Continuity of care

Private midwifery is the oldest form of continuity of midwifery care.  Recent research has demonstrated that this form of care – where a woman is cared for by the same midwife throughout pregnancy, birth and the postnatal period – is beneficial for women and families. It results in increased satisfaction with the birthing experience and enhanced safety.  When multiple care providers are involved in a woman’s care, the chance of errors is high because care is provided in pieces. When a woman is cared for by one midwife, she has one point of reference, no conflicting advice, she can develop trust and a sense of security and the birth will generally proceed naturally.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

 

Knowing Your Midwife

For many women, pregnancy can be an emotional rollercoaster.  Many women experience excitement, joy and hope, but also fear, uncertainty and even disappointment and sadness. The relationship a woman develops with her midwife is important to a woman as she journeys through her pregnancy, birthing and in the early weeks with her baby.

It has been shown that women who are cared for by one dedicated midwife for the duration of their pregnancy, birth and early newborn period find this form of care to be highly satisfying.

It is about having one person who shares in your pregnancy, who listens as you share your fears and concerns, who shares information with you and who supports your decisions and choices.

When a woman knows and trusts her midwife, there is a shift of power towards the woman as she feels a greater sense of control over her entire experience.  She becomes aware of her choices and options, she feels confident to make her own decisions and she goes to her birth feeling confident, informed and supported.  She knows who will be caring for her on the day, and she knows that her midwife knows everything that is important to her for her birth.

There is no sense of being a number in a busy system.  There is no need to repeat yourself at every visit.  There are no lengthy waits for appointments.  Each appointment takes around an hour, so there is plenty of time to get to know one another.

Private midwifery care is an option that more and more women are asking for, although it is only accessed by a small number of women.  Yet research shows that this care model, in which a woman is cared for by one midwife from early pregnancy though to birth and post-birth care, offers numerous benefits to women and babies. These include a greater chance of a spontaneous birth without stitches, feeling in control during labour and exclusive breastfeeding with minimal chance of postnatal depression and baby blues.  Private midwifery care also means much less requirement for pain relief in labour, fewer inductions of labour and of course a much lower chance of needing a caesarean.

The care I am describing - where a woman knows and chooses her midwife – is available for both home and hospital births.  If private midwifery care is available in your area, you may decide that is what you would like.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

At least you have a healthy baby.

   

 

How many times have we heard this?

The most important thing in birth is that you have a healthy baby at the end of it.

Yes, a healthy baby is the most important part.  But is it the only important part?

"At least you have a healthy baby" is a comment that often follows after a woman has shared details of her traumatic birth.  Trauma can come in many forms, and means different things to different people.  For some women, it will be around not feeling listened to and respected during their labour, while for other women it is around the things that were done "to them" during their labour and birth - perhaps with consent, perhaps without.

In today's day and age, we are very fortunate.  We don't have the high maternal and neonatal mortality that we experienced in years gone by.

We are grateful for antibiotics, sanitation, good education, literacy, nutrition, skilled and qualified midwives and obstetricians, hospitals and medications. These have all resulted in safer childbirth for mothers and babies.

With maternal and neonatal mortality as low as it is, perhaps we are entitled to shift the focus to the emotional experience of birth for the mother and baby.  

So how come we still have such low expectations of our births?  We don't dare to plan an active, natural, drug-free birth because it might not happen and we might feel we have failed.  We have low expectations of our bodies, it seems, and we're certain we'll "fail" at birth.

Do we have this mindset in any other aspect of life?

Do we fail to plan our day or our wedding or moving house because it might not happen quite the way we have planned and then we might feel we have failed?  

Rather, we take a different approach: we have plans, but we back them up with research, knowledge, evidence and experience and we have contingency plans.  We know the parts that our in our control, and we know what is not in our control.  And none of this stops us from making plans, for we know that if we made no plans, we would be certain not to get what we want.

Why does all of this matter in birth?

 

Many women don't know that there is a growing body of knowledge that birth matters for a child's development and for mother-baby bonding.

The best predictor of a child's wellbeing, educational attainment, mental health and happiness is the quality of the bond that forms between the mother and baby following birth.  Confident, empowered mothers birthing with respectful and compassionate care leads to confident and empowered mothering.  Birth is so much more than merely having a healthy baby.    

Visit my website to learn more about private midwifery care.

Private midwifery

As a mum-to-be, you are embarking on an amazing and sometimes daunting journey.  Private midwifery care supports women through their pregnancy, birth and early days with their new baby.  It's about care with a midwife you know and trust.  Sadly, most Australian women will not see the same midwife twice.  I believe that having the same dependable, knowledgeable and caring midwife by your side is what makes all the difference.

There is now a wealth of evidence - including fresh new research - that shows that women and babies can expect safer, healthier outcomes in the short- and longer-term when they choose a midwife for their care.

  • More likely to have a normal birth            
  • Less likely to be admitted to hospital during pregnancy
  •  More likely to have a positive and satisfying birth experience            
  • Less likely to have an assisted birth (ventouse / forceps)                                
  • Less likely to have a caesarean
  • Less likely to give birth to a low birth weight or pre-term baby                                
  • More likely to successfully breastfeed            
  • Less likely to request an epidural for labour pain relief

Visit my website to learn more about private midwifery care.

5 thuths about private midwifery care

1. Your chance of caesarean is about as low as it can get

  • Approximately 5%, with almost all studies pointing to rates less than 10%, and some as low as 3%

2. The most likely outcome for you and your baby will be:

  • Your labour will start on its own
  • Well prepared, confident and supported, your labour will not need any form of medication to stimulate it once it has started
  • You will require no medical forms of pain relief
  • You will reflect positively on your birth
  • You will birth normally, and without the need for stitches
  • You will exclusively breastfeed your baby with minimal problems
  • You and your baby will experience optimal health and recovery from birth

3. It is an excellent investment in your health and that of your baby

4. While many women will change from one model of care to private midwifery care, few women change from private midwifery care to another model.

5. Private midwifery care means complete continuity of care.  Your midwife is not restrained by a shift duration, she will not be on annual leave with you give birth and she will personally attend you at the times that you need her.

Learn more about private midwifery care and antenatal shared care

What is driving our rising caesarean rates?

The answer seems quite clear, according to BMJ Open.

Caesarean rates were calculated according to the woman's admission status / funding source (public / private) and type of hospital (public / private). The study found that most of the increase in the caesarean rate could be attributed to an increase in caesareans that were performed before labour had started in first-time Mums who were having their babies as private patients in private hospitals.  The study found that reasons such as breech presentation, placenta praevia and twins did not explain the increase.

Learn more about private midwifery care and antenatal shared care

Epidural rates in Sydney

The NSW Mothers and Babies Report (2010) reveals much about epidural rates in Sydney.  The highest epidural rates occurred in two private hospitals in Sydney's St George and Sutherland areas.  More than 80% women birthing at these hospitals had an epidural. The State average was 46.5% in public hospitals and 68.4% in private hospitals, so the rates for the St George and Sutherland private hospitals were far higher than the average for private hospitals.

Does this matter?  I think it is important to know this when you're looking into birth options.  The statistics apply to each woman equally, so being aware of this can lead women to question their appropriateness of these birthing hospitals if an epidural is not part of plan A.

These same hospitals also topped the State when it came to elective caesareans, with more than a third of women giving birth by this method in 2010.  Elective caesarean refers to a caesarean that is performed before labour has started (it is an emergency caesarean if it is performed once labour has started).

Learn more about private midwifery care and antenatal shared care

Birthing statistics

The statistics listed below are for the births I have attended at home, in birth centres and in hospitals.  They reflect the care that has been provided to women in my care and may or may not represent your individual experience. The number and type of interventions in a birth will depend on many factors:

  • Health and safety factors
  • The decisions that are made by a woman and her care provider
  • A woman's motivation to achieve the birth she has planned

Statistics:

  • Normal birth (no forceps, vacuum or caesarean): 89%
  • Caesarean 5%
  • Vacuum 3%
  • Forceps 4%
  • VBAC 88%
  • Episiotomy 3%
  • Intact perineum 65%
  • 5% women use an epidural for labour
  • 82% women use no medical forms of pain relief in labour
  • 12% women are induced
  • 50% women have a waterbirth
  • 49% women birth at home
  • 60% women have a physiological third stage
  • 97% babies are exclusively breastfed at 6 weeks discharge
  • Homebirth transfer rate 19%
  • Women considered to be "low risk": 45%
  • Women considered to be "high risk": 55%

Statistics for first babies:

  • Normal birth (no forceps, vacuum or caesarean): 90%
  • Caesarean 5%
  • Vacuum 3%
  • Forceps 2%

I feel it is important to compare the measurable benefits of private midwifery care against the statistics for the State as a whole.  These statistics are taken from The NSW Mothers & Babies Report 2010 which are the latest statistics available.

Private midwifery care can increase the chance of a normal birth

  • In NSW, only 58% women birth their babies normally.
  • This rate increases to 89% through this service

Private midwifery care can reduce the need for an epidural

  • 47% of all women used an epidural in labour.  This commonly leads to an assisted delivery, possibly with an episiotomy.
  • The epidural rate is a mere 5% through this service

Private midwifery care can increase a woman’s chance of having a drug-free birth

  • NSW-wide, only 10% women birth their babies drug-free.  90% women use some form of analgesia.
  • Through this service, 82% women use no medical form of pain relief for labour.

Private midwifery care can reduce the need for a caesarean

  • 30% of women in NSW had a caesarean in 2010.
  • 5% women require a caesarean through this service.

26% of first time mothers had caesareans in NSW compared to only 5% of women who chose private midwifery care.

Private midwifery care increase the chance of a successful VBAC

  • In NSW in 2010, only 12% of women who had had a previous caesarean achieved a vaginal birth
  • This increases to 88% when women choose this service

Private midwifery care can increase the chance of  homebirth

  • Only 0.3% babies are born at home in NSW
  • 49% babies are born at home through this service

Choosing a private midwife more than doubles your chance of starting labour without medications

Choosing a private midwife trebles your chance of needing no stitches after birth

Private midwifery care reduces your chance of an episiotomy by 83%

Learn more about private midwifery care and antenatal shared care

Which birth choice is right for me?

In the blog post below, I am going to go through a few scenarios or preferences, and suggest a care option that may best suit that woman. I am going to choose from only four options, even though there are many many different models of care for pregnancy and birth.  The options I am going to choose from are:

Private midwifery care either for a planned homebirth or a planned hospital birth

This is a continuity of carer model whereby a woman is cared for by one midwife from early pregnancy through to birth and the postnatal period until the baby is 6 weeks old.  Where the woman has complications in pregnancy or requires a higher level of care, the midwife is able to refer the woman directly to an obstetrician, or the baby to a paediatrician.  The midwife is also able to order all the necessary tests and scans for the woman.

Private obstetric care for a planned hospital birth

This is a continuity of care model where the woman's pregnancy care is provided by one obstetrician.  The labour is attended by hospital midwives who are not known to the woman before labour starts, and the birth is attended by the obstetrician with whom the woman has a relationship.  The postnatal care is provided by hospital midwives who are not known to the woman, and the obstetrician provides a final check at 6 weeks postnatal.  This model of care is available in public and private hospitals.

Shared care: either with a GP or a private midwife

This is where a woman attends a private midwife or her GP through her pregnancy (continuity of carer for pregnancy), however the birth is attended by the hospital midwives and obstetricians at the hospital at which the woman is booked, as a public patient.  Once the woman is discharged from hospital, she may again be cared for by her private midwife or GP.  This is a model of care within the public system, where some of the care (ie, the pregnancy care) is provided by a private practitioner.

Standard public hospital care

In this model, a woman is cared for entirely by the public hospital staff.  Generally the woman attends the antenatal clinic for her pregnancy care, where she is seen by the midwives who are on duty that day.  From one visit to the next, the woman may be seen by different midwives.  Some hospitals have a midwife clinic where it is possible for the woman to be seen by the same midwife for most of her pregnancy (antenatal) appointments.  In labour, the woman is cared for by the midwives and obstetricians who are on duty.  These midwives and obstetricians will not be known to the woman ahead of time, and they work in shifts.  Once the baby is born, the woman moves to the postnatal ward where she is again cared for by midwives she has not met before, who work in shifts. This model of care is absolutely free to Medicare card holders, and in Australia, our public system delivers a very safe standard of care.

I want to build a relationship with the midwife who will be caring for me during birth.

This woman would be best to choose private midwifery care. This is the only model where all of your care is provided by one midwife.

I want to feel prepared, informed and confident as I approach my birth.

This woman would best be cared for with private midwifery care, or with private midwifery shared care.  In both models, midwives work very closely with women, through education, preparation, support and lots of time for questions and discussion.

I want basic care: just a quick check and basic education to be safe.

This woman could be cared for with private obstetric care, GP shared care or public hospital care.  It might be best suited to a woman who has had a normal, straightforward birth before, who just wants the basics to be safe.

I want to build a firm relationship with the obstetrician who will be present if something goes wrong.

Private obstetric care might be best here, however there are models of collaborative private midwifery / private obstetric care that might also be helpful.

I am planning an elective caesarean.

Probably private obstetric care will be best.  You will get to know your obstetrician well during your pregnancy, and s/he will attend your caesarean.  This is very reassuring care for women planning a caesarean.

I want to have home visits from my midwife after my baby is born.

Private midwifery care would be best.

I am planning a waterbirth / home birth

Private midwifery care again.  Public hospitals generally don't provide homebirth services, and waterbirth rates can be quite low.  Private midwives have the highest rates of homebirth and water birth.

I am planning a VBAC

Private midwifery care will give you the best chance of a VBAC (vaginal birth following a previous caesarean).

 Learn more about private midwifery care and antenatal shared care

FAQs

What are the disadvantages of birthing in hospital? Most women who birth in hospital do not have the same midwife with them throughout pregnancy, birth and the postnatal stay. They have different midwives for each antenatal (pregnancy) visit, then another lot of midwives for the birth (sometimes 3-4, depending on how long the woman is in delivery suite and whether the midwife has a student midwife working with her), followed by another group of midwives who work in shifts in postnatal. The lack of continuity means that the woman does not have the opportunity to really develop a deep sense of trust with her own midwife, something that is intrinsic to positive and safe birthing experiences.  The other issues are around the potential for things to "fall through the cracks" and the need to repeat yourself at every visit.

When women have their own midwife with them, they have the full range of options open to them and they are fully informed and able to make their own decisions around pregnancy and birth care.  The continuity of care that this provides is central to a safe birth.

Birthing option?

To learn more about pregnancy and birth care options, why not book an appointment?  There is no cost with a Medicare card.

Can I have an epidural with a midwife?

Absolutely!  Although many women find that they don’t need one when they’re cared for by the same midwife and well supported in labour. In my practice, only 5% women need an epidural in labour, and 80% women birth their babies with no pain relief at all.  However, epidurals are a good option for some women in some labours.

Can midwives administer oxytocin at a home birth?

Yes, to manage excessive bleeding after the baby is born, but it cannot be used to induce or augment the labour. Those interventions are attended in the hospital as they carry risks to the baby. Midwives routinely carry oxytocics to births in case they are needed.

Does having gestational diabetes mean a C-section?

This would be a good one to ask your care provider. Generally speaking, gestational diabetes does not automatically mean having a caesarean.

Private midwife public hospital Sydney?

Yes, it is possible to take your own midwife with you in a public hospital. This service provides this as an option. Women book with their private midwife and receive all of their pregnancy care from their midwife, including pregnancy, birth and postnatal care for 6 weeks.

Private midwives in Sydney’s east?

Yes, this service provides private midwifery services in the eastern suburbs.

Water birth private hospital Sydney?

None of the private hospitals in Sydney allow waterbirth. Waterbirth is the norm in a homebirth and may be an option in a public hospital.

Learn more about private midwifery care, antenatal shared care and antenatal classes

Vaginal twin birth found to be at least as safe as planned caesarean

A study has found that vaginal birth of twins is as safe as planned caesarean section for twins.  The study looked at twins that were 32-38 weeks through the pregnancy, and with twin one being head-down.  Unfortunately all of the vaginal births were induced, it seems from the study, and it would be interesting to see what the results would have been like had the women laboured spontaneously.  I wonder if they would have found that vaginal birth was actually safer than caesarean when labour was not induced, as we know that inductions can lead to increases in postpartum haemorrhages and an increased need for pain relief in labour. The study concludes that women should find a care provider who is able to assist with vaginal twin birth.

Learn more about private midwifery care, antenatal shared care and antenatal classes

 

In Australia, is it better to have a baby in the public or private system?

It’s a question that many people wonder about.  In Australia, we are fortunate to have very safe public and private health systems, and in either system, you are highly likely to leave the hospital healthy, with a healthy baby.  I am told that in other countries, the public system is not a system you enter if you have a choice, but in Australia our public system is very good, with high standards of care. So what are the main differences between public and private?

Choice

In the public system, you cannot choose your care provider: they are allocated to you by the hospital.  If your local hospital offers several models of care, so long as there are places in each model and you have been assessed as being suitable for a particular model, you may choose it.  However, if the hospital deems that you are unsuitable for a particular model of care, or there are no places in the model of care, then essentially you no longer have those choices available to you.  You are also generally not able to choose your hospital, and instead must attend the hospital that is local to where you live.

In the private system, you choose your care provider and place of birth.  You may choose a private midwife or a private obstetrician, and you may interview several care providers before choosing the one who best meets your needs.

Within the private midwifery system, you have a choice of homebirth or hospital birth, whereas a private obstetrician would generally only attend births in hospital.

Food, surroundings, valet parking, décor

All may appear to be better / more luxurious in a private hospital.  But are these things all that important at the end of the day?

Intervention rates

The private system is interesting in that two ends of the extreme operate here: private obstetric care yields the highest rates of intervention (on average), while private midwifery care yields the lowest rates of intervention (on average).  The public system leans more towards private obstetric intervention rates (on average), for example private obstetric care may have a 40% caesarean rate, the public system may have a 30% caesarean rate, while private midwifery care has a 5% caesarean rate.  Epidurals: 70% under private obstetric care; 50% in the public hospitals and 5% with private midwifery care.

Continuity of carer

This is where one person provides all of your care.

Some public hospitals provide continuity models for a small number of women, where the women have a named midwife who cares for them within a team of midwives (usually 4), and any one of those four midwives will provide the woman’s care.  This is continuity of care, but not continuity of carer.

Private obstetricians provide continuity of carer in pregnancy, as the one person provides all of the woman’s pregnancy care, however, in labour the care is provided by midwives who the woman would not have met before, and this continues into the postnatal period.

Private midwifery care is a true continuity of carer model, where the same midwife provides all of the woman’s pregnancy, birth and postnatal care.  Low client numbers facilitate this model of care.

So it’s really about matching what each system and care provider offers with what you are after.

Costs

The public system is free if you have a Medicare card.

The private system is not free; costs vary. See here.

Learn more about private midwifery care and antenatal shared care

Multiple caesareans

Roughly one third of women having their first baby will have a caesarean. Nation-wide, those women are highly unlikely to birth vaginally in their subsequent pregnancy.  There are many reasons for this, but suffice it to say, less than 15% women who had a caesarean with their first baby will go on to birth vaginally again.

So what?  What does this mean?

New research has found that women who have had numerous caesareans suffer more life threatening complications.  The risk of major bleeding and the need for a blood transfusion were dramatically increased, and this can relate to the way the placenta implants in the uterus.  If the uterus is scarred, sometimes the placenta implants abnormally.  It can implant too low in the uterus, or it can implant too deeply in the uterus.  Either way, this can result in heavy bleeding, even resulting in hysterectomy.

Other complications can include infection, damage to the bladder and bowel, blood clots, pain and reduced milk supply.

Learn more about private midwifery care and shared care.

Birth in NSW

A recent study published in BMJ Open has revealed startling findings about birth in NSW.  Between 1994 and 2004:

  • The proportion of women having a caesarean for their first baby has rose from 18% to 26%
  • Of the women labouring with their first baby, the proportion of women having a caesarean in labour increased from 13% to 19%
  • Of all the women who had a caesarean for their first baby, the proportion of women having an elective repeat caesarean (that is, a caesarean performed before the onset of labour) increased from 54% to 67% between 1994 and 2004
  • Of all the women who had a caesarean for their first baby, the proportion of women planning a VBAC declined from 46% to 33% between 1994 and 2004
  • And of all women planning a VBAC, the proportion of women having a successful VBAC declined from 61% to 48% in 2004.
  • Between 1994 and 1004, caesarean rates increased from 18% to 27%.

What factors are driving this?

Private health insurance and caesarean rates

A recent study has demonstrated an association between private health insurance and caesarean rates. The Australian Private Health Insurance Incentive policy reforms that were implemented in 1997–2000 resulted in increased PHI membership in Australia.  When a woman finds out she is pregnant, her usual first port of call is her GP, and upon learning that she has private health insurance, GPs refer women to private obstetricians.  With more women privately insured, this has resulted in more referrals to private obstetricians for pregnancy and birth care.

There is concern that the the higher rate of obstetric interventions, particularly caesareans, are a direct result of more women seeing private obstetricians for their care.  As well as the increase in caesarean rates, thr length of stay in hospital after birth also increased; this would be due to the longer stay needed following major surgery.  The study concludes that, “The reforms may not have been beneficial for quality obstetric care in Australia or the burden of Australian hospitals”.

The study also showed that private patients were experiencing more interventions other than caesarean, such as episiotomy, forceps, vacuums, epidurals and inductions.  This was in comparison to women who booked into a public hospital to be treated as a public patient.

Although caesareans can be life-saving at times, high rates of intervention that is not warranted results in poorer outcomes for mothers and babies.  For mothers, this impacts not only the current birth, but also the pregnancies and births that follow.

The study found that, “In Australia, caesarean section rates rose from 18% in 1991 to 31% in 2008, reaching the same prevalence as in the United States in 2006”.  We like to think that the US has caesarean rates that are sky-high, however the reailty is that Australia’s caesarean rate is equal to that in the US.

Does this mean you should give up your private health insurance?  I would argue no because there are increasing options for women to use their private health insurance for pregnancy, birth and postnatal care.

In some States, women are able to be admitted to hosapital privately under the care of their midwife.  This will result in fewer interventions for women during birth, as recent research has demonstrated that women cared for by a midwife are far less likely to experience caesareans and other interventions when they are cared for by midwives.  Private health insurance is also helpful for the benefits it provides towards childbirth education and homebirth.  This is generally accessed through extras cover.

Visit my website to learn more about my services.

Continuity of midwifery care means more natural births

New research published in the British Journal of Obstetrics and Gynaecology has revealed that women who choose continuity of midwifery care from early pregnancy until birth, have a lower chance of caesarean and other interventions in birth. This was a randomised-controlled trial, meaning women were allocated to receive caseload midwifery care, or standard hospital care.

caseload midwifery care saw the women being cared for by up to four midwives, while standard care saw the women cared for by a different midwife at each antenatal appointment, and then whichever midwife was on shift at the time that the woman came into labour.

Women allocated to caseload were less likely to have a caesarean, episiotomy, induction and epidural.  Babies of women who were allocated to caseload midwifery were less likely to be admitted to special or neonatal intensive care nurseries.

This is great news for women who choose to birth with their own midwife.  They can now make this choice in the knowledge that this decision will make them more likely to experience a natural birth with minimal intervention.

Visit my website to learn more about my services.

Study questions current caesarean methods

A WA-based study has found that current procedures around caesarean are flawed for women who undergo a caesarean that is deemed to be a medically-necessary elective (before labour has started) caesarean section. The study followed 28 women ranging in age from 23 to 41.  While all approached the day as special, women overwhelmingly reported feelings of irrelevance, invisibility and disconnection following birth. They reported feeling that they were just another case on the operating list. A sense of disassociation prevailed amongst the women, and this condition has been linked to post-traumatic stress symptoms.

Separation of mother and baby was another issue.  It is common place for mothers and babies to be separated after a caesarean, where the baby and Dad are taken up to the ward to await the mother, or back to the delivery suite for observation.  Either way, the mother and baby are separated for often at least an hour, as the mother is sutured and taken to recovery for observation.

Women’s feelings of joy, love and protectiveness at birth were often impacted by the requirement to have the baby examined and assessed for several minutes, before being returned to the mother.  These initial, very strong feelings generally dissipate by the time the mother and baby are reunited in the postnatal ward.  Women felt differently towards their baby when they held their baby for the first time on the postnatal ward, following a period of separation.

It seems that bonding and firm maternal behaviour require constant contact between mother and baby for several hours after birth.

What does this mean for modern maternity services?  Wherever possible, we must make it a priority to keep mothers and babies together following caesarean section.  Babies need to be delivered straight onto their mothers’ chests, as is the norm with a vaginal birth.  Warm towels and blankets need to be readily available to cover the baby as it experiences skin-to-skin contact with its mum.  Any checks or assessments can be performed while the baby lies on its mum’s chest, and the first breastfeed can occur in recovery, or even in theatre if able.  Ideally, there should be no separation of mother and baby.

Visit my website to learn more about my services.

Rise in planned births tips risk balance

There is an increasing trend for planned births before due date.  This means that more and more, women are being induced or having a caesarean before labour has started on its own.  This is known as an elective caesarean, because labour has not yet started. An Australian study has shown that this approach is probably doing more harm than good.

Planned births before 40 weeks rose between 2001 and 2009, with increases in neonatal and maternal morbidity (such as complications), but no offsetting reduction in stillbirths.  What this means is that when we induce women or perform a caesarean before labour has started, before a woman reaches 40 weeks, we are causing complications for mother and baby.  The main reason for planning a birth before 40 weeks should be because there is a risk of harm to mother or baby, and so the planned birth (by induction or caesarean) is hoped to reduce the chance of the baby being stillborn.  However, this reseach has not demonstratated a reduction in the number of stillbirths.

The proportion of planned births before 40 weeks increased from 19% to 26%.

Inductions increased from 8.9% to 11.4% between 2001 and 2009, and planned caesareans before labour starts increased from 11.4% to 14.9%.

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Turkish doctors face fines for elective caesareans

Turkey has become the first country to make elective caesarean sections punishable by law, threatening fines for doctors who persuade women to have surgery deemed unnecessary.The new law permits caesareans only in cases of medical emergency.  This law has become necessary as Turkey has one of the world's highest caesarean rates, at around 48%.  Up to 70% of births in private hospitals are by caesarean.  The ministry accuses doctors of pushing women towards the operation because doctors make more money for performing a caesarean, than what they would make fromattending a vaginal birth. As well as this, there were recommendations for an increase in births attended by midwives, educational campaigns, increased availability of pain relief and legal efforts to reduce doctors' medicolegal fears.  The aim is to lower the caesarean rate to 35% by 2013.

We do not have such a situation in Australia, thankfully.  Obstetricians are not paid more to perform a caesarean than to attend a vaginal birth: they are paid more to attend a complicated birth, but “complications” for this criteria include such things as VBAC, breech presentation, twins, high blood pressure and so on.  If an obstetrician has a low-risk, healthy pregnant woman, s/he is not paid any more to attend her labour, than to perform a caesarean.

We have recently read much in the press about the perceived removal of women’s rights in terms of freebirth and high risk homebirth.  Many would support the Turkish policy, but is this removal of women’s rights any more justified than our Australian situation?

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Caesareans: the easy way out?

New research challenges the notion that a caesarean is an easy way to give birth.  Some believe that a caesarean is quick and easy: you simply choose a day, turn up at the hospital, and voila! Before you know it, you're in theatre and your baby is safely on your chest. Not so, it seems!

At 6, 12, and 18 months postnatally, women who had had a cesarean section were more likely to report extreme tiredness and back pain.  They were, however less likely to report urinary incontinence than women who gave birth vaginally.

Physical health problems commonly persisted through the first 18 months postnatally, with potential long-term consequences for women's health. The study concludes that, "Cesarean section does not result in women experiencing less overall morbidity in the postpartum period compared with women who have a spontaneous vaginal birth".

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