Who controls childbirth: women or doctors?

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

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

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

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

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

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

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

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

No answer.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Melissa Maimann, Essential Birth Consulting 0400 418 448

Your birth after July 1, 2010

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Melissa Maimann, Essential Birth Consulting 0400 418 448

Fancy giving birth with just essential oils for pain relief?

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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Aromatherapy is being offered to women in labour at Southmead Hospital as a natural pain relief … midwives have been trained to mix a range of oils to ease symptoms for women giving birth at the hospital and in their own homes.

The oils … have been found to have therapeutic effects and are used in massage, in a bath or dropped onto a smelling stick.

Bergamot, jasmine, lavender, peppermint, grapefruit, clary sage and frankincense are being used by the midwives to ease symptoms such as nausea and back pain.

… being more relaxed during labour generally helps the birth progress more smoothly.

… a woman who had planned a natural birth and opted for the essential oils could turn to an epidural afterwards should they need it.

… It is hoped that offering women aromatherapy will support the drive from the Department of Health for more women to give birth naturally.

The oils will generally be used in lower risk births … which is generally the criteria for women giving birth in their own homes or in the birth suite at Southmead, which is run by midwives rather than doctors to make it a more relaxed environment.

Previously midwives had only been able to offer women gas and air in their own homes but the aromatherapy provides more options.

Essential oils costs less than 50p per person …

It would be great if this could be implemented across Australian hopsitals – public and private. It seems that the UK has a huge drive at present to increase the rates of normal, natural birth. What is preventing Australia from following suit?

Melissa Maimann, Essential Birth Consulting 0400 418 448

Canadian Researchers Suggest Review Of Current Guidelines On C-Sections

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A recent study showing that the rate of cesarean sections performed at hospitals across … Canada, varied between less than 15% and more than 27% — with only 2% requested by the women — prompted researchers to recommend “revising the current guidelines” on when it is appropriate to perform a c-section … Difficult labor was found to be the most prevalent cause for a c-section …

It will be interesting to read what the new guidelines say. Certainly, some factors promote vaginal birth such as staying at home for as long as possible in labour, planning a homebirth, receiving midwifery care, being well prepared – emotionally, mentally and physically – for birth, reading widely about pregnancy and birth to be well-informed and more comfortable with the process and having the continued support of a midwife who is experienced in supporting women through natural birth.

Melissa Maimann, Essential Birth Consulting 0400 418 448

FAQs

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

framework for privately practicing midwives

The Quality and Safety Framework is not out yet in its final version. A final draft has come out and it is now in the hands of the Nursing and Midwifery Board to accept or reject the Framework in whole or in part. I will update this blog once I know more details about the QSF.

Midwifery in the home nsw legal

Yes, midwifery is – and will remain – legal at home.

Private health insurance, private midwifery care, australia

Yes, Private Health Insurance may cover the cost of private midwifery care. Some health funds are more generous in their benefits than other funds so it’s worth doing your homework before becoming pregnant so you can get the cover that’s most advantageous.

Private midwife vs obstetrician

The role of the obstetrician is to provide care for women with complicated pregnancies and births, so they’re called in to manage things that are not seen to be progressing normally. The role of the midwife is to take care of healthy, well pregnant and birthing women (and their babies) and to refer to obstetricians when it’s necessary. Private midwifery care is holistic in nature, so women can expect that their midwife will be interested in getting to know them, they can expect their pregnancy consultations to be very thorough and to last for 1-2 hours. Private midwives attend the whole labour and birth, we do not just attend for the end of birth. Private midwives take on a much lower caseload – you’ll be hard-pressed to find midwives with more than 4 births a month, so we’re more available to our clients.

Water birth experts australia

That would be a midwife! More specifically, a private midwife or birth centre midwife. We regularly attend waterbirths.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Early Clamping Of The Umbilical Cord May Interrupt Humankind’s First ‘Natural Stem Cell Transplant’

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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… Delaying clamping the umbilical cord … allows more umbilical cord blood volume to transfer from mother to infant and, with that critical period extended, many good physiological “gifts” are transferred through ‘nature’s first stem cell transplant’ occurring at birth.

… [In] Western medical practice, early clamping … remains the most common practice … perhaps because the benefits of delaying clamping have not been clear. However, waiting for more than a minute, or until the cord stops pulsating, may be beneficial …

Birthing methods have also changed over the last century. Throughout human history and currently in cultures and areas where delivering mothers squat to deliver, gravity helps speed the stem cell transfer …

… the relationship between cord clamping time and the transfer of stem cells needs to be understood through the early weeks of the perinatal period and the process of ‘hematopoiesis,’ the formation of blood cells that begins as early as two weeks into pregnancy. A transfer of pluripotent stems cells continues throughout pregnancy, however, and for a time through the umbilical cord following delivery.

…”In pre-term infants, delaying clamping the cord for at least 30 seconds reduced incidences of intraventricular hemorrhage, late on-set sepsis, anemia, and decreased the need for blood transfusions.”

Another potential benefit of delayed cord clamping is to ensure that the baby can receive the complete retinue of clotting factors.

… many common disorders in newborns related to the immaturity of organ systems may receive benefits from delayed clamping. These may include: respiratory distress; anemia; sepsis; intraventricular haemorrhage; and periventricular leukomalacia. They also speculate that other health problems, such as chronic lung disease, prematurity apneas and retinopathy of prematurity, may also be affected by a delay in cord blood clamping …

Melissa Maimann, Essential Birth Consulting 0400 418 448

FAQs

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

Exorbitant prices with Sydney obstetricians, alternatives?

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

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

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

Refusing to be induced at hospital

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

How to have a baby naturally in a hospital

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

Home birth fetal auscultation

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

Melissa Maimann, Essential Birth Consulting 0400 418 448

Homebirth: What to expect

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There is no standard of events for women who give birth at home. Homebirth care is always individualised to the needs of the woman and family.

The following information can help you to understand what may happen in labour, to give you a sense of your options and lessen any surprises. When you birth at home, you can expect to:

- Wear whatever you like in labour
- Have vaginal examinations when / if you want them. Your midwife may suggest an examination if she feels it is needed, which is not very often as we know that babies are born whether vaginal examinations are performed or not and many women prefer to avoid them wherever possible.
- To have your temperature, blood pressure and pulse taken when it is necessary to do so – sometimes this is not done at all
- Have your baby’s heart beat listened to with a hand-held doppler that allows you to remain in the bath or shower.
- If additional fluids are needed, you can expect your midwife to offer you lots of drinks – this will also help to keep up your energy levels. In fact, your midwife will probably offer food and fluids regularly throughout your labour anyway.
- We don’t use ID bands at home. Not for Mum, not for baby. No chance of anyone getting lost, everyone knows who’s who, and no mother is handed the wrong baby!
- Your waters are very unlikely to be broken at home.
- You can expect to give birth in the position that’s most comfortable to you at the time. For many women, this is kneeling (so you can catch your own baby) or all fours (and your partner can catch the baby).
- Waterbirth is a common birth method at home.
- While “pain relief” is not offered, your midwife will make suggestions to assist your level of comfort such as position changes, hot packs, bath, shower, massage and so on.
- You will find that your body will push instinctively when the time’s right.
- Many women will not tear and episiotomy is very rare at home.
- Placentas usually come of their own accord, in their own time provided that the blood loss is not excessive.
- Your baby’s cord will be cut after the placenta is born, and some women prefer to leave it intact and have a lotus birth.
- There is no separation of mother and baby.

Visit my website to learn more about my services.

The Mother Friendly Childbirth Initiative

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

Link

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

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

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

The Mother Friendly Childbirth Initiative:

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

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

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

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

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

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

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

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

9. Discourages non-religious circumcision of the newborn.

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

Melissa Maimann, Essential Birth Consulting 0400 418 448

FAQs

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

home birth: how messy is it

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

midwives home birth still legal

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

how many hours a day do you spend breastfeeding

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

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

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

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

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

what’s the difference between a midwife and obstetrician

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

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

water birth private hospital

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

how to avoid hospital birth

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

how to choose a midwife

See here.

limitations of using a private obstetrician for maternity care pregnancy

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

Melissa Maimann, Essential Birth Consulting 0400 418 448

FAQs

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

Birth trauma symptoms

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

Some women experience:

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

    The msin benefits of using a midwife are:

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

    do you need informed consent episiotomy

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

    duty of care to an unborn child

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

    no obstetrician for birth in private hospital

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

    private birthing classes at home, Sydney

    Yes, this is possible. See here.

    will homebirth be legal after July, 2010?

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

    Birth providers who support vbac in sydney

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    2010 cost of home birth

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

    Birthing hospital expenses

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

    Difference in childbirth with midwife and childbirth in a hospital

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

    First time mothers and homebirth

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

    Hospital midwife compared to private midwives

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

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

    Which is safer for baby repeat c section or vbac?

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    What are the disadvantages of birthing in hospital?

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

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

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

    birthing options

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

    Can I have a midwife as additional support in pregnancy?

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

    midwife medical offset?

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

    midwifery care fees

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

    Are there any homebirth classed in sydney?

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

    access to rebate on midwife visits

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

    Are hospital births unnecessary?

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

    bowral midwife educator

    I’d recommend Peter Jackson’s Calmbirth classes.

    Can i have an epidural with a midwife?

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

    Can midwives administer oxytocin at a home birth?

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

    Cost of homebirths in the illlwarra

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

    Does having gestational diabetes mean a c section?

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

    Private midwife public hospital sydney?

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

    Pprivate midwives in Sydney’s east?

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

    Reasonable obstetricians north shore 2010

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

    What is the difference in cost between public and private?

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

    Transition into parenthood

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

    vbac north shore private?

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

    water birth private hospital sydney

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    What are the advantages to having an independent midwife?

    Independent midwifery practice is the oldest form of continuity of midwifery care. Recent research has demonstrated that this form of care – where a woman is cared for by the same midwife throughout pregnancy, birth and the postnatal period – is beneficial for women and families. It results in increased satisfaction with the birthing experience and enhanced safety. When multiple care providers are involved in a woman’s care, the chance of errors is high because care is provided in pieces. When a woman is cared for by one midwife, she has one point of reference, no conflicting advice, she can develop trust and a sense of security and the birth will generally proceed naturally.

    Who is the best obstetrician in Sydney?

    Good question! It depends how you define “best”. For many women, bedside manner is the only determinant of “best”, while safety records and intervention rates are rarely checked by women. It’s ok to ask questions of your obstetrician and to come to your own conclusions about who is the “best” obstetrician.

    What are my options for birth after July 2010?

    After July, they will be the same as they are currently, and homebirth will remain legal. The difference will be after November, when, for the first time, women will be able to book under the care of a private midwife and birth in hospital – hopefully public and private. Many women would like to birth in a private hospital but they want to be cared for by a midwife. Currently, there is no way to facilitate this: all women who birth in a private hospital must have an obstetrician. This may change in November. As well as this, women will be able to claim Medicare benefits for midwifery care and midwives will be able to prescribe medications and order tests and ultrasounds.

    Birth centre exclusion criteria

    Check with your birth centre. General exclusion criteria include twins, breech babies, high blood pressure, a need for induction or a request for an epidural.

    What is the cost of a midwife birth?

    All midwives charge different amounts, but in Australia you can expect to pay between $3000 and $6000.

    Do midwives give epidurals?

    No, midwives are not qualified or trained to administer epidurals. However the midwife can – on a woman’s request – call for an anaesthetist to administer an epidural.

    What are the positives of hospital birth?

    If you have any complications in your pregnancy, hospital might be a safer environment to birth your baby in. Some women feel reassured by the machines and technology that is commonplace in hospital. I encourage homebirth for all healthy women whose pregnancies are low-risk because home is the safest place to birth a baby. We don’t go to hospital for other bodily functions – unless something is wrong. Why is birth any different?

    How can a midwife own a private practice?

    Midwives are autonomous health professionals, just as dentists, psychologists and dieticians are. Midwives can provide care in any setting – including the home – and if obstetric care is needed, the midwife can access this for the woman readily at the hospital.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    Can I home birth if I have a high blood pressure?

    It is best to discuss this with your midwife and s/he can guide you on this one.

    Can you opt for a c-section in a public hospital?

    Generally speaking, you cannot do this. Caesareans are only performed where there is a clear obstetric reason. Many women have support people with them for their labour and this helps them to feel more comfortable and in control of their experience.

    Can you refuse midwife attendance during birth?

    You can refuse to have a midwife with you if you choose, but this would leave you without professional care during the birth.

    What care is available to women birthing in australia?

    Within the private system, women may choose a midwife for a home or a hospital birth and they will generally experience an empowering and natural birth without complications. If there are complications in the pregnancy or birth, obstetric care is readily available. The other option in the private system is to choose an obstetrician. Intervention rates with obstetricians are high, with caesarean rates up to (and over) 50%, episiotomy rates around 25% and assisted delivery rates around 25%.

    In the public system, midwifery care is the norm, but most women will not have the same midwife all the way through their pregnancy, birth and postnatal period. If there are complications in the pregnancy or birth, obstetric care is readily available.

    Continuity of midwifery care

    The most established method of continuity of midwifery care is private midwifery care or independent midwifery. In this model, women book with the midwife of their choice and this same midwife is there for the woman throughout pregnancy, birth and the postnatal period. Satisfaction rates with this mode of care are very high.

    IVF and home birth?

    Yes, it is possible to bith at home following IVF. Talk to your midwife.

    Are midwives qualified to do cesareans?

    No, midwives are qualified in normal pregnancy and birthing, and we do not perform surgery.

    Natural labour in sydney?

    The best way to achieve a truly natural labour is to book with a private midwife for a home birth or a hospital birth. Home is the safest place to birth for the majority of women, and home – where women feel safe, nurtured and supported – is the most conducive environment for a natural birth.

    Are there any obstetricians in sydney under $5000?

    The best way to research prices is to ask the obstetricians themselves. Don’t forget, the ob’s bill is not the only bill you will receive: there is also the paediatrician, anaesthetist, private hospital fees, health fund excess / co-payment, childbirth education and so on.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Is Water Birthing Safe?

    Visit my website to learn more about my services.

    Link

    … “water birthing,” [is] considered by some women and midwives to be a healthier, more natural alternative to traditional hospital births.

    Mothers who choose water birth go through labor and delivery immersed in warm water, believing that pain will be less severe and the experience more enjoyable and relaxing … studies have shown that mothers who choose a water birth request fewer painkillers than women who don’t, and fewer drugs translate into the perception of a safer and more natural birth.

    … But is it good for the baby?

    The research isn’t clear.

    … researcher Sarah Nguyen questioned the safety of water births and described instances of infants inhaling water and feces following underwater deliveries … other researchers concluded, “… we are convinced there is no evidence to support any benefit of underwater birth for the neonate, and plenty of evidence to suggest harm [including] the potential for drowning, hyponatremic seizure activity, infection, and pneumonia.”

    The American College of Obstetricians and Gynecologists does not recommend water births, suggesting instead that children born in hospitals are safer — if for no other reason than professional medical help is immediately available in case of complications. Unless your bathtub happens to be located near a neonatal unit, emergency medical help may not be available during the baby’s first minutes of life.

    Of course, there is some risk to both the child and the mother during any birth, whether it occurs in a bathtub or a hospital. All births are natural, yet some births are safer than others.

    The research that suggests that water birth ia not safe is based on very small numbers and potential issues. Nothing has been found as conctere evidence that waterbirth is harmful for babies. However, research has shown that waterbirth has enormous benefits for the woman: better pain relief, less likelihood of needing an epidural, less likelihood of tearing, no episiotomies, shorter labours and so on.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQS

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

    Why are are home births with a mid wife preferred over a hospital delivery?

    There are many benefits to birthing at home and having a midwife provide your care. The following pages will explain more about the benefits of birthing at home:

    http://www.essentialbirthconsulting.com.au/home-birth.html

    http://www.essentialbirthconsulting.com.au/home-birth/home-birth-benefits.html

    I had a bad first birthing experience and I’m now waiting for my second baby.

    It’s important to debrief your birth experience to help you to gain clarity around what happened and to explore strategies for helping the same situation to not happen again. Birth debriefing can also help you to choose a care provider who can support what it is you need for your second birth.

    What are the benefits of having my baby with a midwife?

    There are many benefits:
    - Have the same care provider all the way through your pregnancy, birth and postnatal period
    - Lower rates of intevention such as forceps, vacuum, episiotomy, induction, epidural
    - More likely to breastfeed successfully
    - Have continuous support from your midwife throughout labour
    - Babies generally experience gentler births

    What proportion of women birth at home with midwife?

    Australia-wide, around 0.3%. In NSW, it’s around 0.2%. The low rate of homebirth is related to several factors:
    - Homebirth is not actively supported by our health system, and hence it is not offered as an option to women when they see their GPs when they become pregnant.
    - There is a perception that home birth is something only “hippies” or “alternative” people do. This could not be further from the truth!
    - The cost of homebirth is prohibitive for some families as it is totally privately funded.
    - In some areas, there are no midwives available.

    Is it possible to contract a private midwife for postnatal care only?

    Yes! Essential Birth Consulting provides postnatal care independent of birthing services.

    Are there any VBAC friendly doctors at north shore private?

    VBAC rates at North Shore Private are around 5% or lower and this is reflective of the obstetricians who practice there. Conversely, private midwives have VBAC rates as high as 90%. Obstetricians are surgicial specialists; midwives are specialists in normal, natural birth. If you’re after a normal birth (VBAC), you’re best to choose a care provider who specialises in this.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Rising C-section birth rate

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

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

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

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

    Inducing labor before term more common

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

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

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

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

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

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

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

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

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

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

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

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

    But it isn’t a simple call.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Planned home births may have a low rate of complications …

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

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

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

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

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

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    FAQs

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

    informed consent and childbirth

    Every woman who is competent to consent, has the right to refuse any or all professional care. Informed consent must be obtained prior to any procedure being performed.

    how to minimise labour intervention in a hospital?

    The best way to minimise intervention in a hospital is to be as well informed as you can possible be about all things related to pregnancy, labour, birth, breastfeeding and babies. Read widely, attend independent childbirth education classes and consider employing a private midwife to be with you throughout your labour. She can help you to decide if the proposed interventions are necessary in your situation, she can support you emotionally, mentally and physically and she can aso help to ensure that your birth plan is respected without a fuss.

    Do any independent midwives in Sydney offer prenatal care for women who are planning to freebirth?

    Yes! This service enables women to access antenatal care from a midwife without the midwife attending the birth. Postnatal care is available if needed.

    Do you think there are advantages to continuous monitoring for low-risk women

    In a word, no. Intermittent auscultation is the method of choice. Continuous monitoring will increase the chance of a caesarean with no benefit to the mother or baby.

    How much is a private midwife

    Prices range from $3000 – $6000. Melissa Maimann offers for her clients to pay by the hour, making the service one of the cheapest.

    What is a good caesarean rate?

    The World Health Organisation recommends that no more than 15% births need to be caesareans. The WHO argues that when caesarean rates exceed 15%, the risks to the mother and baby increase on the whole. You’ll be hard-pressed to find a hospital with a caesarean rate of less than 15%, but birth centres and private midwives have caresarean rates of less than 10-15%.

    What is the best hospital in sydney for delivering babies?

    It all depends what sort of birth experience you’re after! If you’re wanting a natural birth, home birth will be the best option. If you want a natural birth in a hospital setting, the best options would be birth centre or private midwifery care for a planned hospital birth. If you’re wanting to have intervention in your birth, a hospital birth would be best. If you choose an obstetrician, you’re far more likely to have a caesarean, episiotomy, epidural, forceps or vacuum. Choosing your care provider is the single most important decision you will make in birthing.

    Is there a birth centre at westmead hospital?

    No, there isn’t. If you’re after a natural birth, the best choice would be a home birth.

    C section or natural delivery midwife?

    Midwves cannot perform caesareans. If a caesarean was needed, the midwife would call a doctor in to perform it. Most caesareans that are performed are unnecessary and increase the risks to the mother and baby. A natural birth is the safest way to birth, and midwives are qualified specialists in natural birth.

    giving birth after birth trauma

    Private midwifery care will be really important so that you can have the same midwife all the way through pregnancy, birth and postnatally. It’s also important to debrief your last experience and come to a place where you feel safe to birth again.

    high risk midwife sydney

    Midwives are not qualified to care for high risk pregnancies. We refer these women onto obstetricians. In most cases, one or two consultations is all that is needed with the obstetrician and the midwife continues the care of the woman.

    how many births proceed naturally

    What a great question! It all depends what care provider you choose and where you have your baby. You see, if you choose a private midwife and birth at home, you have about a 95% chance of having a vaginal birth. If you birth in a private hospital, you have about a 33% chace of having an unassisted vaginal birth. In some hospitals, the caesarean rate is more than the vaginal birth rate! Sad but true.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Roxon grilled over proposed midwife changes

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

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    The Federal Government has been grilled at its latest community cabinet meeting over its proposed changes for midwives and maternity services.

    The Government wants to make midwifery services eligible for Medicare rebates, but only if homebirth midwives work in consultation with a doctor.

    Several women at last night’s meeting … told the cabinet ministers that the changes would restrict the choice of women who only want to give birth with a midwife at home.

    But Health Minister Nicola Roxon says the Government is simply taking a cautious approach.

    “To make sure we’ve got some backup protocols in place, so if something does go wrong that there are agreements with the hospital or doctor to be able to step in quickly,” she said.

    “And that is a conservative approach, but it isn’t a conservative approach to say midwives are doing good work, have never been recognised in the history of providing Medicare for the last 50 years and we’re going to actually change that.”

    She told the meeting that medical professionals should be working together.

    “I’m unapologetically on the record as saying let’s encourage people across the health services spectrum to work together and make sure that women can safely choose options that are good for them and suit them,” she said.

    Women who access private midwifery services will be able to access Medicar benefits. As well as this, midwives will be able to order medications via the PBS.

    The maternity reforms provide women with greater access to continuity of midwifery care. The standard care in a public hospital is for women to see one group of midwives in the clinic, another group in the delivery suite (who work shifts) and then another lot of midwives when they are being cared for with their baby. The maternity reforms will make it possible for more women to be cared for by their own midwife, whom they have chosen. The same midwife will provide care from the first antenatal consultation right up until about 2-4 weeks after the baby is born.

    This is a huge step forward for Australian maternity care. For the first time, women will be able to birth in hospital under the care of a private midwife. Private midwifery care will also be available for home births (as is currently the case). We are continuing to book women for home births beyond July.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Hundreds protest homebirth restrictions

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

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    Prime Minister Kevin Rudd is stripping away a woman’s right to have her baby at home, protesters around the country have been told.

    Hundreds of people have come together across Australia at 13 simultaneous rallies to protest against the government’s planned overhaul of maternity care.

    NSW Greens MP Lee Rhiannon told a crowd of about 100 in Sydney that access to a homebirth was a woman’s right.

    “We are in an extraordinary situation when a woman can choose to have a caesarean but she can’t choose to have her children at home,” …

    Ms Rhiannon said the government had succumbed to pressure from Australian Medical Association, which is opposed to home birthing.

    The proposed new laws … will require all midwives to be insured … a two-year exemption will apply for up to 200 independent midwives, who are unable to gain insurance because it is no longer provided for home birthing.

    They will also have to work in collaboration with a doctor – who will be able to override their decisions – to access Medicare, insurance and pharmaceutical benefits for homebirths.

    … homebirth groups … say the practice will be forced underground, a concern that was also highlighted in a recent Senate inquiry.

    Christine Wrightson, who had two planned home births, one of which ended up being in hospital due to complications, told the crowd … “I had one child in hospital and one was born at home – for both births we chose to be under the care of a privately practising midwife,” Ms Wrightson said.

    “This was because it was extremely important to me to minimise the chance of medical intervention as I strived to have a natural birth …

    Women choose private midwifery care for a variety of reasons, not only to birth at home. For some, it’s to have a qualified advocate by their side in hospital, or to have extended postnatal care for 6 weeks, or to have antenatal consultations in their own home rather than attending the local hospital clinic. But for most women, the reason for having a private midwife is about the level of trust, security and confidence that develops over time.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Excess weight raises pregnancy risks: study

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

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

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

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

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

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

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

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

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    More expectant moms choosing water 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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    DENVER – What was once considered alternative is now becoming more mainstream: One Denver hospital is finding more expecting mothers choosing the option of water births.

    … a big free-standing Jacuzzi tub is set up and filled up in a room in the birth center. It is about three feet deep.

    … it is a great option to help … natural child birth.

    “To me being in a confined tub made it really secure, it kind of made it my cave,” … “I felt protected and left to do my own thing.”

    … Patients are coming from as far away as Nebraska for the option.

    “People are seeking it and wanting it so they are willing to make the trip to our Hospital …”

    It wuld be wonderful if waterbirth could become a standard option in all birth places.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Pain relief ‘doesn’t lead to more satisfying births’

    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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    Despite fewer epidurals, the majority of women in midwife-led units were happy with their pain relief.

    MOST IRISH first-time mothers opt for the epidural … But reducing the pain levels doesn’t necessarily mean a more satisfying birth experience …

    The HSE report involved a study of … women who had babies in the Midwifery-led Units (MLUs) … despite having fewer epidurals, 83 per cent of women in the midwife-led units expressed satisfaction with their pain relief, compared with 68 per cent of women in the consultant-led unit.

    midwife-led care was as safe as consultant-led care, resulted in less intervention, gave birthing mothers greater satisfaction and was more cost-effective.

    … the epidural was very effective in complicated labours, for example where the birth was being induced or sped up.

    However, in normal pregnancy … three forms of care reduced epidural use: one-to-one care in labour given by a midwife; access to water immersion, … and access to self- hypnosis or hypnobirthing.

    “When those three forms of care are widely available for women, we see quite a low rate of epidural, even in first-time births. These forms of care are available in birth centres and in home birth situations … ”

    … the downsides of epidural use … included an increase in forceps or vacuum delivery, a lengthening of labour and an increased need for oxytocic drugs to induce labour.

    “Research on women’s satisfaction with labour has found that the one-on-one support they got from the midwife was a much more important part of the actual experience than the experience of pain. Paradoxically, a lot of women talk about a high level satisfaction along with a high level of pain.”

    Dr Peter Boylan … had a different opinion … “The epidural is undoubtedly the most effective form of pain relief … for a first birth … A lot of women find that it transforms what is a miserable experience into one they actually enjoy because they are not suffering the awful pain,” he said …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Girl, 13, starved of oxygen at birth to receive millions

    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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    Alice … was starved of oxygen during the final hour of her mother’s labour after doctors failed to warn her mother that there were risks associated with her second birth.

    Diagnosed with spastic quadraplegic cerebral palsy, she has severely delayed mental development as well as learning difficulties and is now reliant on 24 hour care.

    Her mother Carolyn had a caesarean section with her first child but doctors … did not tell her that there was a chance the womb would rupture during a normal delivery.

    Lawyers for the Joyce family … claimed Alice would have been born healthy if delivered by caesarean …

    … Her father … said: “Although it sounds like a large sum of money it is needed to fund Alice’s around the clock care and ensure she gets as much out of life as her disabilities allow.

    … A court ruling today is expected to award Alice a lump sum payment of £2,250,000 plus annual payments until she is 16 of £95,000 pounds and £185,000 after that for the rest of her life.

    The case was funded through legal aid, without which the family would not have been able to afford legal costs to prove negligence or the experts needed to prove her complex needs.

    … Chief nurse and director of patient care standards Sarah Watson-Fisher said: “We would like to express our sincere apologies to Alice and her family for the errors in the care given at the time of her birth …

    “We take matters like this very seriously and are committed to learning from our mistakes. We hope that the settlement will be of great assistance to Alice and we offer her and her family our best wishes for the future.”

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Benefits of midwifery go beyond money saved

    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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    Midwives in Washington state provide an excellent service to expectant mothers and have their place in the budget under consideration by state lawmakers.

    Midwives provide comprehensive prenatal care for mothers with low-risk pregnancies who plan to deliver at home or at a birth center … they give pregnant women a safe alternative to a hospital delivery, saving taxpayers a considerable amount of money.

    In August 2007, officials at the state Department of Health hired a private consultant to weigh the costs and benefits of midwifery in Washington. The goal … was to compare out-of-hospital births with traditional in-hospital births and determine whether there was a benefit to continue the state’s midwife license and disciplinary program.

    The consultants found that the cost savings of delivery with a midwife — for both public and private insurance — amounted to $2.7 million in a two-year budget cycle. That’s about 10 times the cost to operate the state’s midwife program. The independent analysis found that savings to the state’s Medicaid system alone amounted to almost a half-million dollars.

    The report also looked at cesarean-section births billed to the state subsidized Medicaid program, and found that 12.9 percent of deliveries with a licensed midwife attending resulted in a C-section compared with 24 percent of in-hospital births without midwifery care. C-sections are expensive and sometimes medically crucial. But they also have become the most frequent surgery in the United States and, when performed unnecessarily, are an undue cost to taxpayers.

    Looking at the study findings, there can be no doubt that having the midwife program in place saves tax dollars.

    The consultants also looked at the latest national research on the safety aspects of home deliveries and found that planned home births for low-risk women using midwives had a lower rate of medical interventions and a similar mortality rate with low-risk women who delivered in a hospital.

    … the consultants also found that the risk for cesarean section is lower for women under the care of a licensed midwife as compared with women who did not receive prenatal care from a midwife … women using a midwife were less likely to have an underweight newborn.

    … the average cost for a home delivery for a midwife was $1,000. The cost for a vaginal delivery attended by a physician in a hospital averaged $3,171, increasing to $5,798 for a C-section.

    From the recent reports at the state level, it’s safe to say from a both a cost and safety standpoint, licensed midwives in this state are providing excellent care and saving tax dollars in the process …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Midwife-developed care package shortlisted for award

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

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

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

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

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

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

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Home births: deadly or desirable?

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

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    After six hospital births … Melissa Read decided to bring her seventh child, Ayla, into the world at home.

    “Doctors had told me home births were incredibly risky but I did a lot of research and the midwives understood what I was talking about and how I felt,” Ms Read said.

    “It was an incredible experience that was more than I expected for myself, my husband and my kids.”

    Independent midwives have slammed reports this week that home births put babies at a greater risk of dying than those born in hospital.

    A widely reported … study showed that babies born at home are seven times more likely to die of complications and 27 times more likely to die from lack of oxygen.

    The Australian Medical Association (AMA) and the National Association of Specialist Obstetricians and Gynaecologists used the study to warn against the dangers of home birth.

    But the report, which compared 297,192 planned hospital births with 1141 planned home births … also showed that the perinatal death rate was similar for both kinds of births.

    The 16-year long study recorded nine perinatal deaths in the planned home-birth group, seven of which were actually born in hospital, and 2440 deaths in planned hospital births.

    Home birth advocates criticised the report, saying the research was flawed. The report itself states “small numbers with large confidence intervals limit interpretation of these data”.

    However, homebirth studies in Australia can only include small numbers because less than 1% births occur at home.

    “In the 16-year study period there were only three perinatal deaths for which one can reasonably assume that a different choice of care provider, location of birth or timing of transfer to hospital might have made a difference to the outcome,” says the report.

    … the study showed there was only a slightly higher risk in choosing a home birth. And if done properly with a low-risk pregnancy, there was no real difference.

    Exactly. What the study really shows is that low-risk, midwife-attended home birth is a *safer* option than hospital birth. The issues are around risk assessment and management … and the right of women to accept or reject advice.

    “The risk is mainly in people who have home births that shouldn’t have them, such as having twins, a breach birth or people too far beyond their due date,” Prof Keirse said.

    These outcomes of these births is better when they occur in hospital.

    “A mother has to be responsible when deciding what kind of birth to have and these mothers are taking unacceptably high risks.”

    Prof Keirse said he was scared by the number of women choosing to have home births after already having had a caesarean.

    “When a problem happens and you are at home you have no real way of dealing with it,” he said.

    “One of these days we will not only lose a baby but a mother as well.”

    Homebirth Australia national secretary Justine Caines said the reporting of the study by the AMA was irresponsible.

    “I think they are trying to push a political agenda and outlaw or force home birth underground, which is incredibly irresponsible,” Ms Caines said.

    “The report says there are 7.9 deaths per 1000 in planned home births, compared to 8.2 in planned hospital births, but they didn’t all stay home births and the real figure of births that actually occurred at home is 2.5 deaths per 1000.”

    The study title states it was looking at *planned* home birth and *planned* hospital birth. Actual place of birth was not the focus of the study. If the study focussed on the babies that were born at home, it would have had to include babies who were intended to be born in hospital, but arrived too quickly at home. These births are possibly riskier than planned home birth.

    Last year the Federal Government refused to include home birth under its midwifery indemnity scheme.

    The decision forced many midwives underground and threatened to increase the number of women ”freebirthing”, or delivering at home without any medical supervision.

    This has not happened as the changes will not come into effect until July 1, 2010.

    Ms Caines said from July this year midwives were at risk of not being able to be registered under the Commonwealth reforms.

    “In the UK there is a legislative right that if the woman choses a home birth there is a responsibility that they have a trained health professional with them,” she said.

    In the UK, it is illegal for women to have unassisted births. We do not have this law in Australia.

    “A woman has a right to make an informed consent to a home birth and if she understands the advice she’s received it’s not my right to say you can’t do that.”

    AMA president and obstetrician Andrew Pesce said the study supported the association’s stance against home births.

    “The current evidence would mean we could not support home birth given that it is associated with higher risk of babies dying,” Mr Pesce said.

    “The risk of what is happening now needs to be acknowledged and the midwives and people involved in home births need to put plans in place to manage those risks.”

    The AMA admitted the study revealed many positives for home birth but maintained it was too great a risk for mothers and babies.

    SA independent midwife Julie Garrett said midwives were aware of the complications, but had a duty to support the choice of a mother.

    And this is the crux of the matter: midwives do not act irresponsibly. We do inform women of the risks. But women are free to choose amongst options and to make the right decision for them.

    Ms Garrett said the culture in Australia needed to change to support midwife-based care as an alternative.

    “In England and New Zealand they are bringing in home births, while Holland has an almost completely midwife-based care model. It’s the culture here that needs to change. Women should be able to choose.”

    In the UK, NZ and the Netherlands, health policy supports low risk home birth. Even in a country such as the Netherlands, where home brith is a normal birthing option, the home birth rate is only 30%. 70% women need to birth in hospital or choose to birth in hospital, and there is no stigma attached to it. In a country such as Australia, with a caesarean rate in excess of 30%, a maximum of 70% women will be “eligible” by risk-assessment standards, to birth at home. Add to that twins, breeches, women going over 41 weeks or less than 37 weeks, high blood pressure, gestational diabetes, big babies and so on, and you can understand that even if home birth is a government-supported option, it will not be an option for the majority of women.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Home births: home born is best

    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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    There’s a type of woman that I will never be. She wears a kaftan, fries up a tasty placenta and offers breast milk to a fully verbal six-year-old. But – whisper it – I had a home birth.

    It’s a myth: home births are not the preserve of earth mothers. Give me a G&T over a raspberry tea any day …

    When I became pregnant in 2003, I was terrified. I decided to give myself the best chance of a ”natural” birth. I got fit, watched videos of other births and practised HypnoBirthing. And despite advice to the contrary, I knew that I didn’t want to go through labour in hospital. Lying prostrate in a fluorescent room as personnel shifts changed was nightmarish. I wanted to be relaxed in a darkened room with trusted midwives.

    But I wasn’t reckless. As a first birth, I wanted medical support close by in case there were complications. A London birth centre close to a major hospital was the perfect solution and I enjoyed one-on-one midwifery throughout my pregnancy … I delivered Croyde at 9am and was home in bed by 7pm (nether regions intact thanks to the midwives).

    But as my 12 antenatal friends had their babies, I realised how shockingly rare my experience was. Almost 50 per cent of them had caesarean sections … At least one of the women was left so psychologically traumatised that her daughter will never get a sibling.

    And their stories are fairly typical …

    When I became pregnant in June 2008 I was even more determined to ”own” my experience with a home birth … one month earlier, my sister-in-law’s baby had died after suffering cord asphyxia in the latter stages of a seemingly normal labour. It was traumatic for the whole family. For my husband … it was reason enough to have our next baby in hospital.

    I wouldn’t be swayed, but I did want his support …

    I explained how infant mortality rates have improved due to greater abortions for abnormalities, rather than the hospitalisation of birth; that maternity units are more likely to make hasty interventions; that the stress of hospitals reduces the body’s ability to deal with pain …

    He argued that only two per cent of British babies are home born. I told him that was because the needs of large maternity units are being met, rather than those of women.

    Seven days before our birth, my waters started leaking inexplicably. Had I been under hospital care, an induction would most likely have been advised – only to find that my membranes were intact. My midwife … monitored me daily. She arranged a precautionary scan and administered homoeopathy and aromatherapy to get things moving … The relationship with [our midwife] meant there was no awkwardness or embarrassment.

    The birthing pool was heavenly …

    Croyde dressed his sister an hour after she was born. It was Mother’s Day. My mother made Sunday lunch and my father watched the football. James went for a run. When Manchester United were 3-0 down my father turned off the television. “It had been a good day until then,” he said.

    This, I thought, is how birth should be – normal, surrounded by family and strangely uneventful. Every couple should have the chance to give birth at home; to feel safe, unhurried and in control. James and I would do it all again tomorrow …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    More critique of the homebirth study and its reporting by the media

    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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    Associate Professor Hannah Dahlen, Vice President of the Australian College of Midwives, and an academic at the University of Western Sydney, and Professor Caroline Homer, Professor of Midwifery at the University of Technology Sydney, … had a critical look at the study and the way its findings are being portrayed.

    They write:

    …One of the problems is that the planned home birth group includes women who planned homebirth when booking in for care but then developed risk factors and had their babies in hospital. There are probably only two women whose babies died; who started labour at home planning a homebirth and one of these was a twin pregnancy (high risk). This latter woman persisted in having a homebirth due to ‘unsatisfactory hospital experiences.’ The others had all transferred before the onset of labour. The authors admit they ‘could not differentiate all planned homebirths according to whether transfer to hospital had occurred before or during labour.’ So for low risk women who started labour at home the risk was very low – 1 death in 16 years

    There is no way to tell if these planned homebirths were under the care of a registered midwife.

    This was not a low risk population of women – there was a high rate of post-term pregnancy … twins … and … previous caesarean section.

    … There were two perinatal deaths that actually occurred at home. One baby had lethal congenital abnormalities (this was known before labour and a decision made for the baby to be born at home). The second death at home was after a waterbirth which was not found to be the cause of death but a review identified that increased monitoring may have identified the baby was in distress.

    One perinatal death occurred in hospital after a transfer after the birth of the first twin. The first twin was born at home and second twin was born in hospital after a delay in transfer and subsequently died.

    There were 6 perinatal deaths in the planned homebirth group where the baby was born in hospital. Presumably these women were transferred to hospital during the antenatal period as antenatal risk factors developed. Transferring to hospital if or when risk factors develop during pregnancy is appropriate practice.

    Of the six deaths in hospital: one had hydrops fetalis … one death was unexplained with a cord entanglement seen after birth; one had pulmonary hypoplasia … after a early rupture of membranes; one was a growth restricted baby with an abnormal karotype … one was born to a woman who was very overdue … and underwent induction in hospital without fetal monitoring (the woman refused) and her labour eventuated in a stillbirth; and, one was a woman with known haematological … risk factors whose baby had a lethal abnormality … all these were born in hospital.

    Only three of the deaths are thought to be related to perinatal asphyxia.

    Three of the deaths were thought to be potentially preventable and related to the model of care. These were the baby born after the waterbirth at home; the second twin who was born after an intrapartum transfer and the baby born after being very postdates. Therefore, there were 3 deaths in 16 years – two of which had risk factors present. That means that there was only one death where there were no risk factors in the 16 year period.

    … You would need more than 10,000 births at home to show clinical relevance and have some confidence in the statistical significance in relation to perinatal mortality rates. The authors acknowledge this in the paper and present their data with caution in the paper stating that the ‘small numbers with large confidence intervals limit the interpretation of these data.’

    The facts are there was no difference in perinatal mortality … For those actually born at home the perinatal mortality rate is 2.5 per 1000 births, which is comparatively low.

    … The paper highlights that the system must be so terrible for some women that they would choose to give birth outside of it than in it, even with risk factors. This is an indictment on the current maternity system in Australia – that needs fixing – removing homebirth won’t do this.

    What was missed?

    The conclusion of the paper is very sensible recommending risk assessment, transfer and fetal monitoring.

    So then why did the data get so grossly misinterpreted?

    The reality is despite a malfunctioning system in this country where midwives are uninsured and have no visiting rights, and homebirth is unfunded and often hard to access, the perinatal mortality rate was no different.

    Risk assessment, transfer and fetal monitoring will be improved when private midwives are no longer excluded from mainstream services so we should be aiming for this not continuing the ‘witch hunt’ against private midwives.

    … Some women will always choose homebirth so we should support this choice with safe responsive systems of care. The authors state that ‘women’s autonomy in choosing reproductive behaviour is a fundamental human right enshrined in Australian law’.

    The excess mortality continues to be found in high-risk women and women need to be informed of this risk.

    Freebirth (giving at home birth without a skilled and registered birth attendant) is rising in this country and this is a concerning outcome of restrictions on options like homebirth and trauma from hospital births …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Don’t believe the home-birth horror headlines

    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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    If you’ve been half awake in recent days, you might have heard of a new study showing that “babies are seven times more likely to die during home births”.

    It’s worth having a close look at what the study actually found … and also considering some of the broader context that has been sadly lacking from most of the coverage I’ve seen and heard.

    … The researchers compared the outcomes for 287,192 planned hospital births that took place in SA between 1991 and 2006 with those of 1141 planned home births. Note that this latter group was defined as any birth intended to occur at home at the time of antenatal booking, but about 30% actually ended up occurring in hospital …

    During those 16 years, there were nine perinatal deaths in the planned home birth group (seven of which actually occurred in babies born in hospital) … two deaths occurred among the 792 infants born at home, one of whom had congenital abnormalities.

    … the rates of caesarean sections and other interventions were significantly lower in the home-birth group. Nine per cent of women who’d planned a home birth ended up having a caesarean …

    The home-birth babies were more likely to die during labour and delivery …

    … home-birth babies were 27 times more likely to die from lack of oxygen during delivery. Again, this finding had wide confidence intervals, with the estimate ranging from eight to 89 times greater — clearly, another one to take with caution.

    … The researchers note that … “there were only three perinatal deaths for which one can reasonably assume that a different choice of care provider, location of birth or timing of transfer to hospital might have made a difference to the outcome.”

    It is also worth noting that one of these three deaths occurred in a twin. The reason the parents persisted in a home birth despite being advised against it was that they “had had unsatisfactory hospital experiences during previous pregnancies”.

    … it seems more pertinent than ever to borrow the final words of the study’s authors:

    Although it is not anticipated that large numbers of women will opt for home birth, women’s autonomy in choosing reproductive behaviour is a fundamental human right enshrined in Australian law.

    Respecting their choices and achieving the best outcome for all concerned is likely to remain a challenge that will require more light and less heat than it has received thus far …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Inducing labor may lead to more C-sections

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

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

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

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Obstetricians debate whether Caesarean section is always best for breech babies

    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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    About 32 weeks into her first pregnancy, Christie Craigie-Carter’s obstetrician told her that the baby she was carrying was … breech … and that she’d have to give up her dream of a natural delivery and have a Caesarean section instead.

    Desperate to avoid surgery, Craigie-Carter said she wanted to deliver the baby naturally anyway, but her doctor told her that such a procedure was simply too dangerous. “She said I wouldn’t find a obstetrician on the East Coast who would deliver a breech baby vaginally,” recalled Craigie-Carter.

    When she asked her obstetrician to try to turn the baby into a head-down position … Craigie-Carter was told that such a maneuver might endanger the baby’s life …

    Craigie-Carter went into labor just before her due date and her son Joshua was delivered — via C-section …

    Her experience highlights a debate over whether breech babies should always be delivered by C-section or whether there are cases where a natural delivery is a safe option.

    In the United States, such babies are routinely delivered by C-section, in large part because of an international study … that found breech babies faced greater risks when delivered naturally. But the issue has received fresh attention following the decision last June by the Society of Obstetricians and Gynaecologists of Canada to reverse past opposition to natural deliveries and suggest that “planned vaginal delivery is reasonable in selected women.”

    The American College of Obstetricians and Gynecologists remains firmly opposed to vaginal deliveries of breech babies … Yet some obstetricians believe that breech delivery is reasonable in certain cases and bemoan the loss of this skill among obstetricians trained today.

    “When I started in residency [in the late 1970s] we did not do C-sections on breeches at all; it was normal to have a vaginal breech,” said Michael Hall, 59, an obstetrician- gynecologist in Colorado. He has done about 300 vaginal breech deliveries in his career and continues to do them for carefully selected pregnancies: when labor has been normal, the baby is not too big or in the footling position, and the width of the mother’s pelvis is adequate.

    In a January 2006 article, Marek Glezerman, head of obstetrics and

    gynecology … argued that the study’s recommendations should be withdrawn because most of the deaths or post-birth problems reported in the research “cannot be attributed to the mode of delivery.” Glezerman reported that the study included cases of planned vaginal deliveries of breech babies when “there was no attendance of a clinician with adequate experience.” …

    The second article … found that “when strict criteria are met before
    and during labor,” planned vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to women.”

    Fischbein, a California obstetrician … has delivered about 200 breech babies vaginally but in August was told by his hospital to stop. “The bottom line is litigation mitigation and economics,” he said.

    Regardless of expert guidelines, the reality is that few doctors who graduated in the last decade have the skills to deliver breech babies
    naturally. Lawrence said American medical students are taught the theory behind vaginal breech deliveries and have access to computer simulation training, but exposure to real cases is limited to residents who happen to be on call when a mother presents with a breech baby in advanced labor and it is too late to perform a Caesarean.

    Craigie-Carter, for one, would approve of that approach. After Joshua was born, she went on to have two more breech babies. The first was delivered by C-section. But for the second one, she found a skilled midwife near her New York home who was willing to help her deliver naturally. Her son Ryan was born without complications.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Home birth program that delivers

    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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    It took Bailey … only 75 minutes to slip calmly into the world, amid the comforts of his own loungeroom, unaware he was quietly making history.

    Bailey … is one of a handful born at home under the guidance of midwives from St George Hospital, which runs the first publicly funded scheme of its kind in NSW …

    ”After having a hospital birth for my first child, [Bailey's birth] was very, very different and it was amazing to be told that everything was my choice, my decision,” his mother, Claire, 32, said yesterday. ”It was unbelievably calm and relaxed.”

    Home birthing … is now regarded by most obstetricians as controversial and dangerous.

    Last year the Federal Government refused to include home birth under its midwifery indemnity scheme, which forced many midwives underground and threatened to increase the number of women ”freebirthing”, or delivering at home without any medical supervision.

    Private home birth services have not been forced underground!

    … home birthing advocates are hoping a review of the program … could change the way birth is viewed …

    This would be wonderful! The program opens the home brith option to a more mainstream population who might not otherwise have considered home birth.

    A study of the first 100 women booked to use the service found 63 per cent successfully delivered at home with no intervention or pain relief and minimal vaginal tearing.

    Thirty women were sent to hospital before going into labour and seven were transferred during labour …

    ”It shows that in a controlled environment where midwives are protected by the policies and protocols of a public hospital, home birthing is a safe option for women at low-risk,” the co-director of Women’s and Children’s Health at St George Hospital, Michael Chapman, said yesterday. ”… I’d hate for this study to be used to support programs where there are not over-arching checks and balances in place, but this shows it can be a safe process.”

    The program, launched in 2005, was helping to improve home birth’s poor public image, but was still too restrictive for most women, and had abandoned some in the late stages of their pregnancies, the secretary of Homebirth Australia, Justine Caines, said. ”… this program excludes women without a strong evidence base,” she said.

    ”Women have a right to informed consent and there is an ethical responsibility for a health service not to abandon [them], instead to offer the best health care possible consistent with a woman’s choice.”

    While the home brith service might be considered restrictive, this can also be considered to be providing a safe margin within which home birth services can commence and continue. Birth centres are also considered restrictive by some, but most women wo book into a birth centre will birth there safely.

    I do not agree with the comments about the program “abandoning” women. To my knowledge, this has never happened. A public health service is obliged to provide a basic and safe level of care, and this is done. When a woman’s clinical situation suggests that birth centre or delivery suite care would better meet her needs, this is provided. This is not abandoning women.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Rise in induced births worries doctors

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

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

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

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

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

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

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

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

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

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

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Feedback on our maternity system

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

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

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

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

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

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

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

    47% … said there was a shortage of midwives …

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

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

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

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

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Campaign to promote natural births

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

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

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

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

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Secret report damns safety of model home birth service

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Maternity units led by midwives ‘just as safe’

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    Maternity units led by midwives are just as safe for mothers and babies as those where obstetricians are in control …

    … At a midwife-led unit, women are helped through their labour by [midwives] and they cater for patients who show no signs of difficulty in giving birth naturally, referring any problems to an obstetrician if necessary.

    When the woman starts labour, she goes to the midwife-led unit … and is welcomed into a private room where she stays for the labour, birth and postnatal resting time.

    A consultant-led unit is staffed by obstetricians and and midwives, offering full pain relief cover such as epidurals.

    … The number of babies needing resuscitation at birth or admission to the special care baby unit was the same in both groups.
    60% of women in the consultant-led unit had their baby’s heartbeat monitored continuously in labour by an electronic monitoring machine, compared to 38% of women in midwife-led units.
    Almost half the women in the doctor-led units had their labour speeded up by having their waters broken or having oxytocin, a hormone given intravenously by drip, compared to a third of those in the other.
    Up to 85% of women in the midwife-led unit said they would recommend it, compared to 70% of those having the traditional care.

    Although the facilities in the midwife-led unit were “luxurious”, the cost per patient was €332 less than in the traditional hospital system.

    … 83% of women in the midwife-led units expressed satisfaction with their pain relief, compared with 68% of women in the consultant-led unit.

    … “Midwifery-led care has potential to provide greater choice for the majority of low-risk women, better continuity of personal antenatal care and a more satisfying birth experience.”…

    Melissa Maimann, Essential Birth Consulting 0400 418 448

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

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

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

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

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

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    The Labor Market

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Big girth? Then you can’t give birth

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    NHS chiefs have banned mums-to-be from giving birth at their hospital if they are too fat.

    The hospital’s maternity unit is only suitable for low-risk births …

    Any [women] with a BMI … over 34 will be turned away … “Our foremost concern is for the safety of mothers who deliver here … Mothers with a high BMI are at increased risk in labour …

    … 18 per cent of the population are obese.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Health Plans Work to Reduce the Health Risks and Costs From Elective C-Sections Before Full Term

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    A combination of quality-of-care and cost issues has prompted some health plans to take steps to reduce the number of scheduled, medically unnecessary premature Caesarean section deliveries, mainly through a focus on education of both women and physicians.

    … a growing percentage of women is having C-sections, many of which take place before the 39th week of gestation … between 1990 and 2005 there was a 20% increase in babies born before the 37th week of gestation and a 29% increase in births occurring at 37 to 39 weeks of gestation. Many studies show heightened risks to both babies and mothers when the babies are delivered before 39 weeks.

    Although there are certainly medically necessary reasons for some of these C-sections, newborns delivered prematurely are at risk for more medical complications than those born at full term. Many of these infants are admitted to the neonatal intensive care unit, which can be much more costly for health plans than a C-section or vaginal birth without NICU admission.

    There were more than 1.3 million C-sections in 2006 in the U.S., up from less than 800,000 in 1996 … plans have asked what they can do about this growing rate … “This is not the important question, but it’s the one everyone asks,” she maintains. Rather, she says, the focus should be on what these high C-section rates represent, which is a quality issue mainly with babies and the impact of neonatal costs. “The real quality issue has more to do with the infant than the mom,” …

    “This is both a quality-of-care and a cost issue,” … “A baby should not be born electively before 39 weeks unless there is a clinical indication” to do so … while NICU costs “are not the No. 1 issue … they are in the top couple of issues,” she explains. Average costs for a vaginal delivery are between $5,000 and $6,000, while costs for a C-section delivery are in the $8,000 to $9,000 range. But for births resulting in a NICU stay, those costs jump to the $20,000 to $30,000 range …

    … “While maternal and fetal complications during pregnancy may result in the need for a C-section, we’re concerned that some early C-section deliveries may be occurring for non-medically indicated reasons,”

    … “the rates of adverse respiratory outcomes, mechanical ventilation, newborn sepsis, hypoglycemia, admission to the neonatal ICU, and hospitalization for 5 days or more were increased by a factor of 1.8 to 4.2 for births at 37 weeks and 1.3 to 2.1 for births at 38 weeks.”

    … late preterm babies — … between 34 and 36 weeks gestation — are six times more likely than full-term babies to die within their first week of life and three times more likely to die within their first year. Groat says that babies born within the 37- and 38-week time frame “have twice the likelihood of going to the NICU” than babies born at 39 weeks.

    … If women have already had a C-section, they can safely have a … VBAC later…

    … Many plans are taking steps to help reduce the amount of scheduled premature C-sections.

    … 48% of babies admitted to the NICU were born to mothers who had scheduled deliveries, many of which were before 39 weeks gestation. After the plan shared its data with the hospitals and physicians in those areas, there was a 46% decrease in NICU admissions within the first three months … “We’re taking some of the best practices and sharing them with hospitals,” she explains. … “the last few weeks of pregnancy are important to the baby,” …

    … The Regence Group has a maternity management program, Special Beginnings, designed to promote a healthy pregnancy and delivery. “… we work to educate expectant mothers about the potential incremental risks to mother and infant” when the baby is delivered by C-section electively before the 39th week of gestation … “Through this program, we educate expectant mothers on the benefits of full-term, vaginal delivery to help encourage a healthy pregnancy and delivery. We also educate them about when it may be medically indicated to not have a vaginal birth.” … It also offers members a 24-hour health information line that includes mortality and morbidity information affecting both mothers and babies with elective delivery before 39 weeks … “This helps educate the mother if her doctor suggests early delivery,” …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Women need choice, not caesareans

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    The latest maternity figures released yesterday for England are very concerning. Reduced spontaneous deliveries, increased medical interventions and high caesarean section rates mean that women are not getting the type of birth they want and many are not getting the safest birth.

    There’s a 4% increase in the number of births in consultant wards and a decrease in birth in NHS midwifery facilities. This is exactly the opposite direction to that intended in the government policy, Maternity Matters, which includes the government’s promise to allow women in England to choose where they give birth.

    … Large numbers of women do not have a realistic possibility of choosing between a birth centre run by midwives, a consultant unit or a home birth.

    If women did have choice, we would be expecting to see a falling caesarean section rate, far fewer women choosing obstetric units, a network of birth centres being used by 20-40% of women and a home birth rate approaching 30%. When healthy women can choose care at home or in a unit run by midwives, they are more likely to have straightforward births that are a safe and positive experience.

    … England’s caesarean section rate is at 24.6%, well beyond the World Health Organisation’s recommendation of 10-15%. Obstetric units are there for women and babies with medical problems. It is quite wrong to fill them with healthy women who, given the option, would not choose them …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Childbirth: Nature should be allowed to take its course

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    It was imperative to allow nature to take its course and keep childbirth as normal as possible …

    Welsh consultant midwife Grace Thomas said there should not be any medical interventions unless they were absolutely necessary.

    Interventions … were like a line of dominos – when one fell, it brought all the others tumbling down.

    There have been concerns locally about a high rate of inductions for childbirth …

    “If you induce labour … it leads to further interventions …

    “Some women do need interventions and it is very important that they are available. But it is imperative to minimise interventions so that women have the chance to give birth normally,” …

    … women had the right to information which could allow them to make an informed choice. They should also be able to have an active participation in decision-taking during labour …

    It’s important that all births are allowed to proceed naturally: that midwives are skilled at supporting, promoting and protecting natural labour, and that our birth facilities are supportive of natural labour in their design, equipment, policies and staffing. There must be a valid reason to interfere with the normal processes of pregnancy, labour, birth and breastfeeding.

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Should Men attend the birth of their child?

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    Men attending the birth of their child can make labor ‘more painful and more difficult’ for women …

    Many men are excited about their new children and want to be with their partner when she gives birth. However … during childbirth men create problems for the birthing woman and should have no part of the birth environment.

    Dr. Michel Odent … links high expectations of men in the birth environment to the “industrialization of childbirth”.

    “The ideal birth environment involves no men in general,” …

    “Having been involved for more than 50 years … the best environment I know for an easy birth is where there is nobody around the woman in labor apart from a silent, low-profile and experienced midwife—and no doctor and no husband, nobody else.”

    “In this situation, more often than not, the birth is easier and faster than what happens when there are other people around, especially male figures—husbands and doctors.”

    Dr. Odent … believes the anxiety brought on by male figures can cause a woman’s oxytocin levels to drop. Insufficient oxytocin, a hormone vital to the birthing process, may increase the need for a caesarean section.

    “If she can’t release oxytocin, she can’t have effective contractions, and everything becomes more difficult. Labor becomes longer, more painful and more difficult because the hormonal balance in the woman is disturbed by the environment that’s not appropriate because of the presence of the man.” …

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Home Birth: Safer Than You May Think

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    Giving birth in the hospital is a relatively new option. For most of our time on the planet … humans have given birth right at home. More recently, birth in developed countries has been moved to a hospital setting. While people are now accustomed to the more sterile environment, and are often reassured by having the equipment and staff on hand to mitigate complications, a new study … suggests that for women with low-risk pregnancies, there’s no place like home.

    A team of researchers compared the safety of planned in-hospital births attended by physicians … or midwives … with planned home births attended by midwives … All of the women included in the study were eligible to have a home birth, meaning that they had no conditions that could put them at higher risk for complications …

    … the rates of infant deaths were lowest among those who planned a home birth, followed by those who planned a hospital birth attended by a midwife. Women who planned home births had significantly fewer interventions and complications than their hospital-birthing counterparts, including electronic fetal monitoring, assisted delivery, post-partum hemorrhage, and significant tearing. In addition, newborns in the home birth group were less likely to need resuscitation at birth or oxygen therapy beyond their first day, or to have meconium aspiration, a potentially serious problem affecting the lungs.

    … A US-trained midwife practicing midwife … who took part in the study explains, “Home birth is for low-risk pregnant women. In my practice, just because a woman wants a home birth, doesn’t mean she always gets one. We spend the entire pregnancy monitoring her pregnancy health and discuss the appropriateness and safety of home birth for her individual case. A woman has the right to choose her place of birth, but my job is to guide her safely in her choices. Sometimes that includes talking some women out of a home birth.”

    When it comes to home birth safety, Duong says, “What few people are aware of … is that midwives attend home births well-equipped with emergency medical equipment, including oxygen, IV’s, and medications, and are able to initiate emergency procedures in a home birth setting. In British Columbia, midwives are required to recertify in emergency skills, including obstetrical skills and neonatal ,more frequently than physicians who attend births. Lastly, midwifery is so well integrated into the healthcare system here in BC that we have very good systems in place for the safe care of women and their newborns should transport to the hospital become necessary when a home birth is planned.”…

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    The real safety issues in maternity care

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    Maternity care provides a classic example of the pitfalls of a specialist-driven model of practice in health care. It results in more expensive and interventionist care, rather than a community-based approach which could also help ensure a more equitable distribution of services. It has led us to talk about obstetrics, which implies a focus on a particular professional group, rather than maternity care, which implies a broader focus on the woman’s and baby’s needs, both before and well after the birth.

    Professor Lesley Barclay … is a leading proponent of the need to reorient maternity care around the needs of women and babies …

    “When women talk about what matters to them when it comes to childbirth, the issue they repeatedly mention is safety.

    But their understanding of safety around childbirth is often quite different to how health systems and many professionals define it.

    For women, a safe childbirth is not only about what occurs at the time of the birth. It also refers to longer-term issues, such as their social and emotional wellbeing in the weeks and month after the birth.

    When women talk about safety, they are also thinking about the increased rates of depression and anxiety that manifest after operative birth or the consequences of wound infection on general health.

    The Australian health system often makes it difficult for women to make wise choices around birth …

    For example, evidence shows for most women most of the time birth does not need to take place in hospital. Some women will only feel safe however, whether this is evidence-based or not, with specialist medical services and technology.

    The term “maternity care” … incorporates their social and emotional needs. It puts them – rather than the professional or the service …

    Evidence shows maternity care can be provided by both midwives and obstetricians in public and private sector hospitals and can be safely provided at home.

    … evidence also shows that safety from morbidity is less likely for Australia’s healthiest and wealthiest women cared for by private obstetricians in private hospitals. More recent epidemiological evidence shows as volumes of operative birth increases, deaths of mothers and infants are also increased by overuse of the very operation that was developed to save lives.

    So where does choice fit in this repertoire of terms, locations, professionals, services and outcomes?

    Safe birth should be the goal of choices offered to women and decisions taken by those who provide care for them.

    Unfortunately, the choices some professionals offer or accept are self or income centered and ignore evidence. As a consequence of gender-located power historically, and a rapid increase in the numbers of more technically oriented professionals in recent decades, health services and costs do not reflect women’s needs or evidence.

    The most important example of this is allowing caesarean birth to be a choice rather than only using this as the lifesaving emergency procedure it is.

    … caesarean birth is rapidly becoming a life threatening procedure itself because of excessive use … maternal death reviews and coroner’s reports now show the risks attached to using a major surgical procedure as a routine mode of birth.

    Maternal mortality is between two and seven times higher for surgical than vaginal birth …

    … The physical, social and emotional morbidity attached to women who experience this mode of birth is not recognised therefore ignored within acute care hospitals but is evident in their homes and the community.

    Research has identified that physical morbidity associated with CS is five to ten times higher than for women birthing vaginally. No less importantly there are also psychosocial consequences of surgical birth with women less satisfied, more concerned about the baby’s condition and fearful. Women delivering by CS report feeling less in control than women who have birthed vaginally.

    Research also shows rates of post natal depression significantly different between women who birthed vaginally and the group of women who delivered either by planned or unplanned CS … Women who birth by CS evaluate their babies less favourably, are less likely to breastfeed and/or feed for a shorter duration.

    Paradoxically, the choice to have a normal, safe, confidence affirming birth that is low cost and relieves pressure on hospitals is only available to a small minority of women.

    This is not possible for Australia’s most vulnerable women and families, who, the evidence suggests, would benefit most. How many rural or remote living Aboriginal women can opt for a home birth attended by a skilful midwife?

    … 1 in 10 remote living Aboriginal women in one large community avoid hospital services or skilled professionals because of the unacceptable risks to them of being evacuated from their community …

    Other Australian women with more options are also taking this route, fed up with what they see as biased, self-interested advice and unacceptable risks of our current system.

    To have real choices, one needs options and good information on which to base decisions. Better resourced women … can chase evidence themselves, or question doctors, hospitals and midwives …

    … there are some ultimate arbiters beyond opinion. One of these is the impartial review of evidence provided by such as the Cochrane data base.

    I saw to my great delight a writer (male and medically qualified) who also a Member of Parliament, recently quoting this source in a newspaper. His message, while aimed at indemnifying home birth midwives, was that home birth is safe.

    … home birth is indeed safer at times than hospital birth when planned and supported by good hospital care for rare emergencies.

    I wish the current president of the AMA, an erstwhile obstetrician, would be similarly correct with his claims that certainly are not recognisable as fact to those familiar with the evidence.

    Choices for women are difficult when all they receive is highly partial and ill-informed opinion. Choices around birth are important or women will opt out of a system that does not meet their needs.

    …. Should it be a matter of choice though for women to give birth via major abdominal surgery? Should we permit choice that means their babies avoid the process of vaginal birth that prepares them to live and breathe? Should it be women’s or obstetrician’s choice that health pays or heavily subsidises the avoidable costs of unnecessary operations that prevent other necessary surgery being performed and add to waiting lists? I think not.

    We need to recognise that operative birth is the option to use only when the risks associated with the alternative are unacceptable. This is not a matter of choice.”

    Melissa Maimann, Essential Birth Consulting 0400 418 448

    Should “failure to progress” = caesarean?

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    Pregnant women whose labor stalls while in the active phase of childbirth can reduce health risks to themselves and their infants by waiting out the delivery process for an extra two hours …

    By doing so, obstetricians could eliminate more than 130,000 cesarean deliveries – the more dangerous and expensive surgical approach – per year in the United States …

    The study examined the health outcomes of 1,014 pregnancies that involved active-phase arrest – two or more hours without cervical dilation during active labor – and found that one-third of the women achieved a normal delivery without harm to themselves or their child, with the rest proceeding with a cesarean delivery.

    … it is routine practice in many clinical settings to proceed with a cesarean for “lack of progress”

    “One third of all first-time cesareans are performed due to active-phase arrest during labor … “In our study, we found that just by being patient, one third of those women could have avoided the more dangerous and costly surgical approach.”

    The cesarean delivery rate reached an all-time high in 2006 of 31.1 percent of all deliveries … [failure to progress] has been previously shown to raise the risk of cesarean delivery between four- and six-fold.

    “Cesarean delivery is associated with significantly increased risk of maternal hemorrhage, requiring a blood transfusion, and postpartum infection,” … “… women also have a higher risk in future pregnancies of experiencing abnormal placental location, surgical complications, and uterine rupture.”

    … The study found an increased risk of maternal health complications in the group that underwent cesarean deliveries, including postpartum hemorrhage, severe postpartum hemorrhage and infections such as chorioamnionitis and endomyometritis, but found no significant difference in the health outcomes of the infants.

    It concluded that efforts to continue with a normal delivery can reduce the maternal risks associated with cesarean delivery, without a significant difference in the health risk to the infant.

    “Given the extensive data on the risk of cesarean deliveries, both during the procedure and for later births, prevention of the first cesarean delivery should be given high priority,” …

    Melissa Maimann, Essential Birth Consulting 0400 418 448