Posted by Melissa Maimann on Mar 14, 2010 in
Birth,
Caesarean,
Home birth,
Obstetrics,
VBAC Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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Death after childbirth remains a rarity … but new research suggests that the tragic occurrence is on the rise — and experts are at a loss to pinpoint the reason.
… the United States places 41st on the World Health Organization’s list of safest countries for childbirth. As for 2006, 13 women out of every 100,000 died during or shortly after giving birth, which is higher than rates in Canada, the United Kingdom and Poland …
That’s around 550 deaths out of 4 million annual births across the country.
The federal government had set a goal to reduce maternal deaths by 2010, but the new numbers are four times higher than what they’d hoped to attain.
Health experts aren’t pointing the finger at a specific cause, but they do hypothesize that more obese mothers might be a critical factor.
The high caesarean rates aren’t an issue?
Many maternal fatalities are caused by undetected health issues, such as asthma or heart disease …
Pregnancy can exacerbate pre-existing health conditions, leaving obese women — who now make up 20 percent of pregnancies — more susceptible to potentially fatal consequences.
… Cesarean sections might be another important factor. The number of women scheduling cesarean births has increased by 50 percent … since 1996 … the procedure is … major surgery.
… most maternal fatalities aren’t considered “preventable” …
… advocates hope to see more preventive efforts earlier in pregnancies. That means improved awareness of complications among pregnant women and better screening efforts by doctors, along with thorough postnatal care.
No mention here of midwives, yet the WHO recommends that midwives are the most appropruate care providers for healthy, low-risk women.
Debate also persists over the safety of out-of-hospital births … they’ve increased for the first time in two decades. The births still make up less than 1 percent of all births in the country, but home births in particular were up by 5 percent.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Caesarean, Complicated pregnancy or birth, intervention, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Mar 12, 2010 in
Caesarean,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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Forget for a moment that public hospitals can’t cope with rising demand and elective surgery patients are lingering in pain. We are getting rorted by specialist doctors.
It’s a system where the government pays, the patient pays and the doctor smiles before he or she slaps you with a monstrous bill.
I took notice last year when AAP’s Los Angeles correspondent Peter Mitchell criticised the fees charged by health care providers in the US.
His wife gave birth to a baby boy and the bill come to over $A50,000, but it was completely covered by their $A418 monthly payments for US health insurance.
I have recently confronted a mirror experience as an American journalist living in Australia.
But I calculate that Peter paid less in out-of-pocket costs during his wife’s pregnancy than my wife and I did in Sydney.
We initially decided on the public health system for the birth of our son until we caught sight of our local hospital’s maternity ward: a demountable structure.
… The deal-breaker came when I asked what would be the medical response to an emergency birth.
Answer: a helicopter to transport my wife to a better-equipped facility.
Both of us had private health insurance, which we’d never used, so we thought we’d give it a go.
The out-of-pocket costs for the private hospital were estimated in advance at $500, which turned out to be accurate in the end.
We shopped around for a recommended obstetrician and settled on someone in the CBD who charged $4000, which we thought would be for the delivery, no matter the outcome.
Of that amount, we had to pay $1800 after Medicare.
We heard of prices for obstetricians as low as $3000 in Sydney’s west and as high as $6400 on the north shore.
Our doctor also charged us $100 for every visit to his office, of which we received about $80 back on each bill from Medicare.
So far, we’re in for about $2800, which we thought was about the maximum we wanted to pay in a country that rates its public health care system among the best in the world.
Well, things went a bit pear-shaped during labour and we ended up in the operating theatre …
As often happens in private hospitals …
If I had known what was to come I would have scrubbed up myself for the procedure.
The first anaesthetist charged $700 to stick a needle in my wife for the epidural – a 10-minute procedure.
The second anaesthetist, who was present during the surgery, charged an additional $1386 and did almost nothing.
During my wife’s procedure, a young nurse present made it clear she was there to take photos and asked if I had a camera with me. I did.
The assisting surgeon charged another $420 and to top things off, our obstetrician sent us a bill for another $1539.
Last but certainly not least, a paediatrician making daily rounds at the hospital checked out our son on three separate occasions for less than five minutes a visit.
The cost for that? $700.
Incidentally, we pay $266 a month as a family for private health insurance …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Caesarean, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Mar 10, 2010 in
Birth,
Caesarean,
Home birth,
Midwifery,
Normal Birth,
Obstetrics 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
Tags: Birth choices, Caesarean, Complicated pregnancy or birth, continuity of care, Home birth, hospital birth, midwife, Midwifery, Midwifery services, Normal Birth, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Mar 9, 2010 in
Birth,
Midwifery,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
“Get Me Out: A History of Childbirth” by Randi Hutter Epstein, M.D., 2010, W.W. Norton & Co., $24.95/$31 Canada, 320 pages
You’ve known for days.
The urpy-ness before breakfast (when you can eat breakfast), the swollen bits, the tender bits, all good indications. Even the home-kit was positive but it wasn’t “official” until the doctor said it: you’re pregnant.
But after leaving your first prenatal exam – and after more tests than you’ve had in your lifetime – your mother (overjoyed) read through some information you received and said she never remembered half that stuff when you were born. Grandma (ecstatic) said she wasn’t even awake when your mom was delivered.
Have we come a long way, baby? Yes and no, as you’ll see when you read “Get Me Out” by Randi Hutter Epstein, M.D.
Let’s start in the year 1530. You’re about to become somebody’s mom. Because a sign on the door of your room says “no boys allowed,” you’re surrounded by girlfriends, female relatives and a midwife (if you could afford her). They would have herbs for you, food and drink. Someone might consult a book of pregnancy advice (available for thousands of years). You’d labor with people you knew.
But as an almost-mom in 1530, don’t expect anything for your pain. In 1591, a laboring mother (of twins!) was burned at the stake because she dared to ask for relief.
Fast forward three hundred years.
You’re at a lying-in hospital, so-called because post-delivery recovery takes weeks of bed rest. You might be allowed visitors, but no midwives; male doctors have convinced the general population that midwives are dangerous. Giving birth away from home and family, you’re told, is best for you and the baby.
But there at the hospital, mortality rates are sky-high. A woman might deliver on Monday, feel a little feverish on Wednesday and be dead by Friday. Wouldn’t simple hand-washing be a good idea?
Fast forward a century-and-three-quarters.
By now, doctors know how to repair fistulas (thanks to hundreds of slave women who were operated on without anesthesia), we know that what goes into mom crosses the placenta to baby, and we know how to make a baby in more ways than one.
Fast forward to you.
You’ve got lots of options; more, for sure, than ever before. And if you don’t like any of them, you can join the freebirthers and do it yourself because, hey, that method appears to have worked for millions of years.
Lively, slightly saucy and nowhere near a how-to advice book, “Get Me Out” is a great read that’s purely for the curious, whether a parent or not.
Author Epstein looks closely at the entire baby industry in this book, moving easily between the Middle Ages and modern times, in the laboratory and in the bedroom, from “aha!” moments to plenty of major oopses.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: birth, Birth choices, Home birth, hospital birth, midwife, Midwifery, Obstetrics
Posted by Melissa Maimann on Mar 8, 2010 in
Birth,
Midwifery,
Normal Birth,
Obstetrics 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
Tags: Complicated pregnancy or birth
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
Tags: Caesarean, Home birth, Public and private hospitals, VBAC
Posted by Melissa Maimann on Mar 3, 2010 in
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
… [An] obstetrician who regained his license after the death of two newborns had been monitored by a doctor who himself had been disciplined for a patient’s death.
… Dr. Christopher Dotson had been allowed to help oversee Dr. Andrew Rutland’s probation beginning in 2007. Dotson completed five years of probation in 2005 as part of his settlement of negligence allegations after a woman bled to death following a Caesarean section and a case of a stillborn baby.
A California Medical Board spokeswoman told the Register that probation staff had erred and Dotson has been removed as Rutland’s practice monitor.
Last month the board temporarily barred Rutland from performing surgeries following the death of a 30-year-old abortion patient.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Obstetrics
Posted by Melissa Maimann on Mar 2, 2010 in
Birth,
Midwifery,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
PARENTS of a baby delivered stillborn … claim medical staff repeatedly ignored warning signs their unborn baby was distressed.
… Documents … allege a midwife ignored and turned down the volume of an echocardiogram alarm that sounded for more than three hours …
The documents also claim Mrs Body was diagnosed and treated for deep vein thrombosis and thrombophilia (blood clotting) …
She alleges the hospital ought to have known her medical history and the risks associated and failed to recognise a natural birth “could not be performed safely”.
The documents show Mrs Body was admitted to hospital at 8am on February 26, 2007, and was monitored at half-hour intervals between 9.30am and 3pm.
Her waters were broken by a doctor about 4pm and at 4.30pm an epidural was administered.
It is alleged that at 5.10pm an echocardiogram alarm attached to Mrs Body began making loud noises, but the volume was turned down by a midwife … four other times when the alarm sounded … it was turned down by the same midwife.
Monitors alarm quite often. They do not tell the midwife that the baby is distressed, they prompt the midwife to check the trace and ensure that it is ok. If the midwife determines that the baby is fine, the monitor sound is turned down.
The echocardiogram alarm continued to sound until 8.20pm but medical staff did not respond to it.
It wasn’t until 9.30pm, when Mr Body requested for Mrs Body to have an internal exam that one was performed, court documents claim.
It’s normal practice to leave 4 hours between examinations.
By 10.40pm, Mrs Body was told the baby’s heart rate was “low” and “we need to get her out now”.
This is not an uncommon scenario when a woman has had intervention in her birth. In this case, the woman had her waters broken, had an epidural and presumably also had a syntocinon infusion. All of these can stress babies. I also wonder what position she had been labouring in. It’s common for women with epidurals to labour on their backs and this does not help the baby to navigate the pelvis and be born, and it promotes fetal distress.
Paige Hannah Body was delivered by vacuum extraction about 11pm. She was not breathing and could not be revived … The State Government is yet to file a defence.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: childbirth education, Complicated pregnancy or birth, CTG, Epidural, fetal monitoring, hospital birth, intervention, midwife, Midwifery, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Feb 28, 2010 in
Birth,
Home birth,
Midwifery,
Normal Birth,
Obstetrics,
VBAC 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
Tags: Birth choices, continuity of care, Home birth, hospital birth, midwife, Midwifery, Midwifery services, Normal Birth, Obstetrics, Public and private hospitals, VBAC
Posted by Melissa Maimann on Feb 28, 2010 in
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
Endometriosis affects 10 percent of women of reproductive age, yet the condition remains one of the most neglected and underfunded fields of research in gynecology …
… the statistical association between endometriosis and infertility is beyond dispute. One well-cited study found a higher prevalence of endometriosis in infertile women (48 percent) than in fertile women undergoing tubal sterilization (5 percent) … infertile women are 6-8 times more likely to have endometriosis than fertile women.
… a new diagnostic staging tool has been proposed that predicts the chance of spontaneous pregnancy in those with surgically documented endometriosis who are treated without IVF … The EFI score ranges from 0-10, with 0 representing the poorest prognosis and 10 the best … those patients with scores of 0-3 could expect a cumulative pregnancy rate of 11.1 percent at 3 years, increasing to 68.3 percent for those with scores of 9-10.
… the most common symptoms of endometriosis were painful menstruation, painful intercourse, and incapacitating pain …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Complicated pregnancy or birth, IVF, Obstetrics, Preconception care