Endangered birth

Update:

Thank you to those who flew in from around Australia with children and banners! ACM has no right to be trying to deny women access to midwives and while they’ve already made their decision, here’s hoping some of them have misgivings since those affected by their new regulations think they stink.

A beautiful blog entry from Lisa Barrett with a 35-36 week gestation babe being born beautifully into crystal clear water at home.

http://www.homebirth.net.au/2011/08/homebirth.html

ACM’s new policy documents try to force births like this woman’s birth into hospital. Why?

If you are unhappy with the latest homebirth position statement and midwives guidelines from the Australian College of Midwives that will restrict the majority of women’s access to midwife attended homebirth, please attend a protest rally at the ACM conference on 19th October at Australian Technology Park Sydney. Meet at 12pm at Marian Street Park Redfern then walk to the conference centre for a 12.30pm rally!

 

You can read some other responses to the guidelines here and here.

6 thoughts on “Endangered birth”

  1. I am so much more than unhappy. Those who can’t get there, what can we do to make our very loud voices heard?

  2. How about writing to all those involved and telling them what you think? Make a donation to some of the organising groups? Support a woman to plan a homebirth?

  3. A question a friend asked,I figured you could answer.One of the things that constantly confounds me is how often the homebirth advocates will use late prematurity as a scare tactic against OBs (“your OB will force you to induce at term and your dates could be off and you could have a DANGEROUSLY EARLY 36 weeker!!!”) but at the same time argue that midwives should be able to deliver late premature babies at home!! In Oregon they fought and won to make it legal for licensed midwives to deliver as early as 35 weeks at home, they just have to “consult” with “another professional” first. It doesn’t even have to be an MD they consult with, either.

    But I want them to tell me, which one is it? Are 35-37 weekers dangerously early and at risk, or safe to deliver at home? Or are they arguing they should get to deliver them at home regardless? It makes no sense.

  4. If you induce a baby at 36 weeks, you’re interfering in a gestation without knowing whether or not it might have another two, four, or even six weeks to go. That means the baby may not be born with the basics for life outside the womb in good order and is why those babies so often experience breathing difficulties and suckling difficulties.

    So the difference is that inducing a baby at that time leads to poor outcomes for women and especially babies but babies who begin labour spontaneously to their own timetables, within obvious limits, are simply choosing their own length of gestation and we don’t really know why. That seems pretty simple?

    You can read some more on this here:
    http://www.ohsu.edu/xd/research/centers-institutes/evidence-based-policy-center/med/upload/Elective-Induction-of-Labor_PUBLIC_Rapid-Review_Final_12_10.pdf
    Use of induction, particularly among nulliparous women and those without a favorable (ready for labor) cervix, is associated with increased use of health care resources, longer labors and increased use of cesarean delivery. (Grobman, 2007) There is also increased morbidity for infants of mothers electively induced prior to 39 weeks of gestation, including higher rates of conditions requiring admission to a neonatal intensive care unit (NICU). (Clark, 2009) Neonatal mortality associated with all births in the U.S. population from 1989 to 1998 has been shown to be significantly higher for infants of women induced at term or preterm, even after controlling for both sociodemographic and medical risk factors. (MacDorman, 2002) In contrast, IOL for 4 post-term births in this same analysis demonstrated a statistically significant decrease in perinatal mortality. (MacDorman, 2002)

    Unless there are clear health issues which suggest a baby and woman will be better served by ending the pregnancy, there’s no need to be inducing anyone. You can read some more on that here:
    Indications for Induction of Labor: A Best-Evidence Review, E. Mozurkewich, J. Chilimigras, E. Koepke, K. Keeton, and V.J. King (BJOG. 2009;116(5):626–636).
    Evidence is inadequate to support induction of labor for women with insulin-requiring diabetes, twin gestation, fetal macrosomia, oligohydramnios, cholestasis of pregnancy, maternal cardiac disease, and fetal gastroschisis.

    If a 35 week gestation baby in good health chooses to be born at that gestation then why would that be necessarily problematic?

    As with all babies, simply observing them once born means any problems can be immediately picked up and parents can choose what action to take then.

    You can read more here on babies who choose to be born early, ie not induced benefitting from low tech responses and midwifery care.

    Midwifery
    Volume 7, Issue 2 , Pages 55-63, June 1991
    Safest birth attendants: recent Dutch evidence
    MA Marjorie Tew (Research Statistician), MD
    S.M.I. Damstra-Wijmenga
    Accepted 7 January 1991.

    Abstract
    Analysis of national perinatal statistics from Holland, 1986, demonstrates that for all births after 32 weeks’ gestation mortality is much lower under the non-interventionist care of midwives than under the interventionist management of obstetricians at all levels of predicted risk. This finding confirms with great authority the conclusions of all earlier impartial analyses from Britain and other countries which agree in contradicting the claims on which the organisation of maternity services in most developed countries is now based, namely, that childbirth is made so much safer by the application of high technology that only this option should be provided.

    Early babes really benefit from dedicated Kangaroo Care as they can be less able to suckle consistently without constant drip feeding. Women can also choose to supplement via SNS until the babe is a little bigger.

  5. Janet – are you really saying here that all premature labors are a result of fetal choice – of a baby knowing “when to be born”, even if their lungs are immature and they need to spend time in NICU just to survive? Or are you actually saying that all extremely premature babies were just mean to die? (You say “within obvious limits” – what are the limits?). How does it make sense that all the babies within the “obvious limits” are choosing their own time to be born, but the “outside limits” are not? What makes them decide whether to make an active choice to be born, or not?

    The 1986 study whose abstract you have posted does not answer this question. What percentage of those babies benefited from NICU care AFTER birth?

    The 2009 paper you cite has much more clear cut messages than suggested by just reading the abstract. This was a review of 34 papers published in English. What they found was that there were not enough high-quality RCTs to provide strong recommendations in a number of areas, and that further research is warranted. The studeis they reviewed found that induction for PROM reduced rates of chorioamnionitis, endometritis and need for NICU admission.

    None of this information supports the contention that the baby “knows when to be born.” If it weren’t for NICU and medical advances like steroids and surfactant for lung immaturity, babies choosing to be born prematurely would be committing suicide.

    I support your call for a reduction in procedures with no medical indication, but that doesn;t include preventative action. If there is evidence of risk to the baby and action is taken to minimise the risk, this is a medical indication.

  6. What a beautiful birth, my eyes got teary watching mum meet her baby, thank you for sharing and providing the links to the data as well.

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