Orgasmic Birth In Australia

Lessons of Labour, written by Dr Hannah Dahlen, Associate Professor of Midwivefery at the University of Western Sydney, appeared yesterday on the ABC’s online Unleashed pages ”. Dr  Dahlen makes many important clarifying points, in what has been a media storm over homebirth in recent weeks, marked by misinformation, inappropriately quoted studies, bias and narrow minded conjecture.

Mortality

• According to the perinatal statistics for 2006 (the most recent ones available) 711 babies were born in planned homebirths in Australia with no deaths reported.
• In the same year 2730 babies died in hospitals settings (representing 1% of all live births). For more information see Australian Institute of Health and Welfare’s report Australian Mothers and Babies 2006.
• The four deaths attributed to homebirths, as reported in the Daily Telegraph are yet to be confirmed – but were reported as fact.

Not all Homebirths are the Same

• There has been a lack of acknowledgement in media reports and opinion pieces of the difference between planned homebirths for women with low risk pregnancies attended by a competent midwife who is well networked into mainstream services AND births at home where there is no professional care or where the woman has risk factors in her pregnancy.
• There is definite differences in each option with low risk midwife attended birth at home supported by research as safe, compared with other birth at home options.

Rising Intervention Rates

• Intervention rates during childbirth have sky-rocketed over the past ten years in Australia.
• Women are now more likely to have intervention than not have intervention.
• These interventions cause women to feel traumatised and fearful.

Limited Options

• Options of care for childbearing women remain limited.
• Around three per cent of women able to access continuity of midwifery care (aprox 2% in birthing centre and less than 1% at home.)

Closure of Maternity Units

• In the last 10 years, 130 maternity units have shut down in Australia.
• This has given rise to the growing incidence of ‘roadside births.’
• It also means increasing numbers of women are birthing a great distance away from family and friends.

No Insurance

• Privately practicing midwives have not been able to obtain affordable insurance since 2000.
• Many midwives have stopped practising because of their inability to be insured.

Appropriate Management Complicated

• Privately practicing midwives cannot order routine blood tests or ultrasounds.
• Pricately practicing midwives often find it difficult to obtain the results for the women they care for, causing delays in appropriate management.

Financial Restrictions

• Few financial rebates are available for homebirth
• Families pay out of pocket $3000-5000 dollars for a privately practising medwife.
• Some women simply cannot afford to pay that.

Dr Dahlen states that the ramification of these issues are:

• more traumatised women due to interventions during birth
• fewer options of care - especially continuity of midwifery care
• fewer experienced, networked midwives available to attend women privately
• and no access for women to a hospital birth under a private midwife.

These issues have contributed to the rise in unattended homebirth and more woman with high-risk pregnancies are seeking private midwifery care at home.

You can read Lessons of Labour at the ABC’s Unleased Pages.

Jodi Cleghorn is a homebirth Mum, natural birth and breastfeeding advocate, activist and writer.  For three years Jodi was the editor of the quarterly magazine “Down to Birth” and spent four years involved with the Home Midwifery Association in Brisbane.

Article written by Thea O’Connor | March 28, 2009 for The Australian Newspaper

Supporters of homebirth are asking why the topic is still seen as too hard to handle in this country.

WHEN Natalie Hemingway gave birth to her son 10 months ago, doing so at home seemed an obvious hoice. She had already given birth to her daughter at home three years earlier, and both of her sisters had been born at home.

“That’s what I saw when I was growing up, so birthing at home was normal to me,” says Hemingway, 27, who lives on Sydney’s lower north shore.

Homebirth in developed countries was the norm up until the past 50 years or so. In Australia today, homebirth can seem a radical choice, and the women who chose it anything from brave and alternative to misguided and loopy.

The recent federal government review of maternity services has done little to help bring the practice into the mainstream. It has inflamed an already heated debate over homebirths by stating it does not support Medicare funding of independent midwives attending homebirths. Described in the review as a controversial and sensitive issue that polarises the professions, it seems that homebirths are just too hot for Australia to handle, at least for now.

Part of the problem is that both advocates and opponents of homebirths have research evidence to support their arguments.

According to Hannah Dahlen, associate professor of midwifery at the University of Western Sydney and
spokeswoman for the Australian College of Midwives, the best available evidence comes from a large prospective study of 5000 women planning a homebirth in the US in 2000.

The results, published in the BMJ in 2005, showed that the rate of babies dying during labour or within 28 days of birth (intra-partum and neonatal mortality rate) was 1.7 deaths for every 1000 uncomplicated intended homebirths. The study (2005;330:1416-1419) said this was similar to risks in other studies of uncomplicated home and hospital births in North America.

Dahlen says it is also similar to the risk of first-time mothers having an uncomplicated birth in an Australian
birth centre (1.4 deaths for every 1000), or Australian hospital (1.9 deaths for every 1000), reported in a
population-based study of more than one million women, published in the journal Birth (2007;34:3:194-201).
When the high-risk births (planned breeches and twins) were included in the analysis of the US study, the rate was twodeaths for every 1000 births.

The highly regarded Cochrane database, which assesses the highest quality evidence available, concludes that “there is no strong evidence to favour either home or hospital birth for selected, low-risk pregnant women”. Australian research is scant and a fierce debate rages over what little there is. Andrew Pesce, president of the National Association of Specialist Obstetricians and Gynaecologists, believes we have enough evidence to worry. He points to Australian data that indicates babies have a two to three-fold increased risk of death with homebirths.

A study of 7000 planned homebirths in Australia between 1985 and 1990, published in the BMJ (1998;317:384- 388) reported that deaths occurring during labour and not due to malformations or immaturity were higher than the national average: 2.7 v 0.9 for every 1000.

Dahlen counters that this study provides low-level evidence: the study design was retrospective, it included births by non-registered midwives, it used a number of methods to collect the data, including searching newsletters for death notices, and it’s almost 20 years old.

Pesce also refers to the 12th report of the Perinatal and Infant Mortality Committee of Western Australia. It
documents a 2000-04 death rate for babies that is three times higher for homebirths. The report said the
numbers were too small to be conclusive.

A review was conducted last year, but the results have not yet been released. In December 2007 the West
Australian Department of Health stated “a preliminary review of medical records indicates that it is likely the
setting of the birth did not affect the outcome in at least five of the six deaths”.

Distinguishing the outcomes of uncomplicated births from high-risk births helps to make sense of the conflicting data. Referring to the West Australian figures, Pesce insists that even for uncomplicated births there’s a significantly increased risk. Marc Keirse, head of obstetrics and gynaecology at Flinders University, is one of the authors of the local study of 7000 women. “Most of the elevated risk came from high-risk births, such as breech and twin,” he says.

The study concluded that while homebirth for low-risk women could compare favourably with hospital birth,
high-risk homebirth was “inadvisable and experimental”.

The Australian College of Midwives supports this conclusion.

Dahlen says women should still have the right to attempt high-risk births, provided they are well informed of the risks, as well as their chances of success.

“Women wanting to give birth vaginally after a caesarean, for example, have a 70 to 85per cent chance of
success,” she says.

“I don’t know of any other area where the battle over women’s bodies is as intense as this. We have to make suremwe don’t end up with situations like those in parts of the US, where midwives are put up on criminal charges and women are arrested and taken from their homes to hospital if they are intending any birth at home the medical establishment considers risky.”

Keirse, who has also worked in obstetrics in the Netherlands, characterises the debate as a demarcation dispute. “Holland went through that in the 1970s. When midwives were granted free access to hospitals in the early 1990s, that made a big difference and contributed to improving safety rates.”

Pesce believes it’s not so much a turf war that polarises the homebirth and medical professions. “It’s because we come from different paradigms with different underlying philosophies,” he says. “We can’t even agree on what thepriorities are; what safety means, forexample.”

Britain’s Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have managed to agree. Their 2007 joint statement, which supports homebirths for women with uncomplicated pregnancies, reads: “There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe.”

Safety, the statement says, needs to encompass emotional and psychological wellbeing, not only physical safety. In the Netherlands, 30 per cent of all births take place at home.

“The culture is conducive to homebirths in Holland,” says Keirse. “It’s an accepted government policy and the midwives who conduct homebirths are considered part of the medical profession. They have rights that allow them to continue caring for their clients if they need to transfer to hospital.

“In Australia, there can be large distances between home and hospital, independent midwives have no hospital rights and they are not incorporated into the healthcare system.

“This means that training of homebirth midwives isn’t regulated, which it should be.”
One research finding that is not disputed is that homebirths result in fewer medical interventions. The US study of 5000 women found that compared with the relatively low-risk hospital group, intended homebirths were associated with lower rates of electronic foetal monitoring (9.6 per cent v 84.3 per cent), episiotomy, an incision

made to enlarge the vagina and assist delivery (2.1 per cent v 33 per cent), caesarean section (3.7 v 19.0 per cent) and vacuum extraction (0.6 v 5.5 per cent).

One of the reasons Hemingway wanted a homebirth was to avoid exposing her baby to drugs. “I also wanted to see the same person before, during and after the birth,” she says. “The biggest thing was being able to choose.

Homebirth is just another choice that should beavailable to all women if that’s what they want.”

Reprinted with thanks - Copyright 2009 News Limited.