Posted by Melissa Maimann on Mar 15, 2010 in
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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A panel of medical experts … recommended steps to reverse a trend that has dismayed many pregnant women: the increasing difficulty of finding doctors and hospitals that will let a woman try to give birth normally if she has had a Caesarean section in the past.
The new recommendations came at a conference held in Bethesda, Md., by the National Institutes of Health to examine why the rate of … VBAC … has plummeted, to less than 10 percent from 28.3 percent in 1996. The repeat operations are feeding the nation’s overall Caesarean rate of 31.8 percent, which has been rising steadily for the last 11 years.
“We found … VBAC is certainly a safe alternative for the majority of women who’ve had one prior Caesarean, provided that the incision was horizontal and low on the uterus … About 70 percent of women who have had Caesareans are good candidates for trying for a normal birth, and 60 percent to 80 percent of those who try succeed.
Private midwives have success rates of 80-90%.
… for each woman, the decision involves a balancing act between the surgical risks from a repeat Caesarean and the risk of uterine rupture. Data presented at the conference indicated that both risks are very small. Over all, a vaginal birth is safer for the mother, but a scheduled Caesarean is slightly safer for the baby.
I don’t know how they could have come to this conclusion given that so many caesarean babies have a trip to the nursery for breathing difficulties.
… this poses a profound ethical dilemma for the woman as well as her caregivers because benefit for the woman may come at the price of increased risk for the fetus and vice versa … the quality of much of the data in this area was poor.
… Implicit in the document was the conclusion by the panel that VBAC is a reasonable option for low-risk women. I think that’s fabulous.
But she and others noted that doctors’ fears of malpractice lawsuits lead many to refuse to allow vaginal birth after Caesarean. One speaker mentioned a case of uterine rupture during a vaginal birth after Caesarean in which the baby died and the hospital lost a lawsuit for $35 million. In addition, some insurers threaten to raise premiums if doctors perform vaginal births after Caesareans. In Florida, obstetricians’ premiums are already about $275,000 a year …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: VBAC
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 13, 2010 in
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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Most women who have had a Cesarean delivery can safely have a vaginal delivery … an expert panel concluded …
Surging C-section rates … have worried experts … just because a woman has had a C-section in the past, there’s no reason she must have one in subsequent deliveries.
However, current medical practice and fear of lawsuits are major obstacles to encouraging women to have a vaginal delivery after a C-section …
… Another problem has been … the fact that they have not had access to care where a trial of labor can be offered …
… “vaginal delivery after Cesarean is certainly a safe alternative for the majority of women who have one prior Cesarean,” …
… bad outcomes remain rare — … there are about 10 deleterious outcomes for every 100,000 births, vaginal or otherwise.
… there are no reliable means to spot which women are at risk for complications if they opt for vaginal delivery … [but] … “Pregnancy is … a risky endeavor … women do suffer complications of pregnancy and their babies do have problems. Fortunately these are rare, but they are irrespective of mode of delivery …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: VBAC
Posted by Melissa Maimann on Mar 11, 2010 in
Caesarean,
Home birth,
Midwifery,
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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A sensationalist title as home birth is not about to be banned but here goes:
ABI WHITEHAIR is only nine days old but she’s already saved taxpayers thousands of dollars.
She was delivered at home after her mother, Leah, rejected advice to have a caesarean section … because her first baby … had been born that way …
A surgical birth – about 30,000 are performed in NSW each year – would have cost the public hospital system about $8000.
If she had been admitted to a neonatal special care unit, like 70 per cent of babies born by caesarean, including her big brother, it would have cost another $900 a day.
But her entry to the world, in a Dee Why lounge room, cost taxpayers nothing …
[Midwives] are calling for another urgent meeting with the Health Minister, Nicola Roxon, before the new rules come into effect in July.
More than one in three babies in NSW is born by caesarean section but only one in seven subsequent babies are born vaginally due to the risk of uterine rupture.
The risk is very small: less than one in 200. Most studies on uterine rupture include dehiscenses, which are not complete ruptures, have no symptoms and do not cause any problems for mother or baby.
About 95,000 babies were born in NSW in 2008, but only 258 were born vaginally in public hospitals after a previous caesarean …
It is well-known that VBAC is far more successful – around 90% – with private midwifery care. Otherwise the chance of a siccessful VBAC can be as low as 3%.
… women who had undergone traumatic births, with extensive intervention, were eager to avoid a repeat performance but were often left with little choice.
”Keeping away from obstetric intervention by having a home birth is the best chance they have of achieving a normal vaginal birth,” …
Up to 70 per cent of home births were by women who had previously delivered by caesarean and there was a growing band who would deliver at home alone if home births were outlawed.
… Ms Whitehair, who had longed for a natural birth, spent months researching a home delivery. Abi’s birth, attended by two private midwives, cost her almost $5000 but was ”beautiful and textbook”.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, birth debriefing, Birth trauma, Caesarean, continuity of care, freebirth, Home birth, VBAC
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 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
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
Tags: Babies, birth, Birth choices, birth debriefing, Birth trauma, Breastfeeding, Caesarean, childbirth education, Complicated pregnancy or birth, continuity of care, Epidural, exercise, fetal monitoring, freebirth, Home birth, hospital birth, intermittent auscultation, intervention, IVF, Maternity Services Review, midwife, Midwifery, Midwifery services, Normal Birth, Nutrition, Obstetrics, postnatal depression, Preconception care, Public and private hospitals, VBAC
Posted by Melissa Maimann on Feb 23, 2010 in
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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Michelle Williams is three months’ pregnant and determined to experience childbirth the way nature intended. But because her previous baby was delivered through … cesarean section — she has to travel more than an hour … to find an obstetrician willing to let her try for a vaginal birth.
One out of every three pregnant women now has a C-section …
This is also the case in Australia.
The skyrocketing C-section rate has been hotly debated in birthing and medical communities, yet little attention has been paid to one of the consequences: Once a woman has a C-section, she often has to fight to deliver subsequent babies the old-fashioned way …
This is also the case in Australia. VBAC rates nationally are around 15%.
Repeat C-sections have become so routine that 90 percent of pregnant women who have the surgery give birth that way again. That is a concern to health experts, who say vaginal births after a cesarean, or VBACs, should be far more common.
Successful VBACs result in better health outcomes for the mother and the baby … VBACs [should] be offered in low-risk cases.
… although the attempt carries a risk of uterine rupture, the chance it will happen is relatively low: 0.5 percent. Meanwhile, C-sections carry all the risks of a major surgery. Compared with having a vaginal birth, a woman delivering by C-section experiences more physical problems, longer recovery and more emotional issues on average … babies born by cesarean are less likely to be breastfed and more likely to experience breathing problems at birth and asthma as they get older.
Yet the VBAC rate, 9.2 percent, is a far cry from the objective set by the Centers for Disease Control and Prevention: 37 percent. In Illinois, the rate was 11 percent in 2008, down from 38.6 percent a decade earlier.
… In northwest Illinois, the VBAC rate is as low as 3.9 percent …
Not dissimilar to some of our hospitals here in Australia.
… 73 percent of the women who try VBACs are successful.
Success rates are around 70%-80%, but they are higher, up to 90%, if the woman chooses a private midwife.
“The liability issue is huge,” said Dr. Joseph Pavese, chairman of the obstetrics department at Advocate Christ Medical Center in Oak Lawn, where 97 percent of pregnant women with a previous C-section have another one. “Parents expect good outcomes, and physicians are reluctant to try difficult deliveries. If the baby is not perfect, there is possible litigation.”
… If the scar opens during labor, it would require an emergency C-section. Certain factors — induction of labor, or a vertical (rather than horizontal) incision — can increase the risk of rupture.
In 99.5 percent of the cases, nothing goes awry. But if the scar gives way, results can be catastrophic; the baby has a 10 percent chance of dying or suffering brain damage.
Over the years, “The risk of uterine rupture has not changed,” said Dr. Howard Strassner, director of maternal and fetal medicine at Rush University Medical Center. “What has changed is individual tolerance for risk. It reached the point where no one wants to be associated with an adverse outcome.”
… more recent and balanced research showing VBACs are as safe — if not safer — than repeat C-sections hasn’t had the same effect [as previous research that demonstrated that elective repeat caesarean was safer than VBAC.]
… What crippled the idea of a VBAC, however, was a simple word change. In 1998, ACOG advised that physicians should be “readily available” to provide emergency care because of the dangers of a uterine rupture. Eight months later, the American Congress of Obstetricians and Gynecologists changed the wording to “immediately available,” and many small hospitals in rural areas stopped doing VBACs.
We have the same situation in Australia, with many smaller hospitals and midwife-led units not offering VBAC services.
Katherine Shaw Bethea Hospital in Dixon, which handles about 365 deliveries a year, was one of more than a dozen Illinois hospitals that subsequently dropped VBACs because an on-site anesthesiologist wasn’t always immediately available.
“… too many women are subject to coerced cesareans because hospitals have banned VBACs.”
… Mariana Patzelt … had two previous C-sections, planned to drive from her home … to deliver her third baby … after laboring too long at home in hopes of reducing her chances of a C-section, she ended up delivering in the emergency room of a nearby hospital.
When doctors there asked whether she had had any previous surgeries, she said no.
“The whole time I was hoping they didn’t see the scar,” she said. “I knew if I would have said yes, it would have blown my chances and I wouldn’t be able to fight hard enough for everything I worked for.
“Hospitals treat birth as a medical condition, a disease they have to fix rather than something natural we’ve been doing since the beginning of time.”…
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Caesarean, hospital birth, VBAC
Posted by Melissa Maimann on Feb 21, 2010 in
Caesarean,
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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… Women who attempt vaginal childbirth after having several babies by cesarean section may not have a greater risk of complications than women who’ve had only one prior C-section …
… vaginal delivery is now considered a safe option for many women who have had a past C-section. Because C-sections also carry risks and downsides — such as blood loss or infection from the procedure, and a longer hospital stay and recovery time — many women may prefer a try at labor.
… the American College of Obstetrics and Gynecology (ACOG) does not currently recommend vaginal delivery for women who have had three or more C-sections, as their risk of uterine rupture has generally been thought to be higher.
In the new study … researchers found that women with at least three prior C-sections showed no increased risk of uterine rupture during vaginal delivery.
In fact, none of the 89 women who opted to try vaginal childbirth had the complication …
… the expected rate of uterine rupture among women with one prior C-section would be less than 1 percent …
… The … women who chose to … labor also had no instances of bladder or bowel injury, or lacerations of the uterine artery … compared with just over 2 percent of the women who had a repeat C-section …
When it came to successful [VBAC] the chances were similar regardless of the number of prior C-sections.
[Ampngst women who had one prior caesarean, the] success rate [was] about 75 percent. That rate was 80 percent among women with a history of three or more C-sections …
Research has been around for several years now about the safety of VBAMC. Despite this, women still have a battle on their hands to achieve a VBAMC in the hospital system. While many hospitals support VBAC after one caesarean, successful VBAMC rates are very low. Hopefully this new research will add to the growing body of research that supports VBAMC as a safe option. I believe that VBAMC is a safer option than elective repeat caesarean. While the first caesarean is generally safe, the risks increase after two or more caesareans. The best way to achieve a VBAC or VBAMC in the hospital system is with a private midwife.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: VBAC
Posted by Melissa Maimann on Feb 13, 2010 in
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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… women with three or more prior caesareans who attempt vaginal birth have similar rates of success and risk for maternal morbidity as those with one prior caesarean, and similar overall morbidity … as those delivered by elective repeat caesarean.
Planned vaginal birth after caesarean (VBAC) refers to any woman who has experienced a prior caesarean birth who intends to try for a vaginal birth rather than to deliver by elective repeat caesarean. Although relatively low complication rates, including uterine rupture, have been demonstrated among women with two prior low-transverse caesareans who attempt vaginal birth, there are very limited data available on outcomes among women with more than two prior caesareans …
… researchers sought to estimate the rate of success and risk of maternal morbidity in women with three or more prior caesareans who attempt VBAC … A total of 25,005 women who had a least one prior caesarean delivery were included.
… women with three or more prior caesarean deliveries did not experience a difference in morbidity based on whether they attempted VBAC or elected for a repeat caesarean. The 89 women with three or more prior caesareans who attempted VBAC were as likely to be successful as women with one or two prior caesareans, 79.8% compared to 75.5% and 74.6% respectively. In addition, none of them experienced significant maternal morbidity such as uterine rupture, uterine artery laceration, and bladder or bowel injury.
… precluding VBAC for all women with three or more prior caesareans may not be evidence based. Although there is a measurable maternal morbidity associated with delivery for a woman with a history of three or more prior caesareans, it does not differ significantly by mode of delivery. Risks associated with multiple caesareans are several, including surgical morbidity and abnormal placentation in future pregnancies.
… perhaps it is time to revisit the current recommendations for VBAC attempts for women with more than one prior caesarean”.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, VBAC