Never again in a public hospital

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

The Age special report on maternity care drew a range of responses ...

I GAVE birth to my first child last year in the ... maternity ward as a public patient.

Nothing could have prepared me for my horrible birth experience - ''herding yards'' does not go nearly far enough in describing the way the hospital treats new mothers and babies. The need to minimise expenditure combined with an almost zealous obsession with promoting breastfeeding created an experience so stressful that, for me, resulted in what I call post-traumatic birth disorder - a fear of ever having another child in a public hospital.

My baby was born with fairly high levels of jaundice, which results in a very sleepy baby who is unable to feed well. Bar going under the UV lights, the only means of reducing the jaundice levels is to ''flush'' it out with fluid.

Now that would be fine except for the fact that mothers do not produce milk for at least two days after a natural birth and up to five days after a caesarean. Not once was I offered formula to try to provide extra fluid for my baby. Instead, I was told to breastfeed and express extra fluid in between feeds.

So, in pain after major surgery, with a baby too weak to feed well and not producing milk, I was left struggling for hours to try to provide enough fluid to help my baby.

On day four I was about to be discharged when the attending doctor told me my baby had developed ''nappy rash'' and might need antibiotics. At first the doctor said it would need a cream and I would still go home that day. A few minutes later another doctor said it was a ''severe'' rash and my baby might need oral antibiotics.

Then the head of pediatrics came to look at the rash. The attending [midwife] said they thought it was a hospital-borne staph infection, which was later confirmed. At this point I was about to have a breakdown from being exhausted, stressed and furious that no one had mentioned the staph to me.

Following this diagnosis, I was discharged from maternity and my four-day-old baby was admitted as a pediatrics patient to be given IV antibiotics. The pediatrics ward is for children only so despite just having the caesarean and still being on painkillers, I was not considered a patient. I had to sleep on a fold-out couch to continue three-hourly breastfeeds but was given no food or additional pain relief ...

No perfect system

WHEN my wife fell pregnant, our GP referred her to an obstetrician without discussing any options, such as the public system, birthing centres, home birth etc. This referral sent us down the path of the private health industry. We were keen on more natural options for childbirth, but it became increasingly apparent that our obstetrician was not interested in these options. Through our own research we found out about birthing centres, and decided that this was the go for us.

... our daughter was breech. Through the birthing centre we were told of an obstetrician who manually turned babies in utero. We consulted him, and our daughter was turned. I am sure that had we stayed in the private system with our original obstetrician, we would not have been made aware of this option, and my wife would have had to endure a caesarean. This is one example of the ''over-medicalisation'' of childbirth by the private health care industry.

However, the birthing centre was far from perfect. My wife gave birth at 7.10pm on a Saturday. At 9.30 the next morning we were pressured to leave. We refused, and spent our full allotment of two days in the centre. A couple of days after we left, we received one follow-up visit from a midwife. She noted that our daughter was jaundiced, and advised that we put her in the sun for 10 minutes.

Later that day I took my wife to hospital because she was experiencing pain after the birth. While we were there, a [midwife] noted that our daughter was jaundiced, and requested a blood test. The result was that she was rushed to the neonatal intensive care unit in a serious condition. An hour later the head of the unit informed us our daughter was suffering from a level of jaundice so severe that they saw it only once or twice a year, and that as a result, she could be brain-damaged and suffer hearing loss, among other issues. If I hadn't insisted on taking my wife to hospital for her pain, I dread to think what might have been ...

Happy on home front

I HAD a satisfying birth at home with the help of two lovely independent midwives. The continuity of care from our midwives has been exemplary.

When I read accounts of less-than-adequate hospital-based maternity care, I can only say that home birth is worth every cent we paid.

Improving the maternity system is simple: the Government needs to stop attempting to put independent midwives out of business.

Support midwives

MY HUSBAND and I saved our stimulus packages to pay a private home-birth midwife for the birth of our second child, due any day now. The continuity of care, with antenatal appointments in our own home, is wonderful. I feel much more comfortable ringing my own midwife with questions than I did when I was seeing a different midwife every time at the ... Birth Centre ...

It's not all gloom

WHILE there is room for improvement in any hospital system, the headlines in your report unnecessarily spelt doom and gloom.

In the past 10 years I have had three babies at the public ... [hospitals] Each time I have been impressed with the service and care provided ...

My first baby could not attach to the breast, and ... we were allowed to stay in hospital until day five after the birth. Every time I needed to feed her I buzzed for the midwife to help me, and never had to wait more than a few minutes.

With my second and third babies we went home on day two, but we were ready ... Postnatally, a midwife from the hospital visited me each day for two days after the birth. The midwives were caring, knowledgeable and helpful.

Motherhood's trauma

I GAVE birth to both my sons as a public patient ... There is almost no difference between the private and public patient experience, so having private health cover was of no benefit. My doctor was away both times but the on-call obs I had both times gave good care. Of course, they're only there for the end bit and it's the midwives who do all the work anyway.

... my key criticism is that they sometimes forget the strangeness of becoming a mother for the first time. We are not used to being mostly naked in a room full of other people ... We are flooded with hormones that leave us lost and confused. We think motherhood will be a tender and graceful time, when in fact it can often be a time, particularly the first time, when you feel frighteningly laid bare. I would have appreciated someone to facilitate a more caring and dignified transition into my new role.

A cry for help

A LARGE public hospital means a huge variation in staff on different shifts, which leads to inconsistent care and the danger of ''falling through the cracks''.

Hence, many women benefit from having their own private midwife with them throughout the experience.

Three days after the birth of my baby, I developed ... postnatal depression ... The [midwifery] staff ... were seemingly inexperienced ... I never had the same [midwife] more than once, which meant they were generally unaware of my worsening condition, which didn't appear to be written in my medical notes. On the fifth day when I was to be discharged, I was stuck with terror at the thought of being home alone to cope with my newborn son ...

At home, things got worse. Feeling like you're in an evil, black hole and not wanting to look after your own baby is not a pleasant state to be in. I had enormous problems with breastfeeding, which added even more stress to my already unwell mind.

It was the visiting midwife from the hospital who was the catalyst in getting treatment for me. At first she offered me generic advice in a way that to me seemed somewhat ''hippie dippy'', so I had to persist in letting her know how bad I felt. Eventually she gave a card for the hospital's crisis assessment team hotline. The team member I spoke to was exceptionally understanding and gave me some calming advice. The team followed up with regular phone calls to check I was OK before they were able to send out a diagnostic team, including a psychiatrist, a couple of days later. They were also responsible for my being admitted into a mother and baby unit in the hospital's psychiatric ward soon after.

Intensive counselling, medication, individual monitoring and support finally got me back on my feet. I am now what I would consider a ''normal'' happy mother.

Forgotten option

YOU seem to have left out the home birth option in your report. Provided the woman is healthy, well-informed and well-supported, there is no reason she cannot give birth at home, with the aid of a trusted midwife. My wife did so three times ...

If necessary, a doctor can be called to render extra assistance, and in the rare case of complications, which usually become apparent slowly, the woman can be taken to a hospital.

If more women gave birth at home, this would relieve the pressure on hospital resources. It would also enable women to give birth calmly, in a familiar environment, with loved ones close at hand, and usually escape the effects of postnatal depression.

Rich feedback about our current hospital system. It will be interesting to follow the changes once private midwives are able to birth with their clients in hospital. We know that continuity of care is sought-after, as is explained in the above quotes. Private midwifery in hospitals will enable more women to access midwifery care on their own terms.

I was surprised that the stories of women who were told they could not get the type of birth they wanted - such as vaginal breech, vaginal twins, VBAC and so on - were not mentioned.

Melissa Maimann, Essential Birth Consulting 0400 418 448