IVF

MEDICARE NOW AVAILABLE FOR MIDWIFERY CARE THROUGH THIS SERVICE!
Want to know more about home birth, hospital birth or Medicare-funded private midwifery care? Email Melissa Maimann or call 0400 418 448.

Levels of the hormone ghrelin are low in obese women and a recent study … reports that mice whose mothers had low ghrelin levels were less fertile due to a defect in implantation.

… ghrelin [has] been shown to regulate reproductive function in animals and humans …

… results suggest that low ghrelin levels could program the development of the uterus in the female children of obese women. These women may then be less fertile as adults …

To find out more about the services I offer, please visit my website or call me on 0400 418 448.

Do IVF Pregnancies Raise Death Risk for Mothers?

Jan 29th, 2011

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

Maternal deaths resulting from in vitro fertilization (IVF) are relatively rare, but they do occur …

… In the new report, Susan Bewley, an obstetrician at Kings College in London, and colleagues cite a study in the Netherlands that shows that the rate of pregnant women dying during IVF pregnancies is higher than during pregnancies in the general population. Specifically, there were 42 deaths per 100,000 IVF pregnancies, compared with six deaths seen among 100,000 pregnancies in the general population.

Ovarian hyperstimulation syndrome can occur as a result of fertility drugs used to stimulate the development of eggs in a woman’s ovaries. If the ovaries are overstimulated they can become enlarged and symptoms such as abdominal pain, nausea, and vomiting can occur. In severe cases fluid may accumulate around the lungs or heart.

The authors call for tracking of IVF-associated risks including ovarian hyperstimulation syndrome to better understand risks associated with IVF. “More stringent attention to stimulation regimens, preconceptual care, and pregnancy management is needed so that maternal death and severe morbidity do not worsen further,” they write.

… U.S. fertility doctors point out that the reasons women undergo IVF may account for the increased risk of death seen in the studies.

… Underlying health issues in women who turn to IVF to get pregnant may affect their risk profile, he says. These women may have had previous uterine surgery or are predisposed to high blood pressure or diabetes. Women who undergo IVF are also usually older than their counterparts who conceive without such assistance. Advancing maternal age is associated with riskier pregnancies.

“The population of people who need IVF may add special contributing factors to the risk of death during their pregnancy,” he says. Multiple pregnancies are more likely as a result of IVF, which also increases risks to moms and babies.

The new findings may not apply to the U.S. due to differences in obstetrical care, he says.

“We manage risks better [here], and do reductions more in multiple pregnancies,” Grifo says. The best way to protect the mother’s health and that of the baby regardless of how the pregnancy occurred is good prenatal care …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Elective Single Embryo Transfer Boosts The Chance Of A Healthy Baby

Jan 11th, 2011

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

Women who undergo elective single embryo transfer as part of … IVF are five times more likely to give birth to a healthy baby compared with double embryo transfer …

The study recommends that clinicians should, from now on, advise women to have an elective single embryo transfer (eSET) as part of assisted reproduction treatment rather than a double embryo transfer (DET).

Although there has been increasing success in infertility treatments in recent years, there have also been growing concerns about rising rates of multiple pregnancies, which are associated with increased maternal and perinatal illness and death, as well as increased costs to the health service.

A previous review of studies comparing data on eSET versus DET concluded that, although eSET reduced the odds of multiple pregnancies, it halved the odds of live birth per fresh cycle of treatment.

However, there has been, until now, a lack of evidence about the effect of single versus double embryo transfer in different groups of women and on outcomes such as miscarriage, preterm birth and low birth weight.

So an international team of researchers, led by the University of Aberdeen, studied data on 1,367 women from eight eligible trials …

… the chances of a full-term single birth … following single embryo transfer were almost five times higher than those following double embryo transfer.

Single embryo transfer was also seen to reduce the risk of premature births …

The chance of delivering a baby with low birth weight for single embryo transfer cases was a third of the chance for double embryo transfer cases.

In other words, the chance of a having a healthy baby (not premature or low birth weight) is higher with single embryo transfer than with double embryo transfer …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Study Examines Complication Rates For Pregnancies After Age 44

Nov 25th, 2010

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

Link

Women who become pregnant at age 45 or older have an elevated risk of several complications to their own health and that of their infants …

The older women were more likely to have health conditions during their pregnancies, with 17% experiencing gestational diabetes … Nine percent of the older group had high blood pressure while pregnant, compared with less than 3% of younger women. Older women had caesarean-section births at more than twice the overall rate and experienced placenta previa — a condition in which the placenta blocks the birth canal — at six times the overall rate.

Women who delivered at age 45 or older also had higher rates of early deliveries, more instances of fever and severe bleeding, longer hospital stays, and more trips to the intensive care unit when compared with younger mothers. In terms of the infants’ health, 4% of newborns born to older women had metabolic problems, such as low blood sugar, compared with less than 2% of those born to younger women …

Melissa Maimann, Essential Birth Consulting 0400 418 448

IVF increases the chance of having a baby boy

Sep 29th, 2010

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

Women using IVF to get pregnant should be aware that they will be more likely to have a boy than a girl …

… the odds of a boy went up from 51 in 100 when conceived naturally to 56 in 100.

But another assisted reproduction technique called ICSI, which singles out the sperm that will fertilise the IVF egg, makes a girl more likely.

… “There is no evidence I am aware of to show that sex ratios at a national level have changed as a consequence of assisted conception procedures, although nature can impose some big variations following natural phenomena and man-made events.

“Patients should certainly not consider using this as a method of trying to have a boy or girl, since the procedure used needs to be selected to try and maximise the chance of pregnancy.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

IVF Kids May Have Higher Cancer Risk

Jul 22nd, 2010

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

Children conceived using in vitro fertilization (IVF) appear to have a moderately elevated risk of cancer — although the absolute risk remains low …

Among the 26,692 children studied who were conceived by IVF between 1982 and 2005, after adjusting for year of birth, the estimated odds ratio for cancer risk was 1.42 (95% CI 1.09 to 1.87, P=0.01) compared with children who were not conceived via IVF …

… however, IVF itself may not be responsible …

The reason for the increased risk could be a higher rate of preterm birth and neonatal asphyxia among these children or because of unidentified characteristics of the women who undergo the procedure …

… While mothers who used IVF to conceive had a variety of characteristics that differed from other women, including older age and increased rates of multiple pregnancies, none of these were significantly linked with the elevated cancer risk seen in their children.

… several characteristics of the children did appear to play a role.

After adjustment for year of birth, significantly increased risk for cancer in the entire population was associated with preterm birth before week 37 (odds ratio 1.16), for birth weight of 4,500 g (9.9 lbs) or more (OR 1.21), for large-for-gestational-age birth (OR 1.34), and for low Apgar score (OR 1.33).

The only one of the factors more common among IVF children than among others in the general population was a low Apgar score …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Causes of autism: Could delayed childbearing, infertility treatment, and premature birth contribute to autism?

Jun 4th, 2010

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

Research … suggests the answer is yes.
… At this point, experts can only guess at the biological basis for the links they’re finding. And those clues are not enough to recommend changes in, for example, infertility treatment.

Still, knowing who may be at risk of autism could improve diagnosis, which might enable earlier intervention.
One study … followed babies who weighed less than 4.4 pounds at birth through to age 21. Nearly 5 percent of these 623 young adults had an autism-spectrum disorder, five times the rate in the general population.

… In recent decades, women have been delaying motherhood, which increases both their chance of needing fertility treatment, and their chance of having a low-birth-weight baby, typically due to prematurity.

These changes have emerged as risk factors for autism:
Two studies … linked infertility treatment to the chance of autism … ovulation-inducing drugs … nearly doubled the odds of having an autistic child … autistic children … were three to four times more likely to have been conceived through in-vitro fertilization and to have been born at very low weights than children in the general population. The mothers of autistic children were also older …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Infertility treatments may raise preterm birth risk

Apr 17th, 2010

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

Couples who conceive through … IVF or … ICSI had a higher risk of preterm delivery.

… nearly 8 percent were premature and 1.5 percent were very premature …

… roughly 5 percent of babies born to fertile mothers were premature, and 0.6 percent were very pre-term …

… Other forms of fertility treatment … were not related to the risk of preterm delivery.

[The study only looked at singleton babies, so the findings could not be explained by a higher proportion of twins] … the findings suggest that something about the IVF and ICSI procedures themselves might raise the odds of preterm birth.

… The fact that other forms of fertility treatment were not linked to preterm delivery suggests that infertility itself is not to blame …

… Another possibility … has to do with the “vanishing twin” phenomenon … these surviving fetuses are at increased risk of preterm delivery and low birth weight …

Melissa Maimann, Essential Birth Consulting 0400 418 448

The impact of endometriosis on infertility

Feb 28th, 2010

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

Endometriosis affects 10 percent of women of reproductive age, yet the condition remains one of the most neglected and underfunded fields of research in gynecology …

… the statistical association between endometriosis and infertility is beyond dispute. One well-cited study found a higher prevalence of endometriosis in infertile women (48 percent) than in fertile women undergoing tubal sterilization (5 percent) … infertile women are 6-8 times more likely to have endometriosis than fertile women.

… a new diagnostic staging tool has been proposed that predicts the chance of spontaneous pregnancy in those with surgically documented endometriosis who are treated without IVF … The EFI score ranges from 0-10, with 0 representing the poorest prognosis and 10 the best … those patients with scores of 0-3 could expect a cumulative pregnancy rate of 11.1 percent at 3 years, increasing to 68.3 percent for those with scores of 9-10.

… the most common symptoms of endometriosis were painful menstruation, painful intercourse, and incapacitating pain …

Melissa Maimann, Essential Birth Consulting 0400 418 448

FAQs

Feb 23rd, 2010

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

Fertility Drugs Contribute Heavily To Multiple Births

Jan 30th, 2010

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

The widespread use of … fertility drugs, not just high-tech laboratory procedures, likely plays a larger role than previously realized in the growing problem of premature births in the United States, because these drugs cause a high percentage of multiple births …

… controlled ovarian hyperstimulation (COH) drugs — used to stimulate a woman’s ovaries to speed the maturity and multiply the production of eggs — accounts for four times more live births than assisted reproductive technologies (ARTs) such as in vitro fertilization.

“Many people have focused on the role of ARTs in multiples and have not fully appreciated that fertility drugs alone are responsible for one out of every five multiple births,” … “COH drugs are widely prescribed, and some health care professionals … are not aware of the serious risks of fertility drugs to women and their babies. There is a very high possibility of multi-fetal pregnancy resulting from use of these drugs, and that brings a high risk of prematurity and lifelong health problems for the babies as a consequence.”

… About 60 percent of twins, more than 90 percent of triplets, and virtually all quadruplets and higher-order multiples are born prematurely … studies have also suggested that even infants born singly, but conceived with ovulation stimulation are at increased risk for preterm delivery than naturally conceived single births …

Melissa Maimann, Essential Birth Consulting 0400 418 448

More Birth Defects Seen With Assisted Reproduction

Dec 1st, 2009

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

… A new study has found a higher rate of birth defects among babies conceived by assisted reproduction compared to babies conceived naturally.

… almost 3 percent of infants conceived with assisted reproduction were diagnosed with a major birth defect, compared to less than 2 percent of babies conceived naturally …

… 3.45 percent of those born via IVF had major birth defects.

… One contributing factor could be the greater age of mothers… who undergo this treatment …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Obesity cuts the chances of IVF treatment working

Oct 26th, 2009

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

… obesity cuts the chance of IVF working and increases the risk of premature birth and stillbirth.

… [the] impact becomes more profound as weight increases …

… being overweight and obese affects natural conception too and has a profound impact on a woman and her baby’s health throughout pregnancy and beyond.

… the most obese women … had 35% less chance of falling pregnant and a 59% increased chance of giving birth to a very premature baby …

… “The take-home message … is that women need to reduce their weight before trying fertility treatment.

… “Obesity is a state of inflammation and … It is not conducive to conception and … pregnancy.”

… 32% of women over 16 are overweight … and 21% … are obese …

… being overweight increases the risk of diabetes during and after pregnancy, pre-eclampsia and developing a potentially lethal DVT.

… the chances of recognising foetal abnormalities decrease in overweight and obese women because the quality of ultrasound images falls.

… “Just … losing 5% of their body weight may be enough to restore ovulation in women who are overweight.”

… “Women need to understand that obesity cannot only affect themselves – it can affect their child. If the mother is obese, their child is three times more likely to be obese; and if the father is obese too the child is eight times more likely to be obese.”

Melissa Maimann, Essential Birth Consulting 0400 418 448

In Vitro Fertilization Less Successful With Alternative Fertility Treatments

Aug 30th, 2009

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

The common belief is that it won’t hurt to try alternative fertility treatments before reverting to … IVF. But a new study from Denmark finds that the success of IVF treatment is 30% lower among women who have used alternative medicine … Women who had first tried … reflexology, acupuncture, or herbal- and aroma therapy, had significantly lower pregnancy rates after IVF treatment.

… Whether the effect on IVF success is a direct result of the use of complementary medicine, or whether women who were already having more trouble conceiving were more likely to revert to alternative fertility treatments could not be determined …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Please Don’t Hurt Mothers-to-Be: Doctors Plead With Government.

Aug 24th, 2009

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

Australian families who seek specialist obstetric care during pregnancy will up to $1,830 worse off if the Australian Government does not reconsider its proposed cuts to Medicare payments before the Senate this week.

It doesn’t seem to concern NASOG that Australian families are up to $5,000 “worse off” for seeking private midwifery care. Private midwifery has never been afforded medicare benefits, despite much research that supports the role of the midwife for most women.

… Dr Hilary Joyce, President of the National Association of Specialist Obstetricians and Gynaecologists (NASOG), warned that under the Bill going before the Senate this week, all patients embarking on having a family will be worse off when they go to see their specialist obstetrician.

“All couples who undertake fertility treatments and then who need special obstetric care throughout their pregnancy will be hit harder still with the double financial whammy of fertility treatment and maternity treatment cuts to Medicare,”

I’m not clear why Hilary believes that women who have fallen pregnant through ART require ongoing obstetric care. She has made a statement without backing it up by research. I’d like to read the research that states that this is so. While pregnancies that have been achieved through ART may have risks associated with them, that is also true of every pregnancy. No pregnancy is risk-free. There’s no reason not to have midwifery care pre-emtively. If complications are detected or even suspected, the midwife will make a referral to a hospital or obstetrician, and the woman will receive appropriate care.

“We are concerned about the families who won’t be able to afford the choice of their own obstetrician because of these proposed Medicare cuts. … Will they be forced into the already overwhelmed public hospital system? …

The proposed changes prevent women from accessing the midwife of their choice. Hilary does not seem to be concerned by this. These women will also be forced into the overwhelmed public system.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Mother Dies At 69 Orphaning Twin IVF Babies

Jul 28th, 2009

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

[A woman] … has died at the age of 69, orphaning her two and a half year old twin sons that she gave birth to at the age of 66 after receiving IVF treatment …

[The] death … has reignited the debate about allowing older women to undergo fertility treatment.

[The woman] … admitted lying about her age: she told doctors … that she was 55.

… the babies were born with no complications, apart from having to spend one month in incubators.

[The] family will most likely care for the two boys …

The news has provoked fresh calls for an upper age limit for fertility treatment …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Infertile Couples Encouraged To Look At Lifestyle

Jul 15th, 2009

1 comment

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

A … study has recommended that infertile couples seek advice about their lifestyle before embarking on IVF treatment or other assisted reproductive technology.

… while most people link obesity, smoking, drugs and stress to infertility problems, many infertile couples fail to look at their own lifestyle as a possible obstacle to conceiving.

… only half of the overweight women in this study considered their own weight to be a risk factor for infertility.

… overweight women are also at risk of pregnancy complications such as miscarriage, gestational diabetes and raised blood pressure.

… The study underlines the importance of good preconception advice and support …

Melissa Maimann, Essential Birth Consulting 0400 418 448

During Pregnancy, Women With Endometriosis Need Special Care To Avoid Risk Of Premature Birth

Jul 14th, 2009

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

The largest study to date of endometriosis in pregnant women has found that the condition is a major risk factor for premature birth … women with endometriosis also had a higher risk of other pregnancy complications, as well as being more likely to give birth through Caesarean section …

The researchers investigated the association between adverse pregnancy outcome, assisted reproduction technology (ART), and a previous diagnosis of endometriosis … Compared with women without endometriosis, they had a 1.33 greater risk of preterm birth. Women with endometriosis were also more likely to have difficulty in conceiving and need to receive ART, which is itself a risk factor for adverse pregnancy outcome.

… The risk of preterm birth associated with endometriosis among women with ART was 1.24, and among women without ART 1.37.

“Endometriosis appears to be a risk factor for preterm birth, irrespective of ART,” …

… Women with endometriosis were also more likely to suffer from pre-eclampsia …

Melissa Maimann, Essential Birth Consulting 0400 418 448

Will IVF Work For A Particular Patient? The Answer May Be Found In Her Blood

Jul 11th, 2009

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

… researchers have been able to identify genetic predictors of the potential success or failure of IVF treatment in blood.

… The researchers found that the peripheral blood gene expression ‘signature’ (also known as the transcriptome) before IVF was predictive of IVF outcome.

One of the most difficult decisions for patients who have had unsuccessful IVF treatments is whether they should undergo further attempts at IVF, or if there are ways to optimise chances of success. The researchers hope that the results generated by this work will lead to the development of a test to aid in IVF decision-making. They say that their work will help to identity biomarkers that can identify events occurring at implantation, the maintenance of pregnancy and successful or unsuccessful pregnancy outcome.

Melissa Maimann, Essential Birth Consulting 0400 418 448

British mum’s embryo given to wrong woman, then aborted

Jun 16th, 2009

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

AN IVF clinic has admitted giving a couple’s last embryo to the wrong woman, who then had the baby aborted.

The UK clinic failed to follow its own procedures and has acknowledged the blunder was “extremely upsetting” for everyone involved.

But the woman who should have received the embryo has told how the mistake left her and her husband “shaking with shock and bursting with anger”.

She said: “I kept thinking, ‘They’ve killed our baby! Killed our baby!’

“Even our worst fears didn’t prepare us for the devastating news that our embryo had actually been placed in another woman, and that it had to be taken out and destroyed for ‘medical reasons’.”

… when they were arrived for their appointment they were initially told there had been an accident in the lab and the embryo had been destroyed.

Later it emerged a trainee doctor had failed to carry out sufficient checks and the embryo had been implanted in another woman.

Ian Lane of Cardiff and Vale NHS Trust told The Sun: “We apologise unreservedly for this mistake.

… “Immediately after the event, we carried out an internal investigation …

… “As a result of both of these investigations, we have made a number of improvements to our systems and checks, in line with the recommendations made in the reports.”

It’s sad, but mistakes do happen in health care. No-one is perfect.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Crackdown on doctor rorts: IVF and Obstetrics

May 7th, 2009

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

Link to article

MEDICAL specialists will come under pressure to cut fees for some services – especially in obstetrics and IVF – under a plan in next Tuesday’s federal budget to crack down on rorting of the Medicare safety net.

Under the changes, patients charged excessive fees will have new limits put on how much they can claim back on the Medicare safety net. This could leave some people facing large out-of-pocket expenses for obstetrics, IVF… and some other services if they use high-fee specialists.

But the Government hopes its crackdown, rather than penalising patients, will instead put pressure on high-end specialists to moderate charges.

As an incentive to specialists to cut fees, the Government will increase the cap on its coverage of the services – in effect, raising the base level of its rebate.

… Since the advent of the safety net, fees have leapt by 290% for IVF and 40% for obstetrics – giving rise to claims that the system is being rorted.

… Areas targeted for cuts include artificial reproductive technology (IVF), obstetrics and varicose vein treatment, identified in a report into the scheme.

… The net will continue to cover 80 per cent of patients’ out-of-pocket costs once they reach the threshold – but only up to a new limit in “capped” areas.

… The review found that the safety net benefits were going excessively to some specialists.

For some obstetrics and IVF services, of every dollar spent on the safety net, “78 cents is going to providers and only 22 cents to reducing patients’ costs”, the review said. Providers knew patients were likely to qualify for the net and felt “fewer competitive constraints on their fees”.

Between 2003 and 2008, the average fee charged for planning and management of an artifical reproductive treatment cycle increased from $294 to $1148. The average obstetrics fee for planning and management of a pregnancy rose 40 per cent between September 2004 and 2008 – from $1238 to $1732.

Specialists’ incomes in these areas have soared. In 2008, the highest 10 per cent of IVF specialists were paid $4.5 million each through Medicare – including $2.2 million through the safety net.

In addition to providing incentives to moderate fees, the higher obstetrics medical benefits are also designed to give more incentives for obstetricians to practice in under-serviced areas …

It will be interesting to see the added effects if the changes proposed in the Maternity Services Review are implemented. Those changes will provide private midwives with the right to order tests, prescribe medications and bill through Medicare. In effect, women will have the choice of the public health system, a private obstetrician, or a private midwife. Private midwifery will no doubt be far cheaper for women than private obstetrics, and will confer greater benefits in terms of:
- lower rates of postnatal depression
- lower rates of birth trauma
- lower rates of intervention in pregnancy and labour, and lower rates of complications from said intervention
- higher rates of natural birth
- higher rates of breastfeeding
- higher rates of birth satisfaction from women
- less birth trauma for the baby
- lower rates of admission to special care nursery for the baby
- fewer antenatal (pregnancy) admissions to hospital
- more care provided in women’s homes than hospitals
- lower caeasarean, induction, epidural, episiotomy, forceps and vacuum rates
- higher rates of VBAC
- true continuity of care – even with private obstetrics, you are cared for by midwives you have not met before; with private midwifery, all your care is with the same midwife who you’ve chosen
- more choice and control in birth

Melissa Maimann, Essential Birth Consulting 0400 418 448

The IVF revolution is money badly spent

Mar 26th, 2009

Melissa Maimann, Essential Birth Consulting.

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

Link to article

Jill Singer

March 26, 2009

BABIES are priceless, precious beings who can melt the hardest of hearts.

But they don’t come cheaply, as any parent knows, even when they arrive on the scene with relatively little effort.

Sadly, about one in six couples find babies don’t come to them easily, or at least without medical assistance.

I have enormous sympathy for people experiencing infertility, but, even so, the time has surely come for us to question just how much the public purse can stretch to help finance people in their quest to either become parents for the first time, or add to their existing brood.

No other country is as generous as Australia when it comes to pouring taxpayer dollars into the lucrative baby-making industry … Medicare rebates cover the bulk of scheduled fees and the Medicare safety net kicks in to cover 80 per cent of out-of-pocket costs once a patient has spent just $1111.60 in any year (a mere $550 if you’re getting family tax benefits).

What’s more, patients can elect to have an unlimited number of fruitless IVF cycles subsidised … Not surprisingly, the axe is hanging over the funding scheme for IVF as the Federal Government examines ways of reining in the annual $300 million safety net.

Access Australia, the main lobby group is gloating about its success in flooding Canberra with an orchestrated email protest campaign. Its use of language is enlightening:

it refers to “consumers” rather than patients.

IVF clinics are also exhorting potential patients … to write protest letters to politicians and the media.

The IVF lobby wields enormous power and is used to winning, thanks to the emotional power of the issue. ….

In 1995, 1 per cent of babies born in Australia were the result of assisted reproductive technologies. In just a few years the figure jumped to 2 per cent and is now more than 3 per cent.

Let’s consider some of the consequences. What are we getting for our money … ?

Australian Institute of Health and Welfare figures reveal that in 2002, 27 per cent of these babies were born prematurely.

That means more than a quarter required expensive, taxpayer- subsidised neonatal care …

As recently as 2005, the AIHW was made aware that the perinatal death rate was 7.3 deaths per 1000 births in even the most responsible forms of IVF – where a single embryo was implanted …

And for those babies who do make it, the risks continue.

ICSI … involves injecting the flawed sperm of an infertile man directly into a woman’s egg. Medical evidence is mounting that sons conceived through ICSI inherit their father’s infertility.

The problems with ICSI have been long known, though … Belgian researchers canvassed studies proving the link between the procedure and congenital abnormalities in the children resulting from it.

All IVF carries risks for children … a systematic review … revealed a 30-40 per cent increase in birth defects when comparing IVF and ICSI babies with naturally conceived children.

The fact is that we are paying to create a faulty gene pool, turning Darwin’s theory about survival of the fittest on its head.

What other species would be so foolish as to encourage this form of un-natural selection?

- This is a fair question to ask, and it also begs the question if any of the common interventions we accept in the child bearing process are justified.

Double is trouble when caring for premature babies

Mar 10th, 2009