Re: [ozmidwifery] New models of midwifery care

[Marilyn Kleidon]

Diedre: Were you replying to me? Obviously the inclusion of vbac women as high risk is controversial, I specifically did not list risk factors because the debate can get very very long and somewhat emotional. Just for the record, I have supported many many women both at home and in hospital to vaginal births after c/s and personally do not consider this a high risk labour or pregnancy. I totally understand a woman not wanting to birth in a hospital after having prior c/s. However, I do think consumers have to try to be sensitive to the current insurance climate. I know that is hard especially if you feel confident you are prepared to take the risks if the unimaginable happens. But is not you who will be sued if it does(though you pay a horrible price), it is your care provider and she will be  sued by the authorities regardless of your intent. When I was in seattle  the practice I worked in went from attending vbac at home to attending in hospital in 2001. This was contentious at first, but the success rate was the same as before and the women still had their known midwife; we went with them and managed the birth in the hospital with early discharge. Yes it sucks but it can and does happen and is still midwifery care. Our clients were not strapped to monitors and they birthed in any position etc.. Our practice had hospital privileges. In the state of Washington all childbearing women and their children were govt funded for health insurance, so all women could choose homebirth: 2% did, midwives contracted with health insurance companies to be preferred providers and you had to have insurance (also provided/underwritten by that state)to be eligible.  Our transfer rate varied between 10 and 20%: higher if we were attending more primips.   And yes there were 2 serious attempted homebirth vbac's in the seattle area  from 1996 to 2000 that went horribly wrong, both involved midwives and clients (clients sought out the particular midwives who would push the limits) who had pushed the limits of good midwifery care. Everyone involved paid dearly. I did not work with either of these practices but I had a dear friend who did.   Take a look at the guidelines etc. for midwifery care in the Netherlands, it is quite rigorous the definition of what is normal and it is my understanding that if the midwife says it is time to go to the hospital, there is no negotiation, you go. It has been said many times this is not Holland, clearly it isn't. Yes midwives in the Netherlands, Canada, NZ, and yes the USA (don't know about the UK) do have prescriptive privileges, the ability to order their own path tests, ultrasounds etc., in other word they are autonomous practitioners, to change this I think you need to lobby for legislative changes, these programs in NSW are working within current legalities.   I do think it will be truly sad if these innovative programs are stopped before they get off the ground. Midwives who a confident and competent to attend births at home should not be restricted to opening their own business, it should be a choice for them too. They should not have to put their livelihoods at risk by practising without insurance. It is this insurance issue that has led midwives to creating these innovative programs. At least that is what i thought. Consumers should be able to have a homebirth on medicare either through a hospital midwifery service or an independent midwife duely accredited to receive a rebate. And if both of those are unacceptable to them, then they can pay independently for the care giver of their choice. And many more shoulds.    Personally i don't think any healthcare practitioner working for a government health service should have to make healthcare decisions based on anything but best practice. Unfortunately we have accepted cost accounting into healthcare and many health decisions are based on cost not best practice/evidence based care.   regards marilyn ----- Original Message ----- From: Dierdre Bowman To: [EMAIL PROTECTED] Sent: Saturday, November 29, 2003 3:05 PM Subject: Re: [ozmidwifery] New models of midwifery care I was one of those women who went on to birth vaginally after 2 previous c/s.  I was told, absolutely not, I would not be able to have a vaginal birth.  If I had not had a supportive midwife with skills that aren't taught in medical or midifery school, skills that come by attending women who believe they can birth and work hard at achieving that dream, then chances are really high I would not have had a vagainal birth.  I think this issue is much greater than who should or who shouldn't. It's about informed choice. About women knowing all the risks and being prepared to accept responsibility.  I don't think what I did was dangerous, but many would have at the time. The support and faith my midwife gave and had in me changed who I am as a person. How we birth can affect much of lives and how we live it. I've seen it over and over.   Stop regulating and start educating!!!!!!!   Dierdre B.