Special delivery for mums

Author: Danielle Teutsch
Date: 02/02/2006
Words: 824
Source: SMH




Publication: Sydney Morning Herald
Section: Health & Science
Page: 6


Giving birth at home is slowly shedding its hippie image, writes Danielle Teutsch.

Something radical is happening at St George Hospital in Kogarah. The hospital is offering homebirth as an option for expectant mums. Not only does NSW Health approve, it is footing the bill for insurance.

For the past decade, homebirth has been depicted as unsafe hippie nonsense, and the numbers of women doing it have fallen accordingly.

The 2003 Mothers and Babies report found 0.2 per cent of women gave birth at home, and overall numbers had fallen from 182 to 132 in a five-year period.

The number is "miniscule", admits Associate Professor Nicky Leap, area director of midwifery practice. "It has had an alternative image, associated with an alternative lifestyle," she says.

There is still a small but significant group of women who want to give birth without medical intervention, she says. Until now, their options have been limited unless they were prepared to pay up to $5000 for a private midwife. Some women were also reported to be "freebirthing" - having babies at home without medical support.

"Independent midwives the world over are not able to get insurance," she says. "But homebirth with hospital back-up should be an option for all low-risk women."

The homebirth outreach program at St George is the culmination of a decade of lobbying by the hospital and midwifery groups - the NSW Government was finally convinced that the program would satisfy safety standards.

The program started taking bookings in May last year and has had its first birth. About three women each month are using the service, says St George Hospital's head of women's and children's health, Dr Greg Davis - and the number is expected to rise.

The program has not been introduced at St George by accident. Unlike in some other maternity wards, where "turf wars" have been conducted between midwives and obstetricians, the two groups work in harmony at St George.

Davis, who also works in private obstetrics, says he cannot understand why his fellow obstetricians make such a "fuss" about homebirth. "My colleagues are very suspicious of this," he says. "They are worried about safety, but midwifery-led care at home is the same as having a baby in a birth centre."

Davis says fears about homebirth, such as increased risk of perinatal death and neonatal respiratory difficulty, have been overstated.

"Obstetricians worry about unavoidable complications that may be life threatening such as prolapse and post-partum hemorrhaging. But if you take that argument to its logical conclusion, it means someone can only deliver in a tertiary unit with intensive care - which is totally impractical," he says.

He points to a US study, published in the British Medical Journal, the largest to date on homebirth, which found it was no less safe than giving birth in a hospital. Only 12 per cent of women in the study were moved to hospital, with a quarter of the cases for urgent reasons, and the rest for non-urgent reasons such as fatigue and lack of progress.

Professor Caroline Homer, director of the Centre for Midwifery and Family Health at UTS, says women are carefully screened before they are admitted to the homebirth program to make sure they are low-risk patients, according to guidelines developed by the Australian College of Midwives. Each birth is attended by two midwives equipped to deal with medical emergencies; and there are protocols for transferring to a hospital if necessary.


For her first pregnancy, Narelle Batterham, 34, went to a private hospital with an obstetrician. Her doctor was on holidays when she delivered so another obstetrician was brought in, who insisted she give birth while on her back.

"It was not a position I would have chosen," Batterham says. "In hindsight, I could have said no, but not being confident, I just let it go."

When she became pregnant again, her obstetrician's fees had doubled, so she booked into the birth centre at St George Hospital. "I liked the idea I would be seen by the same midwives all the way through, so I wouldn't have a stranger when I gave birth. I had a water birth there and it was an excellent experience."

For her third child she decided to have a homebirth, as part of the St George Hospital outreach program, confident that the hospital was nearby if there was an emergency.

"It's been a natural progression. In my head I was treating it as if I was in a birth centre," Batterham says.

She planned to use her spa bath at home during labour. But her labour progressed so quickly that she gave birth on a mattress in an open area near the kitchen, assisted by two midwives who arrived just in time. "It was so hot, and that was an area that was air-conditioned," she says.

Her daughters, Jacinda, aged 2, and Brianna, 5, were there to welcome their new sister, Milayna. The family toasted the birth with champagne and a cake.


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