Re: [ozmidwifery] "Midwifery led units"

[Rachele Meredith]

----- Original Message ----- From: Vedrana Valčić   “Nick, I've had 30 years of experience and the disaster can come out of the clear blue sky in a patient who's been assessed as low risk and they happen in a heartbeat. They happen so rapidly that they are stunning.”   This is what we hear in Croatia as well. To my knowledge, this is true when there was a previous intervention, which interfered with the natural process. What is your opinion? What can one say to this? Vedrana,   I am not a midwife, "just" a consumer, but this is something I wondered myself when considering homebirth.  My father is a physician and my mum was an obstetric nurse and both had told me that in birth "when things go wrong they go wrong very quickly and you don't have 20 mintues to get to hospital".  I wondered what would happen if complications arose at home and these questions were answered very well by Marsden Wagner in his piece "Fish Can't See Water".  Apologies for the long quote but I feel he addresses the issue extremely well:   Many clinicians and their organizations continue to believe in the dangers of planned out-of-hospital birth, either in a center birth or at home, rejecting the overwhelming evidence that planned out-of-hospital birth for low risk women is safe. The clinician's response to this evidence is "But what if there is an out-of-hospital birth and something happens?" Since most clinicians have never attended an out-of-hospital birth, their 'what if' question contains several false assumptions. The first assumption is that in birth things happen fast. In fact, with very few exceptions, things happen slowly during labour and birth and a true emergency when seconds count is extremely rare and, as we will see below, often in these cases the midwife in the birth center or home can take care of the emergency. The second false assumption, that when trouble develops there is nothing an out-of-hospital midwife can do, can only be made by someone who has never observed midwives at out-of-hospital births. A trained midwife can anticipate trouble and usually prevent it from happening in the first place as she is providing constant one-on-one care to the birthing woman, unlike in the hospital where usually nurses or midwives can only look in occasionally on the several women in labour for which they are responsible. If trouble does develop, with few exceptions the out-of-hospital midwife can do everything which can be done in the hospital including giving oxygen, etc. For example, when a baby's head comes out but the shoulders get stuck, there is nothing which can be done in the hospital except certain maneuvers of the woman and baby, all of which can be done just as well by the out-of-hospital midwife. The most recent successful maneuver for such shoulder dystocia reported in the medical literature is named after the home birth midwife who first described it (Gaskin maneuver).[10] The third false assumption is there can be faster action in the hospital. The truth is that in private care the woman's doctor often is not even in the hospital most of the time during her labour and must be called in by the nurse when trouble develops. The doctor 'transport time' is as much as the 'transport time' of a woman having a birth center or home birth. Even when a caesarian section is indicated, it takes on average 20 minutes for the hospital to set up for surgery, locate the anesthesiologist, etc. and during this 20 minutes either the doctor or the birth center or home birthing woman are in transit to the hospital. This is why it is important for a good collaborative relationship between the out-of-hospital midwife and the hospital so when the midwife calls the hospital to inform them of the transport, the hospital will waste no time in making arrangements for the incoming birthing woman. These are the reasons there are no data whatsoever to support the single case, anecdotal 'what if' scenario used by some doctors to scare the public and politicians about out-of-hospital birth.   THe whole article can be accessed at http://www.acegraphics.com.au/articles/wagner03.html.  Incidentally, Marsden Wagner is the former head of Maternal and Child Health with the World Health Organisation.   Rachele