Belmont Birthing Service

While being an independent midwife has it's struggles and I often feel like the birthing services are getting worse instead of better, - there are many people working behind the scenes to improve the care women and their families receive. Belmont Birthing Services is a fantastic example of what can be achieved with the right support. The following information is written (and reproduced with permission) by Carolyn Hastie

Hi all, thought I'd write and give you all an update on what's happening at Belmont Birthing Service (BBS) on the shores of the beautiful Lake Macquaire near Newcastle, NSW.

To remind you about BBS, we are a stand alone, women centered, midwifery managed maternity service, situated with in Belmont Hospital. We are a public health service, part of the maternity services offered through John Hunter Hospital. There are 8 of us, seven midwives and one manager. We care for women throughout pregnancy, birth and the postnatal period for two to three weeks. Our service commenced on the 4th July 2005, so we are almost three years old.

We have now cared for 651 women through the birth of their babies and beyond.
72% are having their babies on site at Belmont.

The normal birth rate, even for those women who are transferred to the tertiary referral hospital, either in labour or before is > 95%

Reasons for transfer are predominately post dates for induction of labour and slow progress in labour - either requiring pain relief or augmentation. Interestingly, there were far more transfers in the first two years of our service than there are now. That is due to several factors including the fact that in the first year, women who were Group B Strep positive were transferred for antibiotic cover. Since then, all the midwives have been credentialled as immunisers, so can give IV antibiotics without medical presence. Chlorhexidine douches are very popular and effective for GBS prophylaxis and most women choose to use that as they are not keen on antibiotics.

Other stats you may find interesting include:

• most of the women choose to birth their babies through the water - the baths at BBS are wonderful.
• most of the women choose undisturbed labour, including third stage and so the physiological third stage rate is very high blood loss rates are very normal, postpartum haemorrhage is exceedingly rare there have been only two women with elevated blood pressure (no actual Preclampsia) prenatally and one postnatally.
• there have been five premature births and those babies were one at 32 weeks, the rest at 34-36 weeks.
• Four women have had breech babies and given birth at the tertiary referral hospital.

We are very blessed to have great midwifery and medical management and our health executive are fantastic, very supportive of our service and other innovative ways of caring for the health needs of their population.

Other great items include:

• Hunter New England Health has an area wide homebirth policy based on the wonderful NSWHealth Homebirth policy and we are now able to provide homebirth for those women who choose that option. Our first homebirth occurred on Christmas Day 2007. We have a virtual ward and virtual nursery for these births and babies.
• Intradermal water injections are used as needed and have been very beneficial to the women who have used them.
• The midwives have admitting rights and now women are admitted with the midwife's name as care provider.
• Across the health service, routine birthing medications, such as syntocinon, N2O, Konakion and Hep B, Priorix are now midwife initiated medications, so no doctor's signature is necessary for their administration.

It's all very exciting and wonderful to see the way that everyone in the health service is supportive of enabling women and midwives to work together to keep birth normal and rewarding for everyone.

love, Carolyn Hastie
Midwifery Manager
Belmont Birthing Service
0428112786

To download a flyer on Belmont Birthing Service (PDF Document)

Save Independent Midwifery

Since 2003 Independent Midwives in Australia have been unable to obtain professional indemnity insurance. Insurance companies felt that the number of independent midwives is extremely small and that one claim would wipe out any premiums they'd obtain - making independent midwives an uneconomical group to support. As far as we can ascertain there have been no major claims against independent midwives (or none that the insurance companies have let us know about). This had a big impact on my independent midwifery practice. I'd enjoyed a wonderful working relationship with Prince Alfred Hospital at Camperdown - I had visiting rights as an independent midwife which enabled me to support women as their primary caregiver in the birth centre and also enabled me to continue care for women who required a transfer after a planned homebirth. In NSW the Nurses and Midwives Registration board does state that we are supposed to carry Professional Indemnity insurance but does not enforce it.

It seems that Independent Midwifery in the UK is not so fortunate. The government is proposing that all health professionals carry professional indemnity insurance - which effectively will make it illegal for independent midwives to continue practicing. I cannot believe that such problems face my sisters in the UK. If you wish to read more go to http://www.saveindependentmidwifery.org/

Dangers of Prenatal Testing

Channel 9's Sunday program has a very interesting video footage on the "Dangers of Prenatal Testing"

An ultrasound screening test at 12 weeks is now considered a routine part of pregnancy, but an eminent British Radiologist claims the test, designed to pick up chromosomal abnormalities like Down syndrome, is highly inaccurate.

In a controversial interview with the Sunday program, Dr Hylton Meire claims that the screening test known as a Nuchal Translucency, has a false positive rate of 95%, and that healthy babies are put at risk of miscarriage from more invasive tests to confirm or deny the original suspicion. He argues up to three healthy babies die for every one Downs syndrome baby that goes to term. Read On...

Scared for Life

The Sydney Morning Herald recently put Caesarean Birth's as a major headline for more than a week. As the caesarean rate fast approaches 1:3 births - it was a timely response from a major newspaper. If you happened to miss the headlines you can read about them on Sydney Morning Herald's Website. They have also uploaded a very powerful video interview with two women who's caesarean births went very wrong.

Awesome VBAC story

I was reading my emails this morning and was sent a link to the site One True Media - which I wasn't aware off. It is similar to YouTube so I thought I'd check it out. The link was to a short video of Theresa's journey to a successful vaginal birth after three caesareans - it is one of the most powerful birth stories I've come across - so I thought I'd share it with you.

Make video montages at www.OneTrueMedia.com

The worst intervention in the birth room ...

My recent experience working as a midwife in the hospital system has fastened my belief that the worse intervention in the birth room is the clock. When working with women in the community - there is no clock, there is no pressure and there is no unnecessary intervention. The events of labour unfold as nature intended. This is in stark contrast with birth in hospital. Every aspect of labour is MANAGED according to the clock. For example a women's membranes break the clock starts ticking. Often times she may be offered an induction of labour straight away or alternatively allowed 12 to 24 hours to establish labour or then have the induction of labour (and all it's associated problems).

A women's progress in labour is managed by the clock - the expected dilatation is 1cm per hour or her labour is considered abnormal and her labour sped up with Syntocinon. There is no quality evidence that supports a woman must dilate at a certain rate and in fact speeding up a labour unnecessary is quite harmful. Syntocinon causes the uterus to contract more painfully than a natural labour - increasing the use of pain medications (and their inherent effects). Syntocinon often causes too frequent contractions - depriving the baby of oxygen causing unnecessary fetal distress. One of the most catastrophic problems syntocinon causes in an increase in postpartum haemorrhage and the associated morbidity and occasionally mortality that a haemorrhage can cause.

While Syntocinon, in a few causes, will assist a woman to achieve a vaginal birth where her labour is truly prolonged. In most cases it is used unnecessary, causing a cascade of intervention.

Get rid of the clock in the birth room and allow women to labour under their own steam.

First Post for 2008

I can't believe I've left it this long to add to my blog. I must say that it was exhausting organizing the screening of The Business of Being Born - there was more work than I'd anticipated. The feedback from the screening was very positive - I'd love to make the documentary more widely available. It looks like the DVD will be released in March 2008 - which is great news. I'll keep you posted.

Christmas was fantastic, I enjoyed time with my family doing Christmas activities (like taking my younger children into the city - they are seen in this photo riding Santa's train).

I continue to work at the local hospital in the birth unit. It is challenging as intervention rate is unnecessarily high. The system has lost sight of what normal birth is and complication rate is high. It is rewarding though as I feel like I make a difference and I have access to lots of education programs.