Has labour become a competition?

Sitting at mother’s groups, listening and observing, a general theme emerges when mothers speak of their recent births: competition. Who had the most traumatic birth? Who had the longest labour? And I came to wonder what purpose this competition serves.

I wonder if it serves a few purposes.

It reinforces birth as a scary, dangerous, even deadly experience that really must occur in hospital. “Thank god I was in hospital. My baby would have died if I had been at home!”

It validates the experience of the woman who had the most traumatic labour. The woman who wins the most-traumatic-birth-competition feels good, as any winner would do. Why would she want to give up this good feeling? After-all, she’s been traumatised by the birth and it feels good to finally have a group of women say, “wow, that was really bad!” rather than, “at least you have a healthy baby”. This reinforcement relieves the woman of her quest to find out what went wrong, and more importantly why, in attempt to avoid the same situation from occurring next time. Hence, “I’ll just go for a ceasar next time” if often heard and the other mothers agree that yes, since this woman’s birth was the most traumatic of all the births in the group, this woman is certainly justified in “going for a caesar” next time.

Other themes that emerge are an avoidance of self-responsibility, empowerment, ownership and belief in birth as a process that a woman’s body can do, if let to labour as nature intends. The most-traumatic-birth-competition rarely centres on the woman’s individual choices and decisions. It focuses on what was done to her and what was out of her control. Have we lost the ability to have the courage of our convictions, to trust our instincts, to believe in ourselves, that we hand over responsibility for our births to a stranger / professional? Often times, the mother who has had the most traumatic birth will have handed over the most responsibility for her birth. This protects the mother from any guilt: one the one hand, it was her care provider’s fault if things didn’t go to plan, and on the other hand, thank goodness she had her careprovider to sort things out and rescue her and her baby from the birth. Either way, the woman bears no responsibility for the outcome that was less-than-desirable.

The mother who had the most natural birth often doesn’t speak. She’s in the minority after all. No-one wants to hear about her amazing home waterbirth. And indeed, if she dares to speak of her positive, empowering experience, she is met with disapproval for daring to speak while Mrs Jones is re-living her nightmare to the group. The natural birth mother is labeled “odd” for ever pursuing a natural birth, and even odder for actually achieving it. She best not speak or her views will only isolate her from the group, and motherhood can be isolating enough. So now the situation is that the competition exists entirely of traumatised mothers, all seeking to be awarded the prize for having had the biggest tear, longest labour, greatest number of interventions and biggest baby. Each wants to feel that although the circumstances were not ideal, there was nothing they could have done to avert such outcomes, that they were mere victims in the unpredictable process of birth. They went to a top private hospital with the best obstetrician in Sydney (funny that they’re all “the best”) and that’s where their responsibility ends.

It’s hard to do the self-reflection and question decisions you made. Maybe you’ll learn that other decisions would have led to better outcomes and this starts the painful cycle of regret for something that cannot be changed. However, it’s ok to honour that journey and know that at the time, we made the best decisions we could have made, but now that we know differently, we will choose differently.

When this happens, maybe the competition will be on different terms. I live for the day when the competition is for the most satisfying, safe and empowering birth experience with the woman coming away with her dignity intact and feeling respected and cared for throughout her experience. It’s totally possible!

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Anatomy of a C-section: they save lives, but would you choose one?

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Andrew … watched his partner endure two invasive births, one elective, the other life saving.

My partner’s first cesarean, whilst swift, was disorientating, cold and left my other half feeling cheated.

Lying on her back, she couldn’t see or feel anything, having been given a powerful anesthetic. I could see the staff – their expressions informing whether the operation was going to plan – the bleeping equipment, the blood splashing on the floor, the whitewashed walls. The cutting of the abdomen and subsequent extraction was done out of sight, behind a screen they never seem to bother with on television. Baby was brought into the world, fleetingly given to mum, then handed to me for carrying into the weighing room.

We were later told separation isn’t standard procedure, and that the medics must have felt there was an urgency with doing my partner back up, and didn’t want distractions. That night I had to leave the maternity ward by 8pm – visiting times are strict, with everyone apart from mother and child kicked out, no exceptions.

My partner was put in a bed in a crowded room, a blue curtain separating her from half a dozen other mums plus (wailing) newborns. Our daughter was placed in a white plastic cot adjacent to the bed. Having been sliced open and stitched back together again just hours before, reaching over the short distance to pick our daughter up was difficult, if not impossible, that first night. When she moved, the pain was intense, despite being given a cocktail of drugs. She had to press the buzzer to get a midwife to help every time she wanted to lift her baby up to comfort or attempt to feed her. The first time the [midwife] was more than willing, by the fifth time there was resentment.

In the morning, having had not a minute of sleep – she’d been awake for more than 72 hours by now – my partner was unable to properly tend to her baby or to attempt a shower. She described feeling like the contents of her abdomen were going to fall out onto the floor if she moved. With my help – I’d arrived at 9am, the beginning of visiting hours – she managed to wash. The staff were economic with sympathy for her inability to move around.

Once home after some three days, the difficulties arising from an invasive birth continued to dog my partner’s joy of being a new parent. Doing virtually any normal daily task was difficult, doing everything that our newborn daughter required was impossible. How would someone cope alone? About a week after the birth, mum and baby took their first, tentative trip out. Every step felt alien, she described, the feeling that the stitches were going to come undone at any time persisting. We later attributed this stroll to the nasty infection that settled in my partner’s cut. Although treated, the infection set recovery back, and heightened anxieties.

It was not the physical difficulties that most blighted those post-birth days however. It was the psychological impact of not having had the birth she’d wanted. She felt cheated, having originally wanted a home, or at the very least, natural, delivery. Prior to the birth, owing to the anticipated size (over 11lbs) of our baby one consultant had insisted only a C-section would do. Another consultant had said she could ‘try natural’. The decision was effectively made by the stark warning that if my partner ‘went natural’ and the baby became stuck – ‘very likely’ according to consultant one – they may have to dislocate her shoulder in order to try and bring her out. Afterwards, opinion was that ‘natural’ would have been fine, especially as our daughter weighed in at a much more reasonable (if large) 10lbs. Although acknowledging all medics involved were acting in her best interests, my partner remained deflated – this was not the exhilarating, empowering birth she had wanted, and definitely not what was ‘sold’ in the baby magazines.

She therefore had high hopes for a natural birth second time around. But during a routine early scan she was diagnosed with the potentially dangerous condition placenta previa where the uterus becomes blocked by the placenta.

Although in some cases diagnosed women go on to deliver naturally, as my partner’s due date approached it became apparent this wasn’t an option.

Without intervention … this condition is quite simply a death sentence for mother and child. The operation this time around made the first look like a walk in the park. Surrounded by up to twenty medics – doctors, consultants, anesthetists, nurses and support staff – the initial extraction went smoothly. However, minutes after delivery the surgeons couldn’t get the bleeding to stop. This is always a risk with placenta previa. For the next three hours at least – time moved in slow motion – we watched (from behind a screen) as the medics worked through the full spectrum of options available to them to stem the bleeding.

First the clotting drugs, then the ‘figure of eight’ stitch, then something called the ‘bakri balloon’, a little-known ‘last resort’ that quite literally saw a balloon type device directly inserted into my partners’ womb to bring extra pressure to bear on the uterus.

The latter worked. But she’d lost so much blood she needed a transfusion – urgently. Several hours after the birth, she was lying in intensive care … Needless to say, the birth she’d wanted hadn’t involved major surgery.

But the operation, the C-section, performed by brilliant, dedicated surgeons, had not only saved our son’s life, it had saved hers. The ability of modern medicine to deliver babies via C-sections is nothing sort of a miracle. But would you choose one?

This can be the reality of caesareans: if they are performed for life-saving reasons, they will inevitably involve a degree of risk. If there was no risk, there would be no need for the caesarean. A caesarean performed without risk factors is generally safe – safer than it has ever been and as safe as it can be – but not as safe as a vaginal birth.

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Hospital says No to cesarean

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A NORTH Coast mum who has been told she can’t deliver her baby by cesarean feels [that the] Hospital is prioritising policy over people.

Sylvia … said she was told by an obstetrician at the hospital she could only have a C-section … in an emergency.

“I just had tears streaming down my face – I couldn’t believe it,” …”I feel so powerless and betrayed by the medical system that my choice has been taken away.”

Ms Leveridge, who is 28 weeks pregnant, wants to avoid the 20-hour labour she experienced before undergoing an emergency cesarean to deliver her first child.

Her first baby was a whopping 4.240kg and Ms Leveridge understands this baby will be just as big.

… under the Towards Normal Birth policy, the state is aiming to reduce the cesarean rate to 20% before 2015.

Ms Leveridge said she was advised the hospital has to reduce the number of cesareans it performs in line with the policy.

… there are risks associated with cesarean section operations … the rights of the both babies and mothers have to be balanced out.

“It’s not just the mum’s choice. It’s also the baby’s choice as to how the delivery transpires. This is something that is often lost in the debate about how babies should be delivered,” …

“My problem is I have big babies and I just feel like I’m on the same treadmill,” Ms Leveridge said.

As I see it, there are four issues here:
1. Fear
2. A previous “big” baby
3. A woman’s sense of control over how she will deliver her baby, aka woman-centered care
4. Safety for mother and baby, and the health practitioner’s duty to recommend the safest course of action

Fear
It is not unusual that this woman would feel so fearful of her upcoming birth: her only experience of labour and birth had been an horrendous 20-hour labour with untold interventions delivered in a model of care that provided limited continuity, and ultimately leading to an emergency caesarean. In my practice, women have only one midwife for the whole pregnancy – baby experience. This model of care has been demonstrated to reduce women’s fear, and also promote normal birth. Around 90% women who birth with me experience a normal birth.

A previous “big” baby
A “big” baby is not necessarily a concern, and nor is it necessarily associated with a caesarean. The important factor here is whether the baby was always destined to be a larger baby that is able to fit through an ample pelvis, or whether the baby was abnormally large perhaps because of poor maternal diet or poorly-controlled gestational diabetes. Many “large” babies are born normally: these are often babies who have been nurtured with good nutrition in a woman whose pelvis is amply able to accommodate a larger baby. The labour and birth is often rapid and the baby is born healthily and safely. The same cannot be said of babies who are abnormally large because of high circulating glucose in the mother’s blood. In my practice, much time is spent with women talking about nutrition; why it is important; motivational tools to remain healthy and fit in pregnancy; and finally assisting them with a healthy eating plan that is flexible and is based on their own unique tastes and needs. The average birth weight is around 3.4Kg.

A woman’s sense of control over how she will deliver her baby, aka woman-centered care

We know from studies that a request for a caesarean is based mostly on a woman’s fear of labour. The woman in this article was quite justified in her fear: her only personal knowledge of birth was an awful labour culminating in a caesarean, and she sees herself staring down that same barrel, since she again feels that she has a big baby. I often find that women will make an initial request, for example for a hospital birth or an epidural, and through their pregnancy care experience, they grow massively in terms of their confidence, knowledge and trust, such that they are saying later in pregnancy, “Actually, maybe I can do this without an epidural. Maybe if I can labour and birth in the water, that will help and I won’t need an epidural.” Or, “I know I’ve been wanting a hospital birth all along, but I’m curious about homebirth and if all’s well, I think I might like to stay home in labour.” The power of continuity of care – where every woman has only one midwife as her midwifery care provider – is often understated in the literature.

Safety for mother and baby, and the health practitioner’s duty to recommend the safest course of action

I’ve sometimes been heard to say that as midwives, we really only have one job, and that is safety. Women engage midwives for their care because they understand that midwives have a unique skill-set that includes knowledge, experience, judgment and compassion. If women possessed this skill-set, they would have no need for midwives. It is the health practitioner’s role to recommend the safest course of action, which in this case is a VBAC. The woman is so caught up in fear from a traumatic previous experience that rationally, she is probably not even able to take any of this in. The woman should be supported, not necessarily to birth vaginally or abdominally, but just supported. Nothing more, nothing less. After working one-on-one with her private midwife, towards the end of her pregnancy, and with a healthily-grown baby, she just might see things differently and agree that a VBAC is the safest course of action for her and also for her baby. To thrust this (VBAC) upon a woman who is driven by an unresolved and justified fear state is unreasonable and shows a lack of compassion. Yes, a VBAC is probably the safest for mother and baby. But fear (and the absence of fear: confidence, calmness, surrender) is the most important driver of birth. Until we work to eliminate fear and instill confidence, we will have high caesarean rates, whether these are chosen by women or recommended by health practitioners.

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Women need a year to recover from childbirth

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New mothers may be told that they will be back to ‘normal’ within six weeks of giving birth, but a new study has found that most women take much longer to recover.

… it takes a year to recover from childbirth

… The psychological effects can also take much longer to recover from.

… hospital wards can have a negative impact on women’s ability to recoup and celebrate the birth of their child because of the constant stream of visitors and the unfamiliar rules and regulations.

Helping new mothers adapt to having a baby in the home has also changed a lot over the years.

In the past women were shown how to perform tasks such as baby bathing and were only discharged from hospital when they were ready.

Now women can go home as soon as six hours after childbirth and many feel they are just ‘left to get on with it’.

Dr Wray said: ‘The research shows that more realistic and woman-friendly postnatal services are needed.

‘Women feel that it takes much longer than six weeks to recover and they should be supported beyond the current six to eight weeks after birth.

‘However, government funding cuts and a national shortage of midwives means that postnatal services will only face further challenges. The midwifery profession must raise the status of postnatal care as any further erosion can only be bad for women and their children.’ …

Private midwifery provides women with 6 weeks of comprehensive postnatal care.

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Inducing Labor Better for Big Babies

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The study below has made a compelling argument for induction for babies who are thought to be large for their gestational age. The first thing to ascertain before deciding on a course of action, is that the baby is truly larger than expected. All methods of judging a baby’s size in the uterus are prone to error, for example ultrasound has a 15% margin of error. Therefore we need to take this into account when we are advising women of the safest options. Many inductions (and even caesareans) are performed for “big” babies, only to have the induction go pear-shaped and lead to a caesarean … for a 3.5Kg baby. On the other hand, an earlier induction for a genuinely large baby may well prevent a caesarean, forceps birth, perineal trauma (tears, episiotomy) and so on.

Large-for-date babies are more likely to experience neonatal trauma if nature is allowed to take its course than if labor is induced …

Among fetuses estimated sonographically to be above the 95th percentile for weight, adverse events such as shoulder dystocia were three times less likely if labor was induced …

Induction of labor also was associated with a greater likelihood of spontaneous vaginal delivery …

Previous observational studies have suggested that induction of labor may lower birth weight and decrease the chance for neonatal injury such as shoulder dystocia, brachial plexus injury, and death.

However, studies also found increased rates of cesarean section with induction, and the reliability of fetal weight estimation has been questioned.

… 817 women … were assigned to be induced within three days of enrollment or to expectant management.

They averaged 37 weeks gestation, and fetal weight was estimated at an average of 3,700 grams.

The difference between the groups was approximately nine days additional gestation in the expectant management group along with a 287-g (10 oz.) higher birth weight.

In the expectant management group, 6.6% of neonates experienced shoulder dystocia, compared with 2.2% in the induced group …

Also significant was the difference in vaginal deliveries, which occurred in 58.7% of the induced births and 51.7% of expectant births.

Cesarean section was needed in 28% of the induction group and 31.7% of the expectant group.

Secondary outcomes — including clavicular fracture and brachial plexus injury — were similar between the two groups.

There were no serious or permanent brachial plexus injuries or deaths.

… The study demonstrated that prevention of macrosomia at birth can lead to safe birth outcomes …

The other aspect that has not been mentioned in this study is the importance of caring for women and providing advice that will help them to grow a baby who is appropriate for their pelvis, to maximise the chance of a normal birth. This is an essential aspect of the care that I provide to women.

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Natural Twin Birth

I had a difficult delivery with my first baby, including posterior presentation, premature rupture of membranes, meconium staining, stalled labour, 18 hours of Syntocinon, a largely ineffectual epidural, a 4 hour second stage, and forceps delivery. My daughter had severe respiratory distress and was in the NICU for several days. It was a very tough introduction to parenthood and left me quite traumatised, especially the separation from my daughter. My husband and I decided that we would try for a homebirth if we had another baby, in the hope that a calmer environment would assist the birth process. When I fell pregnant again, we found a lovely homebirth midwife.

I started to show really early. At 8 weeks I was in maternity wear. I thought it was just because it was a second pregnancy, but a 9 week ultrasound showed TWO BABIES. We were completely shocked as there are no twins in my family. Twins of course meant that a homebirth was out of the question.

There followed many long months of argument with various obstetricians about our birth choices. We wanted as little intervention as possible. A standard twin delivery involves syntocinon (which I was very afraid of, after the previous experience), continuous monitoring (which I had hated with my first birth, as I felt chained to the bed) and an epidural prior to the second stage, in case positioning/version or a c-section is necessary to deliver the second twin. In my first birth, the epidural meant I had no pushing urge and seriously compromised my ability to deliver my daughter, hence the very prolonged second stage, so I did not want an epidural this time around, although I was prepared for Synto to be administered between the twins if labour did not re-establish. The hospital also wanted both twins delivered on the bed, which I did not agree with as I had found pushing in that position impossible the first time around. Our views were very challenging to the obstetricians and some were quite aggressive about it, although I must say the head OB was more reasonable and was prepared to admit that my refusal to consent to an epidural would be a “complete contraindication” to giving me one! Throughout this stage our midwife was a pillar of strength and information. She gave us the courage of our convictions and more than once came to the hospital to talk with the obstetricians on our behalf. Even so, the hospital was very unhappy with our birth preferences. It was a stressful time, helped somewhat by a Calmbirth ® course.

In the end all our arguments ended up being moot. At 33 weeks, I started to feel an ominous itching all over. Tests showed elevated bile salts and poor liver function results. I had obstetric cholestasis. Our midwife and the hospital agreed: the babies would need to be delivered by 37 weeks. And I knew that that early, an induction would almost certainly involve Syntocinon.

This was really difficult for me to accept. I was terribly afraid of the drug, and knew that Synto would mean continuous monitoring and therefore limit my movement, which I also feared. However, I knew that my fear would make the delivery more difficult and the pain worse. At this point the hospital dropped the bombshell that despite all their delivery rooms having deep birthing baths, I would not be allowed to use those or the shower if I had to have Synto, as they believe this risks pump damage to the Synto pump. Essentially this meant I was walking into a labour that was likely to be more painful, with less pain relief options. It was going to be down to Calmbirth ® alone, if I wanted to avoid drugs (and I did!).

I did a lot of Calmbirth ® practice from then on. But the Calmbirth ® visualisation exercises presupposed a normal delivery without intervention, and I found it very upsetting to listen to them. I hit on the idea of doing my own visualisations, of a medicalised induction process. After a few of these I was able to work through some of my fears.

On the day of the induction, we kissed our daughter goodbye at 5am and met our midwife at the hospital. Preliminary checks showed a Bishop score of 5, very promising for 36 weeks. The hospital midwife applied prostaglandin gel and sent us out to freedom. We had a lovely breakfast. I started to have sporadic contractions but nothing serious. We returned to the hospital 6 hours later. My cervix had ripened to 2cm, and the very cheerful OB was able to break the waters for twin 1 (our second daughter) at 3.45pm. No meconium staining! I dared to ask the OB how she was presenting. ANTERIOR, WOOHOO! I was very pleased with that.

Contractions came rather more strongly after that point, but were still sporadic. The felt very “knifey”, and our midwife explained this was from the prostaglandin gel. We held off on the Synto as long as possible, but at 6.25pm the drip was put up and contractions started in earnest. Continuous monitoring was in place, but via telemetry so I could have moved. Ironically, though, I didn’t feel the need to. I went deep into calm breathing and spent most of the labour sitting beside the bed on a fit ball, sometimes circling my hips but more often just breathing to ride the contractions with my husband stroking my back. Unlike my first labour, I had no real idea of when the next contraction was coming, and ended up doing my calm breathing (in for 4, out for 6) solidly for hours. I wasn’t afraid of the contractions. I could really feel them doing their work, and little twin 1 moving firm and fast down. I was determined to “get out of the way” of labour and with each contraction focused on opening up and not clenching against the pain. Our midwife was convinced things were going quickly and asked us when we thought we would be having the babies. I told her anything before midnight was a sucker bet! She said 11pm.

At 8.30pm, about 2 hours after I started having regular contractions, the pain was starting to get BIG. The OB did a cervix check – I was 5cm. I was very disheartened by this, but our midwife told me that the first 5cm was the hardest, and the very encouraging OB tried to convince me that it wasn’t all about centimetres and that my cervix felt promisingly thin and stretchy. In hindsight, even in my first labour I dilated from 5 to 10cm in under an hour, so I should have known what was coming – but I didn’t!

Throughout this time I was not making any noise. The hospital’s midwife didn’t seem to think I was in established labour, and threatened to up the Synto dose to make the contractions “strong and regular”, even though they were already sufficient to dilate my cervix 3cm in under 2 hours. I managed to insist “no. more. Synto!” She reserved judgement, but it might have been the adrenaline kick I needed, as by 9.15pm I was having enormous contractions every 2-3 minutes. I could feel them as a giant swelling band of pain stretching around my whole belly and stretching lower. At this point I started vocalising “ah, ah, ah” throughout contractions, to help me ride the pain and stop me clenching down. I remember saying “if this isn’t transition, I’m in trouble!” I didn’t believe it could be transition, though – not so early, not when my first birth had taken almost 3 days. Our midwife said she thought we would have babies by 10pm, and I didn’t believe her.

I needed to get off the fit ball and change position, and asked if I could get on all fours, although the idea of moving seemed impossible to imagine. The hospital midwife set up a crash mat and a nice beanbag for me to lean on. I leaned forward and within one contraction of moving had started making some amazing noises. Unlike my “ah ah ahs” they were completely involuntary. And then I could feel twin 1 crowning. I did not believe it had happened so quickly, and cried out “what’s happening?” Everyone still makes fun of me for this. She was born in only a couple of pushes at 9.25pm, and our midwife had to tell the hospital midwife to put her gloves on to catch her. Our beautiful daughter, with a lovely round head, pink skin and a great big yell! There is a photo of me still on all fours, with a blissed-out grin. I could not believe how easy and quick it had been. I got to hold her straight away, but contractions started up again quite quickly, and she went to her daddy for some skin to skin time.

At this point the obstetricians arrived – a registrar and resident. I wanted to stay on the floor, but the registrar managed to persuade me up on the bed to check twin 2′s position, as we knew he was breech. Contractions started up again within minutes and were really agonising now, as I had lost my Calmbirth focus and as the position (twin 2′s spine to mine) had that sort of posterior feeling to it. But within seconds I was again feeling the inexorable urge to push. The OB flicked twin 2′s feet out as he was in a squatting position, the midwife and OB flexed twin 2′s head by pushing on my stomach and with a few mighty pushes he was out too, at 9.39pm. Our son! He was handed to me but unlike J, had a bit of trouble breathing, and spent some time in the special care nursery. He was back to us almost before we knew it. I must say he had a very breech-looking head, which looked like a mighty frown, but he’s ever so handsome and cheerful now.

J weighed in at 2.98kg (I was really ticked off she could not stretch to the extra 20gm), and P weighed 3.06kg, excellent weights for 36 weekers, let alone twins!

After twin 2 was out, I lost all patience for the pain – rather a pity as the Synto kept getting ramped up to deliver the placentas and then to deal with my uterus which did not want to shrink back down. I ended up with a Synto drip all night. I tell people this birth was meant to help me deal with my fear of Synto once and for all.

Both babies had beautiful breastfeeds within an hour or two of birth, which sadly was not an omen of things to come for twin 1, but it was lovely.


Anyway, that was our birth. Twins born without any pain relief (not even hot water) or really any intervention other than the induction drugs, with 4 hours of contractions total and only about 2 of those active labour. It wasn’t the birth I had wanted but it was a wonderful experience and very healing after my first daughter’s birth. I am so proud of myself, and look back on the birth with amazed gratitude all the time.

Visit my website to learn more about my services.

The Unkindest Cut: Countdown to a C-Section

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… “Usually I start off by telling people my C-section started even before I got to the hospital …

… Sharp Mary Birch Hospital for Women and Newborns had the highest rate of cesarean section deliveries in San Diego County in 2009. The California average was 29.8 per 100 births; at Sharp Mary Birch, the rate was 37.7.

… At 40 weeks … Cooper-Schultz’s water broke, though she was not in labor. In a birthing class … they told her, we have to get the baby out within 24 hours. So she and her husband went to the hospital right away.

“They pretty much wanted to put me on Pitocin the minute I walked in the door because I wasn’t having regular contractions,” …

… women believe their C-section deliveries at Mary Birch were the result of convenience for the doctors, fear of litigation, and/or lack of staff training in nonmedicated childbirth options.

… It is common for hospitals to use Pitocin if a woman has not gone into active labor within 24 hours after her water has broken to avoid the risk of infection. But the staff at Mary Birch wanted to give Cooper-Schultz Pitocin within the first two hours.

Cooper-Schultz refused the Pitocin at first. She wanted to get things going naturally … At the 12-hour mark, her cervix had dilated to four centimeters. She says she now understands that this “is a good natural labor progression for a first-time mom.”

But it wasn’t fast enough for the staff at Mary Birch. Cooper-Schultz … allowed them to give her the Pitocin that she says they’d been pushing since she’d arrived.

… “They weren’t honest with me. They didn’t say, ‘If you get the Pitocin, you’re probably going to need an epidural.’”

… Cooper-Schultz withstood the pain of Pitocin contractions for eight hours before she finally gave in and got an epidural … The epidural worked on only her left half.

At one point, the doctor came in to check on her and alerted the nurses that she was going home to take her kids to school. Sometime later, she returned with wet hair, checked Cooper-Schultz, found her at nine centimeters, and told her to try pushing.

“I pushed, and [the baby’s] heart rate went down … she said she’s worried about it. She said, ‘He’s not in distress, but he’s a little bit stressed.’”

The doctor told Cooper-Schultz it would go one of three ways. In the first scenario, Cooper-Schultz would push for 20 or so minutes and the baby would come out. In the second, she could push for 20 or so minutes, the baby would not come out, and they’d have to do an emergency cesarean section. Or, the doctor said, they could do a cesarean section right now.

Cooper-Schultz chose the cesarean. …
∗ ∗ ∗

Helen … welcomes me into her North Park apartment shortly after the dinner hour on a Tuesday evening in mid-September. She tells me she’s an unlikely candidate for natural childbirth.

“I’m like Woody Allen,” she says. “I am a New Yorker who likes living in the city, who likes creature comforts. And for somebody like me to be embracing [natural childbirth] is humongous.”

… Dover’s story is similar to Cooper-Schultz’s in that it begins with a desire to give birth naturally … and ends in what she considers an unnecessary C-section. One difference is that when Dover started out, she did know she might have to fight for what she wanted … She stayed home and labored for 10 to 12 hours before she went to the hospital, avoiding “the clock” for as long as she could.

When she arrived, armed with her research and her hopes for a natural birth, she found that the environment at Mary Birch had a greater impact on her than she’d imagined it would.

… The progression she’d experienced at home, from two centimeters to four, slowed drastically when she arrived at the hospital. A doctor told her that it might help if he broke her water. So she allowed it. But nothing happened …

… Dover lists her regrets: Not waiting and laboring longer at home. Allowing the Pitocin at 12 hours. Giving in to the epidural after 8 more hours. But the regrets go as far back as her pregnancy, when she chose to stay with Sharp.

“I should’ve just switched … “In order for me to switch to Scripps and go to one of the birth rooms at Scripps, which has a much better record, would have meant changing everything: changing my primary care physician, changing my OBG. I would’ve had to totally change my insurance policy. And at the time, I already had a pediatrician picked out for her and everything. We’d interviewed, and just the idea of doing all of that was overwhelming. I thought I didn’t have the strength to do it.”

… “[The doctor] said, ‘You need a C-section,’” she says. “I said, ‘I don’t understand why I need a C-section. Everything seems to be fine. Her heart rate’s not dropping.’ And he said, ‘Well, she’s stuck.’”

“… I was totally against using the suction, but anything besides the total hands-off. He said, ‘I don’t want to hurt your baby, and you don’t want to hurt your baby.’ I started crying. And I just finally said, ‘Fine. Cut me open.’” …

∗ ∗ ∗

The obstetrician a woman chooses plays as large a role in her birth experience as the place she chooses to deliver her baby. Some doctors have a reputation for being more inclined to help with a natural birth, and others for being less inclined …

Thompson cites the “bait and switch,” where a doctor claims to support a woman’s birth choices up until the final weeks, when it’s too late to change doctors. Messer says she’s seen doctors who’ve initially said they’d support the hypnobirthing process but later changed their minds.

“All of a sudden it’s, ‘That’s not going to work. No, you can’t be on your hands and knees. That’s not safe, and this isn’t,’” Messer says. “And that’s at 40 weeks. So now, where can I switch?”

… Christine Stewart, a petite redhead and mother of twin girls born at Mary Birch in September 2009, says she experienced something similar with her doctor.

… “… we took a Bradley Method childbirth class,” Stewart says, “which is a 12-week class, pretty in-depth, and we decided we wanted to do natural, unmedicated labor.”

When she first mentioned this to her doctor, Stewart says the doctor told her to “keep an open mind” and not to “fixate on any particular way of labor and delivery.” At the time, Stewart thought the doctor didn’t want her to be disappointed if natural birth didn’t work out, but now she speculates that the doctor was always leaning toward a C-section.

At 36 weeks, the doctor suggested they induce her at 38 weeks. Stewart refused.

“From what I can tell,” she says, “it’s just common that it’s more manageable to have twins at 38 weeks because of size. Sometimes they’re concerned about size. But [my girls] were normal-sized.”

The doctor suggested 39 weeks, then 40. Finally, Stewart agreed to induce at 41 weeks if she hadn’t gone into labor by then. But it was unnecessary. At 40 weeks, three days short of her original due date, Stewart went into labor.

Stewart chose Mary Birch because it had everything she was looking for. Originally, she’d wanted to deliver at Best Start Birth Center in Hillcrest, but they don’t accept women who are pregnant with twins. Mary Birch, she says, seemed like the next best thing.

“It had the facilities, doctors on hand, and all these different classes — prenatal yoga — and since I was diagnosed high-risk because I had the twins and since I was over 35,” she says, “I just thought their whole entire focus is for women and newborns, so I’ll probably get the best care because they’ve got all the resources for that.”

Stewart had heard about other women going into the hospital prematurely and getting “strapped down” immediately. But in her natural childbirth class she’d learned that mobility helps with labor. So she and her husband didn’t go in right away.

Once they did arrive at the hospital, Stewart was four centimeters dilated. She gave the nursing staff her birth plan, which stated that she did not want any mention of pain medication.

“Thankfully, they did not offer medication. They were respectful of that … I was slowly dilating in a normal time frame. They were telling me that was normal …

… Christine Stewart believes that the main reason she ended up having a C-section was that her nurses had no training in natural childbirth.

“Ultimately, the outcome was because there was no one in the labor room who had the experience to help get the babies in position to be delivered,” she says.

By the time the doctor arrived, Stewart was fully dilated. She knew her babies were healthy, that they were both head down, in a good position, face forward. Her blood pressure was not elevated, she had no fever, and she’d been in labor for less than 24 hours. Everything was normal except that the babies were wedged in, each trying to get out first.

… At 2:00 a.m., the doctor came in and said, “It’s time to meet your girls.”

… I kind of resigned myself, like, ‘If this is what we have to do, this is what we have to do.’ I felt like crying because it just went against everything I had hoped for, everything I had planned and practiced for.”

“I think the hospital has some standard protocols, and I think that if you don’t follow their standard protocols, they just don’t know what to do with you,” she says. “And a C-section is manageable. They know exactly how to do it, and I think at 2:30 in the morning it’s, ‘We can manage this, and then we can all go home.’”

∗ ∗ ∗

Last March, when her first son was two and a half years old, Elizabeth Cooper-Schultz had her second child in the back bedroom of her UTC apartment, in the company of her husband, her midwife, two apprentice midwives, and a doula.

Today, Helen Dover is pregnant again. When I ask if she plans to give birth at Mary Birch, she and Henry simultaneously answer, “No.”

“What I’ve learned is that at Mary Birch, everybody’s going to try to get you to do the birth that they want you to do,” Dover explains.

For their next baby, the Dovers will stay with Sharp in order to take advantage of the tests, which would cost them thousands of dollars out-of-pocket. They will also register at Mary Birch so that they are prepared in the event of an emergency. But they have hired a midwife to help them birth at home.

“We’re going just to get what doctors are good for,” Henry says, “and then to use the midwives for what they’re good for.”….

Visit my website to learn more about my services.

Do deceptive medical birth procedures de-humanize women?

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It was a rainy Wednesday late afternoon when pregnant Ana Cristina realized it was time to get ‘to know’ her unborn son João. She went to the Maternity Hospital Leonor Mendes de Barros in hopes of an easy delivery. Despite the pain and restlessness, Ana stood quietly for four hours waiting for care. “It’s a scandal that they treat you badly,” she said. After waiting so many hours … Ana was informed that there were no vacancies and she should find another place to have her son.

… They would have make it across São Paulo city to go to another facility, the … famous teaching hospital in Santa Casa renowned in Brazil for its quality of health care …

… Many women face the happiness of their baby’s arrival with a fear of dying, along with the desire to care for their child and also to be cared for by their medical team. They have confidence in the hospital as the safest place to have a child. But they also carry the suspicion that their delivery can be abused by impunity and deceptive medical ethics by some medical teams.

Some women OB/GYN patients hear humiliating phrases from their medical providers during the process of childbirth, such as:

“Aren’t you too old to be having a baby?”
“If you don’t shut your mouth…”
“It didn’t hurt to make it, right?”
“You didn’t close your legs then, now deal with it!”

Often women patients do their best not to complain and to follow the orders of the medical team …

… André François, founder of ImageMagica, an organization that promotes education, culture and health through photography, has worked to document ‘humane medicine’ … In the process he has also documented medical abuse …

Can an unwanted caesarian be a form violence against women?

… vast differences in the health care system do exist. A universal healthcare system set to serve the poor in Brazil was widely established in 1988 offering free public healthcare for the first time to many in need. The system has suffered under many financial strains though with crumbling medical facilities and the theft of medical supplies in over crowed medical clinics that have had long lines with services that have turned critical needs patients away. But improvements in many levels of care have been made as some hospitals have been equipped with the newest medical equipment and trained medical staff.

François saw Brazil’s system of health care up close when he witnessed the case of one woman from the Amazon who urgently needed a caesarean section. But her journey to the doctor would not be an easy one. To get the medical attention she needed, she would have to face 12 hours of … pain as she traveled by motor canoe to the nearest medical facility. In many regions of the country “when a woman needs a caesarean section, she will usually die,” says André.

In spite of attempts to offer free health care to many of the underprivileged, a 2010 Brazilian study, “Women and Gender in Brazilian public and private spaces,” … 1 in 4 women in the country suffer today from some form of abuse during delivery.

But is there a difference between abuse and violence against women during delivery? What is the perception?

“Women with lower education, do not consider that the treatment they received was mistreatment and disrespect,” … “Through accounts of friends and people of the same social group, they listen that the hospital delivery is like that: it will hurt, you will scream, they will scream at you,” … “There is a perception of a picture that indeed is negative, but it is seen as normal. It is not even seen as mistreatment.”

In the public hospital in the town of Ceará in northeastern Brazil there is a sign on the wall alerting patients about their human rights. It tells them that they must demand decent public medical service. At the same hospital though, another sign outlines a very different picture. On another sign is a quote from Article 331 of Brazil’s Criminal Code, known as the ‘Desacato laws,’ that prevents freedom of speech for anyone who wants to speak out against injustice, including any patient who wants to talk about their medical care.

… Female patients who come from poor, rural and uneducated families often tend to be less acknowledged or counted as they become ‘objects’ in the hands of medical staff who can and do hold authority and power over them.

The World Health Organization recommends that the rate of cesarean section in a country should not exceed 15 percent. In Brazil the latest data for cesarean in most public hospitals is 35 percent. … an alarming 80 percent of private hospital [use] cesarean section commonly. When women are asked if they want a cesarean delivery about 70 percent of women patients say no …

Cesarean section, episiotomy, oxytocin and cosmetic vaginal surgery

… “most women go to birth without information.” Many are also convinced to accept cesarean section during labor while they are suffering from acute pain and unable to make the best decision. Women who are able to give birth ‘naturally’ are also most often submitted to episiotomy during childbirth …

… 90 percent of hospital births throughout Latin America use surgical procedures for episiotomy without any medical need or indication. Without consultation with their patients numerous doctors cut and sew the vagina to shrink it after childbirth and to ‘satisfy the husbands.’ This operation is known in Brazil as the ‘husband’s point.’ …

… The time a woman takes to complete labor in birth is another issue for medical teams who want to speed up the process. “There are reports that in some public hospitals, a woman should not be in labor from one shift to another, and all cases have to be ‘fully managed’ during the same shift,” …

In addition to episiotomy, some women receive doses of oxytocin to enhance uterine contractions – and consequently the pain – so their delivery with childbirth is faster. But is it safe? Distinct dangers to the mother with incorrect use of the drug can cause fatal fetal hypoxia, a condition that denies a woman’s baby of life saving oxygen during the process of childbirth …

Is there a solution to the problems?

Why do some medical teams mistreat patients in labor? Professional studies indicate that trivialization of social injustice, especially injustice against women, may be the cause. This can affect the entire society in Brazil, both male and female.

… Finding and supporting a good team of health professionals who will seek better quality health care for Brazil is the goal of photojournalist André François …

Since 2000 the Brazilian program called ‘Working with Traditional Midwives’ … has aimed to improve care for women with birth delivery at home. They also seek to raise awareness among health professionals to recognize midwives as important partners in the birth process for women.

As the definition of violence against women during childbirth can be wide and subject to many interpretations, so can the concept in the ‘humanization’ of childbirth. Numerous advocates who believe that babies who are born through a philosophy of ‘woman-centered childbirth’ are also beginning to see how natural and appropriate approaches to new technology with birthing can work together. The hope by many women’s advocates in Brazil is to see the rates of abuse during childbirth labor decrease sharply.

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Rates of C-sections and postpartum posttraumatic stress disorder on the rise

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The birth of Helen Dunn’s first son didn’t go nearly as smoothly as she had envisioned. Induced two weeks early because of concerns about the baby’s health, the Vancouver clinical counsellor endured 17 hours of painful contractions before her baby went into distress … She had an emergency caesarean section, the whole experience proving to be a traumatic one with terrible, lasting effects.

“I immediately felt disconnected from him when they showed him to me,” … “I didn’t recognize him. I wasn’t attached to him; in fact, I had an aversion to him. I wanted them to take him away, which is hard to admit. After that it was very difficult for me, it was a long process of panic attacks, which I’ve never experienced before, and full-blown agoraphobia.

“I didn’t want to tell people how I felt; I felt a tremendous amount of shame about how I felt toward my child, the difficulty I was having bonding with him,” she adds. “I was diagnosed with postpartum depression, but I had no idea about postpartum posttraumatic stress disorder.”

Looking back now, she can see that those panic attacks were among the condition’s telltale signs … PTSD after childbirth is characterized by two key elements: experiencing or witnessing an event involving actual or threatened danger to oneself or others and a response of intense fear, helplessness, or horror. Symptoms include obsessive thoughts about the birth; feelings of numbness, detachment, or panic; disturbing memories of the birth experience; nightmares; flashbacks; and sadness, fearfulness, anxiety, or irritability.

… the reported prevalence of postpartum PTSD ranges from 1.5 percent to 6 percent …

Dunn was even more struck by the effects of her traumatic birth following the delivery of her second son six years later. She laboured for 17 hours again, but this time delivered vaginally with the assistance of a midwife in hospital and went home soon after.

“I didn’t have any problems,” Dunn says. “He immediately looked familiar to me — he looked like my sister — I felt bonded to him, attached to him.” The stark differences between her two childbirth experiences prompted her to explore other women’s feelings of attachment to their newborns among those who delivered via emergency C-section as well as vaginally in her Master’s thesis. Now she wants to raise awareness among health professionals and the public alike of two pressing issues: postpartum PTSD—in particular signs, early intervention, and effects on maternal-infant attachment—and the high rates of C-sections in this country.

Although C-sections clearly play a vital role in maternal health and can be life-saving, about 26 percent of deliveries in Canada take place this way, which is nearly double the rate recommended by the World Health Organization.

Then there is the way postpartum PTSD is so widely misunderstood and overlooked, in Dunn’s view.

“When I did reach out for help, people would say, ‘You’ve got a healthy baby; what do you have to complain about?’ or ‘This was so long ago; why is it still bothering you?’

… “When someone says, ‘I don’t want to see my child… I really wish someone would have said to me at that point, ‘Can we help you?’ When I told a nurse I was feeling strange, having panic attacks, she said it was because of the medication. Even one gesture of support or kindness from somebody on the front lines can go a long way to help a woman gain a sense of control of what’s happening to her. I think it could have been handled a lot better in my case. I think I would have benefitted from more support had there been more knowledge around it.”

Maternal-health expert Michael Klein … says that … women who have emergency C-sections without adequate support or communication from their caregivers suffer from posttraumatic stress disorder far more frequently than those who don’t.

“What we know about the psychological experiences of women is that women who have a sudden, unexpected, emergency caesarean section without any chance to really adapt to it are the most likely to suffer psychological distress,” … “Posttraumatic stress disorder is much, much, much neglected.”

… Klein emphasizes that the primary determinant of whether a woman will suffer PTSD after child birth is not the mode of delivery. Rather, it’s how she’s cared for. In other words, the condition can occur in women who have vaginal births, deliveries that require forceps, midwife-assisted labours, and in other situations. The crucial factor throughout is how her care team responds to her needs.

Other factors come into play as well, such as prior psychological and psychiatric disorders and the woman’s prepregnancy mental state.

… “We know that women never forget their childbirth experiences,” … “They can be transformative in a positive way or transformative in a negative way. Talk to any 50- or 60-year old woman and she can tell you every minute of their childbirth experience.” …

Continuity of care – that is, being cared for by one person who is trusted and liked throughout the pregnancy, birth and postnatal period – is vital for minimising the chance of PTSD. Continuity models include private obstetric care, where a woman has all of her pregnancy care with one obstetrician and that same obstetrician is on-call for her birth. Continuity models also include private midwifery care where a woman has the same midwife for all of her pregnancy, birth and postnatal care. Obstetric care can be accessed through eligible midwives who have collaborative arrangements with obstetricians.

Visit my website to learn more about my services.

Turbulent times

A lot has been happening in the world of homebirth and midwifery. Many will have read the articles about homebirth, freebirth, midwives and maternity care that are appearing in our papers on a daily basis.

I have not posted for a couple of weeks now, for three main reasons: one I have been really busy with my practice which has not been this busy for about two years. Second, I attended the Australian College of Midwives National Conference – the ACM worked really hard to deliver an excellent conference that was appreciated by all. I had the fantastic opportunity to meet midwives from around Australia and share ideas, discuss practice and talk birthy things. I was pleased that the conference was in Sydney, because as those of you who know me will know, in my non-midwifery life I rescue and care for injured and orphaned native birds, and so I was able to make a trip home most days of the conference to feed everyone at home. They were hungry but they all survived! I digress. The third reason for not posting was that the recent issues have made me re-assess things like responsibility, accountability, safety, choice, control, autonomy, beneficence, informed decision-making and many other issues. I have no answers to report. Just lots of reflection.

Midwifery and maternity care are going through turbulent times and as professionals and organisations, I feel that we have done a major disservice to women that they feel safer birthing at home – with or without a registered midwife – in the presence of risk factors – because they so strongly believe that the hospital system will not enable them to birth in the manner of their choosing. It is a sad reflection on the health system and the professionals who work within it. Women who cannot access midwifery care because they are planning a VBAC. Women who are told that if they insist on birthing vaginally with twins, they must accept continuous monitoring, induction, epidural and birth in stirrups for twin two. Women whose only option is to birth in a hospital that is two hours from their home. We have all heard the stories.

My biggest disappointment is the lack of midwife admitting rights. We are one year into the maternity reforms on November 1 this year. We have eligible midwives with Medicare provider numbers, ordering tests and working with doctors to provide safe care to women and babies – yet we cannot access hospitals to provide this care. I well understand that there are a lot of hurdles to be overcome with midwife admitting rights, and life has taught me that nothing in life is impossible.

The release of the homebirth position statement – which I fully support as an evidence-based and safe way to provide care – combined with the lack of midwife admitting rights, is disastrous for women and midwives. Higher risk women are forced into a position of birthing in hospital without their midwife if the midwife complies with the position statement but has no admitting rights – otr else freebirthing, potentially with disastrous consequences. Overnight, this change occurred and women are fuming.

It is impossible to believe, but an eligible midwife who crosses all the “T”s and dots all the “I”s will suffer incredibly in terms of restriction of clientele, however if she were to remove her name from the register – something that I understand is very easy to do – she may do just as she pleases with no accountability, regulation or practice standards. Midwives are placed in the untenable situation of a dwindling practice, or unregistering and having a flourishing practice. Until admitting rights are in place, midwives will have no place to birth with their higher-risk clients. This situation does not see the Government supporting midwives or women. It is creating a disaster.

The various politics of homebirth and midwifery has created an enormous rift between midwives. It seems that there are the bunch who have elected to become eligible, forge ahead with collaborative arrangements, push for admitting rights and accept the increased regulation that is upon us as our profession matures. The other group opposes the increased regulation and restriction of choice, supports midwife- (or non-midwife)-attended homebirth for any woman who wants it and really wants things to just go back to how they used to be, before insurance became mandatory. Many midwives sit comfortable in the middle of this debate. It is sad to watch such division and animosity amongst midwives. We seem to lack a capacity of saying, “We don’t share each other’s vision and we have made different choices, but we are midwives and we will support each other”. As one midwife said to me, “We are each doing the best we can for the women we care for and we’re making the best of a rotten situation”.

I know 2012 will be better than 2011. Who knows? Maybe it’ll be an historic year where for the very first time, women will birth on their own terms, with their chosen midwife, at home or in hospital. I wonder how many women will insist on homebirth in spite of significant risks, if they are able to birth in hospital with their own midwife and in the manner of their choosing.

Visit my website to explore birthing services.

Charging women for non-medical caesareans?

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The health minister has said that women in Northern Ireland who choose to have a Caesarean for non-medical reasons may have to pay for the operation.

Edwin Poots is launching a consultation on a review of maternity services.

Women at low risk will be encouraged to consider having their baby in a midwife-led unit or at home, if appropriate.

Around 30% of deliveries are by Caesarean section – the highest level in the UK and Ireland.

… giving birth was a natural process and superb assistance was available to help women through the delivery.

“It costs several thousand pounds more for a Caesarean section so there are savings to be made,” …

“… what we want to encourage, is more people to give birth naturally because it has better outcomes for the mother and the baby.

… “We want to ensure that people take the natural choice where they can and to have that back up where they need Caesarean section to take place.”

… At present, women who elect to go private to have a Caesarean on non-medical grounds pay for their pre and post-natal care.

But the cost of the delivery is met by the health service.

… women will be encouraged to have their baby in a midwife led unit

“If you want to go down that route, if you want to pay for it, it is totally up to yourself, but I don’t feel that we the public in Northern Ireland should be paying additional money for people to have the choice.”

The minister said he expected to see a “considerable” number of midwifery units being established.

“A lot of them would be set up in association with the main maternity unit, so they would be on the same site as existing hospitals,” …

“Women would be giving birth totally with the midwives but there would be a fallback position of having an obstetrician nearby if things do not work out.”

Breedagh Hughes from the Royal College of Midwives said the focus was on trying to “normalise” child birth.

… “One of the things we hope will come out in the review will be asking trusts to look at … the reasons for the Caesarean sections and to focus on trying to prevent women from having that first Caesarean section, which very often leads to the old adage – ‘once a section always a section’.”

She said a “fear” of child birth stopped many women from choosing a natural birth.

“When one in every three women gives birth by Caesarean section, you lose that critical mass of people who know what it is like to give birth normally, and women are losing confidence in their own body’s ability to give birth,” she said.

Ms Hughes also welcomed proposals to shift the focus to midwife led care.

“I think if women are given the opportunity to get to know and trust their midwife and to trust their own bodies, we’re more likely to see women saying, ‘OK, this is what nature intended me for and this is what I’m going to do’,” …

Visit my website to explore birthing services

Study researches birth satisfaction for first time mothers

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A pilot … study investigating factors that contribute to birth satisfaction for first time New Zealand mothers has led to a bigger nationwide study examining how birth preparation impacts on birth satisfaction.

… birth satisfaction is important because how a mother perceives the birth of her child influences her confidence in mothering abilities and consequently the early mother/child relationship. In turn this impacts on the child’s sense of security as well as family psychosocial health. … women … wanted to feel safe, have good relationships with those caring for them, and to have responsibility for and control over their birth processes.

“… they had a desire to take part in decision-making about medical interventions considered necessary,”

“These factors all contributed towards a woman experiencing birth satisfaction. In particular, vulnerable women appreciated the close relationships they established with their midwives.”

She also found that those women needing an intervention to give birth, such as a forceps delivery, were very grateful that skilled obstetric help was available.

“However, a poor relationship between midwife and specialist could contribute towards distress experienced by the women, as did an obstetrician’s lack of attention to bedside manner,” she says.

“On the other hand … a few minutes taken by the obstetric team to introduce themselves and explain their roles resulted in her retaining a sense of personal control throughout the intervention. This resulted in an empowering and very satisfying birth experience for her, despite the necessity of an unexpected medical intervention” …

Continuity models are becoming more popular, though still not the norm for most women. Private midwifery care delivers the most effective continuity for women, where women choose their own midwife and are cared for by that same midwife for their pregnancy, birth and new parenting experience.

Visit my website to explore birthing services.

Post-traumatic Stress Disorder and Birth

Research has suggested that up to 9% women meet the diagnostic criteria for post-traumatic stress disorder after birth, and that 18% women scored above the cutoff score, indicating that they were experiencing a degree of post-traumatic stress symptoms.

Amongst variables that were found to be associated with PTSD were lack of support, unplanned pregnancy, pressure to have an induction and epidural analgesia, planned cesarean and consulting with a clinician about mental well-being since birth.

PTSD is an important issue in birth, and one that is attracting more and more attention. It’s time for health services, midwives and obstetricians to become more aware of their practices and treatment of pregnant and birthing women, and for communities to consider how they can best support new mothers.

With almost one in ten women experiencing their birth as traumatic, we also have to wonder if things have really progressed in birth. Pain relief came in in the 1800s with the intention of reducing the trauma associated with a long and painful birth, however in this study, epidural use in labour was associated with PTSD.

The lack of caesareans in years gone by were an important contributor of traumatic births as women endured days of labour only to give birth to a stillborn baby. Nowadays we have ready access (perhaps too ready) to operating theatres and caesareans, yet caesareans are suggested as being associated with PTSD.

I believe that the heart of the issue is a woman feeling supported in the decisions she makes, being able to trust her care providers and ultimately birthing safely. Continuity of care is known to have the lowest rates of PTSD and birth trauma, specifically because women are cared for by one midwife and obstetrician who know the woman, her wishes, fears and hopes, and together they can develop a care plan that places the woman at the centre of her care.

Visit my website for information on birth debriefing, homebirth and hospital birth.

Mom-to-be says her hopes were destroyed by midwife

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

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A … mother says things went tragically wrong when she used a midwife …

… after her baby died, she was surprised to learn, there are different kinds of midwives …

… Muhsin lost her daughter Alia before she even gave birth …

… when she was 7 months pregnant, she felt like her OB/GYN office was a bit impersonal, so she did some research online …

“I walk in this place, very serene, very organized. They have a wall full of babies’ pictures,” …

Muhsin says the midwife who handled her care was also the director … [the midwife's] resume on her website seemed impressive.

“She sold me a very good story, and I believed her,” said Muhsin.

… her original obstetrician had diagnosed her with gestational diabetes. But Muhsin says [the midwife] convinced her that she didn’t really have the condition, which can jeopardize the life of a baby if it’s not properly treated.

Muhsin and her husband got worried when she went nearly 4 weeks past her due date. Muhsin says the midwife kept reassuring her that everything was fine – but it wasn’t.

“I just feel really sick and I told her, I don’t feel contractions anymore, nothing. She told me, it’s okay, you stay home,” …

… “She said, okay, now you have to go to the hospital, because I don’t know what’s going on. We went in; they asked my husband, what is her due date? And they start running.”
Hospital records indicate both mother and baby had a severe infection …

“The baby had no heartbeat,” …

… Direct Entry [Midwives] … are not required to have any formal training – in fact they can be self-taught.

“They’re operating on their own without any oversight by the legislature, without any oversight … ”

… the baby could have been saved if the midwife had transferred Muhsin’s care to a doctor before she went nearly 4 weeks past her due date.

… “Gestational diabetes can be very risky to the baby,” …

… “There’s a great increased risk from 39 weeks onward of in utero fetal distress, and even fetal demise,” …

… [The midwife] denies that she waited nearly 4 weeks after Muhsin’s due date to advise her to go to the hospital. She also says that she’s still working as a midwife …

“We want to be licensed because we want to make sure there’s a standard of care. That consumers are protected,” said Kate Mazzara.

Kate Mazzara is a Certified Professional Midwife … she’s trying to get Lansing to pass a law to license midwives … a licensing board would then be able to hear complaints, and take action against midwives if problems arise.

“I want to make sure that these moms and babies are birthing in a safe way, and the midwifery model of care has been shown to be an extremely safe option for families, but there should be that safety mechanism to which midwives can be held accountable,” …

… the sad stories are rare … home births are a beautiful, natural experience … the number of home births has jumped 20% in recent years …

Part of this article deals with the fact that in the US, there are different types of midwives, from certified nurse midwives who have degrees, work collaboratively with obstetricians, and have visiting rights, through to certified professional midwives and finally direct entry midwives. In Australia, we have registered midwives who are all accountable to the same high standard of care. As well as registered midwives, we also have eligible midwives who have satisfied an additional registration standard that entitles them to access a medicare provider number, and in the future, visiting rights. The next article deals with another aspect: that of choosing a midwife:

How to Choose a Good Home Birth Midwife

If you’re looking into home birth, probably the most important thing is finding a good midwife. Your midwife will be the one who cares for you, watches over you, and makes any decisions if something unexpected or difficult happens in your pregnancy. It is imperative to get a midwife who is well-trained and experienced and whom you trust and feel comfortable with.

How do you know if you’ve found a good midwife?

Feel free to ask anything else that makes you feel comfortable. In my experience, midwives are usually very cautious and ready to refer patients to the hospital or an OB at the first sign that something isn’t right. The should be very conscious of the limits of their training, so that if any situation crops up that they feel uncomfortable about handling, they are prepared to rule you out as a home birth candidate. This doesn’t happen too often, but it’s very important to know that if you are one of the “riskier” cases, your midwife will tell you so and refer you. Any midwife who says that she never transfers or refers women because “all women can do this!” should be avoided!

Go with your instincts, too. If you feel comfortable with the midwife and she’s answered your questions sufficiently, then choose her. If not, keep looking …

Choosing The Best Midwife and Why is choosing a care provider one of the most important pregnancy decisions you will make? are also helpful posts. Ultimately, registered health practitioners are responsible for practicing their profession safely. But as a consumer of a service, it is up to you to make sure that the person you have engaged for your care, is legally and professionally able to care for you (ie, registered). Don’t be afraid to check the AHPRA register of practitioners if you would like to check the registration status of your health practitioner.

Midwives can help traumatised new mums

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About a third of women are traumatised by childbirth …

But counselling by midwives can ease their distress.

… Debra Creedy surveyed 1038 pregnant Australians with no previous history of mental illness.

About 30 per cent described childbirth as “horrific” or “terrifying” after they gave birth.

“They feared for their life or that of their baby,” …

Untreated trauma could lead to anxiety or postnatal depression … or fear of giving birth again.

“Unless these sort of emotions are dealt with in a productive way they can have lasting effects on women.”

“We found midwives are very well placed to support the emotional needs of women because they understand childbirth,” …

“They can talk with the woman about what happened and why that procedure may have been necessary and to normalise a woman’s responses.” …

It’s often unspoken, but it’s real and it matters. It’s great that good quality research is being done into this sensitive and almost-taboo topic so that women are able to access help when they feel they need it. My practice has supported many women who have described their birth as traumatic. The most common feature isn’t a drug-free birth, a caesarean, an epidural or so on – it’s about not being listened to and respected, not experiencing care from one midwife who is known to the woman in advance of labour – and whom the woman likes and trusts – and feeling a sense of loss of control over what is happening in labour. Of course, labour is all about losing control. But control in the sense of birth trauma is very much about the feeling that decisions have been taken away and feeling that you don’t have a voice – either because of exhaustion, confusion, fear or a lack of understanding. These feelings can overwhelm a woman’s coping mechanisms in labour and this is when birth can be perceived as traumatic.

I see birth trauma in women who have experienced the “cascade of intervention” that culminates in a forceps birth or a caesarean, as much as I see it in women who experienced a natural and drug-free birth that was not their intention. It’s not so much about “what” happens in labour, as much as it is about being prepared for what might reasonably happen, and supported by a known, liked and trusted care provider if things don’t go to plan.

Posttraumatic Stress Disorder in New Mothers

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Prevalence [of] … posttraumatic stress disorder after childbirth ranges from 1.7 to 9 percent …

…The following variables were significantly related to elevated posttraumatic stress symptoms levels: low partner support, elevated postpartum depressive symptoms, more physical problems since birth, and less health-promoting behaviors. In addition, eight variables significantly differentiated women who had elevated posttraumatic stress symptom levels from those who did not: no private health insurance, unplanned pregnancy, pressure to have an induction and epidural analgesia, planned cesarean birth, not breastfeeding as long as wanted, not exclusively breastfeeding at 1 month, and consulting with a clinician about mental well-being since birth …

… the high percentage of mothers who screened positive for meeting all the DSM-IV criteria for a posttraumatic stress disorder diagnosis is a sobering statistic …

Time to do something positive about this statistic! Continuity of care and carer is unlikely to result in PTSD. A written birth plan that is agreed by the woman and her health care provider antenatally, and then honoured during the labour and birth, are also key to avoiding PTSD. Another important factor is asking women questions early in their pregnancy so that women who might be at an increased risk of PTSD are able to access help during the pregnancy to avoid issues later on.

Case study: ‘My C-section was a horrific experience’

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HAVING a Caesarean was so traumatic for new mum Pamela Anderson, she had to have counselling after the birth of her son Archie, now nine months.

… “It was the most horrific experience of my life,” …

After 22 hours in labour, hospital staff became concerned when her baby moved into the wrong position for a natural birth.

However, Mrs Anderson is convinced it might not have been necessary.

She said: “It seems to be the case that they don’t give you enough time. After 20 hours they just say ‘that’s enough’ …

She had to have two blood transfusions and had problems later as a result of the surgery.

She said: “Nine months on and still I feel the physical effect of it as well as the emotional side …

The sorts of things that may lead a woman to perceive her birth experience as traumatic are things such as impersonal care, not having a say in decisions that are made, lack of continuity of care, care by strangers, and a lack of care, respect or kindness in labour.

“Do it yourself” births prompt alarm

MEDICARE NOW AVAILABLE FOR MIDWIFERY CARE THROUGH THIS SERVICE!
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A growing number of women are choosing to give birth without the assistance of doctors or midwives, provoked by dissatisfaction with modern obstetric care, fear of unnecessary medical intervention and a desire to reclaim birth as a private, natural act.

It’s a choice the professionals say is fraught with peril. They fear the fledgling “freebirth” movement may undo gains in mother-infant mortality. The women, however, believe unassisted childbirth is emotionally and physically the safest option for themselves and their babies.

Some 33%, or 8708 out of 26 667 homebirths in the United States in 2007 were not attended by a physician or midwife … Two-thirds of those deliveries attended by someone other than a physician or midwife … were reported as “planned” …

Canada lacks similar statistics, but a cursory search online turns up a surfeit of websites, forums … dedicated to freebirth …

It’s a difficult trend to track with any certainty … because advocates of unassisted childbirth aim to avoid interaction with the medical system wherever possible.

While some women forgo prenatal care entirely, others orchestrate a “planned oops” or “accidental” unassisted birth to avoid confrontation with health care providers and the law.

Many are already mothers, wary after a bad experience with a doctor or midwife.

“My first son’s hospital birth left something to be desired … the doctor I had was terrible. When I became pregnant a second time, I sought out a midwife and while one of the women in the practice was great, the other really talked down to my husband and I … ” … “I was probably seven months pregnant when I decided I didn’t want [that midwife] at my birth. I didn’t want it to be a guessing game.”

Others fear being coerced into medical procedures they’re not comfortable with.

“There are some people who can go into the birthing room and put their foot down, but I know when I go into a doctor’s office for an appointment, I get overwhelmed, let alone in a case where they’re saying your baby might die,” … “I think it’s easier to trust yourself if there’s not another voice there. Having that other set of interests involved makes me uncomfortable.”

Doctors and midwives bring their own timelines and expectations about how a delivery should proceed, and will err on the side of intervening in birth to protect themselves against litigation … “I can see the position they’re in, because if you don’t deliver a perfect baby there’s a chance you’ll get sued, and there’s this idea that if you’ve transferred someone to the hospital or done a C-section then you’ve done everything you could.”

… primary C-section rates ranged from a high of 23% of deliveries in Newfoundland and Labrador to a low of 14% in Manitoba.

With up to 15% of all births involving potentially fatal complications, however, “the evidence is overwhelmingly in favour of giving birth with a skilled attendant present,” …

Proponents of unassisted childbirth say it’s all a matter of perspective. They prefer to view birth as a “spiritual, sexual experience, not an inherently dangerous medical event,” says Shanley. “I trust the same intelligence that knows how to grow the baby from an egg and a sperm into a human being also knows how to complete the process.”

Unnecessary intervention in birth is more often the cause of complications than a remedy, she adds. “People counting, measuring and managing birth into this controlled, manipulated act, it’s no wonder women’s bodies shutdown — the way anybody’s would if someone kept interrupting them while they were trying to have sex, go to the bathroom or go to sleep.”

Intervention should be the last resort, not a given … ” … one of the nurses asked why we didn’t go to the hospital and my husband looked her in the eye and said: ‘Because it wasn’t an emergency.’”

The couple prepared for complications by reading books for first responders on how to deliver babies in emergency situations.

Others look for such information online.

“I had to assess what my personal risks were,” says Rundle. “I’m a healthy young woman, so when people say that 15% of the time there’s a complication, are they talking about women who have different medical histories than I have?”

Some women, like Shanley, prefer to put complete faith in their bodies and refer to complications as “variations of normal.”

“There are going to be babies who die during an unassisted birth who may not have if there had been intervention, but there are also going to be babies who die because of interventions,” she explains. “There’s no way to ensure a successful birth every time. Sometimes a baby dies and that’s just the way it is.”

It’s not a stance Shanley takes lightly, having lost a child to a congenital heart defect following an unassisted delivery, and been told by a coroner that the baby would have died even if she had gone to the hospital.

It’s a difficult stance to counter, says Canadian Association of Midwives president Anne Wilson. “You can’t say to a mum that 60% of all unassisted births result in complications where the baby dies because that kind of statistic doesn’t exist. A lot of complications in childbirth are predictable and occur over time, but a few happen without warning, such as severe hemorrhage. And if a woman doesn’t have prenatal care, doesn’t report the birth to the hospital, there’s no way to know.”

… “Unassisted childbirth is unsafe — period,” … “The people advocating this as a mainstream option for women are tragically uninformed.”

Midwives, however, are more “fuzzy” on the issue, says Wilson. The association has yet to take an official stance for fear of alienating women wary of intervention. “If someone came to us who was considering an unassisted birth we would want to keep that person engaged, build a relationship of trust and if they ended up going ahead with it, at least you’re someone they can call if they get half way through a delivery and change their mind.”

Failing that, “some prenatal care is better than none,” she adds.

The debate raises ethical questions of “autonomy versus beneficence” for midwives, Wilson says. “By the nature of what we do, we tend to look after people who don’t want interventions. It would come down to individual choice in terms of how comfortable you are as a practitioner taking that person into your care.”

For Shanley, however, unassisted childbirth is more a question of reproductive rights. “It’s your body, your birth and your baby, so you should have the right to give birth however you want.”

Wales delivers on home birth rates

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Wales is leading the way in a rise in home births

WHEN Lindsey Gage decided to have her baby at home, husband Andrew was anxious.

He worried about the risk, the mess and how long it would take to get to hospital in an emergency.

In the event … Andrew, 34, held Lindsey while she gave birth at their home …

This type of idyllic home birth is what midwives recommend for all women with low-risk pregnancies who want it.

Yet just 4% of babies are born at home in Wales, just up on the 3% figure for across the UK, but still only a tiny proportion.

Until 40 years ago giving birth at home was the norm … This changed with the 1970 Peel Report saying hospital beds should be available for the safety of mother and baby.

Almost overnight giving birth became medicalised, putting doctors rather than midwives in charge.

By the 1990s women wanted to reclaim birth and a National Childbirth Trust study showed intervention was twice as likely in hospital, even in straightforward cases.

… Today, requests for home births are increasing and once again …

Since the Welsh Assembly Government launched its strategy to increase home births in 2002, they have more than doubled …

… rates vary enormously with some areas, including Porthcawl and Pyle, recording 25% to 30% home-birth rates.

… it’s partly growing requests from women, partly the WAG strategy and the fact that Wales is relatively small making communication and change easier.

… England followed this lead after visiting Wales to see how our Know Your Midwife scheme worked …

… Helen Rogers, director of the Royal College of Midwives in Wales, hopes rates will snowball as women see home birth works and says we should still aspire to 10% and more.

Science teacher Clare Sklavounos … who had both her children … at home, has no hesitation recommending it.

Husband Chris delivered both babies in the living room which he describes as an “amazing experience”.

Clare says she began to realise during ante-natal classes that intervention was more likely in hospital and wanted as natural a birth as possible.

After discussing home birth with midwives she says she was confident it was safe and the best option for her.

… “I was totally uninhibited and could eat and drink when I wanted.

“When it started to get intense I got into the birthing pool and gave birth. I didn’t want any pain relief and didn’t need it.

“The midwives were brilliant. They monitored the babies’ hearts during both labours quite regularly but it didn’t feel intrusive and I felt normal afterwards because it was treated as something normal.

“It all felt so natural. I had the labours I wanted.”

Chris says the experience was very different from when his first child Mia, five, from a former relationship, was born.

“Mia was born in the University Hospital Wales in Cardiff. It was my first child and it was amazing but different,” he recalls.

… “I was shattered and got no sleep,” she says.

“I had an epidural which I didn’t want but I did have to have because the baby got stuck and I couldn’t push.

“I was then told to lie on my back and hold my legs up to give birth but it felt wrong. With my second labour at home I stood up and then delivered standing and squatting.

“The home birth was lovely as births go.

… “He got to bond with the baby and he cut the cord.

… Although this type of birth might not be everyone’s choice, the Royal College of Midwives and Royal College of Obstetricians issued a joint statement in 2007 saying home birth should be available to all low-risk women wanting it.

The colleges added that “if women had true choice” home-birth rates would rise to between eight and 10%.

“There is ample evidence showing labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby,” the statement reads.

Not everyone agrees, however.

Last year medical journal The Lancet said “women do not have the right to put their baby at risk” in response to research from the USA suggesting home birth tripled the risk of neonatal mortality – babies dying within a month of birth.

The RCM responded by saying the research didn’t reflect the situation here where midwives are highly experienced and properly equipped to carry out home births.

… Here the RCOG agrees childbirth is unpredictable and says while it supports home birth in low-risk pregnancies, women birthing at home should also have quick access to obstetric care if an emergency occurs.

The RCM, which represents most of the 1,800 midwives in Wales, says choice and proper care are vital wherever you are.

“RCM policy is that women should have choice,” Helen Rogers explains.

“As part of that we expect low-risk women with no complications should be able and encouraged to have home births.

“I believe we are leading the way on this in Wales.

“It’s slow and there are times when I’d like to increase the rate more quickly but it’s a steady increase. I believe midwives are much more confident about home births now.

“In many areas of Wales the demand for home births has always been there and women have pushed for it.

“There has been a world-wide attack on home births. Some of it is the medical profession which seems to think that hospital is the safest place to have a baby.

“But the vast majority of women are fit and healthy and childbirth is a normal, physiological process. They don’t have to be in hospital.”

Helen says there’s no evidence mothers are less safe having babies at home and disputes any suggestion that home birth might be promoted as a way to cut costs.

“I don’t think health boards would promote home birth because it’s cheaper,” she insists.

“It’s more likely they’d cut them and put all staff in one place.

“As services get more cash starved it’s often so-called luxury services, like home birth, that get hit.

“The WAG supports home birth and its strategy to increase home birth has certainly helped.

“We didn’t get 10% home birth rates across Wales although we have more than 10% in many places and that will probably increase throughout Wales as more women have home births.

“A few years back it was only women who went to National Childbirth Council classes who had home births.

“Now women from all walks of life are having them. They’re seeing their friends and husbands’ friends’ wives having home births.”

… Wherever women give birth, studies show those who have positive births are more likely to recover faster and less likely to develop post-natal depression …

… “We find people birth quicker at home because there’s a sense of confidence and security.

“If you feel anxious and frightened you get the flight-and-fright reflex and release adrenalin which stops the labour.

“Anxiety happens because people are frightened of hospitals.

“Hospitals are wonderful places if you need to be there, but if you’re low-risk, home is as safe or safer.”

… “With a home birth women are in control of their birthing experience. They are in their own home and more relaxed.

“Nature gets on with it and you don’t have to interfere. It’s a very nice experience.”

… “When we talk about taking birth away from doctors people ask, ‘What if something happens?’,” she concedes.

“The women we deal with have uncomplicated pregnancies but if we need to transfer women from home or the birthing unit to hospital it’s because labour is not progressing as we’d want.

“Midwives are the experts at looking after women in normal births, not doctors.

“We have very, very experienced midwives with excellent equipment and they continue to train and update their skills. When women choose to go to hospital because doctors are there and it’s safer there are certain times of year, March and August, when junior doctors change rotation.

“In the first instance you might see a junior doctor. Doctors are my best friends and we need to work together but birth is normal and we should encourage women to give birth at home.

“Once you start on intervention it leads to another. If it’s an uncomplicated pregnancy, home and midwife-led birthing centres are social environments whereas hospital is a medical environment.

“I’m not saying things never go wrong but in this country, on the whole, you are dealing with healthy women.” …

Melissa Maimann, Essential Birth Consulting 0400 418 448

After the first caesarean, a second one is much more likely

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TRACY HART had intended to have her first child … naturally. But when Ariane failed to move into the normal birth position, Mrs Hart was told that a caesarean was the safest option.

Second time around, Mrs Hart, 35, was eager to try again for a natural birth, but at 41 weeks and two days into her pregnancy, she still had not gone into labour. A caesarean was ordered – because doctors thought an induction might have been too hard on her scarred uterus – and four days ago son, Saxon was born …

… Mrs Hart said, ”I was mortified and cried, because I had mentally prepared myself for a natural birth. A lot of women who don’t have any problems giving birth don’t realise some women just don’t have a choice.”

Unfortunately Mrs Hart didn’t know that all women have a choice about how their baby enters the world. Some choices are safer than others; some are safer for the mother while others are safer for the baby; but whatever way you look at it, all women have a choice.

First-time mothers with no obvious health problems, and subsequent births like Mrs Hart’s where the first was by caesarean, are overwhelmingly the biggest contributors to the NSW epidemic of caesarean births, state data shows for the first time.

Twins, and babies in the breech or other difficult positions in the uterus, account for a much smaller proportion of the one in three babies now born by caesarean section …

During that time, the overall caesarean rate increased from 19 to 30 per cent of all births. But subsequent caesareans increased much faster, at an average 5.3 per cent a year during the study period.

Among first-time mothers, caesareans grew fastest – on average 6.8 per cent a year – among those who did not go into labour or whose labour was induced, suggesting a big rise in planned procedures. Among first births where the woman went into labour and later delivered surgically, the increase was only 3.5 per cent a year.

… the new data provided the first comprehensive state-wide picture of factors behind the surge in caesareans, which NSW Health has pledged to bring back to 20 per cent of all births by 2050. It suggested that concentrating on promoting normal birth among first-time mothers would have the biggest impact on reducing the overall rate …

I have always known that promoting normal birth – via private midwifery care – to all first time Mums, all women who have had a previous caesarean, and all women who have had a previously traumatic birth – would dramatically lower the cesarean rate.

The research … showed it was highly unlikely the increase in caesareans could be legitimately attributed to complications such as the older age and the increase in overweight mothers … because most of the rise had occurred in women with apparently few medical risks …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Brain-damaged boy awarded £6.4million settlement

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A little boy who suffered severe brain damage during his delivery at an NHS birth centre was today awarded £6.4 million in settlement of his medical negligence claim.

… Mr Justice Tugendhat expressed his “admiration and sympathy” to the boy’s parents, Janet Evans and Earnie Kramer, of Welwyn Garden City, Hertfordshire, over the “catastrophe that Theo has suffered”.

He said: “It is, I’m afraid, not unique to read about events as awful as these, but one sitting as a judge can only be in admiration of the way in which Theo’s parents have looked after him.”

The payment to Theo will be made by Barnet and Chase Farm Hospitals NHS Trust on behalf of the Edgware Birth Centre in north-west London.

In a statement issued after the hearing, the family’s solicitors said the trust “has admitted the birth centre was negligent and was responsible for the appalling injuries suffered by little Theo”.

… Theo’s mother was aged 38 when she became pregnant. His parents wanted him to be delivered in “the most natural way whilst at the same time minimising any risk to their much wanted baby”.

… “Janet and Earnie were told the midwives at the birth centre were better trained and more experienced than many midwives working in hospitals.

“They were also reassured the birth centre would be safer for their baby and in the event their baby needed to be delivered in hospital this would be arranged as fast if not faster than for a woman already in hospital.

“Sadly this was not the case. Janet was left in the care of a student midwife. Theo’s heart rate was not properly monitored and the student midwife failed to realise that Theo was in severe distress and needed to be delivered.

“Theo was gravely ill when he was born because he had been deprived of oxygen and there were further delays in arranging for him to be transferred to Barnet General Hospital.”

Theo, an only child, cannot sit up without support, will never be able to walk and has severe learning difficulties.

… “The Government is pushing forward with greater focus on the use of birth centres but needs to realise that higher standards and safer environments cost money and proper training, and support is needed if tragedies like this are to be avoided.”

… “This is a particularly tragic case where Earnie and Janet feel rightfully angry that they were misled into choosing an NHS birth centre to deliver Theo when a safer option in his case would have been a hospital maternity unit.”

In a statement, the trust offered its “sincere apologies” to Theo and his family for the injuries he suffered.

Often, it’s not so much the place of birth that influences the outcome of the birth, but more the knowledge, skill, judgment and experience of the care provider.

Melissa Maimann, Essential Birth Consulting 0400 418 448

$20m in Vic payouts for childbirth bungles

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Victorian public hospitals secretly paid a combined $20 million in compensation in 2009 over 25 botched births …

… the $20 million figure represented almost half of the $41.7 million in medical compensation paid out in 2009.

… some hospitals were more open than they used to be about the mistakes they made, but more transparency was required.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Mothers ‘too scared to push for baby No2′ as demand for Caesareans increases

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Expectant mothers are increasingly demanding Caesarean sections for second babies because their first births were so traumatic, say midwives.

In some maternity units, the numbers wanting the procedure has doubled in the past year.

On top of that, many women were so distressed first time around that they are putting off, or even abandoning, plans to have more babies.

The experience is often unnecessarily stressful because maternity units can be overstretched.

Women are often left alone and scared before and after labour as midwives simply do not have the time to offer them the advice and reassurance they need.

This is where private midwifery care is so beneficial for women: the private midwife does not leave the woman’s side, acting as a doula / support person and midwife all at once.

The number of expectant mothers asking for a C-section at Liverpool Women’s Hospital, one of the largest female hospitals in Europe, has increased by 40 per cent in a year.

Other maternity units … report similar trends.

Birth trauma clinics, which support women after difficult labours, say they have seen a doubling in patients in the past 12 months. Cathy Warwick, of the Royal College of Midwives, said: ‘If a midwife is very busy, clearly she won’t have time between dealing with women in labour to give others emotional support and reassurance.’

Doctors and midwives increasingly offer C-sections if women are fearful of giving birth …

Midwives also say that increasing numbers of women are suffering from tocophobia, or a fear of childbirth.

Simon Mehigan, a consultant midwife at Liverpool Women’s Hospital, blamed a lack of information or explanation about what was happening in a first pregnancy …

This is a really great point: it is so important for a woman’s first pregnancy and birth experience to be positive as this experience will shape her subsequent pregnancy and birth experiences. It can be easy to “go with the flow” and do what you are told is best for you / your baby, however this approach – almost a passive approach – will lead to a 31% chance of having a caesarean and a majority of women having their first babies with a “go with the flow” attitude will come away disappointed with their experience. It’s important not to have firm, fixed beliefs about how a pregnancy and birth will go, because no-one has a crystal ball to know exactly how things will be on the day. But it is really essential to be well informed and well supported by a private midwife who believes in birth and a woman’s ability to birth her baby naturally.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Your body, your choice

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The transforming experience of childbirth is increasingly blotted by medical interventions. Are women making informed decisions?

LIKE most first-time mothers, Faye Wong … was incredibly excited when she got pregnant. She read baby books and magazines voraciously, signed up for ante-natal class … to prepare for baby’s arrival.

When she was 38 weeks pregnant, her obstetrician said the baby’s head had engaged and his size was quite big. The doctor suggested inducing her labour.

In the labour room, her “nightmare” began. The pain from the drug-induced contractions was a rude jolt to her system. Then she was jabbed and prodded with painkillers, IV tubes and the works.

“I was shocked, confused, and in absolute terror,” recalls Wong, 35. Finally, the induction failed and she had to be wheeled in for emergency caesarean. Thankfully, she delivered a healthy baby boy weighing 3.9kg. When she got home, she struggled with breastfeeding and suffered a severe bout of post-natal blues.

“I felt ‘cheated’ … ” Wong admits. Her son is now seven. “I was a newbie to the birthing process and was meek as a lamb led to the slaughter,” she adds. “If I’d known then what I know now, I probably would have been better prepared, stood my ground and not undergone early inducement.”
Though doctors play a role in giving women the necessary information about labour options, women and their partners need to take their share of responsibility too in making informed choices and decisions.

Wong’s experience isn’t unique.

“We see a fair amount of women who are unhappy about the outcome of their deliveries,” says Jennifer Hor of Jenlia Maternal Services. The UK-trained midwife has been running ante-natal classes and post-natal home visits for 17 years. “Some felt they had a C-section even though they didn’t want it. Or, some felt they didn’t get enough information from their doctors.”

So, are women less assertive when it comes to childbirth? Are they getting or finding the information necessary to make informed choices and decisions? And have we forgotten that childbirth, an age-old practice, is meant to be natural?

Birth trends

… the medicalisation of childbirth means what used to be a straightforward, natural process is now treated as a high-tech medical procedure.

Caesarean rates are on the rise in both developed and developing countries …

… “Women say they want to take ownership of their bodies, yet we have healthy, low-risk women who said they had a C-section for their first births because they listened to their doctors,” says Farouk, who also sub-specialises in reproductive medicine. And because of the risks from the first surgery, these women are requesting for repeat C-sections. “Ironically, women are pushing the trends that way.

“We are also seeing the use of more technology to manage pregnant mothers, for example using CTG (cardiotocography) … and ultrasound scans,” says Farouk. “It’s not all bad, but if you monitor too much, you might pick up something and wonder if you don’t take action, there might be consequences, hence the interventions.”

… Doctors come with their beliefs and agendas, based on experiences. Some underplay certain risks and amplify others. For instance, placental calcification … is not a major issue for some obstetricians if the woman is near term and foetal growth is normal. But for a different doctor, a few specks on the ultrasound scan is reason enough for labour induction.

“There can be grey areas in medical investigations. I tend to be more conservative with placental calcification and continue to monitor foetal health and growth parameters,” …

Also, fear of litigation is scaring obstetricians into defensive and often interventionist practices.

“An obstetrician is more likely to be subjected to litigation because a caesarean section was not performed or was perceived to have been performed too late …”

Medical interventions

Clearly, it’s not always true that C-sections or epidural blocks are being foisted on reluctant women. The fact is, some women don’t question their doctors, or they themselves are asking for interventions.

Labour induction, elective caesarean, epidural jabs, and routine episiotomy are some of the common medical interventions during childbirth.

Induction of labour … is usually done when the mother’s or baby’s health is at risk …

“For such cases, studies have shown that caesarean section rate has been unchanged or lower among the induced group as compared with expectant management of pregnancy … ”

“But induction of labour at 37 to 41 weeks on non-medical grounds is linked with an increased risk of caesarean section for … a woman who has never given birth and an increased risk of instrumental delivery,” …

No doubt, medical interventions can be a lifesaver for mothers and babies …

However, once the natural process of labour and birth has been disturbed, if there is no actual emergency, there is risk that the side effects of the treatment will trigger more intervention necessary to fix the problem. This sequence of events is called the “cascade of interventions”.

“Pitocin (Syntocinon), a synthetic form of the hormone oxytocin used to induce or speed up labour, often results in a rapid increase in the intensity and strength of the woman’s contractions. As a result, she may opt to use pain medications such as pethidine … or epidural anaesthetic. Babies sometimes don’t react favourably to the sudden increase in the intensity of the contractions, which may result in irregularities of the heartbeat. Thus in turn may necessitate delivery by caesarean,” …

“Many women who use epidural do not experience the urges to bear down which help them to birth their babies. Often, in this situation, the doctor will use forceps or vacuum to deliver the baby, which means he needs to do an episiotomy … Many women experience long-term perineal pain following episiotomy.”

A failed induction (when labour doesn’t started after the first cycle of treatment) can either require a rescheduled induction or emergency C-section.

“Women should received accurate information about the risks, benefits, and alternatives of induced labour and understand the possible side effects and interventions, ” …

The big ‘C’

Most women also come with the preconceived idea that C-sections are safer than vaginal delivery …

… “In fact, C-section, which is classed as a major surgical procedure, carries with it the risk of complications and shouldn’t be viewed as an alternative option to normal birth.”

… “Babies delivered by elective caesarean section at 37 to 39 weeks’ of pregnancy are at two to four times more likely to suffer from respiratory morbidity compared with babies delivered by vaginal delivery,” … WHO global maternal survey also finds that women who choose elective caesarean with no medical indication are at increased risk of maternal death and serious complications.

… Studies have linked depression and distress after birth, which affect up to one in five women, to forceps and caesarean births …

Disturbed birth

“You must be mad to give birth without an epidural!” A common reaction these days if you speak with women who have undergone labour. But as the WHO states, “epidural analgesia is one of the most striking examples of the medicalisation of normal birth, transforming a physiological event into a medical procedure.”

… in her book,Gentle birth, gentle mothering, internationally acclaimed birth expert Dr Sarah J. Buckley explains how epidurals or painkilling drugs and synthetic hormones (used during induction) interfere with some of the major hormones of labour and birth. The five major hormones: oxytocin (hormones of love); beta-endorphin (pleasure and transcendence); the catecholamines or CAs, epinephrine and norepinephrine (excitement); and prolactin (tender mothering) form a “cocktail of hormones that nature prescribes to aid birthing mothers of all mammalian species”.

During an undisturbed labour, these hormones rise in crescendo and peak around the time of birth or soon after for mother and baby, and subside over the following hours and days. “An optimal hormonal orchestration provides ease, pleasure, and safety during this time for mother and baby.” Interference with this process, by injecting drugs or synthetic hormones, will “disrupt the hormonal orchestration, making birth more difficult and painful, and potentially less safe”.

For example, epidurals lower the mother’s production of oxytocin or stop its normal rise during labour. Oxytocin causes a woman’s uterus to contract in labour. It peaks at birth and catalyses for the final powerful contractions of labour, and helps mother and baby to fall in love at first meeting.

Under stressful conditions, our body releases epinephrine and norepinephrine (CAs). Towards the end of an undisturbed labour, the mother experiences an adrenaline rush – the natural surge in these hormones gives her the energy to push her baby out, makes her excited and fully alert at first meeting with her baby.

But when a woman feels fearful or unsafe, her labour is inhibited by high CA levels. Epidurals reduce the release of the CAs, which may be helpful if the high levels are restricting her labour. However, a reduction in the final CA surge may make it difficult for the woman to push her baby out, thus increasing the risk of instrumental delivery (forceps and vacuum).

Epidural’s side effects include nausea, slowing of labour and drop in blood pressure, slowing of contractions, and headache.

35-year-old Laila Aziz of Kuala Lumpur was wheelchair-bound for four months after an epidural jab injured her nerves when she delivered her third child.

“I wish my O&G and the anaesthetist had explained in details the pros and cons of using an epidural,” says Laila, who suffered severe post-natal blues after childbirth. “I would at least reconsider whether to use the option at that time.”

… Childbirth educator and lactation consultant Christine Choong has been advocating natural childbirth for the past two decades.

“My main passion is how birthing practices affect breastfeeding. What happens when you’re in labour can have a long-term effect on your breastfeeding,” …

Research has shown that when you put a baby on his mother’s chest (skin-to-skin contact) immediately after he was born, the baby will crawl instinctively towards her breast.

“Quite often the baby won’t do that if you had used drugs during labour … because he will be drowsy the first two to three days,” … “If women use epidural, very often their babies are delivered by suction or forceps which can cause discomfort on baby’s head (a shock to the system) and baby initially will not be happy feeding on one side or the other.”

Whether a labour induction is done on medical grounds or not, the baby is – by definition – relatively immature and likely to have impaired ability to effectively coordinate sucking, swallowing, and breathing at breast …

“In a C-section delivery, very rarely the mother is given the baby straight away,” Christine adds. “Early stimulation or suckling is important to establish breastfeeding. Also a higher percentage of caesarean babies end up with respiratory problems, which results in separation of mom and baby.”

But we need to look at the whole picture – the impact on baby, feeding, and mother-baby relationship.

“It isn’t just feeding but also nurturing,” says Christine, a mother of three.

“When babies are nurtured and their needs are met, in the long term, they will become people who are secure, confident, and know how to form relationships with people.”

Take control

What do you do if your care provider says you or your baby is at risk and an intervention is necessary?

“Using evidence-based information, your doctor should explain the reason for any suggested interventions. He should also explain the benefits and risks of such procedures,” advises Choong. If you’re not sure or not too convinced by your doctor’s explanation, get a second opinion.”

“Empowerment with the correct knowledge and information is useful so women can ask the correct questions,” Chow adds. “And their fear of childbirth should be addressed by getting support and learning about the labour process and pain relief options.”

Ultimately, a woman’s satisfaction with her birth experience is related more to her involvement in decision-making than to the outcome, as Buckley emphasises. Though doctors play a role in giving women the necessary information, women and their partners need to take their share of responsibility too in making informed choices and decisions.

When Wong had her second child, she was more mentally and emotionally prepared.

“Although I ended up having another C-section (due to hypertension), I didn’t feel disappointed and helpless,” Wong says. “I felt as if I was a real mom this time around.”

As Buckley sums it up best, “birth is the beginning of life; the beginning of mothering and of fathering. We all deserve a good beginning.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

Too scared to push: big rise reported in birth trauma

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The NHS is responding to a surge in cases of birth trauma by setting up specialist support services to reduce the rising demand for a caesarean delivery from those who, after a bad experience, are scared to undergo labour again.

Midwives say increasing numbers of women are so badly affected by their first experience of birth that they are postponing for years, or abandoning, plans to have any more children.

… At Liverpool Women’s hospital, for example, the number of mothers who have asked for an elective caesarean with their forthcoming child, because they suffered trauma the last time, has risen 40%.

“Tocophobia [fear of childbirth] is a distressing psychological disorder that is growing at an alarming rate,” said Simon Mehigan, a consultant midwife at the hospital. Most of the women with birth trauma he works with “are so fearful about giving birth for the second or third time that they are making themselves unwell”. Typically, this fear is a result of experiences during the first pregnancy or delivery and can often be traced back to a lack of information or explanation about what was happening, he added.

… In January Stepping Hill will launch a specialist birth trauma support clinic run by a consultant midwife, Debbie Garrod. “Last year I saw 21 women who were troubled by something that happened during their birth, usually a first birth. Before 2009 it was a handful. This year so far I’ve seen 48 women,” said Garrod.

Many other hospitals across the country are also introducing similar counselling services run by specially trained midwives to help women work through their fears and discuss the pros and cons of natural and surgical births. The apparent growth of tocophobia has prompted fresh debate over the variable quality of NHS maternity care as well as prompting some to claim that it is due to women being less prepared than previous generations to endure pain during childbirth.

Ah, I see, it’s the woman’s fault again?

Dr Tracey Johnstone, a consultant in foetal maternal medicine at Birmingham Women’s hospital, said a more confessional culture, soap operas’ portrayal of birth as painful and dramatic, and women’s reluctance to withstand labour pain lie behind the increase.

“Women are more frightened of labour and delivery now. Among women there almost seems to be a competition about who has suffered the most during childbirth, talking about 18-hour labours and the like, and that scares other women before they have their babies,” …

“A lot of women are less tolerant of pain now. They should realise that childbirth is painful,” she said. The greater medicalisation of birth – with more women having pain relief, or a caesarean or being induced – is also making women unsatisfied …

But Cathy Warwick, general secretary of the Royal College of Midwives, said: “There is a worry that, with the increasing birthrate, there are just not enough midwives. If women don’t have support throughout their labours, then they are more likely to feel they have been let down and left alone, and had too little information and explanation, so are more likely to end up feeling traumatised.”

Cathy has hit the nail on the head: the availability of a supportive midwife, preferably a midwife known and liked by the woman.

She added that the NHS would need another 3,000 midwives in order to help women properly during labour.

More and more women are contacting the Birth Trauma Association by email or Facebook or through its helpline. … “Some women have a quite horrific experience of childbirth and often feel they weren’t listened to because they had a baby who was well. Given the lack of care it’s no wonder 30% find it traumatic.”

… “We’re looking into why some births become complicated and traumatic. That could be because the foetus became distressed due to lack of oxygen, or because the baby couldn’t be delivered because the uterus seemed to run out of energy, or women not always having the support they need during long labours,” said Wray.

“It’s vital for the NHS to understand why so many new mothers are left traumatised because this affects so many women, their future fertility and their psychological wellbeing.”

Angela Almond suffered birth trauma after having … her first child …

It was only by getting extra support from a specialist NHS midwife that she felt able, six weeks ago, to have her second child, Scarlett, naturally.

The 32-year-old music teacher and husband Stuart, 31, a marketing manager, live in Liverpool.

“It was a difficult birth with Amelie. I was having a checkup four weeks before she was due when they unexpectedly told me that I was in the early stages of labour and that they were going to admit me there and then and induce me.

And here we read of an intervention that, on the face of it, was completely unnecessary. Whatever was wrong with waiting for labour to take its course? The story of trauma follows:

“The main trauma for me was all the intervention: being induced, having my waters broken for me and being examined all the time. And I found being in such an unfamiliar clinical atmosphere frightening and intimidating.

“I was in for three days and three nights altogether, which didn’t help. That was partly because my labour didn’t progress well because I didn’t dilate enough. In the end they had to use both forceps and a ventouse suction cup to get Amelie out, which was frightening and stressing.

“There was a high turnover of midwives, who were always rushing around looking after patients. Things were going on but staff were too busy to explain what they were doing and why.

“I didn’t know what was happening or going to happen, and I didn’t like that lack of control.

“I was also left alone a lot of the time and didn’t feel supported or reassured.

“I found that first birth experience so frightening and so bad that it was putting me off having a second child. I wanted more children but was put off by the thought of going through another labour like that.

“When I got pregnant again I knew I needed some support. I was frightened at the prospect of nine months of worrying about the labour, and didn’t want that to stop me enjoying the pregnancy.

“Labour is a frightening prospect to the bravest of people. After becoming pregnant I thought I might ask for a caesarean section, to help avoid what happened first time round. But luckily soon after that I was referred to Simon Mehigan, a midwife at Liverpool Women’s Hospital who helps women who have had a traumatic labour. He was absolutely brilliant. He supported me throughout my pregnancy and labour. He guided me and reassured me. Eventually I felt confident enough to have a home birth – Simon’s idea – which he attended.

“The fact that it was at home empowered me and I felt safer and more supported than if I’d had Scarlett in hospital.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

An alternative to “birth rape”

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

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A Venezuelan measure uses the term “obstetric violence” instead …

… An article in the December issue of the International Journal of Gynecology & Obstetrics reports that the country has introduced the new legal term, which carries with it a fine and the potential for professional disciplinary actions. It is explained like so:

[T]he appropriation of the body and reproductive processes of women by health personnel, which is expressed as dehumanized treatment, an abuse of medication, and to convert the natural processes into pathological ones, bringing with it loss of autonomy and the ability to decide freely about their bodies and sexuality, negatively impacting the quality of life of women.

If we’re being honest, my first response to that is to laugh. Why? Because “dehumanized treatment, “abuse of medication” and pathologizing “the natural processes” sounds so much like par for the course, as far as hospitals generally go. Not that it should be that way, but it so often is.

Hence, why so many women will choose to birth at home with a midwife.

But the rule … further details specific violations:

(1) Untimely and ineffective attention of obstetric emergencies; (2) Forcing the woman to give birth in a supine position, with legs raised, when the necessary means to perform a vertical delivery are available; (3) Impeding the early attachment of the child with his/her mother without a medical cause thus preventing the early attachment and blocking the possibility of holding, nursing or breast-feeding immediately after birth; (4) Altering the natural process of low-risk delivery by using acceleration techniques, without obtaining voluntary, expressed and informed consent of the woman; (5) Performing delivery via cesarean section, when natural childbirth is possible, without obtaining voluntary, expressed, and informed consent from the woman.

It seems not all cases of so-called birth rape would be covered by the law, based on the broadness of some activists’ definitions. For example, Amity Reed, who doggedly defends the use of the term, characterized “birth rape” as a case where during labor “an instrument or hand is inserted into a woman’s vagina without permission, after which the woman feels violated.”

We could stand to learn a couple of things from the Venezuelan measure: For starters, using straightforward language like “obstetric violence” might be more effective than relying on a term that employs a loaded word like “rape.” …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Childbirth and post-traumatic stress

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It’s more often associated with survivors of torture or war, but post-traumatic stress disorder (PTSD) can also affect women who have had an unexpectedly difficult childbirth.

Reliable figures are hard to come by as the condition often goes undiagnosed, but studies suggest up to a third of women find labour traumatic, with as many as 6 per cent of new mothers going on to develop symptoms of PTSD.

Symptoms of PTSD in the postnatal period are often confused with post-natal depression. But PTSD is different in that the focus is on the traumatic birth itself, with sufferers typically experiencing flashbacks and seeking to avoid anything that will remind them of the trauma.

“If it’s PTSD, they usually get the classic things such as flashbacks and the fear, a feeling of powerlessness and loss of control,” says obstetrician Ted Weaver, the president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Affected women often feel they did not get the support they needed during a difficult labour, he says.

“A lot of it seems to be related to how a woman is cared for in labour: the support she receives, or the feeling of being ignored perhaps, the care from all the professionals and others, the environment, the calmness or otherwise around the birth…”

Most of which can be prevented by having continuity of midwifery care for pregnancy, labour and the postnatal period. Homebirth or hospital birth, the value of continutiy of midwifery care cannot be understated.

Triggers of future trauma symptoms will vary for individual women but might include an unexpected emergency caesarean, especially if ordered by an unfamiliar clinician, or a request for an epidural when a woman is “in great pain but is told she doesn’t ‘need’ one”.

Two groups of women seem to be at particularly high risk of developing PTSD if their labour does not go according to plan, according to Weaver.

Women who are very anxious and fearful beforehand are at greater risk, as are those who have very high expectations of themselves and of the way they want their labour to go.

For both groups, a key to preventing trauma symptoms is to establish a solid and trusting relationship with care providers before the birth, Weaver believes.

The more anxious women need to be reassured that they will be looked after and health care professionals then need to make sure they deliver on those promises during the actual labour.

The second group are often women who have a “really idealised view of what birth will be”, which leaves them at risk of trauma if things don’t work out the way they expect.

It is important for these women to have the “what if” conversations with caregivers before they go into labour so that they are prepared for the possibility that all might not go according to plan.

In my experience, these “what if” conversations take time – time in each consultation over a period of months. Hence, another good reason why continuity of midwifery care is perfect for women who are fearful of their birth experience. Women who have a “really idealised view of what birth will be” are also fearful in a way, because their idealised view protects them from gently exploring “what if”. This exploration can be done with a trusted midwife over the course of the pregnancy.

Having a trusted support person who understands their wishes present during the birth can help to prevent the feelings of abandonment, or of not being listened to, that are common in many women who later develop trauma symptoms, Weaver says.

For new mothers who develop PTSD, cognitive behaviour therapy has been shown to help, as have opportunities to “debrief” about the birth experience, but too many miss out because their condition is never diagnosed, Weaver says …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Natural childbirth: whose birth plan is it anyway?

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With the trend for ‘natural’ childbirth growing and a government setting targets for home births, are British women really free to choose how they’d like to go through labour, or must they bow to a new earth-mother ideology? …

Hannah Hancock was pregnant with her first child she was keen on the idea of a drug-free birth. But … when labour pains kicked in, ideals were abandoned. ‘It was a long labour. At first I was on an oxytocin drip, then on pethidine, and a few hours later when they asked me if I wanted an epidural I was shouting, “Give it to me now!”‘

This is a common occurrence in hospitals where women do not have continuity of care and women don’t have access to resources and preparation to help them through natural labour and birth.

Two years later Hancock gave birth at a London teaching hospital. There the experience was very different.

‘I knew I wanted an epidural but the midwife ignored me, saying, “Why do you want pain relief? You’re doing really well.” I was crying, saying, “I don’t want to do well!”‘ Hancock begged her to find the anaesthetist. ‘But she just stood outside the door not going anywhere.’

Another scenario that doesn’t generally happen with continuity of midwifery care and in particular private midwifery care. In these cases, the woman and midwife have formed a trusting and caring relationship so that the woman has been able – ahead of time – to let her midwife know her intentions for her birth and the midwife is then able to support her.

In the end Hancock gave birth to her daughter using just gas and air. ‘It didn’t help at all. I was panicking so much at the prospect of no pain relief I couldn’t relax and tore really badly. I couldn’t understand this patronising attitude … It really coloured my view of the birth. When Ines was laid in my arms it was a special, dreamy moment. The second time I was in such shock, I’d been in so much pain without anybody helping, I could barely look at the baby.’

Birth trauma happens after natural birth as well as after birth with intervention.

As any woman with children knows, the politics of childbirth are so highly charged they make infighting between Labour and the Tories look like a teddy bears’ picnic. On one side sit the medics, portrayed by their detractors as men in white coats intent on cutting women open so they can avoid litigation and clock off on the dot of six. On the other sit the midwives, scoffed at as strident feminists denying women modern analgesia in favour of whale-music CDs and back rubs. In the middle of these competing philosophies is a labouring mother, her wishes drowned out in the clamour of debate.

Maureen Treadwell of the Birth Trauma Association, which supports women who have had difficult births, says that far too often ideology takes precedence over individuals’ needs. ‘The consequences can be unbelievably cruel. The truth is that what suits some women can be distressing and wholly unacceptable to others. Some women are obsessed with a natural birth and are distraught if this doesn’t happen. But for others – say, a 40-year-old woman who has had three miscarriages – the priority may be having the safest birth possible with naturalness very low on the list.’

At the heart of much of the argument are the philosophies of Grantly Dick-Read, a British obstetrician who was convinced that much of labour pain came from society conditioning women to expect it. His 1942 classic Childbirth Without Fear expounded his belief that women educated to be free of fear and tension would experience birth as a ‘normal and natural defecation’. Pain relief, he said, was undesirable because it affected the baby and slowed down labour, frequently leading to interventions, such as the use of forceps or the ventouse vacuum pump, or emergency caesareans.

Dick-Read became the first president of the Natural Childbirth Trust, promoting better understanding of his system. This later became the National Childbirth Trust (NCT), whose antenatal classes are seen as a rite of passage for all middle-class couples …

While acknowledging that pain is subjective, Belinda Phipps, the NCT’s chief executive, defends such a stance. ‘A lot of women who feel they are denied an epidural are on the verge of starting to push the baby out and don’t actually need one any more … an experienced midwife will know she’s actually getting ready to push and persuade her to wait a few more minutes. She should reassure her that what she’s feeling is normal and let her know it won’t last much longer …

Others, however, are furious their wishes were ignored. ‘I talk to women who have been left screaming in agony because they were either not offered or were refused pain relief,’ Treadwell says. ‘Afterwards, they’ve needed psychological help, their relationships have been scarred, they’ve been afraid of getting pregnant again, they don’t bond with their babies.’ …

Fashions in giving birth are as variable as hemlines. Tina Cassidy, the author of Birth: A History, asserts, ‘The way we choose to give birth reflects the culture of the age. Whenever women feel their choices are being limited by political decisions, they push back and say, “We can do what we darn well want.”‘

In the early 20th century the church preached that suffering in childbirth was the curse of Eve and that to try to avoid pain was a sin. Outraged by such repression, the suffragette movement embraced the introduction of ‘twilight sleep’, a mixture of morphine and the amnesiac scopolamine injected during labour to made women forget the pain. Obstetricians initially expressed doubts about drugging women, but were rapidly shouted down. The result was that birth quickly became so medicalised that by the 1970s another generation of feminists were fighting for the right to experience childbirth awake.

‘In the 1980s, when women were in thrall to “having it all”, they embraced epidurals that rid them of pain while allowing them to be conscious,’ Cassidy says. ‘In the 1990s, when the focus was on technology and convenience, there was a vogue for elective caesareans.’

In today’s eco-conscious society, the pendulum has swung back towards nature. On Manhattan’s Upper East Side society women reputedly send out birth announcement cards embossed with the words natural childbirth in gold letters …

In Britain the number of home births has risen from a low of one per cent in the 1980s to nearly three per cent today, a trend that the government seems eager to assist …

The debate becomes even more heated when it comes to elective caesareans. The National Institute for Clinical Excellence (Nice), responsible for government guidelines, is pushing for a reduction in the caesarean rate from 23 per cent of all births to the World Health Organisation’s recommended ten to 15 per cent. In fact, while acknowledging that a caesarean is major surgery, some women prefer the idea of a planned operation to the unpredictability of a vaginal birth. When pregnant for the first time, Leigh East, 37, from West Yorkshire, was terrified at the prospect of natural childbirth, not least because so many of her friends’ attempts had ended in traumatic emergency caesareans.

‘At my antenatal class they acted out a caesarean, showing you how there would be 12 people in the room,’ she says. ‘This was portrayed as a negative thing, but for me it seemed like a no-brainer. Why would I not want everyone I could possibly need around me?’ Certain she wanted a caesarean, East had to battle to get one on the NHS. ‘Midwives judged and lectured me,’ she says. Eventually a consultant agreed to her request. ‘It was the most amazing, calm experience, and I knew I had made the right choice.’

East has since had another caesarean and set up a website, csections.org, giving ‘a balanced view of caesareans’. ‘Some people are very negative about it, but the site’s not saying planned C-sections are the best answer; it’s just being pro-choice, letting women know about a route that organisations like the NCT keep quiet about. So much emotion surrounds the birth of the baby that rationality goes out of the window, which I find very frustrating. Birth is the most physically exhausting thing that is ever going to happen to you, and who is anyone else to tell you how to do it?’

East’s sentiments are echoed by Julia Wilson, yet their attitudes could not be more opposed. Last year Wilson chose to give birth to her second child, Maddy, at home unassisted by even a midwife, a trend known as ‘freebirthing’.

‘Birth is a sacred process and nothing should interfere with it,’ she tells me from her home in Worthing, East Sussex. ‘I had a midwife for the home birth of my elder son, and her presence put me off. I believe that having a professional present poses more of a risk than being left alone, because they try to interfere when it’s completely unnecessary.’

When Wilson first mentioned her plan to friends and family, most were horrified. ‘At check-ups midwives were equally dismissive. They didn’t even support a home birth, because my low iron levels meant I might haemorrhage. But that was just nonsense. It was so empowering just believing in myself, rather than relying on other people telling you how to manage your body.’

Such a view makes Pat O’Brien, a spokesman for the Royal College of Obstetricians and Gynaecologists, shake his head. ‘In India and Africa thousands of women with potential complications give birth at home without support because they have no choice, and it ends in disaster. But in the West childbirth has become so safe that people have just about forgotten that there can be major problems. It’s been written out of people’s psyches.’ After all, the risk of dying in childbirth is one in 28,000 at Queen Charlotte’s hospital in west London, compared with one in seven in Niger.

It does seem extraordinary that an event that lasts at most a couple of days compared to the lifetime of actually bringing up a child can provoke so much controversy. Yet Belinda Phipps points out that nature probably has its reasons for this. ‘If we just dropped babies like eggs without noticing, what would that say about the responsibilities we’re taking on for the next 20 years? Birth marks you out as a mother and a carer for a very long time.’

Melissa Maimann, Essential Birth Consulting 0400 418 448

Delivering real choice after a Caesarean

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… LOUISE McCANN felt like a “freak” when her first baby was delivered by Caesarean section, after attempts over three days to induce her failed.

In the immediate aftermath, she was just glad Darragh had finally been born and they were both okay. “It is only down the line, when the initial elation wears off, you kind of think what went wrong?”

It was a question that came back to haunt her when she was pregnant again within a year. Everything had been fine the first time until she went overdue; she was 28 years of age and had had a straightforward pregnancy.

“I was a bit naive, it being my first baby, and I assumed that if I was being induced it was going to work.”

… “I found out later I wasn’t ready to be induced.”

On her second pregnancy she was determined to try for a VBAC … She found the consultant initially supportive but, at 38 weeks, he told her to prepare herself for another section.

She believed he was trying to scare her into it by overstating the risks of a VBAC. “He was throwing stats at me and I would have to come back and say, ‘I looked that up and it is not true’.”

McCann was resolute that there was no need for a section; she was healthy, there were no complications and she had not even gone full term at that stage.

… women who go into spontaneous labour after one previous section have about 80 per cent chance of vaginal delivery …

“When a woman has an unhappy experience with a first labour, she does not want to repeat the experience …

As the second pregnancy progresses, inevitably the memories flood back and they get extremely anxious. They are assured the same thing won’t happen.

… “Women who have had a normal birth and then a section can never understand why somebody would elect for a section,”

… “The majority of women who have had a section and then a normal birth say, ‘I am glad I did that’.”

… research in Scandinavian countries shows that if women are debriefed and counselled after an emergency section, they are more likely to opt for VBAC.

[Debriefing gives] you some closure on what happened and help you plan for the next pregnancy …

… “Women are not getting the information to make an informed decision as to what is the safest option in their case.”

Generally, VBAC is associated with a lower risk of complications, for both mother and baby, than a repeat section.

… To people who argue that all that matters is a healthy baby, not the method of delivery, she says that is exactly where VBAC comes in. “If that in the end is all that you care about, then VBAC is something you should seriously consider.”

… “Every woman’s circumstances are different,” he adds, “but the best way is to go into labour spontaneously.”

That is what Louise McCann was holding out for in her second pregnancy. The consultant scheduled her for a section at 12 days overdue – although she had no intention of going in – but she went into labour at home in Naas, Co Kildare the night before.

“Things had been progressing well at home, but when I arrived in the hospital everything stopped – I suppose it was nerves and fear.

“They were trying to push me for induction and telling me I had 12 hours and that was it …”

When her daughter … arrived, 12 and a half hours later, McCann was relieved that she was healthy and had been born without unnecessary surgery.

… Less than a year later she was pregnant again. Having had a VBAC, there was no pressure on her this time and she was allowed to opt for the midwifery scheme – something which had been ruled out when her history was just one section.

… Ruth Doggett was in labour for 12 hours with her twins before it was decided to deliver them by Caesarean section.

… The official reason given was “failure to progress” … However, she says, “if I was doing it again, having learned more about sections and things, I probably would have fought that more.”

When Iseult and Lachlan were 15 months old, Doggett became pregnant again. She wanted a home birth but was told that having had a section, she was considered too high risk – nor was she eligible for the midwifery scheme.

Although she had gone private for her twins, she did not want to be under the care of one consultant this time.

“Consultants are great but they all have their own opinions and, [by] not knowing them well enough, it is hard to tell will they really have the same values and beliefs that you have – especially when the day comes.”

She opted for semi-private care, where she was seeing midwives and registrars. “I found it fantastic. Every doctor had a different view of my situation, so it reaffirmed my belief that I had to trust my own instincts and my own bit of research of what was best for me and my baby. Then take all the information I was getting and make a decision for myself.”

She was very keen to try for a VBAC and medical staff were supportive, telling her she had a 70 per cent chance of having one.

However, she took issue with some of the hospital’s policies for VBACs, such as that she would be allowed only seven hours of active labour, after which she would need to have a section.

“I was really concerned about that – the possibility of being on a clock and saying I had seven hours to give birth, to me that was just crazy.”

She was told she would need continuous monitoring because of the risk of scar separation (which is less than 1 per cent when women go into spontaneous labour), but she wanted intermittent monitoring so she could be free to move. Also there was a policy for induction at 10 days overdue, but she wanted to be allowed to go 14 days over.

As it turned out, she went into labour at five days over, early one Thursday morning last April. She spent the day at home … “I wanted to get as close to delivery at home so I would not be on the clock.”

At 10pm she went into hospital to be checked. “I was 4cm [dilated] , the baby’s head was down …

Then Doggett was questioned about things she had specified in her birth plan – such as longer time limits and no continuous monitoring. A registrar explained all the risks and asked her, she says, was she prepared to be in labour 24 hours, to have her baby flat-lining at birth or to have cerebral palsy.

“It was an awful thing to be asked. I said, ‘I want what is happening to me in my labour to be dealt with; I don’t want to be dealt with on the basis of statistics. Obviously I want my baby to be healthy’.”

Although she was sent to the delivery ward, she remained at 4cm. “I actually love being in labour, I know that it is a strange thing to say. I don’t find it painful; it is just a cramp. It is quite an exciting time.”

But, conscious of the clock ticking, she was becoming stressed as she heard talk of another section. However, then she was told she was not in established labour and was being moved back to the labour ward where she should try to get some sleep.

On Friday, one registrar said if nothing was happening by 6pm she should have her waters broken. But then word came down from a consultant that, “if I did not want any interruptions or interventions and everything was progressing fine – slow but no distress – that there was no need to get involved”.

She was delighted with that news and was moved into the pre-natal ward. “It was fantastic; I could eat what I wanted and I was off the clock. I relaxed completely there.”

By 10pm she felt the contractions changing and by 1am needed her Tens machine. She was found to be 7cm dilated and moved to the delivery suite.

She agreed to her waters being broken when she was almost 10cm dilated. “Nothing happened for about 15 minutes then the second phase started and that was incredible.” One and a half hours later, at 6.50am on the Saturday morning, Caelan was born, weighing 9lb 9oz.

… “being able to deliver him myself was empowering and kind of healing in lots of ways.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

Post traumatic stress disorder and birth

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It is supposed to be one of life’s most rewarding and wondrous experiences, and fortunately that is how most women describe childbirth.

But if the birth is difficult or distressing it can have a profoundly negative effect on the mother.

A Griffith University research team has found that 6 per cent of Australian women go on to develop debilitating post-traumatic stress disorders after giving birth.

One woman … almost died while giving birth to her son.

On top of that she says her doctor treated her inappropriately during the delivery, and a midwife agreed.

“As soon as I was up on the post-natal ward I was scared that I would see that registrar again …” she said.

That fear prompted Cathy to discharge herself from hospital. When she got home it quickly became clear something was wrong.

“I would have panic attacks for no reason, like, I was really anxious,” she said.

“I didn’t sleep very much. We had to pass the hospital on our way into town, so I rarely went into town because we couldn’t even drive past it.”

Cathy says at her lowest point she felt suicidal and after researching she realised she was suffering from post-traumatic stress disorder (PTSD).

“I did go and see a doctor. That doctor diagnosed post-natal depression, but I knew that it wasn’t post-natal depression. I knew that it was something else and I knew because everything was about the birth,” she said.

An associate professor of midwifery at Griffith University, Jenny Gamble, says her latest study shows about 6 per cent of women in Australia develop PTSD after childbirth.

“… 30 per cent of women report their birth as traumatic,” she said.

“It means that they feared for their life or their baby’s life, or that they, or their baby, would be seriously damaged or permanently injured.”

Professor Gamble says it is common for mothers with PTSD to be misdiagnosed with post-natal depression.

“If we’re not really addressing the key that sparked the distress, the key reason for the distress, then I think that can be a problem for women who’ve had a traumatic birth,” she said.

“Then they just keep blaming themselves about why they’re not better.”

… once PTSD is correctly diagnosed, targeted treatments are very effective.

“What we’re doing is we’re changing a sense of meaning for these women. We’re actually changing the way they look at the trauma and therefore the way they look at themselves,” he said.

… about 90 per cent of women no longer suffer PTSD after about 10-12 weeks of cognitive behaviour therapy …

A good article that exposes the trust about PTSD and childbirth. I am concerned that the focus is on the woman and not on the health services that cause the PTSD. When 30% women report their birth as being traumatic, a large focus needs to be on reforming the maternity service so that women are safe – and feel safe – to birth in clinical settings, or to ensure that they have ready access to homebirth services and midwifery care. Interestingly, birth trauma is very rare in home birth and amongst births attended by private midwives.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Politics of 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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After five hours of active labour, Kate gave birth to her second, healthy baby boy. Holding him tenderly she is oblivious to the drama unfolding … She is hemorrhaging.

Her uterus has failed to contract after the birth causing massive blood loss … the registrar tugs at her umbilical cord in an attempt to remove her placenta. Unable to do so he proceeds manually. There is no explanation, sedation or consent as he plunges into her uterus.

Meanwhile a midwife has been instructed to ‘wring out’ her uterus by gripping her hands deep around Kate’s stomach. Kate is screaming in pain and her partner begs them to stop. Instead he is removed from the room and their baby is taken away … What happens next is hazy for Kate as she passes in and out of consciousness. But what is clear is since that day, four years ago, Kate has been managing posttraumatic stress. Unable to go back to hospital her following two births are at home with no medical practitioners present.

“I know it sounds reckless but … We just can’t fathom going in to the hospital because that previous experience had been so bad,” she says.

“… I felt an unassisted homebirth was safer for me than going back to hospital to let them do the things to me that they did that time.”

Kate is now planning her fifth pregnancy and wants an independent midwife to attend her birth at home. She has been advised to seek a collaborative agreement between her midwife and the Women’s and Children’s Hospital (WCH) as per new Federal laws governing homebirths.

Called the National Health (Collaborative arrangements for midwives) Determination 2010, they were passed by Federal Health Minister Nicola Roxon days before the election was called. They state that for an independent midwife to access Medicare and insurance they must have an obstetrician agree to care plans created for clients.

However when Kate contacted the WCH she was told that they “do not participate in collaborative agreements”. In a statement to The Adelaide Review the hospital says: “The public-funded Homebirth strategy from the Commonwealth is part of the broader National Maternity Services Plan which is yet to be endorsed by the Health Ministers of Australia.”

It reads like a straightforward strategy for insurance purposes, yet it has been met with confusion and anger. Firstly, insurance providers are yet to create a product that allows independent midwives indemnity while attending a homebirth.

The Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG) does not support homebirths and believes women who choose them are putting the birth experience above that of risk. RANZCOG President Dr Edward Weaver welcomes the new legislation and hopes it will curtail the number of high-risk cases that do birth at home.

He believes: “Virtually every obstetrician would have had an experience where he’s been called in to a situation where a woman has been brought in to hospital by an independent midwife and has had difficulties dealing with that situation.”

In 2008 there were 115 planned homebirths or 0.5 percent of births in South Australia. While 94 of those occurred at home, 21 women transferred to hospital for care before they could birth.

RANZCOG advocated for collaborative agreements in submissions to the Maternity Services Review, which informed the legislation. However they concede they cannot make their members adhere to them.

And here lies the problem: a midwife needs to have a collaborative agreement to remain in practice, but there is no requirement on an obstetrician to participate in an agreement. This threatens the ability of women to access midwifery care at all, and threatens the midwife’s ability to remain in practice. At a time when there is an acute shortage of midwives, these moves only mean that there’ll be fewer midwives left to care for pregnant and birthing women and new mothers and babies.

Australian College of Midwives Vice President Hannah Dahlen has found obstetricians will not enter into these agreements because they do not want to take responsibility for a midwives’ practice.

It should not be a case of an obstetrician needing to take responsibility for a midwife’s practice. Midwives are autonomous and regulated practitioners. We do not require an obstetrician to be responsible for our practice any more than an ENT specialist, cardiologist or orthopedic surgeon is responsible for a GP’s practice.

“If our most moderate and collaborative obstetricians are telling us that they are not going to be entering in to signed agreements,” she says. “Then we are potentially stymieing the reform that is going to be rolled out from November.”

Yet one of Dahlen’s greatest concerns is that the reforms go against the World Health Organisation (WHO) definition of a midwife. The WHO states a midwife promotes a natural birth, can detect complications and is able to carry out emergency procedures if required. Hannah is concerned these new laws will end up seeing “one practice of medicine veto and regulate another”.

Christine is an independent midwife with close to two decades of experience in the maternity sector. She has birthed hundreds of babies both within a hospital setting and independently. More than 20 women who want to birth at home have employed her until April 2011.

“I’m happy to work alongside a doctor when it is required but I do not agree, and no midwife will agree, that it is ok for them to sanction our practice,” she claims. If this does not get resolved she is adamant homebirths will go underground with women birthing with unregistered midwives.

… RANZCOG and the Australian Medical Association deem homebirth a high-risk proposition. Of the 202 perinatal deaths in 2008, one was in a homebirth setting. In June the State Coroner ruled to investigate the circumstances surrounding a baby who died at a homebirth in 2007. While this was widely reported in the media, the coronial inquest of an obstetrician who lost two babies to ventouse extraction at the same time was left unreported.

“If a baby does not make it into this world, and not every baby is going to, and it is a midwife’s domain, (they) are really crucified,” says Christine. “But for doctors to lose babies and make mistakes, it is a very different thing.

South Australian MP Frances Bedford is an advocate for a woman’s right to birth at home. She was unable to be interviewed for this article but said in a statement to The Adelaide Review: “(I) find it extraordinary that a woman choosing caesarean section without any medical need is apparently acceptable to the medical fraternity (with Australian taxpayers funding most of those costs) yet a woman choosing to maximise her chances of health and wellbeing through homebirth is discriminated against.”

As this debate continues in the medical fraternity, Kate remains sceptical she will have the birth she wants. Instead her partner has become versed in birth advocacy.

“We should be able to share everything we need with (a midwife) and same for the hospital,” she says. “Our partners should not have to go in there and be aggressive and advocate on our behalf.” …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Toxic epidural ravages mother

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

A very sad story. This family is desperate to hear from anyone who might have experienced anything similar so that they can be guided with treatment.

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ALEXANDER Zheng’s cot is still unassembled in a Sydney apartment where he has never been.

Home, for now, is a bassinet wedged into a room in the high-dependency unit of St George Hospital, where the two-month-old’s mother lies catastrophically injured.

Grace Wang’s spinal canal was injected with a powerful antiseptic instead of anaesthetic, in what should have been a routine epidural to ease the pain of her first child’s birth.

The devastating medical mistake – inconceivable in its magnitude – has poisoned her nervous system, leaving the 32-year-old distressed, confused, in shocking pain and unable to walk or even sit.

She has lost the strength to hold Alex, and rarely asks about her baby, as she did constantly after his birth.

The future may not bring relief, as Ms Wang’s physical and psychological condition has deteriorated since the accident on June 26, and new symptoms continue to emerge.

In the first three relatively hopeful weeks, her husband, Jason Zheng, cooked for Ms Wang and fed and changed Alex, who has apparently not suffered from the drug error.

Now Ms Wang has had surgery to relieve fluid pressure on her brain, and Mr Zheng maintains a vigil beside his increasingly frightened and disoriented wife, leaving little time for his son. The longed-for baby – who followed three miscarriages – is cared for by a nurse the hospital provides. The couple have no family in Sydney, where they migrated from China.

”It’s like we are ignoring that we have a son,” said the distraught father, who will begin legal action.

… Alex snuggles close when placed alongside his mother, but breastfeeding has been impossible for fear the many medicines she is taking may affect the milk.

”Every day she’s suffering and she says she wants to give up,” Mr Zheng said. ”She was crying last night when she touched her son. I just want to change my body to hers.”

Another thing Mr Zheng wants, and which motivated his decision to speak publicly, is to make contact with anyone who has suffered similarly, in the hope their doctors may advise on Ms Wang’s treatment.

Epidural administration of chlorhexidine – used to clean skin before injections and strong enough to neutralise resistant hospital bacteria – is so rare that Ms Wang’s doctors have identified only one other case.

Angelique Sutcliffe, from Britain, was paralysed for life after the chemical entered her epidural in 2001. But this was just a droplet – a fraction of the eight millilitres infused into Ms Wang.

Managers at St George Hospital yesterday admitted error and pledged to support the family, but would not explain the possible source of such a fundamental mistake in a commonplace procedure: nearly 40,000 epidurals were conducted in 2006, the most recent New South Wales statistics show, in 43 per cent of all births.

The state’s Minister for Health, Carmel Tebbutt, said: ”This is an extremely distressing case and I offer my sincere apologies.”

She said investigations had been ordered.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Who controls childbirth: women or doctors?

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That I am pregnant again is an act of either incredible optimism or mind-blowing amnesia. As the sonogram technician squirts jelly over my abdomen for my 20-week checkup, I think it’s the latter. Watching this baby, who the tech tells me is a boy, I am not caught up in visions of his future; I’m caught up in visions of mine. All of a sudden, I know with a certainty I haven’t allowed myself to confront before: Somehow, I am going to have to deliver this baby.
Obviously, you say. But my first birth was traumatic, and although my son and I emerged fine, I lost a year seeking treatment for post-traumatic stress disorder and all the depression, fear and anger it brings. I imitated mothers who seemed normal to me, cooing and tickling my son. In truth, I was a zombie, obsessing about how I had ever let what happened happen.

What happened is this: In my 39th week, I am induced because of high blood pressure. At the hospital, I am given Pitocin, a synthetic form of the labor-inducing hormone oxytocin, and Cervidil, a vaginal insert used to dilate the cervix. Within two hours, my contractions are one minute apart. I had lasted as long as I could without an epidural because I had read that they sometimes slow dilation. That’s the last thing I need: I’m at a pathetic 2 centimeters. My doctor comes up with a solution for the pain: a syringe full of a narcotic called Stadol.

“I have a history of anxiety,” I tell the nurse who has brought in the syringe, as I always warn any medical professional who wants to give me drugs. “Is this drug OK for me?” “It sure is,” she says.

It is not. Within 10 seconds, I begin hallucinating. For five hours, I hallucinate that I’m on a swing that’s soaring too high, that houses are flying at my face. My husband has fallen asleep on the cot next to me, and I’m convinced that if awakened, he will turn into a monster — literally. I’m aware this notion is irrational, that these images are hallucinations. But they are terrifying. I buzz the nurse. “Sometimes that happens,” she says …

By noon the next day, 24 hours after I had arrived, I am only 3 centimeters dilated. The new nurse, a nice lady, tells me the induction isn’t working. “Your blood pressure isn’t even high anymore,” she says. “Tell the doctor you want to go home.”

When my OB comes in, I say, “I’d like to stop this induction, if that’s possible. I’m worn out. I hallucinated all night … I just don’t think this is working out.”

“OK,” he says. “Let me examine you. If you’re still not dilating, we’ll talk about going home.”

My previous dilation exams had been quick and painless, if not entirely pleasant. This one takes a long time. Suddenly, it hurts. “What are you doing?” I scream. “Why does it hurt?”

No answer.

“He’s not examining me,” I scream at my husband. “He’s doing something!” My husband grips my hand, frozen, unsure.

I scream to the nurse, the nice one who had suggested I go home. “What is he doing?” She doesn’t answer me, either. I writhe under the doctor’s grasp. The pain is excruciating.

The first sound I hear is the doctor’s directive to the nurse, in a low voice: “Get me the hook.”

I know the hook is for breaking my water, to speed my delivery by force. I scream, “Get off of me!” He looks up at me, as if annoyed that the specimen is talking. I imagine him thinking of the cadavers he worked on in medical school, how they didn’t scream, how they let him do whatever he wanted.

“You’re not going anywhere,” he says. He breaks my water and leaves. The nurse never looks me in the eye again.

Eleven more futile hours of labor later, I am exhausted and terrified when the doctor comes in and claps his hands together. “Time for a C-section,” he says. I consider not signing the consent form, ripping off these tubes and monitors, and running. But the epidural I’d finally gotten won’t allow me to stand up.

It’s nearly midnight when I hear a cry. My first emotion is surprise; I had almost forgotten I was there to have a baby.

I was desperate to find someone who could tell me what had happened to me was normal. To say, “You hallucinated? Oh, me, too.” Or “My doctor broke my water when I wasn’t looking. Isn’t that the worst?” Nothing …

Now, I’d never loved my doctor … I’d found him patronizing — “Normal!” he’d shout at me, when I asked a question — I thought his assuredness might be a good antidote to my anxiousness. It seemed to work, until it didn’t.

… I also didn’t have a birth plan … Sure, I had a plan for the birth: Have a baby using whatever breathing method I’d learned in the hospital’s birth-preparedness class, maybe get an epidural. But I didn’t have the piece of paper that so many of my friends have brought to the hospital with them … in my opinion, the very act of creating such a contract was to ignore what labor is: something unpredictable that you are in no way qualified to dictate.

… people who hear my story ask … Did I consider a home birth? A midwife instead of an obstetrician? … The answer is no. I am not holistically minded. My philosophy was simple: Everyone I know has been born. It can’t be that complicated.

The women who ask me about my preparations for my first son’s birth — who imply with these questions that I could have prevented what happened to me if I’d been more diligent — are part of an informal movement of women who are trying to “take back” their birth — take it back from the hospital, the insurers and anyone else who thinks he can call the shots.

But hospitals aren’t so interested in giving women back their birth … stipulations dealing with labor and delivery (“I want only one medical professional in the room at a time”) garner barely a glance. University OB/GYN in Provo, Utah, even has a sign that reads, “…we will not participate in: a ‘Birth Contract’, a Doulah [sic] Assisted, or a Bradley Method delivery. For those patients who are interested in such methods, please notify the nurse so we may arrange transfer of your care.”

… This question of whether I could have prevented my trauma has lingered in my mind since that day; now that I am pregnant again, it has become deafening. I have a chance to do it all over. Would I benefit from thinking more holistically? Should I bother taking back my birth?

During my pregnancies, friends gave me two books; their spines are still barely cracked. The first is called “Ina May’s Guide to Childbirth.” … The other book is “Your Best Birth” by Ricki Lake and Abby Epstein; it’s an offshoot of their 2008 documentary, “The Business of Being Born.” Their urgent message is that women who want to deliver vaginally can do so if no one intervenes. Instead, doctors and hospitals are doing all they can to “help” the laboring woman along … and failing. Inductions like mine, epidurals given early in labor, continuous fetal-heart monitoring — all of them have been associated with a higher risk for cesarean section. The result is an epidemic — 32 percent of U.S. births were C-sections at last count, the highest rate in our history. Individual surgeries may be medically necessary, but as a matter of public health, the best outcomes for mothers and babies come with a rate of no more than 15 percent, according to the World Health Organization.

Sam … was five months pregnant when watching “The Business of Being Born” convinced her that hospitals could be dangerous and a home birth would be more meaningful. She and her husband found a midwife … and spent the rest of the pregnancy preparing.

After 24 hours of labor, Sam’s contractions were two or three minutes apart, yet when her midwife examined her, she was only 3 centimeters dilated. The midwife gently told her that she was nowhere close to delivering, despite her contractions, exhaustion and pain. Sam asked to be taken to the hospital.

The change of scenery did her good. “At that point, I had been in labor for 40 hours,” she says. “I entered the relaxed zone. The epidural took the edge off … It was a sacred space.”

After her son’s delivery, Sam passed out, having lost 50 percent of her blood volume in a postpartum hemorrhage. Needless to say, she was relieved that she was in a place where blood transfusions were readily available … she believes she will want midwife care at a hospital next time.

… Bialik’s first birth didn’t go the way she wanted. After three days of labor at home, she stalled at 9 centimeters, one short of the goal. Her midwife suggested they go to the hospital, where after a natural childbirth, Bialik’s son spent four days in the neonatal intensive-care unit. “My son was born with a low temperature and low blood sugar, which isn’t unusual in light of the fact that I had gestational diabetes,” she explains. “I understand doctors need to err on the side of caution, but there was nothing wrong with my child. All of our plans for bed sharing, nursing on demand, bathing him — gone.”

The experience was scarring. “I felt a sense of failure that I had to call my parents from the hospital,” Bialik continues. “Yes, I know vaginal birth in the hospital is the next best thing to a home birth.” …

I point out that natural childbirth in the hospital — her “failure” — was my best-case scenario. But I also understand when she says, “Everyone is allowed her own sense of loss.” She realized her vision when her second son was born at home.

The second time around
I don’t consider myself a candidate for a home birth. The risk of uterine rupture from an attempt at vaginal birth after cesarean (VBAC) makes it unthinkable … I’m also not really interested in a home birth … But I’m also not interested in another C-section …

So I’d like to attempt a VBAC, but I know that it doesn’t always succeed. I have a new doctor — the 10th I interviewed following my son’s birth — at a new hospital, and he has agreed to help me try. But my primary goal is more modest: not to be retraumatized. Even now, my heart pounds at the sight of hospital receiving blankets, the antiseptic smell of the maternity ward.

The common thread in Bialik’s and Sam’s stories that impressed me was how supported and safe they felt with their midwife …

In an e-mail Bialik sends after our meeting, she goes back to my idea that some women weren’t meant to have babies the holistic way. “There are those among us who believe that if the baby can’t survive a home labor, it is OK for it to pass peacefully,” she writes. “I do not subscribe to this, but I know that some feel that … if a baby cannot make it through birth, it is not favored evolutionarily.”

I think about my appendectomy, back in 2003. Had I not made it to the hospital in time, I would be dead. What would it be like to refuse medical intervention? I’d call my family, say my good-byes. “I’m sorry,” I’d say. “But I’m not evolutionarily favored. It’s time for me to go.”

This attitude, that everything was better back when there were no doctors, seems strange to me. C-sections, although certainly done too often, can save lives. Orthodox Jews still say the same prayer after childbirth that those who have been in near-death experiences say — and with good reason. A birth that leaves mother and child healthy may be commonplace, but it’s also a miracle every time.

As the weeks pass and my belly grows, I can’t stop thinking about Sam. Her pregnancy was a sacred time, and she had truly looked forward to labor. Is that what I should try for — a meaningful birth, as well as an untraumatic one? At what point had people like Sam and me learned to feel entitled to a meaningful birth?

“I think that birth should be a beautiful experience,” says obstetrician Kimberly D. Gregory, M.D. She’s the vice chair of women’s health care quality and performance improvement at Cedars-Sinai Medical Center in L.A. “It should be exactly the way you want it, and doctors should intervene only to preserve the health or life of you or your baby.”

Naturally, one would assume that Dr. Gregory advocates birth plans. When I ask her this, she laughs. “We always say, ‘If you show up with a birth plan, just get the C-section room ready,’” she says. “You get everything on that list that you don’t want. It’s like a self-fulfilling prophecy.” Dr. Gregory led an unpublished study that compared women who took traditional hospital birth classes with those who employed Bradley-like training and a birth plan. The birth-plan group trended toward a higher C-section rate and more interventions. “There’s a certain personality type that tends to be more anxious. Maybe the anxiety hormones themselves put them at risk,” Dr. Gregory theorizes. “It seems that being open and honest and choosing the right doctor is probably a better option than writing everything down. Walking in with this list appears to set up an antagonistic relationship.” …

… In the past three weeks, I’ve had the same dream. I’m in a field (I believe at Ina May Gaskin’s Farm), and women in braids are dancing around me as my baby is born, painlessly, joyously. As I reach down, I notice my C-section scar is gone.

I wake up upset. Am I truly under the impression, subconscious though it may be, that taking back this birth will undo the damage of the last one?

“I don’t understand this phrase ‘take back your birth,’” nurse-midwife Pam England, creator of “Birthing From Within,” … tells me. “Who took it? What would a woman tell herself it meant about her if she failed to meet the criteria she made up for ‘taking back’ her birth? I am concerned that this phrase, meant to generate action and a feeling of empowerment, may actually be generated by or feeding the victim part of her.”

England is right: Having a childbirth that I deem successful this time will not change what I haven’t overcome from the first. I try to find a way to make what my doctor and nurses did to me OK, but my mind rebels. I feel loss — no, theft — of an opportunity for me to have a baby the way so many other women do: a carefree pregnancy, a labor that could still go any way.

Maybe I’m not so different from the women I spoke with, after all. Bialik had a successful natural childbirth but felt like a failure because it was in the hospital. Women who had a C-section also used words like failure. Perhaps part of the problem is that our generation of women is so ambitious, so driven, that we don’t know how to do anything without quantifying it as a success or failure.

According to Dr. Gregory, women are now requesting a C-section for their first birth, even without indication. “A lot of people are uncomfortable with the unknown,” she says. Plenty of people are wary of C-sections by choice, from holistic moms to obstetricians. But isn’t this, too, taking back your birth? Refusing to be out of control seems to me the epitome of taking it back. You don’t have to have an unattended birth in the woods to be considered a real woman.

Deciding that you can’t control the uncontrollable — and committing to that decision when you are, in fact, out of control — is also taking back your birth. It’s what your grandmothers did. It’s what their grandmothers did.

With this, I realize that I have already taken back my birth, but not as part of any movement. I have stopped judging women who take extra precautions as defensive and started to understand that everyone has to find her way.

I don’t know how this story ends. I’m still not convinced my body was made to deliver vaginally. But here’s what I do know: I will insist on kindness. I will insist on care. And I hope I will be open to being treated kindly. It’s harder than it seems.

I have another hope, too. I hope there will be a moment when … I will look down at my baby — whether he is handed to me on my belly or from behind a curtain as my body is sewn shut — and I will remember what I’ve known from the beginning, when I looked down at that plus sign and we were alone together for the first time. Before these questions wrapped around my neck, choking me for answers. I will know that I am his mother and he is my son. And maybe, in that moment, I will be ready to say that the only success and failure is the outcome of the birth, that we are healthy …

I’m concerned that birth is defined in terms of success and failure, and that after this author’s journey, she has determined that health is the only important factor. In this day and age, it is entirely possible to have a safe VBAC – a safe birth experience as well as a satisfying one. The vast majority of women who choose VBAC will be successful provided that they choose the right care provider.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Dannii showed home birth safe

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

The obstetricians are determined to use Dannii’s birth as “proof” that homebirth is inherently risky. Just as their assertion is untrue, so is the assertion of the title of this article that states that “Dannii showed home birth safe”.

What Dannii’s birth highlighted is several issues:
- The safety of birth with a midwife
- The importance of good back-up plans
- The need for mental and emotional preparation (as best a possible) for all eventualities (often lacking in hospital birth)
- The need for acceptance in the medical community of midwifery and homebirth. These are options that increasing numbers of women are choosing.

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A YACKANDANDAH mother says the fact Dannii Minogue abandoned her home birth to have her baby at hospital signifies the safety of the practice rather than its dangers.

… obstetrician Pieter Mourik said … the … drama … should bring home the dangers of home births.

I’m not clear how a timely transfer brings home the danger of homebirth. If we’re realistic, a percentage of homebirth plans will change to hospital at some stage of the pregnancy, labour or shortly after the birth. This is called accessing the most appropriate level of care to meet the woman’s needs. Hospital birth is an unnecessary intervention in a healthy woman’s pregnancy. Homebirth delivers safer outcomes and greater satisfaction and breastfeeding rates. The Government ought to be finding ways of promoting it as a public health issue. There are no other healthy life processes that we routinely go to hospital for. We go to hospital or a doctor if we have a problem with a healthy life process (digestion, elimination, menstruation etc) but not in the absense of pathology.

… Donna Jones, who had her second child at home, said it showed home birth participants and their midwives were prepared for the risk.

“The fact that she has transferred to hospital to me suggests that she had a really great midwife who said ‘you know what, it’s time to go and get some help’,” Mrs Jones said.

“To me a home birth transferred to a hospital is not a failure or a disaster.

“It’s just that obviously for whatever reason, it couldn’t happen at home, so the midwife has said let’s go to the hospital we’ve already booked into and get the medical help you require.”

Mrs Jones said the attraction for her to home births was to avoid the adrenalin that affected the natural process.

“The hormonal process is affected by adrenalin which is caused by fear and at hospitals you have doctors and midwives you mightn’t know, it’s a strange environment, you have bright lights — they’re all the sorts of things that leads to everything going wrong in deliveries,” she said.

“I see that as a greater risk than having a home birth.

“At home, you’ve got a midwife who you have been preparing with for months.

“I was confident in my body’s ability to give birth if I was left alone to get along with it.”

… “There needs to be more choices for people when it comes to birthing,” …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Hard labour

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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Australia is one of the safest countries in the world in which to give birth, so why are women more anxious than ever about their pregnancies?

FOR most women, the memory of their baby’s birth remains a vivid mental replay that awakens sensations at times as sharp and clear as the moment itself.

For Fiona Thomas, such memories are hazy, trammelled by darker ones that involved her fight for survival. All she remembers is the baby, her third, being lifted from deep within her; and then feeling faint and unwell.

As the baby lay in her arms, she was elated to discover she had a daughter (she already had two boys.) But there was tension in the room and the obstetrician seemed preoccupied. As the feeling of faintness dragged her deeper into a place she did not want to go, she signalled to the nurse to take the baby.

She remembers the anaesthetist telling her there were ”some complications” with bleeding and the obstetrician saying tersely, ”get her husband back here now” (he had gone with the baby to the nursery).

And then she was lying unconscious, monitored by the rhythmic beep of machines on a 24-hour guard. Meanwhile, the baby slept in the nursery, her life stretched out vast as an open sky.

Unbeknown to her, Fiona was suffering from placenta accreta, a potentially fatal condition in which the baby’s food supply, the placenta, attaches itself to the walls of the uterus so deeply that there’s a risk of haemorrhage if it is removed. It occurs in one in 2500 pregnancies but is difficult to detect beforehand.

In the delivery suite, the obstetrician worked rapidly to stitch up the ends of the blood vessels but the placenta was an open network, pumping blood at a rate of knots. ”My husband had a fright when he came back into the room and saw the obstetrician covered in blood,” Fiona recalls. ”I actually think it was harder for him than for me.”

… Fiona underwent an emergency hysterectomy and woke up in intensive care attached to drips and tubes that leeched donors’ blood back into her depleted body. Pinned to the foot of her bed was a photo of her daughter …

AUSTRALIA is the fourth-safest country in the world in terms of maternal mortality …

The chance of dying in Australia as a result of childbirth is remote – about one in 10,000 …

But globally, women die of pregnancy-related causes at a rate of one a minute, with 99 per cent of deaths happening in developing countries. Clearly, giving birth is a risky business. Good hygiene and better standards of living and prenatal care have gone a long way towards making it safer in this country, but that doesn’t mean it won’t go wrong.

Ironically, despite Australia’s great record, experts say many women are feeling more, rather than less, anxious about the birth process. Some blame this on our risk-averse society, saying the screens and tests and the increasing level of intervention in birth and pregnancy is geared towards making women fearful. As one expert puts it, antenatal care has become ”antenatal scare”.

Louise Kornman, associate professor of obstetrics at the Royal Women’s Hospital, says: ”Birth rarely leads to death, but it can lead to damage. The majority of pregnancies work out fine, but the reality is it doesn’t always go that way. There is a belief that technology can save you if things go wrong, and in doing so you can lose sight of the fact there are inherent risks.”

… ”Of course, women might feel that sometimes the medical profession intervenes too much in what is a natural process, but the reality is that if left to mother nature then the outcome is not very good, often, and there needs to be a sensible balance struck between not interfering in a natural process but judiciously intervening when things start to go wrong – or preferably before things start to go wrong, given that prevention is better than cure. It can be a difficult compromise to reach.”

It is worth remembering that obstetricians are at the coalface of difficult deliveries. Does this make their view distorted? Unlike midwives, who oversee successful, normal births every day, doctors bear witness to the worst-case scenarios. Inevitably this difference in experience manifests itself in an ongoing debate on how best to manage childbirth. Midwifery groups push for normal deliveries and natural births while obstetricians err on the side of caution … Caught in the middle are the mothers.

Rather than becoming too complacent, Melissa Maimann, a private midwife and childbirth educator in Sydney, is seeing more anxiety among her patients, created, she believes, by our risk-averse culture.

”The safest place to have a baby is at home, if everything is going well,” she says firmly. ”The vast majority of people who go through the hospital system are unhappy with their experience.”

Have women been made to feel over-anxious? ”Possibly,” admits Bernadette White, clinical director of obstetrics at the Mercy Hospital For Women. ”It is easy to focus on the things that go wrong, and for some people that’s a source of stress.

”Obviously, a logical approach is to look and say, ‘Yes, that could happen, but how likely is it?’ But people don’t always have an entirely rational view when looking at things that might go wrong in their labour.

”And when you are assessing a risk, there’s a very broad spectrum of interpretation. That’s why some people will look at one set of figures and want a home birth, and someone else will look at the same figures and want an elective caesar.”
Associate professor Jenny Gamble, deputy head of nursing and midwifery at Griffith University, Queensland, has researched birth and post-traumatic stress.

Her findings show that while birth is a relatively safe physical event in Australia, it remains a hazardous psychological journey.

”If we stick with the premise that a high level of intervention has unintended negative consequences, then yes it does. We have consistently found that 30 per cent of women report that their birth was traumatic; that they feared for their life, or their baby’s life. This is a very high figure. We also know that about 6 per cent go on to develop post-traumatic stress disorder.

”Women don’t feel safe. Birth is being geared towards making them feel fearful; strangers are telling them this and that, there is screening and testing at every step and they develop a sense that at any moment they might lose the baby or something catastrophic is going to happen. It’s called ‘antenatal scare’ in the trade.”

Gamble is concerned about the ripple effects of such trauma. Affected women may find it harder to bond with their baby, and their relationships may fall apart. They may develop a fear of hospitals and doctors and even birth itself.

”Most of our gains in maternal morbidity have been based around realistic, basic things, like feeding the mother, sending out health messages such as not smoking in pregnancy and basic care in the community. I am not suggesting that we do nothing, but the pendulum has gone too far the other way.”

ERIN Horsley had her first baby in Britain. Despite her plans for a natural birth with no intervention, she ended up having her baby induced and then delivered by forceps when labour progressed slowly.

Attached to a drip and no longer able to move around, Horsley couldn’t speak through the pain. ”If you can’t tell me what’s the matter then I can’t help you,” said the midwife, brusquely.

Horsley emerged from the experience feeling emotionally battered. ”I felt let down,” she said. ”Not listened to. It caused marital problems. When I had my second baby here in Melbourne I tried to talk the hospital staff about my experiences; they said I was being oversensitive and that birth trauma doesn’t exist.”

Shae Reynolds, 31, was also hoping for a natural delivery but a late scan showed the lake of amniotic fluid surrounding the baby was ”potentially low”. (This turned out not to be the case when the waters finally broke.) In the cascade of intervention that followed, Shae found her legs in stirrups opposite an open doorway with several strangers milling around the room, including someone emptying the bins.

A vacuum extractor was attached to her baby’s head and one her most horrific memories is watching the doctor put a foot on the bed and pulling, saying, ”We have to get this baby out”. She says part of her daughter’s scalp was damaged as a result, and she suffered a big tear.

”I struggled terribly the first six months,” she recalls. ”I couldn’t have sex for over a year. I felt like I’d failed, like I hadn’t protected her.”

Reynolds’s daughter is now five and she has had two more children, both born without complications and naturally, at home.

But every birthday awakens memories of the trauma. ”It’s hard not to feel torn, because one of the happiest days of my life was also one of the most traumatic. Those precious first moments that we had as a family were destroyed. We were cheated of so much more than just the birth. We still are.”

Medics and midwives are united in the belief that it helps if a woman can feel in control, or at least informed about what is happening. Says Maimann: ”We have an excellent public health system. The government’s job is to offer a basic and safe level of care, which it does very well. It doesn’t suit the emotional or mental needs of women having babies, but I don’t think it should.”

She argues that families should be prepared by investing in independent childbirth education, or working with a private midwife who will provide continuity of care at a cost of between $3000 and $6000.
Surely this will be out of reach to many? ”We can afford holidays,” … ”It’s about valuing what you get.”

Melissa Bruijn and midwife Debby Gould run birthtalk.org, a national birth trauma support group … ”People assume that if birth is going to be safe, there has to be lots of intervention, but reducing the amount of birth trauma is not about reducing what can go wrong, because that’s not controllable.

”It’s really about meeting the emotional needs of women. Even if they find themselves undergoing emergency caesareans, they can still feel empowered and part of the process if they are looked after properly. It’s a myth to say that the most important thing is a healthy baby. Traumatic birth gets carried with you – you don’t leave it at the hospital – and it can have profound consequences for both the mother and baby.”

It is almost seven years since Fiona Thomas, 45, an occupational therapist, went into hospital to give birth and ended up in intensive care. She was fortunate to have given birth in a hospital with a good supply of blood; fortunate that there was a team on hand that worked with rhythmic precision to save her. ”You don’t expect that,” she says. ”I went in thinking I was going to have a routine caesarean, just like I’d had before. All our friends were expecting a phone call 10 minutes later with good news, but there was nothing.

”They realised something must have gone wrong and phoned the hospital. I think everyone was shocked by it. It has changed the way I view life. Sometimes I would think, ‘What happened if I had died? If those 30 seconds I got to hold her had been her only contact with me?’ But then you have to flip it around and see it the other way.
”It makes you realise that life spins on a dime.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

Home Births on the Rise

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

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After having her first child in a hospital, Lorra Jacobs decided it was an experience she did not care to repeat.
She had two more children, and she chose to have both of them at home.

“When I had my first child in the hospital … 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.”

… the Centers for Disease Control and Prevention indicate that 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 most recent trend might be a negative reaction to a hospital birth experience, since the majority of mothers choosing a home birth have had children before.

… “It certainly suggests it’s an experience they don’t want to repeat.”

“I suspect that economic issues are not the main issues,” … “I suspect consumers are becoming more informed … and seeing home births are a safe alternative for healthy women with a qualified provider.”

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

The same can be said for the generalisability of these studies to Australia, however that is no reason not to implement a system that can provide safe private homebirth services.

… “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

‘Love drug’ may help mums bond to babies

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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It’s a shame the resesrchers in this study haven’t considered ways of boosting the natural form of this “love drug”: natural bitrh and breastfeeding are the most effective ways to promote this chemical and enhance bonding.

A hormone nasal spray may help mothers bond better with their babies.

A world-first trial by Sydney researchers involves giving mothers a synthetic version of the hormone oxytocin, often dubbed the ”love drug” or the ”cuddle chemical”. Past studies have shown mothers who are deficient in oxytocin are less sensitive to their babies’ cues than mothers with high levels of the hormone.

It’s interesting to take a look at the things that diminish the mother’s production of oxytocin: epidurals, infusions of syntocinon (the artificial form of oxytocin that’s given to women to induce or speed labour), caesareans and pain-relieving medications.

… University of NSW school of psychology have launched the Mothers Early Experiences of Parenting (MEEP) project, which will use oxytocin nasal spray in combination with infant massage and play sessions. They will then measure eye contact, affectionate touch and feelings of closeness and warmth to see if there is improvement in attachment between mother and child.

… although the role of oxytocin in childbirth and breastfeeding was well documented, scientists were increasingly interested in the hormone’s role in human social interaction. It is known to reduce fear, increase empathy and improve memory, especially of happy events.

Hence the research that points to increased rates of violence, suicide, anti-social personality disorders and the like in children who have experienced a raumatic entrance to this world.

”It allows us to recognise and feel connected to loved ones,” Professor Dadds said. ”So after eye contact, cuddling, even an orgasm, with a loved one, you get a big shot of oxytocin, which increases trust and connection.”

Professor Dadds said oxytocin delivered by nasal spray had very subtle effects but could be a powerful intervention when combined with psychological therapies. ”It’s a new age of psychology and medicine working together and magnifying the effects of each other,” he said.

I’d rather see psychology and midwifery working together: midwifery to promote and protect natural birth, and psychology to work with women to reduce the fear surrounding natural birth, to debrief women of their past traumatic birth experiences, and for supporting programs to be developed that enable women to feel safe and trusting again.

… between 10 and 20 per cent of mothers had post-natal depression, and at least a third of those women had trouble bonding with their babies. An impaired early bond is associated with adverse developmental outcomes for children.

And the major cause of PND and impaired bonding is a traumatic birth experience.

”There’s a huge body of research showing that the more securely attached you are by age three to five, the better your outcomes for mental health,” she said …

Melissa Maimann, Essential Birth Consulting 0400 418 448

The Mother Friendly Childbirth Initiative

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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… maternal mortality is on the rise in the U.S … two of the four preventable pregnancy-related deaths were associated with cesarean section-the failure of hospital staff to pay attention to worsening vital signs after women have the operation, and the staff’s inability to respond appropriately to hemorrhage resulting from a cesarean. The two others are uncontrolled high blood pressure and undiagnosed fluid build-up in the lungs of women with pre-eclampsia … by following the principles of the evidence-based Ten Steps of The Mother Friendly Childbirth Initiative (MFCI) and giving low-risk women access to midwifery care mothers’ lives could be saved.

… The Initiative is an effective wellness model of maternity care that offers safe choices to overused and costly high-tech birth interventions that often lead to avoidable cesareans …

… compared to maternity care provided by physicians to low-risk women, women cared for by professional midwives have a lower incidence of hypertension and pre-eclampsia, fewer hospital admissions for complications during pregnancy, fewer cesareans and more VBACs … the risks of maternal mortality are increased with repeat cesarean section compared to vaginal birth after a prior cesarean …

The Mother Friendly Childbirth Initiative:

1. Offers all birthing mothers:
• Unrestricted access to the birth companions of her choice, including fathers, partners, children, ¬family members, and friends;
• Unrestricted access to continuous emotional and physical support from a skilled woman—for ¬example, a doula,* or labor-support professional;
• Access to professional midwifery care.

2. Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.

3. Provides culturally competent care—that is, care that is sensitive and responsive to the specific beliefs, ¬values, and customs of the mother’s ethnicity and ¬religion.

4. Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.

5. Has clearly defined policies and procedures for:
• collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;
• linking the mother and baby to appropriate community resources, including prenatal and post-¬discharge follow-up and breastfeeding support.

6. Does not routinely employ practices and procedures that are unsupported by scientific evidence, ¬including but not limited to the following:
• shaving;
• enemas;
• IVs (intravenous drip);
• withholding nourishment or water;
• early rupture of membranes*;
• electronic fetal monitoring;
other interventions are limited as follows:
• Has an induction* rate of 10% or less;†
• Has an episiotomy* rate of 20% or less, with a goal of 5% or less;
• Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;
• Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.

7. Educates staff in non-drug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.

8. Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.

9. Discourages non-religious circumcision of the newborn.

10. Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:
1. Have a written breastfeeding policy that is routinely communicated to all health care staff;
2. Train all health care staff in skills necessary to implement this policy;
3. Inform all pregnant women about the benefits and management of breastfeeding;
4. Help mothers initiate breastfeeding within a half-hour of birth;
5. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants;
6. Give newborn infants no food or drink other than breast milk unless medically indicated;
7. Practice rooming in: allow mothers and infants to remain together 24 hours a day;
8. Encourage breastfeeding on demand;
9. Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Sexual Abuse In Childhood Can Affect Pregnancy In Later Life

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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Sexual abuse in childhood increases the chances of high-risk pregnancy … “Even when a woman willingly and happily commences a pregnancy, it seems that the body relates the sexual act that created the pregnancy with the abuse trauma, evoking negative feelings which can then be expressed in physical and gynecological problems,” …

The … study examined the possibility of sexual abuse experienced in childhood triggering retraumatization during wanted pregnancy … 1,830 pregnant women participating in the study were divided into high- and low-risk groups, which were further divided into three subgroups: those who were victims of child sexual abuse, those who experienced other types of trauma in childhood, and those who had experienced no notable trauma. Compared with women who had not endured any notable trauma before, those who had been sexually abused in childhood, the study shows, suffered higher levels of depression and more post-traumatic symptoms.

… the main post-traumatic symptoms that these women reported were detachment and avoidance … the more severe the child sexual abuse, the stronger the correlation between the PTS symptoms and poor physical health during pregnancy. “Gynecological problems might be the body’s manifestation of the child sexual abuse trauma,” …

“The current study’s findings have important practical implications for health care providers, practitioners and obstetrical gynecologists. There is a need to to recognize and address the psychological state of pregnant child sexual abuse survivors,” … “It is also important to remember that since the screening process itself may serve as a trigger to retraumatization, a specially trained team should provide a safe environment and psychological assistance.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

FAQs

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

Birth trauma symptoms

The symptoms of birth trauma are many and varied. A common theme is that the trauma interferes with your enjoyment of daily life. The trauma issues may surface at different times, and then completely disappear.

Some women experience:

  • Flashbacks of the event and sudden, vivid memories. You will usually feel distressed, anxious or panicky when you’re exposed to things that remind you of the event
    Avoidance of anything that reminds you of the event. Some women never talk about their births or avoid hospitals. In contrast, other women talk about their birth trauma all the time; this is their way of expressing their extreme hurt, anger and fear.
    You may also experience emotions such as anger, irritability, and hyper-vigilance (feeling jumpy or on-guard all the time)
    Nightmares of the birth
    Physiological responses when you are exposed to events resembling the traumatic event, such as panic attacks, sweating and palpitations
    Numbed emotions
  • benefits of birthing by midwives over doctors

    The msin benefits of using a midwife are:

    Higher chance of natural birth
    Continuity of care: you have the same midwife for pregnancy, labour, birth and postnatal care. Even with a private obstetrician, you’ll be attended by midwives you have not met when you’re in labour and afterwards when you stay in the ward with your new baby. If you choose midwifery care, especially private midwifery care (no private health insurance needed), you have the same person looking after you the whole way through.

    do you need informed consent episiotomy

    Most definitely! The only time consent is not needed is in a genuine emergency. Since women are generally awake for their births, there is no reason why your midwife or doctor would not seek your permission before doing an episiotomy, even in an emergency situation. Remeber – you can always say no to an episiotomy.

    duty of care to an unborn child

    Midwives and obstetricians do owe a duty of care to the baby. Babies do nto have any rights until they are born alive and take their first breath. Once they do that, they are afforded the full rights of a person.

    no obstetrician for birth in private hospital

    Currently, it is not possible to birth in a private hospital without an obstetrician. However, you can have a private midwife and a private obstetrician at aprivate hospital.

    private birthing classes at home, Sydney

    Yes, this is possible. See here.

    will homebirth be legal after July, 2010?

    Absolutely! Homebirth has always been, and will always be, legal. The ability for midwives to practice in women’s homes is dependent on the midwife reporting every homebirth, letting women know that we are not insured for births at home, and also agreeing to abide by a quality and safety framework. This is all designed to give the public greater confidence in private midwifery services and to increase safety for women and babies.

    Birth providers who support vbac in sydney

    The best way of achieving a VBAC in Sydney is to contract a private midwife to provide your care. Private midwives have roughly a 90% VBA success rate.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Hoped-for drop in childbirth deaths not happening

    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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    Eleven days after her son Benjamin’s birth by C-section, Linda Coale awoke in the middle of the night in pain, one leg badly swollen. Just as her doctor returned her phone call asking what to do, she dropped dead from a blood clot.

    Pregnancy-related deaths like Coale’s appear to have risen nationwide over the past decade, nearly tripling in the state with the most careful count — California. And while they’re very rare … they’re nowhere near as rare as they should be. The maternal mortality rate is four times higher than a goal the federal government set for this year.

    … “Maybe as many as half of these are preventable.”

    Two years after Coale’s death near Annapolis, Md., her sister says topping that list should be warning women about signs of an emergency, like the clot called deep vein thrombosis, or DVT, that can kill if it breaks out of the leg and moves to the lung.

    No mention here of warning women of the risks of caesareans! The majority of which are not necessary and are therefore entirely preventable.

    … A jump in cesarean deliveries that now account for almost a third of births. One in five pregnant women is obese, spurring high blood pressure and diabetes. More women are having babies in their late 30s and beyond.

    … black women are at least three times more likely to die from pregnancy complications than white women, and research is too limited to tell why.

    Then there are the near-misses. For every death, 50 additional women suffer serious complications of pregnancy or delivery …

    At issue are deaths directly related to pregnancy or childbirth, up to 42 days after delivery. In 2006 … there were 13.3 maternal deaths for every 100,000 births. A decade ago, the rate hovered around 7 — and by this year, the U.S. government had hoped to lower it to 3.3 deaths. California in 2006 charted 16.9 maternal deaths for every 100,000 births, up from a rate of 5.6 in 1996.

    How pregnancy-related deaths are coded and counted changed during that time period, but … only about 30 percent of the increase may be due to that.

    At the request of California health officials, Main is finishing an in-depth study of maternal deaths that already has prompted a project to reduce hemorrhage in 30 of the state’s hospitals.

    “Jumping on it early is very important,” says Main, who worries that hospitals can lose track of bleeding that happens a bit at a time until “before you know it, you’ve bled a lot.”

    Among other safety steps:

    * Seek early prenatal care …

    * Hospitals should consider using compression boots on C-section patients …

    * C-sections can be lifesaving but women should understand how to reduce their chances of needing one — because next pregnancies tend to end in C-section, too, and repeat C-sections increase hemorrhage risk. Coming to the hospital before you’re properly dilated or seeking induction before the cervix is ready unnecessarily increases the C-section risk …

    What about saying no to caesareans? Health professionals are not obliged to perform unnecessary surgery!

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Midwives want to meet Roxon to avoid home-birth ban

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

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    A sensationalist title as home birth is not about to be banned but here goes:

    ABI WHITEHAIR is only nine days old but she’s already saved taxpayers thousands of dollars.

    She was delivered at home after her mother, Leah, rejected advice to have a caesarean section … because her first baby … had been born that way …

    A surgical birth – about 30,000 are performed in NSW each year – would have cost the public hospital system about $8000.

    If she had been admitted to a neonatal special care unit, like 70 per cent of babies born by caesarean, including her big brother, it would have cost another $900 a day.

    But her entry to the world, in a Dee Why lounge room, cost taxpayers nothing …

    [Midwives] are calling for another urgent meeting with the Health Minister, Nicola Roxon, before the new rules come into effect in July.

    More than one in three babies in NSW is born by caesarean section but only one in seven subsequent babies are born vaginally due to the risk of uterine rupture.

    The risk is very small: less than one in 200. Most studies on uterine rupture include dehiscenses, which are not complete ruptures, have no symptoms and do not cause any problems for mother or baby.

    About 95,000 babies were born in NSW in 2008, but only 258 were born vaginally in public hospitals after a previous caesarean …

    It is well-known that VBAC is far more successful – around 90% – with private midwifery care. Otherwise the chance of a siccessful VBAC can be as low as 3%.

    … women who had undergone traumatic births, with extensive intervention, were eager to avoid a repeat performance but were often left with little choice.

    ”Keeping away from obstetric intervention by having a home birth is the best chance they have of achieving a normal vaginal birth,” …

    Up to 70 per cent of home births were by women who had previously delivered by caesarean and there was a growing band who would deliver at home alone if home births were outlawed.

    … Ms Whitehair, who had longed for a natural birth, spent months researching a home delivery. Abi’s birth, attended by two private midwives, cost her almost $5000 but was ”beautiful and textbook”.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    More women dying from pregnancy complications; state holds on to report

    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 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

    FAQs

    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

    Caesarean births risk mums’ lives

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

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    A 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

    More critique of the homebirth study and its reporting by the media

    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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    Associate Professor Hannah Dahlen, Vice President of the Australian College of Midwives, and an academic at the University of Western Sydney, and Professor Caroline Homer, Professor of Midwifery at the University of Technology Sydney, … had a critical look at the study and the way its findings are being portrayed.

    They write:

    …One of the problems is that the planned home birth group includes women who planned homebirth when booking in for care but then developed risk factors and had their babies in hospital. There are probably only two women whose babies died; who started labour at home planning a homebirth and one of these was a twin pregnancy (high risk). This latter woman persisted in having a homebirth due to ‘unsatisfactory hospital experiences.’ The others had all transferred before the onset of labour. The authors admit they ‘could not differentiate all planned homebirths according to whether transfer to hospital had occurred before or during labour.’ So for low risk women who started labour at home the risk was very low – 1 death in 16 years

    There is no way to tell if these planned homebirths were under the care of a registered midwife.

    This was not a low risk population of women – there was a high rate of post-term pregnancy … twins … and … previous caesarean section.

    … There were two perinatal deaths that actually occurred at home. One baby had lethal congenital abnormalities (this was known before labour and a decision made for the baby to be born at home). The second death at home was after a waterbirth which was not found to be the cause of death but a review identified that increased monitoring may have identified the baby was in distress.

    One perinatal death occurred in hospital after a transfer after the birth of the first twin. The first twin was born at home and second twin was born in hospital after a delay in transfer and subsequently died.

    There were 6 perinatal deaths in the planned homebirth group where the baby was born in hospital. Presumably these women were transferred to hospital during the antenatal period as antenatal risk factors developed. Transferring to hospital if or when risk factors develop during pregnancy is appropriate practice.

    Of the six deaths in hospital: one had hydrops fetalis … one death was unexplained with a cord entanglement seen after birth; one had pulmonary hypoplasia … after a early rupture of membranes; one was a growth restricted baby with an abnormal karotype … one was born to a woman who was very overdue … and underwent induction in hospital without fetal monitoring (the woman refused) and her labour eventuated in a stillbirth; and, one was a woman with known haematological … risk factors whose baby had a lethal abnormality … all these were born in hospital.

    Only three of the deaths are thought to be related to perinatal asphyxia.

    Three of the deaths were thought to be potentially preventable and related to the model of care. These were the baby born after the waterbirth at home; the second twin who was born after an intrapartum transfer and the baby born after being very postdates. Therefore, there were 3 deaths in 16 years – two of which had risk factors present. That means that there was only one death where there were no risk factors in the 16 year period.

    … You would need more than 10,000 births at home to show clinical relevance and have some confidence in the statistical significance in relation to perinatal mortality rates. The authors acknowledge this in the paper and present their data with caution in the paper stating that the ‘small numbers with large confidence intervals limit the interpretation of these data.’

    The facts are there was no difference in perinatal mortality … For those actually born at home the perinatal mortality rate is 2.5 per 1000 births, which is comparatively low.

    … The paper highlights that the system must be so terrible for some women that they would choose to give birth outside of it than in it, even with risk factors. This is an indictment on the current maternity system in Australia – that needs fixing – removing homebirth won’t do this.

    What was missed?

    The conclusion of the paper is very sensible recommending risk assessment, transfer and fetal monitoring.

    So then why did the data get so grossly misinterpreted?

    The reality is despite a malfunctioning system in this country where midwives are uninsured and have no visiting rights, and homebirth is unfunded and often hard to access, the perinatal mortality rate was no different.

    Risk assessment, transfer and fetal monitoring will be improved when private midwives are no longer excluded from mainstream services so we should be aiming for this not continuing the ‘witch hunt’ against private midwives.

    … Some women will always choose homebirth so we should support this choice with safe responsive systems of care. The authors state that ‘women’s autonomy in choosing reproductive behaviour is a fundamental human right enshrined in Australian law’.

    The excess mortality continues to be found in high-risk women and women need to be informed of this risk.

    Freebirth (giving at home birth without a skilled and registered birth attendant) is rising in this country and this is a concerning outcome of restrictions on options like homebirth and trauma from hospital births …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Never again in a public hospital

    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 Age special report on maternity care drew a range of responses …

    I GAVE birth to my first child last year in the … maternity ward as a public patient.

    Nothing could have prepared me for my horrible birth experience – ”herding yards” does not go nearly far enough in describing the way the hospital treats new mothers and babies. The need to minimise expenditure combined with an almost zealous obsession with promoting breastfeeding created an experience so stressful that, for me, resulted in what I call post-traumatic birth disorder – a fear of ever having another child in a public hospital.

    My baby was born with fairly high levels of jaundice, which results in a very sleepy baby who is unable to feed well. Bar going under the UV lights, the only means of reducing the jaundice levels is to ”flush” it out with fluid.

    Now that would be fine except for the fact that mothers do not produce milk for at least two days after a natural birth and up to five days after a caesarean. Not once was I offered formula to try to provide extra fluid for my baby. Instead, I was told to breastfeed and express extra fluid in between feeds.

    So, in pain after major surgery, with a baby too weak to feed well and not producing milk, I was left struggling for hours to try to provide enough fluid to help my baby.

    On day four I was about to be discharged when the attending doctor told me my baby had developed ”nappy rash” and might need antibiotics. At first the doctor said it would need a cream and I would still go home that day. A few minutes later another doctor said it was a ”severe” rash and my baby might need oral antibiotics.

    Then the head of pediatrics came to look at the rash. The attending [midwife] said they thought it was a hospital-borne staph infection, which was later confirmed. At this point I was about to have a breakdown from being exhausted, stressed and furious that no one had mentioned the staph to me.

    Following this diagnosis, I was discharged from maternity and my four-day-old baby was admitted as a pediatrics patient to be given IV antibiotics. The pediatrics ward is for children only so despite just having the caesarean and still being on painkillers, I was not considered a patient. I had to sleep on a fold-out couch to continue three-hourly breastfeeds but was given no food or additional pain relief …

    No perfect system

    WHEN my wife fell pregnant, our GP referred her to an obstetrician without discussing any options, such as the public system, birthing centres, home birth etc. This referral sent us down the path of the private health industry. We were keen on more natural options for childbirth, but it became increasingly apparent that our obstetrician was not interested in these options. Through our own research we found out about birthing centres, and decided that this was the go for us.

    … our daughter was breech. Through the birthing centre we were told of an obstetrician who manually turned babies in utero. We consulted him, and our daughter was turned. I am sure that had we stayed in the private system with our original obstetrician, we would not have been made aware of this option, and my wife would have had to endure a caesarean. This is one example of the ”over-medicalisation” of childbirth by the private health care industry.

    However, the birthing centre was far from perfect. My wife gave birth at 7.10pm on a Saturday. At 9.30 the next morning we were pressured to leave. We refused, and spent our full allotment of two days in the centre. A couple of days after we left, we received one follow-up visit from a midwife. She noted that our daughter was jaundiced, and advised that we put her in the sun for 10 minutes.

    Later that day I took my wife to hospital because she was experiencing pain after the birth. While we were there, a [midwife] noted that our daughter was jaundiced, and requested a blood test. The result was that she was rushed to the neonatal intensive care unit in a serious condition. An hour later the head of the unit informed us our daughter was suffering from a level of jaundice so severe that they saw it only once or twice a year, and that as a result, she could be brain-damaged and suffer hearing loss, among other issues. If I hadn’t insisted on taking my wife to hospital for her pain, I dread to think what might have been …

    Happy on home front

    I HAD a satisfying birth at home with the help of two lovely independent midwives. The continuity of care from our midwives has been exemplary.

    When I read accounts of less-than-adequate hospital-based maternity care, I can only say that home birth is worth every cent we paid.

    Improving the maternity system is simple: the Government needs to stop attempting to put independent midwives out of business.

    Support midwives

    MY HUSBAND and I saved our stimulus packages to pay a private home-birth midwife for the birth of our second child, due any day now. The continuity of care, with antenatal appointments in our own home, is wonderful. I feel much more comfortable ringing my own midwife with questions than I did when I was seeing a different midwife every time at the … Birth Centre …

    It’s not all gloom

    WHILE there is room for improvement in any hospital system, the headlines in your report unnecessarily spelt doom and gloom.

    In the past 10 years I have had three babies at the public … [hospitals] Each time I have been impressed with the service and care provided …

    My first baby could not attach to the breast, and … we were allowed to stay in hospital until day five after the birth. Every time I needed to feed her I buzzed for the midwife to help me, and never had to wait more than a few minutes.

    With my second and third babies we went home on day two, but we were ready … Postnatally, a midwife from the hospital visited me each day for two days after the birth. The midwives were caring, knowledgeable and helpful.

    Motherhood’s trauma

    I GAVE birth to both my sons as a public patient … There is almost no difference between the private and public patient experience, so having private health cover was of no benefit. My doctor was away both times but the on-call obs I had both times gave good care. Of course, they’re only there for the end bit and it’s the midwives who do all the work anyway.

    … my key criticism is that they sometimes forget the strangeness of becoming a mother for the first time. We are not used to being mostly naked in a room full of other people … We are flooded with hormones that leave us lost and confused. We think motherhood will be a tender and graceful time, when in fact it can often be a time, particularly the first time, when you feel frighteningly laid bare. I would have appreciated someone to facilitate a more caring and dignified transition into my new role.

    A cry for help

    A LARGE public hospital means a huge variation in staff on different shifts, which leads to inconsistent care and the danger of ”falling through the cracks”.

    Hence, many women benefit from having their own private midwife with them throughout the experience.

    Three days after the birth of my baby, I developed … postnatal depression … The [midwifery] staff … were seemingly inexperienced … I never had the same [midwife] more than once, which meant they were generally unaware of my worsening condition, which didn’t appear to be written in my medical notes. On the fifth day when I was to be discharged, I was stuck with terror at the thought of being home alone to cope with my newborn son …

    At home, things got worse. Feeling like you’re in an evil, black hole and not wanting to look after your own baby is not a pleasant state to be in. I had enormous problems with breastfeeding, which added even more stress to my already unwell mind.

    It was the visiting midwife from the hospital who was the catalyst in getting treatment for me. At first she offered me generic advice in a way that to me seemed somewhat ”hippie dippy”, so I had to persist in letting her know how bad I felt. Eventually she gave a card for the hospital’s crisis assessment team hotline. The team member I spoke to was exceptionally understanding and gave me some calming advice. The team followed up with regular phone calls to check I was OK before they were able to send out a diagnostic team, including a psychiatrist, a couple of days later. They were also responsible for my being admitted into a mother and baby unit in the hospital’s psychiatric ward soon after.

    Intensive counselling, medication, individual monitoring and support finally got me back on my feet. I am now what I would consider a ”normal” happy mother.

    Forgotten option

    YOU seem to have left out the home birth option in your report. Provided the woman is healthy, well-informed and well-supported, there is no reason she cannot give birth at home, with the aid of a trusted midwife. My wife did so three times …

    If necessary, a doctor can be called to render extra assistance, and in the rare case of complications, which usually become apparent slowly, the woman can be taken to a hospital.

    If more women gave birth at home, this would relieve the pressure on hospital resources. It would also enable women to give birth calmly, in a familiar environment, with loved ones close at hand, and usually escape the effects of postnatal depression.

    Rich feedback about our current hospital system. It will be interesting to follow the changes once private midwives are able to birth with their clients in hospital. We know that continuity of care is sought-after, as is explained in the above quotes. Private midwifery in hospitals will enable more women to access midwifery care on their own terms.

    I was surprised that the stories of women who were told they could not get the type of birth they wanted – such as vaginal breech, vaginal twins, VBAC and so on – were not mentioned.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Feedback on our maternity system

    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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    … 20% of … mothers … said they had witnessed occasions when a lack of resources put a mother at risk; 14 per cent said they had seen shortages put a baby at risk.

    63% of … mothers … agreed that public maternity units resembled ”herding yards” when asked if it was an appropriate description.

    Of … women who gave birth in the public system … more than a third said leaving hospital too soon was a problem, 47 per cent felt their postnatal care was inadequate, and 48 per cent experienced a lack of breastfeeding support.

    Of [the] … women who gave birth in the private system … 17 per cent said they were discharged too early, 39 per cent felt their postnatal care was lacking, and 45 per cent said they did not receive adequate breastfeeding support.

    Of the … mothers who gave birth in both the public and private systems, 43 per cent thought the private system was better; 30 per cent thought the public system was better.

    … providing midwives with more independence to prescribe drugs would improve the system.

    62% … said Australia’s 30 per cent caesarean rate was too high. A quarter thought it was mainly done for professional liability reasons and a fifth believed it was done at a mother’s request.

    47% … said there was a shortage of midwives …

    WHAT MOTHERS SAY
    ”There should be more continuity of care. Knowing your carer and trusting your carer removes the fear from childbirth and fear leads to more interventions.”

    … ”There is a severe shortage of birth centre places available and in many areas it is not even an option.”

    ”There are so many time limits imposed on women which completely disregard the natural progression of labour in women’s bodies. Doctors are too quick to intervene, too impatient to wait and allow the body to do its job.”

    … ”Women are not being given enough time to labour naturally.”

    “I was not supported well enough to have a vaginal birth. I felt like they were more concerned with getting me in and out quickly so they could free up beds.”

    … ”There are too many obstetricians performing unnecessary caesarean sections and other interventions due to fear of litigation.”

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    One in Three Women Infertile After 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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    A study … has found that almost half of all women who have a caesarean section … for their first child, don’t have any more children. Of these, one in five have chosen not to have more children because they are too traumatized by the surgery and one in three are physically unable to because of caesarean-caused infertility problems.

    The rate of post-traumatic stress disorder was six times higher than in first time mothers who had given birth vaginally …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Doctor gets jail after newborn is disabled

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    A … doctor who caused a newborn … to suffer serious permanent disabilities was yesterday jailed for a year and fined …

    The doctor was convicted of practicing midwifery without a licence and conducting a delivery though she was not qualified to do so …

    The … hospital where the doctor worked was fined … for appointing her and making her work as a midwife though it was known that she did not have a licence. The hospital … failed to provide first-class healthcare for newborn babies and this caused the girl’s complications to grow worse, resulting in the disabilities.

    … The newborn suffered complications during the delivery as a result of medical malpractice … This led to the baby … suffering … brain paralysis and quadriplegia.

    Melissa Maimann, Essential Birth Consulting 0400 418 448