Would you give birth in a midwifery led unit?

[Alyssas_Mum]

I am currently seeing my GP who is a registered OB with the hospital im booked in at, I am bulk billed and dont have to pay for parking plus she is 10 minutes from home compared to if i went to the hospital to see the midwives where i would have to travel 1/2 hr and pay for parking. Only reason i chose OB over midwives was a convenience thing, if i didnt have to pay for parking or travel so far to the hosp then i would def go midwife care.

[BekZ]

Midwives over Obs anyday!!

I had both my girls in a public hospital. I loved the care I received from the midwives and I barely saw an Ob. The only time I saw an Ob was at 20 wks and 36wks (I was not happy with either) and post labour. I had 2 fantatic midwives for both my labours and I trusted them completely.

I also had a midwife visit me at home everyday for 5 days post birth.

Now my SIL paid private and had the very best of everything. Her Ob was there for the birth but after going home she had no back up support. All she got was a huge bill.

I Know which option I prefer.

[Dasharity]

I would have this as my second option if i chicken out of a home birth

[Smoke Jaguar]

Wow, parking considerations over empirically safer birthing! Never heard that one before LOL! Each to their own

[Chels]

Wow, parking considerations over empirically safer birthing! Never heard that one before LOL! Each to their own

LOL. I'll second that amazement, Mayaness!

Kurazia, NSW Teachers and I think Unity Health both cover part of (about half with Teachers, which is what I'm with) homebirth. I don't know if it would be too late for you to change funds?

[Early Kids]

I would prefer to be part of the midwifery system If given the choice.... unfortunately I dont have that choice for my next pregnancy (too high risk)

[Chels]

Sounds like a load of bias bull**** to me. I'd love to know where that got their demograhic from for that so-called 10%.
I went private Ob for my first largely due complications during pregnancy (DVT), but in a 'normal' pregnancy like the one I am currently having I am choosing to see a private midwife and am planning a homebirth partly because the Gold Coast Birth Centre doesn't support VBAC. There is no way I want to go through another c-section. I certainly would not pay for a private Ob when, in my opinion it is the Midwives who have most of the birth experince. Obs simply arrive at the 'last minute' to 'deliver' and are useful in 'an emergent' situation only.

[Naxi]

I have had the best OB in the world for both my sons and can't imagine going through pregnancy without him.

The first time round I would have decked the midwife if I had have had the energy.

The second time round I had the most wonderful midwife, who delivered DS2 on her own (the OB hadn't been able to get there in time - Sydney traffic)

However, both times I had complications with the placenta, so needed a doctor on hand - it was so important to me to have someone that I could trust. (Also, with the speed of my labours I need to go to the nearest hospital, so I don't have a choice!)

[jaysmama]

only 10 per cent of women preferred the midwife-led option. This does not justify the use of taxpayers' money

Huh?, Our culture of birth has it backwards , healthy women with low risk pregnancies don't need an OB, except to be on hand in case of an emergency. Midwifes are trained to attend to healthy women giving birth normally, and trained to know when to call in the Specialists in special circumstances.. If anything needs justifying it's why so many healthy women hire surgical specialists when they are not unwell or unhealthy, just having a baby. I think we are so so lucky to have all the amazing obstetric care available to us when it's needed and sad that so many of us submit ourselves to it, I guess out of fear, when it is not needed. I had midwifes care for me throughout my pregnancy and labour, they were wonderful, and gave me every chance to have the natural birth I wanted, they also recognised when my body and my baby wasn't going to co-operate and called in the hospital OB to perform a vacum extraction. Really this is the best of both worlds.

[JuJu300]

I worked in a level three NICU for several years. I would never have my baby at home with a mid-wife. A very skilled mid-wife that is able to pick up on fetal distress that requires hospitalization may still run the risk of long term or permanent damage to the baby. In a emergency situation there needs to be interventions taken with-in seconds to minutes to guarantee the most optimal outcome for the baby. We are talking all it takes is a few minutes of decreased oxygen supply to the baby to cause permanent brain damage. People who delivery their babies at home may have no ideal that there was fetal compromise during delivery, if they were not hooked up to a fetal monitor during the delivery. At the hospital oxygen will be applied if need to increase oxygen supply to the baby. I know some mid-wives do this at home or in birthing centers. As for me, I would not take the risk of compromising my baby delivering at home. Not to say bad things don't ever happen in the hospital, and a lot people have wonderful deliveries at home. You don't know if you are going to have a smooth delivery until it's over. I think you have much better outcome for you and the baby at a hospital with a highly skilled doctors and staff.

[mummato3]

I worked in a level three NICU for several years. I would never have my baby at home with a mid-wife. A very skilled mid-wife that is able to pick up on fetal distress that requires hospitalization may still run the risk of long term or permanent damage to the baby. In a emergency situation there needs to be interventions taken with-in seconds to minutes to guarantee the most optimal outcome for the baby. We are talking all it takes is a few minutes of decreased oxygen supply to the baby to cause permanent brain damage. People who delivery their babies at home may have no ideal that there was fetal compromise during delivery, if they were not hooked up to a fetal monitor during the delivery. At the hospital oxygen will be applied if need to increase oxygen supply to the baby. I know some mid-wives do this at home or in birthing centers. As for me, I would not take the risk of compromising my baby delivering at home. Not to say bad things don't ever happen in the hospital, and a lot people have wonderful deliveries at home. You don't know if you are going to have a smooth delivery until it's over. I think you have much better outcome for you and the baby at a hospital with a highly skilled doctors and staff.

Oh JuJu, 'highly skilled doctors'..what, do you mean the ones that wave their forceps or scalpel the second a CTG shows even the slightest deceleration? The ones that don't know when to back off and allow a woman to birth without them shoving their fingers into the woman's vagina every hour to make sure she is 'progressing as she should'? Sure, the 'specialists' have their place...but you are painting normal, natural birth as some bleak, life threatening procedure that only a dr can handle. I know you dealt with 'sick' babies in NICU, pregnancy and birth isn't a sickness or a dangerous situation ( the majority of the time) that needs to be 'fixed' by medical professionals. Your post is scary! Midwives who choose to help women birth their babies at home must have top rate skills in assessing for compromise during labour and birth, neo natal resus as well as maternal resus skills and knowing when to transfer. I would hate to think what you thought on 'free birthing' is!

[Schmickers]

Hi there JuJu,

I can certainly sympathise with your position. I worked in paediatric oncology for six years, and I often reflected with dismay that so very many children had cancer! But when you put it into context, you realise that your views are somewhat affected by your position; we took almost every case of childhood cancer in the entire state, for instance, so what we saw was only a tiny proportion of the paediatric population (thank goodness!) Working in a Level 3 NICU, I'm sure you receive referrals from a very wide geographical area and a large population. When you only see the worst of the worst, it is easy to become accustomed to seeing that as the "norm".

While the focus of this thread was on midwifery-led care, as opposed to home birth, I guess you could argue that homebirth is simply midwifery-led care in a home, rather than a separate centre, and you raise some points that I think it is important to address.

A very skilled mid-wife that is able to pick up on fetal distress that requires hospitalization may still run the risk of long term or permanent damage to the baby. In a emergency situation there needs to be interventions taken with-in seconds to minutes to guarantee the most optimal outcome for the baby.

I'm sorry, JuJu, but that is simply not backed up by the research. There are no midwifery or obstetric interventions that have to be performed within "seconds" to ensure the well-being of mother and baby during the birth. Complications are rare during labour and birth in a normal, healthy woman, and when they do present, they present with early warning signs that an experienced and adequately skilled midwife will detect. Thomas et. al. in 2004 examined a cross-section of births that occurred in the US that ended in caesarean, and compared the time interval between the decision being made to perform a caesarean, and the procedure actually happening; they found that there was a 75 minute window between the detection of complications and the commencement of a caesarean, for best outcomes.

We are talking all it takes is a few minutes of decreased oxygen supply to the baby to cause permanent brain damage. People who delivery their babies at home may have no ideal that there was fetal compromise during delivery, if they were not hooked up to a fetal monitor during the delivery.

During normal labour, it is not possible for the baby to be deprived of oxygen. It receives oxygenated blood from the mother's placenta. The "danger period" for oxygen deprivation is during and immediately after birth. Once more, in a midwife-led setting, the use of opioid-based pain relief for the mother is reduced, active labour and birth reduces time spent pushing and birthing the baby, and as a result the baby is not as likely to suffer respiratory depression at birth or immediately after. In terms of monitoring, the Cochrane Review in 2006 by Alfirevic et. al. showed continuous fetal monitoring has been shown to be no more effective at preventing neonatal complications as the periodic doppler monitoring that midwives use. It also restricts movement, which actually increases the likelihood of some birth complications.

As for me, I would not take the risk of compromising my baby delivering at home.

Once more, your opinion is not supported by the current evidence. As far back as 1997, analysis of the existing literature at that time by Olsen indicated that there was no difference iin fact hospitals had a higher incidence of low Apgar scores (babies which are slow to breathe and move after the birth) and serious penineal tears than hospital births. These results were backed up by Ligtermoet in 1998. The same year, Murphy & Fullerton examined home births in the US and found that they were as safe as hospital birth as long as hospital support was available for transfer in the event of complications. More recently, in 2002, Parratt & John examined home births in Victoria, and found that they were equally as safe as hospital births; in 2005, a very large study was conducted in the US by Johnson & Daviss, which found overwhelmingly that homebirth with appropriately skilled midwives was as safe or safer than hospital birth. They even went so far as to make the statement that "There can be no more doubt about the safety of homebirth" in a media release about their research findings.

Not to say bad things don't ever happen in the hospital, and a lot people have wonderful deliveries at home. You don't know if you are going to have a smooth delivery until it's over.

Statistically, actually, you do. Homebirth midwives follow quite stringent admission criteria to screen women who may be at higher risk during birth. It is for this reason that the results are as they are; because with appropriate screening, advice, and support during pregnancy, you do know that you will have a trouble-free birth, or at the very least, that if something changes, you will have time to deal with it.

I think you have much better outcome for you and the baby at a hospital with a highly skilled doctors and staff.

That may be your personal opinion, but it is certainly not the reality of our current health care system.

References
1. Olsen O. Meta-Analysis of the Safety of Home Birth. Birth. 1997;24(1):4-13.
2. Ligtermoet H. Safety in childbirth. Birthings. 1998:9-12.
3. Murphy P, Fullerton J. Outcomes of intended home births in nurse-midwifery practice: a prospective descriptive study. Obstet Gynecol. 1998;92(3):461-470.
4. Parratt J, Johnston J. Planned homebirths in Victoria, 1995-1998. Australian Journal of Midwifery: Professional Journal of the Australian College of Midwives Incorporated. 2002;15(2):16-25.
5. Johnson KC, Daviss B. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 2005;330:1416.
6. Alfirevic Z, Devane D, Gyte GML. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Cochrane Review). (Date of most recent substantive amendment: 24 April 2006). The Cochrane Database of Systematic Reviews. issue 3, 2006.
7. Thomas J, Paranjothy S, James D. National cross sectional survey to determine whether the decision to delivery interval is critical in emergency caesarean section. BMJ. vol 328, no 7441, 20 March 2004, pp 665-668.

[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.

[Toomanytoomany]

Following on from this Obstetrician's comment:

If you had a choice, would you choose to give birth in a midwifery led unit (where there is emergency transport available and hospital closeby), or would you prefer an obstetric model of care? I wonder if 10% is reflective of the BellyBelly membership?

I'm pretty sure that I've *had* that guy as an OB! And I'm not sure I'd prefer him over birthing in a barn, let alone a fully equipped midwifery unit!

The ironic thing is, at Wodonga hospital, the midwives manage most of the labour and delivery anyway, even the inductions!!

It's a vicious circle with mid centres, even homebirth - the fewer of them there are, the less normalised they are, the more nervous women are about using them. You offer the services, more people use them, and then it becomes more normalised and people want to use them more.

You just have to look at the demand at birthing centres to see how much in practice women want to use these services.

I'm hoping to use midwifery care, but it will probably be at either a birthing unit attached to a hospital.

[BellyBelly]

It's a vicious circle with mid centres, even homebirth - the fewer of them there are, the less normalised they are, the more nervous women are about using them. You offer the services, more people use them, and then it becomes more normalised and people want to use them more.

You just have to look at the demand at birthing centres to see how much in practice women want to use these services.

Too true. And you just have to look at how booked out our birth centres are to realise women do not actually have choice! They end up in the public system because the birth centres only take you if you found out you were pregnant yesterday. So many missing out on what they want.

At the end of the day it doesn't matter if only 10% wanted to use these services, the fact remains that there is not choice for women, and those 10/20/30 - whatever percent - deserve choice.

[Trillian]

So the magical 10% that's being spoken about is basically just the amount of women that actually get into, and then birth at a birthing centre, and this guy has taken that paltry number and ran a mile with it, not explaining or caring to explain to everyone that in reality, the 10% isn't because that's all that want it, but that's all that can be catered for. So the reality is that there is likely to be far more than 10% wanting to have this mode of care, but due to limited places or being excluded for reasons such as the oh-so-dangerous gestational diabetes, high blood pressure and a myriad of other maternal issues.

[Pandora]

Definitely.
I rang and registered for a caseload midwifery program athe day after I got my BFP and am 100% sure of my choice, even though it means travelling an extra 20 minutes for appts and to the hospital.

[Sass]

I was able to chose this option as a fluke from living in the right postcode. The state government originally funded a midwife practice to run for indigenous mothers in the area and when there weren't as many of them they expanded it to include other mothers in certain postcodes.

All of my antenatal care was through my midwife's practice and one of the midwives from the practice was there for my entire labour (they're only allowed to work for 12hr shifts so they swapped and my main midwife managed to be back just in time for both of them to be there for the actual birth).

I have private health insurance but the only way I was allowed under this model of care was as a public patient - to book in as a private patient I had to go under an Obstetrician.

I ended up with an emergency c-section in the end, but the care from my midwives from start to finish was nothing more than brilliant. Not only that, the only reason I got to have my son in recovery with me was because my midwife was there and thus there was a nurse for the baby. Normally that isn't the case and they're not staffed for infants so the mothers are in there alone.

I'll also say that the post-operative care on the wards was abysmal and the only decent care I got was from midwife who came to check on me every day and a night nurse that was there for one night.

I am not a good candidate for a VBAC, so I'm staring down the barrel of a scheduled cesarian for any future births and that means I have to go under an Ob, but I'll be trying damned hard to find a practice that will allow me to have shared care with a midwife team again.

Edited for clarity - the midwife unit was attached to the hospital as one of their modes of care, so while all my antenatal and postnatal checks were done with the midwife group (and my labour would have been only attended by them had it all gone to plan) it was still attached to the Birthing Centre at the hospital, so I never had to chose between midwife only or hospital care