Posted by Melissa Maimann on Sep 3, 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.
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I was irritated to read this on the NASOG website. NASOG is the National Association of Specialist Obstetricians and Gynaecologists. My irritation lies in the fact that the obstetricians are concerned that with changes to the medicare safety net, the cost of private obstetric care will force it out of the price range of most families and that it will therefore cease to be a viable option (ie, fewer women will be able to access private obstetric care), yet the maternity reforms will have the same impact on midwifery care whereby access to midwifery care will be at the discretion of an obstetrician and fewer women will have access to private midwifery care. Many double standards exist in the article:
Australian women being denied the choice of a doctor during birth
The current changes to private midwifery practice, requiring the midwife to have a signed collaborative agreement with an obstetrician (without the requirement of the obstetrician to sign such an agreement) will result in Australian women being denied the choice of a midwife during birth.
We believe every Australian woman should be entitled to choose a specialist obstetrician or GP.
Likewise, every Australian woman should be entitled to choose a midwife. Around the world, midwives provide affordable, safe and effective care to women and families.
What choices do Australian women currently have?
A woman can:
choose a private obstetrician or GP to deliver her baby in either a private or public hospital;
attend the public health system and be assigned to a midwives or doctors clinic, however, women cannot choose the doctor present at the birth, or
share care between a general practitioner and a public hospital antenatal clinic, however women cannot choose the doctor present at the birth.
Nowhere is the option of private midwifery care mentioned. The author of this article also fails to disclose that midwives attend the majority of births in the public system, not doctors. Within the public system, while women cannot choose the doctor who *might* be present at the birth, in some cases they will know the midwife who will attend them. Private midwifery practice, which delivers virtually 100% continuity of care – the midwife you book with is almost 100% likely to attend the birth – is not even mentioned in this part of the article. If continuity was the concern of the author, surely the model that delivers the greatest continuity would have been mentioned?
The article goes on to say:
In fact doctors are not always present at births in the public hospital.
Shock Horror!! Births happen without a doctor’s presence! Of course, we’re not in there performing caesareans: obstetricians perform these operations. But hey, only about 15% women should need a caesarean; this rate is lower with private midwifery care. So for the vast majority, midwifery care is provided for the entire labour and birth. And the sky doesn’t fall in.
The bottom line is you cannot choose care by an obstetrician in Australia, unless you can afford it. This is hardly supporting a fair choice for women.
Likewise, women cannot choose private midwifery care unless they can afford it AND unless the obstetrician has agreed. And this is hardly supporting a fair choice for women.
How much does private obstetric care now cost? The average out of pocket expense for women to have the care of an obstetrician is around $2,000. Private health insurance does NOT cover this amount. The Medicare safety net used to cover up to 80%, until the current Government placed significant caps on the amounts paid to women for Obstetric care in 2009.
How much does private midwifery care now cost? The average out of pocket expense for women to have the care of a private midwife is around $2,500 – $6,000 (depending on many factors). Private health insurance might cover some of this cost.
Collaboration is the buzz word of the day and it seems that the same issues affecting private midwives are also affecting private obstetricians. What if we lobbied the Government together to make private maternity care more affordable for more women? What if, together, private obstetricians and private midwives were able to attend every woman who was privately insured in a private hospital, private birth centre or private homebirth system? Maybe the pressure on the public health system would abate and women would have safer and more satisfying birth experiences with continuity of care.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Sep 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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… c-sections now account for one third of all births, and … a big reason for this increase is the over-use of labor induction.
•Almost half of women wanting vaginal births were induced.
•Women who were induced were twice as likely to have a cesarean birth as moms whose labor starts spontaneously.
•Of the c-sections done after induction, half were performed before the cervix had dilated to six centimeters, “suggesting that clinical impatience may play a role.”
•A third of first time mothers had c-sections.
•C-sections upon maternal request (those done for non-medical reasons) account for only 9% of c-sections.
•Attempts at VBAC are less likely to result in vaginal birth than previously thought. Few women are offered the option of VBAC.
… what can you do about all this if you are pregnant and want a vaginal birth? Here are a few ideas:
- Talk to your care provider … about his or her rates of induction, c-section and episiotomy …
- Educate yourself about labor induction …
- Stay home in early labor …
- Choose a midwife if you’re opting for a natural birth
- See an experienced independent childbirth educator for childbirth education classes
- Ask questions
- Read, read, read
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Caesarean, Complicated pregnancy or birth, hospital birth, intervention, Public and private hospitals
Posted by Melissa Maimann on Aug 28, 2010 in
Home 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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I live for the day that we have these headlines here in Australia!
The number of women who give birth to their children at home in Wales has more than doubled in less than a decade …
Since 2002 … they have risen from 604 to approximately 1,395 last year.
There has also been a rise in women giving birth in midwife-led units.
… the assembly government has encouraged healthy women with low-risk pregnancies to have their babies out of hospitals.
In 2002, maternity services in Wales were asked to reach a 10% home birth rate by 2007, making it the only nation in the UK to have a target.
Midwives say that while it was a very ambitious aim and many areas have not managed to reach it, it has helped transform the choice in maternity services.
On average, 4% of births in Wales last year were at home, which is higher than the UK average of 3%.
Laura Williams gave birth to her daughter Megan at home in Porthcawl, Bridgend county, on 5 November, 2009.
… “I wanted to be in a more comfortable environment – I liked the fact that with a home birth I could use my own shower and sit on my own sofa.
“As it was, I had a fantastic birth at home. I borrowed a friend’s pool and was really relaxed. The midwife even cleared everything up afterwards – I saw no mess.
… “I also think the fact I was at home and relaxed helped my recovery from the birth – the next day I was up and about and even popped to the shops.”
… “Midwives are continuing to work towards it because many see the benefits home births bring.
“They are cost effective in that women don’t need to stay in hospitals.
“And for the mother, there is less risk of medical intervention, the birth is well planned, she is in a relaxed environment and often doesn’t have to leave other children.”
… Rather than staffing a large obstetric unit at a hospital, which midwives have to do in more populated areas, they can “focus on staffing women’s needs”, she said.
… The issue of home births has been in the headlines recently after medical journal The Lancet said mothers-to-be should not be able to opt for them if they put their babies at risk. Under UK law women can override medical advice.
It came after research published in the American Journal of Obstetrics and Gynaecology suggested home births were more risky than hospital delivery.
But the Royal College of Midwives said the research was “flawed”, and the assembly government insisted that only women with low-risk pregnancies were encouraged to have their children at home.
The chief nursing officer for Wales, Rosemary Kennedy, said: “It is for midwives and other health professionals to explain to pregnant women the birthing options available to them, and decide on the most appropriate option after considering their medical history and preferences.”…
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, Home birth, midwife, Midwifery, Midwifery services, women's rights
Posted by Melissa Maimann on Aug 23, 2010 in
Home birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Hospital-based homebirth services are sometimes criticised for being too restrictive in terms of inclusion / exclusion criteria. Women considered unsuitable for hospital-based homebirth programs include women with high blood pressure, gestational diabetes, previous caesarean section, previous shoulder dystocia, previous postpartum haemorrhage, over 42 weeks, under 37 weeks, baby thought to be too big or too small, prolonged rupture of membranes and so on. Although these programs are considered to be too restrictive, “risking out” most women, I often remind myself that these policies are no more restrictive than the policies of countries such as the Netherlands, and as we know, the Netherlands has a 30% homebirth rate.
We’re at the cusp of a very exciting time in maternity services. For the very first time, midwives will be given medicare provider numbers and women will be able to claim medicare benefits for midwifery care. This opens up the option of homebirth to women by increasing their access to midwifery care. However, for whatever reason, homebirth is still seen by some as being something that only “hippy”, “alternative” or “crazy” people would do. My experience is that the women who birth at home are generally tertiary educated, in their mid- to late 30s, professionally employed (or business-owners) and defintely not crazy! I am a very strong advocate of homebirth and although I provide a private homebirth service, I support hospital-based services because they promote choices for women and provide a sense of legitimacy and acceptability of homebirth. Hopefully more women will a) know they they have an option to birth at home and b) take up that option. Homebirth truly is a most beautiful and amazing way to birth a baby.
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GIVING birth at home was a relaxing experience Sarah Quinn says.
The Hallam mother was the second to take part in Casey Hospital’s new home-birth pilot program …
The Southern Health 12-month initiative provides 50 mothers with free midwife-led pregnancy, home-birth and antenatal care in the hope its success will make it available through the public system.
Ms Quinn, 21, who gave birth to her second child Tennille at home on July 8, said the experience was much better than her first child’s hospital birth.
“I felt much calmer and completely in control of my own body,” Ms Quinn said.
“I was surrounded by people I love, including my other daughter. It was a wonderful experience.”
Professor Euan Wallace from Casey Hospital said many pregnant women considered “low-risk” preferred home births because it provided a more positive transition to motherhood.
“Many women feel that labouring and birthing in their own home gives them a stronger sense of control,” Prof Wallace said.
He said studies had found home-birth was as safe in low-risk women as giving birth in a hospital but provided more satisfaction …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Home birth
Posted by Melissa Maimann on Aug 20, 2010 in
Home 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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Home, as we all know, is where the heart is. It’s where we eat, sleep and raise our families.
Home is the perfect environment for many things, but there’s one thing it’s definitely not right for – and that’s giving birth. For that, there are things called ‘hospitals’ and they are full of lovely people called ‘doctors’.
This week there has been a brouhaha, caused by an article written by Cathy Warwick, the general secretary of the Royal College of Midwives. She … is enraged by a report … [that] indicates that home deliveries can double, or even treble, the risk of a baby dying during childbirth.
Now I don’t know about you, but even the teeniest increase in the risk of death to my unborn child, or to myself, would be more than enough to get me into my car and down the local maternity hospital the second labour started.
We’re talking about the life of two people here – and, by association, the lives of everyone they know – and I value that ever so slightly above the need for comforting personal effects and my favourite CD on the stereo.
And to me, anyone who doesn’t is being not only very foolhardy, but also incredibly selfish. As well as having written three books on parenting, I have given birth three times, and never considered having my baby on the Ikea rug in my living room, even though as a young, healthy, fit woman – I had my first child at 23, and the other two at 25 and 28 – I was in a very low risk category and could easily have opted for a home birth.
But thank goodness I didn’t, because two of my ‘low risk’ labours ended up being more complicated than anyone had predicted. It was lucky I was in a hospital with immediate medical care available, or my babies could have been in real trouble.
‘Where motherhood is concerned, exercising our “right” to have things exactly the way we want is potentially damaging’
The reason for this is very simple: childbirth is not an exact science. It’s not predictable or controllable.
It is a natural, biological process, and like many biological processes, it can outsmart even the best human planner.
… becoming a parent should be the most selfless thing we ever do … It’s the moment we grow as people by giving part of our lives to someone else; the moment we put our child’s needs and wants before our own.
And it’s for that reason that so many women choose to birth at home, where they believe their child will be safer than in a clinical and impersonal hospital setting where they, and their babies, will be handled by strangers.
Not always, of course – it’s vital for mothers to maintain a sense of self, to keep meeting their needs and to teach their children that they are not the most important things in the universe.
I wish more overindulging parents would try this. But where childbirth is concerned, I firmly believe we need to put our self-centred wishes aside, and be in the safest possible place just in case things go unexpectedly wrong.
The best available research supports homebirth as the safer option for low risk women who are attended by a midwife. The study quoted was not the best available research: it was a meta analysis of studies: some good, some bad. the largest study on homebirth supports the safety of it for healthy women, attended by a midwife.
And the word ‘unexpectedly’ is key. All pregnant women are encouraged by their midwife to make a birth plan. Ha! I can tell you now that my first birth plan certainly didn’t include being in labour for 37 hours and having my daughter sucked out by ventouse delivery.
Neither did I plan for my son’s heart rate to slow down to almost zero for long enough that the midwife made an emergency call and got the consultant to run to the delivery room to burst my waters to relieve the pressure around the baby. No, I did not.
Birth plans are not about planning every aspec of a birth; they represent a woman’s intentions for birth, all being well.
Childbirth is unpredictable and therefore inherently risky. We are told it’s a woman’s right to choose where to give birth, and in a way it is. But this isn’t like choosing where to have a facial – it’s deciding where you think your baby, and you, will have the best chance of surviving if things go wrong.
Hmm. What about choosing the best place for birthing, all being well, and moving to an appropriate place if all is not well? Most of the things that go wrong in a labour go wrong with plenty of warning. We don’t all live in a hospital despite the fact that life is risky.
And that ‘if’ is very important . Think about it. The language used in this debate is highly emotive and significant.
Those in favour of home birth speak of it as being a ‘ positive’ choice. Of the journey into hospital being ‘unpleasant’. Of hospitals being ‘uncomfortable’ …
Now, I dislike strip lighting, the clinical smell and not being able to drink a cup of tea out of my favourite mug as much as the next woman trying to get a human out of her body.
But these discomforts seem shamefully insignificant compared with the importance of having a safe, healthy delivery – even if the risk is tiny.
… And I only have to look to all the doctors I know who have chosen to give birth in hospital to know it’s the safest place to be. The other selfish aspect of a home birth is that it requires a fully-trained midwife to leave the hospital and give one woman her undivided attention for the duration of her labour, which can be 24 hours or even much longer.
That’s assuming it’s a hospital-employed, which often it’s not. Often, a woman engages a private midwife to provide her care from pregnancy right through to 6 weeks after the baby is born. And doesn’t every woman deserve one-to-one midwifery care in labour? It’s safest for mother and baby, afterall. And isn’t that the author’s concern?
Websites supporting home births, including the National Childbirth Trust, strongly encourage women to ‘stand your ground’ if a local authority declines a request for a home birth.
There is no mention of all the other women in hospital who might need the midwife’s care during that time. Thought is given only to the right of the woman to choose to give birth wherever she likes.
Thankfully, in the UK, women do have the right to birth at home. This right actually increases safery because no woman has to freebirth owing to the inability to find a midwife to support her homebirth. It’s a mature approach that respects a woman’s right to determine what happens to her body.
How far should we take these rights? Personally, I would much prefer to have all my dental treatment at home, because I think it would be more relaxing and make the procedure less stressful and there wouldn’t be that dentist smell – should I be provided with a dentist who will come to my home and give me a filling? No, I should not.
What if being relaxed and feeling “at home” contributed to a safer outcome for the baby?
It is also, obviously, the case that many home births go perfectly well and many hospital births don’t. It’s not an exact science. What we need is the best of both worlds – for hospitals to provide far better care for women in labour, so that we have the best medical care available immediately, and a comforting environment.
And hospitals (and hospital policies) that are more accepting of homebirth woman and homebirth midwives, hospitals that will “allow” women to give birth to their babies how they see fit: breech waterbirth, VBAC without continuous monitoring, twins without an epidural and so on. When hospital policies are more encouraging, more women will feel comfortable to birth there. How often does a hospital say to a woman, “What would you like to do?” rather than, “we’ll allow you to …”?
For me, the potential benefits of delivering in my kitchen don’t remotely outweigh the risks. I am thankful every day for the care that was on hand within minutes when my babies needed it.
Most women don’t birth in their kitchens. Bedrooms, loungerooms, bathrooms, but not usually a kitchen. Somehow it doesn’t have that cozy feel to it.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Home birth, hospital birth
Posted by Melissa Maimann on Aug 17, 2010 in
Birth,
Midwifery,
Normal 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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MONA Vale Hospital’s new birthing unit will simply be a place for expectant mothers to have a home birth inside a hospital – but a long way from emergency care if a complication occurs – according to an obstetrician.
How anyone can consider a hospital birth to be the same as a homebirth is way beyond me! There is a very big difference between the comfort and familiarity of our homes, and a hospital environment.
Dr David Jollow, one of Mona Vale Hospital’s onsite obstetricians, said the new, midwife-run, Mona Vale birthing unit would mean women who suffer a complication during labour will have to be rushed to Manly Hospital instead of being treated by Mona Vale’s onsite obstetricians.
“The new unit is essentially a home birth that happens to be in a hospital,” Dr Jollow said.
“It would actually be safer to have a home birth in Balgowlah or Seaforth, because an ambulance ride to Manly would be quicker.”
It’s interesting that obstetricians oppose free-standing birth centres, yet we have the existence of midwife-run units where obstetricians are not available. Is ther a differnence? Is it merely a differing terminology to be acceptable to some?
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, Birth choices, continuity of care, Home birth, hospital birth, intervention, Midwifery, Midwifery services, Public and private hospitals
Posted by Melissa Maimann on Aug 14, 2010 in
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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The rise in cesarean-section deliveries in recent years has been characterized by some as a key indication of the overmedicalization of childbirth. While the procedure undoubtedly saves lives and leads to better health outcomes for mothers and infants who face problems during pregnancy and labor, many experts say the procedure is being performed too often, and in many cases for nonmedical reasons, putting healthy women and babies at undue risk of complications of major surgery.
The rate of C-sections has reached more than 31% in the U.S., a historical high …
The rate of caesareans is the same in Australia. Our Government is making moves to cut this rate.
The reasons for the increase are many and have been widely discussed: the rising rate of multiple births, more obesity in pregnant women, the older age of women giving birth. In fact, C-sections have become so common that many women may have an inflated sense of safety about them. “For the most part, moms and babies go through the process healthy and come out healthy, so maybe there’s this sense that we’re invincible,” …
But C-section carries all the attendant risks of major surgery; and data show that compared with vaginal birth, cesarean delivery increases the odds that a mother will end up back in the hospital after birth with complications …
Now obstetrics experts are actively seeking ways to drive down the number of C-sections … the ACOG issued new guidelines recommending that hospitals allow most mothers who desire vaginal birth after cesarean … to attempt a trial of labor, including … mothers who are carrying twins or have had two prior C-sections. Despite studies showing VBAC to be safe for most women — ACOG data suggests that 60% to 80% of women who attempt VBAC will succeed — many hospitals have urged women to undergo a repeat cesarean over the past decade, largely to avoid medical risks and malpractice suits.
Another factor contributing to high C-section rates is the increase in induced labor, especially between 37 weeks and 38 weeks … The use of labor induction in the U.S. has risen from less than 10% of deliveries to more than 22%, between 1990 and 2006 … research suggests that induced labor results in C-sections more often than natural labor … those whose labor was induced were twice as likely to have a C-section delivery as those who experienced spontaneous labor.
… previous studies had come to the same conclusion. In her study of … mothers delivering before 41 weeks’ gestation … 44% of women had their labor induced.
… after 41 weeks’ gestation, at which point it is standard policy to induce labor, it may lower the risk of medical complications for mother and baby — including the risk of stillbirth — and even decrease the likelihood of C-section delivery, but those same effects are not seen in women who induce labor before the 41-week mark.
… Among the women whose labor was induced in Ehrenthal’s study, nearly 40% of cases were categorized as elective. In other words, there was no pressing medical indication for induction. Extrapolating from the study findings, Ehrenthal suggests reducing the use of elective labor induction could lower the national C-section rate by as much as 20%.
Several hospitals have already begun reducing medically unnecessary induction as a way to lower the rate of cesareans …
… under the new policy the overall induction rate dropped 33% and the rate of elective inductions fell by roughly the same amount … the total number of C-sections among first-time mothers who underwent elective induction dropped 60% …
If a relatively simple policy shift based on medical evidence can successfully cut the rate of induced labor and C-sections at a single hospital, experts say similar changes applied broadly may help lower the rate of C-sections on a national level.
But as with the new guidelines regarding VBACs, decisions about labor induction and other issues surrounding childbirth must be shared by women. Patients should be informed and included in the decisionmaking process, Ehrenthal says. “Unlike the decision to do an emergency C-section where there’s no time to talk, usually there is time to have a discussion about induction,” she says.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Caesarean, Complicated pregnancy or birth, hospital birth, intervention, Public and private hospitals
Posted by Melissa Maimann on Aug 10, 2010 in
Birth,
Home birth,
Midwifery,
Obstetrics,
VBAC Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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Last week, midwives and clients of Andaluz Waterbirth Center in Portland announced plans to file a federal lawsuit to “cease intimidation and threats against midwives” by the Oregon Health Licensing Agency and Oregon Health & Science University.
Midwives say doctors and nurses at OHSU have filed baseless complaints to the licensing agency meant to thwart competition … The threatened lawsuit spurred a passionate online debate among supporters and critics of home birth.
Conflicts between midwives and doctors run deep. One of the biggest problems: Many physicians deal with midwives only when a laboring mother experiences difficulties during a home birth and requires transport to a hospital, sometime urgently.
“It’s an extremely tension-fraught encounter,” according to Melissa Cheyney, an Oregon State University assistant professor and practicing midwife who studied the interactions of midwives and doctors in Jackson County last year. Nearly every physician interviewed by Cheyney and her graduate student expressed the view that births must take place in a hospital to be “safe.”
Studies including higher-risk pregnancies have found that fetal deaths are more likely in home births. But in low-risk pregnancies, most research shows no significant difference in risk to the baby, while home-birth mothers experience fewer complications. In a study in British Columbia last year, women giving birth at home suffered fewer than half as many serious perineal tears, and about a third less postpartum bleeding.
By choosing a hospital birth, women substantially increase the risk of having a surgical delivery. More than 29 percent of hospital births in Oregon resulted in a cesarean during the years 2006-2008. Less than 4 percent of home births ended with a cesarean in a 2005 study of 5,400 births attended by midwives in the U.S. and Canada.
Women who choose home birth often cite the desire to keep birth free of medical intervention. Heather Hermans … transferred to the care of a midwife because she wanted to try a vaginal delivery rather than schedule a cesarean section, as her obstetrician-gynecologist recommended.
“My ob-gyn didn’t remember me from appointment to appointment,” Hermans said. “I was treated like pregnant cow No. 45.”
Many women will choose midwifery care to receive personalised care where they can develop a relationship with the midwife who will attend their birth.
Hermans experienced complications during labor and took an ambulance to OHSU, where a surgeon delivered her healthy baby boy by emergency C-section. The surgeon filed a complaint about Hermans’ midwife to the state … Roy Haber, an attorney hired by the midwives, said the Oregon Health Licensing Agency withdrew all six investigations after he challenged them.
Conflicts aren’t inevitable. Cheyney is working with midwives in Lane County and a Eugene obstetrician, Dr. Paul Qualtere-Burcher, on guidelines for smoother, more collaborative relations. Qualtere-Burcher and his colleagues have agreed to help midwives get access to laboratory testing and ultrasound screening for their clients. Midwives are referring higher-risk home birth clients to the physicians for assessment and another perspective.
“We’d like them to come in and see us before it becomes a big issue during labor,” Qualtere-Burcher said. “I think it’s been very successful.”
Home birth by the numbers
Planned home births in Oregon last year: 877 out of 47,675 total births, or 1.8 percent.
Risk of baby dying in a midiwife-attended home birth: 1.7 percent versus 0.6 percent in hospitals, based on a 2009 British study including women with breech births, twins, or attempting a vaginal birth after a previous cesarean (VBAC).
I’d be interested to see what these stats are when high risk homebirths are removed from the data set, or to analyse the risk of each “risk factor” in isolation to determine the riskier “high risk” situations, for example, is HBAC less risky than twin homebirth?
Risk of baby dying in a midwife-attended home birth when comparing only low-risk mothers: 0.5 percent versus 0.3 percent in hospitals.
Chances of giving birth without medical intervention: 78 percent with a home-birth midwife versus 54 percent in hospitals, according to the 2009 British study.
A women’s chances of having cesarean section when giving birth in an Oregon hospital, 2006-2008: 29 percent.
Fetal deaths in births attended by licensed midwives in Oregon, 2001-2007: 4 in 2,906 births, about 0.1 percent.
Fetal deaths in births attended by physicians in Oregon, 2001-2007: 1,455 in 274,278 births, about 0.5 percent.
This would account for the fact that midwives mostly manage uncomplicated pregnancies and births, while doctors are referred higher risk women and babies.
Number of home birth midwives who are licensed in Oregon: 64, up from 54 in 2008.
Complaints lodged against licensed midwives, 1999-2007: 40.
Disciplinary actions imposed by the Board of Direct Entry Midwifery, 2000-2004: 12
Midwife guide
…
Direct Entry Midwife – A general term for practitioners who train directly into midwifery without a nursing or medical background, and attend births outside of hospitals. Oregon law allows direct entry midwives to practice with no licensure.
Certified Professional Midwife — Direct entry midwives certified by the North American Registry of Midwives, which requires written and practical examinations and practical experience attending 40 births.
Licensed Direct Entry Midwife — Direct entry midwives who obtain a license in Oregon are authorized to use some prescription drugs and medical devices. They must pass a national examination, demonstrate experience in attending births, and complete continuing education every three years. They are licensed by the Oregon Board Direct Entry Midwifery and subject to disciplinary actions if they violate professional standards.
Certified Nurse Midwife – Registered nurses who go on to complete an accredited nurse-midwifery program. Oregon requires certified nurse midwives to obtain a Masters degree. CNMs are the only midwives that practice in hospitals. They are licensed by the Oregon State Board of Nursing.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: birth, Birth choices, Caesarean, Complicated pregnancy or birth, continuity of care, hospital birth, midwife, Midwifery, Midwifery services, Obstetrics, Public and private hospitals, VBAC
Posted by Melissa Maimann on Aug 9, 2010 in
Home 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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The increased demand to give birth outside hospital has increased the rate of home delivery. In the Netherlands, a third of women now have home births. In the UK, 3% of total births occur at home, while in the USA home delivery accounts for 1% of births or 25 000 deliveries per year.
In Australia, 0.6% babies are born at home. This rate has increased in past years.
Home birth rates have been increasing in the USA partly because of the increasing proportion of births by caesarean delivery … because doctors and hospitals opt not to do a vaginal birth after a caesarean to avoid liability lawsuits …
Although home birth seems to be safe for low-risk mothers and, when compared with hospital delivery, is associated with a shorter recovery time and fewer lacerations, post-partum haemorrhages, retained placentae and infections, the evidence is contradictory for outcomes of newborn babies delivered at home … The problem arises when planned home births become hospital births when complications arise, and this can then lead to an underestimation of the risk and overestimation of the benefit of home births. Data from the Netherlands, for example, suggest that up to 40% of nulliparous women who start labour at home are transferred to the hospital. Most studies also rely on different midwifery models for home delivery, which are not generalisable.
Professional organisations … have issued contradictory policy statements regarding home deliveries. The Department of Health of South Australia has a detailed policy for home birth among women with low-risk, singleton term pregnancies, while the UK’s Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives jointly support home birth in women with uncomplicated pregnancies. By contrast, ACOG does not support home birth, citing safety concerns and the lack of rigorous scientific evidence. Choosing to deliver a baby at home, states ACOG, is to show preference for the process of giving birth over the goal of having a healthy baby.
A recent meta-analysis … provides the strongest evidence so far that home birth can, after all, be harmful to newborn babies. The research incorporated 12 studies and 500 000 births from several industrialised nations … The data show that planned home births to healthy and low-risk mothers compared with planned hospital births in the same group of women doubled the risk of neonatal deaths (0·2% vs 0·09%). And when infants with congenital defects were excluded, the risk of neonatal mortality tripled. The main attributable factors for the increase in mortality were the occurrence of breathing difficulties and failed attempts at resuscitation—two factors associated with poor midwife training and a lack of access to hospital equipment. In the USA, for example, only a third of home births are accompanied by a certified midwife.
Analysing the outcomes of these studies, what we can learn from this meta-analysis is that homebirth is safe for low risk, healthy women, whereas high risk homebirth translates to mroe complications for mothers and babies.
Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk. There are competing interests that need to be weighed carefully. Hospital delivery should be the preferred method of delivery for high-risk pregnancies … Home delivery is an option for mothers with uncomplicated pregnancies, provided they are advised of the risks involved, have one-to-one midwife care (that includes good resuscitation skills and accreditation by a local regulatory body), and live in a location that allows quick access to obstetric care.
The situation in Australia is that fetuses do not have any rights until they’re born and breathing, therefore, the woman’s preferences are supported in pregnancy. An ethical stance would hold that the duty of care to the fetus increases as it reaches term.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, continuity of care, Home birth, hospital birth, Public and private hospitals
Posted by Melissa Maimann on Jul 31, 2010 in
Midwifery 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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MIDWIVES are aggrieved about new rules that might curb their access to Medicare rebates and prescribing rights …
Last year Ms Roxon announced that from November this year midwives would for the first time be able to use the Pharmaceutical Benefits Scheme and Medicare rebates for their clients.
At the time, Ms Roxon said the historic move would boost a midwife’s ability to work independently and increase options for pregnant women …
But in a long-awaited change to the legislation … midwives will now have to work collaboratively with a doctor, who must endorse their practice before their clients can access financial benefits.
The requirement for collaboration was always planned to be in place, but the detail of collaboration requires that a midwife has a written agreement with an obstetrician to access medicare benefits. This is problematic: more than one obstetrician must sign an agreement because no obstetrician provides 24/7 cover, so there’d need to be at least 2 obstetricians signing the agreement. What happens if one obstetrician leaves the local area? Is sick? Goes on leave? In these situations, the collaborative agreement is very vulnerable. Not only the agreement, but the midwife’s ability to provide ongoing care to her private clients.
After eight months of debate between doctors and midwives, government records show that Ms Roxon signed a determination on the matter two weeks ago, when Parliament was out of session.
Doctors’ groups who say home birth is unsafe are believed to have lobbied the government for the changes.
Yesterday, midwives and home-birth advocates accused Ms Roxon of trying to hide what will be an unpopular decision with midwives and mothers.
Australian College of Midwives president Hannah Dahlen said the change would effectively give doctors the ability to veto their access to Medicare and the PBS.
While midwives working inside hospitals would not be disadvantaged, she said private midwives would find it difficult to find a doctor to endorse them, especially if the doctor did not support home birth.
In fact, doctors have refused to sign agreements with any midwife who attends homebirths. Is this collaboration or control?
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, Home birth, Maternity Services Review, midwife, Midwifery, Obstetrics
