Article about Community Midwifery Program in WA

AT THE VERY BEGINNING . . .

Publication: The West Australian (4,Wed 12 Jul 2006)
Edition: METRO
--------------------------------------------------------------------------------

ALISON BENNETT, NORTH FREMANTLE HOME BIRTH

Giving birth in the clinical confines of a hospital didn't appeal to first-time parents Alison and Alastaire Bennett, so they chose to have their baby boy, Silvan, at home, with the help of the Home Birthing Program at Community Midwifery WA.

"It just felt like the only option for us. It didn't seem necessary to go to a hospital. It didn't feel comfortable there," said Mrs Bennett, 28. "It's an amazing experience, very empowering, and we felt really well supported and cared for. It's an amazing program." Her husband agreed. "It was a profound experience and such a harmonious one not only for us but for Silvan too," Mr Bennett said. "Having the support of an experienced midwife at home was just perfect for us - it felt secure and so much more relaxed in a familiar environment."

Home births are an accessible alternative to hospital births where mothers can go through labour and give birth in a familiar and comfortable environment. Midwifery manager Karen Kruit says there about 240 women involved in the Home Birthing Program at the moment - a blend of first-timers and women with previous children. Ms Kruit said there were also women who had "for some reason maybe had a birth that had been difficult or traumatic"and had chosen a home birth this time round.

"The key of the home-birthing program is that we have a continuity of care where they have one midwife who looks after them from about 14 weeks pregnancy and she would be the one and only constant that the woman will have from 14 weeks right through to four to six weeks after birth," she said. "So they build up a trusting relationship and they can deal with all sorts of personal issues."

When it's time to give birth, both the primary midwife and a back-up midwife are present. The midwives don't administer epidurals or carry any drugs at home births so many women use water birthing to help cope with the pain. "Water is considered, during labour, to have significantly better outcomes as far as pain relief is concerned and is very effective," Ms Kruit says.

Mrs Bennett said her birthing pool was a great relief during labour. "It helped me to relax and to have a rest - it was a lot smoother," she says.

Not all women are ideal candidates for home births - such as those having twins, those over term or those who have medical obstetric issues or conditions that require specialist care. "Any woman who becomes complex while she's on the program, if her pregnancy deviates, will be referred to an obstetrician or a GP, whoever is relevant," Ms Kruit said.

* Community Midwifery WA is funded through the Health Department, with Medicare covering all costs except a $110 administration fee. It can be contacted on 9339 0021.

* About one per cent of WA births are home births (including those that are emergency births at home or en route to the hospital). There are 163 home births and 80 unexpected arrivals a year in WA. Sophie Taylor

NERINE HORABIN, WARWICK PRE-TERM BIRTH AND UNPLANNED CAESAREAN

The day after Nerine Horabin went on maternity leave from her job as a midwife at King Edward Memorial Hospital, she was planning to get up, do yoga and have a break. But instead her waters broke, with five weeks still left to go in her pregnancy, and she had to tell her husband, who was heading to bed after a night shift, that he would not be getting any sleep that day.

"I had had a lot of scenarios about the birth running through my head but not in a million years had I thought that it would be a pre-term birth," the 27-year-old said. The nursery had not been painted and the cot had not been put up. Ms Horabin had wanted a vaginal delivery. Her baby was in the breech position and she had planned to undergo attempts to turn it before birth.

Instead, she ended up having an unplanned caesarean at King Edward last November and her 2.8kg son, William, spent time in the high-care special-care nursery. "It was fairly traumatic at the time but I knew if I had any problems, that was the place I wanted to be," she said. "William took time to get his act together because he was not really ready to come out. But in the grand scheme of things, five weeks is not really a lot."

* Of the 256,925 Australian births in 2003, 20,243 (7.9 per cent) were pre-term, being less than 37 weeks gestation. The average gestational age of babies, overall, is 39 weeks.

* A total of 5345 babies were admitted to level III neonatal intensive care units in Australia.

* Of babies with breech presentations at birth, 87.3 per cent were delivered by caesarean section.