Posted by Melissa Maimann on Aug 31, 2009 in
Caesarean,
Obstetrics For further information, contact Melissa Maimann at Essential Birth Consulting.
Link
DAVID Cuthbertson cannot find the words to explain to his three-year-old daughter Alyssa why her mother was never able to hold her, and never will.
In June 2006, having given birth by caesarean section at Nepean Hospital, Petah Kimm’s blood pressure dropped suddenly. Staff failed to recognise the danger. Two hours later, at age 39, she was found dead in her hospital bed.
On Wednesday, Mr Cuthbertson will front an inquest in Sydney.
… “I will not let the NSW Government sweep this under the carpet. I want them to own up.”
Mr Cuthbertson and Ms Kimm were single parents when they met on the sidelines at Little Athletics near their home town of Mudgee in 2003. They became friends and gradually fell in love, creating a blended family with his son Luke and her children Steven and Nicole.
“Initially I was against the idea of children because it involved IVF. But then one day I looked on as Petah nursed my brother’s baby. The moment I saw the look on her face I melted. We pushed ahead with the IVF. She conceived straight away.”
Alyssa was born without complication before Ms Kimm’s blood pressure fell.
… “Two hours passed before anyone on the next shift bothered to look. That was when Petah was found lying in bed dead,” Mr Cuthbertson said.
… NSW Health made an out of court settlement but Mr Cuthbertson called their treatment of him during that process ”disgusting”. ”Petah and Alyssa should have been here today, playing in the park together. I want justice for them both.”
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Caesarean, Complicated pregnancy or birth, hospital birth, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Aug 30, 2009 in
Birth,
Caesarean,
Home birth,
Midwifery,
Normal Birth,
Obstetrics For further information about birth or private midwifery, contact Melissa Maimann at Essential Birth Consulting.
Link
YOU’RE in the dentist’s chair with a painful tooth, feeling fragile.
“That tooth has to come out,” says the dentist.
“I’ll give you an anaesthetic and extract it.”
You’re surprised – you had hoped the tooth would be all right – but you nod and say something like “Ungh-hnghm” through a mouthful of cotton wool and dentist fingers. After all, he’s the expert.
The dentist turns to prepare the needle, when a dental technician leans over and whispers in your ear: “You know you don’t have to do what he says.
“He doesn’t know what he’s talking about. What about root canal? Or homoeopathic remedies? And anyway, you don’t need an anaesthetic.
“There’s a dentist next door who does acupuncture and hypnosis for pain relief. It’s much safer. Oh, and did you know fluoride is toxic?”
The dentist snaps at her to stop: “Ignore her – she’s pushing her own agenda.”
Tense, stressed and utterly confused, you lie back, open your mouth and look up at two medicos glaring at one another.
Who is in charge here? What’s the real truth? And why didn’t anyone tell you there was some sort of power struggle going on?
Of course, this doesn’t happen in dental surgeries. Open hostility between clinicians would be madness, serving only to baffle patients and undermine the whole purpose of creating healthy smiles.
But this is exactly what happens in maternity care, every day, in birth centres, hospitals and homes. Hostility, suspicion, mistrust, abuse and vitriol abound in relationships between obstetricians and midwives, clinicians, academics and activists.
Many readers already will have decided that this article is biased because I chose to use a dentistry metaphor – they’ll say a diseased tooth is utterly incomparable to the natural process of childbirth.
Or … they might say it’s unfair to choose a dentist and a technician to represent the opposing forces, because it implies one is more expert than the other – or that it’s wrong to mention homoeopathy or acupuncture because they have unfair implications of hippiedom.
Welcome to the birth wars. Everything that is published, posted or broadcast about the topic of pregnancy, birth and parenthood is contentious.
Some midwives and obstetricians are moderate and co-operative – but many are entirely opposed to the idea of working together, or sharing expertise …
There seems to be no middle ground. And that’s the problem, according to author Mary-Rose MacColl, a journalist … who spent years investigating maternity care. Her new book, “The Birth Wars” … is an exploration and denunciation of “the conflict putting Australian women and babies at risk”.
… MacColl uncovers a battleground that she believes Australians need to understand. It’s a fight between “organics” and “mechanics” for control and influence.
In MacColl’s parlance, the “organics” are mainly midwives who believe birth is a natural process that has become overly medicalised, with the consequence that many women are traumatised by cold, clinical births, unnecessary caesareans and excessive medication.
The “mechanics” include many obstetricians and hospital clinicians, who believe birth is a risky, delicate process that must be carefully monitored to ensure women and babies are safe.
Between the two sides, virtually nothing is agreed. Can a breech baby be delivered vaginally? Can a caesarean birth be followed by a vaginal birth? Should women be given synthetic hormones to help deliver placentas quickly after birth? Should home birth be encouraged, or even allowed?
… Beneath those practical questions are deeper, theoretical fights that rage with equal vehemence: what is an acceptable level of risk? What does “safety” mean? Is it essential that women have continuous care from a single, trusted practitioner?
Do we even have a right to expect that all births will result in live, healthy mothers and babies – or have we deluded ourselves about what to expect?
… The biggest problem … is not home births nor caesareans nor any of a hundred other contentious issues: the biggest problem is the destructive birth wars themselves.
“They need to talk to each other and they need to work out their differences, so that women get a coherent view about maternity care from the maternity care profession. I think that’s a reasonable thing for women to expect,” she says.
… if there is no consensus between practitioners, how are expectant parents supposed to make decisions?
… Lillienne’s story is told in The Birth Wars, but the short version is that her mother … was labouring in the midwife-run Birth Centre … After many … hours she was transferred to the hospital’s surgical Birth Suite. The baby’s heart rate dropped dramatically during labour, she was deprived of oxygen for some time and was eventually born by c-section.
Reviews found numerous problems: Debra’s high blood pressure was not interpreted as a warning sign at an early stage; confusion reigned over who was in charge; obstetricians were not welcome in the Birth Centre, where midwives were in charge.
… MacColl says there are many birth centres within hospitals, where doctors and midwives oversee completely separate domains ….
… the federal Government proposes to overhaul maternity by subsidising insurance costs for midwives, helping them to operate in private practice. Home births will not be covered.
… The proposal has sparked a furious debate, with home-birth advocates warning that women will have secret, underground home births without expert care.
… “While ever they’re fighting and it’s `organics versus mechanics’ we’ll have no change in the hospital system. We’ll keep establishing birth centres that draw lines in the linoleum and (say): `He’s on that side, I’m on this side and he better not cross the line.
… How crazy is it that you can be in one of the largest tertiary hospitals in Australia and have a situation where doctors are not allowed in? And, at the same time, how can you not recognise that a woman in labour is going to need a quiet, dark, calm environment like a birth centre, instead of a stark hospital room?”
MacColl has two goals. The first is to raise awareness that the birth wars exist, in the hope that parents can think carefully about their choices before the contractions begin …
I thought that was a fantastic article! I’m not sure that the solution is as simple as midwives and obstetricians sitting down and talking. For one thing, I don’t necessarily agree that obstetricians have an agenda that is too dissimilar to midwives’ agendas. I believe insurance is the key.
Currently, obstetricians have insurance and are far more likely than midwives, to be sued. Midwives essentially cannot be sued. For there to be a case, there needs to be solicitors and barristers on both sides. Private midwives are self-employed, and despite the view that women pay excessive amounts of money for their births, I can assure you we’re not wealthy. Essentially, midwives do not have money to fund lengthy court cases. But obstetricians do. And so do hospitals. Hospital-employed midwives are covered by vicarious liability. So if there’s going to be a court case, the woman or her baby are best suing the doctor or the hospital, rather than the private midwife.
No hospital or doctor wants to go through a court case. Even if they win, it’s emotionally and mentally taxing, it takes much time, and costs money. So there’s a strong incentive to avoid court cases and being sued. And the best way to do this is to practice defensively. Do a caesarean sooner rather than later. It’s easier to sue for a caesarean that was not performed in time – clearly, if something went “wrong”, a woman can argue that a caesarean should have been performed. Conversely, it’s very hard to prove that a caesarean was unnecessary. You can always find a reason why it was necessary.
So we have created – via our legal system – a situation where caesareans and any other interventions are encouraged. You cannot be sued for intervening. Only for failing to intervene.
So our caesarean rate is amongst the highest in the world. Over 31%.
We induce many women.
We continuously monitor many babies in labour.
We do not encourage waterbirth (how can you get a woman out in time if there’s an emergency??)
We encourage birth on the bed so that forceps or a vacuum can be easily applied if needed.
All births ought to take place in hospitals – or at worst, birth centres that are right next to the delivery suite and operating theatre. You just never know when they’re going to be needed.
Can you see what’s happening here? The fear of litigation prompts defensive practice, which leads to higher rates of intervention.
But I come back to my original statement: I don’t believe that mdiwives’ and obstetrician’s agendas are too dissimilar. Both want the best for women and their babies. I do not believe that obstetricians are out there to perform as many caesareans as possible, and to induce all other women and extract their babies with forceps. Nor do I beieve that every midwife wants to birth women in the water, with no monitoring of the baby, letting the labour go on for as long as it takes.
But insurance is the key. People have a need for safety. That includes midwives and obstetricians. Noone goes to work with the intention of traumatising a woman with surgery – particularly unnecessary surgery – but this needs to be balanced with the needs of the professional to practice their profession safely, however they define it.
If it were up to me, I would call for two things:
1. Greater transparency of pratitioner’s intervention rates, perhaps on a public register that is easily accessible, so that women are able to choose their health professionals with accurate information; and
2. Reform of our legal system, to a no-fault system such as the ACC Scheme in NZ.
Midiwves and obstetricians getting together and talking is a way away. It happens every day, but actually sorting out the differences will take time. There are many issues at the heart: competition, money, perceived superiority (from both sides!), the list goes on.
National guidelines on midwifery and obstetric care might help. Guidelines that state that within certain guidelines, women see a midwife. If they choose to see an obstetrician, they may fund this themself. And then, if a woman’s condition deviates from normality, as defined by guidelines, the midwife and woman consults with an obstetrician, or refers the woman’s care to an obstetrician. In this model, we see midwives caring for healthy pregnant and birthing women – doing what we do best, and obstetricians caring for women who need their services – doing what they do best. Such guidelines would optimise the care of pregnant women and eliminate the turf wars. These guidelines are in existence, and have been developed by the College of Midwives. Private midwives and employed midwives use them to guide the care they give to women.
The author of the article states, “obstetricians were not welcome in the Birth Centre, where midwives were in charge” – there is no issue with this. Midwives ought to be in charge of normal birth: it is our specialty. What is wrong is to fail to offer an obstetric consult to a woman when her condition deems it necessary. The GP provides most of the care to a family and refers members of the family to specialists when necessary: this is not perceived as a turf war. Why is midwifery and obstetrics any different?
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: birth, Birth choices, Birth trauma, Caesarean, Complicated pregnancy or birth, continuity of care, CTG, fetal monitoring, freebirth, hospital birth, intervention, midwife, Midwifery, Midwifery services, Obstetrics, Public and private hospitals, VBAC, women's rights
Posted by Melissa Maimann on Aug 29, 2009 in
Birth,
Home birth,
Midwifery For further information, contact Melissa Maimann at Essential Birth Consulting.
Link
WOMEN wanting homebirths are under pressure to have their children before July 1 next year …
… some women are considering limiting their families … if homebirth midwives are refused professional indemnity support.
… all women should have the birth they wanted.
… The Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and two related bills currently under debate could make homebirths unlawful from July 1 next year …
… the legislation could put babies and mothers at risk.
“Does it take a baby to die at home without a midwife for things to change?”
About 30 Ballarat Maternity Coalition members will attend a Homebirth Australia rally in Canberra on September 7.
There has been a lot of media about this issue. I’m hopeful that a resolution will be found, however home birth services as we know them will change forever. I will write another article about the positives that may come of the changes, and also the hesitations that I have.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: birth, Birth choices, continuity of care, freebirth, Home birth, midwife, Midwifery, Midwifery services, women's rights
Posted by Melissa Maimann on Aug 29, 2009 in
Birth For further information, contact Melissa Maimann at Essential Birth Consulting.
Link
Expectant mothers are being warned over the use personal monitors, such as Doppler devices, to listen to their baby’s heartbeat at home. There is concern that they may lead to delays in seeking assistance for reduced fetal movements.
Dr Thomas Aust and colleagues from the Department of Obstetrics and Gynaecology at Arrowe Park Hospital, Wirral, UK describe the case of a 27 year old woman … . She presented to their labor ward 32 weeks into her first pregnancy with reduced fetal movements.
Two days earlier, she had first noted a reduction in her baby’s activity. But she had used her own Doppler device to listen to the heartbeat and reassured herself that everything was normal.
Additional monitoring by the antenatal care team raised the alarm. The baby was delivered by caesarean section later that evening …
The authors explain that a hand-held Doppler device assesses the presence of fetal heart pulsations only at that moment. It is used by midwives and obstetricians … In inexpert hands it is more probable that blood flow through the placenta or the mother’s main blood vessels will be heard.
… a fetal Doppler device could be hired for £10 (about 16.46 USD) a month or bought for £25 to 50 (about 41 to 82 USD) … The companies offering sales state that the device is not intended to replace recommended antenatal care. However, they also make claims such as “you will be able to locate and hear the heartbeat with excellent clarity” …
I have always been concerned about use of dopplers in this way. Midwives and obstetricians are trained to interpret the baby’s heart rate in relation to what is happening for the woman at the time. The best advice for parents is to call your midwife or doctor if you’re concerned about your baby – if you feel that something isn’t right, or if your baby is not moving as much as s/he usually moves.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, Complicated pregnancy or birth, CTG, fetal monitoring, intermittent auscultation
Posted by Melissa Maimann on Aug 28, 2009 in
Birth,
Home birth,
Midwifery For further information about midwifery and birthing services, contact Melissa Maimann at Essential Birth Consulting.
Link
FOR a group of Melbourne parents … maternity service reform is not just a concept but a source of pain and hope.
Seven women and one man told of traumatic childbirths in the hospital system. They described physical and emotional scars to pressure the Federal Government to extend support for private midwives and home births.
Karen … said she believed a series of bad decisions in hospital had led to the death of her third child … the experience had left her shattered and angry about what she called a lack of accountability.
Sharon and Anthony said the birth of their first son had turned into a nightmare after a promising start. A doctor declined their request for an epidural, telling them: ”You will have an immediate C (caesarean) section or you will have to transfer out of the hospital.”
After a long and traumatic operation, Charlie was born safe and well, but Anthony said ”the obstetrician talked to me and he told me it was my fault about what happened – and he said, ‘You haven’t got me at my best and I haven’t done my best work’. I was just shocked.”
Midwife Sally-Anne Brown, of the Australian Private Midwives Association, said these traumas showed that the maternity system was ”a broken mess”.
But a proposed national registration system for midwives threatens to effectively ban private operators and home births, requiring all registered midwives to be insured, but not covering home births.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Home birth, hospital birth, Maternity Services Review, midwife, Midwifery, Midwifery services, Public and private hospitals
Posted by Melissa Maimann on Aug 28, 2009 in
Birth,
Home birth,
Midwifery For further information, contact Melissa Maimann at Essential Birth Consulting.
Link
A warning from Australia’s peak group of obstetricians and gynaecologists that home births carry too much risk to babies and their mothers is completely false, according to an Echuca midwife of 25 years.
The National Association of Specialist Obstetricians and Gynaecologists (NASOG) claims home births, with or without a midwife, are too risky and the government should resist calls to indemnify midwives outside of hospitals.
How can she compare midwife-assisted home births and free births?
Proposed laws … would require midwives to have professional indemnity insurance before they could be registered.
But such insurance is unavailable for people who work outside hospitals.
Midwife and maternal and child health nurse Andrea Quanchi, who operates Echuca-Moama Midwifery and Parenting Service, said if the laws were passed, said she could possibly face fines of up to $30,000 for helping with home births.
… “Then there will be no regulation of midwifery standards and that is dangerous.
… There was nothing dangerous about home birthing – it was about providing women with choices, she said.
… “If there is an emergency, we transfer them to the hospital … The transfers run seamlessly … ”
Mrs Quanchi said she didn’t force clients into home birthing and had been present at countless hospital births.
“It’s not my decision as to where they want to have their baby,” she said.
“It can’t be their ultimate goal. It’s about what’s right for them at the time.
“If something goes wrong, we’re out of there.”
NASOG president Hilary Joyce said Ms Roxon was acting in the best interests of babies and their mothers by refusing to financially endorse the “unsafe practice” of delivering babies at home.
“There are things that can go wrong suddenly in a birth which, if not under specialist care or near medical assistance, can result in an avoidable death or permanent injury,” Dr Joyce said.
And far more goes wrong when women birth in hospitals with every machine that goes ping.
That has not been the case with any of Mrs Quanchi’s 75 clients, over a 10-year period.
“Home births are for women who have low-risk pregnancies, no complications and have a good back-up plan. They also need to be from a good, stable home environment,” Mrs Quanchi said.
“We’re not in the danger game of proving a point.”…
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, freebirth, Home birth, hospital birth, intervention, Maternity Services Review, midwife, Midwifery, Public and private hospitals, women's rights
Posted by Melissa Maimann on Aug 27, 2009 in
Home birth,
Midwifery For further information, contact Melissa Maimann at Essential Birth Consulting.
Link
The Liberals have put at risk the Rudd Government’s landmark reforms for the nursing and midwifery workforce by refusing to indicate the opposition will support the bill before the Parliament.
In a contribution of 30 minutes, the Shadow Minister for Health and Ageing couldn’t bring himself to support these important reforms that will improve choice and support for thousands of families in our community.
Provided that they birth in hospital …
… These landmark changes for nurses and midwives will give them access to the Medical Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) for the first time. These changes will provide all Australians with greater choice about their healthcare via improved access to the skilled services of nurses and midwives.
Again, only for hospital birth. Women choosing home birth will be on their own.
This legislation is a key plank of the government’s $120.5 million maternity reform package, improving the choices for Australian women in accessing high quality, safe maternity care, as well as providing support for the maternity services workforce.
On the separate issue of Registration and Accreditation that is causing concern for those in the community that support homebirths …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Home birth, hospital birth, Maternity Services Review, midwife, Midwifery, Midwifery services, women's rights