture group had less severe symptoms and required less medication than women in the conventionally treated group.

Melissa Maimann, Essential Birth Consulting 0400 418 448

CTG monitoring – whose interests does it serve?

Jun 21st, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

When the FDA isn’t busy rebutting the health claims of Cheerios, it sounds like these days they have their hands full with medical device approvals for modern enhancements to continuous electronic fetal monitoring (EFM). One supposedly “noninvasive” device in the approval pipeline features 32 electrodes attached to the mother’s abdomen that measure beat-to-beat fetal heart rate variability in pregnancies as early as 20 weeks. Another that has already received the green light from the FDA allows obstetricians to view real-time EFM data on their iPhones. And let’s not forget the comical-if-it-weren’t-so-barbaric ”BirthTrack,” an FDA-approved technology that continuously monitors cervical dilation and fetal descent in combination with fetal heart rate.

These are just a few of the latest examples of attempts to improve upon EFM, a technology that is used in 94% of labors despite evidence that it increases the chance of a cesarean or instrumental vaginal birth but does not prevent serious or long-term problems in babies … Confirming EFM findings by testing the acidity of a sample of the baby’s blood is another once-promising approach that is unreliable and has fallen out of favor.

OK, so tweaking the technology doesn’t solve the problem. Maybe the problem is that the professionals charged with interpreting EFM data need better training or can’t communicate effectively? This is the theory behind the latest NICHD Guidelines for interpreting EFM, and countless hospital-based patient safety programs. But even after NICHD’s last attempt at standardizing EFM interpretation, experienced maternal-fetal medicine specialists could not agree about the significance of worrisome EFM patterns, or which tracings warranted immediate cesarean surgery to prevent poor outcomes.

… Perhaps it is the underlying premise itself that we must reassess. Maybe fetal heart rate isn’t such a great predictor of fetal wellbeing after all. Sure, at the extremes it can tell us which babies are in serious trouble and which are sailing through labor with no trouble at all. But anywhere between these extremes is much murkier territory. Many babies will be born pink and screaming despite worrisome heart rate patterns, but a few will be compromised and need resuscitation, ongoing observation, or other measures. And even when fetal heart rate does predict the babies who will be compromised at birth, most of these babies will not suffer any serious or long-term consequences. So fetal heart rate doesn’t predict outcome at birth very well, and poor outcome at birth doesn’t predict long-term morbidity very well. How can we then expect the fetal heart rate to possibly predict or affect long-term outcome well?

… we should spend those resources providing, evaluating, and improving intermittent auscultation, the low-tech, low-risk alternative that has proven safe and effective in healthy women. Not only is intermittent auscultation safe for the vast majority of babies, it facilitates the other practices we know contribute to safe and healthy birth – continuous labor support, freedom of movement, and upright pushing positions, to name just a few.

Research about CTGs has been around for many many years – but it has been ignored. So many hospitals (especially private hospitals) continue to routinely monitor healthy women on admission. Why? So we know the baby’s healthy. And once on the monitor, the slightest hiccup and the CTG gets to stay on for the duration of labour …. all the way to the operating theatre! Some hospitals have a policy of CTGs every 3 or 4 hours in normal labour. Why? If the heart rate is normal, monitor with a doppler. If it’s not normal, why would you remove the CTG and reapply it 4 hours later?

Melissa Maimann, Essential Birth Consulting 0400 418 448

How we went to routine cesarean for breech and back again in the era of evidence-based medicine

Jun 20th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

The media is reporting that the Society of Obstetricians and Gynaecologists of Canada (SOGC) no longer recommends routine cesarean when the baby is presenting breech at term. The new clinical practice guideline entitled “Vaginal Delivery of Breech Presentation” concludes that “vaginal delivery is reasonable in selected women with a term singleton breech fetus.”

Automatic cesarean for breech has been the international standard of care since the results of the Term Breech Trial (TBT) … the trial’s findings … seemed to suggest that vaginal breech birth posed unacceptable risks to the baby. The results included:

combined stillbirth and neonatal mortality rate excluding lethal congenital abnormalities: 0.3% in the planned c-section group vs. 1.25% in the planned vaginal group
combined perinatal mortality and serious neonatal morbidity: 1.6% in the planned c-section group vs. 5.0% in the planned vaginal group
no differences in maternal mortality or morbidity between groups

There has not been another randomized controlled trial of term breech birth since the TBT. … The journey to routine cesarean and back provides an important lesson in the nuances of evidence-based medicine. Let’s take a look at how the evidence has unfolded.

First, over the months and years following the trial’s publication, a flurry of responses poured in from clinicians and researchers … pointing to flaws and irregularities in the trial … Cracks in the evidence were already appearing.

Then … the TBT research team tracked down the trial participants and reported long-term health outcomes. … almost all of the babies with severe morbidity after birth in both trial groups survived without any long-term neurological compromise, and differences in combined mortality and morbidity between the cesarean and vaginal groups had disappeared …

… Those randomized to a trial of labour had a 6% absolute lower chance … of having a two-year-old child with unspecified medical problems, suggesting some lasting benefit of labour to the newborn immune system.

Meanwhile, several large non-randomized studies were released, consistently reporting excellent outcomes of planned vaginal breech birth. The largest, a prospective cohort study four times the size of the TBT … [found] There was no difference in perinatal mortality (0.08% vs. 0.15%) or serious neonatal morbidity (1.6% vs. 1.45%) between planned vaginal and planned cesarean birth …

… SOGC’s change of heart was … also influenced by a vocal and persistent group of consumers and clinicians who pushed back against routine cesarean for breech. … They also recognized the ethical problems inherent in coercing women to accept the risks of surgery in exchange for little if any benefit to their infants …

… We do not yet know if the change in guidelines will translate to a meaningful change in practice, or for that matter, whether we will see a similar guideline revision south-of-the-border …

It will be interesting to see how long it takes in Australia before vaginal breech birth is the norm. Or should I say – vaginal breech delivery. I’d like to see a ransomised controlled trial comparing the difference in outcomes between women having a breech birth and a breech delivery!!! See Lisa Barrett’s Blog for info on vaginal breech birth.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Homebirth will be illegal in 2010. Rally on 7th Sept 2009, Canberra.

Jun 20th, 2009

Please register your intention to attend this rally here.

Homebirth Australia is hosting a MAJOR rally in Canberra (outside Parliament House) on Monday September 7 from 11.30am.

There has been much discussion about the potential outlawing of homebirth and the continued lack of equity for women choosing homebirth. It is now real – private homebirth will be illegal after 2010. If you support choice in birth – even if you don’t support homebirth – PLEASE come to this rally.

We need this to be BIG.

Please forward this meeting far and wide.
Monday, September 7, 2009
Time: 11:30am – 2:30pm
Location: Parliament House, Canberra

Please register as attending if you plan to come.

Breastfeeding reduces your baby’s chances of going to hospital

Jun 20th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

BMJ 300: 11-16, 1990:

A comparison of 227 babies who were breastfed for their first 13 weeks or more with 267 who were formula-fed from birth found that the breastfed babies had fewer hospital admissions, significantly less gastrointestinal illness, and a smaller reduction in respiratory illness. This result was the same even when supplements were introduced before 13 weeks, and lasted beyond the time of breastfeeding. Breastfeeding for less than 13 weeks resulted in a rate of gastrointestinal illness similar to that found in bottle-fed infants.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Homebirths will be illegal in Australia

Jun 19th, 2009

4 comments

For further information, contact Melissa Maimann at Essential Birth Consulting.

HOMEBIRTHS will become illegal under tough new laws that prevent women using midwives to have children outside hospitals.

The move is set to drive homebirths underground, with expectant mothers and their babies at risk.

There are fears women determined to have a homebirth will “go it alone” like birthing advocate Janet Fraser, whose baby died during a natural water birth in April …

Under the draft Health Practitioner Regulation National Law, released last week, a midwife cannot be registered unless she has insurance.

But with insurance companies and the Government so far refusing to include homebirths in the indemnity scheme, midwives will face being de-registered if they attend a homebirth.

… Australian College of Midwives boss Dr Barbara Vernon said the Government’s intention was obvious.

“I had been optimistic until now when you can see it in black and white,” she said.

“Even though only less than half a per cent of women have homebirths, they should have the same rights as a woman who chooses to have a caesarean. Homebirths won’t stop.”

About 150 midwives do homebirths in Australia. Called independent or private midwives, most do not work in a hospital and are uninsured.

But from July 2010, they will no longer be able to call themselves midwives even though they are trained. Only those insured and registered can use the term midwife, otherwise they face a $30,000 fine.

There are about 700 homebirths a year but some say this may be as high as 2100 as they are under-reported.

For TV presenter and marriage celebrant Elizabeth Trevan, giving birth to her 18-month old twins Nash and Harvey at home was an “overwhelming experience.”

… Home Births Australia secretary Justine Caines said the new law took away the rights of women.

“It technically makes homebirthing illegal,” she said.

The Royal Australasian College of Obstetricians and Gynaecologists is against homebirths.

I have been informed that insurance will be provided for provate midwives who birth their clients in hospital. Homebirth will not be insured, however if the midwife also works in a hospital, she will be able to obtain insurance and thus register.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Placenta Harmed By Cocaine And Heroin

Jun 19th, 2009

1 comment

For further information, contact Melissa Maimann at Essential Birth Consulting.

Cocaine and heroin … causes an increase in the passage of some chemicals into the fetus.

… As complete abstinence is impossible for many people addicted to drugs who become pregnant, maintenance treatment with methadone is often used to limit damage to the developing child. However, methadone itself can also be dangerous, too much fetal exposure leading to harmful withdrawal symptoms in the newborn. … while … narcotics didn’t increase transfer of methadone, they did allow transfer of other test substances. This suggests the barrier function of the placenta may be compromised. … substances or bacteria and viruses may cross the placenta and harm the fetus. Previous studies have reported increased prevalence of infectious diagnoses in cocaine-exposed infants”.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Prematurity linked to Depression?

Jun 18th, 2009

1 comment

For further information, contact Melissa Maimann at Essential Birth Consulting.

Researchers trying to uncover why premature birth is a growing problem in the United States and one that disproportionately affects black women have found that pre-pregnancy depressive mood appears to be a risk factor in preterm birth among both blacks and whites.

Black women, however, have nearly two times the odds of having a preterm birth compared to white women …

“Preterm births are one of the most significant health disparities in the United States …

While there appears to be some sort of link between giving birth prematurely and depressed mood, the study found no cause and effect, said Gavin, who studies health disparities …

… “At this point we can’t say that pre-pregnancy depressive mood is a cause of preterm birth or how race effects this association,” said Gavin. “But it seems to be a risk factor in giving birth prematurely and higher pre-pregnancy depressive mood among black women compared to white women may indirectly contribute to the greater odds of preterm birth found among black women.”

In the study 18.1 percent of the black women had a preterm birth compared to 8.5 percent of the white women.

Perhaps the factors that cause depression are also at play, causing preterm births.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Bathurst caesarean blood policy urged is for all of NSW

Jun 17th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

Changes … at Bathurst hospital since the “preventable” death of a woman who had just given birth should extend to all NSW hospitals, a coroner says.

… He was handing down the findings of his inquest into the death of Rebecca Murray, 29, who died after the caesarean … of her healthy third child at Bathurst Base Hospital in June 2007.

She died of multi-system organ failure following postpartum haemorrhage …

… the hospital failed to check her blood type and ensure it had adequate supplies before the caesarean.

… some supplies had to be sent from Orange Base Hospital – 55km away …

“Had a full blood count … and/or cross matching been done, Mrs Murray would have received blood transfusions at an earlier time and her death would have been prevented,” …

He also said the recovery room nurse had been inadequately trained.

Instead of immediately calling for help when Mrs Murray’s blood pressure and pulse dramatically changed, she felt the priority was cleaning up the blood the patient was losing.

… the responsibility rested “squarely on the shoulders of hospital administrators” to ensure appropriately skilled staff were available for patients.

At the start of the inquest on June 1, NSW health authorities apologised to Mrs Murray’s family, informing them that Bathurst Base Hospital now enforced the new blood count and supply policy.

But Milovanovich was told this practice had not been implemented across NSW.

“If the unexpected and avoidable death of a young mother at Bathurst justifies a change in policy at Bathurst Base Hospital, why should that policy not extend statewide,” he said.

… “It is important that we take all steps to ensure the problems that occurred in this case will not be repeated as far as possible,” he said.

It’s great that they’re acting on their mistakes, but what about the central issue: preventing preventable caesareans? This woman most likely had an avoidable caesarean. It was her third baby, and her baby was breech. Would a vaginal birth have been so risky for her? we know that rates of haemorrhage are higher for caesareans than for vaginal births.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Outcomes for births booked under an independent midwife and births in NHS maternity units

Jun 17th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

This article compares outcomes for women using independent midwives versus the NHS. It concludes:

While clinical outcomes across a range of variables were significantly better for women accessing an independent midwife, the significantly higher perinatal mortality rates for high risk cases in this group indicate an urgent need for a review of these cases. The significantly higher prematurity and admission rates to intensive care in the NHS cohort also indicate an urgent need for review.

A very sensible comment was left at another site:

“Once again we find that an independent homebirth for NORMAL pregnancy is better than a hospital birth. Your baby will have a higher birth weight, is less likely to be premature and in intensive care. You’re more likely to start labour spontaneously and breastfeed, and will use fewer drugs. High-risk women who choose an independent midwife should be allowed to deliver in hospital, it is the policy of not allowing independent midwives access to NHS hospitals that puts these women at risk.” – Antony Wright, London

I couldn’t have said it better!

Melissa Maimann, Essential Birth Consulting 0400 418 448

British mum’s embryo given to wrong woman, then aborted

Jun 16th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

AN IVF clinic has admitted giving a couple’s last embryo to the wrong woman, who then had the baby aborted.

The UK clinic failed to follow its own procedures and has acknowledged the blunder was “extremely upsetting” for everyone involved.

But the woman who should have received the embryo has told how the mistake left her and her husband “shaking with shock and bursting with anger”.

She said: “I kept thinking, ‘They’ve killed our baby! Killed our baby!’

“Even our worst fears didn’t prepare us for the devastating news that our embryo had actually been placed in another woman, and that it had to be taken out and destroyed for ‘medical reasons’.”

… when they were arrived for their appointment they were initially told there had been an accident in the lab and the embryo had been destroyed.

Later it emerged a trainee doctor had failed to carry out sufficient checks and the embryo had been implanted in another woman.

Ian Lane of Cardiff and Vale NHS Trust told The Sun: “We apologise unreservedly for this mistake.

… “Immediately after the event, we carried out an internal investigation …

… “As a result of both of these investigations, we have made a number of improvements to our systems and checks, in line with the recommendations made in the reports.”

It’s sad, but mistakes do happen in health care. No-one is perfect.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Specialists want doctors to reduce c-section rate

Jun 16th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

I was shocked just by the title of this article!

Leaders of Canada’s pregnancy specialists are urging doctors not to induce labour unless there are compelling medical reasons.

The call is part of a campaign to “normalize” childbirth and efforts to reduce Canada’s soaring cesarean section rate. Some studies suggest inducing labour in a first-time mother significantly increases her risk of a C-section.

… Doctors say several factors are driving induction rates, including the number of older first-time mothers, medical legal concerns and convenience.

“[Women may say], ‘My husband is going somewhere, can’t you get my baby out Monday?’ ” …

For most expectant mothers, labour begins spontaneously, at about 40 weeks into the pregnancy.

Induction of labour occurs when medications such as prostaglandin and oxytocin are used when a woman is past her due date to ripen the cervix and get the uterus contracting.

“The message … is, be patient and do not consider inductions before the end of the 41st week,” said Lalonde. “If you wait that extra week to 10 days, you will find that most women … will go into spontaneous labour.”

He says “the number one risk” of induction is that it leads to earlier decisions about a C-section … Nearly 28% of babies were born surgically in Canada in 2007-08 … That’s up from 5% in 1969.

… Induction can lead to longer, more painful labour and continuous electronic monitoring of the baby’s heart rate, which itself increases the risk of C-sections, because it generates “a lot of information. In fact, too much information,” says Dr. William Ehman … “So you are trying to sort out the important things versus what’s not important.”

Research shows that, in healthy pregnancies, checking the baby’s heart rate after contractions by listening, or using a hand-held device, reduces the risk of interventions.

But a recently released Canadian survey of more than 6,000 women who have given birth in the last few years found most women (91%) experienced electronic fetal monitoring during labour …

Ehman worries that women, and their doctors, have lost confidence in the ability to give birth without technological interventions.

… “Nature prepares the uterus better than we can,” Ehman said. “There’s probably a whole host of things that triggers labour in the first place — and mainly it’s probably the baby. So when the baby is ready it facilitates labour by lots of mechanisms that we can’t do.

“We can add these chemicals and get the uterus contracting. But we just know that the numbers say that inductions, if they are done unnecessarily, are going to increase the risk of a C-section.”

A very positive article from a doctor. Unfortunately, it’s what midwives have been saying for many many years. Australia’s CS rate is 31% (well, that was in 2006… I dread to think what it might be now); the CS rate in canada was only 28%. I hope that the changes to the provision of maternity services that are proposed to take place at the end of 2010 will help to bring down our caesarean rate.

Melissa Maimann, Essential Birth Consulting 0400 418 448

AMA calls for action on public hospitals

Jun 15th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

The AMA says a report on public hospitals today provides yet another reminder that a single hospital funding system, rather than more of the same, must be put on the table.

… there were more than seven million presentations to emergency departments in 2007-08.

“Our public hospitals are simply not coping with the increasing pressures,” Dr Pesce said.

“Doctors are increasingly frustrated by a system that consistently fails patients; making them wait when they are in pain, then forcing them out of beds too early when they finally get to hospital.

“Rather than endless cost shifting, we need to examine a single funding responsibility for health.

Birthing is no exception, with fewer hospitals providing birth services and the birth rate being higher than in previous years. The simple solution is to encourage low risk women to birth at home with a midwife; this will relieve pressure on obstetricians and hospital beds.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Mother gave birth so quickly her baby slid down her trouser leg

Jun 15th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

A mother told of her shock today after she unexpectedly gave birth at home so quickly her baby daughter slid down her trouser leg.

Katherine Allan, 23, was having regular contractions, but was told by the hospital they were still too far apart to require treatment.
However moments later tiny Hannah made her surprise appearance at the bottom of the stairs as Katherine’s partner Alan Moore, 25, helped her walk.

Little Hannah, who weighed 8lb 5oz, literally popped out where she stood and rolled down the front left leg of her grey jogging pants.
… Alan dived to scoop up Hannah just as she slid out across the floor – still attached to her mother via her umbilical cord.

The unexpected birth happened so quickly that Katherine did not feel any pain as the baby arrived at the couple’s home …

Katherine, who was preparing to go into hospital after her contractions got to seven and a half minutes apart on May 9, said the whole thing had been ‘quite an ordeal’.

The full-time mother to two other sons, Ben, five, and Michael, three, said her previous labours had lasted up to 12 hours and stunned by the ease of this birth.

She said: ‘I got to the bottom of the stairs and I just felt this massive urge to push when all of a sudden my waters broke all over the hallway carpet.

… ‘It was a bit strange seeing this little lump roll down my jogging pants which was actually my daughter.

‘My other births definitely weren’t this easy and I will always recommend standing up to do it in future.’

Katherine wrapped Hannah in a towel and sat on the stairs waiting for ambulance staff to arrive, with the baby’s umbilical cord still stretching down her leg, out of the bottom of her pants and up to her baby.
Paramedics and a midwife checked Katherine’s condition before they decided she didn’t need to visit the local hospital and sent her to bed for a rest.

… ‘The whole think was frightening but really brilliant and I was a very proud dad when I cut the umbilical cord with the help of the paramedics.

Homebirth midwives prepare their clients for the possibility of an unassisted birth, in the event that the midwife does not arrive in time. It would be useful for women if hospitals did this type of preparation too – I think it would save a lot of angst and concern from families who experience this.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Low milk supply? Maybe it’s something you ate.

Jun 15th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

Exposure to dioxins during pregnancy harms the cells in rapidly-changing breast tissue, which may explain why some women have trouble breastfeeding or don’t produce enough milk …

Researchers believe their findings, although only demonstrated in mice at this point, begin to address an area of health that impacts millions of women but has received little attention in the laboratory …

“Estimates are that three to six million mothers worldwide are either unable to initiate breastfeeding or are unable to produce enough milk to nourish their infants,” Lawrence said. “But the cause of this problem is unclear, though it has been suggested that environmental contaminants might play a role. We showed definitively that a known and abundant pollutant has an adverse effect on the way mammary glands develop during pregnancy.”

Dioxins are generated mostly by the incineration of municipal and medical waste, especially certain plastics. Most people are exposed through diet. Dioxins get into the food supply when air emissions settle on farm fields and where livestock graze. Fish also ingest dioxins and related pollutants from contaminated waters. When humans take in dioxin – most often through meat, dairy products, fish and shellfish – the toxin settles in fatty tissues; natural elimination takes place very slowly. The typical human exposure is a daily low dose, which has been linked to possible impairment of the immune system and developing organs.

… researchers showed that dioxin has a profound effect on breast tissue by causing mammary cells to stop their natural cycle of proliferation as early as six days into pregnancy, and lasting through mid-pregnancy. In tissue samples from mice, exposure to dioxin caused a 50-percent decrease in new epithelial cells. This is important, Lawrence said, because mammary glands have a high rate of cell proliferation, especially during early to mid-pregnancy when the most rapid development of the mammary gland occurs.

Researchers also found that dioxin altered the induction of milk-producing genes, which occurs around the ninth day of pregnancy, and reduced the number of ductal branches and mature lobules in the mammary tissue.

… when exposure occurs very early in pregnancy but not later, … sometimes the mammary glands can partially recover from the cellular injury. However … it is irrelevant for humans, who cannot really control their exposure to dioxins …

“Our goal is not to find a safe window of exposure for humans, but to better understand how dioxins affect our health,” she said. “The best thing people who are concerned about this can do is think about what you eat and where your food comes from. We’re not suggesting that we all become vegans — but we hope this study raises awareness about how our food sources can increase the burden of pollutants in the body. Unfortunately, we have very little control over this, except perhaps through the legislative process.” …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Impact of Cesareans on Breastfeeding

Jun 14th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

Excerpted from “The Physical Impact of Cesareans,” Midwifery Today, Issue 88

One of the earliest family relationships we see strained by a cesarean is that of the mother and baby.

Jennifer Block says, “The most common reason why babies are not put to the breast within the first hour is the cesarean section; and cesarean babies are more likely to be given milk substitutes in the nursery while the mother is recovering.”

Mothers who have cesareans are less likely to breastfeed, for many reasons. Often mother and baby are separated, which means a delay in getting baby to breast. The mom is dealing with pain, fatigue, possibly stress, and even trauma. The incision itself causes the mom difficulty in finding a comfortable position in which to nurse. The baby may have respiratory issues.

… The State of the World’s Mothers report asserts that “Immediate breastfeeding is one of the most effective interventions for newborn survival.” I submit that, rather than an intervention, breastfeeding is the normal biological extension of pregnancy and childbirth. It also provides many advantages to mom and baby.

Breastfeeding provides the baby with good immune system protection, gut protection, protection against obesity and short- and long-term disease protection. Breastfeeding also helps the mom. Her uterus returns to normal size more quickly after birth if she breastfeeds. She is less likely to experience postpartum depression. She is less likely to have brittle bones later in life.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Extreme Prems

Jun 14th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

Medical science is increasingly confronting parents with an incredibly tough decision – what to do if a baby arrives extremely prematurely?

Advances in neonatal intensive care mean more, very premature babies are being kept alive … 250 children are born in Australia every year after just 24 weeks in the womb.

Up to half … now survived beyond three days … but their longer-term prognosis was usually not good and a majority faced a life of severe mental and physical disability.

“We’ve got this amazing technology, but there has been little improvement in the outcomes for these babies,” says Dr Green, adding they often face several disabilities including blindness and severe cerebral palsy.

“Some families are willing to take on everything, and that’s fantastic, but some families are not – it’s all about informed decisions.

“It would be the hardest decision they would make in their life.”

In late 2006, a consensus statement was issued … which states in the “grey zone between 23 weeks and 25 weeks and six days gestation … it is acceptable … not to initiate intensive care … if parents so wish after appropriate counselling”.

There is otherwise no law requiring these babies to be resuscitated and treated, and parents can opt to not do so.

… media reports of “miracle babies” often focused solely on survival without including details of long-term disability, which could unfairly inflate the expectations of parents.

… advances in intensive care would continue to improve the ability of doctors to keep these children alive.

Yet this did little to account for the weeks of development these babies had lost by not going even close to full term …

Melissa Maimann, Essential Birth Consulting 0400 418 448

YouTube Births?

Jun 13th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

By her eighth month of pregnancy, Rebecca Sloan, a 35-year-old biologist … had read the what-to-expect books, taken the childbirth classes, joined the mommy chat rooms and still had no idea what she was in for. So, like countless expectant mothers before her, Ms. Sloan typed “childbirth” into YouTube’s search engine. Up popped thousands of videos, showing everything from women giving birth under hypnosis, to Caesarean sections, to births in bathtubs.

“I just wanted to see the whole thing,” Ms. Sloan said. And see it she did, compliments of women like Sarah Griffith … who, when she gave birth … invited her closest friends to join her. One operated the camera … the baby’s crowning head and his first cries. Afterward, Ms. Griffith posted an hour of footage on YouTube …

“Childbirth is beautiful, and I’m not a private person,” Ms. Griffith said.
Mom-and-pop directors like Ms. Griffith think of their home movies as a way to demystify childbirth by showing other women … candid images they might not otherwise see until their contractions begin.

… At first Ms. Sloan says she felt timid watching. She remembers one video … in which the man embraced the woman gently from behind while she crouched and swayed. Soon, Ms. Sloan was in tears. “It was really moving,” she said. “The videos are so unsensational, they’re largely unedited and people aren’t making money off of their videos. And so the purpose seems very genuine.”

Women logging onto YouTube to watch birth is a natural inclination, said Eugene Declercq, a professor at the Boston University School of Public Health. “A hundred and fifty years ago women viewed birth on a pretty regular basis — they saw their sisters or neighbors giving birth,” … it wasn’t until the late 19th century that birthing moved out of living rooms and bedrooms and into hospitals. “But now, with YouTube, we’ve come back around and women have this opportunity to view births again.”

Every day Ms. Griffith signs into YouTube to answer comments and questions … in response to her videos of Bastian’s birth. … her comments section breaks down like this: excited and apprehensive moms-to-be; a few comments so obscene she refuses to post them; and lastly, comments from those Ms. Griffith calls “repetitive guys.” “They’re always like, ‘Whoa, I’m so glad I’m not a woman,’ ” she said.
Ms. Griffith’s footage is difficult to watch. Bastian weighed almost 11 pounds at birth, and she did not edit out the close-ups, the screaming, groaning and cussing. “My goal is not to scare anybody,” she said. “But if someone is pregnant and they haven’t wrapped their head around the fact that there is pain involved, then they might want to start.”

… Childbirth videos have been screened at birthing classes since the 1970s. But those videos tend to be highly edited, and they can be dated … YouTube videos could change the way classes are taught … “This creates a wonderful opportunity to show free, real life, candid videos in a classroom setting.”

The majority of childbirth videos on YouTube are home births, recorded inside living rooms, bedrooms or bathtubs. In the United States, many hospitals and doctors forbid patients to record births because of liability concerns, so few American hospital birth videos appear on YouTube.

The thousands of online childbirth videos, garrulous mommy chat rooms and endless pregnancy blogs are changing the dynamic between pregnant women and their attendant medical professionals.
“The more information you have, the more sources you have, the more informed you are, the better questions you ask,” said Eileen Ehudin Beard, an adviser for the 6,500-member American College of Nurse-Midwives …

Providence Hogan insists she is “not a YouTube person.” Still, Ms. Hogan … has been logging long hours watching birthing videos in preparation for the August arrival of her second child. If Ms. Hogan’s birth goes as planned (at home in a birthing tub), she intends to have her 7-year-old daughter, Sophia, present. After prescreening videos on YouTube and another site, birthvideos.tk, Ms. Hogan started showing Sophia the less graphic ones.

“At first she was like, ‘That’s weird, that’s ugly,’ ” said Ms. Hogan of her daughter’s response. “Now it’s ‘Oh, what a cute baby!’

Melissa Maimann, Essential Birth Consulting 0400 418 448

Breastfeeding: good for baby’s immunity

Jun 13th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

Excerpted from “C-sections, Breastfeeding and Bugs for Your Baby: What the doctor probably won’t tell you,” Midwifery Today, Issue 79

Breastfeeding newborns, like the evolutionary process of vaginal birth, is about bacteria. The breast milk of a human mother, like other mammalian mothers, is species-specific, having been adapted over eons to deliver specific and sufficient nutrition to guarantee proper growth, health, and immunity development. Researchers have long known that breastfed babies possess an intestinal flora that is measurably different than formula-fed infants. Of specific interest is a group of bacteria known as bifidobacterium. … These are probiotics.

Studies have shown that at one month of age, both breastfed and formula-fed infants possess bifidobacterium, but population densities in bottle-fed infants is one-tenth that of breastfed infants. The presence of a healthy and robust population of bifidobacterium throughout the first year or two of life contributes significantly to the child’s resistance to infection and overall development of defense systems—not to mention the physical development of the intestinal system in general. Aside from the substances secreted by these specific bacteria that are known to inhibit the growth of pathogenic bacteria, they also work to make the intestinal environment of the infant more acidic, creating an additional barrier against invading pathogens. In short, breastfed babies are sick less, are less fussy, have fewer and shorter duration of bouts of diarrhea, and have more frequent—and softer—bowel movements.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Risk of stillbirth ‘tripled for women who have their babies at home’

For further information, contact Melissa Maimann at Essential Birth Consulting.

Women who give birth at home with an independent midwife are nearly three times more likely to have a stillbirth than those who give birth in hospital, a study has found.

Many women at high risk of complications choose to give birth outside hospital because the NHS cannot offer the kind of birth they want.

The researchers urged a review of why more babies were stillborn or dying soon after a birth overseen by an independent midwife, but pointed out that many outcomes were “significantly better” for those who gave birth outside the NHS.

For women at low risk of complications, giving birth at home could be as safe as doing so in hospital, they added.

Only 3 per cent of women give birth at home but the Government has pledged to offer women a choice of where and how they give birth by the year’s end.

Campaigners said that the NHS was letting down thousands of women who had to employ an independent midwife because the health service could not offer them a “natural” home birth without painkillers or other medical interventions.

Other women who chose an independent midwife had had a bad experience on the NHS, raising concerns about the quality of childbirth for some women who feel afraid to use the health service again.

Medical leaders say that the health service is unable to provide more home births due to shortages of midwives despite Government promises and the fact that home births could save the NHS money and provide a more natural experience for around 60 per cent of women at low risk of complications.

A report by the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives estimated that if women had “true choice”, between 8-10 per cent of births would be at home. The study, by the University of Dundee, analysed the records of more than 8,600 women who gave birth in Scotland between 2002 and 2005. These included 1,462 who gave birth assisted by a member of the Independent Midwives Association (IMA), and another 7,214 who gave birth on the NHS.

… Nearly nine out of ten women in the IMA group, said they wanted to give birth at home, and two thirds did so. But the researchers noted that women who chose a birth with an IMA member were more likely to have had pre-existing conditions, such as blood pressure or diabetes, or previous obstetric complications.

The risk of stillbirth or neonatal death (within 28 days of birth) was 1.7 per cent in the IMA group compared with 0.6 per cent in those giving birth in the NHS. Once high-risk women were excluded from both groups, the difference — 0.5 per cent versus 0.3 per cent — was not statistically significant.

… Belinda Phipps, chief executive of the National Childbirth Trust, said that many women who opted to pay for an indpendent midwife did so because they wanted “a home birth, or at least a more homely birth”.

“Women at high-risk of complications are still entitled to choose a home birth and I think we have to ask why they are made to feel that their only option is to turn away from the health service.”

Dr Maggie Blott, spokeswoman for the RCOG, said she was not surprised by the higher mortality rate among the IMA group. “Women with an increased risk of complications should be delivered in hospital where obstetricians can spot those complications,” she added. “Independent midwives should not be agreeing to deliver women who are high-risk at home.”

Aaahhh, the debate around high risk home birth and who should decide if it should happen. Should doctors decide where a woman births? By definisition, high risk birth is outside the scope of a midwife’s practice. Maybe midwives should not be taking such women on for home births as it might appear that we’re practicing obstetrics without a license. But where does that leave women? Although this is from the UK, the situation is the same here, except that publicly-funded homebirth is not available in most parts of the country. For the most part, if you want to have a home birth, you need to employ a homebirth midwife (private / independent).

I’d like to say it’s up to the woman to choose where and with whom she births her baby. It’s her body and her baby. But I’d also like to see hospitals providing woman-centered care to women who are “high risk”, and I see this as being possible with private midwifery for hospital birth. It will be a reality after nov 2010, but even now it is possible if the woman wants it to work this way. In my experience, it has worked well. It allows women to labour on their terms, with private midwifery care, and in a safe environment.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Woman gives birth on motorway after being sent home by hospital

For further information, contact Melissa Maimann at Essential Birth Consulting.

A woman gave birth in a car as it drove along a motorway after being sent home twice that day by a hospital because she wasn’t ready.

Rebecca Longley, 20, delivered Aaliyah herself as boyfriend Andrew Mildenhall tried to stay focused on the road ahead.

The couple had first gone to the hospital that morning and then again in the evening but were told both times that Miss Longley wasn’t ready to give birth.

Ten minutes later the couple decided to take matters into their own hands and head back to the Royal Hampshire County Hospital, in Winchester, Hants.

But before they got there Miss Langley went into labour and gave birth to 6lb 1oz baby girl Aaliyah on the front passenger seat on the M3 motorway.

The couple have now called on the hospital to review its admissions procedures.

Miss Longley, from Hamble, Hants, said: “I really had no idea what to expect because it was my first child. I had a real mix of emotions.

… “I had no drugs and I was screaming with pain but my natural instincts kicked in as soon as I saw the baby’s head pop out.

“I just knew what I had to do.”

Miss Longley and Mr Mildenhall, 21, first visited the Royal Hampshire County Hospital at 7am but were turned away.

They tried again at 8pm but were met with the same response.

Two hours later she phoned the hospital’s maternity ward and said that her waters had broken but she was told to stay at home.

Aaliyah made her entrance just before 10.30pm as Mr Mildenhall drove along the motorway …

A hospital spokesman confirmed that Miss Longley was sent home twice but said that the advice was given because of the slow progress of her labour.

… “We would describe Rebecca’s labour as totally natural, albeit rapid once it had begun.”

Why not stay home? As a healthy woman, a midwife-attended home birth would have been far safer than a motorway birth. The experience might have been terrifying for this woman who had been told she was not in labour and to stay home. How would the experience had been if she had been able to call her midwife out to her home, be assessed, maybe the midwife would have gone home, and then when the woman felt her labour had progressed more, the midwife could have come back out and stayed with her?

Melissa Maimann, Essential Birth Consulting 0400 418 448

High blood pressure in pregnancy increases the risk for Type 2 diabetes and hypertension

For further information, contact Melissa Maimann at Essential Birth Consulting.

Researchers have found that women with hypertensive pregnancy disorders have an increased risk for subsequent Type 2 diabetes mellitus and hypertension.

… the researchers found that gestational hypertension, and mild, and severe pre-eclampsia increased the risk for subsequent hypertension 5.31-, 3.61, and 6.07-fold, respectively.

Similarly, women who had gestational hypertension and severe pre-eclampsia had a 3.12- and 3.68-fold increased risk for Type 2 diabetes, respectively.

The authors also found that women who had two pregnancies complicated by pre-eclampsia had an increased risk for subsequent hypertension compared with those who presented with the complication in their first or second pregnancy only (hazard ratio = 6.00 vs 2.70 and 4.34).

Does a history of high blood pressure in a previous pregnancy rule out planning a home birth? No. Your midwife will monitor your blood pressure and advise ways in which your blood pressure can be lowered. Not all women will go on to develop high blood pressure in a subsequent pregnancy and it is perfectly reasonable to plan a home birth with a hospital birth back-up plan in place. In the event that you need to transfer to hospital, your private midwife will remain with you. Obstetric care can be arranged through your midwife if it is needed.

Melissa Maimann, Essential Birth Consulting 0400 418 448

VBAC safer for elective repeat caesarean

For further information on VBAC or natural birth, contact Melissa Maimann at Essential Birth Consulting.

Ref: Obstet Gynecol. 2009;113:1231-1238.

Babies born after elective subsequent cesarean delivery have significantly higher rates of respiratory morbidity and neonatal intensive care unit (NICU) admission and longer length of hospital stay vs those with vaginal birth after cesarean (VBAC) …

“Controversy remains on whether a trial of labor or an elective repeat cesarean delivery is preferable for a woman with a history of cesarean delivery,” write Beena D. Kamath, MD, MPH …

… concerns regarding the increased risk of uterine rupture and perinatal asphyxia in trial of labor after cesarean compared with planned repeat cesarean have swayed obstetricians away from recommending a trial of labor after cesarean delivery; however, the absolute risk of perinatal asphyxia remains small.”

The goals of this study were to compare the outcomes of neonates born by elective subsequent cesarean delivery vs VBAC in women with 1 previous cesarean delivery and to compare the cost differences between these procedures. The study cohort consisted of 672 women with 1 previous cesarean delivery and a singleton pregnancy at or after 37 weeks of gestation. Participants were categorized based on their intention to have an elective subsequent cesarean delivery or a VBAC, whether successful or failed. The main endpoints of the study were NICU admission and measures of respiratory morbidity.

Compared with the VBAC group, neonates born by cesarean delivery had higher NICU admission rates (9.3% vs 4.9%; P = .025). Rates of oxygen supplementation were also higher in the subsequent cesarean group for delivery room resuscitation (41.5% vs 23.2%; P < .01) and after NICU admission (5.8% vs 2.4%; P < .028). The rates of delivery room resuscitation with oxygen were lowest in neonates born by VBAC and highest in neonates delivered after failed VBAC.

Although the costs of elective subsequent cesarean delivery were significantly higher vs VBAC, the highest costs for the total birth experience were for failed VBAC, considering both delivery and NICU use.

"In comparison with vaginal birth after cesarean, neonates born after elective repeat cesarean delivery have significantly higher rates of respiratory morbidity and NICU-admission and longer length of hospital stay," the study authors write.

... this argues for greater selectivity in performing a cesarean delivery in the first place, and certainly a greater need for counseling before a primary elective cesarean delivery.

Melissa Maimann, Essential Birth Consulting 0400 418 448

NSW Maternity hospitals overcrowded. Stay home.

Jun 11th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

AUSTRALIA is delivering record numbers of babies, despite losing a sixth of its public hospital maternity wards over the past decade.

Despite rising fertility rates and population growth, the number of obstetric and maternity services offered by state-run acute-care hospitals has plummeted from 298 in 2000-01 to 248 in 2007-08.

Neonatal intensive care and specialist pediatric services have also become scarcer in the public sector at a time when most other specialist units grew in number.

The Australian Institute of Health and Welfare data shows the bush suffered the steepest decline in maternity services, with medical workforce shortages and low volumes of births speeding closures.

… Justine Caines, a member of the Maternity Coalition executive, said state health services had been too quick to use obstetrician shortages as an excuse to abandon local maternity units, arguing midwives could provide substitute services if current rules were relaxed.

… “Why has this been allowed to happen when the midwifery workforce has been there forever, willing and able and yet prevented from practice by funding arrangements?” she said.

… Australia is expected to register almost 300,000 births in 2008, surpassing the previous record of 287,000 in 2007.

… Queensland cut the deepest into its maternity services this decade, slashing 22 obstetric units and 16 specialist pediatric services …

Victoria lost 11 obstetrics and two neonatal intensive care units, while NSW closed down nine maternity units.

… The federal government’s $120 million budget package for maternity services, which boosted the role of midwives, would allow more creative ways of returning services closer to women’s homes, she said.

Thankfully, overcrowding and lack of care providers is not a problem when you plan a home birth. You will always have a room and a bed, even if you book in late …. you even have your own bathroom, kitchen and living room. I hear the food is better there too!

Melissa Maimann, Essential Birth Consulting 0400 418 448

Breastfeeding Reduces Postpartum MS Relapses

Jun 11th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

Women with multiple sclerosis had a 60% reduction in postpartum relapses when they breastfed exclusively for at least two months after giving birth …

… Note that the study involved a small number of patients.
Exclusive breastfeeding also was associated with a significantly later return of menses, and lactation-associated amenorrhea had a significant association with fewer postpartum relapses …

“Our findings call into question the benefit of forgoing breastfeeding to start MS therapies and should be confirmed in a larger study,” Annette Langer-Gould, M.D., Ph.D., of Stanford University, and colleagues concluded.

Immunomodulatory drugs used to treat MS are not recommended for use during pregnancy or lactation, and the effect of the drugs on postpartum relapses has never been studied. As a result, patients have to choose between nursing and resuming treatment, neither of which has clear supporting evidence, the authors said.

Previous studies of breastfeeding and postpartum relapse found little or no benefit, but none examined exclusive breastfeeding.

… The authors reported that 20 of 29 MS patients (69%) breastfed compared with 27 of 28 (96%) women in the control group. Eleven of 20 MS patients cited resumption of MS therapy as the primary reason for forgoing breastfeeding or early initiation of formula feeding.

A total of 14 of the 29 MS patients breastfed exclusively for at least two months postpartum, and five (36%) had postpartum relapses of MS. In contrast, 13 of the 15 (87%) women who did not breastfeed exclusively had one or more postpartum relapses.

The difference translated into an adjusted hazard ratio for relapse of 7.1 for women who did not breastfeed exclusively (95% CI 2.1 to 24.3, P=0.002).

… Median time to return of menses was 5.9 months postpartum with exclusive breastfeeding versus 2.2 months (P=0.001), and lactational amenorrhea significantly reduced the risk of MS relapse (P=0.01).

“Our findings suggest that women with MS should be encouraged to breastfeed exclusively for at least the first two months postpartum in lieu of starting immunomodulatory treatment shortly after deliver,” the authors concluded.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Choices for Childbirth: Are women being sidelined again?

Jun 11th, 2009

For further information about childbirth choices, contact Melissa Maimann at Essential Birth Consulting.

The current statistics around birth experience in Australia reflect a culture of inappropriate medical management of the natural process of most births. Data released by the Federal Health Minister, the Hon Nicola Roxon states that public hospitals produce a 27.1 percent caesarean section rate while private hospitals boast an astounding rate of 40.3 percent. The World Health Organization (WHO) states that the caesarean rate should be around 10-15%. So why do we, in Australia have the highest rate of medical intervention in the OECD, more than double recommended by WHO?

Using maternal and neonatal deaths as the only measure, Australia is one of the safest places to have a baby. While some attribute this to the high rates of medical intervention, they fail to include other factors that can be used to measure quality of birth outcomes. In fact increased medical intervention often leads to difficulties breastfeeding, reduced ability to bond with baby, post natal depression … and dissatisfaction with the birth experience. The impact of a negative birth experience … can deeply affect the mother’s ability and confidence in early parenting.

However, because these cannot be measured quantitatively, they don’t “count” as much as stats around mortality and morbidity. Yes, Australia is one of the safest countries in the world to have a baby. But not when you use more qualitative measures. Our dissatisfaction with the current delivery of maternity services as evidence in the recent Maternity Services Review adds strength to the push for midwifery services that recognise women as people. I read several of the submissions. Now all, but many. And I did not read one submission from a woman who had recieved private obstetric care and wished that all women had that option. Yet I read many, many submissions from women who had benefited from private midwifery care and wished that it was an option for more women.

In 2008, the Rudd Government initiated the, ‘Improving Maternity Services in Australia Review’. Its aim was to assess the current maternity care system and receive suggestions on how it can be improved. It stated, ‘we must recognise that pregnancy and childbirth, while requiring quick and highly specialised responses to complications, are normal physiological processes, not an illness or disease.’

… Based on the information collected through the review, the Health Minister has made recommendations clearly in support of enhancing midwifery care in the public health system.

The recent release of the budget includes access to Medicare and the Pharmaceutical Benefits Scheme to eligible midwives working in private practice as well as ‘subsidised medical indemnity for eligible midwives working in collaborative arrangements in hospitals and healthcare settings.’ It is still unclear however, how eligibility will be measured and to what extent midwifery fees will be subsidized.

The successful implementation of this budget policy would ensure the provision of true continuity of carer, where a woman chooses her midwife and that midwife cares for her throughout her pregnancy, birth and post natal period.

It does however fall short of providing the option to birth at home. While a woman will be able to claim a Medicare rebate from a privately practicing midwife for all ante-natal and post-natal care, she will not be able to make a claim for services provided during a planned homebirth. In order to be financially supported by the government, a woman must birth in a hospital or birth centre.

… The Rudd government’s neglect in providing options for homebirth is discriminatory and fails to meet acceptable standards of duty of care for all Australian women. It puts both mother and baby at undue risk.

It would appear that according to our government it is acceptable to opt for an elective caesarian, in the absence of medical needs, but to experience a safe, intervention free birth, in the comfort and safety of your own home cannot be socially supported.

It remains to be seen whether or not the recommendations made by Nicola Roxon actually reach ground level of maternity services … Hopefully, she can show true leadership by honouring the choice made by many women and their families to birth at home.

The finer details of insurance and funding have not been determined at the time of this posting. Most likely, private midwifery for home birth will continue to remain an option, albeit unfunded and uninsured. Although it may be seen as discriminatory for the govt to fund most – but not all – birth choices, does the govt have a duty to do so? I thought the govt had a responsibility to provide a basic and safe level of maternity care. The changes that are proposed in the MSR will allow women to access contiuity of midwifery care for hospital birth and this represents a significant improvement on our current (woeful) services.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Multivitamins in Pregnancy Ward Off Low Birth Weight

Jun 10th, 2009

For further information about nutrition in pregnancy, contact Melissa Maimann at Essential Birth Consulting.

Multivitamin supplementation during pregnancy may improve a baby’s birth weight more than iron-folic acid supplementation alone …

In an analysis of 13 studies, women who received a multivitamin had a 17% greater reduction in the risk of having a baby with low birth weight (RR 0.83 …)

… Overall birth weight was significantly higher in the multivitamin group than in the iron-folic acid group (difference 54 g), but there was no significant difference compared with placebo.

There were no significant differences between the three study groups in the risk of preterm birth, small-for-gestational-age birth, or gestational age.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Medical Indemnity and Birth

Jun 10th, 2009

For further information about homebirth, contact Melissa Maimann at Essential Birth Consulting.

Many still believe that the reduction of maternity services is a result of sky-rocketing insurance premiums directly impacting practitioners; a direct result of an over-litigious society …

… despite hundreds of millions of dollars in rescue money to Australia’s medical profession, not one cent has been afforded to midwives.

Many know the collapse of medical/professional indemnity was largely a result of global factors, namely the demise of large re-insurers after September 11, 2001. Interestingly, the decision by Guild insurance to no longer offer a policy to midwives happened before this. Their reasoning, that the midwifery pool was too small, was justifiable. The fear of a major payout for catastrophic birth injury proved correct. In November 2001 the NSW Supreme Court awarded Calandre Simpson, an infant born at St Margaret’s Private Hospital with cerebral palsy, … eleven million dollars for the overdose of syntocinon, which caused her birth defects … This payout assisted in the collapse of Australia’s largest medical indemnity organisation …

Of particular importance is the hospital ‘care’ received by Calandre’s mother. It was proven that she was given an overdose of syntocinon (as part of an induction), five attempts at forceps were tried and finally caesarean section before Calandre was born with severe cerebral palsy. It was concluded that the syntocinon overdose, resulting in atonic uterus, could have caused the cerebral palsy, before the attempted forceps delivery.

… it is prudent to note that the Simpson family had considerable financial resources … This enabled them to fund a nine-year legal battle. It also contributed to the high cost of the claim …

The other interesting point is that although this case essentially toppled the medical indemnity industry, little has been learnt. Whilst the practice of performing a caesarean section rather than forceps is likely to have increased; the incidence of syntocinon use has not reduced. [about 50% women receive syntocinon to induce or augment labour - in some facilities, this is as high as 80%]. … obstetric practice has largely remained unchanged.

… the Ipp Report of 2002 made recommendations for considerable Tort Law reform (the law governing personal injury negligence). Part of this reform was to … implement a modified version of the ‘Bolam Test’. In at least NSW and QLD:
‘The standard of care will be that determined by the court with guidance from evidence of acceptable professional practice unless it is established (in practice, by the defendant) that the defendant acted according to professional practice widely accepted by (rational) peer professional opinion.’

Considering the majority of obstetricians engage in practices that are not based on evidence, this is deeply concerning. …. [For example] The evidence regarding episiotomy effectiveness would assist a consumer in mounting a claim. Under the ‘Modified Bolam Test’, however, if the subject practitioner gathered other specialists who agreed they would also perform an episiotomy, the injured woman could be unsuccessful.

In response, the Australian Plaintiff Lawyers Association stated in a submission to government ‘APLA is concerned that doctors already hold a privileged position in our society and are treated differently to other groups, including other professions. Patients’ rights should not be compromised for the sake of doctors’ hip pockets.’

… the Australian public … still believe that the reduction of maternity services is a result of sky-rocketing insurance premiums directly impacting practitioners; a direct result of an over-litigious society. This could not be further from the truth. Medical practitioners have been very well protected, whilst consumer rights have shrunk and the continuation of a totally anti-competitive maternity health system has resulted in a reduction of services …

… The most obvious outcome of the refusal by both the federal and state governments to assist with midwives’ indemnity insurance has been a great reduction in the numbers of privately practicing midwives. Alongside this very few private health funds provide a midwifery/homebirth benefit. Of those who do, most do not provide a benefit on par with obstetric pay-outs.

The advent of the Bachelor of Midwifery was very positive. Practical experience however has been severely restricted. Students are unable to gain experience with homebirth midwives, rather they experience the highly interventionist ‘system’. It would seem the theory of educating a midwife to work in continuity and community models is of little use when the majority of students are unable to complement this learning in practice.

Access to Medicare provider numbers … is impossible without indemnity. There is however no impediment for the Rudd Government to include midwives in the PSS, only fear from the backlash from some obstetricians. … [as evidence by statements from the recent Maternity Services Review]

Women’s choice is only acceptable if it is palatable to those who control maternity services, the powerful medical lobby.

If Minister Roxon was to facilitate indemnity cover and funding for midwives this would demonstrate a fundamental commitment to maternity reform. It would also enable midwives to take their rightful place as the expert in normal birth.

Consumers have again been silenced in this debate …

Interestingly the rights of Australian women choosing private midwifery don’t have the same value as those women choosing the services of a specialist obstetrician or a procedural G.P. When I challenged the legal branch of NSW Health with this comment I was greeted with silence.

Indemnity insurance will be compulsory from July 2010 … And midwives are still denied any support. Taxpayers have now funded close to $900 million in indemnity support for medical practitioners. Considering the facts of the Calandre Simpson case one has to ask why the Government continues to back such a ‘risky horse’.

Another contentious issue that has surfaced since the loss of indemnity insurance is the establishment of public funded homebirth services. Whilst my socialist heart leaps for joy that women can access the care of a known midwife and the option of homebirth without cost, fundamentally these programs are flawed. They all exist with rigid guidelines and on the back of the benevolence and goodwill of obstetricians. Some of these individuals are truly wonderful and their practice most progressive.

The premise, however, that midwifery practice can only exist on the say so of the medical establishment is dangerous.

Private midwifery services do not exist under the medical establishment: they exist completely outside of the “system”: a very attractive feature for the women who seek such services.

Surely the central tenant of midwifery reform is to establish a midwifery scope of practice that enshrines the appropriateness of midwifery care based on education and registration. It must also enforce the very heart of midwifery, ‘being with woman’ and as such the relationship between a woman and midwife. This, in turn, would help establish the rights of women to make choices around how, where and by who their bodies’ are/or are not handled.

Whilst the catastrophic birth injury of Calandre Simpson is tragic, the impact of her court outcome has not been critically analysed. The whirlwind of risk management and defensive practice that has followed was not justified. Calandre Simpson was a ‘veritable needle in a haystack’ — a terribly injured person as a result of negligence, from a family of considerable means able to fund expensive litigation. Instead of looking at what constitutes negligent practice and rewarding its reduction, the federal government chose to remove the rights of consumers, protect the pay packets of medical practitioners, deny midwives their rightful practice and support on-going dangerous procedures.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Rights and Responsibilities: Where did they Go?

Jun 9th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

Feminism is a dirty word, especially if you are a pro-establishment columnist. Recently, the mass media have spurned the safety of homebirth. Doctors were outraged at the death of four babies, without revealing any case facts … Not one mainstream piece has explored why a number of women feel the need to give birth without any health professional, nor have they explored simple tested legal concepts of informed consent and right of refusal. It would seem far more sensible to herd all women into hospitals where they can be controlled. Women cannot be trusted, especially those who challenge the fierce medical domination of childbirth.

As an owner of a female body I have taken it for a test run seven times. I have chosen to use limited medical technologies … I took ultimate control of my body and became responsible for the life growing within me … I paid a price however. My decision to give birth at home with a registered midwife was not respected or funded. At the same time my taxes paid for a system controlled by medicine—a system with virtually no accountability, that allegedly enabled gross sexual assault under Dr Graeme Reeves. These assaults were extreme but lower level violence continues in maternity wards every day …

With this environment how could a woman previously damaged by the system feel safe? We have a maternity health system that leaves one in four women experiencing birth as a ‘battlefield’ and suffering debilitating post natal depression or even post-traumatic stress disorder, usually reserved for soldiers and victims of crime. Whilst women cry out for a mainstream midwifery option that puts their needs first, the medical establishment remains largely unaccountable.

Federal Health Minister, Nicola Roxon put her toe in the water, by announcing the Maternity Services Review last September. As expected the women who have been denied their rights and are funding others …

While acknowledging it is a preference for some women, the Review Team does not propose Commonwealth funding of homebirths as a mainstream option for maternity care at this time.

The Review also considers that moving prematurely to a mainstream private model of care incorporating homebirthing risks polarising the professions rather than allowing the expansion of collaborative approaches to improving choice and services for Australian women and their babies.

As a woman and lawyer, Nicola Roxon is well placed to oversee the design of a maternity system with the established principles of informed consent and right of refusal at the centre. Arguments of safety and wellbeing are thin guises of tightly held power and control by medical lobby groups …

I attended a roundtable meeting of key stakeholders as part of the Maternity Service Review last year. The topic discussed was ‘high-risk pregnancy’. … many women and babies are classified as ‘high-risk’ by an obstetric community that is largely dogged by fear and distrusts women and women’s bodies.

My conclusion was sadly confirmed at the roundtable meeting, when a senior obstetrician said without hesitation that he ‘would be loathed to think a woman would have the final say in her care.’ … As a consumer, passionate about the rights of women to make informed choices, I believe the paternalism that pervades obstetrics and the widespread midwifery practice of maintaining the status quo pose a major threat to reform.

This view is in direct contradiction to common law in Australia. Kim Forrester, a member of the Queensland Bar states, ‘all adults who are of sound mind and considered legally competent have an absolute right to consent, or refuse to consent, to medical intervention and/or treatment. This is the case regardless of the opinion of health professionals as to what is in the “best interests” of the patient or client.’

… A US appeal case heard in 1914 made a landmark decision still quoted today: Schloendorff v Society of New York Hospital, clearly articulates, ‘Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without the patient’s consent, commits an assault.’

The culture of fear and control in obstetrics has enabled these legal principles to be ignored. Women are consistently misled about procedures performed on them. Ironically most women are grateful and believe that either their own or their baby’s life was saved, often after an unnecessary intervention.

Obstetric dominance pervades midwifery. Virtually all models operate with exclusion criteria that are not based on evidence. A woman with a previous caesarean section is unable to give birth in a bath in a birth centre with a midwife sometimes only seconds from operating theatres. Her safety can only be assured in a ‘labour ward’ sometimes only metres away from the birth centre. The capacity for a healthy woman to deliver her placenta without oxytocics is doubted and feared …

The birth reform process is likely to bring with it guiding principles. The Australian College of Midwives developed guidelines for establishing midwifery models. The recent second edition was mindful of the need to enshrine informed consent and right of refusal. They state:

Ethical principles underlying health care and health law emphasize the importance of respecting the autonomy of those receiving health care and the rights of individuals to choose among alternative approaches, weighing risks and benefits according to their needs and values. Midwives, like all health professionals, are responsible for being clear about their scope of practice and limitations, giving recommendations for care if appropriate and for informing women about risks, benefits and alternative approaches.

Should a situation arise in which the woman chooses care outside the recommendations in the Guidelines the midwife must engage with the woman and her family and with hospital staff through identified channels where applicable, in a thorough discussion of the request, looking for options

The Royal Australian New Zealand College of Obstetricians and Gynaecologists (RANZCOG) do not accept these guidelines … they have released their own guidelines …

It would seem that unless a woman conforms to obstetric dominance she is not informed. If this wasn’t so serious it would be funny.

For too long we have chanted that birth needs to come back to women. Now is the time to empower women with rights too often denied. How can we have a maternity system that largely treats women as incubators where emotional wellbeing is dissected from her uterine cavity; and yet come post-natal discharge the same woman walks out into the world to make major life decisions for her child for the next 16-18 years? As with maternity reform, empowering women will take time, but if the reform process respects the rights of midwives to practice a full scope of practice and that of women that determine how and by whom their bodies are handled (if at all) a true woman-centred approach is possible.

Neither the church nor the state has the right to control a woman’s body. Maternity reform must be based on the three R’s – rights, responsibilities and respect. Consumers have the right to a funded registered health professional in any setting, and the responsibility to demonstrate they have made informed decisions. They deserve these decisions be respected …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Governments Must Take ‘Concrete Action’ To Reduce Maternal Mortality, Morbidity

Jun 8th, 2009

For further information, contact Melissa Maimann at Essential Birth Consulting.

With the U.N. Human Rights Council’s June session coming up, governments have a “chance to prove that they value women’s lives by taking concrete action” to recognize “preventable maternal death as a violation of women’s rights,” …

Although “we know what is needed to save women’s lives” women are still dying or “left with lifelong, debilitating complications. Moreover, when mothers die, children are at greater risk of dropping out of school, becoming malnourished, and simply not surviving. Not only is maternal mortality and morbidity a global health emergency, but it triggers and aggravates cycles of poverty that cause generations of suffering and despair,” Robinson and Yamin write, adding that “saving women’s lives” would cost an estimated additional “$6 billion a year to be on track to achieve” the U.N. MDGs.

They write that “poor governments” will not “be blamed for not doing what they cannot do,” but asserting that these “preventable deaths are an issue of human rights” highlights the “profound injustice of disparities in maternal deaths” and makes it “more urgent that donor states honor their funding commitments.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

Fees for Private Midwifery

Jun 7th, 2009

Melissa Maimann, Essential Birth Consulting.

7 comments

For further information, contact Melissa Maimann at Essential Birth Consulting.

The International Definition of a Midwife, as accepted by FIGO, ACMI and the International Confederation of Midwives:

A midwife is a person who, having been regularly admitted to a midwifery educational programme, duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery.

The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical or other appropriate assistance and the carrying out of emergency measures.

The midwife has an important task in health counselling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and childcare.

A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units.

What is a Private / Independent Midwife?

A private (independent) midwife is employed by families, not hospitals. This is a very important distinction for you as a pregnant and birthing woman. As a consumer of midwifery services, having an independent midwife ensures that you have choice and control over your labour and birth.

Independent (private) midwives are accountable to their profession: to the Code of Conduct (ANMC), Code of Ethics (ANMC) and the Nurses and Midwives Board. However, we are not bound by hospital policy. We follow guidelines established by the Australian College of Midwives Inc (ACMI), in consultation with our clients and are guided by the needs of our clients.

Midwives are specialists in normal pregnancy and birth. The World Health Organisation (WHO) recognises midwives as being the most appropriate professionals for healthy pregnant and birthing women. Midwives are educated in all aspects of normal pregnancy, birth and postnatal care, and importantly, we are also educated in detecting complications and accessing obstetric care if needed.

As a private / independent midwife, I value the relationship I develop with you during your pregnancy. I like to spend time with you through your pregnancy so that you feel safe and comfortable with me at your birth. I focus on labour and birth preparation and childbirth education, ensuring that you approach your birth with confidence.

Why have midwifery care?

A recent study presented several advantages to midwifery care. The study was very large, involving 12,276 women. Women who had midwifery care were:

Less likely to be hospitalised during pregnancy
Less likely to have an epidural
Less likely to have an episiotomy
Less likely to require forceps or a ventouse birth

They were more likely to:

Have a normal vaginal birth
Feel in control during labour and birth
Breastfeed

You can have a home birth or a hospital birth with a private / independent midwife.

Fees

You can expect to pay between $4,000 and $5,000 for private midwifery care, whether you are having a home or hospital birth.

Why does it cost so much?

Fees for professional services reflect my qualifications, experience and commitment to you and your family.

I am not of the opinion that private midwifery is expensive. Please consider what other professionals and trades people charge for their services and their level of on-call commitment and responsibility.

Or, to look at it from another angle, how much money may you spend on a holiday? How much does a computer cost? And how long do these last you? Private midwifery is an investment in you and your baby, after all. And you deserve the very best.

Despite this view, some women ask me whether I will provide reduced services such as no postnatal care, one or two antenatal visits, a late booking, and so on, in order to reduce the cost. If I provided less care, I would not be able to maintain a safe record of care: either I would have to book double the number of clients each month (and risk missing your birth) or I may miss signs that things are not going well with your pregnancy or birth. All of this can compromise your care. I prefer to provide a comprehensive service and the women who book with me see the value in this approach. I am in the business of providing a premium service that is also the best value midwifery service in Sydney.

But …. if you want to know how the figures add up ….
Private midwifery consumes a whopping 86 hours of a midwife’s time. And that’s before we include:

On-call – 24 / 7 for 5 weeks around your due date
Phone and email consultations
Research
Administration time
Attending related appointments with clients
Professional consultation on the client’s behalf

Private midwifery services are comprehensive, and private midwives spend many hours with women and their families, building a strong relationship during the pregnancy that carries through to the birth and beyond. This provides an advantage to you during your birth – having a familiar face who knows you, your family, your wishes, your beliefs and so on. As you can see, the service provided by a private / independent midwife does not compare easily with other maternity services in terms of continuity of care, hours of contact, follow-up and availability. When you choose private midwifery, you are choosing gold standard service.

When midwives provide this level of service, it is impossible to book more than two or three clients each month. I could see women in a clinic setting for 30 minute appointments in business hours – that would eliminate travel time and consultation time – but I know that you’re after a service that really meets your needs.

Financial Hardship
I would rather you don’t let money be the deciding factor for getting the support you need. Call me to discuss a flexible arrangement.

Although I will never compromise on the high level of care that I provide, some areas of the service can be modified to reduce the price. I believe you will benefit from a service that gives you what you need, at the right price. Please note there is only one booking per month available to women who are experiencing genuine financial hardship.

Woman accused of posing as certified midwife

Jun 6th, 2009

2 comments

For further information, contact Melissa Maimann at Essential Birth Consulting.

… A Ventura woman is accused of falsely representing herself as a midwife to a woman who tried to give birth last year …

The woman’s baby was later delivered stillborn at a hospital …

Megan Marie Roy, 33, will be arraigned … on a felony count of unauthorized practice of medicine …

Roy was introduced to the pregnant woman through the woman’s actual midwife – who moved out of state before the delivery, prosecutors said.

Roy, who was not certified as a midwife, acted as one during the delivery …

The baby’s father called 911 after several hours of labor and signs of physical distress, authorities said.

Roy is out of custody on $50,000 bail. She faces up to three years in prison if convicted.

If you birth in hospital, you can be assured that the hospital has shecked the credentials of the midwife who is assigned to your care. If you are birthing with a privately-employed midwife, be sure to see a few documents before employing her services. These should include:
- CV
- Criminal Record Check / Police Check
- Working with Children Check
- Midwifery Registration
- Identification

If your midwife does not have all of these documents on her, or refuses to provide these, view her with suspicion and consider employing the services of another midwife. Your right to safety is paramount.

Midwifery is a protected profession in Australia, meaning it is illegal for one to act as a midwife or to use the title unless one is registered with the Midwifery board as a midwife. Use of the title, “midwife” implies that the person is a registered midwife. Lay midwifery is illegal in this country.

Melissa Maimann, Essential Birth Consulting 0400 418 448

The Truth about Hospital Birth: Why Hospital Is Not An Ideal Place for a Natural Birth

Jun 5th, 2009