Posted by Melissa Maimann on Mar 2, 2010 in
Birth,
Midwifery,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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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
Tags: childbirth education, Complicated pregnancy or birth, CTG, Epidural, fetal monitoring, hospital birth, intervention, midwife, Midwifery, Obstetrics, Public and private hospitals
Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
informed consent and childbirth
Every woman who is competent to consent, has the right to refuse any or all professional care. Informed consent must be obtained prior to any procedure being performed.
how to minimise labour intervention in a hospital?
The best way to minimise intervention in a hospital is to be as well informed as you can possible be about all things related to pregnancy, labour, birth, breastfeeding and babies. Read widely, attend independent childbirth education classes and consider employing a private midwife to be with you throughout your labour. She can help you to decide if the proposed interventions are necessary in your situation, she can support you emotionally, mentally and physically and she can aso help to ensure that your birth plan is respected without a fuss.
Do any independent midwives in Sydney offer prenatal care for women who are planning to freebirth?
Yes! This service enables women to access antenatal care from a midwife without the midwife attending the birth. Postnatal care is available if needed.
Do you think there are advantages to continuous monitoring for low-risk women
In a word, no. Intermittent auscultation is the method of choice. Continuous monitoring will increase the chance of a caesarean with no benefit to the mother or baby.
How much is a private midwife
Prices range from $3000 – $6000. Melissa Maimann offers for her clients to pay by the hour, making the service one of the cheapest.
What is a good caesarean rate?
The World Health Organisation recommends that no more than 15% births need to be caesareans. The WHO argues that when caesarean rates exceed 15%, the risks to the mother and baby increase on the whole. You’ll be hard-pressed to find a hospital with a caesarean rate of less than 15%, but birth centres and private midwives have caresarean rates of less than 10-15%.
What is the best hospital in sydney for delivering babies?
It all depends what sort of birth experience you’re after! If you’re wanting a natural birth, home birth will be the best option. If you want a natural birth in a hospital setting, the best options would be birth centre or private midwifery care for a planned hospital birth. If you’re wanting to have intervention in your birth, a hospital birth would be best. If you choose an obstetrician, you’re far more likely to have a caesarean, episiotomy, epidural, forceps or vacuum. Choosing your care provider is the single most important decision you will make in birthing.
Is there a birth centre at westmead hospital?
No, there isn’t. If you’re after a natural birth, the best choice would be a home birth.
C section or natural delivery midwife?
Midwves cannot perform caesareans. If a caesarean was needed, the midwife would call a doctor in to perform it. Most caesareans that are performed are unnecessary and increase the risks to the mother and baby. A natural birth is the safest way to birth, and midwives are qualified specialists in natural birth.
giving birth after birth trauma
Private midwifery care will be really important so that you can have the same midwife all the way through pregnancy, birth and postnatally. It’s also important to debrief your last experience and come to a place where you feel safe to birth again.
high risk midwife sydney
Midwives are not qualified to care for high risk pregnancies. We refer these women onto obstetricians. In most cases, one or two consultations is all that is needed with the obstetrician and the midwife continues the care of the woman.
how many births proceed naturally
What a great question! It all depends what care provider you choose and where you have your baby. You see, if you choose a private midwife and birth at home, you have about a 95% chance of having a vaginal birth. If you birth in a private hospital, you have about a 33% chace of having an unassisted vaginal birth. In some hospitals, the caesarean rate is more than the vaginal birth rate! Sad but true.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, birth debriefing, Birth trauma, Breastfeeding, Caesarean, childbirth education, Complicated pregnancy or birth, continuity of care, Epidural, exercise, fetal monitoring, freebirth, Home birth, hospital birth, intermittent auscultation, intervention, IVF, Maternity Services Review, midwife, Midwifery, Midwifery services, Normal Birth, Nutrition, Obstetrics, postnatal depression, Preconception care, Public and private hospitals, VBAC
Posted by Melissa Maimann on Feb 8, 2010 in
Birth,
Midwifery,
Normal Birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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 0400 418 448
Tags: Birth choices, childbirth education, continuity of care, Epidural, Midwifery
Posted by Melissa Maimann on Feb 7, 2010 in
Birth,
Midwifery,
Normal Birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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Despite fewer epidurals, the majority of women in midwife-led units were happy with their pain relief.
MOST IRISH first-time mothers opt for the epidural … But reducing the pain levels doesn’t necessarily mean a more satisfying birth experience …
The HSE report involved a study of … women who had babies in the Midwifery-led Units (MLUs) … despite having fewer epidurals, 83 per cent of women in the midwife-led units expressed satisfaction with their pain relief, compared with 68 per cent of women in the consultant-led unit.
… midwife-led care was as safe as consultant-led care, resulted in less intervention, gave birthing mothers greater satisfaction and was more cost-effective.
… the epidural was very effective in complicated labours, for example where the birth was being induced or sped up.
However, in normal pregnancy … three forms of care reduced epidural use: one-to-one care in labour given by a midwife; access to water immersion, … and access to self- hypnosis or hypnobirthing.
“When those three forms of care are widely available for women, we see quite a low rate of epidural, even in first-time births. These forms of care are available in birth centres and in home birth situations … ”
… the downsides of epidural use … included an increase in forceps or vacuum delivery, a lengthening of labour and an increased need for oxytocic drugs to induce labour.
“Research on women’s satisfaction with labour has found that the one-on-one support they got from the midwife was a much more important part of the actual experience than the experience of pain. Paradoxically, a lot of women talk about a high level satisfaction along with a high level of pain.”
Dr Peter Boylan … had a different opinion … “The epidural is undoubtedly the most effective form of pain relief … for a first birth … A lot of women find that it transforms what is a miserable experience into one they actually enjoy because they are not suffering the awful pain,” he said …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Epidural, Home birth, hospital birth, midwife, Midwifery, Midwifery services, Normal Birth
Posted by Melissa Maimann on Sep 19, 2009 in
Birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email me or call 0400 418 448.
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“I’m afraid of something happening to me that I don’t want,” I said. The other women nodded their heads. “Yeah,” said another, “when you’re out of it.”
We had been instructed to form a group separate from our partners to discuss our fears about the labor experience and our expectations of what we would get out of this Childbirth Education Class, now in its first session. But for some of us it was like therapy in a bomb shelter. The issue looming overhead was not the risk our own bodies might present to us, but the risks we knew were standard protocol in the hospitals we were suddenly being farmed out to.
… we learned in mid-May that no more births could take place … [at] the Birth Center … the Birth and Women’s Health Center had been part of the for-profit Associates in Women’s Health Care for the past four years. But midwifery, the care provided at the Birth Center, is not terribly profitable when placed alongside the cash cow of modern obstetrics …
… “One cannot help an involuntary process. The point is not to disturb it.” So renowned French physician Michel Odent articulated the philosophy that has been the cornerstone of birth assistance worldwide since human birth began.
… in the early 1800s the average woman in this country gave birth at home attended by a woman midwife … However, in the 1900s birth moved to the hospital, due in part to industrialized America’s starry-eyed wonder at technology and the male-dominated medical profession, and in part because physicians who’d formerly shunned poor women began to offer their services at free clinics for the purposes of experimentation and instruction …
… “Over the past 30 years, obstetric management has converted what should, in most cases, be a healthy, normal process into a high-tech event.” And while some would argue that we’re better safe than sorry in our caregivers’ preparedness for crisis … the vast majority of hospital births in this country find mother and baby at greater risk for complications due to unnecessary medical intervention …
… “The best way to avoid a c-section is to be informed,” … Despite informed consent laws and assurances from administrators that all procedures are the mother’s decision, few women go into labor confident that they know better than their doctors which procedures are useful and when …
… hierarchical protocols in hospitals sharply reduce the authority of midwives in favor of the medical model, making the obstetrician the authority.
Why not trust the obstetrician? Won’t she or he want what is best for the patients? The answer is complex and alarming: Not always … For example, a woman’s likelihood of having a cesarean depends very little on her or her baby’s physical condition. The factors that sway the statistics much more include where she is giving birth (a hospital, freestanding birth center, or at home), who is assisting (an obstetrician, family practitioner, or midwife), hospital culture and policies, and–the strongest determinant–her caregiver’s cesarean rate. These factors influence not only who has cesareans, but who receives most of the medical procedures and drugs currently in fashion. These include fetal heart monitoring (the machine that goes ping!), episiotomies, IV, labor induction, epidural anesthesia, forceps and vacuum delivery and a host of other technologies that studies show compromise the health of the patients with little or no benefit.
One more factor significantly increases the likelihood of unnecessary procedures: profit. Obstetricians often receive hundreds of dollars more for ceseareans than vaginal births, and hospitals can receive thousands of dollars more. An epidural jacks the bill up another grand. Fetal heart monitoring saves hospitals money by allowing one nurse to monitor several babies, as does the heartless practice of whisking the baby away to the nursery once born.
The philosophy of obstetrics management posits that childbirth is a pathological condition requiring the intervention of surgeons. Hospitals are our culture’s centers of crisis and disaster, and that is why the majority of births do not belong there.
… In the 1970s, women’s dissatisfaction with the medical model of childbirth gave rise to the concept of the freestanding birth center. Birth centers, usually located close to but separate from a hospital, provide more supportive, less technologically oriented maternity care for low-risk women by certified nurse-midwives. By 1989 there were 132 freestanding birth centers operating in the US, delivering about 20,000 babies each year … birth centers offered medical care comparable to hospitals for low-risk women, often at half the price …
I asked the eight women in Childbirth Education class if any were planning a home birth, and only one raised her hand … Home birth in Tucson, together with prenatal and postnatal visits by a midwife, costs around $2,000–a pittance compared to the astronomical costs of hospital birth, which can be over $10,000. Ironically, though most of us had been “lucky” enough to have insurance that covered the birth center, none of our plans cover home birth however inexpensive, so hospital birth has become our only affordable choice.
… Now the 49 women who were due to deliver at the birth center next month, and those like myself who were due not long after, are hauling our backaches around Tucson to check out our alternatives.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, CTG, Epidural, fetal monitoring, intervention, midwife, Midwifery, Midwifery services, Normal Birth, Obstetrics, Public and private hospitals, women's rights
Posted by Melissa Maimann on Sep 9, 2009 in
Birth,
Caesarean,
Midwifery,
Normal Birth,
Obstetrics,
VBAC 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
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, VBAC
Posted by Melissa Maimann on Sep 1, 2009 in
Home birth,
Midwifery,
Normal Birth,
Obstetrics For further information, contact Melissa Maimann at Essential Birth Consulting.
Link
More research to prove the safety of low risk home birth. It’s interesting to note that VBACs are included in this home birth study as low risk. For the record, there were 2 uterine ruptures, both in the hospital-doctor-attended births. The rate of rupture was therefore 0.0154%. Much lower than the oft-quoted 0.7%. The midwives must be doing something right!
Giving birth at home with a midwife present is as safe as a hospital delivery accompanied by a doctor, suggests a new Canadian study …
Actually, they got that bit wrong. Midwife-attended home birth was not found to be as safe as doctor-attended hospital birth: it was found to be the safest. The safest way for a low risk woman to birth is at home with a midwife, then in hospital with a midwife, and the most dangerous way to birth, according to the study, was with an obstetrician in hospital.
The study … analysed nearly 2,900 planned home births in British Columbia that were attended by regulated midwives, more than 4,700 planned hospital births attended by the same midwives and more than 5,300 hospital births attended by physicians.
The research found that women who had a planned home birth had a lower risk of having to undergo obstetric interventions such as electronic fetal monitoring, epidural, assisted vaginal delivery and caesarean section, and adverse outcomes such as hemorrhage and infection.
The babies born at home were also less likely to suffer birth trauma, require resuscitation at birth and less likely to have meconium aspiration, where they inhale a mixture of their feces and amniotic fluid.
The perinatal death rate per 1,000 births was also low across all three groups.
But it was lowest amongst the midwife-attended home births.
“The decision to plan a birth attended by a registered midwife at home versus in hospital was associated with very low and comparable rates of perinatal death,” the authors said. “Women who planned a home birth were at reduced risk of all obstetric interventions assessed and were at similar or reduced risk of adverse maternal outcomes compared with women who planned to give birth in hospital accompanied by a midwife or physician.”
The findings add to the ongoing debate about the safety of home births. According to the study, research from North America, the United Kingdom, Europe, Australia and New Zealand has not found a link between planned home births and an increased risk of complications …
This research adds to the growing body of research that is no longer suggesting – but proving – that low risk home birth is safe. I think we can mount a strong case that the Australian Government is now putting women at risk by failing to indemnify midwives for home births after 2010.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: birth, Birth choices, Caesarean, Complicated pregnancy or birth, continuity of care, CTG, Epidural, fetal monitoring, Home birth, hospital birth, intervention, midwife, Midwifery services, Obstetrics, Public and private hospitals, VBAC, women's rights
Posted by Melissa Maimann on Jun 16, 2009 in
Birth,
Caesarean,
Midwifery,
Normal Birth,
Obstetrics For further information, contact Melissa Maimann at Essential Birth Consulting.
Link
I was shocked just by the title of this article!
Leaders of Canada’s pregnancy specialists are urging doctors not to induce labour unless there are compelling medical reasons.
The call is part of a campaign to “normalize” childbirth and efforts to reduce Canada’s soaring cesarean section rate. Some studies suggest inducing labour in a first-time mother significantly increases her risk of a C-section.
… Doctors say several factors are driving induction rates, including the number of older first-time mothers, medical legal concerns and convenience.
“[Women may say], ‘My husband is going somewhere, can’t you get my baby out Monday?’ ” …
For most expectant mothers, labour begins spontaneously, at about 40 weeks into the pregnancy.
Induction of labour occurs when medications such as prostaglandin and oxytocin are used when a woman is past her due date to ripen the cervix and get the uterus contracting.
“The message … is, be patient and do not consider inductions before the end of the 41st week,” said Lalonde. “If you wait that extra week to 10 days, you will find that most women … will go into spontaneous labour.”
He says “the number one risk” of induction is that it leads to earlier decisions about a C-section … Nearly 28% of babies were born surgically in Canada in 2007-08 … That’s up from 5% in 1969.
… Induction can lead to longer, more painful labour and continuous electronic monitoring of the baby’s heart rate, which itself increases the risk of C-sections, because it generates “a lot of information. In fact, too much information,” says Dr. William Ehman … “So you are trying to sort out the important things versus what’s not important.”
Research shows that, in healthy pregnancies, checking the baby’s heart rate after contractions by listening, or using a hand-held device, reduces the risk of interventions.
But a recently released Canadian survey of more than 6,000 women who have given birth in the last few years found most women (91%) experienced electronic fetal monitoring during labour …
Ehman worries that women, and their doctors, have lost confidence in the ability to give birth without technological interventions.
… “Nature prepares the uterus better than we can,” Ehman said. “There’s probably a whole host of things that triggers labour in the first place — and mainly it’s probably the baby. So when the baby is ready it facilitates labour by lots of mechanisms that we can’t do.
“We can add these chemicals and get the uterus contracting. But we just know that the numbers say that inductions, if they are done unnecessarily, are going to increase the risk of a C-section.”
A very positive article from a doctor. Unfortunately, it’s what midwives have been saying for many many years. Australia’s CS rate is 31% (well, that was in 2006… I dread to think what it might be now); the CS rate in canada was only 28%. I hope that the changes to the provision of maternity services that are proposed to take place at the end of 2010 will help to bring down our caesarean rate.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: birth, Birth choices, Caesarean, Complicated pregnancy or birth, CTG, Epidural, fetal monitoring, Obstetrics, Public and private hospitals
For further information on hospital birth or natural birth, contact Melissa Maimann at Essential Birth Consulting.
Hospital birth … which woman does not want to give birth in hospital in these days? Ask any pregnant woman where she is planning to give birth, and you will find that 96%+ of them will answer, “hospital”.
Less than 3% women will plan to give birth in a birth centre, and approximately 1.5% to 2% will succeed. 0.2% women Australia-wide will birth at home.
Hospital has been the first choice for women who are planning to give birth. Women choose to have their babies in hospitals because they are afraid not to. They are scared that if something goes wrong and they are not in hospital, that their baby will die, or that they will be harmed. They think that having a baby is like undergoing a major medical event so that they feel safe to be close to modern technology and a skilled obstetrician. The more the obstetrician costs, they better they must be. The more equipment and technology available in the hospital, the better it must be.
They are equally scared that if they don’t have a hospital birth, then they or their babies would die. In short, women no longer trust their body to give birth, despite the fact that it has been shown throughout centuries that women’s bodies are perfectly suited to give birth.
Some people argue this point, saying that mortality rates have come down dramatically since we moved birth to hospitals. And yes, mortality has come down and birth has moved to hospital. But it is not a cause-and-effect relationship. In fact, when birth moved to hospitals, MORE women and babies died. They died of infection because doctors would work on cadavers and then attend women in birth. They did not know about infection control.
The mortality rate came down after sanitation improved. Another important change was the development of a transport system that saw food being delivered to people year-round – fruit especially. Improved education and literacy also made a big impact. This all combined to improve the health of women and babies. Later, when contraception became more widely available, women were able to space their children, and this too meant healthier women and babies.
It is very rare, that a woman asks herself whether labour and childbirth are really life threatening and dangerous. This is because all women today are being bombarded practically from childhood to womanhood by the message that childbirth is dangerous. The fact that media portray that childbirth is full of complications and that most women will need medical help to give birth helps to reinforce this myth. How many TV shows depict birth as being easy, safe, painless and non-technical? Very few. And many women poo-haa those scenes saying, “oh, she must have been lucky”. Luck has nothing to do with it. Preparation, choice of care provider and place of birth, and determination have everything to do with it.
For most women, labour and childbirth are normal events.
Labor And Childbirth Are Normal Events
Women who are healthy and have low risk pregnancies should be able to give birth naturally if they are given correct information and preparation on how to do so. I am not of the belief that women need any pain relief in a normal labour. And without the use of pain relief, the vast majority of women will birth without complication.
Most Childbirth Complications Are Iatrogenic
Complications and/or horrible birth experiences that some of these supposedly low risk women experience are not caused by their body’s inability to give birth, but are often caused by medical interventions introduced one after another, during the hospital birth.
It looks something like:
- have an induction because you’re a couple of days past your due date
- this involves giving you gel so your cervix softens
- when your cervix is soft, your waters will be broken
- you will then need a drip to start labour
- because you have a drip (which can stress the baby), you will need continuous monitoring of your baby’s heart rate – that’s that monitor that they strap to your belly. Or, the staff may screw an electrode into your baby’s head and you will have 1 less belt on your tummy
- the drip will be increased until you are in good strong labour
- hopefully this process does not stress your baby. But most likely, it will stress you.
- unable to access the bath or shower or move into positions that help your body to birth your baby, you will need pain relief.
- you start on the gas
- the contractions are too strong for the gas
- you accept a dose of pethidine or morphine
- that wears off.
- you accept an epidural
- you will be examined regularly to assess progress
- you are now in bed, immobilised.
- your baby cannot move effectively through your pelvis
- your baby, unable to descend through your pelvis aided by gravity, and pounded by strong contractions, may become distressed
- if you are not yet fully dilated, you will have a caesarean
- if you are fully dilated, you will have forceps or a vacuum. Maybe an episiotomy too. And stitches
- you have an injection to speed the delivery of the placenta. Your uterus may be tired from the strong syntocinon-induced contractions. You may have a post-partum haemorrhage.
That’s called the cascade of intervention. Google it. It makes for interesting reading!
It is clear that for the most part, it is the hospital or doctor that causes the unnecessary complication of what is supposedly to be a low risk labour. This is achieved by interfering with the course of normal pregnancy or labour every step of the way. One intervention simply leads to another. Sometimes, it even starts in pregnancy with an ultraound because the baby is too big ….
In the scenario described above, see if you can count how many interventions the woman had (answers at the bottom). Let me know if I’ve missed any!
Of course, medical technology can be a life saver for true emergency situations. And I wholeheartedly promote hospital birth for high-risk women. But, the majority of women are not in this category. According to WHO, 80% women have healthy pregnancies.
You may have heard the legal phrase, “innocent until proven guilty”. Unfortunately, this does not apply to pregnant and birthing women in the hospital system. They’re guilty (high risk) until proven innocent (low risk) …. and unfortunately, that’s not until after the labour is over. In obstetric terms, birth is only normal in retrospect. Whereas midwives will always look for normality.
It is therefore not surprising that with this kind of birthing philosophy, birth becomes a more and more of a medical event rather than a normal family event.
Fetal Monitoring
Aside from this kind of obvious interventions, there are other routines along with the ‘dos and don’ts’ within the hospital policies that can potentially cause complications. The routine use of fetal monitoring during hospital birth, for instance, may seem harmless. But it also means you’ll have to lie still for the duration of the monitoring. You may be able to assume other positions, but continual movement will not permit the monitoring to pick up the baby’s heart rate. Unless a “clip” – read – thin wire that’s screwed into the baby’s head – is used.
To make things worse, the trace obtained from this machine (CTG) is often misinterpreted. Studies have shown that if you show the same trace to several people, they’ll all give different interpretations. And if you show the same trace to the same person, a few times over, each time the person will give a different opinion regarding the welfare of the baby.
Indeed, it has been shown that the use of CTG is associated with a dramatic increase in caesareans, without providing an improvement in outcome, compared to the use of the doppler to monitor the baby’s heartbeat.
Hospiral Policies
Interestingly, a lot of hospital policies are not in place to make birth easier. You would think that hospitals would help you to have a more natural experience. Rather, they are designed for the sake of efficiency and legal protection. As an institution, hospitals are more interested in managing the patients, than accomodating every client’s whim. The welfare and feelings of the woman are often taken out of the equation in the policy-making process. As long as the woman and baby are alive at the end of the process, it doesn’t matter whether women and babies are suffering unnecessarily. Suffering is hard to measure legally, whereas outcomes such as low apgar scores and duration of labour, are easier to measure and account for.
When you birth in an institution, no matter how person-friendly it seems to be, at the end of the day, you are on a production line. It is very process-oriented. The midwives are usually expert at not having you feel that you are on that conveyor belt. But you are. You are a thing to be processed according to hospital policies, deviations from which will not be tolerated because it interferes with the smooth running and efficiency of the whole machine (institution). The faster you can be put through the conveyor belt, the better for the institution. They can then have more through-put (income). Or, they (or their share holders) can benefit from fewer expenses (staff time) related to a shorter stay in delivery suite.
Thank you, Doctor
Unfortunately, many women think it’s normal to suffer greatly during childbirth. It is also quite common that they continue to believe that their bodies are abnormal and cannot withstand childbirth. They feel forever grateful to the hospital and their doctor, the one who saved them from the misery of childbirth, or who saved their baby from death. Little that they know that the source of disaster can be from the hospital intervention, not because of their bodies.
Hospital Is Not A Good Place For Healthy Babies
Finally, hospitals may not also be a great place to greet your newborn into the world. Aside from the fact that a hospital is a place full of antibiotic-resistant germs, a lot of hospitals also do not treat the newborn as respectfully or as kindly as you want it to be. In addition, there is usually separation between mother and baby after birth. At least for some time – maybe the baby will be in the same room as you, but may be assessed on the resuscitaire (how many women ask that their baby be assessed in the bed or on the floor or in the bath / shower with them?)
Also, many babies are separated from you over night “to let you get some sleep”. This sounds like a good thing at the time, until you get home and do not know what to do with your baby in the wee hours of the morning.
To Sum Up – The Truth Of Hospital Birth
In short, if you are planning to have a natural birth in hospital, consider the following:
Hospitals are rampant with medical intervention which can increase the risk of complications. As a result, you are at higher risk of having an unnecessary cesarian section if you choose a hospital birth.
You are not in control of your birth. Instead, hospitals control the birth through policies.
Hospitals are full of policies (routines) that are neither evidence-based nor birth-friendly.
In hospital, birth is viewed as a medical, not a normal, event. The health care professionals at the hospital are trained in pathology of birth, not normal birth.
The hospital environment may be impersonal and less cozy. This may impact your birth experience.
It’s almost impossible to have an intimate birth at a hospital.
Hospital Birth – YES or NO
After pondering the above facts, I hope you can now make your own decision on where you want to have your natural birth.
You have to realise that if you choose hospital birth, you have to be ready with all the consequences. A lot of time, requesting or rejecting certain procedures can cause irritation and misunderstanding between patient and the hospital staff. This friction may create a hostile or awkward environment which can make you feel uncomfortable and hard to relax.
Is this the environment you would like to be for your labour and birth ?
What are the other options?
There is good news!! There are two other options.
1. If you are a healthy woman, having a normal pregnancy, birth your baby at home with a registered midwife.
2. If you prefer to birth in hospital, or if you need to birth in hospital because you have a high risk pregnancy, employ the services of a private midwife. She can provide your antenatal (pregnancy) and postnatal (after baby is born) care and birth with you in hospital.
If you birth in hospital, expecting a natural birth, and you do not have a private midwife with you, this is much the same as doing your supermarket shopping in Bunnings. Newsflash! Bunnings do not sell groceries. Do not be disappointed when you do not find groceries in Bunnings. Rather, do your research and make choices that are aligned to the sort of birth you want to have. If you desire a natural birth and you’re healthy, have a home birth or a private midwife for a hospital birth. You do not need anyone’s permission (hospital, doctor etc). No more than you need their permission to have a massage or eat chocolate mousse. Private midwifery is known to carry a high natural birth rate and deliver excellent clinical outcomes to women and babies. The World Health Organisation recognises midwives as primary care providers for healthy, low risk women because midwifery care is know to deliver the best outcomes for this large group of women. For high risk women who are birthing in hospital, private midwifery will see you experiencing the minimal amount of intervention necessary.
ANSWERS:
1 gel
2 waters broken artificially
3 syntocinon drip to start labour
4 syntocinon drip to keep labour going
5 continuous monitoring
6 immobility
7 lack of access to the required tolls to facilitate normal labour
8 gas
9 pethidine or morphine
10 epidural
11 labouring in bed, unaided by gravity
12 caesarean or forceps or vacuum
13 vaginal examinations
14 forced (directed pushing) – needed with an epidural
These are the direct interventions. But what about the indirect interventions?
15 birthing in an unfamiliar environment
16 birthing with strangers
17 lack or direct one-to-one midwifery support
18 lack of continuity of care (can be assumed since vew few women are able to access this option in Australia)
19 imposed time limits on labour
20 managed third stage
21 separation of mother and baby after birth: a baby who is born after an operative delivery (caesarean, forceps, vacuum) will be taken to the resuscitaire for assessment by a paediatrician
22 breastfeeding will be impacted
23 bonding will be impacted.
Have I missed any? Let me know.
So …… 23 interventions when you thought you were only signing up for one!
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, Birth trauma, Caesarean, Complicated pregnancy or birth, continuity of care, CTG, Epidural, fetal monitoring, Home birth, hospital birth, intermittent auscultation, intervention, midwife, Midwifery, Midwifery, Midwifery services, Normal Birth, Obstetrics, Public and private hospitals, women's rights
Posted by Melissa Maimann on May 11, 2009 in
Birth,
Caesarean,
Home birth,
Midwifery,
Normal Birth,
Obstetrics For further information, contact Melissa Maimann at Essential Birth Consulting.
In Australia, all babies are born with the help of a midwife. This is true whether you’re giving birth in hospital, birth centre, at home or in an operating theatre. The question is really – what are the benefits to having a midwife as your primary care provider?
So, what is a primary care provider?
A primary care provider is someone who is responsible for your pregnancy and birth care. It will either be a doctor or a midwife, and in some circumstances, it will be both. Women may choose birth centre, homebirth or hospital midwifery care to benefit from primary midwifery care.
Primary medical care is provided by private obstetricians or through doctor’s clinics in public hospitals.
What are the benefits of having a midwife as your primary care provider?
Midwives generally have a firm belief in pregnancy and birth as natural processes that women can do. In other words, they believe that a woman’s body is perfectly designed for pregnancy and birth. They look for what’s right in the pregnancy and birth, while always being mindful of risks. Midwives help to keep pregnancy and birth normal by focussing on nutrition, lifestyle, health and well being. We that with health in general, healthy people are less likely to get heart disease, diabetes and so on. Well, it’s the same in pregnancy and birth: healthy women and babies are less likely to get sick. So midwives focus on health and well being, while always being alert for situations that need more attention.
Midwives use a holistic, or biopsychosocial model of care. What this means is that you’re not just a pregnancy or a birth to a midwife. You’re a woman, mother, friend, wife, partner, employer / employee and so on. Your midwife will seek information about your life, your family, your interests and so on, as well as your health and medical history. She will take all of this information into account when making recommendations and giving advice.
Midwives are less likely to use disruptive technologies that may lead to further intervention and complications. They’re less likely to induce labour, perform an episiotomy, perform vaginal examinations, break your waters and so on. So your labour is allowed to progress naturally. When you work with your body, it will work with you. When you interfere with your bodily processes, your body will not work as well. This is especially the case in birth where there’s a strong reliance on hormones to initiate labour and keep it going.
Women are usually very satisfied with midwifery care. They feel supported, emotionally, from seeing a midwife. They feel they can trust their midwife and that their wishes are respected. Women feel more comfortable to write a birth plan and discuss their hopes and preferences for their pregnancy and labour when they see a midwife.
So, what does this mean for birth and babies?
Well, there are lots of positives! When you have a midwife as your primary care provider, you can expect:
- choice of birth place (hospital, birth centre, or home)
- a lower rate of caesarean
- a lower rate of episiotomy
- you’re less likely to be induced
- you’re less likely to need pain medication in labour
- you’re less likely to have your waters broken
- you will be listened to and respected
- your birth plan will be respected
- you will be able to build trust with the midwife who will help you in birth
- you will be less likely to have an assisted birth (eg forceps)
- you will have a lower chance of getting postnatal depression
- you will be less likely to have birth trauma
- you will be more likely to bond well with your baby
- your baby will be more likely to breastfeed successfully
- you will most likely view your labour as being very positive
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, birth debriefing, Birth trauma, Breastfeeding, Caesarean, continuity of care, Epidural, Home birth, hospital birth, intervention, midwife, Midwifery, Midwifery, Midwifery services, Normal Birth, Obstetrics, postnatal depression, Public and private hospitals