The State Government announced the $400,000 midwife-led home-birth project last week.

The Albany practice, an independent group in South London held up as a model for the midwifery sector, had its contract with the NHS terminated after an inquiry into alleged poor practice over 30 months.

… Parents … marched to the Department of Health yesterday to protest at the termination of Albany’s contract … They claimed that it was a flawed analysis that had been withheld from the public.

The Government has sought to increase midwife-led and home birth NHS services to address the over-stretched maternity sector.

Women are supposed to be offered the choice of a home birth, but only 3 per cent of births take place at home …

The report … reveals that the hospital identified 11 cases of hypoxic ischaemic encephalopathy (HIE) … in the two and a half years …

… “[King’s] identified the number of admissions of term infants with serious complications … was comparatively ten-fold greater amongst women under the care of the Albany Group Practice than women cared for by other King’s midwifery group practices or by hospital midwives”.

The report … concludes that “risk factors for a poor outcome in pregnancy were being overlooked by Albany midwives”, and that home births were sometimes being encouraged when not medically appropriate.

However, it does not recommend the termination of the service …

Supporters of the Albany consider the hospital’s actions an attack on independent midwifery …

Statisticians and clinicians shown the report also raised concerns about its methodology and the use of HIE as a guide to the quality of care. … they suggested that it was based on “bad science”.

Questions have also been raised as to why the inquiry remains confidential and why it was not carried out in conjunction with the Care Quality Commission, the health regulator.

Professor Alison Macfarlane … said the report did not include proper assessment of birth rates … or additional risk factors … “They haven’t attempted to look at it statistically. There are no rates per babies, only numbers, so you cannot compare like with like.

… Mavis Kirkham, Professor of Midwifery at Sheffield Hallam University, said the report was “bad science and fundamentally flawed” for reasons including the problems with diagnosing HIE.

She pointed to the lack of acknowledgement of success rates, with Albany’s mortality rates for infants at 4.9 per 1,000 compared with the wider borough of Southwark’s 11.4 per 1,000.

The Albany investigation was prompted by the death of Natan Kmiecik one week after he was delivered at the hospital by Albany midwives. Lawyers for his mother … claimed that proper procedures were not followed because Natan’s heartbeat was monitored only by a small hand-held device so she could have a water birth.

A hospital spokesman said the report underlined the need for closer monitoring of midwifery and denied claims that it reflected an aversion to home births …

“While the report reinforced our view of the excellent relationships formed between Albany midwives and their expectant mothers, it also highlighted serious shortcomings in terms of non-compliance with [hospital] trust policies and risk management procedures, particularly during labour and with newborn babies,” he said.

“We felt this was an unacceptable level of risk for our patients and were unhappy with the nature of the contractual arrangements. Therefore a decision has been taken to terminate our contract with Albany.”

… “Most people in the area are poor; they scrape a living as farmers, and most don’t have a senior high education,” …

… “If access to clean water remained out of reach, the quality of women’s and children’s health would have declined, and their lives would have been in danger,” …

Listiani … said she and a new graduate midwife on a temporary posting in the local community were the only health workers in the area, handling childbirths for the 874-hectare village that had a population of more than 7,000 people.

“… together we can serve around 40 patients a day,” she said.

… “The lack of midwives in remote areas … is behind the low quality of health of the people there, as well as the increased number of dying women and babies,” …

Indonesia expects to achieve a maternal mortality rate of 102 per 100,000 live births by 2015, down from the current rate of 228 per 100,000 live births.

Women whose babies presented in the normal anterior position at birth had significantly higher free thyroxine levels than women whose babies presented abnormally … They were also more likely to have a spontaneous delivery …

… ” … this is the first study showing an association between maternal FT4 concentration during late gestation and cephalic fetal head position in healthy pregnant women with normal thyroid function,” …

Earlier research had attributed abnormal fetal presentation to improper rotation during labor, but more recent research suggests it’s a failure to rotate at all that may cause the abnormal presentation.

Thyroid dysfunction is associated with poor obstetrical outcomes, including abortion, stillbirth, preterm delivery, and even neonatal arrhythmia.

Abnormal fetal presentation occurs in up to 25% of congenital endocrinological syndromes …

Often in the places where obstetric fistula is most common, the capacity for treatment can’t meet the needs of all women who require it …

… At a midwife-led unit, women are helped through their labour by [midwives] and they cater for patients who show no signs of difficulty in giving birth naturally, referring any problems to an obstetrician if necessary.

When the woman starts labour, she goes to the midwife-led unit … and is welcomed into a private room where she stays for the labour, birth and postnatal resting time.

A consultant-led unit is staffed by obstetricians and and midwives, offering full pain relief cover such as epidurals.

… The number of babies needing resuscitation at birth or admission to the special care baby unit was the same in both groups.
60% of women in the consultant-led unit had their baby’s heartbeat monitored continuously in labour by an electronic monitoring machine, compared to 38% of women in midwife-led units.
Almost half the women in the doctor-led units had their labour speeded up by having their waters broken or having oxytocin, a hormone given intravenously by drip, compared to a third of those in the other.
Up to 85% of women in the midwife-led unit said they would recommend it, compared to 70% of those having the traditional care.

Although the facilities in the midwife-led unit were “luxurious”, the cost per patient was €332 less than in the traditional hospital system.

… 83% of women in the midwife-led units expressed satisfaction with their pain relief, compared with 68% of women in the consultant-led unit.

… women with a history of preeclampsia in their first pregnancy were more likely to have high levels of thyroid stimulating hormone.

… “Preeclampsia among nulliparous women is associated with a greater subsequent risk of subclinical hypothyroidism in pregnancy, and women with a history of preeclampsia are at greater risk of hypothyroid function many years after preeclampsia,” …

The Albany practice, an independent group in South London previously described as a “gold standard” for the midwifery sector, had its contract with the NHS terminated after an inquiry into alleged poor practice over 30 months.

The move has prompted a campaign by the group’s supporters, who … claim the service was terminated because NHS managers preferred hospital births. Under the Albany group, all women have their babies delivered by the first midwife they see during their pregnancy, with almost half giving birth at home.

… a spokesman for King’s College Hospital, which commissioned the report … defended the decision.

… “While the report reinforced our view of the excellent relationships formed between Albany midwives and their expectant mothers, it also highlighted serious shortcomings in terms of non-compliance with [hospital] trust policies and risk management procedures, particularly during labour and with newborn babies.”

… only about 5 percent of C-sections are true emergencies. Another 3 percent are elective, meaning there’s no medical reason to have one. The rest fall into a murky area: the mother plans a vaginal birth but is past her due date, labor isn’t progressing as quickly as everyone would like and the baby is growing larger …

Factors contributing to the increased number of C-sections include older moms-to-be … heavier pregnant women … and a rise in induced labor, which increases the chance a woman will need a C-section.

Technology, such as recording the fetal heart rate, also plays a role: Skittish doctors are more likely to play it safe and perform major abdominal surgery if there’s any hint of trouble.

C-sections can be lifesaving, but research suggests they’re associated with extra risks in comparison with vaginal birth. New moms experience more physical problems, longer recovery … and more emotional issues. Babies are born by cesarean are less likely to be breastfed and more likely to experience breathing problems at birth and asthma as they get older.

… Mothers were categorized into light and heavy smokers, depending on how many cigarettes they smoked every day during pregnancy.

… they were asked to grade their three year old children’s behavior. They focused particularly on behavioral problems and hyperactivity-attention deficit disorders.

Behavioral conduct problems were based on answers to questions about:
• the child’s temper
• the frequency of physical fights
• bullying of other children
• being argumentative with adults

… boys whose mothers smoked throughout pregnancy were significantly more likely to have behavioral problems, be hyperactive, and have low attention spans than boys whose mothers did not.

Boys whose mothers smoked heavily throughout pregnancy were almost twice as likely to display behavioral problems … sons of light smokers … were almost 80 percent more likely to have hyperactivity-attention deficit disorders.

… daughters of … smokers were significantly more likely to display behavioral problems than girls whose mothers did not smoke.