Induced labor no more likely to go wrong: study

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

An article from “Obstetrics and Gynecology” that contradicts other research in the area of inductions.

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Choosing induced labor is just as safe for first-time pregnant women as waiting for labor to start spontaneously, new research hints.

The number of women who have labor induction … has been climbing steadily in recent years …

At the same time … concerns have grown that induction for non-medical reasons could lead to more unplanned Cesarean sections and complications such as bleeding.

“For women who have a favorable cervix there was no difference in the C-section rate between those who were induced and those with expectant management,” said Dr. Sarah Osmundson …

… Eventually, almost one in five ended up requiring induction, mostly because they reached 41 weeks of pregnancy. Normally, pregnancy lasts about 40 weeks.

Not quite: normal pregnancy lasts up to 42 weeks.

In the “wait-and see” group, 20 percent of the women ended up with a C-section, compared to 21 percent of those who had elective induction. Bleeding after delivery occurred in about three and four percent, respectively.

… women who had induced labor spent nearly 13 hours at the hospital, whereas the other group spent only nine hours …

“The bigger point is the women who were induced spent a lot more time in labor,” said Osmundson, adding that the extra time was likely to translate into higher healthcare costs.

And more interventions in labour, more vaginal examinations, continuous monitoring, more epidurals, more assisted births (forceps and vacuums), a drip etc.

Another study, published along with the first one in the journal Obstetrics and Gynecology, did find a higher C-section rate and more bleeding in first-time pregnant women with elective labor.

… She added that the new findings were interesting, but that they didn’t convince her.

“I would discourage elective induction unless there is a reason we can put our hands on,” …

“What I tell my patients is, I will let you go until 10 days past your due date unless something comes up for mom or the baby…

Melissa Maimann, Essential Birth Consulting 0400 418 448

Women With Diabetes Having More C-Sections And Fetal Complications: Study

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Nearly half of women with diabetes prior to pregnancy have a potentially-avoidable C-section and their babies are twice as likely to die as those born to women without diabetes …

… rates of diabetes in Ontario have doubled in the last 12 years. Nearly one in 10 Ontario adults has been diagnosed with diabetes, including more women than ever before.

As women develop type 2 diabetes (adult onset) during childbearing age, complications during pregnancy are becoming increasingly common ….

* 45 per cent of women with pre-gestational diabetes are having C-sections compared with 37 per cent of women with gestational diabetes and 27 percent of women without diabetes.

* Babies born to women with pre-pregnancy diabetes have twice as many fetal complications as those born to women without diabetes.

* The rate of stillbirth/in-hospital mortality in women with pre-pregnancy diabetes is twice the rate in women with diabetes (5.2 per 1,000 vs 2.5 per 1,000) than women without diabetes.

* Rates of major and minor congenital anomalies were 60 per cent higher among women with pre-pregnancy diabetes than women without diabetes.

* More than 50 per cent of people who don’t yet have diabetes have risk factors for the disease.

… “Infants born to women with diabetes are at much higher risk for serious complications – which can be prevented by controlling glucose and blood pressure levels at the time of conception and during pregnancy,” … “This reflects a need for more targeted pre-pregnancy counselling and better pregnancy care for this group of women.”

… most diabetes can be prevented … “We need to focus on preventing or reducing rates of diabetes among young women, one of the most vulnerable groups, and ensure that women who have diabetes get effective treatment,” …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Natural childbirth: whose birth plan is it anyway?

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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

Why has the USA’s cesarean section rate climbed so high?

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 government-sponsored study of 230,000 births between 2002 and 2007 found that the C-section delivery rate was 30.5%.

• Among women who ended up with an unplanned C-section, failure for labour to progress was cited in nearly half the cases.
• Fetal distress or non-reassuring fetal testing was listed as a reason for more than a quarter of unplanned C-sections.
• Nearly half of all planned C-sections were scheduled because the woman had had a previous C-section.

Regarding failure to progress, the accepted rate of progress is deemed to be 1cm/hour. First baby or fifth baby, this is the rate that your labour is expected to progress at. This is despite that fact that first time labours do take longer than second and subsequent labours. There is research to support 0.5cm/hour as an acceptable rate of progress but this is largely ignored. I wonder what the caesarean rate for FTP would be if 0.5cm/hour was used instead of 1cm/hour?

So what happens to the woman whose labour doesn’t progress at 1cm/hour? Well, in the first instance, her waters are broken. This is done with the aim of speeding the labour. Generally, a vaginal examination will be performed 2 hours afterwards and if the woman has not progressed another 2cm in this time, a syntocinon infusion is commenced. This is part of a package, however, and the package includes continuous monitoring. Continuous monitoring is needed because the syntocinon drip causes unnaturally stronger, longer and more frequent contractions that can stress the baby.

Which leads to the next cause of caesareans, according to the article: fetal distress or non-reassuring fetal status. This accounts for around 25% unplanned caesareans.

And finally, about 50% planned caesareans occur as a result of a previous caesarean.

Are you joining the dots yet? That initial diagnosis of “failure to progress” often leads to augmenting the labour. If the augmentation is not successful – or if the baby becomes distressed in the process – the woman is taken down the corridor for a caesarean. Having had that first caesarean, there’s a good chance all her subsequent babies will be born in this way.

What can be done to avid this? There are a few keys:
- continuity of midwifery care from pregnancy right through to 6 weeks after your baby is born
- planning to birth at home
- Ensuring that you have good support in labour from a loved one.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Women pushed into caesareans

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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… c-sections now account for one third of all births, and … a big reason for this increase is the over-use of labor induction.

•Almost half of women wanting vaginal births were induced.
•Women who were induced were twice as likely to have a cesarean birth as moms whose labor starts spontaneously.
•Of the c-sections done after induction, half were performed before the cervix had dilated to six centimeters, “suggesting that clinical impatience may play a role.”
•A third of first time mothers had c-sections.
•C-sections upon maternal request (those done for non-medical reasons) account for only 9% of c-sections.
•Attempts at VBAC are less likely to result in vaginal birth than previously thought. Few women are offered the option of VBAC.

… what can you do about all this if you are pregnant and want a vaginal birth? Here are a few ideas:

- Talk to your care provider … about his or her rates of induction, c-section and episiotomy …
- Educate yourself about labor induction …
- Stay home in early labor …

- Choose a midwife if you’re opting for a natural birth
- See an experienced independent childbirth educator for childbirth education classes
- Ask questions
- Read, read, read

Melissa Maimann, Essential Birth Consulting 0400 418 448

New unit a ‘home birth in hospital’

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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MONA Vale Hospital’s new birthing unit will simply be a place for expectant mothers to have a home birth inside a hospital – but a long way from emergency care if a complication occurs – according to an obstetrician.

How anyone can consider a hospital birth to be the same as a homebirth is way beyond me! There is a very big difference between the comfort and familiarity of our homes, and a hospital environment.

Dr David Jollow, one of Mona Vale Hospital’s onsite obstetricians, said the new, midwife-run, Mona Vale birthing unit would mean women who suffer a complication during labour will have to be rushed to Manly Hospital instead of being treated by Mona Vale’s onsite obstetricians.

“The new unit is essentially a home birth that happens to be in a hospital,” Dr Jollow said.

“It would actually be safer to have a home birth in Balgowlah or Seaforth, because an ambulance ride to Manly would be quicker.”

It’s interesting that obstetricians oppose free-standing birth centres, yet we have the existence of midwife-run units where obstetricians are not available. Is ther a differnence? Is it merely a differing terminology to be acceptable to some?

Melissa Maimann, Essential Birth Consulting 0400 418 448

Good or Bad Idea? iPhone App Allows OBs to Monitor Patients Remotely

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

A very funny article, I had to share it!

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AirStrip OB was developed to improve the speed and quality of communication in healthcare … ineffective communication is a leading cause of medical errors leading to patient injury and noting that “preventable healthcare related errors cost the U.S. economy $17 to $29 billion each year.” The application sends “critical patient information” to a doctor or nurse’s (midwives not mentioned) smart phone, laptop or desktop, which gives “obstetricians remote access to live views of delivery room data — including fetal heart tracings, contraction patterns, vital statistics and nursing notes.” …

Offered as a success story on the AirStrip OB corporate website is an article in the St. Petersburg Times in which a physician at Community Hospital, which has a 37.7% cesarean rate, was able to see 30 patients in the office while “keep[ing] tabs” on a patient whose induction began at 5 a.m. that day. The doctor “saw a slight fluctuation in [the baby]’s heartbeat that told him the baby wouldn’t be able to withstand a long labor.” He performed a cesarean on the woman at about 1 p.m. and ushered a “healthy 8 pound, 14 ounce girl” into the world.

The page of testimonials features cheers from physicians, one of whom says, ‘At least with AirStrip OB, I can minimize unnecessary trips to the hospital.” Another raves, “But the greatest aid of all is that I can check the strip in real time when a nurse calls and reports concerns…I just open up AirStrip OB on my iPhone, review the strip and discuss the situation with the nurse…Medicolegally, I expect that this ability will not only benefit the obstetrician, but the hospital as well.”

… One of the misunderstandings that many patients have about giving birth in a hospital is that a doctor will be right there, ready to perform a crash cesarean section or operative delivery at the drop of a hat if their baby is experiencing severe fetal distress. But keeping these resources available around the clock is extremely costly … Even in hospitals that do have 24/7 surgical and anesthesia coverage, if they are performing another cesarean, the surgical suite and necessary staff may not be immediately available when an urgent complication develops.

The following guest post was submitted by Amity Reed in reaction to reading about the distancing “benefits” of the AirStrip OB application in an article:

Have you ever been laboring hard in the hospital — attached to all the various wires and machines; surrounded by equipment, instruments and alarms — and thought: how can we upgrade this birth from merely medicalized to hardcore hi-tech? Well, your prayers have been answered, ladies! The latest in baby removal technology allows your OB to take in a movie across town and simultaneously manage your birth. Soon, doctors may not even have to step foot in hospitals in order to do their jobs. This is the wave of the future: taking people out of the care equation altogether!

Yes, my friends, you too can now have major decisions about your maternal care made by any doctor with the latest smartphone application. Called ‘AirStrip OB’, this app delivers (ha!) real-time information about a woman’s labor so that busy doctors can make judgment calls about women they’ve not witnessed in labor (or even met!) from the comfort of their home. No more worries about wasting a highly-educated obstetrician’s time with your piddling requests for mobility, sustenance or support; the AirStrip OB app reduces the embarrassing tendency of patients to ask questions or expect personable care. ‘Emergency’ cesareans can now be ordered and performed before your OB’s sedan has been sufficiently warmed and gone through the Starbucks drive-thru. Technology is amazing, isn’t it? As those of us in the baby removal business like to say: “If you’re not in the room, cut open that womb!”

With this cutting-edge (ha!) technology, it’s never been easier to imagine c-section rates approaching 50 or even 60%. Soon, the use of vaginas for delivering babies will be obsolete altogether, leaving women with fresh, modern ‘love tunnels’ free from the wear and tear of childbirth. No more expensive vaginal rejuvenation surgery or labia lifts! Our technology, with its resulting seven-fold decrease in normal births, maximizes your chance of avoiding dangerous and unsightly vaginal birth.

But, wait, that’s not all! A recent survey found that 85% of the births portrayed on television and in films left fathers-to-be feeling disgusted, terrified and excluded. Everyone knows childbirth is pretty heinous and yucky, am I right? With the AirStrip OB app, you give your partner the gift of feeling secure in his masculinity, allowing him to renew his claim on your vagina. Why have a ghastly ‘husband stitch’ on your perineum when you can have a simple ‘husband staple’ on your tummy? Nothing says ‘I love you’ like abdominal surgery!

We hope all pregnant women come to know and love the AirStrip OB application, as all good mothers should. You don’t want to be one of those mothers who takes her chances for selfish reasons and ends up with a dead baby, now do you?

Look for another of our exciting apps coming soon, in which a Blackberry-controlled robot does all of your prenatal care. His hands might be a little cold but it sure does help your OB get to her dinner table on time! After all, isn’t that what we all want?

Melissa Maimann, Essential Birth Consulting 0400 418 448

Too Many C-Sections: Docs Rethink Induced Labor

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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The rise in cesarean-section deliveries in recent years has been characterized by some as a key indication of the overmedicalization of childbirth. While the procedure undoubtedly saves lives and leads to better health outcomes for mothers and infants who face problems during pregnancy and labor, many experts say the procedure is being performed too often, and in many cases for nonmedical reasons, putting healthy women and babies at undue risk of complications of major surgery.

The rate of C-sections has reached more than 31% in the U.S., a historical high …

The rate of caesareans is the same in Australia. Our Government is making moves to cut this rate.

The reasons for the increase are many and have been widely discussed: the rising rate of multiple births, more obesity in pregnant women, the older age of women giving birth. In fact, C-sections have become so common that many women may have an inflated sense of safety about them. “For the most part, moms and babies go through the process healthy and come out healthy, so maybe there’s this sense that we’re invincible,” …

But C-section carries all the attendant risks of major surgery; and data show that compared with vaginal birth, cesarean delivery increases the odds that a mother will end up back in the hospital after birth with complications …

Now obstetrics experts are actively seeking ways to drive down the number of C-sections … the ACOG issued new guidelines recommending that hospitals allow most mothers who desire vaginal birth after cesarean … to attempt a trial of labor, including … mothers who are carrying twins or have had two prior C-sections. Despite studies showing VBAC to be safe for most women — ACOG data suggests that 60% to 80% of women who attempt VBAC will succeed — many hospitals have urged women to undergo a repeat cesarean over the past decade, largely to avoid medical risks and malpractice suits.

Another factor contributing to high C-section rates is the increase in induced labor, especially between 37 weeks and 38 weeks … The use of labor induction in the U.S. has risen from less than 10% of deliveries to more than 22%, between 1990 and 2006 … research suggests that induced labor results in C-sections more often than natural labor … those whose labor was induced were twice as likely to have a C-section delivery as those who experienced spontaneous labor.

… previous studies had come to the same conclusion. In her study of … mothers delivering before 41 weeks’ gestation … 44% of women had their labor induced.

… after 41 weeks’ gestation, at which point it is standard policy to induce labor, it may lower the risk of medical complications for mother and baby — including the risk of stillbirth — and even decrease the likelihood of C-section delivery, but those same effects are not seen in women who induce labor before the 41-week mark.

… Among the women whose labor was induced in Ehrenthal’s study, nearly 40% of cases were categorized as elective. In other words, there was no pressing medical indication for induction. Extrapolating from the study findings, Ehrenthal suggests reducing the use of elective labor induction could lower the national C-section rate by as much as 20%.

Several hospitals have already begun reducing medically unnecessary induction as a way to lower the rate of cesareans …

… under the new policy the overall induction rate dropped 33% and the rate of elective inductions fell by roughly the same amount … the total number of C-sections among first-time mothers who underwent elective induction dropped 60% …

If a relatively simple policy shift based on medical evidence can successfully cut the rate of induced labor and C-sections at a single hospital, experts say similar changes applied broadly may help lower the rate of C-sections on a national level.

But as with the new guidelines regarding VBACs, decisions about labor induction and other issues surrounding childbirth must be shared by women. Patients should be informed and included in the decisionmaking process, Ehrenthal says. “Unlike the decision to do an emergency C-section where there’s no time to talk, usually there is time to have a discussion about induction,” she says.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Mums speak out about maternity shake-up

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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LOCAL women have expressed grave concerns about the standard of maternity services on the northern beaches, claiming a doctor-free birthing unit at Mona Vale Hospital is a risk to their health.

With the Health Department and midwives’ groups angrily denying the changes would jeopardie the health of women and their babies, The Manly Daily yesterday spoke to the most important people in the debate – new and expecting mums.

Amee Harland said she would wait for the Mona Vale maternity ward to reopen in full before having a second child there.

“I had a 24-hour labour and then they had to call the doctor because the baby’s heart rate was falling and he was there in five minutes and had to use a surgical vacuum,” she said.

… “You wouldn’t want to drive to Manly (or St Leonards) in the middle of labour …

“I would prefer to go to Mona Vale – it is my home town. Why would I want to go anywhere else? They were so good there.”

Mother-of-three Kellie Finney said low-risk births could also require immediate action.

“If there’s an emergency, the time it takes to get to another hospital would be pretty risky for babies in distress,” she said.

Luckily, research is showing that low risk maternity units are a safe option for women and babies, just as homebirth is a safe option for low risk women and babies. Several low-risk maternity units are in operation: Belmont, Wyong, Ryde just to name a few. The provide a fantastic solution to the issue of maintaining local birthing services.

“I don’t know how long exactly it takes for the baby to stop breathing or have serious medical problems.”

Thankfully, midwives can make such assessements. Transfer policies in place would ensure that women and babies who were at risk would be transferred to an appropriate facility in a timely manner.

“After the baby is born, what happens if the mother is bleeding out of control?’‘

The midwife would administer medications to stop the bleeding, insert a drip and start IV fluids, insert a urinary catheter to drain urine and supervise transfer. It is very rare for a woman to “bleed out of control” and most bleeds are controlled with medications to stop the bleeding.

… if a doctor was needed during the birth, such as to deliver the baby by caesarean, use certain medical instruments or administer an epidural injection, women will be transferred to Manly Hospital or Royal North Shore 45 minutes away.

And the problem is … ?

While mothers at the Mona Vale playgroup praised the role of midwives and welcomed the return of some maternity services to Mona Vale, they said they would not give birth without a doctor present.

You can’t please everyone! The majority of midwifery-led units are over-subsctibed with many women wanting to birth there where they’re assured a known midwife and maximum chances of a natural birth. No-one is being forced to birth at Mona Vale; women who prefer to go to manly or RNSH would be able to go there.

Most mothers said a doctor was called in during their previous births, despite some being in a low-risk category.

That might be a larger reflection on the rates of intervention in obstetric-led births rather than on actual need in a natural labour. Let’s not forget, high risk births would not take place at Mona Vale: no-one with diabetes, high blood pressure, premature, over 42 weeks, bleeding, broken waters for more than a certain period of time, anyone needing an induction or caesarean, twins, breech, anyone planning an epidural and so on.

… Catherine Kane, who is expecting her second child, said she is “not low risk enough’’ to give birth at Mona Vale.
“I wouldn’t be allowed to go to Mona Vale although I’m not high risk, I’m not low risk enough either.’‘

Andrea Whitlock, from Terrey Hills, said she would expect the maternity unit where she gave birth to have a doctor on hand.
“I had a natural delivery but if I didn’t have a doctor there I wouldn’t have been able to do it,’’ she said.

Hmm. I think you did do it! No-one else birthed your baby.

… The model will first be tested at Manly Hospital in October and is scheduled to begin at Mona Vale in December.

The Mona Vale maternity unit will also be reduced from 720 births to just 200 a year, with mothers only able to stay four hours after birth …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Who controls childbirth: women or doctors?

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That I am pregnant again is an act of either incredible optimism or mind-blowing amnesia. As the sonogram technician squirts jelly over my abdomen for my 20-week checkup, I think it’s the latter. Watching this baby, who the tech tells me is a boy, I am not caught up in visions of his future; I’m caught up in visions of mine. All of a sudden, I know with a certainty I haven’t allowed myself to confront before: Somehow, I am going to have to deliver this baby.
Obviously, you say. But my first birth was traumatic, and although my son and I emerged fine, I lost a year seeking treatment for post-traumatic stress disorder and all the depression, fear and anger it brings. I imitated mothers who seemed normal to me, cooing and tickling my son. In truth, I was a zombie, obsessing about how I had ever let what happened happen.

What happened is this: In my 39th week, I am induced because of high blood pressure. At the hospital, I am given Pitocin, a synthetic form of the labor-inducing hormone oxytocin, and Cervidil, a vaginal insert used to dilate the cervix. Within two hours, my contractions are one minute apart. I had lasted as long as I could without an epidural because I had read that they sometimes slow dilation. That’s the last thing I need: I’m at a pathetic 2 centimeters. My doctor comes up with a solution for the pain: a syringe full of a narcotic called Stadol.

“I have a history of anxiety,” I tell the nurse who has brought in the syringe, as I always warn any medical professional who wants to give me drugs. “Is this drug OK for me?” “It sure is,” she says.

It is not. Within 10 seconds, I begin hallucinating. For five hours, I hallucinate that I’m on a swing that’s soaring too high, that houses are flying at my face. My husband has fallen asleep on the cot next to me, and I’m convinced that if awakened, he will turn into a monster — literally. I’m aware this notion is irrational, that these images are hallucinations. But they are terrifying. I buzz the nurse. “Sometimes that happens,” she says …

By noon the next day, 24 hours after I had arrived, I am only 3 centimeters dilated. The new nurse, a nice lady, tells me the induction isn’t working. “Your blood pressure isn’t even high anymore,” she says. “Tell the doctor you want to go home.”

When my OB comes in, I say, “I’d like to stop this induction, if that’s possible. I’m worn out. I hallucinated all night … I just don’t think this is working out.”

“OK,” he says. “Let me examine you. If you’re still not dilating, we’ll talk about going home.”

My previous dilation exams had been quick and painless, if not entirely pleasant. This one takes a long time. Suddenly, it hurts. “What are you doing?” I scream. “Why does it hurt?”

No answer.

“He’s not examining me,” I scream at my husband. “He’s doing something!” My husband grips my hand, frozen, unsure.

I scream to the nurse, the nice one who had suggested I go home. “What is he doing?” She doesn’t answer me, either. I writhe under the doctor’s grasp. The pain is excruciating.

The first sound I hear is the doctor’s directive to the nurse, in a low voice: “Get me the hook.”

I know the hook is for breaking my water, to speed my delivery by force. I scream, “Get off of me!” He looks up at me, as if annoyed that the specimen is talking. I imagine him thinking of the cadavers he worked on in medical school, how they didn’t scream, how they let him do whatever he wanted.

“You’re not going anywhere,” he says. He breaks my water and leaves. The nurse never looks me in the eye again.

Eleven more futile hours of labor later, I am exhausted and terrified when the doctor comes in and claps his hands together. “Time for a C-section,” he says. I consider not signing the consent form, ripping off these tubes and monitors, and running. But the epidural I’d finally gotten won’t allow me to stand up.

It’s nearly midnight when I hear a cry. My first emotion is surprise; I had almost forgotten I was there to have a baby.

I was desperate to find someone who could tell me what had happened to me was normal. To say, “You hallucinated? Oh, me, too.” Or “My doctor broke my water when I wasn’t looking. Isn’t that the worst?” Nothing …

Now, I’d never loved my doctor … I’d found him patronizing — “Normal!” he’d shout at me, when I asked a question — I thought his assuredness might be a good antidote to my anxiousness. It seemed to work, until it didn’t.

… I also didn’t have a birth plan … Sure, I had a plan for the birth: Have a baby using whatever breathing method I’d learned in the hospital’s birth-preparedness class, maybe get an epidural. But I didn’t have the piece of paper that so many of my friends have brought to the hospital with them … in my opinion, the very act of creating such a contract was to ignore what labor is: something unpredictable that you are in no way qualified to dictate.

… people who hear my story ask … Did I consider a home birth? A midwife instead of an obstetrician? … The answer is no. I am not holistically minded. My philosophy was simple: Everyone I know has been born. It can’t be that complicated.

The women who ask me about my preparations for my first son’s birth — who imply with these questions that I could have prevented what happened to me if I’d been more diligent — are part of an informal movement of women who are trying to “take back” their birth — take it back from the hospital, the insurers and anyone else who thinks he can call the shots.

But hospitals aren’t so interested in giving women back their birth … stipulations dealing with labor and delivery (“I want only one medical professional in the room at a time”) garner barely a glance. University OB/GYN in Provo, Utah, even has a sign that reads, “…we will not participate in: a ‘Birth Contract’, a Doulah [sic] Assisted, or a Bradley Method delivery. For those patients who are interested in such methods, please notify the nurse so we may arrange transfer of your care.”

… This question of whether I could have prevented my trauma has lingered in my mind since that day; now that I am pregnant again, it has become deafening. I have a chance to do it all over. Would I benefit from thinking more holistically? Should I bother taking back my birth?

During my pregnancies, friends gave me two books; their spines are still barely cracked. The first is called “Ina May’s Guide to Childbirth.” … The other book is “Your Best Birth” by Ricki Lake and Abby Epstein; it’s an offshoot of their 2008 documentary, “The Business of Being Born.” Their urgent message is that women who want to deliver vaginally can do so if no one intervenes. Instead, doctors and hospitals are doing all they can to “help” the laboring woman along … and failing. Inductions like mine, epidurals given early in labor, continuous fetal-heart monitoring — all of them have been associated with a higher risk for cesarean section. The result is an epidemic — 32 percent of U.S. births were C-sections at last count, the highest rate in our history. Individual surgeries may be medically necessary, but as a matter of public health, the best outcomes for mothers and babies come with a rate of no more than 15 percent, according to the World Health Organization.

Sam … was five months pregnant when watching “The Business of Being Born” convinced her that hospitals could be dangerous and a home birth would be more meaningful. She and her husband found a midwife … and spent the rest of the pregnancy preparing.

After 24 hours of labor, Sam’s contractions were two or three minutes apart, yet when her midwife examined her, she was only 3 centimeters dilated. The midwife gently told her that she was nowhere close to delivering, despite her contractions, exhaustion and pain. Sam asked to be taken to the hospital.

The change of scenery did her good. “At that point, I had been in labor for 40 hours,” she says. “I entered the relaxed zone. The epidural took the edge off … It was a sacred space.”

After her son’s delivery, Sam passed out, having lost 50 percent of her blood volume in a postpartum hemorrhage. Needless to say, she was relieved that she was in a place where blood transfusions were readily available … she believes she will want midwife care at a hospital next time.

… Bialik’s first birth didn’t go the way she wanted. After three days of labor at home, she stalled at 9 centimeters, one short of the goal. Her midwife suggested they go to the hospital, where after a natural childbirth, Bialik’s son spent four days in the neonatal intensive-care unit. “My son was born with a low temperature and low blood sugar, which isn’t unusual in light of the fact that I had gestational diabetes,” she explains. “I understand doctors need to err on the side of caution, but there was nothing wrong with my child. All of our plans for bed sharing, nursing on demand, bathing him — gone.”

The experience was scarring. “I felt a sense of failure that I had to call my parents from the hospital,” Bialik continues. “Yes, I know vaginal birth in the hospital is the next best thing to a home birth.” …

I point out that natural childbirth in the hospital — her “failure” — was my best-case scenario. But I also understand when she says, “Everyone is allowed her own sense of loss.” She realized her vision when her second son was born at home.

The second time around
I don’t consider myself a candidate for a home birth. The risk of uterine rupture from an attempt at vaginal birth after cesarean (VBAC) makes it unthinkable … I’m also not really interested in a home birth … But I’m also not interested in another C-section …

So I’d like to attempt a VBAC, but I know that it doesn’t always succeed. I have a new doctor — the 10th I interviewed following my son’s birth — at a new hospital, and he has agreed to help me try. But my primary goal is more modest: not to be retraumatized. Even now, my heart pounds at the sight of hospital receiving blankets, the antiseptic smell of the maternity ward.

The common thread in Bialik’s and Sam’s stories that impressed me was how supported and safe they felt with their midwife …

In an e-mail Bialik sends after our meeting, she goes back to my idea that some women weren’t meant to have babies the holistic way. “There are those among us who believe that if the baby can’t survive a home labor, it is OK for it to pass peacefully,” she writes. “I do not subscribe to this, but I know that some feel that … if a baby cannot make it through birth, it is not favored evolutionarily.”

I think about my appendectomy, back in 2003. Had I not made it to the hospital in time, I would be dead. What would it be like to refuse medical intervention? I’d call my family, say my good-byes. “I’m sorry,” I’d say. “But I’m not evolutionarily favored. It’s time for me to go.”

This attitude, that everything was better back when there were no doctors, seems strange to me. C-sections, although certainly done too often, can save lives. Orthodox Jews still say the same prayer after childbirth that those who have been in near-death experiences say — and with good reason. A birth that leaves mother and child healthy may be commonplace, but it’s also a miracle every time.

As the weeks pass and my belly grows, I can’t stop thinking about Sam. Her pregnancy was a sacred time, and she had truly looked forward to labor. Is that what I should try for — a meaningful birth, as well as an untraumatic one? At what point had people like Sam and me learned to feel entitled to a meaningful birth?

“I think that birth should be a beautiful experience,” says obstetrician Kimberly D. Gregory, M.D. She’s the vice chair of women’s health care quality and performance improvement at Cedars-Sinai Medical Center in L.A. “It should be exactly the way you want it, and doctors should intervene only to preserve the health or life of you or your baby.”

Naturally, one would assume that Dr. Gregory advocates birth plans. When I ask her this, she laughs. “We always say, ‘If you show up with a birth plan, just get the C-section room ready,’” she says. “You get everything on that list that you don’t want. It’s like a self-fulfilling prophecy.” Dr. Gregory led an unpublished study that compared women who took traditional hospital birth classes with those who employed Bradley-like training and a birth plan. The birth-plan group trended toward a higher C-section rate and more interventions. “There’s a certain personality type that tends to be more anxious. Maybe the anxiety hormones themselves put them at risk,” Dr. Gregory theorizes. “It seems that being open and honest and choosing the right doctor is probably a better option than writing everything down. Walking in with this list appears to set up an antagonistic relationship.” …

… In the past three weeks, I’ve had the same dream. I’m in a field (I believe at Ina May Gaskin’s Farm), and women in braids are dancing around me as my baby is born, painlessly, joyously. As I reach down, I notice my C-section scar is gone.

I wake up upset. Am I truly under the impression, subconscious though it may be, that taking back this birth will undo the damage of the last one?

“I don’t understand this phrase ‘take back your birth,’” nurse-midwife Pam England, creator of “Birthing From Within,” … tells me. “Who took it? What would a woman tell herself it meant about her if she failed to meet the criteria she made up for ‘taking back’ her birth? I am concerned that this phrase, meant to generate action and a feeling of empowerment, may actually be generated by or feeding the victim part of her.”

England is right: Having a childbirth that I deem successful this time will not change what I haven’t overcome from the first. I try to find a way to make what my doctor and nurses did to me OK, but my mind rebels. I feel loss — no, theft — of an opportunity for me to have a baby the way so many other women do: a carefree pregnancy, a labor that could still go any way.

Maybe I’m not so different from the women I spoke with, after all. Bialik had a successful natural childbirth but felt like a failure because it was in the hospital. Women who had a C-section also used words like failure. Perhaps part of the problem is that our generation of women is so ambitious, so driven, that we don’t know how to do anything without quantifying it as a success or failure.

According to Dr. Gregory, women are now requesting a C-section for their first birth, even without indication. “A lot of people are uncomfortable with the unknown,” she says. Plenty of people are wary of C-sections by choice, from holistic moms to obstetricians. But isn’t this, too, taking back your birth? Refusing to be out of control seems to me the epitome of taking it back. You don’t have to have an unattended birth in the woods to be considered a real woman.

Deciding that you can’t control the uncontrollable — and committing to that decision when you are, in fact, out of control — is also taking back your birth. It’s what your grandmothers did. It’s what their grandmothers did.

With this, I realize that I have already taken back my birth, but not as part of any movement. I have stopped judging women who take extra precautions as defensive and started to understand that everyone has to find her way.

I don’t know how this story ends. I’m still not convinced my body was made to deliver vaginally. But here’s what I do know: I will insist on kindness. I will insist on care. And I hope I will be open to being treated kindly. It’s harder than it seems.

I have another hope, too. I hope there will be a moment when … I will look down at my baby — whether he is handed to me on my belly or from behind a curtain as my body is sewn shut — and I will remember what I’ve known from the beginning, when I looked down at that plus sign and we were alone together for the first time. Before these questions wrapped around my neck, choking me for answers. I will know that I am his mother and he is my son. And maybe, in that moment, I will be ready to say that the only success and failure is the outcome of the birth, that we are healthy …

I’m concerned that birth is defined in terms of success and failure, and that after this author’s journey, she has determined that health is the only important factor. In this day and age, it is entirely possible to have a safe VBAC – a safe birth experience as well as a satisfying one. The vast majority of women who choose VBAC will be successful provided that they choose the right care provider.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Induction of labour can lead to caesareans

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A new study … looked at 7,804 pregnant women giving birth for the first time and found that 43.6 percent of them had their labor induced … [Women having an induction] regardless of the reason were 2.6 times more likely to have a C-section, meaning 20 percent of them were linked to inducing labor. In 1990, 9.5 percent of women in the United States had their labor induced. Sixteen years later, that number jumped to 22.5 percent. Currently, 32 percent of babies born in the United States are delivered by C-section, an all-time high. Women who deliver by C-section the first time are more likely to have a C-section in subsequent deliveries, so the goal is to prevent C-sections the first time around.

There’s a place for all interventions in labour and birth. Mostly, they’re over-used. However, sometimes intervention is life-saving. Some good reasons for an induction might be high blood pressure or a baby who is not growing well inside. However, reasons such as suspected big baby or wanting to schedule birth for convenience might be re-thought in light of this research that confirms previous research on the topic.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Are Today’s Obstetricians Giving Women What They Really Want?

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It seems patients of Dr. Robert Biter’s are everywhere here in North County San Diego. For a long time now, I’ve enjoyed playing the game of mentioning him when I meet one and just buttoning my lips to listen to the glowing stories that come back to me. Such tales were echoed over and over in comments on my recent post, “Why I’m Protesting for my Natural-birth Friendly OB.”

The post chronicled the buzz over the recent suspension, reinstatement and resignation of popular OB, Dr. Robert Biter, from San Diego’s Scripps Encinitas hospital last month, and the hundreds of people who showed up at local rallies in his support. Even though this piece portrays individual stories — mine with Dr. Biter and his with a contentious hospital — I’m glad to see the attention Huffington Post readers are giving it for the larger issues at play.

Dr. Biter was cleared of any wrong doing under a peer review panel and the California Medical Board declined any sanctions against him … Given the continued silence of both parties, it’s not clear what legal proceedings may still be underway. Regardless, his enormous, continued support in my community says a lot about what many women want as health care consumers today.

A central aspect of Dr. Biter’s popularity seems to be his unique ability to incorporate much of the midwife’s model of care … where birth is seen as a normal process … he puts in endless hours to stay very present in a labor, however lengthy, and tailors the care to maximize a woman’s innate ability to birth her baby without interventions …

… Over the years I’ve met more than one patient in Dr. Biter’s crowded waiting room who has driven hours just to see him. They make one thing clear, Dr. Biter does things differently than most. In addition to being more sincere and caring than some of our past doctors, he has extremely low rates for interventions like labor induction/acceleration drugs or c-sections. He also encourages women to move around during labor, as desired, to help the baby move down and out of her pelvis.

… Perhaps you are asking if Dr. Biter’s way is less safe than the norm … Even though we birth with OBs over 90 percent of the time in the U.S. … we still have the second worst newborn mortality rate of any developing nation and our maternal mortality rate has doubled in the last 25 years.

Of course, there are plenty of women who aren’t interested in a more natural birthing experience and options are abundant for them. But a real number of others are clearly starved for an OB who allows her to take her time in labor and resists the urge to intervene unless there is a genuine complication.

Like me, these women may want the option of having an epidural, or other medical tools available at their birth. But many of them don’t feel their freedom of choice is respected once they walk through a hospital’s doors.

… I do wonder why more doctors don’t offer a way of birthing with fewer medical interventions, when a doctor who does, like Dr. Biter, has such a groundswell of support?

The situation is very similar in Australia, with very few obstetricians providing natural birth services. Obstetric care frequently involves interventions such as induction, epidural, vacuum extraction and so on. Yet it’s very clear that natural birth is important to women. What will it take for obstetricians to feel mroe comfortable to provide natural birth services such as waterbirth, vaginal breech birth, VBAC, physiological birth positions, physiological third stage and so on? I expect it would take a change in our legal system and duty of care legislation to be in place.

a href=”http://www.essentialbirthconsulting.com.au/about-melissa-maimann.html”>Melissa Maimann, Essential Birth Consulting 0400 418 448

Hard labour

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Australia is one of the safest countries in the world in which to give birth, so why are women more anxious than ever about their pregnancies?

FOR most women, the memory of their baby’s birth remains a vivid mental replay that awakens sensations at times as sharp and clear as the moment itself.

For Fiona Thomas, such memories are hazy, trammelled by darker ones that involved her fight for survival. All she remembers is the baby, her third, being lifted from deep within her; and then feeling faint and unwell.

As the baby lay in her arms, she was elated to discover she had a daughter (she already had two boys.) But there was tension in the room and the obstetrician seemed preoccupied. As the feeling of faintness dragged her deeper into a place she did not want to go, she signalled to the nurse to take the baby.

She remembers the anaesthetist telling her there were ”some complications” with bleeding and the obstetrician saying tersely, ”get her husband back here now” (he had gone with the baby to the nursery).

And then she was lying unconscious, monitored by the rhythmic beep of machines on a 24-hour guard. Meanwhile, the baby slept in the nursery, her life stretched out vast as an open sky.

Unbeknown to her, Fiona was suffering from placenta accreta, a potentially fatal condition in which the baby’s food supply, the placenta, attaches itself to the walls of the uterus so deeply that there’s a risk of haemorrhage if it is removed. It occurs in one in 2500 pregnancies but is difficult to detect beforehand.

In the delivery suite, the obstetrician worked rapidly to stitch up the ends of the blood vessels but the placenta was an open network, pumping blood at a rate of knots. ”My husband had a fright when he came back into the room and saw the obstetrician covered in blood,” Fiona recalls. ”I actually think it was harder for him than for me.”

… Fiona underwent an emergency hysterectomy and woke up in intensive care attached to drips and tubes that leeched donors’ blood back into her depleted body. Pinned to the foot of her bed was a photo of her daughter …

AUSTRALIA is the fourth-safest country in the world in terms of maternal mortality …

The chance of dying in Australia as a result of childbirth is remote – about one in 10,000 …

But globally, women die of pregnancy-related causes at a rate of one a minute, with 99 per cent of deaths happening in developing countries. Clearly, giving birth is a risky business. Good hygiene and better standards of living and prenatal care have gone a long way towards making it safer in this country, but that doesn’t mean it won’t go wrong.

Ironically, despite Australia’s great record, experts say many women are feeling more, rather than less, anxious about the birth process. Some blame this on our risk-averse society, saying the screens and tests and the increasing level of intervention in birth and pregnancy is geared towards making women fearful. As one expert puts it, antenatal care has become ”antenatal scare”.

Louise Kornman, associate professor of obstetrics at the Royal Women’s Hospital, says: ”Birth rarely leads to death, but it can lead to damage. The majority of pregnancies work out fine, but the reality is it doesn’t always go that way. There is a belief that technology can save you if things go wrong, and in doing so you can lose sight of the fact there are inherent risks.”

… ”Of course, women might feel that sometimes the medical profession intervenes too much in what is a natural process, but the reality is that if left to mother nature then the outcome is not very good, often, and there needs to be a sensible balance struck between not interfering in a natural process but judiciously intervening when things start to go wrong – or preferably before things start to go wrong, given that prevention is better than cure. It can be a difficult compromise to reach.”

It is worth remembering that obstetricians are at the coalface of difficult deliveries. Does this make their view distorted? Unlike midwives, who oversee successful, normal births every day, doctors bear witness to the worst-case scenarios. Inevitably this difference in experience manifests itself in an ongoing debate on how best to manage childbirth. Midwifery groups push for normal deliveries and natural births while obstetricians err on the side of caution … Caught in the middle are the mothers.

Rather than becoming too complacent, Melissa Maimann, a private midwife and childbirth educator in Sydney, is seeing more anxiety among her patients, created, she believes, by our risk-averse culture.

”The safest place to have a baby is at home, if everything is going well,” she says firmly. ”The vast majority of people who go through the hospital system are unhappy with their experience.”

Have women been made to feel over-anxious? ”Possibly,” admits Bernadette White, clinical director of obstetrics at the Mercy Hospital For Women. ”It is easy to focus on the things that go wrong, and for some people that’s a source of stress.

”Obviously, a logical approach is to look and say, ‘Yes, that could happen, but how likely is it?’ But people don’t always have an entirely rational view when looking at things that might go wrong in their labour.

”And when you are assessing a risk, there’s a very broad spectrum of interpretation. That’s why some people will look at one set of figures and want a home birth, and someone else will look at the same figures and want an elective caesar.”
Associate professor Jenny Gamble, deputy head of nursing and midwifery at Griffith University, Queensland, has researched birth and post-traumatic stress.

Her findings show that while birth is a relatively safe physical event in Australia, it remains a hazardous psychological journey.

”If we stick with the premise that a high level of intervention has unintended negative consequences, then yes it does. We have consistently found that 30 per cent of women report that their birth was traumatic; that they feared for their life, or their baby’s life. This is a very high figure. We also know that about 6 per cent go on to develop post-traumatic stress disorder.

”Women don’t feel safe. Birth is being geared towards making them feel fearful; strangers are telling them this and that, there is screening and testing at every step and they develop a sense that at any moment they might lose the baby or something catastrophic is going to happen. It’s called ‘antenatal scare’ in the trade.”

Gamble is concerned about the ripple effects of such trauma. Affected women may find it harder to bond with their baby, and their relationships may fall apart. They may develop a fear of hospitals and doctors and even birth itself.

”Most of our gains in maternal morbidity have been based around realistic, basic things, like feeding the mother, sending out health messages such as not smoking in pregnancy and basic care in the community. I am not suggesting that we do nothing, but the pendulum has gone too far the other way.”

ERIN Horsley had her first baby in Britain. Despite her plans for a natural birth with no intervention, she ended up having her baby induced and then delivered by forceps when labour progressed slowly.

Attached to a drip and no longer able to move around, Horsley couldn’t speak through the pain. ”If you can’t tell me what’s the matter then I can’t help you,” said the midwife, brusquely.

Horsley emerged from the experience feeling emotionally battered. ”I felt let down,” she said. ”Not listened to. It caused marital problems. When I had my second baby here in Melbourne I tried to talk the hospital staff about my experiences; they said I was being oversensitive and that birth trauma doesn’t exist.”

Shae Reynolds, 31, was also hoping for a natural delivery but a late scan showed the lake of amniotic fluid surrounding the baby was ”potentially low”. (This turned out not to be the case when the waters finally broke.) In the cascade of intervention that followed, Shae found her legs in stirrups opposite an open doorway with several strangers milling around the room, including someone emptying the bins.

A vacuum extractor was attached to her baby’s head and one her most horrific memories is watching the doctor put a foot on the bed and pulling, saying, ”We have to get this baby out”. She says part of her daughter’s scalp was damaged as a result, and she suffered a big tear.

”I struggled terribly the first six months,” she recalls. ”I couldn’t have sex for over a year. I felt like I’d failed, like I hadn’t protected her.”

Reynolds’s daughter is now five and she has had two more children, both born without complications and naturally, at home.

But every birthday awakens memories of the trauma. ”It’s hard not to feel torn, because one of the happiest days of my life was also one of the most traumatic. Those precious first moments that we had as a family were destroyed. We were cheated of so much more than just the birth. We still are.”

Medics and midwives are united in the belief that it helps if a woman can feel in control, or at least informed about what is happening. Says Maimann: ”We have an excellent public health system. The government’s job is to offer a basic and safe level of care, which it does very well. It doesn’t suit the emotional or mental needs of women having babies, but I don’t think it should.”

She argues that families should be prepared by investing in independent childbirth education, or working with a private midwife who will provide continuity of care at a cost of between $3000 and $6000.
Surely this will be out of reach to many? ”We can afford holidays,” … ”It’s about valuing what you get.”

Melissa Bruijn and midwife Debby Gould run birthtalk.org, a national birth trauma support group … ”People assume that if birth is going to be safe, there has to be lots of intervention, but reducing the amount of birth trauma is not about reducing what can go wrong, because that’s not controllable.

”It’s really about meeting the emotional needs of women. Even if they find themselves undergoing emergency caesareans, they can still feel empowered and part of the process if they are looked after properly. It’s a myth to say that the most important thing is a healthy baby. Traumatic birth gets carried with you – you don’t leave it at the hospital – and it can have profound consequences for both the mother and baby.”

It is almost seven years since Fiona Thomas, 45, an occupational therapist, went into hospital to give birth and ended up in intensive care. She was fortunate to have given birth in a hospital with a good supply of blood; fortunate that there was a team on hand that worked with rhythmic precision to save her. ”You don’t expect that,” she says. ”I went in thinking I was going to have a routine caesarean, just like I’d had before. All our friends were expecting a phone call 10 minutes later with good news, but there was nothing.

”They realised something must have gone wrong and phoned the hospital. I think everyone was shocked by it. It has changed the way I view life. Sometimes I would think, ‘What happened if I had died? If those 30 seconds I got to hold her had been her only contact with me?’ But then you have to flip it around and see it the other way.
”It makes you realise that life spins on a dime.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

Your birth after July 1, 2010

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

I came across this interesting article detailing an American woman’s experience of giving birth in an American hospital: Mom fires OB during birth when threatened with a cesarean! The woman writes:

… I let myself be pushed into inducing. We were at 42wks … My family was all becoming quite impatient and there was a lot of pressure to have her out. I agreed to be induced and get things started.

… 6 am we were at the hospital. I took a ton of food in with me, because I was not going to do this with no fuel. We got settled, the first nurse got us all checked in did all the paperwork and started the IV. They had a change of shift, so the next nurse, Anna, come-on and she was wonderful.

Anna spoke with us and I told her how things were going to go. To call the doctor if she needed but I was the one birthing a healthy baby, and unless the stats of baby changed, this is what I wanted …I told her we would be doing the pit slowly. I only wanted an increase every 45 min to an hour, not the every 15 the Dr. had ordered. She called the Dr and it was agreed. So off we set. We had a cervical check and I was barely dilated 2 and my cervix was very posterior.
I had no idea how the pit would work on me and baby so we just waited. Annabella was so squirmy, they couldn’t keep her on the monitors, Anna had to hold them on and move with her …

After awhile the Dr came in and wanted to look for Annabella and when she couldn’t find her well stated the baby was breach and we needed to go have a c-section. I looked at this woman and told her no, baby had not flipped I would have felt it, and I was not getting a c-section today. That if baby had turned, then we would turn off the pit, and I would go see my Chiropractor to help move her around again. I don’t think the Dr liked me. I didn’t care. So she ordered an ultrasound just to see, and I was later told she knew baby was breach and had started the paperwork to send us on.

Annabella was in fact not breech. She was head down just not really engaged. I felt so good knowing I was right. All this happened about 11am. There had been no increase in the pit for awhile … We started upping it again.

During these times since Annabella wasn’t staying on the monitor anyway, I was up. I walked and rolled on the ball. I leaned over the ball to do pelvic tilts. Pretty much anything I wanted. I really enjoyed that. I was eating and drinking … At 2pm I declined another cervical check …

I was standing and rocking my hips back and forth during the waves, and they were nice. Just these waves, they never were uncomfortable. I didn’t feel I needed to go in to off during them so I just stayed in center moving as I felt I needed to. Anna would come in and check baby with a Doppler, and the let us do our thing.

About 4 the Dr was back, she wanted to see where we were so we checked. I was 4cm, and my cervix was no longer posterior, about 70% effaced.

• The Dr. said I was not where she would like to see me by now. She wanted to break my waters and move things along.
• I told her no thanks; I felt we were doing fine. Baby was fine, so was I.
• She didn’t look surprised. She did get quite nasty though, and told me if I didn’t do things the right way this will land in a c-section and was putting myself and child at risk. That she was going off shift and there would be someone else.
• I … looked her square in the eye and told her that my child in fine.
• I am not having a c-section to please her that if she had not noticed this was MY birth. I was the one doing things, until someone can show me that my child was unsafe I would do this all night if needed. That was the RIGHT way.
• Also that it was a good thing that she was going off shift, because she was fired. I didn’t want her back in my room. I didn’t need any one in there being negative. I was sure there were other people around who could catch this child, and if not I would do it myself.
• She left the room in a quick hurry, and as I turned around again, my husband and … the nurse were all just kind of staring at me.

My husband was stunned, and asked if I could do that, firing the Dr. I told him I didn’t care if I could or not, she wasn’t coming back to my room …I don’t know how things happened from there, but another Dr. came in and introduced himself about 45 min. later and was way more respectful than that woman had been.

We continued, at 7pm the waves were more intense and almost on top of one another … I started to shake and shiver but I wasn’t cold. I vomited all over, and then with the next wave I felt pushy. soon there after my waters broke during one of the pushy waves.

… My body had taken over, I had no choice but to push … Annabella was born at 8:06pm 7lbs 10oz. 21 inches long. She cried for a bit but was so awake and alert. She is just perfect. She latched on and nursed minutes after birth. I am so happy with this birth. I did it the way I wanted even if it didn’t start the way I choose. I wish the dr had been more supportive. But you can’t have it all.

Let’s consider this case from the perspective of private midwifery care after July 1, 2010. This woman went to 42 weeks. The ACM Guidelines stipulate that at 42 weeks, the midwife must refer the woman to an obstetrician for opinion. No doubt the opinion will be that induction is warranted. The woman may accept or decline this advice. If she declines, and if the obstetrician does not agree to the midwife’s continued care of the woman, the woman will be left without care under the Government’s insurance policy. On the other hand if the woman agrees and accepts induction, this will take place according to the obstetrician’s preferences or hospital policy. As the story above shows, the woman advocated for herself throughout. She declined a caesarean, artificial rupturing of her membranes, a vaginal examination and continuous monitoring. Currently, women can birth in a hospital with their private midwife and their midwife can advocate for them provided that the woman has a birth plan that clearly states her preferences. After July 1, our continued involvement in the woman’s care will be dictated by the obstetrician in attendance or with whom we have a collaborative agreement. In the interests of maintaining a collaborative agreement and ongoing income, the midwife will need to remain silent when the woman is outside of the ACM Guidelines and does not agree to the care being suggested. After July 1, women must fend for themselves if the care being suggested is at odds with their preferences.

Melissa Maimann, Essential Birth Consulting 0400 418 448

FAQs

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

Exorbitant prices with Sydney obstetricians, alternatives?

There’s a great alternative: private midwifery care. While private midwives may not be cheaper than private obstetricians, the service is experienced by women to be more personalised, thorough, caring and supportive. Consultations are one to two hours in duration, so there’s plenty of time you to get to know your midwife and to talk through all fears and anxieties. All questions are answered thoroughly and there’s time for things like birth planning, childbirth education as well as the clinical things. Of course, if any problems are detected, midwives refer to obstetricians who can provide obstetric care.

How much will it cost me to access a private midwife as my care giver

The fees vary and in Sydney you’d be looking at anywhere between $4000 and $6000.

Refusing to be induced at hospital

All women have the option to accept or decline interventions. The hospital will want to ensure that you understand why they want to induce you, the risks of not inducing, and that you’re accepting responsibility for your decision. You’re perfectly within your rights to refuse interventions and to birth at your chosen birth place with support.

How to have a baby naturally in a hospital

In short, take a private midwife with you! the most important decision you will make in your pregnancy will be choice of care provider. Typically, midwives have lower rates of intervention than do obstetricians. Private midwives have even lower rates of intervention than do hospital-employed midwives. Safety is never compromised.

Home birth fetal auscultation

Yes, this is common-place in homebirths. Your midwife will have with her a doppler which may be used in the water if you are planning a waterbirth. It is common place for midwives to check your baby’s heart rate every 30 minutes in labour and more often if they feel that there is a problem. If your midwife suspects that your baby is distressed, she’ll arrange for you to be transferred to hospital where she will remain with you every step, providing advice, reassurance and support.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Test leads to needless C-sections

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

Link

My patient needed to be delivered. She had just developed eclampsia … She had suffered a seizure and dangerously high blood pressure …

… we gave medication to start labor, and the nurses placed a fetal heart monitor.

… the ultrasound monitor would play a crucial role in the hours to come. It prints a read-out strip of the baby’s heart rate, and the pattern would guide us in determining whether the delivery would be natural or through cesarean section.

… the baby’s heart-rate strip showed worrisome changes soon after labor began, and I knew it would get worse as labor progressed. We would fight through the night to have a natural delivery. But ultimately that single heart-rate test, which is surprisingly unreliable, would be a key factor in whether my patient would get a C-section or not.

… bad fetal heart strips are an important cause of high cesarean section rates …

… For the worst readings, we believed every second counted and rushed the surgery: If the baby wasn’t delivered one minute from the first incision into the skin, we had moved too slowly.

The complication we feared most was … the baby not getting enough oxygen during labor [which] could result in a serious permanent injury, such as cerebral palsy, or even death.

No test is perfect. But almost every time we whisked a mother back to the operating room, and I cut through skin, fat, fascia, and finally the muscle of the uterus, expecting a blue, floppy baby, the child I delivered emerged pink, healthy, and a little bit angry.

Were we saving lives and averting disaster? Or were we performing unnecessary surgery?

Fetal heart-rate monitoring is a screening test. Good tests get several things right: they are cheap, detect a possible problem when there is still time to act, and minimize unnecessary follow-up tests.

… fetal heart monitoring is an appallingly poor test. The test misses the majority of babies with cerebral palsy, the condition researchers hoped it would prevent. It causes increased rates of a painful and invasive surgery: cesarean section …

The odds of my patient’s baby suffering from dangerous lack of oxygen were slim … only 1 of 500 babies with a bad strip had cerebral palsy … it remained unclear if the condition had developed before labor, in which case cesarean couldn’t prevent it.

… fetal heart monitoring failed to reduce perinatal mortality … and increased cesarean section rates and forceps deliveries, compared with listening to a baby’s heart rate intermittently.

As a medical student, I loved watching emergency cesarean sections. The baby’s heart rate went down, doors swung open, residents rushed the patient down to the OR, and a frantic minute or two of surgery later, a screaming baby was out … I never questioned the need for the surgery.

Now, cesarean sections for bad tracings are one of the least satisfying parts of my job.

… “A test leading to an unnecessary major abdominal operation in more than 99.5 percent of cases should be regarded by the medical community as absurd at best,” … “Electronic fetal heart rate monitoring has probably done more harm than good.”

Why do doctors cling to continuous fetal heart monitoring? An obstetrician will most likely point to the fear of being sued, but the complete answer is more complex. Our medical culture prizes technology and tests, even if they don’t work and can cause harm.

… I struggled with my patient’s bad fetal heart strip. I wanted her to avoid a cesarean section. She had type 1 diabetes, and I expected her sugars to swing wildly after surgery, and her recovery to be slow.

… Finally, at 3 a.m., I felt compelled to recommend cesarean … My patient’s child greeted the world pink and well-oxygenated.

The test was wrong again.

Melissa Maimann, Essential Birth Consulting 0400 418 448

FAQs

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

changes to medicare obstetrics

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

waterbirths in sydney

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

antenatal classes sydney and independent childbirth educators sydney

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

can i refuse use of forceps

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

can you go public if you have phi maternity

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

caseload midwifery and homebirth

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

cost of a private midwife sydney

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

how will homebirth be affected by the health reform australia 2010

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

which is safer hospital or midwife?

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

can I have a waterbirth after a caesarean?

Of course you can!

Melissa Maimann, Essential Birth Consulting 0400 418 448

The Mother Friendly Childbirth Initiative

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

Link

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

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

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

The Mother Friendly Childbirth Initiative:

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

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

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

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

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

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

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

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

9. Discourages non-religious circumcision of the newborn.

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

Melissa Maimann, Essential Birth Consulting 0400 418 448

FAQs

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

home birth: how messy is it

Homebirth generally isn’t messy. Many women labour and birth in a birth pool and any bodily fluids are easily contained. Towels and plastic sheeting come in handy and midwives are very good at leaving the house as it was found. Plastic bags collect any garbage, the placenta is collected in a bowl or container, and sheets and towels can be washed.

midwives home birth still legal

Yes, it’s still legal and it will remain legal after July 2010.

how many hours a day do you spend breastfeeding

Breastfeeding can take a long time! Some women spend about 50% to 2/3 their time feeding, especially if it’s a newborn baby. Newborns can healthily feed every couple of hours for an hour at a time. This feeding pattern is helpful to encouraging the mother’s milk supple, allowing bonding to occur, help the baby’s palate and jaw muscles to form well and assist the baby’s digestion.

i would like a private midwife but im giving birth at a public hospital

Women may take private midwives with them to pubic hospitals. Women may book into hospital, have all their pregnancy care with their private midwife, birth in hospital with their midwife and hospital staff, and then return home to continue care with their private midwife.

in home birth, what happens if emergency c-section is needed?

In homebirth, midwives are always on the look out for any signs of things not going well in the pregnancy or labour. This allows for women to be seen by doctors or transferred to hospital before true emergencies occur. Most “emergency” caesareans are not in fact emergencies in that they are life and death situations. They most commonly occur because a labour is not progressing and the baby will not come out any other way. However, in the event that a caesarean is needed, the midwife and woman simply transfer to hospital and are offered the best obstetric and midwifery care possible in the circumstances. planning a homebirth does not commit the woman to birthing at home if circumstances make it that hospital would be safer.

what’s the difference between a midwife and obstetrician

Obstetricians are doctors who have completed a degree in medicine and a degree in surgery. They then complete several years of internship and residency before going back to specialise in obstetrics. An obstetrician is a highly trained and educated doctor who specialises in the care of pregnant and birthing women, mostly dealing with complications. Obstetrics is a surgical specialty.

Midwives are qualified to care for women throughout pregnancy, birth and postnatal. They care for healthy women who are experiencing normal pregnancies. If a woman’s condition warrants consultation with an obstetrician, this can be arranged without fuss. Midwifery care generally affords women lengthier consultations, more personalised care and a greater satisfaction with the birth experience. Women who
are attended by midwives are more likely to experience a normal birth, to breastfeed and to receive fewer interventions in their pregnancy and labour such as induction, epidural and episiotomy.

water birth private hospital

Good luck! Private hospitals (in Sydney at least) do not allow for water births. If anyone knows of a private hospital that allows waterbirths, please let me know! Nabmour allows waterbirths but it is not in Sydney.

how to avoid hospital birth

Well, if you don’t go to hospital, you can avoid a hospital birth. I guess the question is – how can you prepare well for a homebirth so that you minimise your chances of needing to go to hospital? I think an excellent approach is to book with a midwife and explain that you would really like her to help you to birth at home.

how to choose a midwife

See here.

limitations of using a private obstetrician for maternity care pregnancy

1. You’re more likely to have intervention in your pregnancy and labour
2. Your obstetrician is likely to work with other obstetricians, sharing on-call over the weekend. So it’s possible that your obstetrician will not be available to you when you’re in labour.
3. You will be attended by hospital midwives in labour and postnatally who you may not have met.

Melissa Maimann, Essential Birth Consulting 0400 418 448

FAQs

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

birthing centre epidural

It’s not possible to have an epidural in a birth centre. If you need an epidural, the midwife will move you to the delivery suite.

epidural private hospital

On the other hand, it’s very pssible to have an epidural in a private hospital. In some private hospitals, almost 90% women have an epidural.

gestational diabetes midwifery home birth

While it might be possible to birth at home with gestational diabetes, it’s best to speak with your midwife.

homebirth midwives central coast nsw

There are no homebirth midwives on the Central Coast. There is one who will travel up from Sydney.

midwife managed pregnancy Sydney

Private midwifery care will enable midwife-managed pregnancy care. With a private midwife, you choose your own midwife and she will provide all of your pregnancy, birth and postnatal care.

no intervention birth

No-one can guarantee no intervention in birth and also guarantee safety. Most births do not need intervention of any kind. No examinations, no induction, no epidural, no caesarean, no forceps or vacuum and so on. But some women, some babies, or some labours will occasionally need some help, and it can be hard to predict at the start of the pregnancy which ones might need help, and which ones are fine. The best strategy would be to contract a private midwife who you trust, and allow her to provide your care in partnership with you.

the right time for consulting mid wife during pregnancy

It’s best to consult with a midwife as soon as you find out you’re pregnant, especially if you’re choosing a private midwife as we tend to book out fairly fast.

Melissa Maimann, Essential Birth Consulting 0400 418 448

FAQs

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

Birth trauma symptoms

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

Some women experience:

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

    The msin benefits of using a midwife are:

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

    do you need informed consent episiotomy

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

    duty of care to an unborn child

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

    no obstetrician for birth in private hospital

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

    private birthing classes at home, Sydney

    Yes, this is possible. See here.

    will homebirth be legal after July, 2010?

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

    Birth providers who support vbac in sydney

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Netherlands: Epidurals on the increase

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

    I’m sad that it’s happening, even in the Netherlands. I understand the caesarean rate is around 25% too.

    A growing number of Dutch women are opting to have epidural anaesthesia during childbirth …

    The Netherlands has one of the highest rates of home births in the developed world. Around a third of all births take place at home. A similar proportion of pregnant women plan to give birth at home if all goes well, but on the basis of the midwife’s risk assessment they transfer to hospital during labour.

    The Dutch home birth system isn’t the product of any recent move towards de-medicalisation and natural birth – it’s simply that many Dutch women still give birth at home the way their grandmothers did …

    The Dutch midwives association argues in favour of seeing childbirth as a natural process rather than a medical condition. It points out that home births result in a much lower rate of unnecessary medical intervention, which is safer for both mother and child. However, in recent years the Dutch system has increasingly come under attack. Critics claim it is old-fashioned, and women are being denied proper access to pain relief.

    In 2008, the teaching hospital in Maastricht reported that 25 per cent of women opted to have an epidural. A year later this figure has risen to more than 30 percent … the Dutch epidural rate has a long way to go before it matches … some hospitals … [where] as many as 85 percent of women in labour opt for an epidural.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    2010 cost of home birth

    The current cost of homebirth in Sydney is somewhere between $3000 and $6000 but the cost may come down after November 2010 if Medicare benefits are extended to antenatal and postnatal care.

    Birthing hospital expenses

    Good question! If you are going through the public system and you have a Medicare card, it is free. If you have a private midwife, the cost can be anywhere between $3000 and $6000 (some private health funds will provide benefits for private midwifery and you may claim the cost via the net medical expenses tax off-set). If you are birthing in a private hospital, many people assume that their private health insurance covers all of the costs and are very surprised when the bills continue to come after the baby has been born. You can expect to pay for a private obstetrician (anywhere between $2000 and $10000 in Sydney), the private health fund excess or co-payment, ultrasounds and tests, paediatrician and anaesthetist fees. As well as incidentals such as parking at the hospital, TV, phone etc.

    Difference in childbirth with midwife and childbirth in a hospital

    Midwives attend all births in hospitals, even if you have an obstetrician.

    First time mothers and homebirth

    What a great decision! Discuss your situation with your midwife for more advice. Generally, first babies are ideal for home births. Why? Many first-time mums have caesareans in the hospital system. It’s about one in three. The rate with homebirth? A mere 5%. Why does this matter? Well, these days it’s very difficult to have a vaginal birth after a caesarean in the hospital system as the hospital system generally does not support VBAC, either covertly or overtly. So it’s really important that you optimise your chance of a natural birth with your first baby. Transfer can be more likely in a first labour, partly for reasons such as a long labour and the woman’s request to transfer for pain relief, or for other reasons such as high blood pressure. Your midwife will guide you as to whether transfer is necessary.

    Hospital midwife compared to private midwives

    A private midwife is bound by the same regulatory mechanisms as a hospital midwife is/ w e are all bound my a code of ethics, code of conduct, competency standards, we are all registered and are bound to comply with the various Acts such as the Poisons Act, coronial law, civil law, criminal law and the nurses and midwives act etc. the main differences between a private midwife and a hospital employed midwife, for you as a pregnant and birthing woman is as follows:

    - hospital midwives have the additional requirement of having to follow hospital policy. What is wrong with this/ some policies are not based on evidence, and some may be out-of-date. This of course creates safety issues for women. the other problem is that people generally don’t like to be treated “routinely”, they like individual care. this is where a private midwife is a real advantage: women can access evidence-based care and are treated as an individual.
    - the other benefit to having a private midwife – the main benefit – is access to continuity of care. private midwives birth with women at home or in hospital, either as a planned hospital birth, or as part of a homebirth transfer. continuity of care is beneficial to women and babies and has advantages such as enhanced breastfeeding rates, increased satisfaction from women with the service, fewer interventions in labour and birth, fewer admissions to the nursery and so on.

    Which is safer for baby repeat c section or vbac?

    This is a good one to discuss with your care provider. For a balanced appraisal, it would be worth seeking a consultation with a private midwife as well. generally speaking, repeat caesarean has risks for the baby in terms of breathing difficulties and later asthma, allergies and diabetes. VBAC on the other hand has a very small – 0.5% – risk of uterine rupture. When this statistic is put into the perspective of other risks with having a baby, it is a very small risk.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    What are the disadvantages of birthing in hospital?

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

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

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

    birthing options

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

    Can I have a midwife as additional support in pregnancy?

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

    midwife medical offset?

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

    midwifery care fees

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

    Are there any homebirth classed in sydney?

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

    access to rebate on midwife visits

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

    Are hospital births unnecessary?

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

    bowral midwife educator

    I’d recommend Peter Jackson’s Calmbirth classes.

    Can i have an epidural with a midwife?

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

    Can midwives administer oxytocin at a home birth?

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

    Cost of homebirths in the illlwarra

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

    Does having gestational diabetes mean a c section?

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

    Private midwife public hospital sydney?

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

    Pprivate midwives in Sydney’s east?

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

    Reasonable obstetricians north shore 2010

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

    What is the difference in cost between public and private?

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

    Transition into parenthood

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

    vbac north shore private?

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

    water birth private hospital sydney

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Maternal Death Rates are Up

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

    Link

    Death after childbirth remains a rarity … but new research suggests that the tragic occurrence is on the rise — and experts are at a loss to pinpoint the reason.

    … the United States places 41st on the World Health Organization’s list of safest countries for childbirth. As for 2006, 13 women out of every 100,000 died during or shortly after giving birth, which is higher than rates in Canada, the United Kingdom and Poland …

    That’s around 550 deaths out of 4 million annual births across the country.

    The federal government had set a goal to reduce maternal deaths by 2010, but the new numbers are four times higher than what they’d hoped to attain.

    Health experts aren’t pointing the finger at a specific cause, but they do hypothesize that more obese mothers might be a critical factor.

    The high caesarean rates aren’t an issue?

    Many maternal fatalities are caused by undetected health issues, such as asthma or heart disease …

    Pregnancy can exacerbate pre-existing health conditions, leaving obese women — who now make up 20 percent of pregnancies — more susceptible to potentially fatal consequences.

    … Cesarean sections might be another important factor. The number of women scheduling cesarean births has increased by 50 percent … since 1996 … the procedure is … major surgery.

    … most maternal fatalities aren’t considered “preventable” …

    … advocates hope to see more preventive efforts earlier in pregnancies. That means improved awareness of complications among pregnant women and better screening efforts by doctors, along with thorough postnatal care.

    No mention here of midwives, yet the WHO recommends that midwives are the most appropruate care providers for healthy, low-risk women.

    Debate also persists over the safety of out-of-hospital births … they’ve increased for the first time in two decades. The births still make up less than 1 percent of all births in the country, but home births in particular were up by 5 percent.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Couple sues Redcliffe hospital over stillborn baby

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

    Link

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

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

    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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    The mortality rate of California women who die from causes directly related to pregnancy has nearly tripled in the past decade, prompting doctors to worry about the dangers of obesity in expectant mothers and about medical complications of cesarean sections.

    For the past seven months, the state Department of Public Health declined to release a report outlining the trend.

    California Watch spoke with investigators who wrote the report and they confirmed the most significant spike in pregnancy-related deaths since the 1930s. Although the number of deaths is relatively small, it’s more dangerous to give birth in California than it is in Kuwait or Bosnia.

    “The issue is how rapidly this rate has worsened,” … “That’s what’s shocking.”

    … “current trends and evidence suggest that maternal mortality rates may be increasing in the U.S.”

    The alert asked doctors to consider morbid obesity, high blood pressure and diabetes, along with hemorrhaging from C-sections, as contributing factors.

    … Shabbir Ahmad, a scientist … decided to look closer. He organized … a systematic review of every maternal death in California. It’s the largest state review ever conducted. The group’s initial findings provide the first strong evidence that there is a true increase in deaths – not just the number of reported deaths.

    Changes in the population – obese mothers, older mothers and fertility treatments – cannot completely account for the rise in deaths in California …

    … scientists have started to ask what doctors are doing differently. And, he added, it’s hard to ignore the fact that C-sections have increased 50 percent in the same decade that maternal mortality increased. The task force has found that changing clinical practice could prevent a significant number of these deaths.

    … While the maternal mortality rate among black women is rising, the task force found a more dramatic increase in deaths among white, non-Hispanic mothers …

    … In 1996, the maternal death rate in California was 5.6 per 100,000 live births … Between 1998 and 1999, the World Health Organization changed its coding system, which may have increased reporting of deaths. The California rate was 6.7 in 1998 and 7.7 in 1999. Because the number of mothers who die is small, the rate tends to fluctuate from year to year.

    In 2003, when California revised its death certificate, the rate jumped to 14.6. And in 2006, the last year for which data is available, the rate stood at 16.9.

    … When researchers unveiled their initial findings to a conference of the American College of Obstetricians and Gynecologists in 2007, there were gasps from the audience … The idea that California was moving backward even in an era of high-tech birthing was implausible to some. Confirmation of the trend was noted in the 2008 report …

    The state of California has yet to share the report with the public. Researchers say that, after reviewing the report in 2008, officials in the Department of Public Health asked for technical clarifications. Revisions were complete and approved in the first half of 2009 …

    … it is important for the public to be aware now that these trends are worsening …

    “Even though they tend to be small numbers in terms of maternal mortality, it is important – it’s very important – that these trends be looked at,” she said. “And efforts need to be made to try and reverse them when they are going in the wrong direction.”

    Rising C-section birth rate

    Nearly one in three babies is now born by C-section. Many scientists have acknowledged that at some point, as the number of surgeries spiral upward, the risks will outweigh the benefits. But the C-section remains a useful tool, and in the middle of labor, doctors say, it’s hard to balance the potential long-term harm against immediate crisis.

    Today, doctors face a condition called placenta accreta, where the placenta grows into the scar left by a previous C-section. In surgery, doctors must find and suture a web of twisted placental vessels snaking into the patient’s abdomen, which can hemorrhage alarming amounts of blood. Often, doctors must remove the uterus.

    Main said this complication from C-sections has increased eight-to-10 fold in the past decade. Nonetheless, most women survive the ordeal … the rise in deaths is indicative of a larger problem.

    “For every maternal death, there are 10 near misses; for every near miss, there are 10 severe morbidity cases (such as hysterectomy, hemorrhage, or infection), and for every severe morbidity case, there is another 10 morbidity cases related to childbirth,” …

    Inducing labor before term more common

    … Dr. David Lagrew … noticed that a lot of women were having their labor induced before term without a medical reason. And he knew that having an induction doubled the chances of a C-section.

    So he set a rule: no elective inductions before 41 weeks of pregnancy, with only a few exceptions. As a result, Lagrew said, the operating room schedules opened up, and the hospital saw fewer babies admitted to the neonatal intensive care unit, fewer hemorrhages and fewer hysterectomies.

    All this, however, came at a cost: The hospital had to take a cut in revenue for reducing the procedures it performed. Lagrew doubts that any hospital has increased its C-section rate in pursuit of profit, but he does note that the first hospitals to adopt controls on early elective inductions have been nonprofits.

    According to a report issued by the advocacy group Childbirth Connection, “Six of the 10 most common procedures billed to Medicaid and to private insurers in 2005 were maternity related.” On average, a C-section brings in twice the revenue of a vaginal birth. Today, the C-section is the single most common surgical procedure performed in the United States.

    “If all these guys were losing money on every C-section, well, what’s the old saying? Whenever they tell you it’s not about the money, it’s about the money,” Lagrew said.

    The California task force isn’t waiting to determine the ultimate cause of these deaths. It has started pilot projects to improve the way hospitals respond to hemorrhages, to better track women’s medical conditions and to reduce inductions …

    I think they’ve missed one key element: midwives! If every woman was cared for by her own midwife (and home birth and birth centre birth was encouraged as the norm for healthy women), the induction and caesarean rates would fall dramatically …. then maybe fewer women would die in childbirth.

    Midwifery has an important focus on health promotion and education and would work fantastically for poorer women and women with health issues. The other priority ought to be raising the VBAC rate and reducing the number of elective repeat caesareans. Whilst the first caesarean might be safe, second and subsequent caesareans carry serious risks that are alluded to in this article.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

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

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

    Link

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

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

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

    But it isn’t a simple call.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Planned home births may have a low rate of complications …

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

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

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

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

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

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

    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

    Excess weight raises pregnancy risks: study

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

    Link

    Being overweight or obese increases a woman’s chances of having an extra-big baby …

    Excess weight in and of itself also sharply increased a woman’s risk of pre-eclampsia …

    Women have more difficulty delivering very large babies, while these newborns are also at risk of suffering injury during birth, including shoulder dislocation. While women who are overweight or obese are known to run a greater risk of having very large babies and experiencing other pregnancy complications, it has been difficult to separate out the effects of a mother’s weight from those of gestational diabetes …

    This led them to investigate whether BMI … a standard measure of weight in relation to height used to gauge how fat or thin a person is — might influence pregnancy risks and fetal and newborn health, independently of a woman’s blood sugar levels.

    … women with BMIs of 42 or greater … were at more than triple the risk of having an excessively large baby, compared to the thinnest women in the study …

    The heaviest women’s risks of having a C-section were more than doubled, while their likelihood of pre-eclampsia was 14-fold greater than for the leanest women …

    … dietary changes can effectively treat gestational diabetes for more than 90 percent of women with the condition.

    “… treating gestational diabetes going forward is going to continue to be beneficial,” the researcher said. “We have much less evidence at this point as to how to neutralize or reduce the impact of overweight on pregnancy outcome.”

    … it’s probably a woman’s weight before she gets pregnant, rather than how much she gains during pregnancy, that’s important in determining risk.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Caesarean births risk mums’ lives

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

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

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

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

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

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

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

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Midwife-developed care package shortlisted for award

    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 care package for early labour, which centres on midwives giving plenty of one-to-one time to women who are in the latent phase, has been shortlisted for an award.

    The package, called “Getting it right at the very beginning”, has been shortlisted for the “Research into Practice” category of the 2010 Royal College of Midwife Awards.

    … “Not only have we had very positive feedback from the women who received the care, but midwives have also seen the benefits.”

    11 per cent gave birth without any pain relief and 21 per cent used paracetamol to take the edge off the pain … and more women used natural pain relief like a birthing pool or bath.

    Of the group that received the care package, 73 per cent had a normal birth, without any clinical interventions. The Caesarean Section rate was 13.5 per cent.

    This compared with a 37.5 per cent normal birth rate for the women who didn’t have the early targeted support, and a Caesarean Section rate of 37.5 per cent.

    The care package is a set of six proven actions which work in harmony to benefit the outcome of the labour and give women a positive birth experience.
    * L – Look and Listen;
    * A – Assess maternal observations;
    * T – Time;
    * E – Encouragement;
    * N – Non-pharmacological pain relief;
    * T – Telephone

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Home birth advocate slams health service check-up

    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 … home birth advocate says she cannot excuse the … Area Health Service for calling in police to check on a pregnant woman.

    Rochelle Allan, who wanted a home birth and did not want to be induced, was nearly 14 days overdue when she missed an obstetrics appointment.

    … the police were sent to Ms Allan’s home on Friday to conduct a “welfare check” because the midwives could not reach her by telephone.

    … the actions of the hospital staff will not be investigated because they had the best intentions and were concerned for Ms Allan.

    … a woman should be able to make her own birth choices without someone looking over her shoulder.

    “The hospital, they’re service providers, they’re not a regulatory body for pregnant women,” …

    “These checks … they’re not mandatory, so it’s entirely up to that woman if she chooses to attend those hospital checks or not.”

    … Ms Allan had the baby at home … with a private midwife.

    Interesting situation. The hospital owes a duty of care to its patients. If it had failed to conduct a “welfare check” and the woman’s baby had died, the news report would read that the hospital was grossly negligent and how could they allow this to happen? It’s been my experience that these situations can be managed very well by the midwife and woman being upfront with the hospital about the intentions of the woman. When this happens, the hospital is satisfied that the woman is receiving care and sees no reason to send the police around. Some people have questioned the use of police services for this purpose however the hospital staff are generally not permitted to attend patient’s homes in these circumstances.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Mother loses baby after being given ‘abortion’ drug to induce labour

    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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    The death of Sofia Figus three days after she was born was caused by a lack of oxygen … Her mother Anne … was 12 days overdue when she was prescribed Misoprostol – a drug widely used in abortion clinics – to bring on contractions.

    Mrs Willicombe and her husband … are now suing the … Hospital … for failing to monitor the baby …

    Misoprostol is only licensed … for the treatment of stomach ulcers. Under official guidelines … it should not be used to induce labour unless as part of a clinical trial.

    … the drug … is cheaper than other methods to induce birth …

    Belinda Phipps, chief executive of the National Childbirth Trust, said she was “absolutely incredulous” that any hospital would give the drug to women …

    She said: “This drug is not licensed for use in labour, and the NICE guidance is categorical on that point. In this country, misoprostol should only be used in labour if the baby is already dead, or after the birth, because otherwise the risks are simply too great.”

    Mrs Willicombe was not informed the drug was only recommended for use in clinical trials – and nor was she told that she was taking part in any trial.

    “I just remember them being very reassuring and saying this drug is fine,” …

    … Mrs Willicombe … was not properly monitored and was treated in a room unsuitable for what should have then been classified a high-risk birth.

    Within 10 minutes of being given the drug … her waters broke – almost certainly naturally because it was too soon for the Misoprostol to take effect. About four hours later, she was given a second dose leading to contractions which then became more frequent …

    … The mother-to-be was moved from the maternity ward to the delivery suite but then placed in a room … without proper monitoring equipment … The midwife then ordered Mr Figus to hit the alarm button. A team of doctors raced in to deliver the baby, the first time Ms Willicombe realised her dream of a first child was turning into her worst nightmare.

    “She just came out blue and lifeless,” recalled Ms Willicombe, “She was completely floppy. They held her up very briefly for us to see her and then took her away to resuscitate her … she … suffered severe brain damage due to a lack of oxygen … we agreed to take her off the ventilator. Three days later she died.”

    … a coroner in east London concluded Sofia had died of natural causes as a result of neglect.

    Their lawyer … said: “It appears clear that Mrs Willicombe received substandard monitoring during her labour with Sofia. This substandard monitoring also needs to be put in to the context of the use of an unlicensed drug which is known to have the side effect of uterine hyperstimulation. It appears that Sofia’s death could have been avoided, had the monitoring been appropriate.”

    … ” … it was not the drug which led to complications for her mother, but rather the failure of a midwife to provide proper supervision during labour … That midwife has … been dismissed …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Inducing labor may lead to more C-sections

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    Pregnant women tempted to induce labor for convenience rather than medical necessity may want to wait for nature to take its course.

    … inducing labor introduces a risk of 1 to 2 cesareans per 25 inductions that might have been avoided by waiting for spontaneous labor to begin.

    … C-sections are major surgeries, and carry risk of infection, bleeding, blood clots, and injury to other organs …

    … all labor induced groups faced increased risk for C-section, except for those women delivering after 39 weeks.

    … pregnant women and their doctors may be better off waiting for spontaneous labor. “Try to reserve interventions for situations where risk outweighs benefit,” said Glantz, such as in cases of diabetes, high blood pressure, problems with the placenta, a baby that is not growing well, or a woman being 10 days past her due date.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Rise in induced births worries doctors

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    ONE in three pregnant women in NSW has her labour induced – a rise of at least 15 per cent in the past 10 years – with almost half of inductions done without a medical reason.

    The World Health Organisation recommendds that inductions may be necessary in up to 10-15% of women. Clearly, our induction rate is two to three times higher than it ought to be … or alternatively, 50% – 67% of the inductions that are currently performed are not strictly necessary.

    Inducing labour, where women are given drugs such as oxytocin or prostaglandin to stimulate the cervix and start contractions, can increase the chances of a caesarean delivery or cause complications for both mother and baby.

    Both drugs also make labour more painful because contractions are stronger and longer, leading women to require more analgesia and more time to recover after the birth.

    In a study of more than 730,000 births between 1998 and 2007, researchers … were alarmed to find that half of those having inductions were pregnant with their first baby, a move which could change the way any subsequent births were handled if the induction resulted in a caesarean delivery.

    … one-quarter of women given both oxytocin and prostaglandin had caesareans , compared with 19 per cent of those given prostaglandin alone and 15 per cent who had oxytocin.

    The main reasons cited for induction were pregnancies of 41 weeks … hypertension and diabetes, but 45 per cent of women had no medical reason for being induced.

    In the past decade the number of inductions carried out on women with hypertension or diabetes rose from 6 per cent to 22 per cent, a result which could be attributed to Australia’s the obesity epidemic, an increase in older mothers and better antenatal screening.

    … inductions in private hospitals had increased from 18 per cent to 27 per cent.

    … too many inductions were being performed on pre-term women in hospitals that lacked neonatal respiratory support facilities, despite most premature babies needing help with breathing …

    … doctors in Queensland … predicted surgical births would soar in the next decade because one-third of women having their first babies were having [a caesarean] …

    I believe that if the role of the midwife in primary materntiy care was widely supported, we would see a dramtic reversal of the induction and caesarean rates.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Late pre-term babies not out of woods

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    When Tom Cavaliero arrived at the neonatal intensive care unit with his newborn a few weeks ago, he felt like he’d brought in Andre the Giant.

    The other babies in the NICU … were a fraction of the size of Gunner, who weighed 7 pounds, 8 ounces.

    Still, Gunner’s entry into the world was not easy. For a week, a maze of feeding tubes and oxygen lines weaved around him as he struggled to breathe.

    … Gunner is an example of a bigger wave of babies born too soon.

    In the United States, the rate of premature births rose by more than 20 percent from 1990 to 2006, with the largest increase in babies born when the mother was 34 to 36 weeks pregnant …

    These babies, some 70 percent of the premature population, fare better than the 1- and 2-pound infants born earlier. But they often have more problems breathing, feeding and maintaining their body temperature than full-term babies.

    They also have a greater risk of dying.

    … over the past decade, doctors have increasingly induced labor early or conducted a cesarean before full term.

    The percentage of induced late preterm births more than doubled between 1990 and 2006, from 7.5 to 17.3 percent … The percentage of late preterm births delivered by cesarean rose by 46 percent, from 23.5 to 34.3 percent.

    There are many medical reasons for a baby to be delivered early: the mother’s blood pressure is too high, or the baby has stopped growing, or the sac of protective fluid around the baby has ruptured.

    But health officials say there are plenty of non-legitimate reasons, too: a family wants a baby born before a father deploys, or when a relative is available to help out, or before the doctor goes on vacation.

    Health care providers have even heard of families who want a baby born before the end of the year for a tax deduction. Sometimes the expectant mother is just tired of being pregnant.

    A committee called OB Right … has been working … to bring down the rate of unnecessary early inductions.

    In 2005, Sentara Norfolk General Hospital and Sentara Leigh Hospital began to require medical documentation from doctors who schedule an induction or cesarean before 39 weeks of pregnancy. Tests must show that the baby’s lungs are mature enough or that there is a medical reason for early induction …

    “We have better outcomes, less respiratory and transitioning issues,” said Diana Behling, who manages OB Right. “The longer we can keep the baby inside the mother, the less risk for the baby.”

    … Over time … families and health care providers have become more aware that the policy is about protecting a baby’s health.

    Virginia Health Information … released a database … that … shows the cesarean rates of hospitals and doctors. Those statistics show that cesarean births statewide went from 22 percent of all births in 1996 to 35 percent in 2007 …

    If that trend continues, by 2016 half the births in Virginia will be by cesarean. Federal health goals call for a rate of 15 percent.

    The American College of Obstetricians and Gynecologists made guidelines more stringent … to clarify when babies should be delivered before 39 weeks …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Feedback on our maternity system

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

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

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

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

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

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

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

    47% … said there was a shortage of midwives …

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

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

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

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

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Campaign to promote natural births

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    The NHS … has launched a campaign to promote normal births, to try and decrease the number of medical interventions.

    Promoting normal births has been highlighted … to improve patient care …

    … the proportion of births by Caesarean Section has been increasing … In 1989/1990 around 12% of all births were done by CS, whilst by 2005/6 that rate has doubled to 24%.

    Boon Lim is the Chair of the Maternity and Newborn Programme Board of NHS East of England. He told Heart some of the benefits which come with a natural birth: “Be able to get home earlier, and be able to care for the babies in a better position rather than having to contend with having an operation to deliver their babies.”

    “Every woman in the east of England is entitled to receive the highest quality care and support to give her the best chance of a straightforward pregnancy, a positive birth experience and a happy and healthy baby. We are committed to promote normality of birth and guarantee women a choice of where to give birth, based on an assessment of safety for mother and baby.” …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Doctor tells of babies deaths delivered by Ventouse vacuum

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    A SENIOR obstetrician held back tears while recalling the deaths of two newborns she delivered using a Ventouse “vacuum” machine.

    [The doctor], who has delivered more than 2000 babies, yesterday told the Coroner’s Court she had since changed her delivery methods and now “prefers to use forceps” when a baby shows signs of distress.

    The court yesterday heard the babies died of multi-organ failure following a “massive” subgaleal haemorrhage, which may have been caused by the Ventouse machine …

    [The doctor] said she used the procedure when she needed to get the baby out quickly”…

    Subgaleal haemorrhages are more likely to occur when the Ventouse is used, but it is rare for them to be fatal.

    Two midwives … told the court the vacuum setting of the machine was correct at all times during the deliveries …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    One in Three Women Infertile After Caesarean

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    A study … has found that almost half of all women who have a caesarean section … for their first child, don’t have any more children. Of these, one in five have chosen not to have more children because they are too traumatized by the surgery and one in three are physically unable to because of caesarean-caused infertility problems.

    The rate of post-traumatic stress disorder was six times higher than in first time mothers who had given birth vaginally …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Secret report damns safety of model home birth service

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    A leading midwifery service specialising in home births was investigated over concerns that it had ten times the normal rate of babies born with serious complications such as brain damage …

    The Albany practice, an independent group in South London held up as a model for the midwifery sector, had its contract with the NHS terminated after an inquiry into alleged poor practice over 30 months.

    … Parents … marched to the Department of Health yesterday to protest at the termination of Albany’s contract … They claimed that it was a flawed analysis that had been withheld from the public.

    The Government has sought to increase midwife-led and home birth NHS services to address the over-stretched maternity sector.

    Women are supposed to be offered the choice of a home birth, but only 3 per cent of births take place at home …

    The report … reveals that the hospital identified 11 cases of hypoxic ischaemic encephalopathy (HIE) … in the two and a half years …

    … “[King’s] identified the number of admissions of term infants with serious complications … was comparatively ten-fold greater amongst women under the care of the Albany Group Practice than women cared for by other King’s midwifery group practices or by hospital midwives”.

    The report … concludes that “risk factors for a poor outcome in pregnancy were being overlooked by Albany midwives”, and that home births were sometimes being encouraged when not medically appropriate.

    However, it does not recommend the termination of the service …

    Supporters of the Albany consider the hospital’s actions an attack on independent midwifery …

    Statisticians and clinicians shown the report also raised concerns about its methodology and the use of HIE as a guide to the quality of care. … they suggested that it was based on “bad science”.

    Questions have also been raised as to why the inquiry remains confidential and why it was not carried out in conjunction with the Care Quality Commission, the health regulator.

    Professor Alison Macfarlane … said the report did not include proper assessment of birth rates … or additional risk factors … “They haven’t attempted to look at it statistically. There are no rates per babies, only numbers, so you cannot compare like with like.

    … Mavis Kirkham, Professor of Midwifery at Sheffield Hallam University, said the report was “bad science and fundamentally flawed” for reasons including the problems with diagnosing HIE.

    She pointed to the lack of acknowledgement of success rates, with Albany’s mortality rates for infants at 4.9 per 1,000 compared with the wider borough of Southwark’s 11.4 per 1,000.

    The Albany investigation was prompted by the death of Natan Kmiecik one week after he was delivered at the hospital by Albany midwives. Lawyers for his mother … claimed that proper procedures were not followed because Natan’s heartbeat was monitored only by a small hand-held device so she could have a water birth.

    A hospital spokesman said the report underlined the need for closer monitoring of midwifery and denied claims that it reflected an aversion to home births

    “While the report reinforced our view of the excellent relationships formed between Albany midwives and their expectant mothers, it also highlighted serious shortcomings in terms of non-compliance with [hospital] trust policies and risk management procedures, particularly during labour and with newborn babies,” he said.

    “We felt this was an unacceptable level of risk for our patients and were unhappy with the nature of the contractual arrangements. Therefore a decision has been taken to terminate our contract with Albany.”

    … “the report should be made public so all those involved — not least the mothers — know why this action has been taken,” …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Assisted Delivery More Common for Moms with Low Thyroid Levels

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    Otherwise healthy moms with low thyroid levels during the final weeks of pregnancy face an increased risk of abnormal fetal presentation and of requiring assisted delivery …

    Women whose babies presented in the normal anterior position at birth had significantly higher free thyroxine levels than women whose babies presented abnormally … They were also more likely to have a spontaneous delivery …

    … ” … this is the first study showing an association between maternal FT4 concentration during late gestation and cephalic fetal head position in healthy pregnant women with normal thyroid function,” …

    Earlier research had attributed abnormal fetal presentation to improper rotation during labor, but more recent research suggests it’s a failure to rotate at all that may cause the abnormal presentation.

    Thyroid dysfunction is associated with poor obstetrical outcomes, including abortion, stillbirth, preterm delivery, and even neonatal arrhythmia.

    Abnormal fetal presentation occurs in up to 25% of congenital endocrinological syndromes …

    Low thyroid hormone levels influence muscle tone and neurological reflexes, which, in turn, influence motor skills. The researchers hypothesized that low thyroid levels could influence fetal motor skills and ability to navigate the birth canal …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Home birth service closed as report claims midwives put babies at risk

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    A pioneering home birth service has been axed amid concerns it had 10 times the normal rate of babies born with serious complications such as brain damage.

    The Albany practice, an independent group in South London previously described as a “gold standard” for the midwifery sector, had its contract with the NHS terminated after an inquiry into alleged poor practice over 30 months.

    The move has prompted a campaign by the group’s supporters, who … claim the service was terminated because NHS managers preferred hospital births. Under the Albany group, all women have their babies delivered by the first midwife they see during their pregnancy, with almost half giving birth at home.

    … a spokesman for King’s College Hospital, which commissioned the report … defended the decision.

    … “While the report reinforced our view of the excellent relationships formed between Albany midwives and their expectant mothers, it also highlighted serious shortcomings in terms of non-compliance with [hospital] trust policies and risk management procedures, particularly during labour and with newborn babies.”

    The report revealed that the hospital identified 11 cases where brain damage was caused by a lack of oxygen and blood to the brain … It concluded that “risk factors for a poor outcome in pregnancy were being overlooked by Albany midwives”.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    The Labor Market

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    Expectant parents, spare a thought for Mrs. Jacob Nufer, who in 1500 found herself in agonizing labor. More than a dozen midwives … tended to her for days, with no sign of the baby. Facing the likelihood of losing mother and child, and in the absence of any surgeons, Mrs. Nufer’s husband, a swine gelder, decided to cut her open and extricate his offspring. Because there had, at this time, been no known incidence of a woman surviving such a procedure, the couple would have said what were assumed to be their last goodbyes before Jacob Nufer made the first incision.

    As it turned out, mother and baby lived. While it would be nice to say that this had something to do with Mrs. Nufer’s constitution or her husband’s skills with a knife, it was almost certainly because Mrs. Nufer’s pregnancy was extrauterine — a freakishly rare form of gestation in which the baby grows outside the womb, in this case probably in the abdomen. Had the baby been inside the uterus … Mrs. Nufer would have bled to death when the uterine wall was breached … Mrs. Nufer’s is generally accepted as the world’s first completely successful cesarean, or C-section.

    Five hundred years later, surgical delivery seems as trifling as tooth extraction. In Chile … 40% of all births are in the operating theater. But larger populations in Asia mean that greater numbers of C-sections are performed in this region, particularly in South Korea (36.4% of all births in the first half of 2006), Taiwan (with a rate of roughly 33%) … “I’ve seen statistics from Bangkok General Hospital that suggest the national rate is as high as 65% of all births.” …

    Because cesarean delivery is associated with higher maternal mortality and other health issues, these figures are alarming to some medical practitioners and natural-childbirth advocates … Their concern has been exacerbated by statistics recently released in the U.S., showing an increase in the cesarean rate … coinciding with a rise in maternal mortality … For every 100,000 births in the U.S. in 2003, 12.1 women died — the first time the figure exceeded 10 in 26 years. The number rose to 14 in 2004. Figures for 2005 and 2006 are being compiled. After a decade’s study of cesarean birth, Professor Eugene Declercq … cautions against giving too much weight to the cesarean-mortality connection, but concedes that “there is some evidence of higher maternal mortality rates in cases of cesareans to low-risk mothers,” and suggests that a woman contemplating a C-section should ask herself why she should undergo major surgery “when she and her baby are healthy.”

    Nobody questions the rightness of cesareans performed in a medical emergency (which account for up to 20% of the total), but those made simply at the request of the mother, known as “elective cesareans,” are associated with a number of pitfalls. Before these are addressed, however, it is worth remembering that vaginal delivery is not always an appealing alternative.

    Utter the phrase “natural childbirth” and the mind envisages a stoic and earnest woman, surrounded by murmuring midwives in a softly lit room, where ambient music plays and tea lights flicker. Upon the elapse of some decent, manageable labor, she pushes out her baby with honest grunts. While that may be true for some, for most women natural childbirth is one of the most violent physical traumas they will ever experience … it can easily be 20 hours or more. During that time, she is wracked by contractions — … violent spasms that take hold when the body reflexively tries to squeeze a baby through a narrow vaginal opening. The forces involved are such that when the baby’s head emerges, it can do so with sufficient pressure to rip the mother’s perineum … the act of giving birth resembles a medical emergency — in fact, if no medical intervention of any kind were made, up to 1 in 67 women would die in labor. Fear of birth pain is thus legitimate and it is no wonder that many women elect to have C-sections — especially when the procedure is over in about 40 minutes and feels no more uncomfortable, in the words of an anesthetist in one of Hong Kong’s top maternity hospitals, “than someone rummaging around in your tummy.” …

    Wow, what can I say?? How can birth ever be considered to be violent when it is a natural process? Perineal tearing is not necessarily a part of natural labour when the woman is encouraged to choose the position that is right for her, and to push or breathe as her body tells her to. I agree that tearing is a common occurence when women are directed to push thewir babies out while lysing on their backs in bed, with directed pushing and breath-holding, buw when this process is managed naturally, perhaps with the aid of water birth, tears are not a normal finding.

    A caesarean is not no more uncomfortable than having someone rumaging around in ones abdomen: women who have caesareans do have epidural or spinal or general anaesthetic. Without this, the surgery would be excruciating.

    “You often hear people express the wish to have a less painful delivery,” … “They may also want some predictability in the time and day the baby is born” …

    Granted, but life is not predictable and we do not opt out of living!

    Cesareans are not without drawbacks however, and they begin the moment the last stitches are made in the stupefied patient’s lower belly. The WHO recommends that babies be breastfed within an hour of birth, because vital antibodies and protective proteins — in effect, the baby’s first immunizations — are delivered through those precious early drops of milk. But, as Dr. Atwood points out, breastfeeding “is difficult to do if you are coming out of anesthesia …

    In the days following a C-section, a woman will be at an elevated risk of potentially fatal blood clots or infections … more women die as a result of cesarean section than in natural childbirth … 12.1 maternal deaths per 100,000 births … becomes 36 if only cesareans are considered — and the difference … is “attributable to the surgery itself, not any complications that might have led to the need for surgery.”

    … as a woman contemplates future children, she may face the possibility of reduced fertility … women who had cesareans were almost four times more likely to have problems conceiving again, compared to women who gave birth naturally. The former will also experience increased risks of ectopic pregnancy and placenta previa or accreta … And because many doctors will not permit a woman to undergo natural childbirth once she has had a cesarean … it is likely that her subsequent children will also be surgically delivered, multiplying all of these risk factors each time. “If there is no medical reason to have a C-section, we would advise [women] to have a vaginal delivery,” …

    In Thailand, the pleas of natural-birth advocates do not find a large audience. “It’s like pushing a stone uphill,” … “… It’s very easy to get a C-section in Thailand …” … “If you use the term ‘natural birth’ here, people think it means you have to go sit in a paddy field to have your baby.” Cesareans, she says, “have become very fashionable, especially among middle-class women” A third of the babies at Bangkok’s private Samitivej Hospital … are delivered by C-sections, even though its birth unit was set up … to promote natural childbirth …

    … “I blame the obstetricians,” … “They don’t give women confidence in their bodies … They create an environment of fear around birth …” … C-sections are common because “doctors have no patience. Most doctors want to end the birth quickly.”

    … It may become something akin to a rite of passage … When … patients choose to give birth naturally, even to the extent of refusing painkillers, “it’s like they’re climbing Everest without oxygen,” … “They feel very powerful.” And so they should — even if the real climb begins after the baby is born, naturally or not.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Screening, Education And Intervention Tools To Prevent Preterm Birth

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    A gathering of the nation’s leading maternal-child and quality assurance health care experts will review and develop programs that may help lower the nation’s costly preterm birth rate.

    Attendees will review existing programs … that successfully lower cesarean section and induction rates and improve care and services for pregnant women and babies. Some of the highlighted programs will be:

    * Intermountain Health Program … reduced its elective c-sections to less than 5 percent from more than 30 percent.

    * Hospital Corporation of America … implemented an integrated quality improvement program … and reduced the primary c-section rate, lowered maternal and fetal injuries and reduced the cost of obstetric malpractice claims 500 percent.

    * Geisinger Health System … developed an electronic health record to ensure pregnant women are screened for chronic conditions and risk factors that can be treated proactively, lowering the risk of preterm birth and other complications.

    Preterm birth is a serious and costly health problem, and is the leading cause of death in the first month of life in this country … the rate has increased more than 20 percent in nearly 20 years. Babies who survive an early birth face serious risks of lifelong health problems, including learning disabilities, cerebral palsy, blindness, hearing loss … RDS, feeding difficulties, temperature instability, jaundice …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Women Miscalculate Time to Full-Term Birth

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    I don’t agree with the suggestion that it is women who miscalculate the time to full term. While some may believe that a baby is “full term” from 37 weeks onwards, it is the obstetrician who agrees to the induction or caesarean prior to 39 weeks. I’m not comfortable with the implication that if a baby is born electively prior to 39 weeks, that it is the woman’s fault.

    … the rate of preterm deliveries continues to climb … a new study suggests one reason … many women are confused about what constitutes a full-term birth …

    … one-quarter of new mothers surveyed … considered a baby born at 34 to 36 weeks of gestation to be full term, while slightly more than half of women considered 37 to 38 weeks full term.

    Though technically speaking, preterm births are babies born prior to 37 weeks, 39 to 40 weeks is optimal …

    Many women interviewed were also unaware that babies born even a little bit premature are at a higher risk of serious health problems compared to babies born at term …

    … “The data is becoming more and more clear that the outcomes of births at those earlier gestational ages are not as good as babies that are born at 39 or 40 weeks.”

    … any delivery short of 39 weeks puts a baby at higher risk of respiratory distress, sepsis… and needing to be placed in the neonatal intensive care unit …

    … the percentage of babies born preterm rose by more than 20 percent from 1990 to 2006 …

    … the World Health Organization … defines preterm births as babies born before 37 weeks. But that definition … is outdated … studies have shown that babies born … at 37 or 38 weeks have a greater chance of chronic respiratory disease and learning disorders than children born at 39 weeks or later.

    Babies born between 34 and 37 weeks are six times more likely to die during their first week or life and three times more likely to die during their first year than babies born at 39 or 40 weeks …

    … The last few weeks of gestation are critical to fetal development. All of the organs continue to mature in preparation for moving from the womb to the outside world … between 35 and 40 weeks, the fetal brain grows by about 50 percent …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Faithful Mothers Have Healthier Babies

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

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    … pre-eclampsia … was found to be less common in women who had long-term sexual relations exclusively with the biological father, than in those who had been with their partner only for a short time …

    … women who had undersized babies … were also more likely to have been in shorter relationships …

    … “in normal pregnancies … prolonged exposure of the female immune system to paternal antigens following intercourse … [could induce] tolerance of the maternal immune system to the paternal antigens. But the exaggerated maternal inflammatory response in pre-eclampsia is due to a failure of the maternal immune system to down-regulate or tolerate its response to paternal antigens.” …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Late Preterm Births Increasing in U.S.

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    The percentage of babies born preterm in the United States rose by more than 20 percent from 1990 to 2006 …

    … “Late preterm birth … just before term at 34 to 36 weeks of gestation, have increased quite dramatically over the last decade and a half,” …

    … Overall, the rate of preterm births increased from 6.8 to 8.1 percent, according to the report.

    The number of late preterm births resulting from induced labor or cesarean delivery has also increased … induced late preterm births more than doubled between 1990 and 2006, from 7.5 to 17.3 percent … The percentage of late preterm births delivered by cesarean rose by 46 percent, from 23.5 to 34.3 percent.

    … “Studies have found increases in later preterm deliveries that are medically indicated, but other studies have found that there are some late preterm deliveries that are happening where there do not appear to be any medical reasons for the delivery,” …

    Improved technology has made identifying infants in distress easier, and that has also contributed to the increase …

    The rising rate of late preterm deliveries concerns health experts because the babies are not as healthy as babies delivered at full term …

    … “They are more likely to be delivered with respiratory problems. They have a higher death rate. They are more likely to have long-term neurological developmental problems, compared with infants delivered later.”

    … Facing a potential problem … a doctor is inclined to deliver the baby rather than try to manage the problem in utero until the baby reaches full term.

    But no infant should be delivered preterm unless there is a medical reason …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    An Obstetrician’s Birth Plan

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

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    Dear Patient:
    As your obstetrician, it is my goal and responsibility to ensure your safety and your baby’s safety during your pregnancy, delivery, and the postpartum period. My practice approach is to use the latest advances in modern obstetrics. There is no doubt that modern obstetrical advances have significantly decreased the incidence of maternal and fetal complications. The following information should clarify my position and is meant to address some commonly asked questions. Please review this information carefully and let me know if you feel uncomfortable in any way with my approach as outlined below.
    * Home delivery, underwater delivery, and delivery in a dark room is not allowed.
    * I do not accept birth plans. Many birth plans conflict with approved modern obstetrical techniques and guidelines. I follow the guidelines of the American College of Obstetrics and Gynecology which is the organization responsible for setting the standard of care in the United States. Certain organizations, under the guise of “Natural Birth” promote practices that are outdated and unsafe. You should notify me immediately, if you are enrolled in courses that encourage a specific birth plan. Conflicts should be resolved long before we approach your due date. Please note that I do not accept the Bradley Birth Plan. You may ask my office staff for our list of recommended childbirth classes.
    * Doulas … are allowed and will be treated like other visitors … they may be asked to leave if their presence or recommendations hinder my ability to monitor your labor or your baby’s well-being.
    * IV access during labor is mandatory. Even though labor usually progresses well, not too infrequently, emergencies arise suddenly … The precious few minutes wasted trying to start an IV in an emergency may be crucial to your and your baby’s well being.
    * Continuous monitoring of your baby’s heart rate during the active phase (usually when your cervix is dilated 4cm) is mandatory. This may be done using external belts or if not adequate, by using internal monitors at my discretion. This is the only way I can be sure that your baby is tolerating every contraction. Labor positions that hinder my ability to continuously monitor your baby’s heart rate are not allowed.
    * Rupture of membranes may become helpful or necessary during your labor. The decision as whether and when to perform this procedure is made at my discretion.
    * Epidural anesthesia is optional and available at all times. The most recent scientific data suggest that epidurals are safe and do not interfere with labor in anyway even if administered very early in labor.
    * I perform all vaginal deliveries on a standard labor and delivery bed. Your legs will be positioned in the standard delivery stirrups. This is the most comfortable position for you. It also provides maximum space in your pelvis, minimizing the risk of trauma to you and your baby during delivery.
    * Episiotomy is a surgical incision made at the vaginal opening just before the baby’s head is delivered. I routinely perform other standard techniques such as massage and stretching to decrease the need for episiotomies. However, depending on the size of the baby’s head and the degree of flexibility of the vaginal tissue, an episiotomy may become necessary at my discretion to minimize the risk of trauma to you and your baby.
    * I will clamp the umbilical cord shortly after I deliver your baby. Delaying this procedure is not beneficial and can potentially be harmful to your baby.
    * If your pregnancy is normal, it should not extend much beyond your due date. The rate of maternal and fetal complications increases rapidly after 39 weeks. For this reason, I recommend delivering your baby at around 39-40 weeks of pregnancy. This may happen through spontaneous onset of labor or by inducing labor … inducing labor … is safe, and does not increase the amount of pain or the risk of complications or the need for a c-section.
    * … a c-section may become necessary at any time during labor due to maternal or fetal concerns. The decision as to whether and when to perform this procedure is made at my discretion and it is not negotiable, especially when done for fetal concerns.

    Are there any problems with this birth plan? Maybe some of the information and rationales are inaccurate in light of research, but I believe it is great that this obstetrician gives his/her patients this information upfront, rather than having them find out in labour.

    Melissa Maimann, Essential Birth Consulting 0400 418 448