Posted by Melissa Maimann on Jun 30, 2010 in
Birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
A woman’s choice of care provider for pregnancy and birth is one of the most important decisions she will make. This major decision is the major influence on how her birth will go: whether it will be caesarean, successful VBAC, epidural, or natural birth.
Some things to consider when deciding on a care provider are:
• What sort of relationship would you like to have with your care provider? Are you merely looking for physical check ups in pregnancy and someone to turn up for the last few minutes of the birth? Are you wanting to be cared for by strangers who do not know you or your wishes for birth / would you like to feel nurtured? Would you like to know the person who will assist you in birth?
• How much information do you expect to receive? Are you happy with “It’s normal” in response to your questions, or do you need more information and a better understanding of your situation and progress and health?
• Do you wish to be actively involved in the decisions made about your care or are you happy to leave all decision-making up to others?
• Are you well and healthy? The majority of women are. If this is the case for you, your care provider could be a midwife or an obstetrician. If you have significant health issues, an obstetrician might be a better option.
It may take some time and energy to find the right care provider for your pregnancy and birth. It is very helpful to interview several midwives and obstetricians before deciding on the one that is right for you. This is a relationship that is worth investing in, and it’s important to make the right decision. Be prepared to pay for initial consultations with health professionals and consider this money well-spent. Everyone’s individual and a poor choice of care provider (for your needs) can have far-reaching effects.
What about place of birth?
There are three options for place of birth: home, birth centre and hospital. Midwifery care is available at all three locations. Obstetricians generally work only in hospitals, however a few will attend birth centre births. Knowing where you would like to birth your baby can help you in choosing a care provider.
What should I look out for when I am interviewing care providers?
One of the most important issues to consider really doesn’t need much consideration at all. How do you feel about your care provider at the end of the initial consultation? It’s a gut feel. You can trust your gut.
You will want to ask your care provider about his/her practices to ensure that their practices are consistent with what you’re wanting for your pregnancy and birth. If waterbirth is important to you, you need to find a place of birth and care provider who can provide this. It’s best to find this out at the initial consultation stage rather than at 38 weeks.
You will also want to explore your care provider’s philosophy on pregnancy and birth to ensure that there is a match with your own.
Are there any poor reasons for choosing a care provider?
Yes! And I hear them very often. It is not wise to choose a care provider because:
• They are close to your home / office
• Your mother used them
• You feel you don’t have any other choices (there are always choices; it’s not a question of resources, it’s a question of resourcefulness)
• They are female / they are male. Plenty of female obstetricians are more interventionist than male obstetricians.
• Your GP recommended them (unless you are sure of the basis for that recommendation)
• They are cheap
• They do an ultrasound at every visit
• They delivered you
• It would offend Aunt Bessie if you didn’t go to Dr X
• Although you don’t like the person, you’re sure they’ll be fine on the day (your gut is always right)
Can I change my care provider? I’m already 39 weeks pregnant!
It’s never too late to change. It’s uncertain and there are moments of awkwardness but it’s of most importance that you feel right about the care provider you have chosen. I have many women who come to me after months with an obstetrician or another midwife. As time goes on, you will learn more about your needs and about the care provider you have chosen. If you have reason to believe that the care provider who was once right for you, is no longer, then it’s time to find someone who will better meet your needs. The first step, before changing, is to talk to your care provider. Perhaps there’s a misunderstanding that can easily be cleared up. Both of you have an interest in maintaining the relationship and I’m not a fan of breaking relationships unnecessarily. So talk to your care provider first. Let them know what’s important to you and why. Ask them to help you achieve whatever it is you’re hoping to achieve. If, after going through this process the two of you can’t see eye to eye, it’s time to find someone else.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices
Posted by Melissa Maimann on Jun 29, 2010 in
Birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
I am often asked what the difference is between the private and public options for pregnancy and birth.
Both options enable women to access midwifery care or obstetric care and both options enable women to birth at home or in hospital. So you might be wondering what the difference is for the woman going through each system.
Private care generally affords women:
- Choice of care provider
- Choice of place of birth – home, hospital, public or private hospitals
- Greater comfort and a more personalised service
Public care options often mean:
- a midwife or obstetrician will be assigned to you; you will not be able to choose your care provider
- Choice of place of birth is limited. Homebirth is only an option at a minority of hospitals and women generally have to go to the pubic hospital that is closest to their home
- Services cater more to the immediate physical needs with little appreciation for the emotional and mental journey of pregnancy and birth.
- Services are standardised by hospital policies. The same policies will apply to all women birthing at that hospital with little scope for movement.
The good news about private midwifery services is that after November 1 this year, families will be able to claim Medicare benefits for the care that is received from a private midwife. This rebate will significantly bring down the prices for private midwifery care, making it an affordable option for women wanting to birth in hospital with a private midwife, or at home.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Maternity Services Review, Midwifery, Midwifery services, Public and private hospitals
Posted by Melissa Maimann on Jun 28, 2010 in
Home birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
I was sad to read this article in the papers yesterday (although I love the beautiful homebirth photo that it included!)
The article is entitled, “Homebirth Laws Confusion” and only served to increase the confusion about homebirth.
Homebirth is not illegal. Nor will it be after July 1 this year.
MIDWIVES attending home births in Tasmania could be liable for misconduct prosecution after July 1.
The article stated that, “Australian Nursing Federation state secretary Neroli Ellis said the changes meant midwives who continued attending home births could be open to misconduct liability legal action.”
The reported interviewed a well-known and experienced midwife who was quoted as saying, “The new regulations are meant to take effect from July 1 but there is nothing in place and we have no idea what we are meant to do” … She said she suspected the regulations were a backdoor way of banning home births.
The ANF is only correct *if* the midwife practices homebirth without insurance. So long as the midwife has insurance for pregnancy and postnatal care, it is perfectly legal for midwives to continue to attend births.
There may be some issues with insurance:
- The policy is quite expensive, especially for midwives with low caseloads, and costs for homebrith are expected to increase
- The insurance policy requires that the woman books into a hospital and that the midwife shares with the hospital a maternity care plan for the woman – in the interests of safety
- The insurance policy demands that the midwife works to evidence-based guidelines and best practice.
But … so long as these conditions are met, homebirth is, and remains, perfectly legal.
Women having homebirths need to know that there is no insurance for the actual birth. Pregnancy and postnatal care is covered by insurance. You can expect to sign a form stating that your midwife has told you about this fact and that the have understood this.
All births will be reported to the Health Department – already a legal requirement.
As well as this, midwives will need to adhere to a Quality and Safety Framework. This Franework is in the hands of the Nursing and Midwifery Board at the moment and until it is placed in a code or guideline, it is not intended to be folowed. Indeed, we only have a final draft, so cannot follow it as it has not been released.
The bottom line is: homebirth is not illegal!!
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Home birth, Maternity Services Review, midwife, Midwifery, Midwifery services
Posted by Melissa Maimann on Jun 27, 2010 in
Birth,
Caesarean Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
A new study … looked at 7,804 pregnant women giving birth for the first time and found that 43.6 percent of them had their labor induced … [Women having an induction] regardless of the reason were 2.6 times more likely to have a C-section, meaning 20 percent of them were linked to inducing labor. In 1990, 9.5 percent of women in the United States had their labor induced. Sixteen years later, that number jumped to 22.5 percent. Currently, 32 percent of babies born in the United States are delivered by C-section, an all-time high. Women who deliver by C-section the first time are more likely to have a C-section in subsequent deliveries, so the goal is to prevent C-sections the first time around.
There’s a place for all interventions in labour and birth. Mostly, they’re over-used. However, sometimes intervention is life-saving. Some good reasons for an induction might be high blood pressure or a baby who is not growing well inside. However, reasons such as suspected big baby or wanting to schedule birth for convenience might be re-thought in light of this research that confirms previous research on the topic.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Complicated pregnancy or birth, hospital birth, intervention, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Jun 26, 2010 in
Birth,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
It seems patients of Dr. Robert Biter’s are everywhere here in North County San Diego. For a long time now, I’ve enjoyed playing the game of mentioning him when I meet one and just buttoning my lips to listen to the glowing stories that come back to me. Such tales were echoed over and over in comments on my recent post, “Why I’m Protesting for my Natural-birth Friendly OB.”
The post chronicled the buzz over the recent suspension, reinstatement and resignation of popular OB, Dr. Robert Biter, from San Diego’s Scripps Encinitas hospital last month, and the hundreds of people who showed up at local rallies in his support. Even though this piece portrays individual stories — mine with Dr. Biter and his with a contentious hospital — I’m glad to see the attention Huffington Post readers are giving it for the larger issues at play.
Dr. Biter was cleared of any wrong doing under a peer review panel and the California Medical Board declined any sanctions against him … Given the continued silence of both parties, it’s not clear what legal proceedings may still be underway. Regardless, his enormous, continued support in my community says a lot about what many women want as health care consumers today.
A central aspect of Dr. Biter’s popularity seems to be his unique ability to incorporate much of the midwife’s model of care … where birth is seen as a normal process … he puts in endless hours to stay very present in a labor, however lengthy, and tailors the care to maximize a woman’s innate ability to birth her baby without interventions …
… Over the years I’ve met more than one patient in Dr. Biter’s crowded waiting room who has driven hours just to see him. They make one thing clear, Dr. Biter does things differently than most. In addition to being more sincere and caring than some of our past doctors, he has extremely low rates for interventions like labor induction/acceleration drugs or c-sections. He also encourages women to move around during labor, as desired, to help the baby move down and out of her pelvis.
… Perhaps you are asking if Dr. Biter’s way is less safe than the norm … Even though we birth with OBs over 90 percent of the time in the U.S. … we still have the second worst newborn mortality rate of any developing nation and our maternal mortality rate has doubled in the last 25 years.
Of course, there are plenty of women who aren’t interested in a more natural birthing experience and options are abundant for them. But a real number of others are clearly starved for an OB who allows her to take her time in labor and resists the urge to intervene unless there is a genuine complication.
Like me, these women may want the option of having an epidural, or other medical tools available at their birth. But many of them don’t feel their freedom of choice is respected once they walk through a hospital’s doors.
… I do wonder why more doctors don’t offer a way of birthing with fewer medical interventions, when a doctor who does, like Dr. Biter, has such a groundswell of support?
The situation is very similar in Australia, with very few obstetricians providing natural birth services. Obstetric care frequently involves interventions such as induction, epidural, vacuum extraction and so on. Yet it’s very clear that natural birth is important to women. What will it take for obstetricians to feel mroe comfortable to provide natural birth services such as waterbirth, vaginal breech birth, VBAC, physiological birth positions, physiological third stage and so on? I expect it would take a change in our legal system and duty of care legislation to be in place.
a href=”http://www.essentialbirthconsulting.com.au/about-melissa-maimann.html”>Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Complicated pregnancy or birth, continuity of care, hospital birth, intervention, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Jun 24, 2010 in
Birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
The Federal Government is providing more support for Australian women and their families with a new, expanded national 24 hour Pregnancy, Birth and Baby Helpline commencing on 1 July 2010. Women, their partners and families will be able to call the Helpline on 1800 88 24 36 for advice and information about pregnancy, birth and the first 12 months of a baby’s life. The independent charitable organisation, Royal District Nursing Service Ltd, will provide this free service, offering information and counselling on a wide spectrum of topics relating to pregnancy, birthing and life with a new baby – including issues such as nutrition for mothers and babies, breastfeeding, relationship support and health care options.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth
Posted by Melissa Maimann on Jun 23, 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.
Can private midwives be fined for delivering a baby at home?
No. it’s perfectly legal for private midwives to attend homebirths. There are no fees or penalties to the midwife or family.
What is an eligble midwife?
An eligible midwife is a midwife who has:
Current general registration as a midwife in Australia with no restrictions on practice;
Midwifery experience that constitutes the equivalent of 3 years full time post initial registration as a midwife;
Current competence to provide pregnancy, labour, birth and post natal care to women and babies;
Successful completion of an approved professional practice review program for midwives working across the continuum of midwifery care;
40 hours per year of continuing professional development relating to the continuum of midwifery care (20 hours in addition to standard requirements);
Formal undertaking to complete an accredited and approved program of study to develop midwives’ knowledge and skills in prescribing within 18 months.
Clients of eligible midwives are able to access Medicare benefits for the services provided by eligible midwives. eligible midwives are also able to access visiting rights at a later date.
Can you use a private midwife in public hospital in sydney?
Yes. You can work with a private midwife during your pregnancy and she can provide all of your pregnancy care. You can labour at home as long as you like with your private midwife, moving to hospital when you feel ready. In hospital, your midwife will ensure that your needs are met and provide support and advice. After your new family member arrives, you can return home and be cared for by your private midwife.
Sometime after November, private midwives will have visiting access to hospitals.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, Home birth, hospital birth, Maternity Services Review, midwife, Midwifery, Midwifery services, Public and private hospitals
Posted by Melissa Maimann on Jun 20, 2010 in
Birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
Australia is one of the safest countries in the world in which to give birth, so why are women more anxious than ever about their pregnancies?
FOR most women, the memory of their baby’s birth remains a vivid mental replay that awakens sensations at times as sharp and clear as the moment itself.
For Fiona Thomas, such memories are hazy, trammelled by darker ones that involved her fight for survival. All she remembers is the baby, her third, being lifted from deep within her; and then feeling faint and unwell.
As the baby lay in her arms, she was elated to discover she had a daughter (she already had two boys.) But there was tension in the room and the obstetrician seemed preoccupied. As the feeling of faintness dragged her deeper into a place she did not want to go, she signalled to the nurse to take the baby.
She remembers the anaesthetist telling her there were ”some complications” with bleeding and the obstetrician saying tersely, ”get her husband back here now” (he had gone with the baby to the nursery).
And then she was lying unconscious, monitored by the rhythmic beep of machines on a 24-hour guard. Meanwhile, the baby slept in the nursery, her life stretched out vast as an open sky.
Unbeknown to her, Fiona was suffering from placenta accreta, a potentially fatal condition in which the baby’s food supply, the placenta, attaches itself to the walls of the uterus so deeply that there’s a risk of haemorrhage if it is removed. It occurs in one in 2500 pregnancies but is difficult to detect beforehand.
In the delivery suite, the obstetrician worked rapidly to stitch up the ends of the blood vessels but the placenta was an open network, pumping blood at a rate of knots. ”My husband had a fright when he came back into the room and saw the obstetrician covered in blood,” Fiona recalls. ”I actually think it was harder for him than for me.”
… Fiona underwent an emergency hysterectomy and woke up in intensive care attached to drips and tubes that leeched donors’ blood back into her depleted body. Pinned to the foot of her bed was a photo of her daughter …
AUSTRALIA is the fourth-safest country in the world in terms of maternal mortality …
The chance of dying in Australia as a result of childbirth is remote – about one in 10,000 …
But globally, women die of pregnancy-related causes at a rate of one a minute, with 99 per cent of deaths happening in developing countries. Clearly, giving birth is a risky business. Good hygiene and better standards of living and prenatal care have gone a long way towards making it safer in this country, but that doesn’t mean it won’t go wrong.
Ironically, despite Australia’s great record, experts say many women are feeling more, rather than less, anxious about the birth process. Some blame this on our risk-averse society, saying the screens and tests and the increasing level of intervention in birth and pregnancy is geared towards making women fearful. As one expert puts it, antenatal care has become ”antenatal scare”.
Louise Kornman, associate professor of obstetrics at the Royal Women’s Hospital, says: ”Birth rarely leads to death, but it can lead to damage. The majority of pregnancies work out fine, but the reality is it doesn’t always go that way. There is a belief that technology can save you if things go wrong, and in doing so you can lose sight of the fact there are inherent risks.”
… ”Of course, women might feel that sometimes the medical profession intervenes too much in what is a natural process, but the reality is that if left to mother nature then the outcome is not very good, often, and there needs to be a sensible balance struck between not interfering in a natural process but judiciously intervening when things start to go wrong – or preferably before things start to go wrong, given that prevention is better than cure. It can be a difficult compromise to reach.”
It is worth remembering that obstetricians are at the coalface of difficult deliveries. Does this make their view distorted? Unlike midwives, who oversee successful, normal births every day, doctors bear witness to the worst-case scenarios. Inevitably this difference in experience manifests itself in an ongoing debate on how best to manage childbirth. Midwifery groups push for normal deliveries and natural births while obstetricians err on the side of caution … Caught in the middle are the mothers.
Rather than becoming too complacent, Melissa Maimann, a private midwife and childbirth educator in Sydney, is seeing more anxiety among her patients, created, she believes, by our risk-averse culture.
”The safest place to have a baby is at home, if everything is going well,” she says firmly. ”The vast majority of people who go through the hospital system are unhappy with their experience.”
Have women been made to feel over-anxious? ”Possibly,” admits Bernadette White, clinical director of obstetrics at the Mercy Hospital For Women. ”It is easy to focus on the things that go wrong, and for some people that’s a source of stress.
”Obviously, a logical approach is to look and say, ‘Yes, that could happen, but how likely is it?’ But people don’t always have an entirely rational view when looking at things that might go wrong in their labour.
”And when you are assessing a risk, there’s a very broad spectrum of interpretation. That’s why some people will look at one set of figures and want a home birth, and someone else will look at the same figures and want an elective caesar.”
Associate professor Jenny Gamble, deputy head of nursing and midwifery at Griffith University, Queensland, has researched birth and post-traumatic stress.
Her findings show that while birth is a relatively safe physical event in Australia, it remains a hazardous psychological journey.
”If we stick with the premise that a high level of intervention has unintended negative consequences, then yes it does. We have consistently found that 30 per cent of women report that their birth was traumatic; that they feared for their life, or their baby’s life. This is a very high figure. We also know that about 6 per cent go on to develop post-traumatic stress disorder.
”Women don’t feel safe. Birth is being geared towards making them feel fearful; strangers are telling them this and that, there is screening and testing at every step and they develop a sense that at any moment they might lose the baby or something catastrophic is going to happen. It’s called ‘antenatal scare’ in the trade.”
Gamble is concerned about the ripple effects of such trauma. Affected women may find it harder to bond with their baby, and their relationships may fall apart. They may develop a fear of hospitals and doctors and even birth itself.
”Most of our gains in maternal morbidity have been based around realistic, basic things, like feeding the mother, sending out health messages such as not smoking in pregnancy and basic care in the community. I am not suggesting that we do nothing, but the pendulum has gone too far the other way.”
ERIN Horsley had her first baby in Britain. Despite her plans for a natural birth with no intervention, she ended up having her baby induced and then delivered by forceps when labour progressed slowly.
Attached to a drip and no longer able to move around, Horsley couldn’t speak through the pain. ”If you can’t tell me what’s the matter then I can’t help you,” said the midwife, brusquely.
Horsley emerged from the experience feeling emotionally battered. ”I felt let down,” she said. ”Not listened to. It caused marital problems. When I had my second baby here in Melbourne I tried to talk the hospital staff about my experiences; they said I was being oversensitive and that birth trauma doesn’t exist.”
Shae Reynolds, 31, was also hoping for a natural delivery but a late scan showed the lake of amniotic fluid surrounding the baby was ”potentially low”. (This turned out not to be the case when the waters finally broke.) In the cascade of intervention that followed, Shae found her legs in stirrups opposite an open doorway with several strangers milling around the room, including someone emptying the bins.
A vacuum extractor was attached to her baby’s head and one her most horrific memories is watching the doctor put a foot on the bed and pulling, saying, ”We have to get this baby out”. She says part of her daughter’s scalp was damaged as a result, and she suffered a big tear.
”I struggled terribly the first six months,” she recalls. ”I couldn’t have sex for over a year. I felt like I’d failed, like I hadn’t protected her.”
Reynolds’s daughter is now five and she has had two more children, both born without complications and naturally, at home.
But every birthday awakens memories of the trauma. ”It’s hard not to feel torn, because one of the happiest days of my life was also one of the most traumatic. Those precious first moments that we had as a family were destroyed. We were cheated of so much more than just the birth. We still are.”
Medics and midwives are united in the belief that it helps if a woman can feel in control, or at least informed about what is happening. Says Maimann: ”We have an excellent public health system. The government’s job is to offer a basic and safe level of care, which it does very well. It doesn’t suit the emotional or mental needs of women having babies, but I don’t think it should.”
She argues that families should be prepared by investing in independent childbirth education, or working with a private midwife who will provide continuity of care at a cost of between $3000 and $6000.
Surely this will be out of reach to many? ”We can afford holidays,” … ”It’s about valuing what you get.”
Melissa Bruijn and midwife Debby Gould run birthtalk.org, a national birth trauma support group … ”People assume that if birth is going to be safe, there has to be lots of intervention, but reducing the amount of birth trauma is not about reducing what can go wrong, because that’s not controllable.
”It’s really about meeting the emotional needs of women. Even if they find themselves undergoing emergency caesareans, they can still feel empowered and part of the process if they are looked after properly. It’s a myth to say that the most important thing is a healthy baby. Traumatic birth gets carried with you – you don’t leave it at the hospital – and it can have profound consequences for both the mother and baby.”
It is almost seven years since Fiona Thomas, 45, an occupational therapist, went into hospital to give birth and ended up in intensive care. She was fortunate to have given birth in a hospital with a good supply of blood; fortunate that there was a team on hand that worked with rhythmic precision to save her. ”You don’t expect that,” she says. ”I went in thinking I was going to have a routine caesarean, just like I’d had before. All our friends were expecting a phone call 10 minutes later with good news, but there was nothing.
”They realised something must have gone wrong and phoned the hospital. I think everyone was shocked by it. It has changed the way I view life. Sometimes I would think, ‘What happened if I had died? If those 30 seconds I got to hold her had been her only contact with me?’ But then you have to flip it around and see it the other way.
”It makes you realise that life spins on a dime.”
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Birth trauma, Complicated pregnancy or birth, continuity of care, Home birth, hospital birth, intervention, Midwifery, Midwifery services, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Jun 18, 2010 in
Uncategorized I was thrilled to recieve an email yesterday informing me that Sydney Midwife has won the 2010 Top Medical Blog award in the Pregnancy and Childbirth category!
After receiving numerous feedback, Sydney Midwife has won the award for Pregnancy and Childbirth blogs. The award recognises quality blogs and bloggers.
Have a look at the top ten Pregnancy and Childbirth blogs and congratulations to the other recipients.
Posted by Melissa Maimann on Jun 15, 2010 in
Birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
I came across this interesting article detailing an American woman’s experience of giving birth in an American hospital: Mom fires OB during birth when threatened with a cesarean! The woman writes:
… I let myself be pushed into inducing. We were at 42wks … My family was all becoming quite impatient and there was a lot of pressure to have her out. I agreed to be induced and get things started.
… 6 am we were at the hospital. I took a ton of food in with me, because I was not going to do this with no fuel. We got settled, the first nurse got us all checked in did all the paperwork and started the IV. They had a change of shift, so the next nurse, Anna, come-on and she was wonderful.
Anna spoke with us and I told her how things were going to go. To call the doctor if she needed but I was the one birthing a healthy baby, and unless the stats of baby changed, this is what I wanted …I told her we would be doing the pit slowly. I only wanted an increase every 45 min to an hour, not the every 15 the Dr. had ordered. She called the Dr and it was agreed. So off we set. We had a cervical check and I was barely dilated 2 and my cervix was very posterior.
I had no idea how the pit would work on me and baby so we just waited. Annabella was so squirmy, they couldn’t keep her on the monitors, Anna had to hold them on and move with her …
After awhile the Dr came in and wanted to look for Annabella and when she couldn’t find her well stated the baby was breach and we needed to go have a c-section. I looked at this woman and told her no, baby had not flipped I would have felt it, and I was not getting a c-section today. That if baby had turned, then we would turn off the pit, and I would go see my Chiropractor to help move her around again. I don’t think the Dr liked me. I didn’t care. So she ordered an ultrasound just to see, and I was later told she knew baby was breach and had started the paperwork to send us on.
Annabella was in fact not breech. She was head down just not really engaged. I felt so good knowing I was right. All this happened about 11am. There had been no increase in the pit for awhile … We started upping it again.
During these times since Annabella wasn’t staying on the monitor anyway, I was up. I walked and rolled on the ball. I leaned over the ball to do pelvic tilts. Pretty much anything I wanted. I really enjoyed that. I was eating and drinking … At 2pm I declined another cervical check …
I was standing and rocking my hips back and forth during the waves, and they were nice. Just these waves, they never were uncomfortable. I didn’t feel I needed to go in to off during them so I just stayed in center moving as I felt I needed to. Anna would come in and check baby with a Doppler, and the let us do our thing.
About 4 the Dr was back, she wanted to see where we were so we checked. I was 4cm, and my cervix was no longer posterior, about 70% effaced.
• The Dr. said I was not where she would like to see me by now. She wanted to break my waters and move things along.
• I told her no thanks; I felt we were doing fine. Baby was fine, so was I.
• She didn’t look surprised. She did get quite nasty though, and told me if I didn’t do things the right way this will land in a c-section and was putting myself and child at risk. That she was going off shift and there would be someone else.
• I … looked her square in the eye and told her that my child in fine.
• I am not having a c-section to please her that if she had not noticed this was MY birth. I was the one doing things, until someone can show me that my child was unsafe I would do this all night if needed. That was the RIGHT way.
• Also that it was a good thing that she was going off shift, because she was fired. I didn’t want her back in my room. I didn’t need any one in there being negative. I was sure there were other people around who could catch this child, and if not I would do it myself.
• She left the room in a quick hurry, and as I turned around again, my husband and … the nurse were all just kind of staring at me.
My husband was stunned, and asked if I could do that, firing the Dr. I told him I didn’t care if I could or not, she wasn’t coming back to my room …I don’t know how things happened from there, but another Dr. came in and introduced himself about 45 min. later and was way more respectful than that woman had been.
We continued, at 7pm the waves were more intense and almost on top of one another … I started to shake and shiver but I wasn’t cold. I vomited all over, and then with the next wave I felt pushy. soon there after my waters broke during one of the pushy waves.
… My body had taken over, I had no choice but to push … Annabella was born at 8:06pm 7lbs 10oz. 21 inches long. She cried for a bit but was so awake and alert. She is just perfect. She latched on and nursed minutes after birth. I am so happy with this birth. I did it the way I wanted even if it didn’t start the way I choose. I wish the dr had been more supportive. But you can’t have it all.
Let’s consider this case from the perspective of private midwifery care after July 1, 2010. This woman went to 42 weeks. The ACM Guidelines stipulate that at 42 weeks, the midwife must refer the woman to an obstetrician for opinion. No doubt the opinion will be that induction is warranted. The woman may accept or decline this advice. If she declines, and if the obstetrician does not agree to the midwife’s continued care of the woman, the woman will be left without care under the Government’s insurance policy. On the other hand if the woman agrees and accepts induction, this will take place according to the obstetrician’s preferences or hospital policy. As the story above shows, the woman advocated for herself throughout. She declined a caesarean, artificial rupturing of her membranes, a vaginal examination and continuous monitoring. Currently, women can birth in a hospital with their private midwife and their midwife can advocate for them provided that the woman has a birth plan that clearly states her preferences. After July 1, our continued involvement in the woman’s care will be dictated by the obstetrician in attendance or with whom we have a collaborative agreement. In the interests of maintaining a collaborative agreement and ongoing income, the midwife will need to remain silent when the woman is outside of the ACM Guidelines and does not agree to the care being suggested. After July 1, women must fend for themselves if the care being suggested is at odds with their preferences.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: birth, Birth choices, Caesarean, Complicated pregnancy or birth, continuity of care, hospital birth, intervention, midwife, Midwifery, Midwifery services, Normal Birth, Obstetrics, Public and private hospitals
