Posted by Melissa Maimann on Mar 12, 2010 in
Caesarean,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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Forget for a moment that public hospitals can’t cope with rising demand and elective surgery patients are lingering in pain. We are getting rorted by specialist doctors.
It’s a system where the government pays, the patient pays and the doctor smiles before he or she slaps you with a monstrous bill.
I took notice last year when AAP’s Los Angeles correspondent Peter Mitchell criticised the fees charged by health care providers in the US.
His wife gave birth to a baby boy and the bill come to over $A50,000, but it was completely covered by their $A418 monthly payments for US health insurance.
I have recently confronted a mirror experience as an American journalist living in Australia.
But I calculate that Peter paid less in out-of-pocket costs during his wife’s pregnancy than my wife and I did in Sydney.
We initially decided on the public health system for the birth of our son until we caught sight of our local hospital’s maternity ward: a demountable structure.
… The deal-breaker came when I asked what would be the medical response to an emergency birth.
Answer: a helicopter to transport my wife to a better-equipped facility.
Both of us had private health insurance, which we’d never used, so we thought we’d give it a go.
The out-of-pocket costs for the private hospital were estimated in advance at $500, which turned out to be accurate in the end.
We shopped around for a recommended obstetrician and settled on someone in the CBD who charged $4000, which we thought would be for the delivery, no matter the outcome.
Of that amount, we had to pay $1800 after Medicare.
We heard of prices for obstetricians as low as $3000 in Sydney’s west and as high as $6400 on the north shore.
Our doctor also charged us $100 for every visit to his office, of which we received about $80 back on each bill from Medicare.
So far, we’re in for about $2800, which we thought was about the maximum we wanted to pay in a country that rates its public health care system among the best in the world.
Well, things went a bit pear-shaped during labour and we ended up in the operating theatre …
As often happens in private hospitals …
If I had known what was to come I would have scrubbed up myself for the procedure.
The first anaesthetist charged $700 to stick a needle in my wife for the epidural – a 10-minute procedure.
The second anaesthetist, who was present during the surgery, charged an additional $1386 and did almost nothing.
During my wife’s procedure, a young nurse present made it clear she was there to take photos and asked if I had a camera with me. I did.
The assisting surgeon charged another $420 and to top things off, our obstetrician sent us a bill for another $1539.
Last but certainly not least, a paediatrician making daily rounds at the hospital checked out our son on three separate occasions for less than five minutes a visit.
The cost for that? $700.
Incidentally, we pay $266 a month as a family for private health insurance …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Caesarean, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Mar 11, 2010 in
Caesarean,
Home birth,
Midwifery,
VBAC Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
A sensationalist title as home birth is not about to be banned but here goes:
ABI WHITEHAIR is only nine days old but she’s already saved taxpayers thousands of dollars.
She was delivered at home after her mother, Leah, rejected advice to have a caesarean section … because her first baby … had been born that way …
A surgical birth – about 30,000 are performed in NSW each year – would have cost the public hospital system about $8000.
If she had been admitted to a neonatal special care unit, like 70 per cent of babies born by caesarean, including her big brother, it would have cost another $900 a day.
But her entry to the world, in a Dee Why lounge room, cost taxpayers nothing …
[Midwives] are calling for another urgent meeting with the Health Minister, Nicola Roxon, before the new rules come into effect in July.
More than one in three babies in NSW is born by caesarean section but only one in seven subsequent babies are born vaginally due to the risk of uterine rupture.
The risk is very small: less than one in 200. Most studies on uterine rupture include dehiscenses, which are not complete ruptures, have no symptoms and do not cause any problems for mother or baby.
About 95,000 babies were born in NSW in 2008, but only 258 were born vaginally in public hospitals after a previous caesarean …
It is well-known that VBAC is far more successful – around 90% – with private midwifery care. Otherwise the chance of a siccessful VBAC can be as low as 3%.
… women who had undergone traumatic births, with extensive intervention, were eager to avoid a repeat performance but were often left with little choice.
”Keeping away from obstetric intervention by having a home birth is the best chance they have of achieving a normal vaginal birth,” …
Up to 70 per cent of home births were by women who had previously delivered by caesarean and there was a growing band who would deliver at home alone if home births were outlawed.
… Ms Whitehair, who had longed for a natural birth, spent months researching a home delivery. Abi’s birth, attended by two private midwives, cost her almost $5000 but was ”beautiful and textbook”.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, birth debriefing, Birth trauma, Caesarean, continuity of care, freebirth, Home birth, VBAC
Posted by Melissa Maimann on Mar 10, 2010 in
Birth,
Caesarean,
Home birth,
Midwifery,
Normal Birth,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Can I home birth if I have a high blood pressure?
It is best to discuss this with your midwife and s/he can guide you on this one.
Can you opt for a c-section in a public hospital?
Generally speaking, you cannot do this. Caesareans are only performed where there is a clear obstetric reason. Many women have support people with them for their labour and this helps them to feel more comfortable and in control of their experience.
Can you refuse midwife attendance during birth?
You can refuse to have a midwife with you if you choose, but this would leave you without professional care during the birth.
What care is available to women birthing in australia?
Within the private system, women may choose a midwife for a home or a hospital birth and they will generally experience an empowering and natural birth without complications. If there are complications in the pregnancy or birth, obstetric care is readily available. The other option in the private system is to choose an obstetrician. Intervention rates with obstetricians are high, with caesarean rates up to (and over) 50%, episiotomy rates around 25% and assisted delivery rates around 25%.
In the public system, midwifery care is the norm, but most women will not have the same midwife all the way through their pregnancy, birth and postnatal period. If there are complications in the pregnancy or birth, obstetric care is readily available.
Continuity of midwifery care
The most established method of continuity of midwifery care is private midwifery care or independent midwifery. In this model, women book with the midwife of their choice and this same midwife is there for the woman throughout pregnancy, birth and the postnatal period. Satisfaction rates with this mode of care are very high.
IVF and home birth?
Yes, it is possible to bith at home following IVF. Talk to your midwife.
Are midwives qualified to do cesareans?
No, midwives are qualified in normal pregnancy and birthing, and we do not perform surgery.
Natural labour in sydney?
The best way to achieve a truly natural labour is to book with a private midwife for a home birth or a hospital birth. Home is the safest place to birth for the majority of women, and home – where women feel safe, nurtured and supported – is the most conducive environment for a natural birth.
Are there any obstetricians in sydney under $5000?
The best way to research prices is to ask the obstetricians themselves. Don’t forget, the ob’s bill is not the only bill you will receive: there is also the paediatrician, anaesthetist, private hospital fees, health fund excess / co-payment, childbirth education and so on.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Caesarean, Complicated pregnancy or birth, continuity of care, Home birth, hospital birth, midwife, Midwifery, Midwifery services, Normal Birth, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Mar 10, 2010 in
Caesarean Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
Rising C-section rates that show no signs of letting up have stirred a vigorous national debate about whether many are being performed too often, too early and without medical necessity.
With nearly one in three babies born by Cesarean … doctors and natural birth proponents are concerned that factors such as a woman’s preference to schedule birth on a particular day and a doctor’s fear of malpractice are, in part, driving the increase.
There’s worry, too, that fetal heart monitors, which often raise false alarms about the condition of a baby, or drugs used to induce labor might be leading to unnecessary C-sections and subsequent problems, such as a rupture of the uterus, which can lead to a hysterectomy.
“The C-section rate is probably higher than it should be,” … “We have to figure out which ones are medically necessary.”
An initiative at 60 Michigan hospitals hopes to make a dent in at least first-time C-sections by encouraging natural delivery techniques. The hospitals also are encouraging women to postpone scheduled C-sections until the 39th week of a pregnancy, when a baby’s lungs are healthier, and use labor-inducing drugs less often.
Safety a big concern
After a lengthy, dangerous labor that eventually ended in an emergency C-section, Kelly Morphew of New Baltimore wanted to play it safe this time. She scheduled a Cesarean delivery for her second baby.
Her daughter, Madison, was among 16 babies born Feb. 8 at the [hospital] … Four others also were C-section deliveries …
While safety was her biggest concern, Morphew was happy to get a Tuesday afternoon appointment that allowed her to get to the hospital of her choice and arrange a baby-sitter for her 2- 1/2 -year-old daughter.
“For me, C-section was the best way to go,” … Everything was planned. Nothing was scary.”
“We agree the C-section rate is too high, but we can’t just look at the rate alone,” … “We have to look at why women are having C-sections.”
Besides a woman’s preference, other leading reasons include:
• Doctors’ fear of lawsuits. Obstetricians … are sued the most and pay some of the biggest insurance premiums, as much as $200,000 a year. Reluctant to have a labor go wrong, many doctors perform C-sections for more defensive reasons, rather than good medical ones …
• Policy changes at small- and medium-size hospitals against natural delivery of a baby after a prior C-section …
• Technology. Fetal heart monitors, which often can be wrong, pushing too many women along a path to C-section.
• Labor-inducing drugs restrict the baby’s movement, often leading to a C-section.
• Lack of good evidence about which women with possible medical issues like older age, gestational diabetes or high blood pressure
would benefit more from a C-section.
• Fewer training opportunities for doctors to learn how to deliver babies in difficult circumstances [such as] breech …
C-sections, like other surgeries, can have major risks, including infection in the mother, profuse bleeding requiring blood transfusion and, in rare cases, death. They also carry a small risk of uterine rupture, a serious complication that occurs when the uterus tears open, sometimes leading to hysterectomy.
With safety a major focus in medicine, a Michigan campaign at 60 hospitals hopes to reduce childbirth complications. The campaign is encouraging safe birthing practices; lowered use of labor-inducing drugs … and postponement of elective C-sections until the 39th week of pregnancy …
“the real point is to prevent the first [caesarean]” …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Caesarean
Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
How long before my due date will my elective caesarean be performed?
Elective caesareans should not be performed before 39 weeks unless there is a genuine reason to do so. This helps the baby’s lungs to mature.
Are there any breathing issues for babies who are born by cesarean?
Yes, breathing difficulties are more common in babies who are born by caesarean. They are not primed by breathing as they are with a vaginal birth, and the fluid in their lungs isn’t squeezed out as is the case with a vaginal birth. As well as this, ceasar babies are more prone to asthma in childhood and adulthood.
What are the pros and cons of caesareans?
I don’t believe there are any benefits to major surgery without sound reason. There are many potential issues with caesareans:
- increased blood loss
- infections
- blood clots
- poor wound healing
- adhesions inside
- increased chance of miscarriage
- lower rate of fertility
- higher chance of tubal (ectopic) pregnancy
- lower chance of ever having a vaginal birth after a caesarean
- increased pain in the recovery period
- poorer bonding
- more breastfeeding problems
- risks associated with anaesthetics
What does it cost to have an obstetrician in Sydney?
Anywhere between $2000 and $10,000.
What does it cost to have a midwife for a home delivery in Sydney?
Usually around $3000 – $5000. This represents fantastic value for money: midwives see their clients for 1-2 hours for each pregnancy visit, they’re there throughout the labour and of course visit the family for 6 weeks after the new arrival has come.
What are the vbac rates in australian hospitals?
Fairly low! Anywhere between 1% and about 30%. The average is around 15%.
Can i have a water birth after a cesarean?
Yes, but you’ll need to choose your care provider wisely. I’d recommend a private midwife. Most hospitals will not officially “allow” a waterbirth.
What is the best hospital in sydney for a natural childbirth?
The best place for a natural birth is not hospital. Home is the best environment for a natural birth, cared for by a private midwife. Your midwife will refer you into hospital if there are any problems, but most home births go very smoothly.
Can I have a home birth after IVF?
Absolutely!
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Caesarean, Home birth, Public and private hospitals, VBAC
Posted by Melissa Maimann on Mar 4, 2010 in
Caesarean Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
Mums to be should only give birth by caesarean when strictly necessary, insists a new study.
Problem is, how do mothers know when the proposed caesarean is truly necessary? If they ask the doctor, “is there anything else we can do? I really want a vaginal birth”, the doctor is highly likely to say, “we’ve done everything we can do. I’m sorry. I know this is not what you wanted but the baby must come first.”. What woman would seek a second opinion?
Figures suggest caesareans carried out during labour without pressing medical reasons were 14 times more risky than a normal birth.
Data from the World Health Organisation’s global maternal survey … found pregnant women who had C-sections were more likely to die in childbirth or suffer serious complications, such as needing intensive care treatment, blood transfusion or hysterectomy.
… that women who opted for a caesarean because they believed it was merely an easier alternative to normal childbirth had been seriously misinformed.
… “Caesarean section should be done only when there is a medical indication to improve the outcome for the mother or the baby.
“Women and their carers who plan to undertake caesarean section delivery should discuss the potential risks to make an informed decision if they still wish to have a caesarean delivery.” …
Overall, the rate of Caesarean section was 27.3% …
Caesareans performed before labour without pressing medical reason were 2.7 times as risky as normal birth …
… “For those who are still inclined to consider caesarean delivery a harmless option, they need to take a cold, hard look at the evidence against unnecessary caesarean section.”
… Csections are associated with a greater risk of stillbirth and other health problems for the baby.
… children born by caesarean were 80% more likely to develop asthma by the time they were eight. Others studies have linked caesarean births to increased cases of allergies in children …
Of course, the other issue is that women who have caesareans are highly unlikely to have vaginal briths for their subsequent children. With each caesarean a woman has, the risks increase.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Caesarean, childbirth education
Posted by Melissa Maimann on Feb 26, 2010 in
Birth,
Caesarean,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
The mortality rate of California women who die from causes directly related to pregnancy has nearly tripled in the past decade, prompting doctors to worry about the dangers of obesity in expectant mothers and about medical complications of cesarean sections.
For the past seven months, the state Department of Public Health declined to release a report outlining the trend.
California Watch spoke with investigators who wrote the report and they confirmed the most significant spike in pregnancy-related deaths since the 1930s. Although the number of deaths is relatively small, it’s more dangerous to give birth in California than it is in Kuwait or Bosnia.
“The issue is how rapidly this rate has worsened,” … “That’s what’s shocking.”
… “current trends and evidence suggest that maternal mortality rates may be increasing in the U.S.”
The alert asked doctors to consider morbid obesity, high blood pressure and diabetes, along with hemorrhaging from C-sections, as contributing factors.
… Shabbir Ahmad, a scientist … decided to look closer. He organized … a systematic review of every maternal death in California. It’s the largest state review ever conducted. The group’s initial findings provide the first strong evidence that there is a true increase in deaths – not just the number of reported deaths.
Changes in the population – obese mothers, older mothers and fertility treatments – cannot completely account for the rise in deaths in California …
… scientists have started to ask what doctors are doing differently. And, he added, it’s hard to ignore the fact that C-sections have increased 50 percent in the same decade that maternal mortality increased. The task force has found that changing clinical practice could prevent a significant number of these deaths.
… While the maternal mortality rate among black women is rising, the task force found a more dramatic increase in deaths among white, non-Hispanic mothers …
… In 1996, the maternal death rate in California was 5.6 per 100,000 live births … Between 1998 and 1999, the World Health Organization changed its coding system, which may have increased reporting of deaths. The California rate was 6.7 in 1998 and 7.7 in 1999. Because the number of mothers who die is small, the rate tends to fluctuate from year to year.
In 2003, when California revised its death certificate, the rate jumped to 14.6. And in 2006, the last year for which data is available, the rate stood at 16.9.
… When researchers unveiled their initial findings to a conference of the American College of Obstetricians and Gynecologists in 2007, there were gasps from the audience … The idea that California was moving backward even in an era of high-tech birthing was implausible to some. Confirmation of the trend was noted in the 2008 report …
The state of California has yet to share the report with the public. Researchers say that, after reviewing the report in 2008, officials in the Department of Public Health asked for technical clarifications. Revisions were complete and approved in the first half of 2009 …
… it is important for the public to be aware now that these trends are worsening …
“Even though they tend to be small numbers in terms of maternal mortality, it is important – it’s very important – that these trends be looked at,” she said. “And efforts need to be made to try and reverse them when they are going in the wrong direction.”
Rising C-section birth rate
Nearly one in three babies is now born by C-section. Many scientists have acknowledged that at some point, as the number of surgeries spiral upward, the risks will outweigh the benefits. But the C-section remains a useful tool, and in the middle of labor, doctors say, it’s hard to balance the potential long-term harm against immediate crisis.
Today, doctors face a condition called placenta accreta, where the placenta grows into the scar left by a previous C-section. In surgery, doctors must find and suture a web of twisted placental vessels snaking into the patient’s abdomen, which can hemorrhage alarming amounts of blood. Often, doctors must remove the uterus.
Main said this complication from C-sections has increased eight-to-10 fold in the past decade. Nonetheless, most women survive the ordeal … the rise in deaths is indicative of a larger problem.
“For every maternal death, there are 10 near misses; for every near miss, there are 10 severe morbidity cases (such as hysterectomy, hemorrhage, or infection), and for every severe morbidity case, there is another 10 morbidity cases related to childbirth,” …
Inducing labor before term more common
… Dr. David Lagrew … noticed that a lot of women were having their labor induced before term without a medical reason. And he knew that having an induction doubled the chances of a C-section.
So he set a rule: no elective inductions before 41 weeks of pregnancy, with only a few exceptions. As a result, Lagrew said, the operating room schedules opened up, and the hospital saw fewer babies admitted to the neonatal intensive care unit, fewer hemorrhages and fewer hysterectomies.
All this, however, came at a cost: The hospital had to take a cut in revenue for reducing the procedures it performed. Lagrew doubts that any hospital has increased its C-section rate in pursuit of profit, but he does note that the first hospitals to adopt controls on early elective inductions have been nonprofits.
According to a report issued by the advocacy group Childbirth Connection, “Six of the 10 most common procedures billed to Medicaid and to private insurers in 2005 were maternity related.” On average, a C-section brings in twice the revenue of a vaginal birth. Today, the C-section is the single most common surgical procedure performed in the United States.
“If all these guys were losing money on every C-section, well, what’s the old saying? Whenever they tell you it’s not about the money, it’s about the money,” Lagrew said.
The California task force isn’t waiting to determine the ultimate cause of these deaths. It has started pilot projects to improve the way hospitals respond to hemorrhages, to better track women’s medical conditions and to reduce inductions …
I think they’ve missed one key element: midwives! If every woman was cared for by her own midwife (and home birth and birth centre birth was encouraged as the norm for healthy women), the induction and caesarean rates would fall dramatically …. then maybe fewer women would die in childbirth.
Midwifery has an important focus on health promotion and education and would work fantastically for poorer women and women with health issues. The other priority ought to be raising the VBAC rate and reducing the number of elective repeat caesareans. Whilst the first caesarean might be safe, second and subsequent caesareans carry serious risks that are alluded to in this article.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Birth trauma, Caesarean, childbirth education, Complicated pregnancy or birth, hospital birth, intervention, Normal Birth, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Feb 24, 2010 in
Birth,
Caesarean,
Normal Birth,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
In this world where information is so readily accessible, it never ceases to amaze me how mis-informed and ill-informed some people are when it comes to pregnancy and birth. This article is a prime example:
… As for childbirth being a natural process, yes, that is the case in most pregnancies. I know for a fact that my obstetricians don’t just let their patients go willy-nilly picking when they are tired of being pregnant or delivering babies based upon their Blackberry schedules.
Are you sure? How many caesareans and inductions are scheduled around when their husband will be home, when the doctor will be around, or the time of the year?
Have you seen the malpractice insurance premiums these guys pay? They do everything they can to keep babies and mothers alive.
There is a difference between saving a life that clearly needs to be saved, and saving a life just in case it might need to be saved at some point in the future. Intervening for the latter reason causes unnecessary harm to women and babies.
I don’t believe the majority of C-sections or early inductions are for revenue; they are for saving lives.
See above.
My child was a “complete” breech and if was not delivered via C-section, I and the child would have more than likely died during the “natural process of child delivery.”
Actually, recent research and guidelines support vaginal breech birth. It is sad that you were not informed of this.
Let’s stop C-sections or put a stigma on them and see what happens to mortality rates for mothers and babies.
If recent reports have anything to do with this, then the mortality rate will decline if caesareans reduce.
It seems that society wants a guarantee that the baby process is going to be foolproof and everyone gets the perfect “natural birth process” with no drama or sad outcome.
… it is not my right to have a natural childbirth; it is my privilege to have the best medical care in helping me achieve a healthy and safe delivery of my children.
And the best way to achieve a healthy and safe birth and baby is with a midwife. The midwife will make appropriate referrals to an obstetrician if this is needed.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Caesarean, childbirth education, Complicated pregnancy or birth, Obstetrics
Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
informed consent and childbirth
Every woman who is competent to consent, has the right to refuse any or all professional care. Informed consent must be obtained prior to any procedure being performed.
how to minimise labour intervention in a hospital?
The best way to minimise intervention in a hospital is to be as well informed as you can possible be about all things related to pregnancy, labour, birth, breastfeeding and babies. Read widely, attend independent childbirth education classes and consider employing a private midwife to be with you throughout your labour. She can help you to decide if the proposed interventions are necessary in your situation, she can support you emotionally, mentally and physically and she can aso help to ensure that your birth plan is respected without a fuss.
Do any independent midwives in Sydney offer prenatal care for women who are planning to freebirth?
Yes! This service enables women to access antenatal care from a midwife without the midwife attending the birth. Postnatal care is available if needed.
Do you think there are advantages to continuous monitoring for low-risk women
In a word, no. Intermittent auscultation is the method of choice. Continuous monitoring will increase the chance of a caesarean with no benefit to the mother or baby.
How much is a private midwife
Prices range from $3000 – $6000. Melissa Maimann offers for her clients to pay by the hour, making the service one of the cheapest.
What is a good caesarean rate?
The World Health Organisation recommends that no more than 15% births need to be caesareans. The WHO argues that when caesarean rates exceed 15%, the risks to the mother and baby increase on the whole. You’ll be hard-pressed to find a hospital with a caesarean rate of less than 15%, but birth centres and private midwives have caresarean rates of less than 10-15%.
What is the best hospital in sydney for delivering babies?
It all depends what sort of birth experience you’re after! If you’re wanting a natural birth, home birth will be the best option. If you want a natural birth in a hospital setting, the best options would be birth centre or private midwifery care for a planned hospital birth. If you’re wanting to have intervention in your birth, a hospital birth would be best. If you choose an obstetrician, you’re far more likely to have a caesarean, episiotomy, epidural, forceps or vacuum. Choosing your care provider is the single most important decision you will make in birthing.
Is there a birth centre at westmead hospital?
No, there isn’t. If you’re after a natural birth, the best choice would be a home birth.
C section or natural delivery midwife?
Midwves cannot perform caesareans. If a caesarean was needed, the midwife would call a doctor in to perform it. Most caesareans that are performed are unnecessary and increase the risks to the mother and baby. A natural birth is the safest way to birth, and midwives are qualified specialists in natural birth.
giving birth after birth trauma
Private midwifery care will be really important so that you can have the same midwife all the way through pregnancy, birth and postnatally. It’s also important to debrief your last experience and come to a place where you feel safe to birth again.
high risk midwife sydney
Midwives are not qualified to care for high risk pregnancies. We refer these women onto obstetricians. In most cases, one or two consultations is all that is needed with the obstetrician and the midwife continues the care of the woman.
how many births proceed naturally
What a great question! It all depends what care provider you choose and where you have your baby. You see, if you choose a private midwife and birth at home, you have about a 95% chance of having a vaginal birth. If you birth in a private hospital, you have about a 33% chace of having an unassisted vaginal birth. In some hospitals, the caesarean rate is more than the vaginal birth rate! Sad but true.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, birth debriefing, Birth trauma, Breastfeeding, Caesarean, childbirth education, Complicated pregnancy or birth, continuity of care, Epidural, exercise, fetal monitoring, freebirth, Home birth, hospital birth, intermittent auscultation, intervention, IVF, Maternity Services Review, midwife, Midwifery, Midwifery services, Normal Birth, Nutrition, Obstetrics, postnatal depression, Preconception care, Public and private hospitals, VBAC
Posted by Melissa Maimann on Feb 23, 2010 in
VBAC Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
Michelle Williams is three months’ pregnant and determined to experience childbirth the way nature intended. But because her previous baby was delivered through … cesarean section — she has to travel more than an hour … to find an obstetrician willing to let her try for a vaginal birth.
One out of every three pregnant women now has a C-section …
This is also the case in Australia.
The skyrocketing C-section rate has been hotly debated in birthing and medical communities, yet little attention has been paid to one of the consequences: Once a woman has a C-section, she often has to fight to deliver subsequent babies the old-fashioned way …
This is also the case in Australia. VBAC rates nationally are around 15%.
Repeat C-sections have become so routine that 90 percent of pregnant women who have the surgery give birth that way again. That is a concern to health experts, who say vaginal births after a cesarean, or VBACs, should be far more common.
Successful VBACs result in better health outcomes for the mother and the baby … VBACs [should] be offered in low-risk cases.
… although the attempt carries a risk of uterine rupture, the chance it will happen is relatively low: 0.5 percent. Meanwhile, C-sections carry all the risks of a major surgery. Compared with having a vaginal birth, a woman delivering by C-section experiences more physical problems, longer recovery and more emotional issues on average … babies born by cesarean are less likely to be breastfed and more likely to experience breathing problems at birth and asthma as they get older.
Yet the VBAC rate, 9.2 percent, is a far cry from the objective set by the Centers for Disease Control and Prevention: 37 percent. In Illinois, the rate was 11 percent in 2008, down from 38.6 percent a decade earlier.
… In northwest Illinois, the VBAC rate is as low as 3.9 percent …
Not dissimilar to some of our hospitals here in Australia.
… 73 percent of the women who try VBACs are successful.
Success rates are around 70%-80%, but they are higher, up to 90%, if the woman chooses a private midwife.
“The liability issue is huge,” said Dr. Joseph Pavese, chairman of the obstetrics department at Advocate Christ Medical Center in Oak Lawn, where 97 percent of pregnant women with a previous C-section have another one. “Parents expect good outcomes, and physicians are reluctant to try difficult deliveries. If the baby is not perfect, there is possible litigation.”
… If the scar opens during labor, it would require an emergency C-section. Certain factors — induction of labor, or a vertical (rather than horizontal) incision — can increase the risk of rupture.
In 99.5 percent of the cases, nothing goes awry. But if the scar gives way, results can be catastrophic; the baby has a 10 percent chance of dying or suffering brain damage.
Over the years, “The risk of uterine rupture has not changed,” said Dr. Howard Strassner, director of maternal and fetal medicine at Rush University Medical Center. “What has changed is individual tolerance for risk. It reached the point where no one wants to be associated with an adverse outcome.”
… more recent and balanced research showing VBACs are as safe — if not safer — than repeat C-sections hasn’t had the same effect [as previous research that demonstrated that elective repeat caesarean was safer than VBAC.]
… What crippled the idea of a VBAC, however, was a simple word change. In 1998, ACOG advised that physicians should be “readily available” to provide emergency care because of the dangers of a uterine rupture. Eight months later, the American Congress of Obstetricians and Gynecologists changed the wording to “immediately available,” and many small hospitals in rural areas stopped doing VBACs.
We have the same situation in Australia, with many smaller hospitals and midwife-led units not offering VBAC services.
Katherine Shaw Bethea Hospital in Dixon, which handles about 365 deliveries a year, was one of more than a dozen Illinois hospitals that subsequently dropped VBACs because an on-site anesthesiologist wasn’t always immediately available.
“… too many women are subject to coerced cesareans because hospitals have banned VBACs.”
… Mariana Patzelt … had two previous C-sections, planned to drive from her home … to deliver her third baby … after laboring too long at home in hopes of reducing her chances of a C-section, she ended up delivering in the emergency room of a nearby hospital.
When doctors there asked whether she had had any previous surgeries, she said no.
“The whole time I was hoping they didn’t see the scar,” she said. “I knew if I would have said yes, it would have blown my chances and I wouldn’t be able to fight hard enough for everything I worked for.
“Hospitals treat birth as a medical condition, a disease they have to fix rather than something natural we’ve been doing since the beginning of time.”…
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Caesarean, hospital birth, VBAC