Posted by Melissa Maimann on Feb 22, 2010 in
Home birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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IS giving birth at home a positive experience or and unnecessary risk?
ASK any expectant mother what she’s hoping for when she gives birth, and she’ll probably tell you the most important thing is to deliver a healthy, happy baby. But in recent years there’s been great debate about the best way to do this.
Is the ideal to have a child in the relaxed comfort of your own home, or does the medical expertise provided in hospital far outweigh the notion of giving birth in your own living room?
Although homebirth advocates argue the former, it appears the choice may soon be taken out of their hands.
Reports last year revealed that four babies in Sydney died in homebirths in the space of nine months, the NSW Government responded with a strong announcement: from July 2010, independent midwives will be unlikely to gain professional indemnity insurance – effectively making it illegal for them to assist at homebirths. The consequence? Homebirths are facing extinction.
Obstetrician Dr Pieter Mourik believes the ruling will stop women taking unnecessary risks.
“Women who choose to give birth at home expect everything to be normal, but they often don’t consider how far they are from expert help …” he says.
“Eighty per cent of women can have their babies in a paddock – but the problem is choosing these women. You just never know what will happen.”
However, Justine Caines, spokesperson for Homebirth Australia, says putting a blanket ban on homebirths will simply drive the practice underground.
… “Many mothers have had bad experiences in hospital and won’t repeat that.”
She continues: “Why does the government fund women who are choosing to have C-sections, but not women who are choosing to give birth at home?”LAST month a study of over 500,000 women in the Netherlands who gave birth at home … showed there was no significant difference between planned hospital births and planned homebirths in terms of babies dying during labour.
It’s important to note when making a comparison between Australia and the Netherlands, that the Netherlands only has low-risk home birth. If there are any complications in the pregnancy or labour, women see an obstetrician and birth in hospital. This is not the case in Australia at present, but it’s the system that the Govt is trying to set up.
… Dr Mourik says the study is misleading. “Firstly, we must remember Holland has very well-trained midwives who act almost like Australian GPs,” he says.
“It’s also a small country with maternity units often within 10 minutes of someone’s house. The conclusions of this study are based on the availability of well-trained midwives through a good transportation and referral system – and that simply isn’t the case in Australia.”
It’s not currently set up in Australia, but there’s no reason why it couldn’t be. A positive approach would be to set in place a system that supports women to birth at home, and a system that protescts the midwives who support women to birth at home. Home birth has always been and will always be. We can set it up so that it is safe, or we can hope it just goes away … it won’t.
However, despite warnings from obstetricians, women are still choosing to have their babies at home …
“Women should have the right to give birth wherever they feel safest – it’s up to them whether that’s in hospital or at home. But taking away our choice isn’t right. If there were more options within the hospital system, then perhaps more women would feel comfortable going to hospital.”
I disagree that women should make the decision: it should be made within the midwifery partnership. This debate is not about the right of women to bitrh at home: this right is protected by law. This debate is about the mdiwife’s responsibility to pracice safely.
The Health Minister is putting in place a system that will enable more women to access continuity of midwifery care with their chosen midwife in and out of the hospital system. Once this is in place, there will be more options within the hospital system, and hopefully fewer women who are traumatised by the hospital system.
So is there a way to keep everyone happy?
“Homebirth Australia would like the government to present a package for pregnant women that works a bit like the baby bonus,” … “Every woman would be given a sum of money to spend on her pregnancy treatment, then it’s up to her whether she sees a midwife at home, or an obstetrician in a hospital. It’s putting the choice back into women’s hands.”
What about the option to have a baby in hospital with a midwife, or the ability for an obstetrician to attend a woman at home?
However, Dr Mourik believes that when it comes to choice, the only factor to consider is the mother and baby’s health.
“Only a tiny minority of foolish women would risk their own lives and that of their precious babies for an ideal,” he says.
“How many doctors support homebirth? None I know – it’s too bloody risky.”
Many studies opint to the safety of home birth for low-risk women who are attended by a midwife. Women who birth at home are amongst the most health- and safety-conscious people I know. It is offensive to comment that women who birth at home are
risking their own lives and that of their babies, especially when the evidence is to the contrary.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Complicated pregnancy or birth, continuity of care, freebirth, Home birth, hospital birth, Maternity Services Review, midwife, Midwifery, Midwifery services, Public and private hospitals, women's rights
Posted by Melissa Maimann on Feb 20, 2010 in
Home birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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THEY were defending their right to give birth at home … Across the country hundreds of women held rallies …
Homebirth supporters claim doctors and the Government are taking away the rights of women.
Under the proposed Bill … doctors will have the final say if a woman can have a homebirth supervised by a midwife. Previously, private midwives could assist in a homebirth without a doctor’s consent but could not access Medicare rebates.
Passionate homebirth advocate Andrea Smith … said, “We should have the right to choose however we want to birth.” …
After July, midwives will need to work collaboratively with doctors. This will be the case if we are to attend homebirths or if our clients wish to access Medicare benefits for our services.
Collaborative arrangements have not yet been defined so it is hard to say at this stage how they might look. It’s almost certain that high risk homebirths will be off the cards, so no breeches, twins, VBACs, post term or preterm women, or those with high blood pressure or problems in the pregnancy will be able to have a home birth. Women are concerned that these changes will limit their right to a home birth, but the government is concerned for the provision of safe homebirth services. These new laws do not actually prevent “high risk” women from accessing home birth, they just restrict the ability of the midwife to attend them by legistating that midwives will only be able to attend low-risk homebirths.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Complicated pregnancy or birth, Home birth, Maternity Services Review, midwife, Midwifery, Midwifery services, women's rights
Posted by Melissa Maimann on Feb 14, 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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WASHINGTON – A critical safety net for babies — that heelprick of blood taken from every newborn in the U.S. — is facing an ethics attack.
After those tiny blood spots are tested for a list of devastating diseases, some states are storing them for years. Scientists consider the leftover samples a treasure, both to improve newborn screening and to study bigger questions, like which environmental toxins can harm a fetus’ developing heart or which genes trigger childhood cancers.
But seldom are parents asked to consent to such research — most probably do not know it occurs — raising privacy concerns that are shaking up one of public health’s most successful programs. Texas is poised to throw away blood samples from more than 5 million babies to settle a lawsuit from parents angry at what they call secret DNA warehousing …
Advisers to the U.S. government hope to have national recommendations by in two months on how to assure all babies still get their newborn tests while allowing parents more say in what happens next.
… Newborn screening … began in the 1960s, and today every baby is supposed to be tested for at least 29 rare genetic diseases in hopes of catching the fraction who need early treatment to help avoid brain damage or death. Now being added to the list: Bubble-boy disease, formally known as SCID for severe combined immune deficiency.
The program catches about 5,000 babies a year in need of treatment.
Because newborn screening is mandatory, only a handful of states provide much upfront parent education. Leftover spots mainly are used for double-checking that newborn tests are accurate. Sometimes, families ask geneticists to study them after a child’s death from a disease doctors can’t immediately diagnose.
… While blood spots are stripped of identifying information before being handed over to scientists, people generally need to consent to participate in research.
… Among their worries: that genetic information about the children could fall into the wrong hands.
… “DNA is your personal signature, and it uniquely identifies us,” …
… found three-quarters would be willing to have their baby’s leftover blood spot used for research if they were asked first. But they generally oppose that research without consent …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: women's rights
Posted by Melissa Maimann on Feb 6, 2010 in
Birth,
Home birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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The Australian Greens are deeply concerned that a Commonwealth plan to effectively give doctors veto over the rights of midwives to practice will erode women’s care choices.
“The Government amendments to their Midwives legislation are unnecessary and give doctors too much control over midwives practice” … “… any requirement that midwives must work in formal collaborative arrangements with doctors as a condition of insurance will further restrict women’s choices”.
” … the Midwives Bills do not address the needs of many Australian women who make the choice to give birth outside the hospital system, and we will continue to fight for greater choice and less interventionist maternity care. The amendments proposed by the Government further erode women’s choices …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, Home birth, Maternity Services Review, midwife, Midwifery, Midwifery services, Obstetrics, women's rights
Posted by Melissa Maimann on Jan 25, 2010 in
Midwifery,
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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About 54% of all maternal deaths in Africa are due to unsafe abortion because of restrictive legislation and lack of access to modern family planning methods …
… should reject leaders who do not treat the lives of mothers humanely saying that mothers should not be coerced into motherhood.
… women in developing world … are dying from unsafe abortion even though there are great advances in medical technology.
… ‘Women are not dying from the diseases that we cannot treat but they are dying because societies have yet to make the decision that their lives are worth saving’. …
In Uganda, the maternal mortality rate is at 435 deaths per 100,000 live births …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Complicated pregnancy or birth, women's rights
Posted by Melissa Maimann on Jan 24, 2010 in
Home birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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After six hospital births … Melissa Read decided to bring her seventh child, Ayla, into the world at home.
“Doctors had told me home births were incredibly risky but I did a lot of research and the midwives understood what I was talking about and how I felt,” Ms Read said.
“It was an incredible experience that was more than I expected for myself, my husband and my kids.”
Independent midwives have slammed reports this week that home births put babies at a greater risk of dying than those born in hospital.
A widely reported … study showed that babies born at home are seven times more likely to die of complications and 27 times more likely to die from lack of oxygen.
The Australian Medical Association (AMA) and the National Association of Specialist Obstetricians and Gynaecologists used the study to warn against the dangers of home birth.
But the report, which compared 297,192 planned hospital births with 1141 planned home births … also showed that the perinatal death rate was similar for both kinds of births.
The 16-year long study recorded nine perinatal deaths in the planned home-birth group, seven of which were actually born in hospital, and 2440 deaths in planned hospital births.
Home birth advocates criticised the report, saying the research was flawed. The report itself states “small numbers with large confidence intervals limit interpretation of these data”.
However, homebirth studies in Australia can only include small numbers because less than 1% births occur at home.
“In the 16-year study period there were only three perinatal deaths for which one can reasonably assume that a different choice of care provider, location of birth or timing of transfer to hospital might have made a difference to the outcome,” says the report.
… the study showed there was only a slightly higher risk in choosing a home birth. And if done properly with a low-risk pregnancy, there was no real difference.
Exactly. What the study really shows is that low-risk, midwife-attended home birth is a *safer* option than hospital birth. The issues are around risk assessment and management … and the right of women to accept or reject advice.
“The risk is mainly in people who have home births that shouldn’t have them, such as having twins, a breach birth or people too far beyond their due date,” Prof Keirse said.
These outcomes of these births is better when they occur in hospital.
“A mother has to be responsible when deciding what kind of birth to have and these mothers are taking unacceptably high risks.”
Prof Keirse said he was scared by the number of women choosing to have home births after already having had a caesarean.
“When a problem happens and you are at home you have no real way of dealing with it,” he said.
“One of these days we will not only lose a baby but a mother as well.”
Homebirth Australia national secretary Justine Caines said the reporting of the study by the AMA was irresponsible.
“I think they are trying to push a political agenda and outlaw or force home birth underground, which is incredibly irresponsible,” Ms Caines said.
“The report says there are 7.9 deaths per 1000 in planned home births, compared to 8.2 in planned hospital births, but they didn’t all stay home births and the real figure of births that actually occurred at home is 2.5 deaths per 1000.”
The study title states it was looking at *planned* home birth and *planned* hospital birth. Actual place of birth was not the focus of the study. If the study focussed on the babies that were born at home, it would have had to include babies who were intended to be born in hospital, but arrived too quickly at home. These births are possibly riskier than planned home birth.
Last year the Federal Government refused to include home birth under its midwifery indemnity scheme.
The decision forced many midwives underground and threatened to increase the number of women ”freebirthing”, or delivering at home without any medical supervision.
This has not happened as the changes will not come into effect until July 1, 2010.
Ms Caines said from July this year midwives were at risk of not being able to be registered under the Commonwealth reforms.
“In the UK there is a legislative right that if the woman choses a home birth there is a responsibility that they have a trained health professional with them,” she said.
In the UK, it is illegal for women to have unassisted births. We do not have this law in Australia.
“A woman has a right to make an informed consent to a home birth and if she understands the advice she’s received it’s not my right to say you can’t do that.”
AMA president and obstetrician Andrew Pesce said the study supported the association’s stance against home births.
“The current evidence would mean we could not support home birth given that it is associated with higher risk of babies dying,” Mr Pesce said.
“The risk of what is happening now needs to be acknowledged and the midwives and people involved in home births need to put plans in place to manage those risks.”
The AMA admitted the study revealed many positives for home birth but maintained it was too great a risk for mothers and babies.
SA independent midwife Julie Garrett said midwives were aware of the complications, but had a duty to support the choice of a mother.
And this is the crux of the matter: midwives do not act irresponsibly. We do inform women of the risks. But women are free to choose amongst options and to make the right decision for them.
Ms Garrett said the culture in Australia needed to change to support midwife-based care as an alternative.
“In England and New Zealand they are bringing in home births, while Holland has an almost completely midwife-based care model. It’s the culture here that needs to change. Women should be able to choose.”
In the UK, NZ and the Netherlands, health policy supports low risk home birth. Even in a country such as the Netherlands, where home brith is a normal birthing option, the home birth rate is only 30%. 70% women need to birth in hospital or choose to birth in hospital, and there is no stigma attached to it. In a country such as Australia, with a caesarean rate in excess of 30%, a maximum of 70% women will be “eligible” by risk-assessment standards, to birth at home. Add to that twins, breeches, women going over 41 weeks or less than 37 weeks, high blood pressure, gestational diabetes, big babies and so on, and you can understand that even if home birth is a government-supported option, it will not be an option for the majority of women.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Complicated pregnancy or birth, continuity of care, Maternity Services Review, midwife, Midwifery, Midwifery services, Normal Birth, Obstetrics, women's rights
Posted by Melissa Maimann on Jan 22, 2010 in
Home birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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Further to the posts below on the homebirth study, the AMA has sought right of reply.
Dr Andrew Pesce … is the president of the AMA (which opposes homebirth), an obestetrician and gynaecologist, one of the reviewers of the new study, and also the author of the MJA editorial on the study.
He writes:
“Home birthing is a controversial issue in Australia and this week’s debate around the South Australian study is proof of this.
As would be expected, both sides of the debate put their cases strongly and passionately. Unfortunately the passion sometimes gets in the way of the facts and the evidence …
My editorial was primarily about the politics of home birth. Most neutral commentators have commended me on the balance of the editorial.
As AMA President, I transparently declared a potential conflict of interest based on the policy of the AMA. I presume the College of Midwives, which strongly advocates for home birth and the role of private midwives, has similarly declared its potential conflict of interest …
… The seven-fold increased risk is a statistical prediction of the most likely risk according to the data …
The overall rate of perinatal deaths was not different, but only if you ignore the fact that a larger number of women planning to give birth in hospital have risk factors and complicated pregnancies.
When adjusted for prematurity and low birth weight, the overall perinatal mortality rate for all pregnancies planning a home birth was double that of planned hospital birth …
Remeber that the study is on *planned* home birth and *planned* hospital birth, regardless of where the birth actually took place.
The study identified the same contributing factors that were found in a previous larger Australian review … poor adherence to risk assessment, lack of monitoring of foetal wellbeing and delayed response to emerging complications in home births …
If a justification is needed for the AMA highlighting the concerning results of this study, it is that home birth advocates continue to deny the higher risks of current home birth practice, and the need for adequate risk assessment and management.
… my editorial did mention the lower intervention rates, the similar rate of post partum haemorrhage and other favourable outcomes of home births found in the study.
… The AMA … supports women having choice about where they have their babies. The AMA media release stresses the need for evidence and safety …
• Dr Andrew Pesce is President of the AMA and a practising obstetrician and gynaecologist at Westmead Hospital in Sydney
Meanwhile, Croakey has just caught up with the 22 Jan issue of Australian Doctor … including details of a study of the first 100 births through the St George Hospital Homebirth Program in NSW, published in the Australian and New Zealand Journal of Obstetrics.
The story says the study has reported “reassuring outcomes” and that “a growing number of obstetricians are calling for more support for safe homebirth models despite the AMA’s resolute opposition to the practice”.
Professor Michael Chapman, who has been involved in the St George program, is quoted saying that homebirths involving experienced midwives following strict hospital transfer protocols were appropriate for a small group of low-risk women who preferred to give birth at home.
He said: “Homebirth conducted in a random disorganised manner with independent midwives and patients who are pushing the boundaries of safety have given it a bad name. But in a controlled environment, I do believe the risks are minimal.”
Update: The AMA has been in touch to advise that Dr Pesce was a reviewer on this paper as well.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Complicated pregnancy or birth, continuity of care, Home birth, midwife, Midwifery, Midwifery services, women's rights
Posted by Melissa Maimann on Jan 21, 2010 in
Home birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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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
Tags: Birth choices, Complicated pregnancy or birth, Home birth, midwife, Midwifery, Midwifery services, Normal Birth, women's rights
Posted by Melissa Maimann on Jan 18, 2010 in
Home birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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AN ONLINE poll has found huge opposition to draft Federal Government laws which would effectively ban homebirths and could lead to women choosing to freebirth.
The parenting social networking site BellyBelly.com.au found 94 per cent of the 400 respondents opposed the amended legislation …
… 30 per cent of respondents said they would consider freebirthing – giving birth without medical assistance – if not allowed to choose their own midwife.
Under the Federal Government’s draft health practitioner regulation law, independent midwives could be deregistered unless they have private indemnity insurance.
So far, the government has failed to include homebirths in the indemnity scheme while insurance companies refuse to insure private midwives.
Proposed changes … would also see midwives forced to work alongside obstetricians.
… “Women are very angry, passionate and strong-willed on this topic and feel that their rights as a woman are being threatened,” she said. “Many members commented that they are appalled that the government thinks it has the right to choose where and how they birth their babies.”
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, freebirth, Home birth, Maternity Services Review, midwife, Midwifery, Midwifery services, women's rights
Posted by Melissa Maimann on Jan 18, 2010 in
Birth,
Home birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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A … home birth advocate says she cannot excuse the … Area Health Service for calling in police to check on a pregnant woman.
Rochelle Allan, who wanted a home birth and did not want to be induced, was nearly 14 days overdue when she missed an obstetrics appointment.
… the police were sent to Ms Allan’s home on Friday to conduct a “welfare check” because the midwives could not reach her by telephone.
… the actions of the hospital staff will not be investigated because they had the best intentions and were concerned for Ms Allan.
… a woman should be able to make her own birth choices without someone looking over her shoulder.
“The hospital, they’re service providers, they’re not a regulatory body for pregnant women,” …
“These checks … they’re not mandatory, so it’s entirely up to that woman if she chooses to attend those hospital checks or not.”
… Ms Allan had the baby at home … with a private midwife.
Interesting situation. The hospital owes a duty of care to its patients. If it had failed to conduct a “welfare check” and the woman’s baby had died, the news report would read that the hospital was grossly negligent and how could they allow this to happen? It’s been my experience that these situations can be managed very well by the midwife and woman being upfront with the hospital about the intentions of the woman. When this happens, the hospital is satisfied that the woman is receiving care and sees no reason to send the police around. Some people have questioned the use of police services for this purpose however the hospital staff are generally not permitted to attend patient’s homes in these circumstances.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Complicated pregnancy or birth, Home birth, intervention, midwife, Midwifery, Midwifery services, Public and private hospitals, women's rights