Would you give birth in a midwifery led unit?

[Rouge]

I think what we are talking about here, is not having an Ob as part of your pregnancy or birth, not being part of a hospital per-say but giving birth at a standalone birthing unit (like a birth centre) but instead of being affiliated with a hospital they are independent and your entire pregnancy and birth is monitored and cared for solely by midwives. In a hospital (even public) you are still monitored by an Ob. And given the amount of politics and closures with our current birthing centres an independent midwifery centre would be more successful and less likely to close without big guns putting the pressure on because they are associated with a specific hospital. In the US they have centres like this where women can experience a low interventional birth (don't get me wrong I'm not saying the system there is perfect but there are a handful of independent midwifery led birthing centres, which is something I think we lack here).

Its great that people have faith in our medical system, and its great that women have had good experiences. I too had an awesome private hospital birth. But having said that I would have loved an option like this, and I think thats the whole point women should be allowed to have this as a choice.

[fionas]

I just want continuity of care. No-one can predict whether they will need an ob for the birth or not. So I'd be happy to see midwives during my pregnancy but also want to see an ob a few times not because it's medically necessary but because I want the chance to build up a trusting relationship should I need that ob for interventions at the birth.

As it was, I saw a private ob for my pregnancy. When I went into labour, I wasn't comfortable with any of the midwives - probably because I didn't know them from a bar of soap. I needed forceps and I was mighty glad that I had MY ob there because he was a friendly face, I knew him and trusted him. But in an ideal world, I would have known the midwives too. I think having people that you trust there for the birth is crucial but at the moment the models of care force you to choose between continuity of care from midwives versus obs and I think that's a bit stuffed.

I don't want to go to a birthing centre. Don't get me wrong, I think they probably provide a brilliant environment and support for birth but I hate, hate, hate the idea of transferring to hospital should I need to. Yes, I know that might only be through some double-doors down the corridor but I just don't like that idea. I just want to stay in one place.

[River]

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.

Of course they are skewed. That's not a bad thing, it's just not indicative of the general population. Many people are informed, find out more based on studies, facts and evidence and come to the conclusion directly opposite to those formed with the members of this site. And that's okay too.

And yes, ideals are skewed on here. When you have a comment like this:

But its also very well known that deaths at birth prior to obstetric care were due to bad nutrition and that has also changed.

you realise that it is a very skewed POV. Deaths at births prior to obstetric care were not due to bad nutrition. This is not very well known at all. Even the WHO say that 10-15% of all births will REQUIRE a c-section to save the life of mother and/or baby. Nutrition is not an issue here. Birthing can be dangerous.

This means that 1-2 of EVERY 10 women will NEED a c-section. There would be a percentage also who would NEED an assisted delivery. This is a fact and figure that is undisputed. Doesn't matter how well nourished she is or how well informed she is.

Yes, birth is natural and our bodies are built for it, but it's still dangerous. It's dangerous in all animals (of which we are one).

My dog almost died during birth - good thing we rushed her to the vet for an emergency c-section - but the homebirth almost killed her, one of her puppies died from brain damage due to lack of oxygen. She couldn't feed her puppies so they were put straight on formula.

Happens all over the animal kingdom. It's no different for women. But with people it's not okay to casually accept a death as being part of the circle of life. We need to be more careful with people.


Anyway, I wasn't saying it was a bad thing, only that it was a thing .

[tuckers daughter]

^^^ The nutrition claim is a strange one considering that in colonial times Australian women boasted a high level of nutrition compared to the rest of world. Growing and birthing a child is a risky business, there are so many potential complications. The main reason for the dramatic decrease in the last 100 years of mother and child mortality is due to advances in medical technology and surgical techniques, this has been led and achieved by doctors for the benefit of all woman.

There seems to be a real anti doctor agenda here. I find it very strange. What is wrong with having somebody who is exceptionally qualified in the vacinity in case things go wrong?

[SunnyRain]

... it is obvious by my apearance that I am not African.

I really enjoyed your post, Tuckers Daughter. It's interesting that we (humans) keep going through trends of fighting for different freedoms (fighting for excellent medical care in pregnancy and birth one day and then fighting for the freedom to give birth in a maple forest the next.) I enjoy us as a curious species who always has to fight fight fight. Maybe it is a good idea to step back a moment and consider how things are actually pretty good for us women in the first world who aren't giving birth in rice paddies and going straight back on with work.

But just out of pure curiosity because your story was scary, what do you look like? Why did the midwife think you were of African heritage if you're not? 3 weeks overdue is excessive surely for any woman, no matter what her race?

Also, Women used to die in child birth too frequently due to infections because there was no sanitisation in hospitals or by health care providers. Doctors used to wear their white coats splattered with the dried blood of previous operations as a sign of their experience. Mud and guts lined the floors and walls and medical equipment wasn't sterilised properly.

[Smoke Jaguar]

Hygiene practices actually play a bigger part in reducing the mortality rates, and even then women still die from infections in hospitals.
I'll tell you what, if I was in a hospital and monitored throughout my labour just in case there was a complication, I'd most definitely end up with a complication or two! You dont' think a medicalised, highly procedural environment would raise my heart rate, raise my stress levels, increase my adrenalin production, have me automatically feel there was something to fear and thereby take birthing right out of my body and into the hands of someone else? You reckon this has nothing to do with the cascade of interventions??
Doctors are great...when they are needed. It would be great if they could just merely observe normal pregnancy and birth, but because of the 'system' they see you in a medicalised environment (as opposed to in your own home) which is governed by policies that do not see the individual birthing women as top priority. Just the way it is. It's not the doctors themselves I don't trust, it's the system they are bound by.
I will never buy that births should all happen in a hospital, 'just in case'. 'Cascade of Interventions' is a phrase we don't hear often enough because we're taught that all interventions are for our own and our babies' good...which is not always true, as we know anecdotally and from personal experience here on BB etc.
A GF had a baby at home this week.In a hospital she would have had interventions - she would have taken too long to labour and the baby would have been too big for her to birth naturally (she probably would have suddenly had an incompetent cervix or some such justification for a 'just in case' intervention) because her baby was a 10 pounder. Both are doing very well - she had midwives and a doula. I just don't buy that she played Russian Roulette :P
Statistics are not my saviour (though sometimes convenient!), instinct is, and midwives have this, on top of skill, people-skills, experience and truckloads of knowledge
ETA: Giving birth in rice paddies is such a furphy!! A tiny bit of research will lead you to the practice of women in the community taking mother and baby into a safe environment, where she stays for about 40 days to establish breastfeeding, bonding, and maternal nutrition, as well as being completely nurtured herself. This happens in quite a few cultures, from Asia, Middle East and Central America. Rice paddies, my @rse!

[StellaSun]

My first and foremost choice is midwifery supported homebirth. My second choice (if I had to have one!) would be a mid-led birth centre. And my options stop there!

If I was deemed (and proven to be!) high-risk I may consider birthing in a hospital with midwives, and my very last choice would be an Obs.

Obs are taking over normal healthy pregnancies and creating risks out of something often very,very safe. They should stick to their own clientele of (very) high-risk pregnancies and/or complications of pregnancy. They should decline taking on normal and healthy pregnancies and be honest with these women that they probably don't/wont need Ob support. Its a money-making, insurance claiming, women disempowering circus!

Midwifery led care for those 85% healthy normal pregnancies & birth. Leave the 10-15% of the others to the OTHERS.

Birth is safe - interference is risky.

Honour these midwives and start to re-humanise birth!

[Sus]

I had my first baby at OPH which was a nightmare so with the second I decided I wanted as little to do with medical type things as possible. I had my second child at the birthing centre at King Eddy and it was the most fantastic experience I have ever had. The care and the way the place is run, we were greeted by the midwife at the door and she did everything from start to finish. The midwife left it to us to do what we wanted to do, it was very relaxing and I think because of this I needed no drugs. If I do ever have any more children I will be going back there it was wonderful!
Sus xx

[Cassius2]

I think some really good points are being made, and being the true fence-sitter I think some really intelligent and engaging POVs are coming from both 'sides' of the birthing debate.

I have to particularly agree that it would be ideal to have the option to have a full midwife led centre/s available in (at least) every capital city in Australia. Going by what the majority of people are saying, this would be a well used and positive facility. ( would most certainly be there!! with bells on! )

In the end i chose to go the private route as this was the only option of being guaranteed a supportive environment to have my baby surrounded by the two midwives that would provide the primary antenatal, birth and postnatal care. My OB stated from the beginning that they were in charge and as a result I would see them at all appointments and THEN go and see him for a quick scan to say hello, or to go over my birth plan or just to chat about nothing in particular...usually italian football...egad!).
I chose not to go public as i could not be guaranteed a spot at the birth centre, and i also did not want to have to go home straight away. i was living in a city far from family or friends and i knew that i needed a place where i could just focus on getting to know my baby. Having the option to stay the four nights was for me, really useful. I had lovely lactation consultants that came by every day and night and i had the same 3 midwives.

Like people are saying, i think that in whatever we choose it needs to be informed. even if not to avoid disappointment, at least to lessen it. I count myself lucky that my OB was in his field, because he just loves kids and loves seeing families bringing into the world new babies.
If we choose to go home-birth, birth centre or hospital, our informed decisions need to go further to decide what we really want from every scenario. My friend who had her bubs at home, was very picky over who would be her midwives, and I was very picky over who would be my OB. I didnt want any unnecessary intervention (i see unnecessary as intervening on the grounds of labour taking too long, or asking if i wanted pain relief etc), and as a result i needed an OB who could reflect that philosophy. And as much as we want to lynch the OB practice as a whole, like any situation there are remarkable people who have a genuine love, not for operating theatres or scaring women into the fear of their perceived inadequacies, but in celebrating the beauty that is chilbirth and all things babies.

And as i said above, if there was an option for women (and their families) to birth in complete midwife led centres then that's where i'd go (and where i would have gone). i am all for a holistic approach to babies, and would love to see a place that carries through from antenatal to birth and through to post-natal. I would love to see a place that would welcome my family to be there for the birth and would allow my DH and DD to stay with me for the duration of the stay. bring it on people!!

[sushee]

I haven't read the whole thread so am only commenting on the poll.

I would, and have, birthed in a midwife-led birth centre. I also had my first two children in public hospital, and my last child with a private ob (who was also my Fertility Specialist)

IMO, if I were to have a 5th child, I would definitely, absolutely, without a doubt go with a midwife-led Birth Centre again. I had the most amazing experience birthing my son there, and nothing comes even close to comparing. I understand the risk of complications - for my last birth, my son was in distress. For my 2nd birth, the lip of my cervix came down with my son's head. I felt as reassured in my midwives hands and I did my ob's hands, if not more, and in the long run, it was the midwife who actually stayed with me, reassured me, monitored me and assisted me. My ob wanted a c/s when my amniotic fluid was meconium stained and I spent quite some time convincing him to let me try to birth on my own (which the midwife was supporting). It was reassuring to have him there, but in the end, I did it without his help.

So I don't feel like I would need an ob the next time (if there is a next time). I would be perfectly content to be in the care of midwives only. I agreed to an ob with my last birth because it had taken us so long to conceive I was convinced an ob would equal better care, but as much as I love him as an FS, as an ob, he didn't add a lot (if anything) to the whole birth experience and was really just a waste of money.

[sneakysparkle]

Carley - I would love to know who your Ob is so I can recommend him to friends & fam in Melb!!!

[BellyBelly]

Nicola Brian is brilliant - you can recommend her She's great, and even has the Birth Options workshop flyers in her office.

[tuckers daughter]

I really enjoyed your post, Tuckers Daughter. It's interesting that we (humans) keep going through trends of fighting for different freedoms (fighting for excellent medical care in pregnancy and birth one day and then fighting for the freedom to give birth in a maple forest the next.) I enjoy us as a curious species who always has to fight fight fight. Maybe it is a good idea to step back a moment and consider how things are actually pretty good for us women in the first world who aren't giving birth in rice paddies and going straight back on with work.

But just out of pure curiosity because your story was scary, what do you look like? Why did the midwife think you were of African heritage if you're not? 3 weeks overdue is excessive surely for any woman, no matter what her race?

Also, Women used to die in child birth too frequently due to infections because there was no sanitisation in hospitals or by health care providers. Doctors used to wear their white coats splattered with the dried blood of previous operations as a sign of their experience. Mud and guts lined the floors and walls and medical equipment wasn't sterilised properly.

This is what annoyed me, I am run of the mill generic anglo, blonde hair blue eyes etc. The consulting midwife, or whatever her title was being flippant, possibly because she was out of her depth and more interested in pushing a political agenda than offering real medical care. I am all for midwives controlling the birthing process, but can't understand why so many women on this forum are anti doctor. All my experiences have been in public hospitals and any contact I have had with doctors, in terms of forcep deliver of my first and the dreaded stitches post birth in both births have involved caring female doctors. If not for the intervention of doctors with my first child I wouldn't be here, that is the reality. We have access to fabulous medical care in this country, there are women in third world countries who have to endure homebirths as a matter of course who would find many of the anti doctor posts in this thread puzzling to say the least.

[Smoke Jaguar]

Carley - if the majority of OB's were like yours, we'd be having a VERY different conversation right now I do know OB's like this exist, and they are like gold, aren't they? It's a shame that the majority place themselves above the woman instead of with the woman (as midwives do, by definition!).
ETA:Wow, Tuckers Daughter, you really are missing the point with midwives - I don't know any (and I know a few!) who would EVER want to be, or believe they are 'in control' of the birth process. None in the midwifery-led model in continuity of care, at the very least. I don't know any midwife who is that arrogant.

[sushee]

I understand the inequity and injustice of not having access to medical treatment if you need it, and having to endure being untreated for a birth complication, but for the most part, when birth is a normal process, no one needs to 'endure' not having a Dr present, whereever it is you birth your baby.

I find it equally puzzling that anyone would think having a homebirth is something someone would have to 'endure' if they have a normal birth. Not having access to necessary medical treatment for a complication is not the same as birthing normally assisted by midwives, as the latter does not require a Dr.

As yes, I come from an Asian country where until as recently as 30 years ago, homebirths were the norm.

[Mum2seven]

Hi Kelly

Yes Please make me Mum2seven!!!

I think we will call our little one Quinn.

JuJu I understand your concerns as a NICU Nurse, but I find it insulting that you use the weight of this fear to dissuade against midwifery care and homebirth.

Your assertions re oxygen deprivation and injury are extreme. You have also not honoured the wealth of evidence not only demonstrating the safety of midwifery care and homebirth but also the risk of medicalised childbirth today.
Why do we have such full NICU's? Let's look at all the iatrogenic (as a result of healthcare) injury. Around 70% of babies born by c/s spend time in special care/NICU.

It is irrelevant and unfair to compare seriously ill/premmie babies to a mode of birth (when the vast majority of incidences are unrelated).

Please look at the study of all planned homebirths in the U.S (Johnson and Daviss BMJ) This study looked at all planned homebirths and found stunning results (A 3% c/s rate for example). The other US study is MacDorman and this examined 5 million births where vaginal birth and c/s were compared when there was NO MEDICAL COMPLICATION and found nearly 3 times more babies died from c/s birth than vaginal (remember they were healthy to start with!)

Background: The percentage of United States? births delivered by cesarean section
has increased rapidly in recent years, even for women considered to be at low risk for a cesarean section. The purpose of this paper is to examine infant and neonatal mortality risks associated with primary cesarean section compared with vaginal delivery for singleton full-term (37?41 weeks? gestation) women with no indicated medical risks or complications.

Methods: National linked birth and infant death data for the 1998?2001 birth cohorts (5,762,037 live births and 11,897 infant deaths) were analyzed to assess the risk of infant and neonatal mortality for women with no indicated risk by method of delivery and cause of death. Multivariable logistic regression was used to model neonatal survival probabilities as a function of delivery method, and sociodemographic and medical risk factors.

Results: Neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62). The magnitude of this difference was reduced only moderately on statistical adjustment for demographic and medical factors, and when deaths due to congenital malformations and events with Apgar scores less than 4 were excluded. The cesarean/vaginal mortality differential was widespread, and not confined to a few causes of death.

Conclusions: Understanding the causes of these differentials is important, given the rapid growth in the number of primary cesareans without a reported medical indication. (BIRTH 33:3 September 2006)

Justine Caines

[Smoke Jaguar]

I've been watching a lot of documentaries lately, on varying topics. Guess what I found out from one series on the Royal Family? Queen Elizabeth II, siblings and children were all born at home! She knows what's good for her
It's a real wonder that NZ must be hiding all it's dead infant-mother dyads if midwifery-led care is so dangerous and risky! Next someone's going to try to tell my why Australia is so inherently different from NZ and other progressive countries (that are obviously not so overawed by their medical associations) to explain why they don't die (or be born with hideous deformities, brain damage, any other scary things you can think of) like we would if we adopted the same prenatal care models
I didn't start out being so 'militant' (I don't see myself as militant, but surely someone does, so I might as well say it pre-emptorially), and the more I find out, the more stories I hear, the more people I talk to and the more history I piece together, the more I become convinced about normal birth for normal pregnancy

[richsaralex]

As a first time mum I had my little boy (now nearly two) at a midwife only service in Newcastle and would not change that for the world. I despise the idea of medical-based care for my pregnancy - especially considering that women have been giving birth since the beginning of time! Surely we dont need a doctor telling us what to do and whether its all going the way it apparently 'should'.

I am pregnant with my second child now and am planning another relaxed pregnancy with my midwife, and another magical water birth! I couldnt advocate the service that midwives provide any more.

The rate of medical intervention in pregnancy is too high as it is - more women should be encouraged to take advantage of midwifery care for a more relaxed pregnancy, birth and far happier and more contented babies!