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

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

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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

Tags: birth, Birth choices, Birth trauma, Complicated pregnancy or birth, continuity of care, freebirth, Home birth, hospital birth, intervention, midwife, Midwifery, Midwifery, Midwifery services, Obstetrics, Public and private hospitals, women's rights

Woman gives birth on motorway after being sent home by hospital

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

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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

Tags: birth, Home birth, hospital birth, Normal Birth, Public and private hospitals

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

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

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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

Tags: Birth choices, Complicated pregnancy or birth, Home birth, hospital birth, Midwifery, Midwifery, Midwifery services, Normal Birth, Obstetrics, Public and private hospitals, women's rights

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

Tags: birth, Birth choices, Caesarean, Midwifery, Midwifery services, Normal Birth, Obstetrics, women's rights