Would you give birth in a midwifery led unit?

[Inanna]

I haven't been able to read through from the beginning - as I have had a busy weekend.

I voted YES! I see from what I have read that there has been some hearty debate - I love that we do that here on BB. That we put our thoughts and feelings out there and speak up about how we feel.

Now, I planned a homebirth with my first child. We transferred to hospital after 24 hours of labour - I actually lost a lot of faith in my midwife - and I didn't feel "safe" with her in my labour. I was bullied, I was all but called a fool by the obs (now a prominent private obs in Brisbane) who received me. I was even asked to sign my chart that I was undertaking a vaginal birth against his judgement. Aaah but the midwives that night will forever be indellible upon my mind and soul. In her thick Irish accent she looked into my eyes and said: "You can do this woman" - "and I will help". So with the advocacy of that midwife and my own knowledge of birth and belief in my body I birthed my baby safely into my hands.

I chose a birth centre birth for my next two children - a beautiful midwife - who remains in my heart also. My babies wwere born into their fathers hands - only his touching theirs and then my own for the first half hour of life. My placentas I birthed in there own good and gracious time,.

My next child was born into the water in a private hospital. But I chose my midwife and I chose an obstetrician who would agree to wait outside - only to enter my sacred birthing space if the skills of his surgical hands were required. He agreed and the smile and hug I received as he welcomed my daughter and congratulated me in the afterglow of birth when wer were both tucked up safely will be forever indellibly etched on my soul.

He was the man who removed my next child from my womb - my daughter died at 16 ish weeks - I knew I was safe and I knew my childs body would be respected by his hands and heart.

My next child - a son also died in utero - I laboured for 12 hours and bled profusely - it was again the gentle surgical hands that saved my life and blessed my son as his little body met the room that night.

Again another daughter gone...

So, it became clear that I was high risk. Oh and I chose a woman obs - because she had opened her cervix for her own children. She had touched her own soft downy heads and she understood the fire in my belly. She also listened to my heart - and understood my tears. Together we journeyed through a pregnancy that ended with emergency c/section at 28 weeks. Amazing obs - an Englishman - with the kindest eyes. He came in the night just to check me - he knew that this baby was the most precious soul for her mother. He lifted her from my body on a sunny October afternoon and talked me through everything. He told me exactly what he was doing. How she looked. The noise she made. He had never been asked before for "background music" but he dignified my chanting music and respected my dimmed lights. He "allowed" my beautiful woman obs to be a second birth support. She held my right hand and my husband held my left as the room took a deep breath and prayed for a sound. I could hear his excitement that she was making sounds. She is alive.

So, I thank the Universe for obstetricians. They have played a huge role in my life. I thank the Universe for midwives - the stuff of legends I think.
They each play a role - should women have an obstetric birth for an "uncomplicated low risk birth". Well my opinion is that women should have what feels safest for them. However, in knowing what is safest all the information has to be presented. Unlike my colleague Schmickers (love your work my love!) I am too tired and spent after a weekend of sport and bbq's to access all my lovely facts.
So, you will just have to trust me on this! Low risk births are the job of midwives - that's their skill. Most of us are low risk. I was low risk and had 3 very uncomplicated births. My first birth was complicated because I wasn't on the same page as my midwife (long story ).

Our heads give birth before our hoo haas my loves. It's a fact and it's real. If we get our heads right our fanny's do their dance beautifully most of the time. Midwives want the best thing for the woman and her baby - if things don't look so great help is accessed. I was nearly (!) at a homebirth a couple of weeks ago - that midwife has had 1 transfer in awww I am guessing but I would say close to 20 years of birthing.

Obstetric birht is not necessarily the safest option for uncomplicated birth.

[Julie Doula]

"As for the mothers themselves, a study of women in Victoria (by the Victorian Government) concluded that only 10 per cent of women preferred the midwife-led option. This does not justify the use of taxpayers' money for a scheme that most parents do not want". -- Dr Pieter Mourik, consultant obstetrician and gynaecologist, Wodonga

Yeh? Really? Well, I'm a woman in Victoria, and no-one asked ME!

I note he does not say how big the study was, or when it was conducted, neither is there a link to it. I've a feeling his 'study' would not hold up under scrutiny.

He is implying that Victorian women ARE getting their preferences, when overwhelmingly, this is FAR from the case.

Very hot under collar here.

The perinatal statistics for midwifery-led units, which follow the midwifery model, not the obstetric model, kick the butt of obstetrician-controlled units. Who wouldn't want a facility with one tenth the c/s rate of a standard obstetric unit, with three times better chance of having an intact perineum??? (Oh - and of course, better safety rates for the BABY, better breastfeeding rates, lower PND and birth trauma, etc, etc, etc, etc!!!) Of COURSE Victorian women wouldn't want that - what, are they crazy? Bring on the bells and whistles and the machines that go ping! We want technology! We want unscientific science and non-evidence based care! We want institutionalization instead of one-to-one mother to midwife care! We don't WANT continuity of care, who cares if studies show it's safer and more satisfying - NOOOOO! we want our sterile birth rooms to be like Flinders Street Stations and the more unfamiliar, impatient hands being shoved up our fannies the better! Above all - we DON'T WANT to do the hard work of labour! NO WAY! Save us! Oh please doctor - saaaaaavve us! Of COURSE we don't want to experience the most life-changing, life-affirming activity our bodies have been perfectly designed for! We don't want to be heroes! Just numb us silly! What do you think we are - lunatic fringe, sandal-wearing hippies??? Why on earth would be want to exchange being strapped to a monitor and a synto robot for a birth pool???

Oh thank you, thank you wise obstetricians and the Government of Victoria for saving us from ourselves, since we silly women clearly don't know any better!

(See, told you I was hot under the collar ....)

(To understand the difference between the midwifery model of care and the obstetric model, this article is a great read - Fish Can't See Water by Dr. Marsden Wagner.)

[christy]

I wonder if his study included his own patients? Or was inclusive of his own patients?

[richsaralex]

Can I add here that when I said doctors only scare-monger I was referring to many specialists and even GPS (not just Obs). This relates to the entire profession, and what has happened to midwives is one small picture in how the medical profession has slowly squeezed the life out of alternative options.

Doctors are trained in a certain way, and all are trained to 'think' a certain way - my best friend is a doctor training to be a GP and I noticed the difference in her thinking right after she started training in the hospitals!! They train them to beleive they can cure everything - and its up to the individual doctor to pull themselves out of it and become a better doctor. Its a hard & vicious cycle, and not necessarily the fault of the individual doctor but rather the whole system.

My friend has managed to pull herself out of this, and I beleive she'll be an amazing GP, but still I have seen some absolutely terrifying decisions made by GPs and specialists from sheer arrogance & ignorance!

My husband is a chiropractor (Ive seen him fix problems in people who have seen doctor after doctor after doctor and who have come to him as a last resort because they have been told by the medical profession that they will never get better!) and the number of doctors who actively try to avert his patients from his care simply because they dont understand it is staggering! They have no training or education in chiropractic, yet they feel free to make sweeping judgements about the care of a person who is obviously getting better, though they dont understand it.

Similarly, my father who is fighting cancer, has come up across some seriously strong egos in terms of him having to stand up to doctors (similar to a bullying situation, in a school for example) and say "No, I will not have chemotherapy" or whatever other drugs they wanted to pump into him. He has lived longer and is healthier than any of his doctors have expected. This is because he researched, made his own educated decisions and wasnt willing to take the first option offered to him by the medical profession! My father would leave consultation rooms shaking after meeting with specialists, because they have literally told him his decisions are stupid and that he will die - they were nasty and manipulative and he was given the worst scare-mongering that I have ever heard in my life! If it werent for a close knit and supportive family around him he probably would have bowed down to the many doctors' wishes.

I do beleive doctors they have their place, however it has been hugely overstated, so that many people no longer even think twice about the advice their doctor gives them. As far as many people are concerned, a doctors advice is 'god given' and couldnt possibly be wrong. I simply wish people would stand outside the square and look at the big picture of whats really happening.

[richsaralex]

At first I thought this site was driven by a political line but I now realise it is driven by a corporate line. A forum is supposed to be a place where posters can battle out conflicting opinions, not a place that is dominated by the opinions of moderators and the sites creator. The fact that this forum is linked to a business demonstrates that vested interests are at work here.

Dont you realise how ridiculous it is for you to say that? The medical profession is a soley corporate operation! The Pharmaceutical companies fund and orchestrate the entire medical profession - why do you think most GPs push drugs that they dont even understand? They are offered commissions to sell them but arent educated about them - they have to do that on their own (very limited) time.
The medical/Pharmaceutical professions have undergone a whole process of undermining the alternative methods of health care, ultimately to provide more money for the Pharmaceutical companies!! Open up your eyes and dont just follow the herd.

[BellyBelly]

Obviously this thread isn't going to stay on track. Whether we agree with you or not, to be fair, we're going to have to remove all the posts that continued after the warning. Anyone else posting off track will have their posts also removed without warning. We welcome any comments which stick to the original topic, and not any inflammatory posts towards other members, the moderators or how we run BB. It works, it's the rules and you agree to that when you join as a member. Read the forum guidelines if you need a refresh.

[Daydream Believer]

I voted I am undecided as I would like to have my care 100% with midwives but in a hospital because we had problems with DD's birth

In saying that I ended up with a different OB to who I had been seeing and he was fantastic in encouraging me in a natural birth the way I wanted

[Lulu]

Every post on this page is freakin AWESOME.

Well said/done

[Anila]

All 5 of my babies were born at the midwifery clinic at my local hospital, Not a dr in sight, the midwifes did a fantastic job. And i will go there again when i have my next baby.

[Sophia73]

I voted no for myself but I am totally supportive women choosing where they birth. Unfortunately where I live the birth centre is so difficult to get into!

I wanted to add too that I had a dream "healthy" pregnancy - certainly no risk issues - with lots of preparation - which was followed by an extremely trecharous birth - so I agree with those that said low risk pregnancy does not mean low risk birth.

I was actually booked into a midwife program and birth centre to have my bub and changed to private hospital and obstetrician at the last minute as I had heard a few stories that made me think it wasn't for me. One reason was that the birth centre actually send mums home a few hours after birth - now I know that would suit lots of people to a tee - but for me I really felt like I wanted some after care, help with breastfeeding, and a good rest without the distractions of home.

In the end I was happy with my choice...my obs respected my desire to labour without intervention and my care was mostly by midwives in the hospital. My DDs birth was difficult and I only narrowly avoided a caesarean. The truth of the matter is that she was truly stuck in my pelvis and 100 years ago with out the current medical care we probably both would have died.

As it turns out I really needed that intensive care provided by the private hospital as I could barely walk and needed regular pain relief.

So Yes to choice but No for me personally.

[Julie Doula]

Perinatal stats show that 97% of Victorian women give birth in hospitals under the Obstetric Model. Only 2% give birth in Birth Centres, and experience the Midwifery Model. However, these aren't strictly "midwifery-led units": unlike other countries, they are not independent, free-standing or midwife-led - the midwives do their best but are still bound by obstetric policy.
Only 0.3% of Victorian women experience midwifery-led care, those that choose homebirth. Of the 222 Victorian women who gave birth at home in 2005, 90% had a spontaneous vaginal birth, 80% had an intact perineum, 96% had no pharmaceutical pain relief, 16% transfered to hospital and 4% had a caesarean.

Women who obtain birth centre care, and/or Midwifery Model care, are a tiny, tiny, tiny minority in our current birth culture.

I'm not convinced that 97% of women give birth under the Obstetric Model because 97% of women prefer it. I think that the lack of opportunity, information, options and funding have something to do with it. By contrast - 80% of women in NZ choose one-to-one Midwifery Model care. It's not because they're a big bunch of hippies who love suffering. It might have quite a lot to do with the fact that it is funded in NZ, and because the first person most women see when they get pregnant is a midwife - not a GP.

I've heard from so many women that when making enquiries regarding birth options in early pregnancy, they get told their choice is between private and public. I.e. two versions of the Obstetric Model. Many doctors don't mention birth centres, most don't mention homebirth. ONe of my clients, when she informed her GP of her decision to go through a birth centre, was told, "Have you got any idea how many births they botch up???" I think that very few women are presented with the full menu of birth options. They get the censored, abridged version. That's not informed choice. That's not choice at all. If women really did have a choice, and Midwifery Model choices were as well funded and supported as Obstetric Model choices, I think it is possible that more than 3% of Australian women would choose them.

At any rate, those who are opposed to the Midwifery Model, and those who do not desire it out of personal preference or need, are certainly not in a place of duress or at any risk their preferences will become less accessible or less supported.

[hannahfroodoo]

Whether you would chose obstetric or midwifery care, you'd have to agree that there are really very limited options for the women who choose midwifery care. That's what I think needs to change. Let women choose what they want but provide better options so that we CAN choose....

I had my first DD in a public hospital and didn't see an OB until my tear needed stitching. It was a wonderful and empowering experience that I was looking forward to repeating.

I had my twins in a private hospital with a private OB and I hated the experience. I had arguments during labour with the OB that reduced me to tears and ended up having numerous, unnecessary interventions.

Obviously, based on my experiences, I would choose midwifery led care. It disappoints me that women (myself included) don't know about their options for midwifery care. For example, I never realised that a public hospital would let me bring a private midwife to the birth.

I am not demanding that the government pay for more birth centres or midwifery units - just that the same medicare and private insurance coverage be available for private midwives and private birth centres as for private OBs.

But most importantly, that we are made aware of other options beyond just 'public or private.'

[LuluHB]

I chose to be in the hospital system, but TBH I want both. DD#2 was in such a hurry to arrive that there was just no chance for my OB to get there. Had he been on the next floor he'd have had troubles!! So, my gorgeous girl was born into the soft hands of a lovely, supportive midwife. My OB (who delivered DD#1) arrived after DD#2 had been in my arms for 10 minutes. My DH and I joke that I got the most expensive stitch in history - such was the extent of his involvement. I was entirely happy with my daughter's birth with only midwifery care, but at the same time think if I was ever crazy enough to go down this road again for a third child I would again be placing my health and my child's in the hands of an OB. Hypocritical and illogical given what I have said, but the only way I would feel comfortable and safe.

[sunshine_sieben]

Does this include birth centres within hospitals?

I would definitely choose the midwifery led care over the obstetric model for low to medium risk pregnancies. In my opinion the hospital obstetric system is for high rissk pregnancies. Just like you don't go to the doctor at the beginning of every flu seasson just in case you get sick.
I do however believe in good obstetric backup plans just in case something does go wrong. But I think that goes without saying...

Sasa

[Nettie]

I gave birth in a public hospital and had no obs attend me... the midwives were fantastic and I see no reason why I would want it any different next time...

[bellyjiggles]

I am not one of the 10%, as I live in the UK... but I will more than happily lend my support to this cause if it will help.

My personal experience here in the UK is a very medical process via Doctor, hospital consultant and hospital intervention/monitoring, etc. I renounced all this in favour of an independent midwife who supported me at home through a difficult (but nevertheless calm and wonderful) breech first birth at home (against the consultant's advice).

The consultant advised coming immediately to hospital at the first twinge, to be strapped to monitors, unable to move around, and at the first signs of any slowing down immediate transfer to theatre for ceasarian.

My contractions started every 4 mins apart with my waters breaking at 12:30, 1 hour into my night's sleep! My midwife came straight to me and stayed up with ME (AND ONLY ME) all night long, taking sleeps here and there when my partner wasn't sleeping! I felt VERY WELL SUPPORTED but undirected and free to do as I wished. I laboured for 18hours (2.5 hours of second stage, the pushing!) I had about 3 hours with no contractions and had a long rest before going into transition. Again when things weren't progressing and the contractions slowing I was left to rest, and when checked again I was fully dilated and baby heading (or bottoming!) fast .. so I was helped onto my hands and knees to do a gentle, steady and guided delivery.

Once she was born, nobody spoke.. we discovered our baby for ourselves, still attached she was simply laid on the floor under me, and the 3 of us just stared at each other and then had kisses and cuddles and finally checked her sex... all of which is done by the staff, when in a hospital, and they rush to cut the cord, tell you the sex, etc. Those moments are the most precious.. I then had a bath in my bath... as many cups of tea, drinks, sandwiches or whatever I wanted from my well stocked fridge, and laid freshly bathed with my baby in my bed. My midwife left after everything was cleared away and we were in bed resting to return the next days for usual checks.

The Midwive's in hospital have their hands tied to a degree by the physicians and their schedules, I hear this again and again. Whereas, with my midwife by my side keeping me calm and being there for me, absolutely MADE the whole experience the best it could be .. with unobstrusive but consistent care.. She was an absolutely AMAZING LADY. She also seemed to know when I would go into labour (as she discussed what would happen if I went into labour on this night, and I did!) .. she also has done this with others I know.

I also got straight on with handling and managing MY baby and se felt very mine, nobody else took charge of her.. she was mine and WE were assisted, so I never felt nervous at being 'left' to look after her, which I think happens when other people get their hands on your baby first and give you the impression that 'they know what they are doing and you do not', which so undermines a new mother's confidence.

Anyway, end of story.. do hope this helps the cause to giving midwives the experience they so badly need to completely understand each woman in her own very unique labour and delivery, and not following the timetabled delivery and unnecessary ceasarians, ventouse, episiotomoties and high level opiate pain relief!

GOOD LUCK OUT THERE WITH YOUR ENDEAVOURS MAY YOU SUCCEED

[paradise lost]

I'm in the UK, and Kelly i want to complain because i couldn't vote - you didn't give the option:

No, i would only birth away from my own home if i was in real NEED of obstetric care.

That's how i feel about it. If i need a doctor i'll go to hossie and if i don't i'll stay at home. I had an NHS homebirth bellyjiggles, and it was ace, i take it you had to pay for yours? Luckily DD was ceph. presentation so they couldn't find a convincing reason to decline to provide a midwife at home. I guess if i was having a breech i'd hire a private middie before going to hossie too.

Bx

[bellyjiggles]

Hi Hoobly.. interesting to hear another from the UK here!... good for you home birth an all.

Most would have dubbed my labour 'high risk'... but it was MY LABOUR, and very much my choice... but I would not have done it without the support of, and belief in, my fantastic midwife, who would have accompanied me to hospital had it been necessary (it definitely wasn't about staying at home at all costs)...

Unfortunately, even before nearing the end of pregnancy and the realisation that she was breach, my midwife was saying 'yes, we'll attend you at home, but will have to transfer the minute there's any indication of problems' and certainly wouldn't attend at home for a breach.. Although, by law, a midwife has to attend a labouring woman wherever she is. But not something you'd do really I think! I know one who has tho, whilst labouring with a Doula, and the midwives were kept in the back garden until safe delivery in the birthing pool indoors!!!!

The figures say that although women are now encouraged to labour at home, most (somewhere in the 70's %) get transferred anyway.. which wasn't encouraging for me!! whereas my midwife offered pretty much the opposite chances. Interestingly, when the 'community (or NHS) midwife' arrived, she got very concerned and starting trying to talk my partner into getting me to hospital, once again for a caesarian, which he knew I really didn't want but felt incredibly scared at the weight of responsibility having the decision that could be putting us at risk! The independent midwife continued to manage the situation after that and I went on to progress to a very straightforward breach delivery.

I just had complete faith in her YEARS of experience of birthing women at home, with twins, triplets, many breach.. needless to say she has an MBE for her services and dedication to midwifery.. she now lectures.. and YEP, I had to pay... well worth it!