Homebirth General Discussion #1

Hi Smickers,

Thanks for the apology and thanks also for clarifying some of the criteria for being eligble for homebirthing in Australia. I thought there must be strict boxes to tick if midwives were to take on a client for a homebirth but I wasn't sure what they were. Do the criteria differ from state to state in Aus that you know of? Would it be possible to get a broader run down of the type of pregnancy / situation that makes a good candidate for home birth...ie what makes up a low risk mum to be?

I hope you and Victoria are feeling better and the stress is off. Victoria should be applauded for providing this service and not be copping flak.

Cheers, Jen

Hi Jen,

It's up to the individual midwife and the individual woman as to whether or not she births at home. There is no set criteria for who can or can't birth at home. It's the woman's choice and obviously the midwife will decide if she is comfortable attending that woman. If not, the woman can just look for another care provider who is happy to attend her birth. I don't think you can just willy nilly relegate issues into "high" or "low" risk, it's never that clean cut.

My home birthing experience has been wonderful. I read recently about a lady describing her birthing experience as being 'joyous' and decided that I wanted that too. I got it having a homebirth.

When I visited the local hospital's labour ward at 30+ weeks pregnant, I immediately knew that my 'joyous' birth wouldn't be possible there. The anxiety I felt just visiting the place, the sheer depression I felt being shown a room with NO window, the look of horror on the faces of the other soon to be first time parents was all the evidence I needed really. I heard myself say, " I'm not birthing here" but it took a few days and a lengthy discussion with my doula to make the decision.

The out of pocket expense has been completely worth it..worth every cent.

I felt so empowered having a homebirth - there was no fear of the unknown whatsoever as I had read as much as I possibly could. I had watched videos, DVD's and followed the Pink Kit aswell as taking on board Hypnobirthing. My only worry was tearing that 4th degree scar from my first birth.

It's amazing just what the body and mind is capable of. I birthed exactly the way I needed too - very slowly with two long periods of quiet contemplation (although it was a short labour). The second stage was long and birthing my baby's head took time but I didn't tear the scar and only got a little 2nd degree tear and a small graze..

I felt incredibly well supported with my doula, midwife and husband all working together to create an atmosphere for a positive birth.

I would recommend it to anyone, I really would.

But I am finding it a little bit strange dealing with all the 'you're brave' comments. I knew I was in the safest place possible....ther was nothing brave about it. I think you have to be very brave to birth in hospital with the rate of medical intervention being so high.

clare i always say to those who make the "gee your brave" comment that i was brave to have given birth in hospital it was amazing to give birth at home!

Quick question...whats a lotus birth?

As far as I know, in a lotus birth, the umbilical cord is not cut. The placenta remains attached to the baby until the cord falls off. There may be other things that are done too, but that is the one that sticks out in my mind. Mums who choose that kind of birth generally make a special bag for the placenta and fill it with lavendar and salt to keep it from smelling. I don't know if there is anyone on BB who has done a lotus birth - maybe some one else knows? Not really my thing, but obviously some find it quite appealing.

Cricket! I've been thinking about you! How did your homebirth go? Have you written up your birth story? If so, I'll have a read in the birth stories section.

Congrats on the arrival of Emily and I hope your birth experience was everything you were hoping for and more!!

PS thanks for info on lotus birth, dont think its my sort of thing...

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Hi Jen,

It's up to the individual midwife and the individual woman as to whether or not she births at home. There is no set criteria for who can or can't birth at home. It's the woman's choice and obviously the midwife will decide if she is comfortable attending that woman. If not, the woman can just look for another care provider who is happy to attend her birth. I don't think you can just willy nilly relegate issues into "high" or "low" risk, it's never that clean cut.

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Independently Practicing Midwives (IPMs) are not regulated in Australia, however there are some criteria for offering a homebirth that are generally accepted. The woman must be in good general health without any medical conditions that would increase the risk of complications during pregnancy and birth. They should be within reach of medical support, which tends to disqualify women in isolated rural areas; the pregnancy should be a normal single pregnancy, as having a multiple birth carries an increased risk of complications; the woman should be free of any substance abuse issues; some midwives choose not to offer homebirth to women who smoke cigarettes, as nicotine smoking can increase the risk of low birth weight babies; some midwives will not offer homebirths to women who are not willing to breastfeed from birth; and if the woman has a live-in partner, then they must also not have any substance abuse or aggression issues, and must be generally supportive of the choice.

Theres the criteria off the top of my head. The big ones are multiple births (a big no-no) and breech birth (frowned upon by the medical establishment, but the evidence against vaginal breech birth being safe is proving to be quite dubious, so many midwives are choosing to attend them now; sadly, the techniques in supporting a woman through a breech birth have been lost to our current generation of midwives and many are having to re-learn these skills).

Its interesting to note (I don't know exact figures and I am in the process of researching them) that the last midwife in Australia to be succesfully prosecuted for negligence in Australia was Maggie Leckie-Thompson; that was nearly two decades ago, and was as a result of a complaint from two obstetricians that is generally (among the midwifery community, anyway) accepted as being politically motivated. Obstetricians either sued by families, or prosecuted by the courts for negligence, much more frequently. There is little doubt, and the research evidence from countires such as the UK, the US, Europre, and Australia supports this, that homebirth is a safe option, with a much lower incidence of potentially damaging intervention, than hospital birth, for women who meet some basic criteria, such as those outlined above.

What you say is true, Schmickers, but ultimately it is the womans choice if she chooses to birth at home, regardless of so-called risks which are medical constructs anyway.

Thanks Smickers, thats exactly what I was after. So basically if I have a normal pregnancy, I will be able to have a home birth. Excellent!

More questions :D apart from the midwives, doulas etc, patrners etc, what other support people at home births have people had. Were there too many, too few people around? Did you find you were able to keep people away (say a friend that doesn't take no for an answer) when its all happening in your own home? What pain relief are midwives able to offer during a home birth? Did mums find that they were more relaxed and didn't require (as much) pain relief compared to hospital births?

Thanks for playing 20 questions with me!!

you should be able to keep people away by not telling them your in labour....
i always become hermit like in the weeks before i have bubs i only answer calls i want, i dont invite people over. people that you dont want generally get the clue(eventually)
My midwife has no form of pain relief,(water and being home in a positive environment does wonders). most people dont need pain relief its only because its offered(esp in a hospital environment) and we are so use to seeing on tv,movies that we think we will need it!
Also be prepared before hand! knowing that yes it will hurt but you can get through it it!
ALL PAIN GOES WHEN YOU HAVE BUBS IN YOUR ARMS

My midwife did not carry any pain meds and I never asked for them. Birthing at home meant that pain relief never actually crossed my mind. She likened the birthing pool as an equivalent to the gas you'd use at hospital. I's certainly advocate it as a good form of pain relief.

Hi
I don't suppose there's anyone who's birthed at home through the community midwifery program in WA? I'm keen on a HB, but haven't quite got myself to 'make the call'... would love to hear more about the ins and outs etc. One good thing about the CWP here is that it's medicare funded, so only a $120 application fee is payable. I've seen everyone's comments on money - i know it shouldn't really be a big consideration but we just couldn't afford to pay out 2000-4000 unfortunately. (our private OB is covered by insurance).

Not sure what my reluctance to call is... can someone please give me a 'prod'? ;) Don't know how limited the program is, since it's free, but even if we can't get in this time would be good to find out more for next time.

cheers,

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What you say is true, Schmickers, but ultimately it is the womans choice if she chooses to birth at home, regardless of so-called risks which are medical constructs anyway.

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Hi Samantha,

You are absolutely right, it is the woman's choice to give birth wherever he or she chooses. However, in terms of retaining an independently practicing midwife, a reliable midwife will adhere to admission criteria such as those laid out above, as there is research which indicates that certain types of pregnancy carry an increased risk of complications. Twin or multiple pregnancies, for example, are a statistical rarity and certainly not a "normal" pregnancy, in that "normal" human physiology only produces one egg in order that there be only one pregnancy. So therefore, pregnancies such as these carry a greater risk of complications. My personal belief, as a nurse and as a father of two girls born at home (not as a midwife, although as part of our business I am quite familiar with the research surrounding birth at home) is that homebirth is a safer option than hospital birth for women with a normal pregnancy, "normal" being defined according to the kind of criteria I mentioned above, as long as they are supported by an appropriately trained and experienced individual. I also believe that, for women who are isolated from medical care, it is sensible to take measures to ensure that medical care is available; whether that means relocating closer to medical care, or alternatively, choosing to birth in hospital but educating yourself and bringing with you a vocal advocate to be your voice during labour and ensure your well-research wishes and desires are accepted, even if they happen to go against hospital policies, policies which often exist for the convenience of staff, not women.

My wife often poses that exact situation to me as a moral dilemma - knowing the risks inherent in medicalisation of a hospital birth, would I support her to birth twins at home? My answer is that no, I would not; but that I would pay for the services of an IPM to accompany us to the hospital as an advocate; that I would light candles in the birthing suite, burn oils, play music, and dim the lights; bring our doona from home and put it over the bed, close the cupboards and the windows; blow up our own birthing pool; bring sandwiches and food and drink; and then I would politely give the midwives and any obstetric registrar present a packet of Tim Tams and let them know that, if we needed them, we would let them know, and that until that point, the only people who we would permit into the room were one hospital midwife and our own support people, and that we were willing to sign any waiver or document that they desired us to sign to facilitate this birth experience in the safest and most natural possible way, and that we had personally chosen and employed an experienced midwife as a support person whose judgement we trusted and that if they honestly felt that complications were arising that required intervention, we would obviously accept such intervention.

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More questions :D apart from the midwives, doulas etc, patrners etc, what other support people at home births have people had. Were there too many, too few people around? Did you find you were able to keep people away (say a friend that doesn't take no for an answer) when its all happening in your own home? What pain relief are midwives able to offer during a home birth? Did mums find that they were more relaxed and didn't require (as much) pain relief compared to hospital births?

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At our first birth, we had one of Victoria's friends as a support person. She was lovely, very helpful, and not too intrusive. We couldn't thank her enough. Shortly after the birth, we had also invited one of our midwives' daughters, who was a photographger with whom we'd become friends, to come in and take photographs.

At our second birth, we had Victoria's mother. In hindsight, I think we had her there more for her needs (she had never seen a birth before, and really wanted to be there) than our own, and while she was not unhelpful, she wasn't as intuitve as Victoria's friend had been; I think this is reflected in the fact that Victoria's friend had always intended to be there fully for us, whereas her mother wanted to be there for her own experience as much as ours.

So, in answer, I felt we had the right number of people at our first birth, but perhaps that we could have been just the two of us and our midwife at the second. Having said that, our opinion might have been different of Molly had been awake during the birth as Victoria's mother would have been looking after her!

As far as keeping people away, we just took the phone off the hook and didn't tell anyone it was happening until after the birth. And in the days after the birth, we were quite upfront when we didn;t want visitors. Most people understand, and if you have a helpful midwife, they may be happy to talk to family members and gently remind them that "visiting hours" still apply at a home birth!

Midwives offer non-pharmacological pain relief. That means mild pain relief, such as over the counter paracetamol and similar pain relievers, massage, water, homeopathics, and the like. Some midwives will offer transcutaneous electrical nerve stimulation machines (TENS) or you can hire your own. Sterile Water Injections (SWI) are a fairly new practice that can also be used at home to reduce pain. And rarely, with the assistance of a GP, it is possible to hire an entonox machine (nitrous oxide, or "gas") to be used at home. As many midwives will warn you, though, using artificial forms of pain relief inhibits the body's own pain relief mechanisms, and paradoxically, some women find that they cope better in established labour without pain relief, as their body will produce it's own endorphins.

I have quite a few questions and I'm not even sure where to begin. I am VERY keen on a home birth, hubby not so but I'm confident with the amount of research I'm doing at the moment that that can be turned around. I was blown away by the safety of HB.
I guess my biggest question involves my sister. Her last birth was in a hospital (4 mins after arrival) and directly after delivering the placenta, she haemoraged badly. We were all told that had she delivered anywhere but where she was she would have died. I am wandering what would happen to me in a similar position at home? Needless to say the reaction of my family when I tell them I am considering a home birth...

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I guess my biggest question involves my sister. Her last birth was in a hospital (4 mins after arrival) and directly after delivering the placenta, she haemoraged badly. We were all told that had she delivered anywhere but where she was she would have died. I am wandering what would happen to me in a similar position at home?

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In order to answer that, I'd have to ask - how long after the birth was your sister's placenta delivered? Was the cord cut, and was the delivery of the placenta assisted by the midwife or obstetrician pulling on the cord? And what was the nature of the birth - was it an induction, did she go into labour naturally, were there any other interventions?

hi everyone!
well i am back from sydney where i went to the Homebirth conference! it was awesome! on the saturday it was soo emotional and wonderful! and the sunday was great (but not so emotional which was good i dont think i could have handled crying any more!):lol:
oh makon has woken will come back to finish

Hi Schmickers,
The placenta was delivered straight after baby, she was just told to push and the placenta came out of its own accord, in tact with a few clots.
She laboured at home, going into transition in the car and delivering the baby 4 minutes after she arrived at the maternity ward. The midwife didn't even have time to put gloves on! There wasn't time for intervention.

This is her 3rd child, the 1st had a lot of intervention, the second not so much and this one none!

One more question, how far is to far from home to hospital? As in how far away can you be and still be attended by a midwife?

Oh, sorry I forgot to say she went into labour naturally!

Jakana sometimes women hamorhage after birth. It is FAR more common when there has been intervention, but it happens where there has been none too. Previous complications and later pregnancies (3rd and more) can raise the risk, but don't necessarily. In cases like your sister it is difficult to predict and rare. I'm sorry it happened to her :( To minimise your risk of the same thing happening one can decline the use of induction drugs and stay upright and active to minimise the risk of forceps or ventouse being needed, ask for the cord to be left to stop pulsing after the birth and not cut until the placnta is delivered, allow no-one to touch or tug on the cord or push your belly and generally let nature do it her way.

When i gave birth i was about 10 minutes by car from hospital (40 in heavy traffic, 4 in helicopter which was a possibility as there is an air ambulance from there). I'm in the UK so you get a midwife no matter how far from hossie you are. My midwives had pitocin (to make my uterus contract hard, enough for 3 times the dose they use for the 3rd stage), adrenalin and oxygen with them as well as an IV shunt and 1l of fluids (saline). So if i had had a bleed after birth, they had equipment to keep me alive and my blood pressure above a dangerous level long enough to get me to hospital. You can ask what provision miwives have for this circumstance when you're looking to book one.

Another thing i would say is that LOTS of women are told "If you'd been anywhere else you'd have died" - i even know women who had botched inductions ending in c-sections told that - if they'd been elsewher they'd have died! What like, on the sofa waiting for bubs rather than hooked up to a drip at risk of infection after an AROM! Bleeds can happen VERY fast but midwives don't just sit there and watch, they IMMEDIATELY begin to stabilise you and stop the bleeding while simultaneously getting you to hospital as fast as possible. Because of the intervention statistically you're more LIKELY to suffer a PP bleed in hospital (which i know isn't much help when your sister had one with no intervention).

Bx

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One more question, how far is to far from home to hospital? As in how far away can you be and still be attended by a midwife?

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It's up to the midwife. As an absolute maximum, I would say that most midwives would not recommend a homebirth if you are located more than 60 minutes from the nearest hospital. The research indicates that there is a 75 minute window of action from when complications are detected that results in good outcomes for woman and baby.

As far as what happened to your sister, it must have been very distressing to her and all of you. But the statistics suggest that something like that happening as a result of a well-managed natural birth are quite rare. I would go so far as to say that your sister was quite unlucky.

As far as her having died if she wasn't in hospital, I do not believe that is necessarily the case. Initial treatment in the event of a haemorrhage is the same at home or in hospital; insertion of an IV cannula, commencing fluids to expand blood volume, and administering oxytocics to induce strong contraction of the uterus to stop the bleeding. A good homebirth midwife will be able to manage all of this at the same time as arranging for your urgent transfer to hospital.

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We were all told that had she delivered anywhere but where she was she would have died. I am wandering what would happen to me in a similar position at home? Needless to say the reaction of my family when I tell them I am considering a home birth...

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I had a post partum haemmorhage at my last homebirth. I did not die! ;)

HB midwives carry syntocinin, the drug that is used in case of excessive bleeding. Many mws also carry IV fluids. if a woman were to haemorrhage at home the first line of action would be an injection of syntocinin. If additional assistance were needed she could put fluids up and transfer to hospital.

The "if you had been anywhere else you would have died" line is popular but not always accurate. Or as another poster said (altho not relevent in your sister's situation) the "drama" was caused by intervention to begin with. I have had many women tell me their birth horror story that starts with induction, continues with epidural, failed ventouse, then cs. They are told they would have died had they not been in hospital... but they woudn't have had a "failed induction" at home!

Good luck making your decisions. :)

I was at a birth a few months ago which ended in a PPH with about 1.6l lost, so not a small amount. It was an induction with synto and epidural given at 40+4. Once the emergency was over, the midwife said to me 'lucky this didn't happen at home!'. Oh, the irony! I would have laughed in her face if it was not for the poor woman trussed up with a blood transfusion in the background.
Jakana, HB midwives are quite capable of dealing with those sort of situations in the home, with transfer to a hosp, if necessary. It's up to you to decide how far you are happy to travel in an emergency situation. I think that is the beauty of homebirth. It's up to the individual to own and be accountable for what happens during the pregnancy and birth, and I think that's what makes homebirth a much more satisfying and empowering experience.

Question which is off the track of the thread (which I apologise for) but how do you deal with cleaning up the mess after a home birth? Does the midwife "take care of things" (LOL!) or do most people buy a heap of cheap towels and sheets which they just accept will be thrown out afterwards? I mean, you are essentially talking about medical waste so what do you do with the "blood and guts" side of things?

Rory, you do it at your mum's house and she cleans up after you ;)

That's what I did with Tehya. LOL. She was born at 6.35am and I swear by 9.30am all the washing was down, the pool was drained and washed out and all the furniture was back to normal. There is no way you could tell that a baby had just been born there.

I bought some cheap brown towels from best and less for myself and soem pink ones for Tehya. I still have them to this day, everything washed up just fine (thanks mum) I will be reusing them for this birth too.

Generally though, unless you have a mum like mine, your midwife will do some of the cleaning up along with your partner.

Rory,

My midwife actually supplied all the linen and sent it away to be cleaned professionally - great idea!! DH cleaned out the pool and cooked everyone breakfast - no trouble at all. Sometimes your doula may assist with that side of things too.

There was no mess for me. I lay down on 4 incontinence mats for a VE (my waters had gone a good bit before) on my bed (which had a showercurtain under the sheet to protect the mattress) and she was crowning. She was born onto those 4 mats, then the MW put another 2 on top of those for the 3rd stage, put DD on my belly, wrapped a towel over us both and a blanket over that, then gathered all the pads and placenta (after it was examined and deemed whole) up and yllow-bagged them with her gloves. That was it. There was no other mess. We had all the towels in th house clean and dry JIC but we only used 2 - one around DD and me and one when i had a shower an hour later....

Bx

There's invariably not as much blood as you think. Most of the cleaning after our homebirths has just been putting the house back in order - a general tidy up as when everyone is preparing for a baby to be born, no one really pays much attention to where they are putting things or moving furniture, etc. So lots of straightening up sheets, putting towels on to wash, tidying away equipment. Shower curtains are fantastic as mattress and floor protectors, as are painters drop sheets, about $4 each from a hardware shop.

Michael, have you done this before ;)

Just a few times, yes...:D Maybe I should do the Doula course, although I don't know if the sight of a big hairy man as a doula might scare a few poor pregnant women...LOL

Oh Michael, after reading all of your wonderful posts I think you'd make a fantastic doula!!! (although isn't a male doula a contradication in terms?) ;-)

Sorry if this is a little off topic - but I couldn't find a waterbirth general discussion thread. I'm v. v. excited after having my appointment at the hospital to prepare for a waterbirth!! The public hospital I am attending supports and encourages both active and water birth - isn't that a bit of an anomaly within the public system? In any case I am cautiously optimistic about my chances of having the type of birth that I would like!

I would have loved to have a home birth but we just moved to an area with limited home birth resources, and not much time to seek them out. But I have been very happy with the hospital support I've received so far, and if not for the strong BHs I've been getting would have literally skipped out of the hospital after meeting with the waterbirth consultant midwife! The little guy is still determinedly posterior so it's been great reading other BB members' positive experiences with posterior home and waterbirths.

I don't think that I would be going into this experience in such a confident state of mind without all of the wonderful support from BB! Thank you to everyone!

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The public hospital I am attending supports and encourages both active and water birth - isn't that a bit of an anomaly within the public system? [...] and if not for the strong BHs I've been getting would have literally skipped out of the hospital after meeting with the waterbirth consultant midwife!

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Good god, what hospital is that? It sounds marvellously enlightened...

Trish! you make me laugh! Good on your mum for looking after you so well!:lol:

Giving birth at mums house would be really comfortable, she has a big indoor bathtub / jacuzi thingy for the water part and lots of sheets...but since her house is also a B&B, the other guests might not like me hogging the bathroom and squealing in the next room! :p

The other lady from WA, sorry, I've forgotten who you are :redface:...How did you go checking out the HB scheme in WA? I'd be really keen to hear what you found out. Would you mind posting a bit of an update here? Thanks - Think of it as the 'push' you needed to look into it!;)

Smickers...maybe a male version of a 'doula' is a 'doulo' ??And you've raised an interesting point about having a big hairy man as a birth attendant..I'm not sure which way I'd go- it would really depend on if we clicked or not rather than your gender for me, but it does seem a bit odd to begin with...Is it something you would like to get into?

I guess the idea of having a male doula is pretty much the same as having a male midwife now isn't it. And although there aren't alot out there I'm sure of the few that are they would be great.

Micheal, I can see a side job for you with Victoria happening hun ;)

Jen, OH your mum's house sounds perfect for birthing. Umm, charge the other guests a viewing fee and you might be onto something there ;) I remember mum's neighbours wanted us to leave the curtains open so they could watch !!

Eeeow to your sicko neighbours Trish! I hope you shut the curtains tightly and looked the front door!

but then on the other hand.....there are people out there that would be willing to pay to watch a birth...maybe I could auction it off on EBay as an accomodation and 'entertainment' package! :D

Sorry, off topic and very silly!! :lol: bad Trish & BL!!:whip:

"Good god, what hospital is that? It sounds marvellously enlightened..." Cairns Base Hospital Michael.

I know, it does sound too good to be true! I'm waiting for the bubble to burst and to end up with my feet in stirrups, an enema jammed up my bum and some smarmy ob to peer over his glasses at me and say, now come along dear, we must get you moving along, you don't want me to miss my golf game at 5:00 now, do you... I was a bit worried when we first moved up here as they actually have a higher than average c/s rate - but they are an area base hossy and get all of the regional emergencies which tends to skew the stats a bit.

Babylove - a doulo - now that's brilliant!! And if you do convince your mum to turn her house into a Birth and Breakfast, sign me up please. It sounds wonderful!

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Smickers...maybe a male version of a 'doula' is a 'doulo' ??And you've raised an interesting point about having a big hairy man as a birth attendant..I'm not sure which way I'd go- it would really depend on if we clicked or not rather than your gender for me, but it does seem a bit odd to begin with...Is it something you would like to get into?

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Well, I kind of practice midwifery vicariously through my wife, who is a midwife who does some independent midwifery and childbirth education. Hence I'm fairly clued up on the subject area, as I assist with a lot of the research and documentation for her independent practice. I'm a children's nurse currently. But yes, I have frequently considered studying to get my midwifery qualifications, and as times wears on, my reservations about doing so steadily recede. My only real objections now are financial (I'd probably have to drop back to part time, and take a significant drop in pay, to start again as a student midwife) and my location (I'd have to do my practical work at our local hospital, and it and my wife have had certain...disagreements...in the past. And additionally, it would probably necessitate her ceasing work, as they would not be able to roster us on at the same time).

And I like doulo...I may add it to my sig...:D

Cairns Base hospital in my opinion, does not practice what they preach. They are supposedly a Baby Friendly certified hospital, yet the women that I know who have gone there ( some were my clients ) ended up being separated from their babies for a period after birth for unjustifiable reasons.

Like most other hospitals, the experience a woman will have at CBH is dependent on who is rostered on at the time you go into labour. They do have birth pools, but women are only allowed to birth in them if the waterbirth 'specialist' is there at the time to my knowledge. If someone else is using the pools you aren't allowed to bring your own. I don't like how often some midwives will ask if women want pain relief constantly despite the women clearly stating they did not want to be offered and that they were aware of the option.

As for encouraging natural active birth, there are certain routine policies that CBH has that do not work in favour of active birth - like the 20 mins monitoring that they often insist women get on the bed for upon being admission. Again its really dependent on who is on staff at the time. I know some who swear they've had great middies and great births there (but none were first timers which is interesting).

If the woman is a VBAC, CBH is really crap about encouraging natural active birth because their routine protocols for managing VBAC women do nothing to improve or help their chances at VBAC. VBAC protocol doesn't support free active labour. It is pretty restricted and the women I know who have attempted it there have ended up with repeat C/s.

Personally I think the perinatal and maternal data for the hospital says it all, and that blaming it on the amount of "high risk" women who end up there is a cop out. The recommended rates of intervention by the World Health Organisation is based on high risk clientele as well and CBH is well over that margin.

It is a shame that there are no practising homebirth midwives servicing the Cairns area at the moment. The closest is in Mareeba and last I heard, they have stopped attending women in Cairns because of the distance. So basically birth choice is limited to the public or the private (and I'd rather the public), or the highway as one Cairns Post paper put it in Jan 2005 where a woman said she was going to have a home birth without a midwife anyway because the hospital was not an option for her.

That's really interesting to hear Morgaine - and quite disturbing as well. Are you either a doula or midwife yourself (you mentioned clients so I am assuming that you are a birth professional of some description?). It sounds like you have quite a bit of experience with it so thank you for such detailed information! Although I will admit that you have me a bit worried now...!

I've heard that in any public hospital you are at the mercy of whoever happens to be rostered on at the time. I've noticed a difference between some of the midwives that I've seen for appointments, although the majority seem to be really supportive, there have been one or two that I fervently hope are not rostered on when I go into labour! It's a big argument for having a doula or private midwife to attend, but unfortunately it's not an option for me! After reading your post though I am wondering whether to try to scrape together the money for a doula - although at 39 weeks it might be a little late, even if there are any in the area! I am a pretty strong advocate for myself (and my partner knows exactly what I want), but probably won't be in any position to argue on the day if I need to.

In your opinion, do you think that there is any way that I can give myself a better chance for a natural birth (apart from having my fingers crossed that I have a good midwife on the day?).