Private Midwife: Homebirth & Hospital Birth

New baby? Priceless. Doctors’ fees? Incredible

Melissa Maimann — Thu, 11 Mar 2010 19:26:19 +0000

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

Midwives want to meet Roxon to avoid home-birth ban

Melissa Maimann — Wed, 10 Mar 2010 19:58:37 +0000

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

FAQs

Melissa Maimann — Wed, 10 Mar 2010 00:57:35 +0000

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

Safety, ease lead to C-section surge

Melissa Maimann — Tue, 09 Mar 2010 19:08:37 +0000

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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Rising C-section rates that show no signs of letting up have stirred a vigorous national debate about whether many are being performed too often, too early and without medical necessity.

With nearly one in three babies born by Cesarean … doctors and natural birth proponents are concerned that factors such as a woman’s preference to schedule birth on a particular day and a doctor’s fear of malpractice are, in part, driving the increase.

There’s worry, too, that fetal heart monitors, which often raise false alarms about the condition of a baby, or drugs used to induce labor might be leading to unnecessary C-sections and subsequent problems, such as a rupture of the uterus, which can lead to a hysterectomy.

“The C-section rate is probably higher than it should be,” … “We have to figure out which ones are medically necessary.”

An initiative at 60 Michigan hospitals hopes to make a dent in at least first-time C-sections by encouraging natural delivery techniques. The hospitals also are encouraging women to postpone scheduled C-sections until the 39th week of a pregnancy, when a baby’s lungs are healthier, and use labor-inducing drugs less often.

Safety a big concern

After a lengthy, dangerous labor that eventually ended in an emergency C-section, Kelly Morphew of New Baltimore wanted to play it safe this time. She scheduled a Cesarean delivery for her second baby.

Her daughter, Madison, was among 16 babies born Feb. 8 at the [hospital] … Four others also were C-section deliveries …

While safety was her biggest concern, Morphew was happy to get a Tuesday afternoon appointment that allowed her to get to the hospital of her choice and arrange a baby-sitter for her 2- 1/2 -year-old daughter.

“For me, C-section was the best way to go,” … Everything was planned. Nothing was scary.”

“We agree the C-section rate is too high, but we can’t just look at the rate alone,” … “We have to look at why women are having C-sections.”

Besides a woman’s preference, other leading reasons include:

• Doctors’ fear of lawsuits. Obstetricians … are sued the most and pay some of the biggest insurance premiums, as much as $200,000 a year. Reluctant to have a labor go wrong, many doctors perform C-sections for more defensive reasons, rather than good medical ones …
• Policy changes at small- and medium-size hospitals against natural delivery of a baby after a prior C-section …
• Technology. Fetal heart monitors, which often can be wrong, pushing too many women along a path to C-section.
• Labor-inducing drugs restrict the baby’s movement, often leading to a C-section.
• Lack of good evidence about which women with possible medical issues like older age, gestational diabetes or high blood pressure
would benefit more from a C-section.
• Fewer training opportunities for doctors to learn how to deliver babies in difficult circumstances [such as] breech …

C-sections, like other surgeries, can have major risks, including infection in the mother, profuse bleeding requiring blood transfusion and, in rare cases, death. They also carry a small risk of uterine rupture, a serious complication that occurs when the uterus tears open, sometimes leading to hysterectomy.

With safety a major focus in medicine, a Michigan campaign at 60 hospitals hopes to reduce childbirth complications. The campaign is encouraging safe birthing practices; lowered use of labor-inducing drugs … and postponement of elective C-sections until the 39th week of pregnancy …

“the real point is to prevent the first [caesarean]” …

Melissa Maimann, Essential Birth Consulting 0400 418 448

“Get Me Out: A History of Childbirth”: Book Review

Melissa Maimann — Mon, 08 Mar 2010 19:07:58 +0000

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

Twice as Many Women May Soon Be Diagnosed With Gestational Diabetes

Melissa Maimann — Sun, 07 Mar 2010 19:03:19 +0000

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

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New 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

NHMRC: Pregnant women need an iodine supplement

Melissa Maimann — Sat, 06 Mar 2010 19:00:28 +0000

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 National Health and Medical Research Council (NHMRC) today released a new recommendation that all women who are pregnant, breast-feeding or considering pregnancy take an iodine supplement of 150 micrograms each day.

… “Women wanting to conceive, or who are already pregnant or breast-feeding, need a minimum of 250 micrograms of iodine each day for the baby’s brain and nervous system development,” …

“Australians now get more iodine in their diets following the mandatory fortification of bread last October, though it is still appropriate for women to supplement their diet with an additional 150 micrograms of iodine every day,” he said.

… “The body does not store iodine, so amounts taken in excess of the body’s requirements will simply be excreted by the kidneys.”

People with a known iodine deficiency, or who are concerned they may not be getting enough iodine, should consult their healthcare professional.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Home Births on the Rise in U.S.

Melissa Maimann — Sat, 06 Mar 2010 00:57:56 +0000

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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After having her first child in a hospital, Lorra Jacobs decided it was an experience she did not care to repeat.

She had two more children, and she chose to have both of them at home.

“When I had my first child in the hospital, I was young and I didn’t know of any alternatives. It wasn’t a real positive experience,” … “It was a stark, very impersonal feeling, treating me like I was sick and not pregnant.”

Jacobs explained she believed she had more control over many aspects of the birth when it took place at home, including whether she got to be with the baby after delivery and having the siblings there at the birth.

“Doing a home birth, I felt like I had a say,” said Jacobs. “This is not the hospital’s baby. This is my baby.”

… a very small but slightly growing number of women are making the same choice that Jacobs did. While less than 1 percent of all births in the United States take place outside the hospital, the number of those births taking place at home has increased by 3.5 percent between 2003-04 and 2005-06 …

The new numbers came after a period in which births outside the hospital … had been decreasing since 1990.

… [the] trend might be a negative reaction to a hospital birth experience, since the majority of mothers choosing a home birth have had children before.

“The fact that it’s primarily women who had kids before and had birth in hospitals before, certainly suggests it’s a reaction to their prior birth,” … “It certainly suggests it’s an experience they don’t want to repeat.”

… “I suspect consumers are becoming more informed & and seeing home births are a safe alternative for healthy women with a qualified provider.”

She said a likely cause of any increase is a desire to avoid the interventions hospitals perform, ranging from cesarean sections and epidurals to controlling when the mother is with the newborn.

“I think a lot of consumers are really scared by the high cesarean rate, and they’re becoming aware that Caesarian is a major surgical procedure,” …

She stressed that home birth is only a safe option for healthy mothers who are not expected to have complications.

… The American College of Obstetricians and Gynecologists has long opposed home births, citing a lack of data regarding their safety.

“Studies comparing the safety and outcome of U.S. births in the hospital with those occurring in other settings are limited and have not been scientifically rigorous,” …

That’s because you can’t ramdomise women to home or hospital birth. It must remain the woman’s choice. The only way homebirth can be studied is retrospectively – after the fact, and this is the most appropriate way to study it because the outcome of a homebirth that has been forced upon a woman will not be positive, simply because she will be labouring in an environment in which she feels is unsafe. Women labour best where they feel safest.

… “Until the results of such studies are convincing, ACOG strongly opposes home births. Although ACOG acknowledges a woman’s right to make informed decisions regarding her delivery, ACOG does not support programs or individuals that advocate for or who provide home births.”

And that’s how we get to situations where midwives are reluctant to transfer women in pregnancy or labour – because the doctors will not support the woman or her midwife – and so what we see happening is the doctor’s attitudes making home birth unsafe. A spirit of consultation, collaboration, mutual support and trust can make a huge difference.

While the risk of neonatal death is low overall, it may be higher at home births and that is a problem, said Dr. William Barth, Jr., chair of ACOG’s committee on obstetrics practice and chief of the division of maternal-fetal medicine at Massachusetts General Hospital

“May be” – so they don’t really know for sure, they just suspect that it may be. When in fact, the studies show that the neonatal death rate is not higher for planned, midwife-attended, low-risk home births.

Barth cites a study presented by researchers from Maine Medical Center at the Society for Maternal-Fetal Medicine meeting in Chicago in early February. The study, a meta analysis of research from around the country comparing home births to hospital births, appeared to show a twofold increase in the rare event of neonatal death at a home births.

Declercq said one problem with relying on this study is the results may have been skewed because the researchers relied on the location the birth was planned for rather than where it actually took place.

There is a transfer rate for home birth, and it varies between 10% and 50%. What ought to be studied is the outcomes for the births that were intended to take place at home at the onset of labour. That eliminates from the study all the women who were transferred to hospital during pregnancy because the midwife detected problems and made a responsible decision to transfer the woman. This could be for issues such as high blood pressure, twins, babies who aren’t growing well, a placenta that’s too low in the uterus, maybe covering the cervix and so on.

While the gold standard of clinical research is the double-blind, placebo-controlled, randomized clinical trial, it is impossible to blind a mother to whether she is giving birth at home or in a hospital, and most mothers are unwilling to be randomized to a home birth or hospital birth.

Studies of home versus hospital birth are typically the less reliable cohort study, where women who chose one option or the other but have otherwise similar characteristics are compared.

… Home birth advocates have cited several studies supporting the safety of home births among low-risk women. However, those studies have taken place in the Netherlands and Canada.

Barth said its unrealistic to apply the findings to the United States.

“Those are highly regulated, highly integrated systems. Their system is prearranged — it’s very different from the systems available in the United States,” he said.

Or Australia.

Agreeing with that notion, Declercq argued that it is the lack of such a setup that keeps safer home births from being a bigger option in the United States.

Exactly! The system can make home birth less safe, but the system can also make it optimally safe and acceptable.

“In the United States, people who want to have a home birth have to fight the system,” he said, explaining that there is a lack of support for a midwife who decides a patient is too high-risk for a home birth and should be transferred to a hospital.

The same situation arises here in Australia, however some hospitals and their staff are very supportive and bend over backwards to make sure the woman and her mdiwife are comfortable, respected and safe.

“I think if you actually move to a system like that, it would be fine in the United States, because the evidence from other countries suggests that it is as well,” said Declercq.

.. adopting such a system probably wouldn’t lead to widespread home births in the United States. It would not climb to 30 percent like the Netherlands, but would be closer to the rise to 3 percent seen in the United Kingdom.

But for now, he said, it is likely to remain a highly charged issue, with some advocates of home birth irrationally opposing the choice of a hospital while opponents cite risks of home birth while ignoring complications that can happen at a hospital.

“The mothers who are having these home births are not crazy, unaware people,” said Declercq. “They plan carefully, they think about this all the time. They think they’re better off not having the interventions that they feel will happen unnecessarily at hospitals.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

FAQs

Melissa Maimann — Fri, 05 Mar 2010 10:24:49 +0000

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

Is Water Birthing Safe?

Melissa Maimann — Thu, 04 Mar 2010 19:16:01 +0000

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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… “water birthing,” [is] considered by some women and midwives to be a healthier, more natural alternative to traditional hospital births.

Mothers who choose water birth go through labor and delivery immersed in warm water, believing that pain will be less severe and the experience more enjoyable and relaxing … studies have shown that mothers who choose a water birth request fewer painkillers than women who don’t, and fewer drugs translate into the perception of a safer and more natural birth.

… But is it good for the baby?

The research isn’t clear.

… researcher Sarah Nguyen questioned the safety of water births and described instances of infants inhaling water and feces following underwater deliveries … other researchers concluded, “… we are convinced there is no evidence to support any benefit of underwater birth for the neonate, and plenty of evidence to suggest harm [including] the potential for drowning, hyponatremic seizure activity, infection, and pneumonia.”

The American College of Obstetricians and Gynecologists does not recommend water births, suggesting instead that children born in hospitals are safer — if for no other reason than professional medical help is immediately available in case of complications. Unless your bathtub happens to be located near a neonatal unit, emergency medical help may not be available during the baby’s first minutes of life.

Of course, there is some risk to both the child and the mother during any birth, whether it occurs in a bathtub or a hospital. All births are natural, yet some births are safer than others.

The research that suggests that water birth ia not safe is based on very small numbers and potential issues. Nothing has been found as conctere evidence that waterbirth is harmful for babies. However, research has shown that waterbirth has enormous benefits for the woman: better pain relief, less likelihood of needing an epidural, less likelihood of tearing, no episiotomies, shorter labours and so on.

Melissa Maimann, Essential Birth Consulting 0400 418 448