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
[ozmidwifery] Caesareans Put Next Child At Double The Risk of Stillbirth
This article appeared on page 3 of the Weekend Australian (29-30 Nov 03) - Food for thought in the VBAC/csec decision as this is potentially applicable to any woman who has a csec (1st or not) and then a subsequent pregnancy. Caesareans Put Next Child At Risk by Helen Tobler Medical Reporter Women who give birth to their first baby by caesarean section could have double the risk of an unexplained stillbirth in their next pregnancy.new research to be published today prompted experts to warm women to reconsider having a caesarean section if the procedure was not necessary.One in four Australian women give birth by caesarean - one of the highest rates in the developed world and higher than the World Health Organisation's recommendation of 15 per cent.A study of more than 120 600 second births in Scotland between 1992 and 1998 found the proportion of stillbirths in second pregnancies was almost double amont the women who had had caesareans.The risk of stillbirth was 2.4 per 10 000 per week among those who had had caesareans compared with 1.4 per 10 000 per week for those who had vaginal births.The researchers, whose study appears in The Lancet, said the link could be explained by damage to blood vessels in the uterus or placental abnormaliti! es caused by surgery.Head researcher Gordon Smith, from the University of Cambridge, said the results were unlikely to change the decision to have a caesarean for a breech baby."However if women are being counselled about caesarean birth with no clear obstetric advantage, such as caearean section for maternal request, the possible effect on the risk of unexplained stillbirth in future pregnancies should be discussed", he said.Michael Bennett, professor of obstetrics and gynaecology at the University of NSW and Sydney's Royal Hospital for Women, said most caesarean were done for health reasons.Professor Bennett said only 3 per cent to 5 per cent of women who have caesareans do so by choice."The majority don't actually have a choice," he said.The added risk of stillbirth that the study showed was "an extra tiny fraction" of the overall risks.Judith Lumley, director of the centre for study of mothers' and children's health at La Trobe Universi! ty worte a commentary for The Lancet."The finding that caesare an increases the risk of unexplained stillbirth before labour in the next pregnancy has the potential to redefine the nature of the debate about the place of caesarean delivery in maternity care."Hot chart ringtones and polyphonics. Click here -- This mailing list is sponsored by ACE Graphics. Visit to subscribe or unsubscribe.
Re: [ozmidwifery] New models of midwifery care
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
Re: [ozmidwifery] New models of midwifery care
Home birth within the NHS works well in the UK and in New Zealand with guidelines for practice that are in place to protect the Consumer and the Midwife providing services. This is an opportunity for Consumers and Midwives to access an alternative to the Birthing optuions available in Australia now, making informed decisions about their Birth choices .It should be embraced as a step forward in the right direction and a platform to develop an evidence based Midwifery service in Australia which includes choice of Home Birth, Domicillary Birth and Hospital Birth. Providing support for Comsumers and Midwives, negativity has no place here, it should be seen as a really positive option for women in NSW and would be welcomed here in QLD. Anne. - Original Message - From: Jo Bourne [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Saturday, November 29, 2003 2:18 PM Subject: Re: [ozmidwifery] New models of midwifery care 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
RE: [ozmidwifery] New models of midwifery care
Title: RE: [ozmidwifery] New models of midwifery care Dear Andrea, (Jo and Justine) To begin I am really concerned as a midwife and as a homebirth mother at the tone of this letter and feel I want to respond to some comments that have been made. It is really important that these questions are asked in order to have thought through as many possibilities as we are able, to end with the best solution. I welcome and encourage all of us to think about this move to hospital based homebirth. With this in mind I would like to raise my own personal perspective and concerns. Why are we modelling a service based on a UK model when we have a model that works here in Western Australia?? (I would be greatly distressed if our services homebirth rate was 43% I do acknowledge that given their high risk setting this may be adequate but the women that will be using this service will be screened as low risk.)The Community Midwifery Program has a homebirth rate of 72%!! Why is no-one looking to our own home grown homebirth service? To hear that a hospital based caseload midwife is no different from an independent midwife is a surprise to me. There great differences about an independent midwife who employed by a women and a hospital based midwife who is employed by a hospital. The greatest difference is who we work for. Surely a safe midwifery practice has it own guidelines for consultation and transfer? The possibility that this service is being set up to be guided/supervied by obstetrics is of great concern? (We have seen how this fails in birth centres that have high transfer rate in a medical climate that seems to wish our great birth centres to fail) Why not midwifery guidelines? A midwife should have midwifery guidelines. These do not automatically agree with obstetric guideline but does not mean that she is taking risks with the women's health! For example some midwives support VBAC at home.. this does not agree with obstetric guidelines but does not put a woman's health at risk or risk the midwives 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 I would like to point out that 'we' do have a free homebirth service that is community based, supported by state and federal funding and fully insured. We do have in now in Western Australia. Why are we not looking to our own. We have a model that has been tried and tested in Australia. Why are 'we' not looking to our own for information and support. The Community Midwifery Program has worked long and hard to maintain autonomous practice whilst working within agreed guidelines to provide free homebirth services. What political campaign is happening that we may end up with a hospital based homebirth service instigated by imported experts, supervised by obstrtic experts rather than the community based model established by local activist and midwives which is driven by midwifery models of best practice and women's needs. So there it is my personal perspective. I am supportive of government funding of homebirth but not at any cost. Sally Westbury Homebirth Mother/Activist since 1984 Homebirth Midwive since 1992
Re: [ozmidwifery] New models of midwifery care
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
RE: [ozmidwifery] New models of midwifery care
At 18:48 +0800 29/11/03, Sally Westbury wrote: Dear Andrea, (Jo and Justine) To begin I am really concerned as a midwife and as a homebirth mother at the tone of this letter and feel I want to respond to some comments that have been made. It is really important that these questions are asked in order to have thought through as many possibilities as we are able, to end with the best solution. I welcome and encourage all of us to think about this move to hospital based homebirth. With this in mind I would like to raise my own personal perspective and concerns. Why are we modelling a service based on a UK model when we have a model that works here in Western Australia?? (I would be greatly distressed if our services homebirth rate was 43% I do acknowledge that given their high risk setting this may be adequate but the women that will be using this service will be screened as low risk.)The Community Midwifery Program has a homebirth rate of 72%!! Why is no-one looking to our own home grown homebirth service? To hear that a hospital based caseload midwife is no different from an independent midwife is a surprise to me. There great differences about an independent midwife who employed by a women and a hospital based midwife who is employed by a hospital. The greatest difference is who we work for. Surely a safe midwifery practice has it own guidelines for consultation and transfer? The possibility that this service is being set up to be guided/supervied by obstetrics is of great concern? (We have seen how this fails in birth centres that have high transfer rate in a medical climate that seems to wish our great birth centres to fail) Why not midwifery guidelines? A midwife should have midwifery guidelines. These do not automatically agree with obstetric guideline but does not mean that she is taking risks with the women's health! For example some midwives support VBAC at home.. this does not agree with obstetric guidelines but does not put a woman's health at risk or risk the midwives 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 I would like to point out that 'we' do have a free homebirth service that is community based, supported by state and federal funding and fully insured. We do have in now in Western Australia. Why are we not looking to our own. We have a model that has been tried and tested in Australia. Why are 'we' not looking to our own for information and support. The Community Midwifery Program has worked long and hard to maintain autonomous practice whilst working within agreed guidelines to provide free homebirth services. What political campaign is happening that we may end up with a hospital based homebirth service instigated by imported experts, supervised by obstrtic experts rather than the community based model established by local activist and midwives which is driven by midwifery models of best practice and women's needs. So there it is my personal perspective. I am supportive of government funding of homebirth but not at any cost. Sally Westbury Homebirth Mother/Activist since 1984 Homebirth Midwive since 1992 -- Jo Bourne Virtual Artists Pty Ltd -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] New models of midwifery care
Hi Andrea, Thanks for you reply. As spokespeople for homebirthing families in NSW and Australia I believe it is our due to voice concerns of the very families who will be using this service. As I mentioned before I think it is wonderful that this is going ahead. As this will be the first of it's kind in NSW and will possibly set a precedence for the rest of Aus I believe we need to get it right the first time. It's not really good enough (as consumer representatives) to wait and see how this service is going to operate, consumers need to have a say in how it is going to operate and I applaud Pat Brodie for following up my request and offering a position on the steering committee for a HAS rep and I believe there is now an IPM on the committee as well and they will all have their say in outlining the various guidelines and protocols as required by NSW Health. I'm sure there are many different people all with different views on the committee and at the end of the day not everyone will get exactly what they feel is best way to go, however it is our right to have our say on how such a service is operated. As it is a service that will pride itself on midwives and women working together, it is only right that midwives and women work together to set it up. Jo Hunter - 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
Re: [ozmidwifery] New models of midwifery care
Title: RE: [ozmidwifery] New models of midwifery care Dear All I encourage all to have their say particuarly consumers with previous homebirth expereince. I concur with Sally and would add that I also am sad we are following a model from overseas when we have a unique Australian Model - a community based program established by midwives and consumers with the backing of doctors also but ones who understand that most women can manage fine on their own but more safely with a midwife they know and they have accepted. The English environment of birth is not that of Australia those who have worked there know that most of the doctors there also know and accept that women can birth fine with a midwife and they do not want to interfere or come till the midwife says!! Many of those UK obs who do not like the UK systemand want to deliver normal women come here!!In my expereince it is they and their colleagues who run our hospitals and our medical services. I understand Justine's fears having been in the offices of politicians across the country and having seen so many services withdrawn/restricted thru thepressures of 'others' when the outcomes are fine and the midwives and women are happy!! If we settle for less than NMAP or replication of CMP will Australian women be expected to ask for nothing else!! Some of the things I think consumers and midwives contemplating support of this service needto ask is how many of the women in this system will be 'allowed" to opt out of so many tests that I found were routine in NSW that few of the homebirth couples I have known refuse; eg; 12 or 20 week ultra sounds GTT GpB strep testing genetic testing if an "eldery" primip or multip How long will they be allowed to stay home with ruptured membranes? How long past 40 weeks will they be allowed ?? Births with no VE with labours of 8 or more hours?? Vitamin K What of the Hep B other immunisations?? When they refuse the giudelines will their midwives be withdrawn ?This is not the UK no health service is obliged to provide a midwife for a woman who refuses to come to hospital?And what of the midwife who wants to support a woman who does not want to follow giudelines?? CMPis the subject desire of NMAP. CMPhas better outcomes than Albany, CMP is run by women and midwives, in our culture of birth interventions domination with no other optionsI feel we can ill afford to settle for less as a first option? Denise Hynd - Original Message - From: Sally Westbury To: [EMAIL PROTECTED] Sent: Saturday, November 29, 2003 6:48 PM Subject: RE: [ozmidwifery] New models of midwifery care Dear Andrea, (Jo and Justine) To begin I am really concerned as a midwife and as a homebirth mother at the tone of this letter and feel I want to respond to some comments that have been made. It is really important that these questions are asked in order to have thought through as many possibilities as we are able, to end with the best solution. I welcome and encourage all of us to think about this move to hospital based homebirth. With this in mind I would like to raise my own personal perspective and concerns. Why are we modelling a service based on a UK model when we have a model that works here in Western Australia?? (I would be greatly distressed if our services homebirth rate was 43% I do acknowledge that given their high risk setting this may be adequate but the women that will be using this service will be screened as low risk.)The Community Midwifery Program has a homebirth rate of 72%!! Why is no-one looking to our own home grown homebirth service? To hear that a hospital based caseload midwife is no different from an independent midwife is a surprise to me. There great differences about an independent midwife who employed by a women and a hospital based midwife who is employed by a hospital. The greatest difference is who we work for. Surely a safe midwifery practice has it own guidelines for consultation and transfer? The possibility that this service is being set up to be guided/supervied by obstetrics is of great concern? (We have seen how this fails in birth centres that have high transfer rate in a medical climate that seems to wish our great birth centres to fail) Why not midwifery guidelines? A midwife should have midwifery guidelines. These do not automatically agree with obstetric guideline but does not mean that she is taking risks with the women's health! For example some midwives support VBAC at home.. this does not agree with obstetric guidelines but does not put a woman's health at risk or risk the midwives 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
Re: [ozmidwifery] New models of midwifery care
Title: RE: [ozmidwifery] New models of midwifery care Hi Denise and others: I have a couple of questions re the comparison of the Albany UK program and the WA CMP program: isn't the CMP program targeted to low risk women who desire to birth out of hospital ie at home or in the available hospital birth centres? Doesn't the Albany program accept all women in their area regardless of risk status or venue of birth? Thus a 43 % homebirth rate for this group could more reasonably be compared to the homebirth rate of the community at large as it is NOT reflecting a transfer rate. The CMP rate of 73% homebirths (does this include birth centre births?) could be assumed to reflect a transfer rate of 27% during pregnancy and birth for the group, not an unreasonable transfer rate ate all but not comparable with the Albany group because they are measuring different things. My other question regarding using the CMP model vs the Albany one is that aren't you having funding problems in WA? Isn't remuneration of midwives and insurance an issue? Could this be why the Albany model is being used: the finding model is more similar? I don't know, I feel like I am shooting in the dark asking these questions. Regarding practice guidelines, procedures and protocols how do these differ between the two groups? From my reading across the international literature these are very very similar for homebirth groups with good safety records be they the Netherlands, Canada, Washington or California, USA, UK or Australia. Because women get risked out of homebirth does not make a model obstetric based, just based on sound midwifery care. Yes, some high risk women will go on to have normal vaginal births with no complications,I don't think that means they should birth at home. marilyn - Original Message - From: Denise Hynd To: [EMAIL PROTECTED] Sent: Saturday, November 29, 2003 8:17 AM Subject: Re: [ozmidwifery] New models of midwifery care Dear All I encourage all to have their say particuarly consumers with previous homebirth expereince. I concur with Sally and would add that I also am sad we are following a model from overseas when we have a unique Australian Model - a community based program established by midwives and consumers with the backing of doctors also but ones who understand that most women can manage fine on their own but more safely with a midwife they know and they have accepted. The English environment of birth is not that of Australia those who have worked there know that most of the doctors there also know and accept that women can birth fine with a midwife and they do not want to interfere or come till the midwife says!! Many of those UK obs who do not like the UK systemand want to deliver normal women come here!!In my expereince it is they and their colleagues who run our hospitals and our medical services. I understand Justine's fears having been in the offices of politicians across the country and having seen so many services withdrawn/restricted thru thepressures of 'others' when the outcomes are fine and the midwives and women are happy!! If we settle for less than NMAP or replication of CMP will Australian women be expected to ask for nothing else!! Some of the things I think consumers and midwives contemplating support of this service needto ask is how many of the women in this system will be 'allowed" to opt out of so many tests that I found were routine in NSW that few of the homebirth couples I have known refuse; eg; 12 or 20 week ultra sounds GTT GpB strep testing genetic testing if an "eldery" primip or multip How long will they be allowed to stay home with ruptured membranes? How long past 40 weeks will they be allowed ?? Births with no VE with labours of 8 or more hours?? Vitamin K What of the Hep B other immunisations?? When they refuse the giudelines will their midwives be withdrawn ?This is not the UK no health service is obliged to provide a midwife for a woman who refuses to come to hospital?And what of the midwife who wants to support a woman who does not want to follow giudelines?? CMPis the subject desire of NMAP. CMPhas better outcomes than Albany, CMP is run by women and midwives, in our culture of birth interventions domination with no other optionsI feel we can ill afford to settle for less as a first option? Denise Hynd - Original Message - From: Sally Westbury To: [EMAIL PROTECTED] Sent: Saturday, November 29, 2003 6:48 PM Subject: RE: [ozmidwifery] New models of midwifery care Dear Andrea, (Jo and Justine) To begin I am really concerned as a midwife and as a homebirth mother at the tone of this letter and feel I want to respond to some comments
Re: [ozmidwifery] New models of midwifery care
Sally I agree thoroughly. I am very excited to think the NSW government have come far enough to give this ago. There is no doubt this is a huge step and I commend the midwives involved for their role in facilitating such a service, however, I too have grave concerns about this service. I have many times before heard of services directed by obstetric guidlines that firstly, prevent women from taking part who are considered high risk but who otherwise (with the help of an independent midwife) can birth quite safely at home. I know, I'm one of them. The Western Australian model has a lot going for it and we should be using a home grown working model instead of looking over seas to models that inlots of cases lead to 'medical models in the home'.In Holland the midwife is the primary care giver and she is responsible for refering the woman to an obstetrician if problems arise or the woman has conditions which are not favourable to birthing at home. I have my doubts that the proposed system will work in any way like that but will be extremely controlled by the medical protocols that are put inplace. Idon't want to be negative about such a positive advance but I agree with Sally. What is the point of starting aservice that sets wrong standards. And are we not taking the choice away from women again by dictating who can do what?? When are we going to start asking them what they want instead of telling them all the time. It's worth thinking about. Dierdre B.
Re: [ozmidwifery] New models of midwifery care
Bravo Denise, My sentiments exactly. I too have clients that refuse a lot of what you have said, I can't imagine they would fit into this scheme either. Dierdre B.
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.
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 - 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
