Just for 2 seconds can we focus on the big breakthrough in womens maternity care

[Salsa]

I am so pleased to hear this.
I found it very hard not having continuity of care with my last pregnacy. I dont think I saw anyone twice even the same ob! I was dealing with a vbac and continuity would have made a big difference to my stress etc.
having had my first baby in NZ I cannot believe how backwards Australia maternity system seems to be, so yes this is actually a big step forward! Yippee.

[~mamaspice~]

That's fantastic. One question - can you birth with that midwife in a private hospital or only public? Presume that in a private hospital you still have to have a designated (and paid for) ob - is that right?

And can you have both - so a midwife AND an ob (if you pay for it). Realise that sounds like overkill but I'd actually like both. Midwife to birth with me and ob to do any medical stuff that MAY be required. Would actually like to know both people before going to hospital and getting up the pointy end (so to speak).

Thats a great question Fiona,

I'd say you would definately still have to have your own OB.
Wouldn't it be great if you could have midwifery lead care at a private hospital though.

[~mamaspice~]

I am so pleased to hear this.
I found it very hard not having continuity of care with my last pregnacy. I dont think I saw anyone twice even the same ob! I was dealing with a vbac and continuity would have made a big difference to my stress etc.
having had my first baby in NZ I cannot believe how backwards Australia maternity system seems to be, so yes this is actually a big step forward! Yippee.

Thats exactly what has held me back from wanting to VBAC in the public system as there are no continuity of care options available in my region (apart from the birth centre which doesn't take on VBAC's). And that's why to me, the new legislation is so great

[fionas]

Yep, it shouldn't be toooooo much to ask to have TRUE continuity of care which in my book is having a relationship with everyone who is with you during labour and may deliver your baby. I wasn't very cluey last time so I went to a private obstetrician but now, I'm very, very happy with him and would trust him with my (and DS or DD's) life. But obviously he's not going to be there for the duration of the labour, hence I would also like to get to know a midwife. But I guess the best choice for me is a doula.

[~ Mylitta ~]

This sounds like a great improvement. I have Kyson in a private hospital and while my Ob was fantastic, I never once saw a midwife until I was in labour. It would have been nice to have known the people that were going to be with me while I was birthing my son, rather than a couple of strangers. That's not to say they weren't great, because they were, but it would have been nice to have known them beforehand.

[Visitor8]

that's great news A step forward is better than no steps at all

[Sagres]

Wow, thanks so much for posting this! I have been trying to find more information about this since I didn't understand the wording of the original media release, but this has confirmed what I had thought.
This is a great advance! I think it will allow more women to see a midwife for a straight forward pregnancy (exactly what they are best equipt for), leaving obs to deal with the more complicated/surgical situations (exactly what they are best equipt for).

[~mamaspice~]

This sounds like a great improvement. I have Kyson in a private hospital and while my Ob was fantastic, I never once saw a midwife until I was in labour. It would have been nice to have known the people that were going to be with me while I was birthing my son, rather than a couple of strangers. That's not to say they weren't great, because they were, but it would have been nice to have known them beforehand.

krystieLove, I sooo know what you mean. Especially considering the OB only pops in from time to time and then re-appears for the actual birth.

[Julie Doula]

I think it's brilliant that women will be able to access continuity of care with a self-chosen midwife, as per the NZ model. About time! This will be a real blessing for women who choose hospital care. BUT, this needs to include homebirth options as well as birth centre and hospital options. Not at the expense of independent home midwifery. We need an alternative to medically-managed birth, so we can choose which model suits us best.

[~mamaspice~]

I think it's brilliant that women will be able to access continuity of care with a self-chosen midwife, as per the NZ model. About time! This will be a real blessing for women who choose hospital care. BUT, this needs to include homebirth options as well as birth centre and hospital options. Not at the expense of independent home midwifery. We need an alternative to medically-managed birth, so we can choose which model suits us best.

I agree Julie, I just cannot understand why they cannot include HB services as part of the package. Especially with low risk women.

[Julie Doula]

Yeh, I don't like how they've appeared to give on one hand - but taken with the other.

I fear that even with the new continuity of care arrangements (which I think will be a great improvement - for mothers and midwives), if midwives are still controlled by rigid obstetric policy, they will still not be able to offer the true midwifery model as an alternative to the medical model. They'll end up functioning as obstetric nurses collaborating with a medicalised system. it will be very hard for them to really offer the midwifery model. I think they will not have much autonomy to function as professionals in their own right - just like most birth centre midwives are prevented by obstetric policy from offering women real midwifery care.

I think we need independent midwifery and independent birth centres so women can choose between the midwifey model and the medical model, and so midwives can choose to work within the obstetric framework or practice the midwifery model.

Continuity of care, although an improvement, won't help much if the midwives have their wings clipped by a hierarchy of medical control.

I know I'm saying this badly, but I do know midwives in NZ and UK have much more professional autonomy than here, and that midwives in USA are totally under the control of the medical hierarchy and are reduced to being obstetric nurses.

[SammyRo]

Prob a bit off topic, but I had this model in the public system with DD. I didn't get to choose my mw, but that didn't matter, as she was lovely and there was a great continuity of care - I had many of my appointments at home, and once my waters broke, she was happy to leave me for 4 days as long as she came over 2x a day, plus i montiored my temp (not that I needed it), I then gave birth to DD in the birth centre and was totally supported in our choices.

So its great that this model is going to be wider available...although, what i can't understand is, that if there is a fantastic option like this already available in the public system, why more women don't choose it. I obviously only know about my experience, but I felt that my mw whilst probably acting in line with policy, she was also acting in line with what we wanted - I know other hospitals will only let you go 24hrs after waters break, or only push for an hour before they intervene - my mw just let me go because whilst dd was taking her time, everything was fine (she finally appeared after 2 1/2 hours of pushing)

[Julie Doula]

it is normal for first time mothers to push for longer than an hour - up to 6 hours even. I though most hospitals allowed at least two hours? One hour for a first time mama is really draconian. She hardly gets a chance. 2 and a half hours sounds about average for a first timer. (Nice work, SammyRo!)

[Janie]

I know a midwife who now works here in Oz, but trained in Europe, and worked there for most of her career. She finds it difficult that she has less autonomy, and authority, in her work here. She has been known to sometimes go her own way, to give mothers a better chance of unhurried vaginal delivery . I think she is wonderful to do that, but it is sad that she has to do it underhandedly.

[SammyRo]

it is normal for first time mothers to push for longer than an hour - up to 6 hours even. I though most hospitals allowed at least two hours? One hour for a first time mama is really draconian. She hardly gets a chance. 2 and a half hours sounds about average for a first timer. (Nice work, SammyRo!)

THanks I was pretty chuffed! I'm just sad that this time we have moved and aren't in the catchment for the same hospital.

I've only heard this stuff from mothers groups and stuff, and I remember one mum at a diff hosp who was moved from the birthing centre to the labour ward after an hour. Although I could be mistaken. And another friend who went private who was only given about 4-6 hours once her waters broke before they induced her, and then about the same 4 hours after the induction before they took her off for a c-sect. But that was prob because the ob wanted to go play golf or something


I know the HB thing is still a huge issue, but for me, I am really happy that this type of mw care is being opened up to more people - having built that relationship with our lovely mw meant that we got the birth we wanted. But, as you say, it will probably come down to how much freedom they have to do they're job. And that will probably come down to how much respect they are afforded from the obs. doctors.