An amazing homebirth story

Posted on January 9, 2012 by Melissa Maimann

Isabel is an amazing, strong woman who came to me for pregnancy care. She had planned to move overseas, and as you’ll read, her pregnancy came as a surprise. She planned a homebirth with a midwife overseas – but the story has a twist in it! We went about the pregnancy, preparing thoroughly for an active, natural and drug-free birth. I was thrilled to receive Isabel’s birth story, and she has kindly agreed to share it here.

Thank You to all the women out there who shared their birth stories and experiences which gave me to determination to birth at home. Now it is my turn to write the story I have been so looking forward to… I hope I help inspire another mum-to-be to have the great confidence in her own ability and her body’s ability to birth her baby safely and naturally…love Isabel xx

Our beautiful birth story of baby Zachary by Isabel and Jed

It started in mid-April when I noticed an unusual change in my body. I pee-ed my pants when I sneezed. Even though I have a very weak bladder control and recurrent cystitis I had never done that before. I decided to get a urine test and after 4 weak positives I decided the product was defective and I needed to go see a real doctor tomorrow.
Half way through a busy day at work as a Veterinarian, caring for animals, it hit me that I might be pregnant and that we weren’t really ready for this big change in our lives. I broke down and cried. I left work early to go see the doctor. Jed met me at the clinic and we saw the doctor together. The doctor promptly told me, “My Dear, there isn’t such a thing as false positive results. Only false negative are possible. You ARE pregnant!”

I guess at that point both Jed and I had a lot of conflicting feelings. We had only just gotten married less than a month ago. We had a wedding dinner to attend in Malaysia followed by a honeymoon which required us to trek over 4000km up a mountain. At the same time it was such a big surprise and blessing to know that we were able to have a baby. We both set about sorting through our feelings and thoughts for a couple of weeks before letting the rest of the family and friends know about it.

It was a smooth pregnancy and we had amazing help and support from friends and family. We learnt so much from our lovely midwife, Melissa Maimann and our ante natal teacher, Julie Clarke. It was basically life changing. I had known I would have needed to hit the books for this but who would have thought I find so much conflicting information. It was hard making the right choices. It was doubly hard to not have my sisters around which I rely on so much for guidance. Jed was so good and read everything I told him to. I only had to chuck temper tantrums once a month. =)

In the end, I decided I wanted to have a home birth because I dislike being told what to do with regards to my body and I strongly dislike needles. I spent a lot of time visualising what my ideal birth/labour would be like and tried to get the support network I needed to achieve this dream. It wasn’t easy finding medical people to agree so in the end I realised it would probably just be Jed, Alicia and my mom helping me. I prayed to whoever was listening that everything would go smoothly and I that neither Zachary or I would not need medical help.

Fast forward about 9 months to December, my mucus plug came out throughout the day on the 13th with no signs of labour. So we decided to head over to the homeopath for back up help if needed to get the contractions going.
Almost a week later, on the 22nd of December my waters broke at 2am. It was such a surreal feeling as I sneezed and wet the bed. I was surprised at how wet the bed was and decided to stand up and this big gush of clear warm water ran down my legs. I then realised that my waters had broken and that I would be meeting my baby today.
I woke Jed up and told him the news. Since there were no signs of contractions once again I decided to take the homeopathic remedy and we both went back to sleep.

By 4am, I was uncomfortable enough to wake up and walk around. I emptied my bowels multiple times and drank lots of water and ate some fruit. At 5am I woke Jed up and told him to pump up the exercise ball and warm up the heat packs. By 6am, contractions were regular and about 15 minutes apart, Jed started filling up the bath tub. However, there was no hot water because the water heater had been turned off. So off he woke mom up to take over comforting me and went to boil many many pots of water.

I sat on the bathroom floor rocking on the exercise ball and constantly visualising a soft open cervix and my baby descending nicely. I breathed nicely through each contraction remember our Calmbirth classes.
Heat packs placed on the lower back and under the belly helped with the discomfort as well.
The exercise ball was good for sleeping and resting on between contractions. Around 7 o’clock the bath tub was finally ready, got in and felt lots better. Alicia came shortly after and took over from mom. She gave awesome back rubs and was such a grounding energy which was exactly what I needed to get things done. Things went quickly after that.

Jed got into the water around 8am and I knelt down with my arms wrapped around him. Contractions were about 5 minutes apart then and required a lot more attention. I kept reminding myself that each contraction meant one step closer to seeing Zachary. I felt him slowly pressing down on my cervix and my cervix dilating.
Vocalising helped during the contractions. Jed was a great help reminding me to breathe and not hold my breath.
He was like a rock I knew I could rely on. Did a few self vaginal exams and could feel Zachary’s head progressing downwards.
At about 8.20am I realised I was in transition, his head was crowning and I wasn’t fully dilated. Was upset and freaked out but Alicia reminded me to trust in my body. Took a deep breath and focused on opening my cervix up. A few minutes later I was ready to push, Zachary came out head first with a hand. I rested for a few seconds till the next contractions came and looked up at Jed and said “Are you ready? He is coming.” Jed caught Zachary Francis McKenna at 8.38am
We were both ecstatic and sat there admiring for a while. He started crying almost immediately and looked around at all of us.
Stood up and tried to birth placenta but couldn’t so I went back to the room. He started feeding soon after and I was enjoying his skin to skin contact. The doctor arrived soon after he advised us to clamp the cord and get the placenta out.
Jed was frantic and really wanted the placenta out because he was worried about bleeding. I was getting a little annoyed by his constant fussing. We clamped the cord and Jed cut it. The doctor applied gentle traction and got the placenta out. Finally we were left alone for some quiet time.

I would like to thank my lovely husband for supporting me through the pregnancy and birth and agreeing to a home birth and studying so hard.
I would also like to thank Melissa and Julie for their teachings which allowed me to have the confidence to do this, although neither of them endorsed free birthing they were not judgmental.

No amount of thank you can express my gratitude for having Alicia around to show me there were many options and that we need to take charge of our own births.
Many thanks to my Mom and Dad for allowing me to use their house. Last of all, Thank You to all the women out there who shared their birth stories and experiences which gave me to determination to birth at home.

Visit my website to learn more about my services.

Rules on patient safety hit midwives

Posted on July 13, 2011 by Melissa Maimann

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Homebirth supporters claim bureaucrats are restricting women’s choice by stopping some midwives from managing higher-risk homebirths, particularly women who have had a caesarean delivery.

Homebirth Australia said it was aware of more than 20 recent cases … where midwives had been deregistered or had conditions imposed on their registration because of claims they were working outside safe guidelines.

… The Weekend West is aware of a WA midwife who was ordered last week to stop providing care for planned homebirths in women at higher risk, including those who had a caesarean and wanted to have a normal birth in the next pregnancy.

The Australian Health Practitioner Regulation Agency wrote to the midwife, saying the condition was imposed by the WA Nursing and Midwifery Board because the midwife had not proved he or she could provide a safe homebirth environment for a planned vaginal birth after a caesarean.

“The board formed the reasonable belief that because of your alleged conduct issues, you pose a serious risk to persons, and it is necessary to take immediate action to impose conditions on your registration to protect public health or safety,” the letter said.

… the move could force women to have unattended homebirths, putting them and their babies at risk. “We can’t by stealth deregister or pose conditions on midwives which rob women of access to a registered health professional,” she said.

Australian Medical Association WA president Dave Mountain … questioned whether the health system should allow higher-risk women to exercise the choice of homebirth when there were clear risks for them and their babies.

What a huge ethical debate – largely unresolved. All women have the right to autonomy – the right to make choices, have control over what happens to their body, to accept or reject advice and interventions, to decide when, where and by whom they will be cared for, to access care – or not. It is a fundamental human right that is enshrined in law.

On the other side – the health practitioner has a duty of care to the woman and her unborn baby and is obliged to provide safe care at all times. Safety is defined in terms of what the average midwife would do, or by accepted professional standards, or by laws relating to practice. A health practitioner cannot be incited to practice unsafely: they must make a judgment and adhere to professional standards.

So where does this leave us all when the two positions collide? Although we have guidelines on what we ought to do in those situations, as we can see from the above article, they do not hold water. The consequence for now is an increase in the number of women opting to freebirth – that is an unassisted homebirth (no midwife present). I am hopeful that in time, the regulatory authorities will support midwives to support all women.

Prenatal Exams Took Away From The Beauty Of Being Pregnant

Posted on June 11, 2011 by Melissa Maimann

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An unassisted childbirth. No doctor, no midwife, no nothing…

I come from a long line of pioneer women who routinely gave birth alongside the wagon trail, or in the back of a wagon, for that matter. It wasn’t a choice, it was how it had to be done.

Now, hundreds of couples around the world are choosing the experience. Not necessarily in a wagon, but alone … a completely unassisted childbirth, and they call themselves freebirthers. They say it’s healthier physically and psychologically for the baby to enter a calm environment without the glare of hospital lights and intrusive doctors.

… Athena Burke … [gave] birth to her first child in a tent in her backyard so he could “be born among the big hug of the mountains and listening to the birds and water flowing as his first sounds”. Natalie Picone-Louro said she “opted out of prenatal care because I trusted my body. I didn’t want the whole peeing in a cup, doing the heart rate, it all seemed so unnecessary. Prenatal exams took away from the beauty of being pregnant and I wanted to be in control.” …

Such a warm cozy affair, no? Wait! Did she just say “prenatal exams took away from the beauty of being pregnant”? An odd statement considering millions of women all over the world are desperate for access to maternity healthcare.

Do-it-yourself deliveries are not illegal because it’s impossible to prove a woman intentionally chose that path. In fact … in some states … it’s illegal to give birth with an unlicensed midwife but not by yourself.

… the fundamental philosophy behind freebirthing is that women would give birth more easily if they just relaxed and weren’t surrounded by all the medical monitoring madness of doctors and yes, even midwives.

… Although some freebirthers just see no reason for doctors or midwives others in the do-it-yourself movement have made the choice as an indictment of maternity care as a whole. Sick of medical interventions, these women are willing to go to extremes to have the kind of birth they want. But that’s just it – the kind of birth THEY want. What about the baby?

The American College of Obstetrics and Gynecologists is against all home births, even with a midwife. Freebirthers would reply that stress and doctors cause problems and prenatal visits are useless. So the real question becomes how often do things go wrong when doctors and [midwives] aren’t around? No one knows. There aren’t reliable statistics. But if there is a small risk, wouldn’t you want help nearby?

Laura Shanley, a freebirther and author of the book Unassisted Childbirth, had a baby five weeks premature that died after delivery. She believes the baby, who had a congenital heart defect, would have died despite hospital care and suggests the baby was better off dying peacefully at home rather than hooked up to hospital machinery for a few extra weeks of “life”.

At some point I decided to change his diaper. I picked him up, laid him on my bed and realized something was wrong. His eyes stayed closed and he didn’t move at all. We called the paramedics but they were unable to revive him. Efforts by the doctors in the emergency room were also unsuccessful. Our little one was gone.

… the coroner explained to me that our baby’s body had never developed properly. He had a congenital heart defect, influenza, pneumonia, and sepsis …

Are freebirthers onto something? Are they trailblazers sticking it to a medical community trying to interfere and milk mothers out of every last cent? Or are they taking unnecessary risks with their child’s life to chase some crunchy, hippie fantasy of their own? Do their children have a right to have access to medical care?

Freebirth is on the increase in Australia. I’m interested to read your views on it.

Baby born home, alone

Posted on May 21, 2011 by Melissa Maimann

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Before reading the article, it needs to be said that home birth is still legal. Even though it is not covered by insurance, it is legal for women to be attended by a registered midwife in private practice.

NICHOLE Lee-Yidaki’s dream of giving birth to her baby at home came a little too late for the Northern Rivers’ small home-birth industry.

So she decided to go it alone.

When the Federal Government last year tightened insurance regulations around home-birth midwives, the industry warned it risked opening the way for “free-birthers” – women who chose to bear their babies at home regardless of whether they had a midwife to help them.

The changes make it impossible for home-birth midwives to get medical indemnity insurance and effectively ban them from overseeing births at women’s homes.

Ms Lee-Yidaki said she would have preferred to have a midwife to help welcome her son, Aquil, into the world in the kitchen of her Main Arm home two-and-a-half weeks ago, but she had no regrets about choosing “free-birthing” over a hospital birth.

… Ms Lee-Yidaki was helped through the birth by a doula – a professional supporter – but without a midwife because it has become nigh-on impossible to get a home-birth midwife on the Northern Rivers since legal changes last year made it almost impossible for them to operate.

… in most cases mums could only get a private midwife to look after them before and after labour, but not through the birth itself.

… University of Technology Sydney midwifery professor Caroline Homer warned in 2009 “free-birthing” would be the “worst-case scenario” resulting from the Federal Government’s legal changes.

Ms Lee-Yidaki’s “worst-case scenario” was being unable to give birth at home …

Midwives are able to attend home births and home birth is legal. The issue is that insurance is unaffordable to some midwives with small practices. Doulas provide support at births that are attended by a midwife , but doulas do not provide professional care. Reputable doula organisations stipulate that a doula must not attend a home birth without the presence of a midwife.

Freebirth is on the increase, with some reports suggesting that unattended home birth is outnumbering midwife-attended homebirth.

Pregnant women drawn to ‘unassisted childbirth’

Posted on April 30, 2011 by Melissa Maimann

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Andrea Salcedo’s mother was at her side when her first child was born in a hospital.

But when the Calgary woman decided to have her next two children at home, without the assistance of a doctor or midwife, her own mother told her a hospital is the best place to have a baby.

“It was very disheartening,” Salcedo recalled. “It took some time for myself to just kind of accept that it was the way they felt.

“With my third [birth], I offered for my mom to be there and she wasn’t comfortable and I just accepted that …

… a growing number of women are making the same choice as Salcedo, with chat groups and websites bringing people together who are interested in the “freebirth” movement.

In 2006, two-thirds of births attended by someone other than a midwife or doctor in 19 U.S. states were described as “planned,” …

A small percentage of Albertans are having babies at home with midwives … a “very reasonable” option, when there are very minimal or no risk factors. Just over one per cent of births in Canada took place outside a hospital in 2006.

… I think a midwife, if you want a home delivery, is a much, much better choice,” he said.

“If you look at countries where unattended home births are common, the death rate for women is one per cent …

After a “negative” experience having her first child in a hospital, Salcedo enlisted the help of a midwife during her second pregnancy. After a few months, she and her husband realized the midwife wasn’t the right match for them. She talked to two friends who had unassisted births and decided to try it.

“Some people think that it is uneducated or unsupported and it is neither of those,” Salcedo said. “I have a lot of doula training and other training and my husband read everything I put in front of him.”

Her second and third children were born at home with the help of family and friends, but without professional help.

“We were very prepared for different emergency situations. I knew all of the signs for different situations that could happen. It wasn’t like we were saying we won’t go to the hospital if something goes wrong,” she said.

Wilson cautioned that in some situations, there just wouldn’t be time to get help.

“Sometimes in obstetrics, for fetal and newborn, it is minutes. We aren’t talking half an hour. And for maternal situations, there are some things where the birth could go very well, but once you then need to deliver the placenta there are high risks of post-partum hemorrhage, there are high risks of high blood pressure. Those are sometimes risks which can’t be anticipated.”

… “we have over-medicalized certain aspects of delivery, and I think that is a reasonable criticism,” he said. “I think there are ways to do things better.”

Salcedo … is now training to become a midwife.

” … many people put more thought into their wedding than they do their childbirth experience. And it is something that will stick with you the rest of your life,” …

“Unassisted childbirth isn’t for everybody, but empowered birth, and safe birth and normal birth is for everyone.”

“Do it yourself” births prompt alarm

Posted on April 10, 2011 by Melissa Maimann

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A growing number of women are choosing to give birth without the assistance of doctors or midwives, provoked by dissatisfaction with modern obstetric care, fear of unnecessary medical intervention and a desire to reclaim birth as a private, natural act.

It’s a choice the professionals say is fraught with peril. They fear the fledgling “freebirth” movement may undo gains in mother-infant mortality. The women, however, believe unassisted childbirth is emotionally and physically the safest option for themselves and their babies.

Some 33%, or 8708 out of 26 667 homebirths in the United States in 2007 were not attended by a physician or midwife … Two-thirds of those deliveries attended by someone other than a physician or midwife … were reported as “planned” …

Canada lacks similar statistics, but a cursory search online turns up a surfeit of websites, forums … dedicated to freebirth …

It’s a difficult trend to track with any certainty … because advocates of unassisted childbirth aim to avoid interaction with the medical system wherever possible.

While some women forgo prenatal care entirely, others orchestrate a “planned oops” or “accidental” unassisted birth to avoid confrontation with health care providers and the law.

Many are already mothers, wary after a bad experience with a doctor or midwife.

“My first son’s hospital birth left something to be desired … the doctor I had was terrible. When I became pregnant a second time, I sought out a midwife and while one of the women in the practice was great, the other really talked down to my husband and I … ” … “I was probably seven months pregnant when I decided I didn’t want [that midwife] at my birth. I didn’t want it to be a guessing game.”

Others fear being coerced into medical procedures they’re not comfortable with.

“There are some people who can go into the birthing room and put their foot down, but I know when I go into a doctor’s office for an appointment, I get overwhelmed, let alone in a case where they’re saying your baby might die,” … “I think it’s easier to trust yourself if there’s not another voice there. Having that other set of interests involved makes me uncomfortable.”

Doctors and midwives bring their own timelines and expectations about how a delivery should proceed, and will err on the side of intervening in birth to protect themselves against litigation … “I can see the position they’re in, because if you don’t deliver a perfect baby there’s a chance you’ll get sued, and there’s this idea that if you’ve transferred someone to the hospital or done a C-section then you’ve done everything you could.”

… primary C-section rates ranged from a high of 23% of deliveries in Newfoundland and Labrador to a low of 14% in Manitoba.

With up to 15% of all births involving potentially fatal complications, however, “the evidence is overwhelmingly in favour of giving birth with a skilled attendant present,” …

Proponents of unassisted childbirth say it’s all a matter of perspective. They prefer to view birth as a “spiritual, sexual experience, not an inherently dangerous medical event,” says Shanley. “I trust the same intelligence that knows how to grow the baby from an egg and a sperm into a human being also knows how to complete the process.”

Unnecessary intervention in birth is more often the cause of complications than a remedy, she adds. “People counting, measuring and managing birth into this controlled, manipulated act, it’s no wonder women’s bodies shutdown — the way anybody’s would if someone kept interrupting them while they were trying to have sex, go to the bathroom or go to sleep.”

Intervention should be the last resort, not a given … ” … one of the nurses asked why we didn’t go to the hospital and my husband looked her in the eye and said: ‘Because it wasn’t an emergency.’”

The couple prepared for complications by reading books for first responders on how to deliver babies in emergency situations.

Others look for such information online.

“I had to assess what my personal risks were,” says Rundle. “I’m a healthy young woman, so when people say that 15% of the time there’s a complication, are they talking about women who have different medical histories than I have?”

Some women, like Shanley, prefer to put complete faith in their bodies and refer to complications as “variations of normal.”

“There are going to be babies who die during an unassisted birth who may not have if there had been intervention, but there are also going to be babies who die because of interventions,” she explains. “There’s no way to ensure a successful birth every time. Sometimes a baby dies and that’s just the way it is.”

It’s not a stance Shanley takes lightly, having lost a child to a congenital heart defect following an unassisted delivery, and been told by a coroner that the baby would have died even if she had gone to the hospital.

It’s a difficult stance to counter, says Canadian Association of Midwives president Anne Wilson. “You can’t say to a mum that 60% of all unassisted births result in complications where the baby dies because that kind of statistic doesn’t exist. A lot of complications in childbirth are predictable and occur over time, but a few happen without warning, such as severe hemorrhage. And if a woman doesn’t have prenatal care, doesn’t report the birth to the hospital, there’s no way to know.”

… “Unassisted childbirth is unsafe — period,” … “The people advocating this as a mainstream option for women are tragically uninformed.”

Midwives, however, are more “fuzzy” on the issue, says Wilson. The association has yet to take an official stance for fear of alienating women wary of intervention. “If someone came to us who was considering an unassisted birth we would want to keep that person engaged, build a relationship of trust and if they ended up going ahead with it, at least you’re someone they can call if they get half way through a delivery and change their mind.”

Failing that, “some prenatal care is better than none,” she adds.

The debate raises ethical questions of “autonomy versus beneficence” for midwives, Wilson says. “By the nature of what we do, we tend to look after people who don’t want interventions. It would come down to individual choice in terms of how comfortable you are as a practitioner taking that person into your care.”

For Shanley, however, unassisted childbirth is more a question of reproductive rights. “It’s your body, your birth and your baby, so you should have the right to give birth however you want.”

Women may ‘go it alone’ on home births

Posted on October 17, 2010 by Melissa Maimann

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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A campaign group has warned that some women may opt for home births without professional care as a result of problems with indemnity insurance for qualified home-birth midwives.

The Association for Improvements in the Maternity Services-Ireland (AIMS) says proposed new midwifery legislation will in effect make it illegal for a home birth midwife to provide antenatal and birth care if the pregnant woman’s circumstances do not meet criteria set in a current memorandum of understanding which midwives have to sign …

… the memorandum, which will be used in the legislation, outlines the criteria for State indemnity insurance cover for midwives in home births but these criteria were too restrictive.

… AIMS says the restrictive criteria could lead to midwives becoming uninsured in the middle of a home birth should the mother’s clinical circumstances change.

Midwives attending women having home births could face could face fines or imprisonment or both if they are found in breach of the new legislation …

… a growing number of women who do not want to attend maternity hospitals are saying that if professional midwife-led home birth services are not available to them, they will “go it alone” with their home birth without professional care providers …

I believe Australia will head down this same path in 2 years’ time when the exemption for homebirth insurance runs out. I foresee that homebirth will be funded and indemnified, albeit with strict criteria for homebirth.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Natural childbirth: whose birth plan is it anyway?

Posted on September 20, 2010 by Melissa Maimann

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With the trend for ‘natural’ childbirth growing and a government setting targets for home births, are British women really free to choose how they’d like to go through labour, or must they bow to a new earth-mother ideology? …

Hannah Hancock was pregnant with her first child she was keen on the idea of a drug-free birth. But … when labour pains kicked in, ideals were abandoned. ‘It was a long labour. At first I was on an oxytocin drip, then on pethidine, and a few hours later when they asked me if I wanted an epidural I was shouting, “Give it to me now!”‘

This is a common occurrence in hospitals where women do not have continuity of care and women don’t have access to resources and preparation to help them through natural labour and birth.

Two years later Hancock gave birth at a London teaching hospital. There the experience was very different.

‘I knew I wanted an epidural but the midwife ignored me, saying, “Why do you want pain relief? You’re doing really well.” I was crying, saying, “I don’t want to do well!”‘ Hancock begged her to find the anaesthetist. ‘But she just stood outside the door not going anywhere.’

Another scenario that doesn’t generally happen with continuity of midwifery care and in particular private midwifery care. In these cases, the woman and midwife have formed a trusting and caring relationship so that the woman has been able – ahead of time – to let her midwife know her intentions for her birth and the midwife is then able to support her.

In the end Hancock gave birth to her daughter using just gas and air. ‘It didn’t help at all. I was panicking so much at the prospect of no pain relief I couldn’t relax and tore really badly. I couldn’t understand this patronising attitude … It really coloured my view of the birth. When Ines was laid in my arms it was a special, dreamy moment. The second time I was in such shock, I’d been in so much pain without anybody helping, I could barely look at the baby.’

Birth trauma happens after natural birth as well as after birth with intervention.

As any woman with children knows, the politics of childbirth are so highly charged they make infighting between Labour and the Tories look like a teddy bears’ picnic. On one side sit the medics, portrayed by their detractors as men in white coats intent on cutting women open so they can avoid litigation and clock off on the dot of six. On the other sit the midwives, scoffed at as strident feminists denying women modern analgesia in favour of whale-music CDs and back rubs. In the middle of these competing philosophies is a labouring mother, her wishes drowned out in the clamour of debate.

Maureen Treadwell of the Birth Trauma Association, which supports women who have had difficult births, says that far too often ideology takes precedence over individuals’ needs. ‘The consequences can be unbelievably cruel. The truth is that what suits some women can be distressing and wholly unacceptable to others. Some women are obsessed with a natural birth and are distraught if this doesn’t happen. But for others – say, a 40-year-old woman who has had three miscarriages – the priority may be having the safest birth possible with naturalness very low on the list.’

At the heart of much of the argument are the philosophies of Grantly Dick-Read, a British obstetrician who was convinced that much of labour pain came from society conditioning women to expect it. His 1942 classic Childbirth Without Fear expounded his belief that women educated to be free of fear and tension would experience birth as a ‘normal and natural defecation’. Pain relief, he said, was undesirable because it affected the baby and slowed down labour, frequently leading to interventions, such as the use of forceps or the ventouse vacuum pump, or emergency caesareans.

Dick-Read became the first president of the Natural Childbirth Trust, promoting better understanding of his system. This later became the National Childbirth Trust (NCT), whose antenatal classes are seen as a rite of passage for all middle-class couples …

While acknowledging that pain is subjective, Belinda Phipps, the NCT’s chief executive, defends such a stance. ‘A lot of women who feel they are denied an epidural are on the verge of starting to push the baby out and don’t actually need one any more … an experienced midwife will know she’s actually getting ready to push and persuade her to wait a few more minutes. She should reassure her that what she’s feeling is normal and let her know it won’t last much longer …

Others, however, are furious their wishes were ignored. ‘I talk to women who have been left screaming in agony because they were either not offered or were refused pain relief,’ Treadwell says. ‘Afterwards, they’ve needed psychological help, their relationships have been scarred, they’ve been afraid of getting pregnant again, they don’t bond with their babies.’ …

Fashions in giving birth are as variable as hemlines. Tina Cassidy, the author of Birth: A History, asserts, ‘The way we choose to give birth reflects the culture of the age. Whenever women feel their choices are being limited by political decisions, they push back and say, “We can do what we darn well want.”‘

In the early 20th century the church preached that suffering in childbirth was the curse of Eve and that to try to avoid pain was a sin. Outraged by such repression, the suffragette movement embraced the introduction of ‘twilight sleep’, a mixture of morphine and the amnesiac scopolamine injected during labour to made women forget the pain. Obstetricians initially expressed doubts about drugging women, but were rapidly shouted down. The result was that birth quickly became so medicalised that by the 1970s another generation of feminists were fighting for the right to experience childbirth awake.

‘In the 1980s, when women were in thrall to “having it all”, they embraced epidurals that rid them of pain while allowing them to be conscious,’ Cassidy says. ‘In the 1990s, when the focus was on technology and convenience, there was a vogue for elective caesareans.’

In today’s eco-conscious society, the pendulum has swung back towards nature. On Manhattan’s Upper East Side society women reputedly send out birth announcement cards embossed with the words natural childbirth in gold letters …

In Britain the number of home births has risen from a low of one per cent in the 1980s to nearly three per cent today, a trend that the government seems eager to assist …

The debate becomes even more heated when it comes to elective caesareans. The National Institute for Clinical Excellence (Nice), responsible for government guidelines, is pushing for a reduction in the caesarean rate from 23 per cent of all births to the World Health Organisation’s recommended ten to 15 per cent. In fact, while acknowledging that a caesarean is major surgery, some women prefer the idea of a planned operation to the unpredictability of a vaginal birth. When pregnant for the first time, Leigh East, 37, from West Yorkshire, was terrified at the prospect of natural childbirth, not least because so many of her friends’ attempts had ended in traumatic emergency caesareans.

‘At my antenatal class they acted out a caesarean, showing you how there would be 12 people in the room,’ she says. ‘This was portrayed as a negative thing, but for me it seemed like a no-brainer. Why would I not want everyone I could possibly need around me?’ Certain she wanted a caesarean, East had to battle to get one on the NHS. ‘Midwives judged and lectured me,’ she says. Eventually a consultant agreed to her request. ‘It was the most amazing, calm experience, and I knew I had made the right choice.’

East has since had another caesarean and set up a website, csections.org, giving ‘a balanced view of caesareans’. ‘Some people are very negative about it, but the site’s not saying planned C-sections are the best answer; it’s just being pro-choice, letting women know about a route that organisations like the NCT keep quiet about. So much emotion surrounds the birth of the baby that rationality goes out of the window, which I find very frustrating. Birth is the most physically exhausting thing that is ever going to happen to you, and who is anyone else to tell you how to do it?’

East’s sentiments are echoed by Julia Wilson, yet their attitudes could not be more opposed. Last year Wilson chose to give birth to her second child, Maddy, at home unassisted by even a midwife, a trend known as ‘freebirthing’.

‘Birth is a sacred process and nothing should interfere with it,’ she tells me from her home in Worthing, East Sussex. ‘I had a midwife for the home birth of my elder son, and her presence put me off. I believe that having a professional present poses more of a risk than being left alone, because they try to interfere when it’s completely unnecessary.’

When Wilson first mentioned her plan to friends and family, most were horrified. ‘At check-ups midwives were equally dismissive. They didn’t even support a home birth, because my low iron levels meant I might haemorrhage. But that was just nonsense. It was so empowering just believing in myself, rather than relying on other people telling you how to manage your body.’

Such a view makes Pat O’Brien, a spokesman for the Royal College of Obstetricians and Gynaecologists, shake his head. ‘In India and Africa thousands of women with potential complications give birth at home without support because they have no choice, and it ends in disaster. But in the West childbirth has become so safe that people have just about forgotten that there can be major problems. It’s been written out of people’s psyches.’ After all, the risk of dying in childbirth is one in 28,000 at Queen Charlotte’s hospital in west London, compared with one in seven in Niger.

It does seem extraordinary that an event that lasts at most a couple of days compared to the lifetime of actually bringing up a child can provoke so much controversy. Yet Belinda Phipps points out that nature probably has its reasons for this. ‘If we just dropped babies like eggs without noticing, what would that say about the responsibilities we’re taking on for the next 20 years? Birth marks you out as a mother and a carer for a very long time.’

Melissa Maimann, Essential Birth Consulting 0400 418 448

Politics of birth

Posted on September 6, 2010 by Melissa Maimann

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 five hours of active labour, Kate gave birth to her second, healthy baby boy. Holding him tenderly she is oblivious to the drama unfolding … She is hemorrhaging.

Her uterus has failed to contract after the birth causing massive blood loss … the registrar tugs at her umbilical cord in an attempt to remove her placenta. Unable to do so he proceeds manually. There is no explanation, sedation or consent as he plunges into her uterus.

Meanwhile a midwife has been instructed to ‘wring out’ her uterus by gripping her hands deep around Kate’s stomach. Kate is screaming in pain and her partner begs them to stop. Instead he is removed from the room and their baby is taken away … What happens next is hazy for Kate as she passes in and out of consciousness. But what is clear is since that day, four years ago, Kate has been managing posttraumatic stress. Unable to go back to hospital her following two births are at home with no medical practitioners present.

“I know it sounds reckless but … We just can’t fathom going in to the hospital because that previous experience had been so bad,” she says.

“… I felt an unassisted homebirth was safer for me than going back to hospital to let them do the things to me that they did that time.”

Kate is now planning her fifth pregnancy and wants an independent midwife to attend her birth at home. She has been advised to seek a collaborative agreement between her midwife and the Women’s and Children’s Hospital (WCH) as per new Federal laws governing homebirths.

Called the National Health (Collaborative arrangements for midwives) Determination 2010, they were passed by Federal Health Minister Nicola Roxon days before the election was called. They state that for an independent midwife to access Medicare and insurance they must have an obstetrician agree to care plans created for clients.

However when Kate contacted the WCH she was told that they “do not participate in collaborative agreements”. In a statement to The Adelaide Review the hospital says: “The public-funded Homebirth strategy from the Commonwealth is part of the broader National Maternity Services Plan which is yet to be endorsed by the Health Ministers of Australia.”

It reads like a straightforward strategy for insurance purposes, yet it has been met with confusion and anger. Firstly, insurance providers are yet to create a product that allows independent midwives indemnity while attending a homebirth.

The Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG) does not support homebirths and believes women who choose them are putting the birth experience above that of risk. RANZCOG President Dr Edward Weaver welcomes the new legislation and hopes it will curtail the number of high-risk cases that do birth at home.

He believes: “Virtually every obstetrician would have had an experience where he’s been called in to a situation where a woman has been brought in to hospital by an independent midwife and has had difficulties dealing with that situation.”

In 2008 there were 115 planned homebirths or 0.5 percent of births in South Australia. While 94 of those occurred at home, 21 women transferred to hospital for care before they could birth.

RANZCOG advocated for collaborative agreements in submissions to the Maternity Services Review, which informed the legislation. However they concede they cannot make their members adhere to them.

And here lies the problem: a midwife needs to have a collaborative agreement to remain in practice, but there is no requirement on an obstetrician to participate in an agreement. This threatens the ability of women to access midwifery care at all, and threatens the midwife’s ability to remain in practice. At a time when there is an acute shortage of midwives, these moves only mean that there’ll be fewer midwives left to care for pregnant and birthing women and new mothers and babies.

Australian College of Midwives Vice President Hannah Dahlen has found obstetricians will not enter into these agreements because they do not want to take responsibility for a midwives’ practice.

It should not be a case of an obstetrician needing to take responsibility for a midwife’s practice. Midwives are autonomous and regulated practitioners. We do not require an obstetrician to be responsible for our practice any more than an ENT specialist, cardiologist or orthopedic surgeon is responsible for a GP’s practice.

“If our most moderate and collaborative obstetricians are telling us that they are not going to be entering in to signed agreements,” she says. “Then we are potentially stymieing the reform that is going to be rolled out from November.”

Yet one of Dahlen’s greatest concerns is that the reforms go against the World Health Organisation (WHO) definition of a midwife. The WHO states a midwife promotes a natural birth, can detect complications and is able to carry out emergency procedures if required. Hannah is concerned these new laws will end up seeing “one practice of medicine veto and regulate another”.

Christine is an independent midwife with close to two decades of experience in the maternity sector. She has birthed hundreds of babies both within a hospital setting and independently. More than 20 women who want to birth at home have employed her until April 2011.

“I’m happy to work alongside a doctor when it is required but I do not agree, and no midwife will agree, that it is ok for them to sanction our practice,” she claims. If this does not get resolved she is adamant homebirths will go underground with women birthing with unregistered midwives.

… RANZCOG and the Australian Medical Association deem homebirth a high-risk proposition. Of the 202 perinatal deaths in 2008, one was in a homebirth setting. In June the State Coroner ruled to investigate the circumstances surrounding a baby who died at a homebirth in 2007. While this was widely reported in the media, the coronial inquest of an obstetrician who lost two babies to ventouse extraction at the same time was left unreported.

“If a baby does not make it into this world, and not every baby is going to, and it is a midwife’s domain, (they) are really crucified,” says Christine. “But for doctors to lose babies and make mistakes, it is a very different thing.

South Australian MP Frances Bedford is an advocate for a woman’s right to birth at home. She was unable to be interviewed for this article but said in a statement to The Adelaide Review: “(I) find it extraordinary that a woman choosing caesarean section without any medical need is apparently acceptable to the medical fraternity (with Australian taxpayers funding most of those costs) yet a woman choosing to maximise her chances of health and wellbeing through homebirth is discriminated against.”

As this debate continues in the medical fraternity, Kate remains sceptical she will have the birth she wants. Instead her partner has become versed in birth advocacy.

“We should be able to share everything we need with (a midwife) and same for the hospital,” she says. “Our partners should not have to go in there and be aggressive and advocate on our behalf.” …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Midwives in Jeopardy

Posted on May 8, 2010 by Melissa Maimann

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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As she nears the last month of her pregnancy, Piper Harrell is counting on giving birth to her second child in the same place she had her first, in her second-floor walk-up apartment …

But this time, Ms. Harrell … is afraid that if she insists on having her baby at home, she will make her midwife … an outlaw.

Seven of New York’s 13 home-birth midwives … had an agreement with St. Vincent’s Hospital Manhattan that its doctors would back them up in an emergency. But the bankrupt hospital closed on Friday, and those midwives have been unable to negotiate new practice agreements with other hospitals or obstetricians, as required by state law, leaving them in the position of risking their licenses if they choose to deliver babies.

The loss of that 25-year relationship with a sympathetic hospital has left some home-birth midwives not only fighting for the legal viability of their practice but having to justify their very existence. Officials at several hospitals said … they were skeptical of the safety of home births and were concerned about the malpractice implications of taking over their clients in emergencies.

… “This is who we have to get a signature from — people who don’t believe in what we do and that we compete with,” …

The 13 midwives attend about 600 births a year, and about 50 of their clients expect to deliver in the next month.

To them and their clients, having the option of a home birth is an affirmation of their reproductive rights. It is also a reaction against the highly medicalized climate of hospital births, which, they say, has contributed to a Caesarean-section rate of more than 1 in 3 births … with some hospitals having rates above 40 percent …

To the medical establishment, home birth represents a rash choice by women who refuse to believe that things can go dreadfully wrong in an instant …

A large study of planned home births in the United States and Canada … found substantially lower rates of medical intervention compared with low-risk hospital births (high-risk pregnancies rarely, if ever, culminate with a home birth) and a similar rate of infant mortality. No mothers died. About 12 percent were transferred to the hospital. The midwives considered the transfer urgent in 3.4 percent of all intended home births.

… written practice agreements with hospitals or doctors have been a condition for all midwives to practice in New York State since 1992. But obstetricians have become increasingly wary of signing with home-birth midwives since the Congress of Obstetricians put out its strongly negative statement in 2008 …

… Fifteen other states … allow midwives to practice without them …

… midwives … expected that at least some of their clients would insist on delivering at home even without signed hospital backup. (They can still go to an emergency room and be treated.)

Ms. Harrell, 33, said she trusted her midwife … who delivered her first child … she said she was leery of trying to build a relationship with a doctor so late in her pregnancy. But she worried about putting Ms. Leonard in an untenable position.

“I’ve never felt not able to make a choice about my body for myself and my family, and it’s a paralyzing feeling,” Ms. Harrell said …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Midwives want to meet Roxon to avoid home-birth ban

Posted on March 11, 2010 by Melissa Maimann

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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A sensationalist title as home birth is not about to be banned but here goes:

ABI WHITEHAIR is only nine days old but she’s already saved taxpayers thousands of dollars.

She was delivered at home after her mother, Leah, rejected advice to have a caesarean section … because her first baby … had been born that way …

A surgical birth – about 30,000 are performed in NSW each year – would have cost the public hospital system about $8000.

If she had been admitted to a neonatal special care unit, like 70 per cent of babies born by caesarean, including her big brother, it would have cost another $900 a day.

But her entry to the world, in a Dee Why lounge room, cost taxpayers nothing …

[Midwives] are calling for another urgent meeting with the Health Minister, Nicola Roxon, before the new rules come into effect in July.

More than one in three babies in NSW is born by caesarean section but only one in seven subsequent babies are born vaginally due to the risk of uterine rupture.

The risk is very small: less than one in 200. Most studies on uterine rupture include dehiscenses, which are not complete ruptures, have no symptoms and do not cause any problems for mother or baby.

About 95,000 babies were born in NSW in 2008, but only 258 were born vaginally in public hospitals after a previous caesarean …

It is well-known that VBAC is far more successful – around 90% – with private midwifery care. Otherwise the chance of a siccessful VBAC can be as low as 3%.

… women who had undergone traumatic births, with extensive intervention, were eager to avoid a repeat performance but were often left with little choice.

”Keeping away from obstetric intervention by having a home birth is the best chance they have of achieving a normal vaginal birth,” …

Up to 70 per cent of home births were by women who had previously delivered by caesarean and there was a growing band who would deliver at home alone if home births were outlawed.

… Ms Whitehair, who had longed for a natural birth, spent months researching a home delivery. Abi’s birth, attended by two private midwives, cost her almost $5000 but was ”beautiful and textbook”.

Melissa Maimann, Essential Birth Consulting 0400 418 448

FAQs

Posted on February 23, 2010 by Melissa Maimann

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

Homebirth: The great debate

Posted on February 22, 2010 by Melissa Maimann

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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IS giving birth at home a positive experience or and unnecessary risk?

ASK any expectant mother what she’s hoping for when she gives birth, and she’ll probably tell you the most important thing is to deliver a healthy, happy baby. But in recent years there’s been great debate about the best way to do this.

Is the ideal to have a child in the relaxed comfort of your own home, or does the medical expertise provided in hospital far outweigh the notion of giving birth in your own living room?

Although homebirth advocates argue the former, it appears the choice may soon be taken out of their hands.

Reports last year revealed that four babies in Sydney died in homebirths in the space of nine months, the NSW Government responded with a strong announcement: from July 2010, independent midwives will be unlikely to gain professional indemnity insurance – effectively making it illegal for them to assist at homebirths. The consequence? Homebirths are facing extinction.

Obstetrician Dr Pieter Mourik believes the ruling will stop women taking unnecessary risks.

“Women who choose to give birth at home expect everything to be normal, but they often don’t consider how far they are from expert help …” he says.

“Eighty per cent of women can have their babies in a paddock – but the problem is choosing these women. You just never know what will happen.”

However, Justine Caines, spokesperson for Homebirth Australia, says putting a blanket ban on homebirths will simply drive the practice underground.

… “Many mothers have had bad experiences in hospital and won’t repeat that.”

She continues: “Why does the government fund women who are choosing to have C-sections, but not women who are choosing to give birth at home?”LAST month a study of over 500,000 women in the Netherlands who gave birth at home … showed there was no significant difference between planned hospital births and planned homebirths in terms of babies dying during labour.

It’s important to note when making a comparison between Australia and the Netherlands, that the Netherlands only has low-risk home birth. If there are any complications in the pregnancy or labour, women see an obstetrician and birth in hospital. This is not the case in Australia at present, but it’s the system that the Govt is trying to set up.

… Dr Mourik says the study is misleading. “Firstly, we must remember Holland has very well-trained midwives who act almost like Australian GPs,” he says.

“It’s also a small country with maternity units often within 10 minutes of someone’s house. The conclusions of this study are based on the availability of well-trained midwives through a good transportation and referral system – and that simply isn’t the case in Australia.”

It’s not currently set up in Australia, but there’s no reason why it couldn’t be. A positive approach would be to set in place a system that supports women to birth at home, and a system that protescts the midwives who support women to birth at home. Home birth has always been and will always be. We can set it up so that it is safe, or we can hope it just goes away … it won’t.

However, despite warnings from obstetricians, women are still choosing to have their babies at home …

“Women should have the right to give birth wherever they feel safest – it’s up to them whether that’s in hospital or at home. But taking away our choice isn’t right. If there were more options within the hospital system, then perhaps more women would feel comfortable going to hospital.”

I disagree that women should make the decision: it should be made within the midwifery partnership. This debate is not about the right of women to bitrh at home: this right is protected by law. This debate is about the mdiwife’s responsibility to pracice safely.

The Health Minister is putting in place a system that will enable more women to access continuity of midwifery care with their chosen midwife in and out of the hospital system. Once this is in place, there will be more options within the hospital system, and hopefully fewer women who are traumatised by the hospital system.

So is there a way to keep everyone happy?

“Homebirth Australia would like the government to present a package for pregnant women that works a bit like the baby bonus,” … “Every woman would be given a sum of money to spend on her pregnancy treatment, then it’s up to her whether she sees a midwife at home, or an obstetrician in a hospital. It’s putting the choice back into women’s hands.”

What about the option to have a baby in hospital with a midwife, or the ability for an obstetrician to attend a woman at home?

However, Dr Mourik believes that when it comes to choice, the only factor to consider is the mother and baby’s health.

“Only a tiny minority of foolish women would risk their own lives and that of their precious babies for an ideal,” he says.

“How many doctors support homebirth? None I know – it’s too bloody risky.”

Many studies opint to the safety of home birth for low-risk women who are attended by a midwife. Women who birth at home are amongst the most health- and safety-conscious people I know. It is offensive to comment that women who birth at home are
risking their own lives and that of their babies, especially when the evidence is to the contrary.

Melissa Maimann, Essential Birth Consulting 0400 418 448

More critique of the homebirth study and its reporting by the media

Posted on January 21, 2010 by Melissa Maimann

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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Associate Professor Hannah Dahlen, Vice President of the Australian College of Midwives, and an academic at the University of Western Sydney, and Professor Caroline Homer, Professor of Midwifery at the University of Technology Sydney, … had a critical look at the study and the way its findings are being portrayed.

They write:

…One of the problems is that the planned home birth group includes women who planned homebirth when booking in for care but then developed risk factors and had their babies in hospital. There are probably only two women whose babies died; who started labour at home planning a homebirth and one of these was a twin pregnancy (high risk). This latter woman persisted in having a homebirth due to ‘unsatisfactory hospital experiences.’ The others had all transferred before the onset of labour. The authors admit they ‘could not differentiate all planned homebirths according to whether transfer to hospital had occurred before or during labour.’ So for low risk women who started labour at home the risk was very low – 1 death in 16 years

There is no way to tell if these planned homebirths were under the care of a registered midwife.

This was not a low risk population of women – there was a high rate of post-term pregnancy … twins … and … previous caesarean section.

… There were two perinatal deaths that actually occurred at home. One baby had lethal congenital abnormalities (this was known before labour and a decision made for the baby to be born at home). The second death at home was after a waterbirth which was not found to be the cause of death but a review identified that increased monitoring may have identified the baby was in distress.

One perinatal death occurred in hospital after a transfer after the birth of the first twin. The first twin was born at home and second twin was born in hospital after a delay in transfer and subsequently died.

There were 6 perinatal deaths in the planned homebirth group where the baby was born in hospital. Presumably these women were transferred to hospital during the antenatal period as antenatal risk factors developed. Transferring to hospital if or when risk factors develop during pregnancy is appropriate practice.

Of the six deaths in hospital: one had hydrops fetalis … one death was unexplained with a cord entanglement seen after birth; one had pulmonary hypoplasia … after a early rupture of membranes; one was a growth restricted baby with an abnormal karotype … one was born to a woman who was very overdue … and underwent induction in hospital without fetal monitoring (the woman refused) and her labour eventuated in a stillbirth; and, one was a woman with known haematological … risk factors whose baby had a lethal abnormality … all these were born in hospital.

Only three of the deaths are thought to be related to perinatal asphyxia.

Three of the deaths were thought to be potentially preventable and related to the model of care. These were the baby born after the waterbirth at home; the second twin who was born after an intrapartum transfer and the baby born after being very postdates. Therefore, there were 3 deaths in 16 years – two of which had risk factors present. That means that there was only one death where there were no risk factors in the 16 year period.

… You would need more than 10,000 births at home to show clinical relevance and have some confidence in the statistical significance in relation to perinatal mortality rates. The authors acknowledge this in the paper and present their data with caution in the paper stating that the ‘small numbers with large confidence intervals limit the interpretation of these data.’

The facts are there was no difference in perinatal mortality … For those actually born at home the perinatal mortality rate is 2.5 per 1000 births, which is comparatively low.

… The paper highlights that the system must be so terrible for some women that they would choose to give birth outside of it than in it, even with risk factors. This is an indictment on the current maternity system in Australia – that needs fixing – removing homebirth won’t do this.

What was missed?

The conclusion of the paper is very sensible recommending risk assessment, transfer and fetal monitoring.

So then why did the data get so grossly misinterpreted?

The reality is despite a malfunctioning system in this country where midwives are uninsured and have no visiting rights, and homebirth is unfunded and often hard to access, the perinatal mortality rate was no different.

Risk assessment, transfer and fetal monitoring will be improved when private midwives are no longer excluded from mainstream services so we should be aiming for this not continuing the ‘witch hunt’ against private midwives.

… Some women will always choose homebirth so we should support this choice with safe responsive systems of care. The authors state that ‘women’s autonomy in choosing reproductive behaviour is a fundamental human right enshrined in Australian law’.

The excess mortality continues to be found in high-risk women and women need to be informed of this risk.

Freebirth (giving at home birth without a skilled and registered birth attendant) is rising in this country and this is a concerning outcome of restrictions on options like homebirth and trauma from hospital births …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Homebirth ban may create risk

Posted on January 18, 2010 by Melissa Maimann

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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AN ONLINE poll has found huge opposition to draft Federal Government laws which would effectively ban homebirths and could lead to women choosing to freebirth.

The parenting social networking site BellyBelly.com.au found 94 per cent of the 400 respondents opposed the amended legislation …

… 30 per cent of respondents said they would consider freebirthing – giving birth without medical assistance – if not allowed to choose their own midwife.

Under the Federal Government’s draft health practitioner regulation law, independent midwives could be deregistered unless they have private indemnity insurance.

So far, the government has failed to include homebirths in the indemnity scheme while insurance companies refuse to insure private midwives.

Proposed changes … would also see midwives forced to work alongside obstetricians.

… “Women are very angry, passionate and strong-willed on this topic and feel that their rights as a woman are being threatened,” she said. “Many members commented that they are appalled that the government thinks it has the right to choose where and how they birth their babies.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

Utah midwife says unattended births not a good idea

Posted on December 13, 2009 by Melissa Maimann

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

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… there was a 10 percent jump in home births in the United States. But what’s surprising is that neither a midwife nor doctor attended to them.

…”there is so much information available that people feel like they can read on the Internet or in a book how to catch their own baby … some people may also have philosophical reasons …

… “You can’t always predict what’s going to happen in birth. Sometimes you need more emotional support to handle what’s happening in birth. Sometimes you need more clinical support,” …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Women warn they’ll risk birth without midwives

Posted on December 12, 2009 by Melissa Maimann

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

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MANY future mothers say they will give birth at home without any medical assistance if proposed changes to maternity services proceed.

Federal Health Minister Nicola Roxon … has introduced a Bill that means doctors would have the power to veto a midwife’s involvement in births.

Self-employed midwives say this would stop them being able to help with home births.

Almost one in three respondents to an online survey … said they would find an alternative way to birth at home, even if that meant “freebirthing” – without a … midwife.

The Government is saying `You can have your home birth, but not with a registered health professional’,” … “There have been some shocking outcomes from unassisted home births, but some will just do it.” …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Right to Homebirth Threatened in Australia

Posted on November 28, 2009 by Melissa Maimann

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

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Homebirthing is a common phenomenon in most parts of the world, but in Australia, fears surrounding the process are threatening its acceptability.

In New Zealand, Canada, the UK and the Netherlands, giving birth at home is a reasonable choice, supported by both governments and insurers.

In Australia, however, the choice is threatened by proposals from Health Minister Nicola Roxon to leave midwives without insurance or funding to assist home births.

The curbing of that choice started last year when Ms Roxon initiated the Maternity Services Review and announced Medicare funding for midwives in the 2009 budget. In conjunction, she proposed the National Registration and Accreditation Scheme (NRAS) legislation, which would require health professionals to hold indemnity insurance so as to safeguard consumer safety.

… the great omission in her proposal was homebirth midwives, who were not offered funding or indemnity insurance … In effect, this would condemn homebirth midwives to operate illegally if they wanted to continue delivering babies.

… Gary Hastie, who has delivered all four of his children at home while supporting other home birthers, believes homebirthing “is the most natural process for the woman”.

However, he has observed an increasing fear of home births, distrust of a woman’s ability to have a natural birth and a demonisation of … woman’s choice. “It’s a woman’ right to choose where and how and with who she gives birth,” he said.

Nicola Roxon says she supports women having a choice, but is concerned with the consumer and ensuring a system of registration. It is “about lifting standards and ensuring that people are both registered, accredited and insured,” she said.

… Dr Ted Weaver, says it is not only the size of Australia that is a problem, but also cultural differences. “The infrastructure in other countries is completely different from the infrastructure in Australia–these countries have a tradition of home birth.”

Dr Weaver said the biggest danger lies when women get transferred to a hospital after complications arise …

Doubts are expressed too about how qualified Australian midwives are. Dr Weaver says: “Their [overseas] midwives are better trained and act along more stringent guidelines, and the selection for home birth is much more rigorous than in Australia.”

… While most high-risk women will be referred to a hospital by a midwife, … a very small portion of these women who consciously choose home birth … if they are considered “high risk”. “High risk” includes women who are having twins …

Many women, including those considered “high risk”, do not want a hospital birth, which is considered high intervention and impersonal …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Women Giving Birth at Home Without Midwives

Posted on November 19, 2009 by Melissa Maimann

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

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When Jennifer Margulis went into labor with her fourth child, she sent her husband off to take the kids to school, then waited at home for her body to do what she felt confident it had evolved over millions of years to do on its own.

There was no rushing to the hospital, no midwife … Just Jennifer and her husband, home alone, giving birth.

“I think a lot of people think a woman who would want to have an unassisted birth would be a little bit crazy,” said Margulis, who holds a Ph.D. in literature, and is a contributing editor for Mothering Magazine. “I think I may have had that reaction as well. I am definitely not a crazy person. I am a very educated, thoughtful and caring person. I am not a person who takes a lot of unnecessary risks. The whole point is it is not risky if you do your homework.”

Nationwide, 90 percent of births still take place in hospitals with doctors attending … 8 to 10 percent are with midwives in hospitals or birthing centers. And 1 to 2 percent are at home.

… Internet traffic and books on the subject indicate more women are choosing to take control with what is becoming known as freebirth because they are concerned about the United States’ dismal record of maternity care and skyrocketing rate of Cesarean births, now at nearly 32 percent of all births …

… “… they are trying to find a way to work around a system they see as very problematic.”

Though the United States spends more money on childbirth than any other nation, it has one of the world’s worst records for infant mortality and maternal mortality …

… Margulis, a freelance writer, decided to have her fourth child at home without the help of a doctor or midwife. There are signs more women are choosing to do this … because they want a more private and intimate birth.

… an obstetrician and gynecologist at Massachusetts General Hospital in Boston and assistant professor at Harvard medical School, said most women can give birth alone without any problem, but there are still small numbers — as high as 10 percent — who will run into complications, often without warning.

“What worries me is that very often women who have absolutely no risk factors develop an emergency complication,” she said. “I can’t imagine how you can possibly recognize that yourself, particularly if you have no medical training. Sometimes you have only minutes to intervene.”

Tracy said the increase in C-sections appears driven by the high rate of obesity in America, more births of twins and triplets, more women asking for them, as well as the fear of lawsuits …

“None of these make it, I think, a wise choice to have a delivery in a setting where no one has any training,” she said.

… [Margulis] had a bad experience with her first birth in a hospital, and her second birth, which was with a midwife at home. A midwife also assisted with the third, but this midwife had half of her own 10 children unassisted, and was an inspiration for the idea. Margulis began interviewing midwives for her fourth birth, but as she learned more about doing it herself, she became convinced she could.

“I felt like when I read other peoples’ stories, I felt like those were the most amazing women in the world and they were all so much stronger than I am,” she said. “… if we let our bodies do what they evolved to do, what they know how to do, then any woman can have a safe unassisted home birth.”

Jennifer Block, author of the book, “Pushed,” said while it is impossible to track the numbers of women doing unassisted childbirth, they are highly educated, committed, motivated, and frustrated with mainstream medicine.

“… Women should be able to be in control and still have trained support with them. Emergencies do happen. I can’t imagine trying to resuscitate my own infant, or if I had a hemorrhage.”

… Laura Shanley, a leading advocate for freebirth, had her first child in 1978 without a doctor or midwife at home. She and her husband were inspired by the book “Childbirth Without Fear,” by the late British obstetrician Grantly Dick-Read … She went on to have all five of her children that way.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Home birthing: the fiscal nips and tucks to our health system

Posted on October 22, 2009 by Melissa Maimann

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

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All politics is local, and more often than not personal. Just a fraction of Australians birth at home but their fervour is at times
evangelical. In Canberra’s grey rain this week, 2,000 devoted mums and midwives won a two-year reprieve from being
deregistered and fined if they attend a home birth.

But there were few cheers for Minister Roxon’s back flip. Landmark reform stemming from the recent National Maternity
Services Review proposes autonomy for midwives around prescribing certain drugs and ordering tests as well as long-awaited access to Medicare and indemnity cover. But for home birthing midwives, there will neither be Medicare support nor any form of indemnity protection.

When it comes to the safety of low-risk mums birthing at home, the world’s foremost medical evidence authority is the Cochrane Collaboration. With appropriate hospital support … home birth and hospital mortality for low-risk
bubs is comparable …

A final fillip for home births is that Cochrane acknowledges that outcomes for mums may actually be worse in hospitals

… For many mums, the traumatic hospital experience is the centrifugal force pulling hundreds out of our maternity wards to
deliver at home. Midwives have followed, disenchanted by the “clock-in clock-out” hospital work and the constant turnover
of care. They see hospitals as fragmented, overly medicalised and homebirth as a relationship-based approach rather than a technical exercise in baby delivery. The cascade of hospital interference includes needles and gas, probes and clips
through to forceps, extractors and ultimately caesarean section.
For most of us gadgets and tools are part of the safe baby syndrome, the community expectation that every baby arrives in
perfect health …

… home births exert a counter-pressure upon our hospital system. Birth plans, continuity of care, the demand for fewer interventions and the reemphasis upon emotional attachment to mums are all hospital trends originating from the home birthing movement.

Few realise that the emerging threats to home birthing have more to do with the global financial crisis than any bigotry, intolerance or obstetricians. Late last year, flawed Treasury modelling prescribed a ridiculously large stimulus which threw Australia into debt … it’s too late to recover the cash. Now it’s up to Treasury to claw back the balance sheet. From alcopops and cataracts to IVF and pathology, our health system is paying the price for the ill disciplined spending elsewhere.

Until now the fiscal nips and tucks to our health system have been politically painless … Conception however is the most incendiary moral issue in medicine and our elected officials are about to learn birthing isn’t far behind. Australians rarely march in the streets; certainly not for blood tests or eye operations. But mums choosing home births do so in the context of historical resistance to their choices.

The Health Minister understands that extending indemnity cover to include community midwifery will come at a cost … actuarial analysis is complicated by the infrequency of intranatal misadventure and the potential for multi-million dollar payouts …

The Health Minister’s two-year moratorium is a brief reprieve before home birthing again becomes illegal. Bad policy in two years is still bad policy. Its one thing to decimate home birth by setting up an exclusive “registration” club for midwives which excommunicates those attending home births … Such an approach will draw
quality mainstream midwives out of home birthing and imperil safety.
The Minister would be far better advised to draw midwifery together under a single maternity care system of registration, indemnity and support. Home birthing will never disappear; we owe our mums and their babies a comprehensive system which recognises, insures and drives high quality maternity in hospital and at home …

Melissa Maimann, Essential Birth Consulting 0400 418 448

No sense in denying women safe births

Posted on September 9, 2009 by Melissa Maimann

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

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As a medical student, I am encouraged to think critically about health-care legislation. I can see no reason why registered midwives should not be enabled to attend home births, as a safe and desirable part of maternity services.

… the weight of medical evidence shows that for low-risk women, a planned home birth attended by a competent midwife is essentially as safe as giving birth in hospital, and involves fewer interventions such as medicating for pain. The (noticeably fewer) studies that report a higher risk for home births often neglect to discriminate between low- and high-risk situations, such as a preterm or unplanned birth, or where the mother is not attended by a registered carer.

The unavailability of a midwife will not prevent some women giving birth at home with no professional assistance. This year’s Maternity Services Review reported its concern about the ”small number of Australian women [who] are choosing home births without the support of an appropriately trained health professional”. Why, then, did it recommend making it harder for women to obtain such support?

There appear to be two reasons. First, few women in Australia, 700 to 800 a year, choose a home birth. But this is no reason to restrict the practice further. A woman giving birth at home with a midwife will incur lower costs than one using a public hospital and the services of nurses and doctors. In many regional and remote areas , a midwife may be the only option …

The second reason the report gives is that allowing home births risks ”polarising” the health professions and obstructing a collaborative approach to maternity services. I can only ask how restricting the services of one profession can promote a collaborative approach.

Given the proven safety of planned, low-risk home birth attended by a registered caregiver, and its economical and practical benefit, it is strange and disappointing to see Australian women’s choices in giving birth restricted in this manner.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Delivering security for midwives

Posted on September 8, 2009 by Melissa Maimann

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

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OVERTURNED meeting procedure and a unanimous vote will see Mitchell Shire Council requesting future security for home births in Victoria.

Councillor Kelley Stewart – who has given birth to two of her three children at home – put a motion to council last week seeking written representation to the Federal Government in support of privately practising midwives.

Her call comes as Federal Parliament prepares to debate a new Bill regarding public professional indemnity for midwives, which will potentially exclude privately practising midwives.

… “… no private insurance provider will insure a private midwife, not because it’s a ‘safety risk’ profession, but because there are so few privately practising midwives that it’s not a profitable business,” Cr Stewart said.

“If then they are excluded from this public indemnity, they will basically be banned from practising in Victoria because they have to be registered and insured to work in this state.”

Cr Stewart raised the motion for representation to the Federal Health Minister as a matter of urgent business … councillors voted unanimously in favour of the motion.

… private midwives were currently the only midwives in Victoria who attended home births.

… “I made an educated, informed choice to have my children at home where I was relaxed, comfortable, my wishes, my needs were listened to and respected.

“But it was not so much the location that was important to me but that one-on-one continuity of care I got from my private midwife.

“I had the same midwife antenatally, during the birth, postnatally. She knew everything about my pregnancy – labour, breastfeeding issues – from start to finish.”

Kilmore mum Lisa Costantin had planned a homebirth for her first child and, although she was transferred to hospital, was pleased to have had the choice.

“Homebirth is not high risk – women have been doing it for years,” Mr Costantin said.

“For any low-risk pregnancy it should be an option.

“I had planned a homebirth but there were complications and when the time came my midwife said I should go and I trusted her.

“You are not going to risk your baby just to make a stand on an issue.”

Cr Stewart said that banning homebirth as an option in Victoria would force women to either go to hospital or choose freebirthing, which without appropriately trained carers could increase the risk to both baby and mother …

Melissa Maimann, Essential Birth Consulting 0400 418 448

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

Posted on September 1, 2009 by Melissa Maimann

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

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

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

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

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

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

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

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

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

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

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

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

Melissa Maimann, Essential Birth Consulting 0400 418 448

Birth wars rage in your delivery room

Posted on August 30, 2009 by Melissa Maimann

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We induce many women.

We continuously monitor many babies in labour.

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

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

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

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

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

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

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

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

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

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

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

Melissa Maimann, Essential Birth Consulting 0400 418 448

Women and birthing choices

Posted on August 29, 2009 by Melissa Maimann

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

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WOMEN wanting homebirths are under pressure to have their children before July 1 next year …

… some women are considering limiting their families … if homebirth midwives are refused professional indemnity support.

… all women should have the birth they wanted.

… The Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and two related bills currently under debate could make homebirths unlawful from July 1 next year …

… the legislation could put babies and mothers at risk.

“Does it take a baby to die at home without a midwife for things to change?”

About 30 Ballarat Maternity Coalition members will attend a Homebirth Australia rally in Canberra on September 7.

There has been a lot of media about this issue. I’m hopeful that a resolution will be found, however home birth services as we know them will change forever. I will write another article about the positives that may come of the changes, and also the hesitations that I have.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Birth wrangle

Posted on August 28, 2009 by Melissa Maimann

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

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A warning from Australia’s peak group of obstetricians and gynaecologists that home births carry too much risk to babies and their mothers is completely false, according to an Echuca midwife of 25 years.

The National Association of Specialist Obstetricians and Gynaecologists (NASOG) claims home births, with or without a midwife, are too risky and the government should resist calls to indemnify midwives outside of hospitals.

How can she compare midwife-assisted home births and free births?

Proposed laws … would require midwives to have professional indemnity insurance before they could be registered.

But such insurance is unavailable for people who work outside hospitals.

Midwife and maternal and child health nurse Andrea Quanchi, who operates Echuca-Moama Midwifery and Parenting Service, said if the laws were passed, said she could possibly face fines of up to $30,000 for helping with home births.

… “Then there will be no regulation of midwifery standards and that is dangerous.

… There was nothing dangerous about home birthing – it was about providing women with choices, she said.

… “If there is an emergency, we transfer them to the hospital … The transfers run seamlessly … ”

Mrs Quanchi said she didn’t force clients into home birthing and had been present at countless hospital births.

“It’s not my decision as to where they want to have their baby,” she said.

“It can’t be their ultimate goal. It’s about what’s right for them at the time.

“If something goes wrong, we’re out of there.”

NASOG president Hilary Joyce said Ms Roxon was acting in the best interests of babies and their mothers by refusing to financially endorse the “unsafe practice” of delivering babies at home.

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

And far more goes wrong when women birth in hospitals with every machine that goes ping.

That has not been the case with any of Mrs Quanchi’s 75 clients, over a 10-year period.

“Home births are for women who have low-risk pregnancies, no complications and have a good back-up plan. They also need to be from a good, stable home environment,” Mrs Quanchi said.

“We’re not in the danger game of proving a point.”…

Melissa Maimann, Essential Birth Consulting 0400 418 448

Homebirths hit by insurance law

Posted on August 24, 2009 by Melissa Maimann

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

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NORTH COAST midwives who attend homebirths could soon be out of a job after a Senate committee yesterday recommended all homebirth midwives be insured.

Midwives warn this would shut them down because no insurance company in Australia will cover homebirths.

… Ms Juszczak said women intent on having their babies at home would no longer be able to access a registered midwife and would instead have to rely on unqualified help or ‘go it alone’.

“I believe that in most circumstances homebirth is safe, but there are circumstances where intervention is necessary and someone who is not skilled may not pick up on those instances,” Ms Juszczak said.

“So potentially, in those few cases, it will be more dangerous for those women and those babies.”

… “But even if the midwife can’t gain insurance, she is still registered … so you know that the woman has a particular level of expertise and experience,” she said. “The impact of this is that women will no longer be able to access a registered midwife for a homebirth, so basically it opens up the door to unsafe practice for women in homebirths.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

Home births to be outlawed

Posted on August 22, 2009 by Melissa Maimann

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

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HOME births would be driven underground by new maternity laws, a Senate committee has admitted.

The community affairs committee said that without special insurance, midwives would be unable to legally practice.

“The committee acknowledges the concerns expressed by stakeholders that an unintended consequence of this may be to drive home births underground unless an exemption is granted or an insurance product found,” …

But it said the changes should be approved regardless.

Home birth advocates said the recommendation was insane.

The proposed laws would require midwives to have professional indemnity insurance before they could be registered. But such insurance is unavailable for people who work outside hospitals.

“It categorically will be unlawful,” Homebirth Australia secretary Justine Caines said.

“Without amendments, it should not pass through.”

Health Minister Nicola Roxon said she was trying to secure special insurance cover that would allow midwives to work outside hospitals.

… Mara Dower, who gave birth to her son … and daughter … [at home], said women would be deprived of the most nurturing environment if midwives were prevented from overseeing home births.

She said midwives were needed for many women to have safe births, with the level of medical interventions and unknown people involved in hospital births making it an unrealistic option for some.

“I would definitely go underground and still have a midwife if I had to,” she said.

“It would increase the dangers for women because having a personal midwife means they have a duty of care.

“… you get the advice, … feel cared for and looked after, and you have information at your fingertips.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

Homebirth mums ‘forced to use unregistered midwives’

Posted on August 21, 2009 by Melissa Maimann

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

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A national maternity consumers’ group says women will be forced to use unregistered midwives if they want homebirths from the middle of next year.

… under the proposed amendments, new indemnity insurance arrangements for midwives will not apply to homebirths.

… “Women will be able to choose a non-registered care provider to give birth at home, which is of concern to the Maternity Coalition,” she said.

“We would really like women to be able to access a registered midwife for their care during birth and labour at home.”

So long as we don’t use the title “midwife”, and are not registered as midwives, we will be able to attend home births. However, midwives who are not registered will not be able to access valuable continuing professional development exercises, participate in the profession, access additional care for our clients, or have anything to do with the profession. We will nto be able to transfer in with our clients if hospital transfer is necessary. We will need to leave our clients at the front gate of the hospital. They will need to lie about all the antenatal and labour / birth care that they have received. Is this how we provide safe and effective care in 2010? It sounds like a mighty step backwards to me!

Melissa Maimann, Essential Birth Consulting 0400 418 448

Mums angry over fed govt homebirth midwife row

Posted on August 20, 2009 by Melissa Maimann

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

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… federal government legislation could drive the practice of homebirthing underground.

In the chilly pre-dawn moonshine of May 3, 2008, Felicity Gibbins went into labour …

The night was still and the household calm as the family prepared for the arrival of their second child …

… A homebirth is such a beautiful and intimate experience, Felicity says.

“The power of the mind is really an amazing thing. My attitude towards the pain was that each contraction was going to bring me one step closer to seeing my baby,” she says.

“I was really excited about meeting my baby. I’d already fallen in love with it. It was my little friend who I would talk to all the time.”

Using visualisation, meditation and yoga techniques, she worked through the pain, surrounded by her loved ones.

… “We had talked a lot about having the baby and read a few children’s homebirth books, so she was aware of what was going on.

… Maya helped Paul fill the homebirth pool with warm water and baby Haile arrived at 8.22am weighing 3.9 kilograms.

“I pulled him out and into my arms,” Felicity says.

“It was delightful … my eyes were closed and I can still feel him now, his wrinkly skin over his head, his arms and legs stretched out searching for his mummy like a little slippery frog,” she says.

Coaching her through this birth, as she had with Maya’s homebirth, was [an] independent midwife … with 25 years’ experience.

But a federal government proposal could effectively criminalise midwife care for homebirths, jeopardising the health and safety of mothers.

Under the proposed new laws, debated in the House of Representatives this week, midwives must be insured in order to be registered.

But since 2001, private insurers stopped providing cover for homebirthing and the federal government has also refused to subsidise professional indemnity insurance for homebirth claims.

… independent midwives could be deregistered from July 2010. If they continue working they will risk fines of up to $30,000.

Felicity says if she does have a third child she could not imagine going through labour in the public setting of a hospital after two special experiences at home.

But, she said she would not have a homebirth without a midwife … I felt really confident.

“In the hospital you can’t have one-on-one care with a midwife … there might be one midwife for three or four women.

“Being told where I should birth my next baby is offensive … ”

… “I could be at … the hospital and catch people’s babies but you don’t necessarily remember their names; with homebirths you remember everything about it because you have that opportunity to make that connection,” …

“I do all the [antenatal] visits in the client’s time and then give labour support and then post-natally you see them every day for a week or two … so it’s a huge amount of hours that goes into each client.

“You become very good friends. It’s still professional but it’s more than that.”

… if the government changes are adopted, the health of women and their babies could be at risk.

“There’s certain potential for danger,” … “Women could go it alone.”

… it’s a myth that it’s mostly hippies who choose to have homebirths.

“I have had clients who are doctors, lawyers, people in financial services, IT – all sorts of career paths,” she says.

“It’s become a mainstream option.”

… “Women have the opportunity if they have had birth trauma to choose to have a caesarean, which comes at a higher cost to (taxpayers) with higher risk factors, yet women who are low risk can’t choose to homebirth which is deemed to be safe by world-wide reports.”

… up to 2,000 women have home labours each year …

Homebirth mothers and midwives will protest at Parliament House in Canberra on September 7 at 11.30am

Melissa Maimann, Essential Birth Consulting 0400 418 448

Midwife indemnity plan may spark GP obstetrician exodus

Posted on August 19, 2009 by Melissa Maimann

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

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GP obstetricians could ‘down tools’ as a result of Federal Government plans to allow midwives to practise independently with subsidised indemnity insurance.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has warned the move could drive up doctors’ insurance premiums and force them to quit practice.

“Obstetricians may be called in too late to manage an obstetric emergency and have to face the blame for a poor outcome, when an earlier referral may have averted a crisis,” the college said.

“[If] premiums rise, that could be a considerable driver for doctors [to exit] the obstetric workforce, and we are already on… a knife edge with workforce,” RANZCOG president Dr Ted Weaver said.

The college warning comes as three pieces of legislation were introduced to Federal Parliament that would expand MBS and PBS rights for midwives and nurse practitioners, and provide the former with federally subsidised indemnity cover.

In submissions to a Senate inquiry into the legislation, doctor groups have called for clearer detail on the proposed collaborative models of care, amid fears the legislation will lead to fragmented and lower standards of care (MO, 31 July).

There’s no reason for doctors to believe that their premiums will be affected by this legislation. Midwives will have their own indemnity. If a woman or baby needs to sue, they will sue the midwife for her part in what has happened, if negligence can be proved. Instances of unsatisfactory professional conduct or professional misconduct will be dealt with through disciplinary processes, as is the case currently. What the legislation does is to extend to midwives and the women they care for, the professional right to insurance that is shared by all health professionals. It places midwives on par with other professionals who are responsible for their practice.

If RANZCOG / AMA believe that insurance makes a profession safer, as they have previously stated, they ought to be happy that midwives will now have insurance. They ought to be especially pleased if insurance would be extended to cover home births, which they see as high risk and dangerous. Medical groups have been heard to say that doctors are often left to “pick up the pieces” from home birth that have “gone wrong”. Well, if midwives are insured, they would not be sued in place of the midwife. So why aren’t RANZCOG, the AMA and other medical groups right behind our demand for insurance to be extended to cover home birth?

Melissa Maimann, Essential Birth Consulting 0400 418 448

Midwife laws may force homebirths underground

Posted on August 18, 2009 by Melissa Maimann

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

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A SENATE committee has acknowledged that proposed legislation for midwives may ”drive homebirths underground”.

The Government chairwoman of the Senate’s Community Affairs Committee, Claire Moore, said the three Labor members recommended proceeding with legislation that would expand the role of midwives and extend government support for medical indemnity cover for midwives operating in hospitals.

Senator Moore said the legislation did not make homebirth unlawful, but separate legislation dealing with the accreditation of health workers ”may result in homebirths being outside the scope of practice of registered midwives due to the requirement for indemnity insurance as a condition of registration”.

The committee acknowledged the concerns that ”an unintended consequence of this may be to drive homebirths underground unless an exemption is granted or an insurance product found”.

Since the potential barrier to homebirths emerged, the Health Minister, Nicola Roxon, has indicated that she is prepared to consider ways of extending medical indemnity to homebirths, provided this could be achieved without making the insurance costs ”unaffordable”.

The Liberal members of the committee, Sue Boyce and Judith Adams, called for the Government to commission an actuarial analysis of the risks of professional homebirth and, if feasible, make it eligible for government support.

A Greens senator, Rachel Siewert, also called for the indemnity scheme to be extended to low-risk homebirths.

” … the voices of more than 2000 women speaking out on fundamental women’s rights has been ignored and given the sheer magnitude of the evidence put forward and the results the committee has come up with, it looks like we are getting to the end of the line when it comes to options.”

More than 10,000 women are expected to attend a rally outside Parliament House in Canberra next month to continue the fight.

If you’re wanting to have a home birth, it’s best to start trying for a baby now so that you birth before June 30, 2010. It’s almost certain that this legislation will be passed. National Registration demands that all health professionals have professional indemnity insurance to practice. That does not make home birth illegal. The other 3 Bills around PI for midwives and midwife eligibility for MBS, PBS and insurance, state that insurance will not be extended to home birth. That also does not make home birth with a private midwife illegal. It is the intersection of the 2 laws that make private home birth illegal.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Roxon joins mother of birthing battles

Posted on August 17, 2009 by Melissa Maimann

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

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The author of this article has got the facts very wrong, but none-the-less, it’s great to get home birth and midwifery in the media.

THE Rudd Government’s threatened ban on home births is moving closer to reality …

From July 1 next year, the requirements of a new registration scheme mean independent midwives – long denied medical indemnity insurance – will be fined $30,000 if they practice without it. This finishes their ability to work outside the hospital system.

Midwives will not be fined $30,000. Midwives who practice without insurance may be deregistered. If we continue to practice midwifery once we’re deregistered, we face fines and/or a jail term. This is the same rule that applies to anyone who practices midwifery without registration.

… Where to give birth, and who attends, is a medical decision. If a pregnant woman is competent and informed, it is her decision to make. Australian law allows patients to choose who will treat them and where, and even to refuse interventions – like transfusions – that medicos deem life-saving.

Again, I disagree. The decision about where to give birth rests with the woman and the professional who is attending her. This may be a doctor (in which case, the decision is medical). However, for the majority of women birthing at home, the decision is a midwifery decision.

This means that even if evidence showed that hospital births were life-saving, pregnant women could still refuse them. Given that the evidence shows no such thing, this right seems even stronger.

A recent article in the British Journal of Obstetrics and Gynaecology looked at 529,688 cases and found no difference in the health of babies born at home to low-risk women and those born in hospital. Another large study found that the only difference in outcomes favoured home birth, which produced babies with higher Apgar scores, and showed home births were less likely than hospital births to result in unnecessary and risky medical interventions, such as induced and augmented labour, forceps delivery and caesarean sections.

… Denying independent midwives registration won’t stop women from birthing at home. It will simply increase the risks they take doing so. It will be backyard abortion all over again – complete with shonky providers, death and suffering – except this time it’s backyard birth.

The mantra that birth is simply a normal part of a woman’s life is rubbish. It is an extraordinary event that most women will face just a few times. They need medical guidance, in the form of proper pre-natal care to know if home birth is a safe option for them.

Professional, experienced, independent midwives can offer this advice, and a safe and secure environment for low-risk women who birth at home.

Again, it is midwifery guidance, not medical guidance. If doctors supervised home births, there would be no home births.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Up to 200 midwives may be deregistered

Posted on August 17, 2009 by Melissa Maimann

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

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A SENATE committee will today deliver its findings following an inquiry into the Federal Government’s proposed healthcare laws, which could see up to 200 midwives deregistered.
Under the changes, midwives must be insured in order to be registered, but private insurers no longer provide cover for homebirthing.

Opponents believe it will drive the practice underground and increase health risks.

Midwives have argued that outlawing homebirths removes a mother’s right to choose and will be a step back to the dark ages.

About 2000 women have submitted their names to the senate inquiry, showing the depth of opposition to the issue, Australian Private Midwives Association president Liz Wilkes said.

It’s great that this is getting out in the media, but it’s so important that facts are reported, not hysteria. No midwife will be deregistered as a result of the proposed legislation. Private midwives will be able to register, but as non-practicing midwives. What is affected is our ability to practice, not our ability to register. Practicing without insurance may result in disciplinary action that may include deregistration.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Insurance measures could force homebirths underground, Opposition says

Posted on August 16, 2009 by Melissa Maimann

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

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HOMEBIRTHS will be driven underground by Rudd Government moves to force midwives to be insured. Some 200 midwives could be driven to practice clandestine homebirthing because they will be denied indemnity insurance, the Opposition says.

Opposition health spokesman Peter Dutton said the Coalition backed women’s choice of where a child was born but Prime Minister Kevin Rudd and Health Minister Nicola Roxon were trying to drive the practice of homebirth underground.

“Does Mr Rudd really believe that by making homebirth illegal or for midwives making homebirth illegal to practice, that that will somehow stop the practice of homebirth,” he told reporters.

Under proposed new laws, midwives must be insured in order to be registered.

But private insurers will no longer provide cover for homebirthing and the Federal Government has also refused to subsidise professional indemnity insurance for homebirth claims.

… In a statement released by her office, Ms Roxon said the Government recognised the important role played by qualified midwives in the birthing experience of many Australian women.

… “… [I] am currently investigating if there is some way that we can provide this as an option without making the proposed midwife indemnity insurance unaffordable,” she said.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Government discriminating against home births, says Homebirth Australia

Posted on August 11, 2009 by Melissa Maimann

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

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PROPOSED laws which would stop mothers from accessing registered midwives for homebirths would jeopardise the health of thousands of women and babies, a peak maternity group says.

… Under the draft laws, midwives must be insured to join the register but private insurers no longer provide cover for homebirthing and the Federal Government has also refused to subsidise professional indemnity for homebirth claims.

HA secretary Justine Caines said the draft laws effectively stop registered midwives legally attending home births.

“The national registration requirement is absolutely appropriate,” she told a Senate inquiry into the legislation.

“What is not appropriate has been the (Health Minister Nicola Roxon’s) response to say …’I will enable the funding of one-to-one midwifery care through Medicare for midwives who care for women birthing in the hospital system, but I won’t do it for homebirth’.”
Related Coverage

… Australian Greens senator Rachel Siewert said draft laws effectively rendered homebirths illegal.

“Where there is a low-risk pregnancy it is safe to have a home birth and women and families need to be able to have that choice,” she said.

The Greens will seek to amend the bills to ensure homebirthing with registered midwives remains an option for women in Australia.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Maternity body slams home birth proposal

Posted on August 7, 2009 by Melissa Maimann

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

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Proposed laws which would stop mothers from accessing registered midwives for homebirths would jeopardise the health of thousands of women and babies …

Homebirth Australia … is angry about a suite of bills … which propose … midwives must be insured to join the register but private insurers no longer provide cover for homebirthing and the federal government has also refused to subsidise professional indemnity for homebirth claims.

… draft laws effectively stop registered midwives legally attending home births.

“The national registration requirement is absolutely appropriate,” … “What is not appropriate has been the (Health Minister Nicola Roxon’s) response to say … `I will enable the funding of one-to-one midwifery care through Medicare for midwives who care for women birthing in the hospital system, but I won’t do it for homebirth’.”

…. “What she has done is made a giant step forward and been too scared to take the next step because of medical objection, because of the power of the medical lobby.”

The Australian Medical Association has previously spoken out against homebirthing, warning it is significantly more dangerous than giving birth in a hospital.

But Ms Caines said Labor’s legislation would endanger pregnant women who were unable to access registered midwives for their homebirths.

… “Where there is a low-risk pregnancy it is safe to have a home birth and women and families need to be able to have that choice,”

… The Greens will seek to amend the bills to ensure homebirthing with registered midwives remains an option for women in Australia.

… The government was examining ways of allowing home births to continue without imposing prohibitive costs on midwives …

If you’re planning to have a home birth, it’s best to start trying for a baby now so that you can birth before June 30, 2010. The future of home birth is uncertain after that date.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Government plan to ban homebirth an attack on “Women’s Rights”

Posted on August 4, 2009 by Melissa Maimann

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

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The Rudd Government’s plan to ban midwives from attending homebirths is an attack on women and their right to give birth how they choose …

Senator Fielding will be attending a rally today … to voice his opposition to the ban on homebirths.

“This is an outrageous decision … totally inconsistent with all other health care systems which operate around the world.

… “It is a woman’s right to decide how she gives birth. It is not up to the Government to tell her how to do this or where to do this.

… “Numerous studies have shown that for low-risk women with appropriate transfer… options available, homebirths are at least as safe as births in hospitals or birth centres.

“This Bill is a dangerous move … “whether the government likes it or not, women will continue to give birth at home. All this will do is drive homebirths underground with disastrous ramifications for women and their newborn.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

Defending the right of Mums to have a safe home birth

Posted on August 3, 2009 by Melissa Maimann

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

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Home-birthing can be a safe option for parents with proper medical supervision.

My wife and I were very lucky with both our babies. High quality medical advice mixed with relatively easy births … meant that our experience was everything we could have hoped for.

It was a very intense and private experience.

… I was surprised when I saw the Federal Government’s reforms to maternity services … I was very surprised by a small but concerning provision in the legislation that bans a range of medical professionals from delivering babies at home.

As it stands now, you are able to legally choose to have your baby at home …

Many [women] have had horrific experiences in state run public hospitals and simply refuse to risk that experience again.

The new Roxon plan will ban these women from having professional assistance during their home birth. It will not prevent the practice of home birthing, it just proposes to outlaw health professionals from assisting with the birth. It has the potential to make these home births much more dangerous.

It would seem to me that banning health professionals from assisting with home births is more likely to increase the danger by pushing the practice underground …

Now this is just crazy. The Government is not suggesting that birthing at home is dangerous, indeed there are Government funded programmes that operate home birthing services.

The evidence suggests that the health outcomes from home births have not led to increasingly dire outcomes, to the contrary it appears that many parents who have chosen to have home births have healthy babies and then recommend the experience to others …

… Home births are not for everyone … But I don’t believe removing this choice will help ensure that the birthing experience should be as safe and special as it can be.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Birthing after July 1, 2010?

Posted on July 23, 2009 by Melissa Maimann

Here’s the full text of an article I have written for Essential Baby.

Melissa Maimann
July 22, 2009

Currently, all health professionals are registered by their own State Board. There are approximately 90 Registration Boards throughout Australia. Come July 1, 2010, all of these Registration Boards will be merged into one National Registration Board.

The benefits of National Registration include:

• Health professionals will be able to work between States and Territories, without having to register in each State or Territory prior to practicing
• Consistency of registration requirements and implementation of national standards
• Cost savings for both government and professionals with the elimination of unnecessary complexity and duplication
• A framework for maintaining consistency of state and territory regulation for individual professions
• Admission to professional practice (restrictions on professional practice by non-professionals)
• Regulation of professional practice (through consistent standards for accreditation and registration)
• Consumer protection (through complaints processes, insurance of professionals, criminal record checks of professionals and so on).

Alongside the changes to the registration of health professionals, there was a recent review of maternity services in this country (the Maternity Services Review, or MSR). There were several recommendations from this review.

What does all of this mean for pregnancy and birth?

The intersection of these changes has significant meaning for women, midwives and obstetricians.

Insurance will be a requirement for general registration after July 1, 2010. This is in place to protect the public, so that in the event of negligence that results in a baby or woman being harmed, the family may access a pool of funds to support medical and other expenses. That is fair and reasonable, however insurance is not available for midwives who are self employed.

To explain this further, most midwives are employed by a hospital and are covered by insurance through their employment. Midwives who work in private practice attending home births or hospital births do not have access to insurance. These midwives perform a very special role. Since they are contracted by women and are not employed by hospitals, they are uniquely placed to provide families with evidence-based and independent advice. This is significant for families, and often means the difference between a surgical birth and a natural birth. Currently, independent / private midwives may attend women at home or in hospital.

After 2010, all midwives will be required to have proof of insurance in order to register on the general (practicing) register. There will be different levels of registration, such as general (ie, a practicing health professional), non-practicing (in which case the professional cannot practice or give advice), student, and so on. All midwives will be able to register, but those who do not have insurance may only register as a non-practicing health professional. In that case, they may not attend births, provide advice and so on.

This affects all women! Yes, that includes you.

It is thought that these changes only affect families who want home births. This is not true! The changes affect all women who seek private midwifery care. Women consult with private midwives on a range of matters, regardless of the place of birth or chosen care provider. Things like, “My doctor / hospital said I have to have an induction / caesarean / epidural because… Do I have any other options?”

Private midwives give second opinions, run independent childbirth education classes, attend women who are birthing in hospital, and also attend home births. All of this will be affected by the changes to Registration come July 1, 2010. If midwives cannot secure insurance, your ability to seek private midwifery care and impartial advice will be impacted.

Which midwives will be able to access insurance?

Private midwives will need to show proof of insurance in order to practice. With insurance, private midwives will be able to birth with women in hospital, but not at home. Employed midwives working in hospitals will not need insurance.

In order for a midwife to access insurance, the midwife must work in a collaborative team with a doctor. Currently in Australia, midwifery is still seen by some as a profession that is only practiced under the direction and supervision of an obstetrician or obstetric guidelines. Although the Maternity Services Review does much to provide a framework through which midwifery may be seen as a profession in its own right, we have some time to pass before this is realised in the wider community. In the meantime, it is hard to say what will become of women’s choices when their choices are not within obstetric guidelines.

The midwife must be credentialed. This means participating in annual Peer Review and being up-to-date with continuing professional development.

S/he must have completed a certain amount of practice in a setting such as a hospital (eg one year) prior to entering private practice.

Then – the private midwife may apply to have access to the Medicare Benefits Schedule and the Pharmaceutical Benefits Schedule.

What does this mean for hospital birth?

Currently, a mere 3% women Australia-wide are able to access continuity of care with a midwife. The good news is that after November 2010, it may be possible to contract a private midwife to attend you for a hospital birth. The details in this instance are a bit hazy. It would seem that you will be able to choose your own midwife, have your antenatal (pregnancy) consultations in your home, birth in hospital with your midwife, and then continue postnatal care at home with your midwife for up to 6 weeks. As well as this, you will be able to claim a Medicare benefit for midwifery services (in other words, midwifery will be bulk-billed). And your midwife will be able to order blood tests and ultrasounds, and s/he will be able to order medications such as Syntocinon, Vitamin K, Anti-D and Hepatitis B vaccines.

There are, however, a lot of unknowns, such as:
• What is the process by which a midwife becomes eligible for MBS and PBS, and how long does this process take?
• Can midwives access any hospital, or only a select few, and can a hospital refuse visiting rights to the midwife?
• What are the hospital’s requirements for granting private midwives with visiting rights?
• If a doctor is required to intervene in the labour or birth, does the midwife forego her / his payment to the doctor?
• What are the $ values of Medicare benefits for antenatal and postnatal consultations?

These questions remain unanswered. The current Medicare fee for midwives to attend to antenatal care is approximately $23 per antenatal consultation. Private midwives typically book 4 women each month, so they do not spent a full eight hours a day seeing women in 20-minute time slots. More likely, private midwives drive an hour to consult with a family in their home for one or two hours, and then drive home for another hour. $23 remuneration for this service will not make ends meet for the midwife.

Likewise, if the midwife forgoes the birth fee because she has needed to call a doctor to intervene, it will not be economically viable for the midwife to continue practice.

I have no doubt that the Health Minister would not put the energy into making these changes if they could not work, however, the detail that is missing is the essential “nuts and bolts” that will see private practice flourish or die.

What does this mean for home birth?

Currently, there are two ways to have a midwife-attended home birth: you may have a home birth through a government-funded program, or you may access a private / independent midwife. Women who choose a private midwife generally experience more choice and control over their pregnancies and births. Care is usually provided in the woman’s home, and consultations are one to two hours long. Publicly-funded programs usually see women going to the hospital for antenatal consultations, which are around 20-30 minutes long. The programs have strict inclusion criteria and generally have high transfer rates. What this means is that if you are accepted onto the program, you have a reasonable chance – up to 40% or 50% – of being transferred out of the home birth program at some point in your pregnancy or labour and birthing your baby in delivery suite.

If a woman contracts a private midwife to attend the home birth, she generally has a higher chance of being accepted for homebirth, and the transfer rate is lower: around 20%. Publicly-funded home birth is not possible for women having vaginal births after a caesarean (VBAC), breech babies, twins, women who have their babies after 42 weeks or before 37 weeks, women with gestational diabetes, previous bleeding after birth, previous shoulder dystocia, women whose BMI is over 35 (or who are over 100Kg in weight) and so on. Come July 1, 2010, all of these women will have no choice but to birth in delivery suite if they are to be professionally attended.

What about women who do not meet the criteria for publicly-funded homebirth programs, or those women who cannot access a public home birth program?

There are two options for women who wish to birth at home but either cannot access a publicly-funded home birth program, or are not accepted into such a program.

One option is to freebirth, and the other option is for a midwife to attend the woman.

1. Freebirth
The safety of freebirth (home birth without a midwife) has not been researched, and indeed, it would be unethical to have a randomised controlled trial of freebirth. So it is impossible to say that it is safe, or that it is not safe. However, it remains an option for women.

2. Midwife-attended home birth
Midwives who attend home births outside of the publicly-funded models cannot access insurance. It is a requirement of registration that everything a health professional does in the course of their practice, is indemnified. Since insurance will not cover home birth, the midwife will be in breach of her / his registration by attending a home birth. This may lead to disciplinary action, up to and including de-registration.

If a midwife lets her / his registration lapse, planning to perhaps work as a doula or in some other capacity and attends a birth, s/he can be charged with practicing midwifery without registration. This carries a jail term or a fine.

It is important to note that there are no penalties for women and families who ask midwives to attend their births. Consumers of health services can never be charged for inciting professionals into unprofessional behaviour.

If midwives decide to work “under the radar”, although s/he may not be “found out”, there are important considerations for women and families:

• A midwife working under the radar will most likely not have the same access to continuing professional development as a registered midwife working legally. This can compromise safety as the midwife will not be up-to-date in her / his practice.
• Midwives working under the radar will not be able to report their births to the government for statistical analysis.
• Midwives working under the radar will not be able to register births or sign Medicare and Tax forms.
• Midwives working under the radar will only be able to take cash payments and they will not be able to declare their income.
• Women who experience complications at home with a midwife working under the radar will have to front up to hospital alone, without the ongoing support and advice of their midwife, and lie about all prior antenatal and birth care.

Additionally, there is a requirement of registration that includes mandatory reporting of health professionals. This means that health professionals must report other health professionals who place the public at risk of harm, for example by practicing the profession in a way that constitutes a departure from accepted professional standards. Hence, the midwife who attends home births without insurance risks being reported by her / his peers.

Clearly, the options of freebirth or midwife-attended home birth (if the midwife works under the radar) are not acceptable to women and families and have the potential to severely compromise safety for women and babies.

Although home birth is not every woman’s cup of tea, many people accept that it is the right of every family to choose where and with whom they will birth their baby. Forcing women to birth in hospital is no different to forcing women to accept other birth choices that they find unacceptable. Currently, your right to an elective caesarean, elective epidural, or elective induction is not questioned. Yet your right to home birth and private midwifery care is compromised, quite severely, by this new legislation. Imagine the outcry if hospital birth or epidurals were no longer possible for women!

Wow! That’s serious. What can I do to help?

• Increase awareness of the issue. Tell everyone you know, send an email to everyone in your address book, place a note about this in your email signature.
• Visit Save Birth Choices for information on what you can do.
• Attend the rally on September 7, 2009 in Canberra. See http://www.homebirthaustralia.org/ and scroll to the bottom of the page.
• Talk to the media.
• Talk to your local MP. These changes need to be accepted by every State and Territory in order to go ahead.

Author Melissa Maimann is an Essential Baby member and a private midwife.

DIY birth it’s radical, it’s dangerous

Posted on July 22, 2009 by Melissa Maimann

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

Link

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

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

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

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

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

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

… there is a real issue at the core.

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

That means they have to go underground.

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

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

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

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

Melissa Maimann, Essential Birth Consulting 0400 418 448

Home birth program now available to Illawarra mums-to-be (Note: This heading is a lie: homebirth has always been available!)

Posted on July 8, 2009 by Melissa Maimann

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

Pregnant women living between Helensburgh and Kiama can now access a publicly funded home birth program.
The South East Sydney Illawarra Area Health Service expects the first births through the program soon.

The program is open to women accepted into the health service’s Midwifery Group Practice (MGP) program whose deliveries are considered to be low-risk.

So, first you need to be accepted onto the program, next you have to be accepted for home birth, and finally, you need to remain accepted foe home birth. No wonder no-one has birthed on the program yet.

… The program would tend to “err on the side of caution” and only women living within 30 minutes of a hospital could participate …

“Should a mother experience complexities in their pregnancy, they will be referred to other hospital-based delivery options,” …

Um, what options? There is only one other option and that is delivery suite.

… the program had been operating out of St George Hospital for three years, but of the thousands who gave birth in the area just 50 had chosen home births.

This shows just how narrow the inclusion criteria are. And this is tje model that the govt is trying to push forward. Hospital-based homebirth models that meet the needs of a *very* select number of women.

Ms Cameron said independent midwives already offered a home birth service, but issues surrounding indemnity insurance for them had seen numbers decline.

I wish Ms Cameron would refrain from commenting on things she clearly has very little knowledge of!! More and mroe independent midwives have commenced practice in recent years. As of Jan next year, this number will increase further. Issues surrounding indemnity are not new: indemnity has not been available since 2001. While that change created a massive decline in the number of home birth midwives, the trend has been reversed in recent years. Numbers are on the increase. But possible not in the hospital programs where it’s amost impossible to get on the program and stay on the program. And that’s in a healthy population of women!

“The new program will hopefully allow women to avoid free birth situations, (births) with no clinical support,” she said.

The decision to free birth is complex and is nowhere near as simple as freebirthing because midwifery support is not available. Some women freebirth simply because they believe that birth is a natural process, that their body is designed to do (without midwifery care). Or they free birth to avoid possible being kicked off hospital home birth programs at 36 weeks if they do not “pass” their GBS swab!

It seems that the media is keen to promote hospital-based homebirth services as being safe and “better” than private home birth midwifery services. As if they only way to have a safe home birth is to do it through a public hospital program. This reminds me of the move from home birth to hospital birth and the propaganda that was put out to women and families: pictures of home birth midwives who were old, illiterate, “dirty” and supposedly dangerous. Hospital birth was promoted as the safe option. Why would you want to birth at home with a dirty, uneducated and unsafe midwife? Come into the hospital, where our shiny metal delivery tables complete with stirrups, drugs and doctors are available. Have a safe birth. Have a hospital birth. And so maternal mortality rose. Because doctors hadn’t yet cottoned onto the fact that clean hands were essential – that if you go digging around in cadavers and then attend labouring women, you will transfer infection to the woman – and kill her. Let’s not see this happen again! Home birth (private) midwifery is safe and effective.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Access For Pregnant Women To Medicare Funded Midwifery Care On The Way: But not for homebirths

Posted on June 25, 2009 by Melissa Maimann

Link

… Heath Minister Nicola Roxon has today introduced the first bills to legislate giving women access to Medicare funding for expert midwifery care.

It doesn’t. Expert midwifery care is provided by the minority of midwives who provide continutiy of care – eg for homebirths. Women, as a whole, will not be able to access this care because few midwives provide it.

“This is historic legislation for childbearing women and their families” said Dr Barbara Vernon, Executive Officer of the Australian College of Midwives.

Yep – it is. For the first time in Australian history, women are denied the right to have amidwife-attended homebirth. Great step forward!

“From November next year, women will be able to choose the care of a midwife to provide their pregnancy care in the community, follow the woman into hospital to provide her labour and birth, and follow her home again afterwards to provide the vital professional support in the early weeks of caring for a newborn baby”.

So long as the woman births in hospital.

The government’s bills will pave the way for women to receive Medicare rebates for private midwifery care, as well as providing for Pharmaceutical Benefits Scheme rebates for relevant tests and drugs. One bill will specifically support eligible midwives to access professional indemnity insurance for their care.

… Midwives, working collaboratively with GP obstetricians, will help meet women’s need for local care.

Collaborative care has not been defined and most likely there will be several hoops for midwives to jump through in order to access MBS and PBS and insurance. I wonder if the current midwives who work independently of the hospital system will be eligible.

“This national legislation recognises for the first time that midwives make a valuable contribution to maternity care in their own right.

Actually, it doesn’yt. It places midwifery fairly and squarely under obstetric dominance. It affords midwives some rights that they already have in hospital, provided they work with a doctor and ensure that their clients follow the obetetric rules. The new laws place midwifery subservient to obstetrics. Imagine if GPs were only able to practice provided they worked in a collaborative team with a nurse, pathologist, radiographer etc? Imagine if an obstetrician was only able to practice if they worked collaboratively with a midwife, referring all women to the midwife if the woman is low risk and healthy?

Midwives who provide Medicare funded care will work collaboratively with doctors and other health professionals to ensure the individual needs of each woman and baby are fully met.

The needs of women will only be met when they have the final say. What if the woman declines a cosultation with the onstetrician? What if the woman makes an intelligent decision not to have certain tests? Will the midwife be able to support her? The midwife will cease to be “collaborative” if the woman does not comply. So is this an attempt to use an acceptable (to the woman) person (ie, the midwife) to coerce women to have tests, consults and care that she does not want, or perhaps need? I can’t help but this it’s the govt’s way of using midwives to assert control over women.

…“These reforms will not only give women greater choice than they currently have, they will also give most midwives more choice about how and where they provide care to women, thereby helping to reduce stress and loss of midwives to the maternity care workforce.”

So long as it is within the confines of the hospital and so long as the woman and midwife play by the rules of the hospital. I doubt a doctor will work collaboratively with the midwife if the midwife’s clients decline synto for the third stage, decline routine induction, decline a diabetes screen, or insist on having a VBAC. If the midwife is no longer in a collaborative team, she no longer has insurance (and therefore registration) or access to PBS and MBS.

This is perhaps the only part I agree with:

“The only dark cloud in these historic reforms is that they will not provide for women who choose to give birth at home under the care of a midwife. There is mounting international evidence that the option of birth at home is safe for low risk women. ACM is concerned that the rise in unattended homebirths will only get worse unless the government extends its proposed indemnity scheme to ensure healthy low risk women can continue to choose homebirth with competent networked midwives.”

This has all come out of the maternity services review, in which 53% of respondents were women who demanded homebirth services to be provided by midwives. Is the govt listening? Does anyone really care?

Don’t cut the cord, says mum

Posted on June 23, 2009 by Melissa Maimann

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

Link

WHEN Cher Sievey gave birth to her baby daughter Ophelia she decided to do things a little differently.

Not only did she choose a homebirth without a midwife but she chose not to cut the umbilical cord.

It’s a practice known as Lotus Birth, when the placenta and cord remain attached to the baby until the cord detaches naturally, usually after three to five days.

Cher, 28, and her partner Will Thielker live in Brimscombe with their older daughter Aurora, five, and 13-month–old Ophelia. They will be moving to Wales at the end of the month to establish an Instinctual Living Retreat focusing on pregnancy and birth.

“Lotus Birth allows babies to receive all of their blood, oxygen and nutrients through what is known as the placental transfusion …

“There is iron-rich blood in the placenta that the baby doesn’t access until after the birth. When Aurora was born her cord was cut after 30 seconds, so she didn’t receive all her blood volume.” ….

Melissa Maimann, Essential Birth Consulting 0400 418 448

Homebirths will be illegal in Australia

Posted on June 19, 2009 by Melissa Maimann

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

Link

HOMEBIRTHS will become illegal under tough new laws that prevent women using midwives to have children outside hospitals.

The move is set to drive homebirths underground, with expectant mothers and their babies at risk.

There are fears women determined to have a homebirth will “go it alone” like birthing advocate Janet Fraser, whose baby died during a natural water birth in April …

Under the draft Health Practitioner Regulation National Law, released last week, a midwife cannot be registered unless she has insurance.

But with insurance companies and the Government so far refusing to include homebirths in the indemnity scheme, midwives will face being de-registered if they attend a homebirth.

… Australian College of Midwives boss Dr Barbara Vernon said the Government’s intention was obvious.

“I had been optimistic until now when you can see it in black and white,” she said.

“Even though only less than half a per cent of women have homebirths, they should have the same rights as a woman who chooses to have a caesarean. Homebirths won’t stop.”

About 150 midwives do homebirths in Australia. Called independent or private midwives, most do not work in a hospital and are uninsured.

But from July 2010, they will no longer be able to call themselves midwives even though they are trained. Only those insured and registered can use the term midwife, otherwise they face a $30,000 fine.

There are about 700 homebirths a year but some say this may be as high as 2100 as they are under-reported.

For TV presenter and marriage celebrant Elizabeth Trevan, giving birth to her 18-month old twins Nash and Harvey at home was an “overwhelming experience.”

… Home Births Australia secretary Justine Caines said the new law took away the rights of women.

“It technically makes homebirthing illegal,” she said.

The Royal Australasian College of Obstetricians and Gynaecologists is against homebirths.

I have been informed that insurance will be provided for provate midwives who birth their clients in hospital. Homebirth will not be insured, however if the midwife also works in a hospital, she will be able to obtain insurance and thus register.

Melissa Maimann, Essential Birth Consulting 0400 418 448

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

Posted on June 12, 2009 by Melissa Maimann

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Melissa Maimann, Essential Birth Consulting 0400 418 448

Rights and Responsibilities: Where did they Go?

Posted on June 9, 2009 by Melissa Maimann

Visit my website to learn more about my services.

Article

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Melissa Maimann, Essential Birth Consulting 0400 418 448

Homebirth: Study Reveals Conflict Between Doctors And Midwives

Posted on May 18, 2009 by Melissa Maimann

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

Link to article

Two Oregon State University researchers have uncovered a pattern of distrust – and sometimes outright antagonism – among physicians at hospitals and midwives who are transporting their home-birth clients to the hospital because of complications.

Oregon State University assistant professor Melissa Cheyney and doctoral student Courtney Everson said their work revealed an ongoing conflict between physicians and midwives that is reflective of discord across the country.

The pair recently examined birth records in Oregon’s Jackson County from 1998 through 2003, a period when that county saw higher-than-expected rates of prematurity and low birth weight in some populations. The researchers wanted to assess whether those rates were linked to midwife-attended homebirths.

The findings revealed that assisted homebirths did not appear to be contributing to the lower-than-average health outcomes and, in fact, that the homebirths documented all had successful outcomes. But even more importantly … discussions with doctors and midwives uncovered a deep gulf between the two groups … with doctors expressing the firm belief that only hospital births are safe, while midwives felt marginalized, mocked and put on the defensive when in contact with physicians.

… Cheyney, who is a practicing midwife in addition to being an assistant professor of medical anthropology and reproductive biology, said she was surprised that physicians, when presented with scientifically conducted research that indicates homebirths do not increase infant mortality rates, still refuse to believe that births outside of the hospital are safe.

“Medicine is a social construct, and it’s heavily politicized,” she said.

Last year the American Medical Association passed Resolution 205, which states: “the safest setting for labor, delivery and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex…” The resolution was passed in direct response to media attention on home births, the AMA stated.

What is interesting, Cheyney points out, is that 99 percent of American births occur in the hospital, but the United States has one of the highest infant mortality rates of any developed country, with 6.3 deaths per 1,000 babies born. Meanwhile, the Netherlands, where a third of deliveries occur in the home with the assistance of midwives, has a lower rate of 4.73 deaths per 1,000.

One of the biggest problems Cheyney sees is that physicians only come into contact with midwives when something has gone wrong with the homebirth, and the patient has been transported to the hospital for care. There are a number of reasons why this interaction often is tension-filled and unpleasant for both sides, she says.

First is the assumption that homebirth must be dangerous, because the patient they’re seeing has had to be transported to the hospital. Secondly, the physician is now taking on the risk of caring for a patient who is unknown to them, and who has a medical chart provided by a midwife which may not include the kind of information the physician is used to receiving.

Hence the benefit of women booking in to a hospital: if their resources are needed in an emergency, or even for consultation, the hospital has information about the woman, her history and her risk factors.

And because the midwife is often feeling defensive and upset, Cheyney said, the contact between her and the physician can often be tense and unproductive. Meanwhile, the patient, whose intention was not to have a hospital birth, is already feeling upset at the change in birth plan, and is now watching her care provider come into conflict with the stranger who is about to deliver her baby.

“It’s an extremely tension-fraught encounter,” Cheyney said, “and something needs to be done to address it.” As homebirths increase in popularity, she added, these encounters are bound to increase and a plan needs to be in place so that doctors and midwives know what protocol to follow.

She is working with Lane County obstetrician Dr. Paul Qualtere-Burcher to draft guidelines that would help midwives and their clients decide when they need to seek medical help, based in large part on Cheyney’s research, and another that would ask physicians to recognize midwives as legitimate caregivers.

Qualtere-Burcher said creating an open channel of communication isn’t easy.

… Qualtere-Burcher said he believes that if midwives felt more comfortable contacting physicians with medical questions or concerns, there would be a greater chance that women would get medical help when they needed it.

“Treat (midwives) with respect, as colleagues, and they’ll not be afraid to call,” he said.

Qualtere-Burcher doesn’t expect immediate buy-in, but hopes that if a small group on each side agrees to the plan, it will provide more evidence that a stronger relationship between physicians and midwives will lead to better outcomes for mothers and infants.

“We’re having a meeting in early May to propose a draft for a model of collaborative care that might be the first of its kind in the United States,” Cheyney said.

Cheyney is also pushing to get hospitals and the state records division to better track homebirths. The department of vital records had no way to indicate whether a birth occurred at home until 2008, and without being able to pull data, Cheyney said it’s hard to explore the nature of home birth in Oregon.

I think this article raises some excellent points. Hospital transfer rates for home births vary from around 40% to as low as 10% according to research and anecdotal reports. Publicly-funded home birth models have higher rates of hospital transfer, and first time mothers have higher rates of transfer.

The article mentions, “As homebirths increase in popularity, she added, these encounters are bound to increase and a plan needs to be in place so that doctors and midwives know what protocol to follow.” Some Area Health Services have such plans in place; sadly, not all Area Health Services have plans in place. There is, however, a Dept of Health policy on home birth transfer situations that states that homebirth transfer women are to be treated with respect at all times.

The article also mentions, “She is working with Lane County obstetrician Dr. Paul Qualtere-Burcher to draft guidelines that would help midwives and their clients decide when they need to seek medical help” We have such guidelines in Australia, but sadly they do see most women needing a consultation, if not transfer of care. However, consulting does not mean that the woman must agree with what is proposed by medical staff: she is free to make her own decision with the support of her midwife. The guidelines potentially make it difficult for the midwife to provide care if the woman declines to follow medical advice once it has been sought though.

The articale speaks of, “pushing to get hospitals and the state records division to better track homebirths”. In Australia, midwives are required to report all births to the health dept for stats. Most midwives put their stats in, however freebirths most likely are not reported. The oft-quoted 0.2% homebirth rate in this country is possible higher, but this is not known. It would be fantastic if we could compile all homebirth stats to see how safe homebirth really is in Australia. What a great push that would give to make midwife-attended private home birth a medicare-funded option!

Melissa Maimann, Essential Birth Consulting 0400 418 448

Lessons from Labour

Posted on April 20, 2009 by Melissa Maimann

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

Link to article

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Recent media has revealed the hazard of ignoring this evidence.

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

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

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

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

Melissa Maimann, Essential Birth Consulting 0400 418 448

530,000 new mums prove home births safe

Posted on April 17, 2009 by Melissa Maimann

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

Link to article

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

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

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

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

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

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

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

Melissa Maimann, Essential Birth Consulting 0400 418 448

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