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

Posted by Melissa Maimann on Jul 8, 2009 in Birth, Home birth, Midwifery

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

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,” …

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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

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Repeat Elective Caesarean Before 39 Weeks Increases Neonatal Risk

Posted by Melissa Maimann on Jul 8, 2009 in Caesarean

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

Link

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

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