Posted by Melissa Maimann on Feb 28, 2010 in
Birth,
Home birth,
Midwifery,
Normal Birth,
Obstetrics,
VBAC Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Why are are home births with a mid wife preferred over a hospital delivery?
There are many benefits to birthing at home and having a midwife provide your care. The following pages will explain more about the benefits of birthing at home:
http://www.essentialbirthconsulting.com.au/home-birth.html
http://www.essentialbirthconsulting.com.au/home-birth/home-birth-benefits.html
I had a bad first birthing experience and I’m now waiting for my second baby.
It’s important to debrief your birth experience to help you to gain clarity around what happened and to explore strategies for helping the same situation to not happen again. Birth debriefing can also help you to choose a care provider who can support what it is you need for your second birth.
What are the benefits of having my baby with a midwife?
There are many benefits:
- Have the same care provider all the way through your pregnancy, birth and postnatal period
- Lower rates of intevention such as forceps, vacuum, episiotomy, induction, epidural
- More likely to breastfeed successfully
- Have continuous support from your midwife throughout labour
- Babies generally experience gentler births
What proportion of women birth at home with midwife?
Australia-wide, around 0.3%. In NSW, it’s around 0.2%. The low rate of homebirth is related to several factors:
- Homebirth is not actively supported by our health system, and hence it is not offered as an option to women when they see their GPs when they become pregnant.
- There is a perception that home birth is something only “hippies” or “alternative” people do. This could not be further from the truth!
- The cost of homebirth is prohibitive for some families as it is totally privately funded.
- In some areas, there are no midwives available.
Is it possible to contract a private midwife for postnatal care only?
Yes! Essential Birth Consulting provides postnatal care independent of birthing services.
Are there any VBAC friendly doctors at north shore private?
VBAC rates at North Shore Private are around 5% or lower and this is reflective of the obstetricians who practice there. Conversely, private midwives have VBAC rates as high as 90%. Obstetricians are surgicial specialists; midwives are specialists in normal, natural birth. If you’re after a normal birth (VBAC), you’re best to choose a care provider who specialises in this.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, Home birth, hospital birth, midwife, Midwifery, Midwifery services, Normal Birth, Obstetrics, Public and private hospitals, VBAC
Posted by Melissa Maimann on Feb 28, 2010 in
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
Endometriosis affects 10 percent of women of reproductive age, yet the condition remains one of the most neglected and underfunded fields of research in gynecology …
… the statistical association between endometriosis and infertility is beyond dispute. One well-cited study found a higher prevalence of endometriosis in infertile women (48 percent) than in fertile women undergoing tubal sterilization (5 percent) … infertile women are 6-8 times more likely to have endometriosis than fertile women.
… a new diagnostic staging tool has been proposed that predicts the chance of spontaneous pregnancy in those with surgically documented endometriosis who are treated without IVF … The EFI score ranges from 0-10, with 0 representing the poorest prognosis and 10 the best … those patients with scores of 0-3 could expect a cumulative pregnancy rate of 11.1 percent at 3 years, increasing to 68.3 percent for those with scores of 9-10.
… the most common symptoms of endometriosis were painful menstruation, painful intercourse, and incapacitating pain …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Complicated pregnancy or birth, IVF, Obstetrics, Preconception care
Posted by Melissa Maimann on Feb 27, 2010 in
Birth,
Midwifery,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
The Canberra Hospital’s obstetric training program could be at risk unless more doctors with surgical experience are found.
… workplace problems are preventing Canberra-based obstetricians from doing more public work.
As many as 16 registrars … can be attached to the Canberra Hospital Obstetric and Gynaecology Department at one time.
But RANZCOG spokesman Andrew Foote says five consultant obstetricians have left in just over a year.
“In order to do surgery, you need senior doctors who are seeing the cases and putting the cases on operating lists,” he said.
“That has fallen to a quite significant level.”
… the Canberra Hospital had “the potential to be a leader in the RANZCOG program throughout Australia and New Zealand.”
But in its recommendations it listed “dysfunctional relationships within the Obstetric and Gynaecology Department …
… conflict between senior staff … was having an impact on trainees.
… obstetricians would work at the hospital if the conditions were better.
… many of the doctors and registrars who have left the hospital … complained of a toxic workplace and uncooperative relationships with some midwives.
… they were concerned some midwives raised the alarm too late in emergency situations with potentially disastrous consequences.
“One of the cultural concerns I have is that there’s this ‘I’ve failed if I have to call in a doctor’, both at the patient level and at the midwife level,” …
… “This concept has been built up and perhaps sold to the public that it is possible to have a pregnancy unencumbered by any medical staff,” he said.
Gill Hall from the ACT College of Midwives says most doctors and midwives work well together.
“There’s a lot of people in both professions who are working very hard to change the culture and to make practice much more collaborative,” she said.
Health Minister Katy Gallagher says the Federal Government’s changes to Medicare which will reduce rebates to private obstetricians could be partly behind doctors raising the allegations.
“I think the building of a new Women’s and Children’s Hospital is causing turbulence and I think the sale of Calvary is causing turbulence,” she said …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Complicated pregnancy or birth, hospital birth, midwife, Midwifery, Midwifery services, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Feb 26, 2010 in
Birth,
Caesarean,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
The mortality rate of California women who die from causes directly related to pregnancy has nearly tripled in the past decade, prompting doctors to worry about the dangers of obesity in expectant mothers and about medical complications of cesarean sections.
For the past seven months, the state Department of Public Health declined to release a report outlining the trend.
California Watch spoke with investigators who wrote the report and they confirmed the most significant spike in pregnancy-related deaths since the 1930s. Although the number of deaths is relatively small, it’s more dangerous to give birth in California than it is in Kuwait or Bosnia.
“The issue is how rapidly this rate has worsened,” … “That’s what’s shocking.”
… “current trends and evidence suggest that maternal mortality rates may be increasing in the U.S.”
The alert asked doctors to consider morbid obesity, high blood pressure and diabetes, along with hemorrhaging from C-sections, as contributing factors.
… Shabbir Ahmad, a scientist … decided to look closer. He organized … a systematic review of every maternal death in California. It’s the largest state review ever conducted. The group’s initial findings provide the first strong evidence that there is a true increase in deaths – not just the number of reported deaths.
Changes in the population – obese mothers, older mothers and fertility treatments – cannot completely account for the rise in deaths in California …
… scientists have started to ask what doctors are doing differently. And, he added, it’s hard to ignore the fact that C-sections have increased 50 percent in the same decade that maternal mortality increased. The task force has found that changing clinical practice could prevent a significant number of these deaths.
… While the maternal mortality rate among black women is rising, the task force found a more dramatic increase in deaths among white, non-Hispanic mothers …
… In 1996, the maternal death rate in California was 5.6 per 100,000 live births … Between 1998 and 1999, the World Health Organization changed its coding system, which may have increased reporting of deaths. The California rate was 6.7 in 1998 and 7.7 in 1999. Because the number of mothers who die is small, the rate tends to fluctuate from year to year.
In 2003, when California revised its death certificate, the rate jumped to 14.6. And in 2006, the last year for which data is available, the rate stood at 16.9.
… When researchers unveiled their initial findings to a conference of the American College of Obstetricians and Gynecologists in 2007, there were gasps from the audience … The idea that California was moving backward even in an era of high-tech birthing was implausible to some. Confirmation of the trend was noted in the 2008 report …
The state of California has yet to share the report with the public. Researchers say that, after reviewing the report in 2008, officials in the Department of Public Health asked for technical clarifications. Revisions were complete and approved in the first half of 2009 …
… it is important for the public to be aware now that these trends are worsening …
“Even though they tend to be small numbers in terms of maternal mortality, it is important – it’s very important – that these trends be looked at,” she said. “And efforts need to be made to try and reverse them when they are going in the wrong direction.”
Rising C-section birth rate
Nearly one in three babies is now born by C-section. Many scientists have acknowledged that at some point, as the number of surgeries spiral upward, the risks will outweigh the benefits. But the C-section remains a useful tool, and in the middle of labor, doctors say, it’s hard to balance the potential long-term harm against immediate crisis.
Today, doctors face a condition called placenta accreta, where the placenta grows into the scar left by a previous C-section. In surgery, doctors must find and suture a web of twisted placental vessels snaking into the patient’s abdomen, which can hemorrhage alarming amounts of blood. Often, doctors must remove the uterus.
Main said this complication from C-sections has increased eight-to-10 fold in the past decade. Nonetheless, most women survive the ordeal … the rise in deaths is indicative of a larger problem.
“For every maternal death, there are 10 near misses; for every near miss, there are 10 severe morbidity cases (such as hysterectomy, hemorrhage, or infection), and for every severe morbidity case, there is another 10 morbidity cases related to childbirth,” …
Inducing labor before term more common
… Dr. David Lagrew … noticed that a lot of women were having their labor induced before term without a medical reason. And he knew that having an induction doubled the chances of a C-section.
So he set a rule: no elective inductions before 41 weeks of pregnancy, with only a few exceptions. As a result, Lagrew said, the operating room schedules opened up, and the hospital saw fewer babies admitted to the neonatal intensive care unit, fewer hemorrhages and fewer hysterectomies.
All this, however, came at a cost: The hospital had to take a cut in revenue for reducing the procedures it performed. Lagrew doubts that any hospital has increased its C-section rate in pursuit of profit, but he does note that the first hospitals to adopt controls on early elective inductions have been nonprofits.
According to a report issued by the advocacy group Childbirth Connection, “Six of the 10 most common procedures billed to Medicaid and to private insurers in 2005 were maternity related.” On average, a C-section brings in twice the revenue of a vaginal birth. Today, the C-section is the single most common surgical procedure performed in the United States.
“If all these guys were losing money on every C-section, well, what’s the old saying? Whenever they tell you it’s not about the money, it’s about the money,” Lagrew said.
The California task force isn’t waiting to determine the ultimate cause of these deaths. It has started pilot projects to improve the way hospitals respond to hemorrhages, to better track women’s medical conditions and to reduce inductions …
I think they’ve missed one key element: midwives! If every woman was cared for by her own midwife (and home birth and birth centre birth was encouraged as the norm for healthy women), the induction and caesarean rates would fall dramatically …. then maybe fewer women would die in childbirth.
Midwifery has an important focus on health promotion and education and would work fantastically for poorer women and women with health issues. The other priority ought to be raising the VBAC rate and reducing the number of elective repeat caesareans. Whilst the first caesarean might be safe, second and subsequent caesareans carry serious risks that are alluded to in this article.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Birth trauma, Caesarean, childbirth education, Complicated pregnancy or birth, hospital birth, intervention, Normal Birth, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Feb 25, 2010 in
Uncategorized Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
What does an obstetrician cost in Sydney?
Fees vary greatly. As well as considering obstetrician’s fees, also consider costs such as private health insurance co-payment or excess, extra fees and charges associated with private hospital stays, paediatrician and anaesthetist fees and additional costs for ultrasounds and tests. All up, you’re looking at somewhere between $2,000 and $10,000.
Private midwifery care, on the other hand, costs somewhere between $3,000 and $6,000.
Are there any antenatal / prenatal birthing classes in the Westmead area?
Yes, this service provides antenatal classes in the Westmead area.
What is the ceasearan rate in Australia in 2009?
This won’t be known until around 2011. In 2007 it was around the 30% mark and caesarean rates have increased most years. The current caesarean rate is around 30% – 35%.
induction vs cesarean and diabetes
What about another option? What about a natural birth? Provided that there are no complications as a result of the diabetes, this might be a great option to discuss with your care provider. You might also wish to seek a second opinion with a private midwife.
Intervention in midwifery?
Midwives are experts in natural birth, and therefore tend not to intervene in births. If intervention was felt to be necessary, an obstetrician would be consulted.
natural birth in a hospital australia?
Natural birth is far more likely in a homebirth (homebirth has an average transfer rate of 25% and the births that occur at home are 100% natural). In some hospitals in Australia, natural births are around 5%. Private midwifery care dramatically increases the chance of a natural birth in any setting.
Prenatal classes sydney
Yes, this service provides antenatal classes in Sydney.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: childbirth education, continuity of care, hospital birth, midwife, Midwifery, Midwifery services, Public and private hospitals
Posted by Melissa Maimann on Feb 25, 2010 in
Birth,
Home birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
For Stephanie Foley … the home birth of her son Calvin was a “peaceful, great experience.”
And while Foley said she’s pleased with how her home birth went, and that she would do it again, the issue of the safety of out-of-hospital birth is up for debate.
Statistics show that while the desire for a less sterile, more intimate birth experience is growing, most mothers in the U.S. still have their babies in a hospital. It’s the prudent choice, safer if something goes wrong, experts say.
But it isn’t a simple call.
Family history, health of the mother and fetus, available and trusted midwives and personal preference all weigh in the decision.
On average, only 1 percent of all births in the U.S. are conducted out of hospitals annually …
Tori Kropp, a perinatal registered nurse at San Francisco’s California Pacific Medical Center, says it’s safer to give birth in a hospital.
… hospital births have gotten a bad rap due, in part, to the efforts of home-birth proponents, such as TV personality Ricki Lake.
Lake’s 2008 documentary “The Business of Being Born,” ignited a fire storm by implying many common medical practices may be doing new mothers more harm than good.
Kropp has participated in 5,000 births, including that of her 9-year-old son Alexander. By participating in so many deliveries Kropp said she has “seen all the things that can happen” during what is still a potentially dangerous event in a woman’s life.
Has she been at any homebirths? It’s totally ok to have an opinion in something that one has not seen, attended, experienced or directly been a part of. But if Kropp has never been to a home birth, only obstetricially-driven hospital births, who is she to say that home is not at least as safe as hospital for healthy, low-risk women who are attended by a midwife?
“Most of the time it’s wonderful, but sometimes it’s not,” Kropp said. “At the end of the day, it’s safer to give birth in a hospital.”
Through education and outreach Kropp strives to correct what she says is “misleading” information promoted by Lake’s film. ”
“The problem with many home births,” Kropp says, is that they are performed by midwives “without the support of either physicians or a hospital.”
And is that because the midwife has not consulted with the hospital or doctor, or because they were not willing to consult when it was requested?
To spread her message, Kropp is planning a 100-hospital tour across the country beginning in Michigan on Labor Day. Kropp plans to offer free pregnancy seminars at the hospitals …
Is she planning to get her message out to women who are planning to birth at home? If so, she can talk to the hospitals all she likes, she will not reach her intended audience.
Overall Kropp’s mission is a simple one – “helping women feel empowered about the choice they make, and not the choice society wants them to make.”
But … not if they choose to birth at home. It’s ok to choose an epidural or a caesarean though!
Regardless of birth location, 8 percent of births in 2006 were performed by midwives, according to the CDC.
Definitely room for improvement there. 80% would be a great target!
When Foley gave birth to her first and only child in December 2007 she and her husband lived in a one-bedroom, second-floor apartment in Lansing.
After about 6 hours of active labor, with the help of a direct-entry midwife, Foley gave birth to her son in an inflatable pool filled with water, which is described as a water birth.
… “Pregnancy and childbirth are normal, healthy events in a woman’s life and interventions, such as cesarean sections, should be used only when medically necessary, Winkler said. “Women choose to come to the birthing center for freedom of choice.”
But Winkler cautioned that women who have chronic diseases, such as kidney disease, high blood pressure or diabetes are “safest when (giving birth) at the hospital.”
Planned home births may have a low rate of complications …
Among 13,000 planned births studied, researchers found that the mortality rate was similarly low – less than one in 1,000 – among women who gave birth at home with a midwife, women who gave birth in a hospital with a midwife, and women who gave birth in a hospital with a physician.
… “Birth is safe. It is safe to give birth out-of-hospital when a woman is healthy and having a normal pregnancy,” Winkler said.
But Kropp says even if a woman is healthy, there is still the possibility of complications in childbirth.
“Our hospital system for childbirth is so far from perfect,” Kropp said. “But someone who is completely healthy could very easily have something very unexpected happen in childbirth. Childbirth is still the No. 1 cause of death for women (worldwide), so we can’t get too cavalier in saying ‘we don’t need medical help.’”
It’s the leading cause of death for women who are not suited to home birth, such as those in third world countries who experience malnutrition, undernutrition, anaemia, bleeding in pregnancy, high blood pressure and so on. For healthy, low-risk women, the benefits of home birth are enormous.
Foley said she considered safety when making her decision to give birth at home.
“I had had no reproductive issues … for me I felt that being at home would be as safe as at the hospital,” Foley said.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, childbirth education, Complicated pregnancy or birth, continuity of care, Home birth, hospital birth, intervention, midwife, Midwifery, Midwifery services, Normal Birth, Public and private hospitals
Posted by Melissa Maimann on Feb 24, 2010 in
Birth,
Caesarean,
Normal Birth,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
In this world where information is so readily accessible, it never ceases to amaze me how mis-informed and ill-informed some people are when it comes to pregnancy and birth. This article is a prime example:
… As for childbirth being a natural process, yes, that is the case in most pregnancies. I know for a fact that my obstetricians don’t just let their patients go willy-nilly picking when they are tired of being pregnant or delivering babies based upon their Blackberry schedules.
Are you sure? How many caesareans and inductions are scheduled around when their husband will be home, when the doctor will be around, or the time of the year?
Have you seen the malpractice insurance premiums these guys pay? They do everything they can to keep babies and mothers alive.
There is a difference between saving a life that clearly needs to be saved, and saving a life just in case it might need to be saved at some point in the future. Intervening for the latter reason causes unnecessary harm to women and babies.
I don’t believe the majority of C-sections or early inductions are for revenue; they are for saving lives.
See above.
My child was a “complete” breech and if was not delivered via C-section, I and the child would have more than likely died during the “natural process of child delivery.”
Actually, recent research and guidelines support vaginal breech birth. It is sad that you were not informed of this.
Let’s stop C-sections or put a stigma on them and see what happens to mortality rates for mothers and babies.
If recent reports have anything to do with this, then the mortality rate will decline if caesareans reduce.
It seems that society wants a guarantee that the baby process is going to be foolproof and everyone gets the perfect “natural birth process” with no drama or sad outcome.
… it is not my right to have a natural childbirth; it is my privilege to have the best medical care in helping me achieve a healthy and safe delivery of my children.
And the best way to achieve a healthy and safe birth and baby is with a midwife. The midwife will make appropriate referrals to an obstetrician if this is needed.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Caesarean, childbirth education, Complicated pregnancy or birth, Obstetrics
Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
informed consent and childbirth
Every woman who is competent to consent, has the right to refuse any or all professional care. Informed consent must be obtained prior to any procedure being performed.
how to minimise labour intervention in a hospital?
The best way to minimise intervention in a hospital is to be as well informed as you can possible be about all things related to pregnancy, labour, birth, breastfeeding and babies. Read widely, attend independent childbirth education classes and consider employing a private midwife to be with you throughout your labour. She can help you to decide if the proposed interventions are necessary in your situation, she can support you emotionally, mentally and physically and she can aso help to ensure that your birth plan is respected without a fuss.
Do any independent midwives in Sydney offer prenatal care for women who are planning to freebirth?
Yes! This service enables women to access antenatal care from a midwife without the midwife attending the birth. Postnatal care is available if needed.
Do you think there are advantages to continuous monitoring for low-risk women
In a word, no. Intermittent auscultation is the method of choice. Continuous monitoring will increase the chance of a caesarean with no benefit to the mother or baby.
How much is a private midwife
Prices range from $3000 – $6000. Melissa Maimann offers for her clients to pay by the hour, making the service one of the cheapest.
What is a good caesarean rate?
The World Health Organisation recommends that no more than 15% births need to be caesareans. The WHO argues that when caesarean rates exceed 15%, the risks to the mother and baby increase on the whole. You’ll be hard-pressed to find a hospital with a caesarean rate of less than 15%, but birth centres and private midwives have caresarean rates of less than 10-15%.
What is the best hospital in sydney for delivering babies?
It all depends what sort of birth experience you’re after! If you’re wanting a natural birth, home birth will be the best option. If you want a natural birth in a hospital setting, the best options would be birth centre or private midwifery care for a planned hospital birth. If you’re wanting to have intervention in your birth, a hospital birth would be best. If you choose an obstetrician, you’re far more likely to have a caesarean, episiotomy, epidural, forceps or vacuum. Choosing your care provider is the single most important decision you will make in birthing.
Is there a birth centre at westmead hospital?
No, there isn’t. If you’re after a natural birth, the best choice would be a home birth.
C section or natural delivery midwife?
Midwves cannot perform caesareans. If a caesarean was needed, the midwife would call a doctor in to perform it. Most caesareans that are performed are unnecessary and increase the risks to the mother and baby. A natural birth is the safest way to birth, and midwives are qualified specialists in natural birth.
giving birth after birth trauma
Private midwifery care will be really important so that you can have the same midwife all the way through pregnancy, birth and postnatally. It’s also important to debrief your last experience and come to a place where you feel safe to birth again.
high risk midwife sydney
Midwives are not qualified to care for high risk pregnancies. We refer these women onto obstetricians. In most cases, one or two consultations is all that is needed with the obstetrician and the midwife continues the care of the woman.
how many births proceed naturally
What a great question! It all depends what care provider you choose and where you have your baby. You see, if you choose a private midwife and birth at home, you have about a 95% chance of having a vaginal birth. If you birth in a private hospital, you have about a 33% chace of having an unassisted vaginal birth. In some hospitals, the caesarean rate is more than the vaginal birth rate! Sad but true.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, birth debriefing, Birth trauma, Breastfeeding, Caesarean, childbirth education, Complicated pregnancy or birth, continuity of care, Epidural, exercise, fetal monitoring, freebirth, Home birth, hospital birth, intermittent auscultation, intervention, IVF, Maternity Services Review, midwife, Midwifery, Midwifery services, Normal Birth, Nutrition, Obstetrics, postnatal depression, Preconception care, Public and private hospitals, VBAC
Posted by Melissa Maimann on Feb 23, 2010 in
VBAC Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
Michelle Williams is three months’ pregnant and determined to experience childbirth the way nature intended. But because her previous baby was delivered through … cesarean section — she has to travel more than an hour … to find an obstetrician willing to let her try for a vaginal birth.
One out of every three pregnant women now has a C-section …
This is also the case in Australia.
The skyrocketing C-section rate has been hotly debated in birthing and medical communities, yet little attention has been paid to one of the consequences: Once a woman has a C-section, she often has to fight to deliver subsequent babies the old-fashioned way …
This is also the case in Australia. VBAC rates nationally are around 15%.
Repeat C-sections have become so routine that 90 percent of pregnant women who have the surgery give birth that way again. That is a concern to health experts, who say vaginal births after a cesarean, or VBACs, should be far more common.
Successful VBACs result in better health outcomes for the mother and the baby … VBACs [should] be offered in low-risk cases.
… although the attempt carries a risk of uterine rupture, the chance it will happen is relatively low: 0.5 percent. Meanwhile, C-sections carry all the risks of a major surgery. Compared with having a vaginal birth, a woman delivering by C-section experiences more physical problems, longer recovery and more emotional issues on average … babies born by cesarean are less likely to be breastfed and more likely to experience breathing problems at birth and asthma as they get older.
Yet the VBAC rate, 9.2 percent, is a far cry from the objective set by the Centers for Disease Control and Prevention: 37 percent. In Illinois, the rate was 11 percent in 2008, down from 38.6 percent a decade earlier.
… In northwest Illinois, the VBAC rate is as low as 3.9 percent …
Not dissimilar to some of our hospitals here in Australia.
… 73 percent of the women who try VBACs are successful.
Success rates are around 70%-80%, but they are higher, up to 90%, if the woman chooses a private midwife.
“The liability issue is huge,” said Dr. Joseph Pavese, chairman of the obstetrics department at Advocate Christ Medical Center in Oak Lawn, where 97 percent of pregnant women with a previous C-section have another one. “Parents expect good outcomes, and physicians are reluctant to try difficult deliveries. If the baby is not perfect, there is possible litigation.”
… If the scar opens during labor, it would require an emergency C-section. Certain factors — induction of labor, or a vertical (rather than horizontal) incision — can increase the risk of rupture.
In 99.5 percent of the cases, nothing goes awry. But if the scar gives way, results can be catastrophic; the baby has a 10 percent chance of dying or suffering brain damage.
Over the years, “The risk of uterine rupture has not changed,” said Dr. Howard Strassner, director of maternal and fetal medicine at Rush University Medical Center. “What has changed is individual tolerance for risk. It reached the point where no one wants to be associated with an adverse outcome.”
… more recent and balanced research showing VBACs are as safe — if not safer — than repeat C-sections hasn’t had the same effect [as previous research that demonstrated that elective repeat caesarean was safer than VBAC.]
… What crippled the idea of a VBAC, however, was a simple word change. In 1998, ACOG advised that physicians should be “readily available” to provide emergency care because of the dangers of a uterine rupture. Eight months later, the American Congress of Obstetricians and Gynecologists changed the wording to “immediately available,” and many small hospitals in rural areas stopped doing VBACs.
We have the same situation in Australia, with many smaller hospitals and midwife-led units not offering VBAC services.
Katherine Shaw Bethea Hospital in Dixon, which handles about 365 deliveries a year, was one of more than a dozen Illinois hospitals that subsequently dropped VBACs because an on-site anesthesiologist wasn’t always immediately available.
“… too many women are subject to coerced cesareans because hospitals have banned VBACs.”
… Mariana Patzelt … had two previous C-sections, planned to drive from her home … to deliver her third baby … after laboring too long at home in hopes of reducing her chances of a C-section, she ended up delivering in the emergency room of a nearby hospital.
When doctors there asked whether she had had any previous surgeries, she said no.
“The whole time I was hoping they didn’t see the scar,” she said. “I knew if I would have said yes, it would have blown my chances and I wouldn’t be able to fight hard enough for everything I worked for.
“Hospitals treat birth as a medical condition, a disease they have to fix rather than something natural we’ve been doing since the beginning of time.”…
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Caesarean, hospital birth, VBAC
Posted by Melissa Maimann on Feb 22, 2010 in
Home birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
IS giving birth at home a positive experience or and unnecessary risk?
ASK any expectant mother what she’s hoping for when she gives birth, and she’ll probably tell you the most important thing is to deliver a healthy, happy baby. But in recent years there’s been great debate about the best way to do this.
Is the ideal to have a child in the relaxed comfort of your own home, or does the medical expertise provided in hospital far outweigh the notion of giving birth in your own living room?
Although homebirth advocates argue the former, it appears the choice may soon be taken out of their hands.
Reports last year revealed that four babies in Sydney died in homebirths in the space of nine months, the NSW Government responded with a strong announcement: from July 2010, independent midwives will be unlikely to gain professional indemnity insurance – effectively making it illegal for them to assist at homebirths. The consequence? Homebirths are facing extinction.
Obstetrician Dr Pieter Mourik believes the ruling will stop women taking unnecessary risks.
“Women who choose to give birth at home expect everything to be normal, but they often don’t consider how far they are from expert help …” he says.
“Eighty per cent of women can have their babies in a paddock – but the problem is choosing these women. You just never know what will happen.”
However, Justine Caines, spokesperson for Homebirth Australia, says putting a blanket ban on homebirths will simply drive the practice underground.
… “Many mothers have had bad experiences in hospital and won’t repeat that.”
She continues: “Why does the government fund women who are choosing to have C-sections, but not women who are choosing to give birth at home?”LAST month a study of over 500,000 women in the Netherlands who gave birth at home … showed there was no significant difference between planned hospital births and planned homebirths in terms of babies dying during labour.
It’s important to note when making a comparison between Australia and the Netherlands, that the Netherlands only has low-risk home birth. If there are any complications in the pregnancy or labour, women see an obstetrician and birth in hospital. This is not the case in Australia at present, but it’s the system that the Govt is trying to set up.
… Dr Mourik says the study is misleading. “Firstly, we must remember Holland has very well-trained midwives who act almost like Australian GPs,” he says.
“It’s also a small country with maternity units often within 10 minutes of someone’s house. The conclusions of this study are based on the availability of well-trained midwives through a good transportation and referral system – and that simply isn’t the case in Australia.”
It’s not currently set up in Australia, but there’s no reason why it couldn’t be. A positive approach would be to set in place a system that supports women to birth at home, and a system that protescts the midwives who support women to birth at home. Home birth has always been and will always be. We can set it up so that it is safe, or we can hope it just goes away … it won’t.
However, despite warnings from obstetricians, women are still choosing to have their babies at home …
“Women should have the right to give birth wherever they feel safest – it’s up to them whether that’s in hospital or at home. But taking away our choice isn’t right. If there were more options within the hospital system, then perhaps more women would feel comfortable going to hospital.”
I disagree that women should make the decision: it should be made within the midwifery partnership. This debate is not about the right of women to bitrh at home: this right is protected by law. This debate is about the mdiwife’s responsibility to pracice safely.
The Health Minister is putting in place a system that will enable more women to access continuity of midwifery care with their chosen midwife in and out of the hospital system. Once this is in place, there will be more options within the hospital system, and hopefully fewer women who are traumatised by the hospital system.
So is there a way to keep everyone happy?
“Homebirth Australia would like the government to present a package for pregnant women that works a bit like the baby bonus,” … “Every woman would be given a sum of money to spend on her pregnancy treatment, then it’s up to her whether she sees a midwife at home, or an obstetrician in a hospital. It’s putting the choice back into women’s hands.”
What about the option to have a baby in hospital with a midwife, or the ability for an obstetrician to attend a woman at home?
However, Dr Mourik believes that when it comes to choice, the only factor to consider is the mother and baby’s health.
“Only a tiny minority of foolish women would risk their own lives and that of their precious babies for an ideal,” he says.
“How many doctors support homebirth? None I know – it’s too bloody risky.”
Many studies opint to the safety of home birth for low-risk women who are attended by a midwife. Women who birth at home are amongst the most health- and safety-conscious people I know. It is offensive to comment that women who birth at home are
risking their own lives and that of their babies, especially when the evidence is to the contrary.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Complicated pregnancy or birth, continuity of care, freebirth, Home birth, hospital birth, Maternity Services Review, midwife, Midwifery, Midwifery services, Public and private hospitals, women's rights