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Posts Tagged ‘birth’

I’m pretty fed up with reading stories in the papers from those who are either pro-midwife or anti-midwife, and as a result, anti-obstertrician or pro-obstetrician. When I wrote an article recently for Mamamia.com.au, I was shocked at the amount of comments it received, many of which were telling tales about ‘horrible midwives’, and others hitting back at these comments. Some were downright nasty, and others accused me of making up the story. Yes, my article talked about a particular interaction I had with a particular midwife whose views I didn’t agree with, but that wasn’t the point of writing it.

Recently, there has been huge debate in the media about homebirths, fuelled perhaps by the tragic death of a mother in Victoria while birthing at home (reported here in The Age) and Danni Minogue’s failed home birth (which required her to be transferred to hospital – reported here).

Recent laws passed here in Western Australia regarding recognition of the unborn baby as a legal life led to statements from the WA Australian Medical Association (WA AMA)* calling for the criminalisation of mothers who insist on a home birth despite prior knowledge of pregnancy complications (reported here). This week, there was a story highlighting the lack of obstetricians available in Western Australia and suggesting that more GPs (as well as midwives and specialists) need to be trained to help cope with the growing number of births each year. This led to letters in the papers suggesting that we don’t need more doctors, just midwives…you get the idea.

The two camps seem to be divided by their philosophy of birthing as either a ‘natural’ event or a ‘medical’ event. Those who feel it is ‘natural’ blame the medicalisation of birth for causing more intervention and resulting physical and emotional trauma.

The only thing that this polarisation does is risk alienating mothers, who are often confused and vulnerable about such a major life event as having a baby, and make them feel that they have to choose between the options and wave their flag firmly in one camp. It also splits staff in both the public and private health care sectors, causing overt and covert tension between ‘nurses’ and ‘doctors’ rather than encouraging cohesive team work and coordinated care for patients.

I am a doctor and of course recognise the value of medical intervention in pregnancy. Personally I would not choose to have a home birth, but I do not believe in unnecessary medical intervention either. I have had obstetric-led care for my three pregnancies, and have been very happy with it. However, I also see a midwife at every antenatal appointment, and my two labours so far have been largely managed by fantastic midwives. I have also had potentially serious medical complications which have required medical input, but have every confidence that even if I hadn’t chosen to be managed by an obstetrician, I would have been referred to one by my midwife when the complications became known.

Perhaps it is because I am medically trained that I believe that while childbirth is natural, it was previously a major cause of morbidity and mortality of newborns and mothers, and still is in many developing countries. In 2010, Australia had a maternal mortality rate of 5.1 deaths per 100000 live births, but the rate in Afghanistan was 1575.1/100000 and Malawi 1140.1/100000 (reference here). Our access to good, integrated midwifery and medical care makes childbirth as safe as it can be.

We need — and have — great midwives and great doctors who all work towards making our pregnancies and births as safe and enjoyable as possible. Let’s stop asking people to choose and be grateful that we have such easy access to both.

*While I have been a member of AMA WA, this statement does not represent my views.

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I had an article published today on mamamia.com.au – you can read it here.

I wrote the post not long after my first child was born – over two years ago now, and finally submitted it a few months ago to mamamia. It’s essentially the story of an experience I had on one night in hospital after my daughter was born, and my feelings of powerlessness after an interaction with one particular night nurse. It’s been really interesting reading the comments on the article, particulalry to hear about others’ experiences – good and bad. I do want to point out that I am definitely not ‘anti’ hospitals or ‘anti’ midwives at all, but rather I wanted to share one experience that I had to highlight how hard it can be to ‘speak up’ and follow your instincts when you are exhausted and vulnerable.

I have had lots of positive experiences too and with my second child, my experience was far better. The midwives caring for me at the moment with my third pregnancy are great and I am having my third child in a hospital too. With each child though, I am of course more experienced and secure with my plans and choices.

Do feel free to comment – it’s an important area to discuss I think…

 

 

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Kangaroo care refers to early skin to skin contact between a mother and her newborn infant. It involves the newborn infant being placed straight onto the mother’s chest immediately after birth. The infant is covered with a blanket on top, but has bare skin to skin contact with mum for as long as the mother and infant are happy.

There seems to be a culture in our society of taking the baby away to be weighed and examined, cleaned up and wrapped before being given to the parents to hold. Obviously if there is any concern about the infant’s health, then they need to be given the appropriate treatment, but in healthy babies, there is now evidence of the positive benefits of early skin to skin contact.

The Cochrane Library publishes systematic reviews of existing studies on particualr topics. By collating all the data and assessing the methodological merit of the studies, they aim to provide evidence based papers. They have a review, last updated in 2007, on early skin to skin contact (Moore ER, Anderson GC, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD003519. DOI: 10.1002/14651858.CD003519.pub2).

This review found statistically significant evidence that early skin to skin contact had positive effects on the success and duration of breastfeeding, and trends towards positive effects on maternal affection behaviour during feeding and attachment. The infants also cried less and one group (late preterm infants) showed more stable cardiorespiratory function.The authors  also commented that there were no negative associations found.

It is completely natural and instinctive for mothers and their young to be in close contact after birth, and it makes sense that this creates the optimal physiological state for the pair. I am not against hospital births at all; both my children have been born under obstetric care in modern hospitals and personally, I wouldn’t have had it any other way. However, within that medical system, there are ways to make sure that you and your infant start your relationship in the best way possible, and one way is to make sure you have early skin to skin contact.

 

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