Posted by Melissa Maimann on Jul 14, 2010 in
Midwifery,
Normal Birth,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
Pregnant women who develop gestational diabetes during their first pregnancy are at increased risk for developing this condition in their second or third pregnancies …
… gestational diabetes … affects about 4% of all pregnancies, according to the American Diabetes Association.
In the new study of 65,132 pregnant women, those who had gestational diabetes during their first pregnancy had a 13.2-fold increased risk of developing gestational diabetes in their second pregnancy.
Those who had gestational diabetes in their first pregnancy but not their second had a 6.3-fold increased risk for developing this condition during their third pregnancy, and those women who had gestational diabetes in their first and second pregnancies had close to a 26-fold increased risk for developing gestational diabetes in their third pregnancy, the study showed …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Complicated pregnancy or birth, Preconception care
Posted by Melissa Maimann on Jul 7, 2010 in
Birth,
Midwifery,
Normal Birth,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
A question I have often wondered.
Through my practice, I have a lot of women coming to be because although they have chosen an obstetrician, they really want a natural birth and it has recently occurred to them that their obstetrician will only “deliver” their baby if they’re on their back in bed / do an episiotomy / induce by 41 weeks / insist on continuous monitoring etc, and this is not what they want.
I often ask the question, “What was it that made you decide to have an obstetrician?” or, “What was it that made you decide on this particular obstetrician?”
And the responses are generally very interesting.
• My GP referred me
• My mother / sister / friend / neighbour used this doctor and she said he’s wonderful
• Well, when I got pregnant I went to my GP. She asked me if I have private health insurance and I said yes, so she wrote a referral to Dr XX.
I ask these women if they considered any other options. “What options?” comes the response.
I’m amazed that with the marvels of modern technology, internet etc, that women don’t know they have other options. It seems to be to be an interesting handing-over of responsibility and I’m curious why it happens with pregnancy and birth, but not in any other aspect of life. Do we buy a particular computer – that can’t meet our needs – because it was recommended and we didn’t know there were other computers on the market? Do we buy a large house when we need a small house because it was recommended by the real estate agent?
In most other situations where choices are involved, people will engage in a process of assessing options.
We might list all the possible options and then assess each option across a range of qualities.
We might seek the recommendations (note: plural, not singular) from significant others.
We ask questions.
We consider what it is that we really want, and then match it to what’s available, seeking the most satisfactory choice.
But sadly, this does not happen with pregnancy and birth. Countless women come to see me, having chosen an obstetrician, but really desiring a natural birth that the obstetrician states openly he will not have a part in. There might be a birth centre in their local area, private midwives who could attend them, or even a public hospital caseload midwifery program. Sadly, these options were not explored by the family.
The next question, then, is why, having chosen a care provider who is truly not suited to our needs, do we stay with that care provider?
I always applaud women who make the courageous change. Many women who come to me describing their “predicament” will re-appraise their options and make choices that are aligned to their preferences. Others will remain with their original decision but will ask me to attend them throughout their pregnancy and birth in attempt to act as an intermediary between them and their obstetrician. I don’t consider this to be the most advantageous position, either for the woman, the obstetrician or myself. However, surprisingly, it seems to work well and all the births I have attended in this capacity have occurred on the woman’s terms. I am in awe of those women for having the courage of their convictions to remain with an ill-suited care provider and find the resources that will help them to still have their birth on their terms. They come away elated, feeling they have truly achieved the best of both worlds: an obstetrician they know for if something “goes wrong” and a private midwife who is an expert on natural birth.
Ideally, women will see a midwife for a pre-conception consultation where birth options can be discussed. Some women will ultimately benefit from – or desire – an obstetrician for their pregnancy and birth and this should not be denied to those women. However, a large majority of women simply want a “natural birth” and assistance to avoid tearing and a long labour. They want a healthy baby, a satisfying experience and they really want continuity of care. These women need to know – even before they become pregnant – the options that are open to them. It’s never too early to meet with private midwives and choose the one who is suited to your needs.
Ultimately, if the maternity reforms work to women’s advantage and if obstetricians and midwives are able to put The Birth Wars aside, women ought to be able to have continuity of midwifery and obstetric care: one midwife and one obstetrician who provide the woman’s care so that she benefits from a natural birth expert and an expert in things that “go wrong”. Place of birth could be home, birth centre or hospital and waterbirth would be a supported option.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, midwife, Midwifery, Midwifery services, Obstetrics, Preconception care, Public and private hospitals
Posted by Melissa Maimann on Jun 4, 2010 in
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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Research … suggests the answer is yes.
… At this point, experts can only guess at the biological basis for the links they’re finding. And those clues are not enough to recommend changes in, for example, infertility treatment.
Still, knowing who may be at risk of autism could improve diagnosis, which might enable earlier intervention.
One study … followed babies who weighed less than 4.4 pounds at birth through to age 21. Nearly 5 percent of these 623 young adults had an autism-spectrum disorder, five times the rate in the general population.
… In recent decades, women have been delaying motherhood, which increases both their chance of needing fertility treatment, and their chance of having a low-birth-weight baby, typically due to prematurity.
These changes have emerged as risk factors for autism:
Two studies … linked infertility treatment to the chance of autism … ovulation-inducing drugs … nearly doubled the odds of having an autistic child … autistic children … were three to four times more likely to have been conceived through in-vitro fertilization and to have been born at very low weights than children in the general population. The mothers of autistic children were also older …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, Complicated pregnancy or birth, IVF, Preconception care
Posted by Melissa Maimann on May 30, 2010 in
Birth,
Caesarean,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
Obesity increases the risk of needing to deliver a baby by Cesarean section. That in turn leads added risks from major surgery, potential for serious complications, and additional recovery time …
… obesity can interfere with a woman’s ability to get pregnant …“Obese patients have no good options,” … they are at increased risk of complications from a C-section, such as clotting in the legs associated with a pulmonary embolism, and increased risk of wound breakdown.
“Obesity decreases fertility and increases the chance of losing the baby, of hypertension and pre-eclampsia, which kills a lot of women around the world,” … because fertility drops with rising obesity, many women seek help in conceiving from fertility treatments, which increases the chance of having multiples (twins and triplets) and therefore increases the chance of having a C-section.
Obesity is a risk factor in C-sections independent of other factors, but it goes hand in hand with other serious complications, like diabetes and cardiovascular disease …
Ideally, women will attend preconception care where issues such as lifestyle, stress, nutrition, exercise and health can be addressed prior to becoming pregnant.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Caesarean, Complicated pregnancy or birth, Preconception care
Posted by Melissa Maimann on Mar 7, 2010 in
Birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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The National Health and Medical Research Council (NHMRC) today released a new recommendation that all women who are pregnant, breast-feeding or considering pregnancy take an iodine supplement of 150 micrograms each day.
… “Women wanting to conceive, or who are already pregnant or breast-feeding, need a minimum of 250 micrograms of iodine each day for the baby’s brain and nervous system development,” …
“Australians now get more iodine in their diets following the mandatory fortification of bread last October, though it is still appropriate for women to supplement their diet with an additional 150 micrograms of iodine every day,” he said.
… “The body does not store iodine, so amounts taken in excess of the body’s requirements will simply be excreted by the kidneys.”
People with a known iodine deficiency, or who are concerned they may not be getting enough iodine, should consult their healthcare professional.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: birth, Breastfeeding, Nutrition, Preconception care
Posted by Melissa Maimann on Feb 28, 2010 in
Obstetrics 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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Endometriosis affects 10 percent of women of reproductive age, yet the condition remains one of the most neglected and underfunded fields of research in gynecology …
… the statistical association between endometriosis and infertility is beyond dispute. One well-cited study found a higher prevalence of endometriosis in infertile women (48 percent) than in fertile women undergoing tubal sterilization (5 percent) … infertile women are 6-8 times more likely to have endometriosis than fertile women.
… a new diagnostic staging tool has been proposed that predicts the chance of spontaneous pregnancy in those with surgically documented endometriosis who are treated without IVF … The EFI score ranges from 0-10, with 0 representing the poorest prognosis and 10 the best … those patients with scores of 0-3 could expect a cumulative pregnancy rate of 11.1 percent at 3 years, increasing to 68.3 percent for those with scores of 9-10.
… the most common symptoms of endometriosis were painful menstruation, painful intercourse, and incapacitating pain …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Complicated pregnancy or birth, IVF, Obstetrics, Preconception care
Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
informed consent and childbirth
Every woman who is competent to consent, has the right to refuse any or all professional care. Informed consent must be obtained prior to any procedure being performed.
how to minimise labour intervention in a hospital?
The best way to minimise intervention in a hospital is to be as well informed as you can possible be about all things related to pregnancy, labour, birth, breastfeeding and babies. Read widely, attend independent childbirth education classes and consider employing a private midwife to be with you throughout your labour. She can help you to decide if the proposed interventions are necessary in your situation, she can support you emotionally, mentally and physically and she can aso help to ensure that your birth plan is respected without a fuss.
Do any independent midwives in Sydney offer prenatal care for women who are planning to freebirth?
Yes! This service enables women to access antenatal care from a midwife without the midwife attending the birth. Postnatal care is available if needed.
Do you think there are advantages to continuous monitoring for low-risk women
In a word, no. Intermittent auscultation is the method of choice. Continuous monitoring will increase the chance of a caesarean with no benefit to the mother or baby.
How much is a private midwife
Prices range from $3000 – $6000. Melissa Maimann offers for her clients to pay by the hour, making the service one of the cheapest.
What is a good caesarean rate?
The World Health Organisation recommends that no more than 15% births need to be caesareans. The WHO argues that when caesarean rates exceed 15%, the risks to the mother and baby increase on the whole. You’ll be hard-pressed to find a hospital with a caesarean rate of less than 15%, but birth centres and private midwives have caresarean rates of less than 10-15%.
What is the best hospital in sydney for delivering babies?
It all depends what sort of birth experience you’re after! If you’re wanting a natural birth, home birth will be the best option. If you want a natural birth in a hospital setting, the best options would be birth centre or private midwifery care for a planned hospital birth. If you’re wanting to have intervention in your birth, a hospital birth would be best. If you choose an obstetrician, you’re far more likely to have a caesarean, episiotomy, epidural, forceps or vacuum. Choosing your care provider is the single most important decision you will make in birthing.
Is there a birth centre at westmead hospital?
No, there isn’t. If you’re after a natural birth, the best choice would be a home birth.
C section or natural delivery midwife?
Midwves cannot perform caesareans. If a caesarean was needed, the midwife would call a doctor in to perform it. Most caesareans that are performed are unnecessary and increase the risks to the mother and baby. A natural birth is the safest way to birth, and midwives are qualified specialists in natural birth.
giving birth after birth trauma
Private midwifery care will be really important so that you can have the same midwife all the way through pregnancy, birth and postnatally. It’s also important to debrief your last experience and come to a place where you feel safe to birth again.
high risk midwife sydney
Midwives are not qualified to care for high risk pregnancies. We refer these women onto obstetricians. In most cases, one or two consultations is all that is needed with the obstetrician and the midwife continues the care of the woman.
how many births proceed naturally
What a great question! It all depends what care provider you choose and where you have your baby. You see, if you choose a private midwife and birth at home, you have about a 95% chance of having a vaginal birth. If you birth in a private hospital, you have about a 33% chace of having an unassisted vaginal birth. In some hospitals, the caesarean rate is more than the vaginal birth rate! Sad but true.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, birth debriefing, Birth trauma, Breastfeeding, Caesarean, childbirth education, Complicated pregnancy or birth, continuity of care, Epidural, exercise, fetal monitoring, freebirth, Home birth, hospital birth, intermittent auscultation, intervention, IVF, Maternity Services Review, midwife, Midwifery, Midwifery services, Normal Birth, Nutrition, Obstetrics, postnatal depression, Preconception care, Public and private hospitals, VBAC
Posted by Melissa Maimann on Feb 16, 2010 in
Birth,
Caesarean,
Midwifery,
Normal Birth,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
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
Tags: Complicated pregnancy or birth, exercise, intervention, Normal Birth, Nutrition, Preconception care
Posted by Melissa Maimann on Jan 30, 2010 in
Birth,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
The widespread use of … fertility drugs, not just high-tech laboratory procedures, likely plays a larger role than previously realized in the growing problem of premature births in the United States, because these drugs cause a high percentage of multiple births …
… controlled ovarian hyperstimulation (COH) drugs — used to stimulate a woman’s ovaries to speed the maturity and multiply the production of eggs — accounts for four times more live births than assisted reproductive technologies (ARTs) such as in vitro fertilization.
“Many people have focused on the role of ARTs in multiples and have not fully appreciated that fertility drugs alone are responsible for one out of every five multiple births,” … “COH drugs are widely prescribed, and some health care professionals … are not aware of the serious risks of fertility drugs to women and their babies. There is a very high possibility of multi-fetal pregnancy resulting from use of these drugs, and that brings a high risk of prematurity and lifelong health problems for the babies as a consequence.”
… About 60 percent of twins, more than 90 percent of triplets, and virtually all quadruplets and higher-order multiples are born prematurely … studies have also suggested that even infants born singly, but conceived with ovulation stimulation are at increased risk for preterm delivery than naturally conceived single births …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Complicated pregnancy or birth, IVF, Obstetrics, Preconception care
Posted by Melissa Maimann on Jan 23, 2010 in
Birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Link
In recent years, there has been a large increase in the prevalence of overweight and obese women of childbearing age, with approximately 51% of non-pregnant women ages 20 to 39 being classified as overweight or obese.
… obesity in pregnant women is associated with pregnancy complications, birth defects, as well as a greater risk of childhood and adult obesity in infants born to obese mothers.
… obese women are more likely to have an infant with a neural tube defect, heart defects, or multiple anomalies than women with a normal BMI.
Obese pregnant women also put themselves at a higher risk of pregnancy complications, including gestational diabetes, hypertension, preeclampsia, induction of labor, cesarean delivery, and postpartum hemorrhage, compared with women with normal pregnancy body mass indexes.
… obesity among pregnant mothers is linked to childhood obesity in their infants. Obesity during pregnancy more than doubles the risk of obesity in children at two to four years of age …
The article emphasizes the need for women to consult with their healthcare providers about what their ideal pre-conception weight should be …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Complicated pregnancy or birth, exercise, Nutrition, Preconception care
