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June 24th, 2009:

Caesarean Rates so high even doctors are concerned

Jun 24th, 2009
by Melissa Maimann.
2 comments

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

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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
by Melissa Maimann.
1 comment

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.