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
Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
informed consent and childbirth
Every woman who is competent to consent, has the right to refuse any or all professional care. Informed consent must be obtained prior to any procedure being performed.
how to minimise labour intervention in a hospital?
The best way to minimise intervention in a hospital is to be as well informed as you can possible be about all things related to pregnancy, labour, birth, breastfeeding and babies. Read widely, attend independent childbirth education classes and consider employing a private midwife to be with you throughout your labour. She can help you to decide if the proposed interventions are necessary in your situation, she can support you emotionally, mentally and physically and she can aso help to ensure that your birth plan is respected without a fuss.
Do any independent midwives in Sydney offer prenatal care for women who are planning to freebirth?
Yes! This service enables women to access antenatal care from a midwife without the midwife attending the birth. Postnatal care is available if needed.
Do you think there are advantages to continuous monitoring for low-risk women
In a word, no. Intermittent auscultation is the method of choice. Continuous monitoring will increase the chance of a caesarean with no benefit to the mother or baby.
How much is a private midwife
Prices range from $3000 – $6000. Melissa Maimann offers for her clients to pay by the hour, making the service one of the cheapest.
What is a good caesarean rate?
The World Health Organisation recommends that no more than 15% births need to be caesareans. The WHO argues that when caesarean rates exceed 15%, the risks to the mother and baby increase on the whole. You’ll be hard-pressed to find a hospital with a caesarean rate of less than 15%, but birth centres and private midwives have caresarean rates of less than 10-15%.
What is the best hospital in sydney for delivering babies?
It all depends what sort of birth experience you’re after! If you’re wanting a natural birth, home birth will be the best option. If you want a natural birth in a hospital setting, the best options would be birth centre or private midwifery care for a planned hospital birth. If you’re wanting to have intervention in your birth, a hospital birth would be best. If you choose an obstetrician, you’re far more likely to have a caesarean, episiotomy, epidural, forceps or vacuum. Choosing your care provider is the single most important decision you will make in birthing.
Is there a birth centre at westmead hospital?
No, there isn’t. If you’re after a natural birth, the best choice would be a home birth.
C section or natural delivery midwife?
Midwves cannot perform caesareans. If a caesarean was needed, the midwife would call a doctor in to perform it. Most caesareans that are performed are unnecessary and increase the risks to the mother and baby. A natural birth is the safest way to birth, and midwives are qualified specialists in natural birth.
giving birth after birth trauma
Private midwifery care will be really important so that you can have the same midwife all the way through pregnancy, birth and postnatally. It’s also important to debrief your last experience and come to a place where you feel safe to birth again.
high risk midwife sydney
Midwives are not qualified to care for high risk pregnancies. We refer these women onto obstetricians. In most cases, one or two consultations is all that is needed with the obstetrician and the midwife continues the care of the woman.
how many births proceed naturally
What a great question! It all depends what care provider you choose and where you have your baby. You see, if you choose a private midwife and birth at home, you have about a 95% chance of having a vaginal birth. If you birth in a private hospital, you have about a 33% chace of having an unassisted vaginal birth. In some hospitals, the caesarean rate is more than the vaginal birth rate! Sad but true.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, birth debriefing, Birth trauma, Breastfeeding, Caesarean, childbirth education, Complicated pregnancy or birth, continuity of care, Epidural, exercise, fetal monitoring, freebirth, Home birth, hospital birth, intermittent auscultation, intervention, IVF, Maternity Services Review, midwife, Midwifery, Midwifery services, Normal Birth, Nutrition, Obstetrics, postnatal depression, Preconception care, Public and private hospitals, VBAC
Posted by Melissa Maimann on Feb 1, 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
A study of more than 100,000 births showed mums-to-be who had a caesarean section when there was no medical need were 2.7 times more likely to have complications than those who gave birth naturally.
… mothers should only have a C-section for medical reasons, according to the authors of the World Health Organisation study.
Women who chose a caesarean over a natural birth were 10 times more likely to be admitted to intensive care and suffer severe bleeding.
… “I do get women who ask for a C-section, often because they’ve got a pathological fear of childbirth, fears of pelvic floor problems in later life or have been sexually abused earlier in life, so they choose to have a C-section to avoid any genital tract trauma which would remind them of what’s happened.”
Dr Kliman said Epworth Freemasons had about 20 mother-requested caesareans out of 3500 deliveries a year.
“I tell them it is not necessarily an easy way out,” he said.
“They have risk of haemorrhage, infection and more discomfort after the procedure.”
Vice-president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Michael Permezel, said …”If a woman said, ‘I want a C-section’ and had no understanding of the risks, I think most doctors may decline the request,” Prof Permezel said.
“If she’s having her first baby later in life and perhaps planning to have one more, then the pros and cons are pretty even, but if it’s a younger woman planning a relatively large family then certainly the recommendation would be for a vaginal birth if possible because of the risks associated with each subsequent pregnancy …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, birth debriefing, Birth trauma, Caesarean, childbirth education, Complicated pregnancy or birth, hospital birth, intervention, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Oct 14, 2009 in
Birth,
Caesarean,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email me or call 0400 418 448.
Link
Every 30 seconds in the US, a cesarean is performed.This overuse of cesarean surgery puts moms and babies at risk—not just physically, but emotionally … A cesarean can reach far beneath the bogus smile on mom‘s face. It can scar her heart, as well as her uterus.
A baby girl is born. She grows and begins menstruating. She becomes sexually active and becomes pregnant. She births her baby. She breastfeeds her baby. This is life—normal and natural, yet exciting and important. In the continuum of life, pregnancy, birth and the postpartum period are milestone events. These experiences profoundly affect women, babies, fathers and families …
When a woman gives birth, she has to reach down inside herself and give more than she thought she had … There is a moment when every woman thinks, “I can‘t do this.” If she is lucky, she has a midwife … to whisper in her ear, “You are doing it.” As she does it, she becomes someone new: a mother. If the birthing process is skipped or occurs in a hostile situation, or if the interventions become overwhelming, she becomes a different mother than she would have been if she had only had a supportive, midwifery model of care.
… A woman‘s confidence and ability to give birth and to care for her baby are enhanced or diminished by every person who gives her care and by the environment in which she gives birth.
To control and actively manage a woman‘s labor and delivery, modern obstetrical practice relies on conformity. A woman is “subject” to rules, restrictions and protocols … Physicians and the hospital staff have authority—there is an unbalance of power … I say: You can only consent to that which you are capable of refusing. If you can‘t refuse the test, the drug, the procedure or the surgery, then you did not consent to it. This is coercion and it leads to disempowerment of women …
Many women who have cesareans suffer in silence because society expects them to “just be happy about their baby.” …
… Research has shown that when we stray from evidence-based maternity care, we have a high degree of obstetric intervention that is associated with acute trauma symptoms … how a woman perceives the event, not the event itself, plays a vitally important role in whether she has trauma symptoms.
Women report experiences that fall into the following categories:
* A sense of loss: birth didn‘t turn out like expected, loss of the experience of participating in the birth experience, not being there when the baby enters the world
* Interrupted relationship with baby: feelings of detachment from her baby
* Altered identity: sense of failure, feminine identity altered; lowered confidence in her body
* Intimations of mortality: surgery gives “rise to fears about mortality”
* Feelings of violation: from surgery where the body boundaries are violated, feeling “mutilated” or “butchered”
* Anger at caregivers: particularly regarding “what was perceived to be an unnecessary cesarean, lack of involvement in medical decisions, feeling unsupported by hospital staff before, during and after the cesarean”
* Dissociation: feeling that the surgery was taking place on someone else or from a distance
* Humiliation: being scolded
* Helplessness: not being able to take care of herself or her baby
* Posttraumatic Stress Disorder symptoms: anxiety, trouble sleeping, panic attacks
Let‘s consider that a moment. What if we went to a wedding today and while waving the couple off in the limo, we see it get hit by a truck before it turns the corner. If the bride were to spend her honeymoon in the hospital, no one would tell her, “Well, at least you have a healthy husband.” …
… Some women have such a traumatic experience, they close themselves off to the possibility of more children. They never consider the idea that it doesn‘t have to happen that way …
… Women who have had cesareans have higher rates of voluntary … infertility … This is often due to their determination that the trauma, whether physical or emotional, was too much to repeat.
Men are in a unique place during labor. They have been asked to be the support person and the labor coach. Now they are asked to be the protector. While historically men have taken the role of protector, I submit that the labor room is not the place men want to be trying to protect their wives.
Is it fair to expect this of partners? How are partners to be effective protectors / advocates when it is their partner and baby going through the experience? Is it fair to expect this role on anyoen who does not have the qualifications and experience to advocate?
Husbands of women who had had cesareans responded … mainly with fear and anger … “The pall that the experience placed over our entire relationship was stronger than a death in the family, because we both feel that we should have been able to do better. She has an alibi and can say she did all she could. I have no such explanation.”
Another husband expressed … he was “ashamed that I let them hurt my wife as I stood by.”
What is a husband protecting his wife from? We trust our obstetricians to provide care that is safe and effective for women and their babies. Yet, in the US, the norm in maternity care that is provided is technology-intensive and not consistent with the best available research.
This is the norm in Australia too.
Healthy women often are given … interventions that could have been avoided. In the hospital, some procedures or interventions are done freely and routinely, whether or not the mother or baby has shown a clear need. These interventions are disruptive, uncomfortable, can cause serious side effects and often lead to the use of other procedures …
… Birth has become extremely interventive and this includes everything from the seemingly minor … to the most invasive—the cesarean. It has become so interventive that it takes something away from what the experience should be. As a result, many women find themselves grieving.
… Partners witnessing birth trauma are also at risk of developing depression, caused by feelings of helplessness during the traumatic event. Men are more likely to express their feelings of depression through anger and abusive behavior. Truman stated, “The cesarean completely destroyed my faith in the medical community … ”
… Tim stated: “I‘m mad and bitter—disillusioned. That likely won‘t change with time. Recovery is not a term I would use. I‘m not recovering. I have learned a lesson.”
How the couple process their experience can determine whether the marriage survives. Chris said, “… It put us at the brink of divorce. I didn‘t understand fully what happened and my wife thought I didn‘t care.”
The cesarean may be difficult for the father. A husband may have seen his wife rushed to the OR. He saw her uterus taken out of her body. He was worried about her. He may not have words to describe the experience, but he needs to process it.
When I broached the subject of intimacy after cesareans to husbands, some asserted, “Everything‘s fine there, thank you.”
Others report having to work hard to restore intimacy to their marriages: “It took more than a year for intimacy to start returning. More than a year.”
One husband, when asked, snorted, “Hah, are we seriously going there? Personally, it has left ’intimacy‘ out in the dark. She is embarrassed about her scar and she thinks it makes her less sexy. I guess it‘s more of an emotional hardship for her and she just doesn‘t feel sexy anymore.”
The cesarean recovery has an impact on the couple‘s ability to resume intimate relationships. The immediate problem is healing of the incision and recovery from the surgery itself. There also is long-term impact that is rarely noted by the medical community. Some women report a loss of feeling around the scar. Others are hypersensitive to any touch or pressure in the scar area—which may be psychological as well as physical. They report pain and discomfort.
Intimacy is an emotional connection. After a cesarean a number of things may interfere with this connection. The husband may have been frightened by the sight and sounds of—or the scenario that lead to—the cesarean. He may be hesitant to resume relations, worrying that he might hurt her. What if she gets pregnant again? He certainly doesn‘t want to do that again. His wife might feel the same way. She has to focus on her own recovery, which takes away from what she can give to their relationship.
… Stephanie‘s cesarean changed her husband‘s view of the medical community. He said, “… To know that people we trust with our lives and the lives of our children are so careless and insensitive about our lives and the little ones they savagely bring into this world.”
The veil has been removed—even doctors no longer believe in the Hippocratic Oath. They cite liability as the main reason they do many things, including unnecessary surgeries and banning VBACs. Since they are more concerned with money than with the health and safety of women and babies, we must now claim the right to have full and complete information about the risks and benefits of, and alternatives to, every test, drug, procedure and surgery. We must claim the right to make medical decisions for ourselves and in behalf of our babies.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, birth debriefing, Caesarean, Complicated pregnancy or birth, hospital birth, intervention, Obstetrics, postnatal depression, Public and private hospitals, women's rights
Posted by Melissa Maimann on Oct 13, 2009 in
Birth,
Caesarean,
Home birth,
Midwifery,
Normal Birth,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email me or call 0400 418 448.
Link
Maternity care provides a classic example of the pitfalls of a specialist-driven model of practice in health care. It results in more expensive and interventionist care, rather than a community-based approach which could also help ensure a more equitable distribution of services. It has led us to talk about obstetrics, which implies a focus on a particular professional group, rather than maternity care, which implies a broader focus on the woman’s and baby’s needs, both before and well after the birth.
Professor Lesley Barclay … is a leading proponent of the need to reorient maternity care around the needs of women and babies …
“When women talk about what matters to them when it comes to childbirth, the issue they repeatedly mention is safety.
But their understanding of safety around childbirth is often quite different to how health systems and many professionals define it.
For women, a safe childbirth is not only about what occurs at the time of the birth. It also refers to longer-term issues, such as their social and emotional wellbeing in the weeks and month after the birth.
When women talk about safety, they are also thinking about the increased rates of depression and anxiety that manifest after operative birth or the consequences of wound infection on general health.
The Australian health system often makes it difficult for women to make wise choices around birth …
For example, evidence shows for most women most of the time birth does not need to take place in hospital. Some women will only feel safe however, whether this is evidence-based or not, with specialist medical services and technology.
The term “maternity care” … incorporates their social and emotional needs. It puts them – rather than the professional or the service …
Evidence shows maternity care can be provided by both midwives and obstetricians in public and private sector hospitals and can be safely provided at home.
… evidence also shows that safety from morbidity is less likely for Australia’s healthiest and wealthiest women cared for by private obstetricians in private hospitals. More recent epidemiological evidence shows as volumes of operative birth increases, deaths of mothers and infants are also increased by overuse of the very operation that was developed to save lives.
So where does choice fit in this repertoire of terms, locations, professionals, services and outcomes?
Safe birth should be the goal of choices offered to women and decisions taken by those who provide care for them.
Unfortunately, the choices some professionals offer or accept are self or income centered and ignore evidence. As a consequence of gender-located power historically, and a rapid increase in the numbers of more technically oriented professionals in recent decades, health services and costs do not reflect women’s needs or evidence.
The most important example of this is allowing caesarean birth to be a choice rather than only using this as the lifesaving emergency procedure it is.
… caesarean birth is rapidly becoming a life threatening procedure itself because of excessive use … maternal death reviews and coroner’s reports now show the risks attached to using a major surgical procedure as a routine mode of birth.
Maternal mortality is between two and seven times higher for surgical than vaginal birth …
… The physical, social and emotional morbidity attached to women who experience this mode of birth is not recognised therefore ignored within acute care hospitals but is evident in their homes and the community.
Research has identified that physical morbidity associated with CS is five to ten times higher than for women birthing vaginally. No less importantly there are also psychosocial consequences of surgical birth with women less satisfied, more concerned about the baby’s condition and fearful. Women delivering by CS report feeling less in control than women who have birthed vaginally.
Research also shows rates of post natal depression significantly different between women who birthed vaginally and the group of women who delivered either by planned or unplanned CS … Women who birth by CS evaluate their babies less favourably, are less likely to breastfeed and/or feed for a shorter duration.
Paradoxically, the choice to have a normal, safe, confidence affirming birth that is low cost and relieves pressure on hospitals is only available to a small minority of women.
This is not possible for Australia’s most vulnerable women and families, who, the evidence suggests, would benefit most. How many rural or remote living Aboriginal women can opt for a home birth attended by a skilful midwife?
… 1 in 10 remote living Aboriginal women in one large community avoid hospital services or skilled professionals because of the unacceptable risks to them of being evacuated from their community …
Other Australian women with more options are also taking this route, fed up with what they see as biased, self-interested advice and unacceptable risks of our current system.
To have real choices, one needs options and good information on which to base decisions. Better resourced women … can chase evidence themselves, or question doctors, hospitals and midwives …
… there are some ultimate arbiters beyond opinion. One of these is the impartial review of evidence provided by such as the Cochrane data base.
I saw to my great delight a writer (male and medically qualified) who also a Member of Parliament, recently quoting this source in a newspaper. His message, while aimed at indemnifying home birth midwives, was that home birth is safe.
… home birth is indeed safer at times than hospital birth when planned and supported by good hospital care for rare emergencies.
I wish the current president of the AMA, an erstwhile obstetrician, would be similarly correct with his claims that certainly are not recognisable as fact to those familiar with the evidence.
Choices for women are difficult when all they receive is highly partial and ill-informed opinion. Choices around birth are important or women will opt out of a system that does not meet their needs.
…. Should it be a matter of choice though for women to give birth via major abdominal surgery? Should we permit choice that means their babies avoid the process of vaginal birth that prepares them to live and breathe? Should it be women’s or obstetrician’s choice that health pays or heavily subsidises the avoidable costs of unnecessary operations that prevent other necessary surgery being performed and add to waiting lists? I think not.
We need to recognise that operative birth is the option to use only when the risks associated with the alternative are unacceptable. This is not a matter of choice.”
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: birth, Birth choices, birth debriefing, Birth trauma, Caesarean, childbirth education, Complicated pregnancy or birth, continuity of care, Home birth, hospital birth, intervention, Maternity Services Review, midwife, Midwifery, Midwifery services, Normal Birth, Obstetrics, postnatal depression, Preconception care, Public and private hospitals, women's rights
Posted by Melissa Maimann on Aug 6, 2009 in
Birth,
Midwifery For further information, contact Melissa Maimann at Essential Birth Consulting.
Link
How a woman gives birth provokes strong views, with impassioned arguments for normal births, and for Caesareans.
But … the most important thing is for women to be able to choose.
The use of technology in birth – such as the development of epidurals for pain relief and Caesarean sections – has long been a cauldron into which divisive and conflicting issues and opinions have been poured.
… Women can be left deeply scarred by a birth which may have been physically safe but has ignored the emotional aspect of it
When the … NICE was considering guidance on giving birth in the NHS, the large number of midwives who sent in comments were only too aware of how the home birth option was once again nearly lost.
They had to challenge the appropriateness and interpretation of the evidence being considered on the safety of place of birth.
There is a fundamental question needing to be asked here: why do some doctors and midwives devalue the choice of home birth, despite the lack of evidence against it?
… what women want at all times, is good and unbiased information from the health professionals caring for them, so that they can make the appropriate choice about how technology can help them.
One high-profile obstetrician recently relating the birth experience to the advances in agriculture, transport and energy production reminded us alarmingly of the language previously used in the “active management of labour”, when women’s bodies were viewed as machines that were frequently “inefficient” and in need of acceleration.
It has seemed that the health professionals that care for women today had largely moved on from this strange and controlling discourse, and it’s disappointing this may not be the case.
The bottom line here is that what women want is to be able to make a real choice, for the health service to offer them that choice, and for that choice to be based on having all the information needed to make an informed decision …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: birth, Birth choices, birth debriefing, Birth trauma, childbirth education, continuity of care, midwife, Midwifery services, Normal Birth, Obstetrics, women's rights
Posted by Melissa Maimann on May 18, 2009 in
Birth For further information, contact Melissa Maimann at Essential Birth Consulting.
Juat an interesting article I came across ….
Article
new study in rats at the University of Haifa reveals that tauma experienced by a mother even before pregnancy will influence her offspring’s behavior.
The findings show that trauma from a mother’s past, which does not directly impact her pregnancy, will affect her offspring’s emotional and social behavior. We should consider whether such effects occur in humans too,” stated Prof. Micah Leshem who carried out the study.
A mother who experienced trauma prior to becoming pregnant affects the emotional and social behavior of her offspring …
The effects of trauma that a mother experienced in the course of pregnancy are known from earlier research, but until now the influence of adversity before conception has not been examined …
The researchers chose to investigate rats, as social mammals with cerebral activity that is similar in many ways to that of humans. The present study examined three groups of rats: one group was put through a series of stress-inducing activities two weeks before mating, allowing the female time to recover before becoming pregnant; the second group was similarly treated over the course of a week immediately prior to mating; and the third, control group, were not given any form of stress. When the rats’ offspring reached maturity (at 60 days), the researchers examined their emotional behavior – anxiety and depression – and social behavior.
The main finding revealed that trauma experienced by the females prior to conception had varied effects on the offspring … these effects varied between groups and between male and female offspring; but their behavior was without doubt different from that of the rats from the control group.
All the offspring of stressed mothers showed reduced social contact compared with that of the control mothers’ offspring: these rats spent less time with one another and interacted less. In other tests, there were important sex differences. The female rats displayed more symptoms of anxiety, while the males exhibited less anxiety. Finally, those rats whose mothers became pregnant immediately after being stressed were hyperactive, indicating that how long before pregnancy adversity is experienced, is also important. “Everyone knows that smoking harms the fetus and therefore a mother must not smoke during pregnancy. The findings of the present study show that adversity from a mother’s past, even well before her pregnancy, does affect her offspring, even when they are adult. We should be prepared for analogous effects in humans: for example, in children born to mothers who may have been exposed to war well before becoming pregnant,” Prof. Leshem concluded.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, birth debriefing, Birth trauma
Posted by Melissa Maimann on May 12, 2009 in
Birth,
Midwifery,
Normal Birth,
Obstetrics For further information, contact Melissa Maimann at Essential Birth Consulting.
Link to article
Today Gerald F. Joseph Jr, MD, of Louisiana, became the 60th president of The American College of Obstetricians and Gynecologists (ACOG)… . During his inaugural speech at ACOG’s Annual Clinical Meeting, Dr. Joseph announced that postpartum depression is the theme of his presidential initiative.
“While in an ideal world, the newly delivered mother is at the peak of her reproductive health, with a beautiful child and, ideally, a supportive, loving family, this unfortunately is not always the case,” said Dr. Joseph. “Studies show that this is a most vulnerable time for our patients, especially those prone to depression or those with a history of depression.” Complicating matters is that the new mother often can’t bring herself to admit to any problems or negative emotions due to societal pressures, he said. Instead of asking for help, she may feel guilty for not being ‘grateful’ or a ‘good’ mother.
Dr. Joseph explained that the ‘baby blues,’ which affect as many as 80% of new mothers, usually start early after delivery and spontaneously resolve within a very short period of time. “But what happens when these negative feelings don’t resolve and true major depression becomes a part of the process?” he asked. “This can be devastating for the mother, the child, the partner, the family, and the ob-gyn who is caring for her.”
There are three areas in particular that need to be addressed, according to Dr. Joseph. “First, we need to determine the true prevalence and incidence of postpartum depression,” he said. … postpartum depression is estimated to range anywhere from five percent to more than 25 percent … we need to develop evidence-based guidelines for ACOG members to screen for postpartum depression.”
It would be great if there was some sot of acknowledgement of the role that pregnancy- and birth-related interventions have on the incidence of PND. It would also be great to see a study looking specifically at women with PND, to establish what sort of birth experience the woman had, and who her primary care provider was (midwife or obstetrician). It’s not hard to see that when women are told, overtly or covertly, that their bodies don’t work and that they need intervention to start labour, keep it going, or bring it to an end, that they take this learning away to motherhood, and approach motherhood with the same sense of failure.
Rates of PND are lower with midwifery care and with home births. Birth debriefing may help women who are experiencing PND.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: birth debriefing, Birth trauma, Complicated pregnancy or birth, continuity of care, Home birth, hospital birth, Midwifery, Midwifery, Midwifery services, Normal Birth, Obstetrics, postnatal depression, Public and private hospitals, women's rights
Posted by Melissa Maimann on May 11, 2009 in
Birth,
Caesarean,
Home birth,
Midwifery,
Normal Birth,
Obstetrics For further information, contact Melissa Maimann at Essential Birth Consulting.
In Australia, all babies are born with the help of a midwife. This is true whether you’re giving birth in hospital, birth centre, at home or in an operating theatre. The question is really – what are the benefits to having a midwife as your primary care provider?
So, what is a primary care provider?
A primary care provider is someone who is responsible for your pregnancy and birth care. It will either be a doctor or a midwife, and in some circumstances, it will be both. Women may choose birth centre, homebirth or hospital midwifery care to benefit from primary midwifery care.
Primary medical care is provided by private obstetricians or through doctor’s clinics in public hospitals.
What are the benefits of having a midwife as your primary care provider?
Midwives generally have a firm belief in pregnancy and birth as natural processes that women can do. In other words, they believe that a woman’s body is perfectly designed for pregnancy and birth. They look for what’s right in the pregnancy and birth, while always being mindful of risks. Midwives help to keep pregnancy and birth normal by focussing on nutrition, lifestyle, health and well being. We that with health in general, healthy people are less likely to get heart disease, diabetes and so on. Well, it’s the same in pregnancy and birth: healthy women and babies are less likely to get sick. So midwives focus on health and well being, while always being alert for situations that need more attention.
Midwives use a holistic, or biopsychosocial model of care. What this means is that you’re not just a pregnancy or a birth to a midwife. You’re a woman, mother, friend, wife, partner, employer / employee and so on. Your midwife will seek information about your life, your family, your interests and so on, as well as your health and medical history. She will take all of this information into account when making recommendations and giving advice.
Midwives are less likely to use disruptive technologies that may lead to further intervention and complications. They’re less likely to induce labour, perform an episiotomy, perform vaginal examinations, break your waters and so on. So your labour is allowed to progress naturally. When you work with your body, it will work with you. When you interfere with your bodily processes, your body will not work as well. This is especially the case in birth where there’s a strong reliance on hormones to initiate labour and keep it going.
Women are usually very satisfied with midwifery care. They feel supported, emotionally, from seeing a midwife. They feel they can trust their midwife and that their wishes are respected. Women feel more comfortable to write a birth plan and discuss their hopes and preferences for their pregnancy and labour when they see a midwife.
So, what does this mean for birth and babies?
Well, there are lots of positives! When you have a midwife as your primary care provider, you can expect:
- choice of birth place (hospital, birth centre, or home)
- a lower rate of caesarean
- a lower rate of episiotomy
- you’re less likely to be induced
- you’re less likely to need pain medication in labour
- you’re less likely to have your waters broken
- you will be listened to and respected
- your birth plan will be respected
- you will be able to build trust with the midwife who will help you in birth
- you will be less likely to have an assisted birth (eg forceps)
- you will have a lower chance of getting postnatal depression
- you will be less likely to have birth trauma
- you will be more likely to bond well with your baby
- your baby will be more likely to breastfeed successfully
- you will most likely view your labour as being very positive
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, birth debriefing, Birth trauma, Breastfeeding, Caesarean, continuity of care, Epidural, Home birth, hospital birth, intervention, midwife, Midwifery, Midwifery, Midwifery services, Normal Birth, Obstetrics, postnatal depression, Public and private hospitals
For further information, contact Melissa Maimann at Essential Birth Consulting.
Link to article
The article commences with the story of Rachel, who plans a midwife-attended home birth. Her waters break three weeks after her due date, and after 2 days, there is evidence of meconium in the amniotic fluid. The article goes on to say that two days later, she has a fever and is transferred to hospital, not in labour. Hospital induces labour and the baby has an infection, and has sadly died. The woman bleeds and requires resuscitation, a hysterectomy and two weeks in an intensive care unit.
I cannot vouch for the accuracy of the reporting. We know reporters say what they want to say and sensationalise stories. However, there are a few points I’d like to make, assuming the article is true. There are several risk factors here: 43 weeks (1 week “overdue”, since normal pregnancy lasts until 42 weeks), prolonged rupture membranes, and mecomium-stained liquor (amniotic fluid). Should this woman have birthed her baby at home? Maybe not. Homebirth is the domain of low-risk, healthy birth. What we need is a system whereby the midwife can transfer that woman into hospital and remain her primary care provider. I think blame needs to be laid fairly and squarely with a system that does not recognise the full scope of midwifery practice and that does not welcome privately-practicing midwives in the hospital system. It seems to me that much information has been left out of the story above. We do not know if the midwife has taken the woman into hospital already; perhaps the hospital has discharged her saying all was well. We do not know the point at which the midwife was made aware that the woman’s waters had broken; maybe the midwife was not aware of the situation until after the baby passed meconium. Maybe the midwife had taken the woman for scans after 42 weeks to ensure that the baby was well. My point is, we will never know the full details. We read what the media wants us to read, and this story has heped blacken the name of home birth in this country. What it lacks are the details to support what happened.
‘It is not possible to know exactly what information Rachel was given regarding the possible benefits and risks of planned home birth which led to her decision to choose this option, but it is likely she was told that planned home birth with a qualified midwife is as safe as hospital birth, and decreases the likelihood of medical intervention, which harms women and babies.’
Women who choose homebirth research information as if it were an obsession. Yes, planned, midwife-attended homebirth is safe for low risk women. To say otherwise would be a lie. What we need to communicate very clearly is that when freebirths and high-risk homebirths are added to the equation, the risk profile of homebirth changes significantly.
What happened to Rachel and her baby was a terrible, avoidable tragedy and certainly, the majority of home birth midwives would not have advised Rachel to stay at home as long as she did.
Thank goodness they said it! Homebirth midwives are very risk-adverse.
… it is important to them to feel they can have as ‘natural and active’ a birth as possible when receiving care from mainstream maternity services.
No, it is not important for them to merely “feel” they can have a natural birth in the system, it is important that they actually get a natural birth in the system! With some hospitals having caesarean rates of over 46% (NSW stats, 2006), it’s no wonder women don’t quite trust that they can have a “natural” birth in the system. Whatever natural means these days.
“It is always sad when any baby dies perinatally, but it is even more concerning when it happens to a woman having a home birth, because mothers attempting a home birth should only be those considered to be at low risk of poor pregnancy outcome.”
At least one of the deaths that the article refers to was a freebirth. The important factor that was not present there was a midwife. The emphasis on low risk homebirth also needs to be made. Trouble is, many women are attracted to homebirth because of the deficiencies in the hospital system. So they are attracted to homebirth to:
- Have continuity of care and build a trusting relationship with their midwife. Not midwives, midwife. 1.
- Give birth in familiar surroundings, not an institution.
- Have choice and control because that was taken away from them in hospital.
- Be pregnant and give birth in a relaxed setting that is not dominated by clocks, a delivery bed, drugs, strangers who can come in at any time and shift changes.
- Have care as and when they need it – not have to attend noisy, uncomfortable and impersonal hospital clinics, where they wait for an hour or two and are seen for 5 minutes by a midwife or doctor they have not met before; where they leave with unanswered questions and have no idea what this diabetes test is for that they’re told they have to have (or their baby may die).
What system is this that we’re putting women through? And during pregnancy and birth? These are natural and healthful experiences, not medical conditions. Home birth services are a stark contrast!
It is very disappointing that women can feel completely disenfranchised from any sort of hospital care, and feel that the only way their needs can be meet is to attempt birth at home.
Yes, it is disappointing, isn’t it. hospital birth with a private midwife is a great way around this issue.
RANZCOG considers that there is no place for the ‘independent’ practitioner, working in isolation and having no link with any other health professional or hospital,
No “independent” midwife works in isolation! All IMs collaborate with hospitals, consulting and referring when necessary. We work in our full scope of practice and we are autonomous care providers, as is supported by WHO, FIGO and ACMI.
The four deaths referred to above indicate why RANZCOG is opposed to ‘independent’ practitioners.
Even though at least one of them was not professionally attended?
Melissa Maimann, Essential Birth Consulting.
Tags: Babies, birth, Birth choices, birth debriefing, Birth trauma, Complicated pregnancy or birth, continuity of care, freebirth, Home birth, hospital birth, intervention, Maternity Services Review, midwife, Midwifery, Midwifery, Midwifery services, Normal Birth, Obstetrics, Public and private hospitals, women's rights