0

Double standards?

Posted by Melissa Maimann on Sep 3, 2010 in Birth, Midwifery, Obstetrics

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

Link

I was irritated to read this on the NASOG website. NASOG is the National Association of Specialist Obstetricians and Gynaecologists. My irritation lies in the fact that the obstetricians are concerned that with changes to the medicare safety net, the cost of private obstetric care will force it out of the price range of most families and that it will therefore cease to be a viable option (ie, fewer women will be able to access private obstetric care), yet the maternity reforms will have the same impact on midwifery care whereby access to midwifery care will be at the discretion of an obstetrician and fewer women will have access to private midwifery care. Many double standards exist in the article:

Australian women being denied the choice of a doctor during birth
The current changes to private midwifery practice, requiring the midwife to have a signed collaborative agreement with an obstetrician (without the requirement of the obstetrician to sign such an agreement) will result in Australian women being denied the choice of a midwife during birth.

We believe every Australian woman should be entitled to choose a specialist obstetrician or GP.
Likewise, every Australian woman should be entitled to choose a midwife. Around the world, midwives provide affordable, safe and effective care to women and families.

What choices do Australian women currently have?
A woman can:
 choose a private obstetrician or GP to deliver her baby in either a private or public hospital;
 attend the public health system and be assigned to a midwives or doctors clinic, however, women cannot choose the doctor present at the birth, or
 share care between a general practitioner and a public hospital antenatal clinic, however women cannot choose the doctor present at the birth.

Nowhere is the option of private midwifery care mentioned. The author of this article also fails to disclose that midwives attend the majority of births in the public system, not doctors. Within the public system, while women cannot choose the doctor who *might* be present at the birth, in some cases they will know the midwife who will attend them. Private midwifery practice, which delivers virtually 100% continuity of care – the midwife you book with is almost 100% likely to attend the birth – is not even mentioned in this part of the article. If continuity was the concern of the author, surely the model that delivers the greatest continuity would have been mentioned?

The article goes on to say:
In fact doctors are not always present at births in the public hospital.

Shock Horror!! Births happen without a doctor’s presence! Of course, we’re not in there performing caesareans: obstetricians perform these operations. But hey, only about 15% women should need a caesarean; this rate is lower with private midwifery care. So for the vast majority, midwifery care is provided for the entire labour and birth. And the sky doesn’t fall in.

The bottom line is you cannot choose care by an obstetrician in Australia, unless you can afford it. This is hardly supporting a fair choice for women.

Likewise, women cannot choose private midwifery care unless they can afford it AND unless the obstetrician has agreed. And this is hardly supporting a fair choice for women.

How much does private obstetric care now cost? The average out of pocket expense for women to have the care of an obstetrician is around $2,000. Private health insurance does NOT cover this amount. The Medicare safety net used to cover up to 80%, until the current Government placed significant caps on the amounts paid to women for Obstetric care in 2009.

How much does private midwifery care now cost? The average out of pocket expense for women to have the care of a private midwife is around $2,500 – $6,000 (depending on many factors). Private health insurance might cover some of this cost.

Collaboration is the buzz word of the day and it seems that the same issues affecting private midwives are also affecting private obstetricians. What if we lobbied the Government together to make private maternity care more affordable for more women? What if, together, private obstetricians and private midwives were able to attend every woman who was privately insured in a private hospital, private birth centre or private homebirth system? Maybe the pressure on the public health system would abate and women would have safer and more satisfying birth experiences with continuity of care.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Tags: , ,

 
0

Be a Mother with Condfidence, Awareness and Acceptance

Posted by Melissa Maimann on Sep 2, 2010 in Birth

Click here for details of these exciting workshops for pregnant women.

Tags:

 
0

Women pushed into caesareans

Posted by Melissa Maimann on Sep 1, 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

… c-sections now account for one third of all births, and … a big reason for this increase is the over-use of labor induction.

•Almost half of women wanting vaginal births were induced.
•Women who were induced were twice as likely to have a cesarean birth as moms whose labor starts spontaneously.
•Of the c-sections done after induction, half were performed before the cervix had dilated to six centimeters, “suggesting that clinical impatience may play a role.”
•A third of first time mothers had c-sections.
•C-sections upon maternal request (those done for non-medical reasons) account for only 9% of c-sections.
•Attempts at VBAC are less likely to result in vaginal birth than previously thought. Few women are offered the option of VBAC.

… what can you do about all this if you are pregnant and want a vaginal birth? Here are a few ideas:

- Talk to your care provider … about his or her rates of induction, c-section and episiotomy …
- Educate yourself about labor induction …
- Stay home in early labor …

- Choose a midwife if you’re opting for a natural birth
- See an experienced independent childbirth educator for childbirth education classes
- Ask questions
- Read, read, read

Melissa Maimann, Essential Birth Consulting 0400 418 448

Tags: , , , , ,

 
0

Mum nurses baby back to life

Posted by Melissa Maimann on Aug 29, 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

AN Australian mum has made headlines worldwide after cuddling her tiny baby back to life.
The grieving mother had given up hope of saving newborn Jamie, after doctors pronounced the tiny boy dead.

While Jamie’s twin sister, Emily, was delivered safely, doctors worked for about 20 minutes to get premature Jamie to breathe before declaring that he couldn’t be saved.

… “I unwrapped Jamie from his blanket. He was very limp. I took my gown off and arranged him on my chest with his head over my arm and just held him. He wasn’t moving at all and we just started talking to him.”

Ms Oggs said she and her husband, David, had given up saving Jamie, who was born at 27 weeks and weighed less than 1kg.

… after about two hours of being hugged, touched and spoken to, little Jamie miraculously showed signs of life.

“Jamie occasionally gasped for air, which doctors said was a reflex action,” Ms Oggs said.

“But then I felt him move as if he were startled, then he started gasping more and more regularly.

“I gave Jamie some breast milk on my finger, he took it and started regular breathing.”

… “A short time later he opened his eyes. It was a miracle,” Ms Oggs said.

“Then he held out his hand and grabbed my finger.

“He opened his eyes and moved his head from side to side. The doctor kept shaking his head, saying, ‘I don’t believe it’.”

The Sydney mum spoke publicly to highlight the importance of skin-on-skin care for sick babies.

The technique, known as kangaroo care, is often used in neo-natal wards and is thought to promote a more stable temperature, better breathing and weight gain …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Tags: , , , ,

 
0

Bonding, Oxytocin and Fatherhood

Posted by Melissa Maimann on Aug 26, 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

The hormone oxytocin has come under intensive study in light of emerging evidence that its release contributes to the social bonding that occurs between lovers, friends, and colleagues. Oxytocin also plays an important role in birth and maternal behavior, but until now, research had never addressed the involvement of oxytocin in the transition to fatherhood.

A fascinating new paper reports the first longitudinal data on oxytocin levels during the initiation of parenting in humans. They evaluated 160 first-time parents (80 couples) twice after the birth of their first child, at 6 weeks and 6 months, by measuring each parents’ oxytocin levels and monitoring and coding their parenting behavior.

… At both time-points, fathers’ oxytocin levels were not different from levels observed in mothers. Thus, although oxytocin release is stimulated by birth and lactation in mothers, it appears that other aspects of parenthood serve to stimulate oxytocin release in fathers.

… this finding “emphasizes the importance of providing opportunities for father-infant interactions immediately after childbirth in order to trigger the neuro-hormonal system that underlies bond formation in humans.”

The neuroscientists also found a relationship between oxytocin levels in husbands and wives. Since oxytocin levels are highly stable within individuals, this finding suggests that some mechanisms, perhaps social or hormonal factors, regulate oxytocin levels in an interactive way within couples.

Finally, the findings revealed that oxytocin levels were associated with parent-specific styles of interaction. Oxytocin was higher in mothers who provided more affectionate parenting, such as more gazing at the infant, expression of positive affect, and affectionate touch. In fathers, oxytocin was increased with more stimulatory contact, encouragement of exploration, and direction of infant attention to objects …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Tags:

 
0

Outdated medical procedure behind catastrophic epidural injury

Posted by Melissa Maimann on Aug 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.

Link

THE medication practice that led to the catastrophic neurological injuries of a Sydney woman, Grace Wang, during an epidural was phased out of other hospitals more than a decade ago.

Ms Wang was poisoned during the birth of her first child in June at St George Hospital when an antiseptic skin preparation was accidentally injected into her spinal canal in place of an anaesthetic. The case has rocked NSW Health and shocked the public.

The two substances – both clear liquids – were placed in separate dishes on a sterile table in the delivery room, the Herald has learned, and were mixed up as a consequence of being unlabelled. Other hospitals insist drugs are drawn by the anaesthetist directly from their original vial or ampoule into a syringe.

… the practice of drawing medications from stainless steel dishes was routine a generation ago. ”It was identified as being an undesirable and unsafe practice.”

The antiseptic infused into Ms Wang’s spine, chlorhexidine, has increasingly been used in the past five years in NSW because it mixes readily with alcohol, which accelerates drying and the epidural catheter can be inserted sooner.

The chlorhexidine wrongly injected into Ms Wang, who has suffered severe pain and can no longer walk, is understood to have been mixed with alcohol.

… The shift to chlorhexidine has been controversial, and a senior anaesthetist told the Herald betadine – the yellow iodine-based antiseptic which is easily distinguishable from clear epidural drugs – was probably safer …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Tags: , ,

 
0

Toxic epidural ravages mother

Posted by Melissa Maimann on Aug 21, 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 very sad story. This family is desperate to hear from anyone who might have experienced anything similar so that they can be guided with treatment.

Link

ALEXANDER Zheng’s cot is still unassembled in a Sydney apartment where he has never been.

Home, for now, is a bassinet wedged into a room in the high-dependency unit of St George Hospital, where the two-month-old’s mother lies catastrophically injured.

Grace Wang’s spinal canal was injected with a powerful antiseptic instead of anaesthetic, in what should have been a routine epidural to ease the pain of her first child’s birth.

The devastating medical mistake – inconceivable in its magnitude – has poisoned her nervous system, leaving the 32-year-old distressed, confused, in shocking pain and unable to walk or even sit.

She has lost the strength to hold Alex, and rarely asks about her baby, as she did constantly after his birth.

The future may not bring relief, as Ms Wang’s physical and psychological condition has deteriorated since the accident on June 26, and new symptoms continue to emerge.

In the first three relatively hopeful weeks, her husband, Jason Zheng, cooked for Ms Wang and fed and changed Alex, who has apparently not suffered from the drug error.

Now Ms Wang has had surgery to relieve fluid pressure on her brain, and Mr Zheng maintains a vigil beside his increasingly frightened and disoriented wife, leaving little time for his son. The longed-for baby – who followed three miscarriages – is cared for by a nurse the hospital provides. The couple have no family in Sydney, where they migrated from China.

”It’s like we are ignoring that we have a son,” said the distraught father, who will begin legal action.

… Alex snuggles close when placed alongside his mother, but breastfeeding has been impossible for fear the many medicines she is taking may affect the milk.

”Every day she’s suffering and she says she wants to give up,” Mr Zheng said. ”She was crying last night when she touched her son. I just want to change my body to hers.”

Another thing Mr Zheng wants, and which motivated his decision to speak publicly, is to make contact with anyone who has suffered similarly, in the hope their doctors may advise on Ms Wang’s treatment.

Epidural administration of chlorhexidine – used to clean skin before injections and strong enough to neutralise resistant hospital bacteria – is so rare that Ms Wang’s doctors have identified only one other case.

Angelique Sutcliffe, from Britain, was paralysed for life after the chemical entered her epidural in 2001. But this was just a droplet – a fraction of the eight millilitres infused into Ms Wang.

Managers at St George Hospital yesterday admitted error and pledged to support the family, but would not explain the possible source of such a fundamental mistake in a commonplace procedure: nearly 40,000 epidurals were conducted in 2006, the most recent New South Wales statistics show, in 43 per cent of all births.

The state’s Minister for Health, Carmel Tebbutt, said: ”This is an extremely distressing case and I offer my sincere apologies.”

She said investigations had been ordered.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Tags: , , , ,

 
0

New unit a ‘home birth in hospital’

Posted by Melissa Maimann on Aug 17, 2010 in Birth, Midwifery, Normal Birth

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

Link

MONA Vale Hospital’s new birthing unit will simply be a place for expectant mothers to have a home birth inside a hospital – but a long way from emergency care if a complication occurs – according to an obstetrician.

How anyone can consider a hospital birth to be the same as a homebirth is way beyond me! There is a very big difference between the comfort and familiarity of our homes, and a hospital environment.

Dr David Jollow, one of Mona Vale Hospital’s onsite obstetricians, said the new, midwife-run, Mona Vale birthing unit would mean women who suffer a complication during labour will have to be rushed to Manly Hospital instead of being treated by Mona Vale’s onsite obstetricians.

“The new unit is essentially a home birth that happens to be in a hospital,” Dr Jollow said.

“It would actually be safer to have a home birth in Balgowlah or Seaforth, because an ambulance ride to Manly would be quicker.”

It’s interesting that obstetricians oppose free-standing birth centres, yet we have the existence of midwife-run units where obstetricians are not available. Is ther a differnence? Is it merely a differing terminology to be acceptable to some?

Melissa Maimann, Essential Birth Consulting 0400 418 448

Tags: , , , , , , , ,

 
0

Woman reportedly pregnant for nearly two years

Posted by Melissa Maimann on Aug 16, 2010 in Birth

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

Unbelievable!

Link

Chien’s husband, Duong Van Tuan .. .claimed that his wife has been pregnant for 21 months. He explained that his wife saw doctors the first time when she was over three months pregnant.

Doctors examined her and made an ultrasound scan, saying the child was a boy and very healthy. They calculated that she would give birth in early September 2009.

The woman had no labor pain on the days that doctors anticipated … doctors examined her again and told the family they must wait because Chien has not begun labor yet. The placenta clung to the womb, so they couldn’t perform an operation, which could cause hemorrhaging.

For two months afterwards, Chien still have no sign of labor pain though she still felt the child move. When she was 11 months pregnant, the couple went to the Central Obstetrics Hospital in Hanoi and doctors still said that they must wait.

“I have been waiting for my wife’s labor for nearly one year. But I can’t wait anymore because the fetus is 21 months old already. Doctors at the Central Obstetrics Hospital made an appointment for us on August 20 to decide on an operation …

Dr. Tran Danh Cuong, chief of the Central Obstetrics Hospital’s Obstetrics 1 Ward, said this is a very weird case. He stated that no child can live for over 45 weeks in the womb. “No doctor should let a woman be pregnant for 21 months,” Cuong confirmed.

Correction: some babies can live beyond 45 weeks. It is unheard of in today’s times because most babies are induced even before 42 weeks (which is still considered normal pregnancy). In our grandparent’s generation and prior, some babies did indeed remain inside until well beyond 42 weeks and survive.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Tags: ,

 
0

Good or Bad Idea? iPhone App Allows OBs to Monitor Patients Remotely

Posted by Melissa Maimann on Aug 15, 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.

A very funny article, I had to share it!

Link

AirStrip OB was developed to improve the speed and quality of communication in healthcare … ineffective communication is a leading cause of medical errors leading to patient injury and noting that “preventable healthcare related errors cost the U.S. economy $17 to $29 billion each year.” The application sends “critical patient information” to a doctor or nurse’s (midwives not mentioned) smart phone, laptop or desktop, which gives “obstetricians remote access to live views of delivery room data — including fetal heart tracings, contraction patterns, vital statistics and nursing notes.” …

Offered as a success story on the AirStrip OB corporate website is an article in the St. Petersburg Times in which a physician at Community Hospital, which has a 37.7% cesarean rate, was able to see 30 patients in the office while “keep[ing] tabs” on a patient whose induction began at 5 a.m. that day. The doctor “saw a slight fluctuation in [the baby]’s heartbeat that told him the baby wouldn’t be able to withstand a long labor.” He performed a cesarean on the woman at about 1 p.m. and ushered a “healthy 8 pound, 14 ounce girl” into the world.

The page of testimonials features cheers from physicians, one of whom says, ‘At least with AirStrip OB, I can minimize unnecessary trips to the hospital.” Another raves, “But the greatest aid of all is that I can check the strip in real time when a nurse calls and reports concerns…I just open up AirStrip OB on my iPhone, review the strip and discuss the situation with the nurse…Medicolegally, I expect that this ability will not only benefit the obstetrician, but the hospital as well.”

… One of the misunderstandings that many patients have about giving birth in a hospital is that a doctor will be right there, ready to perform a crash cesarean section or operative delivery at the drop of a hat if their baby is experiencing severe fetal distress. But keeping these resources available around the clock is extremely costly … Even in hospitals that do have 24/7 surgical and anesthesia coverage, if they are performing another cesarean, the surgical suite and necessary staff may not be immediately available when an urgent complication develops.

The following guest post was submitted by Amity Reed in reaction to reading about the distancing “benefits” of the AirStrip OB application in an article:

Have you ever been laboring hard in the hospital — attached to all the various wires and machines; surrounded by equipment, instruments and alarms — and thought: how can we upgrade this birth from merely medicalized to hardcore hi-tech? Well, your prayers have been answered, ladies! The latest in baby removal technology allows your OB to take in a movie across town and simultaneously manage your birth. Soon, doctors may not even have to step foot in hospitals in order to do their jobs. This is the wave of the future: taking people out of the care equation altogether!

Yes, my friends, you too can now have major decisions about your maternal care made by any doctor with the latest smartphone application. Called ‘AirStrip OB’, this app delivers (ha!) real-time information about a woman’s labor so that busy doctors can make judgment calls about women they’ve not witnessed in labor (or even met!) from the comfort of their home. No more worries about wasting a highly-educated obstetrician’s time with your piddling requests for mobility, sustenance or support; the AirStrip OB app reduces the embarrassing tendency of patients to ask questions or expect personable care. ‘Emergency’ cesareans can now be ordered and performed before your OB’s sedan has been sufficiently warmed and gone through the Starbucks drive-thru. Technology is amazing, isn’t it? As those of us in the baby removal business like to say: “If you’re not in the room, cut open that womb!”

With this cutting-edge (ha!) technology, it’s never been easier to imagine c-section rates approaching 50 or even 60%. Soon, the use of vaginas for delivering babies will be obsolete altogether, leaving women with fresh, modern ‘love tunnels’ free from the wear and tear of childbirth. No more expensive vaginal rejuvenation surgery or labia lifts! Our technology, with its resulting seven-fold decrease in normal births, maximizes your chance of avoiding dangerous and unsightly vaginal birth.

But, wait, that’s not all! A recent survey found that 85% of the births portrayed on television and in films left fathers-to-be feeling disgusted, terrified and excluded. Everyone knows childbirth is pretty heinous and yucky, am I right? With the AirStrip OB app, you give your partner the gift of feeling secure in his masculinity, allowing him to renew his claim on your vagina. Why have a ghastly ‘husband stitch’ on your perineum when you can have a simple ‘husband staple’ on your tummy? Nothing says ‘I love you’ like abdominal surgery!

We hope all pregnant women come to know and love the AirStrip OB application, as all good mothers should. You don’t want to be one of those mothers who takes her chances for selfish reasons and ends up with a dead baby, now do you?

Look for another of our exciting apps coming soon, in which a Blackberry-controlled robot does all of your prenatal care. His hands might be a little cold but it sure does help your OB get to her dinner table on time! After all, isn’t that what we all want?

Melissa Maimann, Essential Birth Consulting 0400 418 448

Tags: , , ,

Top Pregnancy and Childbirth Blog
Medical Billing and Coding Certification

Copyright © 2010 Private Midwife: Homebirth & Hospital Birth All rights reserved. Theme by Laptop Geek.