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arachne
March 3rd 05, 05:38 AM
http://dailytelegraph.news.com.au/story.jsp?sectionid=1258&storyid=2750430
Coming to a home near you - births

By ANNA PATTY State Political Reporter

March 3, 2005

A SYDNEY hospital will become the first in the state to offer
publicly-funded home births when it starts taking bookings from May
this year.

If successful, the project at St George hospital in Kogarah will be
extended to Sutherland hospital and the Royal Hospital for Women.

The Australian Medical Association yesterday questioned the safety of
the proposal announced by the State Government yesterday.

NSW Health Minister Morris Iemma said the home birth model had been
developed in consultation with doctors, midwives and the community.

"This is a first for NSW," Mr Iemma said.

"Since the insurance indemnity crisis in 2001, it has been very
difficult for mothers to access home birthing services, but there is
considerable demand for this option."

Mr Iemma said there were 99 reported home births with GP or private
midwife support in NSW, costing $5000 each in 2003.

"There is also anecdotal evidence that a number of women choose to
give birth at home without professional assistance, potentially
putting themselves and their baby at risk.

"The provision of publicly-funded home birth will address these
issues, providing indemnity cover for the midwives involved, providing
an affordable service and ensuring women have professional assistance
during childbirth," Mr Iemma said.

"Women who book with the project will receive continuity of care from
midwives from the first booking, through pregnancy, labour, birth and
the early postnatal period."

NSW AMA spokesman and Westmead hospital obstetrician Andrew Pesce said
the British Medical Journal had published the largest survey of home
births ever undertaken, showing they placed babies at a two- to
three-fold increased risk of death.

The study involved Homebirth Australia and reviewed 7000 home births
in Australia over a seven-year period.

"I would like to know how they [the State Government] is going to face
the challenge of putting in place systems of care which will avoid a
repetition of those results," Dr Pesce said.

"As a doctor working within the hospital system, I don't want to see
our services lose any funding to fund this.

"There is no fat in our budget," Dr Pesce said.

A spokesman for Mr Iemma said that women who currently elected to have
a home birth without any professional support were putting themselves
and their babies at risk.

"What this model will do is provide professional support for women who
want a home birth and clearly identify who will be suitable and who
will not be," he said.

--
elizabeth (in australia)
DS 20th august 2002
#2 due 14th october 2005

"In these matters the only certainty is that nothing is certain." -- Pliny
the Elder (23 AD - 79 AD)

Jo
March 3rd 05, 02:05 PM
arachne wrote:
> http://dailytelegraph.news.com.au/story.jsp?sectionid=1258&storyid=2750430


It is certainly a step forward, but overall, a not-so-positive article...

Jo (RM) (Lucky to live in WA with the community midwifery program)

Hope
March 3rd 05, 09:12 PM
On Thu, 03 Mar 2005 22:05:36 +0800, Jo >
wrote:

>arachne wrote:
>> http://dailytelegraph.news.com.au/story.jsp?sectionid=1258&storyid=2750430
>
>
>It is certainly a step forward, but overall, a not-so-positive article...
>
>Jo (RM) (Lucky to live in WA with the community midwifery program)

It sounds like the HB midwives would be as tightly bound by protocol
as the ones in hospital are, what do you think Jo, as an
"insider"?

Hope
--
Riley 1993 c/s
Tara 2002 HBAC

Jo
March 4th 05, 01:16 AM
Hope wrote:
> On Thu, 03 Mar 2005 22:05:36 +0800, Jo >
> wrote:
>
>
>>arachne wrote:
>>
>>>http://dailytelegraph.news.com.au/story.jsp?sectionid=1258&storyid=2750430
>>
>>
>>It is certainly a step forward, but overall, a not-so-positive article...
>>
>>Jo (RM) (Lucky to live in WA with the community midwifery program)
>
>
> It sounds like the HB midwives would be as tightly bound by protocol
> as the ones in hospital are, what do you think Jo, as an
> "insider"?
>
> Hope
> --
> Riley 1993 c/s
> Tara 2002 HBAC
>
The community midwives here aren't bound THAT much by hospital protocol,
as they aren't attached to any hospital. There was talk recently though
about increasing funding of homebirths by attaching it to the Big
Tertiary Hospital here, which meant that the births at home HAD to
follow the same policies as the birth centre/hospital. That would have
meant NO waterbirth, and induction after 24 hours SROM if not in labour,
etc. So it depends on what kind of model they are planning to use in
NSW whether it will be sort of autonomous or still hospital-protocol-y.
I think we are very lucky here to have gotten away by the skin of
our teeth from the hospital dominance. Hey, it will still be better
than nothing, but there will be the pressure on the women and midwives
to follow the protocols, although less pressure than if they were
actually in hosptial with the not-so-supportive people. I hope it goes
ahead, anyway...

Jo (RM)

Hope
March 4th 05, 05:26 AM
On Fri, 04 Mar 2005 09:16:42 +0800, Jo >
wrote:

>Hope wrote:
>> On Thu, 03 Mar 2005 22:05:36 +0800, Jo >
>> wrote:
>>
>>
>>>arachne wrote:
>>>
>>>>http://dailytelegraph.news.com.au/story.jsp?sectionid=1258&storyid=2750430
>>>
>>>
>>>It is certainly a step forward, but overall, a not-so-positive article...
>>>
>>>Jo (RM) (Lucky to live in WA with the community midwifery program)
>>
>>
>> It sounds like the HB midwives would be as tightly bound by protocol
>> as the ones in hospital are, what do you think Jo, as an
>> "insider"?
>>
>> Hope
>> --
>> Riley 1993 c/s
>> Tara 2002 HBAC
>>
>The community midwives here aren't bound THAT much by hospital protocol,
>as they aren't attached to any hospital. There was talk recently though
>about increasing funding of homebirths by attaching it to the Big
>Tertiary Hospital here, which meant that the births at home HAD to
>follow the same policies as the birth centre/hospital. That would have
>meant NO waterbirth, and induction after 24 hours SROM if not in labour,
>etc. So it depends on what kind of model they are planning to use in
>NSW whether it will be sort of autonomous or still hospital-protocol-y.
> I think we are very lucky here to have gotten away by the skin of
>our teeth from the hospital dominance. Hey, it will still be better
>than nothing, but there will be the pressure on the women and midwives
>to follow the protocols, although less pressure than if they were
>actually in hosptial with the not-so-supportive people. I hope it goes
>ahead, anyway...
>
>Jo (RM)


me too.

H
--
Riley 1993 c/s
Tara 2002 HBAC

Jenrose
March 6th 05, 09:52 AM
>>
> The community midwives here aren't bound THAT much by hospital protocol,
> as they aren't attached to any hospital. There was talk recently though
> about increasing funding of homebirths by attaching it to the Big Tertiary
> Hospital here, which meant that the births at home HAD to follow the same
> policies as the birth centre/hospital. That would have meant NO
> waterbirth, and induction after 24 hours SROM if not in labour, etc. So
> it depends on what kind of model they are planning to use in NSW whether
> it will be sort of autonomous or still hospital-protocol-y. I think we are
> very lucky here to have gotten away by the skin of our teeth from the
> hospital dominance. Hey, it will still be better than nothing, but there
> will be the pressure on the women and midwives to follow the protocols,
> although less pressure than if they were actually in hosptial with the
> not-so-supportive people. I hope it goes ahead, anyway...
>

Such a hard issue. I actually greatly prefer the British model, where
homebirth is a right, and practitioners are "freed" in many ways from
liability if they recommend a transport or intervention and the client
refuses. "Risk out" protocols are a huge part of why I would never consider,
for example, a birth center birth or a homebirth with most midwives. I had
to look long and hard to find a midwife who would give me care on my terms,
with my risk factors, and let *me* be the one to judge which risks I was
willing to take or not. It makes me crazy when protocol systems make it so
that if a woman decides that the protocol is not in HER best interest, she
cannot then find care within that context. Or worse, faces legal coercion to
"make" her follow the protocol.

If I followed protocol, I'd have been induced a week ago after spending a
pregnancy on Lovenox. I shudder to think how bad the whooping cough and
broken rib could have gotten with me on anticoagulants. Or how bad my
bleeding might have been at 10 weeks... my mom lost a baby on heparin due to
abruption and almost died from the resulting hemorrhage. Can you imagine my
stress level at having to inject myself daily after watching that happen at
age 14? While spotting? I've been on thinners in the past. I *know* what it
means in terms of how you live your life. I avoided that in this pregnancy,
and thus what could have been a highly dangerous pregnancy with tons of
medical complications was merely very unpleasant, but not unsafe.

Protocols may help the decision-making process, but when they become the
be-all and end-all of maternity care, women lose. I know that I can get
through a pregnancy without clotting problems, without thinners. I know that
I can birth without trouble. The last thing I need is *anyone* adding to my
stress because I don't happen to agree with their policies, protocols and
routines.

I'm lucky. I actually found a midwife who meets me on my terms, gives me the
care I'm willing to have without trying to shove the rest of it down my
throat when she knows I know the risk/benefit ratios, etc. and have made an
informed decision.

Jenrose