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July, 2009:

Magee-Womens Hospital Awarded For Achievements In Reducing Elective Induced Labor

Jul 31st, 2009
by Melissa Maimann.
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For further information, contact Melissa Maimann at Essential Birth Consulting.

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Magee-Womens Hospital … recently won a first-place achievement award … for achievements in researching and improving the process for elective induction of a woman’s labor.

… a team … led the initiative, recognizing the negative consequences of electively inducing labor upon mothers’ requests.

Over a 15 year period, from 1989 to 2004, elective inductions in the U.S. saw a four-fold increase, escalating from 9 percent of expectant mothers in 1989 to 21 percent in 2004. Premature or inappropriate inductions-those prior to 39 weeks gestation-can lead to complications including an increased risk of cesarean birth, longer and more complicated labor, and higher risk of admission to a neonatal intensive care unit for the newborn.

To address these issues … [the] team developed stricter guidelines and criteria for electively inducing labor before the pregnancy comes to term, with only situations involving an unwell mother or infant warranting an early induction. Since the beginning of this initiative … [elective induction rates have fallen from ] 12 percent to zero.

Can we do the same here with our caesarean and induction rates? I think it could be achieved easily if all doctors were required to send women for a second opinion with a midwife before an induction or elective caesarean can be approved. I also think that it is in line with the Health Minister’s recommendation of providing collaborative care to women.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Women ‘unprepared for childbirth’

Jul 30th, 2009
by Melissa Maimann.
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Many women are going into labour vastly underestimating how painful it can be and overly optimistic that they will be able to manage without drugs, a study suggests. How has this happened?

… In England around a quarter of women who give birth end up having an epidural … although many did not plan on having one.

Growing emphasis on birth as an entirely natural process – which may be better carried out in your front-room than in a labour ward – also means many women feel they have somehow failed if they end up rapidly making their way through every form of pain relief available.

Much evidence suggests … that women who are well supported by midwives and partners throughout their labour and made to feel at ease are the ones who manage their pain the most effectively and require the fewest drugs.

… “The problem with some of the [antenatal] courses out there is that they concentrate so much on doing it naturally that inevitably women feel as though they’ve done something wrong when those techniques simply aren’t enough for them.”

” … the bottom line is that we encourage women to have confidence in themselves and their bodies,” says Gillian Fletcher, a former president of the NCT.

“We help women weigh up the pros and cons of every method [of pain relief]. … we do make clear that if you have [an epidural] you are two to three times more likely to end with a forceps delivery.”

“What’s crucial is that women are ready to negotiate with their midwife, and don’t find themselves lying flat on the bed, which we now know is a sure way to a more difficult experience.”

Indeoendent childbirth education is one way to ensure that your childbirth preparation meets your needs and that you feel confident approaching to your birth.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Where to, maternity?

Jul 29th, 2009
by Melissa Maimann.
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A tiny kick reminds Anna Edlington that her life is about to change. Forever. Soon the 27-year-old West Aucklander will not only be a daughter, a wife or a teacher. She is becoming a mother … Foxcroft investigates the midwife crisis, and the state of the baby business across Auckland.

… The ability to choose who delivers a baby sets New Zealanders apart internationally. Our maternity system is discussed, held up and analysed by other nations. This year, the hard-fought-for system is set for a shake-up with a new Ministry of Health Maternity Action Plan.

… It is given that Auckland has very real problems in the baby business. The Aucklander reported more than two years ago that there are not nearly enough lead maternity carers (LMCs) for the population.

… The College of Midwives recommends midwives care for four women a month, or 50 a year. Some midwives cannot say no to the voice on the phone, pleading: they are taking eight or more clients in a month because the women have no one else to turn to.

… “My husband and I were lucky. We were able to find a midwife late – I was eight weeks pregnant. I know it’s not the same for others.”

Mrs Edlington also counts her lucky stars her midwife takes only a limited number of clients – four a month.

“For her, it’s never been an issue that she is at one birth when someone else goes into labour. It just doesn’t happen,” she says.

“In terms of personal care, it makes a huge difference. It’s harder the more clients your midwife has.”

… the shortage of midwives is the biggest problem.

… Another problem is the lack of primary birthing centres … We would like more women giving birth in primary units or at home.”

… We have to remember that New Zealand is often referred to as the gold standard.”

BEFORE 1990 a doctor had to supervise all births, which is still the case in other countries. The Nurses Amendment Act 1990 allowed midwife-led care for well women; in 1996 the Government enshrined choice for women by developing the Lead Maternity Care model. This meant women could choose who would look after them during pregnancy, birth and post-natal care.

It was a brave and socially challenging decision …

… there is no standard model for health boards to collect electronic data. The methods differ from area to area …

Post-natal care is another issue. “Having primary care centres where mums and dads can get used to being parents would help …

Fray, an independent midwife based on the North Shore, sees areas ”screaming out for improvement.

”Hospital shiftwork midwives earn minimal incomes, especially considering the enormous responsibilities of managing the care of a labouring woman and unborn foetus,” she says. ”Self-employed midwives can earn a reasonable income but only with the cost to lifestyle by being on call 24-7. Let’s face it, that deserves an excellent income.”

… ”The other horrid area … is the hideous way the media revels in attacking midwifery. Childbirth has never been so safe, yet midwives have never been so slammed with criticism. It’s incredibly denigrating and disparaging to all of us who work with phenomenal dedication.”

For Denise Hynd, another independent midwife, the main concern is the high level of medical intervention, stemming in part from where most of the country’s babies are born.

”Even with midwives it’s still a very medicalised system,” she says. ”All the evidence suggests that normal healthy women have best outcomes if they give birth at home or at birthing centres.”

But she praises our approach against other countries where she’s worked – Australia and Britain.

… Dr Mark Peterson, the Medical Association’s maternity spokesman, helped write the draft action plan but believes it needs refinement.

”Maternity care requires a team,” he says. ”The potential problem of our system is we have lost the team philosophy. Care is concentrated on one person.

”Disasters tend to happen because of system errors, not because of people. But when you only have one person the system is not so robust. When you have a team you have more eyes.” …

… An overwhelming 75 per cent of women chose a midwife as their lead maternity carer
6 per cent chose an obstetrician
6 per cent went to their local GP
The other 13 per cent? Believe it or not, most don’t use ante-natal services – they ”rock on up” to hospital when the time comes …

We asked a range of people what works in Auckland’s maternity services and where the challenges are …

Anna Edlington (mother-to-be) loves the choice for women but believes the present system needs more resources.

… Denise Hynd (independent midwife) ”The system is too ‘medicalised’ but it’s OK. We need more birthing centres.”

Kathy Fray (independent midwife) ”The dedication of lead maternity carers makes our system so successful. But the people who work in the field need to be recognised for their work.”

Karen Gulliland (NZ College of Midwives) ”The system is sound but we need more lead maternity carers, a standardised system across district health boards and more birthing centres.”

Dr Mark Peterson (NZ Medical Association) ”We need more teamwork and integration between GPs, specialists and midwives.”

In Australia, we can only dream of such a maternity system!

Melissa Maimann, Essential Birth Consulting 0400 418 448

Mother Dies At 69 Orphaning Twin IVF Babies

Jul 28th, 2009
by Melissa Maimann.
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[A woman] … has died at the age of 69, orphaning her two and a half year old twin sons that she gave birth to at the age of 66 after receiving IVF treatment …

[The] death … has reignited the debate about allowing older women to undergo fertility treatment.

[The woman] … admitted lying about her age: she told doctors … that she was 55.

… the babies were born with no complications, apart from having to spend one month in incubators.

[The] family will most likely care for the two boys …

The news has provoked fresh calls for an upper age limit for fertility treatment …

Melissa Maimann, Essential Birth Consulting 0400 418 448

If Breast Is Best, Why Are 70% of U.S. Hospitals Pushing Formula?

Jul 27th, 2009
by Melissa Maimann.
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The majority of U.S. hospitals are providing formula packets … to breastfeeding mothers while nearly one-fifth of hospitals give something other than breast milk as a first feeding to … babies … This practice contradicts the best medical evidence available …

Breast milk … provides … antibodies and essential nutrients … breastfeeding benefits [include] decreased risk of diabetes, obesity, juvenile leukemia, heart disease, asthma and ear infections. Breastfed children also have been found to have better jaw and eye development than those who are not breastfed.

… breastfeeding helps a uterus return to its normal size. It may help a new mother lose pregnancy weight, and studies show that it reduces the risk of breast and ovarian cancer … breastfeeding [increases] bonding between mother and baby.

Melissa Maimann, Essential Birth Consulting 0400 418 448

MPs praise East Lancashire midwives

Jul 26th, 2009
by Melissa Maimann.
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MIDWIVES from East Lancashire’s hospitals, who more than doubled the area’s home and water birth rate in just two years, have received a prestigious MPs’ award.

… The team were awarded the “Normality of Childbirth” category at the annual awards after transforming the choices and opportunities available to expectant mums.

… water birth training for just two midwives in 2006 had spread through the service and sparked a “phenomenal shift” in the ways births are managed … By the end of 2008, almost six per cent of East Lancashire mothers were opting for water births, and more than three per cent chose a home birth.

Why is this not possible in this country? There was nothing other than support for the supreme efforts of these midwives who supported women to birth at home. Home birth is safe and midwifery care is a great option for women.

Melissa Maimann, Essential Birth Consulting 0400 418 448

If you think the caeasrean rate is high in Australia ….

Jul 25th, 2009
by Melissa Maimann.
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For further information, contact Melissa Maimann at Essential Birth Consulting.

Check out this link to caesarean rates in Florida. Some hospitals are have up to 70% caesarean rates! All the more reason to have midwives as primary care providers for healthy pregnant women.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Risk Of Complications In Pregnancy Increased By Obesity

Jul 24th, 2009
by Melissa Maimann.
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Expectant mothers who are obese are much more likely to suffer from minor complications such as heart burn and chest infections during pregnancy …

… Obese pregnant women were three times more likely to have carpal tunnel syndrome … [and] … a more than three-fold increased risk of suffering … symphysis-pubis dysfunction …

… Obesity during pregnancy also increases the risk of gestational diabetes, pre-eclampsia and the need for a caesarean section. More than one-third of pregnancy-related deaths occur in mothers who are obese.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Birthing after July 1, 2010?

Jul 23rd, 2009
by Melissa Maimann.
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Here’s the full text of an article I have written for Essential Baby.

Melissa Maimann
July 22, 2009

Currently, all health professionals are registered by their own State Board. There are approximately 90 Registration Boards throughout Australia. Come July 1, 2010, all of these Registration Boards will be merged into one National Registration Board.

The benefits of National Registration include:

• Health professionals will be able to work between States and Territories, without having to register in each State or Territory prior to practicing
• Consistency of registration requirements and implementation of national standards
• Cost savings for both government and professionals with the elimination of unnecessary complexity and duplication
• A framework for maintaining consistency of state and territory regulation for individual professions
• Admission to professional practice (restrictions on professional practice by non-professionals)
• Regulation of professional practice (through consistent standards for accreditation and registration)
• Consumer protection (through complaints processes, insurance of professionals, criminal record checks of professionals and so on).

Alongside the changes to the registration of health professionals, there was a recent review of maternity services in this country (the Maternity Services Review, or MSR). There were several recommendations from this review.

What does all of this mean for pregnancy and birth?

The intersection of these changes has significant meaning for women, midwives and obstetricians.

Insurance will be a requirement for general registration after July 1, 2010. This is in place to protect the public, so that in the event of negligence that results in a baby or woman being harmed, the family may access a pool of funds to support medical and other expenses. That is fair and reasonable, however insurance is not available for midwives who are self employed.

To explain this further, most midwives are employed by a hospital and are covered by insurance through their employment. Midwives who work in private practice attending home births or hospital births do not have access to insurance. These midwives perform a very special role. Since they are contracted by women and are not employed by hospitals, they are uniquely placed to provide families with evidence-based and independent advice. This is significant for families, and often means the difference between a surgical birth and a natural birth. Currently, independent / private midwives may attend women at home or in hospital.

After 2010, all midwives will be required to have proof of insurance in order to register on the general (practicing) register. There will be different levels of registration, such as general (ie, a practicing health professional), non-practicing (in which case the professional cannot practice or give advice), student, and so on. All midwives will be able to register, but those who do not have insurance may only register as a non-practicing health professional. In that case, they may not attend births, provide advice and so on.

This affects all women! Yes, that includes you.

It is thought that these changes only affect families who want home births. This is not true! The changes affect all women who seek private midwifery care. Women consult with private midwives on a range of matters, regardless of the place of birth or chosen care provider. Things like, “My doctor / hospital said I have to have an induction / caesarean / epidural because… Do I have any other options?”

Private midwives give second opinions, run independent childbirth education classes, attend women who are birthing in hospital, and also attend home births. All of this will be affected by the changes to Registration come July 1, 2010. If midwives cannot secure insurance, your ability to seek private midwifery care and impartial advice will be impacted.

Which midwives will be able to access insurance?

Private midwives will need to show proof of insurance in order to practice. With insurance, private midwives will be able to birth with women in hospital, but not at home. Employed midwives working in hospitals will not need insurance.

In order for a midwife to access insurance, the midwife must work in a collaborative team with a doctor. Currently in Australia, midwifery is still seen by some as a profession that is only practiced under the direction and supervision of an obstetrician or obstetric guidelines. Although the Maternity Services Review does much to provide a framework through which midwifery may be seen as a profession in its own right, we have some time to pass before this is realised in the wider community. In the meantime, it is hard to say what will become of women’s choices when their choices are not within obstetric guidelines.

The midwife must be credentialed. This means participating in annual Peer Review and being up-to-date with continuing professional development.

S/he must have completed a certain amount of practice in a setting such as a hospital (eg one year) prior to entering private practice.

Then – the private midwife may apply to have access to the Medicare Benefits Schedule and the Pharmaceutical Benefits Schedule.


What does this mean for hospital birth?

Currently, a mere 3% women Australia-wide are able to access continuity of care with a midwife. The good news is that after November 2010, it may be possible to contract a private midwife to attend you for a hospital birth. The details in this instance are a bit hazy. It would seem that you will be able to choose your own midwife, have your antenatal (pregnancy) consultations in your home, birth in hospital with your midwife, and then continue postnatal care at home with your midwife for up to 6 weeks. As well as this, you will be able to claim a Medicare benefit for midwifery services (in other words, midwifery will be bulk-billed). And your midwife will be able to order blood tests and ultrasounds, and s/he will be able to order medications such as Syntocinon, Vitamin K, Anti-D and Hepatitis B vaccines.

There are, however, a lot of unknowns, such as:
• What is the process by which a midwife becomes eligible for MBS and PBS, and how long does this process take?
• Can midwives access any hospital, or only a select few, and can a hospital refuse visiting rights to the midwife?
• What are the hospital’s requirements for granting private midwives with visiting rights?
• If a doctor is required to intervene in the labour or birth, does the midwife forego her / his payment to the doctor?
• What are the $ values of Medicare benefits for antenatal and postnatal consultations?

These questions remain unanswered. The current Medicare fee for midwives to attend to antenatal care is approximately $23 per antenatal consultation. Private midwives typically book 4 women each month, so they do not spent a full eight hours a day seeing women in 20-minute time slots. More likely, private midwives drive an hour to consult with a family in their home for one or two hours, and then drive home for another hour. $23 remuneration for this service will not make ends meet for the midwife.

Likewise, if the midwife forgoes the birth fee because she has needed to call a doctor to intervene, it will not be economically viable for the midwife to continue practice.

I have no doubt that the Health Minister would not put the energy into making these changes if they could not work, however, the detail that is missing is the essential “nuts and bolts” that will see private practice flourish or die.

What does this mean for home birth?

Currently, there are two ways to have a midwife-attended home birth: you may have a home birth through a government-funded program, or you may access a private / independent midwife. Women who choose a private midwife generally experience more choice and control over their pregnancies and births. Care is usually provided in the woman’s home, and consultations are one to two hours long. Publicly-funded programs usually see women going to the hospital for antenatal consultations, which are around 20-30 minutes long. The programs have strict inclusion criteria and generally have high transfer rates. What this means is that if you are accepted onto the program, you have a reasonable chance – up to 40% or 50% – of being transferred out of the home birth program at some point in your pregnancy or labour and birthing your baby in delivery suite.

If a woman contracts a private midwife to attend the home birth, she generally has a higher chance of being accepted for homebirth, and the transfer rate is lower: around 20%. Publicly-funded home birth is not possible for women having vaginal births after a caesarean (VBAC), breech babies, twins, women who have their babies after 42 weeks or before 37 weeks, women with gestational diabetes, previous bleeding after birth, previous shoulder dystocia, women whose BMI is over 35 (or who are over 100Kg in weight) and so on. Come July 1, 2010, all of these women will have no choice but to birth in delivery suite if they are to be professionally attended.

What about women who do not meet the criteria for publicly-funded homebirth programs, or those women who cannot access a public home birth program?

There are two options for women who wish to birth at home but either cannot access a publicly-funded home birth program, or are not accepted into such a program.

One option is to freebirth, and the other option is for a midwife to attend the woman.

1. Freebirth
The safety of freebirth (home birth without a midwife) has not been researched, and indeed, it would be unethical to have a randomised controlled trial of freebirth. So it is impossible to say that it is safe, or that it is not safe. However, it remains an option for women.

2. Midwife-attended home birth
Midwives who attend home births outside of the publicly-funded models cannot access insurance. It is a requirement of registration that everything a health professional does in the course of their practice, is indemnified. Since insurance will not cover home birth, the midwife will be in breach of her / his registration by attending a home birth. This may lead to disciplinary action, up to and including de-registration.

If a midwife lets her / his registration lapse, planning to perhaps work as a doula or in some other capacity and attends a birth, s/he can be charged with practicing midwifery without registration. This carries a jail term or a fine.

It is important to note that there are no penalties for women and families who ask midwives to attend their births. Consumers of health services can never be charged for inciting professionals into unprofessional behaviour.

If midwives decide to work “under the radar”, although s/he may not be “found out”, there are important considerations for women and families:

• A midwife working under the radar will most likely not have the same access to continuing professional development as a registered midwife working legally. This can compromise safety as the midwife will not be up-to-date in her / his practice.
• Midwives working under the radar will not be able to report their births to the government for statistical analysis.
• Midwives working under the radar will not be able to register births or sign Medicare and Tax forms.
• Midwives working under the radar will only be able to take cash payments and they will not be able to declare their income.
• Women who experience complications at home with a midwife working under the radar will have to front up to hospital alone, without the ongoing support and advice of their midwife, and lie about all prior antenatal and birth care.

Additionally, there is a requirement of registration that includes mandatory reporting of health professionals. This means that health professionals must report other health professionals who place the public at risk of harm, for example by practicing the profession in a way that constitutes a departure from accepted professional standards. Hence, the midwife who attends home births without insurance risks being reported by her / his peers.

Clearly, the options of freebirth or midwife-attended home birth (if the midwife works under the radar) are not acceptable to women and families and have the potential to severely compromise safety for women and babies.

Although home birth is not every woman’s cup of tea, many people accept that it is the right of every family to choose where and with whom they will birth their baby. Forcing women to birth in hospital is no different to forcing women to accept other birth choices that they find unacceptable. Currently, your right to an elective caesarean, elective epidural, or elective induction is not questioned. Yet your right to home birth and private midwifery care is compromised, quite severely, by this new legislation. Imagine the outcry if hospital birth or epidurals were no longer possible for women!

Wow! That’s serious. What can I do to help?

• Increase awareness of the issue. Tell everyone you know, send an email to everyone in your address book, place a note about this in your email signature.
• Visit Save Birth Choices for information on what you can do.
• Attend the rally on September 7, 2009 in Canberra. See http://www.homebirthaustralia.org/ and scroll to the bottom of the page.
• Talk to the media.
• Talk to your local MP. These changes need to be accepted by every State and Territory in order to go ahead.

Author Melissa Maimann is an Essential Baby member and a private midwife.

No Psychological Risk In Children Next-Born After Stillbirth

Jul 23rd, 2009
by Melissa Maimann.
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There is no evidence that children next-born after stillbirth are clinically at risk compared to children of non-bereaved mothers … However, the study did find evidence of less optimal mother-child interaction.

Anecdotal accounts have suggested that children born subsequent to stillbirth of a sibling may be psychologically vulnerable …

The researchers found no significant between-group differences in child cognitive or health assessments … However, mothers … reported increased child difficulties … and there were higher levels of maternal criticism of the child’s behaviour …

Melissa Maimann, Essential Birth Consulting 0400 418 448

DIY birth it’s radical, it’s dangerous

Jul 22nd, 2009
by Melissa Maimann.
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IMAGINE giving birth on your own, with no professional help. Imagine choosing to do that. Women do. It’s called freebirthing or DIY birth and it’s a pretty radical idea. It scares the crap out of me …

… it’s dangerous, and it could be on the rise if new legislation comes into effect.

The Federal Government has given increased rights to midwives – as long as they are “eligible” or attached to a hospital.

They will not grant indemnity insurance to private midwives attending homebirths, effectively banning them from the practice.

… there are some women who reject the idea that childbirth is a medical procedure and want to give birth at home.

They are not a bunch of … hippies … It’s … well-educated women, many of whom have had horrific births in hospitals … that they want their next one in the security of their own home.

… there is a real issue at the core.

… It is … a public health issue because these women are determined not to birth in a hospital unless it is medically necessary.

That means they have to go underground.

Some independent midwives, who will be deregistered if the laws go through, will sell their services as masseuses or photographers. They will charge a premium and they will give women what they want.

Women … will be forced to make dangerous choices. If they … run into trouble, they could be more reluctant to seek emergency help.

… In SA, there is a hospital-based homebirth program, but it is selective. Women have to meet strict criteria and … be in the right catchment area … they only do a handful of homebirths a year.

… Of 107 homebirths [in SA], three were stillbirths, two of these were unplanned and the women had had no antenatal care at all …

Melissa Maimann, Essential Birth Consulting 0400 418 448

National Health Registration Law Flawed – Should Be Scrapped

Jul 22nd, 2009
by Melissa Maimann.
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For various reasons, some of the health professions that are set to be regulated under National Registration, are opposing the legislation. National Registration – and the requirement of all health professionals to have insurance (which is not available to private midwives currently) – is placing private home birth and the safety of mothers and babies under threat. Here are the Australian Doctors’ Fund’s comments:

The Australian Doctors’ Fund has called for medical practitioners to be removed from the Health Practitioner Regulation National Law (Bill B), claiming the Bill is flawed.

… “Were this bill to become law, a state parliament would no longer have jurisdiction in its own state, since a “disallowed regulation” by a state parliament would still be in force until a majority of other states disallowed it” … This effectively means that the citizens of any state would be governed by other states.

“Here we have the most complex piece of health legislation ever devised, affecting over 400 000 health and allied health professionals, owned by no single jurisdiction. It is an orphan with 9 mothers, none of whom can claim any legal responsibility for their child.”

… “Yes, it is quite a complicated structure. It is sort of underpinned by the IGA… The Boards are accountable to ministers; it’s just that they are accountable to multiple ministers” …

… Despite stating that “the object of this law is to protect the public”, Bill B would set up the apparatus for the deregulation of complex medical procedures …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Memory Forms at 30 Weeks in the Womb

Jul 22nd, 2009
by Melissa Maimann.
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Fetuses that are only 30 weeks old may already possess short-term memory …

… The authors stated that habituation is a form of learning and needs an intact central nervous system.

… According to background information in the paper, the first study to look at fetal habituation took place in 1925 and involved repeated honking of a car horn. Since then, similar studies have been conducted with electric toothbrushes and door buzzers, as well as the vibroacoustic stimulator.

In this study, fetuses were exposed to the vibroacoustic stimulation at 30, 32, 34, 36 and 38 weeks’ gestation.

Fetuses as young as 30 weeks demonstrated a short-term memory of 10 minutes, and fetuses at 34 weeks seemed able to remember information they stored four weeks prior, the authors stated …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Chemicals In Common Consumer Products May Play A Role In Pre-Term Births

Jul 21st, 2009
by Melissa Maimann.
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A new study of expectant mothers suggests that a group of common environmental contaminants called phthalates, which are present in many industrial and consumer products including everyday personal care items, may contribute to the country’s alarming rise in premature births.

… women who deliver prematurely have, on average, up to three times the phthalate level in their urine compared to women who carry to term.

… Premature birth is a significant risk factor for many health problems in childhood that can persist into adulthood … In the United States, premature births have increased by more than 30 percent since 1981 and by 18 percent since 1990. In 2004, premature births accounted for 12.8 percent of live births nationwide.

Premature births … account for one-third of infant deaths in the United States, making it the leading cause of neonatal mortality. Being born too early can also lead to chronic health problems such as blindness, deafness, cerebral palsy, low IQ and more.

Phthalates are commonly used compounds in plastics, personal care products, home furnishings (vinyl flooring, carpeting, paints, etc.) and many other consumer and industrial products … past studies show that several phthalates cause reproductive and developmental toxicity in animals.

Melissa Maimann, Essential Birth Consulting 0400 418 448

It’s a woman’s right to choose how she births

Jul 20th, 2009
by Melissa Maimann.
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Changes that will effectively outlaw supported home births are paternalistic.

IN FIVE months’ time, if my pregnancy progresses without complication, I will birth my second child at home, attended by two registered private midwives. If I’d become pregnant a mere six months later, this carefully researched, intensely personal decision would have been far more tenuous.

From the middle of next year, if the draft legislation establishing a new national registration scheme for health professionals becomes law, midwives will be required to hold indemnity insurance and midwives in private practice — those who typically attend home births — will be unable to access this insurance. This means that, with the exception a few small home-birth support programs run out of public hospitals, home birthing will effectively be outlawed.

… Dr Hilary Joyce, the new president of the National Association of Specialist Obstetricians and Gynaecologists, dismissed the significance of this ban by pointing out that only a small percentage of women in Australia choose to give birth at home …

She misses the point. It’s not about numbers. It’s about choice. The government has no right to remove choices from people. Registered midwives, independent of the hospital system, are available to attend home births. Women, some of whom prefer their care to be independent of the hospital system, wish to contract these midwives to attend their births. There is demand, and there is supply. A market exists. The government’s failure to provide insurance for midwives is against the laws of economics.

The assumption underlying her argument — that minority rights are unimportant and can be casually overridden — is both offensive and antithetical …

… The legislative squeezing-out of home birth represents a serious regression in this reform process. Given that the new laws will effectively make private midwife-assisted home birth illegal, the Federal Government is acting to deprive most women of the ability to make a fundamental choice about their own bodies; the choice to birth in a non-medicalised environment.

Birthing is an extremely intimate, uniquely visceral, sometimes terrifying physical experience. There is much that will inevitably be out of a woman’s control during her confinement, so allowing her to birth in the place in which she is most comfortable is fundamental to maintaining both her personal dignity and her sense of ownership over the experience.

Just as adequate abortion rights are important for all women, not just those with unwanted pregnancies, so the fundamental right to birth in the way one chooses is an issue for us all. In this respect the proposed legislation is a setback for all women, not just those who would take up the option of a home birth if it was offered to them.

… Many assume that this is the crux of the matter; that home births are simply unsafe. But the facts suggest otherwise. International studies, and experience in countries such as the Netherlands and Britain, have conclusively demonstrated that for uncomplicated pregnancies, home births carried out with proper support are just as safe as hospital births.

… Such a paternalistic provision, effectively telling women what is and isn’t good for them, cuts to the heart of women’s collective dignity and autonomy. While women were once routinely patronised in this way, the contemporary assumption is that those bad old days are behind us. Sadly, this does not appear to be the case when it comes to birthing.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Dobbing in drs will breed culture of fear

Jul 20th, 2009
by Melissa Maimann.
1 comment

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

National Registration brings with a requirement that health professionals and employers must report other professionals who are deemed to be placing rhe public at risk of harm, for example by being intoxicated while at work, or for departing from accepted standards of safe care.

This article questions the wisdom of this requirement.

A proposed national accreditation scheme … will make it mandatory for practitioners to report others they fear are placing the public at risk.

Reportable conduct includes a physical or mental impairment affecting a doctor’s ability to practise or a departure from accepted professional standards, as well as drug and alcohol abuse or sexual misconduct.

… “A statutory duty to report is likely to create a punitive atmosphere and a culture of fear among practitioners … and potentially drive problems underground,” …

The association wants spouses, practising doctors and health advisory services exempted from any potential mandatory reporting laws.

That’s an interesting request. This part of the legislation has supposedly come into effect after the cases incolving Dr Graeme Reeves and Dr Jayant Patel. It is no longer acceptable to sit by while a colleague harms patients. Why should doctors be exempt from the requirement, while all other health professionals need to comply?

… Claire Moore said there remained an overriding public belief that doctors protected one another, especially in the wake of surgeon Jayant Patel’s case at Bundaberg.

The public needed to be reassured there were adequate safeguards in place to protect patients, she said.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Pilot Study Removes Standard Hospital Bed As Focal Point Of Labor

Jul 20th, 2009
by Melissa Maimann.
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A … study that re-conceptualized the hospital labour room by removing the standard, clinical bed and adding relaxation-promoting equipment had a 28 per cent drop in infusions of artificial oxytocin, a powerful drug used to advance slow labours.

I’m not surprised. Stress and adrenaline lower the level of natural oxytocin and create the “need” for the artificial form of the hormone. If the environment feels safe for the woman, her oxytocin levels will rise and she will not need the synthetic form to be dripped into her veins. Home usually provides the most relaxing environment for labour.

… In addition, more than 65 percent of the labouring women in the ambient room, compared to 13 per cent in the standard labour room, reported they spent less than half their hospital labour in the standard labour bed.

…. Hodnett devised a set of simple, but radical modifications to the standard hospital labour room, with the intention of surrounding the women and their caregivers with specific types of auditory, visual and tactile stimuli.

“The removal of the standard hospital bed sent a message that this was not the only place a woman could labour,” says Hodnett. A portable, double-sized mattress with several large, comfortable cushions was set up in the corner of the ambient room. Fluorescent lighting was dimmed, and DVDs of ocean beaches, waterfalls and other soothing vistas were projected onto a wall. A wide variety of music was also made available.

… “This study raises questions about the assumptions underlying the design of the typical hospital labour room,” says Hodnett. “The birth environment seems to affect the behaviour of everyone in it – the laboring women as well as those who provide care for her.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Reducing Maternal Death In Bangladesh

Jul 19th, 2009
by Melissa Maimann.
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New strategies to reduce maternal death in Bangladesh will be presented at the Royal College of Obstetricians and Gynaecologists (RCOG) South Asia Day …

The maternal mortality ratio has significantly declined in Bangladesh, from 512 deaths per 100,000 live births in 1996-2000, to 3.2 deaths per 100,000 live births in 2007. One of the main reasons for this is the decrease in unsafe abortion and abortion-related complications due to the wide availability of abortion services. Maternal deaths have also been reduced through improved access to contraception, skilled birth attendants, antenatal care and obstetric surgery.

Despite these gains, challenges remain for many women in Bangladesh, especially those who live in rural and hard to reach areas …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Promoting Safer Childbirth

Jul 18th, 2009
by Melissa Maimann.
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Despite recent internal conflict, Sri Lanka has emerged as a success story in promoting safer childbirth. The country’s significant decline in maternal deaths will be presented today at the Royal College of Obstetricians and Gynaecologists (RCOG) South Asia Day.

… Despite the country’s meagre healthcare budget, its maternal and child health indicators are vastly more favourable than what would be expected.

The maternal mortality ratio of Sri Lanka has declined dramatically as a direct result of the availability of midwives and trained assistance at birth – from 340 per 100,000 live births in 1960 to 43 per 100,000 live births in 2005.

Dr. Hemantha Senanayake, from the University of Colombo, said “The most important contribution to maternal and child care has come from Sri Lankan midwives …

“Every household in Sri Lanka belongs to a designated Public Health Midwife (PHM) area and the norm is for the PHM to provide home-based care. During the past few decades the Government has made a policy decision to increase the number of midwives. The number of women having a minimum of 4 antenatal visits has reached 99%.”

Let’s hope that with the proposed changes in this country, for maternity care, that women are not denied access to skilled and competent midwifery care for home birth.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Mom’s Weight During Pregnancy Affects Her Daughter’s Risk Of Being Obese

Jul 17th, 2009
by Melissa Maimann.
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A mother’s weight and the amount she gains during pregnancy both impact her daughter’s risk of obesity decades later …

… “If we can help women reach a healthy weight before they start a family, we can make a difference for two generations.”

… The heavier a mother was before her pregnancy, the more likely her daughter was to be obese in later life …

Weight gain during pregnancy mattered, too both too little and too much weight gain increased a daughter’s risk of becoming obese, especially if a mother was overweight before she got pregnant

Melissa Maimann, Essential Birth Consulting 0400 418 448

Bottle-Feeding Moms Ignored

Jul 17th, 2009
by Melissa Maimann.
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The lack of information and support for mothers who bottle-feed could put the health of their infants at risk …

… Variations in bottle-feeding can have long-term health consequences for children …

… Some mothers who bottle-fed … experienced negative emotions such as guilt, worry about the impact on their baby, concern about health professionals’ opinions, uncertainty about how to proceed, a sense of failure and anger at feeling pressure to breast-feed.

Some mothers said they didn’t receive enough information on correct bottle-feeding techniques …

It was common for mothers to make mistakes in bottle-feeding preparation. Incorrect preparation can increase the risk of infection, promote excessive weight gain or leave babies undernourished.

It’s important to promote breast-feeding because it’s the healthiest option for both mother and baby … But … it’s “also necessary to ensure that the needs of bottle-feeding mothers are met … Inadequate information and support for mothers who decide to bottle-feed may put the health of their babies at risk.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

Colostrum Functions Like Human Growth Hormone

Jul 16th, 2009
by Melissa Maimann.
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Colostrum … is the first food, in which all the immune and growth factors that insure health and vitality are transferred from the mother to the newborn. Research has shown that colostrum is the one supplement that can bring help to everyone that uses it, largely because of its ability to perform many of the functions of human growth hormone (HGH) in the body … colostrum can prevent the death of human neurons and effectively treat Alzheimer’s patients. … Colostrum knocks out intestinal inflammation.

… a proline-rich polypeptide isolated from colostrum, can effectively treat Alzheimer’s disease patients.

… Colostrum works in a unique manner to protect the body from pathology. Most pathogens enter the system through the mucous membranes of the intestinal tract. Bacteria, viruses, pollutants, contaminants and allergens must be combated there. … a high percentage of the antibodies and immunoglobulins present in colostrum are not absorbed but remain in the intestinal tract. Immune factors work there to support proper immune function and healthy intestinal flora …

… Colostrum is the essence of pure nutrition, containing immunoglobulins, growth factors, antibodies, vitamins, minerals, enzymes, amino acids, and other special substances designed to prime the body to face a lifetime of invasion by various microorganisms and environmental toxins bent on destruction.

Even more data to support breastfeeding!

Melissa Maimann, Essential Birth Consulting 0400 418 448

The Long Road To Safe Motherhood In Nepal

Jul 16th, 2009
by Melissa Maimann.
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Women in Nepal face the highest risk of maternal death in South Asia.

… the maternal mortality ratio still stands at 281 deaths per 100,000 live births. The majority of women (81%) deliver at home, and less than 19% of births take place with the assistance of a Skilled Birth Attendant.

Key challenges include the limited number of health workers in Nepal, as well as the inadequacy of emergency obstetric care services. Women also face barriers due to costs, lack of transportation and long distances to health facilities.

Dr. Pushpa Chaudhary, from the Paropkar Maternity and Women’s Hospital in Kathmandu, said “For the first time in the history of Nepal, the new Interim Constitution has declared the state’s commitment and responsibility for people’s health. Free maternity services and a safe delivery incentive program have been launched, but it is important to ensure quality of services and regular funding to sustain the program.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Infertile Couples Encouraged To Look At Lifestyle

Jul 15th, 2009
by Melissa Maimann.
1 comment

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

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A … study has recommended that infertile couples seek advice about their lifestyle before embarking on IVF treatment or other assisted reproductive technology.

… while most people link obesity, smoking, drugs and stress to infertility problems, many infertile couples fail to look at their own lifestyle as a possible obstacle to conceiving.

… only half of the overweight women in this study considered their own weight to be a risk factor for infertility.

… overweight women are also at risk of pregnancy complications such as miscarriage, gestational diabetes and raised blood pressure.

… The study underlines the importance of good preconception advice and support …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Midwife tells pregnant women to take the pain

Jul 14th, 2009
by Melissa Maimann.
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Link and another link

WOMEN should embrace the full pain of childbirth to bond with their babies …

The pain prepares women for the responsibilities of motherhood …

… Dr Walsh said the “epidural epidemic” sweeping maternity units should be abandoned in favour of a “working with pain” approach.

… “Pain in labour is a purposeful, useful thing which has a number of benefits, such as preparing a mother for the responsibility of nurturing a newborn baby.”

… He called on health authorities to encourage women to use yoga, hypnosis, massage, hydrotherapy and support from their partners as natural ways of alleviating pain.

Dr Walsh warned that epidurals increased medical risks such as prolonged first and second stages of labour and the chance of the baby’s head being in the wrong place. They also led to lower rates of breast-feeding.

He added: “Emerging evidence shows that normal labour and birth prime the bonding areas of the mother’s brain more than caesarean or pain-free birth.”

Dr Lavender disputed the theory that epidurals reduced the bonding experience. “Regardless of the amount of pain, every mother will bond with her baby.”

Marino mother-of-two Namaaraalee Braun had two very different childbirth experiences with Kaija and Harper …

Kaija, 3, was born in hospital following an epidural and caesarean section.

Harper, 3 months, was born at home with the help of a midwife.

… “It was horrible really, it was just out of control,” Ms Braun said.

“I didn’t feel respected or like my wishes were high on anyone’s agenda and intervention was commenced pretty much as soon as I walked through the door and continued on down the path of the caesarean.

“I was really drugged and out of control with the first birth and I was separated from her (baby Kaija).”

Ms Braun said the second birth, undertaken without drugs, was less painful.

“It was pretty indescribable, it was just bliss, everything that I hoped a birth would be for myself,” she said.

” … I had a water birth … ” … “I did a lot of mental preparation, being in control and not being fearful alleviated most of my pain.”

Royal Australian and New Zealand College of Obstetricians and Gynaecologists president Dr Ted Weaver said … “If a woman does get one-on-one maternity care from a midwife she is less likely to need an epidural,” he said. “Maybe our maternity system does need to change a bit to allow that to happen.

Melissa Maimann, Essential Birth Consulting 0400 418 448

During Pregnancy, Women With Endometriosis Need Special Care To Avoid Risk Of Premature Birth

Jul 14th, 2009
by Melissa Maimann.
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The largest study to date of endometriosis in pregnant women has found that the condition is a major risk factor for premature birth … women with endometriosis also had a higher risk of other pregnancy complications, as well as being more likely to give birth through Caesarean section …

The researchers investigated the association between adverse pregnancy outcome, assisted reproduction technology (ART), and a previous diagnosis of endometriosis … Compared with women without endometriosis, they had a 1.33 greater risk of preterm birth. Women with endometriosis were also more likely to have difficulty in conceiving and need to receive ART, which is itself a risk factor for adverse pregnancy outcome.

… The risk of preterm birth associated with endometriosis among women with ART was 1.24, and among women without ART 1.37.

“Endometriosis appears to be a risk factor for preterm birth, irrespective of ART,” …

… Women with endometriosis were also more likely to suffer from pre-eclampsia …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Increasing Age Of Mothers Leads To Rise In Mortality Rates

Jul 13th, 2009
by Melissa Maimann.
2 comments

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A new study examining the evolution of maternal mortality rates in Spain since 1996 shows a 17% increase in deaths. This trend is linked to the widespread increase in maternal age …

… European studies show a clear and constant increase in maternal mortality rates over recent years. …

“This change, linked to the rise in maternal age, clearly shows the need for epidemiological monitoring of maternal mortality, because this is an avoidable phenomenon, and above all because it shows the importance of studying the causes in order to prevent deaths”, …

… The risk was three times greater for women aged between 35 and 44 than those who were younger. Most deaths were due to preeclampsia … and obstetric embolisms (pulmonary, or the amniotic liquid, etc.) …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Cancer Survivors At Greater Risk Of Birth Complications

Jul 12th, 2009
by Melissa Maimann.
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Survivors of childhood cancer run particular risks when pregnant and should be closely monitored … although such women may have conceived spontaneously and considered themselves to be perfectly healthy, their deliveries should always take place in a hospital.

… women treated with abdominal radiotherapy delivered more prematurely. These women also had more postpartum haemorrhages the loss of more than one litre of blood after delivery.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

Pregnancy Complications Are A Stress Test For Future Maternal Health And Pregnancies

Jul 11th, 2009
by Melissa Maimann.
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… women who have had two pregnancies complicated by preeclampsia are at a higher risk of hypertension after pregnancy.

… “while delivery may ‘cure’ preeclampsia in the moment, these mothers are at high risk of chronic hypertension, type 2 diabetes mellitus and blood clots for the rest of their lives. Pregnancy acts like a natural stress test for women.”

… the research adds to growing data on the link between hypertensive pregnancy disorders, diabetes, cardiovascular disease and maternal death …

… preterm delivery, preeclampsia and low-birth weight tend to recur and predispose to each other in a second pregnancy. The severity of the complication in the first pregnancy further increases these risks.

… if their first pregnancy resulted in a delivery between 32 and 36 weeks of gestation, the risk of a preterm delivery in the second pregnancy increased to 14.7% … if their first pregnancy resulted in an even earlier preterm delivery- between 28 and 32 weeks of gestation-the risk of a preterm delivery in the second pregnancy increased to 25.4%. Delivery between 20 and 27 weeks in the first pregnancy doubled the risk for delivering a baby that was small for gestational age in the second pregnancy.

… spontaneous preterm delivery, preeclampsia, low fetal growth, placental abruption and stillbirth in a first and second pregnancy are interrelated,” … “Perhaps they all may be features of a ‘placenta-associated syndrome.’ …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Home birth worries prompt action call

Jul 11th, 2009
by Melissa Maimann.
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HOME-birth advocates have welcomed the Federal Government’s reaction to the Maternity Services Review but say there is still a long way to go if women’s choices are to be truly respected.

In April, the Leader reported that home-birth supporters were alarmed that births outside of hospitals and birthing centres could become illegal after July 1, 2010, unless issues over the indemnity of privately practising midwives were resolved.

The Federal Government, in its response to the review, has flagged the establishment of a new government-supported professional indemnity scheme for eligible midwives.

However, this PI insurance will not cover private home birth.

Does anyone ever hear the term “hospital birth advocates”? “Home birth advocates” seems to be thrown around, as if it’s some sort of odd thing to want or to do. I would think that willingly putting yourself in a place that is intended for sick and dying people, when you’re healthy and well, deserves more attention. Anyway …. back to the article:

… Other changes announced by the Government include the introduction of legislation that will give midwives access to the Medical Benefits Schedule and Pharmaceutical Benefits Scheme (PBS) for the first time.

But only for hospital birth.

… Maternity Coalition’s national president, Lisa Metcalfe, welcomed the changes, especially those giving midwives access to Medicare and the PBS, but said many women would miss out on the proposed changes if national registration of all health professionals proceeds for it would effectively ban homebirth with a midwife.

“… we are taking a big step backward for a women’s right to choose their place of birth,” she said. “Our vision is for all Australian women to be able to choose where, how and with whom they birth.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

Endometriosis ups risk of preterm birth

Jul 11th, 2009
by Melissa Maimann.
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Link

Pregnant women with endometriosis are at increased risk for delivering prematurely as well as suffering a number of other adverse pregnancy outcomes …

… While 5 in 100 women without endometriosis delivered preterm, nearly 7 in 100 women with endometriosis delivered preterm …

“Endometriosis appears to be a risk factor for preterm birth, irrespective of ART,” …

… delivery by C-section was almost twice as common in women with endometriosis compared to women without endometriosis.

Women with endometriosis were also more likely to suffer from pre-eclampsia …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Will IVF Work For A Particular Patient? The Answer May Be Found In Her Blood

Jul 11th, 2009
by Melissa Maimann.
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… researchers have been able to identify genetic predictors of the potential success or failure of IVF treatment in blood.

… The researchers found that the peripheral blood gene expression ‘signature’ (also known as the transcriptome) before IVF was predictive of IVF outcome.

One of the most difficult decisions for patients who have had unsuccessful IVF treatments is whether they should undergo further attempts at IVF, or if there are ways to optimise chances of success. The researchers hope that the results generated by this work will lead to the development of a test to aid in IVF decision-making. They say that their work will help to identity biomarkers that can identify events occurring at implantation, the maintenance of pregnancy and successful or unsuccessful pregnancy outcome.

Melissa Maimann, Essential Birth Consulting 0400 418 448

IPS Examines Obstetric Fistula In Southern Senegal

Jul 10th, 2009
by Melissa Maimann.
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Inter Press Service News Agency examines the prevalence of obstetric fistula in the southern region of Senegal. According to state reproductive health officials … 58 percent of births take place at home without medical assistance. “Women in the region suffer from exceptionally high rates of fistula,” which “occurs when extended pressure damages the soft tissue in a woman’s pelvis during … birth” and can lead to debilitating complications and ostracization from their families …

For every 20 deliveries … at least nine women develop fistula …

“… girls are married off between the ages of 13 and 15. … from a morphological perspective, their pelvic girdles are not yet fully developed … labour is prolonged,” …

“The extreme poverty … means that fistula sufferers stay away from health facilities … Being ashamed of their condition also keeps them away, as well as their awareness of the odour they give off,” … because the condition can cause leakage of urine or feces.

A shortage of health workers … also contributes to the pervasiveness of fistula … there are seven doctors … for every 100,000 people, and one midwife for every 400,000 people …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Pregnancy Complications May Increase Autism Risk

Jul 9th, 2009
by Melissa Maimann.
3 comments

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Complications during pregnancy may increase the risk of having a child with autism …

The team reviewed 64 studies of prenatal risk factors for autism. It is the first time a meta-analysis of the relationship between pregnancy-related factors and risk of autism has been carried out …

… the factors most strongly associated with an increased autism risk are:

- Being born to an older mother or father.
- Having a mother who was born abroad.
- Having a mother who experienced bleeding during pregnancy.
- Having a mother who experienced gestational diabetes.
- Having a mother who used medication during pregnancy.
- Being the first born – or later born in families where there are three or more children.

… Mothers who are born in another country may not have natural resistance to infections in the country where they give birth, which may increase the risk for autism. Moving to another country may also put women under stress, which could increase their chances of having a child who develops autism.

Bleeding during pregnancy, gestational diabetes and medication use are also associated with increased autism risk. Bleeding can cause foetal hypoxia … Women who develop diabetes during pregnancy experience hormonal and metabolic changes, which may affect their baby’s health and development. Foetal development may also be affected by some medications which can cross the placenta during pregnancy.

The association between birth order and autism risk is unclear …

“There is some evidence to suggest that exposure to pregnancy complications in general may increase the risk of autism.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

Home birth program now available to Illawarra mums-to-be (Note: This heading is a lie: homebirth has always been available!)

Jul 8th, 2009
by Melissa Maimann.
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Pregnant women living between Helensburgh and Kiama can now access a publicly funded home birth program.
The South East Sydney Illawarra Area Health Service expects the first births through the program soon.

The program is open to women accepted into the health service’s Midwifery Group Practice (MGP) program whose deliveries are considered to be low-risk.

So, first you need to be accepted onto the program, next you have to be accepted for home birth, and finally, you need to remain accepted foe home birth. No wonder no-one has birthed on the program yet.

… The program would tend to “err on the side of caution” and only women living within 30 minutes of a hospital could participate …

“Should a mother experience complexities in their pregnancy, they will be referred to other hospital-based delivery options,” …

.

Um, what options? There is only one other option and that is delivery suite.

… the program had been operating out of St George Hospital for three years, but of the thousands who gave birth in the area just 50 had chosen home births.

This shows just how narrow the inclusion criteria are. And this is tje model that the govt is trying to push forward. Hospital-based homebirth models that meet the needs of a *very* select number of women.

Ms Cameron said independent midwives already offered a home birth service, but issues surrounding indemnity insurance for them had seen numbers decline.

I wish Ms Cameron would refrain from commenting on things she clearly has very little knowledge of!! More and mroe independent midwives have commenced practice in recent years. As of Jan next year, this number will increase further. Issues surrounding indemnity are not new: indemnity has not been available since 2001. While that change created a massive decline in the number of home birth midwives, the trend has been reversed in recent years. Numbers are on the increase. But possible not in the hospital programs where it’s amost impossible to get on the program and stay on the program. And that’s in a healthy population of women!

“The new program will hopefully allow women to avoid free birth situations, (births) with no clinical support,” she said.

The decision to free birth is complex and is nowhere near as simple as freebirthing because midwifery support is not available. Some women freebirth simply because they believe that birth is a natural process, that their body is designed to do (without midwifery care). Or they free birth to avoid possible being kicked off hospital home birth programs at 36 weeks if they do not “pass” their GBS swab!

It seems that the media is keen to promote hospital-based homebirth services as being safe and “better” than private home birth midwifery services. As if they only way to have a safe home birth is to do it through a public hospital program. This reminds me of the move from home birth to hospital birth and the propaganda that was put out to women and families: pictures of home birth midwives who were old, illiterate, “dirty” and supposedly dangerous. Hospital birth was promoted as the safe option. Why would you want to birth at home with a dirty, uneducated and unsafe midwife? Come into the hospital, where our shiny metal delivery tables complete with stirrups, drugs and doctors are available. Have a safe birth. Have a hospital birth. And so maternal mortality rose. Because doctors hadn’t yet cottoned onto the fact that clean hands were essential – that if you go digging around in cadavers and then attend labouring women, you will transfer infection to the woman – and kill her. Let’s not see this happen again! Home birth (private) midwifery is safe and effective.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Repeat Elective Caesarean Before 39 Weeks Increases Neonatal Risk

Jul 8th, 2009
by Melissa Maimann.
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If a woman who has had a Caesarean delivery has another such elective procedure before 39 weeks of gestation, the risk of an adverse neonatal outcome increases by 50% or more …

A repeat elective Caesarean at 38 weeks was associated with an odds ratio of 1.5 for adverse outcomes, increasing to 2.1 for Caesarean delivery at 37 weeks …

Adverse respiratory outcomes, need for mechanical ventilation, newborn sepsis, hypoglycemia, admission to the neonatal ICU, and hospitalization for five days or longer all occurred more often in babies delivered by Caesarean before 39 weeks of gestation.

“These early deliveries are associated with a preventable increase in neonatal morbidity and admissions to the neonatal ICU, which carry a high economic cost,” the authors concluded. “These findings support recommendations to delay elective delivery until 39 weeks of gestation and should be helpful in counseling.”

… Approximately 40% of Caesarean deliveries are repeat procedures. As the number of procedures increases, so do the public health implications related to the timing of delivery …

… Compared with births at 39 weeks, births at 37 weeks had more than a two-fold increased risk of the primary outcome (OR 2.1, 95% CI 1.7 to 2.5). For births at 38 weeks, the hazard remained increased (OR 1.5, 95% CI 1.3 to 1.7) …

The authors noted that they “also observed a higher risk of neonatal complications with Caesarean delivery at 41 weeks or later although the overall proportion of mothers delivering this late was small (<5%)."

Melissa Maimann, Essential Birth Consulting 0400 418 448

Postpartum Hemorrhage Blamed for Rising Maternal Morbidity in Developed World

Jul 7th, 2009
by Melissa Maimann.
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Postpartum hemorrhage may account for rising morbidity among new mothers in affluent nations …

Adverse maternal outcomes jumped 20.9% from 1999 to 2004 with rates that rose a significant 3.8% per year among women giving birth in the most populous Australian state …

… the increase was almost entirely accounted for by women with postpartum hemorrhage …

Smaller studies in Canada and Britain have reported similar increases in postpartum hemorrhage and related maternal deaths …

Active management, such as early cord clamping and controlled cord traction … can reduce postpartum hemorrhage. Those procedures are recommended in guidelines from professional societies such as the International Confederation of Midwives and the International Federation of Gynecologists.

But practitioners may not be adhering to them, possibly explaining the increase in postpartum hemorrhage rates …

Among risk factors associated with adverse outcome in women with postpartum hemorrhage, the study noted prior Caesarean section, multiple births, a mother whose age was under 20 or over 35, extremes of parity, smoking, and induced labor and birth in a small rural hospital.

… from 1999 to 2004, annual adverse maternal outcome rates rose from 11.5 to 13.8 per 1,000 deliveries. Pregnancy and birth factors did not account for this relative increase of 3.8% per year …

… the growth primarily resulted from a 32% increase in blood transfusions (from 8.0 to 10.7 per 1,000 deliveries) …

… The majority of adverse maternal outcomes (60%) occurred among women with postpartum hemorrhage …

The overall postpartum hemorrhage rate rose significantly, from 6.2% in 1999 to 6.8% in 2004. Although most cases were not severe, adverse outcome rates increased from 10.9% to 12.5% among women with postpartum hemorrhage, (relative increase 3.1% per year, 95% CI 1.2% to 5.2%).

Interesting that they are blaming mis management of the third stage in terms of staff not employing active management of the third stage. This management is almost universal in hospitals. Birth centres and home births generally have natural third stages and their PPH rates are lower than those found in hospital delivery suites. In my experience, the cause of PPH is linked more closely to intervention in birth such as induction, epidural and caesarean.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Complications Early In Pregnancy Or In Previous Pregnancies Adversely Affect Existing Or Subsequent Pregnancies

Jul 6th, 2009
by Melissa Maimann.
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Complications in early pregnancy or in previous pregnancies can predict the likelihood of further problems in current or subsequent pregnancies …

Improving care for pregnant women and their babies is of particular importance in countries such as The Netherlands where perinatal mortality is a cause for concern. The Netherlands has a perinatal mortality rate of 9.8 per 1000 (2006 figures) – the second highest rate in Europe [1].

… “There were several interesting findings. To name two: firstly, we found that after any first trimester complication or event, the risk of preterm or very preterm delivery is increased in the subsequent or ongoing pregnancy; secondly, we found that increased risks of adverse obstetric outcome are, in all cases, related to the severity or recurrence, or both, of the first trimester complication or event. To our knowledge, this is the first comprehensive review in which the impact of more than one first trimester complication on adverse obstetric outcome has been investigated systematically.”

The researchers found that a history of one or more miscarriages nearly doubled the risk in an ongoing pregnancy of preterm premature rupture of the membrane that surrounds the baby in the womb, and increased the risk of premature or very premature delivery (earlier than 37 or 34 weeks respectively). Recurrent miscarriages (three or more miscarriages) increased the risk in a subsequent pregnancy of all of these conditions; in addition, it increased the risk of placenta praevia (where the placenta partially or completely blocks the cervix) six-fold and congenital malformations nearly two-fold. If a previous pregnancy had to be terminated for any reason, this increased the risk of premature rupture of the membrane, premature and very premature delivery in subsequent pregnancies.

… vaginal bleeding in the first trimester increased the risk of preeclampsia, premature or very premature delivery and more than doubled the risk of low birth weight …

… “While it is true that most conditions are difficult to prevent, with improved monitoring in high risk pregnancies it is possible to reduce perinatal or postnatal foetal complications.

Melissa Maimann, Essential Birth Consulting 0400 418 448

What will change for midwives and women post 2010?

Jul 5th, 2009
by Melissa Maimann.
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For further information, contact Melissa Maimann at Essential Birth Consulting.

OK, so we know home birth (with a midwife) will be illegal after 2010, unless it is via one of 2 or 3 public home birth programs currently being offered in the State (and only to a select few women).

So I’ve had a look through the legislation to identify areas of concern. I’d like to share with you what I have found:

For the purposes of this Act, a person is an eligible midwife if the person:
(3) Without limiting the requirements that may be specified in regulations made for the purposes of paragraph (1)(b), those requirements may include one or more of the following: (a) a requirement to hold particular qualifications in midwifery; (b) a requirement to have particular experience in midwifery; (c) a requirement to be credentialled by a particular body.

Qualifications – great. “particular experience” is worrisome. Does this “experience” mean that the midwife must have worked for x number of years in a hospital? Does it mean she will have had to have worked in hospital continuity of acre models? What about the private midwives who practice continuity of care as the only form of their practice?

(1) The Minister may approve a common form of undertaking to be given by an eligible midwife who wishes to become a participating midwife under this Act. Without limiting the generality of subsection (2), the common form of undertaking may make provision for any of the following matters: (a) the kinds of service to which the undertaking relates; (b) a specification of the premises at which the eligible midwife provides services of a kind to which the undertaking relates; (c) an assurance by the eligible midwife that the fee to be charged by him or her for a service that is covered by an item that is expressed to relate to a service provided by a participating midwife will not, except in the circumstances specified in the undertaking in accordance with paragraph (d), exceed the appropriate fee stated in the item; (d) increases of specified amounts in the maximum fee that may be charged under paragraph (c) in respect of services provided in circumstances specified in the undertaking.

So, the government can decide what services we provide (maybe no care of women post 42 weeks, no VBACs etc). And we cannot, as I had been assured, charge over and above the medicare rebate. I’m not sure how we can go 1-2 hour long antenatal visits for a mere $16. That would not even cover petrol. Let alone travel time. Maybe we’ll need to do what obetetricians do and book 20-30 women a month. Sorry if we miss your birth. And, please have your baby via induction as it really will help us to schedule appointments and other births.

Melissa Maimann, Essential Birth Consulting 0400 418 448

C-Section Births Cause Genetic Changes That May Increase Odds For Developing Diseases In Later Life

Jul 5th, 2009
by Melissa Maimann.
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… babies born by Caesarean section experience changes to the DNA pool in their white blood cells, which could be connected to altered stress levels during this method of delivery …

It is thought that these genetic changes, which differ from normal vaginal deliveries, could explain why people delivered by C-section are more susceptible to immunological diseases such as diabetes and asthma in later life, when those genetic changes combine with environmental triggers.

… “Delivery by C-section has been associated with increased allergy, diabetes and leukaemia risks” … “Although the underlying cause is unknown, our theory is that altered birth conditions could cause a genetic imprint in the immune cells that could play a role later in life.

… As the diseases that tend to be more common in people delivered by C-section are connected with the immune system, we decided to focus our research on early DNA changes to the white blood cells.”

The authors point out that the reason why DNA-methylation is higher after C-section deliveries is still unclear and further research is needed. “Animal studies have shown that negative stress around birth affects methylation of the genes and therefore it is reasonable to believe that the differences in DNAmethylation that we found in human infants are linked to differences in birth stress. “We know that the stress of being born is fundamentally different after planned Csection compared to normal vaginal delivery. When babies are delivered by Csection, they are unprepared for the birth and can become more stressed after delivery than before. This is different to a normal vaginal delivery, where the stress gradually builds up before the actual birth, helping the baby to start breathing and quickly adapt to the new environment outside the womb.”

… “C-section delivery is rapidly increasing worldwide and is currently the most common surgical procedure among women of child-bearing age. Until recently, the long-term consequences of this mode of delivery had not been studied. However, reports that link C-section deliveries with increased risk for different diseases in later life are now emerging. Our results provide the first pieces of evidence that early ‘epigenetic’ programming of the immune system may have a role to play.” The authors feel that their discovery could make a significant contribution to the ongoing debate about the health issues around C-section deliveries.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Researchers Say Stress In The Womb Can Last A Lifetime

Jul 4th, 2009
by Melissa Maimann.
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… The placenta is crucial for fetal development and it usually protects the unborn baby from the stress hormone cortisol. However, when the mother is stressed, the placenta becomes less protective and the mother’s cortisol may have an effect on the fetus.

… maternal stress and anxiety can alter the development of the baby’s brain. This in turn can result in a greater risk of emotional problems such as anxiety or depression, behavioural problems such as Attention Deficit Hyperactivity Disorder, and being considerably slower at learning. Some studies have even suggested that it may increase the likelihood of later violent or criminal behaviour. Their findings have suggested that the effects of stress during pregnancy can last many years, including into adolescence.

… The researchers say that the stress hormone cortisol may be one way in which the fetus is affected by the mother’s anxiety during pregnancy. Usually the placenta protects the unborn baby from the mother’s cortisol, by producing an enzyme that breaks the hormone down. When the mother is very stressed, this enzyme works less well and lets her cortisol through the placenta. … the Imperial researchers’ latest study suggests that the higher the level of cortisol in the womb, the lower the toddler’s cognitive development or “baby IQ” at 18 months.

Melissa Maimann, Essential Birth Consulting 0400 418 448

14.3 Million Midwives, Nurses And Doctors Demand Action On Maternal Deaths At July G8 Summit

Jul 3rd, 2009
by Melissa Maimann.
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In an unprecedented move today, millions of midwives, nurses and doctors across the world delivered a message to G8 leaders to take urgent action to prevent women dying needlessly in pregnancy and childbirth.

With more than half a million maternal deaths every year, health workers have joined forces to ask world leaders to put the issue of maternal mortality at the top of the agenda at next month’s G8 Summit.

… This unprecedented mass action is designed to put maximum pressure on G8 leaders in the run up to their next Summit in Italy.

The petition … asks G8 leaders to deliver the extra $10 billion per year to provide the health workers and health systems needed, to meet the Millennium Development Goal which commits to cutting maternal mortality by 75% by 2015. http://www.whiteribbonalliance.org/

Melissa Maimann, Essential Birth Consulting 0400 418 448

Aussie women ‘too posh to push’

Jul 2nd, 2009
by Melissa Maimann.
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IT seems that some Australian women really are too posh to push.

A national report on the hospital system … shows that private patients are much more likely to have a caesarean birth than public patients.

Forty-two per cent of pregnant women who go private have a caesarian, compared with 27 per cent of women in public hospital …/blockquote>

And that’s evidence that women are too posh to push> I’d say it’s evidence that obstetricians prefer to perform operations that assist women in natural childbirth. If I was a surgeon, I’d probably prefer to perform surgery too! The general view is that if you have PHI, you ought to use it, and currently the only way to do this is with a private obetetrician. Rather than blaming women for the high ceasarean rate, we need to look at the choices that are available to women and the information that they receive about their hospital.

Melissa Maimann, Essential Birth Consulting 0400 418 448

No more tears

Jul 1st, 2009
by Melissa Maimann.
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Howard Chilton has probably cradled a small percentage of Sydney’s locally born population in his arms. The specialist in newborn babies has devoted his career to the pointy end of medicine, keeping alive infants the size of a matchbox and inventing medical devices to help his work.

But after three decades, two of which he was director of pediatrics at the Royal Hospital for Women, the respected doctor has turned his attention to their often-anxious parents, risking facing the ire of many women in the heated debate on mothercraft.

… “I desperately want parents to enjoy their babies,” he says. “Mostly I call myself a reassurologist.”

… “If you want to have an independent baby, love-bomb them,” he declares. Feed them, cuddle them, let them rule your world. For the first six months of their lives at least….

… new interests have replaced old ones. He wants to convince health authorities to fund human milk banks across Australia for infants who need breast milk. Despite the fact that such services are common in other developed countries, he seems remarkably patient with the slow progress here. “They will move at their own speed,” he says.

… Perhaps more engrossing is his passion for educating parents against trying to create order in their new life with a tiny baby. Still a visiting medical officer at the Royal and in private practice, he wants to ensure such ideas for infants aged younger than six months are banished for good.

Every Thursday morning he meets new parents at the Royal to deliver his message. His group talk started because he found he was being asked the same questions again and again. The most pressing being how to settle a crying, distressed baby.

“I enjoy one-on-ones but one on 30 is a more efficient way of helping parents, reassuring parents that they are capable of looking after their baby.”

His introduction to parenthood has blossomed into an hour-long guided tour that begins with evolution. Humans are born premature, with brains that are only 25 per cent formed. Because humans walk on two feet, the birth canal in women is too narrow to allow a large, more fully developed brain to fit through the pelvis.

Because babies are therefore not fully formed at birth, parents should replicate the baby’s experience in the womb by providing a secure, quiet and well-fed environment for the first months after birth. He tells mothers to ignore age-old rules of mothercraft, urging them not to bother burping their babies, to breastfeed them (if possible) as much the baby wants, to sleep with them (under correct conditions) and not to let them get distressed if avoidable.

Chilton has been known to urge his audience to throw out any copies of the likes of best-selling author Gina Ford …

“I think the [likes of] Gina Ford are attractive to a small section of the population, usually career women who want their babies to fit into a template … teachers and accountants, people who really like things to be timetabled,” he says.

In reality, only about 15 per cent of babies conform to sleeping and eating at the whim of the parent. The rest pay no heed to day and night and end up crying to be held or fed. “I know a lot of people who sob over Gina Ford because it just doesn’t work for them or their baby.”

Chilton also has a book, Baby On Board, in which he warns of the effects of repeatedly leaving babies less than six months old to cry: “Without therapy or a change in their life, these babies can grow up into people who panic and fly off the handle when things aren’t going well, who are prone to depression and anxiety, and may use alcohol and other drugs in an attempt to blunt the way they feel about themselves and their world. The seeds of such life are sown in the nursery.”

Chilton bases this claim on neurobiological research. Evidence collected … shows it is during the early months after birth that crucial connections are established in the brain between the limbic system, where emotions are experienced and the neocortex, the part of the brain that rationalises experience. Babies can feel emotions but not rationalise them. If they are left to feel fear or stress, their brain releases stress hormones such as cortisol and adrenalin. If it happens in a sustained way, perhaps by parents trying to make them sleep on demand, their brains anticipate further stress as a matter of course.

Chilton acknowledges that his views may make parents even more anxious about such an enormous responsibility. It might sound sweet to “love-bomb” your baby but could you bear the guilt if you don’t? And what if your child grows up to experience depression or anxiety? Even though you tried, could you have loved him that little bit more?

At the same time he admits that the brain is highly “plastic”. “Just because you have a problem in your first year doesn’t mean you will have a problem later,” he says, the reassurologist in him returning …

Melissa Maimann, Essential Birth Consulting 0400 418 448