Misleading headlines! Homebirths!

The phenomenon of Free birthing, Unattended childbirth whatever it is called, women who choose to birth at home with no medical or midwifery assistance. This phenomenon continues to happen and we knew it was only a matter of time before we started hearing about some tragic deaths. Now it has been reported that there have been 4 tragic baby deaths in the last 9 months. The web is full of sites of how to do your own birth (DIY) homebirth complete with what to do if things go wrong, even DIY u tube videos on waterbirth.
The Daily Telegraph has reported that AT least four babies have died during home births in Sydney in the past nine months, including the daughter of one of Australia's most vocal advocates for hospital-free deliveries. These are homebirths, but they are unattended homebirths or freebirths, without midwives or doctors.

Janet Fraser, national convener of Joyous Birth, which encourages women to shun hospitals, is dealing with the death of her own baby during a water birth at her Croydon Park home. Ms Fraser went into labour at home assisted only by her partner and a female friend when things went horribly wrong.

It is woeful that women are forced to choose this option of birth because our maternity system does not offer them a safer option, informed choice or support their option of birth without feeling threatened, bullied or patronised by the medical profession.

Now that independent midwives are under threat of being not allowed to practice if they do not have indemnity insurance, due to National Registration we will be forcing more women to do it alone. Already there is debate as to whether to outlaw or ban homebirth. Alison Leeman for the ABC reports

So as long as the AMA and RANZCOG are hostile to homebirth -ideologically, not evidentially - the government is not prepared to stare them down

– how deplorable is that, banning homebirth, what sort of democracy are we? What happened to choice and women’s right to choose? We certainly do not want to go down the same road as our American counterparts who are not permitted to do homebirths and the fetus has more rights than the woman who carries the fetus.

The Honourable Minister of Health Nicola Roxon’s report on Maternity Services stops short of supporting Homebirth and independent midwifery. However the report does acknowledge the need to increase the role of the midwife within Maternity Services and listen to what the women of our country want and that is informed choice about how to birth their babies. Without feeling intimidated by paternalistic obstetricians.

Even when reading this news story at no time is it reported that these are unattended homebirths, that is no midwife or doctor in attendance – they stipulate that the

dangers of homebirth need to acknowledge and that there are down sides to a homebirth’
Dr Pesce said it was time the increased risks of home birth were acknowledged and addressed.
"There are one or two extra deaths per 1000 deliveries and I wish people would acknowledge that," Dr Pesce said.
"It's often presented as if there are no downsides to a home birth only up sides."
He said obstetricians and the health system had to take some responsibility and try to attract women back to the hospital system.

Australian College of Midwives president Professor Pat Brodie said more was urgently needed to be done to avoid future tragedies.

"We are very concerned about a maternity care system that is so abhorrent that women choose to do this (give birth without a midwife),'' Professor Brodie said.
She said the maternity services system needed to be re-organised so women were assigned to a single midwife who they knew and trusted and who could provide continuity of care throughout their pregnancy.

'Home births in Australia represent just 0.25 per cent of all births.
Of the 277,436 babies born in 2006, just 708 were home births.
The majority of the home births are done with the assistance of a midwife.'

Surprise, surprise hospitals are now asking the question? Why are women choosing to birth at home without medical or midwifery assistance? Dr Pesce described it well when he said “ In the hospital system we need to get our act together rather than make them (women) refugees of the system” well said doctor.

It is all about informed choice, allowing the woman to know her own body and make the right decisions. Collaborative work with our obstetricians, we need to work together each one acknowledging that each profession has an equal place. Midwives specialize in the ‘normal’ obstetricians specialize in the ‘abnormal’

The making of Isabella Rose's christening gown

Isabella's christening was last week, Faye organised it for March and has asked me to make the dress. Which was not unexpected as I did make Dylan's outfit and his was a challenge because you want it to be special but boyish. Me I like grandiose, lace pretty etc, but for a boy well you have to curtail the pretty and lace, so I made a Satin suit, bow tie and a satin blue embosted waist coat. However for a girl, well, I could just go mad. But my daughter added a special challenge for me, that was to incorporate some family lace on her husbands side for me to use - some beautifully handmade lace which was around some pillow cases. The lace was handmade by Isabella's great grandmother it was quite heavy looked croqueted but it wasn't it was very nice but not what I had in mind, so I had to re think the whole outfit. I looked for a pattern that would enhance both my ideas of what I wanted and also bring out the best in the lace. I spent several weeks looking for material that would match this lace. If you know anything about material it fades or looses it's original colour, for whites they go yellowish or off white. I eventually found some beautiful off white satinish material, imprinted with a rose through out, it matched the lace perfectly. Faye and I both went to this fantastic store called 'Fabulous Fabrics' in Balcatta, what a store, lace galore from all prices we looked at some that were $175.00 per meter, I could not justify that, we settled for one that was $45.00 per meter and it was fabulous.


Now the hard bit was done, finding the pattern, lace and material. I set aside a whole weekend for the job of making the outfit, nobody was invited to the house for dinner and no looking after grandchildren or socialising with friends. A small problem occurred I had not used my sewing machine for at least a year an had forgotten how to use the roll hem feature - so had to call on my Shaz to help, we used to do lots of crafts together, those were the days, making teddy bears, where have they gone! just not enough time. Thankfully between us both we worked out how to roll hem the lace. I spent the whole weekend sewing - Bella had a fitting on the Saturday night, Faye cooked us a lovely dinner then it was home to burn the midnight oil, which is not unusual for me at the best of times.
You might well ask how do you fit it all in, well you know there is an old saying 'the more you have to do in a day the more you do' 'the less you have to do, the less you do' how true that is for me, however very rarely do I have less to do.
I thoroughly enjoyed challenge of making the outfit, where I added the lace was trial and error, it looked perfect on the bottom and around the sleeves of the dress, however the hat really showed off the lace and Bella, I am sure great grandmother would be smiling from heaven, both Nanni's and mum were delighted and Bella is truly blessed.

I get such joy out of making things for the children, I feel the days of hand making are over, it is so expensive now to make your own clothes. Material is not cheap any more and then off course there is your own time and labour. When my children were small it was cheaper to make there clothes, now it is not, apart from the personal pleasure there is no benefit from it at all.
My consolation is that in generations to come I will be the great grandmother smiling from heaven and I will be remembered for making this gown and a tradition continues.

I am so happy & grateful for having a wonderful family.


Dylan's Christening 16 October 2006 & Jessica

Baby Confiscation in Bali - Midwife in question

This is a very interesting story, one I had not thought of before. It just goes to show you that anything is possible in the name of money. We are very fortunate here in Australia.

This story was reported in the "Jakarta Post" "Baby Confiscation goes to police"

A couple whose baby was reportedly "confiscated" because they were unable to pay for its delivery have reported their midwife to the Bali Police, accusing her of human trafficking.

The couple have accused their midwife of "confiscating" their baby for financial purposes. The couple also felt that the midwife was not displaying ‘goodwill’ over the issue.
The parents could not afford to pay their bill of 1.5 million rupee (Rp) after the delivery so the father left the mother and baby at the clinic until he could return with the money to pay his debts.
He returned three weeks later with 1.Million rupee and hoped that this would be enough for his family to return home with him. However the midwife had added a further 4.5 million to the bill for expenses totaling 6 million Rp. He was forced to sign an agreement stipulating that he must leave one of his sons at the clinic to assure he would return to pay his debt or in order to be released from all his debts.

The midwife is defending the charges and disputed the amount of fees charged as only 2.5 million, and has a lawyer representing her.

The midwife is under investigation for Human Trafficking, possible adoption issues and child protection laws.

The human trafficking laws carries a penalty of between 3 and 15 years in prison and a fine of between Rp 60 million and Rp 300 million (US$27,000).

This is a sad story and certainly contravenes any Code of Ethics throughout the world.
I am thankful that I work in Australia as a midwife and do not have to deal with these issues.
What do you think?

A vaginal Birth with an epidural. It is all about informed choice!

Birth of Logan Mark

This birth story has been written with the permission of Nikki & Scott. Thank you.

Firstly I will congratulate my son Scott and his fiancé Nikki on the birth of their son on the 19th October at 0115, weighing in at 3420gm. Nikki has always wanted an epidural, with the birth of Jessica (8hr labour) their first child, she also had an epidural which was not very effective and Nikki ended up with an episiotomy and Neville Barnes forceps – not very nice. Why do some women want an epidural? – Well that is simple, as Nikki would say “I don’t do pain” and “I am the biggest sook”. Now I don’t agree with Nikki’s choice of terminology, because pain is whatever the woman/client says it is and epidurals have a place in childbirth, because it is all about informed choice. The aim is to achieve a safe spontaneous vaginal delivery (SVD) or birth. As midwives our role is to inform women of their options and assist them to achieve the birth they choose. Nikki wanted a normal birth without an episiotomy and that was pain free. The only way to have a pain free birth is by having an epidural, all other forms of pain relief do not take the pain away completely they just knock the top off the mountain. In saying all this, epidurals are not completely foolproof; sometimes they do not work or only partially work as Nikki found out. Full credit to the excellent midwife who was looking after Nikki, who did everything possible to make sure that Nikki’s epidural was working effectively, finally after all possible top-ups etc Nikki was comfortable, now we could concentrate on getting more effective contractions.

Nikki called me at about 3pm not sure if her waters had broken, I was on my way to see my friend and decided to call in a see how Nikki was going – sure enough there was a wet patch on the bed, and most women hate the thought that they may have wet the bed, heaven knows why, you have a baby constantly pushing on your bladder, it would not be surprising at 38+5 days. Anyway after resting on the bed with a pad on for 20 minutes the pad was wet, had a sweet odour and was clear. The baby was moving nicely, the head was engaged, and there was a good fetal heart. There were no apparent contractions and Nikki described having a cramping feeling, so we decided to keep her walking around the house. I decided to go home, which is only 10 minutes away, and finish cooking my dinner and we would share it. Scott’s sister Faye and Brendon & their children would come over and we would pass some time – Nikki reminded me that she still wanted an epidural and not to leave it too late, I also said to Nikki that it would be beneficial if she was in established labour before she had the epidural to ensure an vaginal birth and she was agreeable.

About 6:30 Nikki’s pad changed colour, it was meconium stained (the baby has done a poo in-utero), lightly stained meconium. Nikki was still not contracting regularly or strongly, we rang the hospital, and were advised to make our way in. There was mild disappointment in the air, meconium stained liquor, and this changes things now.

We arrived at the Labour and Birth suite at about 1945hrs – Scott was dropping off Jess and would meet us there shortly. Nikki was great, we had a good talk in the car about expectations, epidurals and how to push effectively when you have an epidural in place so as to avoid having an episiotomy. Nikki laughed at my analogy – as you can’t feel anything, close your eyes and imagine that you are totally constipated and you have to push the biggest shit out – that’s what you have to do.
No sooner were we there when Nikki was assessed, hooked up to the CTG, examined – it was good to see that she was 4cm dilated, however the head was -3. IV inserted and bloods taken. Nikki was happy to stand next to the bed whilst being monitored; it was now meconium 2, which meant continuous fetal monitoring. Her contractions were still not strong, getting more uncomfortable for Nikki, so the epidural was arranged. The CTG had good variability however a couple of late decelerations – the decision about using an oxytocics was made, to increase the strength and frequency of the contractions, due to the meconium and late decelerations. Nikki was happy to get things going, anything to make it work rather than having a caesarean section. Nikki was coping really well, now comfortable with her epidural almost working effectively – it was denser block on one side, her left leg was numb and difficult to move.

Scott was like a cat on a hot tin roof – he had his own expectations, and did not share them. He is 6’+ and seems like a gentle giant and he felt out of place in the delivery suite, although he very much wanted to be there. Like most men he was busy comparing the CTG machine to the equipment he used when working out in the bush with the geologist comparing it to the seismograph. This did make me smile; he was constantly eating, lollies, biscuits, fruit and pacing the floor.


The baby was difficult to monitor, and I really could not understand why, as Nikki is tall and fairly slim – certainly not obese – therefore theoretically should be easy to monitor, however the “little fella” was playing possum with us. The CTG baseline rate was about 145bpm, variability was good however we were getting complicated variable decelerations. The pressure was on; “I don’t want a caesarean section” was Nikki’s lament. It was time to reassess due to the complicated variables, at approximately 1130pm Nikki was still 4cm, head 2-, so the head had come down, it was really no surprise that the cervix was still 4cm as the contractions really were not yet effective or strong enough. The decision was made to continue and reassess in 30 minutes. We changed positions, left lateral, right lateral, then upright to try and improve the trace. Another top-up as well as self administered top-ups were given, Nikki still has an uneven block, however she was more comfortable now. The syntocinon was titrated upwards as per the protocol and Nikki’s contractions finally kicked in, 4:10 strongly, however with this came more complicated variable decelerations, the registrar decided to tickle the baby’s head, to ascertain if the baby’s heart rate would accelerate which would be equivalent to a 7.25 pH and therefore the baby is not hypoxic. Hooray! The little fella’s heart rate went up to 165bpm, which bought us some more time.

At 0100hrs the midwife decided to put a scalp electrode on the baby’s head, so it would be easier to monitor him – and to her/our surprise Nikki was fully dilated – fantastic – that is an efficient uterus - she did a test push, Nikki was fantastic, she visualised and pushed well. It was time to birth, Nikki, Scott and the midwife were happy for me to catch – as was discussed earlier.




It was a wonderful vaginal birth, intacted perineum – little Logan Mark was born at 0115hrs weighting 3420gms.



On reflection talking to Nikki and Scott a few days later – Nikki found the birth easier than Jessica’s birth and was grateful to have the midwife and myself present, “everything was easy, casual and relaxed – it was awesome!” Nikki said that she had back pain for at 5 days post the epidural.
Scott reflected that he thought that there would be more blood and gore! He cut the cord which gave him a sense of fatherhood. However, Scott did say that he felt superfluous through the whole process. I wonder when women have an epidural does it change the focus for men, as the level of support may change due to the level of pain being different. I did notice that both Nikki and Scott watched TV and debated which movies to watch.

As for me...............This was as always a memorable experience. It is a privilege to help birth your grandchildren, to support the women of your family and share your knowledge, expertise, love, warmth, caring, just being there. It is truly a magnificent moment – a true reminder of the miracle of birth and the power of a woman’s body, truly spectacular.



It’s all about what the woman wants!

Best poem nominated by United Nations in 2006

I have to share this poem that was passed to me at work today:

This poem was nominated by UN as the best poem of 2006, Written by an African.





The poem is called

Kid

When I born, I black
When I grow up, I black
When I go in Sun, I black
When I scared, I black
When I sick, I black
And when I die, I still black
And you white fellow
When you born, you pink
When you grow up, you white
When you go in sun, you red
When you cold, you blue
When you scared, you yellow
When you sick, you green
And when you die, you gray
And you calling me colored?

Issues of CONSENT! When is a consent valid?

"THE lesbian mothers of IVF twin girls have lost a legal bid to sue their doctor for the cost of raising one of the toddlers."

Issues surrounding consent are always interesting. As you are aware there are many forms of consent, verbal, implied and written. Off course we expect that clients are informed about the procedure therefore have "informed" consent. However the notion of informed" is open to interpretation.
The above case was reported in the Sun Herald today:
http://www.news.com.au/heraldsun/story/0,21985,24070929-661,00.html.
A lesbian couple lost their case against an obstetrician when he implanted two embryos instead of one. They also complained of loss of love within their relationship due to the increase in family due to having two babies instead of one. Now we all do know that the chances of multiply pregnancies are greater in IVF when you implant more than one egg - it would be interesting to know if this couple were aware of that. However it was stated that

the birth mother only told him she wanted one embryo minutes before she was sedated, after previously signing a form consenting for up to two embryos to be implanted.

Does this mean that the obstetrician should have postponed the procedure until he was sure what his client wanted? or that the written consent was more valid than the spoken word?

The couple said it was Dr Armellin's responsibility to ensure his patients wishes were carried out during the operation

The case, before Justice Annabelle Bennett, sparked nationwide condemnation of the women in the media.
The mothers issued a statement during the civil proceedings arguing the case had nothing to do with their feelings towards their daughters, but with Dr Armellin's failure to comply with their wishes....

The ACT Supreme Court today ruled in favour of Dr Armellin, and ordered the couple, who live in Melbourne, to pay his legal costs

I think this case involved several issues: that is, it was blurred due to it being a lesbian couple, and the perception that the couple were suing because they were unhappy about the second baby. The real issue here for me was of CONSENT, the woman changed her mind at the last minute and was ignored, she said "I only want one egg inserted" the rest is a red hearing!
It will be interesting to read the full judgement, what do you think?

Its Nanna time again! more grandchildren on the way!

It is really a busy time of year for me. Like tearing my hair out, the storm before the calm. I know it is meant to be the calm before the storm. I am trying to get this semester rounded off and get papers marked before I leave next week and get unit outlines ready for second semester. As well as tie off loose ends at the hospital. So busy, busy, busy.

Our trip to Glasgow has been planned since the Brisbane ICM 2005. Between Ian and I we have 6 children, you could call us the Brady Bunch. My daughter Faye got married in October last year and was planning another baby - At present we have 4 grandchildren and 3 on the way. Now we did say to all the children that we would be away around June/July 2008 so please do not get pregnant or have you babies around this time if you want us to be around. Maybe that's it we weren't meant to be around! no I don't think so.
Yes you guessed it, kids never listen, even when they are all grown up, maybe we should of said "go ahead have your babies" because guess what! Jodie is due the 15 July, Faye is due 12 July, and when do we return from our European jaunt - the 12 July. Now that is cutting it fine! At least Nikki is not due until October, that gives us a little breathing space.
This means I have my friends (midwives) as backups should any of them go early and need some assistance whilst mum/mother in law is away. It will make shopping in Europe more exciting having all these babies to buy for, however thank goodness for weight restrictions, meaning, we can not buy to much, which is good for me. I do have the tendency to buy too much.


Faye & Brendon's baby 20 weeks - due July
Jodie & Danny's baby picture is posted on the 19 March story in my blog.


Scott & Niki's baby 12 weeks - due October

I am looking forward to buying my Harrods Bears, might get one for all the girls (grandchildren).
9 days to go - then up up and away!!!!!!!!!!!!