A few weeks ago, I mentioned to a fellow health worker that I'd co-written a book on postnatal depression. ''Really? I have an interest in postnatal depression,'' she said.(cheap canvas prints canvas printing sydney)
Assuming she meant a professional interest, I asked her to elaborate. ''My sister committed suicide a few years ago,'' she said.
The story she went on to tell me was an eerily familiar one: a traumatic vaginal delivery, family interstate, no one checking on the mental health of a vulnerable young woman, a devastated husband and a motherless child left behind.
Unthinkable, but more common than you'd imagine. In last Saturday's News Review, Catherine Naylor reported on the rise in birth complications in Australia. In the story, Hannah Dahlen, a midwifery professor at the University of Western Sydney, is quoted as saying the following:
''Suicide is one of the leading causes of women dying after childbirth in the developed world.
''According to some studies, one in 10 women are coming out of childbirth traumatised, showing symptoms of post-traumatic stress disorder … If you are coming out of childbirth feeling devastated, like a failure, unable to get on with life, those interactions with your baby are fundamentally wiring that baby's brain and there are psychological implications for children.''
The causes of postnatal depression are many and varied: genetics, hormones, an anxious disposition, no family support and stressful life events among them. But I can't help wondering if the language that surrounds childbirth is part of the problem. Why would a woman feel ''like a failure'' after a birth that hadn't gone to plan unless someone suggested she should?
Modern motherhood has taken on a disturbingly competitive edge. There seems to be a right way (vaginal delivery with extra points for no epidural/ breastfeeding for a year) and a wrong way (caesarean delivery/ bottle feeding) to become a mum. If you fall into the latter category, you risk being judged, or at very least perceiving yourself as being judged. During the emotionally charged months after childbirth, this is a potentially dangerous mix.
In another story, Amy Corderoy reported that the Royal Hospital for Women at Randwick is bucking the trend on rising caesarean rates, having reduced the rate in their public wing from 28 per cent to 25 per cent in the past three years. No one doubts this is a laudable public health initiative - a vaginal delivery is always preferable if there's no risk to mother and baby.
However, I did a double take at the interview with mother Audrey Tamburini, who had delivered vaginally after a previous caesarean. According to the story, Tamburini's caesarean had left her feeling ''disempowered, traumatised and incapacitated''. Tamburini says: ''I believe the whole experience helped me to heal emotionally from the [previous] C-section and gave me heaps of confidence and empowerment in the first months of Juliette's life.'' ''Heal'' and ''empowerment'' - such emotionally laden words. Audrey Tamburini had the outcome she desired, but what about other women reading the story who need to have a second caesarean? How would they feel? I suspect for some it would be a kick in guts, making them feel less worthy.
I'm willing to bet that empowerment in childbirth is a uniquely Western preoccupation. I wonder if the women on the plains of Africa feel empowered when they give birth naturally or whether they're just grateful that they and their babies have survived the experience. Or go back a few generations. I expect my maternal great-grandmother, who died in childbirth, would have gratefully accepted a caesarean if one had been on offer.
I could be accused of bias as I've had three caesareans. My first baby was breech. With my second, my obstetrician pushed for a trial of labour, but it didn't work out. The third was a no-brainer. I don't remember feeling unempowered or even particularly incapacitated after the births, just very much in love with my three beautiful babies.
I don't think it is bias because I was an exemplary breast feeder and get just as angry when the ''breast is best'' public health message is distorted by overzealous lactation advocates. One of my closest friends couldn't breastfeed and was made to feel a failure because of it. Breastfeeding difficulties are a recognised trigger for postnatal depression.
My first baby is now nearly 20. Motherhood is a long haul and if we are to judge mothers at all (although I'd prefer we didn't), it should be on how well they nurture their child's emotional development, not on how they deliver or feed their baby in first few months. When you have a 20-year-old, all that early stuff seems very unimportant.
So can we please mind our language when it comes to the birth experience? There may be a vulnerable young woman reading or listening.
Friday, February 6, 2015
Caesarean rate not just a result of ageing, overweight mums
For a man who has spent his whole life researching the pelvic floor, Dr Peter Dietz's comments that women are endangering their health in a quest for natural birth to avoid caesarean sections comes as no surprise.(canvas prints acrylic prints)
There is no doubt that pelvic floor injuries are a threat to the health of child-bearing women. It's imperative that we continue research in this area, and work to make birth safer. But women need comprehensive information that goes beyond the pelvic floor when considering the pros and cons of vaginal birth versus caesarean section.
I was part of the multi-disciplinary committee in 2010 that worked on the 'Towards Normal Birth' policy that Dr Dietz criticises. The policy was based on sound scientific evidence, and is in line with international recommendations from groups such as the World Health Organization.
More importantly, it was in response to intense consumer lobbying over the high rates of caesarean section in NSW and the resulting trauma (physical and emotional) for women.
Dr Dietz argues the rising caesarean section rate is linked to older and overweight women giving birth. This is, in part, true. It does not, however, account for the fact that we see significantly lower rates of caesarean sections in Scandinavia and the Netherlands, where women have the same demographic profile.
We published a paper last year repeating a study undertaken a decade earlier, which showed that with the same matched low-risk (no medical complications, under 35 years of age) population of women in NSW, there had been a 5 per cent rise in caesarean sections in the public sector, and 10 per cent rise in the private sector.
The ''oldest'' women giving birth in NSW do so in birth centres and at home, and have the highest rates of normal vaginal birth.
Studies show that women who give birth in private hospitals are much less likely to be overweight than those birthing in the public section, yet they have nearly twice the caesarean section rate.
So the question that must be asked is this: is the problem more about our attitude to women and the models of care and environments in which they give birth, rather than changing demographics and medical risks?
The rising caesarean section rate is therefore not as ''inevitable as the weather'', as Dr Dietz argues.
Dr Dietz states that reducing epidural pain relief is ''reprehensible and anti-Hippocratic''. There is no intent to deny a woman an epidural if she wants one; we need to ensure they're not used unnecessarily. Women who have epidurals during labour have higher rates of instrumental birth (forceps and vacuum), which Dr Dietz quite rightly points out is a major cause of pelvic floor problems.
But continuity of midwifery care, for example, leads to a reduced need for epidural and higher satisfaction with birth, along with many other advantages. Immersion in water reduces the need for epidural and increases women's sense of control, so access to this is supported under the 'Towards Normal Birth' policy.
Dr Dietz's statement that ''human childbirth is a fundamental biomechanical mismatch: the opening is way too small and the passenger is way too big'' provides a real insight into why the caesarean section rate may be so high in this country.
If health professionals truly believe this, then what chance do women have to feel confident in their bodies and their capacity to give birth?
There is no doubt that pelvic floor injuries are a threat to the health of child-bearing women. It's imperative that we continue research in this area, and work to make birth safer. But women need comprehensive information that goes beyond the pelvic floor when considering the pros and cons of vaginal birth versus caesarean section.
I was part of the multi-disciplinary committee in 2010 that worked on the 'Towards Normal Birth' policy that Dr Dietz criticises. The policy was based on sound scientific evidence, and is in line with international recommendations from groups such as the World Health Organization.
More importantly, it was in response to intense consumer lobbying over the high rates of caesarean section in NSW and the resulting trauma (physical and emotional) for women.
Dr Dietz argues the rising caesarean section rate is linked to older and overweight women giving birth. This is, in part, true. It does not, however, account for the fact that we see significantly lower rates of caesarean sections in Scandinavia and the Netherlands, where women have the same demographic profile.
We published a paper last year repeating a study undertaken a decade earlier, which showed that with the same matched low-risk (no medical complications, under 35 years of age) population of women in NSW, there had been a 5 per cent rise in caesarean sections in the public sector, and 10 per cent rise in the private sector.
The ''oldest'' women giving birth in NSW do so in birth centres and at home, and have the highest rates of normal vaginal birth.
Studies show that women who give birth in private hospitals are much less likely to be overweight than those birthing in the public section, yet they have nearly twice the caesarean section rate.
So the question that must be asked is this: is the problem more about our attitude to women and the models of care and environments in which they give birth, rather than changing demographics and medical risks?
The rising caesarean section rate is therefore not as ''inevitable as the weather'', as Dr Dietz argues.
Dr Dietz states that reducing epidural pain relief is ''reprehensible and anti-Hippocratic''. There is no intent to deny a woman an epidural if she wants one; we need to ensure they're not used unnecessarily. Women who have epidurals during labour have higher rates of instrumental birth (forceps and vacuum), which Dr Dietz quite rightly points out is a major cause of pelvic floor problems.
But continuity of midwifery care, for example, leads to a reduced need for epidural and higher satisfaction with birth, along with many other advantages. Immersion in water reduces the need for epidural and increases women's sense of control, so access to this is supported under the 'Towards Normal Birth' policy.
Dr Dietz's statement that ''human childbirth is a fundamental biomechanical mismatch: the opening is way too small and the passenger is way too big'' provides a real insight into why the caesarean section rate may be so high in this country.
If health professionals truly believe this, then what chance do women have to feel confident in their bodies and their capacity to give birth?
Thursday, February 5, 2015
Birth, blokes and 'the business end'
Robbie Williams probably isn’t the first man to compare watching the birth of his daughter to the loss of a great love. “It was like my favourite pub burning down”, he said when he appeared on the Graham Norton Show in November. But is there any truth in this popular quip, or is it merely male bravado?
“Sometimes men just find it easier to make jokes about our favourite pub than actually talk about how special and beautiful something was, that’s what we do”, says parenting blogger Matt Ross.(cheap canvas prints canvas print)
“But I’m sure there are men who see the birth of their child and the biology of it all and do find it hard to shake that image or association”.
Mark Knight is one such man, confessing that witnessing the birth of his son did leave him with some uncomfortable mental images. “I never really had any reservations about being down there – I was fascinated. But it was not what I expected”.
“When our son started to crown I was overwhelmed. I fought like mad to hold back the tears. But at the same time I was trying really hard to ignore the fact that my wife’s bum hole was inverted and being pushed out too.
“Did it make me fancy my wife any less? You know what…I know that I should say ‘no’, but it kind of did a bit. The ‘poo shoot’ memory is one which haunts me and does make intimacy less appealing”, admits Mark.
Dr Rakime Elmir, a nursing and midwifery lecturer at the University of Western Sydney, says that a small proportion of men are negatively affected when witnessing their partner give birth.
“These men feel out of control, powerless and helpless. Relationships are affected as these men are unable to be intimate with their partners due to the images seen at the birth”, explains Dr Elmir.
For fathers that have witnessed a particularly traumatic birth in which things have not gone according to plan or medical intervention has been needed it may be necessary to seek professional counselling in order to move on.
“If fathers feel that they are constantly recounting the events of the birth in a negative way it is paramount for them to seek professional advice to prevent postnatal depression and other emotional and physical symptoms”, advices Dr Elmir.
There are some men who avoid the risk of having negative memories of their partner’s anatomy by staying a safe distance from the ‘action’. David Pruell says that while he wasn’t worried about “ruining” his “admiration for the 'area' concerned”, his partner, Sarah, had made it clear she wanted him to stay away from the ‘business end’. He also says that he wanted to meet his baby at the same time as Sarah.
“I had always considered childbirth to be something we experienced together and wanted us both to 'meet' our child at the same time rather than have a staggered introduction. I also wanted to be close to Sarah so that I could give her the support that she needed during the birth”.
Liz Wilkes, practicing midwife and spokesperson for Midwifes Australia estimates that around 50% of men want to be at the ‘business end’. “Some men are not worried about the visual around birth, whilst other are adamant that they want to see nothing at all”, she says.
Wilkes says that in the twenty years she has been delivering babies the most common reaction to birth from the father’s perspective is one of joy. “Most men who support their partner through labour feel the same surge of love for the baby as the woman, and with that an overwhelming feeling of love for their partner”, she explains.
There is no doubt Robbie Williams experienced this ‘surge of love’ too. After making jokes with fellow guests about “rebuilding” the “ruins” of his favourite pub he concluded the conversation about his daughter’s birth by looking directly into the camera and emphatically telling his wife Ayda, “I love your foo”.
“Sometimes men just find it easier to make jokes about our favourite pub than actually talk about how special and beautiful something was, that’s what we do”, says parenting blogger Matt Ross.(cheap canvas prints canvas print)
“But I’m sure there are men who see the birth of their child and the biology of it all and do find it hard to shake that image or association”.
Mark Knight is one such man, confessing that witnessing the birth of his son did leave him with some uncomfortable mental images. “I never really had any reservations about being down there – I was fascinated. But it was not what I expected”.
“When our son started to crown I was overwhelmed. I fought like mad to hold back the tears. But at the same time I was trying really hard to ignore the fact that my wife’s bum hole was inverted and being pushed out too.
“Did it make me fancy my wife any less? You know what…I know that I should say ‘no’, but it kind of did a bit. The ‘poo shoot’ memory is one which haunts me and does make intimacy less appealing”, admits Mark.
Dr Rakime Elmir, a nursing and midwifery lecturer at the University of Western Sydney, says that a small proportion of men are negatively affected when witnessing their partner give birth.
“These men feel out of control, powerless and helpless. Relationships are affected as these men are unable to be intimate with their partners due to the images seen at the birth”, explains Dr Elmir.
For fathers that have witnessed a particularly traumatic birth in which things have not gone according to plan or medical intervention has been needed it may be necessary to seek professional counselling in order to move on.
“If fathers feel that they are constantly recounting the events of the birth in a negative way it is paramount for them to seek professional advice to prevent postnatal depression and other emotional and physical symptoms”, advices Dr Elmir.
There are some men who avoid the risk of having negative memories of their partner’s anatomy by staying a safe distance from the ‘action’. David Pruell says that while he wasn’t worried about “ruining” his “admiration for the 'area' concerned”, his partner, Sarah, had made it clear she wanted him to stay away from the ‘business end’. He also says that he wanted to meet his baby at the same time as Sarah.
“I had always considered childbirth to be something we experienced together and wanted us both to 'meet' our child at the same time rather than have a staggered introduction. I also wanted to be close to Sarah so that I could give her the support that she needed during the birth”.
Liz Wilkes, practicing midwife and spokesperson for Midwifes Australia estimates that around 50% of men want to be at the ‘business end’. “Some men are not worried about the visual around birth, whilst other are adamant that they want to see nothing at all”, she says.
Wilkes says that in the twenty years she has been delivering babies the most common reaction to birth from the father’s perspective is one of joy. “Most men who support their partner through labour feel the same surge of love for the baby as the woman, and with that an overwhelming feeling of love for their partner”, she explains.
There is no doubt Robbie Williams experienced this ‘surge of love’ too. After making jokes with fellow guests about “rebuilding” the “ruins” of his favourite pub he concluded the conversation about his daughter’s birth by looking directly into the camera and emphatically telling his wife Ayda, “I love your foo”.
Babies, not burgers: why we need better designed labour wards
I recently visited a new McDonald’s outlet on the northern fringes of Sydney. What I found inside left me gawping in astonishment: soft lighting, views of nature, a mixture of private and communal spaces, adaptable furnishings, excellent way-finding, warm colours, natural materials, positive distractions!
Everywhere I looked I saw evidence-based design features that, when translated to the hospital environment, have been shown to improve experiences and outcomes for users. But this was a McDonald’s ... so why did it feel better designed for low-risk maternity care than most hospitals?(canvas prints canvas prints melbourne)
The answer is simple. McDonald’s is using design to create spaces that support an optimal consumer experience.
The influence of design
In the maternity care setting, the childbearing woman is the primary consumer. And from a health perspective, the optimal experience and outcome for most women is a normal birth – without medical intervention.
But despite this, medical intervention is at an all-time high in this country, with caesarean sections now accounting for 33 per cent of all births.
About 97 per cent of Australian women give birth in conventional hospital labour ward rooms. These rooms are commonly designed with a narrow bed as the focal point, contain multiple pieces of medical equipment and display a clinical aesthetic.
According to a Cochrane Review, women who labour in conventional birth rooms are more likely to experience interventions, including caesarean section. Women who labour in alternately designed or ambient rooms use less epidural pain relief, have fewer medical interventions and a higher chance of having a normal birth.
Women have reported that the birth environment is a key factor in how easy or hard it is to give birth. Remarkably, one UK study found that simply obscuring medical equipment from view with a painted screen shortened the duration of labour by two hours and reduced requests for epidural pain relief by 7 per cent.
Although the reasons that underlie birth outcomes are complex, design is likely to play a role. This is partly because the designed environment has widely acknowledged effects on human neurobiology.
The complex hormonal system that controls labour is disrupted when part of the brain called the neocortex is stimulated. A range of environmental factors can stimulate the neocortex, including bright lights, loud noises, unknown people and places that are perceived as hostile or frightening.
By adapting the design of hospital birth rooms to minimise these factors, we give women a better chance of achieving a normal birth and optimal health outcomes.
Spaces for an optimal experience
Maternity care providers are now implementing strategies to increase the normal birth rate and decrease caesarean sections. The NSW Health policy directive 'Towards Normal Birth', for instance, states that all women giving birth in hospital should have access to an environment that "is conducive to facilitating/promoting normal birth".
This is reinforced in the Australasian Health Facility Guidelines for maternity units. They state that birth rooms should be designed so “women may use them much as they would use their own homes”. The guidelines clarify that the bed should not be the focal point of the room, and a calm, private, ambient space is the ideal.
The cost of refurbishing or rebuilding maternity units to reflect these guidelines is perceived as a barrier to the birth rooms that support optimal outcomes. However, many design features that facilitate normal birth, such as wall-mounted bars, benches of various heights, birth stools and inflatable birth pools can be added to existing birth rooms without major alterations to architecture or infrastructure.
Simple changes to enhance ambience can be made by simply altering colour, lighting and room layout. These changes may ultimately reduce health expenditure by lowering the number of costly interventions performed during labour and birth.
Even simple changes to enhance ambience can make a difference.
Designing for health
Innovative, evidence-based hospital birth room design has been incorporated into a handful of new maternity units around the country, such as the Centenary Hospital for Women and Children in the ACT and the (yet-to-open) Royal North Shore Hospital in Sydney. In these units, rooms incorporate the needs of healthy, active women while still providing safe emergency options.
These units show that normal birth and unexpected outcomes can be catered for in the same space by implementing thoughtful design. Hopefully these advances inspire further change around the country.
Let’s face it: if you can get good design when you’re having a burger, you should really be able to get it when you’re having a baby.
Everywhere I looked I saw evidence-based design features that, when translated to the hospital environment, have been shown to improve experiences and outcomes for users. But this was a McDonald’s ... so why did it feel better designed for low-risk maternity care than most hospitals?(canvas prints canvas prints melbourne)
The answer is simple. McDonald’s is using design to create spaces that support an optimal consumer experience.
The influence of design
In the maternity care setting, the childbearing woman is the primary consumer. And from a health perspective, the optimal experience and outcome for most women is a normal birth – without medical intervention.
But despite this, medical intervention is at an all-time high in this country, with caesarean sections now accounting for 33 per cent of all births.
About 97 per cent of Australian women give birth in conventional hospital labour ward rooms. These rooms are commonly designed with a narrow bed as the focal point, contain multiple pieces of medical equipment and display a clinical aesthetic.
According to a Cochrane Review, women who labour in conventional birth rooms are more likely to experience interventions, including caesarean section. Women who labour in alternately designed or ambient rooms use less epidural pain relief, have fewer medical interventions and a higher chance of having a normal birth.
Women have reported that the birth environment is a key factor in how easy or hard it is to give birth. Remarkably, one UK study found that simply obscuring medical equipment from view with a painted screen shortened the duration of labour by two hours and reduced requests for epidural pain relief by 7 per cent.
Although the reasons that underlie birth outcomes are complex, design is likely to play a role. This is partly because the designed environment has widely acknowledged effects on human neurobiology.
The complex hormonal system that controls labour is disrupted when part of the brain called the neocortex is stimulated. A range of environmental factors can stimulate the neocortex, including bright lights, loud noises, unknown people and places that are perceived as hostile or frightening.
By adapting the design of hospital birth rooms to minimise these factors, we give women a better chance of achieving a normal birth and optimal health outcomes.
Spaces for an optimal experience
Maternity care providers are now implementing strategies to increase the normal birth rate and decrease caesarean sections. The NSW Health policy directive 'Towards Normal Birth', for instance, states that all women giving birth in hospital should have access to an environment that "is conducive to facilitating/promoting normal birth".
This is reinforced in the Australasian Health Facility Guidelines for maternity units. They state that birth rooms should be designed so “women may use them much as they would use their own homes”. The guidelines clarify that the bed should not be the focal point of the room, and a calm, private, ambient space is the ideal.
The cost of refurbishing or rebuilding maternity units to reflect these guidelines is perceived as a barrier to the birth rooms that support optimal outcomes. However, many design features that facilitate normal birth, such as wall-mounted bars, benches of various heights, birth stools and inflatable birth pools can be added to existing birth rooms without major alterations to architecture or infrastructure.
Simple changes to enhance ambience can be made by simply altering colour, lighting and room layout. These changes may ultimately reduce health expenditure by lowering the number of costly interventions performed during labour and birth.
Even simple changes to enhance ambience can make a difference.
Designing for health
Innovative, evidence-based hospital birth room design has been incorporated into a handful of new maternity units around the country, such as the Centenary Hospital for Women and Children in the ACT and the (yet-to-open) Royal North Shore Hospital in Sydney. In these units, rooms incorporate the needs of healthy, active women while still providing safe emergency options.
These units show that normal birth and unexpected outcomes can be catered for in the same space by implementing thoughtful design. Hopefully these advances inspire further change around the country.
Let’s face it: if you can get good design when you’re having a burger, you should really be able to get it when you’re having a baby.
Wednesday, February 4, 2015
Push for more home births in the UK
Home births are in the news in the UK this week, after new guidelines have recommended that more women should be encouraged to labour at home.(cheap canvas prints canvas print)
The guidelines have come from the National Institute for Health and Care Excellence (NICE), and have been largely met with support. They suggest that all women with uncomplicated pregnancies should be encouraged to give birth in midwife-led units instead of hospital labour wards, and that women who are pregnant with their second or subsequent children should be encouraged to give birth at home, as long as they aren't considered medium or high risk.
It's easy, in my view, to see why the guidelines have had such a positive response. There's a continued argument about the over-medicalisation of pregnancy and birth, and intervention rates are consistently high. So if we're changing direction towards a framework that empowers women and returns confidence in their bodies, surely that is a good thing? Reducing medical intervention rates is surely beneficial, too.
Sadly, however, it feels like much of the debate around home births comes back to the central issue of funding. There simply isn't enough money. Many areas lack midwife-led units. Other areas have seen those units closed due to financial constraints. These are the issues that are resulting in more women being on labour wards.
There is also a desperate need for more independent midwives. Without them, there cannot be more home births.
In addition, it is an inescapable fact that birth is unpredictable. Women considered to be low risk and women who have had straightforward pregnancies can still experience complications during birth. There needs to be adequate funding to ensure these women can immediately access the medical help they need if that happens. That means the creation of more birthing units, because currently, many women can't have home births because they are too far from help if they need it.
Aside from funding, the guidelines have seen many mothers repeat a call for choice and information. On talkback radio, on internet forums, on comment sections, women have been discussing their own birth stories, and the common theme is that women must be able to make their own decisions.
It is brilliant that women will be encouraged to have home births - but only if they want them. Pregnant women should be given the information they need to make well-researched choices. Just as there should be no pressure for them to birth at hospitals if it isn't necessary, there should be no pressure on them to have home births if they don't feel that option is right for them.
I've heard many women say in response to the new guidelines that they wouldn't be "brave enough" to have a home birth. If encouraging women to have a home birth means some feel this way, then the movement has gone too far. No woman should feel that giving birth is about being "brave enough". Similarly, no woman should feel that giving birth is about surrendering their body to a medical system that is beyond her control or comprehension.
Every woman is different, and every woman will have a different experience of pregnancy and birth. Hopefully the new guidelines will go some way to helping women give birth in the way that is right for them.
The guidelines have come from the National Institute for Health and Care Excellence (NICE), and have been largely met with support. They suggest that all women with uncomplicated pregnancies should be encouraged to give birth in midwife-led units instead of hospital labour wards, and that women who are pregnant with their second or subsequent children should be encouraged to give birth at home, as long as they aren't considered medium or high risk.
It's easy, in my view, to see why the guidelines have had such a positive response. There's a continued argument about the over-medicalisation of pregnancy and birth, and intervention rates are consistently high. So if we're changing direction towards a framework that empowers women and returns confidence in their bodies, surely that is a good thing? Reducing medical intervention rates is surely beneficial, too.
Sadly, however, it feels like much of the debate around home births comes back to the central issue of funding. There simply isn't enough money. Many areas lack midwife-led units. Other areas have seen those units closed due to financial constraints. These are the issues that are resulting in more women being on labour wards.
There is also a desperate need for more independent midwives. Without them, there cannot be more home births.
In addition, it is an inescapable fact that birth is unpredictable. Women considered to be low risk and women who have had straightforward pregnancies can still experience complications during birth. There needs to be adequate funding to ensure these women can immediately access the medical help they need if that happens. That means the creation of more birthing units, because currently, many women can't have home births because they are too far from help if they need it.
Aside from funding, the guidelines have seen many mothers repeat a call for choice and information. On talkback radio, on internet forums, on comment sections, women have been discussing their own birth stories, and the common theme is that women must be able to make their own decisions.
It is brilliant that women will be encouraged to have home births - but only if they want them. Pregnant women should be given the information they need to make well-researched choices. Just as there should be no pressure for them to birth at hospitals if it isn't necessary, there should be no pressure on them to have home births if they don't feel that option is right for them.
I've heard many women say in response to the new guidelines that they wouldn't be "brave enough" to have a home birth. If encouraging women to have a home birth means some feel this way, then the movement has gone too far. No woman should feel that giving birth is about being "brave enough". Similarly, no woman should feel that giving birth is about surrendering their body to a medical system that is beyond her control or comprehension.
Every woman is different, and every woman will have a different experience of pregnancy and birth. Hopefully the new guidelines will go some way to helping women give birth in the way that is right for them.
Mum sues over forced c-section delivery
After two caesarean sections, Rinat Dray wanted to give birth naturally.
The mum of three said that during her first pregnant, her doctor began urging her to have a caesarean after her water had broken and she had laboured for a few hours. Hoping for a different outcome for her second pregnancy, she went to a different hospital, with the same result.(canvas prints canvas prints melbourne)
Still hoping for a vaginal birth, she changed doctors again for the third pregnancy. She also hired a doula to help her with the childbirth.
But when she arrived at Staten Island University Hospital in labour, the doctor immediately began pressuring her, she said, to have a C-section.
The doctor told her the baby would be in peril and her uterus would rupture if she didn’t have the surgery, and that she would be committing the equivalent of child abuse and that her baby would be taken away from her, she said.
“I was begging, give me another hour, give me another two hours,” Dray said. In return, she claims, the doctor said “I’m not bargaining here … don’t speak.”
After several hours of trying to deliver vaginally and arguing with the doctors, Dray was wheeled to an operating room, where her baby was delivered surgically.
The hospital record leaves little question that the operation was conducted against her will: “I have decided to override her refusal to have a C-section,” a handwritten note signed by James Ducey, the director of maternal and foetal medicine, says, adding that her doctor and the hospital’s lawyer had agreed.
But Dray is suing the doctors and the hospital for malpractice, charging them with “improperly substituting their judgment for that of the mother” and of trying to persuade her by “pressuring and threatening” her during the birth of her third son, Yosef, in July 2011.
More broadly, her case is part of a debate over the use of caesarean sections. It also raises issues about the rights of pregnant women to control their own bodies, even if that might compromise the life of a foetus.
High caesarean rates
Across the country, nearly 33 percent of births, or almost 1.3 million, were by caesarean section in 2012, according to the Centers for Disease Control and Prevention. The World Health Organization recommends that the rate should not be higher than 10 to 15 percent.
The rate has been climbing since 1996, despite warnings from health officials that C-sections are more likely than normal births to cause problems for the health of the mother and the baby. It has recently leveled off.
Indeed, in Dray’s case, her bladder was cut during the procedure, according to court papers.
The increase in the number of caesareans has been attributed to a rise in high-risk pregnancies; a desire by doctors and mothers to schedule their deliveries; and fears of malpractice lawsuits should the baby be injured during a normal delivery. Obstetricians pay some of the highest malpractice insurance premiums of any medical specialty because of the frequency of birth-related lawsuits.
A spokesman for the hospital, Christian Preston, said he couldn’t comment on the case because of the litigation and privacy concerns. But he defended the hospital’s record, saying it had a 22 percent caesarean section rate, compared with a state average of 34 percent. Its 2012 rate of VBAC (vaginal birth after C-section) was almost 29 percent, much higher than the state average of 11 percent, he said.
The lawsuit, filed last month in Brooklyn’s Supreme Court, also names Leonid Gorelik, who delivered the baby, and Ducey as defendants.
Gorelik, in court papers, denied that he had taken Dray for the surgery against her will. He said her own “conduct and want of care” contributed to any injuries she may have suffered.
“We won’t tie you down”
Howard Minkoff, chairman of obstetrics at Maimonides Medical Center in Brooklyn, who has published on the subject of patient autonomy, said he believed that women had an absolute right to refuse treatment even if it meant the death of an unborn child.
“In my worldview, the right to refuse is uncircumscribed,” Minkoff said, cautioning that he was not commenting on the particular facts of Dray’s case. “I don’t have a right to put a knife in your belly ever.”
Such a person might be accused of being immoral or a terrible mother, he said, “but we won’t tie you down.”
The mum of three said that during her first pregnant, her doctor began urging her to have a caesarean after her water had broken and she had laboured for a few hours. Hoping for a different outcome for her second pregnancy, she went to a different hospital, with the same result.(canvas prints canvas prints melbourne)
Still hoping for a vaginal birth, she changed doctors again for the third pregnancy. She also hired a doula to help her with the childbirth.
But when she arrived at Staten Island University Hospital in labour, the doctor immediately began pressuring her, she said, to have a C-section.
The doctor told her the baby would be in peril and her uterus would rupture if she didn’t have the surgery, and that she would be committing the equivalent of child abuse and that her baby would be taken away from her, she said.
“I was begging, give me another hour, give me another two hours,” Dray said. In return, she claims, the doctor said “I’m not bargaining here … don’t speak.”
After several hours of trying to deliver vaginally and arguing with the doctors, Dray was wheeled to an operating room, where her baby was delivered surgically.
The hospital record leaves little question that the operation was conducted against her will: “I have decided to override her refusal to have a C-section,” a handwritten note signed by James Ducey, the director of maternal and foetal medicine, says, adding that her doctor and the hospital’s lawyer had agreed.
But Dray is suing the doctors and the hospital for malpractice, charging them with “improperly substituting their judgment for that of the mother” and of trying to persuade her by “pressuring and threatening” her during the birth of her third son, Yosef, in July 2011.
More broadly, her case is part of a debate over the use of caesarean sections. It also raises issues about the rights of pregnant women to control their own bodies, even if that might compromise the life of a foetus.
High caesarean rates
Across the country, nearly 33 percent of births, or almost 1.3 million, were by caesarean section in 2012, according to the Centers for Disease Control and Prevention. The World Health Organization recommends that the rate should not be higher than 10 to 15 percent.
The rate has been climbing since 1996, despite warnings from health officials that C-sections are more likely than normal births to cause problems for the health of the mother and the baby. It has recently leveled off.
Indeed, in Dray’s case, her bladder was cut during the procedure, according to court papers.
The increase in the number of caesareans has been attributed to a rise in high-risk pregnancies; a desire by doctors and mothers to schedule their deliveries; and fears of malpractice lawsuits should the baby be injured during a normal delivery. Obstetricians pay some of the highest malpractice insurance premiums of any medical specialty because of the frequency of birth-related lawsuits.
A spokesman for the hospital, Christian Preston, said he couldn’t comment on the case because of the litigation and privacy concerns. But he defended the hospital’s record, saying it had a 22 percent caesarean section rate, compared with a state average of 34 percent. Its 2012 rate of VBAC (vaginal birth after C-section) was almost 29 percent, much higher than the state average of 11 percent, he said.
The lawsuit, filed last month in Brooklyn’s Supreme Court, also names Leonid Gorelik, who delivered the baby, and Ducey as defendants.
Gorelik, in court papers, denied that he had taken Dray for the surgery against her will. He said her own “conduct and want of care” contributed to any injuries she may have suffered.
“We won’t tie you down”
Howard Minkoff, chairman of obstetrics at Maimonides Medical Center in Brooklyn, who has published on the subject of patient autonomy, said he believed that women had an absolute right to refuse treatment even if it meant the death of an unborn child.
“In my worldview, the right to refuse is uncircumscribed,” Minkoff said, cautioning that he was not commenting on the particular facts of Dray’s case. “I don’t have a right to put a knife in your belly ever.”
Such a person might be accused of being immoral or a terrible mother, he said, “but we won’t tie you down.”
Tuesday, February 3, 2015
How to use birth pools safely
The recall of hired home-birthing pools after a baby contracted Legionnaires' disease will inevitably lead some women to worry about having a water birth at home. While the incidence is rare, it is worth keeping in mind some clear guidelines about how to best use a water pool.(photo on canvas Acrylic canvas printing)
Home birth is an option for women who are at low risk of complications, but it is certainly not widespread. In the UK, the percentage of women who have their baby at home is very low – only 2.3 per cent in 2012 (included in this figure are many home births that are unplanned). Others who plan home births initially labour at home using water, but then transfer to hospital for additional pain relief.
But about half of women who planned home births use water birth pools, as immersion in water helps relieve pain.
In the case of the baby with Legionnaires', it was born in a pool that was pre-filled and kept heated for several days before. The recommended water temperature for water birth pools is 36-37°C so that during labour the baby isn't overheated or shocked by cold water. But this is also an ideal temperature for many bacteria to flourish in, including the Legionnelle bacteria, which can cause a severe lung infection, so the recommendation is that home birth pools should never be pre-filled and kept warm. This is the reason hot tubs that aren’t looked after have also been implicated in cases of Legionnaires' disease.
Some women may be tempted to pre-fill the pool when they know they could go into labour so they don’t have to wait while it fills up when labour starts, or to try it out beforehand. But a good idea is to fill it with cold water to see how long it takes to fill – most only take 10-20 minutes – before emptying, cleaning and drying the pool until it’s actually needed, which will also give you an idea of when to start the process. This would prevent the unusual Legionnaire bacteria and also more common bacteria.
Hiring a pool
Not all women buy pools as they're usually for a one-off use, or they may be too expensive to buy. As a result, many women prefer to hire them. These hired pools come in a variety of types, usually free standing, and can have inflatable or rigid frames with disposable liners. Most come with pumps and pipes to aid filling and draining, and most companies provide advice about safety and hygiene which should be read and adhered to. Even so, it’s ideal to discuss the pool, how and when to fill it and ensure it’s clean and safe with a midwife.
While an investigation into how the baby contracted Legionnaires' is carried out, certain types of birthing pools have been bannedin the UK until further notice. Heated pools from the particular supplier in this case have been recalled, and a further six companies that hire out pools are being questioned over whether they carry out the right risk assessments.
Concerns about infection are not new. But a Cochrane review I lead that looked at the evidence to date showed no difference in the incidence of infection in mothers or babies using a variety of pools, both plumbed in and free-standing. Importantly, however, all were filled at the time of use, were carefully maintained with strict cleaning regimes, or used with one time use only liners.
All midwives are also very aware of the risk of infection and any woman considering birth at home or using water during birth should speak to her midwife about her plans. Advice in local waterbirth workshops for expectant parents also now often includes not using pre-filled/heated pools because of the rare but possible infection risk.
There are important advantages for women giving birth at home, such as a sense of well-being from being in their own environment. The use of water during labour and birth is likely to be a contributing factor to this, so it's vital that women have all the information they need to safely birth at home and use water immersion during labour if they wish.
So the key message must be that any infection is unusual – and Legionnaires' is extremely rare – but good practice when it comes to birthing pools, and under the guidance of a midwife, will contribute to a positive birth experience for all.
Home birth is an option for women who are at low risk of complications, but it is certainly not widespread. In the UK, the percentage of women who have their baby at home is very low – only 2.3 per cent in 2012 (included in this figure are many home births that are unplanned). Others who plan home births initially labour at home using water, but then transfer to hospital for additional pain relief.
But about half of women who planned home births use water birth pools, as immersion in water helps relieve pain.
In the case of the baby with Legionnaires', it was born in a pool that was pre-filled and kept heated for several days before. The recommended water temperature for water birth pools is 36-37°C so that during labour the baby isn't overheated or shocked by cold water. But this is also an ideal temperature for many bacteria to flourish in, including the Legionnelle bacteria, which can cause a severe lung infection, so the recommendation is that home birth pools should never be pre-filled and kept warm. This is the reason hot tubs that aren’t looked after have also been implicated in cases of Legionnaires' disease.
Some women may be tempted to pre-fill the pool when they know they could go into labour so they don’t have to wait while it fills up when labour starts, or to try it out beforehand. But a good idea is to fill it with cold water to see how long it takes to fill – most only take 10-20 minutes – before emptying, cleaning and drying the pool until it’s actually needed, which will also give you an idea of when to start the process. This would prevent the unusual Legionnaire bacteria and also more common bacteria.
Hiring a pool
Not all women buy pools as they're usually for a one-off use, or they may be too expensive to buy. As a result, many women prefer to hire them. These hired pools come in a variety of types, usually free standing, and can have inflatable or rigid frames with disposable liners. Most come with pumps and pipes to aid filling and draining, and most companies provide advice about safety and hygiene which should be read and adhered to. Even so, it’s ideal to discuss the pool, how and when to fill it and ensure it’s clean and safe with a midwife.
While an investigation into how the baby contracted Legionnaires' is carried out, certain types of birthing pools have been bannedin the UK until further notice. Heated pools from the particular supplier in this case have been recalled, and a further six companies that hire out pools are being questioned over whether they carry out the right risk assessments.
Concerns about infection are not new. But a Cochrane review I lead that looked at the evidence to date showed no difference in the incidence of infection in mothers or babies using a variety of pools, both plumbed in and free-standing. Importantly, however, all were filled at the time of use, were carefully maintained with strict cleaning regimes, or used with one time use only liners.
All midwives are also very aware of the risk of infection and any woman considering birth at home or using water during birth should speak to her midwife about her plans. Advice in local waterbirth workshops for expectant parents also now often includes not using pre-filled/heated pools because of the rare but possible infection risk.
There are important advantages for women giving birth at home, such as a sense of well-being from being in their own environment. The use of water during labour and birth is likely to be a contributing factor to this, so it's vital that women have all the information they need to safely birth at home and use water immersion during labour if they wish.
So the key message must be that any infection is unusual – and Legionnaires' is extremely rare – but good practice when it comes to birthing pools, and under the guidance of a midwife, will contribute to a positive birth experience for all.
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