----- Original Message -----
Sent: Monday, December 01, 2003 7:15
AM
Subject: Re: [ozmidwifery] New models
of midwifery care
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 -----
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.
