Posted by Melissa Maimann on Jun 24, 2010 in
Birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
The Federal Government is providing more support for Australian women and their families with a new, expanded national 24 hour Pregnancy, Birth and Baby Helpline commencing on 1 July 2010. Women, their partners and families will be able to call the Helpline on 1800 88 24 36 for advice and information about pregnancy, birth and the first 12 months of a baby’s life. The independent charitable organisation, Royal District Nursing Service Ltd, will provide this free service, offering information and counselling on a wide spectrum of topics relating to pregnancy, birthing and life with a new baby – including issues such as nutrition for mothers and babies, breastfeeding, relationship support and health care options.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth
Posted by Melissa Maimann on Jun 14, 2010 in
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Houston, we have a problem.
At July 1, 2010 eligible midwives must work in a collaborative agreement with an obstetrician. This agreement must be signed by the obstetrician. It legitimises obstetric control over women’s choices. Even basic choices such as limited (or no) vaginal examinations in labour, refusal of continuous monitoring in women who are planning a VBAC, delayed (or no) induction and so on. Of course, it also depends on how reasonable the obstetrician is.
You see, in order for an eligible midwife to be insured for her practice, she must work collaboratively with an obstetrician and this is evidenced by a signed collaborative agreement. No signed agreement = no collaboration = insurance will not respond to any claims and therefore the midwife is working uninsured (and therefore outside the conditions of her registration) and may be de-registered.
Once in the collaborative agreement, the midwife, woman and obstetrician must reach agreement about the plan of care if the woman’s condition is classed as a B or C in the ACM Guidelines.
What sorts of conditions are listed as B in the Guidelines?
Previous post-partum haemorrhage
Hypothyroidism
Weight over 100kg
History of mental health disorders
Mild asthma
IVF pregnancy
Previous forceps or vacuum delivery
Having baby number 5 or more
Previous shoulder dystocia
VBAC
Long labour (<1cm/hr progress)
And the list goes on. These women must have a consultation with an obstetrician and the ongoing plan of care must be agreed by the woman, midwife and obstetrician.
What sorts of conditions are listed as C in the Guidelines?
Type 1 diabetes
Coagulation disorders
Lupus
Twins
Pre-eclampsia
Breech in labour
Gestational diabetes requiring insulin
Prem labour
And so on. These women cannot be cared for by a midwife; their care must be transferred to an obstetrician. The midwife’s continued involvement in the woman’s care must be agreed by the obstetrician. Even though the woman engaged the service of the midwife, has a contract of care with the midwife and has paid her midwife.
There is no right of refusal. The midwife will consult with an obstetrician on the woman’s behalf if the woman refuses to consult in person. If the obstetrician does not agree to the plan of care – the midwife cannot continue care of the woman because the woman’s condition is considered outside the scope of the midwife’s practice (and therefore outside of insurance and registration).
This system of collaboration is in place in other countries such as The Netherlands, NZ and Canada. The difference in those countries is the professional respect and standing of midwives that enables them to act as autonomous care providers to their women. Have you read The Birth Wars? Read it – it’s an eye opener and provides great insight into the current maternity system. Nicole Roxon wants obstetricians and midwives to work together. It seems she’s thrown us all into the bucket and simply said, “make it work!”. Unfortunately, entrenched attitudes and beliefs do not change quickly.
Collaboration will work when:
Collaborative agreements are negotiated at College level, not local level.
Obstetricians are mandated to require with collaborative agreements. At present they can refuse to sign a collaborative agreement.
Midwives have an avenue for appeal if they – or their clients – are treated unfairly.
Visiting rights are in place.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, Complicated pregnancy or birth, continuity of care, Maternity Services Review, midwife, Midwifery services, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Jun 11, 2010 in
Birth,
Caesarean Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
Babies born only a week early are at higher risk of a host of serious health problems from autism to deafness …
A study of hundreds of thousands of British schoolchildren found that those born at 39 weeks are more likely to need extra help in the classroom than those delivered after a full 40 weeks in the womb.
… With most planned caesareans carried out at 39 weeks, the finding raises concerns that women who have the operation for non-medical reasons could unwittingly be endangering the health and prospects of their children.
… Almost 18,000 had been classed as having special educational needs. The term covers learning disabilities such as attention deficit hyperactivity disorder, autism and dyslexia, and physical problems such as deafness and poor vision.
The risk was highest in those who spent the shortest time in the womb. For instance, babies born at between 24 and 27 weeks were almost seven times more likely to need help at school than those delivered at 40 weeks. But even being born just a few weeks early made a difference …
Those born at 37 weeks were 36 per cent more likely to have learning difficulties, while for those born at 38 weeks the figure stood at 19 per cent.
Babies born at 39 weeks … were 9 per cent more likely to have special needs …
… These findings … suggest that deliveries should ideally wait until 40 weeks of gestation … ‘However the cause of early birth may contribute to the risk, for example, a baby who’s already sick may need to be delivered early to give it a chance of survival …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, Caesarean, Complicated pregnancy or birth, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Jun 5, 2010 in
Birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Well, maybe not. The study below compared postnatal care in the public and private system. Read on to find out more.
Link
Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care …
A statewide review of public hospital postnatal care in Victoria from the perspective of care providers found many barriers to care provision including the busyness of postnatal wards, inadequate staffing and priority being given to other episodes of care; however the study did not include private hospitals. The aim of this study was replicate the review in the private sector, to explore the structure and organisation of postnatal care in private hospitals and identify those aspects of care potentially impacting on women’s experiences and maternal and infant care.
This provides a more complete overview of the organisational structures and processes in postnatal care in all Victorian hospitals from the perspective of care providers.
… Private hospital care providers report that postnatal care is provided in very busy environments, and that meeting the aims of postnatal care (breastfeeding support, education of parents and facilitating rest and recovery for women following birth) was difficult in the context of increased acuity of postnatal care; prioritising of other areas over postnatal care; high midwife-to-woman ratios; and the number and frequency of visitors. These findings were similar to the public review.
Organisational differences in postnatal care were found between the two sectors: private hospitals are more likely to have a separate postnatal care unit with single rooms and accommodate partners over-night; very few have a policy of infant rooming-in; and most have well-baby nurseries. Private hospitals are also more likely to employ staff other than midwives, have fewer core postnatal staff and have a greater dependence on casual and bank staff to provide postnatal care.
… Key differences between the two sectors relate to the organisational and aesthetic aspects of service provision rather than the delivery of postnatal care. The key messages emerging from both reviews is the need to review and monitor the adequacy of staffing levels and to develop alternative approaches to postnatal care to improve this episode of care for women and care providers alike.
And there we have it: care is not necessarily better in the private system.
What this study showed is that both the public and private health systems struggle to provide postnatal care. In both settings, staffing presents a major challenge: too many patients, not enough midwives, yet care needs to be provided. Hospital administrators in private hospitals make up this short fall by providing nurses instead of midwives in postnatal wards. The Australian College of Midwives is opposed to this because nurses are not qualified or educated to care for postnatal mothers and babies.
The private hospital staff reported “increased acuity of postnatal care” meaning that the women they are caring for have increased care needs. This may be a direct result of the high caesarean rates in private hospitals: up to 45%+. Caesareans often result in babies who do not feed as well, delayed milk production (and associated problems such as jaundice and weight loss in babies), greater need for pain relief, diminished mobility, far more observations are taken (blood pressure, temperature etc) and these women have a longer length of stay in hospital.
Added to this, the increased use of single rooms, while certainly loved by women, means that midwives have much further to travel to get to their patients. Those corridors can be pretty long in private hospitals! The staff desk and treatment room are often quite a distance from the patient’s room and numerous trips back and forth eat into the time that is available for the midwife to provide care.
Private hospitals often have a well-baby nursery where babies sleep overnight. In some hospitals, rooming-in is not encouraged (“get a good night’s sleep. We’ll look after your baby for you”) This separation of mother and baby impacts breast milk production, bonding and affects breastfeeding the following day. More breastfeeding problems = increased time required to care for each patient, but there is simply not enough midwives to provide this care. Nurses step in and formula may be suggested, compounding the problem … and so it goes on.
Yes, a private hospital looks nice, and granted the food is much better. Certain service aspects are better too: you get newspapers delivered, messages are delivered to your room and so on. But at the end of the day, people go to hospitals with the expectation of a safe birth and the provision of safe care. When care is provided by nurses, when caesarean rates are high and hospitals fail to meet the WHO Guidelines on breastfeeding, care may be compromised.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, Birth choices, Caesarean, Complicated pregnancy or birth, hospital birth, Public and private hospitals
Posted by Melissa Maimann on Jun 4, 2010 in
Birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
Research … suggests the answer is yes.
… At this point, experts can only guess at the biological basis for the links they’re finding. And those clues are not enough to recommend changes in, for example, infertility treatment.
Still, knowing who may be at risk of autism could improve diagnosis, which might enable earlier intervention.
One study … followed babies who weighed less than 4.4 pounds at birth through to age 21. Nearly 5 percent of these 623 young adults had an autism-spectrum disorder, five times the rate in the general population.
… In recent decades, women have been delaying motherhood, which increases both their chance of needing fertility treatment, and their chance of having a low-birth-weight baby, typically due to prematurity.
These changes have emerged as risk factors for autism:
Two studies … linked infertility treatment to the chance of autism … ovulation-inducing drugs … nearly doubled the odds of having an autistic child … autistic children … were three to four times more likely to have been conceived through in-vitro fertilization and to have been born at very low weights than children in the general population. The mothers of autistic children were also older …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, Complicated pregnancy or birth, IVF, Preconception care
Posted by Melissa Maimann on Jun 1, 2010 in
Birth,
Caesarean 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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Babies born by caesarean section are more vulnerable to asthma, allergies and infection because they miss out on receiving their mothers’ good bacteria during birth.
… This bacteria … [colonises] the intestine …
“This can have long-term health implications, as the development of a good intestinal ecosystem is necessary for health and immunity to allergies, from childhood right through to adulthood.”
… emergency caesareans, performed after labour had already begun, meant babies did receive some of the beneficial bacteria, particularly if the waters had broken.
However, elective caesareans … gave babies no chance to pick up any of the good bacteria.
… Australian College of Midwives vice-president Hannah Dahlen said babies born vaginally also had the advantage of hormonal surges during labour that made them more wide-eyed and able to connect with their mothers. Both mother and baby experienced a surge in catecholamines, the fight-or-flight hormone, during labour, making babies more alert at birth.
… white blood cells in babies born by caesarean were different to those of babies born vaginally, potentially altering the way their bodies responded to attacks on their immune systems for the rest of their lives.
The studies could explain dramatic increases in rates of diabetes, testicular cancer, leukaemia and asthma among babies born surgically, said Associate Professor Dahlen.
”In labour, the baby has a gradual escalation in its stress response and then a gradual decline. Research has shown that this could prime our bodies to respond to stress in a certain way,” she said.
”With a c-section, there is a … dramatic stress response. It could be setting that child up to always over-respond to stress.”
… previous studies … found babies born surgically had a 20 per cent increased risk of developing diabetes …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, Caesarean
Posted by Melissa Maimann on May 26, 2010 in
Birth 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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… Delaying clamping the umbilical cord … allows more umbilical cord blood volume to transfer from mother to infant and, with that critical period extended, many good physiological “gifts” are transferred through ‘nature’s first stem cell transplant’ occurring at birth.
… [In] Western medical practice, early clamping … remains the most common practice … perhaps because the benefits of delaying clamping have not been clear. However, waiting for more than a minute, or until the cord stops pulsating, may be beneficial …
Birthing methods have also changed over the last century. Throughout human history and currently in cultures and areas where delivering mothers squat to deliver, gravity helps speed the stem cell transfer …
… the relationship between cord clamping time and the transfer of stem cells needs to be understood through the early weeks of the perinatal period and the process of ‘hematopoiesis,’ the formation of blood cells that begins as early as two weeks into pregnancy. A transfer of pluripotent stems cells continues throughout pregnancy, however, and for a time through the umbilical cord following delivery.
…”In pre-term infants, delaying clamping the cord for at least 30 seconds reduced incidences of intraventricular hemorrhage, late on-set sepsis, anemia, and decreased the need for blood transfusions.”
Another potential benefit of delayed cord clamping is to ensure that the baby can receive the complete retinue of clotting factors.
… many common disorders in newborns related to the immaturity of organ systems may receive benefits from delayed clamping. These may include: respiratory distress; anemia; sepsis; intraventricular haemorrhage; and periventricular leukomalacia. They also speculate that other health problems, such as chronic lung disease, prematurity apneas and retinopathy of prematurity, may also be affected by a delay in cord blood clamping …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, Birth choices, Normal Birth
Posted by Melissa Maimann on May 9, 2010 in
Birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
Babies are being handed to the wrong mothers who are unknowingly breastfeeding another woman’s child, with a string of dangerous hospital blunders in New South Wales exposing both mums and newborns to disease.
In one shocking case uncovered in an investigation … a newborn baby had to have its stomach pumped after being given month-old breastmilk from a woman who was not the child’s mother.
At least 26 cases where babies have been wrongly identified have occurred in NSW public maternity wards in the past three years. Staff shortages and the failure by some midwives to check identification tags have been blamed for the errors.
After a year-long investigation, documents released under Freedom of Information reveal the extent of the bungles.
One of the most serious cases was at Blacktown Hospital … with a baby given unnecessary medication because of incorrect identification tags.
In another incident, a 10-hour-old baby girl was given to the wrong mother to be breastfed at Westmead Hospital … because staff did not check the identification tags properly.
At least half of the errors … occurred in the Sydney South West Area Health Service …
It is the same health service which tried to hide its mistakes by refusing to release the documents until ordered by the Ombudsman.
Documents released by the hospitals reveal mothers have been left distraught after being told,or discovering themselves, the child they were breastfeeding was not theirs.
… NSW Health’s breast-milk safe management policy advises staff to double-check ID tags on the baby’s ankles and wrists against the mother. Expressed milk should be cross checked with the mother and ideally stored in a fridge in her room …
These problems can be avoided by birthing at home. If a woman births in hospital, it is important to avoid separation from the baby, even if she is tired. Midwives typically care for 8-15 women on afternoon and night shifts and this can obviously impact patient care. It does not excuse the issue, but with a huge shortage of midwives, keeping your new baby with you can help minimise your chances of being handed someone else’s baby, or having your baby handed to another mother.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, Breastfeeding, hospital birth, Public and private hospitals
Posted by Melissa Maimann on Apr 17, 2010 in
Birth,
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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Couples who conceive through … IVF or … ICSI had a higher risk of preterm delivery.
… nearly 8 percent were premature and 1.5 percent were very premature …
… roughly 5 percent of babies born to fertile mothers were premature, and 0.6 percent were very pre-term …
… Other forms of fertility treatment … were not related to the risk of preterm delivery.
[The study only looked at singleton babies, so the findings could not be explained by a higher proportion of twins] … the findings suggest that something about the IVF and ICSI procedures themselves might raise the odds of preterm birth.
… The fact that other forms of fertility treatment were not linked to preterm delivery suggests that infertility itself is not to blame …
… Another possibility … has to do with the “vanishing twin” phenomenon … these surviving fetuses are at increased risk of preterm delivery and low birth weight …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Complicated pregnancy or birth, IVF, Public and private hospitals
Posted by Melissa Maimann on Mar 20, 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.
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
Tags: Babies, birth, Birth choices, childbirth education, Complicated pregnancy or birth, continuity of care, CTG, Epidural, Home birth, hospital birth, intervention, Maternity Services Review, midwife, Midwifery, Midwifery services, Normal Birth, Obstetrics, Public and private hospitals, VBAC
