Doctor gets jail after newborn is disabled

Posted on November 27, 2009 by Melissa Maimann

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

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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

The real safety issues in maternity care

Posted on October 13, 2009 by Melissa Maimann

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Maternity care provides a classic example of the pitfalls of a specialist-driven model of practice in health care. It results in more expensive and interventionist care, rather than a community-based approach which could also help ensure a more equitable distribution of services. It has led us to talk about obstetrics, which implies a focus on a particular professional group, rather than maternity care, which implies a broader focus on the woman’s and baby’s needs, both before and well after the birth.

Professor Lesley Barclay … is a leading proponent of the need to reorient maternity care around the needs of women and babies …

“When women talk about what matters to them when it comes to childbirth, the issue they repeatedly mention is safety.

But their understanding of safety around childbirth is often quite different to how health systems and many professionals define it.

For women, a safe childbirth is not only about what occurs at the time of the birth. It also refers to longer-term issues, such as their social and emotional wellbeing in the weeks and month after the birth.

When women talk about safety, they are also thinking about the increased rates of depression and anxiety that manifest after operative birth or the consequences of wound infection on general health.

The Australian health system often makes it difficult for women to make wise choices around birth …

For example, evidence shows for most women most of the time birth does not need to take place in hospital. Some women will only feel safe however, whether this is evidence-based or not, with specialist medical services and technology.

The term “maternity care” … incorporates their social and emotional needs. It puts them – rather than the professional or the service …

Evidence shows maternity care can be provided by both midwives and obstetricians in public and private sector hospitals and can be safely provided at home.

… evidence also shows that safety from morbidity is less likely for Australia’s healthiest and wealthiest women cared for by private obstetricians in private hospitals. More recent epidemiological evidence shows as volumes of operative birth increases, deaths of mothers and infants are also increased by overuse of the very operation that was developed to save lives.

So where does choice fit in this repertoire of terms, locations, professionals, services and outcomes?

Safe birth should be the goal of choices offered to women and decisions taken by those who provide care for them.

Unfortunately, the choices some professionals offer or accept are self or income centered and ignore evidence. As a consequence of gender-located power historically, and a rapid increase in the numbers of more technically oriented professionals in recent decades, health services and costs do not reflect women’s needs or evidence.

The most important example of this is allowing caesarean birth to be a choice rather than only using this as the lifesaving emergency procedure it is.

… caesarean birth is rapidly becoming a life threatening procedure itself because of excessive use … maternal death reviews and coroner’s reports now show the risks attached to using a major surgical procedure as a routine mode of birth.

Maternal mortality is between two and seven times higher for surgical than vaginal birth …

… The physical, social and emotional morbidity attached to women who experience this mode of birth is not recognised therefore ignored within acute care hospitals but is evident in their homes and the community.

Research has identified that physical morbidity associated with CS is five to ten times higher than for women birthing vaginally. No less importantly there are also psychosocial consequences of surgical birth with women less satisfied, more concerned about the baby’s condition and fearful. Women delivering by CS report feeling less in control than women who have birthed vaginally.

Research also shows rates of post natal depression significantly different between women who birthed vaginally and the group of women who delivered either by planned or unplanned CS … Women who birth by CS evaluate their babies less favourably, are less likely to breastfeed and/or feed for a shorter duration.

Paradoxically, the choice to have a normal, safe, confidence affirming birth that is low cost and relieves pressure on hospitals is only available to a small minority of women.

This is not possible for Australia’s most vulnerable women and families, who, the evidence suggests, would benefit most. How many rural or remote living Aboriginal women can opt for a home birth attended by a skilful midwife?

… 1 in 10 remote living Aboriginal women in one large community avoid hospital services or skilled professionals because of the unacceptable risks to them of being evacuated from their community …

Other Australian women with more options are also taking this route, fed up with what they see as biased, self-interested advice and unacceptable risks of our current system.

To have real choices, one needs options and good information on which to base decisions. Better resourced women … can chase evidence themselves, or question doctors, hospitals and midwives …

… there are some ultimate arbiters beyond opinion. One of these is the impartial review of evidence provided by such as the Cochrane data base.

I saw to my great delight a writer (male and medically qualified) who also a Member of Parliament, recently quoting this source in a newspaper. His message, while aimed at indemnifying home birth midwives, was that home birth is safe.

… home birth is indeed safer at times than hospital birth when planned and supported by good hospital care for rare emergencies.

I wish the current president of the AMA, an erstwhile obstetrician, would be similarly correct with his claims that certainly are not recognisable as fact to those familiar with the evidence.

Choices for women are difficult when all they receive is highly partial and ill-informed opinion. Choices around birth are important or women will opt out of a system that does not meet their needs.

…. Should it be a matter of choice though for women to give birth via major abdominal surgery? Should we permit choice that means their babies avoid the process of vaginal birth that prepares them to live and breathe? Should it be women’s or obstetrician’s choice that health pays or heavily subsidises the avoidable costs of unnecessary operations that prevent other necessary surgery being performed and add to waiting lists? I think not.

We need to recognise that operative birth is the option to use only when the risks associated with the alternative are unacceptable. This is not a matter of choice.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

The great Caesarean section debate

Posted on September 9, 2009 by Melissa Maimann

Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email me at Essential Birth Consulting or call 0400 418 448.

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PARENTING: WHAT IS IT with Irish women and obstetricians? Most of us feel so much safer putting our pregnancy in their care. That makes absolute sense for the minority of expectant mothers who have complications. But why do the rest of us not see midwives as the experts on normal birth? It is abnormal births that are the business of consultants, …

… “Sometimes the idea of ‘my obstetrician’ is flaunted like a Prada bag. … I have never seen it in any other country to that degree, except in America,” says Krysia Lynch, press officer for the Association of Improvements in Maternity Services (AIMS) – Ireland.

“They feel if they get an obstetrician, somehow it is going to be safer. What a lot of women don’t realise is that what you’re doing with an obstetrician is you are getting continuity of care, that is the only thing that is different; when you are going for antenatal visits you are seeing the same person.

However, when women are in labour, they are cared for by midwives they have not met before, so there’s not true continuity of care.

“But when you have your baby it is the same midwives that will deliver your baby as are delivering the public patient in the next room and I think a lot of woman feel very taken aback by this,” Lynch suggests. (Although I would have thought that at that point in labour, you should be glad that you don’t need the services of your consultant.)

There is plenty of evidence to suggest that the “medicalisation” of straightforward births increases the risk of complications, with one intervention leading to another, until an emergency Caesarean section is the best option. Some pregnant women, terrified of the pain and unpredictable nature of labour, see a planned Caesarean as the best choice from the start.

A planned caesarean can almost be guaranteed, whereas a planned vaginal birth is not a certainty. Women planning vaginal births are sometimes encouraged to also consider the possibility of a caesarean, whereas women planning caesareans are not encouraged to consider the possibility of a fast labour and natural birth. Women who plan caesareans generally want the certainty that a caesarean brings.

This ultimate intervention into the natural birth process has risen dramatically in the past 15 years.

Australia’s CS rate is most likely around 35% now. It was 31% in 2006 and CS rates increase every year. Our low VBAC rate suggests that most women who have a primary caesarean will have an elective repeat caesarean for their next birth. This is contrary to the best evidence around VBAC.

According to the World Health Organisation, Caesarean sections should account for no more than 15 per cent of all births. It found there were no additional health benefits associated with a higher rate.

… There is no doubt that a Caesarean section increases the risk to both mothers and babies, when compared with spontaneous vaginal birth, and it is also significantly more expensive for the health service.

… the reasons behind this increase are much more opaque …

… known risk factors, such as older maternal age at birth and the earlier gestational age of the child, only explained half of the increase in the rate among first-time mothers …

… “If we are saying the section rate is too high, we have to come up with logical reasons as to how we can decrease it.”

I have a few suggestions:
1. Increase the numbers of women who receive primary midwifery care. Encourage midwifery care for all low risk and healthy women.
2. Encourage home as the normal place for birth to occur for all healthy and low risk women.
3. Provide continuity of midwifery care for all high risk women (in conjunction with obstetric care).
4. Ensure that all women having their first babies, all VBAC women and all women who have previously been traumatised by their birth, have continuity of midwifery care.

… Our maternity services certainly have an excellent safety record … Ireland had the lowest rate in the world of women dying during or just after pregnancy – one out of 47,600 women, compared with one in 4,800 in the US …

… the factors at play in driving up the rate of Caesarean births seem to range from medical and health policy issues to cultural and social influences.

The huge variation in rates from hospital to hospital indicates the complexities of the situation …

… Caesarean rates range … from a low of 18 per cent … to 37 per cent …

… we have no national guidelines on Caesarean section … “If we did, and they were applied across the board, we would have possibly lower C-section rates.”

Secondly … “We have a high birth rate, too few midwives; we have quite inadequate circumstances for dealing in proper one-to-one care for women in labour.”

She sees a third major factor being the “inappropriate” use of routine foetal heartbeat monitoring, known as CTG. Research shows that continuous monitoring of the heartbeat leads to a substantial increase in the risk of a woman having a Caesarean section.

… “More C-sections will be performed for abnormal foetal heart rates, but they may not really be abnormal foetal heart rates.”

Fourthly, there is a perception that Caesarean section is a safe and trouble-free intervention – that is a view held not only by the public but also by the consultants, she argues. “Women are not informed of complications.”

… “sometimes come to classes with the notion that maybe they would go for an elective section … It has become sort of accepted that this would be an option. I think some women would be very glad if there was a reason an elective section had to be performed.”

She attributes much of that to fear: “They are not hearing that many good stories from their friends, their sisters and their cousins about birth – particularly birth in the current maternity services. It doesn’t really allow women to build up any degree of confidence.”

What Healy describes as “my precious baby syndrome” among older mothers is also a factor. “They have either waited a long time to have their first baby, or perhaps in some instances unfortunately it took a long time to conceive their first baby.

“People are acutely aware that they don’t have too many shots at this and they need to be taken better care of. In actual fact, Caesarean isn’t safer at all, but the general population thinks that it is.”

When she hears back from clients who have had an emergency Caesarean section, they typically talk about feeling very grateful that their baby was saved and that nothing terrible went wrong.

“That is great, except what I would often question is what went before it? Was there a cascade of intervention that is a well-known phenomenon in the medicalised birth?”

Research shows that continuity of care, typically provided in midwife-led units, and lack of time pressures, increases the chances of a normal birth.

Mothers are not caught in the following cycle: induction causing greater pain, leading to the need for epidurals, which slow down labour, that is speeded up with synthetic hormones, which result in faster and harder contractions, that may distress the baby and require a surgeon to come to the rescue.

… the way to cut the rate of Caesareans is to look at more low-tech solutions and to get more midwives in there.

“Conceiving your baby for most people is not a high-tech activity; birthing your baby also shouldn’t be,” she adds. “If we supported women, they would have a more enjoyable experience, which is a better start to motherhood.”

… the philosophy of any given maternity unit is also influential. “If you have a high section rate, you have a high instrumental delivery rate, you have a high intervention rate.”

The fear of litigation is there, he agrees, but not a significant factor …

… In Dublin’s three public maternity hospitals, the principal increase has been among women who have had previous Caesareans …

… “… Obstetric care doesn’t make sense, unless a woman has complications.”

She believes changes are imminent as policymakers focus on normal birth and the cost of intervention. Positive findings are coming through in research on the few midwifery-led schemes.

“In 10 years’ time I think we will be looking at a very different maternity system,” Donegan says. “But while consultants are seen to be the experts on maternity care, I think Mary Harney is going to have her work cut out for her.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

Put The Safety Of Babies And Their Mothers Ahead Of Home Birth Ideology

Posted on September 1, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

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The title of this article is offensive to say the least! The vast majority of home birthing women do not put home birth ideology ahead of a safe birth.

Australia’s peak group of obstetricians and gynaecologists today repeated its warning that home births – with or without a midwife – carry too much risk to babies and their mothers and the Government should resist calls to indemnify midwives outside of hospitals.

For starters, she does not seem to even acknowledge the difference between midwife-attended home births and free births.

The President of the National Association of Specialist Obstetricians and Gynaecologists (NASOG), Dr Hilary Joyce, congratulated the Government-majority Senate Committee investigating proposed legislation relating to the role of midwives, for putting the safety of babies ahead of protestations by a small but vocal minority of people.

“I would urge all politicians to look to the evidence and to speak to the doctors and the midwives who have to deal with some of the tragic consequences of home births,” Dr Joyce said today.

“Australia has one of the safest and highest quality maternity services in the world where specialist doctors work side by side with qualified midwives to ensure babies and their mothers have a safe and successful birth experience.”

Safe and successful? Many women who enter the hospital system to give birth come away traumatised. The majority of women who birth at home with a midwife are happy and satisfied with their experience. Rates of mortality are the same for low risk women whether they birth at home or in hospital. But morbidity is far higher in hospital.

… “There is irrefutable evidence that women and babies are significantly safer in hospitals because of the immediate access to specialist care. Thankfully, only 0.25% of Australian women risk their lives and that of their babies by choosing a home birth.”

I’d like to see this irrefutable evidence. I cannot find it. “only 0.25% of Australian women risk their lives and that of their babies by choosing a home birth.” – is this offensive or what? The vast majority of home birthing women I know will not risk their baby’s life or their own simply to birth at home.

Dr Joyce said the Minister for Health and Ageing was acting in the best interests of babies and their mothers by refusing to financially endorse the unsafe practice of delivering babies at home.

“There are things that can go wrong suddenly in a birth which, if not under specialist care or near medical assistance, can result in an avoidable death or permanent injury,” Dr Joyce explained …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Birth wars rage in your delivery room

Posted on August 30, 2009 by Melissa Maimann

For further information about birth or private midwifery, contact Melissa Maimann at Essential Birth Consulting.

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YOU’RE in the dentist’s chair with a painful tooth, feeling fragile.

“That tooth has to come out,” says the dentist.

“I’ll give you an anaesthetic and extract it.”

You’re surprised – you had hoped the tooth would be all right – but you nod and say something like “Ungh-hnghm” through a mouthful of cotton wool and dentist fingers. After all, he’s the expert.

The dentist turns to prepare the needle, when a dental technician leans over and whispers in your ear: “You know you don’t have to do what he says.

“He doesn’t know what he’s talking about. What about root canal? Or homoeopathic remedies? And anyway, you don’t need an anaesthetic.

“There’s a dentist next door who does acupuncture and hypnosis for pain relief. It’s much safer. Oh, and did you know fluoride is toxic?”

The dentist snaps at her to stop: “Ignore her – she’s pushing her own agenda.”

Tense, stressed and utterly confused, you lie back, open your mouth and look up at two medicos glaring at one another.

Who is in charge here? What’s the real truth? And why didn’t anyone tell you there was some sort of power struggle going on?

Of course, this doesn’t happen in dental surgeries. Open hostility between clinicians would be madness, serving only to baffle patients and undermine the whole purpose of creating healthy smiles.

But this is exactly what happens in maternity care, every day, in birth centres, hospitals and homes. Hostility, suspicion, mistrust, abuse and vitriol abound in relationships between obstetricians and midwives, clinicians, academics and activists.

Many readers already will have decided that this article is biased because I chose to use a dentistry metaphor – they’ll say a diseased tooth is utterly incomparable to the natural process of childbirth.

Or … they might say it’s unfair to choose a dentist and a technician to represent the opposing forces, because it implies one is more expert than the other – or that it’s wrong to mention homoeopathy or acupuncture because they have unfair implications of hippiedom.

Welcome to the birth wars. Everything that is published, posted or broadcast about the topic of pregnancy, birth and parenthood is contentious.

Some midwives and obstetricians are moderate and co-operative – but many are entirely opposed to the idea of working together, or sharing expertise …

There seems to be no middle ground. And that’s the problem, according to author Mary-Rose MacColl, a journalist … who spent years investigating maternity care. Her new book, “The Birth Wars” … is an exploration and denunciation of “the conflict putting Australian women and babies at risk”.

… MacColl uncovers a battleground that she believes Australians need to understand. It’s a fight between “organics” and “mechanics” for control and influence.

In MacColl’s parlance, the “organics” are mainly midwives who believe birth is a natural process that has become overly medicalised, with the consequence that many women are traumatised by cold, clinical births, unnecessary caesareans and excessive medication.

The “mechanics” include many obstetricians and hospital clinicians, who believe birth is a risky, delicate process that must be carefully monitored to ensure women and babies are safe.

Between the two sides, virtually nothing is agreed. Can a breech baby be delivered vaginally? Can a caesarean birth be followed by a vaginal birth? Should women be given synthetic hormones to help deliver placentas quickly after birth? Should home birth be encouraged, or even allowed?

… Beneath those practical questions are deeper, theoretical fights that rage with equal vehemence: what is an acceptable level of risk? What does “safety” mean? Is it essential that women have continuous care from a single, trusted practitioner?

Do we even have a right to expect that all births will result in live, healthy mothers and babies – or have we deluded ourselves about what to expect?

… The biggest problem … is not home births nor caesareans nor any of a hundred other contentious issues: the biggest problem is the destructive birth wars themselves.

“They need to talk to each other and they need to work out their differences, so that women get a coherent view about maternity care from the maternity care profession. I think that’s a reasonable thing for women to expect,” she says.
… if there is no consensus between practitioners, how are expectant parents supposed to make decisions?

… Lillienne’s story is told in The Birth Wars, but the short version is that her mother … was labouring in the midwife-run Birth Centre … After many … hours she was transferred to the hospital’s surgical Birth Suite. The baby’s heart rate dropped dramatically during labour, she was deprived of oxygen for some time and was eventually born by c-section.

Reviews found numerous problems: Debra’s high blood pressure was not interpreted as a warning sign at an early stage; confusion reigned over who was in charge; obstetricians were not welcome in the Birth Centre, where midwives were in charge.

… MacColl says there are many birth centres within hospitals, where doctors and midwives oversee completely separate domains ….

… the federal Government proposes to overhaul maternity by subsidising insurance costs for midwives, helping them to operate in private practice. Home births will not be covered.

… The proposal has sparked a furious debate, with home-birth advocates warning that women will have secret, underground home births without expert care.

… “While ever they’re fighting and it’s `organics versus mechanics’ we’ll have no change in the hospital system. We’ll keep establishing birth centres that draw lines in the linoleum and (say): `He’s on that side, I’m on this side and he better not cross the line.

… How crazy is it that you can be in one of the largest tertiary hospitals in Australia and have a situation where doctors are not allowed in? And, at the same time, how can you not recognise that a woman in labour is going to need a quiet, dark, calm environment like a birth centre, instead of a stark hospital room?”

MacColl has two goals. The first is to raise awareness that the birth wars exist, in the hope that parents can think carefully about their choices before the contractions begin …

I thought that was a fantastic article! I’m not sure that the solution is as simple as midwives and obstetricians sitting down and talking. For one thing, I don’t necessarily agree that obstetricians have an agenda that is too dissimilar to midwives’ agendas. I believe insurance is the key.

Currently, obstetricians have insurance and are far more likely than midwives, to be sued. Midwives essentially cannot be sued. For there to be a case, there needs to be solicitors and barristers on both sides. Private midwives are self-employed, and despite the view that women pay excessive amounts of money for their births, I can assure you we’re not wealthy. Essentially, midwives do not have money to fund lengthy court cases. But obstetricians do. And so do hospitals. Hospital-employed midwives are covered by vicarious liability. So if there’s going to be a court case, the woman or her baby are best suing the doctor or the hospital, rather than the private midwife.

No hospital or doctor wants to go through a court case. Even if they win, it’s emotionally and mentally taxing, it takes much time, and costs money. So there’s a strong incentive to avoid court cases and being sued. And the best way to do this is to practice defensively. Do a caesarean sooner rather than later. It’s easier to sue for a caesarean that was not performed in time – clearly, if something went “wrong”, a woman can argue that a caesarean should have been performed. Conversely, it’s very hard to prove that a caesarean was unnecessary. You can always find a reason why it was necessary.

So we have created – via our legal system – a situation where caesareans and any other interventions are encouraged. You cannot be sued for intervening. Only for failing to intervene.

So our caesarean rate is amongst the highest in the world. Over 31%.

We induce many women.

We continuously monitor many babies in labour.

We do not encourage waterbirth (how can you get a woman out in time if there’s an emergency??)

We encourage birth on the bed so that forceps or a vacuum can be easily applied if needed.

All births ought to take place in hospitals – or at worst, birth centres that are right next to the delivery suite and operating theatre. You just never know when they’re going to be needed.

Can you see what’s happening here? The fear of litigation prompts defensive practice, which leads to higher rates of intervention.

But I come back to my original statement: I don’t believe that mdiwives’ and obstetrician’s agendas are too dissimilar. Both want the best for women and their babies. I do not believe that obstetricians are out there to perform as many caesareans as possible, and to induce all other women and extract their babies with forceps. Nor do I beieve that every midwife wants to birth women in the water, with no monitoring of the baby, letting the labour go on for as long as it takes.

But insurance is the key. People have a need for safety. That includes midwives and obstetricians. Noone goes to work with the intention of traumatising a woman with surgery – particularly unnecessary surgery – but this needs to be balanced with the needs of the professional to practice their profession safely, however they define it.

If it were up to me, I would call for two things:

1. Greater transparency of pratitioner’s intervention rates, perhaps on a public register that is easily accessible, so that women are able to choose their health professionals with accurate information; and
2. Reform of our legal system, to a no-fault system such as the ACC Scheme in NZ.

Midiwves and obstetricians getting together and talking is a way away. It happens every day, but actually sorting out the differences will take time. There are many issues at the heart: competition, money, perceived superiority (from both sides!), the list goes on.

National guidelines on midwifery and obstetric care might help. Guidelines that state that within certain guidelines, women see a midwife. If they choose to see an obstetrician, they may fund this themself. And then, if a woman’s condition deviates from normality, as defined by guidelines, the midwife and woman consults with an obstetrician, or refers the woman’s care to an obstetrician. In this model, we see midwives caring for healthy pregnant and birthing women – doing what we do best, and obstetricians caring for women who need their services – doing what they do best. Such guidelines would optimise the care of pregnant women and eliminate the turf wars. These guidelines are in existence, and have been developed by the College of Midwives. Private midwives and employed midwives use them to guide the care they give to women.

The author of the article states, “obstetricians were not welcome in the Birth Centre, where midwives were in charge” – there is no issue with this. Midwives ought to be in charge of normal birth: it is our specialty. What is wrong is to fail to offer an obstetric consult to a woman when her condition deems it necessary. The GP provides most of the care to a family and refers members of the family to specialists when necessary: this is not perceived as a turf war. Why is midwifery and obstetrics any different?

Melissa Maimann, Essential Birth Consulting 0400 418 448

Fear of childbirth increases risk for dystocia, emergency C-section

Posted on August 8, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

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Nulliparous women who fear childbirth during pregnancy are at increased risk for dystocia and emergency cesarean section but not fetal distress …

“Fear and anxiety activate a hormonal stress response in pregnant and laboring women, which can result in dystocia or protracted labor,” …

Fear of childbirth in early (16 weeks) and late (31 weeks) pregnancy was associated with emergency cesarean section, with corresponding odds ratios (ORs) of 1.23 and 1.32. When fear of childbirth was present in both early and late pregnancy, the OR increased to 1.43.

… women who feared childbirth … had an increased risk for dystocia, but not fetal distress (OR = 1.33 and 0.94, respectively).

They recommend optimal support during labor to reduce the risk for emergency cesarean section.

It would be interesting to see a comparison study between midwifery-led care and obstetric-led care in terms of women’s perceived anxiety at the end of pregnancy and subsequent caesarean rates for dystocia.

Melissa Maimann, Essential Birth Consulting 0400 418 448

C-Section Anesthetics Not Linked to Learning Disabilities

Posted on August 7, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

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Anesthesia during a cesarean delivery is not associated with an increased risk of learning disabilities compared with vaginal birth …

The finding … suggests that brief exposure to anesthetics during birth has no long-term neurodevelopmental consequences … in an unexpected finding, regional anesthesia during cesarean was associated with a lower risk of learning disabilities compared with vaginal birth …

One possible explanation for that … is that cesarean delivery with regional anesthesia “attenuates the neonatal stress response to vaginal delivery that in turn has significant effects on later neural development.”

… The issue has been of concern, since animal studies have shown that anesthetics can cause degenerative changes when applied to the young brain.

… Among those delivered vaginally, the cumulative incidence of learning disabilities was 20.8%, compared with 19.4% for those whose mothers received general anesthesia for cesarean delivery and 15.4% for those whose mothers had a regional anesthetic for cesarean delivery.

… the pairwise comparison of vaginal birth with cesarean delivery and regional anesthetic yielded a hazard ratio of 0.73, which was significant at P=0.046.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Don’t tell women how to give birth

Posted on August 6, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

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How a woman gives birth provokes strong views, with impassioned arguments for normal births, and for Caesareans.

But … the most important thing is for women to be able to choose.

The use of technology in birth – such as the development of epidurals for pain relief and Caesarean sections – has long been a cauldron into which divisive and conflicting issues and opinions have been poured.

… Women can be left deeply scarred by a birth which may have been physically safe but has ignored the emotional aspect of it

When the … NICE was considering guidance on giving birth in the NHS, the large number of midwives who sent in comments were only too aware of how the home birth option was once again nearly lost.

They had to challenge the appropriateness and interpretation of the evidence being considered on the safety of place of birth.

There is a fundamental question needing to be asked here: why do some doctors and midwives devalue the choice of home birth, despite the lack of evidence against it?

… what women want at all times, is good and unbiased information from the health professionals caring for them, so that they can make the appropriate choice about how technology can help them.

One high-profile obstetrician recently relating the birth experience to the advances in agriculture, transport and energy production reminded us alarmingly of the language previously used in the “active management of labour”, when women’s bodies were viewed as machines that were frequently “inefficient” and in need of acceleration.

It has seemed that the health professionals that care for women today had largely moved on from this strange and controlling discourse, and it’s disappointing this may not be the case.

The bottom line here is that what women want is to be able to make a real choice, for the health service to offer them that choice, and for that choice to be based on having all the information needed to make an informed decision …

Melissa Maimann, Essential Birth Consulting 0400 418 448

DIY birth it’s radical, it’s dangerous

Posted on July 22, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

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IMAGINE giving birth on your own, with no professional help. Imagine choosing to do that. Women do. It’s called freebirthing or DIY birth and it’s a pretty radical idea. It scares the crap out of me …

… it’s dangerous, and it could be on the rise if new legislation comes into effect.

The Federal Government has given increased rights to midwives – as long as they are “eligible” or attached to a hospital.

They will not grant indemnity insurance to private midwives attending homebirths, effectively banning them from the practice.

… there are some women who reject the idea that childbirth is a medical procedure and want to give birth at home.

They are not a bunch of … hippies … It’s … well-educated women, many of whom have had horrific births in hospitals … that they want their next one in the security of their own home.

… there is a real issue at the core.

… It is … a public health issue because these women are determined not to birth in a hospital unless it is medically necessary.

That means they have to go underground.

Some independent midwives, who will be deregistered if the laws go through, will sell their services as masseuses or photographers. They will charge a premium and they will give women what they want.

Women … will be forced to make dangerous choices. If they … run into trouble, they could be more reluctant to seek emergency help.

… In SA, there is a hospital-based homebirth program, but it is selective. Women have to meet strict criteria and … be in the right catchment area … they only do a handful of homebirths a year.

… Of 107 homebirths [in SA], three were stillbirths, two of these were unplanned and the women had had no antenatal care at all …

Melissa Maimann, Essential Birth Consulting 0400 418 448

IPS Examines Obstetric Fistula In Southern Senegal

Posted on July 10, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

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Inter Press Service News Agency examines the prevalence of obstetric fistula in the southern region of Senegal. According to state reproductive health officials … 58 percent of births take place at home without medical assistance. “Women in the region suffer from exceptionally high rates of fistula,” which “occurs when extended pressure damages the soft tissue in a woman’s pelvis during … birth” and can lead to debilitating complications and ostracization from their families …

For every 20 deliveries … at least nine women develop fistula …

“… girls are married off between the ages of 13 and 15. … from a morphological perspective, their pelvic girdles are not yet fully developed … labour is prolonged,” …

“The extreme poverty … means that fistula sufferers stay away from health facilities … Being ashamed of their condition also keeps them away, as well as their awareness of the odour they give off,” … because the condition can cause leakage of urine or feces.

A shortage of health workers … also contributes to the pervasiveness of fistula … there are seven doctors … for every 100,000 people, and one midwife for every 400,000 people …

Melissa Maimann, Essential Birth Consulting 0400 418 448

C-Section Births Cause Genetic Changes That May Increase Odds For Developing Diseases In Later Life

Posted on July 5, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

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… babies born by Caesarean section experience changes to the DNA pool in their white blood cells, which could be connected to altered stress levels during this method of delivery …

It is thought that these genetic changes, which differ from normal vaginal deliveries, could explain why people delivered by C-section are more susceptible to immunological diseases such as diabetes and asthma in later life, when those genetic changes combine with environmental triggers.

… “Delivery by C-section has been associated with increased allergy, diabetes and leukaemia risks” … “Although the underlying cause is unknown, our theory is that altered birth conditions could cause a genetic imprint in the immune cells that could play a role later in life.

… As the diseases that tend to be more common in people delivered by C-section are connected with the immune system, we decided to focus our research on early DNA changes to the white blood cells.”

The authors point out that the reason why DNA-methylation is higher after C-section deliveries is still unclear and further research is needed. “Animal studies have shown that negative stress around birth affects methylation of the genes and therefore it is reasonable to believe that the differences in DNAmethylation that we found in human infants are linked to differences in birth stress. “We know that the stress of being born is fundamentally different after planned Csection compared to normal vaginal delivery. When babies are delivered by Csection, they are unprepared for the birth and can become more stressed after delivery than before. This is different to a normal vaginal delivery, where the stress gradually builds up before the actual birth, helping the baby to start breathing and quickly adapt to the new environment outside the womb.”

… “C-section delivery is rapidly increasing worldwide and is currently the most common surgical procedure among women of child-bearing age. Until recently, the long-term consequences of this mode of delivery had not been studied. However, reports that link C-section deliveries with increased risk for different diseases in later life are now emerging. Our results provide the first pieces of evidence that early ‘epigenetic’ programming of the immune system may have a role to play.” The authors feel that their discovery could make a significant contribution to the ongoing debate about the health issues around C-section deliveries.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Childbirth-Related Injuries Decline

Posted on June 30, 2009 by Melissa Maimann

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There were nearly 158,000 potentially avoidable childbirth-related injuries to women and their infants in 2006, a significant decline from 2000 …

… Between 2000 and 2006, the rate of potentially avoidable injuries during vaginal childbirth without the use of instruments, such as forceps, declined by 30%, according to the report. The injury rate declined by 21.3% for vaginal childbirth using instruments and by 16.7% for women undergoing caesarean sections.

… rates of injury were higher when instruments were used during childbirth. …trauma to the woman during vaginal delivery with the use of instruments occurred 160.5 times per 1,000 discharges, compared with 36.2 times when instruments were not used. The report said that the most common injuries to women were perineum tears, which are avoidable in many cases. Traumatic injury to infants during childbirth — such as broken collarbones, head injuries and infections — occurred 1.6 times per 1,000 discharges.

…. Women giving birth in high-income areas had 44% more injuries during vaginal delivery than their counterparts in low-income areas.

… The report found that women covered by Medicaid were less likely to be injured during childbirth — 127 injuries per 1,000 deliveries — compared with women with private insurance plans — 185 injuries per 1,000 deliveries. However, the rate of injury for infants covered under Medicaid was higher — 1.7 per 1,000 deliveries — than those under private plans — 1.5 per 1,000 deliveries.

Risk of stillbirth ‘tripled for women who have their babies at home’

Posted on June 12, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

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Women who give birth at home with an independent midwife are nearly three times more likely to have a stillbirth than those who give birth in hospital, a study has found.

Many women at high risk of complications choose to give birth outside hospital because the NHS cannot offer the kind of birth they want.

The researchers urged a review of why more babies were stillborn or dying soon after a birth overseen by an independent midwife, but pointed out that many outcomes were “significantly better” for those who gave birth outside the NHS.

For women at low risk of complications, giving birth at home could be as safe as doing so in hospital, they added.

Only 3 per cent of women give birth at home but the Government has pledged to offer women a choice of where and how they give birth by the year’s end.

Campaigners said that the NHS was letting down thousands of women who had to employ an independent midwife because the health service could not offer them a “natural” home birth without painkillers or other medical interventions.

Other women who chose an independent midwife had had a bad experience on the NHS, raising concerns about the quality of childbirth for some women who feel afraid to use the health service again.

Medical leaders say that the health service is unable to provide more home births due to shortages of midwives despite Government promises and the fact that home births could save the NHS money and provide a more natural experience for around 60 per cent of women at low risk of complications.

A report by the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives estimated that if women had “true choice”, between 8-10 per cent of births would be at home. The study, by the University of Dundee, analysed the records of more than 8,600 women who gave birth in Scotland between 2002 and 2005. These included 1,462 who gave birth assisted by a member of the Independent Midwives Association (IMA), and another 7,214 who gave birth on the NHS.

… Nearly nine out of ten women in the IMA group, said they wanted to give birth at home, and two thirds did so. But the researchers noted that women who chose a birth with an IMA member were more likely to have had pre-existing conditions, such as blood pressure or diabetes, or previous obstetric complications.

The risk of stillbirth or neonatal death (within 28 days of birth) was 1.7 per cent in the IMA group compared with 0.6 per cent in those giving birth in the NHS. Once high-risk women were excluded from both groups, the difference — 0.5 per cent versus 0.3 per cent — was not statistically significant.

… Belinda Phipps, chief executive of the National Childbirth Trust, said that many women who opted to pay for an indpendent midwife did so because they wanted “a home birth, or at least a more homely birth”.

“Women at high-risk of complications are still entitled to choose a home birth and I think we have to ask why they are made to feel that their only option is to turn away from the health service.”

Dr Maggie Blott, spokeswoman for the RCOG, said she was not surprised by the higher mortality rate among the IMA group. “Women with an increased risk of complications should be delivered in hospital where obstetricians can spot those complications,” she added. “Independent midwives should not be agreeing to deliver women who are high-risk at home.”

Aaahhh, the debate around high risk home birth and who should decide if it should happen. Should doctors decide where a woman births? By definisition, high risk birth is outside the scope of a midwife’s practice. Maybe midwives should not be taking such women on for home births as it might appear that we’re practicing obstetrics without a license. But where does that leave women? Although this is from the UK, the situation is the same here, except that publicly-funded homebirth is not available in most parts of the country. For the most part, if you want to have a home birth, you need to employ a homebirth midwife (private / independent).

I’d like to say it’s up to the woman to choose where and with whom she births her baby. It’s her body and her baby. But I’d also like to see hospitals providing woman-centered care to women who are “high risk”, and I see this as being possible with private midwifery for hospital birth. It will be a reality after nov 2010, but even now it is possible if the woman wants it to work this way. In my experience, it has worked well. It allows women to labour on their terms, with private midwifery care, and in a safe environment.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Medical Indemnity and Birth

Posted on June 10, 2009 by Melissa Maimann

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Article

Many still believe that the reduction of maternity services is a result of sky-rocketing insurance premiums directly impacting practitioners; a direct result of an over-litigious society …

… despite hundreds of millions of dollars in rescue money to Australia’s medical profession, not one cent has been afforded to midwives.

Many know the collapse of medical/professional indemnity was largely a result of global factors, namely the demise of large re-insurers after September 11, 2001. Interestingly, the decision by Guild insurance to no longer offer a policy to midwives happened before this. Their reasoning, that the midwifery pool was too small, was justifiable. The fear of a major payout for catastrophic birth injury proved correct. In November 2001 the NSW Supreme Court awarded Calandre Simpson, an infant born at St Margaret’s Private Hospital with cerebral palsy, … eleven million dollars for the overdose of syntocinon, which caused her birth defects … This payout assisted in the collapse of Australia’s largest medical indemnity organisation …

Of particular importance is the hospital ‘care’ received by Calandre’s mother. It was proven that she was given an overdose of syntocinon (as part of an induction), five attempts at forceps were tried and finally caesarean section before Calandre was born with severe cerebral palsy. It was concluded that the syntocinon overdose, resulting in atonic uterus, could have caused the cerebral palsy, before the attempted forceps delivery.

… it is prudent to note that the Simpson family had considerable financial resources … This enabled them to fund a nine-year legal battle. It also contributed to the high cost of the claim …

The other interesting point is that although this case essentially toppled the medical indemnity industry, little has been learnt. Whilst the practice of performing a caesarean section rather than forceps is likely to have increased; the incidence of syntocinon use has not reduced. [about 50% women receive syntocinon to induce or augment labour - in some facilities, this is as high as 80%]. … obstetric practice has largely remained unchanged.

… the Ipp Report of 2002 made recommendations for considerable Tort Law reform (the law governing personal injury negligence). Part of this reform was to … implement a modified version of the ‘Bolam Test’. In at least NSW and QLD:
‘The standard of care will be that determined by the court with guidance from evidence of acceptable professional practice unless it is established (in practice, by the defendant) that the defendant acted according to professional practice widely accepted by (rational) peer professional opinion.’

Considering the majority of obstetricians engage in practices that are not based on evidence, this is deeply concerning. …. [For example] The evidence regarding episiotomy effectiveness would assist a consumer in mounting a claim. Under the ‘Modified Bolam Test’, however, if the subject practitioner gathered other specialists who agreed they would also perform an episiotomy, the injured woman could be unsuccessful.

In response, the Australian Plaintiff Lawyers Association stated in a submission to government ‘APLA is concerned that doctors already hold a privileged position in our society and are treated differently to other groups, including other professions. Patients’ rights should not be compromised for the sake of doctors’ hip pockets.’

… the Australian public … still believe that the reduction of maternity services is a result of sky-rocketing insurance premiums directly impacting practitioners; a direct result of an over-litigious society. This could not be further from the truth. Medical practitioners have been very well protected, whilst consumer rights have shrunk and the continuation of a totally anti-competitive maternity health system has resulted in a reduction of services …

… The most obvious outcome of the refusal by both the federal and state governments to assist with midwives’ indemnity insurance has been a great reduction in the numbers of privately practicing midwives. Alongside this very few private health funds provide a midwifery/homebirth benefit. Of those who do, most do not provide a benefit on par with obstetric pay-outs.

The advent of the Bachelor of Midwifery was very positive. Practical experience however has been severely restricted. Students are unable to gain experience with homebirth midwives, rather they experience the highly interventionist ‘system’. It would seem the theory of educating a midwife to work in continuity and community models is of little use when the majority of students are unable to complement this learning in practice.

Access to Medicare provider numbers … is impossible without indemnity. There is however no impediment for the Rudd Government to include midwives in the PSS, only fear from the backlash from some obstetricians. … [as evidence by statements from the recent Maternity Services Review]

Women’s choice is only acceptable if it is palatable to those who control maternity services, the powerful medical lobby.

If Minister Roxon was to facilitate indemnity cover and funding for midwives this would demonstrate a fundamental commitment to maternity reform. It would also enable midwives to take their rightful place as the expert in normal birth.

Consumers have again been silenced in this debate …

Interestingly the rights of Australian women choosing private midwifery don’t have the same value as those women choosing the services of a specialist obstetrician or a procedural G.P. When I challenged the legal branch of NSW Health with this comment I was greeted with silence.

Indemnity insurance will be compulsory from July 2010 … And midwives are still denied any support. Taxpayers have now funded close to $900 million in indemnity support for medical practitioners. Considering the facts of the Calandre Simpson case one has to ask why the Government continues to back such a ‘risky horse’.

Another contentious issue that has surfaced since the loss of indemnity insurance is the establishment of public funded homebirth services. Whilst my socialist heart leaps for joy that women can access the care of a known midwife and the option of homebirth without cost, fundamentally these programs are flawed. They all exist with rigid guidelines and on the back of the benevolence and goodwill of obstetricians. Some of these individuals are truly wonderful and their practice most progressive.

The premise, however, that midwifery practice can only exist on the say so of the medical establishment is dangerous.

Private midwifery services do not exist under the medical establishment: they exist completely outside of the “system”: a very attractive feature for the women who seek such services.

Surely the central tenant of midwifery reform is to establish a midwifery scope of practice that enshrines the appropriateness of midwifery care based on education and registration. It must also enforce the very heart of midwifery, ‘being with woman’ and as such the relationship between a woman and midwife. This, in turn, would help establish the rights of women to make choices around how, where and by who their bodies’ are/or are not handled.

Whilst the catastrophic birth injury of Calandre Simpson is tragic, the impact of her court outcome has not been critically analysed. The whirlwind of risk management and defensive practice that has followed was not justified. Calandre Simpson was a ‘veritable needle in a haystack’ — a terribly injured person as a result of negligence, from a family of considerable means able to fund expensive litigation. Instead of looking at what constitutes negligent practice and rewarding its reduction, the federal government chose to remove the rights of consumers, protect the pay packets of medical practitioners, deny midwives their rightful practice and support on-going dangerous procedures.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Rights and Responsibilities: Where did they Go?

Posted on June 9, 2009 by Melissa Maimann

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Feminism is a dirty word, especially if you are a pro-establishment columnist. Recently, the mass media have spurned the safety of homebirth. Doctors were outraged at the death of four babies, without revealing any case facts … Not one mainstream piece has explored why a number of women feel the need to give birth without any health professional, nor have they explored simple tested legal concepts of informed consent and right of refusal. It would seem far more sensible to herd all women into hospitals where they can be controlled. Women cannot be trusted, especially those who challenge the fierce medical domination of childbirth.

As an owner of a female body I have taken it for a test run seven times. I have chosen to use limited medical technologies … I took ultimate control of my body and became responsible for the life growing within me … I paid a price however. My decision to give birth at home with a registered midwife was not respected or funded. At the same time my taxes paid for a system controlled by medicine—a system with virtually no accountability, that allegedly enabled gross sexual assault under Dr Graeme Reeves. These assaults were extreme but lower level violence continues in maternity wards every day …

With this environment how could a woman previously damaged by the system feel safe? We have a maternity health system that leaves one in four women experiencing birth as a ‘battlefield’ and suffering debilitating post natal depression or even post-traumatic stress disorder, usually reserved for soldiers and victims of crime. Whilst women cry out for a mainstream midwifery option that puts their needs first, the medical establishment remains largely unaccountable.

Federal Health Minister, Nicola Roxon put her toe in the water, by announcing the Maternity Services Review last September. As expected the women who have been denied their rights and are funding others …

While acknowledging it is a preference for some women, the Review Team does not propose Commonwealth funding of homebirths as a mainstream option for maternity care at this time.

The Review also considers that moving prematurely to a mainstream private model of care incorporating homebirthing risks polarising the professions rather than allowing the expansion of collaborative approaches to improving choice and services for Australian women and their babies.

As a woman and lawyer, Nicola Roxon is well placed to oversee the design of a maternity system with the established principles of informed consent and right of refusal at the centre. Arguments of safety and wellbeing are thin guises of tightly held power and control by medical lobby groups …

I attended a roundtable meeting of key stakeholders as part of the Maternity Service Review last year. The topic discussed was ‘high-risk pregnancy’. … many women and babies are classified as ‘high-risk’ by an obstetric community that is largely dogged by fear and distrusts women and women’s bodies.

My conclusion was sadly confirmed at the roundtable meeting, when a senior obstetrician said without hesitation that he ‘would be loathed to think a woman would have the final say in her care.’ … As a consumer, passionate about the rights of women to make informed choices, I believe the paternalism that pervades obstetrics and the widespread midwifery practice of maintaining the status quo pose a major threat to reform.

This view is in direct contradiction to common law in Australia. Kim Forrester, a member of the Queensland Bar states, ‘all adults who are of sound mind and considered legally competent have an absolute right to consent, or refuse to consent, to medical intervention and/or treatment. This is the case regardless of the opinion of health professionals as to what is in the “best interests” of the patient or client.’

… A US appeal case heard in 1914 made a landmark decision still quoted today: Schloendorff v Society of New York Hospital, clearly articulates, ‘Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without the patient’s consent, commits an assault.’

The culture of fear and control in obstetrics has enabled these legal principles to be ignored. Women are consistently misled about procedures performed on them. Ironically most women are grateful and believe that either their own or their baby’s life was saved, often after an unnecessary intervention.

Obstetric dominance pervades midwifery. Virtually all models operate with exclusion criteria that are not based on evidence. A woman with a previous caesarean section is unable to give birth in a bath in a birth centre with a midwife sometimes only seconds from operating theatres. Her safety can only be assured in a ‘labour ward’ sometimes only metres away from the birth centre. The capacity for a healthy woman to deliver her placenta without oxytocics is doubted and feared …

The birth reform process is likely to bring with it guiding principles. The Australian College of Midwives developed guidelines for establishing midwifery models. The recent second edition was mindful of the need to enshrine informed consent and right of refusal. They state:

Ethical principles underlying health care and health law emphasize the importance of respecting the autonomy of those receiving health care and the rights of individuals to choose among alternative approaches, weighing risks and benefits according to their needs and values. Midwives, like all health professionals, are responsible for being clear about their scope of practice and limitations, giving recommendations for care if appropriate and for informing women about risks, benefits and alternative approaches.

Should a situation arise in which the woman chooses care outside the recommendations in the Guidelines the midwife must engage with the woman and her family and with hospital staff through identified channels where applicable, in a thorough discussion of the request, looking for options

The Royal Australian New Zealand College of Obstetricians and Gynaecologists (RANZCOG) do not accept these guidelines … they have released their own guidelines …

It would seem that unless a woman conforms to obstetric dominance she is not informed. If this wasn’t so serious it would be funny.

For too long we have chanted that birth needs to come back to women. Now is the time to empower women with rights too often denied. How can we have a maternity system that largely treats women as incubators where emotional wellbeing is dissected from her uterine cavity; and yet come post-natal discharge the same woman walks out into the world to make major life decisions for her child for the next 16-18 years? As with maternity reform, empowering women will take time, but if the reform process respects the rights of midwives to practice a full scope of practice and that of women that determine how and by whom their bodies are handled (if at all) a true woman-centred approach is possible.

Neither the church nor the state has the right to control a woman’s body. Maternity reform must be based on the three R’s – rights, responsibilities and respect. Consumers have the right to a funded registered health professional in any setting, and the responsibility to demonstrate they have made informed decisions. They deserve these decisions be respected …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Governments Must Take ‘Concrete Action’ To Reduce Maternal Mortality, Morbidity

Posted on June 8, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Article

With the U.N. Human Rights Council’s June session coming up, governments have a “chance to prove that they value women’s lives by taking concrete action” to recognize “preventable maternal death as a violation of women’s rights,” …

Although “we know what is needed to save women’s lives” women are still dying or “left with lifelong, debilitating complications. Moreover, when mothers die, children are at greater risk of dropping out of school, becoming malnourished, and simply not surviving. Not only is maternal mortality and morbidity a global health emergency, but it triggers and aggravates cycles of poverty that cause generations of suffering and despair,” Robinson and Yamin write, adding that “saving women’s lives” would cost an estimated additional “$6 billion a year to be on track to achieve” the U.N. MDGs.

They write that “poor governments” will not “be blamed for not doing what they cannot do,” but asserting that these “preventable deaths are an issue of human rights” highlights the “profound injustice of disparities in maternal deaths” and makes it “more urgent that donor states honor their funding commitments.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

The Truth about Hospital Birth: Why Hospital Is Not An Ideal Place for a Natural Birth

Posted on June 5, 2009 by Melissa Maimann

For further information on hospital birth or natural birth, contact Melissa Maimann at Essential Birth Consulting.

Hospital birth … which woman does not want to give birth in hospital in these days? Ask any pregnant woman where she is planning to give birth, and you will find that 96%+ of them will answer, “hospital”.

Less than 3% women will plan to give birth in a birth centre, and approximately 1.5% to 2% will succeed. 0.2% women Australia-wide will birth at home.

Hospital has been the first choice for women who are planning to give birth. Women choose to have their babies in hospitals because they are afraid not to. They are scared that if something goes wrong and they are not in hospital, that their baby will die, or that they will be harmed. They think that having a baby is like undergoing a major medical event so that they feel safe to be close to modern technology and a skilled obstetrician. The more the obstetrician costs, they better they must be. The more equipment and technology available in the hospital, the better it must be.

They are equally scared that if they don’t have a hospital birth, then they or their babies would die. In short, women no longer trust their body to give birth, despite the fact that it has been shown throughout centuries that women’s bodies are perfectly suited to give birth.

Some people argue this point, saying that mortality rates have come down dramatically since we moved birth to hospitals. And yes, mortality has come down and birth has moved to hospital. But it is not a cause-and-effect relationship. In fact, when birth moved to hospitals, MORE women and babies died. They died of infection because doctors would work on cadavers and then attend women in birth. They did not know about infection control.

The mortality rate came down after sanitation improved. Another important change was the development of a transport system that saw food being delivered to people year-round – fruit especially. Improved education and literacy also made a big impact. This all combined to improve the health of women and babies. Later, when contraception became more widely available, women were able to space their children, and this too meant healthier women and babies.

It is very rare, that a woman asks herself whether labour and childbirth are really life threatening and dangerous. This is because all women today are being bombarded practically from childhood to womanhood by the message that childbirth is dangerous. The fact that media portray that childbirth is full of complications and that most women will need medical help to give birth helps to reinforce this myth. How many TV shows depict birth as being easy, safe, painless and non-technical? Very few. And many women poo-haa those scenes saying, “oh, she must have been lucky”. Luck has nothing to do with it. Preparation, choice of care provider and place of birth, and determination have everything to do with it.

For most women, labour and childbirth are normal events.

Labor And Childbirth Are Normal Events
Women who are healthy and have low risk pregnancies should be able to give birth naturally if they are given correct information and preparation on how to do so. I am not of the belief that women need any pain relief in a normal labour. And without the use of pain relief, the vast majority of women will birth without complication.

Most Childbirth Complications Are Iatrogenic
Complications and/or horrible birth experiences that some of these supposedly low risk women experience are not caused by their body’s inability to give birth, but are often caused by medical interventions introduced one after another, during the hospital birth.

It looks something like:
- have an induction because you’re a couple of days past your due date
- this involves giving you gel so your cervix softens
- when your cervix is soft, your waters will be broken
- you will then need a drip to start labour
- because you have a drip (which can stress the baby), you will need continuous monitoring of your baby’s heart rate – that’s that monitor that they strap to your belly. Or, the staff may screw an electrode into your baby’s head and you will have 1 less belt on your tummy
- the drip will be increased until you are in good strong labour
- hopefully this process does not stress your baby. But most likely, it will stress you.
- unable to access the bath or shower or move into positions that help your body to birth your baby, you will need pain relief.
- you start on the gas
- the contractions are too strong for the gas
- you accept a dose of pethidine or morphine
- that wears off.
- you accept an epidural
- you will be examined regularly to assess progress
- you are now in bed, immobilised.
- your baby cannot move effectively through your pelvis
- your baby, unable to descend through your pelvis aided by gravity, and pounded by strong contractions, may become distressed
- if you are not yet fully dilated, you will have a caesarean
- if you are fully dilated, you will have forceps or a vacuum. Maybe an episiotomy too. And stitches
- you have an injection to speed the delivery of the placenta. Your uterus may be tired from the strong syntocinon-induced contractions. You may have a post-partum haemorrhage.

That’s called the cascade of intervention. Google it. It makes for interesting reading!

It is clear that for the most part, it is the hospital or doctor that causes the unnecessary complication of what is supposedly to be a low risk labour. This is achieved by interfering with the course of normal pregnancy or labour every step of the way. One intervention simply leads to another. Sometimes, it even starts in pregnancy with an ultraound because the baby is too big ….

In the scenario described above, see if you can count how many interventions the woman had (answers at the bottom). Let me know if I’ve missed any!

Of course, medical technology can be a life saver for true emergency situations. And I wholeheartedly promote hospital birth for high-risk women. But, the majority of women are not in this category. According to WHO, 80% women have healthy pregnancies.

You may have heard the legal phrase, “innocent until proven guilty”. Unfortunately, this does not apply to pregnant and birthing women in the hospital system. They’re guilty (high risk) until proven innocent (low risk) …. and unfortunately, that’s not until after the labour is over. In obstetric terms, birth is only normal in retrospect. Whereas midwives will always look for normality.

It is therefore not surprising that with this kind of birthing philosophy, birth becomes a more and more of a medical event rather than a normal family event.

Fetal Monitoring
Aside from this kind of obvious interventions, there are other routines along with the ‘dos and don’ts’ within the hospital policies that can potentially cause complications. The routine use of fetal monitoring during hospital birth, for instance, may seem harmless. But it also means you’ll have to lie still for the duration of the monitoring. You may be able to assume other positions, but continual movement will not permit the monitoring to pick up the baby’s heart rate. Unless a “clip” – read – thin wire that’s screwed into the baby’s head – is used.

To make things worse, the trace obtained from this machine (CTG) is often misinterpreted. Studies have shown that if you show the same trace to several people, they’ll all give different interpretations. And if you show the same trace to the same person, a few times over, each time the person will give a different opinion regarding the welfare of the baby.

Indeed, it has been shown that the use of CTG is associated with a dramatic increase in caesareans, without providing an improvement in outcome, compared to the use of the doppler to monitor the baby’s heartbeat.

Hospiral Policies
Interestingly, a lot of hospital policies are not in place to make birth easier. You would think that hospitals would help you to have a more natural experience. Rather, they are designed for the sake of efficiency and legal protection. As an institution, hospitals are more interested in managing the patients, than accomodating every client’s whim. The welfare and feelings of the woman are often taken out of the equation in the policy-making process. As long as the woman and baby are alive at the end of the process, it doesn’t matter whether women and babies are suffering unnecessarily. Suffering is hard to measure legally, whereas outcomes such as low apgar scores and duration of labour, are easier to measure and account for.

When you birth in an institution, no matter how person-friendly it seems to be, at the end of the day, you are on a production line. It is very process-oriented. The midwives are usually expert at not having you feel that you are on that conveyor belt. But you are. You are a thing to be processed according to hospital policies, deviations from which will not be tolerated because it interferes with the smooth running and efficiency of the whole machine (institution). The faster you can be put through the conveyor belt, the better for the institution. They can then have more through-put (income). Or, they (or their share holders) can benefit from fewer expenses (staff time) related to a shorter stay in delivery suite.

Thank you, Doctor
Unfortunately, many women think it’s normal to suffer greatly during childbirth. It is also quite common that they continue to believe that their bodies are abnormal and cannot withstand childbirth. They feel forever grateful to the hospital and their doctor, the one who saved them from the misery of childbirth, or who saved their baby from death. Little that they know that the source of disaster can be from the hospital intervention, not because of their bodies.

Hospital Is Not A Good Place For Healthy Babies
Finally, hospitals may not also be a great place to greet your newborn into the world. Aside from the fact that a hospital is a place full of antibiotic-resistant germs, a lot of hospitals also do not treat the newborn as respectfully or as kindly as you want it to be. In addition, there is usually separation between mother and baby after birth. At least for some time – maybe the baby will be in the same room as you, but may be assessed on the resuscitaire (how many women ask that their baby be assessed in the bed or on the floor or in the bath / shower with them?)

Also, many babies are separated from you over night “to let you get some sleep”. This sounds like a good thing at the time, until you get home and do not know what to do with your baby in the wee hours of the morning.

To Sum Up – The Truth Of Hospital Birth
In short, if you are planning to have a natural birth in hospital, consider the following:

Hospitals are rampant with medical intervention which can increase the risk of complications. As a result, you are at higher risk of having an unnecessary cesarian section if you choose a hospital birth.

You are not in control of your birth. Instead, hospitals control the birth through policies.

Hospitals are full of policies (routines) that are neither evidence-based nor birth-friendly.

In hospital, birth is viewed as a medical, not a normal, event. The health care professionals at the hospital are trained in pathology of birth, not normal birth.

The hospital environment may be impersonal and less cozy. This may impact your birth experience.

It’s almost impossible to have an intimate birth at a hospital.

Hospital Birth – YES or NO
After pondering the above facts, I hope you can now make your own decision on where you want to have your natural birth.

You have to realise that if you choose hospital birth, you have to be ready with all the consequences. A lot of time, requesting or rejecting certain procedures can cause irritation and misunderstanding between patient and the hospital staff. This friction may create a hostile or awkward environment which can make you feel uncomfortable and hard to relax.

Is this the environment you would like to be for your labour and birth ?

What are the other options?

There is good news!! There are two other options.

1. If you are a healthy woman, having a normal pregnancy, birth your baby at home with a registered midwife.

2. If you prefer to birth in hospital, or if you need to birth in hospital because you have a high risk pregnancy, employ the services of a private midwife. She can provide your antenatal (pregnancy) and postnatal (after baby is born) care and birth with you in hospital.

If you birth in hospital, expecting a natural birth, and you do not have a private midwife with you, this is much the same as doing your supermarket shopping in Bunnings. Newsflash! Bunnings do not sell groceries. Do not be disappointed when you do not find groceries in Bunnings. Rather, do your research and make choices that are aligned to the sort of birth you want to have. If you desire a natural birth and you’re healthy, have a home birth or a private midwife for a hospital birth. You do not need anyone’s permission (hospital, doctor etc). No more than you need their permission to have a massage or eat chocolate mousse. Private midwifery is known to carry a high natural birth rate and deliver excellent clinical outcomes to women and babies. The World Health Organisation recognises midwives as primary care providers for healthy, low risk women because midwifery care is know to deliver the best outcomes for this large group of women. For high risk women who are birthing in hospital, private midwifery will see you experiencing the minimal amount of intervention necessary.

ANSWERS:
1 gel
2 waters broken artificially
3 syntocinon drip to start labour
4 syntocinon drip to keep labour going
5 continuous monitoring
6 immobility
7 lack of access to the required tolls to facilitate normal labour
8 gas
9 pethidine or morphine
10 epidural
11 labouring in bed, unaided by gravity
12 caesarean or forceps or vacuum
13 vaginal examinations
14 forced (directed pushing) – needed with an epidural

These are the direct interventions. But what about the indirect interventions?

15 birthing in an unfamiliar environment
16 birthing with strangers
17 lack or direct one-to-one midwifery support
18 lack of continuity of care (can be assumed since vew few women are able to access this option in Australia)
19 imposed time limits on labour
20 managed third stage
21 separation of mother and baby after birth: a baby who is born after an operative delivery (caesarean, forceps, vacuum) will be taken to the resuscitaire for assessment by a paediatrician
22 breastfeeding will be impacted
23 bonding will be impacted.

Have I missed any? Let me know.

So …… 23 interventions when you thought you were only signing up for one!

Melissa Maimann, Essential Birth Consulting 0400 418 448

Offspring’s Behavior Influenced By Trauma Experienced By The Mother Even Before Pregnancy

Posted on May 18, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Juat an interesting article I came across ….

Article

new study in rats at the University of Haifa reveals that tauma experienced by a mother even before pregnancy will influence her offspring’s behavior.

The findings show that trauma from a mother’s past, which does not directly impact her pregnancy, will affect her offspring’s emotional and social behavior. We should consider whether such effects occur in humans too,” stated Prof. Micah Leshem who carried out the study.

A mother who experienced trauma prior to becoming pregnant affects the emotional and social behavior of her offspring …

The effects of trauma that a mother experienced in the course of pregnancy are known from earlier research, but until now the influence of adversity before conception has not been examined …

The researchers chose to investigate rats, as social mammals with cerebral activity that is similar in many ways to that of humans. The present study examined three groups of rats: one group was put through a series of stress-inducing activities two weeks before mating, allowing the female time to recover before becoming pregnant; the second group was similarly treated over the course of a week immediately prior to mating; and the third, control group, were not given any form of stress. When the rats’ offspring reached maturity (at 60 days), the researchers examined their emotional behavior – anxiety and depression – and social behavior.

The main finding revealed that trauma experienced by the females prior to conception had varied effects on the offspring … these effects varied between groups and between male and female offspring; but their behavior was without doubt different from that of the rats from the control group.

All the offspring of stressed mothers showed reduced social contact compared with that of the control mothers’ offspring: these rats spent less time with one another and interacted less. In other tests, there were important sex differences. The female rats displayed more symptoms of anxiety, while the males exhibited less anxiety. Finally, those rats whose mothers became pregnant immediately after being stressed were hyperactive, indicating that how long before pregnancy adversity is experienced, is also important. “Everyone knows that smoking harms the fetus and therefore a mother must not smoke during pregnancy. The findings of the present study show that adversity from a mother’s past, even well before her pregnancy, does affect her offspring, even when they are adult. We should be prepared for analogous effects in humans: for example, in children born to mothers who may have been exposed to war well before becoming pregnant,” Prof. Leshem concluded.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Postpartum Depression Is Top Priority For New ACOG President

Posted on May 12, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Link to article

Today Gerald F. Joseph Jr, MD, of Louisiana, became the 60th president of The American College of Obstetricians and Gynecologists (ACOG)… . During his inaugural speech at ACOG’s Annual Clinical Meeting, Dr. Joseph announced that postpartum depression is the theme of his presidential initiative.

“While in an ideal world, the newly delivered mother is at the peak of her reproductive health, with a beautiful child and, ideally, a supportive, loving family, this unfortunately is not always the case,” said Dr. Joseph. “Studies show that this is a most vulnerable time for our patients, especially those prone to depression or those with a history of depression.” Complicating matters is that the new mother often can’t bring herself to admit to any problems or negative emotions due to societal pressures, he said. Instead of asking for help, she may feel guilty for not being ‘grateful’ or a ‘good’ mother.

Dr. Joseph explained that the ‘baby blues,’ which affect as many as 80% of new mothers, usually start early after delivery and spontaneously resolve within a very short period of time. “But what happens when these negative feelings don’t resolve and true major depression becomes a part of the process?” he asked. “This can be devastating for the mother, the child, the partner, the family, and the ob-gyn who is caring for her.”

There are three areas in particular that need to be addressed, according to Dr. Joseph. “First, we need to determine the true prevalence and incidence of postpartum depression,” he said. … postpartum depression is estimated to range anywhere from five percent to more than 25 percent … we need to develop evidence-based guidelines for ACOG members to screen for postpartum depression.”

It would be great if there was some sot of acknowledgement of the role that pregnancy- and birth-related interventions have on the incidence of PND. It would also be great to see a study looking specifically at women with PND, to establish what sort of birth experience the woman had, and who her primary care provider was (midwife or obstetrician). It’s not hard to see that when women are told, overtly or covertly, that their bodies don’t work and that they need intervention to start labour, keep it going, or bring it to an end, that they take this learning away to motherhood, and approach motherhood with the same sense of failure.

Rates of PND are lower with midwifery care and with home births. Birth debriefing may help women who are experiencing PND.

Melissa Maimann, Essential Birth Consulting 0400 418 448

The Benefits of Using a Midwife During Childbirth

Posted on May 11, 2009 by Melissa Maimann

In Australia, all babies are born with the help of a midwife. This is true whether you’re giving birth in hospital, birth centre, at home or in an operating theatre. The question is really – what are the benefits to having a midwife as your primary care provider?

So, what is a primary care provider?
A primary care provider is someone who is responsible for your pregnancy and birth care. It will either be a doctor or a midwife, and in some circumstances, it will be both. Women may choose birth centre, homebirth or hospital midwifery care to benefit from primary midwifery care.

Primary medical care is provided by private obstetricians or through doctor’s clinics in public hospitals.

What are the benefits of having a midwife as your primary care provider?
Midwives generally have a firm belief in pregnancy and birth as natural processes that women can do. In other words, they believe that a woman’s body is perfectly designed for pregnancy and birth. They look for what’s right in the pregnancy and birth, while always being mindful of risks. Midwives help to keep pregnancy and birth normal by focussing on nutrition, lifestyle, health and well being. We that with health in general, healthy people are less likely to get heart disease, diabetes and so on. Well, it’s the same in pregnancy and birth: healthy women and babies are less likely to get sick. So midwives focus on health and well being, while always being alert for situations that need more attention.

Midwives use a holistic, or biopsychosocial model of care. What this means is that you’re not just a pregnancy or a birth to a midwife. You’re a woman, mother, friend, wife, partner, employer / employee and so on. Your midwife will seek information about your life, your family, your interests and so on, as well as your health and medical history. She will take all of this information into account when making recommendations and giving advice.

Midwives are less likely to use disruptive technologies that may lead to further intervention and complications. They’re less likely to induce labour, perform an episiotomy, perform vaginal examinations, break your waters and so on. So your labour is allowed to progress naturally. When you work with your body, it will work with you. When you interfere with your bodily processes, your body will not work as well. This is especially the case in birth where there’s a strong reliance on hormones to initiate labour and keep it going.

Women are usually very satisfied with midwifery care. They feel supported, emotionally, from seeing a midwife. They feel they can trust their midwife and that their wishes are respected. Women feel more comfortable to write a birth plan and discuss their hopes and preferences for their pregnancy and labour when they see a midwife.

So, what does this mean for birth and babies?
Well, there are lots of positives! When you have a midwife as your primary care provider, you can expect:
- choice of birth place (hospital, birth centre, or home)
- a lower rate of caesarean
- a lower rate of episiotomy
- you’re less likely to be induced
- you’re less likely to need pain medication in labour
- you’re less likely to have your waters broken
- you will be listened to and respected
- your birth plan will be respected
- you will be able to build trust with the midwife who will help you in birth
- you will be less likely to have an assisted birth (eg forceps)
- you will have a lower chance of getting postnatal depression
- you will be less likely to have birth trauma
- you will be more likely to bond well with your baby
- your baby will be more likely to breastfeed successfully
- you will most likely view your labour as being very positive

Visit my website to learn more about my services.

Crackdown on doctor rorts: IVF and Obstetrics

Posted on May 7, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Link to article

MEDICAL specialists will come under pressure to cut fees for some services – especially in obstetrics and IVF – under a plan in next Tuesday’s federal budget to crack down on rorting of the Medicare safety net.

Under the changes, patients charged excessive fees will have new limits put on how much they can claim back on the Medicare safety net. This could leave some people facing large out-of-pocket expenses for obstetrics, IVF… and some other services if they use high-fee specialists.

But the Government hopes its crackdown, rather than penalising patients, will instead put pressure on high-end specialists to moderate charges.

As an incentive to specialists to cut fees, the Government will increase the cap on its coverage of the services – in effect, raising the base level of its rebate.

… Since the advent of the safety net, fees have leapt by 290% for IVF and 40% for obstetrics – giving rise to claims that the system is being rorted.

… Areas targeted for cuts include artificial reproductive technology (IVF), obstetrics and varicose vein treatment, identified in a report into the scheme.

… The net will continue to cover 80 per cent of patients’ out-of-pocket costs once they reach the threshold – but only up to a new limit in “capped” areas.

… The review found that the safety net benefits were going excessively to some specialists.

For some obstetrics and IVF services, of every dollar spent on the safety net, “78 cents is going to providers and only 22 cents to reducing patients’ costs”, the review said. Providers knew patients were likely to qualify for the net and felt “fewer competitive constraints on their fees”.

Between 2003 and 2008, the average fee charged for planning and management of an artifical reproductive treatment cycle increased from $294 to $1148. The average obstetrics fee for planning and management of a pregnancy rose 40 per cent between September 2004 and 2008 – from $1238 to $1732.

Specialists’ incomes in these areas have soared. In 2008, the highest 10 per cent of IVF specialists were paid $4.5 million each through Medicare – including $2.2 million through the safety net.

In addition to providing incentives to moderate fees, the higher obstetrics medical benefits are also designed to give more incentives for obstetricians to practice in under-serviced areas …

It will be interesting to see the added effects if the changes proposed in the Maternity Services Review are implemented. Those changes will provide private midwives with the right to order tests, prescribe medications and bill through Medicare. In effect, women will have the choice of the public health system, a private obstetrician, or a private midwife. Private midwifery will no doubt be far cheaper for women than private obstetrics, and will confer greater benefits in terms of:
- lower rates of postnatal depression
- lower rates of birth trauma
- lower rates of intervention in pregnancy and labour, and lower rates of complications from said intervention
- higher rates of natural birth
- higher rates of breastfeeding
- higher rates of birth satisfaction from women
- less birth trauma for the baby
- lower rates of admission to special care nursery for the baby
- fewer antenatal (pregnancy) admissions to hospital
- more care provided in women’s homes than hospitals
- lower caeasarean, induction, epidural, episiotomy, forceps and vacuum rates
- higher rates of VBAC
- true continuity of care – even with private obstetrics, you are cared for by midwives you have not met before; with private midwifery, all your care is with the same midwife who you’ve chosen
- more choice and control in birth

Melissa Maimann, Essential Birth Consulting 0400 418 448

Breastfeeding debate revived after death of British mother Katy Isden

Posted on May 6, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Link to article

THE death of a British mum in despair at not being able to breastfeed properly should well shock the world but will not surprise some mothers … Sitting among the flowers and cards, clutching her first-born child, my sister Lia could do nothing but sob.

Left alone in her hospital room and attempting to breastfeed her new daughter for the first time on her own, she felt her anxiety skyrocket, the mother guilt take over.

A broken emergency buzzer didn’t help, nor post-birth hormones and lack of sleep.

But almost two hours after she’d begun trying to attach her baby’s small mouth to her painfully engorged breasts, my niece was screaming and so was her struggling mum.

… Her experiences with the births of her next two children were equally traumatic, marred by a recurrent sense of inadequacy and in the case of her third, mastitis so bad she was forced to temporarily relinquish care of her family to seek medical help.

News, then, of the death of 30-year-old British mother Katy Isden, who fell to her death from a New York apartment block after becoming depressed over her bid to breastfeed, should well shock the world but will not surprise mothers with tales like my sister’s.

… “The pressure to breastfeed, the anxiety to be this super person, is just no way to live.”

The coroner said that although Mrs Isden had been depressed when she died, it was not clear if she fell or jumped. He therefore recorded an open verdict.

… The research about the benefits of feeding babies “naturally” – delivering vital nutrients and a bond between mother and child – appears black and white.

But for many it’s anything but a natural experience; rather a grey area of conflicting advice and a trauma that can torture women.

… there is no doubt support is the key to relieving the pressure.

Extra funding for the Australian Breastfeeding Association’s national helpline resulted in a 30 per cent increase in those seeking help since March, with more than 28,328 calls taken between October and April.

… “So many of us have issues,” she said. “This is a matter of seeking assistance, not being left to feel like a failure.

“The solution is for the community to get behind mothers rather than patronising them with the ‘breast is best’ slogan. It’s what’s best for you and your baby that counts, not breastfeeding at any cost.”

The ABA’s 24-hour helpline is 1800 Mum(686) 2 Mum (686)

Support is most definitely the key to successful breastfeeding, which is, without a doubt, the safest way to feed a baby – safest for mother and safest for baby. But I do wonder if we set women up to fail. Our current obstetric system churns women out as mothers who have “failed” even before they hold their baby for the first time. They “failed to progress” in labour, they were a “failed induction”, they had an “incompetent cervix”, they “failed to dilate”, their pelvis was too small. However you phrase it, the message is clear: women’s bodies don’t work; their bodies are broken. Is it any wonder that with this mindset in action, they also fail at breastfeeding?

To look at it from another perspective, breastfeeding can be effortless and enjoyable. If we look at what goes on in birth, before the breastfeeding experience, we see that a relaxed and healthy breastfeeding experience is correlated highly with a natural birth (no induction, no epidural, no caesarean etc). If you like, natural birth primes mother and baby for breastfeeding. Maybe we’re expecting too much of mothers and babies to breastfeed successfully after their induced, pethidined, epiduralised, and surgically-extracted birth. Babies are traumatised by their birth experience, as are mothers. The cocktail of natural hormones that lights the path for a successful breastfeeding experience is grossly absent. Not just absent, but the very hormones that are the anti-dote to the natural-high-hormones, are present in ever-abundant quantities.

Women report feeling a disconnect with their baby when they meet their baby for the first time after a labour and birth that has been marked with various interventions. They report not bonding. That they really had to work at the relationship with their baby. And some women even resent their baby. All of this is very uncommon after a natural birth without drugs, induction, epidural, forceps, episiotomy and of course caesarean.

The best way to achieve a natural birth is to choose a care provider who specialises in natural birth. Currently, we have 2 types of maternity care providers: midwives and obstetricians. Obstetricians are surgical specialists. That may come as a surprise for some! But it’s true: obstetrics is not a medical specialty. It’s a surgical specialty. Obstetricians, on the whole, do surgery. And most do it very well. Thankfully!! Midwives on the other hand, are natural birth specialists. We’re trained in recognising normal, keeping pregnancy and labour normal, and in getting help when things are no longer normal. If you see a midwife and have a natural birth, you’re highly unlikely to ever have the issues with breastfeeding that are described in this article. Not to mention, if you did have problems with breastfeeding, your private midwife would be following you up for 6 weeks after your baby is born, so you would have a midwife on the end of the phone, 24/7 who knows you well, who has known you the whole of your pregnancy. The continuity of care provided by a private midwife is known to reduce breastfeeding complications and postnatal depression, whether you birth at home or in hospital.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Do women prefer caesareans?

Posted on May 6, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Link to article

Study results suggest that women do not really see decision-making about birth method as their “choice” and challenge the notion of choice currently prevalent in international debates about cesarean delivery for maternal request (CDMR).

CDMR is currently perceived as a leading reason for increasing cesarean section (CS) rates by obstetricians worldwide.

… study researchers explored the views and experiences of 454 primigravid women accessing National Health Service maternity care to analyze decision-making surrounding birth method.

In total, 72 percent of the 397 women who returned their questionnaires reported that they would prefer to give birth vaginally, while only 3 percent reported a preference for planned CS.

By late pregnancy the proportion of women expressing a preference for CDMR declined to 2 percent, while those reporting a preference for vaginal birth increased to 80 percent. Furthermore, only one woman out of 454 women consistently expressed a preference for planned CS.

… Moreover, women accepted that their actual birth method would be determined by the circumstances of their pregnancy, and questionnaire responses indicated that over 55 percent of women believe their right to choice should be overridden by healthcare professionals.

Carol Kingdon (University of Central Lancashire, Preston, UK) and co-authors recommend, in light of the study findings, that birth options should be revisited and discussed at different time-points throughout pregnancy.

Melissa Maimann, Essential Birth Consulting 0400 418 448

No room at hospital for ‘high-risk’ pregnancies

Posted on April 24, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Link to article

PREGNANT women were being turned away from Bowral
Hospital because the maternity ward doesn’t treat high-risk pregnancies, a mother of six has claimed.

The News understands there is only one permanent obstetrician currently on staff after two had left during the past six months.

Several women claim they were told they couldn’t deliver at Bowral because they were considered high-risk and not because of inadequate resources.

… the hospital no longer delivers babies for women who have had caesareans.

Mother of six Kellie Bennett said she was forced to have her first home birth in February after her obstetrician … left the hospital late last year.

… A GP told Mrs Bennett a few days later she couldn’t deliver her baby at Bowral because the hospital had a no-vaginal birth after caesarean policy.

She was told she would have to attend Campbelltown Hospital, but should be prepared to travel to Liverpool Hospital as Campbelltown had issues with their own numbers and may not be able to accommodate her.

Mrs Bennett’s fifth child was delivered via caesarean in July 2007 with no complications.

Worried about where she would deliver her most recent child, Mrs Bennett arranged to meet Bowral’s temporary obstetrician at the time … to discuss a plan of action … She was unsatisfied with the response.

That was the last time Mrs Bennett attended Bowral Hospital.

Bowral Hospital general manager Denis Thomas denied there was a policy of rejecting women with previous caesareans.

… He said Bowral was not equipped to deal with high-risk pregnancies and only catered for women with low risk and selected moderate risk pregnancies.

After obtaining her medical records before her home birth Mrs Bennett said she discovered abnormalities in her previous pregnancies.

She said her fourth child was delivered by caesarean because she was told it was in a difficult breech position but her records show the baby was in normal breech position for a natural birth.

…She added she was told she was at high-risk because of high blood pressure, but her records didn’t indicate that.

“I was upset at the time as I assumed they knew best,” she said. “Maybe women who are told they are at high-risk aren’t at high-risk at all.”

The Colo Vale resident wondered if women were being unnecessary induced and given caesarean births because of the lack of resources at the maternity ward.

…. The birth of her sixth child Matilda on February 27 went perfectly and she recommended home births to other expectant mothers.

… Mrs Bennett said more information on home births needed to be available to mothers if the hospital was unable to look after them.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Lessons from Labour

Posted on April 20, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Link to article

Dr Hannah Dahlen wrote a great article on Unleashed. She is the Associate Professor of Midwifery at the University of Western Sydney. She has been a midwife for more than 20 years. Hannah is also the Secretary of the Australian College of Midwives, NSW Branch. She has researched women’s birth experiences at home and in hospital and published extensively in this area.

I have had the pleasure of Hannah’s company several times and I am impressed by her skill, commitment and dedication.

The front page of the Daily Telegraph ran the sensational headline recently ‘Four dead in home birthing’. The article went on to say that at least four babies had died ‘during homebirths in the past nine months’ and a further four babies had suffered brain damage. This was presented as ‘fact’ although it remains unconfirmed to date.

The facts we have from the latest Australian Institute of Health and Welfare (published in 2008), indicate that 708 women had planned homebirths in Australia in 2006 (0.3%) and there were no deaths reported amongst these births. In this same year 2730 babies died – most of them in Australian hospitals. While we must remain committed to trying to reduce these deaths, the reality is this rate has remained unchanged for nearly 15 years, despite a doubling in the caesarean section rate.

What has been missed in this debate is the difference between a planned home birth for a woman with a low risk pregnancy attended by a competent midwife who is well networked into mainstream services (supported by evidence as safe), and a birth at home where there is no professional care or where the woman has risk factors in her pregnancy (supported by evidence as less safe).

To put some balance into this argument the following issues need to be considered.

Firstly, the intervention rates during childbirth have sky-rocketed over the past ten years in Australia, leaving many women traumatised and fearful. A first time mother in Australia now has a greater chance of having surgical intervention during her birth than of not having it. Miranda Devine’s mocking disregard for the emotional trauma that stems from this reality was evident in her article ‘A home birth is not a safe birth’.

Secondly, options of care for childbearing women remain limited with around three per cent of women able to access continuity of midwifery care.

Thirdly, around 130 maternity units have shut down in Australia over the past 10 years, many of these in rural and remote Australia, leaving women with little option but to travel great distances from family and community to give birth. The rising incidence of ‘roadside births,’ is the unintended consequence of such actions.

Fourthly, privately practicing midwives have not been able to obtain affordable insurance since 2000, leading many to stop practicing, with the remaining midwives practicing uninsured and without visiting rights to hospitals. Midwives cannot even order routine blood tests or ultrasounds and often find it difficult to obtain the results for the women they care for, causing delays in appropriate management.

Fifthly, there are very few financial rebates women can access for midwifery care, and they pay between $3000-5000 dollars for this service. Some women clearly cannot afford it.

The ramifications of these issues are: more traumatised women due to interventions during birth; fewer options of care – especially continuity of midwifery care; fewer experienced, networked midwives available to attend women privately; and no access for women to a hospital birth under a private midwife. The result has been increasing numbers of unattended births and more women with high-risk pregnancies seeking midwifery care at home.

The rise in the numbers of unattended births is ironically being seen in two countries – Australia and the USA – both with the highest intervention rates in birth and limited access to continuity of midwifery care.

The answer to all this is not to demonise women but to stop and consider our responsibility as a society to mothers and babies. It is time we made our maternity care system accountable and really listened to what women are telling us. Over 400 submissions from women to the government, as part of the National Maternity Review should not be dismissed as irrelevant, as Miranda Devine seemed determined to do. It is time to make birth safe, physically, emotionally, culturally and spiritually.

Never before in history have women been able to reap the benefits of safe and satisfying birth like we can now. We need to give women access to choice and continuity of care, where midwives and doctors are willing and able to work together respectfully. We need to begin to reconstruct our maternity system with women, their babies and families at the centre – not the health professionals and their inevitable turf wars.

In the United Kingdom they have made an effort to do just this, with a joint statement on home births produced by the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives. In this joint statement they say, “The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that 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.”

In Scotland they are now urging mothers to give birth at home. In the Netherlands where 30 per cent of babies are born at home, and the caesarean section rate is more than half ours (14 per cent versus 31 per cent), both private insurance companies and government health funds cover only midwives or general practitioners and home birth; or short stay hospital births (anything more women pay for), for low-risk pregnancies.

Financial support for care from an obstetrician is only available to women with high-risk pregnancies. For women with low-risk pregnancies in the Netherlands, outcomes of planned home births are as good or better than the outcomes of hospital births. The often misquoted Bastian study of homebirth in Australia between 1985 and 1990 showed, “while homebirth for low risk women can compare favourably with hospital birth, high risk home birth is inadvisable and experimental.”

The Bastian study provided what we call low-level evidence – the study design was retrospective (looking back at what had been done), it included births by non-registered and registered midwives and it used a number of methods to collect the data (eg searching newsletters for death notices). The one study you will never hear the medical profession quote is the USA home birth study. This was a prospective study (gathering data as it happens) looking at 5418 low risk women who planned a home birth with midwives in the USA and Canada in the year 2000. There was no difference between the numbers of babies dying at home or in hospital, but the intervention rates were significantly lower amongst homebirth women.

The largest study done to date in the world was published this month and showed that out of more than 500,000 births in the Netherlands there was no difference in outcomes for babies of planned homebirths and babies of planned hospital births. What all this research indicates is homebirth is safe for low risk women under the care of competent, networked midwives who work in collaboration with mainstream maternity services.

Recent media has revealed the hazard of ignoring this evidence.

Whatever your beliefs about home birth, the facts are this – never in history, and in no country on earth, has homebirth ever been eradicated. There are two potential responses to this fact. One, we put in place supportive, safe, collaborative systems of care that respect a woman’s right to choose her place of birth and care provider, like they have in the UK and the Netherlands, or two, we bury our heads in the sand and hope it will all go away.

This last choice is the one we have made to date in Australia and it is clearly not working. It’s time to take the proverbial ‘log’ out of our own eye and seriously consider where we have let women down in the maternity system we currently make available to them, before we try to pick the ‘spec’ out of our sister’s and criticise the choices some may make.

Perhaps then we will all see more clearly, and hopefully respond more wisely.

I think what really needs to be addressed is the hospital system that currently delivers the majority of maternity services. We can enable independent midwifery practice, open birth centres – even freestanding birth centres – but until we address the real issue – the medically-dominated and un-woman-centered care that is present in most hospitals, we will not move forward.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Your Perineum: To tear (or cut!) or not to tear?

Posted on April 19, 2009 by Melissa Maimann

The NSW 2006 data reveals interesting statistics about the fate of your perineum in NSW hospitals. Overall, 13% – 56% did not have stitches after their birth. The average was 27%.

3% – 35% women had an episiotomy. Huge variation, don’t you think? The average was 15%.

When we look at first time mums, 12% – 51% birthed their babies and needed no stitches. The average was 32%. And episiotomy rates varied from 2% – 45% (average 18%).

In home birth studies, 53% – 66% women have an intact perineum (no tears, no stitches). Episiotomy rates vary between 1% and 4%

So if you don’t want to have stitches after you have your baby, and if you don’t want your vagina to be cut, choose a home birth with a midwife. A very large and recent study has shown it (once again) to be very safe for healthy low risk women. Phone a midwife today to talk about homebirth.

Visit my website to learn more about my services.

A hospital is not a natural environment for a natural event

Posted on April 18, 2009 by Melissa Maimann

Visit my website to learn more about my services.

Link to article

This week a study – the largest of its kind – was published in … an International Journal of Obstetrics and Gynaecology. It showed that giving birth at home was “as safe” as giving birth in a hospital.

Periodically, we get studies like these. They come, they make a bit of a splash and then they go again. What they’re saying however is so fundamental that we can’t ignore it. Because a woman’s experience of labour can shape her entire life, even the relationship she then forms with her child.

I’d go further than these studies and say that giving birth at home, these days, is safer than being in a hospital. A woman in labour needs to be confident and relaxed. Fear is the enemy of labour progressing because it causes the woman’s body to release adrenalin which inhibits oxytocin – the hormone needed to make the uterus contract.

A pregnant woman needs to build a relationship with her midwife so that she feels confident and the midwife can anticipate problems before they actually occur. Despite popular scare-mongering, a woman or her baby don’t just die without warning in labour. There are signs that something is amiss, and these signs can be missed in a busy hospital.

All of this is difficult to achieve in a hospital where you’re in a strange place, with people you may have only just met coming and going (“how are you getting on?”) and with the almost constant threat of induction (which ironically is when they administer artificial oxytocin – having inhibited the natural stuff – to speed things along) if your labour doesn’t conform to their timetables.

In The Father’s Home Birth Handbook (a quite brilliant book, as dads are often more fearful than women of homebirths), it asks which would you prefer? Having sex at home, all low lights and candles; or in a hospital with bright lights, and where everyone is monitoring your every move. A hospital is not a natural environment for a natural event.

Eight weeks ago I gave birth to my second child. She was born at home. I had no drugs. Easy for you, you may be thinking: you were obviously low risk, brave and had a high pain threshold. I was none of those things. I was 42, my previous labour had ended in an emergency C-section and I’d spent five years grappling The Fear. But, crucially, since I’d last given birth, I’d been a lay representative in a major maternity hospital (so I had also seen the wonderful things hospitals could do) and spent four and a half years as co-founder of a parenting board. I learned that the majority of problems with childbirth weren’t solved by hospitals, but introduced by them.

When I hear a woman say, “If it wasn’t for the hospital little Johnny would be dead” and trace the story back, nine times out of 10 you see little Johnny would never have got into distress if his mother hadn’t been in a hospital in the first place.

Home birthsaren’t for everyone. But then, neither are hospital births, which also carry risks. We’re in a unique position now in that we have more medical knowledge than ever before and most of us are near a hospital in case we need to transfer. Yet women are still told of all the risks of a home birth, and none of the benefits. The latter far outweigh the former.

Melissa Maimann, Essential Birth Consulting 0400 418 448

530,000 new mums prove home births safe

Posted on April 17, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Link to article

WOMEN who give birth at home with a midwife are just as safe as those who go to hospital, a major study has found.

More than 500,000 women participated in the seven-year Dutch study, which showed there was no difference between home births and hospital births when it came to the number of babies admitted to intensive care units.

Upwey mum Gypsy O’Dea, 34, had her first two children in maternity hospitals before delivering third child Reid at home … “Thankfully I had a very uneventful pregnancy and was able to have a home birth. It was amazing, it was the most wonderful thing I have ever done,” she said.

… Ms O’Dea said she decided on a home birth after a traumatic experience in hospital with first daughter Zahra, now 7.

“I ended up having a lot of intervention I didn’t want,” Ms O’Dea said.

… Associate Professor Hannah Dahlen, from the Australian College of Midwives, said home births were completely safe for low-risk women if a trained midwife was present.

“We have known for many years mothers have lower intervention rates and higher satisfaction rates when giving birth at home,” she said.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Mother and baby are doing well

Posted on April 9, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Link to article

The article commences with the story of Rachel, who plans a midwife-attended home birth. Her waters break three weeks after her due date, and after 2 days, there is evidence of meconium in the amniotic fluid. The article goes on to say that two days later, she has a fever and is transferred to hospital, not in labour. Hospital induces labour and the baby has an infection, and has sadly died. The woman bleeds and requires resuscitation, a hysterectomy and two weeks in an intensive care unit.

I cannot vouch for the accuracy of the reporting. We know reporters say what they want to say and sensationalise stories. However, there are a few points I’d like to make, assuming the article is true. There are several risk factors here: 43 weeks (1 week “overdue”, since normal pregnancy lasts until 42 weeks), prolonged rupture membranes, and mecomium-stained liquor (amniotic fluid). Should this woman have birthed her baby at home? Maybe not. Homebirth is the domain of low-risk, healthy birth. What we need is a system whereby the midwife can transfer that woman into hospital and remain her primary care provider. I think blame needs to be laid fairly and squarely with a system that does not recognise the full scope of midwifery practice and that does not welcome privately-practicing midwives in the hospital system. It seems to me that much information has been left out of the story above. We do not know if the midwife has taken the woman into hospital already; perhaps the hospital has discharged her saying all was well. We do not know the point at which the midwife was made aware that the woman’s waters had broken; maybe the midwife was not aware of the situation until after the baby passed meconium. Maybe the midwife had taken the woman for scans after 42 weeks to ensure that the baby was well. My point is, we will never know the full details. We read what the media wants us to read, and this story has heped blacken the name of home birth in this country. What it lacks are the details to support what happened.

‘It is not possible to know exactly what information Rachel was given regarding the possible benefits and risks of planned home birth which led to her decision to choose this option, but it is likely she was told that planned home birth with a qualified midwife is as safe as hospital birth, and decreases the likelihood of medical intervention, which harms women and babies.’

Women who choose homebirth research information as if it were an obsession. Yes, planned, midwife-attended homebirth is safe for low risk women. To say otherwise would be a lie. What we need to communicate very clearly is that when freebirths and high-risk homebirths are added to the equation, the risk profile of homebirth changes significantly.

What happened to Rachel and her baby was a terrible, avoidable tragedy and certainly, the majority of home birth midwives would not have advised Rachel to stay at home as long as she did.

Thank goodness they said it! Homebirth midwives are very risk-adverse.

… it is important to them to feel they can have as ‘natural and active’ a birth as possible when receiving care from mainstream maternity services.

No, it is not important for them to merely “feel” they can have a natural birth in the system, it is important that they actually get a natural birth in the system! With some hospitals having caesarean rates of over 46% (NSW stats, 2006), it’s no wonder women don’t quite trust that they can have a “natural” birth in the system. Whatever natural means these days.

“It is always sad when any baby dies perinatally, but it is even more concerning when it happens to a woman having a home birth, because mothers attempting a home birth should only be those considered to be at low risk of poor pregnancy outcome.”

At least one of the deaths that the article refers to was a freebirth. The important factor that was not present there was a midwife. The emphasis on low risk homebirth also needs to be made. Trouble is, many women are attracted to homebirth because of the deficiencies in the hospital system. So they are attracted to homebirth to:
- Have continuity of care and build a trusting relationship with their midwife. Not midwives, midwife. 1.
- Give birth in familiar surroundings, not an institution.
- Have choice and control because that was taken away from them in hospital.
- Be pregnant and give birth in a relaxed setting that is not dominated by clocks, a delivery bed, drugs, strangers who can come in at any time and shift changes.
- Have care as and when they need it – not have to attend noisy, uncomfortable and impersonal hospital clinics, where they wait for an hour or two and are seen for 5 minutes by a midwife or doctor they have not met before; where they leave with unanswered questions and have no idea what this diabetes test is for that they’re told they have to have (or their baby may die).

What system is this that we’re putting women through? And during pregnancy and birth? These are natural and healthful experiences, not medical conditions. Home birth services are a stark contrast!

It is very disappointing that women can feel completely disenfranchised from any sort of hospital care, and feel that the only way their needs can be meet is to attempt birth at home.

Yes, it is disappointing, isn’t it. hospital birth with a private midwife is a great way around this issue.

RANZCOG considers that there is no place for the ‘independent’ practitioner, working in isolation and having no link with any other health professional or hospital,

No “independent” midwife works in isolation! All IMs collaborate with hospitals, consulting and referring when necessary. We work in our full scope of practice and we are autonomous care providers, as is supported by WHO, FIGO and ACMI.

The four deaths referred to above indicate why RANZCOG is opposed to ‘independent’ practitioners.

Even though at least one of them was not professionally attended?

Melissa Maimann, Essential Birth Consulting.

More press about Home births and Freebirths

Posted on April 9, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Unfortunately, the media does not distinguish between homebirth and freebirth …. I really wish they would!

A home birth is not a safe birth

Reports this week of the death during childbirth of the baby of a leading home birth advocate at her inner-western Sydney home come just as the Government is considering a review of maternity services … The most ardent of lobby groups is Joyous Birth, whose convener, Janet Fraser, 40, tragically lost her baby after several days of labour at her Croydon Park home, which ended on March 27, when an ambulance was called. The NSW Coroner’s Office yesterday confirmed it had received a report of the baby’s death.

… as one of the most extreme proponents of home births, Joyous Birth has been influential in persuading pregnant women to shun medical intervention in childbirth. It describes as “birth rape” doctor intervention that saves the lives of mothers and babies …

Birthrape is not simply medical intervention: it is intervention that has not been consented to. You know, episiotomies that are performed without permission, vaginal examinations without permission – that sort of thing. Just as you would not accept these actions from a stranger if you walked down the street, so you do not need to accept this from care providers in labour. So you can understand:

Despite the disasters, Joyous Birth continues to promote 2009 as “Birth Trauma Awareness” year, urging members to write … “Birth rape on demand, a surgeon’s right to choose”; “Did your rapist wear a mask and gown? Mine did”; “Episiotomy is genital mutilation”; “Fingers, forceps, hands, ventouse, baby – which one belongs in a vagina?”; “My body, my birth, my choice”.

Women seduced by the “empowering” idea that only a woman knows how to deliver her child forget, as Pesce said yesterday, that “100 years ago … women died from complications of childbirth, and [so did] babies”.

The cases [stillbirths] are mainly from the Blue Mountains area, and two stillbirths occurred at the hands of “doulas” – women paid to help women give birth, often former midwives.

Doulas are mostly not former midwives. They are birth support people who have usually done a short course in birth support. But they are not former midwives!

Again, it is very important to distinguish freebirths – birth at home that is not assisted by a midwife – from midwife-assisted homebirth. The latter has deen demonstrated to be safe, for low-risk, healthy women. The former – there is no research to suggest it is safe, nor would it be ethical to do such research. So we will never know.

A midwife is a professional. When you have a midwife at your birth, you’re employing their knowledge, skill, judgment and experience. This is not present in a freebirth. It’s very easy to read a lot and think you know a lot. How does a a labouring couple accurately assess the situation when their experience might be less than 5 or 10 births, one of thich is their own? Midwives study for 3 years and attend many many births – complicated and normal. And their education needs to be this way: most complications are not common, so you need to see many births to come across those complications.

Having a midwife at your home birth who has the experience to resolve a shoulder dystocia, safely administer an injection of syntocinon, resus a baby and so on, is essential for a healthy outcome. I believe midwives have a vital role in all births.

Melissa Maimann, Essential Birth Consulting.

Freebirth in the news

Posted on April 7, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Here are some links to recent news articles about freebirth and homebirth:

Maternity Wars: Why homebirth could soon be illegal in Australia

According to Justine Caines, Maternity Coalition National President, the proposed register will have dire consequences for homebirthing in Australia. “[The review] will spell the absolute death knell to private practice homebirth because midwives will have to provide evidence of their indemnity insurance to be registered… Yes they’ll be able to seek registration if they provide hospital care but they will not be registered for homebirth practices. So essentially from one day to the next homebirth will be putting the midwife at risk of being jailed for providing a service as an unregistered midwife.”

Homebirthing vs Freebirthing: There is a Difference!

There is a massive difference between midwife-attended homebirths, which have been proven in other countries to have a similar level of safety to hospital births, and what is known as ‘freebirthing’, where no qualified medical attendant is present … The Joyous Birth forums, originally established to give to support to women who have experienced traumatic births, have become increasingly radical recently, to the point where planned freebirthing is seen as the ultimate statement of protest over the medicalistion of birth … Advocates of the hospital system claim that perhaps if hospitals were to become friendlier more women would birth there, problem solved. And maybe they would. But homebirthers say hey – we’re not refugees, we don’t want to be irresponsible, we’re happy to have midwives, we just want them covered by a medicare rebate.

Tragic sequel to home birth

The Sunday Age published an article that included an interview with Janet Fraser, a leading home birth advocate.

Ms Fraser … revealed that at no time during the pregnancy had she consulted a health professional — and that she intended delivering the baby at home without an attending midwife.

“Free-birthing, plenty of women do it,” she said.

The Australian College of Midwives, in an earlier interview, had criticised Ms Fraser for “recklessly” promoting free-birthing on the Joyous Birth website. Ms Fraser is the national convener of the Joyous Birth network.

… Ms Fraser reportedly delivered a baby girl in a water birth.

An ambulance was called when the infant reportedly suffered a cardiac arrest and wasn’t breathing.

… In the following days, there was a posting on the Joyous Birth website that announced the death, but this posting has since been removed …

NSW police are investigating the death, and have said it was not clear whether the baby was stillborn or died after delivery. If a baby is stillborn, there is no autopsy. If a baby is alive at birth and dies soon after, it is considered a matter for the coroner.

Four dead in home birthing including Joyous Birth advocate

Dr Pesce said the tragedies showed it was time to reform maternity services to attract back women who have become refugees from the hospital system … “We are very concerned about a maternity care system that is so abhorrent that women choose to do this (give birth without a midwife),” Professor Brodie said … the maternity services system needed to be re-organised so women were assigned to a single midwife who they knew and trusted and who could provide continuity of care throughout their pregnancy … A maternity services review commissioned by the Government called for a major overhaul of the system in February … The review wants a greater role for midwives in the system.

Why hospital horrors bring birth risks home

THE death of four Sydney babies involved in home births in the past nine months has obstetricians asking what they have to do to improve women’s confidence in a hospital birth … And it has also raised questions about what might happen next year when it could become illegal for midwives to attend such births … Older mothers, those who have previously had caesarians, those undergoing a breech birth who have higher risks attached to their births were choosing sometimes to go it alone … Home births in Australia could get even riskier from next July when a new national registration scheme for health professionals kicks in. From then health professionals will need indemnity insurance to gain the registration they need to practise … Dr Pesce hoped such a system might make a hospital birth a more appealing option for those women he now calls refugees from our health system.

Home births are irresponsible

Home births are selfish, irresponsible, anti-reason and anti-progress … We are gifted with advances in maternity practices that just a few generations ago would have dreamed of and in Australia we have obstetrics which are the envy of the modern medical world.

Births at home could be thing of the past

Throughout her pregnancy, during and after the birth, the Clunes mum was cared for by two privately practising midwives.

The services of these independent midwives are essential to most home births … The National Registration and Accreditation Scheme being considered will require all practising health professionals to have professional indemnity insurance, effectively sidelining these midwives … “A lot of people will still have babies at home but will not be attended by a midwife – at great risk to mother and baby,” Ms McAllister said.

Melissa Maimann, Essential Birth Consulting.

PND More Prevalent In Mothers Of Multiple Births

Posted on April 6, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Link to article

Mothers of multiple births have a 43 percent increased odds of having moderate to severe postnatal depression symptoms nine months after giving birth compared to mothers of single-born children, according to new research. 19 percent of mothers of multiple births had moderate to severe depressive symptoms nine months after delivery, compared to 16 percent among mothers of singleton pregnancies. Women who had a history of hospitalisation due to mental health problems or a history of alcohol or drug abuse also had significantly increased odds.

The question needs to be asked – does a multiple birth cause PND, is it about the social support offered to women who are at home with twins or triplets, or is it about the way the birth is managed?

It is well-known that a lot of PND is mis-diagnosed, and that these women are really experiencing birth trauma - a normal reaction to abnormal events and situations that have been beyong the woman’s control. Perhaps it is a combination of factors. Either way, the study does lead to the notion that women who are having multiple births need more support before, during and after birth. I would be interested to know if the woman in the study received continuity of midwifery care, which is known to positively impact a woman’s experience of birth and new motherhood.

Melissa Maimann, Essential Birth Consulting.

Men Are The Weaker Sex

Posted on April 5, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Article Date: 02 Apr 2009 – 2:00 PDT

Link to article

A University study provides scientific proof that a male baby comes with a bigger package of associated risks than his female counterparts. The study found that while girls were at a higher risk for restricted growth in utero and for breech presentation at birth, risks associated with boy fetuses were more abundant. Boy labours are more likely to result in a premature rupture of the membranes and preterm birth. And male babies who make it to term are more likely to be bigger, making labour and birth more difficult, leading to more caesarian sections.

The study notes than in general, boys are more vulnerable in their life in utero, and this vulnerability continues to exist throughout their lives: men are known to have a shorter lifespan, are more susceptible to infections, and have less chance of withstanding disease than women.

This new evidence confirms the old wives’ tale that boy fetuses are more troublesome in the womb and the delivery room.

But this is not necessarily a bad thing, according to the researchers. “Men become soldiers, construction workers, and work as firefighters,” he notes. “They take on these risks quite naturally to protect their society, and they’re trained to do this without question.”

- Interesting study. I have usually found that women who report their labours to be more difficult, have been carrying boys.

Melissa Maimann, Essential Birth Consulting.

Why Birth at Home?

Posted on April 1, 2009 by Melissa Maimann

Visit my website to learn more about my services.

Homebirth provides a familiar and safe environment for birthing. This helps to keep stress hormones low, and positive birth hormones high, and can therefore make the birth easier and less painful.

Women choose a homebirth because they believe in their body’s ability to birth, wish to involve their partner and other children more, or prefer to reduce the chance of intervention in their labour. And becuase let’s face it: pregnancy and birth are normal, healthy and natural experiences. We don’t go to hospital to experience other normal, healthy and natural bodily experiences such as food digestion, urination, menstruation, defecation …. we trust that our bodies work, and that these processes work too.

Women choose homebirth to:
Experience fewer complications in labour
Reduce the need for interventions
Use less pain medication
Lower their chances of a caesarean from about 35% to around 5%
Remain in comfortable and familiar surroundings
Have a baby who has fewer problems after the birth
Increase their success with breastfeeding
Avoid time limits being imposed on labour and birth
Experience antenatal and postnatal visits in their home
Improve bonding with their baby
Provide a gentle birth for their baby
Involve other siblings and family
Have choice and control
Reduce birth trauma
Receive care from the same midwife right the way through
Benefit from having more choices available
Benefit from sound education and birth preparation
Have a great birth!

Visit my website to learn more about my services.

Hospital Birth with your own Private Midwife!

Posted on April 1, 2009 by Melissa Maimann

Visit my website to learn more about my services.

Many women prefer to birth their babies in hospital, but they want to have the same midwife all the way through their pregnancy, birth and post-birth period. It’s about building trust, having a familiar face and being understood and supported.

There are a range of options. Some women see the hospital midwives or their own doctor for care, and see me for pregnancy, birth and postnatal support.

Other women have some or even all of their antenatal, labour and postnatal care with me, and we birth in hospital. You’ll find this service very flexible – no more waiting in hospital clinics for 30 – 60 mins: I can come to you when it suits you and we can take our time addressing the things that matter to you.

I support you in your decisions, whatever birth you’re planning. We explore what birth means to you and discuss your goals for pregnancy and birth, focussing on what’s important to you, what you need, and looking at ways of making the birth as positive and healthy as possible.

I know that no two women are the same, so services are tailored and individualised to your needs and budget.

The service ….

As a midwife, I can provide clinical care, birth support, information, advice and emotional support as you journey through your pregnancy and birth. I meet with you several times in your pregnancy so we can learn about each other, and so you can more feel comfortable with me. I help you formulate a birth plan and de-brief previous birth experiences. Your consultations may be instead of, or in addition to, your hospital or doctor appointments. Some women have all of their antenatal care with me.

When your labour starts, I come to your home and stay with you until you’re ready to go to hospital. I will stay with you in hospital, supporting you through your labour and advocating for you, until your baby is safely born. You leave the hospital when you feel ready and we continue your care at home, for up to 6 weeks.

I will facilitate communication with midwifery and medical caregivers to ensure that you have the information necessary to make informed decisions during labour and birth. Childbirth education is provided. After your baby is born, I can meet with you to discuss your birth and review your medical records, if requested.

What are the Advantages of Midwifery Birth Support?
Many women ask me how they can benefit from having a midwife provide birth support when they have family, friends, doulas or hospital staff to support them. Family and friends love and care for you, and this emotional attachment can prevent them from seeing situations objectively. Also, they may not be aware of the full range of options that are open to you. Some family and friends also feel reluctant to advocate for you.

Hospital staff are often busy caring for other women in labour: a hospital-employed midwife often cares for 2 labouring women at any given time, while also answering phones, performing administrative roles and so on. So if good birth support and advocacy are what you’re after, your best options are to employ a doula or a midwife. “What’s the difference?”, I hear you ask. Read on to find out ….

An independent / private midwife can provide all the services that a doula can provide. In addition, you benefit from:
- being professionally cared for by a registered health professional who is recognised by legislation
- being cared for by someone who is educated to university level
- being cared for by somoene who is educated in skills such as resuscitation
- higher chance of normal vaginal birth
- minimal intervention during birth
- professional advice and clinical care
- having some or all of your antenatal and postnatal care with your midwife
- lowest chance of caesarean
- lowest chance of episiotomy
- midwives can advise on VBAC options
- lower requirement for pain relief
- higher breastfeeding rates
- lower rates of pregnancy admissions to hospital
- access to midwife means you can change to home birth at any time and have that mifwife as your primary care provider
- midwives can monitor your baby in pregnancy and labour
- midwives can monitor your health in pregnancy and labour
- midwives can liaise with other health professionals if needed

Visit my website to learn more about my services.

Birth by surgery: The skyrocketing cesarean rate

Posted on March 30, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Story By Mary Beth Pfeiffer • Photos By Lee Ferris • March 29, 2009

Two weeks before Kristi Ashley gave birth to a son in 2007, an ultrasound exam estimated the baby at a hefty 12 pounds, 10 ounces — too big, her doctor believed, for a safe vaginal delivery. After the child weighed in at 9 pounds, 4 ounces in the delivery room, Ashley came to believe that the planned cesarean section she had, with its attendant pain, long recovery and what she called “emotional damage,” may have been a rush to judgment.

It is well-known that ultrasounds are inaccurate for estimation of fetal size in the third trimester. Why is it still being used as a basis for clinical decisions??

“It’s very hard to go up against your physician, especially at the 12th hour,” said Ashley, 38, of Hopewell Junction. “I think doctors are very quick these days to get scared. They would rather opt for the surgical solution.”

Determined to avoid another surgical birth and aided by a supportive doctor, hospital and birthing coach, Ashley last month did something that has become increasingly rare for post-cesarean women today: She gave birth vaginally, to another son. … From 1999 to 2007, the proportion of New York babies born by cesarean section skyrocketed 42 percent. In 1999, just under 1 in 4 babies was born surgically. By 2007, the figure was 1 in 3 — or 34 percent of births — and there is nothing to suggest that the relentless uptick, evident locally as well, is showing any sign of slowing.

In Australia, the national CS rate is currently over 31%.

In Ulster and Dutchess counties, with cesarean rates in the top sixth of counties statewide, surgical birth rates increased from 1999 to 2007 by 64 percent and 36 percent respectively …

Don’t women question why their caesarean is deemed “necessary” with a wide window of suspicion? If the CS rate is 42%, that’s 280% higher than what is recommended by WHO.

At Vassar Brothers Medical Center in Poughkeepsie … 40 percent [of babies were born by caesarean]. In Ulster County, Kingston Hospital had a cesarean rate of 40 percent in 2007, the latest figure available, while Benedictine Hospital’s was 35 percent, nearly double what it was in 1999 …

The World Health Organization calls for a maximum cesarean section rate of 15 percent in any nation in the world. Anything above that “seems to result in more harm than good,” according to a 2006 research summary in the British medical journal Lancet.

Physicians, midwives, childbirth experts and researchers point to a confluence of factors behind the growing rate of cesarean section … Some say that more mothers are older, obese, more prone to multiple births and, in particular at Kingston and Vassar Brothers hospitals, less healthy, increasing risks of surgical measures. Others contend that overused interventions to induce and augment labor, manage pain and monitor for fetal distress have driven cesarean rates to unnecessary heights.

I disagree. The only important variable is the care provider’s support for birth as a natural process.

All agree that fewer women are opting for once-popular vaginal birth after cesarean, or VBAC, as Ashley did. But some believe doctors emphasize its risk – that the scarred uterus could tear – while minimizing the drawbacks of surgery. VBACs have declined precipitously at five local maternity hospitals … In 2007, just 3 percent of post-cesarean women birthed vaginally at Kingston Hospital, where the procedure is officially banned. The figure was 33 percent in 1999.

VBAC rates have also declined because they are not supported by care providers.

Amid the debate, there is widespread agreement that medical factors are only a part of the story. Cesareans have become so common and accepted that first-time mothers – frightened by societal depictions of overwrought laboring women — sometimes request them simply to avoid labor; doctors, hospitals and insurance companies acquiesce. Moreover, obstetricians, who pay $84,500 a year for malpractice insurance in Ulster and Dutchess and $137,600 in Orange, may see cesareans as a way to avoid lawsuits over injuries to infants from vaginal birth — as well to manage precious time. “I see colleagues around me who seem to operate out of fear,” said Dr. Ira Jaffe, a Rhinebeck obstetrician, [commented]. “They always have in the back of their mind, ‘How is it going to look in court?’ It’s the defensive medicine.” “It’s not in the best interest of women and babies to do this many C-sections,” he said.

….

For a community of activists who say the cesarean section rate is out of control, the question is whether women like Revak are getting both sides of the story – on one hand that cesarean sections no doubt save lives in high-risk circumstances and are generally safe, but that they contribute in other cases to prematurity, cause respiratory problems in babies and increase maternal bleeding and infection.

“Women are getting cheated by not being encouraged to believe both in their ability to birth and that birth can be a positive experience,” said Christie Craigie-Carter, Hudson Valley coordinator of the International Cesarean Awareness Network, or ICAN.

A Paulin bill, signed into law last year, requires the state to educate women on birthing procedures, such as the induction of labor and use of pain-numbing techniques like epidurals, that increase risk of cesarean section. Paulin, a three-time mother who had two midwife-attended babies at home, believes that cesareans are often performed for reasons of convenience, fear and liability. “We have a huge problem,” she said.

“There’s more fevers, wound infections associated with C-section,” acknowledged Dr. John McAndrew, chairman of obstetrics and gynecology at Kingston Hospital, where the cesarean rate hit 43 percent in 2006. “However, it’s safer for the baby.”

Physicians and researchers concerned with rising cesarean rates take issue with that assertion, which they say fails to weigh the risk that a baby will be damaged or die in vaginal delivery.

“In low-risk or no-risk mothers, studies have consistently shown higher morbidity (illness) in infants delivered by cesarean section,” said Dr. Lucky Jain, a pediatrics professor at Emory University School of Medicine in Atlanta … “There is no evidence that cesarean is safer for the baby,” said Dr. Jed Turk, newly appointed obstetrics and gynecology chairman at Vassar Brothers Medical Center and a proponent of lower cesarean rates. “It is not a good trend.”

…

Vaginal birth undoubtedly has risks. One in 5,000 to 10,000 babies suffers permanent shoulder damage, and one in 1,000 suffers moderate to severe brain damage, according to a 2006 article in the professional journal Seminars in Perinatology. These injuries, as well as 6,000 stillbirths, could be avoided nationwide if the nation’s 3 million annual vaginal births were performed surgically at term — but that would mean additional costs and maternal and infant complications.

…

“C-section is major surgery, which involves a longer recovery time for the mother and can have other significant consequences,” said Barbara McTague, family health director for the state Health Department.

The cost of cesareans in a cash-starved health-care system is just one consequence. A cesarean birth cost the state Medicaid program $7,200 on average for hospital care in 2007 – 49 percent more than a vaginal delivery. The state’s cesarean price tag was $189 million.

Of greater concern may be the effect of cesareans on babies that are increasingly being delivered early. Thirty-six percent of elective cesareans were performed before 38 weeks, according to a study published in January in the New England Journal of Medicine, producing infants who had high rates of breathing problems, prolonged hospitalization and sepsis, a severe bacterial infection.

As significant, the study found that 10.2 percent of all cesarean-born babies were admitted to neonatal intensive care units, and 4.4 percent suffered from respiratory distress syndrome caused by fluids that are normally wrung from infant lungs during labor and vaginal delivery. … death rates of C-section babies before 28 days were nearly triple those of vaginal deliveries, according to a 2006 study by researchers at the U.S. Centers for Disease Control in Birth: Issues in Perinatal Care.

Studies have also found 20 percent higher incidence in both childhood-onset diabetes and asthma among cesarean babies, who have one-third to three-quarters the level of healthy bacteria in their intestines as vaginally born babies.

“When a baby comes out the normal way, they swallow vaginal mucus en route and get a nice dose of healthy bacteria to jump start their digestion,” said Dr. Joseph Malak, a Poughkeepsie pediatrician who called “surreal” the number of cesarean babies he sees on hospital rounds. “This doesn’t happen when babies come out through an abdominal incision.”

Malak believes that the rising cesarean rate may be linked to “a dramatic increase” in recent years in infants with colic, acid reflux, eczema and milk allergies – effects that, some say, obstetricians do not consider when weighing vaginal versus cesarean birth.

While cesarean delivery is safer than ever for the mother, it is not risk-free. According to a 2008 report in the American Journal of Obstetrics and Gynecology, 2.2 women died for every 100,000 cesarean births – 10 times higher than for vaginal births. “Cesarean delivery is associated with an increased risk of postpartum maternal death,” concluded a 2006 report in the same journal.

In New York, the rate of maternal mortality rose 70 percent from 1997 to 2007, when 40 women died as a consequence of pregnancy … three of the major causes of maternal death as embolism, hemorrhage and infection – all of which occur at higher rates in cesarean section.

Growing complications
Indeed, serious obstetrical complications increased by 27 percent from 1998-99 to 2004-05, according to a 2008 report in Obstetrics and Gynecology. These included renal failure, pulmonary blood clots, shock, blood transfusion and ventilation — upticks that parallel rising cesarean rates.

“It looks like there’s an association,” said the study’s author, Dr. Susan Meikle, an obstetrician and medical officer at the National Institutes of Child Health and Human Development …

“There is an awful lot of lying to women about cesarean,” said Dr. Marsden Wagner, former director of women’s and children’s health for the World Health Organization and author of several books on childbirth. “All of those thousands of women who are getting unnecessary cesareans in New York state are at double or more risk of dying and the babies are at risk of dying.”

The argument over cesarean’s benefits is perhaps most pointed when it comes to vaginal birth after cesarean; many doctors fear that the scarred uterus will tear, resulting in hemorrhage and loss of oxygen to the infant.

“There’s a real risk,” said Dr. Maureen Terranova, obstetrics chief at Northern Dutchess Hospital. “They have to be willing to accept that 1 percent risk of uterine rupture.”

“When it occurs, it can be catastrophic,” said Kingston Hospital’s McAndrew.

Melissa Ptacek, 47, of Garrison in Putnam County, said it took her years to recover from a uterine rupture from which her daughter – now a normal 11-year-old – had to be resuscitated. “I wouldn’t want anyone to go through what I had to go through,” she said.

In a study published in the New England Journal of Medicine in 2004, 124 women suffered uterine rupture among 17,898 who attempted vaginal birth after cesarean — a rate of 0.7 percent. Seven babies suffered brain damage, including two who died. A 2000 research summary by the American College of Obstetricians and Gynecologists put the risk of rupture in vaginal birth at 0.2 to 1.5 percent for most women with one prior cesarean.

Proponents of vaginal birth after cesarean say the risks of rupture must be balanced against the downsides of surgical birth. “The conversation about VBAC doesn’t touch on dozens of other concerning outcomes that favor vaginal birth,” said Sakala of Childbirth Connection, noting that cesareans make breastfeeding difficult, lead to adhesions and cause significant pain for up to six months. More than 7,000 repeat cesareans would be needed to save the life of one baby from a ruptured uterus, she said, citing a 2004 British Medical Journal study.

Other proponents argue that not all ruptures are catastrophic and some have actually been caused by labor-enhancing medications, called prostaglandins, whose dangers for post-cesarean women are now recognized.

Melissa Maimann, Essential Birth Consulting.

Birth Trauma

Posted on March 29, 2009 by Melissa Maimann

As published on the Essential Baby website http://www.essentialbaby.com.au/parenting/baby/birth-trauma-20081013-4zm2.html?page=-1

Visit my website to learn more about my services.

October 13, 2008

birth trauma

Birth trauma can affect any woman who has given birth. Although it is experienced by many women, most women do not talk about it and many may not even know they have it. This silence does nothing to help women move past their trauma; it is my hope that this article will help you along the path to recovery.

What is Birth Trauma?
Birth trauma is a normal reaction to events in labour and birth that you perceive as being scary, out-of-control, helpless, or painful. Birth trauma can result from pregnancy, birth or even during the postnatal period. The woman’s response may be one of intense fear, helplessness or horror. Sometimes the events trigger memories of earlier trauma that remain unresolved. Symptoms might not emerge for many months after the birth, or even later, when you plan for the birth of your next baby.

How will I know if I have Birth Trauma?
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

What causes it?
Most of the causes of Birth Trauma can be avoided or lessened considerably by those looking after the woman, through simple measures such as understanding the woman’s needs and expectations and providing sensitive care in response. This is where continuity of care programs offered by midwives really benefit women! Explanations need to be provided before interventions are carried out, and your permission needs to be sought before any treatment, procedure or examination takes place in order for you to feel respected and safe. Women also have a role to play in clearly communicating their needs and expectations to their care providers. One way to do this is through a birth plan.

There is no standard cause of Birth Trauma. Some experiences than can result in birth trauma include:

• Traumatic birth – eg episiotomy, caesarean, forceps, a baby who was injured during birth
• Emergency situations, including caesarean section
• Lack of pain relief when pain relief has been requested
• Impersonal treatment
• Loss of control over the experience, or the perception that your wishes were not respected
• Being cared for by strangers
• Invasive procedures such as vaginal examinations, episiotomy, stitches
• Separation from your baby
• Feelings of loss of control - eg an induction that you did not want to have, a caesarean for a breech baby when you wanted a vaginal birth etc
• Invasive procedures without explanation or your permission
• Forceps delivery or suturing without adequate pain relief
• Post Partum Haemorrhage

Treatment Options for Birth Trauma
During your path to recovery, you will need a few helpers along the way. A trusted friend or relative can help enormously – someone who knows you well, understands what it’s like to be you, and who accepts you. They need to be empathic and non-judgmental.

Some women see professionals to help them recover, such as psychologists and midwives. Psychologists are educated to provide therapy for people who have experienced trauma and they provide excellent services for as long as you need them. Independent midwives have usually studied counselling as part of their education, and they have the added bonus of knowing about pregnancy and birth.

Family and friends can help too – for example, babysitting while you get some sleep or time out from your baby / toddler. Some women like to talk to other women who have experienced birth trauma as this helps them to see that they are not alone. Sharing experiences is very healing and allows you to gain perspective and validation about what has happened.

During these times, it’s easy to forget to take care of yourself. Remember to eat well and get some daily exercise. This will do wonders for encouraging a restful sleep and high energy levels during the day. Limit caffeine, sugar and salt, and tuck into veges, fruit and whole grains. Balance this with fish, chicken, eggs, nuts and seeds, and you have a recipe for health!

Natural therapies can help a lot – therapies to try include yoga, massage, reflexology, aromatherapy, homoeopathy, naturopathy and yoga.

Journaling is a great exercise; some women also draw. This gives the added bonus of being able to use colour and “left brain” action to express yourself. When you’re journaling, you might want to record your birth story. Some women write it a few times. You might like to write your birth story from your perspective, then from the perspective of your baby, partner, midwife or doctor, and so on. When you’re writing about your experience, pay attention to any feelings that come up for you as you write. Notice how writing makes you feel in your body. As you write your story, you may begin to discover more clearly which events are particularly hard for you to deal with, or to clarify your emotions.

Read books or articles on birth trauma.

Some women also like to write a letter to their care providers (no need to post it), as this helps to express their emotions in a safe way. Other women explore the option of writing a formal complaint to the hospital or Health Care Complaints Commission.

Another option is to obtain a copy of your medical record. Simply contact the hospital medical records department or the Patient Representative. A fee may apply for this service. Once you have a copy, it’s a good idea to go through your record with a professional such as a GP, midwife or obstetrician who can interpret all the “medical-speak” for you and help you to make sense of the notes. This exercise can go a long way to answering the “why?” for you.

In the end
There is a positive end for all women who have experienced birth trauma. The personal growth that this event affords you, the insight into your values and beliefs, and the journey of healing are all very positive outcomes that can help you move forward in all ways in your life.

Advice for pregnant women
So, what can you do to avoid birth trauma? There are many things you can do!

• Be assertive about your needs. Change your care provider if you need to; ask for help; research your options from a wide variety of sources
• Explore what sort of birth experience you would like and then set about finding a care provider who will support you in achieving this
• Write a birth plan so that your care providers know your preferences
• Consider home birth as this will allow you more control over the experience
• Get help early if you need it
• Consider what you will need in order to feel safe during your pregnancy, labour and birth

Visit my website to learn more about my services.

Home delivery too hot to touch

Posted on March 28, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Link to article

Supporters of homebirth are asking why the topic is still seen as too hard to handle in this country, writes Thea O’Connor | March 28, 2009
Article from: The Australian

WHEN Natalie Hemingway gave birth to her son 10 months ago, doing so at home seemed an obvious choice. She had already given birth to her daughter at home three years earlier, and both of her sisters had been born at home.

“That’s what I saw when I was growing up, so birthing at home was normal to me,” says Hemingway, 27, who lives on Sydney’s lower north shore.

Homebirth in developed countries was the norm up until the past 50 years or so. In Australia today, homebirth can seem a radical choice, and the women who chose it anything from brave and alternative to misguided and loopy.

The recent federal government review of maternity services has done little to help bring the practice into the mainstream. It has inflamed an already heated debate over homebirths by stating it does not support Medicare funding of independent midwives attending homebirths …

Part of the problem is that both advocates and opponents of homebirths have research evidence to support their arguments.

According to Hannah Dahlen, associate professor of midwifery at the University of Western Sydney and spokeswoman for the Australian College of Midwives, the best available evidence comes from a large prospective study of 5000 women planning a homebirth in the US in 2000.

The results, published in the BMJ in 2005, showed that the rate of babies dying during labour or within 28 days of birth … was 1.7 deaths for every 1000 uncomplicated intended homebirths. The study (2005;330:1416-1419) said this was similar to risks in other studies of uncomplicated home and hospital births in North America.

Dahlen says it is also similar to the risk of first-time mothers having an uncomplicated birth in an Australian birth centre … or Australian hospital … (2007;34:3:194-201).

When the high-risk births … were included in the analysis of the US study, the rate was two deaths for every 1000 births.

- When women have home births with a midwife, and they are low-risk (term, singleton baby, head down, no blood pressure problems etc), home birth has been shown in many studies to be safe. Not only that, women who have home births experience a greater level of satisfaction with their experience, and mush lower rates of intervention compared with hospital birth.

The highly regarded Cochrane database … concludes that “there is no strong evidence to favour either home or hospital birth for selected, low-risk pregnant women”.

Andrew Pesce, president of the National Association of Specialist Obstetricians and Gynaecologists, believes we have enough evidence to worry. He points to Australian data that indicates babies have a two to three-fold increased risk of death with homebirths.

A study of 7000 planned homebirths in Australia between 1985 and 1990, published in the BMJ (1998;317:384-388) reported that deaths occurring during labour and not due to malformations or immaturity were higher than the national average. …

Dahlen counters that this study provides low-level evidence: the study design was retrospective, it included births by non-registered midwives, it used a number of methods to collect the data, including searching newsletters for death notices …

- While there is strong support for midwife (registered, qualified) assisted home birth for low risk women, there is very little evidence that birth at home without a qualified and registered midwife, for women who have risk factors, will yield a good outcome.

Pesce also refers to the 12th report of the Perinatal and Infant Mortality Committee of Western Australia. It documents a 2000-04 death rate for babies that is three times higher for homebirths. The report said the numbers were too small to be conclusive.

… In December 2007 the West Australian Department of Health stated “a preliminary review of medical records indicates that it is likely the setting of the birth did not affect the outcome in at least five of the six deaths”.

- We need clarity on this matter. Babies die in hospitals and they die at home too. The question needs to be thus: In low risk, healthy women, is the home birth death rate higher than a low risk, healthy opulation of women birthing in hospital. The answer, according to a large North American study, is no.

Distinguishing the outcomes of uncomplicated births from high-risk births helps to make sense of the conflicting data …

The study concluded that while homebirth for low-risk women could compare favourably with hospital birth, high-risk homebirth was “inadvisable and experimental”.

The Australian College of Midwives supports this conclusion.

Dahlen says women should still have the right to attempt high-risk births, provided they are well informed of the risks, as well as their chances of success.

- A woman’s right to autonomy must be respected. It would be great if high risk women were supported to achieve the birth they want within a hospital setting.

“Women wanting to give birth vaginally after a caesarean, for example, have a 70 to 85per cent chance of success,” she says.

Versus hospital VBAC rates which sit between 2% and 15%.

“I don’t know of any other area where the battle over women’s bodies is as intense as this. We have to make sure we don’t end up with situations like those in parts of the US, where midwives are put up on criminal charges and women are arrested and taken from their homes to hospital if they are intending any birth at home the medical establishment considers risky.”

Keirse, who has also worked in obstetrics in the Netherlands, characterises the debate as a demarcation dispute. “Holland went through that in the 1970s. When midwives were granted free access to hospitals in the early 1990s, that made a big difference and contributed to improving safety rates.”

Britain’s Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have managed to agree. Their 2007 joint statement, which supports homebirths for women with uncomplicated pregnancies, reads: “There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe.” … In the Netherlands, 30 per cent of all births take place at home.

“The culture is conducive to homebirths in Holland,” says Keirse. “It’s an accepted government policy and the midwives who conduct homebirths are considered part of the medical profession. They have rights that allow them to continue caring for their clients if they need to transfer to hospital.

“In Australia, there can be large distances between home and hospital, independent midwives have no hospital rights and they are not incorporated into the healthcare system.

“This means that training of homebirth midwives isn’t regulated, which it should be.”

- The training of midwives is most certainly regulated. All registered, qualified midwives have a university degree or two or three. Some are educated to maters level.

One research finding that is not disputed is that homebirths result in fewer medical interventions … compared with the relatively low-risk hospital group, intended homebirths were associated with lower rates of electronic foetal monitoring (9.6 per cent v 84.3 per cent), episiotomy (2.1 per cent v 33 per cent), caesarean section (3.7 v 19.0 per cent) and vacuum extraction (0.6 v 5.5 per cent).

Melissa Maimann, Essential Birth Consulting.

Home deliveries

Posted on March 23, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Link to article

John Elder
March 22, 2009

JANET Fraser is in labour. Her plan is to drop the baby on the loungeroom floor, or wherever feels good at the time. Has she called the hospital to let them know what’s happening? “When you go on a skiing trip, do you call the hospital to say, ‘I’m coming down the mountain, can you set aside a spot for me in the emergency room?’ I don’t think so,” says Fraser, whose breathing sounds strained.

This is pretty much where we end the conversation that started with me calling Fraser and asking if it was true that her organisation, Joyous Birth, was advocating that women go it alone giving birth at home, with no midwife …

“Free-birthing, plenty of women do it,” she says. In fact, Fraser is doing it right now. “I prefer to be an autonomous care-provider,” she says.

By the time she tells me the birth of her third child is “impending”, Fraser has already talked intensely about the likelihood that home births attended by midwives will be illegal from July next year, when the national registration scheme for health professionals kicks in …

She has also talked about how the Joyous Birth group, of which she is national convener, wasn’t encouraging women to free-birth as a means of flouting the law, but to run their pregnancies and birthing in the manner they desire.

“If that happens to be free-birth, then you go for it … We don’t advocate hospital-based birth or being beholden to all sorts of authority figures,” she says.

Janet Fraser’s son, 5, was planned as a home birth, but came into the world via an emergency caesarean after Fraser was transferred to hospital. Her daughter, 2, was born at home …

Fraser is 40. She hasn’t seen a doctor or any health professional since becoming pregnant this time. No ultrasound, no genetic testing, no internal examinations, no stethoscope. [Internal examinations do not form part of the routine care of pregnant women.] Does she have any feeling for how long the labour will go? “I could do this for days. My daughter’s birth was 50-something hours. You just do it — it’s just birth, a normal physiological process.”

At the time of publication, Ms Fraser’s labour was continuing to progress slowly.

[A very small proportion of Australian choose to birth at home].

The home-birth crowd has always been loud, but if they are more strident of late it’s possibly because they are feeling left behind in an evolving birth scene, where hospital midwives are increasingly required to train for emergency situations, including home-birth complications.

St George [Hospital] is one of a number of hospitals in NSW trialling home-birth programs where two midwives are required to attend a birth, and the home births need to be sanctioned according to a set of low-risk protocols [that do not see the majority of women as low risk, and therefore the woman cannot access that services. Women are not "cleared" for home birth until 36 weeks when they have a compulsory swab to determine if they have group B strep, which may or may not be present when they do into labour, perhaps some 4 - 5 weeks later]. Independent midwives generally work alone, with a more lenient policy on risk. For example, independent midwives will home-birth twins, breech presentations and … VBACs.

The status of midwives is the key to where birthing is headed. The Maternity Services Review has recommended an expanded role for them. One option on the table would see their services covered by a Medicare rebate for the first time. However, this would not be extended to independent midwives attending home births.

There is growing enthusiasm for the case that continuous care by a midwife through the prenatal, birth and post-natal stages tends to result in happier and healthier outcomes for a pregnant woman. And that if the midwife role was expanded … then a significant portion of … hospital resources could be freed up, and the nation’s health bill somewhat reduced. [Not to mention the outcomes for women and babies would be greatly improved].

Within this context, home birth might sit more comfortably in the public mind as a viable option.

Justine Caines, secretary of Homebirth Australia, [says]: … “It’s only the home-birth mothers who have experienced one-to-one midwifery who advocate for change … The vast majority aren’t passionate about their experience basically because … The system basically treats them as someone to shuffle through. The whole passion around home birth is about the experience of one-to-one midwifery care.”

Caines sees midwives as the great hope of the overburdened health system. “We fund private obstetrics to hundreds of millions of dollars through Medicare … fees for services that don’t relate to case load. Most of it is a waste of money,” she says.

“(Federal Health Minister) Nicola Roxon could offer a $5000 birth package that would cover continuous care for each pregnancy … as opposed to women engaging in private obstetric care spending $20,000 believing they have the best care money can buy.

“I have a midwife come to my home every day for the first seven to 10 days. The most expensive is $4000 for the entire package … and no health fund covers it. People could get better, cheaper care.”

Barbara Vernon, chief executive of the Australian College of Midwives, says this message gets lost in media sensationalism sparked by organisations such as Joyous Birth and a small number of midwives who don’t make risk minimisation their primary focus, whereas most midwives working privately — and there are only 50 registered with the college, possibly 100 throughout the country — are “very risk-averse”.

“Midwives have the skills and equipment for the safe care of a mother and baby in a home-birth situation, and they recognise quickly when something’s going wrong.

“What fails to compete with the sensationalism is … the evidence showing that a trust relationship between a woman and a midwife, established from early in the pregnancy, means that the woman in labour is feeling safe and less anxious. It’s a better experience.”

Vernon says the flow-on effects of continuous midwife care include shorter labours, a reduced need for drugs and pain relief, reduced admissions to neonatal intensive care, reduced vulnerability to post-natal depression and improved rates of breastfeeding to 12 months of age.

“Even if she has a caesarean, the woman is not traumatised by the process … “It’s the women who get run over by the system that feel most vulnerable after that experience. They can’t understand why all of that happened.”

… is a hospital-governed home-birth system the answer to mainstreaming home birth? Free-birther Janet Fraser says: “It would be a disaster if hospitals ran home birth. Hospitals are dangerous.”

Justine Caine says: “Not until obstetric care is kept in check. The problem with most of (the trial schemes) is that women and midwives are not able to make decisions. Hospital midwives are handmaidens of the doctors. Obstetricians call the shots and much of the exclusion criteria is not based on evidence.”

Veteran private midwife Robyn Thompson, who has spent 30 years assisting home births, says: “It wouldn’t be a disaster. I’m welcoming whatever it takes that makes it good for women.”

Thompson says the average transfer rate over those 30 years had been about 17 per cent … “You anticipate what’s happening…”
…..
Barbara Vernon says: “RANZCOG has a position statement where home births are not endorsed. But some women are going to always birth at home.” [And therefore the approach needs to be one of harm-minimisation, not making home brith illegal by denying midwives access to professional indemnity insurance, and therefore registration].

- I guess the real question is – who owns birth? Midwives? Obstetricians? Maybe it’s time for women to claim birth.
……
Home-birth advocates insist that doctors only have a role to play when a birth becomes problematic. They say doctor intervention has led to skyrocketing induction, epidural and caesarean rates, issues that were at the heart of the Maternity Services Review. [And this is true. Midwives do not intervene in these ways. We cannot perform caesareans, we do not authorise inductions and we cannot insert epidurals. These are in the medical domain.]

In April 2007, Melbourne lawyer Ann Catchlove was told by her obstetrician that she needed a caesarean with her first child because her pelvis was not big enough. “He said, ‘You can keep going if you want but we’ll still be here at 3am’,” she says … The doctor told Catchlove that her future babies would have to be delivered by caesarean. Research on the internet convinced her otherwise. “I found the original caesarean probably wasn’t necessary.”

She also found research that indicated vaginal birth after caesarean was a reasonable option. She started thinking about a birth centre “but none of them would accept me”.

Last November she gave birth to a son at home. “… once I’d made the decision, and met the midwives, I never had any doubts. There’s an idea of hippies burning incense in the background, which is wrong. They were very focused on safety … the birth itself was very smooth and relaxed, other than the pain. I felt very safe and in control.”

Obstetrician Pieter Mourik warns ominously that graveyards are full of “failed home births”. He has called Janet Fraser’s Joyous Birth group “a bunch of nutters” and Fraser herself “a fool”. When told Fraser was free-birthing at home, Mourik was quieter than usual, less on the soapbox.

Fraser had said she didn’t expect anything to happen for another couple of days; that nothing bad happened quickly in a labour and that there would be time to get to hospital if things went wrong.

Mourik paused. “She told me (during a debate) she’d had a caesarean. That’s how a uterus is most likely to rupture. If that happens, there won’t be time … Well, I wish her well.”

Melissa Maimann, Essential Birth Consulting.

Memory of Labor Pain Influenced by a Woman’s Childbirth Experience

Posted on March 19, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

By Megan Rauscher
NEW YORK (Reuters Health) Mar 11 – Research shows that for about half of women who give birth, memories of the intensity of labor pain decline over time. However, for some women, their recollection of pain does not seem to diminish and for a minority, their memory of pain increases with time.

The study also shows that the memory of childbirth pain is influenced by a woman’s overall satisfaction with her labor experience.
….
Women who reported labor as a positive experience 2 months after childbirth had the lowest pain scores, and their memory of the intensity of pain had declined by 1 year and 5 years after giving birth.
“Memory of labor pain declined during the observation period but not in women with a negative overall experience of childbirth,” the team notes in the March issue of BJOG ….

Roughly 60% of women reported positive experiences and less than 10% had negative experiences. For women who said that their childbirth experience was negative or very negative, on average, their assessment of labor pain did not change after 5 years.

“A woman’s long-term memory of pain is associated with her satisfaction with childbirth overall,” Dr. Waldenstrm said, summing up. “The more positive the experience, the more women forget how painful labour was …”

The researchers also found that women who had epidural analgesia remembered pain as more intense than women who did not have an epidural …

- I was not surprised to read that women who have epidurals rate their labour as more painful. Generally, those women may have had an expectation of having pain relief, or of having a pain-free birth. Hence, any pain would have been experienced negatively, and perhaps also they would not have had good birth preparation. I find that women who are well-prepared for labour and birth, have positive experiences and rate their satisfaction with labour very highly.

It is well-known that continuity of care from a known midwife is key to a positive labour experience.

Melissa Maimann, Essential Birth Consulting.

The Trouble With Repeat Cesareans

Posted on March 18, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Link to article

By Pamela Paul
Thursday, Feb. 19, 2009
To avoid another C-section, Barton has to drive 100 miles to deliver in Los Angeles.
For many pregnant women in America, it is easier today to walk into a hospital and request major abdominal surgery than it is to give birth as nature intended. (It’s often the same in Australia, unless you have a private midwife or doula with you) Jessica Barton knows this all too well … her first child ended up being delivered by cesarean section, she can’t find an obstetrician in her county who will let her even try to push this go-round. And she could locate only one doctor in nearby Ventura County who allows the option of vaginal birth after cesarean (VBAC). But what if he’s not on call the day she goes into labor? … in order to give birth the old-fashioned way, Barton is planning to go to UCLA Medical Center in Los Angeles.

Much ado has been made recently of women who choose to have cesareans, but little attention has been paid to the vast number of moms who are forced to have them. More than 9 out of 10 births following a C-section are now surgical deliveries … the International Cesarean Awareness Network (ICAN) … found that 28% of [hospitals] don’t allow VBACs … ICAN’s latest findings note that another 21% of hospitals have what it calls “de facto bans,” i.e., the hospitals have no official policies against VBAC, but no obstetricians will perform them …

Why the VBAC-lash? … The risk of uterine rupture during VBAC is real–and can be fatal to both mom and baby–but rupture occurs in just 0.7% of cases … only 1 in 2,000 babies die or suffer brain damage as a result of oxygen deprivation.

After 1980 … more women began having VBACs. By 1996, they accounted for 28% of births among C-section veterans, and in 2000, the Federal Government issued [a] … report proposing a target VBAC rate of 37%. Yet as of 2006, only about 8% of births were VBACs, and the numbers continue to fall–even though 73% of women who go this route successfully deliver [vaginally].

So what happened? In 1999, after several high-profile cases in which women undergoing VBAC ruptured their uterus, the American College of Obstetricians and Gynecologists (ACOG) changed its guidelines from stipulating that surgeons and anesthesiologists should be “readily available” during a VBAC to “immediately available.” …

Some doctors, however, argue that any facility ill equipped for VBACs shouldn’t do labor and delivery at all …

Part of the answer has to do with malpractice insurance. Following a few major lawsuits stemming from VBAC cases, many insurers started jacking up the price of malpractice coverage for ob-gyns who perform such births … 26% [of OBs] said they had given up on VBACs because insurance was unaffordable or unavailable; 33% said they had dropped VBACs out of fear of litigation …

Of course, the alternative to a VBAC isn’t risk-free either. With each repeat cesarean, a mother’s risk of heavy bleeding, infection and infertility, among other complications, goes up. Perhaps most alarming, repeat C-sections increase a woman’s chances of developing life-threatening placental abnormalities that can cause hemorrhaging during childbirth. The rate of placenta accreta–in which the placenta attaches abnormally to the uterine wall–has increased thirtyfold in the past 30 years …

… while many obstetricians say fewer patients are requesting VBACs, others counter that the medical profession has been too discouraging of them … 57% of C-section veterans who gave birth in 2005 were interested in a VBAC but were denied the option of having one.

… “the pendulum has swung too far the other way,” So how to reverse the trend? For one thing, patients and doctors need to be as aware of the risks of multiple cesareans as they are of those of VBACs. [Concern arises that perhaps doctors will forget how to do VBACs.]

- Well, fortunately, you “do” a VBAC the same way you “do” a natural birth. By supporting the natural processes that women’s bodies are designed to perform. In this country, VBAC rates are between 10% and 16%. In some private hospitals, the rates are as low as 1%. In homebirth, the rates of VBAC are at least 80%. And it is a numbers game, so put yourself where the numbers are stacked with you, not against you. Plan a home birth for your VBAC, or employ a private midwife for a hospital birth.

Melissa Maimann, Essential Birth Consulting.

Making Tough Decisions Without All the Facts: How Inadequate Informed Consent Puts Childbearing Families at Risk

Posted on March 12, 2009 by Melissa Maimann

For further information, contact Melissa Maimann at Essential Birth Consulting.

Making Tough Decisions Without All the Facts: How Inadequate Informed Consent Puts Childbearing Families at Risk
WASHINGTON (March 10, 2009)

Imagine you are a woman in labor and your doctor tells you that electronic fetal monitoring is necessary to record your baby’s heartbeat. Without any further information about the monitoring or its risks, you are given a consent form to sign. Believing the doctor is doing what is best for you and your baby, you sign. By neglecting to tell you that electronic fetal monitoring can result in labor complications and increases the need for cesarean surgery, your doctor has not held up his or her end of the informed consent process.

This shocking scenario plays out nationwide thousands of times a day across a range of procedures. The purpose of informed consent is to ensure that before a health professional or researcher does something to a patient’s body, the patient must understand what is being done and give his or her voluntary consent. But in all aspects of medical care, informed consent can fall short of the mark. In the instance of childbirth, women and their partners may be asked to make decisions without being well-informed of the risks and potential outcomes that can affect moms and babies.
….
A recent article published … reveals how sub-par information provided by health care providers undermines the purpose of informed consent. This results in parents having incomplete information when making decisions with potentially grave implications, such as whether or not to use medication or submit to obstetrical procedures during childbirth. [Inadequate informed consent is] a major barrier to women benefiting from evidence-based maternity care.

- I have seen this many many times in hospital settings in this country. Most women do not give truly informed consent because their care providers only tell women what care providers want them to know. I believe most women would not sign up to the vast array of interventions offered on the “menu” if they really knew the risks, benefits, potential complications resulting from the intervention, and the lack of research that has been done (especially in the case of fetal monitoring) prior to the introduction of the intervention on a wide scale.

Why does it matter? It matters how babies are born. It matters for women and it matters for babies. Intervention in birth that is not what you signed up for, can lead to postnatal depression, birth trauma, being labelled “high risk” in your future pregnancies and births, complications in your current birth and future births, not bonding with your baby, breastfeeding problems, and the list goes on.

All women birthing in hospital, planning “natural” births – whatever that means to each woman – needs support in labour. Australia’s caesarean rate is over 31%. Many NSW hospitals have caesarean rates of over 40%. Most women have a “high risk” label of some sort. If you want a successful natural vaginal birth, you need good support. The best support will come from a private / independent midwife.

Melissa Maimann, Essential Birth Consulting.

UK: Mothers face crackdown on epidural births

Posted on March 1, 2009 by Melissa Maimann

For further information, please contact Melissa Maimann at Essential Birth Consulting.

From http://www.timesonline.co.uk/tol/news/uk/article5822051.ece

Mothers face crackdown on epidural births
Sarah-Kate Templeton

HOSPITALS are under attack from staff and patients for trying to stop large numbers of women from having epidurals during birth … The controversial restrictions … aim drastically to reduce the number of women having epidurals, caesareans or other artificial procedures to 40%.

In some hospitals the proportion of first-time mothers now having epidurals is far higher at 60%.

The targets are contained in a guidance document, Making Normal Birth a Reality, drawn up by the National Childbirth Trust (NCT) with the backing of the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists.

The document argues that mothers and doctors are too ready to resort to medical intervention and that any such procedure brings risks …

Professor James Walker, a consultant obstetrician at Leeds Teaching Hospitals NHS Trust, said … “Epidurals should not be done without reason; they should be kept to a minimum. There are some women, however, who require an epidural because they cannot cope with the pain in any other way.”

Belinda Phipps, chief executive of the NCT, argues, however, that there are medical reasons for trying to restrict the procedure. An epidural, she says, is more likely to result in a baby being delivered with forceps or a ventouse – a suction device – because the mother is less able to push the baby out.

A British review … found the procedure prolonged labour and increased the chance of further medical intervention by 40%.

When I did my midwifery degree, midwives were supported by management and other midwives to support women through natural labour, if that was their intention. We all know that at some point in labour, many women want something, anything – epidural, caesarean, whatever! But that is where the skill of the midwife really comes in. It is about calming the woman, helping her to change position, getting her a hotpack, moving into the bath, talking calmly to her, surrounding her with love and supportive people – these “interventions” are both safe and effective.

Epidurals have been demonstrated to have complications associated with their use: longer labour leading to augmentation (breaking waters or using an infusion of syntocinon), fetal distress from augmentation, malpositioning of the baby (such as posterior), back ache, spinal tap, infection, increase in the caesarean rate as a consequence of being continuously monitored, and forceps or a vacuum birth because of the woman’s inability to feel to push.

With all these consequences of epidurals, is there any question why there’s a push towards normal birth?

It does, however, beg the question – who should decide what intervention a woman has in her bitrh? Surely it’s the woman’s choice, and hers alone. I agree with this comment, and happily support women through hospital births where they may elect to have an epidural. However, I tend to find that a well-informed woman who has attended comprehensive childbirth education and perhaps Calmbirth classes, will be far less likely to choose an elective epidural.

Smriti Singh, mentioned in the article, alludes to the potential for birth trauma related to the pain of birth. Most quality research points to their being less birth trauma for women who have experienced natural birth, than women who have experienced interventionist birth. Mitigating factors are things such as birth preparation, having an awareness and understanding of all available options, and the presence of a supportive person during your birth.

Melissa Maimann, Essential Birth Consulting.