I re read my post and realise that I didn't stress enough how much I DO hope the service gets off the ground and succeeds - I may well be using it. I have had wonderful experiences with midwives in the public system (and OBs actually, and obstetric physicians even), I am sure there will be many wonderful people working on this project. My train of thought was following after the questions about how IPMs might be affected and hospital control of the program. As a consumer I would prefer to choose and hire my own midwife and I feel anxious about a homebirth system run by a hospital I got a bad impression of. Never the less I very much hope it comes to fruition because a choice that might involve some anxious moments is better than no choice :-).
cheers Jo At 18:13 +0800 29/11/03, Lesley Kuliukas wrote: >Hear, hear! >----- Original Message ----- >From: "Andrea Robertson" <[EMAIL PROTECTED]> >To: <[EMAIL PROTECTED]> >Sent: Saturday, November 29, 2003 3:53 PM >Subject: Re: [ozmidwifery] New models of midwifery care > > >> Hello Jo and Justine, >> >> Thanks for sharing your thoughts with us - can I suggest that you wait to >> see how this service will operate before you worry unnecessarily about >> "obstetric care" interfering with your planned home birth? The way this >> service will operate will be very similar to the Albany practice in the UK >> - which has wonderful outcomes: 43% home birth rate with an 85% hight >risk >> caseload (social risk mainly - homeless, drug users, teenagers, >non-English >> speaking, etc). The women at St George will have their own caaseloading >> midwife, which will be no different from an independent midwife. >> >> All independent midwives use guidelines for accepting women for a home >> birth and if they choose to contract in to any Government supported >service >> (e.g. through Community Health) then they will be asked to work strictly >to >> agreed guidelines in order to obtain their insurance cover. All guidelines >> will have some obstetric input because they will be dealing with criteria >> for transfer when there is a problem. If a midwife decides to work outside >> these guidelines then she is taking risks with the woman's health and also >> her own legal safety. >> >> The big advantage of the hospital based home birth service is that it will >> be free. Women who cannpt afford a private practitioner will not be >> excluded from having a home birth as happens now. THe people involved in >> setting up this service have vast experience of home birth in the UK and >> elsehwere and are dedicated to providing the best woman-centreds care they >> can. They wouldn't want anything else! >> >> We need this propject to go ahead, and quickly. At the moment we have no >> homebirth service that provides safety for the woman in terms of insurance >> and this is a worry for both women and their midwives. Let's all support >> this model rather than be trying to pick holes in it before the facts are >> known and it has even had a chance to be tried and tested! There are some >> very dedicated midwives out there who are trying to create the best birth >> options for women and they need out support. >> >> Regards, >> >> Andrea >> >> >> At 03:18 PM 29/11/2003, Jo Bourne wrote: >> >speaking as a consumer I would definitely view a public hospital run >> >homebirth service as a second choice to a private midwife that I chose >for >> >myself - partly because of the choosing the best personality for our >> >family an partly because I would be very frightened of the hospital >> >controlled service having far more rigid and beurocratic rules and >> >regulations about when OB care was required during pregnancy or when >> >transfer was required during labour. I would most likely spend the whole >> >pregnancy worried about the day that my assigned midwife said "well an OB >> >has reviewed your notes and says you have to birth in hospital" (for some >> >reason that I don't agree with). I was very fearful (at least at the > > >start) of my first pregnancy that I would be forced into labour ward for >a >> >reason I didn't agree with but was able to tell myself "they can make me >> >use the labour ward - they can't make me use the bed/drugs/whatever, its >> >all the same floor of the building and same staff so I just w! >> > on't let it bother me". I would find it much harder to think soothing >> > thoughts about being denied a homebirth at the last minute... I realise >> > that the risk of being denied a homebirth might be much less than I >think >> > but intellectual knowledge is somewhat separate from the intense >> > *feeling* of anxiety about my midwife not being her own boss and able to >> > use entirely her own judgement about appropriate care in my >circumstances >> > rather than a very rigid rule book. >> > >> >We don't know if we will be able to afford a private midwife in NSW if we >> >get pregnant here. We very much want a homebirth and are very near RHW so >> >I hope this service gets off the ground as we may need to use it - but I >> >do feel anxious about it as I didn't get the best impression of the >> >hospital/birth centre there when we did a tour. RHW seemed very hospital >> >rule oriented rather than woman centred. I came away with a sense of >> >inflexibility so I feel anxious that the same hospital will be running >the >> >homebirth service... For example StGeorge seem to have a far more >flexible >> >approach to postdates and breech presentation than RHW. I would not be >> >impressed to be forced to birth in hospital after 41 weeks or some other >> >arbitary date set by the hospital managing the homebirth service. I would >> >want to at least discus breech birth at home with my midwife and I know >> >many IPMs would be open to this, I feel certain a service run from RHW >> >would not only force a hospital birth but would! >> > be trying to force a ceaser. >> > >> >cheers >> >Jo >> > >> >At 12:02 -0800 29/11/03, Marilyn Kleidon wrote: >> > >Dierdre, Jo, Justine: >> > > >> > >Coming from another state I am a little confused by a few things: >> > > >> > >When would women who are having a planned home birth within these >models of >> > >midwifery care have to go to the hospital? Do they have to attend an >> > >antenatal clinic at the hospital? If so how often? >> > > >> > >Why do you consider this model of care obstetrics based rather than >> > >midwifery/woman centred care? >> > > >> > >Also, why would you consider having a high transfer rate >(hypothetically) >> > >from home to hospital birth being a reason for government funders to >knock >> > >back NMAP? Surely cost could not be the answer. Internationally and >> > >historically homebirthing actually gets into trouble when the transfer >rate >> > >is too low. Having trained in a homebirth midwifery school the mantra >of our >> > >senior preceptors to new grads was "better too many transfers than too >few". >> > >These were very wise words from wise women. The evidence does not say >that >> > >homebirth is safer than hospital birth it simply says it is as safe as >> > >hospital birth for low risk, healthy women (all under the caveat of >care >> > >with a known midwife). >> > > >> > >marilyn >> > > >> > > >> > >----- Original Message ----- >> > >From: "jo hunter" <[EMAIL PROTECTED]> >> > >To: <[EMAIL PROTECTED]> >> > >Sent: Friday, November 28, 2003 5:25 AM >> > >Subject: Re: [ozmidwifery] New models of midwifery care >> > > >> > > >> > >> I have to agree Deirdre. One of the huge advantages of homebirth with >an >> > >> independent midwife is that the woman has chosen and employed this >> > > > particular midwife as her caregiver. The midwife is a guest in the >> > woman's >> > >> home and is being paid directly from the woman, which in turn places >the >> > >> woman much more in control of what occurs during her birth. >> > >> Whilst I think it is wonderful that these homebirth models are in the >> > >> pipeline and it opens the homebirth option up to many more women, it >does >> > >> concern me, as women shouldn't need to go to hospital (ever during >> > >> pregnancy) to have a homebirth. >> > >> The midwives who will be working in the model may have little >experience >> > >of >> > >> the unique work of a homebirth midwife and I worry that there will be >a >> > >huge >> > >> transfer rate the minute something appears slightly out of the >ordinary >> > >and >> > >> when we lobby Govts some more for the NMAP, they'll look at the stats >of >> > >the >> > >> hospital run homebirth service and say no way, look at their transfer >> > >rate. >> > >> It doesn't mean this is necessarily going to happen, however it is >food >> > >for >> > >> thought. >> > >> Deirdre, if their is a hospital run homebirth service I know for a >fact >> > >that >> > >> the majority of (current) homebirthers in NSW will still want to >employ an >> > >> independent midwife, regardless of the cost, to be with them during >labour >> > >> and birth because many believe that they don't want it attached to a >> > >> hospital system and certainly don't want their births overseen by >> > >> Obstetricians. As well as those women who are seen as 'high risk' - >VBAC, >> > >> breech etc I assume they wouldn't be permitted to birth at home >through a >> > >> hospital run homebirth service. >> > >> I believe there needs to be strong consumer input to any model that >is set >> > >> up - lets listen to the women and find out what it is that they want. >> > >> Jo Hunter >> > >> >> > >> ----- Original Message ----- >> > >> From: "Dierdre Bowman" <[EMAIL PROTECTED]> >> > >> To: <[EMAIL PROTECTED]> >> > >> Sent: Tuesday, January 01, 2002 5:02 AM >> > >> Subject: Re: [ozmidwifery] New models of midwifery care >> > >> >> > >> >> > >> > While I think that it is TERRIFIC that homebirth will finally be >offered >> > >> as >> > >> > a choice. I think that the way midwives are compensated for this >work is >> > >> > important to look at. The system in NZ is somewhat dodgy where >payment >> > >is >> > >> > concerned. I would like to see funds made directly available to >parent >> > >so >> > >> > that they may choose and fund their own midwife, not one assigned >to >> > >them >> > >> or >> > >> > where couples only have the choice of recieving paid homebirth if >they >> > >> > choose the few midwives set up through these schemes. This has the >> > >> > potential to damage the livelihood of midwives currently working >> > >> > independently of the system. >> > >> > >> > >> > Any thoughts???????? >> > >> > >> > >> > Dierdre B. >> > >> > >> > >> > -- >> > >> > This mailing list is sponsored by ACE Graphics. >> > >> > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. >> > >> >> > >> >> > >> -- >> > >> This mailing list is sponsored by ACE Graphics. >> > >> Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. >> > >> >> > > >> > > >> > >-- >> > >This mailing list is sponsored by ACE Graphics. >> > >Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. >> > >> > >> >-- >> >Jo Bourne >> >Virtual Artists Pty Ltd >> >-- >> >This mailing list is sponsored by ACE Graphics. >> >Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. >> >> >> ----- >> Andrea Robertson >> Birth International * ACE Graphics * Associates in Childbirth Education >> >> e-mail: [EMAIL PROTECTED] >> web: www.birthinternational.com >> >> >> -- >> This mailing list is sponsored by ACE Graphics. >> Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > >-- >This mailing list is sponsored by ACE Graphics. >Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- Jo Bourne Virtual Artists Pty Ltd -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
