Posted by Melissa Maimann on Aug 28, 2010 in
Home birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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I live for the day that we have these headlines here in Australia!
The number of women who give birth to their children at home in Wales has more than doubled in less than a decade …
Since 2002 … they have risen from 604 to approximately 1,395 last year.
There has also been a rise in women giving birth in midwife-led units.
… the assembly government has encouraged healthy women with low-risk pregnancies to have their babies out of hospitals.
In 2002, maternity services in Wales were asked to reach a 10% home birth rate by 2007, making it the only nation in the UK to have a target.
Midwives say that while it was a very ambitious aim and many areas have not managed to reach it, it has helped transform the choice in maternity services.
On average, 4% of births in Wales last year were at home, which is higher than the UK average of 3%.
Laura Williams gave birth to her daughter Megan at home in Porthcawl, Bridgend county, on 5 November, 2009.
… “I wanted to be in a more comfortable environment – I liked the fact that with a home birth I could use my own shower and sit on my own sofa.
“As it was, I had a fantastic birth at home. I borrowed a friend’s pool and was really relaxed. The midwife even cleared everything up afterwards – I saw no mess.
… “I also think the fact I was at home and relaxed helped my recovery from the birth – the next day I was up and about and even popped to the shops.”
… “Midwives are continuing to work towards it because many see the benefits home births bring.
“They are cost effective in that women don’t need to stay in hospitals.
“And for the mother, there is less risk of medical intervention, the birth is well planned, she is in a relaxed environment and often doesn’t have to leave other children.”
… Rather than staffing a large obstetric unit at a hospital, which midwives have to do in more populated areas, they can “focus on staffing women’s needs”, she said.
… The issue of home births has been in the headlines recently after medical journal The Lancet said mothers-to-be should not be able to opt for them if they put their babies at risk. Under UK law women can override medical advice.
It came after research published in the American Journal of Obstetrics and Gynaecology suggested home births were more risky than hospital delivery.
But the Royal College of Midwives said the research was “flawed”, and the assembly government insisted that only women with low-risk pregnancies were encouraged to have their children at home.
The chief nursing officer for Wales, Rosemary Kennedy, said: “It is for midwives and other health professionals to explain to pregnant women the birthing options available to them, and decide on the most appropriate option after considering their medical history and preferences.”…
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, Home birth, midwife, Midwifery, Midwifery services, women's rights
Posted by Melissa Maimann on Aug 17, 2010 in
Birth,
Midwifery,
Normal Birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
MONA Vale Hospital’s new birthing unit will simply be a place for expectant mothers to have a home birth inside a hospital – but a long way from emergency care if a complication occurs – according to an obstetrician.
How anyone can consider a hospital birth to be the same as a homebirth is way beyond me! There is a very big difference between the comfort and familiarity of our homes, and a hospital environment.
Dr David Jollow, one of Mona Vale Hospital’s onsite obstetricians, said the new, midwife-run, Mona Vale birthing unit would mean women who suffer a complication during labour will have to be rushed to Manly Hospital instead of being treated by Mona Vale’s onsite obstetricians.
“The new unit is essentially a home birth that happens to be in a hospital,” Dr Jollow said.
“It would actually be safer to have a home birth in Balgowlah or Seaforth, because an ambulance ride to Manly would be quicker.”
It’s interesting that obstetricians oppose free-standing birth centres, yet we have the existence of midwife-run units where obstetricians are not available. Is ther a differnence? Is it merely a differing terminology to be acceptable to some?
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, Birth choices, continuity of care, Home birth, hospital birth, intervention, Midwifery, Midwifery services, Public and private hospitals
Posted by Melissa Maimann on Aug 10, 2010 in
Birth,
Home birth,
Midwifery,
Obstetrics,
VBAC Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
Last week, midwives and clients of Andaluz Waterbirth Center in Portland announced plans to file a federal lawsuit to “cease intimidation and threats against midwives” by the Oregon Health Licensing Agency and Oregon Health & Science University.
Midwives say doctors and nurses at OHSU have filed baseless complaints to the licensing agency meant to thwart competition … The threatened lawsuit spurred a passionate online debate among supporters and critics of home birth.
Conflicts between midwives and doctors run deep. One of the biggest problems: Many physicians deal with midwives only when a laboring mother experiences difficulties during a home birth and requires transport to a hospital, sometime urgently.
“It’s an extremely tension-fraught encounter,” according to Melissa Cheyney, an Oregon State University assistant professor and practicing midwife who studied the interactions of midwives and doctors in Jackson County last year. Nearly every physician interviewed by Cheyney and her graduate student expressed the view that births must take place in a hospital to be “safe.”
Studies including higher-risk pregnancies have found that fetal deaths are more likely in home births. But in low-risk pregnancies, most research shows no significant difference in risk to the baby, while home-birth mothers experience fewer complications. In a study in British Columbia last year, women giving birth at home suffered fewer than half as many serious perineal tears, and about a third less postpartum bleeding.
By choosing a hospital birth, women substantially increase the risk of having a surgical delivery. More than 29 percent of hospital births in Oregon resulted in a cesarean during the years 2006-2008. Less than 4 percent of home births ended with a cesarean in a 2005 study of 5,400 births attended by midwives in the U.S. and Canada.
Women who choose home birth often cite the desire to keep birth free of medical intervention. Heather Hermans … transferred to the care of a midwife because she wanted to try a vaginal delivery rather than schedule a cesarean section, as her obstetrician-gynecologist recommended.
“My ob-gyn didn’t remember me from appointment to appointment,” Hermans said. “I was treated like pregnant cow No. 45.”
Many women will choose midwifery care to receive personalised care where they can develop a relationship with the midwife who will attend their birth.
Hermans experienced complications during labor and took an ambulance to OHSU, where a surgeon delivered her healthy baby boy by emergency C-section. The surgeon filed a complaint about Hermans’ midwife to the state … Roy Haber, an attorney hired by the midwives, said the Oregon Health Licensing Agency withdrew all six investigations after he challenged them.
Conflicts aren’t inevitable. Cheyney is working with midwives in Lane County and a Eugene obstetrician, Dr. Paul Qualtere-Burcher, on guidelines for smoother, more collaborative relations. Qualtere-Burcher and his colleagues have agreed to help midwives get access to laboratory testing and ultrasound screening for their clients. Midwives are referring higher-risk home birth clients to the physicians for assessment and another perspective.
“We’d like them to come in and see us before it becomes a big issue during labor,” Qualtere-Burcher said. “I think it’s been very successful.”
Home birth by the numbers
Planned home births in Oregon last year: 877 out of 47,675 total births, or 1.8 percent.
Risk of baby dying in a midiwife-attended home birth: 1.7 percent versus 0.6 percent in hospitals, based on a 2009 British study including women with breech births, twins, or attempting a vaginal birth after a previous cesarean (VBAC).
I’d be interested to see what these stats are when high risk homebirths are removed from the data set, or to analyse the risk of each “risk factor” in isolation to determine the riskier “high risk” situations, for example, is HBAC less risky than twin homebirth?
Risk of baby dying in a midwife-attended home birth when comparing only low-risk mothers: 0.5 percent versus 0.3 percent in hospitals.
Chances of giving birth without medical intervention: 78 percent with a home-birth midwife versus 54 percent in hospitals, according to the 2009 British study.
A women’s chances of having cesarean section when giving birth in an Oregon hospital, 2006-2008: 29 percent.
Fetal deaths in births attended by licensed midwives in Oregon, 2001-2007: 4 in 2,906 births, about 0.1 percent.
Fetal deaths in births attended by physicians in Oregon, 2001-2007: 1,455 in 274,278 births, about 0.5 percent.
This would account for the fact that midwives mostly manage uncomplicated pregnancies and births, while doctors are referred higher risk women and babies.
Number of home birth midwives who are licensed in Oregon: 64, up from 54 in 2008.
Complaints lodged against licensed midwives, 1999-2007: 40.
Disciplinary actions imposed by the Board of Direct Entry Midwifery, 2000-2004: 12
Midwife guide
…
Direct Entry Midwife – A general term for practitioners who train directly into midwifery without a nursing or medical background, and attend births outside of hospitals. Oregon law allows direct entry midwives to practice with no licensure.
Certified Professional Midwife — Direct entry midwives certified by the North American Registry of Midwives, which requires written and practical examinations and practical experience attending 40 births.
Licensed Direct Entry Midwife — Direct entry midwives who obtain a license in Oregon are authorized to use some prescription drugs and medical devices. They must pass a national examination, demonstrate experience in attending births, and complete continuing education every three years. They are licensed by the Oregon Board Direct Entry Midwifery and subject to disciplinary actions if they violate professional standards.
Certified Nurse Midwife – Registered nurses who go on to complete an accredited nurse-midwifery program. Oregon requires certified nurse midwives to obtain a Masters degree. CNMs are the only midwives that practice in hospitals. They are licensed by the Oregon State Board of Nursing.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: birth, Birth choices, Caesarean, Complicated pregnancy or birth, continuity of care, hospital birth, midwife, Midwifery, Midwifery services, Obstetrics, Public and private hospitals, VBAC
Posted by Melissa Maimann on Jul 30, 2010 in
Birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
The AMA welcomes the Government’s introduction of new regulations that require midwives … to collaborate with medical practitioners in order to provide Medicare-funded services to patients or prescribe them medications under the Pharmaceutical Benefits Scheme (PBS).
AMA President, Dr Andrew Pesce, said today that the new arrangements would provide a safer higher standard of care for patients.
… “There is now a requirement for midwives … to establish collaborative arrangements with a medical practitioner in order for the service to attract a Medicare patient rebate or PBS benefit.
And that’s the problem: midwives are required to establish collaborative agreements, but obstetricians do not have to collaborate with the midwife. And there are fears that if the midwife does not work according to the obstetrician’s protocols, the agreement will be revoked. this does nothing to establish midwifery as a profession in its on right.
… “Evidence shows that patients enjoy better health outcomes when they receive coordinated, continuous, and comprehensive care that is delivered by appropriately trained health professionals,” Dr Pesce said.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, Maternity Services Review, midwife, Midwifery services, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Jul 29, 2010 in
Birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
THE NORTHERN beaches health service will proceed with plans for a midwife-only maternity scheme at Mona Vale Hospital …
The new scheme will see the majority of northern beaches births take place at Manly Hospital, where a combined obstetric maternity service will operate, with about 200 births a year scheduled for Mona Vale, where midwives will now manage them all.
… the new “midwifery group practice model” was unanimously endorsed …
But Mona Vale obstetrician Dr Chester Kent said the hospital had no representatives on the council and that none of its maternity staff supported the decision.
“It seems there is nobody being included in the decision-making process who really represents the interest of local women,” he said.
Another hospital worker, who did not want to be named, said they were only told about the changes at a meeting on Tuesday and that neither Manly or Mona Vale staff supported the decision, which they found “very distressing”.
Pittwater State Liberal MP Rob Stokes said operating a midwifery group practice model at Mona Vale was not a bad idea, but it should not be used as a replacement for obstetric services.
… “It’s not good enough to put a delivering mother into an ambulance and take them down to Manly, or the North Shore.”
Northern Sydney Central Coast Health chief executive Matthew Daly, who was present at Monday night’s clinical council meeting, said improved health outcomes for mothers and babies had influenced its decision to endorse a “united obstetric service” at Manly.
It’s wonderful to see midwifery-led services expand. We have midwifery-led services in private midwifery practice, Ryde Hospital, Belmont and Wyong, to name a few. They’re a great way to maintain midwifery services and are proving very popular with women and families.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, hospital birth, Midwifery services, Public and private hospitals
Posted by Melissa Maimann on Jul 19, 2010 in
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
The Government’s $120 million national Maternity Reform Package is currently being implemented. There is still much work to do. From 1 November 2010, women will be able to claim Medicare benefits from care that is provided by eligible midwives. Women will need to ensure that their midwife is eligible, prior to engaging her services, if she wishes to claim medicare benefits.
It is still not known how much women will be able to claim through medicare and these details will not be known until closer to November 1, 2010.
Midwives have been lobbying hard around the one key sticking point of these reforms: how midwives and obstetricians will work together in defined collaborative agreements. The Maternity Services Review recommended that medicare be extended to midwives who work in collaborative agreements with obstetricians, however the definition of collaboration has only just been revealed.
The definition of a collaborative arrangement provides for four options, each requiring signed agreement from the obstetrician. No collaborative agreement = no medicare benefits for the woman.
One option is a contract of employment whereby the midwife is employed by the obstetrician. Personally, I would have suggested that this go the other way around: considering that most women have healthy pregnancies and do not require the services of an obstetrician, the midwife ought to employ the obstetrician on a sessional basis for her private clients when obstetric services are required.
Option two requires that the obstetrician refers a woman to a midwife for midwifery care. I truly cannot see this option working in the private health system. What incentive is there for the obstetrician to refer his/her patients to a midwife?
Option three requires a signed collaborative agreement between the midwife and obstetrician. But there’s a catch: no obstetrician is on call for 24/7/365. Hence, at least two obstetricians will need to sign this agreement for it to be in force 24/7/365. What should happen when one partner wishes to pull out, goes on leave, has a holiday and so on? This suddenly leaves the midwife – and all of her private clients – without an agreement, without medicare and without care.
Option four requires oodles of paperwork on the midwife’s part. I don’t mean to be negative but it would work out to be: spend one hour with the woman and one hour chasing the paperwork. Yes, there’s a *lot* of paperwork. And every time a piece of paper is forwarded to the obstetrician, the obstetrician must acknowledge receipt of this. There are at least seven points in the pregnancy where a midwife will need to photocopy and fax / post; or scan and email documents to the obstetrician and then document that the obstetrician has acknowledged receipt of these documents. A nightmare for all!!
So where are we going with all of this and what is the big picture? The big picture as I see it, is that sometime towards the end of the year, eligible midwives will have visiting / admitting rights at hospitals. Their clients will be able to claim medicare benefits for their services for the very first time, bringing down the cost of private midwifery care significantly. Women will be able to book with their private midwife of their choice, and also be admitted to hospital for birth under the care of their chosen private midwife, presumably as a private patient. If obstetric care is needed, the midwife would have ready access to a named obstetrician who could assist the woman, enhancing continuity of care to the woman. This system would provide true continuity of midwifery and obstetric care to women.
However, we have a long way to go. The collaborative agreements, as they stand, require an obstetrician’s sign off before the midwife can provide medicare-rebatable services to women. Some obstetricians, it seems, are very supportive of an employment model whereby the midwife is an employee of the obstetrician, however for the midwife who has her own successful and thriving business, this option will not be satisfactory. Much work needs to be done to explore models of care, facilitate visiting rights for midwives and protect the right of the midwife to practice as an autonomous practitioner, a specialist in natural birth.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Maternity Services Review, Midwifery, Midwifery services
Posted by Melissa Maimann on Jul 18, 2010 in
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
In order to claim Medicare benefits from care with your midwife, you will need to ensure that your midwife is Medicare Eligible. A Medicare-Eligible Midwife meets certain advanced requirements:
Current general registration as a midwife in Australia with no restrictions on practice;
Midwifery experience that constitutes the equivalent of 3 years full time post initial registration as a midwife;
Current competence to provide pregnancy, labour, birth and postnatal care to women and babies;
Successful completion of an approved professional practice review program for midwives working across the continuum of midwifery care;
40 hours per year of continuing professional development relating to the continuum of midwifery care (20 hours in addition to standard requirements);
Formal undertaking to complete an accredited and approved program of study to develop midwives’ knowledge and skills in prescribing within 18 months.
Essential Birth Consulting provides a high standard of care to women and babies and is committed to becoming a Medicare Eligible Midwife. Clients of Medicare-eligible midwives are able to claim Medicare benefits for midwifery services and are able to have their midwife order and interpret tests, prescribe, supply and administer medications and access visiting rights to hospitals.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Midwifery services
Posted by Melissa Maimann on Jul 11, 2010 in
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
I am a midwife who wants to continue to provide private midwifery care. The systems and protection mechanisms that came into effect on July 1 are letting down midwives and women …
The experienced midwife has watched the deteriorating standards of care in hospitals. Consumers and midwives asked the politicians and the various health authorities for change, but what have we ended up with? A confusing set of rules that reduce women’s birthing choices and rights to privacy.
I have read the two professional indemnity insurance policies available for private midwives … I now have to scratch a plan of care that by virtue is demonstrating the “collaboration of care”, or signing over a woman’s right to privacy to a doctor or a hospital.
As for collaboration, the definition of this term cannot be agreed by legislators, health professionals or bureaucrats. I will pay a minimum of $5000 for the four to five private clients a year. Since July 1, if I do not have profession indemnity I will not be meeting the professional standards of the new national Nurses Midwives Registration Board, and I could be disciplined, de-registered or fined.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Maternity Services Review, midwife, Midwifery, Midwifery services
Posted by Melissa Maimann on Jul 7, 2010 in
Birth,
Midwifery,
Normal Birth,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
A question I have often wondered.
Through my practice, I have a lot of women coming to be because although they have chosen an obstetrician, they really want a natural birth and it has recently occurred to them that their obstetrician will only “deliver” their baby if they’re on their back in bed / do an episiotomy / induce by 41 weeks / insist on continuous monitoring etc, and this is not what they want.
I often ask the question, “What was it that made you decide to have an obstetrician?” or, “What was it that made you decide on this particular obstetrician?”
And the responses are generally very interesting.
• My GP referred me
• My mother / sister / friend / neighbour used this doctor and she said he’s wonderful
• Well, when I got pregnant I went to my GP. She asked me if I have private health insurance and I said yes, so she wrote a referral to Dr XX.
I ask these women if they considered any other options. “What options?” comes the response.
I’m amazed that with the marvels of modern technology, internet etc, that women don’t know they have other options. It seems to be to be an interesting handing-over of responsibility and I’m curious why it happens with pregnancy and birth, but not in any other aspect of life. Do we buy a particular computer – that can’t meet our needs – because it was recommended and we didn’t know there were other computers on the market? Do we buy a large house when we need a small house because it was recommended by the real estate agent?
In most other situations where choices are involved, people will engage in a process of assessing options.
We might list all the possible options and then assess each option across a range of qualities.
We might seek the recommendations (note: plural, not singular) from significant others.
We ask questions.
We consider what it is that we really want, and then match it to what’s available, seeking the most satisfactory choice.
But sadly, this does not happen with pregnancy and birth. Countless women come to see me, having chosen an obstetrician, but really desiring a natural birth that the obstetrician states openly he will not have a part in. There might be a birth centre in their local area, private midwives who could attend them, or even a public hospital caseload midwifery program. Sadly, these options were not explored by the family.
The next question, then, is why, having chosen a care provider who is truly not suited to our needs, do we stay with that care provider?
I always applaud women who make the courageous change. Many women who come to me describing their “predicament” will re-appraise their options and make choices that are aligned to their preferences. Others will remain with their original decision but will ask me to attend them throughout their pregnancy and birth in attempt to act as an intermediary between them and their obstetrician. I don’t consider this to be the most advantageous position, either for the woman, the obstetrician or myself. However, surprisingly, it seems to work well and all the births I have attended in this capacity have occurred on the woman’s terms. I am in awe of those women for having the courage of their convictions to remain with an ill-suited care provider and find the resources that will help them to still have their birth on their terms. They come away elated, feeling they have truly achieved the best of both worlds: an obstetrician they know for if something “goes wrong” and a private midwife who is an expert on natural birth.
Ideally, women will see a midwife for a pre-conception consultation where birth options can be discussed. Some women will ultimately benefit from – or desire – an obstetrician for their pregnancy and birth and this should not be denied to those women. However, a large majority of women simply want a “natural birth” and assistance to avoid tearing and a long labour. They want a healthy baby, a satisfying experience and they really want continuity of care. These women need to know – even before they become pregnant – the options that are open to them. It’s never too early to meet with private midwives and choose the one who is suited to your needs.
Ultimately, if the maternity reforms work to women’s advantage and if obstetricians and midwives are able to put The Birth Wars aside, women ought to be able to have continuity of midwifery and obstetric care: one midwife and one obstetrician who provide the woman’s care so that she benefits from a natural birth expert and an expert in things that “go wrong”. Place of birth could be home, birth centre or hospital and waterbirth would be a supported option.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, midwife, Midwifery, Midwifery services, Obstetrics, Preconception care, Public and private hospitals
Posted by Melissa Maimann on Jul 6, 2010 in
Home birth,
Midwifery,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
When Sigrid Chapman gave birth last month … she turned to a midwife instead of an obstetrician to handle the delivery, a choice being made by more women.
Although nurse-midwives attend to a small portion of births in the United States, demand for their services has increased almost every year …
Now, midwives in New York State see the potential for additional growth. They won a major battle last week to work more independently after the Legislature repealed a requirement for written agreements with doctors to deliver babies.
The change … could increase the availability of midwives to women … who opted for midwifery because of its focus on natural childbirth.
“My obstetrician wanted to do a repeat Caesarean section, and the midwife was less skeptical and more encouraging about doing what I wanted,” said Chapman.
Midwives work with obstetricians … But … the professions practice with different philosophies.
Midwives specialize in assisting through low-risk pregnancies and helping women who want natural births with minimal technological intervention. Obstetricians tend more toward active management of deliveries to anticipate and prevent potential problems.
The written agreements spelled out the working arrangement between doctors and the 1,300 licensed midwives in the state.
Midwives contended the agreements were unnecessary because midwives have a professional and ethical obligation to consult with obstetricians with or without a written practice agreement, particularly when a pregnant woman encounters problems and needs the expertise of a physician.
Midwives argued that physicians … refused to sign agreements, preventing them from delivering babies. They noted that elimination of the agreements doesn’t change the scope of their practice — what it is they are allowed to do professionally as midwives.
We recently had the same situation in Australia, with insurance requiring a signed collaborative agreement with an obstetrician. The only catch was that obstetricians refused to sign such agreements. We are now required to submit a care plan for every woman in our care.
“The bill makes it easier to practice, and for patients, it removes a barrier to access us,” said Laura Sheparis, president of the New York State Association of Licensed Midwives.
… The American College of Obstetricians and Gynecologists made the legislation a patient safety issue, arguing that the agreements ensure an OB-GYN will be contacted immediately if a midwife is faced with a high-risk birth. After passage of the bill in the Legislature, the organization stated that patient safety will continue to exist in midwife-attended births in hospitals but not for home births.
“The agreements are a safety net in case something goes wrong at the end of labor,” said Donna Montalto, executive director of the college’s New York State section. “If there’s no doctor supervision, midwives shouldn’t be doing obstetrics.”
It must be said that midwives do not practice obstetrics. Only obstetricians do that. Midwives practice midwifery which is a separate and distinct profession to obstetrics. And nursing. And physiotherapy. And dietetics. Midwifery is a profession in its own right.
Dr. Mark Weissman, a Buffalo OB-GYN, said he supports midwifery and believes most midwives will continue to collaborate with physicians, but he worries that the relationship will be unregulated with the elimination of the agreements.
“The delivery of a baby should be a shared responsibility. Without the agreement, midwives will be able to perform home births and create their own birth centers,” said Weissman, chairman of the college’s Buffalo-area section.
Shock horror! Midwives running birth centres! What is the world coming to?!?!
For midwives, the written agreements come across as an unneeded obstacle to providing services that they see as increasingly relevant to pregnant women, especially in efforts to help avoid Caesarean sections. “We have a pretty good track record of achieving natural births,” …
… the report lends support to midwifery. She cited its conclusion that choosing a midwife will likely decrease the chance of an unnecessary Caesarean since the likelihood that one will be needed is generally less with midwives than with obstetricians.
With obstetricians more inclined to perform a Caesarean, some women worry about losing control of their delivery.
Chapman, a neonatal nurse … received a Caesarean for her first birth in 2008, but she found it difficult to recover from what turned out to be a physically and emotionally wrenching process for her.
“It was very hard on my body,” she said. “When I got pregnant again, I wanted the delivery on my terms. I wanted to do it on my own and feel like a real woman.”
Her second baby was larger than average, like her first, and the obstetrician worried that a normal birth could cause a uterine rupture, particularly with the previous Caesarean.
“When I asked her about doing a vaginal birth, she looked at me as though I was crazy,” said Chapman.
She sought out a midwife anyway … and liked that her desire for a vaginal birth was treated with encouragement rather than skepticism.
The baby was born naturally … Mom was thrilled with the way it went. ” … the midwives made me believe I could do it instead of leaving me with the feeling that I would have to fight for it.”
The situation can be likened to GPs referring their patients to specialists when the need arises. Do GPs have practice agreements with cardiologists, rehab specialists, endocrinologists, paediatricians, neurologists, haematologists, oncologists, gynaecologists, psychiatrists etc? Or do they simply consult and refer according to best practice, as required by their professional body?
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Midwifery, Midwifery services, Obstetrics
