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May, 2010:

Fancy giving birth with just essential oils for pain relief?

May 31st, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

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Aromatherapy is being offered to women in labour at Southmead Hospital as a natural pain relief … midwives have been trained to mix a range of oils to ease symptoms for women giving birth at the hospital and in their own homes.

The oils … have been found to have therapeutic effects and are used in massage, in a bath or dropped onto a smelling stick.

Bergamot, jasmine, lavender, peppermint, grapefruit, clary sage and frankincense are being used by the midwives to ease symptoms such as nausea and back pain.

… being more relaxed during labour generally helps the birth progress more smoothly.

… a woman who had planned a natural birth and opted for the essential oils could turn to an epidural afterwards should they need it.

… It is hoped that offering women aromatherapy will support the drive from the Department of Health for more women to give birth naturally.

The oils will generally be used in lower risk births … which is generally the criteria for women giving birth in their own homes or in the birth suite at Southmead, which is run by midwives rather than doctors to make it a more relaxed environment.

Previously midwives had only been able to offer women gas and air in their own homes but the aromatherapy provides more options.

Essential oils costs less than 50p per person …

It would be great if this could be implemented across Australian hopsitals – public and private. It seems that the UK has a huge drive at present to increase the rates of normal, natural birth. What is preventing Australia from following suit?

Melissa Maimann, Essential Birth Consulting 0400 418 448

Obesity Leading To More Caesareans

May 30th, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

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Obesity increases the risk of needing to deliver a baby by Cesarean section. That in turn leads added risks from major surgery, potential for serious complications, and additional recovery time …

… obesity can interfere with a woman’s ability to get pregnant …“Obese patients have no good options,” … they are at increased risk of complications from a C-section, such as clotting in the legs associated with a pulmonary embolism, and increased risk of wound breakdown.

“Obesity decreases fertility and increases the chance of losing the baby, of hypertension and pre-eclampsia, which kills a lot of women around the world,” … because fertility drops with rising obesity, many women seek help in conceiving from fertility treatments, which increases the chance of having multiples (twins and triplets) and therefore increases the chance of having a C-section.

Obesity is a risk factor in C-sections independent of other factors, but it goes hand in hand with other serious complications, like diabetes and cardiovascular disease …

Ideally, women will attend preconception care where issues such as lifestyle, stress, nutrition, exercise and health can be addressed prior to becoming pregnant.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Canadian Researchers Suggest Review Of Current Guidelines On C-Sections

May 29th, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

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A recent study showing that the rate of cesarean sections performed at hospitals across … Canada, varied between less than 15% and more than 27% — with only 2% requested by the women — prompted researchers to recommend “revising the current guidelines” on when it is appropriate to perform a c-section … Difficult labor was found to be the most prevalent cause for a c-section …

It will be interesting to read what the new guidelines say. Certainly, some factors promote vaginal birth such as staying at home for as long as possible in labour, planning a homebirth, receiving midwifery care, being well prepared – emotionally, mentally and physically – for birth, reading widely about pregnancy and birth to be well-informed and more comfortable with the process and having the continued support of a midwife who is experienced in supporting women through natural birth.

Melissa Maimann, Essential Birth Consulting 0400 418 448

FAQs

May 28th, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

framework for privately practicing midwives

The Quality and Safety Framework is not out yet in its final version. A final draft has come out and it is now in the hands of the Nursing and Midwifery Board to accept or reject the Framework in whole or in part. I will update this blog once I know more details about the QSF.

Midwifery in the home nsw legal

Yes, midwifery is – and will remain – legal at home.

Private health insurance, private midwifery care, australia

Yes, Private Health Insurance may cover the cost of private midwifery care. Some health funds are more generous in their benefits than other funds so it’s worth doing your homework before becoming pregnant so you can get the cover that’s most advantageous.

Private midwife vs obstetrician

The role of the obstetrician is to provide care for women with complicated pregnancies and births, so they’re called in to manage things that are not seen to be progressing normally. The role of the midwife is to take care of healthy, well pregnant and birthing women (and their babies) and to refer to obstetricians when it’s necessary. Private midwifery care is holistic in nature, so women can expect that their midwife will be interested in getting to know them, they can expect their pregnancy consultations to be very thorough and to last for 1-2 hours. Private midwives attend the whole labour and birth, we do not just attend for the end of birth. Private midwives take on a much lower caseload – you’ll be hard-pressed to find midwives with more than 4 births a month, so we’re more available to our clients.

Water birth experts australia

That would be a midwife! More specifically, a private midwife or birth centre midwife. We regularly attend waterbirths.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Fact or Fiction: Fathers Can Get Postpartum Depression

May 27th, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

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… Previous research has found rates of depression in new dads that range from 1 percent to 25 percent, but a new meta-analysis … found that an average of 10.4 percent suffered from depression sometime between the first trimester of their partner’s pregnancy and the child’s first birthday.

Rates of paternal depression were highest three to six months after birth (25.6 percent) … All of these numbers are considerably higher than the annual rate for adult male depression, which is 4.8 percent …

… Extreme examples of parental depression can lead to suicide or to harm or neglect of the baby, but even mild to moderate depression in fathers has been shown to have lasting negative effects on their children for years to come.

… “there’s a general cultural myth that men don’t get depressed,” … “Because of that cultural myth, men oftentimes think they shouldn’t get depressed, and when they are depressed they try to hide it.”

… for people who have clear cases of clinical depression, there are cues beyond typical parenting troubles, such as persistent detachment, feeling hopeless or worthless, or thoughts of death.

… doctors and pediatricians usually see new fathers less often than they do new mothers … Even though screening for depression in mothers is far from perfect, it is much easier to do given their more regular contact with the health care system …

… The sleep deprivation that comes along with being a new parent can alter neurochemical balances in the brain, making some people with underlying risk factors more vulnerable to depression …

… A personal history of depression puts both mothers and fathers at a higher risk, as does a sick baby, financial strain or relationship problems. Add to that list the changing expectations pushing dads to become more involved parents … and many new fathers are left feeling overwhelmed and at greater risk for anxiety and depressive symptoms.

… Like mothers who are depressed, fathers who suffer from depression can have negative impacts on their children’s development years down the road.

“When Dad is depressed, Dad tends to interact less with the child and bonds less with the child,” …

… “depression in fathers during the postnatal period was associated with adverse emotional and behavioral outcomes in children aged 3.5 years.” …

… children whose fathers had been depressed during their early infancy were more likely to have behavioral problems by the time they were school age …

Depression in dads also seems to correlate with depression in mothers. Although the relationship is not one-to-one, having a partner with this sort of depression seems to increase an individual’s likelihood of having it, too …

… Paulson recommends investigating treatment that focuses on whole families, addressing depression “as a family problem, not an individual problem.”

Courtenay proposes ways to help prevent paternal—and maternal—depression from becoming a problem in the first place. With a growing checklist of risk factors … the best thing to do is address any of them “before the baby comes along.”

… The first step … is improving awareness that paternal prenatal and postpartum depression exists and is likely to affect about one in 10 fathers …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Early Clamping Of The Umbilical Cord May Interrupt Humankind’s First ‘Natural Stem Cell Transplant’

May 26th, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

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… Delaying clamping the umbilical cord … allows more umbilical cord blood volume to transfer from mother to infant and, with that critical period extended, many good physiological “gifts” are transferred through ‘nature’s first stem cell transplant’ occurring at birth.

… [In] Western medical practice, early clamping … remains the most common practice … perhaps because the benefits of delaying clamping have not been clear. However, waiting for more than a minute, or until the cord stops pulsating, may be beneficial …

Birthing methods have also changed over the last century. Throughout human history and currently in cultures and areas where delivering mothers squat to deliver, gravity helps speed the stem cell transfer …

… the relationship between cord clamping time and the transfer of stem cells needs to be understood through the early weeks of the perinatal period and the process of ‘hematopoiesis,’ the formation of blood cells that begins as early as two weeks into pregnancy. A transfer of pluripotent stems cells continues throughout pregnancy, however, and for a time through the umbilical cord following delivery.

…”In pre-term infants, delaying clamping the cord for at least 30 seconds reduced incidences of intraventricular hemorrhage, late on-set sepsis, anemia, and decreased the need for blood transfusions.”

Another potential benefit of delayed cord clamping is to ensure that the baby can receive the complete retinue of clotting factors.

… many common disorders in newborns related to the immaturity of organ systems may receive benefits from delayed clamping. These may include: respiratory distress; anemia; sepsis; intraventricular haemorrhage; and periventricular leukomalacia. They also speculate that other health problems, such as chronic lung disease, prematurity apneas and retinopathy of prematurity, may also be affected by a delay in cord blood clamping …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Bring back VBAC

May 25th, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

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Deaths and severe complications in pregnancy and childbirth are increasing in the United States … More pregnant women today are older and obese, and childbirth practices have changed greatly over the past two decades with more cesarean sections and induction of labor …

Why is having a baby today less safe than it was two decades ago? Two studies … make suggestions for addressing the crisis …

… vaginal birth after cesarean is “a reasonable choice for the majority of women.” … although both elective repeat cesarean section and VBAC are highly safe, maternal death was higher for elective repeat Cesarean sections (0.013% versus 0.004% for a trial of labor). The rates of hysterectomy, hemorrhage and transfusions did not differ between the two groups. Uterine rupture — the complication that is usually given for discouraging VBACs — was rare but higher in the trial of labor group (0.47% compared with 0.03% in the repeat C-section group). Infant death was higher in the trial of labor group (0.13% compared with 0.05% in the repeat C-section group).

About one-third of all births today in the U.S. are cesareans, and the most common reason for needing a C-section is that the mother has already had one. But recent studies show that two or more cesareans increase the risk of dangerous complications of the placenta that may be contributing to the increase in maternal deaths in recent years. That complication may prove to be more significant than the risk of uterine rupture in a woman attempting a VBAC …

It’s time to start reversing C-section rates in part by allowing VBACs …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Doctor preferences may explain high C-section rates

May 24th, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

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The number of Cesarean sections performed at hospitals across British Columbia is highly variable, Canadian researchers have found.

Even when accounting for differences in women’s preferences and conditions that could complicate vaginal delivery, C-section rates varied from less than 15 percent to more than 27 percent of all births.

“Thus, our results illustrate what we believe to be ‘unwarranted variation,’” … noting that mothers requested C-sections in only 2 percent of the cases.

… earlier studies have found marked variation in the United States as well. Both Canadian and US experts agree that the current Cesarean rate — in the US, one-third of all births — is too high …

We have a similar situation in Australia where caesarean rates vary widely between public and private hospitals and midwifery-led services and obstetric-led services. Our National caesarean rate is also around 1 in 3.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Among the more than 100,000 deliveries that they analyzed, the most common reason for C-section was difficult labor, which accounted for one-third of the surgeries, and was also highly variable between different areas.

As a result, the researchers write, “we suggest that revising the current guidelines regarding the management of (difficult labor) may be a good starting point on the road to decreasing unwarranted variation in cesarean delivery and assisted vaginal delivery rates.”

Home Births on the Rise

May 23rd, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

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After having her first child in a hospital, Lorra Jacobs decided it was an experience she did not care to repeat.
She had two more children, and she chose to have both of them at home.

“When I had my first child in the hospital … It wasn’t a real positive experience,” … “It was a stark, very impersonal feeling, treating me like I was sick and not pregnant.”

Jacobs explained she believed she had more control over many aspects of the birth when it took place at home, including whether she got to be with the baby after delivery and having the siblings there at the birth.

“Doing a home birth, I felt like I had a say,” said Jacobs. “This is not the hospital’s baby. This is my baby.”

… the Centers for Disease Control and Prevention indicate that a very small but slightly growing number of women are making the same choice that Jacobs did. While less than 1 percent of all births in the United States take place outside the hospital, the number of those births taking place at home has increased by 3.5 percent between 2003-04 and 2005-06 …
… the most recent trend might be a negative reaction to a hospital birth experience, since the majority of mothers choosing a home birth have had children before.

… “It certainly suggests it’s an experience they don’t want to repeat.”

“I suspect that economic issues are not the main issues,” … “I suspect consumers are becoming more informed … and seeing home births are a safe alternative for healthy women with a qualified provider.”

… a likely cause of any increase is a desire to avoid the interventions hospitals perform, ranging from cesarean sections and epidurals to controlling when the mother is with the newborn.
… Home birth advocates have cited several studies supporting the safety of home births among low-risk women …those studies have taken place in the Netherlands and Canada … its unrealistic to apply the findings to the United States.
“Those are highly regulated, highly integrated systems. Their system is prearranged — it’s very different from the systems available in the United States,” he said.

The same can be said for the generalisability of these studies to Australia, however that is no reason not to implement a system that can provide safe private homebirth services.

… “The mothers who are having these home births are not crazy, unaware people,” said Declercq. “They plan carefully, they think about this all the time. They think they’re better off not having the interventions that they feel will happen unnecessarily at hospitals.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

FAQs

May 22nd, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

Exorbitant prices with Sydney obstetricians, alternatives?

There’s a great alternative: private midwifery care. While private midwives may not be cheaper than private obstetricians, the service is experienced by women to be more personalised, thorough, caring and supportive. Consultations are one to two hours in duration, so there’s plenty of time you to get to know your midwife and to talk through all fears and anxieties. All questions are answered thoroughly and there’s time for things like birth planning, childbirth education as well as the clinical things. Of course, if any problems are detected, midwives refer to obstetricians who can provide obstetric care.

How much will it cost me to access a private midwife as my care giver

The fees vary and in Sydney you’d be looking at anywhere between $4000 and $6000.

Refusing to be induced at hospital

All women have the option to accept or decline interventions. The hospital will want to ensure that you understand why they want to induce you, the risks of not inducing, and that you’re accepting responsibility for your decision. You’re perfectly within your rights to refuse interventions and to birth at your chosen birth place with support.

How to have a baby naturally in a hospital

In short, take a private midwife with you! the most important decision you will make in your pregnancy will be choice of care provider. Typically, midwives have lower rates of intervention than do obstetricians. Private midwives have even lower rates of intervention than do hospital-employed midwives. Safety is never compromised.

Home birth fetal auscultation

Yes, this is common-place in homebirths. Your midwife will have with her a doppler which may be used in the water if you are planning a waterbirth. It is common place for midwives to check your baby’s heart rate every 30 minutes in labour and more often if they feel that there is a problem. If your midwife suspects that your baby is distressed, she’ll arrange for you to be transferred to hospital where she will remain with you every step, providing advice, reassurance and support.

Melissa Maimann, Essential Birth Consulting 0400 418 448

‘Love drug’ may help mums bond to babies

May 21st, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

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It’s a shame the resesrchers in this study haven’t considered ways of boosting the natural form of this “love drug”: natural bitrh and breastfeeding are the most effective ways to promote this chemical and enhance bonding.

A hormone nasal spray may help mothers bond better with their babies.

A world-first trial by Sydney researchers involves giving mothers a synthetic version of the hormone oxytocin, often dubbed the ”love drug” or the ”cuddle chemical”. Past studies have shown mothers who are deficient in oxytocin are less sensitive to their babies’ cues than mothers with high levels of the hormone.

It’s interesting to take a look at the things that diminish the mother’s production of oxytocin: epidurals, infusions of syntocinon (the artificial form of oxytocin that’s given to women to induce or speed labour), caesareans and pain-relieving medications.

… University of NSW school of psychology have launched the Mothers Early Experiences of Parenting (MEEP) project, which will use oxytocin nasal spray in combination with infant massage and play sessions. They will then measure eye contact, affectionate touch and feelings of closeness and warmth to see if there is improvement in attachment between mother and child.

… although the role of oxytocin in childbirth and breastfeeding was well documented, scientists were increasingly interested in the hormone’s role in human social interaction. It is known to reduce fear, increase empathy and improve memory, especially of happy events.

Hence the research that points to increased rates of violence, suicide, anti-social personality disorders and the like in children who have experienced a raumatic entrance to this world.

”It allows us to recognise and feel connected to loved ones,” Professor Dadds said. ”So after eye contact, cuddling, even an orgasm, with a loved one, you get a big shot of oxytocin, which increases trust and connection.”

Professor Dadds said oxytocin delivered by nasal spray had very subtle effects but could be a powerful intervention when combined with psychological therapies. ”It’s a new age of psychology and medicine working together and magnifying the effects of each other,” he said.

I’d rather see psychology and midwifery working together: midwifery to promote and protect natural birth, and psychology to work with women to reduce the fear surrounding natural birth, to debrief women of their past traumatic birth experiences, and for supporting programs to be developed that enable women to feel safe and trusting again.

… between 10 and 20 per cent of mothers had post-natal depression, and at least a third of those women had trouble bonding with their babies. An impaired early bond is associated with adverse developmental outcomes for children.

And the major cause of PND and impaired bonding is a traumatic birth experience.

”There’s a huge body of research showing that the more securely attached you are by age three to five, the better your outcomes for mental health,” she said …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Mum Knows Best? Pregnant Women Are More Likely To Follow Their Mothers’ Wisdom Than Medical Advice

May 20th, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

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… pregnant … women, while wanting to do the best for their baby, do not follow medical advice without question and are more likely to adopt practices their mothers and grandmothers carried out during their pregnancies.

… The women who were interviewed said they knew their mothers and grandmothers had their best interests at heart when they offered them advice …

[Women] … found ways to ‘resist’ what they considered inappropriate pressures from advisors and were more likely to follow advice given to them from their mothers and grandmothers even if it went against the medical professions’ advice.

“Women tend to discuss the advice they are given with their female relatives and this leads to resistance to some types of advice. For example, despite being advised to cut down on caffeine during pregnancy one woman we questioned said she continued to drink tea because her grandmother told her it relieved her morning sickness.”

… women who take notice of general public health information about … healthy lifestyle … are those who are most likely to be in-tune with their bodies and can therefore ‘use’ guidelines but not be constrained by them.

… “Taking all the guidelines too seriously leads to anxieties. Lack of self-confidence also can lead to worry about ‘doing the wrong thing’ which is potentially more harmful than taking the odd glass of wine or eating soft cheese.”

Researchers from Royal Holloway, University of London have found that pregnant and postnatal women, while wanting to do the best for their baby, do not follow medical advice without question and are more likely to adopt practices their mothers and grandmothers carried out during their pregnancies.

The study by Professor Paula Nicolson and Dr Rebekah Fox from the Department of Health and Social Care at Royal Holloway is published in the ‘Journal of Health Psychology’ and explores three recent generations of women’s experiences of pregnancy, questioning those who gave birth in the 1970s, 1980s and 2000s.

The women who were interviewed said they knew their mothers and grandmothers had their best interests at heart when they offered them advice. For the older women questioned, the advice from their female relations was their main source of information.

The 1980s and 2000s group, however, had to reconcile what they heard from older generations with direct advice from their doctors, midwives and health visitors as well as the numerous health messages on the web and self-help books.

Professor Nicolson says, “It is much to the credit of contemporary women that despite the unprecedented pressures from the media, medicine and the ‘pregnancy police’ that they are still able to filter-in the advice that really suits them from all these sources. Each of the three generations found ways to ‘resist’ what they considered inappropriate pressures from advisors and were more likely to follow advice given to them from their mothers and grandmothers even if it went against the medical professions advice.

“Women tend to discuss the advice they are given with their female relatives and this leads to resistance to some types of advice. For example, despite being advised to cut down on caffeine during pregnancy one woman we questioned said she continued to drink tea because her grandmother told her it relieved her morning sickness.”

Professor Nicolson says women who take notice of general public health information about what is a healthy lifestyle, i.e not smoking, taking regular exercise, not taking drugs and drinking alcohol in moderation are those who are most likely to be in-tune with their bodies and can therefore ‘use’ guidelines but not be constrained by them.

She added: “Taking all the guidelines too seriously leads to anxieties. Lack of self-confidence also can lead to worry about ‘doing the wrong thing’ which is potentially more harmful than taking the odd glass of wine or eating soft cheese.” …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Up to a third of Aussies against public breastfeeding

May 19th, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

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Up to a third of Australians still believe mothers should not breastfeed babies in public, while a third think a baby should stop breastfeeding within six months.

Despite 65 per cent of people saying breastfed babies had a better chance of surviving beyond a year old … only 29 per cent “strongly agree” that women should be encouraged do so in public.

… young adults … were the least supportive of public breastfeeding.

… “Part of the issue why young mothers wean their babies too early is societal pressure …”

… The World Health Organisation recommends breastfeeding exclusively for a baby’s first six months, continuing for up to two years …

… breastfed babies have lower risks of cot death and a decreased likelihood of developing diabetes or becoming obese.

“While nearly 90 per cent of Australian women initiate breastfeeding, one per cent of Australian children are breastfed for the minimum duration recommended by the WHO,” Dr James says.

“Australia needs a paradigm shift, and it has to start in our schools with education that normalises breastfeeding …”

Melissa Maimann, Essential Birth Consulting 0400 418 448

New York midwives lose right to deliver babies at home

May 18th, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

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… New Yorkers can have anything delivered to their door at any time. They can have their hair cut in the living room, have champagne and caviar rushed to them on a whim, enjoy a shiatsu massage in their own bed or invite a clairvoyant to predict their future from Tarot cards laid out on the kitchen table.

But there is one thing that is currently unavailable for delivery to those who live in this most can-do of metropolises. Women can not legally give birth at home in the presence of a trained and experienced midwife.

This city … now lacks a single midwife legally permitted to help women have a baby in their own homes …

The collapse of New York’s legal home birth midwifery services has come as a result of the closure two weeks ago of one of the most progressive hospitals in the city, St Vincent’s in Manhattan. When the bankrupt hospital shut its doors on 30 April the midwives suddenly found themselves without any backing or support.

… under a system introduced in 1992 [midwives] are obliged … to be approved by a hospital or obstetrician …

St Vincent’s was prepared to underwrite their services, but most other doctors and institutions are not, and they now find themselves without the paperwork they need to work lawfully.

… Jitters are spreading among the tiny community of home birth midwives … one of them has already been shopped to the authorities by an obstetrician at a hospital where she transferred one of her clients in need of medical attention.

The crisis of home birth in New York city is an extreme example of a pattern found across America. Fewer than 1% of babies are born at home in the US, and in New York that figure is as low as 0.48% — about 600 babies every year out of 125,000. That compares with a rate of about 30% in the Netherlands.

In much of Europe, midwives play the lead role in assisting most low-risk and healthy women to give birth, handing over to a specialist doctor or surgeon only when conditions demand. In the US, that relationship is reversed.

Obstetricians, who are trained to focus on interventionist methods and often have never even witnessed a natural birth, are in charge of about 92% of all cases. As a body, they are fiercely resistant both to midwives – who under the private medical system in America are their competitors – and to women choosing to remain at home.

In 2008 the American Congress of Obstetricians and Gynaecologists put out a statement effectively instructing its members to have nothing to do with the “trendy” fashion towards home births. Yet despite Acog’s stance, and despite the fact that the US spends more money on pregnancy and childbirth-related hospital costs than any other type of hospital care ($86bn a year), the country has the unfortunate distinction of having one of the highest rates of maternal mortality in the industrialised world. Its rate stands at 16.7 maternal deaths per 100,000 live births, compared with 7.6% in the Netherlands and 3.9% in Italy. Britain’s rate is 8.2%.

On top of that, about one in three pregnancies in the US end in a caesarean section — a product, critics say, of the highly interventionist approach that includes frequent induced labours …

… Midwifery organisations are scrambling to persuade other hospitals to take over St Vincent’s role by signing the so-called “written practice agreements” the midwives need to be legal. So far 75 hospitals have been approached; not one has replied.

Meanwhile, a bill is sitting before the New York state assembly that would scrap the system of practice agreements and allow the midwives to offer their services free of the control of obstetricians. But the bill may not be put to a vote at all this year …

In Australia, private midwives will be required to have collaborative agreements with obstetricians in order for their clients to access medicare benefits for their services and also for midwives to be eligible for the government insurance that will cover hospital birth. I hope that what has happened in New York will not happen on a large scale in this country.

Melissa Maimann, Essential Birth Consulting 0400 418 448

FAQs

May 17th, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

Can my private midwife go with me to public hospital?

Yes. Private midwives attend women wherever they are giving birth. Many women who seek out the services of a private midwife will be planning a homebirth, but may other women want a private midwife to be by their side in a planned hospital birth. This may be because the woman wishes to have all her pregnancy and postnatal care requirements met by her midwife, with the option of birthing at home or labouring at home as long as possible before heading into hospital. Once in hospital, although the woman will be assigned a hospital midwife, the woman’s private midwife will be by her side providing emotional and physical support, encouragement and most of all continuing the safe and trusting relationship that has been developing over the months.

This is truly a great way of getting continuity of care within the hospital system and maximising the chance of a natural and healthy birth.

Difference between midwife and obstetrician

A midwife is a specialist in normal pregnancy, birth and postnatal. Midwives are qualified and educated to care for women and babies on their own authority while ever women and babies remain healthy and well. the other part of the midwife’s role is to detect complications in the pregnancy and to refer to an obstetrician in a timely manner. Some women will consult with an obstetrician once or twice if there are problems, while other times the obstetrician will continue the care of the woman. Obstetricians are surgical specialists who have degrees in medicine, surgery and obstetrics. While they are certainly qualified to care for healthy pregnant women, their specialty is in pregnancies and births that are complicated. An obstetrician can perform surgery such as a caesarean, and they can perform assisted births such as forceps and vacuums.

Both obstetricians and midwives are essential in our maternity care system.

Average cost parking at hospital

It can be expensive! Some hospitals offer free parking, while other hospitals may be around $30 per day. Remember to carry lots of change with you as some hospital car parks take coins only.

Can you have midwives deliver in private hospitals?

Generally speaking, no. you’ll be admitted under the care of an obstetrician and the midwife who is looking after you in labour will call your obstetrician when your baby is close to being born so that your obstetrician can “deliver” your baby.

Melissa Maimann, Essential Birth Consulting 0400 418 448

The Quality and Safety Framework for Homebirth

May 15th, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

The long-awaited final draft of the QSF is now out for public consultation. I have copied excertps from it below. PPM refers to privately practising midwife.

National Registration demands that all health professionals have professional indemnity insurance that covers all aspects of the care that they provide, however there is no insurance for births that take place at home in a private capacity. The QSF is in place to provide a framework so that private midwives can continue to provide homebirth services and secure an exemption to the requirement of insurance for home birth. Private midwives will still need insurance to cover pregnancy and postnatal care.

… the Health Ministers have agreed to provide an exemption for PPMs attending a homebirth until June 2012 subject to certain conditions. No other privately practising clinicians are able to practise without insurance. This exemption only applies to intrapartum services provided in the home.

The conditions that AHMC required are that:
• PPMs report all homebirths according to the requirements of their jurisdiction
• Women booking with a PPM receive written disclosure that the PPM is practising without insurance coverage for intrapartum care services in the home
• PPMs participate in a Safety and Quality Framework for midwifery care

… For the framework to be legally required, the NMBA (Nurses and Midwives Board of Australia) will need to, using section 39 of the National Law, develop and approve a code or guideline that contains or reflects the contents of the framework. As such the final say on the contents and mandatory use of this framework will rest with the NMBA as the professional regulating body.

Context

The choices made by women about their maternity care and birthing are commonly determined by:
• previous pregnancy and birthing experiences, including … levels of intervention
• a strong desire for continuity of carer
• confidence that respect for their choice of care and carer will improve outcomes for themselves and their babies
• a personal philosophy that is congruent with a preference for care to be provided outside of a clinical setting.

The choices made by midwives in this context about the antenatal, intrapartum and postnatal care which they offer are commonly determined by:
• a preference to work as a private practitioner
• a perception that working within a clinical setting limits their ability to work across the full scope of midwifery practice
• a strong desire to provide continuity of care through pregnancy, labour and birth and the postnatal period
• a belief that the woman’s wishes can be more effectively addressed by engaging with a privately practising midwife
• a personal philosophy that is congruent with a preference for care to be provided outside of a clinical setting.

Midwives are qualified health professionals whose practice is governed by … the Nursing and Midwifery Board of Australia (NMBA) and … the requirements of … the Australian College of Midwives and their guidelines. Those in public systems also work within the parameters, and protection, of the clinical governance of the employing organisation … The NMBA Continuing professional development standard requires a minimum of 20 hours of professional development to be undertaken by all registered nurses and midwives each year.

… the National Health & Medical Research Council draft “National Guidance on Collaborative Maternity Care” was disseminated. It is acknowledged that this document, together with “Primary Maternity Services in Australia – A Framework for Implementation (AHMAC 2008)” and “National Midwifery Guidelines for Consultation and Referral” Australian College of Midwives 2nd Edition 2008, are consistent with the spirit and intent of the development of the Framework.

… This framework will be provided to the NMBA with the intent that it is placed in a code or guideline. Once in a code or guideline of the NMBA, PPMs will need to adhere to it in order to meet the requirements of the exemption. The way in which the NMBA monitors the adherence to any code or guideline is a matter for them to decide …

Safety and Quality Framework for Privately Practising Midwives attending homebirths

To be exempt from requiring insurance for providing intrapartum care for homebirths, the privately practising midwife is expected to comply with a number of requirements. The exemption and its requirements are reflected within the National Law as reproduced below.

… to be exempt from requiring insurance for providing intrapartum care for homebirths, the privately practising midwife will be required to abide by any safety and quality framework that the NMBA has approved and required through a code or guideline. It is intended that this framework will be provided to the NMBA to consider for such a purpose. Until it is approved by the NMBA it is not a legal requirement for PPM to use this framework in order to be exempt.

The framework is written to ensure safe, quality care of the woman and her baby choosing to birth at home with a privately practising midwife. Women considered appropriate for inclusion in this option of care are women with a singleton pregnancy, cephalic presentation, at term and free from any significant pre existing medical or pregnancy complications. Further to this, distance and time to travel to an appropriately staffed maternity service should be considered when assessing appropriateness for this option of care.

The framework … is not intended as a document which is exclusionary. It does, however, articulate parameters of midwifery led care as a mechanism to balance the priorities of women’s choice and quality and safety of maternity care to deliver positive outcomes for mothers and babies.

… both the midwife and the woman need to be informed early in the pregnancy of the likelihood of needing to interact with other health professionals and the potential for transfer to other care settings. Given that access to continuity of care is a primary driver of women to choose private midwifery models, choice of appropriate models of care including clearly articulated plans of escalation and collaboration, are integral to satisfaction levels.

… the ACM Consultation and Referral Guidelines and the principles and practices outlined in the draft NHMRC National Guidance on Collaborative Maternity Care are a key element of this Safety and Quality Framework.

The midwife’s requirements to fulfil the QSF will increase the standard of care and provide the public with an expectation of safety, collaborative care and higher standards:

Minimum Quality and Safety Requirements for Interim Exemption from Insurance

In addition to holding current registration in their State or Territory, or with the Nursing and Midwifery Board of Australia after 1 July 2010, to comply with the exemption from the insurance requirement of the National Registration and Accreditation Scheme midwives need to be able to provide evidence outlined in the table below:

- written information detailing evidence informed materials (consumer information package)
- Process for complaint management (Documented process, including complaint escalation information)
- Consumer participation (Women involved in case and peer review)
- Consumer satisfaction templates
- Documented evidence informed clinical practice guidelines on which practice is based e.g NHMRC, NICE, or state & territory guidelines
- Referral pathways: clearly articulated referral pathways for referral and /or consultation in accordance with ACM Consultation and Referral Guidelines
- Comprehensive clinical notes to share with other health professionals engaged in the woman’s care
- Reporting of all births as per each state & territory requirement
- Clinical audit: Comprehensive clinical notes to guide reflective practice and enable review and evaluation of care provided
- Clinical Risk: incident & adverse event reporting – documented process in accordance with state and territory requirements
- Sentinel event reporting: documented process in accordance with state and territory requirements
- Documented involvement in case investigation.
- Risk profile analysis: documented process for identification and evaluation of clinical risk and evidence of correcting, eliminating or reducing these risks
- Professional Development: maintenance of professional standards – complies with NMBA minimum standards
- Awareness and monitoring of new procedures and practices
- Involvement in professional organisation/s and documented schedule for formal practice review and mentoring processes
- Competency standards – ensures appropriate skills and experience
- Demonstrates practice in accordance with ANMC national competency standards for the Midwife
- Continuing professional development: documented evidence of attendance at ongoing and regular education and research activities determined by the NMBA standard relating to CPD
- Maintenance of professional portfolio

The Nursing and Midwifery Board of Australia (NMBA), the principal regulatory body for the midwifery profession, is the appropriate authority to hold the governance of this framework. While significant consultation has occurred, the decision to accept or use this framework in whole or in part is a matter for the NMBA to decide.

This framework is not a legal requirement for a PPM who is exempt, until it is approved in a code or guideline by the NMBA under s39 of the National Law.

Positives:
- Insistence on high standards of private midwifery practice
- Commitment to quality and safety
- The potential for medicare-eligible midwives to offer women the option of home, birth centre or hospital birth, with all antenatal and postnatal care funded. Hospital and birth centre births will also be funded, but not homebirths. This opening up of options will improve safety by increasing options to women.
- Midwives will be able to remain the primary carers in the ecent of hospital transfer.
- This document reflects great respect for women’s choices to engage a private midwife for a homebirth and provides support to the midwife (in terms of a framework) and to women (in terms of safety).
- The enormous amounts of media generated by the maternity services reforms have had a positive impact on homebirth, just by increasing awareness of homebirth as a respected and mainstream option.

Negatives:
- Some are disappointed that twins, breech and other risk-associated pregnancies cannot be supported in a homebirth.
- The requirements on the midwife who wishes to attend private homebirths are fairly onerous if the midwife had previously not attended to any quality, safety, professional development and documentation issues.
- The cost of the government insurance is prohibitive for many midwives, although it may be possible that other insurance products may be available that will only cover antenatal and postnatal care.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Homebirth: What to expect

May 11th, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

There is no standard of events for women who give birth at home. Homebirth care is always individualised to the needs of the woman and family.

The following information can help you to understand what may happen in labour, to give you a sense of your options and lessen any surprises. When you birth at home, you can expect to:

- Wear whatever you like in labour
- Have vaginal examinations when / if you want them. Your midwife may suggest an examination if she feels it is needed, which is not very often as we know that babies are born whether vaginal examinations are performed or not and many women prefer to avoid them wherever possible.
- To have your temperature, blood pressure and pulse taken when it is necessary to do so – sometimes this is not done at all
- Have your baby’s heart beat listened to with a hand-held doppler that allows you to remain in the bath or shower.
- If additional fluids are needed, you can expect your midwife to offer you lots of drinks – this will also help to keep up your energy levels. In fact, your midwife will probably offer food and fluids regularly throughout your labour anyway.
- We don’t use ID bands at home. Not for Mum, not for baby. No chance of anyone getting lost, everyone knows who’s who, and no mother is handed the wrong baby!
- Your waters are very unlikely to be broken at home.
- You can expect to give birth in the position that’s most comfortable to you at the time. For many women, this is kneeling (so you can catch your own baby) or all fours (and your partner can catch the baby).
- Waterbirth is a common birth method at home.
- While “pain relief” is not offered, your midwife will make suggestions to assist your level of comfort such as position changes, hot packs, bath, shower, massage and so on.
- You will find that your body will push instinctively when the time’s right.
- Many women will not tear and episiotomy is very rare at home.
- Placentas usually come of their own accord, in their own time provided that the blood loss is not excessive.
- Your baby’s cord will be cut after the placenta is born, and some women prefer to leave it intact and have a lotus birth.
- There is no separation of mother and baby.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Hospital birth: What to expect

May 10th, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

There is a fairly normal standard of events for women who give birth in a hospital setting, whether public or private.

The following information can help you to understand what may happen in labour, to give you a sense of your options and lessen any surprises. When you go to hospital in labour, you can expect to:

- be asked to remove your clothes and wear a hospital gown.
- To have a vaginal examination when you are admitted and at least every 4 hours thereafter.
- To have your temperature, blood pressure and pulse taken regularly throughout labour
- In some hospitals, continuous monitoring is used for 20-30 minutes when you arrive. In many cases, it is left on for the whole labour.
- Many women will have a cannula in their arm. Some women will have antibiotics put through this cannula; others will have IV fluids.
- You can expect food to be limited in labour. Some hospitals have a policy of ice chips only when in labour.
- You will have one or two ID bands placed around your wrist.
- If you’re giving birth in a private hospital, it’s fairly standard to have your waters broken in labour by the staff.
- You can expect to give birth lying on your back in bed with the back rest elevated somewhat. In some hospitals, stirrups are used.
- In many hospitals, pain relief is routinely offered.
- You will most likely be told when and how to push.
- Many women will be given an episiotomy.
- You will routinely be given an injection to speed the delivery of the placenta.
- Your baby’s cord will be cut before it has stopped pulsating.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Another reason to birth at home? Mothers brought the wrong baby to breastfeed.

May 9th, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

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Babies are being handed to the wrong mothers who are unknowingly breastfeeding another woman’s child, with a string of dangerous hospital blunders in New South Wales exposing both mums and newborns to disease.

In one shocking case uncovered in an investigation … a newborn baby had to have its stomach pumped after being given month-old breastmilk from a woman who was not the child’s mother.

At least 26 cases where babies have been wrongly identified have occurred in NSW public maternity wards in the past three years. Staff shortages and the failure by some midwives to check identification tags have been blamed for the errors.

After a year-long investigation, documents released under Freedom of Information reveal the extent of the bungles.

One of the most serious cases was at Blacktown Hospital … with a baby given unnecessary medication because of incorrect identification tags.

In another incident, a 10-hour-old baby girl was given to the wrong mother to be breastfed at Westmead Hospital … because staff did not check the identification tags properly.

At least half of the errors … occurred in the Sydney South West Area Health Service …

It is the same health service which tried to hide its mistakes by refusing to release the documents until ordered by the Ombudsman.

Documents released by the hospitals reveal mothers have been left distraught after being told,or discovering themselves, the child they were breastfeeding was not theirs.

… NSW Health’s breast-milk safe management policy advises staff to double-check ID tags on the baby’s ankles and wrists against the mother. Expressed milk should be cross checked with the mother and ideally stored in a fridge in her room …

These problems can be avoided by birthing at home. If a woman births in hospital, it is important to avoid separation from the baby, even if she is tired. Midwives typically care for 8-15 women on afternoon and night shifts and this can obviously impact patient care. It does not excuse the issue, but with a huge shortage of midwives, keeping your new baby with you can help minimise your chances of being handed someone else’s baby, or having your baby handed to another mother.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Midwives in Jeopardy

May 8th, 2010
by Melissa Maimann.
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As she nears the last month of her pregnancy, Piper Harrell is counting on giving birth to her second child in the same place she had her first, in her second-floor walk-up apartment …

But this time, Ms. Harrell … is afraid that if she insists on having her baby at home, she will make her midwife … an outlaw.

Seven of New York’s 13 home-birth midwives … had an agreement with St. Vincent’s Hospital Manhattan that its doctors would back them up in an emergency. But the bankrupt hospital closed on Friday, and those midwives have been unable to negotiate new practice agreements with other hospitals or obstetricians, as required by state law, leaving them in the position of risking their licenses if they choose to deliver babies.

The loss of that 25-year relationship with a sympathetic hospital has left some home-birth midwives not only fighting for the legal viability of their practice but having to justify their very existence. Officials at several hospitals said … they were skeptical of the safety of home births and were concerned about the malpractice implications of taking over their clients in emergencies.

… “This is who we have to get a signature from — people who don’t believe in what we do and that we compete with,” …

The 13 midwives attend about 600 births a year, and about 50 of their clients expect to deliver in the next month.

To them and their clients, having the option of a home birth is an affirmation of their reproductive rights. It is also a reaction against the highly medicalized climate of hospital births, which, they say, has contributed to a Caesarean-section rate of more than 1 in 3 births … with some hospitals having rates above 40 percent …

To the medical establishment, home birth represents a rash choice by women who refuse to believe that things can go dreadfully wrong in an instant …

A large study of planned home births in the United States and Canada … found substantially lower rates of medical intervention compared with low-risk hospital births (high-risk pregnancies rarely, if ever, culminate with a home birth) and a similar rate of infant mortality. No mothers died. About 12 percent were transferred to the hospital. The midwives considered the transfer urgent in 3.4 percent of all intended home births.

… written practice agreements with hospitals or doctors have been a condition for all midwives to practice in New York State since 1992. But obstetricians have become increasingly wary of signing with home-birth midwives since the Congress of Obstetricians put out its strongly negative statement in 2008 …

… Fifteen other states … allow midwives to practice without them …

… midwives … expected that at least some of their clients would insist on delivering at home even without signed hospital backup. (They can still go to an emergency room and be treated.)

Ms. Harrell, 33, said she trusted her midwife … who delivered her first child … she said she was leery of trying to build a relationship with a doctor so late in her pregnancy. But she worried about putting Ms. Leonard in an untenable position.

“I’ve never felt not able to make a choice about my body for myself and my family, and it’s a paralyzing feeling,” Ms. Harrell said …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Test leads to needless C-sections

May 7th, 2010
by Melissa Maimann.
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My patient needed to be delivered. She had just developed eclampsia … She had suffered a seizure and dangerously high blood pressure …

… we gave medication to start labor, and the nurses placed a fetal heart monitor.

… the ultrasound monitor would play a crucial role in the hours to come. It prints a read-out strip of the baby’s heart rate, and the pattern would guide us in determining whether the delivery would be natural or through cesarean section.

… the baby’s heart-rate strip showed worrisome changes soon after labor began, and I knew it would get worse as labor progressed. We would fight through the night to have a natural delivery. But ultimately that single heart-rate test, which is surprisingly unreliable, would be a key factor in whether my patient would get a C-section or not.

… bad fetal heart strips are an important cause of high cesarean section rates …

… For the worst readings, we believed every second counted and rushed the surgery: If the baby wasn’t delivered one minute from the first incision into the skin, we had moved too slowly.

The complication we feared most was … the baby not getting enough oxygen during labor [which] could result in a serious permanent injury, such as cerebral palsy, or even death.

No test is perfect. But almost every time we whisked a mother back to the operating room, and I cut through skin, fat, fascia, and finally the muscle of the uterus, expecting a blue, floppy baby, the child I delivered emerged pink, healthy, and a little bit angry.

Were we saving lives and averting disaster? Or were we performing unnecessary surgery?

Fetal heart-rate monitoring is a screening test. Good tests get several things right: they are cheap, detect a possible problem when there is still time to act, and minimize unnecessary follow-up tests.

… fetal heart monitoring is an appallingly poor test. The test misses the majority of babies with cerebral palsy, the condition researchers hoped it would prevent. It causes increased rates of a painful and invasive surgery: cesarean section …

The odds of my patient’s baby suffering from dangerous lack of oxygen were slim … only 1 of 500 babies with a bad strip had cerebral palsy … it remained unclear if the condition had developed before labor, in which case cesarean couldn’t prevent it.

… fetal heart monitoring failed to reduce perinatal mortality … and increased cesarean section rates and forceps deliveries, compared with listening to a baby’s heart rate intermittently.

As a medical student, I loved watching emergency cesarean sections. The baby’s heart rate went down, doors swung open, residents rushed the patient down to the OR, and a frantic minute or two of surgery later, a screaming baby was out … I never questioned the need for the surgery.

Now, cesarean sections for bad tracings are one of the least satisfying parts of my job.

… “A test leading to an unnecessary major abdominal operation in more than 99.5 percent of cases should be regarded by the medical community as absurd at best,” … “Electronic fetal heart rate monitoring has probably done more harm than good.”

Why do doctors cling to continuous fetal heart monitoring? An obstetrician will most likely point to the fear of being sued, but the complete answer is more complex. Our medical culture prizes technology and tests, even if they don’t work and can cause harm.

… I struggled with my patient’s bad fetal heart strip. I wanted her to avoid a cesarean section. She had type 1 diabetes, and I expected her sugars to swing wildly after surgery, and her recovery to be slow.

… Finally, at 3 a.m., I felt compelled to recommend cesarean … My patient’s child greeted the world pink and well-oxygenated.

The test was wrong again.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Professional indemnity insurance for midwives

May 6th, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

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“… I am pleased to announce that the Government has signed the contract to provide the first ever Commonwealth-supported professional indemnity insurance for midwives.

The insurance will be provided by Medical Insurance Group Australia.

Privately practising midwives will be able to purchase their own insurance, and be covered from 1 July 2010.

This is the first time since 2002 that midwives can purchase professional indemnity insurance.

This is an important step for Australia’s midwives. It is also an important step for Australian women and their families.

This insurance arrangement will help midwives who wish to provide high quality midwifery services to Australian women as part of a collaborative team with doctors and other health professionals.

It is a key part of the $120 million package of maternity reform measures the Government announced in the last Budget to improve choice and support for Australian mothers.It also helps underscore the importance of midwives in providing high-quality, safe maternity care in Australia.

It builds on the new legislation passed by the Parliament on 16 March 2010 to give midwives access to the MBS and PBS.

The Commonwealth-supported insurance will not cover services provided during home births.

Medical Insurance Group Australia were selected via a tender process and has been providing insurance to doctors and other health care professionals in Australia for many years.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

Sex Of Baby Drives Response To Pregnancy Stress

May 5th, 2010
by Melissa Maimann.
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…. Male and female [fetuses] … show different growth and development patterns following stressors during pregnancy such as disease, cigarette use or psychological stress.

… “The male, when mum is stressed, pretends it’s not happening and keeps growing … The female … will reduce her growth rate a little bit; not too much so she becomes growth restricted, but just dropping a bit below average.

“When there is another complication in the pregnancy … the female will continue to grow on that same pathway and do okay but the male baby doesn’t do so well and is at greater risk of pre-term delivery, stopping growing or dying in the uterus.”

… this … growth response had been observed in pregnancies complicated by asthma, pre-eclampsia and cigarette use [and] psychological stress …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Risk assessment in pregnancy and birth

May 4th, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

Risk assessment has been around for a long time in maternity care and has become more widely spoken about as midwifery-led services have expanded. Risk assessment is a way of identifying potential problems and minimising risks to the woman and baby. Some form of risk assessment is used in almost every profession and although the actual risk assessment process is not perfect, it’s the best tool we have at present. Risk assessment is used on OH&S, education, food service, health, media, emergency services, law and so on.

In maternity, risk assessment is an incredibly useful tool. The benefit of risk assessment is that it is based on science and evidence. We can state with certainty the risks of certain complications such as pre-eclampsia and this is helpful when preparing women for what to expect and things to be on the look-out for. In this way, risk assessment actually lowers the risk to the woman because she can become more involved in her care and more alert for signs that mean she needs to get help.

The downside of risk assessment is that it does tend to categorise women according to a tick-box system. Although the risk might be there, it might not necessarily apply to the woman sitting with us. This might be because the study that exposed, defined or quantified the risk does not apply in the current situation.

How can risk assessment be useful?

Risk assessment can be an incredibly useful tool for both women and midwives in helping to plan care that will meet the woman’s needs safely. Midwives are primary care providers and are responsible for proving care to healthy, low-risk women and babies throughout pregnancy, birth and the postnatal period. So a risk assessment tool helps the midwife and woman to know when a referral is needed.

Risk assessments can also highlight potential problems that would benefit from early organisation and planning before labour. This might include reviewing the birth plan, reviewing place of birth, engaging other health professionals and putting in place supports so that the woman can cope well after the baby is born.

Risk assessment can also be useful for discussing homebirth with women and their partners. Some women are perfectly suited to homebirth: they’re healthy, their pregnancy is going well and they’re wanting a natural birth. In this case, risk assessment can be used to explain to the woman that she’s safer at home.

Melissa Maimann, Essential Birth Consulting 0400 418 448

FAQs

May 2nd, 2010
by Melissa Maimann.
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Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.

changes to medicare obstetrics

It will cost more out of pocket to have an obstetrician. Conversely, midwifery will attract medicare benefits after November, making private midwifery care more affordable to families.

waterbirths in sydney

The easiest way to have a waterbirth is to contract a private midwife and have a home waterbirth. Some hospitals are offering waterbirth. Sometimes it will depend on having a room available with a bath in it; other times it will depend on which midwife is on staff as some are accredited to do waterbirths and others aren’t.

antenatal classes sydney and independent childbirth educators sydney

The best value antenatal classes are with Julie Clarke who is an experienced childbirth educator and Calmbirth (R) Practitioner.

can i refuse use of forceps

You can refuse anything you don’t want to have. Often obstetricians will use a vacuum rather than forceps. Avoiding an epidural is the best way to avoid forceps or a vacuum.

can you go public if you have phi maternity

Absolutely! PHI is there in case you need it, but having it doesn’t mean you have to use it.

caseload midwifery and homebirth

Homebirth is the original caseload midwifery model! Each woman books with her own midwife, one she has sought out, trusts and knows well. That same midwife attends all the woman’s pregnancy, birth and postnatal care.

cost of a private midwife sydney

Anywhere from $3000 upwards. Most are around $3000 – $5000. It’s money well spent.

how will homebirth be affected by the health reform australia 2010

Truth is, we still don’t know. We’re awaiting another draft of the Quality and Safety Framework. As soon as something is released publicly, I’ll place it on this blog.

which is safer hospital or midwife?

It’s not really an either / or because midwives work in hospitals as well as in the community. Midwives attend every birth. In some cases, a doctor will also attend, but every birth is attended by a midwife.

can I have a waterbirth after a caesarean?

Of course you can!

Melissa Maimann, Essential Birth Consulting 0400 418 448