Home birth has pros and cons

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The number of at-home births is small but growing as pregnant women weigh the idea of a drug-free and surgery-free birth in a familiar setting versus the risk of harm to the baby in case of complications.

When most pregnant women go into labor, they pack their bags for the hospital. When Lara Carlos felt the contractions in November 2008, she set up a birthing tub in her bedroom.

For the next several hours, Carlos alternated between padding around her home and squatting and pushing in the tub. Her midwife poured water down her back and dabbed her forehead with cold towels. When the baby (they chose the name Vincent) arrived at 1:21 a.m., he spent his first few hours cuddling with his parents in their bed.

Carlos … is one of a small but growing number of women who are choosing to deliver their babies at home. Her first son, Ivan, had been delivered in a hospital, and she says she found labor at home a dramatic improvement.

“In the hospital, there were seven medical students in the room when I was pushing my son out,” she said. “At home, it was a very quiet, slow experience, and the water helped me to relax.”

Though home births account for only about 1% of all births each year … they increased by 20% from 2004 to 2008 … The practice is most popular among well-educated mothers who favor natural childbirth without the drugs or surgeries a hospital might use.

… The increase has reenergized the fierce debate over the safety of at-home delivery. The practice is officially frowned on by the American College of Obstetricians and Gynecologists … because the absence of emergency medical equipment and specialists accustomed to dealing with complications means that problems during labor could cost the baby’s life.

“All the existing scientific evidence, as well as state and national statistics, make it ultra-clear that home birth increases the risk of death,” …

The American College of Obstetricians and Gynecologists does acknowledge that home births are associated with fewer medical interventions than hospital births … 61% of women who had vaginal delivery received an epidural in 2008, the year the report studied. And a 2006 national survey of women’s childbearing experiences showed that 55% were given Pitocin to speed labor.

“There’s no doubt that once you end up in a hospital, you end up with more interventions — that’s what drives some families away,” … home birth is reasonable as long as women have few risk factors …, have an emergency backup plan and understand the risks involved.

Women also turn to home birth in order to avoid caesarean sections, which have become more common as obstetricians became increasingly reluctant to take chances at the slightest sign of fetal distress …

What’s more, many hospitals do not allow women who have previously had a caesarean to attempt a vaginal birth because of the risk of uterine rupture, even though a 2010 National Institutes of Health advisory panel concluded that the risk of uterine rupture during a vaginal birth after one caesarean was just 1% and that more women should be offered the choice. Women wishing to have a VBAC (vaginal birth after caesarean) may have no option but to do so on their own turf.

Sarah … had two caesareans but chose a home birth for her third pregnancy, successfully delivering a baby girl in January 2010.

“We had visited numerous hospitals, and the first time I mentioned a VBAC, I was just shut down completely,” Bolson says. Doctors refused to consider it because of the chance of rupture, she recalls, and one said he couldn’t risk having his medical malpractice insurance skyrocket.

She eventually found a certified professional midwife who was willing to help her deliver at home, with a backup plan of transfer to a nearby hospital. Though initially worried about complications, “after I was able to release the fear, I was free to birth without any inhibition.”

Many home-birth moms also say they object to other aspects of hospital births, such as having to lie in a bed, abstain from food during labor and be monitored by an army of nurses.

“I believe in the intuitive power of the human body,” said Mayim Bialik, an actress and natural-birth advocate who has given birth at home. “I believe in having as much privacy as possible, in being able to move freely, to eat when I want, drink when I want, and to be surrounded by the sounds and smells of what is familiar to me.”

“Other mammals go off on their own to labor,” adds Dr. Stuart Fischbein, a Los Angeles-based obstetrician who has been delivering exclusively in homes since 2010. “When a patient goes to a hospital, she gets told to lay flat on her back strapped down with monitors with constant interruptions from hospital personnel — does that sound conducive to having a normal labor?”

Arrangements for a home birth go something like this: Early in the pregnancy a woman finds either a … midwife … The midwife provides some or all of the woman’s prenatal care and is on call as the woman approaches her due date …

During labor, many women use water tubs because they find the water soothing and pain-relieving; others choose to just move about their homes as they see fit. The midwife monitors the fetus’ heart tones with a Doppler device, and most also bring equipment such as oxygen tanks, anti-hemmorhagic medication, local anesthetic and suturing supplies in case of tearing or bleeding. If an emergency arises that the midwife can’t manage, home-birth moms are advised to transfer immediately to a hospital.

The core of the home-birth debate lies with the safety of the baby — and here, opinions and the data are sharply divided. A 2005 study of 5,418 births in the U.S. and Canada during 2000 … found that the neonatal death rates of at-home births were comparable to those of births in hospitals.

But a July 2010 analysis published in the American Journal of Obstetrics & Gynecology examined the outcomes of 12 home-and-hospital-birth studies and found that babies born at home die at two to three times the rate of those born in hospitals …

… the distance to the nearest emergency room can sometimes mean the difference between life and death. “Saying, ‘trust birth’ is like saying ‘trust the weather,’” she says, referring to a slogan occasionally used in natural-birth groups.

Just as vocal online communities have sprung up to promote home birth, so too have others populated by women whose home-birth attempts turned into tragedies … Liz Paparella’s fourth child was stillborn on her living room couch because her midwife failed to take Paparella to the hospital when she began bleeding during labor.

“I never thought it was more dangerous to have a baby at home than at the hospital,” says Paparella, who had given birth successfully at home two times previously. “In birth, the risk can change from low to high in a matter of minutes.”

… A clear answer to the safety question is hard to find because nearly every home-birth study has some flaw that is flagged by one side of the debate or the other as invalidating the results. Given this uncertainty, Ouzounian cautions women to research, prepare and choose wisely.

Home births, he says, should be considered only by those who have a well-trained midwife and are experiencing no complications with their pregnancy …

“Under the right circumstances, with the right patient selection and with a … midwife attending, the overall maternal complication rates with home births are comparable” to those of a hospital birth …

But he also advises women not to think about birth in black-or-white terms: There are many ways to make delivery more “natural” even if it takes place in the hospital …

Fischbein says that doctors could be more accommodating to their patients by providing them with information about all of their birth options — at home and in the hospital — and stand ready to serve as backups for those who wish to labor at home with a midwife.

“There’s room in this world for low-risk home birthing and for hospital birthing,” he says. “We really should support each individual woman’s right to choose how to deliver her baby.”

Re-thinking Maternity Care Systems

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… fewer than 30 per cent of women approaching their first birth attend prenatal classes, and books and the Internet are their primary sources for information about birth.

Women attending obstetricians were more favourable to the use of birth technology and were less appreciative of women’s roles in their own delivery. In contrast, women attending midwives reported less favourable views toward the use of technology and were more supportive of the importance of women’s roles …

Even late in pregnancy, questions about epidural analgesia, Caesarean section and episiotomy solicited the most “I don’t know” responses from women who took the survey. But women attending midwives appeared more knowledgeable on these issues.

“Our findings suggest that obstetricians, midwives and family physicians are caring for different populations of women, with different attitudes and expectations towards childbirth,” … “But regardless of the type of care providers they attended … many women reported uncertainty about benefits and risks of common procedures used at childbirth. This is worrisome because a lack of knowledge affects their ability to engage in informed discussions with their caregivers.”

A second study, published last month in the journal Birth, compared the attitudes toward birth technology and women’s role in their childbirth between the younger generation of obstetricians and their predecessors.

Klein and colleagues surveyed 800 Canadian obstetricians who include birth delivery in their practice. Out of 549 respondents, 81 per cent of those 40 years or younger were women (vs. 40 per cent over 40 years of age) …

… younger obstetricians were significantly more likely to favour the use of routine epidural analgesia and were more concerned about the perceived adverse effects of vaginal birth …

… the younger generation sees Cesarean section as a solution to many labour and birth problems, and incorrectly sees C-section as safer for both mothers and babies … younger obstetricians are more likely to choose C-section for themselves or their partners, and are less likely to believe women missed out on an important experience by having a C-section.

… “This study shows it’s generation, not gender, that affects obstetricians’ views about procedures like C-sections,” … “this could present a challenge to efforts to decrease C-section rates in both U.S. and Canada.” As well … up to a third of obstetricians were not evidence-based in their views. This creates concern about informed decision-making, especially for women who are uncertain about procedures that might be used in birth.

… 75 per cent [of obstetricians] thought home birth was more dangerous than hospital birth … even though home birth by regulated midwives has been shown to be safe in Canada.

… “These three studies taken together show us that educational leaders and provincial policy-makers need to seriously examine the educational models and experiences that appear to teach the non-evidence-based view that vaginal childbirth is primarily a dangerous activity,” … ” … we need more midwives … while obstetricians in training will need to have more experience with normal birth, and in the future, restrict their role to that of consultants to midwives … In this way they can maximize the appropriateness of their surgical training.

“This means rethinking the design of the entire Canadian maternity care system. Finally, if women are to be empowered with the information that they need to dialogue with their providers, new forms of accurate information transfer will need to be developed.”

C-section not best option for breech birth

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Physicians should no longer automatically opt to perform a cesarean section in the case of a breech birth, according to new guidelines by the Society of Obstetricians and Gynecologists of Canada.

Released yesterday, the guidelines are a response to new evidence that shows many women are safely able to vaginally deliver babies who enter the birth canal with the buttocks or feet first …

… Since 2000, C-sections have been the preferred method of delivery in breech births. Studies suggested that breached births were associated with an increased rate of complication when performed vaginally.

As a result, many medical schools have stopped training their physicians in breech vaginal delivery.

The problem now, according to Dr. Lalonde, is that there is a serious shortage of doctors to teach and perform these deliveries.

With the release of the new guidelines, the SOGC will launch a nationwide training program to ensure that doctors will be adequately prepared to offer vaginal breech births .

The new approach was prompted by a reassessment of earlier trials. It now appears that there is no difference in complication rates between vaginal and cesarean section deliveries in the case of breech births.

… Ms. Guy started the group after the birth of her second child in the fall of 2006. Although she had given birth to her first child at home with a midwife, Ms. Guy delivered her daughter in the hospital because of the baby’s breech position.

“I was cornered into an unneeded and unwanted C-section because the obstetrician that I had didn’t have the experience to catch her,” said Ms. Guy.

The aim of the coalition is to ensure that women know what their options are when it comes to breech birth. Ms. Guy believes that many women don’t realize that vaginal breech births are even possible.

… The new decision to offer vaginal breech birth aligns with the SOGC promotion of normal childbirth – spontaneous labour, followed by a delivery that is not assisted by forceps, vacuum or cesarean section. In December of 2008, the society release a policy statement that included its recommendation for a development of national practice guidelines on normal childbirth.

“The safest way to deliver has always been the natural way,” …

… The SOGC believes that if a woman is well-prepared during pregnancy, she has the innate ability to deliver vaginally …

In NSW, we have the Towards Normal Birth Policy which also promotes normal birth, waterbirth, vaginal breech birth, vaginal twin birth and VBACs. The policy directive recommends one-to-one midwifery care for all women having their first baby, twins, breech or VBAC. It’s a very encouraging policy.

QLD: Mums-to-be pushed into caesareans with private hospitals leading the way

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SOME of the state’s biggest private hospitals are performing caesareans on more than half the women giving birth …

The caesarean rates among the highest in the country were uncovered in hospital birth statistics from 2007-2010 obtained by The Sunday Mail under Right to Information laws.

Queensland’s “caesars palace” was the North West Brisbane Private Hospital, which performed the surgery on 56.8 per cent of women giving birth. Toowoomba’s St Vincent’s Hospital and The Wesley Hospital in Brisbane rounded out the Top 3, with rates of 54.8 per cent and 51.8 per cent respectively.

The latest figures … will reignite the turf war between midwives, who espouse natural birth, and obstetricians who defend surgical intervention.

Caesarean births are recommended as safer options for women having large babies, twins or breech births, as well as older mums and women who have had previous caesareans.

Latest recommendations from Canada suggest that vaginal birth is safest for most breech babies. NSW Health promotes vaginal birth for twins and of course we know that vaginal birth after a caesarean is safer than elective repeat caesarean provided that the birth takes place in a facility that has resources available to perform an emergency caesarean if needed. And “big” babies? This cannot be known with any accuracy ahead of time and the current recommendation is for a planned vaginal birth.

But some critics say growing numbers of medical professionals are convincing mothers to undergo caesareans just to streamline private maternity ward schedules and maximise revenue.

Across the state the figures add weight to the theory, with caesareans accounting for 27.6 per cent of births in public hospitals and a huge 48.3 per cent in private hospitals.

We know that this difference is not comprised of women requesting caesareans: only 2-3% women actually request a caesarean. Most are told they “need” a caesarean because their baby is “big” (3.3Kg), “late” at 39 weeks and 6 days, a previous caesarean, breech, twins, IVF, mum is “overweight”, mildly elevated blood pressure (130/80) and so on. I have heard all of these and more, as “valid” reasons for caesarean.

Several new mothers approached by The Sunday Mail last week said they had been pushed into having caesareans by private hospital obstetricians after initially wanting to give birth naturally.

One Coolum mum, 45, said her obstetrician told her she had “no choice” because the baby would “not fit through my birthing canal”.

This can not be known ahead of time. The only way to find out is to labour and see how it goes. Dedicated, exclusive, one-to-one midwifery care in labour from a midwife who is know to the woman by name and trusted by the woman, is the most important factor in ensuring a normal birth.

… “I just wanted a natural birth, to me that was important …

I think personal responsibility also plays a part here. If a woman genuinely wants a natural birth, she needs to consider which care provider will maximise her chances of achieving this. Consumers of any service are wise to research options thoroughly before they go ahead with them. We do more research about buying a car, house or holiday than we do when choosing our care providers. Having chosen an ill-suited care provider, it is never too late to change.

Another mum … desperate to avoid a caesarean, said her obstetrician also tried to book an induction because she had passed her due date in the Christmas-New Year period.

“The obstetrician said we can book you in for an induction because we just don’t like calling people in on public holidays,” …

But doctors point the finger at today’s “too posh to push” mothers, who they say demand caesars, as well as older mothers who have an added risk with vaginal births.

Australian College of Midwives spokeswoman Professor Jenny Gamble said the health system was driven by profit.

“It’s all about less night disturbance and more throughput; it all comes down to money,” she said. “It’s a fee-for-service model the more women obstetricians see, the more they earn.”

Australian Medical Association Queensland president Dr Gino Pecoraro rejected as “urban myth” claims that obstetricians earned more for caesarean births.

Private Hospitals Association Queensland said birthing decisions were not made by the hospital.

This is true: hospitals do not make any decisions about birth: those decisions are made by the doctor and patient. As we have read in this article, many of the decisions are “guided” by the doctor. The other factor in these escalating caesarean rates is litigation. When caesarean rates increase and doctors are reluctant to attend VBACs, the caesarean rate will automatically increase.

Not all doctors have high caesarean rates and some are very supportive of normal birth BUT … if a woman genuinely wants a normal birth, the best advice is to go a normal birth specialist.

Ina May Gaskin: Are We Having Babies All Wrong?

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Ina May Gaskin started delivering babies in 1970 while on a hippie cross-country trip known as the caravan. She had no medical training, just a … gut feeling that women deserved kinder, gentler births. When the hundreds of caravaners settled in Tennessee on what they called the Farm, Gaskin and several other women began delivering the community’s babies at home … Word got around when Gaskin wrote about her successes in Spiritual Midwifery, and a movement was born.

Today, women still travel far and wide to give birth on the Farm, and Gaskin’s methods have the respect of clinicians around the world …

You started attending births with no formal medical training. How did you know you could do it?
I knew how to deal with potential complications because kind doctors helped me. But basically I was behaving the way my aunt, who had a farm, would around any laboring mammal. You don’t disturb her, you don’t upset her. She deserves peace and quiet and respect. Doing that meant that no C-sections were necessary for the first 200 births on the Farm.

The C-section rate on the Farm is very low, under 2% for about 3,000 births, while the average in the U.S. for low-risk women is 20%. Can you explain?
It’s very rare to see an undisturbed birth in a modern U.S. teaching hospital, but when you see a woman who isn’t frightened, who’s giving birth without interference, you stand back in awe and realize how little needed you are except in the rare circumstance. That doesn’t mean that you shouldn’t be around in case there is a problem. It just means that you should be able to tell when there’s a problem, and you should be able to tell how not to create problems.

Why the title Birth Matters? Who are you trying to convince?
Lately, I’ve been thinking we really need to get men interested in birth … fathers-to-be have a very strong protective instinct … Men instantly understand what I call “sphincter law.” You don’t try to defecate while lying flat on your back tied to various machines with somebody shouting at you! Why do we, then, continue to treat women as if their emotions and comfort, and the postures they might want to assume while in labor, are against the rules?

… If birth matters, midwives matter. In Europe, there are hospitals where the cesarean rate is less than 10%, and you’ll find midwives in these hospitals …

Do you talk this frankly to obstetricians when you give grand rounds at major hospitals? Do they take offense?
A lot of OBs aren’t happy about the high cesarean rate either. Malpractice-insurance companies have become the boss of obstetricians. It used to be that OBs were taught skills to deliver twins and breech babies vaginally. Now all they can really offer is surgery … When I go into hospitals, I talk about how we do things on the Farm. I love talking to OBs. We midwives and physicians have a lot to teach each other.

Midwives Deliver Change

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Midwives are urging all political parties to support the development of birth centres in Ontario …

“Birth centres provide a safe, supportive environment where women can access prenatal, labour, birth and post-partum care,” said Katrina Kilroy, RM, president of the AOM. “We believe they can improve maternal-newborn care while cutting health care costs.”

Birth centres are well established in the US, UK, Australia and Quebec. Ontario midwives currently attend births in both home and hospital, but there is increasing demand from women and families for another out-of-hospital birth option. Birth centres help divert healthy women and newborns from hospital, which in turn lowers costly intervention rates such as c-sections. They provide for community-based care in a family-oriented environment.

… There are over 500 Registered Midwives in Ontario, serving communities in 85 clinics across the province. Midwives have privileges at most Ontario hospitals. They have been provincially funded and regulated since 1994.

A midwife is a registered health care professional who provides primary care to women with low-risk pregnancies. Midwives provide care throughout pregnancy, labour and birth and provide care to both mother and baby during the first six weeks following the birth. The Association of Ontario Midwives is the professional organization representing midwives and the profession of midwifery in Ontario …

Labouring over options for pain relief

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Ma.Fe Jackson didn’t want to miss any part of the birthing experience, so she refused to have an epidural …

“Childbirth is very, very painful, but that’s normal and it’s only for a short time,” says the new mom who gave birth in February to first baby, Angelique.

Jackson is Filipino and most Filipinos don’t have epidurals, she explains. Besides, she’s scared of needles, which is how an epidural is administered.

Pain may be a normal part of childbirth, but most North American women today don’t experience it.

In Edmonton in 2009, 57 per cent of the 11,782 women who gave birth in hospital asked for an epidural … The majority of those who didn’t have an epidural had some other form of pain relief …

Thirty years ago only two to four per cent of women had epidurals.

“We only used them for longer, more complicated labours,” … “There was a general desire to have a natural childbirth because there was a feeling that birth had become medicalized.

“Now, I would say the majority of women are coming in and they’ve already decided that they will have an epidural as soon as they get into labour. It’s really swung the other way.”

Even women who plan to have an epidural only as a last resort, usually end up having one …

Dr. Michael Klein, a family physician, pediatrician and neonatologist from Vancouver, thinks the trend reflects the lack of knowledge that women having babies, especially first babies, have about labour and delivery.

His maternity research … shows one-third to one-half … aren’t fully informed about childbirth, including the effects of an epidural.

That may have something to do with the fact that only one-third of first-time moms-to-be sign up for prenatal classes. The majority get their information, or misinformation, as Klein calls it, from highly questionable Internet websites.

A similar survey of 5,000 health providers who care for these women, found they too were similarly lacking in information, says Klein, professor emeritus of family practice and pediatrics at the University of British Columbia, and senior scientist emeritus at the Child and Family Research Institute in Vancouver.

Although the epidural is considered safe, there are risks …

“ … epidural headache, and in very rare cases you could have a significant neurological problem because of it,” …

“ … it will lengthen the first and second stages of your labour significantly, that you’re more likely to have an epidural fever, and that it increases the likelihood of forceps or vacuum … You’re more likely to have an episiotomy or perineal trauma, and the issue of caesarean sections tend to be avoided altogether because doctors actually believe that even an early epidural will not cause a problem.”

… in general, younger obstetricians (under age 40), were more supportive of the role of birth technology in normal birth, including routine epidural analgesia, than physicians over 40, and they were less appreciative of the role of women in their own birth. They also saw caesarean section as a solution to many perceived labour and birth problems.

“ … I think women really need to know the full picture,” he adds. If they were fully informed he believes fewer women would ask for an epidural.

Klein is best known for his research that found routine episiotomies caused the very problems they’re supposed to prevent …

… Klein acknowledges that birth is painful, but argues many women would be able to handle it without drugs if they had support.

“There is a difference between pain and suffering, and no one is in favour of suffering,” Klein says. “You suffer when you are abandoned, when people aren’t there to help you with your pain.

“Nobody is going to deny there is pain in labour nor that it is significant, but if you are cared for by somebody who understands the pain and tells you only have a contraction or two as intense as this until you’re fully dilated and you’ll be much more in control of the pain, if you had that kind of information, you might decide to hold off (having pain relief).”

… “Midwifery intervention has positive outcomes that no other intervention that we have to offer in medicine can even touch. If we all practised that way we wouldn’t be having this discussion,” …

Childbirth: More Labor Interventions, Same Outcomes

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Hospitals vary considerably in the frequency with which they induce labor and perform Caesarean sections. But a new study finds that these differences do not seem to affect how newborns fare in these facilities.

Dr. J. Christopher Glantz, a professor of obstetrics at the University of Rochester, reviewed records of almost 30,000 births … Some hospitals relied heavily on induced labor and Caesarean sections, while others performed the procedures much less often.

Dr. Glantz measured neonatal outcomes in three ways: whether a child was moved to an intensive care hospital, whether a child needed immediate assisted ventilation and whether a child received a low Apgar score.

He found no difference in outcomes for babies born in the hospitals with the highest rates of these procedures and those with the lowest. The result suggests that routine reliance on the procedures does little to improve outcomes …

The recipe for safe, empowering, minimal-intervention birthing is:
A woman who is positively motivated to have a natural birth
Who is well-prepared for pregnancy, labour, birth and parenthood
Who is supported by one midwife and one obstetrician right the way through her pregnancy, birth and postnatal experience
Care providers who collaborate, communicate, respect and trust one another, who work for the best interests of the woman and her baby

Pioneering Collaborative Private Maternity Care: Continuity, woman-centered, personalised, safe.

Our brand new model of care – launched for the first time in Australia – has recently welcomed its third baby. So far, three families have benefited from a collaborative model of private maternity care that enables women to have care with a private midwife (with Medicare funding) and also develop a trusting and nurturing relationship with a Specialist Obstetrician who is available for the pregnancy, labour and birth. Our service has so far supported an empowered birth after caesarean, a waterbirth and a natural birth. All within a hospital setting, with all the support available that is occasionally needed.

We’ve received some really positive feedback:

“The collaborative model seemed unique to me. To have a private midwife and our own birth experience but in a hospital with an obstetrician who was known to us as back-up in case of unexpected complications, allowed us to feel totally comfortable and confident for our first baby.”
“I felt entirely supported and encouraged.”
“A highly personalised level of care was offered which makes you feel listened to and allows time for lots of questions.”
“I liked the fact that we got time to develop a relationship and feel comfortable together, allowing us a better birth experience. Postnatally, it was nice to have the same person continuing my care. It was highly personalised.”

Our model sees women booking with me for their care. Women who are interested in having collaborative maternity care meet with the obstetrician early in their pregnancy and again between 32 and 36 weeks. Women see the obstetrician more often if additional visits with him are needed. Otherwise, I am in frequent communication with him and we work together to provide safe, evidence-based, woman-centered care to our pregnant women. This allows women to build a sense of connection, trust and continuity.

We support natural birth, active birth, physiological birth positions, physiological third stage, water birth, VBAC, twin births, breech births … and so on. Women are really well prepared for natural birth with an emphasis on informed decision making and woman-centered care. Childbirth education is included, as well as access to a lending library of books and DVDs.

Birth care is provided initially at home and then we move to hospital where I provide full midwifery care. The birth is attended by myself and the Obstetrician if needed / desired. It’s an intimate, calm, peaceful experience and facilitates a gentle and safe birth.

After we have welcomed the baby and birthed the placenta, women generally stay in hospital for 4 – 24 hours before returning home. Of course, if there are any issues women are welcome to stay longer, but generally I find that women feel more comfortable in their own homes, in their own beds. I visit at home every day for a week and continue care for 6 weeks. Since women book into hospital as a private patient, they are almost assured a private room with an en-suite.

I’m really excited about this model of care because it meets the needs of women so perfectly:

  • Women having their first babies, maybe feeling unsure of what to expect
  • Women who previously experienced dis-continuous care from care providers who were unknown to them
  • Women who are planning a natural birth but perhaps with a more challenging pregnancy
  • Women who want a home birth / birth centre birth but with a known obstetrician available if needed
  • Women who really desire a sense of control over their birthing experience
  • This is a new way of working for both midwives and obstetricians and is a really supportive and nurturing way to practice. There is a huge potential for professional growth and learning. The most positive element, however, is the radiant smiles on the faces of the women who have birthed with us and the babies who have received a safe and gentle start to life.

    C-section puts children at food risk

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

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    Caesareans are the safest they have ever been, and for some women and some babies, they are life-saving and very necessary. However, we do have a current caesarean rate of over 30% and this is deemed to be too high; ie, the rate cannot be justified by medical need and at this level, may cause more harm than good. If a caesarean is genuinely necessary, the risks reported below of food allergies would be well justified by the benefit of having the caesarean.

    GIVING birth by caesarean section increases the risk of your child suffering from food allergies …

    Pediatric allergy specialist Dr Peter Smith is urging expectant mothers to consider a vaginal delivery because of growing evidence a c-section can “significantly increase the risk of your child suffering from an allergy to cow’s milk”.

    Admissions to hospital emergency departments for allergic reactions have increased by 500 per cent since 1990 in Australia.

    … the massive rise in food allergies [is] likely to be attributed to several causes rather than one.

    But symptomatic food allergy was found to occur more frequently in children born by c-section.

    “… studies have shown a difference in the composition of the gastrointestinal flora of children with food allergies compared to those without,”

    “When a child moves through the birth canal, they ingest bacteria and become naturally inoculated through a small mouthful of secretions.

    “The oral ingestion of those healthy bugs is the first bacteria that comes into their system.”

    Dr Smith said that first bacteria entering the body established “the population”.

    Not only does Australia have one of the highest prevalence of allergic disorders in the developed world, but recent studies have demonstrated a doubling in some conditions such as allergic rhinitis (hay fever), eczema and potentially dangerous anaphylaxis.

    … the next best thing to a “natural” birth was to follow birth with breast feeding.

    “Breast milk contains lots of healthy bugs … to promote the growth of healthy bacteria and assist your child’s immune system in the first few week’s of life,” …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Can ‘hypnobirthing’ really take the pain out of having a baby?

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

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    Emma Shaw admits that she turned up for her first hypnobirthing class with a strong dose of scepticism.

    A down-to-earth and pragmatic TV producer, she fully expected to walk into a room ‘full of hippy, airy-fairies giving birth in yurts’.

    Like most mothers-to-be, the 30-year-old had been drip-fed horror stories from colleagues and friends of women screaming, swearing and assaulting their husbands, surrounded by beeping, blinking monitors.

    She was convinced that was ‘the only way’. Anything else was just a pipe dream, wasn’t it?

    The theory behind hypnobirthing holds that 95 per cent of labour pain is due to fear and tension, which could be eliminated through relaxation techniques

    … after researching alternative birth techniques for a documentary, Emma was introduced to the idea of using her mind to seize control of the birthing process through hypnosis.

    And when her son Leo was born 14 months ago, following a relatively pain and stress-free labour, Emma is convinced hypnobirthing is most certainly ‘the other way’.

    … This is exactly what the NHS is seeking to investigate in an 18-month study on the effectiveness of hypnobirthing being launched this week, which, it is hoped, will reduce the financial strain on tightening NHS budgets caused by costly drug treatments such as epidurals — and also make births easier and safer for women and babies.

    At present, 60 per cent of women opt for forms of pain relief which some professionals have blamed for everything from difficulties with breastfeeding to postnatal depression.

    … Women will be taught deep relaxation techniques which are said to induce an almost trance-like state, making women calmer and more able to block out pain.

    … Judith Flood, a 41-year-old midwife who trained as a hypnobirthing teacher eight years ago after noticing the difference it made to women’s experience of labour.

    … ‘I was working at St Thomas’ Hospital in London when a women walked in, a first-time mother in her late 30s, who was totally calm, smiley and chatty.

    ‘I nearly sent her away again, assuming labour couldn’t be established … ‘When we examined her she was almost fully dilated. Even as she gave birth, she was totally calm and able to talk, simply by practising her deep breathing techniques to manage the pain.’

    … From that point, Judith became fascinated with the practice, noticing in many cases it actually halved the duration of labour from an average 12 hours to four to six hours …

    ‘It teaches women how to become deeply relaxed, quickly and easily. It is a skill like any other that gets better with practice, so that as she goes into labour it is second nature. We also use association techniques, where a woman’s partner can use a simple touch as the trigger to relax …

    The Australian version of Hyponobirthing – taught by a midwife – is Calmbirth, which I highly recommend for all of my clients. Julie Clarke runs fantastic Calmbirth classes in Sylvania, as well as her famous Transition into Parenthood classes.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Midwife encourages natural births

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

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    GOLD Coast Midwifery Practice … is all for natural births.

    When it comes to having a baby … a vaginal birth was the best-designed system.

    ”A vaginal birth has many inherent safety mechanisms that protect both mother and baby,” …

    However, elective cesareans are becoming more common on the Gold Coast …

    ”We live in a very technocratic society where people like to have as much control as possible,”

    … ”It … raises the question of a lack of continuity of care in the health system.

    ”Care is fragmented and many women aren’t able to form a bond with a care giver. Therefore the process of having a baby can be frightening and they opt for the easy option of having an elective cesarean.” …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Vaginal delivery connected to lower morbidity in twins

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

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    Twins tend to do better if born vaginally, rather than by caesarean section … But regardless of delivery mode, the first-born twin is less likely to suffer complications than the second.

    … Neonatal morbidity was lower in the first than the second twin (3.0% versus 4.6%). This was also true of mortality (0.35% versus 0.6%).

    In either twin there were no differences between vertex and non-vertex and attempted vaginal delivery versus planned caesarean section.

    In the first twin, neonatal morbidity was lower after vaginal delivery than caesarean section (1.1% versus 2.1%).

    When the first twin underwent vaginal delivery and the co-twin underwent caesarean section (combined delivery), morbidity was significantly higher in the co-twin (19.8%) than in the case of vaginal delivery (9%) or caesarean delivery of both newborns (7.2%).

    “In the absence of more definitive data, our systematic review suggests that an attempt at vaginal delivery should be considered in twin pregnancies,” …

    “With regard to the second twin, no differences are noted between caesarean section and vaginal delivery …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Big mums risk babies’ health

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    Pregnant women are packing on too many kilograms, risking their health and that of their babies – and costing the health system a fortune.

    A staggering 41.5 per cent of the 7735 women who gave birth at Auckland’s National Women’s Hospital in 2009 were classed as overweight or obese.

    Those with a body mass index (BMI) of more than 25 were considered overweight, while those who exceeded 30 were said to be obese.

    … national and international research showed it was a growing problem …

    … Big mums … were at increased risk of:

    * Developing diabetes and other serious pregnancy complications such as pre-eclampsia.

    * Having a stillbirth. There is a two-fold increase for obese mothers.

    * Needing a caesarean section.

    * Breast-feeding problems.

    * Having a big baby, which in turn is at risk of becoming an obese child.

    … Another concern was a trend in pregnant women, aged under 25, being obese.

    … obese mums also had a higher chance of having a baby with an abnormality …

    Nutrition and exercise are the foundations of a healthy pregnancy, healthy birth and healthy baby. In my service. I focus a lot on optimising women’s nutrition because it is a modifiable aspect of care that can really make a difference. For women choosing homebirths, I think it’s especially important to make really healthy food choices and to exercise most days of the week. I acknowledge that it’s really hard to change habits – especially exercise and nutrition habits – so I provide lots of support, guidance and motivational tools to help women work towards health.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Health chiefs encourage more home births over caesareans

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    HEALTH chiefs are aiming to slash the number of mothers giving birth by caesarean section and encourage more home births in Poole and Bournemouth.

    The area has the highest rates of births by caesarean section in the south west, including the worst emergency rates – two per cent higher than the next primary care trust.

    In Bournemouth and Poole, 11 per cent of mothers choose to have their babies by C-section, compared to eight per cent in the three best performing primary care trusts in the region, and seven per cent in Southampton.

    NHS Bournemouth and Poole is working with maternity services to try and normalise the local pattern of births.

    A spokeswoman explained: “We are concerned with the increase in planned and unplanned caesarean section rates because these procedures can present more risk to mother and baby.

    “Women who have had a normal birth can return home more quickly to their family and their recovery is quicker.

    “With appropriate care and support the majority of healthy women can give birth with a minimum of medical procedures and most women prefer to avoid interventions, provided their baby is safe and they feel supported.”

    A spokeswoman for Poole Hospital’s maternity unit, the centre for high risk births in East Dorset, said: “The majority of caesarean sections are undertaken only where there is a clear clinical reason to do so – for example, if babies become distressed during labour, or for the safe delivery of breech babies or twins.

    “However, we are working closely with NHS Bournemouth and Poole to reduce the number we carry out.”

    The trust plans to recruit more midwives and use experienced obstetricians to increase the number of breech babies born normally.

    Extra ante-natal clinics will be introduced to help women have a normal birth after previously having a caesarean, and the hospital will stop providing caesarean sections by choice instead of medical need.”

    The hospital already has birthing pools and has just launched an on-call service to support women who choose home births.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Women choosing midwives

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    When Lisa Unger was pregnant … she saw a gynecologist for medical care. Then she made the switch.

    … “I decided I wanted a midwife, I was pregnant, it was not an illness, I didn’t need a doctor. I was going with a midwife who could empower and coach me through the natural function of my body. I wanted to do it in the hospital, I wasn’t comfortable with a home birth … ”

    … “The term ‘midwife’ means ‘being with women’. We support them, empower them. We tell them how wonderful they’re doing. ”

    The midwife and mom-to-be establish a bond, since midwives are able to spend more time connecting with their patients over time …

    Visit my website to learn more about my services.

    Unnecessary C-Sections on the Rise

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

    Australia’s caesarean rate was 31.1% in 2008.

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    Five years ago, Jill Arnold got some unwanted news at her obstetrician’s office. At 37 weeks pregnant, Arnold was told her baby was too big for her body to deliver naturally. Flipping open a calendar, the obstetrician asked when Arnold would like to schedule a cesarean section.

    Fact: You cannot know that a baby is “too big” until you give labour a go.

    Unconvinced she needed the surgery — the doctor “couldn’t provide any statistics or data” her baby was too large — Arnold delivered her 10-pound, 3-ounce (4.6 kilogram) baby the old-fashioned way. Since then, the now 36-year old … delivered another baby weighing 11 pounds, and now pens a blog called The Unnecesarean.

    Women like Arnold, however, are becoming increasingly rare. Between 1996 and 2007, the number of C-sections performed in U.S. hospitals rose by more than 50 percent to an all-time high: Almost one in three pregnant women …

    “The most concerning problem is the high rate in first-time mothers,” …

    … The shift is toward a more streamlined labor and delivery, and profoundly affects mothers-to-be.

    … this shift is not likely to reverse any time soon.

    In 2009, 26-year old Ann Carter … labored for 14 hours. With her cervix dilated to only 6 centimeters … her doctor told her it was time for a C-section.

    “I was devastated and scared,” Carter said, “I knew it was a possibility but I was hoping it wouldn’t happen.”

    During the surgery, the doctor discovered the umbilical cord had wrapped around the baby’s neck, which explained why Carter’s labor had stalled. The C-section saved the baby boy’s life.

    Um, actually, it is very common for the cord to be around the baby’s neck, and it rarely causes concerns.

    “Most times the decision to perform a C-section is based on the physician’s judgment,” Zhang said, “but there are great variations in decision-making among physicians.”

    … there are “few clear-cut indications” of when to do one.

    … For example, the American Congress of Obstetricians and Gynecologists (ACOG) lists “failure to progress” during labor, as an indication that cesarean delivery is needed … When things slow down, there is an element of judgment involved where a physician determines whether to continue to wait, induce or perform a C-section … it can take hours to determine whether or not labor is progressing.

    In Zhang’s study, however, he found that many patients weren’t given a sufficiently long time period to allow their labor to progress. In other words, doctors were calling it quits on waiting and opting for a C-section too soon — often before the patient’s cervix was dilated to 6 centimeters.

    This was especially true in cases of induced labor … Almost half of the C-sections in these women occurred before they were 6 centimeters dilated …

    Still, it is not clear whether inducing labor raises the risk of C-section, or whether other factors are involved that contribute to why women were induced in the first place …

    … Another factor contributing to the record-high cesarean rates is a drastic decline in vaginal births after cesarean … 70 percent of women in his study who had previously undergone a cesarean delivery had C-sections with their subsequent pregnancies, without attempting vaginal delivery.

    One reason for this is a fear of lawsuits. If a physician doesn’t perform a C-section, and something goes wrong with a patient who previously had a C-section, the law often does not protect the physician …

    … the number of malpractice claims involving obstetric and gynecologic surgery are the second highest of all medical specialties. In 2009, the claims totaled over $133 million.

    Fears of legal action also explain why at least 30 percent of all U.S. hospitals have official bans prohibiting VBACs …

    The risks associated with a vaginal birth following a C-section have been somewhat exaggerated, however, Zhang said.

    “Women and physicians may be concerned about uterine rupture, but the risk is less than 1 percent,” …

    To help reduce rising cesarean rates, the American Congress of Obstetricians and Gynecologists announced less restrictive guidelines in July, stating that vaginal birth “has fewer complications than a repeat cesarean….restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against her will.” …

    … some medical experts have suggested the rapid rise of C-sections in the last decade is also due in small part to mothers-to-be requesting them, not doctors. Still, data on “patient choice cesareans” is lacking, as statistics used as support of their frequency are often based on ambiguous procedural codes used on hospital discharge records.

    In any case, women who opt for a C-section may not be getting adequate information about risks, and may fear they have no other option …

    … To curb the rise, many advocate giving women more autonomy over their labor and delivery, and combining the strengths of modern medicine with the principles and practices of midwifery.

    La Follette’s California office is an example of this more comprehensive approach: After participating in a larger practice for 12 years, she now works with two experienced midwives and another physician. Her practice has a successful VBAC rate of 75 percent.

    “We take into account the expectations and ideas of the mom and balance that with medical guidance,” La Follette said.

    As more women consider practices with midwives and home births — which can be dangerous if complications arise — much of the medical establishment has been digging in its heels. In 2008, the American Medical Association’s House of Delegates proposed a resolution to declare hospitals the only safe place for labor, and only midwives who work under the supervision of physicians as safe.

    The Midwives Alliance of North America declared the resolution “seriously out-of-step with the ethical concept of patient autonomy in healthcare [that] distracts from other critical issues in maternity care.”

    If there is any chance of lowering the rates of C-sections, professional organizations will need to review all the available evidence, Zhang said.

    But any change won’t be easy. On the one hand, doctors need to include expectant moms in their own care; on the other, it sometimes seems that doctors who are worried about potential legal consequences can’t focus on a patient’s best interests.

    “We’re fighting a cultural issue,” Scott said, that extends beyond C-sections.

    She said, “We need to change the entire way we view birth and we have to be able to trust our caregivers. The alternative would be terrifying.”

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Your body, your choice

    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 transforming experience of childbirth is increasingly blotted by medical interventions. Are women making informed decisions?

    LIKE most first-time mothers, Faye Wong … was incredibly excited when she got pregnant. She read baby books and magazines voraciously, signed up for ante-natal class … to prepare for baby’s arrival.

    When she was 38 weeks pregnant, her obstetrician said the baby’s head had engaged and his size was quite big. The doctor suggested inducing her labour.

    In the labour room, her “nightmare” began. The pain from the drug-induced contractions was a rude jolt to her system. Then she was jabbed and prodded with painkillers, IV tubes and the works.

    “I was shocked, confused, and in absolute terror,” recalls Wong, 35. Finally, the induction failed and she had to be wheeled in for emergency caesarean. Thankfully, she delivered a healthy baby boy weighing 3.9kg. When she got home, she struggled with breastfeeding and suffered a severe bout of post-natal blues.

    “I felt ‘cheated’ … ” Wong admits. Her son is now seven. “I was a newbie to the birthing process and was meek as a lamb led to the slaughter,” she adds. “If I’d known then what I know now, I probably would have been better prepared, stood my ground and not undergone early inducement.”
    Though doctors play a role in giving women the necessary information about labour options, women and their partners need to take their share of responsibility too in making informed choices and decisions.

    Wong’s experience isn’t unique.

    “We see a fair amount of women who are unhappy about the outcome of their deliveries,” says Jennifer Hor of Jenlia Maternal Services. The UK-trained midwife has been running ante-natal classes and post-natal home visits for 17 years. “Some felt they had a C-section even though they didn’t want it. Or, some felt they didn’t get enough information from their doctors.”

    So, are women less assertive when it comes to childbirth? Are they getting or finding the information necessary to make informed choices and decisions? And have we forgotten that childbirth, an age-old practice, is meant to be natural?

    Birth trends

    … the medicalisation of childbirth means what used to be a straightforward, natural process is now treated as a high-tech medical procedure.

    Caesarean rates are on the rise in both developed and developing countries …

    … “Women say they want to take ownership of their bodies, yet we have healthy, low-risk women who said they had a C-section for their first births because they listened to their doctors,” says Farouk, who also sub-specialises in reproductive medicine. And because of the risks from the first surgery, these women are requesting for repeat C-sections. “Ironically, women are pushing the trends that way.

    “We are also seeing the use of more technology to manage pregnant mothers, for example using CTG (cardiotocography) … and ultrasound scans,” says Farouk. “It’s not all bad, but if you monitor too much, you might pick up something and wonder if you don’t take action, there might be consequences, hence the interventions.”

    … Doctors come with their beliefs and agendas, based on experiences. Some underplay certain risks and amplify others. For instance, placental calcification … is not a major issue for some obstetricians if the woman is near term and foetal growth is normal. But for a different doctor, a few specks on the ultrasound scan is reason enough for labour induction.

    “There can be grey areas in medical investigations. I tend to be more conservative with placental calcification and continue to monitor foetal health and growth parameters,” …

    Also, fear of litigation is scaring obstetricians into defensive and often interventionist practices.

    “An obstetrician is more likely to be subjected to litigation because a caesarean section was not performed or was perceived to have been performed too late …”

    Medical interventions

    Clearly, it’s not always true that C-sections or epidural blocks are being foisted on reluctant women. The fact is, some women don’t question their doctors, or they themselves are asking for interventions.

    Labour induction, elective caesarean, epidural jabs, and routine episiotomy are some of the common medical interventions during childbirth.

    Induction of labour … is usually done when the mother’s or baby’s health is at risk …

    “For such cases, studies have shown that caesarean section rate has been unchanged or lower among the induced group as compared with expectant management of pregnancy … ”

    “But induction of labour at 37 to 41 weeks on non-medical grounds is linked with an increased risk of caesarean section for … a woman who has never given birth and an increased risk of instrumental delivery,” …

    No doubt, medical interventions can be a lifesaver for mothers and babies …

    However, once the natural process of labour and birth has been disturbed, if there is no actual emergency, there is risk that the side effects of the treatment will trigger more intervention necessary to fix the problem. This sequence of events is called the “cascade of interventions”.

    “Pitocin (Syntocinon), a synthetic form of the hormone oxytocin used to induce or speed up labour, often results in a rapid increase in the intensity and strength of the woman’s contractions. As a result, she may opt to use pain medications such as pethidine … or epidural anaesthetic. Babies sometimes don’t react favourably to the sudden increase in the intensity of the contractions, which may result in irregularities of the heartbeat. Thus in turn may necessitate delivery by caesarean,” …

    “Many women who use epidural do not experience the urges to bear down which help them to birth their babies. Often, in this situation, the doctor will use forceps or vacuum to deliver the baby, which means he needs to do an episiotomy … Many women experience long-term perineal pain following episiotomy.”

    A failed induction (when labour doesn’t started after the first cycle of treatment) can either require a rescheduled induction or emergency C-section.

    “Women should received accurate information about the risks, benefits, and alternatives of induced labour and understand the possible side effects and interventions, ” …

    The big ‘C’

    Most women also come with the preconceived idea that C-sections are safer than vaginal delivery …

    … “In fact, C-section, which is classed as a major surgical procedure, carries with it the risk of complications and shouldn’t be viewed as an alternative option to normal birth.”

    … “Babies delivered by elective caesarean section at 37 to 39 weeks’ of pregnancy are at two to four times more likely to suffer from respiratory morbidity compared with babies delivered by vaginal delivery,” … WHO global maternal survey also finds that women who choose elective caesarean with no medical indication are at increased risk of maternal death and serious complications.

    … Studies have linked depression and distress after birth, which affect up to one in five women, to forceps and caesarean births …

    Disturbed birth

    “You must be mad to give birth without an epidural!” A common reaction these days if you speak with women who have undergone labour. But as the WHO states, “epidural analgesia is one of the most striking examples of the medicalisation of normal birth, transforming a physiological event into a medical procedure.”

    … in her book,Gentle birth, gentle mothering, internationally acclaimed birth expert Dr Sarah J. Buckley explains how epidurals or painkilling drugs and synthetic hormones (used during induction) interfere with some of the major hormones of labour and birth. The five major hormones: oxytocin (hormones of love); beta-endorphin (pleasure and transcendence); the catecholamines or CAs, epinephrine and norepinephrine (excitement); and prolactin (tender mothering) form a “cocktail of hormones that nature prescribes to aid birthing mothers of all mammalian species”.

    During an undisturbed labour, these hormones rise in crescendo and peak around the time of birth or soon after for mother and baby, and subside over the following hours and days. “An optimal hormonal orchestration provides ease, pleasure, and safety during this time for mother and baby.” Interference with this process, by injecting drugs or synthetic hormones, will “disrupt the hormonal orchestration, making birth more difficult and painful, and potentially less safe”.

    For example, epidurals lower the mother’s production of oxytocin or stop its normal rise during labour. Oxytocin causes a woman’s uterus to contract in labour. It peaks at birth and catalyses for the final powerful contractions of labour, and helps mother and baby to fall in love at first meeting.

    Under stressful conditions, our body releases epinephrine and norepinephrine (CAs). Towards the end of an undisturbed labour, the mother experiences an adrenaline rush – the natural surge in these hormones gives her the energy to push her baby out, makes her excited and fully alert at first meeting with her baby.

    But when a woman feels fearful or unsafe, her labour is inhibited by high CA levels. Epidurals reduce the release of the CAs, which may be helpful if the high levels are restricting her labour. However, a reduction in the final CA surge may make it difficult for the woman to push her baby out, thus increasing the risk of instrumental delivery (forceps and vacuum).

    Epidural’s side effects include nausea, slowing of labour and drop in blood pressure, slowing of contractions, and headache.

    35-year-old Laila Aziz of Kuala Lumpur was wheelchair-bound for four months after an epidural jab injured her nerves when she delivered her third child.

    “I wish my O&G and the anaesthetist had explained in details the pros and cons of using an epidural,” says Laila, who suffered severe post-natal blues after childbirth. “I would at least reconsider whether to use the option at that time.”

    … Childbirth educator and lactation consultant Christine Choong has been advocating natural childbirth for the past two decades.

    “My main passion is how birthing practices affect breastfeeding. What happens when you’re in labour can have a long-term effect on your breastfeeding,” …

    Research has shown that when you put a baby on his mother’s chest (skin-to-skin contact) immediately after he was born, the baby will crawl instinctively towards her breast.

    “Quite often the baby won’t do that if you had used drugs during labour … because he will be drowsy the first two to three days,” … “If women use epidural, very often their babies are delivered by suction or forceps which can cause discomfort on baby’s head (a shock to the system) and baby initially will not be happy feeding on one side or the other.”

    Whether a labour induction is done on medical grounds or not, the baby is – by definition – relatively immature and likely to have impaired ability to effectively coordinate sucking, swallowing, and breathing at breast …

    “In a C-section delivery, very rarely the mother is given the baby straight away,” Christine adds. “Early stimulation or suckling is important to establish breastfeeding. Also a higher percentage of caesarean babies end up with respiratory problems, which results in separation of mom and baby.”

    But we need to look at the whole picture – the impact on baby, feeding, and mother-baby relationship.

    “It isn’t just feeding but also nurturing,” says Christine, a mother of three.

    “When babies are nurtured and their needs are met, in the long term, they will become people who are secure, confident, and know how to form relationships with people.”

    Take control

    What do you do if your care provider says you or your baby is at risk and an intervention is necessary?

    “Using evidence-based information, your doctor should explain the reason for any suggested interventions. He should also explain the benefits and risks of such procedures,” advises Choong. If you’re not sure or not too convinced by your doctor’s explanation, get a second opinion.”

    “Empowerment with the correct knowledge and information is useful so women can ask the correct questions,” Chow adds. “And their fear of childbirth should be addressed by getting support and learning about the labour process and pain relief options.”

    Ultimately, a woman’s satisfaction with her birth experience is related more to her involvement in decision-making than to the outcome, as Buckley emphasises. Though doctors play a role in giving women the necessary information, women and their partners need to take their share of responsibility too in making informed choices and decisions.

    When Wong had her second child, she was more mentally and emotionally prepared.

    “Although I ended up having another C-section (due to hypertension), I didn’t feel disappointed and helpless,” Wong says. “I felt as if I was a real mom this time around.”

    As Buckley sums it up best, “birth is the beginning of life; the beginning of mothering and of fathering. We all deserve a good beginning.”

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    New unit a ‘home birth in hospital’

    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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    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

    Who controls childbirth: women or doctors?

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    That I am pregnant again is an act of either incredible optimism or mind-blowing amnesia. As the sonogram technician squirts jelly over my abdomen for my 20-week checkup, I think it’s the latter. Watching this baby, who the tech tells me is a boy, I am not caught up in visions of his future; I’m caught up in visions of mine. All of a sudden, I know with a certainty I haven’t allowed myself to confront before: Somehow, I am going to have to deliver this baby.
    Obviously, you say. But my first birth was traumatic, and although my son and I emerged fine, I lost a year seeking treatment for post-traumatic stress disorder and all the depression, fear and anger it brings. I imitated mothers who seemed normal to me, cooing and tickling my son. In truth, I was a zombie, obsessing about how I had ever let what happened happen.

    What happened is this: In my 39th week, I am induced because of high blood pressure. At the hospital, I am given Pitocin, a synthetic form of the labor-inducing hormone oxytocin, and Cervidil, a vaginal insert used to dilate the cervix. Within two hours, my contractions are one minute apart. I had lasted as long as I could without an epidural because I had read that they sometimes slow dilation. That’s the last thing I need: I’m at a pathetic 2 centimeters. My doctor comes up with a solution for the pain: a syringe full of a narcotic called Stadol.

    “I have a history of anxiety,” I tell the nurse who has brought in the syringe, as I always warn any medical professional who wants to give me drugs. “Is this drug OK for me?” “It sure is,” she says.

    It is not. Within 10 seconds, I begin hallucinating. For five hours, I hallucinate that I’m on a swing that’s soaring too high, that houses are flying at my face. My husband has fallen asleep on the cot next to me, and I’m convinced that if awakened, he will turn into a monster — literally. I’m aware this notion is irrational, that these images are hallucinations. But they are terrifying. I buzz the nurse. “Sometimes that happens,” she says …

    By noon the next day, 24 hours after I had arrived, I am only 3 centimeters dilated. The new nurse, a nice lady, tells me the induction isn’t working. “Your blood pressure isn’t even high anymore,” she says. “Tell the doctor you want to go home.”

    When my OB comes in, I say, “I’d like to stop this induction, if that’s possible. I’m worn out. I hallucinated all night … I just don’t think this is working out.”

    “OK,” he says. “Let me examine you. If you’re still not dilating, we’ll talk about going home.”

    My previous dilation exams had been quick and painless, if not entirely pleasant. This one takes a long time. Suddenly, it hurts. “What are you doing?” I scream. “Why does it hurt?”

    No answer.

    “He’s not examining me,” I scream at my husband. “He’s doing something!” My husband grips my hand, frozen, unsure.

    I scream to the nurse, the nice one who had suggested I go home. “What is he doing?” She doesn’t answer me, either. I writhe under the doctor’s grasp. The pain is excruciating.

    The first sound I hear is the doctor’s directive to the nurse, in a low voice: “Get me the hook.”

    I know the hook is for breaking my water, to speed my delivery by force. I scream, “Get off of me!” He looks up at me, as if annoyed that the specimen is talking. I imagine him thinking of the cadavers he worked on in medical school, how they didn’t scream, how they let him do whatever he wanted.

    “You’re not going anywhere,” he says. He breaks my water and leaves. The nurse never looks me in the eye again.

    Eleven more futile hours of labor later, I am exhausted and terrified when the doctor comes in and claps his hands together. “Time for a C-section,” he says. I consider not signing the consent form, ripping off these tubes and monitors, and running. But the epidural I’d finally gotten won’t allow me to stand up.

    It’s nearly midnight when I hear a cry. My first emotion is surprise; I had almost forgotten I was there to have a baby.

    I was desperate to find someone who could tell me what had happened to me was normal. To say, “You hallucinated? Oh, me, too.” Or “My doctor broke my water when I wasn’t looking. Isn’t that the worst?” Nothing …

    Now, I’d never loved my doctor … I’d found him patronizing — “Normal!” he’d shout at me, when I asked a question — I thought his assuredness might be a good antidote to my anxiousness. It seemed to work, until it didn’t.

    … I also didn’t have a birth plan … Sure, I had a plan for the birth: Have a baby using whatever breathing method I’d learned in the hospital’s birth-preparedness class, maybe get an epidural. But I didn’t have the piece of paper that so many of my friends have brought to the hospital with them … in my opinion, the very act of creating such a contract was to ignore what labor is: something unpredictable that you are in no way qualified to dictate.

    … people who hear my story ask … Did I consider a home birth? A midwife instead of an obstetrician? … The answer is no. I am not holistically minded. My philosophy was simple: Everyone I know has been born. It can’t be that complicated.

    The women who ask me about my preparations for my first son’s birth — who imply with these questions that I could have prevented what happened to me if I’d been more diligent — are part of an informal movement of women who are trying to “take back” their birth — take it back from the hospital, the insurers and anyone else who thinks he can call the shots.

    But hospitals aren’t so interested in giving women back their birth … stipulations dealing with labor and delivery (“I want only one medical professional in the room at a time”) garner barely a glance. University OB/GYN in Provo, Utah, even has a sign that reads, “…we will not participate in: a ‘Birth Contract’, a Doulah [sic] Assisted, or a Bradley Method delivery. For those patients who are interested in such methods, please notify the nurse so we may arrange transfer of your care.”

    … This question of whether I could have prevented my trauma has lingered in my mind since that day; now that I am pregnant again, it has become deafening. I have a chance to do it all over. Would I benefit from thinking more holistically? Should I bother taking back my birth?

    During my pregnancies, friends gave me two books; their spines are still barely cracked. The first is called “Ina May’s Guide to Childbirth.” … The other book is “Your Best Birth” by Ricki Lake and Abby Epstein; it’s an offshoot of their 2008 documentary, “The Business of Being Born.” Their urgent message is that women who want to deliver vaginally can do so if no one intervenes. Instead, doctors and hospitals are doing all they can to “help” the laboring woman along … and failing. Inductions like mine, epidurals given early in labor, continuous fetal-heart monitoring — all of them have been associated with a higher risk for cesarean section. The result is an epidemic — 32 percent of U.S. births were C-sections at last count, the highest rate in our history. Individual surgeries may be medically necessary, but as a matter of public health, the best outcomes for mothers and babies come with a rate of no more than 15 percent, according to the World Health Organization.

    Sam … was five months pregnant when watching “The Business of Being Born” convinced her that hospitals could be dangerous and a home birth would be more meaningful. She and her husband found a midwife … and spent the rest of the pregnancy preparing.

    After 24 hours of labor, Sam’s contractions were two or three minutes apart, yet when her midwife examined her, she was only 3 centimeters dilated. The midwife gently told her that she was nowhere close to delivering, despite her contractions, exhaustion and pain. Sam asked to be taken to the hospital.

    The change of scenery did her good. “At that point, I had been in labor for 40 hours,” she says. “I entered the relaxed zone. The epidural took the edge off … It was a sacred space.”

    After her son’s delivery, Sam passed out, having lost 50 percent of her blood volume in a postpartum hemorrhage. Needless to say, she was relieved that she was in a place where blood transfusions were readily available … she believes she will want midwife care at a hospital next time.

    … Bialik’s first birth didn’t go the way she wanted. After three days of labor at home, she stalled at 9 centimeters, one short of the goal. Her midwife suggested they go to the hospital, where after a natural childbirth, Bialik’s son spent four days in the neonatal intensive-care unit. “My son was born with a low temperature and low blood sugar, which isn’t unusual in light of the fact that I had gestational diabetes,” she explains. “I understand doctors need to err on the side of caution, but there was nothing wrong with my child. All of our plans for bed sharing, nursing on demand, bathing him — gone.”

    The experience was scarring. “I felt a sense of failure that I had to call my parents from the hospital,” Bialik continues. “Yes, I know vaginal birth in the hospital is the next best thing to a home birth.” …

    I point out that natural childbirth in the hospital — her “failure” — was my best-case scenario. But I also understand when she says, “Everyone is allowed her own sense of loss.” She realized her vision when her second son was born at home.

    The second time around
    I don’t consider myself a candidate for a home birth. The risk of uterine rupture from an attempt at vaginal birth after cesarean (VBAC) makes it unthinkable … I’m also not really interested in a home birth … But I’m also not interested in another C-section …

    So I’d like to attempt a VBAC, but I know that it doesn’t always succeed. I have a new doctor — the 10th I interviewed following my son’s birth — at a new hospital, and he has agreed to help me try. But my primary goal is more modest: not to be retraumatized. Even now, my heart pounds at the sight of hospital receiving blankets, the antiseptic smell of the maternity ward.

    The common thread in Bialik’s and Sam’s stories that impressed me was how supported and safe they felt with their midwife …

    In an e-mail Bialik sends after our meeting, she goes back to my idea that some women weren’t meant to have babies the holistic way. “There are those among us who believe that if the baby can’t survive a home labor, it is OK for it to pass peacefully,” she writes. “I do not subscribe to this, but I know that some feel that … if a baby cannot make it through birth, it is not favored evolutionarily.”

    I think about my appendectomy, back in 2003. Had I not made it to the hospital in time, I would be dead. What would it be like to refuse medical intervention? I’d call my family, say my good-byes. “I’m sorry,” I’d say. “But I’m not evolutionarily favored. It’s time for me to go.”

    This attitude, that everything was better back when there were no doctors, seems strange to me. C-sections, although certainly done too often, can save lives. Orthodox Jews still say the same prayer after childbirth that those who have been in near-death experiences say — and with good reason. A birth that leaves mother and child healthy may be commonplace, but it’s also a miracle every time.

    As the weeks pass and my belly grows, I can’t stop thinking about Sam. Her pregnancy was a sacred time, and she had truly looked forward to labor. Is that what I should try for — a meaningful birth, as well as an untraumatic one? At what point had people like Sam and me learned to feel entitled to a meaningful birth?

    “I think that birth should be a beautiful experience,” says obstetrician Kimberly D. Gregory, M.D. She’s the vice chair of women’s health care quality and performance improvement at Cedars-Sinai Medical Center in L.A. “It should be exactly the way you want it, and doctors should intervene only to preserve the health or life of you or your baby.”

    Naturally, one would assume that Dr. Gregory advocates birth plans. When I ask her this, she laughs. “We always say, ‘If you show up with a birth plan, just get the C-section room ready,’” she says. “You get everything on that list that you don’t want. It’s like a self-fulfilling prophecy.” Dr. Gregory led an unpublished study that compared women who took traditional hospital birth classes with those who employed Bradley-like training and a birth plan. The birth-plan group trended toward a higher C-section rate and more interventions. “There’s a certain personality type that tends to be more anxious. Maybe the anxiety hormones themselves put them at risk,” Dr. Gregory theorizes. “It seems that being open and honest and choosing the right doctor is probably a better option than writing everything down. Walking in with this list appears to set up an antagonistic relationship.” …

    … In the past three weeks, I’ve had the same dream. I’m in a field (I believe at Ina May Gaskin’s Farm), and women in braids are dancing around me as my baby is born, painlessly, joyously. As I reach down, I notice my C-section scar is gone.

    I wake up upset. Am I truly under the impression, subconscious though it may be, that taking back this birth will undo the damage of the last one?

    “I don’t understand this phrase ‘take back your birth,’” nurse-midwife Pam England, creator of “Birthing From Within,” … tells me. “Who took it? What would a woman tell herself it meant about her if she failed to meet the criteria she made up for ‘taking back’ her birth? I am concerned that this phrase, meant to generate action and a feeling of empowerment, may actually be generated by or feeding the victim part of her.”

    England is right: Having a childbirth that I deem successful this time will not change what I haven’t overcome from the first. I try to find a way to make what my doctor and nurses did to me OK, but my mind rebels. I feel loss — no, theft — of an opportunity for me to have a baby the way so many other women do: a carefree pregnancy, a labor that could still go any way.

    Maybe I’m not so different from the women I spoke with, after all. Bialik had a successful natural childbirth but felt like a failure because it was in the hospital. Women who had a C-section also used words like failure. Perhaps part of the problem is that our generation of women is so ambitious, so driven, that we don’t know how to do anything without quantifying it as a success or failure.

    According to Dr. Gregory, women are now requesting a C-section for their first birth, even without indication. “A lot of people are uncomfortable with the unknown,” she says. Plenty of people are wary of C-sections by choice, from holistic moms to obstetricians. But isn’t this, too, taking back your birth? Refusing to be out of control seems to me the epitome of taking it back. You don’t have to have an unattended birth in the woods to be considered a real woman.

    Deciding that you can’t control the uncontrollable — and committing to that decision when you are, in fact, out of control — is also taking back your birth. It’s what your grandmothers did. It’s what their grandmothers did.

    With this, I realize that I have already taken back my birth, but not as part of any movement. I have stopped judging women who take extra precautions as defensive and started to understand that everyone has to find her way.

    I don’t know how this story ends. I’m still not convinced my body was made to deliver vaginally. But here’s what I do know: I will insist on kindness. I will insist on care. And I hope I will be open to being treated kindly. It’s harder than it seems.

    I have another hope, too. I hope there will be a moment when … I will look down at my baby — whether he is handed to me on my belly or from behind a curtain as my body is sewn shut — and I will remember what I’ve known from the beginning, when I looked down at that plus sign and we were alone together for the first time. Before these questions wrapped around my neck, choking me for answers. I will know that I am his mother and he is my son. And maybe, in that moment, I will be ready to say that the only success and failure is the outcome of the birth, that we are healthy …

    I’m concerned that birth is defined in terms of success and failure, and that after this author’s journey, she has determined that health is the only important factor. In this day and age, it is entirely possible to have a safe VBAC – a safe birth experience as well as a satisfying one. The vast majority of women who choose VBAC will be successful provided that they choose the right care provider.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Study Measures Gestational Diabetes Risk

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

    Link

    Pregnant women who develop gestational diabetes during their first pregnancy are at increased risk for developing this condition in their second or third pregnancies …

    … gestational diabetes … affects about 4% of all pregnancies, according to the American Diabetes Association.

    In the new study of 65,132 pregnant women, those who had gestational diabetes during their first pregnancy had a 13.2-fold increased risk of developing gestational diabetes in their second pregnancy.

    Those who had gestational diabetes in their first pregnancy but not their second had a 6.3-fold increased risk for developing this condition during their third pregnancy, and those women who had gestational diabetes in their first and second pregnancies had close to a 26-fold increased risk for developing gestational diabetes in their third pregnancy, the study showed …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Fancy giving birth with just essential oils for pain relief?

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

    Link

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

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

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

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

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

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

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

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

    Essential oils costs less than 50p per person …

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Canadian Researchers Suggest Review Of Current Guidelines On C-Sections

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

    Link

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    framework for privately practicing midwives

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

    Midwifery in the home nsw legal

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

    Private health insurance, private midwifery care, australia

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

    Private midwife vs obstetrician

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

    Water birth experts australia

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    Exorbitant prices with Sydney obstetricians, alternatives?

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

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

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

    Refusing to be induced at hospital

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

    How to have a baby naturally in a hospital

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

    Home birth fetal auscultation

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    Can my private midwife go with me to public hospital?

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

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

    Difference between midwife and obstetrician

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

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

    Average cost parking at hospital

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

    Can you have midwives deliver in private hospitals?

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Homebirth: What to expect

    Visit my website to learn more about my services.

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

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

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

    Visit my website to learn more about my services.

    Professional indemnity insurance for midwives

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

    Link

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

    The insurance will be provided by Medical Insurance Group Australia.

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

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

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

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

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

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

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    changes to medicare obstetrics

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

    waterbirths in sydney

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

    antenatal classes sydney and independent childbirth educators sydney

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

    can i refuse use of forceps

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

    can you go public if you have phi maternity

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

    caseload midwifery and homebirth

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

    cost of a private midwife sydney

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

    how will homebirth be affected by the health reform australia 2010

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

    which is safer hospital or midwife?

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

    can I have a waterbirth after a caesarean?

    Of course you can!

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    The Mother Friendly Childbirth Initiative

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

    Link

    … maternal mortality is on the rise in the U.S … two of the four preventable pregnancy-related deaths were associated with cesarean section-the failure of hospital staff to pay attention to worsening vital signs after women have the operation, and the staff’s inability to respond appropriately to hemorrhage resulting from a cesarean. The two others are uncontrolled high blood pressure and undiagnosed fluid build-up in the lungs of women with pre-eclampsia … by following the principles of the evidence-based Ten Steps of The Mother Friendly Childbirth Initiative (MFCI) and giving low-risk women access to midwifery care mothers’ lives could be saved.

    … The Initiative is an effective wellness model of maternity care that offers safe choices to overused and costly high-tech birth interventions that often lead to avoidable cesareans …

    … compared to maternity care provided by physicians to low-risk women, women cared for by professional midwives have a lower incidence of hypertension and pre-eclampsia, fewer hospital admissions for complications during pregnancy, fewer cesareans and more VBACs … the risks of maternal mortality are increased with repeat cesarean section compared to vaginal birth after a prior cesarean …

    The Mother Friendly Childbirth Initiative:

    1. Offers all birthing mothers:
    • Unrestricted access to the birth companions of her choice, including fathers, partners, children, ¬family members, and friends;
    • Unrestricted access to continuous emotional and physical support from a skilled woman—for ¬example, a doula,* or labor-support professional;
    • Access to professional midwifery care.

    2. Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.

    3. Provides culturally competent care—that is, care that is sensitive and responsive to the specific beliefs, ¬values, and customs of the mother’s ethnicity and ¬religion.

    4. Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.

    5. Has clearly defined policies and procedures for:
    • collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;
    • linking the mother and baby to appropriate community resources, including prenatal and post-¬discharge follow-up and breastfeeding support.

    6. Does not routinely employ practices and procedures that are unsupported by scientific evidence, ¬including but not limited to the following:
    • shaving;
    • enemas;
    • IVs (intravenous drip);
    • withholding nourishment or water;
    • early rupture of membranes*;
    • electronic fetal monitoring;
    other interventions are limited as follows:
    • Has an induction* rate of 10% or less;†
    • Has an episiotomy* rate of 20% or less, with a goal of 5% or less;
    • Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;
    • Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.

    7. Educates staff in non-drug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.

    8. Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.

    9. Discourages non-religious circumcision of the newborn.

    10. Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:
    1. Have a written breastfeeding policy that is routinely communicated to all health care staff;
    2. Train all health care staff in skills necessary to implement this policy;
    3. Inform all pregnant women about the benefits and management of breastfeeding;
    4. Help mothers initiate breastfeeding within a half-hour of birth;
    5. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants;
    6. Give newborn infants no food or drink other than breast milk unless medically indicated;
    7. Practice rooming in: allow mothers and infants to remain together 24 hours a day;
    8. Encourage breastfeeding on demand;
    9. Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;
    10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    home birth: how messy is it

    Homebirth generally isn’t messy. Many women labour and birth in a birth pool and any bodily fluids are easily contained. Towels and plastic sheeting come in handy and midwives are very good at leaving the house as it was found. Plastic bags collect any garbage, the placenta is collected in a bowl or container, and sheets and towels can be washed.

    midwives home birth still legal

    Yes, it’s still legal and it will remain legal after July 2010.

    how many hours a day do you spend breastfeeding

    Breastfeeding can take a long time! Some women spend about 50% to 2/3 their time feeding, especially if it’s a newborn baby. Newborns can healthily feed every couple of hours for an hour at a time. This feeding pattern is helpful to encouraging the mother’s milk supple, allowing bonding to occur, help the baby’s palate and jaw muscles to form well and assist the baby’s digestion.

    i would like a private midwife but im giving birth at a public hospital

    Women may take private midwives with them to pubic hospitals. Women may book into hospital, have all their pregnancy care with their private midwife, birth in hospital with their midwife and hospital staff, and then return home to continue care with their private midwife.

    in home birth, what happens if emergency c-section is needed?

    In homebirth, midwives are always on the look out for any signs of things not going well in the pregnancy or labour. This allows for women to be seen by doctors or transferred to hospital before true emergencies occur. Most “emergency” caesareans are not in fact emergencies in that they are life and death situations. They most commonly occur because a labour is not progressing and the baby will not come out any other way. However, in the event that a caesarean is needed, the midwife and woman simply transfer to hospital and are offered the best obstetric and midwifery care possible in the circumstances. planning a homebirth does not commit the woman to birthing at home if circumstances make it that hospital would be safer.

    what’s the difference between a midwife and obstetrician

    Obstetricians are doctors who have completed a degree in medicine and a degree in surgery. They then complete several years of internship and residency before going back to specialise in obstetrics. An obstetrician is a highly trained and educated doctor who specialises in the care of pregnant and birthing women, mostly dealing with complications. Obstetrics is a surgical specialty.

    Midwives are qualified to care for women throughout pregnancy, birth and postnatal. They care for healthy women who are experiencing normal pregnancies. If a woman’s condition warrants consultation with an obstetrician, this can be arranged without fuss. Midwifery care generally affords women lengthier consultations, more personalised care and a greater satisfaction with the birth experience. Women who
    are attended by midwives are more likely to experience a normal birth, to breastfeed and to receive fewer interventions in their pregnancy and labour such as induction, epidural and episiotomy.

    water birth private hospital

    Good luck! Private hospitals (in Sydney at least) do not allow for water births. If anyone knows of a private hospital that allows waterbirths, please let me know! Nabmour allows waterbirths but it is not in Sydney.

    how to avoid hospital birth

    Well, if you don’t go to hospital, you can avoid a hospital birth. I guess the question is – how can you prepare well for a homebirth so that you minimise your chances of needing to go to hospital? I think an excellent approach is to book with a midwife and explain that you would really like her to help you to birth at home.

    how to choose a midwife

    See here.

    limitations of using a private obstetrician for maternity care pregnancy

    1. You’re more likely to have intervention in your pregnancy and labour
    2. Your obstetrician is likely to work with other obstetricians, sharing on-call over the weekend. So it’s possible that your obstetrician will not be available to you when you’re in labour.
    3. You will be attended by hospital midwives in labour and postnatally who you may not have met.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    birthing centre epidural

    It’s not possible to have an epidural in a birth centre. If you need an epidural, the midwife will move you to the delivery suite.

    epidural private hospital

    On the other hand, it’s very pssible to have an epidural in a private hospital. In some private hospitals, almost 90% women have an epidural.

    gestational diabetes midwifery home birth

    While it might be possible to birth at home with gestational diabetes, it’s best to speak with your midwife.

    homebirth midwives central coast nsw

    There are no homebirth midwives on the Central Coast. There is one who will travel up from Sydney.

    midwife managed pregnancy Sydney

    Private midwifery care will enable midwife-managed pregnancy care. With a private midwife, you choose your own midwife and she will provide all of your pregnancy, birth and postnatal care.

    no intervention birth

    No-one can guarantee no intervention in birth and also guarantee safety. Most births do not need intervention of any kind. No examinations, no induction, no epidural, no caesarean, no forceps or vacuum and so on. But some women, some babies, or some labours will occasionally need some help, and it can be hard to predict at the start of the pregnancy which ones might need help, and which ones are fine. The best strategy would be to contract a private midwife who you trust, and allow her to provide your care in partnership with you.

    the right time for consulting mid wife during pregnancy

    It’s best to consult with a midwife as soon as you find out you’re pregnant, especially if you’re choosing a private midwife as we tend to book out fairly fast.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    Birth trauma symptoms

    The symptoms of birth trauma are many and varied. A common theme is that the trauma interferes with your enjoyment of daily life. The trauma issues may surface at different times, and then completely disappear.

    Some women experience:

  • Flashbacks of the event and sudden, vivid memories. You will usually feel distressed, anxious or panicky when you’re exposed to things that remind you of the event
    Avoidance of anything that reminds you of the event. Some women never talk about their births or avoid hospitals. In contrast, other women talk about their birth trauma all the time; this is their way of expressing their extreme hurt, anger and fear.
    You may also experience emotions such as anger, irritability, and hyper-vigilance (feeling jumpy or on-guard all the time)
    Nightmares of the birth
    Physiological responses when you are exposed to events resembling the traumatic event, such as panic attacks, sweating and palpitations
    Numbed emotions
  • benefits of birthing by midwives over doctors

    The msin benefits of using a midwife are:

    Higher chance of natural birth
    Continuity of care: you have the same midwife for pregnancy, labour, birth and postnatal care. Even with a private obstetrician, you’ll be attended by midwives you have not met when you’re in labour and afterwards when you stay in the ward with your new baby. If you choose midwifery care, especially private midwifery care (no private health insurance needed), you have the same person looking after you the whole way through.

    do you need informed consent episiotomy

    Most definitely! The only time consent is not needed is in a genuine emergency. Since women are generally awake for their births, there is no reason why your midwife or doctor would not seek your permission before doing an episiotomy, even in an emergency situation. Remeber – you can always say no to an episiotomy.

    duty of care to an unborn child

    Midwives and obstetricians do owe a duty of care to the baby. Babies do nto have any rights until they are born alive and take their first breath. Once they do that, they are afforded the full rights of a person.

    no obstetrician for birth in private hospital

    Currently, it is not possible to birth in a private hospital without an obstetrician. However, you can have a private midwife and a private obstetrician at aprivate hospital.

    private birthing classes at home, Sydney

    Yes, this is possible. See here.

    will homebirth be legal after July, 2010?

    Absolutely! Homebirth has always been, and will always be, legal. The ability for midwives to practice in women’s homes is dependent on the midwife reporting every homebirth, letting women know that we are not insured for births at home, and also agreeing to abide by a quality and safety framework. This is all designed to give the public greater confidence in private midwifery services and to increase safety for women and babies.

    Birth providers who support vbac in sydney

    The best way of achieving a VBAC in Sydney is to contract a private midwife to provide your care. Private midwives have roughly a 90% VBA success rate.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Netherlands: Epidurals on the increase

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

    I’m sad that it’s happening, even in the Netherlands. I understand the caesarean rate is around 25% too.

    A growing number of Dutch women are opting to have epidural anaesthesia during childbirth …

    The Netherlands has one of the highest rates of home births in the developed world. Around a third of all births take place at home. A similar proportion of pregnant women plan to give birth at home if all goes well, but on the basis of the midwife’s risk assessment they transfer to hospital during labour.

    The Dutch home birth system isn’t the product of any recent move towards de-medicalisation and natural birth – it’s simply that many Dutch women still give birth at home the way their grandmothers did …

    The Dutch midwives association argues in favour of seeing childbirth as a natural process rather than a medical condition. It points out that home births result in a much lower rate of unnecessary medical intervention, which is safer for both mother and child. However, in recent years the Dutch system has increasingly come under attack. Critics claim it is old-fashioned, and women are being denied proper access to pain relief.

    In 2008, the teaching hospital in Maastricht reported that 25 per cent of women opted to have an epidural. A year later this figure has risen to more than 30 percent … the Dutch epidural rate has a long way to go before it matches … some hospitals … [where] as many as 85 percent of women in labour opt for an epidural.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    2010 cost of home birth

    The current cost of homebirth in Sydney is somewhere between $3000 and $6000 but the cost may come down after November 2010 if Medicare benefits are extended to antenatal and postnatal care.

    Birthing hospital expenses

    Good question! If you are going through the public system and you have a Medicare card, it is free. If you have a private midwife, the cost can be anywhere between $3000 and $6000 (some private health funds will provide benefits for private midwifery and you may claim the cost via the net medical expenses tax off-set). If you are birthing in a private hospital, many people assume that their private health insurance covers all of the costs and are very surprised when the bills continue to come after the baby has been born. You can expect to pay for a private obstetrician (anywhere between $2000 and $10000 in Sydney), the private health fund excess or co-payment, ultrasounds and tests, paediatrician and anaesthetist fees. As well as incidentals such as parking at the hospital, TV, phone etc.

    Difference in childbirth with midwife and childbirth in a hospital

    Midwives attend all births in hospitals, even if you have an obstetrician.

    First time mothers and homebirth

    What a great decision! Discuss your situation with your midwife for more advice. Generally, first babies are ideal for home births. Why? Many first-time mums have caesareans in the hospital system. It’s about one in three. The rate with homebirth? A mere 5%. Why does this matter? Well, these days it’s very difficult to have a vaginal birth after a caesarean in the hospital system as the hospital system generally does not support VBAC, either covertly or overtly. So it’s really important that you optimise your chance of a natural birth with your first baby. Transfer can be more likely in a first labour, partly for reasons such as a long labour and the woman’s request to transfer for pain relief, or for other reasons such as high blood pressure. Your midwife will guide you as to whether transfer is necessary.

    Hospital midwife compared to private midwives

    A private midwife is bound by the same regulatory mechanisms as a hospital midwife is/ w e are all bound my a code of ethics, code of conduct, competency standards, we are all registered and are bound to comply with the various Acts such as the Poisons Act, coronial law, civil law, criminal law and the nurses and midwives act etc. the main differences between a private midwife and a hospital employed midwife, for you as a pregnant and birthing woman is as follows:

    - hospital midwives have the additional requirement of having to follow hospital policy. What is wrong with this/ some policies are not based on evidence, and some may be out-of-date. This of course creates safety issues for women. the other problem is that people generally don’t like to be treated “routinely”, they like individual care. this is where a private midwife is a real advantage: women can access evidence-based care and are treated as an individual.
    - the other benefit to having a private midwife – the main benefit – is access to continuity of care. private midwives birth with women at home or in hospital, either as a planned hospital birth, or as part of a homebirth transfer. continuity of care is beneficial to women and babies and has advantages such as enhanced breastfeeding rates, increased satisfaction from women with the service, fewer interventions in labour and birth, fewer admissions to the nursery and so on.

    Which is safer for baby repeat c section or vbac?

    This is a good one to discuss with your care provider. For a balanced appraisal, it would be worth seeking a consultation with a private midwife as well. generally speaking, repeat caesarean has risks for the baby in terms of breathing difficulties and later asthma, allergies and diabetes. VBAC on the other hand has a very small – 0.5% – risk of uterine rupture. When this statistic is put into the perspective of other risks with having a baby, it is a very small risk.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    What are the disadvantages of birthing in hospital?

    Most women who birth in hospital do not have the same midwife with them throughout pregnancy, birth and the postnatal stay. They have different midwives for pregnancy care, then another lot of midwives for the birth (sometimes 3-4, depending on how long the woman is in delivery suite and whether the midwife has a student midwife working with her), followed by another lot of midiwves who work in shifts in postnatal. The lack of continuity means that the woman does not have the opportunity to really develop a deep sense of trust with her own midwife, something that is intrinsic to positive and safe birthing experiences.

    Women who are attended by hospitals have hospital policies drive their care. Policies around induction: when and how it’s done; when a caesarean is done; how often they are to be examined; which women are to be continuously monitored; which babies are to be admitted to the nursery and so on. It’s a bit like checking a box and then applying a treatment or intervention – without first checking if that treatment or intervention is genuinely needed in the woman’s case.

    When women have their own midwife with them – either for hospital, birth centre or home birth, they have the full range of options open to thema nd they are fully informed and able to make their own decisions around pregnancy and birth care.

    birthing options

    To learn more about birthing options, why not come along to the Essential Birth Consulting workshops?

    Can I have a midwife as additional support in pregnancy?

    Absolutely! It’s a great way to supplement and complement the care option that you have chosen. You can have a midwife as additional support whether you’re going to a public or private hospital, and even if you also have a private obstetrician. See here for details of birthing statistics with and without your own midwife.

    midwife medical offset?

    It’s called the net medical expenses tax offset. Contact your registered tax agent or accountant for more advice. my understanding is that once you have $1500 in out-of-pocket medical expenses (doctor’s fees, midwifery, prescriptions, optical, dental etc) you can claim 20% the cost through tax.

    midwifery care fees

    Private midwifery costs somewhere between $3000 and $6000. Essential Birth Consulting has new payment structure where families may choose to pay by the hour, potentially making this the best value midwifery service in Sydney, at around $3000 for a complete package of pregnancy, birth and postnatal care. Birth support is available for around $1500.

    Are there any homebirth classed in sydney?

    Yes! Why not come along to the Essential Birth Consulting workshops?

    access to rebate on midwife visits

    After November this year, women who are planning a hospital birth with a private midwife will be able to claim a medicare benefit for midwifery services. The benefit amount is not known at this stage and it is likely that there may be some out-of-pocket expenses too, but it will bring down the cost once Medicare benefits are payable.

    Are hospital births unnecessary?

    Every woman will need to come to her own conclusions on this one. My opinion is that home is the safest place for a low-risk, healthy woman to birth her baby. Leave hospitals for those who need them! In that case, most women would actually birth at home.

    bowral midwife educator

    I’d recommend Peter Jackson’s Calmbirth classes.

    Can i have an epidural with a midwife?

    Absolutely! Although many women find that they don’t need one when they’re cared for by the same midwife and supported well in labour. My experience has been that the call for an epidural is mostly a call for more support and suggestions for getting though the labour. Epidurals are a good option for some women in some labours.

    Can midwives administer oxytocin at a home birth?

    Yes, if it’s to manage excessive bleeding after the baby is born, but we cannot use it to induce or augment the labour. Those interventions must be attended in the hospital as they carry risks to the baby. Midwives routinely carry oxytocics to births in case they are needed.

    Cost of homebirths in the illlwarra

    Private midwifery costs somewhere between $3000 and $6000. Essential Birth Consulting has new payment structure where families may choose to pay by the hour, potentially making this the best value midwifery service in Sydney, at around $3000 for a complete package of pregnancy, birth and postnatal care.

    Does having gestational diabetes mean a c section?

    This would be a good one to ask your care provider. Generally speaking, gestational diabetes does not automatically mean having a caesarean.

    Private midwife public hospital sydney?

    Yes, it is possible to take your own midwifey with you in a public hospital. This service provides this as an option. Women book with their private midwife, booki into the hospital, receive all of their pregnancy care from their midwife, labour at home as long as possible with their midwife (even having the option of staying home if all is well), head off to hospital when the time is right, and then come home as soon as possible and continue care for 6 weeks. In the hospital, a hospital midwife will also be assigned to you.

    Pprivate midwives in Sydney’s east?

    Yes, this service provides private midwifery services in the eatern suburbs.

    Reasonable obstetricians north shore 2010

    What is reasonable? What is important to you? At the end of thr day, it’s about choosing a care provider who is suited to your needs. As experts in abnormal pregnancy and surgery, obstetricians are ideal care providers for risk-associated pregnancies. If your pregnancy is normal and you prefer a more natural option, midwifery care will best meet your needs. Private midwifery is the oldest form of continuity of midwifery care, however there is a price attached to this model as it is a private service. Public options are free but will lead you down the path of hospital policy and interventions.

    What is the difference in cost between public and private?

    Private has costs attached: obstetrician, paediatrician and anaesthetist fees, private hospital fund excess / co-payment, any other fees and charges from the private hospital (eg TV, phone, parking etc) and also tests and ultrasounds. Public is free if you have a Medicare card.

    Transition into parenthood

    These are highly recommended childbirth education classes that prepare couples well for the changes in pregnancy, birth and parenthood.

    vbac north shore private?

    It’s very unlikely to happen at North Shore Private! Around 5% of the women who have previously had a caesarean go on to have a vaginal birth in that hospital. Private midwifery care – either for home birth or hospital birth – increases that percentage to 80-90%.

    water birth private hospital sydney

    None of the private hospitals in Sydney allow waterbirth. Waterbirth is the norm in a homebirth and may be an option in a public hospital if there are midwives on shift – and baths / pools available – to facilitate this.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    What are the advantages to having an independent midwife?

    Independent midwifery practice is the oldest form of continuity of midwifery care. Recent research has demonstrated that this form of care – where a woman is cared for by the same midwife throughout pregnancy, birth and the postnatal period – is beneficial for women and families. It results in increased satisfaction with the birthing experience and enhanced safety. When multiple care providers are involved in a woman’s care, the chance of errors is high because care is provided in pieces. When a woman is cared for by one midwife, she has one point of reference, no conflicting advice, she can develop trust and a sense of security and the birth will generally proceed naturally.

    Who is the best obstetrician in Sydney?

    Good question! It depends how you define “best”. For many women, bedside manner is the only determinant of “best”, while safety records and intervention rates are rarely checked by women. It’s ok to ask questions of your obstetrician and to come to your own conclusions about who is the “best” obstetrician.

    What are my options for birth after July 2010?

    After July, they will be the same as they are currently, and homebirth will remain legal. The difference will be after November, when, for the first time, women will be able to book under the care of a private midwife and birth in hospital – hopefully public and private. Many women would like to birth in a private hospital but they want to be cared for by a midwife. Currently, there is no way to facilitate this: all women who birth in a private hospital must have an obstetrician. This may change in November. As well as this, women will be able to claim Medicare benefits for midwifery care and midwives will be able to prescribe medications and order tests and ultrasounds.

    Birth centre exclusion criteria

    Check with your birth centre. General exclusion criteria include twins, breech babies, high blood pressure, a need for induction or a request for an epidural.

    What is the cost of a midwife birth?

    All midwives charge different amounts, but in Australia you can expect to pay between $3000 and $6000.

    Do midwives give epidurals?

    No, midwives are not qualified or trained to administer epidurals. However the midwife can – on a woman’s request – call for an anaesthetist to administer an epidural.

    What are the positives of hospital birth?

    If you have any complications in your pregnancy, hospital might be a safer environment to birth your baby in. Some women feel reassured by the machines and technology that is commonplace in hospital. I encourage homebirth for all healthy women whose pregnancies are low-risk because home is the safest place to birth a baby. We don’t go to hospital for other bodily functions – unless something is wrong. Why is birth any different?

    How can a midwife own a private practice?

    Midwives are autonomous health professionals, just as dentists, psychologists and dieticians are. Midwives can provide care in any setting – including the home – and if obstetric care is needed, the midwife can access this for the woman readily at the hospital.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    Can I home birth if I have a high blood pressure?

    It is best to discuss this with your midwife and s/he can guide you on this one.

    Can you opt for a c-section in a public hospital?

    Generally speaking, you cannot do this. Caesareans are only performed where there is a clear obstetric reason. Many women have support people with them for their labour and this helps them to feel more comfortable and in control of their experience.

    Can you refuse midwife attendance during birth?

    You can refuse to have a midwife with you if you choose, but this would leave you without professional care during the birth.

    What care is available to women birthing in australia?

    Within the private system, women may choose a midwife for a home or a hospital birth and they will generally experience an empowering and natural birth without complications. If there are complications in the pregnancy or birth, obstetric care is readily available. The other option in the private system is to choose an obstetrician. Intervention rates with obstetricians are high, with caesarean rates up to (and over) 50%, episiotomy rates around 25% and assisted delivery rates around 25%.

    In the public system, midwifery care is the norm, but most women will not have the same midwife all the way through their pregnancy, birth and postnatal period. If there are complications in the pregnancy or birth, obstetric care is readily available.

    Continuity of midwifery care

    The most established method of continuity of midwifery care is private midwifery care or independent midwifery. In this model, women book with the midwife of their choice and this same midwife is there for the woman throughout pregnancy, birth and the postnatal period. Satisfaction rates with this mode of care are very high.

    IVF and home birth?

    Yes, it is possible to bith at home following IVF. Talk to your midwife.

    Are midwives qualified to do cesareans?

    No, midwives are qualified in normal pregnancy and birthing, and we do not perform surgery.

    Natural labour in sydney?

    The best way to achieve a truly natural labour is to book with a private midwife for a home birth or a hospital birth. Home is the safest place to birth for the majority of women, and home – where women feel safe, nurtured and supported – is the most conducive environment for a natural birth.

    Are there any obstetricians in sydney under $5000?

    The best way to research prices is to ask the obstetricians themselves. Don’t forget, the ob’s bill is not the only bill you will receive: there is also the paediatrician, anaesthetist, private hospital fees, health fund excess / co-payment, childbirth education and so on.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Twice as Many Women May Soon Be Diagnosed With Gestational Diabetes

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

    Link

    New measurements for determining dangerous blood sugar levels for pregnant women and their unborn babies mean that two to three times as many women will be diagnosed with gestational diabetes …

    Instead of 5 percent to 8 percent of pregnant women being diagnosed with gestational diabetes, the new measurements mean that more than 16 percent would be diagnosed with the condition …

    The current gestational diabetes measurements are based on blood sugar levels that identified women at high risk for developing diabetes in the future, but didn’t take into account other risks to the mother or baby, including increased risk of overweight babies with high insulin levels, early deliveries, cesarean deliveries, and potentially life-threatening preeclampsia …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    How long before my due date will my elective caesarean be performed?

    Elective caesareans should not be performed before 39 weeks unless there is a genuine reason to do so. This helps the baby’s lungs to mature.

    Are there any breathing issues for babies who are born by cesarean?

    Yes, breathing difficulties are more common in babies who are born by caesarean. They are not primed by breathing as they are with a vaginal birth, and the fluid in their lungs isn’t squeezed out as is the case with a vaginal birth. As well as this, ceasar babies are more prone to asthma in childhood and adulthood.

    What are the pros and cons of caesareans?

    I don’t believe there are any benefits to major surgery without sound reason. There are many potential issues with caesareans:
    - increased blood loss
    - infections
    - blood clots
    - poor wound healing
    - adhesions inside
    - increased chance of miscarriage
    - lower rate of fertility
    - higher chance of tubal (ectopic) pregnancy
    - lower chance of ever having a vaginal birth after a caesarean
    - increased pain in the recovery period
    - poorer bonding
    - more breastfeeding problems
    - risks associated with anaesthetics

    What does it cost to have an obstetrician in Sydney?

    Anywhere between $2000 and $10,000.

    What does it cost to have a midwife for a home delivery in Sydney?

    Usually around $3000 – $5000. This represents fantastic value for money: midwives see their clients for 1-2 hours for each pregnancy visit, they’re there throughout the labour and of course visit the family for 6 weeks after the new arrival has come.

    What are the vbac rates in australian hospitals?

    Fairly low! Anywhere between 1% and about 30%. The average is around 15%.

    Can i have a water birth after a cesarean?

    Yes, but you’ll need to choose your care provider wisely. I’d recommend a private midwife. Most hospitals will not officially “allow” a waterbirth.

    What is the best hospital in sydney for a natural childbirth?

    The best place for a natural birth is not hospital. Home is the best environment for a natural birth, cared for by a private midwife. Your midwife will refer you into hospital if there are any problems, but most home births go very smoothly.

    Can I have a home birth after IVF?

    Absolutely!

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQS

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

    Why are are home births with a mid wife preferred over a hospital delivery?

    There are many benefits to birthing at home and having a midwife provide your care. The following pages will explain more about the benefits of birthing at home:

    http://www.essentialbirthconsulting.com.au/home-birth.html

    http://www.essentialbirthconsulting.com.au/home-birth/home-birth-benefits.html

    I had a bad first birthing experience and I’m now waiting for my second baby.

    It’s important to debrief your birth experience to help you to gain clarity around what happened and to explore strategies for helping the same situation to not happen again. Birth debriefing can also help you to choose a care provider who can support what it is you need for your second birth.

    What are the benefits of having my baby with a midwife?

    There are many benefits:
    - Have the same care provider all the way through your pregnancy, birth and postnatal period
    - Lower rates of intevention such as forceps, vacuum, episiotomy, induction, epidural
    - More likely to breastfeed successfully
    - Have continuous support from your midwife throughout labour
    - Babies generally experience gentler births

    What proportion of women birth at home with midwife?

    Australia-wide, around 0.3%. In NSW, it’s around 0.2%. The low rate of homebirth is related to several factors:
    - Homebirth is not actively supported by our health system, and hence it is not offered as an option to women when they see their GPs when they become pregnant.
    - There is a perception that home birth is something only “hippies” or “alternative” people do. This could not be further from the truth!
    - The cost of homebirth is prohibitive for some families as it is totally privately funded.
    - In some areas, there are no midwives available.

    Is it possible to contract a private midwife for postnatal care only?

    Yes! Essential Birth Consulting provides postnatal care independent of birthing services.

    Are there any VBAC friendly doctors at north shore private?

    VBAC rates at North Shore Private are around 5% or lower and this is reflective of the obstetricians who practice there. Conversely, private midwives have VBAC rates as high as 90%. Obstetricians are surgicial specialists; midwives are specialists in normal, natural birth. If you’re after a normal birth (VBAC), you’re best to choose a care provider who specialises in this.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    C-section saved my life and baby’s (clear need for education here!)

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

    Link

    In this world where information is so readily accessible, it never ceases to amaze me how mis-informed and ill-informed some people are when it comes to pregnancy and birth. This article is a prime example:

    … As for childbirth being a natural process, yes, that is the case in most pregnancies. I know for a fact that my obstetricians don’t just let their patients go willy-nilly picking when they are tired of being pregnant or delivering babies based upon their Blackberry schedules.

    Are you sure? How many caesareans and inductions are scheduled around when their husband will be home, when the doctor will be around, or the time of the year?

    Have you seen the malpractice insurance premiums these guys pay? They do everything they can to keep babies and mothers alive.

    There is a difference between saving a life that clearly needs to be saved, and saving a life just in case it might need to be saved at some point in the future. Intervening for the latter reason causes unnecessary harm to women and babies.

    I don’t believe the majority of C-sections or early inductions are for revenue; they are for saving lives.

    See above.

    My child was a “complete” breech and if was not delivered via C-section, I and the child would have more than likely died during the “natural process of child delivery.”

    Actually, recent research and guidelines support vaginal breech birth. It is sad that you were not informed of this.

    Let’s stop C-sections or put a stigma on them and see what happens to mortality rates for mothers and babies.

    If recent reports have anything to do with this, then the mortality rate will decline if caesareans reduce.

    It seems that society wants a guarantee that the baby process is going to be foolproof and everyone gets the perfect “natural birth process” with no drama or sad outcome.

    … it is not my right to have a natural childbirth; it is my privilege to have the best medical care in helping me achieve a healthy and safe delivery of my children.

    And the best way to achieve a healthy and safe birth and baby is with a midwife. The midwife will make appropriate referrals to an obstetrician if this is needed.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    informed consent and childbirth

    Every woman who is competent to consent, has the right to refuse any or all professional care. Informed consent must be obtained prior to any procedure being performed.

    how to minimise labour intervention in a hospital?

    The best way to minimise intervention in a hospital is to be as well informed as you can possible be about all things related to pregnancy, labour, birth, breastfeeding and babies. Read widely, attend independent childbirth education classes and consider employing a private midwife to be with you throughout your labour. She can help you to decide if the proposed interventions are necessary in your situation, she can support you emotionally, mentally and physically and she can aso help to ensure that your birth plan is respected without a fuss.

    Do any independent midwives in Sydney offer prenatal care for women who are planning to freebirth?

    Yes! This service enables women to access antenatal care from a midwife without the midwife attending the birth. Postnatal care is available if needed.

    Do you think there are advantages to continuous monitoring for low-risk women

    In a word, no. Intermittent auscultation is the method of choice. Continuous monitoring will increase the chance of a caesarean with no benefit to the mother or baby.

    How much is a private midwife

    Prices range from $3000 – $6000. Melissa Maimann offers for her clients to pay by the hour, making the service one of the cheapest.

    What is a good caesarean rate?

    The World Health Organisation recommends that no more than 15% births need to be caesareans. The WHO argues that when caesarean rates exceed 15%, the risks to the mother and baby increase on the whole. You’ll be hard-pressed to find a hospital with a caesarean rate of less than 15%, but birth centres and private midwives have caresarean rates of less than 10-15%.

    What is the best hospital in sydney for delivering babies?

    It all depends what sort of birth experience you’re after! If you’re wanting a natural birth, home birth will be the best option. If you want a natural birth in a hospital setting, the best options would be birth centre or private midwifery care for a planned hospital birth. If you’re wanting to have intervention in your birth, a hospital birth would be best. If you choose an obstetrician, you’re far more likely to have a caesarean, episiotomy, epidural, forceps or vacuum. Choosing your care provider is the single most important decision you will make in birthing.

    Is there a birth centre at westmead hospital?

    No, there isn’t. If you’re after a natural birth, the best choice would be a home birth.

    C section or natural delivery midwife?

    Midwves cannot perform caesareans. If a caesarean was needed, the midwife would call a doctor in to perform it. Most caesareans that are performed are unnecessary and increase the risks to the mother and baby. A natural birth is the safest way to birth, and midwives are qualified specialists in natural birth.

    giving birth after birth trauma

    Private midwifery care will be really important so that you can have the same midwife all the way through pregnancy, birth and postnatally. It’s also important to debrief your last experience and come to a place where you feel safe to birth again.

    high risk midwife sydney

    Midwives are not qualified to care for high risk pregnancies. We refer these women onto obstetricians. In most cases, one or two consultations is all that is needed with the obstetrician and the midwife continues the care of the woman.

    how many births proceed naturally

    What a great question! It all depends what care provider you choose and where you have your baby. You see, if you choose a private midwife and birth at home, you have about a 95% chance of having a vaginal birth. If you birth in a private hospital, you have about a 33% chace of having an unassisted vaginal birth. In some hospitals, the caesarean rate is more than the vaginal birth rate! Sad but true.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Roxon grilled over proposed midwife changes

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

    Link

    The Federal Government has been grilled at its latest community cabinet meeting over its proposed changes for midwives and maternity services.

    The Government wants to make midwifery services eligible for Medicare rebates, but only if homebirth midwives work in consultation with a doctor.

    Several women at last night’s meeting … told the cabinet ministers that the changes would restrict the choice of women who only want to give birth with a midwife at home.

    But Health Minister Nicola Roxon says the Government is simply taking a cautious approach.

    “To make sure we’ve got some backup protocols in place, so if something does go wrong that there are agreements with the hospital or doctor to be able to step in quickly,” she said.

    “And that is a conservative approach, but it isn’t a conservative approach to say midwives are doing good work, have never been recognised in the history of providing Medicare for the last 50 years and we’re going to actually change that.”

    She told the meeting that medical professionals should be working together.

    “I’m unapologetically on the record as saying let’s encourage people across the health services spectrum to work together and make sure that women can safely choose options that are good for them and suit them,” she said.

    Women who access private midwifery services will be able to access Medicar benefits. As well as this, midwives will be able to order medications via the PBS.

    The maternity reforms provide women with greater access to continuity of midwifery care. The standard care in a public hospital is for women to see one group of midwives in the clinic, another group in the delivery suite (who work shifts) and then another lot of midwives when they are being cared for with their baby. The maternity reforms will make it possible for more women to be cared for by their own midwife, whom they have chosen. The same midwife will provide care from the first antenatal consultation right up until about 2-4 weeks after the baby is born.

    This is a huge step forward for Australian maternity care. For the first time, women will be able to birth in hospital under the care of a private midwife. Private midwifery care will also be available for home births (as is currently the case). We are continuing to book women for home births beyond July.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Excess weight raises pregnancy risks: study

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

    Link

    Being overweight or obese increases a woman’s chances of having an extra-big baby …

    Excess weight in and of itself also sharply increased a woman’s risk of pre-eclampsia …

    Women have more difficulty delivering very large babies, while these newborns are also at risk of suffering injury during birth, including shoulder dislocation. While women who are overweight or obese are known to run a greater risk of having very large babies and experiencing other pregnancy complications, it has been difficult to separate out the effects of a mother’s weight from those of gestational diabetes …

    This led them to investigate whether BMI … a standard measure of weight in relation to height used to gauge how fat or thin a person is — might influence pregnancy risks and fetal and newborn health, independently of a woman’s blood sugar levels.

    … women with BMIs of 42 or greater … were at more than triple the risk of having an excessively large baby, compared to the thinnest women in the study …

    The heaviest women’s risks of having a C-section were more than doubled, while their likelihood of pre-eclampsia was 14-fold greater than for the leanest women …

    … dietary changes can effectively treat gestational diabetes for more than 90 percent of women with the condition.

    “… treating gestational diabetes going forward is going to continue to be beneficial,” the researcher said. “We have much less evidence at this point as to how to neutralize or reduce the impact of overweight on pregnancy outcome.”

    … it’s probably a woman’s weight before she gets pregnant, rather than how much she gains during pregnancy, that’s important in determining risk.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    No labouring of point on use of epidurals

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

    Link

    The use of epidurals in Ireland during labour has roughly doubled over the past 20 years. “This development isn’t a good thing. Because of the increased risk of potential complications during childbirth, administering an epidural during labour is not only undesirable — it’s also often unnecessary.”

    That is the message from Dr Denis Walsh, Associate Professor of Midwifery at the University of Nottingham, who says a more naturalistic approach to labour-pain management should be considered.

    … “There’s a physiological purpose to labour pain; it’s a natural state rather than a problem. So normal labour shouldn’t need to be treated as a pathology,” said Dr Walsh.

    “Administering an epidural can interfere with the body’s natural responses. During labour the body releases endorphins, which not only affect the state of consciousness, but also stimulate movement. Studies have shown that walking and increased physical activity during labour can assist in the process.” An epidural, in most cases, requires that a woman remain in bed.

    … Epidurals have been shown to increase the duration of labour, and cause a decrease in oxytocin. Additionally, the baby may become malpositioned to transverse or posterior.

    Studies have shown a correlation between the use of epidurals and an increase in the use of forceps to aid delivery, by up to 40 per cent, and some recent research has indicated that epidural anaesthesia can lower prolactin levels in response to breastfeeding in the days following birth.

    … women need to be presented with all the information regarding epidurals before undergoing anaesthesia. … “Some 50 per cent [of anaesthetists] didn’t mention the risk of intervention with forceps. The need to communicate all the risk factors is essential.

    “… if a woman is in severe distress, or there are complications, of course it should be administered.

    “But during a normal birth, there are other ways to make the mother more comfortable,” …

    “… it’s the support given to the mother, not pain management, that’s the more significant factor in a positive experience of childbirth. Key to a positive experience is one-to-one support from a midwife.

    “… One-to-one support has been shown to reduce the number of Caesareans carried out, and reduces the number of epidurals. A midwife can help in pain management both physically, for instance [with] massage, and psychologically, by offering emotional support.”

    Dr Walsh suggests that access to water-immersion facilities … could reduce the need for epidurals. There is evidence to show a correlation between water immersion during the first stage of labour and a reduction in the use of epidurals …

    It’s my experience that women who are well prepared for labour and who are supported in their labours with one-to-one midwifery care, do not need epidurals. A mere 3% of women who use my services choose an epidural for their labours and 80% use no pain relief at all.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Pain relief ‘doesn’t lead to more satisfying births’

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

    Link

    Despite fewer epidurals, the majority of women in midwife-led units were happy with their pain relief.

    MOST IRISH first-time mothers opt for the epidural … But reducing the pain levels doesn’t necessarily mean a more satisfying birth experience …

    The HSE report involved a study of … women who had babies in the Midwifery-led Units (MLUs) … despite having fewer epidurals, 83 per cent of women in the midwife-led units expressed satisfaction with their pain relief, compared with 68 per cent of women in the consultant-led unit.

    midwife-led care was as safe as consultant-led care, resulted in less intervention, gave birthing mothers greater satisfaction and was more cost-effective.

    … the epidural was very effective in complicated labours, for example where the birth was being induced or sped up.

    However, in normal pregnancy … three forms of care reduced epidural use: one-to-one care in labour given by a midwife; access to water immersion, … and access to self- hypnosis or hypnobirthing.

    “When those three forms of care are widely available for women, we see quite a low rate of epidural, even in first-time births. These forms of care are available in birth centres and in home birth situations … ”

    … the downsides of epidural use … included an increase in forceps or vacuum delivery, a lengthening of labour and an increased need for oxytocic drugs to induce labour.

    “Research on women’s satisfaction with labour has found that the one-on-one support they got from the midwife was a much more important part of the actual experience than the experience of pain. Paradoxically, a lot of women talk about a high level satisfaction along with a high level of pain.”

    Dr Peter Boylan … had a different opinion … “The epidural is undoubtedly the most effective form of pain relief … for a first birth … A lot of women find that it transforms what is a miserable experience into one they actually enjoy because they are not suffering the awful pain,” he said …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Benefits of midwifery go beyond money saved

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

    Link

    Midwives in Washington state provide an excellent service to expectant mothers and have their place in the budget under consideration by state lawmakers.

    Midwives provide comprehensive prenatal care for mothers with low-risk pregnancies who plan to deliver at home or at a birth center … they give pregnant women a safe alternative to a hospital delivery, saving taxpayers a considerable amount of money.

    In August 2007, officials at the state Department of Health hired a private consultant to weigh the costs and benefits of midwifery in Washington. The goal … was to compare out-of-hospital births with traditional in-hospital births and determine whether there was a benefit to continue the state’s midwife license and disciplinary program.

    The consultants found that the cost savings of delivery with a midwife — for both public and private insurance — amounted to $2.7 million in a two-year budget cycle. That’s about 10 times the cost to operate the state’s midwife program. The independent analysis found that savings to the state’s Medicaid system alone amounted to almost a half-million dollars.

    The report also looked at cesarean-section births billed to the state subsidized Medicaid program, and found that 12.9 percent of deliveries with a licensed midwife attending resulted in a C-section compared with 24 percent of in-hospital births without midwifery care. C-sections are expensive and sometimes medically crucial. But they also have become the most frequent surgery in the United States and, when performed unnecessarily, are an undue cost to taxpayers.

    Looking at the study findings, there can be no doubt that having the midwife program in place saves tax dollars.

    The consultants also looked at the latest national research on the safety aspects of home deliveries and found that planned home births for low-risk women using midwives had a lower rate of medical interventions and a similar mortality rate with low-risk women who delivered in a hospital.

    … the consultants also found that the risk for cesarean section is lower for women under the care of a licensed midwife as compared with women who did not receive prenatal care from a midwife … women using a midwife were less likely to have an underweight newborn.

    … the average cost for a home delivery for a midwife was $1,000. The cost for a vaginal delivery attended by a physician in a hospital averaged $3,171, increasing to $5,798 for a C-section.

    From the recent reports at the state level, it’s safe to say from a both a cost and safety standpoint, licensed midwives in this state are providing excellent care and saving tax dollars in the process …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Midwife-developed care package shortlisted for award

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

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    A care package for early labour, which centres on midwives giving plenty of one-to-one time to women who are in the latent phase, has been shortlisted for an award.

    The package, called “Getting it right at the very beginning”, has been shortlisted for the “Research into Practice” category of the 2010 Royal College of Midwife Awards.

    … “Not only have we had very positive feedback from the women who received the care, but midwives have also seen the benefits.”

    11 per cent gave birth without any pain relief and 21 per cent used paracetamol to take the edge off the pain … and more women used natural pain relief like a birthing pool or bath.

    Of the group that received the care package, 73 per cent had a normal birth, without any clinical interventions. The Caesarean Section rate was 13.5 per cent.

    This compared with a 37.5 per cent normal birth rate for the women who didn’t have the early targeted support, and a Caesarean Section rate of 37.5 per cent.

    The care package is a set of six proven actions which work in harmony to benefit the outcome of the labour and give women a positive birth experience.
    * L – Look and Listen;
    * A – Assess maternal observations;
    * T – Time;
    * E – Encouragement;
    * N – Non-pharmacological pain relief;
    * T – Telephone

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Giving new life to the role of the father

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

    Link

    More fathers than ever before may attend the birth of their child, but the government is keen to involve them even more closely in pregnancy …

    … fathers-to-be will be the target audience of new leaflets and pamphlets, while the midwives’ body has been asked to draw up new guidelines for its members on how to better draw fathers into the process of pregnancy and birth.

    The Guide for New Dads, produced in conjunction with the Fatherhood Institute (FI), will provide information on a range of issues from paternity leave to breastfeeding.

    “We know men want to be involved with a new baby, but so many chances to engage them are missed,” says Adrienne Burgess, head of research at the FI. “The truth is if you want a mother to eat well during pregnancy, or quit smoking, you have to get the father involved at early stage because his behaviour will unquestionably influence hers.

    And while fathers may say when it comes to breastfeeding – ‘I’ll support you in whatever you choose to do’, mothers’ perceptions about what the father really thinks about breastfeeding and the toll it may take on the body are one reason she may stop.

    … “One issue this raises is whether men will in the end feel more confident … – many studies attest to the way maternal anxiety has increased significantly under the weight of ‘expert’ advice about how to rear children,” …

    Melissa Maimann, Essential Birth Consulting 0400 418 448