Thank you! ----- Original Message ----- From: Andrea Robertson <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Saturday, November 29, 2003 6:53 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. 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