The package, called “Getting it right at the very beginning”, has been shortlisted for the “Research into Practice” category of the 2010 Royal College of Midwife Awards.

… “Not only have we had very positive feedback from the women who received the care, but midwives have also seen the benefits.”

11 per cent gave birth without any pain relief and 21 per cent used paracetamol to take the edge off the pain … and more women used natural pain relief like a birthing pool or bath.

Of the group that received the care package, 73 per cent had a normal birth, without any clinical interventions. The Caesarean Section rate was 13.5 per cent.

This compared with a 37.5 per cent normal birth rate for the women who didn’t have the early targeted support, and a Caesarean Section rate of 37.5 per cent.

The care package is a set of six proven actions which work in harmony to benefit the outcome of the labour and give women a positive birth experience.
* L – Look and Listen;
* A – Assess maternal observations;
* T – Time;
* E – Encouragement;
* N – Non-pharmacological pain relief;
* T – Telephone

… controlled ovarian hyperstimulation (COH) drugs — used to stimulate a woman’s ovaries to speed the maturity and multiply the production of eggs — accounts for four times more live births than assisted reproductive technologies (ARTs) such as in vitro fertilization.

“Many people have focused on the role of ARTs in multiples and have not fully appreciated that fertility drugs alone are responsible for one out of every five multiple births,” … “COH drugs are widely prescribed, and some health care professionals … are not aware of the serious risks of fertility drugs to women and their babies. There is a very high possibility of multi-fetal pregnancy resulting from use of these drugs, and that brings a high risk of prematurity and lifelong health problems for the babies as a consequence.”

The boom in unnecessary surgeries is jeopardising women’s health …

Unnecessary C-sections … raise the risk of complications for the mother … C-sections have reached “epidemic proportions” in many countries worldwide.

The most dramatic findings were in China, where 46 per cent of births reviewed were C-sections — a quarter of them not medically necessary …

“So many pregnant women ask for a Caesarean birth in China, but we always suggest that they have a natural birth,” …

“It’s bad to have so many Caesarean births because natural birth is the ideal way.”

The WHO … found 27 per cent were … partially motivated by hospitals eager to make more money.

… Women undergoing C-sections that are not medically necessary are more likely to die …

… babies born by Caesarean have a greater chance for respiratory problems. The … procedure benefits babies during breech births.

In Asia, some women opt for the surgery to choose their delivery day after consulting fortune tellers for “lucky” birthdays or times. Others fear painful natural births or worry their vaginas may be stretched or damaged by a normal delivery …

… China’s 46 per cent C-section rate was followed by Vietnam and Thailand with 36 per cent and 34 per cent, respectively. The lowest rates were in Cambodia, with 15 per cent, and India, with 18 per cent.

… fathers-to-be will be the target audience of new leaflets and pamphlets, while the midwives’ body has been asked to draw up new guidelines for its members on how to better draw fathers into the process of pregnancy and birth.

The Guide for New Dads, produced in conjunction with the Fatherhood Institute (FI), will provide information on a range of issues from paternity leave to breastfeeding.

“We know men want to be involved with a new baby, but so many chances to engage them are missed,” says Adrienne Burgess, head of research at the FI. “The truth is if you want a mother to eat well during pregnancy, or quit smoking, you have to get the father involved at early stage because his behaviour will unquestionably influence hers.

And while fathers may say when it comes to breastfeeding – ‘I’ll support you in whatever you choose to do’, mothers’ perceptions about what the father really thinks about breastfeeding and the toll it may take on the body are one reason she may stop.

“… there is no justification for the restriction of fluids and food in labor for women at low risk of complications,” …

… Until the 1940s, women were generally encouraged to eat and drink during labor … to keep up their strength.

… a 1946 paper … suggested that access to food increased the risk that women under anesthesia would aspirate acidic stomach contents during labor, potentially causing serious lung injury and even death.

Mendelson’s work persuaded many obstetricians to urge that women fast until after delivery …

… anesthesia procedures have changed markedly since the 1940s, with regurgitation of stomach contents now considered very rare.

Victoria Anderson needed extensive plastic surgery after [her] … midwife ‘randomly hacked’ at her and her 12lb baby with a pair of scissors.

Little [baby] Daisy was cut and pulled so forcefully during her birth that the nerves in her neck and arm were completely severed. She is disabled as a result.

The Nursing and Midwifery Council yesterday heard that Mrs Anderson, 39, employed [the midwife] to deliver her third daughter at her home …

Mrs Anderson … wanted the deal with the same midwife throughout her pregnancy.

However, she had developed diabetes while pregnant and as a result baby Daisy had grown to an enormous 12lb inside her womb.

… ‘I got in the birthing pool but I was struggling to get the head out.

‘I’ve got a history of having big babies so I asked [my midwife] to cut me to get the baby out.

‘She did cut me and I could see the head so I thought I was home and dry – but then nothing happened.

‘I thought I would deliver the shoulders and Daisy would be out but suddenly [my midwife] started to get stressed.

… When Daisy eventually arrived she had lost colour through a lack of oxygen and so was put in an ambulance and rushed to hospital.

… ‘It seemed to me that [our midwife] was wrestling with the head …

‘I remember lots of cuts and … blood. The last thing I remember before the baby was born was [our midwife] putting both hands inside Ms A and just pulling her out.’

Mrs Anderson, who has three other daughters, told the panel that her bowel had been permanently damaged during the procedure and she has since had to have extensive reconstructive surgery.

Her daughter Daisy suffers from Erb’s palsy, a condition which causes paralysis …

Professor Cathy Warwick, general secretary of the Royal College of Midwives, described the loss of the Albany practice, a leading group based in South London, as a “great disappointment”. She said she was concerned it was being used to “colour the debate” on giving birth at home.

… In her first interview since King’s College Hospital ended the Albany contract last year, Professor Warwick told The Times that the situation should have been avoided as it was widely acknowledged that the home birth service brought “a huge number of positives”.

Professor Warwick’s comments come after fierce criticism of the decision to axe the Albany by mothers, health professionals and politicians. She said that a confidential report into the practice, commissioned by King’s, had highlighted legitimate issues of governance, but it had neither recommended closure nor supported conclusions being drawn about the safety of giving birth away from hospital.

Professor Warwick, the former director of midwifery and women’s services at King’s, was responsible for drawing up the first contract with the Albany service in 1997. The group was widely celebrated as a pioneering means of providing expectant mothers with more birthing choices and a greater continuity of care during and after pregnancy …

… King’s remained one of the best providers of maternity care in hospital and community settings … “I think there is still a core of people who do fundamentally feel that babies are better born in hospital,” …

… The CMACE review was commissioned after King’s identified 11 cases … brain damage … in two and a half years.

The report … concluded 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. It does not recommend the termination of the service, and also criticises the negative attitudes of some hospital staff “to the whole concept of birth taking place outside a hospital’s perimeters, and towards midwives who promote home birth”.

Dozens of mothers and other campaigners have protested over the termination of the contract …

Professor Warwick said … she felt the service had fallen victim to wrangling by both sides which had prevented a satisfactory resolution. She said: “The inference is being made that [this midwifery model] is on the more extreme end of safety. You cannot say this model is more or less safe in terms of morbidity and mortality,” she said. “The issue that is most pertinent is we want to give women choice.”

… should reject leaders who do not treat the lives of mothers humanely saying that mothers should not be coerced into motherhood.

… women in developing world … are dying from unsafe abortion even though there are great advances in medical technology.

… ‘Women are not dying from the diseases that we cannot treat but they are dying because societies have yet to make the decision that their lives are worth saving’. …

“Doctors had told me home births were incredibly risky but I did a lot of research and the midwives understood what I was talking about and how I felt,” Ms Read said.

“It was an incredible experience that was more than I expected for myself, my husband and my kids.”

Independent midwives have slammed reports this week that home births put babies at a greater risk of dying than those born in hospital.

A widely reported … study showed that babies born at home are seven times more likely to die of complications and 27 times more likely to die from lack of oxygen.

The Australian Medical Association (AMA) and the National Association of Specialist Obstetricians and Gynaecologists used the study to warn against the dangers of home birth.

But the report, which compared 297,192 planned hospital births with 1141 planned home births … also showed that the perinatal death rate was similar for both kinds of births.

The 16-year long study recorded nine perinatal deaths in the planned home-birth group, seven of which were actually born in hospital, and 2440 deaths in planned hospital births.

Prof Keirse said he was scared by the number of women choosing to have home births after already having had a caesarean.

“When a problem happens and you are at home you have no real way of dealing with it,” he said.

“One of these days we will not only lose a baby but a mother as well.”

Homebirth Australia national secretary Justine Caines said the reporting of the study by the AMA was irresponsible.

“I think they are trying to push a political agenda and outlaw or force home birth underground, which is incredibly irresponsible,” Ms Caines said.

The decision forced many midwives underground and threatened to increase the number of women ”freebirthing”, or delivering at home without any medical supervision.

This has not happened as the changes will not come into effect until July 1, 2010.

Ms Caines said from July this year midwives were at risk of not being able to be registered under the Commonwealth reforms.

“In the UK there is a legislative right that if the woman choses a home birth there is a responsibility that they have a trained health professional with them,” she said.

In the UK, it is illegal for women to have unassisted births. We do not have this law in Australia.

“A woman has a right to make an informed consent to a home birth and if she understands the advice she’s received it’s not my right to say you can’t do that.”

SA independent midwife Julie Garrett said midwives were aware of the complications, but had a duty to support the choice of a mother.

And this is the crux of the matter: midwives do not act irresponsibly. We do inform women of the risks. But women are free to choose amongst options and to make the right decision for them.

Ms Garrett said the culture in Australia needed to change to support midwife-based care as an alternative.

“In England and New Zealand they are bringing in home births, while Holland has an almost completely midwife-based care model. It’s the culture here that needs to change. Women should be able to choose.”

In the UK, NZ and the Netherlands, health policy supports low risk home birth. Even in a country such as the Netherlands, where home brith is a normal birthing option, the home birth rate is only 30%. 70% women need to birth in hospital or choose to birth in hospital, and there is no stigma attached to it. In a country such as Australia, with a caesarean rate in excess of 30%, a maximum of 70% women will be “eligible” by risk-assessment standards, to birth at home. Add to that twins, breeches, women going over 41 weeks or less than 37 weeks, high blood pressure, gestational diabetes, big babies and so on, and you can understand that even if home birth is a government-supported option, it will not be an option for the majority of women.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Tags: Birth choices, Complicated pregnancy or birth, continuity of care, Maternity Services Review, midwife, Midwifery, Midwifery services, Normal Birth, Obstetrics, women's rights