Posted by Melissa Maimann on Jun 11, 2009 in
Birth,
Home birth,
Midwifery,
Normal Birth,
Obstetrics For further information, contact Melissa Maimann at Essential Birth Consulting.
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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
Tags: birth, Birth choices, continuity of care, Home birth, hospital birth, Maternity Services Review, midwife, Midwifery, Midwifery services, Normal Birth, Obstetrics, Public and private hospitals, women's rights
Posted by Melissa Maimann on Jun 11, 2009 in
Birth,
Midwifery,
Obstetrics For further information, contact Melissa Maimann at Essential Birth Consulting.
Article
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
Tags: Babies, Breastfeeding
Posted by Melissa Maimann on Jun 11, 2009 in
Birth,
Home birth,
Midwifery For further information about childbirth choices, contact Melissa Maimann at Essential Birth Consulting.
Link
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
Tags: birth, Birth choices, continuity of care, Home birth, hospital birth, intervention, Maternity Services Review, midwife, Midwifery, Midwifery, Midwifery services, Normal Birth, Obstetrics, women's rights