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June 30th, 2009:

Insurance plea for home-birth midwives

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

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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

Childbirth-Related Injuries Decline

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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.