Choosing your Birth Place

Choosing where you will have your baby is an important decision which can have an enourmous influence on how your birth unfolds. If you would like a natural birth for example, it is important that you choose an environment and care providers who can support that.

Once you have a basic understanding of what conditions are required for birth to unfold best you can see how important choosing the right environment for you can be. In Australia, depending on where you live, you have the choice between private and public hospitals, birth centres and homebirth. If you want a natural birth you will want to choose a birth place that has low intervention rates and if you are wanting a VBAC (Vaginal Birth After Cesarean) then it’s important to look at the VBAC success rates of the places and care providers you are choosing between.

Luckily in NSW, hospital statistics are made publicly available so that you can look at and compare intervention rates . Homebirth statistics  are also available.

Locally I compared Manly Hospital with Royal North Shore Private, the Mater and 3 homebirth midwives. I just had a quick look at the VBAC (Vaginal birth after caesarean) success rates (Manly 17.5%, Private 4-6%, Homebirth 80-90%)  episiotomy rates (Manly 10%, Private 26.5%, Homebirth 0-3%),and caesarean rates (Manly 24%, Private 45%, Homebirth 5-8%) which are quite telling.

Choosing your care provider carefully is probably even more important than birth place. One-to-one care with a midwife has been shown to result in the best outcomes for women and babies. This is where you know your midwife and she looks after all your care antenatally, attends your birth and visits you postnatally until 6-8 weeks after the birth.

There are some public hospital based programs that offer this service in Sydney: the RHW in Randwick, RNSH in St Leonards and soon (fingers crossed!) there should be one opening through Mona Vale Hospital (set to open November 2010). With these public programs there is no guarantee that your midwife would be available for the birth however, so if you want true continuity of care then the “Gold Standard” would be to hire a midwife in private practice (MIPP).  Most MIPPs offer homebirth and many will look after your antenatal and postnatal care in your home and support you in the hospital if you choose to birth there. 

I could move onto discussing Doulas, but we’ll save that for a new post!

Happy Hunting,

H

Postnatal Depression & Dads

I am doing an assignment for my psych subject for midwifery and we had to find an article in the press regarding a mental/emotional issue relating to pregnancy or birth. I found an article in the SMH regarding a review of popular websites and how well they cater to fathers in a family where the mother is suffering from postnatal depression (not that well, in comparison).

I went hunting for the actual review (full report HERE) by Dr Richard Fletcher of the University of Newcastle and thought I would list a few of the websites here with links to the relevant stuff for Dads. They are Australian based, but the information and suggestions for support would be useful anywhere:

• Raising Children Network
• Ngala
• Beyondblue
• WA Health Department
• Panda – the Ínformation for Men section is under construction
• The Better Health Channel

I also found these American sites:

• Postpartum Men
• Fatherhood Institute

Acupuncture for Depression in Pregnancy

During Pregnancy Acupuncture Found To Lessen Depression Symptoms, Stanford Study Shows.

The researchers found that women who received the depression-specific acupuncture experienced a bigger reduction in depression symptoms than the women in the other groups. The response rate – defined as having a 50 percent or greater reduction in symptoms – was 63 percent for the women receiving depression-specific acupuncture, compared with 44 percent for the women in the other two treatment groups combined.

C-section not the best option for breech birth

I’ve been a bit slow to post on this one, despite it’s relevance to many of my lovely clients, but here it is…

As an acpuncturist I see my fair share of women with breech babies who are frantically trying to do everything they can to get their babies to turn and avoid a caesarean. While I give them treatment and teach them how to do the moxa themselves,  I also do my best to let them know that they do have options. Unfortunately they don’t have many and if their baby doesn’t turn head down most go ahead and have a c-section. If you live in Sydney and would like a vaginal breech birth the options are basically:

1) go to John Hunter Hospital in Newcastle

2) hire a privately practicing midwife and birth at home

In Canada, things are changing and hopefully (although at the moment Maternity care in Australia seems to be going backwards, not forwards) Australia will catch on? We can but dream.

In June the Society of Obstetricians and Gynecologists of Canada released new recommendations that vaginal breech birth be offered to women.

From an article in the Globe and Mail:

Physicians should no longer automatically opt to perform a cesarean section in the case of a breech birth, according to new guidelines by the Society of Obstetricians and Gynecologists of Canada.

The new approach was prompted by a reassessment of earlier trials. It now appears that there is no difference in complication rates between vaginal and cesarean section deliveries in the case of breech births….

For more info you can read the full article and see these great blog posts from Stand and Deliver (Canadian) and Lisa Barrett (Australian).

The end of Midwifery as we know it?

Today hundreds of people in NSW, QLD and VIC rallied outside the offices of Kevin Rudd (Prime Minister), Julia Gillard (Deputy Prime Minister) and Tanya Plibersek (Minister for the Status of Women) to protest the proposed ammendments to the new health legislation. A clear summary of what these ammendments mean for women and midwives can be found HERE. Below is the Australian College of Midwives media release and HERE is an article from the Sydney Morning Herald.

MEDIA RELEASE 9 November 2009

Midwives reject doctors’ veto over their ability to enter private practice and provide care to women.

The Australian College of Midwives has grave concerns that the proposed amendment to the Health Legislation (Midwives and Nurse Practitioners) Bill, proposed by federal Health Minister Nicola Roxon last week, will do nothing to improve women’s access to collaborative midwifery and obstetric care – the objective of the reforms.

The proposed amendment will require a Medicare eligible midwife to have a collaborative agreement with a medical practitioner(s).

“It’s hard to see the amendment as anything other than an attempt by the medical lobby to ensure doctors have a power of veto over the regulated professional practice of a midwife” said ACM President, Assoc. Professor Jenny Gamble.

“Insisting on agreements with individual privately practising doctors is simply not workable.” Gamble said. “In rural and remote Australia sometimes there is no doctor available within hundreds of kilometres and those available are often locums who change every three months or so, making collaboration with a single doctor impossible.”

“Even in the cities, if a woman’s midwife has an agreement with a particular private obstetrician, that doctor may not be available when the woman requires medical care, such as a caesarean section.”

“Maternity hospitals have many different doctors, so is the midwife to have agreements with 12 different doctors on 12 different terms? There has to be a system of care that supports each midwife and the women she cares for in evidence based collaborative arrangements regardless of the individuals involved.”

“The proposed collaborative arrangements, are not just unworkable, they are potentially unsafe and undermine regulation of the midwifery profession.” Gamble said.

“Midwives are committed to collaboration with doctors in the interests of pregnant women and their babies. Such collaboration is already a daily occurrence. Midwives’ competency standards, against which they are registered every year, require collaborative practice. Failure to practice in accordance with these and other professional standards can lead to disciplinary action by the Board.

The proposed amendments will give power to medical practitioners to essentially decide which midwives will be able to practice privately or not, have insurance or not and access Medicare or not. Instead of the regulatory authority – the Nursing and Midwifery Board of Australia – determining safe and competent practice by midwives, it will be down to the whim of individual obstetricians. This will not pave the way to safe, high quality, collaborative care for women and their babies”

“There is no argument that women who choose an MBS eligible midwife to provide their care will need timely and seamless access to medical care if and as they require it. An agreement between a midwife and a private obstetrician (GP or specialist) may be one option for some midwives and women. But this must not be the only way. It is essential that midwives can forge agreements with public maternity services as an alternative way of working collaboratively and meeting the requirements of the Act. We are concerned that the proposed amendment does not provide for this.” Gamble.

The World Health Organisation recognises the midwife as “a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant.”

Midwifery care has received the highest scientific endorsement in the past year, with a systematic review of 11 randomised controlled trials involving over 12,000 women from around the world demonstrating that outcomes for women receiving continuity of care from known midwives were better than for women who received fragmented care from multiple midwives and doctors. Midwives can be trusted to refer and consult when needed.

“This amendment will be especially problematic for midwives providing homebirth services, as medical organisations are publicly opposed to woman’s choice of birthplace. They need only urge their members to refuse to collaborate with midwives if they provide homebirth services. Homebirth will go underground and midwives will not be able to register to provide current and accountable care to these women. This is a serious safety concern for Australian women wishing to make this choice.”

“Collaboration is about mutual trust and respect and professional cooperation focused on the needs of individual women and babies. It’s not going to work if it’s a forced relationship with someone who holds all the power and can choose whether or not to collaborate. It’s like one hand clapping”.

“The ACM urges the Rudd Government to consider the interests and safety of women and babies and to leave the collaborative arrangements in the regulations or at the very least to change the amendment to make clear that midwives can have agreements with maternity services, as an alternative to having one with an individual private obstetrician.” said ACM President, Assoc. Professor Jenny Gamble.

Clamping the Cord

The birth of the placenta is the third stage of labour and I have posted about this before with links to research articles and some Sarah Buckley articles.

Check out Gloria Lemay’s blog post on Umbilical Cord Integrity with some great information and stuff to think about.

New Canadian Homebirth Study

A Canadian Homebirth study just published looked at 2889 planned homebirths attended by midwives, 4752 hospital births attended by the SAME midwives and 5331 hospital births attended by doctors.

The study found that birth at home with a midwife was as safe as birth in hospital and homebirth was associated with fewer adverse outcomes for mothers and babies.

Women who birthed at home were less likely to experience obstetric interventions including:

• electronic fetal monitoring
• augmentation of labour (‘moving things along’ by rupturing the membranes or administering oxytocin)
• assisted vaginal delivery (with forceps or vacuum)
• caesareans
• episiotomies (cutting the opening of the vagina)

Those having a homebirth were less likely to:

• have a 3rd or 4th degree tear
• have a postpartum haemorrhage
• have a newborn who had birth trauma
• have a newborn requiring resuscitation at birth
• have a newborn requiring oxygen for more than 24hours

When the 88 women who had had a previous c-section were excluded from the homebirth group there were no changes to any of the statistics.

If you know nothing about the physiology of birth you may be asking WHY do women and babies do better at home? The best article I have found that explains this so beautifully was published in MIDIRS and is by Tricia Anderson. The only online copies I can find are HERE and HERE.

Some of Dr Sarah Buckley’s articles on the hormones of birth also give a good idea about how birth works:

• Ecstatic Birth: Natures hormonal blueprint for labour
• Pain in Labour: Your hormones are your helpers
• Leaving well alone: a natural approach to the 3rd stage of labour

Homebirth Debated in Parliament

I just want to HUG Andrew Laming! And the way those stats just rolled off his tongue…if only the other side were listening.

The joys of natural childbirth

You will have noticed that I don’t really post many of my own thoughts and opinions on things and simply provide links to other people’s thoughts and opinions. This is partly because I am majorly short on time (the reason I started this blog in the first place so that there was just one place with all my favourite links that I could send people to) and partly because I just can’t put it better than the ‘real’ bloggers out there like Heather Armstrong. In her own words:

I was also under the impression, having never really researched the subject whatsoever, that any woman who would opt for a homebirth was not only COMPLETELY OUT OF HER MIND but also not interested in the safety of her unborn child. I mean, there’s a reason that infant and maternal mortality rates are so much better than a hundred years ago, right? HOSPITALS. And MEDICINE. And smart people we call DOCTORS. Yes, women routinely used to go out into the field by themselves and give birth without any assistance, and many of them routinely did not return BECAUSE THEY DIED.

But then out of no where the publishers of Ricki Lake and Abby Epstein’s book Your Best Birth sent me a copy, just like the publishers of many books send me copies of other books all the time. Internet, I have rooms full of books that publishers have sent me. ROOMS FULL. And I was just about to toss this onto the mountainous pile of ones I’d eventually drop off at Goodwill when, I don’t know, I flipped through a few pages and gave a full minute to one or two paragraphs. And those two paragraphs happened to be ones that really pissed me off. So much so that I read them aloud to Jon and said something like GOD, THOSE HIPPIES! or I BET THEY SMELL LIKE PATCHOULI!

You know, something totally open-minded.

You can read her brilliant posts here:

• Labor story, part one
• Labor story, part two
• Labor story, part three

The Lie of the EDD

Great article on Estimated Due Dates, you can also see my previous post on this topic.

Why your due date isn’t when you think…

We have it ingrained in our heads throughout our entire adult lives-pregnancy is 40 weeks. The “due date” we are given at that first prenatal visit is based upon that 40 weeks, and we look forward to it with great anticipation. When we are still pregnant after that magical date, we call ourselves “overdue” and the days seem to drag on like years. The problem with this belief about the 40 week EDD is that it is not based in fact. It is one of many pregnancy and childbirth myths which has wormed its way into the standard of practice over the years-something that is still believed because “that’s the way it’s always been done”.

The folly of Naegele’s Rule

The 40 week due date is based upon Naegele’s Rule. This theory was originated by Harmanni Boerhaave, a botanist who in 1744 came up with a method of calculating the EDD based upon evidence in the Bible that human gestation lasts approximately 10 lunar months. The formula was publicized around 1812 by German obstetrician Franz Naegele and since has become the accepted norm for calculating the due date. There is one glaring flaw in Naegele’s rule. Strictly speaking, a lunar (or synodic – from new moon to new moon) month is actually 29.53 days, which makes 10 lunar months roughly 295 days, a full 15 days longer than the 280 days gestation we’ve been lead to believe is average. In fact, if left alone, 50-80% of mothers will gestate beyond 40 weeks.

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