Home Births on the Rise

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

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

… 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

Tags: Birth choices, Birth trauma, childbirth education, continuity of care, Home birth

Hospital birth: What to expect

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

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.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Tags: birth, Birth choices, childbirth education, CTG, fetal monitoring, hospital birth, Obstetrics, Public and private hospitals

FAQs

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

Tags: Birth choices, Caesarean, childbirth education, Complicated pregnancy or birth, continuity of care, Home birth, hospital birth, intervention, Maternity Services Review, midwife, Midwifery, Midwifery services, Obstetrics, Public and private hospitals, VBAC

The Mother Friendly Childbirth Initiative

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

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

… 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

Tags: birth, Birth choices, Birth trauma, Caesarean, childbirth education, Complicated pregnancy or birth, continuity of care, CTG, Epidural, fetal monitoring, hospital birth, intervention, midwife, Midwifery, Midwifery services, Normal Birth, Obstetrics, Public and private hospitals

Preparing for a Natural Birth

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

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 t natural birth but I’ll see how it goes. I don’t need to be a martyr. If it gets too bad, I’ll just get an epidural”.

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 best given once labour is well established, so 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 to do is to learn techniques for managing the sensations of labour. Being prepared goes a long way to helping women in natural birth.

When preparing for a natural birth, the first thing you need to do is begin reading. 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.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Tags: birth, Birth choices, childbirth education, Normal Birth

Improving Your Chances of a Natural Birth in Hospital

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

The best option for women who want a natural birth is to plan a homebirth. Planning a homebirth does not mean that the birth goes ahead at home despite risks or problems, but merely planning a homebirth and engaging the services of a private midwife,will see the vast majority of women achieving a safe and natural birth.

However, if for whatever reason homebirth is not the right choice for you, the best way to achieve a natural birth is to engage the services of a private midwife and plan to birth in hospital.

Here are some ideas to get a natural birth 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 or there is a big chance that your baby will die or that you will die”. This statement is dishonest and is manipulative, using a woman’s fears and her maternal instinct to encourage her to acceot 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. Again, with a private midwife by her side, the woman is able to ask questions, obtain honest and impartial advice and obtain more information to help her come to a decision that she is comfortable with.

Be assertive, never aggressive. 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. Have a private midwife as advocate, by your side. If you start to feel frustrated, upset or angry, you will have somoene to talk to who is on your side.

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 by using an obstetrician – a specialist in when things go wrong – you are automatically increasing the chance of intervention in your birth.

Be Flexible. A hospital birth simply isn’t going to be exactly like a homebirth. Understand that sometimes things don’t go the way we had planned. There might be some occasions where you’ll be happy to accomodate 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.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Tags: birth, Birth choices, childbirth education, Home birth, hospital birth, intervention, midwife, Midwifery, Midwifery services, Normal Birth, Obstetrics, Public and private hospitals, women's rights

FAQs

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

Birth trauma symptoms

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

Some women experience:

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

Tags: birth, Birth choices, birth debriefing, Birth trauma, Caesarean, childbirth education, continuity of care, Home birth, hospital birth, intervention, Maternity Services Review, midwife, Midwifery services, Normal Birth, Obstetrics, Public and private hospitals, VBAC

FAQs

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

Tags: Babies, birth, Birth choices, childbirth education, Complicated pregnancy or birth, continuity of care, CTG, Epidural, Home birth, hospital birth, intervention, Maternity Services Review, midwife, Midwifery, Midwifery services, Normal Birth, Obstetrics, Public and private hospitals, VBAC

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

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

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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.

… children born by caesarean were 80% more likely to develop asthma by the time they were eight. Others studies have linked caesarean births to increased cases of allergies in children …

Of course, the other issue is that women who have caesareans are highly unlikely to have vaginal briths for their subsequent children. With each caesarean a woman has, the risks increase.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Tags: Caesarean, childbirth education

Couple sues Redcliffe hospital over stillborn baby

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

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

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

Tags: childbirth education, Complicated pregnancy or birth, CTG, Epidural, fetal monitoring, hospital birth, intervention, midwife, Midwifery, Obstetrics, Public and private hospitals