FYI
Jo
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.
BIRTH NEAR KITCHEN TOASTED WITH CHAMPERS AND CAKE
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,
