Would you give birth in a midwifery led unit?

[Novella]

I had planned on having my daughter in a midwife led unit however I was only 36 weeks when I went into labour however the birth was managed by my midwife with a neonatologist there to review my daughter after the birt.

For low risk pregnancys I beleive midwife led care during pregnncy, birth and postnatally should be an available option. I am going through the birth centre again this time. I want as minimal intervention as possible.

I feel that obstertricians have an important role in pregnancies with medical complications.

juju300 - if you are discussing statistics/studies many studies have been done that show low risk pregnancies and home birth is equally as safe if not safer than hospital birth for low risk pregnacies. Maternal and neonatal death rates are the same or higher for low risk pregancies in hospital compared to homebirths attended by qualafied midwives. I beleive that there is a place for obstertricians and that is in the hospital attending women who have medical complications of pregnancy.

I hope kelly doesn't mind but here is a link of one such article
Outcomes of planned home births with certified professional midwives: large prospective study in North America -- Johnson and Daviss 330 (7505): 1416 -- BMJ
there are many more if you choose to google the topic.

I think women should have the right to choose where they birth by being given accurate information.

I am a nurse and I think there are times when I see the worst outcomes of an illness and it skews my preception as I don't see the x number of people with really good outcomes as they don't need my assistance.

[JuJu300]

While the United States reports every case of infant mortality, it has been suggested that some other developed countries do not. A 2006 article in U.S. News & World Report claims that "First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country." [2] However, all of the countries named adopted the WHO definition in the late 1980s or early 1990s.[2]

Historically, until the 1990s Russia and other countries of the former Soviet Union did not count as a live birth or as an infant death extremely premature infants (less than 1,000 g, less than 28 weeks gestational age, or less than 35 cm in length) that were born alive (breathed, had a heartbeat, or exhibited voluntary muscle movement) but failed to survive for at least 7 days.[3] Although such extremely premature infants typically accounted for only about 0.005 of all live-born children, their exclusion from both the numerator and the denominator in the reported IMR led to an estimated 22%-25% lower reported IMR.[4] In some cases, too, perhaps because hospitals or regional health departments were held accountable for lowering the IMR in their catchment area, infant deaths that occurred in the 12th month were "transferred" statistically to the 13th month (i.e., the second year of life), and thus no longer classified as an infant death.[5]

Another challenge to comparability is the practice of counting frail or premature infants who die before the normal due date as miscarriages (spontaneous abortions) or those who die during or immediately after childbirth as stillborn. Therefore, the quality of a country's documentation of perinatal mortality can matter greatly to the accuracy of its infant mortality statistics. This point is reinforced by the demographer Ansley Coale, who finds dubiously high ratios of reported stillbirths to infant deaths in Hong Kong and Japan in the first 24 hours after birth, a pattern that is consistent with the high recorded sex ratios at birth in those countries and suggests not only that many female infants who die in the first 24 hours are misreported as stillbirths rather than infant deaths but also that those countries do not follow WHO recommendations for the reporting of live births and infant deaths.[6]

Another seemingly paradoxical finding is that when countries with poor medical services introduce new medical centers and services, instead of declining the reported IMRs often increase for a time. The main cause of this is that improvement in access to medical care is often accompanied by improvement in the registration of births and deaths. Deaths that might have occurred in a remote or rural area and not been reported to the government might now be reported by the new medical personnel or facilities. Thus, even if the new health services reduce the actual IMR, the reported IMR may increase.

[edit] Global infant mortality trends

[JuJu300]

While the United States reports every case of infant mortality, it has been suggested that some other developed countries do not. A 2006 article in U.S. News & World Report claims that "First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country." [2] However, all of the countries named adopted the WHO definition in the late 1980s or early 1990s.[2]

Historically, until the 1990s Russia and other countries of the former Soviet Union did not count as a live birth or as an infant death extremely premature infants (less than 1,000 g, less than 28 weeks gestational age, or less than 35 cm in length) that were born alive (breathed, had a heartbeat, or exhibited voluntary muscle movement) but failed to survive for at least 7 days.[3] Although such extremely premature infants typically accounted for only about 0.005 of all live-born children, their exclusion from both the numerator and the denominator in the reported IMR led to an estimated 22%-25% lower reported IMR.[4] In some cases, too, perhaps because hospitals or regional health departments were held accountable for lowering the IMR in their catchment area, infant deaths that occurred in the 12th month were "transferred" statistically to the 13th month (i.e., the second year of life), and thus no longer classified as an infant death.[5]

Another challenge to comparability is the practice of counting frail or premature infants who die before the normal due date as miscarriages (spontaneous abortions) or those who die during or immediately after childbirth as stillborn. Therefore, the quality of a country's documentation of perinatal mortality can matter greatly to the accuracy of its infant mortality statistics. This point is reinforced by the demographer Ansley Coale, who finds dubiously high ratios of reported stillbirths to infant deaths in Hong Kong and Japan in the first 24 hours after birth, a pattern that is consistent with the high recorded sex ratios at birth in those countries and suggests not only that many female infants who die in the first 24 hours are misreported as stillbirths rather than infant deaths but also that those countries do not follow WHO recommendations for the reporting of live births and infant deaths.[6]

Another seemingly paradoxical finding is that when countries with poor medical services introduce new medical centers and services, instead of declining the reported IMRs often increase for a time. The main cause of this is that improvement in access to medical care is often accompanied by improvement in the registration of births and deaths. Deaths that might have occurred in a remote or rural area and not been reported to the government might now be reported by the new medical personnel or facilities. Thus, even if the new health services reduce the actual IMR, the reported IMR may increase.

[La pachamama]

The government doesn't actually "have" any money. There seems to be some confusion about this in general. It all comes out of each other's back pockets, and once it has trickled through the red tape and excessive madness of bureau-crazy, it ends up costing a lot more than it should. We never know the true cost of government funded medicine, but I'm going to hunt it down one day and shock everyone. How much are you really paying?

Why do midwives have to be a government funded option? I might be all over a private midwife in a home-birth situation (I voted undecided on this poll for this reason), but as a choice I would never, ever expect anyone else to pay for it.

Public hospitalisation is there for emergencies. A home birth option doesn't fall under the emergency umbrella no matter how you view it. It just doesn't.

Yes, I know how well received a libertarian's opinions are when it comes to health care ... but

kuraiza, you sound just like my DH - true libertarian. Me on the other hand, I figure that if we have to pay tax and have public health care (because that seems to be the way the majority want to go) why not give people options when it comes to birthing? After all, it is our tax money.

[awhite2306]

Um - why isn't there an option to have both an OB and midwives working together for patient care? Why does it need to be a turf war?

[JuJu300]

Libertarian Party | Smaller Government | Lower Taxes | More Freedom

That is pretty funny that you gather me for a libertarian from my postings. I'm not sure if you know what a Libertarian is then. I'm assuming when you said we pay tax that you meant taxes. I think it would be great for everyone to be able to seek medical care where ever they like. Unfortunately, we are having a hard enough time covering the medical cost of sick children and adults in this country. We have a long ways to go to get to that point. I think it would be great if doctors and mid-wives worked together for the best optimal care of mother and baby. I still would choose to have my baby in the hospital. Some mid-wives will go to the hospital with you.

[La pachamama]

Libertarian Party | Smaller Government | Lower Taxes | More Freedom

That is pretty funny that you gather me for a libertarian from my postings. I'm not sure if you know what a Libertarian is then. I'm assuming when you said we pay tax that you meant taxes. I think it would be great for everyone to be able to seek medical care where ever they like. Unfortunately, we are having a hard enough time covering the medical cost of sick children and adults in this country. We have a long ways to go to get to that point. I think it would be great if doctors and mid-wives worked together for the best optimal care of mother and baby. I still would choose to have my baby in the hospital. Some mid-wives will go to the hospital with you.

JuJu my post was directed to kuraiza, I wrote her name at the beginning of my post to indicate this. I was not responding to your post.

[Olive]

Um - why isn't there an option to have both an OB and midwives working together for patient care? Why does it need to be a turf war?

isnt this what happens in private hospitals everyday?
midwives do teh work, the ob blows in delivers the baby, cuts the cord and collects a few thousand dollars for the privledge? thats if they even make it, in that case the still collect their thousands!

[River]

I would prefer to be in the hospital system. After 2 inductions for high BP, three retained placentas and one very significant haemorrage, I am safer in that environment. Although my last birth didn't have a doctor present, I was solely in the care of the midwife (and no retained placenta ).

However I am a capable woman and I am able to stand up for my rights and desires to the doctors. I don't get bullied .

I wonder if 10% is reflective of the BellyBelly membership?

Of course it isn't LOL. It would never be reflective of a gentle birthing community whose ideals are skewed the other way.

[vona]

I chose a midwife run birth centre. It was the best for US. The thing I cherish most about being an Australian is we have a choice. Lose that and we lose control over our bodies, pregnancies and birth's.
I needed to be transferred to the hospital after the baby was born. If we decide to have another we will choose the birth centre again.

[BellyBelly]

Until medical intervention was available a lot of woman and babies died during child birth. Yes, it's something that is natural your body does, however, it isn't without very high risks involved that need medical interventions in some cases.

But its also very well known that deaths at birth prior to obstetric care were due to bad nutrition and that has also changed. Also, it was safer giving birth with a midwife than an obstetrician who were new to the scene.

Also, with mortality rates, check out the new zealand stats. The rates actually reduced when they introduced midwifery led care again. You have Obs in the USA who believe that there is too much intervention at birth in the USA leading to these deaths!

I'm sorry, but I don't buy it. Obstetrics CAN save lives, but what is done to normal healthy women results in the NEED to save a baby, when if those inductions/interventions weren't done in the first place, there wouldn't have been a need to save a baby.

Yet the profession blames women for the skyrocketing c/s rates well above WHO levels. Shame on them. It's all about the women isn't it! 'Failure to progress' and other labels - shame on us faulty women!

River, our ideals are not skewed. We choose to be informed and find out more BASED ON STUDIES, FACTS and EVIDENCE. Alot more than many women are realising they need to do.

[Freya]

Having been a mother who delivered with both options (first hosp birth was only midwives as OB didnt make it and 2nd was OB & midwife) I voted yes I would. I dont think midwives give any less care and Im starting to realise that OB's charge a ton of money to women who in the end dont even need an OB there. My OBs did just about nothing for the $$$ I forked out (I was happy with their treatment though, great OBs) and the midwives did all the medical stuff.
So Im going to a birth centre this time round and ditching the OB option unless neccesary.

Half the problem nowdays is people tar all OBs and all midwives with the same brush when in every bunch there are going to be bad apples, including some dodgy midwives. I think the focus needs to be more on empowering women to make informed choices about their births. Maybe compulsory classes run by unbiased people about pro's and con's of all birth procedures, what options and rights birthing women have and maybe some personal stories from women who've given birth in every manner. Id certainly have attended as a first timer.

Funny side note - I had Dr Mourik as a locum for my OB that delivered baby #2 in Wodonga at the start of the year. Nice guy but very old school.

[Janie]

Gosh, I must be very lucky. Our Ob gave us enormous amounts of his time, which I expected (yes, that's what you pay for). I was pretty aware that was his way, as he has been my gynae for 10 years. I went into labour on a Saturday night, and although he was rostered off that night, the midwives must have called him, because he was at the hospital within 20 minutes of me arriving. He spent a little time with me then, but once things were really under way he did disappear for awhile. But I remember him coming to check how I was going (just watching me, no exams) a number of times, and by the time I had gone into my (lengthy) second stage he was there for good. Again, not bothering me, just observing how things were going.

So no Ob blowing in for the last push here, I would very annoyed if that's the treatment I received! I am happy to be pg, and birth under his care again, but if I couldn't have him as my Ob for some reason I would be rethinking my options........

[SunnyRain]

isnt this what happens in private hospitals everyday?
midwives do teh work, the ob blows in delivers the baby, cuts the cord and collects a few thousand dollars for the privledge? thats if they even make it, in that case the still collect their thousands!

That isn't really fair. I'm a bit concerned about the number of people who appear genuinely afraid of doctors in this thread. They aren't the boogey man. As a daughter of a surgeon I can assure you that the vast majority of surgeons are very serious about patient care. They can have their arses sued off at the drop of a scalpel, for one thing, but they are generally quite principled people. Obstetricians have a bad time fighting off the stigma that they are too eager to perform unnecessary c-sections or get out their forceps. This isn't the case. Surgery is risky. Patients die on operating tables in the most simple operations. Doctors don't like killing patients.

In my antenatal class I asked an innocent question "At what stage during labour does the obstetrician enter the picture?" The midwife running the class became immediately defensive and started barking that midwives are perfectly capable, as if I had mortally wounded her. God forbid I ask a midwife any question she doesn't like ... she'll tear my head off! Luckily I've also met nice midwives who are reasonable and intelligent and don't get skittish at the mere mention of an obstetrician.

Um - why isn't there an option to have both an OB and midwives working together for patient care? Why does it need to be a turf war?

This does work in the private system. I have an Ob I meet with regularly and he's lovely. He works closely with a midwife who takes his patients when he is unavailable (like on holidays or at a conference). She is great, too. They seem to have a good working relationship with each other.

kuraiza, you sound just like my DH - true libertarian.

It's all very clear to us libertarians how crap the system is. It won't be long before I'm a full-blown anarchist. The more I hear about people "expecting" free health care and saying things like "I would never pay to look after my body and the life of my unborn child, although I'm perfectly happy to spend $120 every 6 weeks on a hair cut and dye ..." Bleh!

A question for everyone: What is a low-risk pregnancy?

My sister had a low-risk pregnancy, but around her due date she went for a routine visit with her Ob and they discovered the umbilical cord was wrapped 3 times around the baby's neck and was stretched over his face cutting off his blood supply, so she was suddenly booked in for an emergency c-section. Without that meeting with her Ob, her baby would have died. So there you go, no such thing ... all pregnancies are risky. We should all be able to choose for ourselves what risks we're prepared to take, but again I stress the importance of not expecting others to pay for the risks we take.

[~Kate~]

Also you have to understand in midwifery led care its completely different to hospital midwives who work in shiftwork. I think because so many women don't understand midwifery led care because so little get to have it (i.e. small team of midwives and knowing one of the few who will be with you, seeing them at each visit). Nothing like hospital midwifery.

Ipswich hospital has the 'normal' hospital midwifery as well as the midwifery model of care. Like I said I was unfortunate enough to miss out by just a few months. I love the fact that you continue on with one midwife throughout the pregnancy as it creates a special bond that makes the birth so much more relaxed

[Freya]

I just wanted to comment to that although Wodonga Maternity has mixed reviews on its care I had no problems delivering there. They are a bit csection happy, with public or private patients, and they have no options for VBAC's which is a bit disappointing.

I had a fabulous midwife who was with me from the moment I came in til a few hours after I delivered. My OB started the induction and then went back to his surgery to see patients. We had already discussed the fact that he may not make it in time because I have fast births so we were both satisfied that the midwife would be just fine for delivery. I never had an internal after the initial one, I was allowed to push when I felt it was time. I couldnt have asked for better care from either one.

ETA - Kuraiza, your right about that, there is no truly low-risk pregnancy as no two pregnancies are the same. BUT I truly feel that you can gain a better perspective of whether a woman has any risk or not by previous deliveries. I deliver quite easily, never had any retained products, tearing, haemhorraging, fetal distress etc so its fair to say after 2 such deliveries Id be very unlikely to have any of these complications OR need intervention/csection. Obviously Id never say never but I would not want to be treated as high risk if there was no real need.

[tuckers daughter]

Went with total midwife care for second child and I am going back to the standard hospital option for my third. I don't really understand the argument. Midwives do all the work during birth anyway. The only time you ever seem to see a doctor in a public hospital is if complications arise and then it is a very welcome thing.
The problem I encountered was with the midwife care during pregnancy. There was no consistency, according to the midwives my baby shrunk a number of times during pregnancy, mainly because different midwives take their measurements from different places. It is most disconcerting to be told your child has shrunk between seven and eight months, their attitude was very casual.
I was induced with my first after going 11 days over. When 2 weeks late with my second we were sent to see the big pooh ba midwife who said not to worry cause African women often go to 43-44 weeks, it is obvious by my apearance that I am not African. I was 3 weeks over when we demanded to be induced, the placenta was stuffed and their casual removal technique meant they lost the placenta and had to do a manual removal without gloves. I would have welcomed a doctors intervention.
It seems to me that so much of this demand for midwife only care has some political motivation. Our grandmothers fought hard so that women could have access to proper medical during birth, we seem to be going backwards. We have a great public hospital system in this country, why snub it?
For my first child I had a wonderful young woman doctor and will be seeking same with my third.

[Mumma2three]

The reason I prefer midwives is not because I think Ob's like to interfere. Mine is purely because I feel more comfortable with a woman. Saying that I had a WONDERFUL male midwife last time whom made me immediately comfortable. It's just with the OBs they seem so serious (my two have done anyway). I am more than happy for the midwife to be there and the Ob to run in to catch the bub! But I definitely did not feel in anyway that my first Ob was interferring at all. It was all up to me. And this time (number 3) different Ob, it will all be my decision regardless of what he wants. But I have heard he's very open to whatever a woman wants which I think is great.
I also remembered that at my first birth I had the most gorgeous midwife, but she went off shift and I got a "not so happy midwife" next! If I could gaurantee the nice midwife then I'd be really happy!! (but often in team midwife its' the luck of the draw which of the 6 or so comes in for the birth, whoever is on call)!

PS Tuckers daughter, SAME thing happened to me, midwife said DD had shrunk and I was rushed off (in total fear and panic) for an u/s. All was fine. However with my first OB he told me I had gestational diabetes and I was treated for it for entire pregnancy, but I didn't have it. He had gone on first reading and NOT sent me on to the second test..........so either way I guess there is going to be something!! (funny how I forgot all the bad ....)

PPS Kuraiza,, my step sister was considered low risk too as she was 23 and had one healthy bub, but because of absolute hospital neglegence, they said not to bother with u/s because of low risk and it turned out baby was severely brain damaged and if she had birthed bub she would've died. They only discovered this after SHE complained of something "not right", and they had to terminate at 38weeks. Absolutely SHOCKING........ I shudder to think of her going to 40 weeks and delivering in her "low risk" environment...