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#51 Fright bat

Posted 02 November 2013 - 07:42 PM

View PostStopTheGoats, on 02 November 2013 - 06:51 PM, said:



It's not the birth centre, it's the 30mins transfer time even in an ambulance during peak hour from Ryde to RNSH. My birth centre had a transfer rate of 25%. It's not outside the realms of possibility that you will fall within that 25%

I think this should be reiterated.

I think that obstetrics (both doctors and midwives) have come a really long way from the unarguably overmedicalised births of the 1950s (no husbands in labour ward, enemas as routine etc).

I think it's unfair to suggest that only midwives 'protect' natural birth, just as it's unfair to suggest that only obstetricians can deal with potential complications.

For me, the concern in most situations arises from transfer times, not who is actually managing your care. I would just as equally suggest that having a baby under obstetrician care in a small and poorly set up private hospital (these exist!) can be just as risky as having a midwife led delivery in a small birth centre. A midwife led birth in a proper hospital with obstetric backup in case actual surgical intervention is needed is undoubtedly just as safe as obstetrician led care in the same environment.

I know that not everyone in Australia is lucky enough to live near to major hospitals with obstetricians on site. And the vast majority of births in small hospitals, rural centre and home births have good outcomes. I don't think anyone is saying that it's 'dangerous' per se to deliver in a birth centre, or at home.

But personal, I would focus on aspects I wanted rather than a place. It's unlikely that a birth centre is the only place capable of giving you a woman oriented natural birth experience, and it may be that there are even lower risk places to access the same sorts of things you think are important. And for me, no requirement for transfer of me or baby, and staff on site in case of emergency were non negotiables.

For me, the no intervention natural birth experience was found in a private hospital with a published high Caesar rate (presumably due to patient preference).

Edited by AvadaKedavra, 02 November 2013 - 07:43 PM.


#52 echolalia

Posted 02 November 2013 - 07:58 PM

I'm sorry your family is not respecting your wishes about your birth choices. They may disagree with what you have chosen but your birth choices should not be up for discussion.

Choosing a midwife-led care will give you the best chance of having a normal birth, which willl reduce the risk of complications for you and the baby. Obviously there are risks in having a baby in a birth centre, but there are also risks in having a baby in hospital. If you choose hospital you are much more likely to end up having interventions than if you are in the birth centre e.g. epidurals, inductions, instrumental delivery and caesareans. It is commonly assumed that hospital birth is always safe, but these interventions do carry risks to both mother and baby, including the risk of death. There really is no risk-free option.

ETA:
A couple of EB articles about the relative safety of midwife-led care:
http://www.essential...0726-22vuv.html

http://www.essential...0822-2sczq.html

Edited by catnapper, 02 November 2013 - 08:08 PM.


#53 StopTheGoats

Posted 02 November 2013 - 08:09 PM

View Postcatnapper, on 02 November 2013 - 07:58 PM, said:

I'm sorry your family is not respecting your wishes about your birth choices. They may disagree with what you have chosen but your birth choices should not be up for discussion.

Choosing a midwife-led care will give you the best chance of having a normal birth, which willl reduce the risk of complications for you and the baby. Obviously there are risks in having a baby in a birth centre, but there are also risks in having a baby in hospital. If you choose hospital you are much more likely to end up having interventions than if you are in the birth centre e.g. epidurals, inductions, instrumental delivery and caesareans. It is commonly assumed that hospital birth is always safe, but these interventions do carry risks to both mother and baby, including the risk of death. There really is no risk-free option.

My bold.

The rate of Caesarean section births at RPA are only slightly higher in the delivery ward than amongst birth centre patient and you've got to assume that considering it is one of the largest and most well equipped teaching hospitals in the country that the delivery ward see a lot of high risk patients.

It is not in a public hospitals interests to intervene unnecessarily in a textbook birth.

#54 Fright bat

Posted 02 November 2013 - 08:23 PM

View Postcatnapper, on 02 November 2013 - 07:58 PM, said:



Choosing a midwife-led care will give you the best chance of having a normal birth, which willl reduce the risk of complications for you and the baby. Obviously there are risks in having a baby in a birth centre, but there are also risks in having a baby in hospital. If you choose hospital you are much more likely to end up having interventions than if you are in the birth centre e.g. epidurals, inductions, instrumental delivery and caesareans. It is commonly assumed that hospital birth is always safe, but these interventions do carry risks to both mother and baby, including the risk of death. There really is no risk-free option.



I utterly despise posts like this.

There is a risk of death to the mother or baby from intervention. In emergency cases, the risk of death due to NO intervention is vastly higher and therefore the comparison is irrelevant. In elective cases, the mother has made an informed decision to accept that risk. Therefore the comparison is also not relevant.

Of course the rate of intervention free delivery is higher in a birth centre. Birth centres only accept low risk patients, and only patients who are highly motivated to have an intervention free delivery self select to a birth centre. If you look at this particular group of women, they are EQUALLY likely to have an intervention free birth in a public hospital, private hospital or birth centre.

Remarkably (for those who are fanatical about natural birth) some women actually CHOOSE interventions electively. And these women often CHOOSE a private hospital because they feel that their preference to have an epidural, or an elective Caesar will more likely be met there than at a public hospital or other birth venue. So it follows that of course a private hospital has a higher published rate of 'intervention'.

The risk of birth complications is inherent to each mother-baby team (because birth is a partnership between a mother and each of her babies). Not the venue in which the birth takes place.

#55 Mianta

Posted 02 November 2013 - 08:31 PM

Just to give further information into midwife led, birth centre models, I actually work in a rural one. We are 25 mins from a hospital that can "handle" an emergency requiring a theatre. My official title as a caseload midwife is a clinical midwifery specialist, meaning myself and my colleagues have developed skills that can allow us to practice autonomously and deal with emergencies such as PPH and shoulder dystocia, even breech birth, if it went undiagnosed, without an obstetric consultant present.

The key to why our service remains safe is the fact that we practice well within our scope of practice and within the Australian College of Midwives guidelines. ANYTHING that falls outside of these guidelines, antenatally, during labour/birth, postnatally is transferred out of our care immediately.

Basically, we minimise our risks. Ryde MGP are almost identical to our MGP.

These models of care are safe.

#56 echolalia

Posted 02 November 2013 - 08:33 PM

Good luck OP

Edited by catnapper, 09 November 2013 - 08:48 PM.


#57 Penguin78

Posted 02 November 2013 - 08:38 PM

The OP was asking about how to discuss with her sister her birth choices, not for anyone else's opinion on her birth choices.

I can't imagine how the OP must be feeling given the hard time she is having for choosing an option that best suits her family and one that must be medically sound or wouldn't be able to run!

Good luck for a happy and healthy pregnancy and birth OP

#58 Ellie bean

Posted 02 November 2013 - 08:43 PM

View PostPenguin78, on 02 November 2013 - 08:38 PM, said:

The OP was asking about how to discuss with her sister her birth choices, not for anyone else's opinion on her birth choices.

I can't imagine how the OP must be feeling given the hard time she is having for choosing an option that best suits her family and one that must be medically sound or wouldn't be able to run!

Good luck for a happy and healthy pregnancy and birth OP

Penguin you took the words out of my.mouth, I was going to say exactly this! If her sister expresses an opinion, and the OP says thanks but I've made an informed decision, that should be the end of it where her family is concerned. As far as we are concerned, she wasn't asking EB for an opinion on her choice of birth model.

#59 maeby

Posted 02 November 2013 - 08:55 PM

OP, if you end up wanting to placate your family and take the middle ground, the midwife programme at RNSH is great (in my experience), and there's also the possibility that you'll get into the version where you see the same midwife the whole way through.  Good luck.

#60 Fright bat

Posted 02 November 2013 - 09:08 PM

View Postcatnapper, on 02 November 2013 - 08:33 PM, said:



I don't care if you despise my posts. I would much rather address the lies, such that all childbirth interventions are necessary.  Women, babies, and families are damaged and traumatised by these unecessary interventions every day.  All you can do is pretend that everything is hunky dory.  It's nauseating.

I'm calling BS on the bolded point.  The articles I linked to show that this clearly is not the case.

ETA: I'm not a childbirth "fanatic" and I fully respect every woman's right to choose whatever interventions she wants. Unlike you, I do respect women's choices.  Which you clearly do not, or you would not be scaremongering the OP in this thread.  She did not ask for your opinion on birth centres, she asked for support in dealing with her family's interfering..

1. If you actually read my posts you will see that I clearly state that quality midwife care is just as good as obstetrician led care. You on the other hand state categorically that hospital care causes worse outcomes than midwife led care. It is then disingenuous to suggest that you care about womens birth choices and I don't.

2. It is equally 'scaremongering' to suggest that hospital care dooms women to intervention they don't want. It is again disingenuous to suggest that I am scaremongering when I have repeatedly said that the risks of birth complications in Australia is low and midwife led care can be just as good as anything else.

3. It is impossible to talk about how the OP should deal with her family without discussing how that family might be feeling and why they might be making the comments they have - which comes down to the differences between various birth options. To say the latter is inappropriate excludes any meaningful discussion at all. Especially for those who don't fall into the camp of 'just tell your family to STFU'.

To reiterate - my opinion on birth centres is that they can be excellent, but given the WHO statement that at least 15% of births require surgical intervention, I personally would advocate ANY birth venue that had no transfer access to such intervention (be that a public hospital, private hospital or birth centre with any combination of midwife or obstetrician care) if such a facility were easily accessible to the patient. And I wonder if the sister feels similarly - that her issue is not so much that it is a birth centre with midwife led care, but that transfers can be dangerous as they may delay life saving care for mother or baby. Even if such a scenario is vanishingly rare, for people who live in an urban area with a plethora of birth choices, perhaps the sister feels a different place might be safer for her beloved sister.



#61 ali-song

Posted 02 November 2013 - 09:12 PM

OP, I'm sorry you're not really getting the advice you came for. I've found that the best way to counter "concern" like what you're hearing from your family can be to be super dooper positive and excited. Develop a standard phrase to address their concerns - something like "yes, they have protocols to deal with risk X" then QUICKLY move on to gushing about how fantastic the midwives are or how supported you feel or similar. Do it every time. You could even throw in a thanking them for their concern (as I'm sure it comes from a good place).

#62 lucky 2

Posted 02 November 2013 - 09:28 PM

Quote

Obstetrician believes that my problems were exacerbated by the midwives ideological commitment to allowing women to go quite far overdue
What a nasty, unprofessional and disingenuous comment.
To imply that those MW's base their clinical practice on ideology rather than on clinical guidelines set by their employer (and based on current scientific evidence) is outrageous and insulting. And that they were to blame for the problems when they would have been following hospital or unit guidelines. Disgusting.
And misleading you pp.

Sorry for being a bit off thread OP, all the best.

#63 07gbam

Posted 02 November 2013 - 11:57 PM

And yet , PP , this sort of comment is made about obstetricians all the time without such a fierce reaction...

#64 BluJay

Posted 03 November 2013 - 12:56 AM

Honestly?

I can understand their concern.

Midwife only care during pregnancy (if considered low risk) - great.

Midwife only assisting you to deliver your baby (if considered low risk) - great.

But to have that midwife deliver your baby at a site where there are NO doctors, no emergency care, no surgeons, no theatres, no ICUs for mother and baby - to my mind is just so unnecessarily risky.

As others have said - it's not so much about the model of care but the site it is being offered at. Emergencies happen during labour. You can't predict them. That's why they are emergencies.

If something terrible does go wrong for you and/or your baby during labour, you would have to survive a lengthy ambulance transfer to a hospital before you could even begin to get the care you would need during that emergency.

As wonderful as the care midwives can provide is  - they are not Doctors. And a Birth Centre (when not attached to a hospital) cannot provide the lifesaving facilities and staff that a hospital can.

You can actually get a Midwife led model of care that you seem to be wanting, yet still be attached to an actual hospital. That doesn't require you to be transferred by ambulance to another site in the midst of an emergency. Despite what a certain person has tried to tell you on here - just because you birth in, or even in the vicinity of, a hospital doesn't mean you will have interventions forced on you or that you will suffer birth trauma or injury.

As others have said - it's not just maternal and/or foetal death to consider, it's complications that can cause permanent, massive and lifelong injury and disability should something go wrong during birth.

At the end of the day it is you who has to weigh the risks to yourself and your baby. But if you are going to 'stick to your guns' then at the end of the day you are just going to have to be more assertive with your family :shrug:

#65 scarfie

Posted 03 November 2013 - 05:40 AM

Ryde Midwifery Group Practice is located at Ryde Hospital.  There are doctors, emergency care, surgeons, theatres, and ICU  

#66 Mianta

Posted 03 November 2013 - 05:49 AM

View PostEmma1980, on 03 November 2013 - 12:56 AM, said:

Honestly?

I can understand their concern.

Midwife only care during pregnancy (if considered low risk) - great.

Midwife only assisting you to deliver your baby (if considered low risk) - great.

But to have that midwife deliver your baby at a site where there are NO doctors, no emergency care, no surgeons, no theatres, no ICUs for mother and baby - to my mind is just so unnecessarily risky.

As others have said - it's not so much about the model of care but the site it is being offered at. Emergencies happen during labour. You can't predict them. That's why they are emergencies.

If something terrible does go wrong for you and/or your baby during labour, you would have to survive a lengthy ambulance transfer to a hospital before you could even begin to get the care you would need during that emergency.

As wonderful as the care midwives can provide is  - they are not Doctors. And a Birth Centre (when not attached to a hospital) cannot provide the lifesaving facilities and staff that a hospital can.

You can actually get a Midwife led model of care that you seem to be wanting, yet still be attached to an actual hospital. That doesn't require you to be transferred by ambulance to another site in the midst of an emergency. Despite what a certain person has tried to tell you on here - just because you birth in, or even in the vicinity of, a hospital doesn't mean you will have interventions forced on you or that you will suffer birth trauma or injury.

As others have said - it's not just maternal and/or foetal death to consider, it's complications that can cause permanent, massive and lifelong injury and disability should something go wrong during birth.

At the end of the day it is you who has to weigh the risks to yourself and your baby. But if you are going to 'stick to your guns' then at the end of the day you are just going to have to be more assertive with your family :shrug:

Sorry, am I the "certain person" you are talking about?

Because I can tell you, with absolute certainty, that you really have no idea how these models of care run and I can tell that by your post.

MGPs, such as Ryde and such as my own, do not look after any woman who has any inkling of risk, whatsoever.

This means no women with previous "at risk" obstetric history, no women with co-morbidities, no women with a BMI of over 34 or who are over 100 kgs pre pregnancy, no women who develop gestational diabetes, pre eclampsia, fetal growth concerns or anything outside a midwives scope of practice. Same goes for labour, the most common transfers we do are for mec stained liquor or failure to progress or even of we are concerned about the baby in labour, midwives in services like this do not hold onto cases that are becoming risky.

I don't know about Ryde, but my hospital does actually have an on call neonatal resus dr and a dr in emergency, so we are not completely "stand alone" but we are trained well and would be able to tell the drs what to do during an emergency.

I know it's hard for people to wrap their head around but that is how it works and what makes these models safe. Our model has the FULL support of all the obstetric consultants in our area.

#67 FauxPas

Posted 03 November 2013 - 06:10 AM

I agree with the following:

It's not the birth centre, it's the 30mins transfer time even in an ambulance during peak hour from Ryde to RNSH. My birth centre had a transfer rate of 25%. It's not outside the realms of possibility that you will fall within that 25%

I think midwife program is amazing and quite a few of my friends have had lovely natural births through the Royal Women's Hospital this way.  I had an OB as I had a PROM in pregnancy 1 but even then considered the program for number 2.

At Royal Women's the birth centre is right next to the delivery suites.  I cannot stress enough how important that is.  When something goes wrong it goes wrong unexpectedly and very quickly.

Is there another midwife program you can consider nearby which doesn't require the transfer?

Also, your mum and sister are only concerned for you.  They want the very best for you and baby - even if their view is different to your.  I was 100% on your side until I read about the transfer.  

Edited by FauxPas, 03 November 2013 - 06:11 AM.


#68 FauxPas

Posted 03 November 2013 - 06:16 AM

I just checked the distance on google maps and wow it is quite a distance even without peak hour traffic.

I would seriously consider the risk and talk to the midwives at Ryde about their experiences with transfers in emergency situations.

#69 scarfie

Posted 03 November 2013 - 07:22 AM

I understand that Birth Centres, and god forbid stand alone midwifery led units, are not everyones cup of tea, but for some women that is what THEY want.  That is why these sorts of units exist.  


So, for the naysayers, enough!  The OP asked how she could deal with her family who didn't agree with her birth plan.  She did not ask for anyones opinions on whether she should birth in a stand alone midwifery led unit.

Edited by scarfie, 05 November 2013 - 10:44 PM.


#70 cinnabubble

Posted 03 November 2013 - 07:23 AM

Yet, FauxPas, hundreds of women safely give birth there each year.  Do you think if they had a negative outcome rate higher than comparable patients in hospitals they'd be allowed to keep doing it?

OP, your sister has had the opportunity to share her opinion.  She may be a doctor but she's not your doctor. Now she needs to STFU.

Edited by cinnabubble, 03 November 2013 - 07:24 AM.


#71 Crombek

Posted 03 November 2013 - 07:34 AM

You are only 6 weeks pregnant? Honestly I'd just stop talking to them about it right now, you seem very invested in birthing at Ryde but you have no idea what will happen yet during your pregnancy.

I have just gone 20 weeks & found out I have Velamentous cord insertion. Less than 1% occurrence rate. No reason for it whatsoever in my history. But just like that has gone my hope of a no intervention pregnancy and most likely birth as well.

Tell them you are hearing what they are saying and will consider your options further as you advance.

#72 Unatheowl

Posted 03 November 2013 - 07:43 AM

View Postcatnapper, on 02 November 2013 - 08:33 PM, said:

. I would much rather address the lies, such that all childbirth interventions are necessary.  Women, babies, and families are damaged and traumatised by these unecessary interventions every day.  



Genuinely curious here.  Ive always wondered when people give these little opinions about the dreaded intervention, why then, if unnecessary, would a doctor perform an intervention?  I just don't get it?  What's your take on that? Why? For fun?

In addition, its not scaremongering if explaining the risks is the truth.  Covering up the risks and implying that interventions themselves cause damage is like saying that CPR results in a high rate of deaths.  

Of course it may be associated with poor outcomes, but thats probably because of whatever complication arose to cause the need for intervention in the first place.  You are conveniently ignoring this major part of it.

The only other explanation is that there is some huge conspiracy around where doctors are willingly performing unnecessary interventions with no indication or cause which quite frankly, makes you sound paranoid and kooky.

And yes, Glitterfarts, there is a percentage of the population who are incapable of making appropriate decisions for their own care and an even higher proportion who are misled and fed rubbish propaganda by paranoid individuals pushing their own agendas.  Pregnant women are part of the general population and do not suddenly become enlightened and beyond reproach about their care decisions.  People make stupid decisions all the time.  Why is this any different?


Edited by Unatheowl, 03 November 2013 - 02:33 PM.


#73 T2Mum

Posted 03 November 2013 - 08:01 AM

I think the concerns from your family are being raised because they think that you have not considered or are unaware of the risks involved. It is your pregnancy and baby and if you are prepared to accept the risk involved in an emergency transfer being required then that is it really. My guess is that in their mind it is an unacceptable and unnecessary risk and that is why they are having a hard time accepting your decision.

#74 FuzzyChocolateToes

Posted 03 November 2013 - 08:02 AM

View Postscarfie, on 03 November 2013 - 05:40 AM, said:

Ryde Midwifery Group Practice is located at Ryde Hospital.  There are doctors, emergency care, surgeons, theatres, and ICU  

So this BC does have access to medical staff?  Does that mean this thread went to 3 pages over a misunderstanding that the bc has no D available?

Just out of curiosity when would they need to transfer someone out to RNSH?

Edited by ednaboo, 03 November 2013 - 08:06 AM.


#75 R2B2

Posted 03 November 2013 - 08:09 AM

Ok ill bite.

I had an emergency situation with my Ryde born baby.

the midwife I had was so fast at responding to the situation, and the medical team from the emergency department responded so fast that the issue was resolved in great time.

the paediatrician also arrived and made sure everything was perfectly well and safe.
you are not left in the middle of the woods to birth like an animal.
there is always help at hand.

just because it is a stand alone unit, does not mean that emergency medical help is not on hand if needed.




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