Posted by Melissa Maimann on Jun 30, 2009 in
Home birth,
Midwifery For further information, contact Melissa Maimann at Essential Birth Consulting.
Link
A CORONER handing down findings into the death of a baby born at home has called on the Federal Government to rethink its refusal to indemnify private midwives outside hospitals, saying home births will be driven underground with “disastrous ramifications”.
In releasing his report on Jasper Kosch-Coyne, a newborn baby who died while being driven from his parents’ farm to Nimbin hospital two years ago, the Byron Bay coroner, Nick Reimer, said home-birthing was a mother’s inherent right and a practice “that will not go away”.
Last month the federal Health Minister, Nicola Roxon, announced that … indemnity insurance would not be extended to midwives attending home births.
“History has shown there will always be a small group of expectant mothers who will want to give birth in their home,” Mr Reimer said. “Birthing at home should be an available option.”
In an unusual move, he sent the Kosch-Coyne inquest findings to the federal and state health ministers, urging them to exercise “great care” in drafting legislation that would make home-birthing illegal.
The inquest found that baby Jasper died … after the midwife … failed to seek help when it was clear he could be swallowing meconium in the womb. [The midwife] had attended the birth on her own, had not organised transport in case of an emergency and did not transfer Jasper’s mother, Angel Kosch, to hospital before delivery even though she had requested it because her labour had become difficult and protracted. The inquest was told the baby’s heart rate was not monitored adequately and [the midwife] failed to call an ambulance when the baby was born breathing inadequately with the umbilical cord wrapped tightly around his neck.
She left Ms Kosch at home to deliver her placenta with no medical assistance while she travelled in a car to Nimbin hospital, performing cardio-pulmonary resuscitation on the baby in the front seat.
[The midwife] had asked a family member to administer an intramuscular injection to Ms Kosch if she began hemorrhaging. [the midwife] was cleared of responsibility for the tragedy because there had been a “series of shortcomings” and it was not possible to conclude any of them had contributed to Jasper’s death, Mr Reimer said.
… spokeswoman for the Australian College of Midwives, Hannah Dahlen, said such tragedies would become more commonplace if home-birthing was made illegal.
“Women have said they will have no option but to freebirth, midwives have said they will work so far underground no one will ever find them … and there will be a reluctance to transfer [a woman to hospital] when there is an emergency,” Ms Dahlen said.
“No country has ever been able to eradicate home-birthing. The system will simply become unchecked and dangerous.”
The secretary of Homebirth Australia … said more mothers and babies would die if home-birthing became illegal. “Women will continue to homebirth, but will do so without the assistance of a qualified professional … removing women’s rights to the point where we are back providing care in dark alleys or in back rooms, is ridiculous in 2009.”
Why does it take tragedies for the govt to be asked to see some sense?
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Home birth, Maternity Services Review, midwife, Midwifery, Midwifery services, women's rights
Posted by Melissa Maimann on Jun 30, 2009 in
Birth,
Obstetrics Link
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.
Tags: Babies, birth, Birth trauma, Caesarean, Complicated pregnancy or birth, hospital birth, intervention, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Jun 29, 2009 in
Birth,
Home birth,
Midwifery,
Obstetrics For further information, contact Melissa Maimann at Essential Birth Consulting.
Link
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
Tags: Birth choices, continuity of care, hospital birth, intervention, Maternity Services Review, midwife, Midwifery, Midwifery services, Obstetrics, Public and private hospitals, women's rights
Posted by Melissa Maimann on Jun 29, 2009 in
Birth For further information, contact Melissa Maimann at Essential Birth Consulting.
Link
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
Tags: Babies
Posted by Melissa Maimann on Jun 28, 2009 in
Obstetrics For further information, contact Melissa Maimann at Essential Birth Consulting.
Link
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
Tags: Complicated pregnancy or birth
Posted by Melissa Maimann on Jun 28, 2009 in
Birth,
Obstetrics For further information, contact Melissa Maimann at Essential Birth Consulting.
Link
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
Tags: Caesarean, Complicated pregnancy or birth, hospital birth, intervention, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Jun 27, 2009 in
Caesarean For further information, contact Melissa Maimann at Essential Birth Consulting.
Link
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
Tags: Caesarean, hospital birth, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Jun 26, 2009 in
Birth,
Midwifery Link
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 …
Tags: Birth choices, continuity of care, hospital birth, Maternity Services Review, midwife, Midwifery, Midwifery services, Obstetrics, Public and private hospitals, women's rights
Posted by Melissa Maimann on Jun 26, 2009 in
Birth,
Midwifery For further information, contact Melissa Maimann at Essential Birth Consulting.
Link
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
Tags: Babies, Breastfeeding
Posted by Melissa Maimann on Jun 25, 2009 in
Home birth,
Midwifery Link
… 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?
Tags: Birth choices, freebirth, Home birth, Maternity Services Review, Midwifery, Midwifery services, women's rights