Mother and baby are doing well

For further information, contact Melissa Maimann at Essential Birth Consulting. Link to article

The article commences with the story of Rachel, who plans a midwife-attended home birth. Her waters break three weeks after her due date, and after 2 days, there is evidence of meconium in the amniotic fluid. The article goes on to say that two days later, she has a fever and is transferred to hospital, not in labour. Hospital induces labour and the baby has an infection, and has sadly died. The woman bleeds and requires resuscitation, a hysterectomy and two weeks in an intensive care unit.

I cannot vouch for the accuracy of the reporting. We know reporters say what they want to say and sensationalise stories. However, there are a few points I'd like to make, assuming the article is true. There are several risk factors here: 43 weeks (1 week "overdue", since normal pregnancy lasts until 42 weeks), prolonged rupture membranes, and mecomium-stained liquor (amniotic fluid). Should this woman have birthed her baby at home? Maybe not. Homebirth is the domain of low-risk, healthy birth. What we need is a system whereby the midwife can transfer that woman into hospital and remain her primary care provider. I think blame needs to be laid fairly and squarely with a system that does not recognise the full scope of midwifery practice and that does not welcome privately-practicing midwives in the hospital system. It seems to me that much information has been left out of the story above. We do not know if the midwife has taken the woman into hospital already; perhaps the hospital has discharged her saying all was well. We do not know the point at which the midwife was made aware that the woman's waters had broken; maybe the midwife was not aware of the situation until after the baby passed meconium. Maybe the midwife had taken the woman for scans after 42 weeks to ensure that the baby was well. My point is, we will never know the full details. We read what the media wants us to read, and this story has heped blacken the name of home birth in this country. What it lacks are the details to support what happened.

'It is not possible to know exactly what information Rachel was given regarding the possible benefits and risks of planned home birth which led to her decision to choose this option, but it is likely she was told that planned home birth with a qualified midwife is as safe as hospital birth, and decreases the likelihood of medical intervention, which harms women and babies.'

Women who choose homebirth research information as if it were an obsession. Yes, planned, midwife-attended homebirth is safe for low risk women. To say otherwise would be a lie. What we need to communicate very clearly is that when freebirths and high-risk homebirths are added to the equation, the risk profile of homebirth changes significantly.

What happened to Rachel and her baby was a terrible, avoidable tragedy and certainly, the majority of home birth midwives would not have advised Rachel to stay at home as long as she did.

Thank goodness they said it! Homebirth midwives are very risk-adverse.

... it is important to them to feel they can have as 'natural and active' a birth as possible when receiving care from mainstream maternity services.

No, it is not important for them to merely "feel" they can have a natural birth in the system, it is important that they actually get a natural birth in the system! With some hospitals having caesarean rates of over 46% (NSW stats, 2006), it's no wonder women don't quite trust that they can have a "natural" birth in the system. Whatever natural means these days.

"It is always sad when any baby dies perinatally, but it is even more concerning when it happens to a woman having a home birth, because mothers attempting a home birth should only be those considered to be at low risk of poor pregnancy outcome."

At least one of the deaths that the article refers to was a freebirth. The important factor that was not present there was a midwife. The emphasis on low risk homebirth also needs to be made. Trouble is, many women are attracted to homebirth because of the deficiencies in the hospital system. So they are attracted to homebirth to: - Have continuity of care and build a trusting relationship with their midwife. Not midwives, midwife. 1. - Give birth in familiar surroundings, not an institution. - Have choice and control because that was taken away from them in hospital. - Be pregnant and give birth in a relaxed setting that is not dominated by clocks, a delivery bed, drugs, strangers who can come in at any time and shift changes. - Have care as and when they need it - not have to attend noisy, uncomfortable and impersonal hospital clinics, where they wait for an hour or two and are seen for 5 minutes by a midwife or doctor they have not met before; where they leave with unanswered questions and have no idea what this diabetes test is for that they're told they have to have (or their baby may die).

What system is this that we're putting women through? And during pregnancy and birth? These are natural and healthful experiences, not medical conditions. Home birth services are a stark contrast!

It is very disappointing that women can feel completely disenfranchised from any sort of hospital care, and feel that the only way their needs can be meet is to attempt birth at home.

Yes, it is disappointing, isn't it. hospital birth with a private midwife is a great way around this issue.

RANZCOG considers that there is no place for the 'independent' practitioner, working in isolation and having no link with any other health professional or hospital,

No "independent" midwife works in isolation! All IMs collaborate with hospitals, consulting and referring when necessary. We work in our full scope of practice and we are autonomous care providers, as is supported by WHO, FIGO and ACMI.

The four deaths referred to above indicate why RANZCOG is opposed to 'independent' practitioners.

Even though at least one of them was not professionally attended?

Melissa Maimann, Essential Birth Consulting.