Posted by Melissa Maimann on Aug 28, 2010 in
Home birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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I live for the day that we have these headlines here in Australia!
The number of women who give birth to their children at home in Wales has more than doubled in less than a decade …
Since 2002 … they have risen from 604 to approximately 1,395 last year.
There has also been a rise in women giving birth in midwife-led units.
… the assembly government has encouraged healthy women with low-risk pregnancies to have their babies out of hospitals.
In 2002, maternity services in Wales were asked to reach a 10% home birth rate by 2007, making it the only nation in the UK to have a target.
Midwives say that while it was a very ambitious aim and many areas have not managed to reach it, it has helped transform the choice in maternity services.
On average, 4% of births in Wales last year were at home, which is higher than the UK average of 3%.
Laura Williams gave birth to her daughter Megan at home in Porthcawl, Bridgend county, on 5 November, 2009.
… “I wanted to be in a more comfortable environment – I liked the fact that with a home birth I could use my own shower and sit on my own sofa.
“As it was, I had a fantastic birth at home. I borrowed a friend’s pool and was really relaxed. The midwife even cleared everything up afterwards – I saw no mess.
… “I also think the fact I was at home and relaxed helped my recovery from the birth – the next day I was up and about and even popped to the shops.”
… “Midwives are continuing to work towards it because many see the benefits home births bring.
“They are cost effective in that women don’t need to stay in hospitals.
“And for the mother, there is less risk of medical intervention, the birth is well planned, she is in a relaxed environment and often doesn’t have to leave other children.”
… Rather than staffing a large obstetric unit at a hospital, which midwives have to do in more populated areas, they can “focus on staffing women’s needs”, she said.
… The issue of home births has been in the headlines recently after medical journal The Lancet said mothers-to-be should not be able to opt for them if they put their babies at risk. Under UK law women can override medical advice.
It came after research published in the American Journal of Obstetrics and Gynaecology suggested home births were more risky than hospital delivery.
But the Royal College of Midwives said the research was “flawed”, and the assembly government insisted that only women with low-risk pregnancies were encouraged to have their children at home.
The chief nursing officer for Wales, Rosemary Kennedy, said: “It is for midwives and other health professionals to explain to pregnant women the birthing options available to them, and decide on the most appropriate option after considering their medical history and preferences.”…
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, Home birth, midwife, Midwifery, Midwifery services, women's rights
Posted by Melissa Maimann on Jun 12, 2010 in
Midwifery,
Obstetrics,
VBAC 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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Although this article is from America, we can expect tis to transfer to Australia in just 19 days! That’s right, in just 19 days midwives will not be able to autonomously care for women who are planning VBACs. All women requesting a VBAC will have a consultation with an obstetrician and although the woman would have booked with her private midwife for private midwifery care, her ongoing care will be determined by the obstetrician. She can expect to see the obstetrician several times in her pregnancy, homebirth will be denied to her as an option and when in hospital, the obstetrician will determine the way the woman is cared for. Any non-compliance will be met with refusal of care.
Read on for the situation in Alaska. It’s coming to Australia in less than 3 weeks.
One thing that has been on my mind lately, is my inability to utilize the services of a midwife. Unfortunately, because I have had two cesareans, heck, even if I had only had one, I am not allowed to use a midwife for my pregnancy and birth in the state of Alaska. I know that I can do prenatal care through a midwife who has a backup, but they cannot do my actual labor and birth. They are subject to losing their license if they do accept me as a client.
I don’t know who is familiar with it, but if you look at the medical model of maternity care and the midwifery model, you’ll see that the outcomes of both models are drastically different, with the midwifery model being the more positive of the two.
And Alaska isn’t the only state that does this. A lot of them do … it’s ridiculous that women attempting VBACs are being denied access to midwifery care …
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, Obstetrics, Public and private hospitals, VBAC, women's rights
Posted by Melissa Maimann on May 8, 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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As she nears the last month of her pregnancy, Piper Harrell is counting on giving birth to her second child in the same place she had her first, in her second-floor walk-up apartment …
But this time, Ms. Harrell … is afraid that if she insists on having her baby at home, she will make her midwife … an outlaw.
Seven of New York’s 13 home-birth midwives … had an agreement with St. Vincent’s Hospital Manhattan that its doctors would back them up in an emergency. But the bankrupt hospital closed on Friday, and those midwives have been unable to negotiate new practice agreements with other hospitals or obstetricians, as required by state law, leaving them in the position of risking their licenses if they choose to deliver babies.
The loss of that 25-year relationship with a sympathetic hospital has left some home-birth midwives not only fighting for the legal viability of their practice but having to justify their very existence. Officials at several hospitals said … they were skeptical of the safety of home births and were concerned about the malpractice implications of taking over their clients in emergencies.
… “This is who we have to get a signature from — people who don’t believe in what we do and that we compete with,” …
The 13 midwives attend about 600 births a year, and about 50 of their clients expect to deliver in the next month.
To them and their clients, having the option of a home birth is an affirmation of their reproductive rights. It is also a reaction against the highly medicalized climate of hospital births, which, they say, has contributed to a Caesarean-section rate of more than 1 in 3 births … with some hospitals having rates above 40 percent …
To the medical establishment, home birth represents a rash choice by women who refuse to believe that things can go dreadfully wrong in an instant …
A large study of planned home births in the United States and Canada … found substantially lower rates of medical intervention compared with low-risk hospital births (high-risk pregnancies rarely, if ever, culminate with a home birth) and a similar rate of infant mortality. No mothers died. About 12 percent were transferred to the hospital. The midwives considered the transfer urgent in 3.4 percent of all intended home births.
… written practice agreements with hospitals or doctors have been a condition for all midwives to practice in New York State since 1992. But obstetricians have become increasingly wary of signing with home-birth midwives since the Congress of Obstetricians put out its strongly negative statement in 2008 …
… Fifteen other states … allow midwives to practice without them …
… midwives … expected that at least some of their clients would insist on delivering at home even without signed hospital backup. (They can still go to an emergency room and be treated.)
Ms. Harrell, 33, said she trusted her midwife … who delivered her first child … she said she was leery of trying to build a relationship with a doctor so late in her pregnancy. But she worried about putting Ms. Leonard in an untenable position.
“I’ve never felt not able to make a choice about my body for myself and my family, and it’s a paralyzing feeling,” Ms. Harrell said …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, freebirth, Home birth, midwife, Midwifery, Midwifery services, women's rights
Posted by Melissa Maimann on May 3, 2010 in
Birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Who is really responsible for intervention that happens in our births? Is it us or our health professionals? Or is it both?
In this blog post, I’m referring to situations where unnecessary intervention has taken place. Of course there’s a place for intervention in some labours and this post does not address interventions that are truly necessary. However that’s defined!
Some women argue that birth – and what happens n the birth – is their responsibility and they take charge of all decisions and also take responsibility for the outcome of those decisions – good or bad. Women in this category would never dream of suing for a bad outcome because the decision was theirs alone and they made a fully informed decision that they were comfortable with. When things go well, they attribute that great outcome to their good preparation and decision making.
Other women will outsource decision making to a health professional such as a midwife or a doctor. “They’re the experts”. In life, we outsource all sorts of decisions, so it’s not surprising that women may choose to do this for pregnancy and birth.
When things go according to plan – a woman has the birth she was hoping for, the baby is healthy, breastfeeding goes really well – there’s no issue at all. When things don’t go as planned, issues of responsibility (and sometimes blame) come up.
Over the years, I’ve sat back and observed women’s reactions when things don’t go well.
I think there are two parts to things not going well. One is the woman’s responsibility for her decisions and the other is the health professional’s conduct.
I’ve observed that when things don’t go to plan, very few women take responsibility for the choices they made that might have led them down a path that they never planned to walk. Eg women who might really want a natural birth who choose a hospital with a very high caesarean, episiotomy, epidural and induction rate. “It won’t happen to me” and then it does.
Some go right back to the same care provider and place of birth – it’s what they know and what they’re comfortable with, even though the outcome is not what they really want. Should they complain about their [caesarean / epidural / induction / forceps / episiotomy] and say they’re not responsible: their care provider is? I think not – choosing the right care provider and place of birth is each woman’s responsibility. If the hospital / health professional has a 50% caesarean rate – yep, that applies to you too.
Some people argue that women can never take full responsibility for their births because the information that’s relevant to them is hidden, disguised, not available until it’s too late and so on, or that they lack access to a skilled advocate in hospital such as a private midwife. In these cases, some argue that the woman could not have possibly got the information that would have assisted them to make a choice for their birth that is more aligned to what they’re trying to achieve. But if this is the case, how do we account for women who do magically find information, change care providers or place of birth (even at 38+ weeks of pregnancy), and experience the birth they had wanted? What sets these women apart from other women? Determination? A strong sense of self-efficacy? Confidence? Having options?
Information is all around us. We can talk to care providers, hospital midwives, friends / family, google relevant articles and information, join consumer advocacy groups, talk to private midwives, join yahoo groups or forums … there’s lots of information out there, even in rural / remote areas, thanks to the WWW. In NSW, hospital statistics are publicly available. Is there any excuse for not knowing your hospital’s caesarean rate if you live in NSW?
When we buy a car, we know we have many choices. Not just the make of the car, also auto / manual, number of doors, convenience features, comfort features and so on. If we only go to Toyota and buy a car that’s not suited to our needs – and this becomes apparent a couple of weeks later – is this Toyota’s fault? Maybe, but only if Toyota falsely advertised the car’s features because we’re responsible for the choices we make. Likewise, if we choose hospital X without exploring other hospitals, or settle on Dr Y or Midwife Z without interviewing others who might be better suited to our needs – is it the doctor’s / hospital’s / midwife’s fault if the birth has more intervention than the woman had hoped for?
In all industries, it is the responsibility of the consumer to first work out what they want, and next to set about finding a service / product that meets their needs. Is birth any different?
Now, the other side of this whole argument is the issue of conduct. While I firmly believe – and know – that information is out there, freely available, and that women are most definitely responsible for choosing the right care provider and place of birth for their needs, I also appreciate that health professionals are responsible for their conduct.
This brings up issues of negligence. Negligence says that a health professional owes a duty of care to the patient, the duty of care is breached, the patient suffered harm, and the harm is a reasonably foreseeable consequence of the breach of duty of care.
If this happens, then of course the health professional is to blame and the patient ought to raise this as an issue so that it can be addressed either legally or within the profession. Drug errors, incorrect surgical technique, performing the wrong operation, failing to gain consent, working while under the influence of drugs or alcohol – these are all serious issues that ought to be reported to the Health Care Complaints Commission.
So, in summing up, I think that responsibility for birth is a complex issue. While women are most certainly responsible for choosing the right care provider and place of birth (amongst other decisions), health professionals are responsible for how they practice their profession.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, women's rights
Posted by Melissa Maimann on Apr 11, 2010 in
Birth,
Normal Birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
The best option for women who want a natural birth is to plan a homebirth. Planning a homebirth does not mean that the birth goes ahead at home despite risks or problems, but merely planning a homebirth and engaging the services of a private midwife,will see the vast majority of women achieving a safe and natural birth.
However, if for whatever reason homebirth is not the right choice for you, the best way to achieve a natural birth is to engage the services of a private midwife and plan to birth in hospital.
Here are some ideas to get a natural birth in hospital:
Read, read, read. Books, websites, any written info from your care provider … read it all. You also need to know the difference between facts presented to you in an honest and unbiased way, and facts that are being filtered through hospital policy. This is where women benefit from having a private midwife by their side.
For example, “Some risks rise slightly when a woman has high blood pressure. I am uncomfortable with letting your pregnancy continue with high blood pressure because of the risks to the baby and to you if something happens” is an honest and factual statement. You have the right to accept the risks and refuse induction. However, some women hear “I’m going to induce you today or there is a big chance that your baby will die or that you will die”. This statement is dishonest and is manipulative, using a woman’s fears and her maternal instinct to encourage her to acceot intervention. There is also no discussion of alternative options. Informed consent requires that women are presented with options so that they can make the best decision for them, in their situation. Again, with a private midwife by her side, the woman is able to ask questions, obtain honest and impartial advice and obtain more information to help her come to a decision that she is comfortable with.
Be assertive, never aggressive. As with most human relationships, a great deal can be resolved with a calm, respectful and firm manner. Know what you want and why you want it. Have a private midwife as advocate, by your side. If you start to feel frustrated, upset or angry, you will have somoene to talk to who is on your side.
Listen. If you are choosing to use a hospital and an obstetrician for your birth, then you acknowledge that their presence, education and experience have some value. Your wishes are important but be willing to listen even when what’s being said is really not what you want to hear. You must also acknowledge that by using an obstetrician – a specialist in when things go wrong – you are automatically increasing the chance of intervention in your birth.
Be Flexible. A hospital birth simply isn’t going to be exactly like a homebirth. Understand that sometimes things don’t go the way we had planned. There might be some occasions where you’ll be happy to accomodate the hospital policy, and other times when you’ll want to stand your ground.
Ultimately, it is true that the most important aspect of birth is safety and a healthy mother and baby. But that doesn’t mean the other aspects are unimportant, and I firmly believe you can have a great birth – and a safe birth – in any location.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: birth, Birth choices, childbirth education, Home birth, hospital birth, intervention, midwife, Midwifery, Midwifery services, Normal Birth, Obstetrics, Public and private hospitals, women's rights
Posted by Melissa Maimann on Mar 19, 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.
Link
PREGNANT women could be given the right to choose where to give birth by law under proposals being considered by the [UK] Government. Any risks to the mother and child would have to be taken into account, but the plan could see parents given the right to choose a home birth, hospital birth or one in a midwifery-led centre.
The entitlement would be enshrined in the NHS Constitution, which sets out a patient’s rights by law.
… It tells expectant parents: “You will be offered the opportunity to choose where you want to give birth to your baby.
“The Government supports this principle and will consult on an entitlement around choice of place of birth, following further research.”
… Furthermore, both mothers and fathers with babies on neonatal wards would be offered accommodation so they can both stay in hospital overnight.
Hospitals are being told to “recognise the importance of involving fathers for a baby’s development and making families welcome”.
The document also promises joined-up local services “so that families have continuous care and support from early pregnancy to at least the child’s sixth month” …
Fantastic news for the UK. Hopefully we will have the same in Australia.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Home birth, hospital birth, midwife, Midwifery, Midwifery services, Public and private hospitals, women's rights
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.
Link
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
