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.
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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: Birth choices, Obstetrics, Public and private hospitals
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: Babies, Birth choices, continuity of care, Home birth, hospital birth, intervention, Midwifery, Midwifery services, Public and private hospitals
Posted by Melissa Maimann on Aug 13, 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.
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LOCAL women have expressed grave concerns about the standard of maternity services on the northern beaches, claiming a doctor-free birthing unit at Mona Vale Hospital is a risk to their health.
With the Health Department and midwives’ groups angrily denying the changes would jeopardie the health of women and their babies, The Manly Daily yesterday spoke to the most important people in the debate – new and expecting mums.
Amee Harland said she would wait for the Mona Vale maternity ward to reopen in full before having a second child there.
“I had a 24-hour labour and then they had to call the doctor because the baby’s heart rate was falling and he was there in five minutes and had to use a surgical vacuum,” she said.
… “You wouldn’t want to drive to Manly (or St Leonards) in the middle of labour …
“I would prefer to go to Mona Vale – it is my home town. Why would I want to go anywhere else? They were so good there.”
Mother-of-three Kellie Finney said low-risk births could also require immediate action.
“If there’s an emergency, the time it takes to get to another hospital would be pretty risky for babies in distress,” she said.
Luckily, research is showing that low risk maternity units are a safe option for women and babies, just as homebirth is a safe option for low risk women and babies. Several low-risk maternity units are in operation: Belmont, Wyong, Ryde just to name a few. The provide a fantastic solution to the issue of maintaining local birthing services.
“I don’t know how long exactly it takes for the baby to stop breathing or have serious medical problems.”
Thankfully, midwives can make such assessements. Transfer policies in place would ensure that women and babies who were at risk would be transferred to an appropriate facility in a timely manner.
“After the baby is born, what happens if the mother is bleeding out of control?’‘
The midwife would administer medications to stop the bleeding, insert a drip and start IV fluids, insert a urinary catheter to drain urine and supervise transfer. It is very rare for a woman to “bleed out of control” and most bleeds are controlled with medications to stop the bleeding.
… if a doctor was needed during the birth, such as to deliver the baby by caesarean, use certain medical instruments or administer an epidural injection, women will be transferred to Manly Hospital or Royal North Shore 45 minutes away.
And the problem is … ?
While mothers at the Mona Vale playgroup praised the role of midwives and welcomed the return of some maternity services to Mona Vale, they said they would not give birth without a doctor present.
You can’t please everyone! The majority of midwifery-led units are over-subsctibed with many women wanting to birth there where they’re assured a known midwife and maximum chances of a natural birth. No-one is being forced to birth at Mona Vale; women who prefer to go to manly or RNSH would be able to go there.
Most mothers said a doctor was called in during their previous births, despite some being in a low-risk category.
That might be a larger reflection on the rates of intervention in obstetric-led births rather than on actual need in a natural labour. Let’s not forget, high risk births would not take place at Mona Vale: no-one with diabetes, high blood pressure, premature, over 42 weeks, bleeding, broken waters for more than a certain period of time, anyone needing an induction or caesarean, twins, breech, anyone planning an epidural and so on.
… Catherine Kane, who is expecting her second child, said she is “not low risk enough’’ to give birth at Mona Vale.
“I wouldn’t be allowed to go to Mona Vale although I’m not high risk, I’m not low risk enough either.’‘
Andrea Whitlock, from Terrey Hills, said she would expect the maternity unit where she gave birth to have a doctor on hand.
“I had a natural delivery but if I didn’t have a doctor there I wouldn’t have been able to do it,’’ she said.
Hmm. I think you did do it! No-one else birthed your baby.
… The model will first be tested at Manly Hospital in October and is scheduled to begin at Mona Vale in December.
The Mona Vale maternity unit will also be reduced from 720 births to just 200 a year, with mothers only able to stay four hours after birth …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Complicated pregnancy or birth, continuity of care, intervention, Midwifery, Public and private hospitals
Posted by Melissa Maimann on Aug 11, 2010 in
Midwifery,
Obstetrics,
VBAC 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 title’s enough to cause concern! Women always have decision-making power over their own bodies.
Although it is “understandable” that some health care providers are “cautious” about vaginal births after caesarean sections, it “should hardly be a controversial notion” that a woman who has had a c-section “should have a say in whether to try a vaginal birth during her next delivery,” …
… one-third of U.S. hospitals and 50% of physicians refuse to allow women to attempt VBACs “due to a fear of lawsuits over uterine ruptures,” which occur in 0.7% to 0.9% of cases … “Extremely small as that risk may be, even tiny numbers represent real women and real babies who can suffer serious consequences in a delivery gone bad,” …
Sydney has the same situation, with some smaller hospitals not allowing VBACs owing to lack of 24/7 theatre facilities.
However, “when up to 80% of women who are ‘allowed’ to attempt VBAC succeed, it’s not so easy to understand why all women aren’t ‘allowed’ to weigh the risks and to make their own choices regarding their own childbirth experiences,” … The American College of Obstetricians and Gynecologists ” recently eased its guidelines to say that hospitals offering women trial labors after caesareans should have a surgical team ‘readily available’ instead of ‘immediately available,’” …
“It’s a small change, but one that might send the precipitously declining VBAC rates headed in the right direction again,” the editorial argues, concluding, “Let these new guidelines be the impetus for giving women the information they need to weigh the risks and to be able to choose a trial labor or a repeat caesarean themselves”
Given the risks of repeat caesareans, particularly for women who have multiple caesareans, VBAC ought to be encouraged for most women. We also need to focus on woman-friendly care in pregnancy and labour; care that affirms the woman’s belief in her ability to birth her baby and care that is sensitive and individualised.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Caesarean, Midwifery, Obstetrics, VBAC
Posted by Melissa Maimann on Aug 10, 2010 in
Birth,
Home birth,
Midwifery,
Obstetrics,
VBAC Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
Last week, midwives and clients of Andaluz Waterbirth Center in Portland announced plans to file a federal lawsuit to “cease intimidation and threats against midwives” by the Oregon Health Licensing Agency and Oregon Health & Science University.
Midwives say doctors and nurses at OHSU have filed baseless complaints to the licensing agency meant to thwart competition … The threatened lawsuit spurred a passionate online debate among supporters and critics of home birth.
Conflicts between midwives and doctors run deep. One of the biggest problems: Many physicians deal with midwives only when a laboring mother experiences difficulties during a home birth and requires transport to a hospital, sometime urgently.
“It’s an extremely tension-fraught encounter,” according to Melissa Cheyney, an Oregon State University assistant professor and practicing midwife who studied the interactions of midwives and doctors in Jackson County last year. Nearly every physician interviewed by Cheyney and her graduate student expressed the view that births must take place in a hospital to be “safe.”
Studies including higher-risk pregnancies have found that fetal deaths are more likely in home births. But in low-risk pregnancies, most research shows no significant difference in risk to the baby, while home-birth mothers experience fewer complications. In a study in British Columbia last year, women giving birth at home suffered fewer than half as many serious perineal tears, and about a third less postpartum bleeding.
By choosing a hospital birth, women substantially increase the risk of having a surgical delivery. More than 29 percent of hospital births in Oregon resulted in a cesarean during the years 2006-2008. Less than 4 percent of home births ended with a cesarean in a 2005 study of 5,400 births attended by midwives in the U.S. and Canada.
Women who choose home birth often cite the desire to keep birth free of medical intervention. Heather Hermans … transferred to the care of a midwife because she wanted to try a vaginal delivery rather than schedule a cesarean section, as her obstetrician-gynecologist recommended.
“My ob-gyn didn’t remember me from appointment to appointment,” Hermans said. “I was treated like pregnant cow No. 45.”
Many women will choose midwifery care to receive personalised care where they can develop a relationship with the midwife who will attend their birth.
Hermans experienced complications during labor and took an ambulance to OHSU, where a surgeon delivered her healthy baby boy by emergency C-section. The surgeon filed a complaint about Hermans’ midwife to the state … Roy Haber, an attorney hired by the midwives, said the Oregon Health Licensing Agency withdrew all six investigations after he challenged them.
Conflicts aren’t inevitable. Cheyney is working with midwives in Lane County and a Eugene obstetrician, Dr. Paul Qualtere-Burcher, on guidelines for smoother, more collaborative relations. Qualtere-Burcher and his colleagues have agreed to help midwives get access to laboratory testing and ultrasound screening for their clients. Midwives are referring higher-risk home birth clients to the physicians for assessment and another perspective.
“We’d like them to come in and see us before it becomes a big issue during labor,” Qualtere-Burcher said. “I think it’s been very successful.”
Home birth by the numbers
Planned home births in Oregon last year: 877 out of 47,675 total births, or 1.8 percent.
Risk of baby dying in a midiwife-attended home birth: 1.7 percent versus 0.6 percent in hospitals, based on a 2009 British study including women with breech births, twins, or attempting a vaginal birth after a previous cesarean (VBAC).
I’d be interested to see what these stats are when high risk homebirths are removed from the data set, or to analyse the risk of each “risk factor” in isolation to determine the riskier “high risk” situations, for example, is HBAC less risky than twin homebirth?
Risk of baby dying in a midwife-attended home birth when comparing only low-risk mothers: 0.5 percent versus 0.3 percent in hospitals.
Chances of giving birth without medical intervention: 78 percent with a home-birth midwife versus 54 percent in hospitals, according to the 2009 British study.
A women’s chances of having cesarean section when giving birth in an Oregon hospital, 2006-2008: 29 percent.
Fetal deaths in births attended by licensed midwives in Oregon, 2001-2007: 4 in 2,906 births, about 0.1 percent.
Fetal deaths in births attended by physicians in Oregon, 2001-2007: 1,455 in 274,278 births, about 0.5 percent.
This would account for the fact that midwives mostly manage uncomplicated pregnancies and births, while doctors are referred higher risk women and babies.
Number of home birth midwives who are licensed in Oregon: 64, up from 54 in 2008.
Complaints lodged against licensed midwives, 1999-2007: 40.
Disciplinary actions imposed by the Board of Direct Entry Midwifery, 2000-2004: 12
Midwife guide
…
Direct Entry Midwife – A general term for practitioners who train directly into midwifery without a nursing or medical background, and attend births outside of hospitals. Oregon law allows direct entry midwives to practice with no licensure.
Certified Professional Midwife — Direct entry midwives certified by the North American Registry of Midwives, which requires written and practical examinations and practical experience attending 40 births.
Licensed Direct Entry Midwife — Direct entry midwives who obtain a license in Oregon are authorized to use some prescription drugs and medical devices. They must pass a national examination, demonstrate experience in attending births, and complete continuing education every three years. They are licensed by the Oregon Board Direct Entry Midwifery and subject to disciplinary actions if they violate professional standards.
Certified Nurse Midwife – Registered nurses who go on to complete an accredited nurse-midwifery program. Oregon requires certified nurse midwives to obtain a Masters degree. CNMs are the only midwives that practice in hospitals. They are licensed by the Oregon State Board of Nursing.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: birth, Birth choices, Caesarean, Complicated pregnancy or birth, continuity of care, hospital birth, midwife, Midwifery, Midwifery services, Obstetrics, Public and private hospitals, VBAC
Posted by Melissa Maimann on Aug 8, 2010 in
Midwifery 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 data has confirmed that newly qualified midwives are providing care that compares very well with the care provided by more experienced midwives.
The Midwifery and Maternity Providers Organisation (MMPO) figures show that women who gave birth under the care of a newly qualified midwife in 2008, had vaginal birth, breastfeeding, caesarean and postpartum haemorrhage rates comparable with those under the care of more experienced midwives.
These data cannot be used to support the safety of care by newly qualified midwives; rather, outcomes such as need for resuscitation, admission to special care / intensive care nurseries, mortality, morbidity etc need to be analysed.
… “New Zealand midwives receive intensive and extensive training and education … the equivalent of a four year degree … Student midwives are involved with more than 100 births as a minimum training requirement and are required to undertake (manage) 40 births of which 10 can be for women having forceps, ventouse or caesarean births and are also required to provide care for 40 women who are experiencing complications during pregnancy, birth or during the postnatal period.
… before they can be registered, midwifery students in NZ have to:
1. Successfully complete a Bachelor of Midwifery programme at one of the four accredited Midwifery Schools (attached to tertiary institutions/universities);
2. Have the required amount of practical experience by observing 25 births, undertaking 40 normal births on their own responsibility & being involved in a further 40 complicated pregnancies or births. This compares to the current obstetrician training requirement to attend 20 normal births.
3. Attain a pass mark of at least 70% for each theory and 100% for each clinical paper as part of the undergraduate degree
4. Pass the National Midwifery Examination set by the Midwifery Council; and
5. Satisfy the Midwifery Council that they are fit for registration as defined by the Health Practitioners Competence Assurance Act 2003.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Midwifery
Posted by Melissa Maimann on Aug 3, 2010 in
Home birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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The Royal College of Midwives has rejected claims that women who opt for a home birth put their baby at risk.
According to a report in medical journal The Lancet, the risk of infant death can be up to three times higher in home births.
But midwives have hit back, saying the practice is generally very safe, and that childbirth is “not an illness”.
Cathy Warwick, general secretary of the RCM, claimed the Lancet article was “incomplete and flawed”.
The report was based on a study carried out in the US, … Europe and Australia.
Led by Dr Joseph Wax … the study found that for healthy women, giving birth at home instead of in hospital doubled the chances of the baby dying.
When infants with congenital defects were excluded from the study, the death rate tripled.
In the UK, 3 per cent of births take place at home – three times more than in the US but far fewer than in the Netherlands, where home births make up a third of the total.
The Lancet editorial said the US study, published in the American Journal of Obstetrics & Gynaecology, provided “the strongest evidence so far that home birth can … be harmful to newborn babies”.
Ms Warwick said: “We are deeply disappointed and dismayed that The Lancet has published an editorial indicating that women would choose to harm their baby in favour of their own needs by choosing a home birth.
“The editorial also cites research that is incomplete and methodologically flawed. There is no evidence to suggest that hospital births are safer than home births.”
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Home birth
Posted by Melissa Maimann on Jul 31, 2010 in
Midwifery 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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MIDWIVES are aggrieved about new rules that might curb their access to Medicare rebates and prescribing rights …
Last year Ms Roxon announced that from November this year midwives would for the first time be able to use the Pharmaceutical Benefits Scheme and Medicare rebates for their clients.
At the time, Ms Roxon said the historic move would boost a midwife’s ability to work independently and increase options for pregnant women …
But in a long-awaited change to the legislation … midwives will now have to work collaboratively with a doctor, who must endorse their practice before their clients can access financial benefits.
The requirement for collaboration was always planned to be in place, but the detail of collaboration requires that a midwife has a written agreement with an obstetrician to access medicare benefits. This is problematic: more than one obstetrician must sign an agreement because no obstetrician provides 24/7 cover, so there’d need to be at least 2 obstetricians signing the agreement. What happens if one obstetrician leaves the local area? Is sick? Goes on leave? In these situations, the collaborative agreement is very vulnerable. Not only the agreement, but the midwife’s ability to provide ongoing care to her private clients.
After eight months of debate between doctors and midwives, government records show that Ms Roxon signed a determination on the matter two weeks ago, when Parliament was out of session.
Doctors’ groups who say home birth is unsafe are believed to have lobbied the government for the changes.
Yesterday, midwives and home-birth advocates accused Ms Roxon of trying to hide what will be an unpopular decision with midwives and mothers.
Australian College of Midwives president Hannah Dahlen said the change would effectively give doctors the ability to veto their access to Medicare and the PBS.
While midwives working inside hospitals would not be disadvantaged, she said private midwives would find it difficult to find a doctor to endorse them, especially if the doctor did not support home birth.
In fact, doctors have refused to sign agreements with any midwife who attends homebirths. Is this collaboration or control?
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, Home birth, Maternity Services Review, midwife, Midwifery, Obstetrics
Posted by Melissa Maimann on Jul 30, 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.
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The AMA welcomes the Government’s introduction of new regulations that require midwives … to collaborate with medical practitioners in order to provide Medicare-funded services to patients or prescribe them medications under the Pharmaceutical Benefits Scheme (PBS).
AMA President, Dr Andrew Pesce, said today that the new arrangements would provide a safer higher standard of care for patients.
… “There is now a requirement for midwives … to establish collaborative arrangements with a medical practitioner in order for the service to attract a Medicare patient rebate or PBS benefit.
And that’s the problem: midwives are required to establish collaborative agreements, but obstetricians do not have to collaborate with the midwife. And there are fears that if the midwife does not work according to the obstetrician’s protocols, the agreement will be revoked. this does nothing to establish midwifery as a profession in its on right.
… “Evidence shows that patients enjoy better health outcomes when they receive coordinated, continuous, and comprehensive care that is delivered by appropriately trained health professionals,” Dr Pesce said.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, Maternity Services Review, midwife, Midwifery services, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Jul 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.
Link
THE NORTHERN beaches health service will proceed with plans for a midwife-only maternity scheme at Mona Vale Hospital …
The new scheme will see the majority of northern beaches births take place at Manly Hospital, where a combined obstetric maternity service will operate, with about 200 births a year scheduled for Mona Vale, where midwives will now manage them all.
… the new “midwifery group practice model” was unanimously endorsed …
But Mona Vale obstetrician Dr Chester Kent said the hospital had no representatives on the council and that none of its maternity staff supported the decision.
“It seems there is nobody being included in the decision-making process who really represents the interest of local women,” he said.
Another hospital worker, who did not want to be named, said they were only told about the changes at a meeting on Tuesday and that neither Manly or Mona Vale staff supported the decision, which they found “very distressing”.
Pittwater State Liberal MP Rob Stokes said operating a midwifery group practice model at Mona Vale was not a bad idea, but it should not be used as a replacement for obstetric services.
… “It’s not good enough to put a delivering mother into an ambulance and take them down to Manly, or the North Shore.”
Northern Sydney Central Coast Health chief executive Matthew Daly, who was present at Monday night’s clinical council meeting, said improved health outcomes for mothers and babies had influenced its decision to endorse a “united obstetric service” at Manly.
It’s wonderful to see midwifery-led services expand. We have midwifery-led services in private midwifery practice, Ryde Hospital, Belmont and Wyong, to name a few. They’re a great way to maintain midwifery services and are proving very popular with women and families.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, hospital birth, Midwifery services, Public and private hospitals
