Tag Archives: childbirth education

Preparing for a natural birth and going with the flow

Posted on by
Reply

In society today, there is a great focus on pain in labour birth, with the assumption that women cannot handle the pain of labour and that women need medical assistance in the form of an epidural or drugs to get through. Many women go to hospital saying, “Well, I’d like a natural birth, but I’ll go with the flow”.

Even with today’s technology, birth comes with pain most of the time. Even for those women who are sure they want an epidural, they will still feel some pain as epidurals are given once labour is established, after 4cm dilation. There is usually pain / discomfort to get to that point.

And once women get to 4cm, the last 6 are usually much faster and easier to get through. That’s because our bodies are designed to release natural pain relief that helps with the later stages of labour.

The best thing is to learn techniques for managing the sensations of labour, to feel well prepared for labour and birth.

When preparing for a natural birth, most women feel better informed – and therefore relaxed – if they have read a lot about labour and birth. Women who are well-informed about the process of birth, the options available to them and what they can expect, are generally more accepting of the sensations of labour. They are not fearful because they know what to expect and what might happen next.

It’s a great idea to read other women’s birth stories – positive and negative – to give a balanced view of what happens, what is possible and what you might like for your own labour.

Independent childbirth education is excellent for teaching women in an unbiased way about all the options available to them.

Calmbirth is another fantastic tool for assisting with natural birth.

It’s essential to be surrounded with positive messages about birth. Try to limit contact with people who are skeptical and judgmental of your plans for a natural birth. Don’t let people discourage you or tell you birth horror stories. If you expect it to be terrible, it will be.

Think about what you want your birth to be like. Make a birth plan, detailing what you’d like for your labour, birth and postnatal period. Show it to your midwife or doctor and get their agreement to help you achieve that birth that’s right for you.

Of course, birth plans are always flexible and we understand that sometimes they need to be modified and that’s ok. A birth plan is just that – a plan. It’s not set in concrete and women can change it at any stage.

Watch DVDs on natural birth. See, hear, read and talk about natural birth. Focus on becoming the healthiest person you can be with great nutrition and a firm exercise program. Women who are physically fit and well-nourished often have easier labours.

Finally, your choice of care provider is also worth considering. Do you know the midwife who will be caring for you in labour? Would you like to know the midwife who’ll be caring for you? Women who are well supported in continuity of carer programs such as private midwifery care are far more likely to rate their labour and birth experience as being positive and satisfying.

Visit my website to learn more about my services.

Natural Twin Birth

Posted on by
Reply

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

Visit my website to learn more about my services.

Natural birth in hospital?

Posted on by
Reply

Here are some ideas to birth naturally in hospital:

Read, read, read. Books, websites, any written info from your care provider … read it all. You also need to know the difference between facts presented to you in an honest and unbiased way, and facts that are being filtered through hospital policy. This is where women benefit from having a private midwife by their side.

For example, “Some risks rise slightly when a woman has high blood pressure. I am uncomfortable with letting your pregnancy continue with high blood pressure because of the risks to the baby and to you if something happens” is an honest and factual statement. You have the right to accept the risks and refuse induction. However, some women hear “I’m going to induce you today because if we don’t do this now, there is a good chance your baby will not make it”. This statement is dishonest, using a woman’s fears and her maternal instinct to encourage her to accept intervention. There is also no discussion of alternative options. Informed consent requires that women are presented with options so that they can make the best decision for them, in their situation.

Be assertive As with most human relationships, a great deal can be resolved with a calm, respectful and firm manner. Know what you want and why you want it. Engage a private midwife to assist you with obtaining relevant and impartial information.

Listen. If you are choosing to use a hospital and an obstetrician for your birth, then you acknowledge that their presence, education and experience have some value. Your wishes are important but be willing to listen even when what’s being said is really not what you want to hear. You must also acknowledge that an obstetrician is trained in all things that go wrong, and they are on the look-out for any sign of things going wrong. Midwives, on the other hand, will promote normalcy and assist your pregnancy and birth to remain normal. These differing philosophies do result in big differences in intervention rates.

Be Flexible. Understand that sometimes things don’t go the way we had planned. There might be some occasions where you’ll be happy to accommodate the hospital policy, and other times when you’ll want to stand your ground.

Ultimately, it is true that the most important aspect of birth is safety and a healthy mother and baby. But that doesn’t mean the other aspects are unimportant, and I firmly believe you can have a great birth – and a safe birth – in any location.

Visit my website to explore birthing services.

‘We know the reality of childbirth’

Posted on by
Reply

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

Link

A new report on NHS maternity care has revealed divisions between midwives and obstetricians. One of the disputes … is over the best way to give birth. While midwives, and the government, advocate natural birth, many female obstetricians opt for a caesarean when they have their own children. Do they know something we don’t?

… Sher, 38, chose an elective caesarean … because she decided it was the safest method … Sher makes decisions on delivery and surgery every day, and she understands the consequences more than most – she is a consultant obstetrician.

One London study … reported that 31% of female obstetricians would personally prefer a caesarean birth. In the US, the figure is almost 50%. Many female surgeons and GPs quietly take this option too – though, as one told me, “to admit as much is still massively un-PC”.

In April 2007, the then health secretary, Patricia Hewitt, launched her strategy for the future of maternity care. Maternity Matters trumpeted “choice”, promising better access to “normal” deliveries via home births and midwife units. Her plans chimed with recent guidelines from the National Institute for Clinical Excellence (Nice) drawn up to reduce caesareans – currently 23% of all births – by advising obstetricians against granting them without medical justification. The official disapproval of elective C-sections means Sher daren’t talk under her real name; Stephanie Sher is a pseudonym.

So while the government promotes “normal” deliveries to the public, its employees are privately planning caesareans. Why do so many obstetricians opt not to push? What do they know that we don’t?

It’s important to remember that it is the obstetrician’s and the surgeon’s task to remedy the rarer complications and consequences of childbirth. Unlike midwives, who oversee successful, normal births every day, doctors bear witness to the worst-case scenarios.

Inevitably this difference in experience manifests itself in an ongoing debate on how best to manage childbirth. Midwife groups advocate normal delivery and “natural” births while obstetricians tend to see medical intervention as a benefit rather than a bane. Yesterday, the healthcare commission published a report highlighting several key problems in Britain’s maternity services, one of which was an inherent tension between midwives and doctors on maternity wards. Caught up in the middle are the mothers.

Maternity experts across the board believe that a straightforward vaginal delivery is by far the best for both mother and baby. Most women agree: 63% of mothers see childbirth as a natural experience that should not be interfered with unless necessary. In “putting women at the centre of maternity provision”, the government’s strategy reflects the overwhelming consensus.

Nevertheless, among all the furore that surrounds the issue of childbirth, for Sher and her colleagues, one thing is clear: the government’s promotion of delivery “choice” is a promise rarely kept. “There is nothing wrong with hoping for a natural event,” Sher says, “and for everything to happen beautifully. But it just isn’t like that for a large proportion of women.”

Sher’s greatest fear was not the pain of spontaneous labour. It was the prospect of emergency intervention, if the birth went wrong. According to the most recent NHS maternity statistics made available (2005-6), just under half (47%) of expectant mothers have a regular, uncomplicated “normal” labour. The rest have interventions ranging from induction, to forceps, to an emergency caesarean. In other words, when a woman tries for a normal birth and the best, safest kind of delivery, she has only a 50% chance of achieving it. For a significant number of others, the birth will be more complex.

I wonder if those women had access to one-to-one midwifery care for their pregnancy, birth and postnatal care? When women are put through a system that sees women having a different midwife at every antenatal visit, shifts of midwives in delivery suite and then shifts of midwives in postnatal, it’s no wonder that most women do not experience a natural birth. bur when women are cared for by the same midwife right from the first visit to 6 weeks postnatal, the outcomes are very different. The ability to develop trust, rapport and understanding are paramount to experiencing natural birth.

With odds like this, it is not illogical to consider alternatives, particularly not if your line of work exposes you to the most extreme of cases. Many obstetricians find the second safest solution is a planned caesarean. The National Caesarean Section Audit (2001) revealed half of obstetricians think this is the safest delivery method for the baby – though not for the mother.

The surgical risks of a planned caesarean include haemorrhage, thrombosis and infection. Scarring on the uterus means the more caesareans you have, the more risky later pregnancies become. But Sher knew she only wanted two children and made the choice that suited her best – both were delivered by C-section. The baby’s safety was her primary motive – but not, she adds, the only one. “The other issue was the risk of pelvic floor damage. Again small, but to me, just not worth it.”

… Michelle Thornton, a colorectal surgeon, sees around 100 women a year suffering from faecal incontinence. “I’m seeing the end result of a traumatic birth,” she says. “Very few of my colleagues would opt for a vaginal delivery and, if any of them asked me, then it’s an elective C-section.”

What about planning for a natural vaginal birth and preparing well for an intact perineum and a short second stage? Private midwives are expert at working with women to achieve these aims. Most women who birth with private midwives do not need stitches and experience a healthy return to normal pelvic floor function.

… Not all experts agree that the risks of a surgical birth outweigh the benefit of protecting the pelvic floor. But calibrating clinical percentages is different from witnessing the lives of women with faecal incontinence, says Thornton. “It’s definitely altered the way I think about childbirth. The thought of being faecally incontinent – to have a life like my patients – I don’t think I’m strong enough.”

… Thornton has half a dozen women in their early 30s. They have “bonding issues with their babies . . . as well as young partners expecting to resume a normal sexual relationship. Two of the couples have split up because of the traumas.” She counsels patients both psychologically and physically. “Emotionally it is tough,” she says. “Having those patients with you when they get upset is tough.” When treatments fail, “it’s terrible, because the patient is absolutely gutted”. Her patients know a permanent colostomy is the only solution. Imparting this news always makes Thornton anxious. “It’s a terrible feeling. It’s like giving them a cancer diagnosis.”

When it comes to medical matters, we assume that knowledge is a good thing. Looking at the childbirth choices made by some female doctors, we might think their superior professional experience makes them right. But many admit their exposure to complications inevitably taints their personal choices. Is it really better to know what they know? Perhaps it’s not that most women don’t know enough – but that female doctors, and particularly obstetricians, know too much.

… If you’ve seen deliveries, she says, “you know the reality.” And “maybe that’s why doctors go and have caesareans – they know it is quite a risky time”.

Interesting, as many midwives opt for homebirths when they have their babies.

Consultant obstetrician Virginia Beckett also puts it plainly: “When I was 14 weeks pregnant I dealt with 12 stillbirths in one 24-hour shift. You can imagine that might skew your view of how to manage your labour.” (Beckett has had two caesareans, the first because her baby was breach, the second was elective). On that particular shift, her baby was too small for her to feel any movement. Emotionally drained and anxious, she scanned herself in the middle of the night. She needed to know her own baby was still alive.

Beckett has worked in obstetrics for more than 16 years, but dealing with stillbirths “doesn’t get any easier”. As the obstetrician, you “go in with the machine and with the patient’s eyes boring in to the side of your head, make the diagnosis and break the news”.

Every time it happens Beckett finds it “heartbreaking, sometimes I do cry actually, not in front of the patient. You feel terrible . . . But there’s nothing you can do.” In the middle of a busy shift there is no time to reflect. “You can’t spend half an hour coming down from every case,” Beckett says, “because there will be another one along in a minute.”

Complications include “abruptions, where the placenta separates and mum and baby can bleed to death. We see people having seizures with pre-eclampsia or eclampsia. We see people’s uteruses rupturing when they’ve had a caesarean section in the past. We see acute fetal distress. We see very complicated vaginal deliveries using instruments, at which various degrees of injury can be sustained . . . All life is here as they say.”

It is the obstetrician’s job to control the less palatable, natural, consequences of childbirth. And they are very good at it. The UK is one of the safest places in the world to have a baby. And of the 1,917 babies born each day in this country, just 11 will be stillborn. “We know that when we work effectively we’re able to make a difference and that’s why we keep doing the job. When it goes to plan, you feel very positive.”

And when things go badly? “You feel absolutely awful: drained and disempowered, really.” Choosing a caesarean, admits Beckett, is one way of redressing this because “you realise how out of control things can be sometimes” and ultimately, “how fragile life is”.

The medics making this choice are unlikely to find support among their colleagues in the midwife unit or even, in some cases, their employers. Current Nice guidelines discourage obstetricians from offering C-sections on “maternal request”. Instead, natural births top the government’s maternity “menu”, with home births promised alongside other “normal” delivery options by 2009.

Privately, however, many obstetricians believe women should be able to choose a caesarean, if they are aware of the risks. Consultant obstetrician Sara Paterson-Brown has publicly asserted a woman’s right to an informed choice because “mothers must live with the consequences”. Her hospital has not since suffered a stampede of women eager for the surgeon’s knife. “Women are counselled and fully informed and recommendations are made,” she says. “We don’t feel threatened by women expressing their choice.”

Paterson-Brown won’t tell me how her own children were delivered, but resolutely feels “the best way to have a baby is normally with no complications. The trouble is, you don’t know if that’s going to be you or not.”

The vast majority of women want a vaginal birth. Just 3% of women even ask for a caesarean without medical indication. Almost 25% will end up having one anyway – largely in emergency circumstances – and a substantial number find their “normal” delivery will go seriously off plan. “There is a lot of luck involved,” says Beckett, “and sometimes the luck isn’t there for you.” Doctors know this, lay women don’t; and when things go wrong, they blame themselves.

Luck? Is it “luck” if we get a uni degree? Is it “luck” if we pull off a dinner party? Is it luck if we get through a very busy week with everything achieved as planned? Or, is it good planning, good information, good support and confidence in our abilities? There is so much a woman can do to achieve a positive, natural birth: she can inform herself, plan for a great birth, increase confidence and engage supportive care providers. Without this, intervention is the most likely result because that is the world we live in today: a world that is fear-ridden and that seeks to control that which we do not fully understand. I believe that most pregnancy and childbirth “complications” are mediated emotionally and mentally. When women are supported, informed, confident, prepared and cared for by a care provider who supports natural birth, she is most likely to birth her baby naturally.

Dr Abigail Fry remembers one birth as a medical student which turned from “calm” to “completely crazy” when a cautious doctor intervened. It became a difficult forceps delivery. Afterwards she remembers “the registrar doing the woman’s stitches and saying: ‘Do you think this bit, you know, should go there?’ And I was like ‘I don’t know!’ It was a mess.” Unlike her obstetric colleagues, Fry chose a home birth.

… “I really enjoyed it.” …

A recent study also found a huge polarity between pregnant women’s expectations of birth and the reality. Expectant mothers need not be frightened by rare, unlikely risks, but they should be given realistic information about the pain and unpredictability of childbirth.

How is that not frightening women? “It’s going to hurt like nothing else … it’ll be excruciating. Oh, and by the way, birth is also unpredictable so don’t have any expectations because they’ll be shattered”. How about, “The sensations of birth can be managed in many ways such as with water, hot packs, movement, position changes (etc). Birth can be unpredictable and so it might be helpful to spend some time going through some of the more likely issues that can come up and to look at how they might be managed at the time.” The latter is far more empowering and less fear-provoking than the former.

Instead there exists a misguided, competitive birth culture; where “lucky” or natural “birthers” are praised for their success, while mothers who “succumb” to medical intervention openly admit they’ve “failed”. Elective caesarean births are so low on the league table they can barely be mentioned without fear of acrimony.

“Women need education,” says Linda Cardozo, a professor in urogynaecology, who blames the “brand of doing it naturally” for this competitive approach as well as the trend for the “madness” of home births. “Most are perfectly safe,” Cardozo admits, “but if something does go wrong you’re in the wrong place to deal with it.” Childbirth is a natural process, but she thinks we’ve forgotten it’s also “a natural process for far more mothers to be damaged and far more babies to die, and medical intervention is absolutely wonderful because it’s prevented that”.

But this does not make Cardozo an advocate of elective caesareans. She remembers colleagues choosing them 20 years ago, but personally felt differently. “You see bad experiences in all deliveries, not just vaginal,” she says, besides which, “I truly don’t believe the risk is worthwhile.

Caesarean section is an operation and all operations carry a complication rate.” So Cardozo did what most women in the UK do, and delivered her three children vaginally, in hospital. Two were twins, one delivered by forceps. “And I’m not incontinent – yet,” she says …

Melissa Maimann, Essential Birth Consulting 0400 418 448

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

Posted on by
Reply

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

Link

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

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

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

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

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

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

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

Other maternity units … report similar trends.

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

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

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

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

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

Melissa Maimann, Essential Birth Consulting 0400 418 448

Your body, your choice

Posted on by
Reply

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

Link

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

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

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

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

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

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

Wong’s experience isn’t unique.

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

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

Birth trends

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

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

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

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

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

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

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

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

Medical interventions

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

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

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

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

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

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

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

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

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

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

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

The big ‘C’

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

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

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

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

Disturbed birth

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Take control

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

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

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

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

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

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

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

Melissa Maimann, Essential Birth Consulting 0400 418 448

Home Births on the Rise

Posted on by
Reply

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

Link

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

“When I had my first child in the hospital … It wasn’t a real positive experience,” … “It was a stark, very impersonal feeling, treating me like I was sick and not pregnant.”

Jacobs explained she believed she had more control over many aspects of the birth when it took place at home, including whether she got to be with the baby after delivery and having the siblings there at the birth.

“Doing a home birth, I felt like I had a say,” said Jacobs. “This is not the hospital’s baby. This is my baby.”

… the Centers for Disease Control and Prevention indicate that a very small but slightly growing number of women are making the same choice that Jacobs did. While less than 1 percent of all births in the United States take place outside the hospital, the number of those births taking place at home has increased by 3.5 percent between 2003-04 and 2005-06 …
… the most recent trend might be a negative reaction to a hospital birth experience, since the majority of mothers choosing a home birth have had children before.

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

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

… a likely cause of any increase is a desire to avoid the interventions hospitals perform, ranging from cesarean sections and epidurals to controlling when the mother is with the newborn.
… Home birth advocates have cited several studies supporting the safety of home births among low-risk women …those studies have taken place in the Netherlands and Canada … its unrealistic to apply the findings to the United States.
“Those are highly regulated, highly integrated systems. Their system is prearranged — it’s very different from the systems available in the United States,” he said.

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

… “The mothers who are having these home births are not crazy, unaware people,” said Declercq. “They plan carefully, they think about this all the time. They think they’re better off not having the interventions that they feel will happen unnecessarily at hospitals.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

Hospital birth: What to expect

Posted on by
Reply

Visit my website to learn more about my services.

There is a fairly normal standard of events for women who give birth in a hospital setting, whether public or private.

The following information can help you to understand what may happen in labour, to give you a sense of your options and lessen any surprises. When you go to hospital in labour, you can expect to:

- be asked to remove your clothes and wear a hospital gown.
- To have a vaginal examination when you are admitted and at least every 4 hours thereafter.
- To have your temperature, blood pressure and pulse taken regularly throughout labour
- In some hospitals, continuous monitoring is used for 20-30 minutes when you arrive. In many cases, it is left on for the whole labour.
- Many women will have a cannula in their arm. Some women will have antibiotics put through this cannula; others will have IV fluids.
- You can expect food to be limited in labour. Some hospitals have a policy of ice chips only when in labour.
- You will have one or two ID bands placed around your wrist.
- If you’re giving birth in a private hospital, it’s fairly standard to have your waters broken in labour by the staff.
- You can expect to give birth lying on your back in bed with the back rest elevated somewhat. In some hospitals, stirrups are used.
- In many hospitals, pain relief is routinely offered.
- You will most likely be told when and how to push.
- Many women will be given an episiotomy.
- You will routinely be given an injection to speed the delivery of the placenta.
- Your baby’s cord will be cut before it has stopped pulsating.

Visit my website to learn more about my services.

FAQs

Posted on by
Reply

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

changes to medicare obstetrics

It will cost more out of pocket to have an obstetrician. Conversely, midwifery will attract medicare benefits after November, making private midwifery care more affordable to families.

waterbirths in sydney

The easiest way to have a waterbirth is to contract a private midwife and have a home waterbirth. Some hospitals are offering waterbirth. Sometimes it will depend on having a room available with a bath in it; other times it will depend on which midwife is on staff as some are accredited to do waterbirths and others aren’t.

antenatal classes sydney and independent childbirth educators sydney

The best value antenatal classes are with Julie Clarke who is an experienced childbirth educator and Calmbirth (R) Practitioner.

can i refuse use of forceps

You can refuse anything you don’t want to have. Often obstetricians will use a vacuum rather than forceps. Avoiding an epidural is the best way to avoid forceps or a vacuum.

can you go public if you have phi maternity

Absolutely! PHI is there in case you need it, but having it doesn’t mean you have to use it.

caseload midwifery and homebirth

Homebirth is the original caseload midwifery model! Each woman books with her own midwife, one she has sought out, trusts and knows well. That same midwife attends all the woman’s pregnancy, birth and postnatal care.

cost of a private midwife sydney

Anywhere from $3000 upwards. Most are around $3000 – $5000. It’s money well spent.

how will homebirth be affected by the health reform australia 2010

Truth is, we still don’t know. We’re awaiting another draft of the Quality and Safety Framework. As soon as something is released publicly, I’ll place it on this blog.

which is safer hospital or midwife?

It’s not really an either / or because midwives work in hospitals as well as in the community. Midwives attend every birth. In some cases, a doctor will also attend, but every birth is attended by a midwife.

can I have a waterbirth after a caesarean?

Of course you can!

Melissa Maimann, Essential Birth Consulting 0400 418 448

The Mother Friendly Childbirth Initiative

Posted on by
Reply

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

Link

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

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

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

The Mother Friendly Childbirth Initiative:

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

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

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

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

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

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

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

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

9. Discourages non-religious circumcision of the newborn.

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

Melissa Maimann, Essential Birth Consulting 0400 418 448

FAQs

Posted on by
Reply

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

Birth trauma symptoms

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

Some women experience:

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

    • benefits of birthing by midwives over doctors

    The msin benefits of using a midwife are:

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

    do you need informed consent episiotomy

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

    duty of care to an unborn child

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

    no obstetrician for birth in private hospital

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

    private birthing classes at home, Sydney

    Yes, this is possible. See here.

    will homebirth be legal after July, 2010?

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

    Birth providers who support vbac in sydney

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

    Posted on by
    Reply

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

    What are the disadvantages of birthing in hospital?

    Most women who birth in hospital do not have the same midwife with them throughout pregnancy, birth and the postnatal stay. They have different midwives for pregnancy care, then another lot of midwives for the birth (sometimes 3-4, depending on how long the woman is in delivery suite and whether the midwife has a student midwife working with her), followed by another lot of midiwves who work in shifts in postnatal. The lack of continuity means that the woman does not have the opportunity to really develop a deep sense of trust with her own midwife, something that is intrinsic to positive and safe birthing experiences.

    Women who are attended by hospitals have hospital policies drive their care. Policies around induction: when and how it’s done; when a caesarean is done; how often they are to be examined; which women are to be continuously monitored; which babies are to be admitted to the nursery and so on. It’s a bit like checking a box and then applying a treatment or intervention – without first checking if that treatment or intervention is genuinely needed in the woman’s case.

    When women have their own midwife with them – either for hospital, birth centre or home birth, they have the full range of options open to thema nd they are fully informed and able to make their own decisions around pregnancy and birth care.

    birthing options

    To learn more about birthing options, why not come along to the Essential Birth Consulting workshops?

    Can I have a midwife as additional support in pregnancy?

    Absolutely! It’s a great way to supplement and complement the care option that you have chosen. You can have a midwife as additional support whether you’re going to a public or private hospital, and even if you also have a private obstetrician. See here for details of birthing statistics with and without your own midwife.

    midwife medical offset?

    It’s called the net medical expenses tax offset. Contact your registered tax agent or accountant for more advice. my understanding is that once you have $1500 in out-of-pocket medical expenses (doctor’s fees, midwifery, prescriptions, optical, dental etc) you can claim 20% the cost through tax.

    midwifery care fees

    Private midwifery costs somewhere between $3000 and $6000. Essential Birth Consulting has new payment structure where families may choose to pay by the hour, potentially making this the best value midwifery service in Sydney, at around $3000 for a complete package of pregnancy, birth and postnatal care. Birth support is available for around $1500.

    Are there any homebirth classed in sydney?

    Yes! Why not come along to the Essential Birth Consulting workshops?

    access to rebate on midwife visits

    After November this year, women who are planning a hospital birth with a private midwife will be able to claim a medicare benefit for midwifery services. The benefit amount is not known at this stage and it is likely that there may be some out-of-pocket expenses too, but it will bring down the cost once Medicare benefits are payable.

    Are hospital births unnecessary?

    Every woman will need to come to her own conclusions on this one. My opinion is that home is the safest place for a low-risk, healthy woman to birth her baby. Leave hospitals for those who need them! In that case, most women would actually birth at home.

    bowral midwife educator

    I’d recommend Peter Jackson’s Calmbirth classes.

    Can i have an epidural with a midwife?

    Absolutely! Although many women find that they don’t need one when they’re cared for by the same midwife and supported well in labour. My experience has been that the call for an epidural is mostly a call for more support and suggestions for getting though the labour. Epidurals are a good option for some women in some labours.

    Can midwives administer oxytocin at a home birth?

    Yes, if it’s to manage excessive bleeding after the baby is born, but we cannot use it to induce or augment the labour. Those interventions must be attended in the hospital as they carry risks to the baby. Midwives routinely carry oxytocics to births in case they are needed.

    Cost of homebirths in the illlwarra

    Private midwifery costs somewhere between $3000 and $6000. Essential Birth Consulting has new payment structure where families may choose to pay by the hour, potentially making this the best value midwifery service in Sydney, at around $3000 for a complete package of pregnancy, birth and postnatal care.

    Does having gestational diabetes mean a c section?

    This would be a good one to ask your care provider. Generally speaking, gestational diabetes does not automatically mean having a caesarean.

    Private midwife public hospital sydney?

    Yes, it is possible to take your own midwifey with you in a public hospital. This service provides this as an option. Women book with their private midwife, booki into the hospital, receive all of their pregnancy care from their midwife, labour at home as long as possible with their midwife (even having the option of staying home if all is well), head off to hospital when the time is right, and then come home as soon as possible and continue care for 6 weeks. In the hospital, a hospital midwife will also be assigned to you.

    Pprivate midwives in Sydney’s east?

    Yes, this service provides private midwifery services in the eatern suburbs.

    Reasonable obstetricians north shore 2010

    What is reasonable? What is important to you? At the end of thr day, it’s about choosing a care provider who is suited to your needs. As experts in abnormal pregnancy and surgery, obstetricians are ideal care providers for risk-associated pregnancies. If your pregnancy is normal and you prefer a more natural option, midwifery care will best meet your needs. Private midwifery is the oldest form of continuity of midwifery care, however there is a price attached to this model as it is a private service. Public options are free but will lead you down the path of hospital policy and interventions.

    What is the difference in cost between public and private?

    Private has costs attached: obstetrician, paediatrician and anaesthetist fees, private hospital fund excess / co-payment, any other fees and charges from the private hospital (eg TV, phone, parking etc) and also tests and ultrasounds. Public is free if you have a Medicare card.

    Transition into parenthood

    These are highly recommended childbirth education classes that prepare couples well for the changes in pregnancy, birth and parenthood.

    vbac north shore private?

    It’s very unlikely to happen at North Shore Private! Around 5% of the women who have previously had a caesarean go on to have a vaginal birth in that hospital. Private midwifery care – either for home birth or hospital birth – increases that percentage to 80-90%.

    water birth private hospital sydney

    None of the private hospitals in Sydney allow waterbirth. Waterbirth is the norm in a homebirth and may be an option in a public hospital if there are midwives on shift – and baths / pools available – to facilitate this.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Don’t have a caesarean unless it’s essential, warns news study

    Posted on by
    Reply

    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

    Couple sues Redcliffe hospital over stillborn baby

    Posted on by
    Reply

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

    Link

    PARENTS of a baby delivered stillborn … claim medical staff repeatedly ignored warning signs their unborn baby was distressed.

    … Documents … allege a midwife ignored and turned down the volume of an echocardiogram alarm that sounded for more than three hours …

    The documents also claim Mrs Body was diagnosed and treated for deep vein thrombosis and thrombophilia (blood clotting) …

    She alleges the hospital ought to have known her medical history and the risks associated and failed to recognise a natural birth “could not be performed safely”.

    The documents show Mrs Body was admitted to hospital at 8am on February 26, 2007, and was monitored at half-hour intervals between 9.30am and 3pm.

    Her waters were broken by a doctor about 4pm and at 4.30pm an epidural was administered.

    It is alleged that at 5.10pm an echocardiogram alarm attached to Mrs Body began making loud noises, but the volume was turned down by a midwife … four other times when the alarm sounded … it was turned down by the same midwife.

    Monitors alarm quite often. They do not tell the midwife that the baby is distressed, they prompt the midwife to check the trace and ensure that it is ok. If the midwife determines that the baby is fine, the monitor sound is turned down.

    The echocardiogram alarm continued to sound until 8.20pm but medical staff did not respond to it.

    It wasn’t until 9.30pm, when Mr Body requested for Mrs Body to have an internal exam that one was performed, court documents claim.

    It’s normal practice to leave 4 hours between examinations.

    By 10.40pm, Mrs Body was told the baby’s heart rate was “low” and “we need to get her out now”.

    This is not an uncommon scenario when a woman has had intervention in her birth. In this case, the woman had her waters broken, had an epidural and presumably also had a syntocinon infusion. All of these can stress babies. I also wonder what position she had been labouring in. It’s common for women with epidurals to labour on their backs and this does not help the baby to navigate the pelvis and be born, and it promotes fetal distress.

    Paige Hannah Body was delivered by vacuum extraction about 11pm. She was not breathing and could not be revived … The State Government is yet to file a defence.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    More women dying from pregnancy complications; state holds on to report

    Posted on by
    Reply

    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

    FAQs

    Posted on by
    Reply

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

    What does an obstetrician cost in Sydney?

    Fees vary greatly. As well as considering obstetrician’s fees, also consider costs such as private health insurance co-payment or excess, extra fees and charges associated with private hospital stays, paediatrician and anaesthetist fees and additional costs for ultrasounds and tests. All up, you’re looking at somewhere between $2,000 and $10,000.

    Private midwifery care, on the other hand, costs somewhere between $3,000 and $6,000.

    Are there any antenatal / prenatal birthing classes in the Westmead area?

    Yes, this service provides antenatal classes in the Westmead area.

    What is the ceasearan rate in Australia in 2009?

    This won’t be known until around 2011. In 2007 it was around the 30% mark and caesarean rates have increased most years. The current caesarean rate is around 30% – 35%.

    induction vs cesarean and diabetes

    What about another option? What about a natural birth? Provided that there are no complications as a result of the diabetes, this might be a great option to discuss with your care provider. You might also wish to seek a second opinion with a private midwife.

    Intervention in midwifery?

    Midwives are experts in natural birth, and therefore tend not to intervene in births. If intervention was felt to be necessary, an obstetrician would be consulted.

    natural birth in a hospital australia?

    Natural birth is far more likely in a homebirth (homebirth has an average transfer rate of 25% and the births that occur at home are 100% natural). In some hospitals in Australia, natural births are around 5%. Private midwifery care dramatically increases the chance of a natural birth in any setting.

    Prenatal classes sydney

    Yes, this service provides antenatal classes in Sydney.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Desire for old-fashioned, peaceful labor at home gaining appeal

    Posted on by
    Reply

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

    Link

    For Stephanie Foley … the home birth of her son Calvin was a “peaceful, great experience.”

    And while Foley said she’s pleased with how her home birth went, and that she would do it again, the issue of the safety of out-of-hospital birth is up for debate.

    Statistics show that while the desire for a less sterile, more intimate birth experience is growing, most mothers in the U.S. still have their babies in a hospital. It’s the prudent choice, safer if something goes wrong, experts say.

    But it isn’t a simple call.

    Family history, health of the mother and fetus, available and trusted midwives and personal preference all weigh in the decision.

    On average, only 1 percent of all births in the U.S. are conducted out of hospitals annually …

    Tori Kropp, a perinatal registered nurse at San Francisco’s California Pacific Medical Center, says it’s safer to give birth in a hospital.

    … hospital births have gotten a bad rap due, in part, to the efforts of home-birth proponents, such as TV personality Ricki Lake.

    Lake’s 2008 documentary “The Business of Being Born,” ignited a fire storm by implying many common medical practices may be doing new mothers more harm than good.

    Kropp has participated in 5,000 births, including that of her 9-year-old son Alexander. By participating in so many deliveries Kropp said she has “seen all the things that can happen” during what is still a potentially dangerous event in a woman’s life.

    Has she been at any homebirths? It’s totally ok to have an opinion in something that one has not seen, attended, experienced or directly been a part of. But if Kropp has never been to a home birth, only obstetricially-driven hospital births, who is she to say that home is not at least as safe as hospital for healthy, low-risk women who are attended by a midwife?

    “Most of the time it’s wonderful, but sometimes it’s not,” Kropp said. “At the end of the day, it’s safer to give birth in a hospital.”

    Through education and outreach Kropp strives to correct what she says is “misleading” information promoted by Lake’s film. ”

    “The problem with many home births,” Kropp says, is that they are performed by midwives “without the support of either physicians or a hospital.”

    And is that because the midwife has not consulted with the hospital or doctor, or because they were not willing to consult when it was requested?

    To spread her message, Kropp is planning a 100-hospital tour across the country beginning in Michigan on Labor Day. Kropp plans to offer free pregnancy seminars at the hospitals …

    Is she planning to get her message out to women who are planning to birth at home? If so, she can talk to the hospitals all she likes, she will not reach her intended audience.

    Overall Kropp’s mission is a simple one – “helping women feel empowered about the choice they make, and not the choice society wants them to make.”

    But … not if they choose to birth at home. It’s ok to choose an epidural or a caesarean though!

    Regardless of birth location, 8 percent of births in 2006 were performed by midwives, according to the CDC.

    Definitely room for improvement there. 80% would be a great target!

    When Foley gave birth to her first and only child in December 2007 she and her husband lived in a one-bedroom, second-floor apartment in Lansing.

    After about 6 hours of active labor, with the help of a direct-entry midwife, Foley gave birth to her son in an inflatable pool filled with water, which is described as a water birth.

    … “Pregnancy and childbirth are normal, healthy events in a woman’s life and interventions, such as cesarean sections, should be used only when medically necessary, Winkler said. “Women choose to come to the birthing center for freedom of choice.”

    But Winkler cautioned that women who have chronic diseases, such as kidney disease, high blood pressure or diabetes are “safest when (giving birth) at the hospital.”

    Planned home births may have a low rate of complications …

    Among 13,000 planned births studied, researchers found that the mortality rate was similarly low – less than one in 1,000 – among women who gave birth at home with a midwife, women who gave birth in a hospital with a midwife, and women who gave birth in a hospital with a physician.

    … “Birth is safe. It is safe to give birth out-of-hospital when a woman is healthy and having a normal pregnancy,” Winkler said.

    But Kropp says even if a woman is healthy, there is still the possibility of complications in childbirth.

    “Our hospital system for childbirth is so far from perfect,” Kropp said. “But someone who is completely healthy could very easily have something very unexpected happen in childbirth. Childbirth is still the No. 1 cause of death for women (worldwide), so we can’t get too cavalier in saying ‘we don’t need medical help.’”

    It’s the leading cause of death for women who are not suited to home birth, such as those in third world countries who experience malnutrition, undernutrition, anaemia, bleeding in pregnancy, high blood pressure and so on. For healthy, low-risk women, the benefits of home birth are enormous.

    Foley said she considered safety when making her decision to give birth at home.

    “I had had no reproductive issues … for me I felt that being at home would be as safe as at the hospital,” Foley said.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    C-section saved my life and baby’s (clear need for education here!)

    Posted on by
    Reply

    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

    FAQs

    Posted on by
    Reply

    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

    Fears for mothers as hospitals up the ante for birth classes

    Posted on by
    Reply

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

    Link

    THE cost of antenatal classes should be means-tested and made uniform across all hospitals, according to the Australian College of Midwives.

    Increasingly, NSW hospitals are using private contractors to run antenatal classes because of tight budgets, which means women are being charged hundreds of dollars …

    The cost varies by up to five times between hospitals.

    … increasing fees were shutting some women out and the system was unfair.

    … ”Antenatal education is not seen so much as core business any more so I think that’s a real problem.”

    … ”Women who hold Commonwealth Health Care Cards have access to free or reduced-cost antenatal classes in many services. This decision is made on a case-by-case basis after referral from midwives, obstetricians and social workers,” he said.

    Sarah Monch … attended antenatal classes at Royal Hospital for Women, which charges $270 for a six-week evening course.

    Mrs Monch … thought it was not expensive and had already paid $475 for a private birth class weekend in Bowral.

    ”I think I got value out of both the classes and I’m glad I did them,” Mrs Monch said.

    By contrast, Nicole Harris … paid $55 … at Campbelltown. ”There was so much that you learn that you don’t know.

    ”I wouldn’t have had a clue about anything, I would have been lost if I didn’t do that class.” …

    The cost of childbirth education will rightly vary from location to location to account for differing overheads. While the cost may seem prohibitive, women do have other options to hospital classes: reading, internet, talking to friends and so on. I have always believed that the best value childbirth education is not the classes that are provided by hospitals, but the classes that are provided by independent childbith educators. These classes will not only talk through hospital policies, but also all the other options for care.

    While the cost of independent classes cost may be prohibitive to some families, their brith experiences are more likely to be rated as extremely positive and the rates of intervention in the birth are lower.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    No labouring of point on use of epidurals

    Posted on by
    Reply

    Link

    The use of epidurals in Ireland during labour has roughly doubled over the past 20 years. “This development isn’t a good thing. Because of the increased risk of potential complications during childbirth, administering an epidural during labour is not only undesirable — it’s also often unnecessary.”

    That is the message from Dr Denis Walsh, Associate Professor of Midwifery at the University of Nottingham, who says a more naturalistic approach to labour-pain management should be considered.

    … “There’s a physiological purpose to labour pain; it’s a natural state rather than a problem. So normal labour shouldn’t need to be treated as a pathology,” said Dr Walsh.

    “Administering an epidural can interfere with the body’s natural responses. During labour the body releases endorphins, which not only affect the state of consciousness, but also stimulate movement. Studies have shown that walking and increased physical activity during labour can assist in the process.” An epidural, in most cases, requires that a woman remain in bed.

    … Epidurals have been shown to increase the duration of labour, and cause a decrease in oxytocin. Additionally, the baby may become malpositioned to transverse or posterior.

    Studies have shown a correlation between the use of epidurals and an increase in the use of forceps to aid delivery, by up to 40 per cent, and some recent research has indicated that epidural anaesthesia can lower prolactin levels in response to breastfeeding in the days following birth.

    … women need to be presented with all the information regarding epidurals before undergoing anaesthesia. … “Some 50 per cent [of anaesthetists] didn’t mention the risk of intervention with forceps. The need to communicate all the risk factors is essential.

    “… if a woman is in severe distress, or there are complications, of course it should be administered.

    “But during a normal birth, there are other ways to make the mother more comfortable,” …

    “… it’s the support given to the mother, not pain management, that’s the more significant factor in a positive experience of childbirth. Key to a positive experience is one-to-one support from a midwife.

    “… One-to-one support has been shown to reduce the number of Caesareans carried out, and reduces the number of epidurals. A midwife can help in pain management both physically, for instance [with] massage, and psychologically, by offering emotional support.”

    Dr Walsh suggests that access to water-immersion facilities … could reduce the need for epidurals. There is evidence to show a correlation between water immersion during the first stage of labour and a reduction in the use of epidurals …

    It’s my experience that women who are well prepared for labour and who are supported in their labours with one-to-one midwifery care, do not need epidurals. A mere 3% of women who use my services choose an epidural for their labours and 80% use no pain relief at all.

    Melissa Maimann, Essential Birth Consulting

    Girl, 13, starved of oxygen at birth to receive millions

    Posted on by
    Reply

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

    Link

    Alice … was starved of oxygen during the final hour of her mother’s labour after doctors failed to warn her mother that there were risks associated with her second birth.

    Diagnosed with spastic quadraplegic cerebral palsy, she has severely delayed mental development as well as learning difficulties and is now reliant on 24 hour care.

    Her mother Carolyn had a caesarean section with her first child but doctors … did not tell her that there was a chance the womb would rupture during a normal delivery.

    Lawyers for the Joyce family … claimed Alice would have been born healthy if delivered by caesarean …

    … Her father … said: “Although it sounds like a large sum of money it is needed to fund Alice’s around the clock care and ensure she gets as much out of life as her disabilities allow.

    … A court ruling today is expected to award Alice a lump sum payment of £2,250,000 plus annual payments until she is 16 of £95,000 pounds and £185,000 after that for the rest of her life.

    The case was funded through legal aid, without which the family would not have been able to afford legal costs to prove negligence or the experts needed to prove her complex needs.

    … Chief nurse and director of patient care standards Sarah Watson-Fisher said: “We would like to express our sincere apologies to Alice and her family for the errors in the care given at the time of her birth …

    “We take matters like this very seriously and are committed to learning from our mistakes. We hope that the settlement will be of great assistance to Alice and we offer her and her family our best wishes for the future.”

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Caesarean births risk mums’ lives

    Posted on by
    Reply

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

    Link

    A study of more than 100,000 births showed mums-to-be who had a caesarean section when there was no medical need were 2.7 times more likely to have complications than those who gave birth naturally.

    … mothers should only have a C-section for medical reasons, according to the authors of the World Health Organisation study.

    Women who chose a caesarean over a natural birth were 10 times more likely to be admitted to intensive care and suffer severe bleeding.

    … “I do get women who ask for a C-section, often because they’ve got a pathological fear of childbirth, fears of pelvic floor problems in later life or have been sexually abused earlier in life, so they choose to have a C-section to avoid any genital tract trauma which would remind them of what’s happened.”

    Dr Kliman said Epworth Freemasons had about 20 mother-requested caesareans out of 3500 deliveries a year.

    “I tell them it is not necessarily an easy way out,” he said.

    “They have risk of haemorrhage, infection and more discomfort after the procedure.”

    Vice-president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Michael Permezel, said …”If a woman said, ‘I want a C-section’ and had no understanding of the risks, I think most doctors may decline the request,” Prof Permezel said.

    “If she’s having her first baby later in life and perhaps planning to have one more, then the pros and cons are pretty even, but if it’s a younger woman planning a relatively large family then certainly the recommendation would be for a vaginal birth if possible because of the risks associated with each subsequent pregnancy …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Giving new life to the role of the father

    Posted on by
    Reply

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

    Link

    More fathers than ever before may attend the birth of their child, but the government is keen to involve them even more closely in pregnancy …

    … fathers-to-be will be the target audience of new leaflets and pamphlets, while the midwives’ body has been asked to draw up new guidelines for its members on how to better draw fathers into the process of pregnancy and birth.

    The Guide for New Dads, produced in conjunction with the Fatherhood Institute (FI), will provide information on a range of issues from paternity leave to breastfeeding.

    “We know men want to be involved with a new baby, but so many chances to engage them are missed,” says Adrienne Burgess, head of research at the FI. “The truth is if you want a mother to eat well during pregnancy, or quit smoking, you have to get the father involved at early stage because his behaviour will unquestionably influence hers.

    And while fathers may say when it comes to breastfeeding – ‘I’ll support you in whatever you choose to do’, mothers’ perceptions about what the father really thinks about breastfeeding and the toll it may take on the body are one reason she may stop.

    … “One issue this raises is whether men will in the end feel more confident … – many studies attest to the way maternal anxiety has increased significantly under the weight of ‘expert’ advice about how to rear children,” …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Never again in a public hospital

    Posted on by
    Reply

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

    Link

    The Age special report on maternity care drew a range of responses …

    I GAVE birth to my first child last year in the … maternity ward as a public patient.

    Nothing could have prepared me for my horrible birth experience – ”herding yards” does not go nearly far enough in describing the way the hospital treats new mothers and babies. The need to minimise expenditure combined with an almost zealous obsession with promoting breastfeeding created an experience so stressful that, for me, resulted in what I call post-traumatic birth disorder – a fear of ever having another child in a public hospital.

    My baby was born with fairly high levels of jaundice, which results in a very sleepy baby who is unable to feed well. Bar going under the UV lights, the only means of reducing the jaundice levels is to ”flush” it out with fluid.

    Now that would be fine except for the fact that mothers do not produce milk for at least two days after a natural birth and up to five days after a caesarean. Not once was I offered formula to try to provide extra fluid for my baby. Instead, I was told to breastfeed and express extra fluid in between feeds.

    So, in pain after major surgery, with a baby too weak to feed well and not producing milk, I was left struggling for hours to try to provide enough fluid to help my baby.

    On day four I was about to be discharged when the attending doctor told me my baby had developed ”nappy rash” and might need antibiotics. At first the doctor said it would need a cream and I would still go home that day. A few minutes later another doctor said it was a ”severe” rash and my baby might need oral antibiotics.

    Then the head of pediatrics came to look at the rash. The attending [midwife] said they thought it was a hospital-borne staph infection, which was later confirmed. At this point I was about to have a breakdown from being exhausted, stressed and furious that no one had mentioned the staph to me.

    Following this diagnosis, I was discharged from maternity and my four-day-old baby was admitted as a pediatrics patient to be given IV antibiotics. The pediatrics ward is for children only so despite just having the caesarean and still being on painkillers, I was not considered a patient. I had to sleep on a fold-out couch to continue three-hourly breastfeeds but was given no food or additional pain relief …

    No perfect system

    WHEN my wife fell pregnant, our GP referred her to an obstetrician without discussing any options, such as the public system, birthing centres, home birth etc. This referral sent us down the path of the private health industry. We were keen on more natural options for childbirth, but it became increasingly apparent that our obstetrician was not interested in these options. Through our own research we found out about birthing centres, and decided that this was the go for us.

    … our daughter was breech. Through the birthing centre we were told of an obstetrician who manually turned babies in utero. We consulted him, and our daughter was turned. I am sure that had we stayed in the private system with our original obstetrician, we would not have been made aware of this option, and my wife would have had to endure a caesarean. This is one example of the ”over-medicalisation” of childbirth by the private health care industry.

    However, the birthing centre was far from perfect. My wife gave birth at 7.10pm on a Saturday. At 9.30 the next morning we were pressured to leave. We refused, and spent our full allotment of two days in the centre. A couple of days after we left, we received one follow-up visit from a midwife. She noted that our daughter was jaundiced, and advised that we put her in the sun for 10 minutes.

    Later that day I took my wife to hospital because she was experiencing pain after the birth. While we were there, a [midwife] noted that our daughter was jaundiced, and requested a blood test. The result was that she was rushed to the neonatal intensive care unit in a serious condition. An hour later the head of the unit informed us our daughter was suffering from a level of jaundice so severe that they saw it only once or twice a year, and that as a result, she could be brain-damaged and suffer hearing loss, among other issues. If I hadn’t insisted on taking my wife to hospital for her pain, I dread to think what might have been …

    Happy on home front

    I HAD a satisfying birth at home with the help of two lovely independent midwives. The continuity of care from our midwives has been exemplary.

    When I read accounts of less-than-adequate hospital-based maternity care, I can only say that home birth is worth every cent we paid.

    Improving the maternity system is simple: the Government needs to stop attempting to put independent midwives out of business.

    Support midwives

    MY HUSBAND and I saved our stimulus packages to pay a private home-birth midwife for the birth of our second child, due any day now. The continuity of care, with antenatal appointments in our own home, is wonderful. I feel much more comfortable ringing my own midwife with questions than I did when I was seeing a different midwife every time at the … Birth Centre …

    It’s not all gloom

    WHILE there is room for improvement in any hospital system, the headlines in your report unnecessarily spelt doom and gloom.

    In the past 10 years I have had three babies at the public … [hospitals] Each time I have been impressed with the service and care provided …

    My first baby could not attach to the breast, and … we were allowed to stay in hospital until day five after the birth. Every time I needed to feed her I buzzed for the midwife to help me, and never had to wait more than a few minutes.

    With my second and third babies we went home on day two, but we were ready … Postnatally, a midwife from the hospital visited me each day for two days after the birth. The midwives were caring, knowledgeable and helpful.

    Motherhood’s trauma

    I GAVE birth to both my sons as a public patient … There is almost no difference between the private and public patient experience, so having private health cover was of no benefit. My doctor was away both times but the on-call obs I had both times gave good care. Of course, they’re only there for the end bit and it’s the midwives who do all the work anyway.

    … my key criticism is that they sometimes forget the strangeness of becoming a mother for the first time. We are not used to being mostly naked in a room full of other people … We are flooded with hormones that leave us lost and confused. We think motherhood will be a tender and graceful time, when in fact it can often be a time, particularly the first time, when you feel frighteningly laid bare. I would have appreciated someone to facilitate a more caring and dignified transition into my new role.

    A cry for help

    A LARGE public hospital means a huge variation in staff on different shifts, which leads to inconsistent care and the danger of ”falling through the cracks”.

    Hence, many women benefit from having their own private midwife with them throughout the experience.

    Three days after the birth of my baby, I developed … postnatal depression … The [midwifery] staff … were seemingly inexperienced … I never had the same [midwife] more than once, which meant they were generally unaware of my worsening condition, which didn’t appear to be written in my medical notes. On the fifth day when I was to be discharged, I was stuck with terror at the thought of being home alone to cope with my newborn son …

    At home, things got worse. Feeling like you’re in an evil, black hole and not wanting to look after your own baby is not a pleasant state to be in. I had enormous problems with breastfeeding, which added even more stress to my already unwell mind.

    It was the visiting midwife from the hospital who was the catalyst in getting treatment for me. At first she offered me generic advice in a way that to me seemed somewhat ”hippie dippy”, so I had to persist in letting her know how bad I felt. Eventually she gave a card for the hospital’s crisis assessment team hotline. The team member I spoke to was exceptionally understanding and gave me some calming advice. The team followed up with regular phone calls to check I was OK before they were able to send out a diagnostic team, including a psychiatrist, a couple of days later. They were also responsible for my being admitted into a mother and baby unit in the hospital’s psychiatric ward soon after.

    Intensive counselling, medication, individual monitoring and support finally got me back on my feet. I am now what I would consider a ”normal” happy mother.

    Forgotten option

    YOU seem to have left out the home birth option in your report. Provided the woman is healthy, well-informed and well-supported, there is no reason she cannot give birth at home, with the aid of a trusted midwife. My wife did so three times …

    If necessary, a doctor can be called to render extra assistance, and in the rare case of complications, which usually become apparent slowly, the woman can be taken to a hospital.

    If more women gave birth at home, this would relieve the pressure on hospital resources. It would also enable women to give birth calmly, in a familiar environment, with loved ones close at hand, and usually escape the effects of postnatal depression.

    Rich feedback about our current hospital system. It will be interesting to follow the changes once private midwives are able to birth with their clients in hospital. We know that continuity of care is sought-after, as is explained in the above quotes. Private midwifery in hospitals will enable more women to access midwifery care on their own terms.

    I was surprised that the stories of women who were told they could not get the type of birth they wanted – such as vaginal breech, vaginal twins, VBAC and so on – were not mentioned.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Feedback on our maternity system

    Posted on by
    Reply

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

    Link

    … 20% of … mothers … said they had witnessed occasions when a lack of resources put a mother at risk; 14 per cent said they had seen shortages put a baby at risk.

    63% of … mothers … agreed that public maternity units resembled ”herding yards” when asked if it was an appropriate description.

    Of … women who gave birth in the public system … more than a third said leaving hospital too soon was a problem, 47 per cent felt their postnatal care was inadequate, and 48 per cent experienced a lack of breastfeeding support.

    Of [the] … women who gave birth in the private system … 17 per cent said they were discharged too early, 39 per cent felt their postnatal care was lacking, and 45 per cent said they did not receive adequate breastfeeding support.

    Of the … mothers who gave birth in both the public and private systems, 43 per cent thought the private system was better; 30 per cent thought the public system was better.

    … providing midwives with more independence to prescribe drugs would improve the system.

    62% … said Australia’s 30 per cent caesarean rate was too high. A quarter thought it was mainly done for professional liability reasons and a fifth believed it was done at a mother’s request.

    47% … said there was a shortage of midwives …

    WHAT MOTHERS SAY
    ”There should be more continuity of care. Knowing your carer and trusting your carer removes the fear from childbirth and fear leads to more interventions.”

    … ”There is a severe shortage of birth centre places available and in many areas it is not even an option.”

    ”There are so many time limits imposed on women which completely disregard the natural progression of labour in women’s bodies. Doctors are too quick to intervene, too impatient to wait and allow the body to do its job.”

    … ”Women are not being given enough time to labour naturally.”

    “I was not supported well enough to have a vaginal birth. I felt like they were more concerned with getting me in and out quickly so they could free up beds.”

    … ”There are too many obstetricians performing unnecessary caesarean sections and other interventions due to fear of litigation.”

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Transition into Parenthood

    Posted on by
    Reply

    This wonderful article is written by Julie Clarke. Julie is a highly esteemed childbirth educator and calmbirth® practitioner in Sydney. I am confident that all couples will benefit from the dynamic and sensitive way in which she teaches her classes.

    *****************************************

    For some couples the transition into parenthood is filled with wonderful, exciting memories, and for others filled with anxiety and stress. Most men and women will experience a mix of emotions as they move through the series of changes which is the rite of passage to parenthood – pre-conception, pregnancy, labour, birth and the newborn period.

    The wisest advice I can give for couples contemplating the journey to parenthood is to (with an open mind) read everything, ask millions of questions, listen to as many friends stories as possible, and then finally make decisions based on your intuition as to what seems right for you and your set of circumstances.

    There is no doubt having a first baby is one of the most significantly life changing event in any person’s life, so it’s worth spending time mulling over some of the important concepts beforehand, such as who will you select to help support you through this process? It’s really important to gather a good support network to assist you, such as: family and friends, a general practitioner, a private midwife, public or private hospital, selecting between delivery suite or the birth centre, a naturopath, a chiropractor, a childbirth and parenting educator, the local breastfeeding association, just to name a few.

    Many couples find the experience of pregnancy more than they expected both in terms of adjustment and the feeling of thrill, excitement, anticipation and wonder.

    The current generation of expecting parent’s often describe themselves as ‘pioneers’ in comparison to the previous generation, as they have so many new and wonderful options the previous generation may not have been able to select. An example of this is the option of having their partner not only being present at the birth, but also very involved and supportive both physically and emotionally. Many men currently expecting their first child when asked, “Was your father at your birth?” reply emphatically “No!”, and for the rare one who says “Yes!” they usually haven’t had much of a description from their father as to what occurred – you could say for previous generation’s it’s all a bit of a blank.

    Most grown men these days have been taught by their fathers how to mow the lawn, how to change a tyre on the car, how to BBQ steak and sausages, but can’t confidently turn to their Dad and ask expectantly, “Dad how do you support a woman during labour?” it’s a question that might possibly turn up a blank perhaps?

    However, for the next generation it will be completely different, the vast majority of dads-to-be will be able to say “Ah well you’re asking me something that takes me back to one of the most incredible days of your mum’s and my life…on the day you were born and, by the way, because you were our first it was a bit of a long day and night actually, we spent hours in the shower with me rubbing your mum’s back for comfort, and then she decided to rest her legs as they were getting tired, so she laid in the bath under the midwife’s instruction and then next thing she pushed you out in the bath, it was the most incredible thing I’ve ever seen in my life, truly it was like witnessing a miracle! And then all of a sudden I remembered from our birth classes that if I wanted to receive the baby, and be the first person to hold you, to mention it to the midwife, which I did, and so she guided me easily into how to receive you. It was amazing I have never felt anything so soft and vulnerable in my life! I’ll never forget it, I looked up at your mum and she had tears in her beautiful eyes, and she was crying and I passed you up to her arms and she held you gently and quietly talked to you and cuddled you for a long time. Son, I hope you have an experience as wonderful as that when you meet your first child for the first time. It’s a memory your mother and I cherish together, and always will.”

    I frequently hear from the dads-to-be attending my courses that, “I just don’t want to be useless to my partner during the labour and the birth, but I don’t know what to do?” I respond with many ideas and suggestions throughout the course, and I always recommend to couples pluck and choose what suits them best, as there are a wonderful variety of choices available to be able to create your own positive and memorable birth experience.

    Underpinning all of my work in my classes is the philosophy of calmbirth® training, and that is encouraging, supporting and guiding family bonding between a couple as they prepare for the birth of their baby. To focus on the role and the value of each parent, the importance of mothers, and equally the importance of fathers in the life of their unborn and newborn baby. With this in mind, by encouraging enjoyment rather than stress and fear during the period of the pregnancy and birth, creates the space for a more conducive atmosphere for good solid family bonding. Relaxation, joy, hope, courage, determination, togetherness creates good strong loving relationships. In a nutshell that’s what it’s all about.

    My Transition into Parenthood course covers birth and baby care aspects in a very practical way whilst the calmbirth® course guides the “thinking and feeling” preparation, and focuses on the important skills for labour. Plenty of couples prefer to do both courses for a well rounded sense of readiness.

    Whatever steps you take towards childbirth, look for the things that both inform and nurture both of you in your transition to parenthood. It’s my passion and something I know creates the best outcomes for new parents.

    Julie Clarke is a Childbirth and Parenting Educator & calmbirth® practitioner based in Sylvania in Sydney and can be contacted on 9544 6441 or visit www.julieclarke.com.au for courses and dates.

    The real safety issues in maternity care

    Posted on by
    Reply

    Visit my website to learn more about my services.

    Link

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Independent childbirth education

    Posted on by
    Reply

    Visit my website to learn more about my services.

    Top Reasons Why Women Choose Independent Birth Education Classes

    1. Independent educators are specialists in what they do. They are trained specifically in birth education. Some are also skilled in other areas including midwifery.

    2. Independent educators are not bound by hospital policies. All hospitals all have varying pregnancy and birth policies. These policies may be based on best practice and evidence, reducing litigation, making the labour faster so there are more beds available, making things easier or safer for staff – even if it’s not in the mother’s best interest.

    Accordinly, hospital-based classes generally let women know what the policies are. They are based around the policy and don’t necessarily reflect the real options or best care for labouring women. Hospital classes will tell you what the hospital says you are allowed/not allowed to do based on their own ‘rules’. When women engage independent childbirth educators, they learn about hospital policies and all other options that are available.

    3. You’ll see birth DVDs that are designed to inspire, not scare.
    There are many birth DVDs that depict birth as an impossible experience to get through without an epidural or a caesarean. Waching DVDs such as these can leave couples feeling that they cannot cope with a vaginal birth, and this convinces them that they actually do need drugs (and a hospital) for the birth – just like all their friends have told them.

    Contrastingly, the DVD’s you see in independent classes are very inspiring, uplifting and show you the potential of women’s bodies when they are supported in birth.

    4. You’ll learn more tools for natural labour
    Women and their partners have more confidence to cope with the tougher parts to labour when they are given more options and tools for natural pain relief. Classes than skim through natural pain relief, only to focus on the epidural, tend to see more couples opting for medical pain relief.

    5. Families will discover all their options
    Again, independent birth educators do not operate based on policy, but what is possible for you – what options and rights you have as a labouring couple. There will be no ‘we do this’ or ‘we do that’, only: ‘you could choose to do this’ or ‘you could choose to do that’– with the pros and cons both ways. It is a much more balanced view of what’s possible, with the view that your body is extremely capable – and not just what everyone else is like.

    6. You pay for what you get
    Yes, generally speaking, independent childbirth education classes are more expensive than the hospital classes. There are several reasons why this is the case:
    - Independent childbirth educators do childbirth education. Hospital classes are an extra that is added, it is not their “bread and butter”.
    - Independent childbirth educators often spend several days each year in additional education to remain up-to-date in their education sontent and style.
    - Some educators offer classes one-on-one, in couple’s homes. Providing tailored services such as one-on-one classes, particularly in the convenience of a family’s home, accounts for the increased cost.
    - The care factor of independent childbirth educators is exemplary. They really want families to get a lot out of the classes. Their reputation depends on it! The educators genuinely want you to have a great experience and have great philosophies about birth.

    7. You know who you are getting … and what their birth philosophy is
    Families can explore their options for classes, including educators. Couples can choose educators who have other qualifications, such as midwifery. You can read the testimonials ahead of time, so you know you are getting a great service. Educators are also happy to take your calls and questions before and after the classes.

    9. It will help you to form a birth plan
    When women are more aware of the options that are available to the, they are better able to select the options that are consistent with their goals for their labour and birth. To put it simply, if you don’t know you have options, you don’t have any.

    A deeper awareness and understanding of all the available options will help you to write a birth plan that’s right for you. You will have more control, rather than feeling you have to ‘leave it to the experts.’

    It’s important to note that while there are some brilliant birth educators out there, birth classes alone will not get you across the line. They are a great start and will likely have you thinking about lots of things you hadn’t already thought about, but all your choices as a whole will shape your birth, not just education. The care provider you choose and the hospital (or not) that you you birth in will be the main determinents of your birthing experience.

    For example, if you really want a natural birth and have chosen an obstetrician and private hospital – then you have chosen the statistically worst option for avoiding interventions including pain relief, caesarean sections and assisted delivery. If a natural birth is important to you, then private midwifery and perhaps a home birth will place the odds in your favour for a natural birth.

    Visit my website to learn more about my services.

    Family history affects gestational diabetes risk

    Posted on by
    Reply

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

    Link

    … diabetes in first-degree relatives may be associated with the risk of a woman developing gestational diabetes.

    … The greatest risk was conferred by having a sibling with diabetes. Indeed, women who had a sibling with a history of diabetes were at much greater risk of gestational diabetes than were women whose parents (either or both) had a history of diabetes.

    … adjustment for body mass index attenuated the link between paternal diabetes and gestational diabetes but did not affect the association between maternal diabetes and gestational diabetes.

    … having a sibling with diabetes “may be a greater risk factor than previously documented” …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    How Did Men End Up in the Delivery Room?

    Posted on by
    Reply

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

    Link

    Although women carry the fetus for nine months and do the … physical work of labor and delivery, important and relatively recent changes in fathers’ roles have revolutionized the experience of childbirth for men and women alike.

    In 1938, half of all American babies were born in the hospital; by 1955 it was 95 per cent. Yet along with professionalized medical care, an expectant mother now found herself “alone among strangers” on a kind of conveyor belt moving from admissions to a prep room, where she was shaved and given an enema. Then she was moved to the labor room, where she stayed, mostly alone and sometimes sedated, during the long hours while her body got ready for delivery. She then was taken into a separate, sterile delivery room, indistinguishable from an operating room, where she actually gave birth, and then went on to the recovery room. She awoke in a maternity ward room, where she stayed for as long as two weeks before going home with her baby. During the long hours of labor and delivery, the men were segregated, kept away from the action, and relegated to an all-male waiting room, where they fidgeted, paced, smoked cigarettes, and anxiously awaited news of mother and child.

    Beginning in the late 1940s, many men began to find this isolation intolerable. As they wrote and read comments in “fathers’ books” that many hospitals provided as semi-public diaries, they took action, as one father put it, “[to] grab hatchets and chop through the partition” separating them from their laboring wives. Fathers joined with the natural childbirth movement, childbirth educators, and the emerging women’s movement to revolutionize hospital birth and make it less impersonal. The men contested the separate hospital spaces and the exclusionary routines of medical authority to find a place for themselves and, in so doing, created unprecedented new masculine domestic roles while enhancing the birth experience for mothers.

    In the 1950s and 1960s men succeeded in entering labor rooms with their wives. Here, “alone together,” couples shared intimate moments, holding hands, reading out loud together, playing cards; husbands often rubbed their wives’ backs during contractions. One woman in labor said, “It made me feel peaceful and confident, somehow, just his sitting there.”

    The experience of easing labor soon led to its logical conclusion: being present in the delivery room. In the 1970s hospitals and physicians gradually relented and permitted men to be in delivery rooms, where they were positioned at the head of the table and could encourage laboring women in their work. … One wrote, “While the doctor was holding our baby, the cord still attached to my wife, I felt tears rolling down my face. … The whole delivery was beautiful beyond words … ”

    … men continued to press for change in hospital policies and practices. … In the 1970s and 1980s … hospitals … opened birthing rooms, combined labor and delivery rooms, which were decorated more like home bedrooms than operating rooms. Despite criticisms of these frills as mere window dressing, men felt much more comfortable in them and more a part of the birthing process …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    The great Caesarean section debate

    Posted on by
    Reply

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

    Link

    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

    Don’t tell women how to give birth

    Posted on by
    Reply

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

    Link

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

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

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

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

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

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

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

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

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

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Women ‘unprepared for childbirth’

    Posted on by
    Reply

    Visit my website to learn more about my services.

    Link

    Many women are going into labour vastly underestimating how painful it can be and overly optimistic that they will be able to manage without drugs, a study suggests. How has this happened?

    … In England around a quarter of women who give birth end up having an epidural … although many did not plan on having one.

    Growing emphasis on birth as an entirely natural process – which may be better carried out in your front-room than in a labour ward – also means many women feel they have somehow failed if they end up rapidly making their way through every form of pain relief available.

    Much evidence suggests … that women who are well supported by midwives and partners throughout their labour and made to feel at ease are the ones who manage their pain the most effectively and require the fewest drugs.

    … “The problem with some of the [antenatal] courses out there is that they concentrate so much on doing it naturally that inevitably women feel as though they’ve done something wrong when those techniques simply aren’t enough for them.”

    ” … the bottom line is that we encourage women to have confidence in themselves and their bodies,” says Gillian Fletcher, a former president of the NCT.

    “We help women weigh up the pros and cons of every method [of pain relief]. … we do make clear that if you have [an epidural] you are two to three times more likely to end with a forceps delivery.”

    “What’s crucial is that women are ready to negotiate with their midwife, and don’t find themselves lying flat on the bed, which we now know is a sure way to a more difficult experience.”

    Indeoendent childbirth education is one way to ensure that your childbirth preparation meets your needs and that you feel confident approaching to your birth.

    Visit my website to learn more about my services.