Health bosses have moved to reassure expectant mothers in the county that there is enough staff to deal with rising birth rates in the county.
Concerns have been raised that women are being turned away by maternity units due to a shortage of staff or beds but the Norfolk and Norwich University Hospital said they are “in control” of the situation.
During 2008 there were 18 delivery suite closures with none in May, September, November or December. The delivery suite was closed for a total of 101 hours during 2008 and longest single closure was nine hours on July 10.
Although this has caused some degree of distress for mothers-to-be and their families hospital bosses said they have one of the best delivery suite records in the country.
A hospital spokesman said: “We have been recruiting more midwives during 2008 and we are still recruiting to fill eight vacancies. We have increased our midwifery staffing from 145 midwives to 165 and our midwife to birth ratio is: 1:32.
“A rising birth rate has been putting more pressure on maternity services generally. In the years before the new hospital opened the birth rate had been falling but it has been rising ever since NNUH opened. In 2001 our staff delivered 4,397 babies but that rose last year to 5,627.”
The Royal College of Midwives (RCM) claimed earlier this year that hospitals across the country had been unable to employ enough midwives to cope with rising birth rates because £330m of extra government funding to primary care trusts was not getting through.
http://www.eveningnews24.co.uk/content/News/story.aspx?brand=ENOnline&category=News&tBrand=enonline&tCategory=news&itemid=NOED14%20Feb%202009%2011:51:10:917
Showing posts with label home birth. Show all posts
Showing posts with label home birth. Show all posts
Tuesday, February 17, 2009
Births in public hospitals more likely to have complications
Julia Medew and Louise Hall
February 16, 2009
WOMEN who give birth in public hospitals are twice as likely to suffer serious complications and their babies are at greater risk of death, research shows.
An analysis of more than 780,000 full-term births in Australia between 2001 and 2004 found one in 1000 babies died in private hospitals, compared with three in 1000 in public hospitals.
It also concluded that women giving birth in public hospitals had twice the rate of severe perineal tearing. The rate of high-level resuscitation of babies in public hospitals was double that of private hospitals.
Obstetrician and co-author of the study, Associate Professor Stephen Robson of Australian National University, said the results, published in The Medical Journal of Australia today, were "startling", given the high rate of interventions in private hospitals. "Having a caesarean section, being induced and having an instrumental delivery usually increases complications, so we were staggered that in the private hospital group where these things happen more, the rate of complications was much lower," he said.
"We are loathe to draw too many conclusions, but it upends the orthodoxy that the more you intervene, the worse off the woman and her baby will be."
Professor Robson said he and his colleagues, Elizabeth Sullivan and Paula Laws of the Perinatal and Reproductive Epidemiology Research Unit at the University of New South Wales, took into account factors that would undermine fair comparison, such as smoking, diabetes and high blood pressure.
They also eliminated women with multiple pregnancies, premature deliveries and those with complications that were referred from private to public hospitals. "Our conclusion is that obstetrician-led care, the model of care where an obstetrician directly manages a woman's labour and delivery, confers quite an advantage," Professor Robson said, adding that experience may also contribute.
"If you look at the obstetricians who deliver babies in private hospitals they are generally highly trained, experienced people. If you look at public hospitals, there is more junior staff, midwifery-led care and a lot of trainees," he said.
The results are likely to spark debate as the Federal Government continues to assess different models of care as part of its review of maternity services.
Professor Robson said some factors not examined by the study, such as the socio-economic status of mothers, may have contributed, and urged more research.
But a spokeswoman for the Australian College of Midwives, Hannah Dahlen, said private hospitals tended to underreport adverse outcomes such as perineal tearing because of fear of medio-legal action.
President of the Maternity Coalition, Caroline McCullough, said the most important thing for women was to make informed decisions and have access to all types of care, regardless of the type of hospital in which they delivered.
"The medical lobby needs to pull its head in because it's not an either/or situation, it's about midwives and obstetricians and other health workers working together to support women in whatever choice they make," she said.
http://www.theage.com.au/national/public-hospital-births-double-risk-for-mother-and-baby-says-report-20090215-8861.html
February 16, 2009
WOMEN who give birth in public hospitals are twice as likely to suffer serious complications and their babies are at greater risk of death, research shows.
An analysis of more than 780,000 full-term births in Australia between 2001 and 2004 found one in 1000 babies died in private hospitals, compared with three in 1000 in public hospitals.
It also concluded that women giving birth in public hospitals had twice the rate of severe perineal tearing. The rate of high-level resuscitation of babies in public hospitals was double that of private hospitals.
Obstetrician and co-author of the study, Associate Professor Stephen Robson of Australian National University, said the results, published in The Medical Journal of Australia today, were "startling", given the high rate of interventions in private hospitals. "Having a caesarean section, being induced and having an instrumental delivery usually increases complications, so we were staggered that in the private hospital group where these things happen more, the rate of complications was much lower," he said.
"We are loathe to draw too many conclusions, but it upends the orthodoxy that the more you intervene, the worse off the woman and her baby will be."
Professor Robson said he and his colleagues, Elizabeth Sullivan and Paula Laws of the Perinatal and Reproductive Epidemiology Research Unit at the University of New South Wales, took into account factors that would undermine fair comparison, such as smoking, diabetes and high blood pressure.
They also eliminated women with multiple pregnancies, premature deliveries and those with complications that were referred from private to public hospitals. "Our conclusion is that obstetrician-led care, the model of care where an obstetrician directly manages a woman's labour and delivery, confers quite an advantage," Professor Robson said, adding that experience may also contribute.
"If you look at the obstetricians who deliver babies in private hospitals they are generally highly trained, experienced people. If you look at public hospitals, there is more junior staff, midwifery-led care and a lot of trainees," he said.
The results are likely to spark debate as the Federal Government continues to assess different models of care as part of its review of maternity services.
Professor Robson said some factors not examined by the study, such as the socio-economic status of mothers, may have contributed, and urged more research.
But a spokeswoman for the Australian College of Midwives, Hannah Dahlen, said private hospitals tended to underreport adverse outcomes such as perineal tearing because of fear of medio-legal action.
President of the Maternity Coalition, Caroline McCullough, said the most important thing for women was to make informed decisions and have access to all types of care, regardless of the type of hospital in which they delivered.
"The medical lobby needs to pull its head in because it's not an either/or situation, it's about midwives and obstetricians and other health workers working together to support women in whatever choice they make," she said.
http://www.theage.com.au/national/public-hospital-births-double-risk-for-mother-and-baby-says-report-20090215-8861.html
A nice story about home birthing midwife
CHARLESTON, W.Va. -- Nurse midwife Angy Nixon hugged her way around a recent meeting of home-birth advocates and moms. She admired the healthy babies held by their beaming mothers and exclaimed over how much they'd changed since she last saw them at their birth.
She shares an intimate bond with these women, who trusted her with their pregnancies and the deliveries of their babies, most of them in their own homes. Since 2003, Nixon's midwifery practice has been mostly home deliveries. She spent her first five years as a midwife delivering babies in a birth center.
"Women choose home births for a variety of reasons," she said, listing the reasons in no particular order. "Some want to save money. They expect the birth to be normal and are not afraid. They appreciate the privacy of their own homes. They control who's in the room."
Continue Reading
She shares an intimate bond with these women, who trusted her with their pregnancies and the deliveries of their babies, most of them in their own homes. Since 2003, Nixon's midwifery practice has been mostly home deliveries. She spent her first five years as a midwife delivering babies in a birth center.
"Women choose home births for a variety of reasons," she said, listing the reasons in no particular order. "Some want to save money. They expect the birth to be normal and are not afraid. They appreciate the privacy of their own homes. They control who's in the room."
Continue Reading
New Regulations of Midwives in Virginia
Obstetricians and certified professional midwives have differing philosophies when it comes to ushering babies into the outside world.
However, a bill before the General Assembly might bring them into a closer working relationship. At least, that's the hope of certified professional midwife, Brynne Potter.
Del. Matt Lohr, R-Harrisonburg, has introduced a bill that would amend the regulation of midwifery.
It would require that midwives inform patients of potential risks associated with delivering at home, "including but not limited to special risks associated with vaginal births after a prior C-section, breech births, births by women experiencing high-risk pregnancies, and births of twins or multiples."
Lohr said the bill is motivated by a desire to protect mothers and children, and was brought to him by Dr. Catherine Slusher, an obstetrician and gynecologist in Harrisonburg.
"Right now, midwives, when they begin working with patients, they have to go over forms about their practices and what they do, and what we're trying to add. ... is a notification sheet that basically educates patients on high-risk categories," he said. "It just comes down to safety.
"I certainly support midwives and support what they do. We just need to make sure we are giving these women all the information that they need."
A second Lohr-sponsored bill, which would deny reimbursement to midwives who attend high-risk home births, didn't make it out of committee.
While researching several cases involving midwives that went before the Virginia Board of Medicine, Lohr said he found that each involved a high-risk patient.
According to the Board of Medicine's Web site, a Virginia Beach midwife's license was suspended for at least two years following two stillbirths to morbidly obese women who delivered breech babies.
In one case, the mother carried strep B, and failed a one-hour glucose-tolerance test, according to a Board of Medicine order. The midwife moved up the woman's estimated due date, and waited more than 24 hours after her water broke before performing a vaginal exam, the order says.
Despite the fact that the baby was premature and she'd never delivered a breech baby, the midwife didn't send the patient to the hospital, and in fact didn't call paramedics until the lifeless baby was born, the order says. The midwife had the mother sign a consent form to continue the delivery despite the breech position of the baby.
"However, the informed consent to a home vaginal breech delivery signed by Patient A and her husband did not specify stillbirth or death of the baby as a risk of such a delivery," the order says.
The baby had a ruptured liver and a strep B infection, it says, and an autopsy indicated a C-section could have saved the baby, who was born in January 2008.
The same midwife was involved in another stillbirth last June. That mother was Rh negative and was 42, among other risk factors.
In that case, the midwife spoke to paramedics about the partially delivered breech baby, telling them to wait a half hour for her to get to the patient's home.
Lohr said the bill was originally met with some opposition, but now the midwifery lobby has come on board, Lohr said.
That's true, said Rebecca Bowers-Lanier, lobbyist for the Commonwealth Midwives Alliance.
"We decided that we not only support it, but [wanted to] strengthen it so that all midwives can work with the Board of Medicine in creating standard practices around informed consent and disclosure," Bowers-Lanier said.
While midwives provide informed consent throughout every stage of pregnancy, she said, "it hasn't been standardized, and they realize that."
Potter, who is the policy liaison for the Commonwealth Midwives Alliance, said she thinks the proposed legislation will be "precedent-setting."
"The thing I'm most excited about is medicine and midwives are going to be on the same page," she said. "I feel like this is the first step in a peace process between physicians and midwives practicing in Virginia."
Good communication between ob-gyns and certified professional midwives will benefit mothers and babies, said Potter, who practices in Charlottesville. The bill should help reassure physicians that midwives are providing their clients with adequate, informed choices, she said.
The midwives alliance is submitting a substitute to the bill that would require information given to expectant mothers be "evidence-based," Potter said.
"We will let the evidence, the research, the studies dictate what we tell our clients in terms of risks of home births," she said. "That is the midwife model of care."
Most women interested in having their babies at home are healthy, according to Potter, who says she attends about 40 births a year.
About two dozen certified professional midwives practice in Virginia, Bowers-Lanier said. These differ from nurse-midwives who mainly work in hospitals in collaboration and consultation with doctors.
Marshall University and Shenandoah University have recently teamed up to offer a master's degree in nurse-midwifery. Shenandoah has had the degree program for several years now.
"Certified professional midwives only attend births outside of hospitals," Bowers-Lanier said.
She said the C-section rate for women who use midwives is between 5 percent and 9 percent, compared to 31 percent for women who give birth in hospitals in Virginia. Bowers-Lanier said about 10 percent of women who intend to have home births wind up in the hospital.
"Most people go in for pain relief," she said. "They just can't make that final push and they need pain relief."
Slusher, of Harrisonburg Ob-Gyn Associates, said she and other obstetrician-gynecologists have seen cases of midwives attempting to deliver babies for women who have previously had C-sections. The American College of Obstetricians and Gynecologists recommends that labor only be tried if an obstetrician, anesthesiologist and operating room are immediately available, she said.
"These patients are at risk for uterine rupture," Slusher said.
That almost always results in a dead baby and is dangerous for the mother, she said.
"Our concern is for women to think it's an OK thing to do at home," Slusher said.
There have been failed attempts at home deliveries after C-sections, she said, which led doctors to realize this practice was occurring.
"I'm not opposed to people having choices and being able to do what they need to do, but I do think the people responsible for home deliveries ... need to also assume the responsibility to conduct them in a safe fashion," Slusher said. "I have no idea how many are going on in the region. What I'm concerned about is if one is going on and [the uterus] ruptures at home, [and] the mother and baby die, that's one too many. Especially, if that person wasn't appropriately counseled that it was an inappropriate delivery to try at home.
"Anything that we can do to make the home midwifery practices safer and more practical would be welcomed by the obstetric community because when they have disasters, they fall in our laps unexpectedly for cleanup. They fall into whoever's on call lap. You have inherited a disaster and get the privilege of dealing with it and owning it. When you have never been consulted throughout the entire pregnancy and when it's inappropriate, it becomes an even greater problem."
Contact Sally Voth at svoth@nvdaily.com
http://www.nvdaily.com/lifestyle/2009/02/legislation-would-impose-new-r.html
However, a bill before the General Assembly might bring them into a closer working relationship. At least, that's the hope of certified professional midwife, Brynne Potter.
Del. Matt Lohr, R-Harrisonburg, has introduced a bill that would amend the regulation of midwifery.
It would require that midwives inform patients of potential risks associated with delivering at home, "including but not limited to special risks associated with vaginal births after a prior C-section, breech births, births by women experiencing high-risk pregnancies, and births of twins or multiples."
Lohr said the bill is motivated by a desire to protect mothers and children, and was brought to him by Dr. Catherine Slusher, an obstetrician and gynecologist in Harrisonburg.
"Right now, midwives, when they begin working with patients, they have to go over forms about their practices and what they do, and what we're trying to add. ... is a notification sheet that basically educates patients on high-risk categories," he said. "It just comes down to safety.
"I certainly support midwives and support what they do. We just need to make sure we are giving these women all the information that they need."
A second Lohr-sponsored bill, which would deny reimbursement to midwives who attend high-risk home births, didn't make it out of committee.
While researching several cases involving midwives that went before the Virginia Board of Medicine, Lohr said he found that each involved a high-risk patient.
According to the Board of Medicine's Web site, a Virginia Beach midwife's license was suspended for at least two years following two stillbirths to morbidly obese women who delivered breech babies.
In one case, the mother carried strep B, and failed a one-hour glucose-tolerance test, according to a Board of Medicine order. The midwife moved up the woman's estimated due date, and waited more than 24 hours after her water broke before performing a vaginal exam, the order says.
Despite the fact that the baby was premature and she'd never delivered a breech baby, the midwife didn't send the patient to the hospital, and in fact didn't call paramedics until the lifeless baby was born, the order says. The midwife had the mother sign a consent form to continue the delivery despite the breech position of the baby.
"However, the informed consent to a home vaginal breech delivery signed by Patient A and her husband did not specify stillbirth or death of the baby as a risk of such a delivery," the order says.
The baby had a ruptured liver and a strep B infection, it says, and an autopsy indicated a C-section could have saved the baby, who was born in January 2008.
The same midwife was involved in another stillbirth last June. That mother was Rh negative and was 42, among other risk factors.
In that case, the midwife spoke to paramedics about the partially delivered breech baby, telling them to wait a half hour for her to get to the patient's home.
Lohr said the bill was originally met with some opposition, but now the midwifery lobby has come on board, Lohr said.
That's true, said Rebecca Bowers-Lanier, lobbyist for the Commonwealth Midwives Alliance.
"We decided that we not only support it, but [wanted to] strengthen it so that all midwives can work with the Board of Medicine in creating standard practices around informed consent and disclosure," Bowers-Lanier said.
While midwives provide informed consent throughout every stage of pregnancy, she said, "it hasn't been standardized, and they realize that."
Potter, who is the policy liaison for the Commonwealth Midwives Alliance, said she thinks the proposed legislation will be "precedent-setting."
"The thing I'm most excited about is medicine and midwives are going to be on the same page," she said. "I feel like this is the first step in a peace process between physicians and midwives practicing in Virginia."
Good communication between ob-gyns and certified professional midwives will benefit mothers and babies, said Potter, who practices in Charlottesville. The bill should help reassure physicians that midwives are providing their clients with adequate, informed choices, she said.
The midwives alliance is submitting a substitute to the bill that would require information given to expectant mothers be "evidence-based," Potter said.
"We will let the evidence, the research, the studies dictate what we tell our clients in terms of risks of home births," she said. "That is the midwife model of care."
Most women interested in having their babies at home are healthy, according to Potter, who says she attends about 40 births a year.
About two dozen certified professional midwives practice in Virginia, Bowers-Lanier said. These differ from nurse-midwives who mainly work in hospitals in collaboration and consultation with doctors.
Marshall University and Shenandoah University have recently teamed up to offer a master's degree in nurse-midwifery. Shenandoah has had the degree program for several years now.
"Certified professional midwives only attend births outside of hospitals," Bowers-Lanier said.
She said the C-section rate for women who use midwives is between 5 percent and 9 percent, compared to 31 percent for women who give birth in hospitals in Virginia. Bowers-Lanier said about 10 percent of women who intend to have home births wind up in the hospital.
"Most people go in for pain relief," she said. "They just can't make that final push and they need pain relief."
Slusher, of Harrisonburg Ob-Gyn Associates, said she and other obstetrician-gynecologists have seen cases of midwives attempting to deliver babies for women who have previously had C-sections. The American College of Obstetricians and Gynecologists recommends that labor only be tried if an obstetrician, anesthesiologist and operating room are immediately available, she said.
"These patients are at risk for uterine rupture," Slusher said.
That almost always results in a dead baby and is dangerous for the mother, she said.
"Our concern is for women to think it's an OK thing to do at home," Slusher said.
There have been failed attempts at home deliveries after C-sections, she said, which led doctors to realize this practice was occurring.
"I'm not opposed to people having choices and being able to do what they need to do, but I do think the people responsible for home deliveries ... need to also assume the responsibility to conduct them in a safe fashion," Slusher said. "I have no idea how many are going on in the region. What I'm concerned about is if one is going on and [the uterus] ruptures at home, [and] the mother and baby die, that's one too many. Especially, if that person wasn't appropriately counseled that it was an inappropriate delivery to try at home.
"Anything that we can do to make the home midwifery practices safer and more practical would be welcomed by the obstetric community because when they have disasters, they fall in our laps unexpectedly for cleanup. They fall into whoever's on call lap. You have inherited a disaster and get the privilege of dealing with it and owning it. When you have never been consulted throughout the entire pregnancy and when it's inappropriate, it becomes an even greater problem."
Contact Sally Voth at svoth@nvdaily.com
http://www.nvdaily.com/lifestyle/2009/02/legislation-would-impose-new-r.html
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