Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
informed consent and childbirth
Every woman who is competent to consent, has the right to refuse any or all professional care. Informed consent must be obtained prior to any procedure being performed.
how to minimise labour intervention in a hospital?
The best way to minimise intervention in a hospital is to be as well informed as you can possible be about all things related to pregnancy, labour, birth, breastfeeding and babies. Read widely, attend independent childbirth education classes and consider employing a private midwife to be with you throughout your labour. She can help you to decide if the proposed interventions are necessary in your situation, she can support you emotionally, mentally and physically and she can aso help to ensure that your birth plan is respected without a fuss.
Do any independent midwives in Sydney offer prenatal care for women who are planning to freebirth?
Yes! This service enables women to access antenatal care from a midwife without the midwife attending the birth. Postnatal care is available if needed.
Do you think there are advantages to continuous monitoring for low-risk women
In a word, no. Intermittent auscultation is the method of choice. Continuous monitoring will increase the chance of a caesarean with no benefit to the mother or baby.
How much is a private midwife
Prices range from $3000 – $6000. Melissa Maimann offers for her clients to pay by the hour, making the service one of the cheapest.
What is a good caesarean rate?
The World Health Organisation recommends that no more than 15% births need to be caesareans. The WHO argues that when caesarean rates exceed 15%, the risks to the mother and baby increase on the whole. You’ll be hard-pressed to find a hospital with a caesarean rate of less than 15%, but birth centres and private midwives have caresarean rates of less than 10-15%.
What is the best hospital in sydney for delivering babies?
It all depends what sort of birth experience you’re after! If you’re wanting a natural birth, home birth will be the best option. If you want a natural birth in a hospital setting, the best options would be birth centre or private midwifery care for a planned hospital birth. If you’re wanting to have intervention in your birth, a hospital birth would be best. If you choose an obstetrician, you’re far more likely to have a caesarean, episiotomy, epidural, forceps or vacuum. Choosing your care provider is the single most important decision you will make in birthing.
Is there a birth centre at westmead hospital?
No, there isn’t. If you’re after a natural birth, the best choice would be a home birth.
C section or natural delivery midwife?
Midwves cannot perform caesareans. If a caesarean was needed, the midwife would call a doctor in to perform it. Most caesareans that are performed are unnecessary and increase the risks to the mother and baby. A natural birth is the safest way to birth, and midwives are qualified specialists in natural birth.
giving birth after birth trauma
Private midwifery care will be really important so that you can have the same midwife all the way through pregnancy, birth and postnatally. It’s also important to debrief your last experience and come to a place where you feel safe to birth again.
high risk midwife sydney
Midwives are not qualified to care for high risk pregnancies. We refer these women onto obstetricians. In most cases, one or two consultations is all that is needed with the obstetrician and the midwife continues the care of the woman.
how many births proceed naturally
What a great question! It all depends what care provider you choose and where you have your baby. You see, if you choose a private midwife and birth at home, you have about a 95% chance of having a vaginal birth. If you birth in a private hospital, you have about a 33% chace of having an unassisted vaginal birth. In some hospitals, the caesarean rate is more than the vaginal birth rate! Sad but true.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, birth debriefing, Birth trauma, Breastfeeding, Caesarean, childbirth education, Complicated pregnancy or birth, continuity of care, Epidural, exercise, fetal monitoring, freebirth, Home birth, hospital birth, intermittent auscultation, intervention, IVF, Maternity Services Review, midwife, Midwifery, Midwifery services, Normal Birth, Nutrition, Obstetrics, postnatal depression, Preconception care, Public and private hospitals, VBAC
Posted by Melissa Maimann on Feb 22, 2010 in
Home birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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IS giving birth at home a positive experience or and unnecessary risk?
ASK any expectant mother what she’s hoping for when she gives birth, and she’ll probably tell you the most important thing is to deliver a healthy, happy baby. But in recent years there’s been great debate about the best way to do this.
Is the ideal to have a child in the relaxed comfort of your own home, or does the medical expertise provided in hospital far outweigh the notion of giving birth in your own living room?
Although homebirth advocates argue the former, it appears the choice may soon be taken out of their hands.
Reports last year revealed that four babies in Sydney died in homebirths in the space of nine months, the NSW Government responded with a strong announcement: from July 2010, independent midwives will be unlikely to gain professional indemnity insurance – effectively making it illegal for them to assist at homebirths. The consequence? Homebirths are facing extinction.
Obstetrician Dr Pieter Mourik believes the ruling will stop women taking unnecessary risks.
“Women who choose to give birth at home expect everything to be normal, but they often don’t consider how far they are from expert help …” he says.
“Eighty per cent of women can have their babies in a paddock – but the problem is choosing these women. You just never know what will happen.”
However, Justine Caines, spokesperson for Homebirth Australia, says putting a blanket ban on homebirths will simply drive the practice underground.
… “Many mothers have had bad experiences in hospital and won’t repeat that.”
She continues: “Why does the government fund women who are choosing to have C-sections, but not women who are choosing to give birth at home?”LAST month a study of over 500,000 women in the Netherlands who gave birth at home … showed there was no significant difference between planned hospital births and planned homebirths in terms of babies dying during labour.
It’s important to note when making a comparison between Australia and the Netherlands, that the Netherlands only has low-risk home birth. If there are any complications in the pregnancy or labour, women see an obstetrician and birth in hospital. This is not the case in Australia at present, but it’s the system that the Govt is trying to set up.
… Dr Mourik says the study is misleading. “Firstly, we must remember Holland has very well-trained midwives who act almost like Australian GPs,” he says.
“It’s also a small country with maternity units often within 10 minutes of someone’s house. The conclusions of this study are based on the availability of well-trained midwives through a good transportation and referral system – and that simply isn’t the case in Australia.”
It’s not currently set up in Australia, but there’s no reason why it couldn’t be. A positive approach would be to set in place a system that supports women to birth at home, and a system that protescts the midwives who support women to birth at home. Home birth has always been and will always be. We can set it up so that it is safe, or we can hope it just goes away … it won’t.
However, despite warnings from obstetricians, women are still choosing to have their babies at home …
“Women should have the right to give birth wherever they feel safest – it’s up to them whether that’s in hospital or at home. But taking away our choice isn’t right. If there were more options within the hospital system, then perhaps more women would feel comfortable going to hospital.”
I disagree that women should make the decision: it should be made within the midwifery partnership. This debate is not about the right of women to bitrh at home: this right is protected by law. This debate is about the mdiwife’s responsibility to pracice safely.
The Health Minister is putting in place a system that will enable more women to access continuity of midwifery care with their chosen midwife in and out of the hospital system. Once this is in place, there will be more options within the hospital system, and hopefully fewer women who are traumatised by the hospital system.
So is there a way to keep everyone happy?
“Homebirth Australia would like the government to present a package for pregnant women that works a bit like the baby bonus,” … “Every woman would be given a sum of money to spend on her pregnancy treatment, then it’s up to her whether she sees a midwife at home, or an obstetrician in a hospital. It’s putting the choice back into women’s hands.”
What about the option to have a baby in hospital with a midwife, or the ability for an obstetrician to attend a woman at home?
However, Dr Mourik believes that when it comes to choice, the only factor to consider is the mother and baby’s health.
“Only a tiny minority of foolish women would risk their own lives and that of their precious babies for an ideal,” he says.
“How many doctors support homebirth? None I know – it’s too bloody risky.”
Many studies opint to the safety of home birth for low-risk women who are attended by a midwife. Women who birth at home are amongst the most health- and safety-conscious people I know. It is offensive to comment that women who birth at home are
risking their own lives and that of their babies, especially when the evidence is to the contrary.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Complicated pregnancy or birth, continuity of care, freebirth, Home birth, hospital birth, Maternity Services Review, midwife, Midwifery, Midwifery services, Public and private hospitals, women's rights
Posted by Melissa Maimann on Feb 20, 2010 in
Home birth,
Midwifery 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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THEY were defending their right to give birth at home … Across the country hundreds of women held rallies …
Homebirth supporters claim doctors and the Government are taking away the rights of women.
Under the proposed Bill … doctors will have the final say if a woman can have a homebirth supervised by a midwife. Previously, private midwives could assist in a homebirth without a doctor’s consent but could not access Medicare rebates.
Passionate homebirth advocate Andrea Smith … said, “We should have the right to choose however we want to birth.” …
After July, midwives will need to work collaboratively with doctors. This will be the case if we are to attend homebirths or if our clients wish to access Medicare benefits for our services.
Collaborative arrangements have not yet been defined so it is hard to say at this stage how they might look. It’s almost certain that high risk homebirths will be off the cards, so no breeches, twins, VBACs, post term or preterm women, or those with high blood pressure or problems in the pregnancy will be able to have a home birth. Women are concerned that these changes will limit their right to a home birth, but the government is concerned for the provision of safe homebirth services. These new laws do not actually prevent “high risk” women from accessing home birth, they just restrict the ability of the midwife to attend them by legistating that midwives will only be able to attend low-risk homebirths.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Complicated pregnancy or birth, Home birth, Maternity Services Review, midwife, Midwifery, Midwifery services, women's rights
Posted by Melissa Maimann on Feb 20, 2010 in
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Home birth,
Midwifery,
Normal Birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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The Federal Government has been grilled at its latest community cabinet meeting over its proposed changes for midwives and maternity services.
The Government wants to make midwifery services eligible for Medicare rebates, but only if homebirth midwives work in consultation with a doctor.
Several women at last night’s meeting … told the cabinet ministers that the changes would restrict the choice of women who only want to give birth with a midwife at home.
But Health Minister Nicola Roxon says the Government is simply taking a cautious approach.
“To make sure we’ve got some backup protocols in place, so if something does go wrong that there are agreements with the hospital or doctor to be able to step in quickly,” she said.
“And that is a conservative approach, but it isn’t a conservative approach to say midwives are doing good work, have never been recognised in the history of providing Medicare for the last 50 years and we’re going to actually change that.”
She told the meeting that medical professionals should be working together.
“I’m unapologetically on the record as saying let’s encourage people across the health services spectrum to work together and make sure that women can safely choose options that are good for them and suit them,” she said.
Women who access private midwifery services will be able to access Medicar benefits. As well as this, midwives will be able to order medications via the PBS.
The maternity reforms provide women with greater access to continuity of midwifery care. The standard care in a public hospital is for women to see one group of midwives in the clinic, another group in the delivery suite (who work shifts) and then another lot of midwives when they are being cared for with their baby. The maternity reforms will make it possible for more women to be cared for by their own midwife, whom they have chosen. The same midwife will provide care from the first antenatal consultation right up until about 2-4 weeks after the baby is born.
This is a huge step forward for Australian maternity care. For the first time, women will be able to birth in hospital under the care of a private midwife. Private midwifery care will also be available for home births (as is currently the case). We are continuing to book women for home births beyond July.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, hospital birth, Maternity Services Review, Midwifery, Midwifery services, Normal Birth, Public and private hospitals
Posted by Melissa Maimann on Feb 19, 2010 in
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Midwifery 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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Prime Minister Kevin Rudd is stripping away a woman’s right to have her baby at home, protesters around the country have been told.
Hundreds of people have come together across Australia at 13 simultaneous rallies to protest against the government’s planned overhaul of maternity care.
NSW Greens MP Lee Rhiannon told a crowd of about 100 in Sydney that access to a homebirth was a woman’s right.
“We are in an extraordinary situation when a woman can choose to have a caesarean but she can’t choose to have her children at home,” …
Ms Rhiannon said the government had succumbed to pressure from Australian Medical Association, which is opposed to home birthing.
The proposed new laws … will require all midwives to be insured … a two-year exemption will apply for up to 200 independent midwives, who are unable to gain insurance because it is no longer provided for home birthing.
They will also have to work in collaboration with a doctor – who will be able to override their decisions – to access Medicare, insurance and pharmaceutical benefits for homebirths.
… homebirth groups … say the practice will be forced underground, a concern that was also highlighted in a recent Senate inquiry.
Christine Wrightson, who had two planned home births, one of which ended up being in hospital due to complications, told the crowd … “I had one child in hospital and one was born at home – for both births we chose to be under the care of a privately practising midwife,” Ms Wrightson said.
“This was because it was extremely important to me to minimise the chance of medical intervention as I strived to have a natural birth …
Women choose private midwifery care for a variety of reasons, not only to birth at home. For some, it’s to have a qualified advocate by their side in hospital, or to have extended postnatal care for 6 weeks, or to have antenatal consultations in their own home rather than attending the local hospital clinic. But for most women, the reason for having a private midwife is about the level of trust, security and confidence that develops over time.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, Home birth, Maternity Services Review, midwife, Midwifery, Midwifery services, Normal Birth
Posted by Melissa Maimann on Feb 6, 2010 in
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Midwifery 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 Australian Greens are deeply concerned that a Commonwealth plan to effectively give doctors veto over the rights of midwives to practice will erode women’s care choices.
“The Government amendments to their Midwives legislation are unnecessary and give doctors too much control over midwives practice” … “… any requirement that midwives must work in formal collaborative arrangements with doctors as a condition of insurance will further restrict women’s choices”.
” … the Midwives Bills do not address the needs of many Australian women who make the choice to give birth outside the hospital system, and we will continue to fight for greater choice and less interventionist maternity care. The amendments proposed by the Government further erode women’s choices …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, Home birth, Maternity Services Review, midwife, Midwifery, Midwifery services, Obstetrics, women's rights
Posted by Melissa Maimann on Feb 2, 2010 in
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… Academic midwifery … researchers say [an] … amendment … that enforces collaborative arrangements on midwives will effectively hold the midwifery profession hostage to the whims of doctors …
… Such an arrangement is unprecedented internationally, and would restrict midwife access and fragment care, says Professor Barclay.
“This can effectively institute medical control over individual women’s access to Medicare funded midwifery care,” she writes
… midwifery is strongly evidence based … showing that outcomes for women receiving continuity of care from known midwives were better than for women who received fragmented care from multiple midwives and doctors.
“It is untenable that one professional unionised group has the potential to derail Australia’s long awaited maternity reforms,” concludes Professor Barclay.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, Home birth, Maternity Services Review, midwife, Midwifery, Midwifery services
Posted by Melissa Maimann on Jan 24, 2010 in
Home birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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After six hospital births … Melissa Read decided to bring her seventh child, Ayla, into the world at home.
“Doctors had told me home births were incredibly risky but I did a lot of research and the midwives understood what I was talking about and how I felt,” Ms Read said.
“It was an incredible experience that was more than I expected for myself, my husband and my kids.”
Independent midwives have slammed reports this week that home births put babies at a greater risk of dying than those born in hospital.
A widely reported … study showed that babies born at home are seven times more likely to die of complications and 27 times more likely to die from lack of oxygen.
The Australian Medical Association (AMA) and the National Association of Specialist Obstetricians and Gynaecologists used the study to warn against the dangers of home birth.
But the report, which compared 297,192 planned hospital births with 1141 planned home births … also showed that the perinatal death rate was similar for both kinds of births.
The 16-year long study recorded nine perinatal deaths in the planned home-birth group, seven of which were actually born in hospital, and 2440 deaths in planned hospital births.
Home birth advocates criticised the report, saying the research was flawed. The report itself states “small numbers with large confidence intervals limit interpretation of these data”.
However, homebirth studies in Australia can only include small numbers because less than 1% births occur at home.
“In the 16-year study period there were only three perinatal deaths for which one can reasonably assume that a different choice of care provider, location of birth or timing of transfer to hospital might have made a difference to the outcome,” says the report.
… the study showed there was only a slightly higher risk in choosing a home birth. And if done properly with a low-risk pregnancy, there was no real difference.
Exactly. What the study really shows is that low-risk, midwife-attended home birth is a *safer* option than hospital birth. The issues are around risk assessment and management … and the right of women to accept or reject advice.
“The risk is mainly in people who have home births that shouldn’t have them, such as having twins, a breach birth or people too far beyond their due date,” Prof Keirse said.
These outcomes of these births is better when they occur in hospital.
“A mother has to be responsible when deciding what kind of birth to have and these mothers are taking unacceptably high risks.”
Prof Keirse said he was scared by the number of women choosing to have home births after already having had a caesarean.
“When a problem happens and you are at home you have no real way of dealing with it,” he said.
“One of these days we will not only lose a baby but a mother as well.”
Homebirth Australia national secretary Justine Caines said the reporting of the study by the AMA was irresponsible.
“I think they are trying to push a political agenda and outlaw or force home birth underground, which is incredibly irresponsible,” Ms Caines said.
“The report says there are 7.9 deaths per 1000 in planned home births, compared to 8.2 in planned hospital births, but they didn’t all stay home births and the real figure of births that actually occurred at home is 2.5 deaths per 1000.”
The study title states it was looking at *planned* home birth and *planned* hospital birth. Actual place of birth was not the focus of the study. If the study focussed on the babies that were born at home, it would have had to include babies who were intended to be born in hospital, but arrived too quickly at home. These births are possibly riskier than planned home birth.
Last year the Federal Government refused to include home birth under its midwifery indemnity scheme.
The decision forced many midwives underground and threatened to increase the number of women ”freebirthing”, or delivering at home without any medical supervision.
This has not happened as the changes will not come into effect until July 1, 2010.
Ms Caines said from July this year midwives were at risk of not being able to be registered under the Commonwealth reforms.
“In the UK there is a legislative right that if the woman choses a home birth there is a responsibility that they have a trained health professional with them,” she said.
In the UK, it is illegal for women to have unassisted births. We do not have this law in Australia.
“A woman has a right to make an informed consent to a home birth and if she understands the advice she’s received it’s not my right to say you can’t do that.”
AMA president and obstetrician Andrew Pesce said the study supported the association’s stance against home births.
“The current evidence would mean we could not support home birth given that it is associated with higher risk of babies dying,” Mr Pesce said.
“The risk of what is happening now needs to be acknowledged and the midwives and people involved in home births need to put plans in place to manage those risks.”
The AMA admitted the study revealed many positives for home birth but maintained it was too great a risk for mothers and babies.
SA independent midwife Julie Garrett said midwives were aware of the complications, but had a duty to support the choice of a mother.
And this is the crux of the matter: midwives do not act irresponsibly. We do inform women of the risks. But women are free to choose amongst options and to make the right decision for them.
Ms Garrett said the culture in Australia needed to change to support midwife-based care as an alternative.
“In England and New Zealand they are bringing in home births, while Holland has an almost completely midwife-based care model. It’s the culture here that needs to change. Women should be able to choose.”
In the UK, NZ and the Netherlands, health policy supports low risk home birth. Even in a country such as the Netherlands, where home brith is a normal birthing option, the home birth rate is only 30%. 70% women need to birth in hospital or choose to birth in hospital, and there is no stigma attached to it. In a country such as Australia, with a caesarean rate in excess of 30%, a maximum of 70% women will be “eligible” by risk-assessment standards, to birth at home. Add to that twins, breeches, women going over 41 weeks or less than 37 weeks, high blood pressure, gestational diabetes, big babies and so on, and you can understand that even if home birth is a government-supported option, it will not be an option for the majority of women.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Complicated pregnancy or birth, continuity of care, Maternity Services Review, midwife, Midwifery, Midwifery services, Normal Birth, Obstetrics, women's rights
Posted by Melissa Maimann on Jan 19, 2010 in
Home birth,
Midwifery 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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BABIES are seven times more likely to die during home births.
That is the finding of a study conducted by Marc Keirse of Flinders University … who examined data on almost 300,000 births in South Australia between 1991 and 2006.
Babies born at home were also 27 times more likely to suffer asphyxiation during labour …
… The AMA is backing the federal government’s proposed overhaul of home birthing laws, which will require all midwives to be insured and join a national register.
… a… Senate committee recognised the legislation could drive home births underground.
… Professor Keirse said the home births regime needed a stronger safety net.
“Prohibition doesn’t work. It would just make it less safe than it already is” Professor Keirse said.
“But what we should do is have a larger safety net to make sure people are doing it properly.”
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, Home birth, Maternity Services Review, midwife, Midwifery services
Posted by Melissa Maimann on Jan 18, 2010 in
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Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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AN ONLINE poll has found huge opposition to draft Federal Government laws which would effectively ban homebirths and could lead to women choosing to freebirth.
The parenting social networking site BellyBelly.com.au found 94 per cent of the 400 respondents opposed the amended legislation …
… 30 per cent of respondents said they would consider freebirthing – giving birth without medical assistance – if not allowed to choose their own midwife.
Under the Federal Government’s draft health practitioner regulation law, independent midwives could be deregistered unless they have private indemnity insurance.
So far, the government has failed to include homebirths in the indemnity scheme while insurance companies refuse to insure private midwives.
Proposed changes … would also see midwives forced to work alongside obstetricians.
… “Women are very angry, passionate and strong-willed on this topic and feel that their rights as a woman are being threatened,” she said. “Many members commented that they are appalled that the government thinks it has the right to choose where and how they birth their babies.”
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, freebirth, Home birth, Maternity Services Review, midwife, Midwifery, Midwifery services, women's rights