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.
Link
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 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.
Link
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
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 6, 2010 in
Home birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
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
Tags: Birth choices, Home birth
Posted by Melissa Maimann on Mar 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.
Link
… “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
Tags: Birth choices, Normal Birth
Posted by Melissa Maimann on Mar 1, 2010 in
Home birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
THE number of women choosing to give birth at home in Wales has reached a plateau …
Despite a rise in the birth rate, the percentage of home births has remained static at 3.7%.
But Wales still has the highest rate of home births in the UK.
The National Childbirth Trust (NCT) has said it was “very disappointed” about the lack of progress in Wales in raising the home birth rate.
Former Health Minister Jane Hutt said in 2003 that she wanted to see a 10% increase in the number of babies born at home over the course of a decade. And the Heads of Midwifery Advisory Group for Wales set a 10% home birth target for Wales to be achieved two years’ ago.
… “We need to see action … to deliver on policy commitments for choice. It is vital there are enough midwives and that they are supported.”
… almost 90% of women in the UK live in areas that “realistically do not offer the choice of a home birth with a midwife”.
… “We advocate home births because, with hospital births, the worry is that there is more risk of intervention.”
… women are twice as likely to need physical intervention when giving birth in hospital than at home. Women choosing home births are also less likely to rely on pain-relieving drugs … home births vary across Wales, from 9.5% in Bridgend to just 1.3% in Merthyr Tydfil.
“A target of 10% is quite a reasonable target. You would have to ask the Welsh Assembly Government why there is such a difference between areas. Sometimes it is down to midwife staffing levels but I would hope that is being looked at …
… “Home births provide women with an environment where they can feel more comfortable and as relaxed as possible …
I live for the day when Australia has a 10% home birth target!! We’re currently at about 0.3%.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, Home birth, midwife, Midwifery, Midwifery services
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 26, 2010 in
Birth,
Caesarean,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
The mortality rate of California women who die from causes directly related to pregnancy has nearly tripled in the past decade, prompting doctors to worry about the dangers of obesity in expectant mothers and about medical complications of cesarean sections.
For the past seven months, the state Department of Public Health declined to release a report outlining the trend.
California Watch spoke with investigators who wrote the report and they confirmed the most significant spike in pregnancy-related deaths since the 1930s. Although the number of deaths is relatively small, it’s more dangerous to give birth in California than it is in Kuwait or Bosnia.
“The issue is how rapidly this rate has worsened,” … “That’s what’s shocking.”
… “current trends and evidence suggest that maternal mortality rates may be increasing in the U.S.”
The alert asked doctors to consider morbid obesity, high blood pressure and diabetes, along with hemorrhaging from C-sections, as contributing factors.
… Shabbir Ahmad, a scientist … decided to look closer. He organized … a systematic review of every maternal death in California. It’s the largest state review ever conducted. The group’s initial findings provide the first strong evidence that there is a true increase in deaths – not just the number of reported deaths.
Changes in the population – obese mothers, older mothers and fertility treatments – cannot completely account for the rise in deaths in California …
… scientists have started to ask what doctors are doing differently. And, he added, it’s hard to ignore the fact that C-sections have increased 50 percent in the same decade that maternal mortality increased. The task force has found that changing clinical practice could prevent a significant number of these deaths.
… While the maternal mortality rate among black women is rising, the task force found a more dramatic increase in deaths among white, non-Hispanic mothers …
… In 1996, the maternal death rate in California was 5.6 per 100,000 live births … Between 1998 and 1999, the World Health Organization changed its coding system, which may have increased reporting of deaths. The California rate was 6.7 in 1998 and 7.7 in 1999. Because the number of mothers who die is small, the rate tends to fluctuate from year to year.
In 2003, when California revised its death certificate, the rate jumped to 14.6. And in 2006, the last year for which data is available, the rate stood at 16.9.
… When researchers unveiled their initial findings to a conference of the American College of Obstetricians and Gynecologists in 2007, there were gasps from the audience … The idea that California was moving backward even in an era of high-tech birthing was implausible to some. Confirmation of the trend was noted in the 2008 report …
The state of California has yet to share the report with the public. Researchers say that, after reviewing the report in 2008, officials in the Department of Public Health asked for technical clarifications. Revisions were complete and approved in the first half of 2009 …
… it is important for the public to be aware now that these trends are worsening …
“Even though they tend to be small numbers in terms of maternal mortality, it is important – it’s very important – that these trends be looked at,” she said. “And efforts need to be made to try and reverse them when they are going in the wrong direction.”
Rising C-section birth rate
Nearly one in three babies is now born by C-section. Many scientists have acknowledged that at some point, as the number of surgeries spiral upward, the risks will outweigh the benefits. But the C-section remains a useful tool, and in the middle of labor, doctors say, it’s hard to balance the potential long-term harm against immediate crisis.
Today, doctors face a condition called placenta accreta, where the placenta grows into the scar left by a previous C-section. In surgery, doctors must find and suture a web of twisted placental vessels snaking into the patient’s abdomen, which can hemorrhage alarming amounts of blood. Often, doctors must remove the uterus.
Main said this complication from C-sections has increased eight-to-10 fold in the past decade. Nonetheless, most women survive the ordeal … the rise in deaths is indicative of a larger problem.
“For every maternal death, there are 10 near misses; for every near miss, there are 10 severe morbidity cases (such as hysterectomy, hemorrhage, or infection), and for every severe morbidity case, there is another 10 morbidity cases related to childbirth,” …
Inducing labor before term more common
… Dr. David Lagrew … noticed that a lot of women were having their labor induced before term without a medical reason. And he knew that having an induction doubled the chances of a C-section.
So he set a rule: no elective inductions before 41 weeks of pregnancy, with only a few exceptions. As a result, Lagrew said, the operating room schedules opened up, and the hospital saw fewer babies admitted to the neonatal intensive care unit, fewer hemorrhages and fewer hysterectomies.
All this, however, came at a cost: The hospital had to take a cut in revenue for reducing the procedures it performed. Lagrew doubts that any hospital has increased its C-section rate in pursuit of profit, but he does note that the first hospitals to adopt controls on early elective inductions have been nonprofits.
According to a report issued by the advocacy group Childbirth Connection, “Six of the 10 most common procedures billed to Medicaid and to private insurers in 2005 were maternity related.” On average, a C-section brings in twice the revenue of a vaginal birth. Today, the C-section is the single most common surgical procedure performed in the United States.
“If all these guys were losing money on every C-section, well, what’s the old saying? Whenever they tell you it’s not about the money, it’s about the money,” Lagrew said.
The California task force isn’t waiting to determine the ultimate cause of these deaths. It has started pilot projects to improve the way hospitals respond to hemorrhages, to better track women’s medical conditions and to reduce inductions …
I think they’ve missed one key element: midwives! If every woman was cared for by her own midwife (and home birth and birth centre birth was encouraged as the norm for healthy women), the induction and caesarean rates would fall dramatically …. then maybe fewer women would die in childbirth.
Midwifery has an important focus on health promotion and education and would work fantastically for poorer women and women with health issues. The other priority ought to be raising the VBAC rate and reducing the number of elective repeat caesareans. Whilst the first caesarean might be safe, second and subsequent caesareans carry serious risks that are alluded to in this article.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Birth trauma, Caesarean, childbirth education, Complicated pregnancy or birth, hospital birth, intervention, Normal Birth, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Feb 25, 2010 in
Birth,
Home birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
For Stephanie Foley … the home birth of her son Calvin was a “peaceful, great experience.”
And while Foley said she’s pleased with how her home birth went, and that she would do it again, the issue of the safety of out-of-hospital birth is up for debate.
Statistics show that while the desire for a less sterile, more intimate birth experience is growing, most mothers in the U.S. still have their babies in a hospital. It’s the prudent choice, safer if something goes wrong, experts say.
But it isn’t a simple call.
Family history, health of the mother and fetus, available and trusted midwives and personal preference all weigh in the decision.
On average, only 1 percent of all births in the U.S. are conducted out of hospitals annually …
Tori Kropp, a perinatal registered nurse at San Francisco’s California Pacific Medical Center, says it’s safer to give birth in a hospital.
… hospital births have gotten a bad rap due, in part, to the efforts of home-birth proponents, such as TV personality Ricki Lake.
Lake’s 2008 documentary “The Business of Being Born,” ignited a fire storm by implying many common medical practices may be doing new mothers more harm than good.
Kropp has participated in 5,000 births, including that of her 9-year-old son Alexander. By participating in so many deliveries Kropp said she has “seen all the things that can happen” during what is still a potentially dangerous event in a woman’s life.
Has she been at any homebirths? It’s totally ok to have an opinion in something that one has not seen, attended, experienced or directly been a part of. But if Kropp has never been to a home birth, only obstetricially-driven hospital births, who is she to say that home is not at least as safe as hospital for healthy, low-risk women who are attended by a midwife?
“Most of the time it’s wonderful, but sometimes it’s not,” Kropp said. “At the end of the day, it’s safer to give birth in a hospital.”
Through education and outreach Kropp strives to correct what she says is “misleading” information promoted by Lake’s film. ”
“The problem with many home births,” Kropp says, is that they are performed by midwives “without the support of either physicians or a hospital.”
And is that because the midwife has not consulted with the hospital or doctor, or because they were not willing to consult when it was requested?
To spread her message, Kropp is planning a 100-hospital tour across the country beginning in Michigan on Labor Day. Kropp plans to offer free pregnancy seminars at the hospitals …
Is she planning to get her message out to women who are planning to birth at home? If so, she can talk to the hospitals all she likes, she will not reach her intended audience.
Overall Kropp’s mission is a simple one – “helping women feel empowered about the choice they make, and not the choice society wants them to make.”
But … not if they choose to birth at home. It’s ok to choose an epidural or a caesarean though!
Regardless of birth location, 8 percent of births in 2006 were performed by midwives, according to the CDC.
Definitely room for improvement there. 80% would be a great target!
When Foley gave birth to her first and only child in December 2007 she and her husband lived in a one-bedroom, second-floor apartment in Lansing.
After about 6 hours of active labor, with the help of a direct-entry midwife, Foley gave birth to her son in an inflatable pool filled with water, which is described as a water birth.
… “Pregnancy and childbirth are normal, healthy events in a woman’s life and interventions, such as cesarean sections, should be used only when medically necessary, Winkler said. “Women choose to come to the birthing center for freedom of choice.”
But Winkler cautioned that women who have chronic diseases, such as kidney disease, high blood pressure or diabetes are “safest when (giving birth) at the hospital.”
Planned home births may have a low rate of complications …
Among 13,000 planned births studied, researchers found that the mortality rate was similarly low – less than one in 1,000 – among women who gave birth at home with a midwife, women who gave birth in a hospital with a midwife, and women who gave birth in a hospital with a physician.
… “Birth is safe. It is safe to give birth out-of-hospital when a woman is healthy and having a normal pregnancy,” Winkler said.
But Kropp says even if a woman is healthy, there is still the possibility of complications in childbirth.
“Our hospital system for childbirth is so far from perfect,” Kropp said. “But someone who is completely healthy could very easily have something very unexpected happen in childbirth. Childbirth is still the No. 1 cause of death for women (worldwide), so we can’t get too cavalier in saying ‘we don’t need medical help.’”
It’s the leading cause of death for women who are not suited to home birth, such as those in third world countries who experience malnutrition, undernutrition, anaemia, bleeding in pregnancy, high blood pressure and so on. For healthy, low-risk women, the benefits of home birth are enormous.
Foley said she considered safety when making her decision to give birth at home.
“I had had no reproductive issues … for me I felt that being at home would be as safe as at the hospital,” Foley said.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, childbirth education, Complicated pregnancy or birth, continuity of care, Home birth, hospital birth, intervention, midwife, Midwifery, Midwifery services, Normal Birth, Public and private hospitals