How do Midwives Work?

Posted on September 15, 2011 by Melissa Maimann

It’s a common question I am asked! When people ask me what I do, I tell them I am a midwife. The next question is usually, “Oh, so you’re a nurse?”. “No”, I reply, “a midwife – I care for women though pregnancy and birth and with their new baby.” Then they really look puzzled. “So you’re not an obstetrician then?” “No, I’m not an obstetrician. An obstetrician is a doctor who specialises in caring for women with complicated pregnancies and births. A midwife specialises in caring for women who are having healthy pregnancies and births.” By that stage they’re well and truly confused and I start to wonder if midwifery is an invisible and undervalued role, or whether it’s simply not promoted as a care option for all women.

The term midwife means ‘with woman’. Midwives work in partnership with women through pregnancy, birth and the postnatal period. Midwives can provide care to women from the time that the woman discovers she is pregnant, right up until her baby is 6 weeks old. In fact, women who experience a normal, healthy pregnancy and birth may not see a doctor at all! Eligible midwives are able to order all the necessary tests and scans during pregnancy and may refer directly to an obstetrician if their services are necessary.

Midwives provide education, support, advice and information, as well as doing all the routine checks of mother and baby.

Midwives advocate measures throughout pregnancy and birth that promote normal birth: that is a birth without interventions. Midwives and are experienced in such things as water birth, active birth, and so on.

Midwives are also specially educated to know if anything is out of the ordinary, and they can get help from obstetricians. In pregnancy, midwives see women at intervals so that any issues that may present can be dealt with before they cause any major issues.

Women who are cared for by one midwife from pregnancy through to birth have better outcomes in terms of safety, lower rates of intervention and satisfaction with their experience. Midwives too prefer to work in this way, getting to know each family individually.

Visit my website to explore birthing services.

Is caesarean now the ‘normal’ way to give birth, and should we be worried?

Posted on September 13, 2011 by Melissa Maimann

There’s no doubt that caesarean sections are an essential procedure that can save the lives of women and babies. But around one in three Australian women will give birth by caesarean section – and that’s not just to save lives.

… The rising caesarean section rate in most of the developed world has not resulted in reduced rates of stillbirth or infant death – quite the contrary.

One Australian study showed that babies were more likely to be admitted to a neonatal intensive care unit if they were born by elective caesarean section than other types of delivery. A previous caesarean section also increases the risk of stillbirth.

In terms of outcomes for women, those who have emergency and elective cesarean sections are less likely to exclusively breastfeed. And there is growing evidence that caesarean operations increase the risk of the mother dying or becoming ill with blood loss, blood clots, abdominal organ injury and the need for a hysterectomy.

It’s important to consider the risks of caesarean births. But rather than just focus on the polarised “vaginal birth vs caesarean birth” debate – which pitches doctors against midwives, and doesn’t help women who are stuck in the middle – we need to focus on the ways we can support all women to have the best outcome from childbirth.

It seems that one of the driving forces behind the rising caesarean section rate is fear … about labour and birth, and from doctors and midwives who are themselves fearful of the birthing process.

… we should be examining why women are fearful of labour and birth and what our health system can do to reduce this fear.

Our health system is generally an unfriendly one for pregnant women and it’s likely that this compounds the fear of birth. It’s common for a pregnant woman receiving care in the public system to see up to 30 different caregivers through pregnancy, labour and birth and the postnatal period.

The opportunity for pregnant women to develop a meaningful relationship with her health care provider, discuss her fears, affirm her needs and develop confidence in labour and birth are minimal.

… One of the disturbing elements of birth in the 21st century is the lack of respect for privacy for labouring women. The entourage of people appearing uninvited into labour rooms in most hospitals is astonishing. Each labour and birth can have a multitude of spectators, including a midwife, obstetrician, registrar, resident, student midwife, medical student and on it goes.

… To address this problem and encourage Australian women to give birth normally, … In NSW, the Towards Normal Birth Policy was released last year and provides 10 steps towards supporting more women to go into labour and ultimately have a normal birth.

The policy recognises that ”… unnecessary interference in the natural process may disturb the expected course and may lead to a cascade of intervention.”

The challenge is to redesign the health system to facilitate women’s confidence and trust in birth. Fundamental changes need to occur to ensure all women are supported during pregnancy and feel confident in their ability to give birth, including:

Continuity of caregiver;

Increased options for the style of birth, with access to a birthing pool;

A positive environment, free of disruptions; and

One-to-one midwifery care in labour so women are never left alone or fearful.

Visit my website to explore birthing services.

I’m pregnant! What are my next steps?

Posted on September 11, 2011 by Melissa Maimann

If you have just found out you are pregnant, congratulations! You might be feeling a range of emotions: excited, fearful, overwhelmed, happy, anxious … this is all very normal! Many women who contact me feel unsure about what to do next and are anxious to know all their options before making a choice, so I have put together a few tips to make you feel a little more confident.

Although many women see their GP as their first port of call when they are pregnant, it’s handy to know that women may also see an eligible midwife who can order all the necessary pregnancy tests and any scans that are needed. An eligible midwife can also talk with you about the available options for your pregnancy and birth care, in a relaxed and unhurried setting. An eligible midwife can help you determine your due date and arrange any referrals that you may need. She can book you into a hospital, refer you to an obstetrician if needed, and also provide full pregnancy, birth and postnatal care.

Visit my website to learn more about my services.

I’m pregnant. Who should I go to for care? A Midwife or an Obstetrician?

Posted on September 9, 2011 by Melissa Maimann

Private Midwife:

Provides autonomous pregnancy, birth and postnatal care for women who are experiencing normal, healthy pregnancies

Provides care in consultation with an obstetrician when a woman’s pregnancy has risk factors (eg high blood pressure, prem labour, concern for baby’s growth, gestational diabetes etc)

Transfers responsibility for care to an obstetrician if complications emerge and continues to provide care within the midwifery scope of practice

Supports women to birth normally with a high rate of natural birth

Supports women to breastfeed

Provides pregnancy, birth and postnatal care

Pregnancy appointments allow time for questions, education and discussion with appointments typically 45-60 minutes in duration

Women are highly likely to report satisfaction with their care and experience

Private Obstetrician:

Provides autonomous care for women regardless of risk factors

Receives referrals from midwives for women with risk-associated pregnancies or births

Always provides labour and birth care (including caesarean) in collaboration with a midwife

Obstetric care on average results in a high degree of intervention such as induction, epidural, caesarean and episiotomy

Provides brief in-hospital consultations after the baby is born, followed by a 6-week check

Pregnancy appointments are generally no more than 15 minutes in duration

Collaborative care: private midwife and private obstetrician

Receive autonomous pregnancy, birth and postnatal care from one midwife and one obstetrician regardless of risk factors

No transfer of care if risk factors emerge

Supports women to birth normally with a high rate of natural birth

Supports women to breastfeed

Provides pregnancy, birth and postnatal care

Pregnancy appointments allow time for questions, education and discussion with appointments typically 45-60 minutes in duration

Women are highly likely to report satisfaction with their care and experience

Provides autonomous care for women regardless of risk factors

Supports women to birth naturally, including with twins, a breech baby or a VBAC

Visit my website to explore birthing services.

Mum sent home in taxi four hours after birth

Posted on September 8, 2011 by Melissa Maimann

ON Monday night, Casey Benger gave birth to a beautiful little boy at … Hospital.

Four hours later they were on their way home.

The taxi driver who collected the mum and her new baby was outraged that she would be released in the middle of the night so soon after giving birth, but the hospital says it’s normal practice.

… under the community midwifery program, if a mother has given birth before, if it was a vaginal birth, and the delivery was uncomplicated, the mother and baby can go home four hours after the delivery.

… “I was a bit shocked at first and asked if it would be better to stay …”

“The staff are under a lot of pressure up there. They were very busy with people coming and going …

This is the experience for many women birthing in the public system where resources are stretched. Women can expect to be discharged home between 4 and 48 hours following birth, with some follow-up at home.

Visit my website to explore birthing services.

Choosing the right care provider

Posted on September 7, 2011 by Melissa Maimann

Choosing the right practitioner is a very personal decision and there is no right or wrong choice. Some women will make an initial choice of care provider and decide to change care providers during the pregnancy other women will make one choice in their first pregnancy and then a different choice in a subsequent pregnancy. What’s important is understanding all the options available so that you can feel confident to choose the best option for your needs.

When you are considering a care provider, it’s also necessary to consider where you would like to give birth and to ensure that your care provider can attend you in your chosen setting. You might choose to birth your baby in a public hospital as a public or private patient, in a private hospital as a private patient, in a birth centre or at home. It can be helpful when trying to make a decision to write down a list of questions you may have and also consider what is important to you as you make your choices. For example:

What do I want from my care?
What type of practitioner would I feel most comfortable with?
Do I want public or private care?

These are questions only you can answer. Other questions are for your care providers, and it’s a good idea to interview a few care providers – midwives and obstetricians – before making a choice. Midwives and obstetricians will charge a fee for interviews and you are able to claim this through Medicare (your midwife will need to be eligible in order for you to claim a Medicare benefit). It is important during the interview that you ask all the questions that are on your mind, and to be aware of how you feel throughout the interview. Your care provider should inspire you with confidence, help you to feel at ease and comfortable, and the appointment should feel unhurried.

Likewise, your care provider may like to “interview” you, and this is so that your care provider can be sure that s/he can meet your needs. Maternity care is provided in a partnership and so it’s important that both parties feel really comfortable with the other.

There are many questions you might wish to ask your care provider; the best suggestion is to consider what is important to you and write a list of questions.

Visit my website to explore birthing services.

I’m pregnant and I have private health insurance. What are my options?

Posted on September 2, 2011 by Melissa Maimann

Great question! There are a few options available to you as a private patient, as well as all of the options that are available to public patients. Specifically, the private options are either a private midwife, or a private obstetrician.

Private midwife
To receive care from a private midwife and obtain Medicare benefits, your midwife will need to work with an obstetrician or a doctor who provides obstetric services. Some private midwives are able to provide labour and birth care in hospital settings, while others are only able to provide labour and birth care at home. All private midwives can provide pregnancy and postnatal care. Hospital options may include private or public hospitals; it’s best to ask your midwife which hospitals she attends births at.

Private obstetrician
Private obstetricians can provide pregnancy, birth and postnatal care, although birth care would also be provided by hospital midwives who may be unknown to you until birth. Private obstetricians deliver babies at public and private hospitals.

Visit my website to explore birthing services.

Are home births safe?

Posted on August 31, 2011 by Melissa Maimann

Jon Barrett is accustomed to dealing with anxious mothers-to-be. As chief of maternal-fetal medicine at Toronto’s Sunnybrook Health Sciences Centre, one of the main concerns he hears from patients involves unnecessary medical interventions during delivery.

He acknowledges that the rate of Caesarian sections and episiotomies is far too high … But he’s more unnerved by what that phenomenon appears to be triggering: a surge in demand for home births.

Barrett’s concerns about home births stem from experience. Between 1990 and 1992, he was part of an obstetric “flying squad” in Newcastle, England. His job was to travel, by ambulance, to the bedsides of women whose home births had gone awry …

Two incidents are particularly vivid. The first occurred in winter. Navigating the ambulance through snowy laneways, Barrett’s team arrived to find two midwives frantically working over an unconscious woman. She was in shock and hemorrhaging badly. “I’ve never seen so much blood in my life.” She survived, but only after a massive blood transfusion in hospital. The second woman developed pre-eclampsia, which caused seizures, and went into cardiac arrest as his ambulance pulled up. His team was able to restart her heart and intubate her before rushing her to hospital. She also survived. He says both conditions were unpredictable and could have occurred anywhere, “But I know they would have come less close to dying if it would have happened in hospital.”

Unlike some of his colleagues on the squad who witnessed fetal deaths during home births, if Barrett’s memories were reduced to pure data in a typical study, they’d be unremarkable. That’s because most home birth data measures deaths, not complications, and his patients survived. “If you want a retrospective study, there’s no maternal mortality there . . . and so is that safe? No, it’s just bloody lucky.”

The question of how best to measure home birth safety has long plagued researchers … what is counted — mortality rates for mothers and babies during childbirth — offers little insight on the maternal side because … maternal deaths from childbirth are rare … But stories like Barrett’s suggest the numbers don’t tell the whole story. In his view, the bottom line should be obvious: “Sooner or later you’re going to get a disaster because that’s the nature of obstetrics.” He adds, “It’s very rare that it will happen, but it’s got to happen more in home birth.”

That assertion is at the heart of a furious debate in the birthing community. Mothers who choose to give birth at home often cite research showing there are fewer medical interventions and no increased risk. But in the past year, a new study has emerged that contradicts this. It shows that home births are associated with significantly higher death rates for babies. If correct, the rights of women to control their own bodies and birth experience would seem to conflict with the best interests of their children.

When the American Journal of Obstetrics and Gynecology (AJOG) released the now-controversial “Wax Study” last summer, it created the medical equivalent of the Rift Valley amongst birthing experts … [It] confirmed significant benefits to mothers who gave birth at home, including less hemorrhaging, vaginal tearing and epidural use, and fewer infections and Caesarean sections. Unfortunately, these benefits seemed to occur at the baby’s expense: … the report showed that neonatal deaths (defined as deaths within 28 days of birth) were two to three times higher for home births. Clearly, no woman who chooses home birth believes she’s jeopardizing her baby’s health, but the study suggested such faith in the safety of home birthing is undermined by medical evidence. For those who accepted Wax’s results, the benefits of giving birth at home suddenly appeared trivial compared to the risks.

In many ways, Wax’s study was groundbreaking … a meta-analysis, combined and re-analyzed existing studies, in order to create a bigger sample and, ideally, a more accurate result. He looked at more than 230 peer-reviewed papers published between 1950 and 2009, and selected a dozen that compared planned home births with planned hospital births by low-risk mothers in industrialized countries (Australia, Sweden, the Netherlands, Switzerland, Canada and the U.S.). The study’s vast scope—it encompassed more than 500,000 deliveries—boosted its credibility. As one doctor put it, “half a million births cuts out a lot of noise.”

Perhaps, but the momentary silence was followed by an outraged roar from home birth supporters, including some whose research showed very different results. “The Wax study is full of mathematical errors,” says Patti Janssen, a professor at the University of British Columbia’s School of Population and Public Health, and lead author of a 2009 cohort study that showed home births to be as safe as hospital births, for women and babies. “The design was wrong, and the calculations were wrong, and it just has to be thrown out the window.” …

… Wax initially defended his work, but then began refusing interviews … As a flood of letters poured into the AJOG … the publication convened an independent panel to examine the main complaints. In April, it published a sample of those letters, along with a detailed response from Wax. It also released the panel’s conclusion that the study did not need to be retracted.

But the debate has continued, and gained force, in the wake of a second study … out of the Netherlands … it concluded that babies born to low-risk women, under a midwife’s care (in hospital or at home) are more than twice as likely to die as those born to high-risk women who give birth under an obstetrician.

Although these results were specific to Holland, and may indicate problems in the way the Dutch system categorizes women as “low- risk,” the study nevertheless provided fresh ammunition to those who believe babies are best delivered by obstetricians, and added fuel to the home birth debate. More letters began to fly, adding to the stack of seemingly contradictory information through which pregnant women are required to sift in order to make an educated decision.

Nathalie Waite could be the poster mother for the perfect home birth. Waite’s considerations were largely pragmatic when she decided, two years ago, that her fifth baby should be born at home. She had four children attending three different Toronto schools, no nanny, and wanted her delivery to disrupt life as little as possible. It wasn’t a decision she made lightly. Her husband was nervous, but Waite’s midwife reassured them both. They lived near a hospital. Two attending midwives would be in close contact with Waite’s obstetrician and, at the slightest sign of trouble, an ambulance would be in her driveway. Most importantly, Waite knew her own body. She’d had four hospital births. During the two deliveries in which she’d fought … for a natural birth she’d experienced far less pain …

Had she known what a home delivery would be like, Waite says none of her children would have been born in hospital. “It was purely beautiful.” … “it just felt so natural. It just felt right.”

This is why home births are special, says Anne Wilson, president of the Canadian Association of Midwives. “It’s a non-medicalized environment where birth becomes a normal part of your family life.” …

… there is no debating the fact that home births have lower intervention rates. And everyone, on both sides of the argument, agrees that hospital intervention rates are too high …

His daughter’s birth, in Kingston, Ont., in 2007, was such “a spectacular experience” he and his wife decided to repeat it at their new home in Guelph this year. Unfortunately, their son was born with fluid in his lungs, which concerned their midwife enough to send them to hospital. Everything they experienced from that point on, Shaw says, reinforced their preconceptions. Their son was given blood tests, a chest X-ray and an IV for a condition Shaw believes would have cleared up on its own after several hours. They had to fight for permission to breastfeed … and, he says, when the pediatrician went home without leaving instructions for release, their son remained in an incubator for an additional 15 hours. “Our rights were completely taken away and doctors more or less said this is what we’re going to do to your baby and there’s nothing you can do about it.”

… Shaw’s mistrust of the medical system runs deep. “I’ve hung around scientists enough to be skeptical of everything I’m told,” … He and his wife refused vitamin K and erythromycin ointment for their children, two treatments hospitals and midwives administer as standard protocol after birth. (Vitamin K ensures the baby’s blood can clot until it starts making the vitamin itself, and erythromycin is an antibiotic that protects against infections from the birth canal that can cause blindness.) …

In many ways, Shaw and Waite represent opposite ends of the home birth spectrum. Certainly Shaw’s rejection of many of the fundamental tenets of modern medicine contrasts with Waite’s attempt to adapt its benefits to a home birth. But they share an important piece of common ground: both chose to deliver their babies with the help of a midwife.

Freebirthers, women who deliver without assistance (and often shun prenatal care), represent the smallest sub-section of home birth mothers, and aren’t included in studies on home birth safety. Among their most famous advocates is Janet Fraser, an Australian woman who made famous the term “birth rape” to describe an emergency episiotomy during the birth of her son. “I don’t care if you don’t like the word or the idea, it’s real so get used to it,” … In 2009, Fraser’s baby daughter died after five days of home labour. She continues to advocate for freebirth.

Freebirthers make most midwives nervous and they horrify obstetricians. Freebirth is the equivalent of playing “Russian roulette with your child,” says André Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada (SOGC). “You don’t play with a child’s life. Especially not where [health care is] free.” That said, the SOGC does believe that midwife-assisted home births are “a reasonable alternative for low-risk women.”

Yet, asked if he would consider home birth a reasonable option for his family, Lalonde is unequivocal. “No. Definitely not.” He falls back on experience for explanation. “I’ve participated in over 6,000 deliveries in my career and I know that everything looks very fine and suddenly disaster strikes.”

That conflict between medical experience and faith in a woman’s body to deliver naturally lies at the heart of the home birth debate. But is the concept of natural childbirth in danger of being romanticized? … There is a documentary, popular amongst home birth advocates, entitled Orgasmic Birth; its website invites viewers to “witness the passion as birth is revealed as an integral part of woman’s sexuality and a neglected human right.” Ami McKay’s award-winning novel The Birth House makes a compelling case for home births to a more mainstream audience. In it, the doctor is portrayed as a condescending, patriarchal figure who knocks out his protesting patients with ether, then yanks out their babies. In contrast, the methods of midwife Dora Rare are equally suspect (think mandrake root and witchcraft) yet portrayed with exquisite humanity …

That kind of experience need not be exclusive to home birth, insist obstetricians. “We should be working to make the environment of the hospital conducive to the home birth experience, rather than having more deliveries at home,” Sunnybrook’s Barrett says.

But midwives like Anne Wilson maintain there’s nothing to equal the experience of a home birth. “If I am delivering a baby in the hospital, you’re a guest in my house. If I’m delivering a baby at home, I’m a guest in your house. And there’s quite a lot of psychological difference there.” Wilson hopes the demand for home births will continue to rise in Canada … she believes that all low-risk women, including those who choose to give birth in hospital, should deliver with a midwife.

That’s the system adopted by the Netherlands — and the Evers study suggests it’s failing dramatically …

“I don’t think it’s that important to debate whether [homebirth is] safe, safer or not safe. I think it’s very important to debate how we can make home birth safer because women are going to do it anyway.”

In the United States, one way to improve safety is by improving midwifery. Training and regulations are a patchwork across the country; in some states, midwives aren’t even required to finish high school. In that respect, the U.S. lags many industrialized countries, including Canada. It’s one of the reasons Canadian midwives bristle at comparisons.

In contrast to the U.S., {Canadian] midwives are university educated, highly regulated, and well-trained in emergency skills …

Obstetricians and midwives are in broad agreement on the key measures necessary to reduce risk during home birth. They are the steps taken by Waite: ideally, a low-risk woman would deliver with the assistance of two highly trained midwives who are in close contact with an obstetrician at a nearby hospital. When those steps are put in place, Waldman says, “it can work almost as safely as the hospital situation.”

Is “almost” good enough when you’re talking about the survival of a newborn baby? Although he describes himself as a long-time supporter of midwives and birthing centres, the ACOG’s Waldman echoes his Canadian counterpart, Lalonde, when he says he wouldn’t want a home birth for his wife or daughter. “The intrapartum loss rate has got to be higher at home, it’s just intuitional for anybody who does this work. How big that number is could be debated.”

And is being debated. As larger and larger studies are undertaken, Sunnybrook’s Jon Barrett believes the data will start to show consistently higher risks associated with home births …

Visit my website to explore birthing services.

Homebirth midwifery

Posted on August 25, 2011 by Melissa Maimann

In 2010, National Registration came in and required that all health practitioners carry professional indemnity insurance. Indemnity insurance had to cover every aspect of practice. Except there would be no insurance for homebirth. Threatened with the extinction of private homebirth services, the government inserted an exemption to the requirement of insurance for a homebirth. We still need insurance for pregnancy and postnatal care, but not the actual birth …. At home.

What about when we need to transfer women to hospital? It happens in 10% – 50% of cases, depending on how a midwife practices, how adherent she is to the ACM Guidelines, safety issues and so on.

Typically, we go with our clients to hospital and stay to support them when they are transferred. This has not been questioned until now.

Does “support” at a homebirth transfer constitute “midwifery practice” for which we need insurance? In considering the support vs practice issue, we should consider the sorts of situations that may arise while we are supporting a woman in hospital, and how we would respond. Please consider the following scenarios:

A woman transfers from home to hospital and has a CTG (baby heart rate monitor) in progress. The private midwife is in the room with the woman and her partner. There is a concerning abnormality in the baby’s heart rate. The midwife rings the bell. Several minutes elapse. The midwife rings the bell again. Should she act (change the woman’s position, cease the Syntocinon infusion if it is in progress, increase fluids etc) or not? Because if the midwife did act she’d be practicing midwifery. Let’s assume the midwife did not act. Fast forward to the birth and there is a bad outcome. Will the midwife be considered to have been partly liable for failing to act? How will the woman see this scenario if the midwife didn’t act and her baby was harmed? Do you think the woman might try to sue her midwife who she has paid to attend her birth as advocate / support / immediate second opinion person and so on?
A woman has had her baby. Hospital staff have left the room and it’s quiet time for the parents. The woman mentions to her private midwife that she feels a sudden warmth and dampness and asks her midwife to check. Should the private midwife check? Should she simply press a buzzer and wait? If she does check, she notices a concerning about of vaginal bleeding. She rings the bell and waits. Should she act to stem the flow of blood by massaging the woman’s uterus to a state of contraction? If the hospital staff come and it’s obvious that they’re run off their feet, should the private midwife assist them perhaps by preparing an IV infusion, locating equipment for them to use, reassuring the woman who is the midwife’s client as well as the hospital’s client? Who’s liable if the private midwife prepares the infusion incorrectly and the hospital staff administer it? You might think the hospital staff are liable; they might argue that the private midwife is.
A woman is labouring and the hospital recommends a particular course of action which the woman does not want to follow. She looks to her private midwife for guidance. What should the private midwife say? Nothing? Because if she ventures to provide any advice, she is practicing midwifery.
The hospital staff make an incorrect assessment, for whatever reason. They intend to act on this incorrect assessment with a management plan that the private midwife knows to be inappropriate for the woman. Should she speak up? If she does, she is practicing; if she does not and there’s a bad outcome, could she be liable?

So you can understand the dilemma that is faced by a midwife who “supports” her client in hospital, and why insurance is necessary whenever “the individual uses their skills and knowledge as a … midwife”. You can also understand the conflict experienced by all – the hospital, woman and midwife, when a midwife attends the hospital with her private client.

The homebirth exemption covers the birth at home; it does not extend to a home birth transfer. One insurance product covers labour and birth care, however it only covers the care of private patients. Obstetricians don’t – as yet – provide back-up care for home birth women, and midwives do not have admitting rights to be able to admit women. Hence, women are admitted as public patients when they transfer from a homebirth.

This has been known for a while now, that insurance does not cover the care of public patients, women who transfer from home to hospital are public, therefore the midwife is not covered. We didn’t think it mattered because we assumed that “support” requires no insurance. Right? Wrong!

We need to have insurance to practice, but how is practice defined? The Registration Board defines it:

Practice means any role, whether remunerated or not, in which the individual uses their skills and knowledge as a nurse or midwife. For the purposes of this registration standard, practice is not restricted to the provision of direct clinical care. It also includes working in a direct non-clinical relationship with clients, working in management, administration, education, research, advisory, regulatory or policy development roles, and any other roles that impact on safe, effective delivery

In effect this means if you are a private midwife, you are a private midwife wherever you are and whomever you’re with. As soon as we use our knowledge or skills, we are considered to be practicing, and we cannot not use knowledge that we have.

Where does this leave homebirth and midwifery?

From the woman’s perspective, who would choose a private midwife for home birth care when faced with a possibility of transfer to hospital without the private midwife whose “support” / advice would be most valuable when faced with an unexpected situation?

From the private midwife’s perspective, who can sleep at night knowing she may have to leave a woman at the hospital gate right when the woman needs her midwife the most?

The absurd thing about all of this is that midwives can simply unregister and have none of these issues. And they are doing just that! So long as we don’t call ourselves “midwife”, we can do just as we please. You see, we have title protection (“midwife” is a protected title), but not practice protection. Anyone can assist a woman in birth. Unregistered midwives work with no practice and referral guidelines, no regulation, no compulsory hospital booking for homebirth clients, no insurance costs, no continuing professional development costs, no obstetric consultation if it is not desired – you can do what you want, so long as you don’t call yourself a midwife. It’s absolutely legal.

Is this a safe system of care? Is this meeting the needs of homebirth women and babies? Isn’t it far better to have a system whereby a private midwife can admit her client to hospital if need be, and continue her care in the hospital?

It seems that no-one can force hospitals to enable admitting rights for midwives, even though this is was the Health Minister’s intention when the reforms were rolled out. We have reached a situation that requires urgent resolution.

For now, I have taken the decision to cease my homebirth practice. I am no longer accepting homebirth bookings, however I am of course homebirthing with my booked clients who have chosen homebirth.

This has been a distressing and difficult decision. I love attending homebirths. There’s something special about being home with a woman in labour and welcoming a baby into the world gently and peacefully at home. It’s really special. Relaxed, calm, peaceful, joyous. No hospital noises or smells, no clinical store rooms, no hospital bed and stainless steel, no doors banging, phones / pagers ringing, people yelling down corridors. Just home furnishings, carpet, softness, warmth and love. The perfect way for a baby to journey into this world. My heart is very heavy with this decision. Once I have admitting rights, I will start homebirthing again. However for now, I feel incapable of dropping a woman at the hospital gate and not supporting her through labour; and I am not willing to be seen to be practicing without insurance as this is an offense.

I am continuing to birth with women in hospital as I am fortunate to be able to do so and we have had amazing feedback from women and their partners. I truly believe it represents the ultimate in private maternity care. No-one is ever “transferred” as we can accommodate all levels of care and care needs and women are supported by continuity of midwifery and obstetric care. This is a far superior model than home birth where any obstetric involvement entails the woman being seen by an unfamiliar obstetrician in a hospital clinic and any labour transfer entails moving to a new location to be cared for by strangers. I strive to give women and babies the very best care and in my heart, I know that our collaborative model of care is the very best in private care. I am, however, very sad to leave behind homebirth for now. It has been my passion and dream for most of my life.

‘Illegal’ midwives: Is Australia destined for the same?

Posted on August 21, 2011 by Melissa Maimann

An article from Canada explains their midwifery system which includes unregistered midwives.

Ann (not her real name) operates outside the regulated profession, living life on the edge, exposed to a constant threat of legal action should births under her watch go wrong.

She knows five other unregistered midwives working in Montreal’s so-called “parallel network.” They typically help women who are unable to secure legal midwife services to have their babies at home or in a birthing centre, and who reject the official alternative of giving birth in a hospital

There is no shortage of demand for their services. With just 140 registered midwives able to practise across the entire province, the parallel network fills a yawning gap in the market. Much of the birthing industry – obstetricians, gynecologists and some registered midwives – would consider its covert practitioners to be charlatans. But, to women determined to choose how, where and with whom they give birth, they are valued allies.

Take Teprine Baldo, who had her eldest child, now 2 years old, at home with the help of what she calls a “midwife recognized by the community. I prefer the term. It’s more respectful. People tend to talk about illegal midwives the way they used to talk about witches,” she says.

There has been one prosecution over the years. In 2006, Diane Boutin was forced to transfer a woman in her care to … Hospital after complications set in mid-labour. Following an emergency Caesarean, the gynecologist on duty filed a complaint with the provincial order of midwives … which went on to successfully pursue Boutin for illegal practice under Quebec’s professional code, a felony carrying a fine of up to $6,000.

In the days before the profession began its slow march toward legalization in the 1990s, all midwives were renegades operating outside the system, some entirely self-taught, others holding foreign qualifications unrecognized by the province. But, times have changed and as the now-regulated profession wages a PR battle for public acceptance, pushing against residual resistance from an often skeptical medical establishment, it cannot be seen to condone illegal practice.

parents are likely to be the biggest losers when things go wrong, should newborns be left damaged as a direct result of negligence or malpractice.

It’s a hugely sensitive issue. Sinclair Harris, a registered midwife at Pointe Claire birthing centre, is sympathetic with her unregistered counterparts. But, she says, “You need an understanding of pathology, of the things that can go wrong, if you are to be available for the mainstream public.”

Women like Baldo are incredulous that they are still being denied that choice, outraged that the black market midwives helping the most determined to exercise basic rights over their bodies risk prosecution.

“It’s like we’re being told we can’t birth properly,” she says. “I’m not against hospitals. My issue is that there’s often no alternative.”

At 32 weeks, she dropped out of the system, switching to an unregistered midwife

Seeking closure after a traumatic first birth in hospital, Caroline Gauthier gave birth to her second child at home with an unregistered midwife.

She was living in British Columbia, pregnant with her first child, when her dream of an intervention-free home birth went awry. Transferred to hospital by her registered midwife after her cervix was slow to dilate, she was administered hormones to speed up labour.

“I was like Jabba the Hutt, hooked up to the monitor,” she says. Staff forgot to turn on the oxygen supply to her mask, leaving her flailing about for help. When her baby finally arrived after a traumatic final push, she was barely able to touch his foot before he was whisked away.

Pregnant with her second child in Quebec, she immediately set about trying to secure a midwife at the Du Boisé birthing centre in the Laurentians. However, her place was contingent on her delivering at the birthing centre.

But Gauthier had already set her heart on giving birth at home. At 32 weeks, she dropped out of the system, switching to an unregistered midwife. Again, her labour was long, but she sat out the hours in the bath and in bed. “This time, I had a midwife who didn’t have a system to please,” she says.

After three days of labour, the baby’s head popped out while she was on her way to the bath. “In less than two minutes, the whole body was out,” she says. He didn’t immediately cry, “but nobody made a circus out of it.”

Vindicated by her second experience, she is now a fierce advocate of women’s right to give birth as they choose. “I was given the time my baby needed,” she says. “My neighbours tell me I was so brave delivering at home. My reaction is: ‘My God, you’re brave giving birth in hospital. You’re putting yourself at their mercy. You don’t know what you’re getting yourself into.’ ”

The midwife: With no insurance, every new client is a gamble

On D-day, Ann arrives on the scene with a case containing oxygen supplies, a heart monitor, synthetic oxytocin, herbal remedies, suture material and local anesthetic for stitches.

She has been practising midwifery in the parallel network for more than 10 years. Clients find their way to her by word of mouth. She has a busy schedule year round, attending to three or four clients a month.

Clients are generally women who have been unable to find a registered midwife …

Occasionally she has transferred cases to hospital …

With no insurance, every new client is a gamble. “My insurance is the trust I develop with the parents. I trust people who have the deep belief that it’s best for the birth of the baby. Nobody can be sure of the end result.”

There is a contract, though she is clearly ill at ease with cold legal realities. “It’s about ensuring the parents understand what they’re getting into,” she says. “But, sometimes I forget to get people to sign. We’re on another level. It’s not about business.”

She describes herself as a self-taught midwife eschewing a system where midwives are “too stressed, too watched.” …

The four-year university program didn’t appeal to her. “I thought it was too focused on pathology. There was no alternative medicine. No spirituality,” she says. “It’s as if only one kind of intelligence is allowed. Forget emotional intelligence.”

Midwifery was legalized in Quebec in 1999, following a five-year pilot project. Home births with the assistance of registered midwives have only been allowed since 2005.

In a 2007 Statistics Canada report, 71 per cent of women who had delivered with a registered midwife rated the experience as “very positive,” compared with 53 per cent of women who had delivered in a hospital.

According to research … midwife-assisted home births are associated with lower rates of obstetric interventions and adverse outcomes. Newborns born at home were also less likely to require resuscitation or oxygen therapy.

Australia is heading for a similar situation, brought about by a few factors: the recent position statement on homebirth which effectively prevents midwives from attending high risk births at home, the lack of visiting rights to enable most midwives to birth in hospital with their clients, dissatisfaction with current hospital-based maternity services that are seen by women to be impersonal and highly interventionist, and a differing view of things such as risk and responsibility. Although some midwives are making the choice to unregister and continue to attend births, they do face the same issues that are explained in the article.

Visit my website to explore homebirth and hospital birth.

NZ Midwifery system hailed as world leader

Posted on August 18, 2011 by Melissa Maimann

New Zealand midwives provide the best care in the world for mothers and newborn babies.

That’s how international delegates attending a major international conference on midwifery and maternity care have described New Zealand’s midwifery led maternity model of care.

They acknowledged that New Zealand is leading the world in setting the standards for midwifery practice and professionalism, citing midwifery education, regulation and training, and strong collaboration with other health professionals.

… The report highlighted “midwifery services as the focus of global efforts to realise the best possible care during pregnancy and childbirth for every woman and her newborn”.

… New Zealand is alone in achieving a high level of access to midwives for all women and their babies.

The focus of the more than 3000 participants attending the 29th Triennial Congress of the International Confederation of Midwives (ICM) in South Africa was to further develop strategies to reduce maternal and infant mortality by strengthening midwifery worldwide.

The consensus world wide is that an educated well supported midwifery workforce will improve outcomes for mothers and babies.

… New Zealand is the only country that already conforms 100% to these new standards and competencies, and delegates from many countries are looking to us to help them with implementing similar models of midwifery care.

Several international agencies including the United Nations Population Fund, the World Health Organisation and the International Federation of Gynaecologists and Obstetricians pledged to support the implementation of the ICM standards.

… New Zealand midwives become degree qualified through three-year (equivalent to four years, as each academic year is 47 weeks long) Bachelor of Midwifery programmes. They are professionally accountable as they are regulated by the Midwifery Council, set up under the Health Practitioners Competence Assurance Act of 2003.

“The NZCOM is New Zealand’s professional organisation for midwives and we provide ongoing educational development for midwives after they are registered. We also promote ‘Standards of Practice’ through a variety of mechanisms including the Midwifery Standards Review process,” …

While there are some very positive aspects of the New Zealand maternity system, there are also a few concerning areas, such as the huge caseloads that NZ midwives are required to take, which can impact on continuity of care and in the time that is available to each woman. That aside, they have a great system where women are supported to birth at home or in hospital, and midwives are able to access any hospital of their choosing. Hence they can provide complete continuity of care, 100% funded by the government so women are not out-of-pocket. In Australia, the gates to private practice have opened and private practice is encouraged. Eligible midwives are able to provide medicare-funded care, but there is still an out-of-pocket cost to women, as there is with any private health service. Visiting rights have not yet been established, but some private midwives have negotiated ways of birthing in hospital with their clients. And of course homebirth remains an option. Hopefully in years to come, Australia will also be hailed as a midwifery world leader.

Visit my website to explore homebirth and hospital birth.

Well-off mothers spend thousands on private midwives

Posted on August 16, 2011 by Melissa Maimann

An article
from the UK explains that women are spending thousands of pounds on private midwives to achieve the ‘perfect’ birth. The situation is not too different to the Australian experience.

In the UK, private midwives charge between £1,800 and £5,000 for a birth, but their services are in high demand from professional, well-educated women who have become disenchanted with the hospital experience. The number of mothers paying for private midwives to attend home births has tripled in the last eight years.

Demand has become so high in parts of London and the South East that some expectant mothers have been unable to find a private midwife to assist them.

Many of the expectant mothers are older and have been put off by previous experiences in NHS maternity wards.

Women who engage private midwives claim they can form a relationship with one person rather than seeing a succession of strangers.

Midwives understand that women want continuity of care and someone to talk to them and answer their questions. Women don’t want routine and unnecessary interventions in their pregnancy and birth, and they want more extensive postnatal care.

The Australian experience is the same as that in the UK. Women seek private midwifery care for home birth or hospital birth so that they can form a relationship with one person who will be with them from their first antenatal appointment, through to birth and 6 weeks after their baby is born.

In Australia, eligible midwives can provide medicare-funded care which makes private midwifery care more affordable to women, thanks to the maternity reforms.

Visit my website to explore homebirth and hospital birth.

Homebirth Position Statement

Posted on August 6, 2011 by Melissa Maimann

The Australian College of Midwives (ACM) is Australia’s professional body for midwives. Recently, ACM was charged with the task of preparing a position statement on home birth. This position statement will have a great impact on the future of home birth services in Australia, so it is of enormous significance to home birthing women and their midwives. As well as a position statement, ACM has developed a Guidance which clarifies the expectations for private midwives when providing midwifery care for a planned homebirth.

The documents are:
Literature Review
Homebirth position statement
Guidance for private midwives attending homebirths

Probably the best way to read these documents is to start with the literature review because it provides the context for the guidance and position statement.

ACM’s literature review was restricted to studies which met all of the following criteria:

Studies of planned homebirths with a registered provider/s, compared with planned hospital birth

Research articles that also addressed maternal and neonatal outcomes

Articles from developed countries, written in English and with a publication date between 1995 and 2011.

Any articles that did not describe studies which included a comparison group, investigate planned homebirths or relate to maternal and/or neonatal outcomes were excluded. This rigorous process identified eleven studies which formed the basis of the literature review. The review covered 352,655 homebirths from Australia and around the world.

In general terms, the studies say that for a low-risk, healthy woman and baby, midwife-attended home birth does not increase the chance of the baby dying or being harmed. Home birth does, however, increase the chance that the woman will have a drug-free, intervention-free birth: that her labour will most likely start on its own, progress normally and lead to a normal birth with little likelihood of needing any stitches. Also, she is far more likely to breastfeed and to experience her birth as very positive and satisfying. This is important because it is well-known that interventions carry risks and that there can be a cascade effect, so that when you begin with one intervention, you often end up doing more interventions as the labour progresses (eg induction leading to long labour, leading to epidural, leading to forceps delivery). This is all minimised in the group of women and babies who birth at home with a qualified midwife who has a link in to the hospital with ready access to obstetric and paediatric care if needed.

However, a small number of studies demonstrated that home birth increases the rate of perinatal mortality. The research suggests that the inclusion of high risk factors in home birth, increases the chance of a baby dying or being seriously harmed during birth (most commonly through low levels of oxygen). Other issues may relate to the time and distance to travel from home to hospital during labour if transfer is needed, as well as the woman’s acceptance or refusal of recommended interventions once she has transferred. It is important to note that the outcomes of women and their babies who transfer to hospital during labour will generally compare unfavourably with those not transferred due to the change in risk status of the women.

The ACM concludes that, “It seems evident from the literature that planned home birth is a safe option for women who are at low risk of complications and who receive care from qualified attendants with adequate access to support, advice, referral and transfer mechanisms.”

With that conclusion in mind, the ACM has developed a position statement on home birth, and following on from that, guidance for private midwives who attend home births. Much discussion has been had about these documents on various forums and email lists. Some excerpts from the position statement and guidance follow:

It is the position of the Australian College of Midwives that home is an appropriate place of birth for women considered to be at low obstetric risk, and that women must be supported in safe, planned homebirth, by midwives and/or other appropriately qualified and regulated health professionals with adequate access to support, advice, and referral and transfer mechanisms.

Some women may choose a planned homebirth even when this is not recommended by her care providers. In such circumstances, a midwife should, after discussions with each woman and in consultation with other health professionals, work with the woman looking for options and resolutions within midwifery professional standards to address the woman’s needs.

Following documented discussions and appropriate consultation and referral as may be indicated, a midwife has the right to decline to continue to provide, or to accept, midwifery care if it is felt that this would require the midwife to practise outside of the midwife’s scope, skills and competencies.

Midwives have a duty of care to each woman they provide care to, and this means that in labour, or urgent situations, a midwife must attend the woman.

In the absence of a consistent definition of ‘low obstetric risk’, low obstetric risk is considered to be a pregnancy, labour and birth that are anticipated to be problem free.

There are some contraindications to a planned homebirth which women should be informed of at booking. These are;
• Multiple pregnancy
• Abnormal presentation (including breech presentation)
• Preterm labour prior to 37 completed weeks of pregnancy
• Post term pregnancy of more than 42 completed weeks
• Scarred uterus

Issues identified as “B” or “C” in the Australian College of Midwives National Midwifery Guidelines for Consultation and Referral (“the Guidelines”) would require consultation with an Obstetrician prior to proceeding with a planned homebirth. Consultation is mandatory for the midwife providing care.

Women must be made aware of the midwife’s obligation to consult at – or prior to – booking-in.

Ideally, midwives should meet the criteria for gaining notation as an Eligible Midwife.

Midwives must ensure that they have documented processes in place for consultation and referral

Any decision to provide care for a planned homebirth should take into account the possibility of transfer to a hospital and the time needed for transfer to that hospital in the event that this is deemed necessary. Women should be counselled on the possibility of transfer, and midwives should ensure that the supporting hospital is provided with a care plan/documentation around the woman’s intention for a planned homebirth.

Midwives must utilise documented evidence-based guidelines to support antenatal, intrapartum and postnatal midwifery care.

Midwives should undergo a formal professional peer review process at least once every three years.

At – or prior to – booking, the midwife must advise the woman of situations where homebirth cannot be supported. At any time, the midwife is not obliged to participate in a homebirth that the midwife considers will increase the risk of harm to the woman or her baby.

Women must be respected in the choices that they make, and that includes choices to refuse a recommended course of action at any stage of her pregnancy,

An information pack should be made available to women that should include a ‘Terms of Care’ document outlining the terms under which midwifery care will be provided.
Information should also include the potential for transfer to hospital for unforseen complications.
The following information must be provided to women at the onset of their care, ideally in writing, followed up in discussion and signed by the woman:
• Midwifery scope of practice, including the Australian College of Midwives Guidelines for Consultation and Referral;
• Philosophy of care;
• Choice of birth setting, including requirements for homebirth;
• Contact information for the midwife;
• Back-up arrangements;
• Standards of practice and protocols, including consultation and referral
• Responsibilities of the woman;
• Confidentiality and access to the woman’s records (privacy agreement); and
• Financial arrangements

It’s fair to say that ACM’s position statement and guidance are not ideologically- or belief-driven. It’s clear that the documents are driven by evidence. ACM has tackled the conflicting issue of the woman’s negative right to autonomy versus the midwife’s responsibility to practice safely and within accepted standards of care. While much is being said on various forums, email lists and face-to-face about these documents, somehow, I can’t help but wonder if the issue is really about the restriction of home birth to low-risk women, or the fact that at this point in time, a woman and private midwife have no option but to birth at home.

In the whole of Australia, there is currently no clinical privileging except in one small hospital. A high risk woman’s only option via this new position statement is to birth in hospital, however her private midwife would not be able to attend in the full capacity of midwife – or even as a support midwife: it has recently come to our attention that the midwife cannot legally attend in hospital at all.

I’ll explain why: the MIGA insurance policy covers privately-admitted patients. If the woman is admitted as a public patient after being transferred from a home birth (either in pregnancy or during labour), MIGA insurance does not provide indemnity cover to the midwife in respect of the birth. Most women planning a home birth will have a back-up hospital booking as a public patient. Hence, when the midwife goes in with the woman, the midwife’s insurance does not cover her. It is against the requirements of registration to work without insurance, except at a home birth. In other words, the midwife would be attending the woman in hospital against the requirements of registration.

In time (hopefully sooner rather than later), midwives will have admitting rights where we can admit, care for and discharge our own private patients, all funded by Medicare and indemnified by MIGA but in the meantime, this is not possible.

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

Doctor backs call for reform of maternity care in Greater Manchester

Posted on July 22, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

A top Greater Manchester doctor has backed a national call for reform of maternity care.

Dr Michael Maresh, clinical lead for the Greater Manchester Maternity Network, spoke out after a major report recommended a reorganisation of services.

The Royal College of Obstetrics and Gynaecology called for more midwifery-led units to be set up so women with low-risk pregnancies could be in the sole care of midwives.

It also calls for the number of consultant units be reduced so that senior clinicians are available around the clock.

… “The fact is that there are too many maternity units which means senior doctors’ availability is spread too thinly – reorganisation to provide fewer, specialist units is the only sensible solution.

“… we are in the process of reducing the number of maternity units and ensuring that the new model of care concentrates the expertise of doctors and midwives on eight, better staffed and safer sites.

“By providing a co-located midwife led facility at each of the remaining units, we are able to offer improved choice to the majority of women who experience an uncomplicated birth.”

With good referral systems and collaboration, a model such as this would work very well. The majority of women are healthy and have normal pregnancies and births, if they are given the right support, information and care. The midwifery model of care is a safe and satisfying model of care for healthy women.

Expectant mothers need facts, not fear

Posted on July 21, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

Here we go again. A debate about home vs hospital birth.

There is only one thing … that’s more emotive than where you give birth to a baby, and that is how you feed it.

This week, the Royal College of Obstetricians and Gynaecologists … proposed that more women give birth away from doctors and hospitals. I really want to see how this works, because if there’s anyone more scared of home births than the parents, it’s doctors and midwives. (Note: not all, I know.)

I’m not a doctor, nor a midwife. I have slightly more experience of pregnancy and birth than some, by virtue of being co-founder of a parenting website for the past seven years and working as a lay rep in a large maternity hospital for four. But really, my opinion, just like so many birthing women, counts for little.

Look at what this report says: “The model we are proposing focuses on the needs of the woman and her baby by providing the right care, at the right time, in the right place, provided by the right person and which enhances the woman’s experience.” Sound great, doesn’t it? But who will decide what the right care, at the right time, etc, is? Who listens to what a mother … wants?

Hospitals are so tied by NHS policy and guidelines, and are so scared of being sued that midwives who once were perfectly capable of delivering breech babies, big babies or twins at home (yes, it can be done) no longer can, or do. So it’s easier to book everyone into the hospital. What will change? How will it change? There aren’t enough midwives as it is.

When I decided to try for a home birth I had to take myself out of the NHS system (an option that may no longer exist soon because of the threat to our independent midwives, but that is another story, for another time) because the idea so terrified almost everyone I met. I was simply deemed too high-risk. But this wasn’t based on any analysis of my actual, individual risks. It was because I ticked two boxes: “over 40″ (this is still being cited as a reason not to have a home birth) and “previous C-section” (ditto). One of the paediatricians at the hospital where I was a lay rep told me I was being irresponsible, that my scar would tear (the risk of uterine rupture is, in fact, very small) and that I’d kill myself and my baby.

“Don’t expect us to attend to you” were her actual words. Amazingly, because I wasn’t on a dual suicide/infanticide mission, and I didn’t want to leave my firstborn motherless, I asked two separate, senior midwives to go through my previous notes with a fine-tooth comb. Conclusion: no reason at all not to try for a home birth if you want to …

For many … the thought of giving birth at home is terrifying. I toyed with the idea of a home birth with my first for about 10 minutes. It was only when I saw firsthand what hospitals could offer and after five years of researching birth that I was brave enough even to think about it for my second baby.

I’ll cut to the chase. I had my home birth without drugs or incident. Yes, it was fantastic. No, you shouldn’t have to have a home birth if you don’t want to, no more than I should have had to go to hospital if I didn’t want to. This brings me on to something that no report can ever address, and that’s the baggage we all – health professionals included – bring into maternity services: our own experiences. They should inform, but not dictate.

There is one bit of the report that I think is underplayed: … “Women themselves need the support and encouragement of society, including the professionals, to take responsibility for their own health”. Indeed, we all need to take responsibility for how babies are born. Women need to stop dramatising labour, especially to their daughters. (Maternal influence is huge on a daughter’s subsequent expectation of her own labour.) Health professionals need to stop lecturing a woman on how to give birth and start listening to what women want – and then provide consistent, accurate, non-emotive information to help her set the agenda.

We all need to stop projecting our own experiences and think that’s how it will/should be for everyone else. Only then can we hope to reverse this collective hysteria that surrounds giving birth. People who make TV programmes and films: I have a special message for you, because how you portray birth is so hugely influential. I know it makes for better TV to have a woman on her back, in a hospital, screaming and tearing off her husband’s earlobes, but please, counterbalance this with women also giving birth quietly, in a position other than prone and sometimes at home. It’s partly because of you that it took me nearly 40 years to realise that it could be done.

Home birth has pros and cons

Posted on July 15, 2011 by Melissa Maimann

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The number of at-home births is small but growing as pregnant women weigh the idea of a drug-free and surgery-free birth in a familiar setting versus the risk of harm to the baby in case of complications.

When most pregnant women go into labor, they pack their bags for the hospital. When Lara Carlos felt the contractions in November 2008, she set up a birthing tub in her bedroom.

For the next several hours, Carlos alternated between padding around her home and squatting and pushing in the tub. Her midwife poured water down her back and dabbed her forehead with cold towels. When the baby (they chose the name Vincent) arrived at 1:21 a.m., he spent his first few hours cuddling with his parents in their bed.

Carlos … is one of a small but growing number of women who are choosing to deliver their babies at home. Her first son, Ivan, had been delivered in a hospital, and she says she found labor at home a dramatic improvement.

“In the hospital, there were seven medical students in the room when I was pushing my son out,” she said. “At home, it was a very quiet, slow experience, and the water helped me to relax.”

Though home births account for only about 1% of all births each year … they increased by 20% from 2004 to 2008 … The practice is most popular among well-educated mothers who favor natural childbirth without the drugs or surgeries a hospital might use.

… The increase has reenergized the fierce debate over the safety of at-home delivery. The practice is officially frowned on by the American College of Obstetricians and Gynecologists … because the absence of emergency medical equipment and specialists accustomed to dealing with complications means that problems during labor could cost the baby’s life.

“All the existing scientific evidence, as well as state and national statistics, make it ultra-clear that home birth increases the risk of death,” …

The American College of Obstetricians and Gynecologists does acknowledge that home births are associated with fewer medical interventions than hospital births … 61% of women who had vaginal delivery received an epidural in 2008, the year the report studied. And a 2006 national survey of women’s childbearing experiences showed that 55% were given Pitocin to speed labor.

“There’s no doubt that once you end up in a hospital, you end up with more interventions — that’s what drives some families away,” … home birth is reasonable as long as women have few risk factors …, have an emergency backup plan and understand the risks involved.

Women also turn to home birth in order to avoid caesarean sections, which have become more common as obstetricians became increasingly reluctant to take chances at the slightest sign of fetal distress …

What’s more, many hospitals do not allow women who have previously had a caesarean to attempt a vaginal birth because of the risk of uterine rupture, even though a 2010 National Institutes of Health advisory panel concluded that the risk of uterine rupture during a vaginal birth after one caesarean was just 1% and that more women should be offered the choice. Women wishing to have a VBAC (vaginal birth after caesarean) may have no option but to do so on their own turf.

Sarah … had two caesareans but chose a home birth for her third pregnancy, successfully delivering a baby girl in January 2010.

“We had visited numerous hospitals, and the first time I mentioned a VBAC, I was just shut down completely,” Bolson says. Doctors refused to consider it because of the chance of rupture, she recalls, and one said he couldn’t risk having his medical malpractice insurance skyrocket.

She eventually found a certified professional midwife who was willing to help her deliver at home, with a backup plan of transfer to a nearby hospital. Though initially worried about complications, “after I was able to release the fear, I was free to birth without any inhibition.”

Many home-birth moms also say they object to other aspects of hospital births, such as having to lie in a bed, abstain from food during labor and be monitored by an army of nurses.

“I believe in the intuitive power of the human body,” said Mayim Bialik, an actress and natural-birth advocate who has given birth at home. “I believe in having as much privacy as possible, in being able to move freely, to eat when I want, drink when I want, and to be surrounded by the sounds and smells of what is familiar to me.”

“Other mammals go off on their own to labor,” adds Dr. Stuart Fischbein, a Los Angeles-based obstetrician who has been delivering exclusively in homes since 2010. “When a patient goes to a hospital, she gets told to lay flat on her back strapped down with monitors with constant interruptions from hospital personnel — does that sound conducive to having a normal labor?”

Arrangements for a home birth go something like this: Early in the pregnancy a woman finds either a … midwife … The midwife provides some or all of the woman’s prenatal care and is on call as the woman approaches her due date …

During labor, many women use water tubs because they find the water soothing and pain-relieving; others choose to just move about their homes as they see fit. The midwife monitors the fetus’ heart tones with a Doppler device, and most also bring equipment such as oxygen tanks, anti-hemmorhagic medication, local anesthetic and suturing supplies in case of tearing or bleeding. If an emergency arises that the midwife can’t manage, home-birth moms are advised to transfer immediately to a hospital.

The core of the home-birth debate lies with the safety of the baby — and here, opinions and the data are sharply divided. A 2005 study of 5,418 births in the U.S. and Canada during 2000 … found that the neonatal death rates of at-home births were comparable to those of births in hospitals.

But a July 2010 analysis published in the American Journal of Obstetrics & Gynecology examined the outcomes of 12 home-and-hospital-birth studies and found that babies born at home die at two to three times the rate of those born in hospitals …

… the distance to the nearest emergency room can sometimes mean the difference between life and death. “Saying, ‘trust birth’ is like saying ‘trust the weather,’” she says, referring to a slogan occasionally used in natural-birth groups.

Just as vocal online communities have sprung up to promote home birth, so too have others populated by women whose home-birth attempts turned into tragedies … Liz Paparella’s fourth child was stillborn on her living room couch because her midwife failed to take Paparella to the hospital when she began bleeding during labor.

“I never thought it was more dangerous to have a baby at home than at the hospital,” says Paparella, who had given birth successfully at home two times previously. “In birth, the risk can change from low to high in a matter of minutes.”

… A clear answer to the safety question is hard to find because nearly every home-birth study has some flaw that is flagged by one side of the debate or the other as invalidating the results. Given this uncertainty, Ouzounian cautions women to research, prepare and choose wisely.

Home births, he says, should be considered only by those who have a well-trained midwife and are experiencing no complications with their pregnancy …

“Under the right circumstances, with the right patient selection and with a … midwife attending, the overall maternal complication rates with home births are comparable” to those of a hospital birth …

But he also advises women not to think about birth in black-or-white terms: There are many ways to make delivery more “natural” even if it takes place in the hospital …

Fischbein says that doctors could be more accommodating to their patients by providing them with information about all of their birth options — at home and in the hospital — and stand ready to serve as backups for those who wish to labor at home with a midwife.

“There’s room in this world for low-risk home birthing and for hospital birthing,” he says. “We really should support each individual woman’s right to choose how to deliver her baby.”

Thank this doc for the episiotomy you won’t have

Posted on July 10, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

When you picture a birth activist, you probably imagine a 20-something woman marching in the streets with an enormous belly.

You are less likely to envision a 70-something academic and grandfather.

And yet physician Michael C. Klein has had – and continues to have – a remarkable impact on the lives of mothers and babies around the world.

Klein is the first to admit that he owes a good measure of the birthing wisdom that first sparked his career to a group of midwives he met in Ethiopia, back when he was on a year-and-a-half leave of absence from medical school at Stanford University.

… “The midwives let me catch babies,” …

He was fascinated by natural childbirth: by the way midwives delivered babies without episiotomy …

What he learned from those midwives set the stage for Klein’s entire career, igniting his interest in old and new birth technologies and the need to improve maternity care.

It also set him on a collision course with his professors when he returned to Stanford. “If you want to practice primitive medicine, you will have to go to the county hospital,” he was told. His crime? Delivering babies without episiotomy.

Fortunately, Klein is not someone who is easily dissuaded. Faced with resistance, he simply applies additional gentle, consistent pressure. That was his style then and it continues to be his style today … he reviewed the information on episiotomy in every edition of Williams’ Obstetrics from the 1920s through the early 1990s in his quest to challenge the traditional wisdom about the procedure …

His best-known study … turned decades of obstetrical thinking on its head by demonstrating that episiotomy caused the very types of trauma that it was believed to prevent …

… What drives his research is his concern about mothers and babies … he’s also troubled by the fact that technology is becoming a routine part of the birth environment, even though research suggests that epidurals and non-stop electronic fetal monitoring should only happen when specifically warranted.

“The fundamental problem is not about normal childbirth; it’s about making normal childbirth abnormal,” he explains. “When we treat high-risk women in high-risk settings, we lower their risk. When we treat low-risk women as if they were high risk, we increase their risk and create complications. That is what we are doing today.”

His research has shown that the younger generation of obstetricians (those age 40 or younger) is more likely to support the routine use of technology during birth than older obstetricians … Klein blames this on fear of normal birth, the result of simply not having attended enough normal births to build confidence in the process.

Today it’s midwives who tend to be the guardians of normal birth … midwives’ thoughts and beliefs about birth are very much in synch with those of normal birth.

… the Society of Obstetricians and Gynaecologists of Canada (SOGC)… recently issued a press release objecting to comments he made in a press release issued by the University of British Columbia describing his most recent research.

Klein, in turn, describes the SOGC as a very progressive organization. His issue is with the obstetrical profession as opposed to the SOGC itself: “The problem is that society has invested surgeons with control over normal childbirth.”

He’d really prefer to sidestep the politics entirely to focus on what matters most to him. “I’m primarily interested in the well-being of mothers and babies rather than the internal politics of medicine. I see nothing incompatible with promoting family practice and midwifery.”

Lack of collaboration stalls maternity reform

Posted on July 7, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

Midwives urge government to relook at legislation.

The government’s maternity reforms are “doomed to fail” as a result of obstetricians refusing to enter into collaborative arrangements with midwives.

… “We always feared that these arrangements would be more about control than collaboration,” … only … three [collaborative agreements have been signed] …

“Midwives are asking obstetricians in writing and calling up to 10 times to organise collaboration. Some get no response, some a polite no and others a very rude no,” …

“We did expect that this would be the case. When you put one competing professional group over another group competing for the same market share, the group in control isn’t going to do something that threatens their sizeable share. I can understand that they are threatened.”

It is true that there are only one or two obstetricians who have signed collaborative agreements with midwives, and only one that I know of whose agreement covers labour and birth care. This is disappointing because the models of care that are possible with collaborative agreements between private obstetricians and private midwives are so beneficial for women.

Maternity Reforms: Good news for expanded birthing options

Posted on June 28, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

Maternity reforms came into effect in November 2010 which gave women access to Medicare benefits for private midwifery care for the very first time. In addition, eligible midwives were to be able to order relevant tests and ultrasounds through Medicare. Medicare benefits are available to clients of eligible midwives for pregnancy and postnatal care, however there is no benefit for birth care at home.

So, 6-odd months on, how are things looking for maternity care and what possibilities await us?

Well, for a start, we had around 200 private midwives in Australia. 6-odd months into the reforms and we have at least 30-40 eligible midwives. Some of those 200 midwives have ceased private practice, leaving about 100 in private practice. So 30-40 eligible midwives represents a 30%-40% update of the maternity reforms by the current private practice workforce in just 6 months. That is phenomenal. As well as this, private practice has become a more attractive option to employed midwives now that private practice is medicare-funded and indemnified. So in months and years to come, we will have more midwives in private practice, and less in the hospital employed system. This is not a concern as the hospitals would not need their own staff: women will bring their midwife with them to the hospital when they come in to birth their babies. From the hospitals’ perspective, this is excellent news: they may benefit from significant cost savings in terms of recruitment, retention, staff education, pay-roll, rostering, management and so on.

What about for women? Well, it is well-known that women benefit from exclusive one-to-one midwifery care through pregnancy, labour, birth and the postnatal period. When women are cared for exclusively by one midwife, we know that they experience lower rates of interventions without compromising safety, and they experience higher rates of satisfaction with their birth and new parenting experience. When women choose a Eligible midwife, they can access significant medicare benefits that do reduce the cost by quite a lot. Depending on the number of pregnancy and postnatal consultations a woman has, the benefits range from say $1,000 – $2,500.

However, in order for eligible midwives to provide medicare-rebatable services, midwifery care needs to be delivered within a collaborative arrangement. And this does open the possibility for private midwives and private obstetricians to work together in collaborative practice. The huge benefit to the woman is that she has midwifery care right the way through, from early pregnancy to 6 weeks after her baby arrives, with the reassurance of having a known obstetrician who is available is needed. Women meet the obstetrician twice in pregnancy, and the obstetrician is available for labour and birth if his care is needed, and in this way, women can benefit from the ultimate in continuity of carer. This model of care is now available for the very first time in Australia history, and we are very pleased to be able to offer it to women. So far it is a very popular option! More to come.

Women, docs misinformed about childbirth tools

Posted on June 21, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

A trio of studies … shows many women and doctors are ignorant about the adverse effects associated with caesarean sections, and many mistakenly believe vaginal births are more dangerous.

… when it comes to decisions like whether they should have a natural childbirth, first-time moms follow their health-care provider’s lead.

While listening to your doctor seems like the best idea, most women choose obstetricians over midwives, and obstetricians are more likely to opt for C-sections …

Women who saw midwives were a bit more knowledgeable about their options …

… “But regardless of the type of care providers they attended, even late in pregnancy, many women reported uncertainty about benefits and risks of common procedures used at childbirth. This is worrisome because a lack of knowledge affects their ability to engage in informed discussions with their caregivers.”

A second study … shows younger obstetricians are more likely to recommend a C-section than a natural birth because they believe a C-section is less likely to cause sexual issues or urinary incontinence.

But a number of recent studies show C-sections pose health risks for mothers and children.

A New England Journal of Medicine study from 2009 says repeat C-sections double the risk of complications for newborns, including neonatal death.

A 2007 study in the Canadian Medical Association Journal said C-sections increase a mother’s risk of cardiac arrest, infections and hemorrhage requiring hysterotomy.

The third study shows family practitioners who deliver babies are much less likely to fear vaginal birth, and are more likely to opt for natural birth themselves or for their partners …

Choose your care provider carefully! Interview several midwives or doctors before choosing one. Ask questions about the things that are important to you. For example, if you want a normal birth, ask your potential care provider what % of the births they attend are by caesarean. If you want a waterbirth – ask your care provider if they attend water births.

Docs to Women: Pay No Attention to Ricki Lake’s Home Birth

Posted on June 20, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

Ladies, the physicians of America have issued their decree: they don’t want you having your babies at home with midwives.

We can’t imagine why not. Study upon study have shown that planning a home birth with a trained midwife is a great choice if you want to avoid unnecessary medical intervention. Midwives are experts in supporting the physiological birth process: monitoring you and your baby during labor, helping you into positions that help labor progress, protecting your pelvic parts from damage while you push, and “catching” the baby from the position that’s most effective and comfortable for you — hands and knees, squatting, even standing — not the position most comfortable for her.

When healthy women are supported this way, 95% give birth vaginally, with hardly any intervention.

And yet, the American Medical Association doesn’t see the point. Yesterday at its annual meeting it adopted a policy written by the American College of Obstetricians and Gynecologists against “home deliveries” and in support of legislation “that helps ensure safe deliveries and healthy babies by acknowledging that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital” …

… The trouble is, they have no evidence to back up their safety claims. In fact, the largest and most rigorous study of home birth internationally to date found that among 5,000 healthy, “low-risk” women, babies were born just as safely at home under a midwife’s care as in the hospital. And not only that, the study, like many before it, found that the women actually fared better at home, with far fewer interventions like labor induction, cesarean section, and episiotomy …

Which is why the American Public Health Association and the American College of Nurse Midwives support women choosing home birth. The British OB/GYNs have read the research, too, and have this to say: “There is no reason why home birth should not be offered to women at low risk of complications… it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe…”

The other trouble with the American MDs is that they seem to have lost all respect for women’s civil rights, indeed for the U.S. Constitution — the right to privacy, to bodily integrity, and the right of every adult to determine her own health care. The “father knows best” legislation they are promoting could indeed be used to criminally prosecute women who choose home birth, say, by equating it with child abuse.

Research evidence be damned, the doctors want to mandate you to go to the hospital. They don’t want you to have a choice.

… The docs are on the defensive.

After all, birth is big business — it’s in fact the most common reason for a woman to be admitted to the hospital. And if more women start giving birth outside of it, who will get paid? Not doctors and not hospitals …

Re-thinking Maternity Care Systems

Posted on June 19, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

… fewer than 30 per cent of women approaching their first birth attend prenatal classes, and books and the Internet are their primary sources for information about birth.

Women attending obstetricians were more favourable to the use of birth technology and were less appreciative of women’s roles in their own delivery. In contrast, women attending midwives reported less favourable views toward the use of technology and were more supportive of the importance of women’s roles …

Even late in pregnancy, questions about epidural analgesia, Caesarean section and episiotomy solicited the most “I don’t know” responses from women who took the survey. But women attending midwives appeared more knowledgeable on these issues.

“Our findings suggest that obstetricians, midwives and family physicians are caring for different populations of women, with different attitudes and expectations towards childbirth,” … “But regardless of the type of care providers they attended … many women reported uncertainty about benefits and risks of common procedures used at childbirth. This is worrisome because a lack of knowledge affects their ability to engage in informed discussions with their caregivers.”

A second study, published last month in the journal Birth, compared the attitudes toward birth technology and women’s role in their childbirth between the younger generation of obstetricians and their predecessors.

Klein and colleagues surveyed 800 Canadian obstetricians who include birth delivery in their practice. Out of 549 respondents, 81 per cent of those 40 years or younger were women (vs. 40 per cent over 40 years of age) …

… younger obstetricians were significantly more likely to favour the use of routine epidural analgesia and were more concerned about the perceived adverse effects of vaginal birth …

… the younger generation sees Cesarean section as a solution to many labour and birth problems, and incorrectly sees C-section as safer for both mothers and babies … younger obstetricians are more likely to choose C-section for themselves or their partners, and are less likely to believe women missed out on an important experience by having a C-section.

… “This study shows it’s generation, not gender, that affects obstetricians’ views about procedures like C-sections,” … “this could present a challenge to efforts to decrease C-section rates in both U.S. and Canada.” As well … up to a third of obstetricians were not evidence-based in their views. This creates concern about informed decision-making, especially for women who are uncertain about procedures that might be used in birth.

… 75 per cent [of obstetricians] thought home birth was more dangerous than hospital birth … even though home birth by regulated midwives has been shown to be safe in Canada.

… “These three studies taken together show us that educational leaders and provincial policy-makers need to seriously examine the educational models and experiences that appear to teach the non-evidence-based view that vaginal childbirth is primarily a dangerous activity,” … ” … we need more midwives … while obstetricians in training will need to have more experience with normal birth, and in the future, restrict their role to that of consultants to midwives … In this way they can maximize the appropriateness of their surgical training.

“This means rethinking the design of the entire Canadian maternity care system. Finally, if women are to be empowered with the information that they need to dialogue with their providers, new forms of accurate information transfer will need to be developed.”

Is ‘tribal’ obstetric culture endangering mothers and babies?

Posted on June 15, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

How we are born, who supports mothers and the quality of the care provided during birth are vital to good public health and personal well being. But all is not well in modern birthing in spite of the advances of modern medicine.

In the United Kingdom, health policies aim to keep childbirth normal or natural and dynamic …

In Australia, a national Review of Maternity Services (MSR) in 2009-10 generated heated public debate. It spawned critiques of the medical control of birth and the self-interest of privately practising obstetricians.

Its outcomes remain hotly contested, particularly over women’s access midwives and home birthing.

Much health policy now promotes strategies to improve quality and safety as being critical to good patient-centred care.

But the Maternity Services Review overlooked some problems in the culture of obstetrics.

… It is their philosophy and practices that have shaped the system of modern hospitalized childbirth care.

The obstetric profession … is accountable for making sure neither practitioners nor the systems of care cause harm to women and their babies.

… several public inquiries … showed that harm was not just being caused but was covered up.

… painful details of serious harm done by doctors to women in maternity units, including unnecessary hysterectomies, assault, and even genital mutilation.

… Most worrying were the common patterns of denial: stories of damage to women were mostly not reported by colleagues out of professional or “tribal” loyalty.

Until the cases became public, they were seen just as “mistakes” or medical “misdemeanours”, or as caused by individual “bad apples” in the profession.

Even many anaesthetists, pathologists and midwives colluded in keeping silent about women’s tragedies.

… Individual, institutional and systemic problems are interwoven. Viewing childbirth care as a field full of power though allows us also to see how it can be reformed.

Encouragingly, the public inquiries point to changing times: women as health care consumers used the press to agitate for these inquiries and have lobbied for wider reform.

Midwives have also been speaking up about problems in the system.

Some obstetricians, too, are committed to the reform of professional practice …

But we need to go even further.

Obstetric undergraduate and postgraduate education also needs reform. More critical reflection on the profession’s gendered and racialized power is necessary, and greater awareness of public health and social issues.

Professional bodies … should also be expected … to develop mechanisms for critical self-examination of attitudes toward women.

Similarly, doctors need to engage seriously with midwives’ concerns about policies pushing “inter-professional collaboration”.

Too often, these seem to be on medical terms and experienced as continued domination rather than an equal, respectful relationship.

High quality obstetric care remains essential for women with complex medical problems … It should be effectively supported by public funds but obstetricians are accountable for how they use them.

… “Birth is not an illness”. Quality and safety in maternity care should not be equated with providing obstetric care.

Women deserve real choice and autonomy in childbirth. Improving care requires more than good hospital incident-reporting systems and support for staff to report medical errors. These are valuable but not enough.

Cultural change in maternity care institutions and health professions, and in the broader society’s views of childbirth care, is essential if we are to keep mothers and babies safe from harm.

C-section not best option for breech birth

Posted on June 14, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

Physicians should no longer automatically opt to perform a cesarean section in the case of a breech birth, according to new guidelines by the Society of Obstetricians and Gynecologists of Canada.

Released yesterday, the guidelines are a response to new evidence that shows many women are safely able to vaginally deliver babies who enter the birth canal with the buttocks or feet first …

… Since 2000, C-sections have been the preferred method of delivery in breech births. Studies suggested that breached births were associated with an increased rate of complication when performed vaginally.

As a result, many medical schools have stopped training their physicians in breech vaginal delivery.

The problem now, according to Dr. Lalonde, is that there is a serious shortage of doctors to teach and perform these deliveries.

With the release of the new guidelines, the SOGC will launch a nationwide training program to ensure that doctors will be adequately prepared to offer vaginal breech births .

The new approach was prompted by a reassessment of earlier trials. It now appears that there is no difference in complication rates between vaginal and cesarean section deliveries in the case of breech births.

… Ms. Guy started the group after the birth of her second child in the fall of 2006. Although she had given birth to her first child at home with a midwife, Ms. Guy delivered her daughter in the hospital because of the baby’s breech position.

“I was cornered into an unneeded and unwanted C-section because the obstetrician that I had didn’t have the experience to catch her,” said Ms. Guy.

The aim of the coalition is to ensure that women know what their options are when it comes to breech birth. Ms. Guy believes that many women don’t realize that vaginal breech births are even possible.

… The new decision to offer vaginal breech birth aligns with the SOGC promotion of normal childbirth – spontaneous labour, followed by a delivery that is not assisted by forceps, vacuum or cesarean section. In December of 2008, the society release a policy statement that included its recommendation for a development of national practice guidelines on normal childbirth.

“The safest way to deliver has always been the natural way,” …

… The SOGC believes that if a woman is well-prepared during pregnancy, she has the innate ability to deliver vaginally …

In NSW, we have the Towards Normal Birth Policy which also promotes normal birth, waterbirth, vaginal breech birth, vaginal twin birth and VBACs. The policy directive recommends one-to-one midwifery care for all women having their first baby, twins, breech or VBAC. It’s a very encouraging policy.

QLD: Mums-to-be pushed into caesareans with private hospitals leading the way

Posted on June 13, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

SOME of the state’s biggest private hospitals are performing caesareans on more than half the women giving birth …

The caesarean rates among the highest in the country were uncovered in hospital birth statistics from 2007-2010 obtained by The Sunday Mail under Right to Information laws.

Queensland’s “caesars palace” was the North West Brisbane Private Hospital, which performed the surgery on 56.8 per cent of women giving birth. Toowoomba’s St Vincent’s Hospital and The Wesley Hospital in Brisbane rounded out the Top 3, with rates of 54.8 per cent and 51.8 per cent respectively.

The latest figures … will reignite the turf war between midwives, who espouse natural birth, and obstetricians who defend surgical intervention.

Caesarean births are recommended as safer options for women having large babies, twins or breech births, as well as older mums and women who have had previous caesareans.

Latest recommendations from Canada suggest that vaginal birth is safest for most breech babies. NSW Health promotes vaginal birth for twins and of course we know that vaginal birth after a caesarean is safer than elective repeat caesarean provided that the birth takes place in a facility that has resources available to perform an emergency caesarean if needed. And “big” babies? This cannot be known with any accuracy ahead of time and the current recommendation is for a planned vaginal birth.

But some critics say growing numbers of medical professionals are convincing mothers to undergo caesareans just to streamline private maternity ward schedules and maximise revenue.

Across the state the figures add weight to the theory, with caesareans accounting for 27.6 per cent of births in public hospitals and a huge 48.3 per cent in private hospitals.

We know that this difference is not comprised of women requesting caesareans: only 2-3% women actually request a caesarean. Most are told they “need” a caesarean because their baby is “big” (3.3Kg), “late” at 39 weeks and 6 days, a previous caesarean, breech, twins, IVF, mum is “overweight”, mildly elevated blood pressure (130/80) and so on. I have heard all of these and more, as “valid” reasons for caesarean.

Several new mothers approached by The Sunday Mail last week said they had been pushed into having caesareans by private hospital obstetricians after initially wanting to give birth naturally.

One Coolum mum, 45, said her obstetrician told her she had “no choice” because the baby would “not fit through my birthing canal”.

This can not be known ahead of time. The only way to find out is to labour and see how it goes. Dedicated, exclusive, one-to-one midwifery care in labour from a midwife who is know to the woman by name and trusted by the woman, is the most important factor in ensuring a normal birth.

… “I just wanted a natural birth, to me that was important …

I think personal responsibility also plays a part here. If a woman genuinely wants a natural birth, she needs to consider which care provider will maximise her chances of achieving this. Consumers of any service are wise to research options thoroughly before they go ahead with them. We do more research about buying a car, house or holiday than we do when choosing our care providers. Having chosen an ill-suited care provider, it is never too late to change.

Another mum … desperate to avoid a caesarean, said her obstetrician also tried to book an induction because she had passed her due date in the Christmas-New Year period.

“The obstetrician said we can book you in for an induction because we just don’t like calling people in on public holidays,” …

But doctors point the finger at today’s “too posh to push” mothers, who they say demand caesars, as well as older mothers who have an added risk with vaginal births.

Australian College of Midwives spokeswoman Professor Jenny Gamble said the health system was driven by profit.

“It’s all about less night disturbance and more throughput; it all comes down to money,” she said. “It’s a fee-for-service model the more women obstetricians see, the more they earn.”

Australian Medical Association Queensland president Dr Gino Pecoraro rejected as “urban myth” claims that obstetricians earned more for caesarean births.

Private Hospitals Association Queensland said birthing decisions were not made by the hospital.

This is true: hospitals do not make any decisions about birth: those decisions are made by the doctor and patient. As we have read in this article, many of the decisions are “guided” by the doctor. The other factor in these escalating caesarean rates is litigation. When caesarean rates increase and doctors are reluctant to attend VBACs, the caesarean rate will automatically increase.

Not all doctors have high caesarean rates and some are very supportive of normal birth BUT … if a woman genuinely wants a normal birth, the best advice is to go a normal birth specialist.

Still no midwives in New Brunswick

Posted on June 12, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

There are still no midwives in New Brunswick, despite legislation passed by the previous Liberal government to legalize and regulate the profession.

Legislation recognizing midwifery as a profession was adopted in 2008. In 2010, the regulations were set up.

… so far no one has applied to be licensed as a midwife in the province.

Licensed midwives would become employees of the Regional Health Authorities and their services would be publicly funded.

Midwives help women in their pregnancies, including deliveries, often in their homes.

… She said it’s hard to say when midwives will be practicing in the province, given no one has applied for a licence yet …

A failed reform? I wonder if they consulted with the midwives in drafting the reform process, to ensure that the reforms would be acceptable to the midwives.

Mom-to-be says her hopes were destroyed by midwife

Posted on June 9, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

A … mother says things went tragically wrong when she used a midwife …

… after her baby died, she was surprised to learn, there are different kinds of midwives …

… Muhsin lost her daughter Alia before she even gave birth …

… when she was 7 months pregnant, she felt like her OB/GYN office was a bit impersonal, so she did some research online …

“I walk in this place, very serene, very organized. They have a wall full of babies’ pictures,” …

Muhsin says the midwife who handled her care was also the director … [the midwife's] resume on her website seemed impressive.

“She sold me a very good story, and I believed her,” said Muhsin.

… her original obstetrician had diagnosed her with gestational diabetes. But Muhsin says [the midwife] convinced her that she didn’t really have the condition, which can jeopardize the life of a baby if it’s not properly treated.

Muhsin and her husband got worried when she went nearly 4 weeks past her due date. Muhsin says the midwife kept reassuring her that everything was fine – but it wasn’t.

“I just feel really sick and I told her, I don’t feel contractions anymore, nothing. She told me, it’s okay, you stay home,” …

… “She said, okay, now you have to go to the hospital, because I don’t know what’s going on. We went in; they asked my husband, what is her due date? And they start running.”
Hospital records indicate both mother and baby had a severe infection …

“The baby had no heartbeat,” …

… Direct Entry [Midwives] … are not required to have any formal training – in fact they can be self-taught.

“They’re operating on their own without any oversight by the legislature, without any oversight … ”

… the baby could have been saved if the midwife had transferred Muhsin’s care to a doctor before she went nearly 4 weeks past her due date.

… “Gestational diabetes can be very risky to the baby,” …

… “There’s a great increased risk from 39 weeks onward of in utero fetal distress, and even fetal demise,” …

… [The midwife] denies that she waited nearly 4 weeks after Muhsin’s due date to advise her to go to the hospital. She also says that she’s still working as a midwife …

“We want to be licensed because we want to make sure there’s a standard of care. That consumers are protected,” said Kate Mazzara.

Kate Mazzara is a Certified Professional Midwife … she’s trying to get Lansing to pass a law to license midwives … a licensing board would then be able to hear complaints, and take action against midwives if problems arise.

“I want to make sure that these moms and babies are birthing in a safe way, and the midwifery model of care has been shown to be an extremely safe option for families, but there should be that safety mechanism to which midwives can be held accountable,” …

… the sad stories are rare … home births are a beautiful, natural experience … the number of home births has jumped 20% in recent years …

Part of this article deals with the fact that in the US, there are different types of midwives, from certified nurse midwives who have degrees, work collaboratively with obstetricians, and have visiting rights, through to certified professional midwives and finally direct entry midwives. In Australia, we have registered midwives who are all accountable to the same high standard of care. As well as registered midwives, we also have eligible midwives who have satisfied an additional registration standard that entitles them to access a medicare provider number, and in the future, visiting rights. The next article deals with another aspect: that of choosing a midwife:

How to Choose a Good Home Birth Midwife

If you’re looking into home birth, probably the most important thing is finding a good midwife. Your midwife will be the one who cares for you, watches over you, and makes any decisions if something unexpected or difficult happens in your pregnancy. It is imperative to get a midwife who is well-trained and experienced and whom you trust and feel comfortable with.

How do you know if you’ve found a good midwife?

Feel free to ask anything else that makes you feel comfortable. In my experience, midwives are usually very cautious and ready to refer patients to the hospital or an OB at the first sign that something isn’t right. The should be very conscious of the limits of their training, so that if any situation crops up that they feel uncomfortable about handling, they are prepared to rule you out as a home birth candidate. This doesn’t happen too often, but it’s very important to know that if you are one of the “riskier” cases, your midwife will tell you so and refer you. Any midwife who says that she never transfers or refers women because “all women can do this!” should be avoided!

Go with your instincts, too. If you feel comfortable with the midwife and she’s answered your questions sufficiently, then choose her. If not, keep looking …

Choosing The Best Midwife and Why is choosing a care provider one of the most important pregnancy decisions you will make? are also helpful posts. Ultimately, registered health practitioners are responsible for practicing their profession safely. But as a consumer of a service, it is up to you to make sure that the person you have engaged for your care, is legally and professionally able to care for you (ie, registered). Don’t be afraid to check the AHPRA register of practitioners if you would like to check the registration status of your health practitioner.

Insurance Must Cover Midwife Services

Posted on June 4, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

Vermont Gov. Peter Shumlin signed a bill last week to require health insurers to cover midwifery services and home births. Insurance companies … will be required to cover prenatal care by midwives and home births in Vermont. Medicaid and the Vermont Health Access Plan already cover midwifery services and home births.

The Midwife Bill is intended to improve access to wide-ranging health services for women, reduce health care costs, and strengthen the quality of care that mothers receive during pregnancy and childbirth, according to a statement on the state website.

… “Access to midwifery care and home birth should not be limited only to those who can afford those services out of pocket,” … “This law will ensure that all expectant mothers get the coverage and care they want and deserve.”

… childbirth outside of hospitals is becoming more popular. “Homebirth is only expected to grow …

… Vermont Medical Society president said … “We’re concerned it somehow creates the impression that homebirths are the safe alternative to hospital birth. It creates a false sense of security.” … more newborn babies died after home births than after hospital births. It said newborn mortality tripled in home births compared to hospital births. It also found that mothers giving birth at home had less risk of “lacerations, hemorrhage, and infections.”

… “The medical lobby continues to have a monopoly over the maternity care in the United States and the Wax study is deeply flawed, as well very politically motivated to give mothers the idea that wanting a good birth experience is selfish and harmful to the baby, when it is actually the opposite.”

In only 27 states may CPMs legally deliver babies, and in 23 states it is illegal for a CPM to deliver babies. Only in New Mexico, New York, New Jersey, and now Vermont are home births covered by insurance.

It’s time to end the discrimination against midwifery care and homebirth. If we say we provide woman-centered care, and women want care from midwives and to birth at home, then we must provide these services to women. There is a great demand for women to have choice and control over their care, just as people generally wish to have choice and control over their lives.

Midwives not Confident to Lead Normal Births ???

Posted on June 2, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

This article was a bit grrr to read! Essentially, a small hospital – serviced by midwives and GP Obstetricians – is facing a crisis where the GP Obstetricians are no longer able to offer an obstetric service. It is a low-risk unit that transfers any high risk women and babies in pregnancy or labour – most issues would arise in pregnancy, or would even be apparent at booking-in. The role of the midwife is to care for low risk pregnancies and births on his/her own authority. Yet as you’ll read below, the Director of Nursing (who for some odd reason comments on a service that is not related to the one that she directs) allows these midwives – who she understands cannot perform in their role – to continue to practice in the hospital. Does this happen anywhere else? If your optometrist can’t examine your eyes, or your dentist can’t check your teeth or do a basic filling, we wouldn’t consider them fit to practice. Do members of the public expect that their health practitioners are able to perform in their roles? Maybe we do have this expectation, but the Director of Nursing in this article doesn’t agree. Perhaps they need a Director of Midwifery?

Kerang District Health was one of the big winners from north-west Victoria in this year’s budget … but despite this welcome injection of funds, there is some concern about how the hospital will continue to offer maternity services …

Kerang District Health does not deal with high risk birthing situations …

… following the announcement that Kerang’s three GP obstetricians will no longer be working in this area beyond the end of this year, the hospital’s CEO, Rob Jarman, says the limited services that are offered are under threat.

… Though there are around 12-15 midwives, Ms Hendrick says that they are currently not confident enough to lead the births and that in some cases an obstetric doctor is the only option.

… Kerang is working on updating the skills of their midwives – and Ms Hendrick says she hopes that with this will come an increase in confidence that will enable a greater involvement of the midwives in the care of the mothers during the birth.

The article goes on to talk about a woman who had her baby by emergency caesarean at the hospital, and thank god there were doctors there to save everyone because who knows what would have happened if there had “only” been midwives around? I’m not suggesting that doctors aren’t needed at births and that they shouldn’t be involved in the care of pregnant and birthing women – in fact, I work collaboratively with an obstetrician for the majority of the clients who book-in with me, and I love working this way. What I am saying is that midwives must be competent to perform in their roles – as care providers for normal pregnancy and normal birth – and to know when to consult and refer to our obstetric colleagues.

More midwives needed: ACM

Posted on May 23, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

Australia is around 2000 midwives short and the world needs 350,000 more midwives, according to the Australian College of Midwives (ACM).

… Australia was home to one of the highest caesarean rates in the developed world and has limited access to continuity of midwifery care models that improve outcomes for mothers and babies.

“We want to see mothers and babies getting the support they need through increased global and local commitment to midwifery services,” she said.

Ms Martin said around 30 midwives have now become eligible midwives in Australia with access to the Medicare Benefits Schedule and the PBS.

“In 2010, women and midwives welcomed in a new era in maternity reform in Australia that brings promise,” she said.

“From November 2010, for the first time in Australian history, women have been able to choose their own midwife for pregnancy, birth in hospital and for the postnatal period, and to access Medicare rebates for care from the midwife of their choice.

“We hope to see this model of care expand significantly in the next few years.”

Baby born home, alone

Posted on May 21, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

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

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

So she decided to go it alone.

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

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

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

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

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

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

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

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

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

Midwives Deliver Change

Posted on May 19, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

Midwives are urging all political parties to support the development of birth centres in Ontario …

“Birth centres provide a safe, supportive environment where women can access prenatal, labour, birth and post-partum care,” said Katrina Kilroy, RM, president of the AOM. “We believe they can improve maternal-newborn care while cutting health care costs.”

Birth centres are well established in the US, UK, Australia and Quebec. Ontario midwives currently attend births in both home and hospital, but there is increasing demand from women and families for another out-of-hospital birth option. Birth centres help divert healthy women and newborns from hospital, which in turn lowers costly intervention rates such as c-sections. They provide for community-based care in a family-oriented environment.

… There are over 500 Registered Midwives in Ontario, serving communities in 85 clinics across the province. Midwives have privileges at most Ontario hospitals. They have been provincially funded and regulated since 1994.

A midwife is a registered health care professional who provides primary care to women with low-risk pregnancies. Midwives provide care throughout pregnancy, labour and birth and provide care to both mother and baby during the first six weeks following the birth. The Association of Ontario Midwives is the professional organization representing midwives and the profession of midwifery in Ontario …

Childbirth: More Labor Interventions, Same Outcomes

Posted on May 2, 2011 by Melissa Maimann

Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

Hospitals vary considerably in the frequency with which they induce labor and perform Caesarean sections. But a new study finds that these differences do not seem to affect how newborns fare in these facilities.

Dr. J. Christopher Glantz, a professor of obstetrics at the University of Rochester, reviewed records of almost 30,000 births … Some hospitals relied heavily on induced labor and Caesarean sections, while others performed the procedures much less often.

Dr. Glantz measured neonatal outcomes in three ways: whether a child was moved to an intensive care hospital, whether a child needed immediate assisted ventilation and whether a child received a low Apgar score.

He found no difference in outcomes for babies born in the hospitals with the highest rates of these procedures and those with the lowest. The result suggests that routine reliance on the procedures does little to improve outcomes …

The recipe for safe, empowering, minimal-intervention birthing is:
A woman who is positively motivated to have a natural birth
Who is well-prepared for pregnancy, labour, birth and parenthood
Who is supported by one midwife and one obstetrician right the way through her pregnancy, birth and postnatal experience
Care providers who collaborate, communicate, respect and trust one another, who work for the best interests of the woman and her baby

Pioneering Collaborative Private Maternity Care: Continuity, woman-centered, personalised, safe.

Posted on April 26, 2011 by Melissa Maimann

Our brand new model of care – launched for the first time in Australia – has recently welcomed its third baby. So far, three families have benefited from a collaborative model of private maternity care that enables women to have care with a private midwife (with Medicare funding) and also develop a trusting and nurturing relationship with a Specialist Obstetrician who is available for the pregnancy, labour and birth. Our service has so far supported an empowered birth after caesarean, a waterbirth and a natural birth. All within a hospital setting, with all the support available that is occasionally needed.

We’ve received some really positive feedback:

“The collaborative model seemed unique to me. To have a private midwife and our own birth experience but in a hospital with an obstetrician who was known to us as back-up in case of unexpected complications, allowed us to feel totally comfortable and confident for our first baby.”
“I felt entirely supported and encouraged.”
“A highly personalised level of care was offered which makes you feel listened to and allows time for lots of questions.”
“I liked the fact that we got time to develop a relationship and feel comfortable together, allowing us a better birth experience. Postnatally, it was nice to have the same person continuing my care. It was highly personalised.”

Our model sees women booking with me for their care. Women who are interested in having collaborative maternity care meet with the obstetrician early in their pregnancy and again between 32 and 36 weeks. Women see the obstetrician more often if additional visits with him are needed. Otherwise, I am in frequent communication with him and we work together to provide safe, evidence-based, woman-centered care to our pregnant women. This allows women to build a sense of connection, trust and continuity.

We support natural birth, active birth, physiological birth positions, physiological third stage, water birth, VBAC, twin births, breech births … and so on. Women are really well prepared for natural birth with an emphasis on informed decision making and woman-centered care. Childbirth education is included, as well as access to a lending library of books and DVDs.

Birth care is provided initially at home and then we move to hospital where I provide full midwifery care. The birth is attended by myself and the Obstetrician if needed / desired. It’s an intimate, calm, peaceful experience and facilitates a gentle and safe birth.

After we have welcomed the baby and birthed the placenta, women generally stay in hospital for 4 – 24 hours before returning home. Of course, if there are any issues women are welcome to stay longer, but generally I find that women feel more comfortable in their own homes, in their own beds. I visit at home every day for a week and continue care for 6 weeks. Since women book into hospital as a private patient, they are almost assured a private room with an en-suite.

I’m really excited about this model of care because it meets the needs of women so perfectly:

Women having their first babies, maybe feeling unsure of what to expect

Women who previously experienced dis-continuous care from care providers who were unknown to them

Women who are planning a natural birth but perhaps with a more challenging pregnancy

Women who want a home birth / birth centre birth but with a known obstetrician available if needed

Women who really desire a sense of control over their birthing experience

This is a new way of working for both midwives and obstetricians and is a really supportive and nurturing way to practice. There is a huge potential for professional growth and learning. The most positive element, however, is the radiant smiles on the faces of the women who have birthed with us and the babies who have received a safe and gentle start to life.

Midwives urged by health service to let volunteers help with chores

Posted on April 9, 2011 by Melissa Maimann

MEDICARE NOW AVAILABLE FOR MIDWIFERY CARE THROUGH THIS SERVICE!
Visit my website to explore home birth, hospital birth and Medicare-funded private midwifery care.

Are we headed for the same here in Australia?

Hospitals should use volunteers to relieve the pressure on busy maternity units so that overworked midwives can spend more time with women in labour, a new report urges the NHS.

Many more women could be cared for by midwives if they were freed from tasks such as filling in forms, taking blood pressure and giving breastfeeding advice …

It is calling on hospitals to use their existing maternity staff in different ways rather than relying on the government to hire more midwives. Midwives’ leaders have accused ministers of reneging on promises to hire thousands more to cope with the rising birthrate.

The King’s Fund wants the NHS to improve maternity care by … midwives undertaking some jobs currently done by doctors, such as examining newborn babies; nurses attending elective caesarean section operations instead of midwives; midwives supervising the labour and birth of many women now looked after by a doctor; and maternity support workers taking on extra roles.

The report wants hospitals to copy the experience of a few maternity units that are already working in different ways. For example … “active labour volunteers”, each working up to 18 hours a week. “They provide support in labour by massaging women, encouraging and supporting them, and staying with them if a midwife has to leave the room to do other things,” …

… “task-shifting” has increased the amount of time midwives spend with mothers-to-be from 32% to 50%. A round-the-clock ward clerk has been hired to welcome expectant mothers and help them fill in their paperwork, allowing the midwives to concentrate on one-to-one care of women in labour. Hospital managers had found that midwives were spending 32% of their time dealing with patients but 34% on clerical duties.

A dedicated equipment store means midwives no longer have to search wards for machines such as heart-rate monitors, while an electronic keypad security system for the nine drugs cupboards has ended midwives’ regular searches for the two sets of keys previously needed to unlock medication for epidurals …

At Bedford hospital, nurses help look after women having caesarean sections so midwives can spend more time on antenatal screening, surveillance and one-to-one labour care.

Anna Dixon, the King’s Fund’s head of policy, said such innovative practices could greatly increase the number of low and medium-risk pregnant women whose care in labour is supervised by a midwife …

But Cathy Warwick, general secretary of the Royal College of Midwives, said that while midwives could take on some new roles “these should not be added at the expense of the essential care many midwives are currently struggling to provide because there simply are not enough of them to deal with their current workload”. She also voiced concern at other health workers taking on roles in maternity care. “You cannot compensate for not having the right number of midwives by transferring to other members of staff care that only midwives can and should provide,” Warwick said.

… The Royal College of Obstetricians and Gynaecologists said: “The new report misses the crucial fact that midwifery care is needed throughout a woman’s pregnancy. For continuity of care to occur, more midwives are needed.”

Eighty-year-old midwife comes out of retirement after neighbour’s rushed labour

Posted on April 7, 2011 by Melissa Maimann

MEDICARE NOW AVAILABLE FOR MIDWIFERY CARE THROUGH THIS SERVICE!
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A RETIRED midwife found herself recalling old skills when her neighbour unexpectedly went into labour in the street.

Mum-to-be Helen Pallister feared she might give birth on Chester Road in Sunderland.

… Helen’s instinct was to push the baby out there and then, but [Jean's] … help, Helen managed to hold on until she reached Sunderland Royal Hospital, where healthy eight-pound-one-and-a-half-ounce baby James was born.

… “I woke up and was having pains all day, but thought nothing of it until they started coming on really strong at 2.30pm and I decided to leave the house at 3.10pm.

… Jean, who retired 22 years ago, had been shopping and was walking up the street when she spotted Helen in the throws of labour pains.

… Calm Jean talked Helen through her pain and managed to get her comfortable for the journey to the hospital.

Helen said: “Jean managed to keep me right until we got to the hospital, where they said I was ready to push and seven minutes later he was there.

“Jean was my birthing partner because there was no one else …

… Jean added: “I was a midwife for many years. When it’s something you’ve done all your working life it isn’t a problem. You don’t forget it.

“It was a very happy occasion.”

Continuity of midwifery care and gestational weight gain in obese women: a randomised controlled trial

Posted on April 6, 2011 by Melissa Maimann

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.

The increased prevalence of obesity in pregnant women in Australia … is a significant public health concern. Obese women are at increased risk of serious perinatal complications and guidelines recommend weight gain restriction and additional care.

There is limited evidence to support the effectiveness of dietary and physical activity lifestyle interventions in preventing adverse perinatal outcomes and new strategies need to be evaluated. The primary aim of this project is to evaluate the effect of continuity of midwifery care on restricting gestational weight gain in obese women to the recommended range.

The secondary aims of the study are to assess the impact of continuity of midwifery care on: women’s experience of pregnancy care; women’s satisfaction with care and a range of psychological factors.

Methods: A two arm randomised controlled trial (RCT) will be conducted with primigravid women recruited from maternity services in Victoria, Australia. Participants will be primigravid women, with a BMI[greater than or equal to]30 who are less than 17 weeks gestation.

Women allocated to the intervention arm will be cared for in a midwifery continuity of care model and receive an informational leaflet on managing weight gain in pregnancy. Women allocated to the control group will receive routine care in addition to the same informational leaflet.

Weight gain during pregnancy, standards of care, medical and obstetric information will be extracted from medical records …

Increasingly, midwifery continuity models of care are being introduced in low risk maternity care, and information on their application in high risk populations is required. There is an identified need to trial alternative antenatal interventions to reduce perinatal risk factors for women who are obese and the findings from this project may have application in other maternity services.

A fantastic research study and I would be very interested to learn the results. It is well-known that continuity of midwifery care is beneficial for low-risk women; the unanswered question remains: how does continuity of midwifery and obstetric care benefit women with complicated pregnancies? My hunch is that this form of care is most beneficial for women and babies.

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

Legislators introduce bill to license certified professional midwives

Posted on April 4, 2011 by Melissa Maimann

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A month after the arrest of a certified professional midwife, N.C. legislators this week introduced a bill to legalize the practice of similarly trained experts in home-based maternity care.

The bill … would create a licensing board for CPMs and allow them to practice legally, as they do in 27 states …

… The N.C. Medical Society has objected to licensing for CPMs.

“We have concerns about patient safety, the training of the person delivering the baby and the need for supervision,” …

Wilkins said he understands that nurse midwives and obstetrician-gynecologists have concerns about home births. But he hopes all parties can meet and work out their differences.

… “I’d like to find some common ground …

Weight Worries For Mother-To-Be

Posted on March 30, 2011 by Melissa Maimann

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.

Being seriously overweight during pregnancy increases dangers for both mother and unborn child, but little is being done to help obese mums-to-be …

… maternal obesity has more than doubled over the last two decades with one in six pregnant women now facing extra risks to themselves and their babies.

More than half the women who die in pregnancy or childbirth are obese or overweight and being seriously overweight increases the likelihood of conditions such as cardiac disease, diabetes and pre-eclampsia and can be a contributing factor in stillbirth, congenital anomalies and prematurity.

“But very little is being done nationally to support women in achieving a healthy weight before bearing children” … “Despite the potential risks, there is no strategic public information campaign.”

… “Once obese women become pregnant there are still things they can do to minimise the potential for complications for themselves and their babies, such as healthy eating and moderate levels of physical activity,” …

… The lack of weight management services and weight gain guidance made it difficult for midwives to discuss obesity with women during pregnancy. “Midwives seek to build up a good relationship with women and they struggle to know how to initiate discussion with them about their weight as it is such a sensitive issue,” …

“There is an urgent need for obesity training for midwives and better communication between the public health and maternity services,”

Lessons could be learned from the development of smoking cessation services during pregnancy, she suggests. Midwives participating in the study felt that the national drive for smoking cessation with its structured training, support and funding had worked successfully, whereas previous local initiatives without that level of strategic support had failed.

Ideally, a preconception appointment would be attended by women who are planning a pregnancy and at this time, the midwife or doctor would provide some practical suggestions and goals to assist the woman to move to a better state of health prior to conceiving.

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

Hungarian doctor advocating home births given 2-year prison sentence for malpractice

Posted on March 25, 2011 by Melissa Maimann

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.

An obstetrician considered the main advocate for home births in Hungary was sentenced … to two years in prison for malpractice …

Agnes Gereb was found guilty of medical negligence in two separate home births, including one in which the baby died. She will have to spend at least a year behind bars before parole and was also banned from practicing both as an obstetrician and a midwife for five years.

Lawyers representing Gereb … had appealed the decision of the Budapest City Court.

… The verdict … was unusual because the judge’s sentence was much tougher than the suspended prison term originally sought by the prosecution.

… Gereb’s litigation became a rallying point for Hungarians seeking to accept home births as a regulated method of delivery.

Earlier this month, the government said home births will be allowed from May 1, but only under strict safety conditions.

Until now, women in Hungary had the right to give birth at home, but medical professionals were banned from assisting planned home births.

… midwives criticized the ruling against Gereb, saying the court applied different standards to home births from those used in deliveries at a hospital.

“In civilized countries, midwives answer for their work to professional associations, not courts,” … “They are judged not solely by experts who have experience only in hospital births, but by professionals who know about home births.”

… Because of a similar case in 2007, Gereb was already given a three-year ban from exercising her profession.

Gereb’s advocacy and her determination to assist with thousands of home births over the years has received plenty of media attention in Hungary, with public opinion about her deeply split.

She was recently voted one of Hungary’s “Women of the Decade” …

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

New midwifery group at Canterbury Hospital

Posted on March 24, 2011 by Melissa Maimann

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.

Fantastic news for the women in the Canterbury area and well done to the team at Canterbury who have worked really hard to implement their brand new midwifery group practice. It’s exciting to read about the new group practices that are being developed in support of natural birth and in line with the Towards Normal Birth Policy in NSW.

FOUR midwives will run a new midwifery group at Canterbury Hospital …

… the Midwifery Group Practice would offer care to women with low-risk pregnancies.

“Women at Canterbury Hospital can now receive care from the same midwife prior to, during and after the birth of their baby,” she said.

… “Midwives will also visit mothers and babies at home for up to two weeks after the birth to make sure they are healthy and settled.”

Data shows there is strong support for such services …

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

Get men in the delivery room, say Bangladesh’s first midwives

Posted on March 18, 2011 by Melissa Maimann

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.

One-in-500 women die in childbirth in Bangladesh – with cultural factors as much to blame as a lack of medical care.

There’s hardly a man to be seen in the maternity ward of the Maternal and Child Health Training Institute in Dhaka, the capital of Bangladesh.

Despite the lack of any law forbidding men to enter the delivery room, fathers are normally not present during the birth of their own child – an attitude that needs to change …

“Men need to be involved in the labour process if we are to reduce maternal mortality,” says Mala Reberio, one of the 20 midwives being trained to international standards in Bangladesh, which is still heavily reliant on community skilled birth attendants, who lack the skill and the authority to perform more complicated deliveries. Currently, one in 500 women in Bangladesh dies during childbirth.

“If [men] could see firsthand the complications of childbirth, they would be more likely to send their pregnant wives to proper medical facilities and less likely to insist on early childbirth after marriage,” … More than 75% of deliveries take place at home, and the average age of women having their first child is just 16 years …

… Bangladesh is on target to … reducing maternal mortality … the maternal mortality ratio in Bangladesh has declined from 322 per 100,000 in 2001 to 194 in 2010 …

The Bangladesh government aims to have 3,000 fully qualified midwives who can provide round-the-clock assistance in all 427 sub-districts by 2015 …

The programme still faces a number of major obstacles, despite being well received by the general public. First, doctors who can earn large sums of money by delivering a baby through a caesarean-section may be unwilling to lose that income if midwives are available to do the surgery for free. Second, the potential fallout from introducing a new cadre of midwives or professionals into an already hierarchical sector could prove difficult.

The government’s biggest challenge, though, remains getting women into the healthcare facilities and continuing to bring about behavioural changes in men and women …

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

Birth of a great idea

Posted on March 16, 2011 by Melissa Maimann

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.

LIKE most first-time mothers, Kyla Lake is eagerly awaiting the birth of her baby this month.

Her midwife Teresa Walsh is just as excited because Kyla’s baby will be the first born in Ipswich under the new Medicare for midwives laws, part of the government’s health care reform package.

A change in national laws on November 1 last year gave mothers the choice of a private midwife for their pregnancy and birth care in hospital and the ability to claim a Medicare rebate for the services.

Ms Lake said having a midwife had helped quell any fears or concerns she had regarding her pregnancy and birth.

“They give you tips and advice and talk to you regarding what will happen at hospital,” Ms Lake said. “It makes you feel more relaxed about the whole process.”

The 24-year-old Walloon resident is due on March 20 and plans to give birth in Ipswich Hospital.

… expectant mothers and midwives got to know each other during the pregnancy and birth, with the midwife available for advice and support for six weeks after the birth.

… “My Midwives clients had 13 beautiful babies in February, which was more than we expected, so women really seem to like our service.

… midwives worked in collaboration with obstetricians at the hospital and other health providers to make sure women got all the care and support they needed during pregnancy, birth and afterwards.

Very exciting times for maternity in Australia! We are in the midst of rapid and very positive change.

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

How maternity services could be reborn

Posted on March 11, 2011 by Melissa Maimann

Visit my website to learn more about my services.

Barely a month goes by without an article in the press on the shortage of midwives and hard-pressed maternity departments struggling with their workload. But is it just about the numbers of staff, or could the situation be improved if maternity services changed the way they use their current workforce?

Absolute numbers of staff are, of course, important, and services are coming under more pressure thanks to a rising birth rate, a growing number of older mothers with pre-existing long-term conditions, and many midwives approaching retirement. However, a significant increase in the number of midwives is looking more and more unlikely as NHS budgets are squeezed and commissioners look for savings across the board. The pledge made by David Cameron last year to provide an additional 3,000 midwives looks set to remain unfulfilled.

So, what can be done? The King’s Fund’s inquiry into the safety of maternity services concluded that the key to improvement is effective deployment: the right staff doing the right thing at the right time in the right place. Unless effective deployment and the right skill mix are achieved, simply increasing staff numbers will have limited impact. We have explored this further, looking at evidence from around the world of different models investigating ways in which maternity units can better use the staff they do have without compromising safety during labour and birth.

… the most striking finding is the potential for task-shifting. Highly qualified medical staff – who should be focused on the highest risk women – currently perform tasks that midwives could do just as effectively, while midwives perform duties that could be undertaken by nurses, and nurses, doctors and midwives undertake clerical work that should be done by administrative staff. This has serious implications for the safety and cost-effectiveness of services.

Continuous lay support during labour has also been associated with positive birth experiences, and some NHS units are now using doulas, who stay with the mothers during labour. Of course they do not replace midwives but, in providing continuous support to women throughout labour, they allow midwives to focus on delivering the care they have been trained to provide …

I disagree with the dilution of the role of the midwife. Midwives provide labour support, and in doing so, are monitoring the labour in a very covert, sensitive and unobtrusive manner. Marching in and out of the room every half-hour to “do obs” is far from conducive to promotion of natural birth. However, a midwife sitting quietly with a woman in labour, supporting her emotionally, mentally and physically while also monitoring the labour – now that’s skilled midwifery care!

Further use of midwife-led services also appears to hold potential for improving standards. The UK already has a relatively high use of midwives when compared to other European nations – Germany and Spain, for example – which have obstetrician-led approaches, but there is still further potential to extend midwife-led care to low- and medium-risk women. So far, evidence shows that midwife-led care not only offers a range of better outcomes but also has the potential to deliver cost savings by freeing up the obstetric workforce to focus on the most complex cases …

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

Midwives gaining in popularity

Posted on March 10, 2011 by Melissa Maimann

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When Christy Gasstrom gave birth to her son five years ago, the first-time mom from Ilion received care from an obstetrician.

But when a Utica doctor told her during her second pregnancy that she no longer was a candidate for natural birth because of her previous Caesarean section, she decided to go a different way.

“I didn’t like that answer so I did some research and ended up moving over to the midwives at Bassett (Healthcare),” she said.

A few months later, Gasstrom successfully delivered her daughter Logan …

Midwives … are gaining popularity as more women embrace natural childbirth, local practitioners said.

Officials at Mohawk Valley Women’s Health Associates in New Hartford and Bassett Healthcare in Cooperstown said the majority of their maternity patients now work with midwives at some stage of their pregnancy. And statewide, more new midwifery licenses were issued in 2010 than in any year since 2006, bringing the total number of licensed practitioners to 879.

A state law that took effect in October also gave midwives more freedom to practice without direct doctor supervision …

Gasstrom, who had a midwife … at her delivery last year, said the experience was drastically different from the labor that led to her C-section. The midwife spent more time with her and was “more involved” than her first doctor had been …

… Joann Roberts, one of four certified nurse midwives who work with Mohawk Valley Women’s Health Associates, said midwives bring a different perspective to childbirth than most obstetricians and have been shown to reduce Caesarean rates. Rome Memorial Hospital, where she performs deliveries, for example, had an 8 percent Caesarean rate in 2010 compared to the national average rate of 26.5 percent reported in 2007.

“We always expect that our mother will be having a normal birth right from the beginning, unless an emergency comes up,” Roberts said, adding that patient education and patience with the labor process are key in her practice.

Many midwives considered it a victory last summer when then-Gov. David Paterson signed the Midwifery Modernization Act, which allowed them to begin practicing without written agreements from doctors. But Roberts, who works with two physicians, said the professions complement each other and that she expects most midwives to continue working in partnership with them.

… Dwynn Golden, one of the certified nurse midwives at Bassett Healthcare’s new birthing center in Cooperstown, said collaborative arrangements also give patients the widest choice of available options without changing providers.

New patients at Bassett meet with a midwife during their initial visit and are given resources explaining the differences in training and experience between midwives and doctors. They then choose to work primarily with a midwife, alternate visits between a midwife and a doctor, or see a doctor exclusively.

“With the popularity of natural childbirth, midwives are viewed as the ideal provider of prenatal care and attending the birth,” … (But) for some women who prefer inductions to be scheduled and desire an epidural throughout labor, they may not view the role of the midwife as essential to their experience.”

Golden said facilities such as Bassett’s birthing center also offer some mothers more peace of mind because they have access to tools for facilitating natural birth, such as birthing balls and private Jacuzzi tubs, but know there is emergency medical equipment nearby should something go wrong.

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

Midwife-led births ‘should be the norm not exception’

Posted on March 9, 2011 by Melissa Maimann

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.

Maternity units should offer midwife-led care as the norm rather than the exception, says a health think tank.

The King’s Fund report notes that last year only 10% of hospital births in England were in midwife-led wards.

… The Royal College of Midwives (RCM) said an extra 4,000 midwives were needed before a change in care patterns could be implemented.

The researchers looked at studies from the UK and other countries to find out how maternity services could be made safer – without any increase in resources.

They recommend midwife-led care be used much more widely for women who are not at a high risk of having problematic births.

One UK study suggested that £2.5m could be saved by getting midwives … to examine healthy newborn babies.

… The King’s Fund’s director of policy, Anna Dixon, said: “Expanding midwife-led care would free up doctors to spend more time caring for higher-risk women.

The Royal College of Midwives believes up to 4,000 extra midwives are needed to keep pace with the UK’s rising birth rate and the increased complexity of many births.

… The NHS is under pressure to save up to £20bn over the next four years by finding more efficient ways of working.

The parenting charity NCT (National Childbirth Trust) said it was delighted about the recommendation for more midwife-led care.

… “The Government is committed to giving people more control over their own care. We want mothers-to-be to be able to have a normal birth wherever possible.

“There should be real choice over where to give birth, supported by accessible midwife-led care …

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

Hungary legalizes mothers’ right to home delivery

Posted on March 8, 2011 by Melissa Maimann

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.

A long-awaited detailed regulation on home birth allows women to decide where they want to give birth as long as the baby is not in danger and so does not need a hospital environment.

… the regulation, that comes into effect on April 1 and will affect births after May 1, lays down all the duties, responsibilities and competencies of those assisting homebirths. Professionals helping baby deliveries outside hospitals have to have the required qualification as well as a license from public health and medical officer service.

They have to be a professional obstetricians or midwives with labor room experience exceeding two years and registered assistance at minimum 50 births. Mothers who want to give birth in a non-hospital environment have to choose the health supplier and the professionals to assist at the delivery by the 36th week of the pregnancy. The selected professionals have to be contracted with the given health supplier.

Also, mothers have to declare in advance that if the leading birth assistant or the pediatrician finds that hospitalization is necessary, they will accept it without opposition. At this point, the infant’s right to life comes before the mother’s right to autonomy.

… The detailed regulation is seen putting an end to a long struggle of women wishing to give birth outside hospitals and also of those professionals helping these mothers. Due to homebirths having been so unregulated so far, an internationally recognized home birth expert Agnes Gerab was arrested for helping a pregnant woman who unexpectedly went into labor during a birth training course. At that time, Gerab was prohibited from practicing due to a former incident that ended up in the death of a baby. After Gerab was taken in custody last October, her supporters held numerous demonstrations for her release and also for a clear regulation on home birth.

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

Study Raises Questions About Childbirth Drug

Posted on March 2, 2011 by Melissa Maimann

MEDICARE NOW AVAILABLE FOR MIDWIFERY CARE THROUGH THIS SERVICE!
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A study … is raising questions about a drug commonly used in childbirth.

Pitocin is a synthetic form of oxytocin, which a mother’s body produces to start labor and cause contractions.

A study … found a strong link between high amounts of the drug during labor and severe postpartum hemorrhage for the mother, which can be a terrifying and dangerous complication.

… “… women who had prolonged infusions of pitocin [were] actually at increased risk of bleeding after delivery,” …

… when women receive a lot of pitocin during labor, they can become desensitized, causing it to fail to work when it counts most, immediately after a baby is born.

The drug is supposed to help clamp down the uterus and stop the bleeding.

“We do feel it is a strong finding,” …

Severe hemorrhage happens to just 1 percent of mothers, but it is the No. 1 cause of maternal death in childbirth worldwide.

Pitocin is given to 60 to 70 percent of laboring mothers …

“Anytime they can use less oxytocin, it’s beneficial,” …

… while pitocin is necessary at times, there are ways mothers-to-be can reduce their chances of needing the drug during labor.

# Avoid elective inductions when there is no medical reason
# Labor at home until the labor pattern is well-established
# Move around and stay upright during labor
# Hold off on epidural until dilated to at least 4 centimeters
# Consider a certified nurse midwife instead of an obstetrician if the pregnancy has no complications.

Midwives … reported using pitocin in only 5 to 8 percent of births, instead of the 40 to 70 percent rates cited by other doctors and nurses in 6News’ research.

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

House clears bill to cover midwives under Medicaid

Posted on March 1, 2011 by Melissa Maimann

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.

… The Idaho House has signed off on a bill that would give Medicaid clients the option of using midwives during childbirth.

The bill … has the potential to save the state’s Medicaid fund thousands of dollars annually if more women opt for a midwife over a hospital visit.

… the cost of a Medicaid-covered hospital birth is a little more than $6,000, while a midwife-assisted birth is estimated at Medicaid about $1,500 …

Great news!

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

When The Doctor Is A Woman Patients Expect Being Involved In Decision Making

Posted on February 28, 2011 by Melissa Maimann

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.

… patients have greater expectations of their family doctor listening actively to them, keeping them informed and considering their opinions than in getting involved in decision making …

When the family doctor is a woman, patients expect her to let them get involved in the management of their health problem …when consulting for biomedical problems”.

This might explain why women are drawn to midwives for their pregnancy and birth care, given that most midwives are women and many women do expect to play an active role in all decisions that need to be made in their pregnancy and birth.

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