Whoops, in true nit-like manner I forgot to say who this was from!!

Christine Horner


iishin2001 wrote:
>
> Hi folks,
>
> Here is an interesting article from Australia. I think some of you may
> have already read it.
>
> It's a bit long. I'd put it in the files section but I'm not sure how!
> Sorry, I'm a bit of a computer nit.
>
> "High Risk Birth" - Defined by Whom?
> by Justine Caines
>
> In the last 5 years working for Maternity Coalition I have worked
> tirelessly to help establish one-to-one midwifery care across
> Australia. I am passionate that women can choose a midwife in any
> setting, but especially at home as I have experienced the beauty of
> homebirth. I do not at see myself as conservative or someone who
> 'sells out' in my role as an advocate. In the last year however I
> have been forced to reassess all of this. After 4 very normal
> pregnancies with stunning, intervention-free homebirths I was greeted
> with the news that I was having twins. In a split second I plummeted
> into the category of 'high-risk' - but did I really, and who defined
> it anyway?
>
> Breech birth, vaginal birth after caesarean (VBAC) and twins birth can
> carry additional risk. The risk must be measured rationally however.
> The risk of uterine rupture for example after a primary c/s is not
> quite 1%. The vast majority of Obstetricians do not support women to
> achieve a VBAC. Many paint a picture of fear and death citing uterine
> rupture as a compelling reason to elect for a repeat caesarean. The
> risk of spontaneous abortion after amniocentesis is 1-2%. This test
> is routinely offered to women over 35 without any of the trappings of
> death and injury.
>
> Before I was aware I was carrying twins I had planned another
> homebirth. I very much look forward to it. My first thought was "My
> homebirth is out the window'. Although I resist becoming a prisoner
> to the language of obstetrics that sees women as deficient beings in
> need of rescuing, I think some of it had rubbed off. In our advocacy
> we spend much of it demonstrating that midwifery care should be a
> mainstream option, but also accept the obstetric line that breech and
> twins and VBAC belong within a high-risk category. Now with a label
> threatening to choke me I sat back and thought, "Where is the
> individual rights of the woman and her body here?'
>
> Very few women would knowingly put their baby or themselves at risk.
> Why then are women with 'special needs' granted less insight or
> knowledge of their body's capacity or their baby's wellbeing? Again
> we know the answer. It is because current obstetric practice in
> Australia is not about women, or even babies. It is about fear and
> control, the necessary ingredients in keeping maternity services
> dominated by the medical profession, and keeping the birthing of
> babies as big business.
>
> After the huge shock I researched obstetric management of twins. It
> seemed at best if I fought hard I could give birth to my babies
> vaginally, but I would be very likely to be pressured to have an
> epidural (for the fast removal of twin 2, via c/s or forceps), I would
> also be pressured to have constant foetal monitoring. In the event of
> twin 2 presenting breech I would be likely to have a very managed
> birth (via forceps). In the event that I had not given birth by 38
> weeks, induction would be strongly recommended. Of course the far more
> acceptable option would be an elective caesarean section again at 38
> weeks. Despite many twins being born by caesarean section, like many
> obstetric practices it is not supported by evidence.
>
> "Virtually no data from controlled trails are available to help
> determine the choice between vaginal birth and caesarean section for
> women with multiple pregnancy. A single trial has assessed the effect
> of caesarean section for delivery when the second twin was in a
> non-vertex presentation. As would be expected, maternal febrile
> morbidity and need for general anaesthesia was increased with
> caesarean section. No offsetting advantages in terms of decreased
> fetal or neonatal morbidity or mortality were found." Enkin et al 3rd
> Ed Guide to effective care in pregnancy and childbirth ... p.146
>
> At 38 weeks my babies would be smaller and more likely to need
> additional care. In the event of a caesarean section I would need to
> recover from major surgery and at the same time attempt to breastfeed
> 2 babies and care for another 4 children. This was considered a safe
> option? I was very fortunate to be sent the now out of print book,
> "Having Twins' by Elizabeth Noble (copies can be found on Amazon.com
> etc). This text reaffirmed my gut feeling that although a multiple
> pregnancy required some special care through nutrition and rest there
> is no reason that twins should be treated as high risk. The
> misconception that all twins arrive early was a consistent theme. Why
> does one neglect the power of a woman's mind in determining when and
> how she gives birth? Currently there are very few practitioners who
> affirm a woman's ability to carry twins to term. In my case I gave
> birth to two, three-kilogram babies at 40weeks, 1 day. With the
> exception of my midwives everyone I spoke to would say"You won't go
> full term' "You'll have these babies early' "No –one carries twins
> to term'. Interestingly the women I spoke to who had birthed twins at
> home or at least been cared for by an independent midwife all went
> very close to term. Those who birthed in hospital had to fight off
> the routine 38-week induction but with supportive care they all
> achieved term babies at 39 to 40 weeks.
>
> This was very welcome news. I told my babies daily that they would
> grow to term. I did not give a thought to the fact that I would birth
> premature babies. Living in rural NSW this would have been disastrous
> for our family and myself. I would have been hours away from home and
> our children. I was fortunate enough to read a fascinating book
> called Pre-natal Parenting by US Neonatologist, Frederick Wirth.
> After 35 years seeing the often tragic consequences of premature
> birth, Dr Wirth researched how the mind affected the body. He makes a
> compelling case for women to focus on positive and loving thoughts
> throughout their pregnancy; Guiding families to address relationship
> problems and potential fears to enable not only a healthy pregnancy
> and birth but also an affirming start to bonding and parenting a new
> human. He says:
>
> "Prenatal visits help your healthcare provider recognize complications
> during pregnancy, and they do an excellent job, but too many patients
> believe that their pregnancy outcome depends solely on the quality of
> their medical care. The success of your pregnancy also depends on the
> psychological and spiritual content of your life.'
>
> I was intrigued; Dr Wirth must be supportive of midwifery care and the
> option of homebirth (due to the very model of care being holistic
> blending health care into the social fabric of our lives). Dr Wirth
> in fact described the first homebirth he attended as the most
> beautiful, despite witnessing hundreds in the hospital system. He
> felt like an intruder and wanted to leave the couple to do what they
> were doing so beautifully, creating a safe and loving environment to
> welcome new life.
>
> I was buoyed by what I read. I progressed full steam with confidence
> that the only place to have my babies was at home full term.
> Instinctively I knew that home was the safest place to give birth (in
> the absence of medical complications or conditions). Importantly I
> had also proven clinically that it was also much safer for me to be
> cared for by midwives at home.
>
> How could my babies be safer with a routine induction at 38 weeks,
> when they were more likely to need resuscitation and medical care?
> How would constant foetal monitoring assist when studies have shown
> it's routine use has seen no improvement in outcomes only an increase
> in caesarean section? How would my babies or I be safer with an
> epidural that would prevent me being upright, the proven best
> physiological position for normal birth? How would I be safer being
> denied deep water for pain relief? (Do you know of a hospital that
> will enable a woman birthing twins to use a birth pool for pain relief
> in labour and to give birth if she wishes?).
>
> As my pregnancy progressed I remained healthy and happy. I had
> decided to have 3 ultrasounds one at 20 weeks (soon after I realised I
> was carrying twins) one at 28 weeks and another at 34 weeks. All
> these scans revealed healthy babies of a good size. I was carrying
> fraternal twins (in all likelihood) I had a single placenta that had
> probably fused. One baby was head down the other breech. This is the
> only interaction I had with obstetrics. I used technology in a
> limited way to keep my home birth plans alive.
>
> Like many women in a way I would of liked to have given birth at
> around 38 weeks, I felt pretty heavy. Although at 39 weeks I felt
> excellent (even had a spring in my stride). My midwives said I looked
> 'too good' to be close to birth!
>
> At 40 weeks I decided it was really time to meet my babies and they
> must have agreed. My midwives and doula were with me. On the last
> day we enjoyed time together with the kids, had a nice meal together
> and all went to bed. At 1.30am my waters broke with a huge gush. By
> 2 am I had strong contractions. I then woke my midwives and doula, as
> I was conscious the pool needed to be filled. My labour progressed
> furiously. I could feel twin 1 moving down. I entered the pool with
> the water level a little low. The pain relief was instant and
> considerable. Our digital camera revealed I was only in the pool for
> 7 minutes before our first baby was born. The water was just deep
> enough! Amazingly I put my hand on her head and felt her shoulders
> rotate as she was born. I also caught her and drew her close to me
> revealing her gender. It was an awesome feeling to catch my own child
> (something I had been previously unable to manoeuvre).
>
> My husband entered the pool at this stage. Contractions started
> again, 6 minutes after our first baby was born. I was very uneasy
> holding our first baby with a contraction winding up. Paul held her
> as I got on with birthing our second baby. The cord had stopped
> pulsing with baby 1 and I asked that it be cut. Although this would
> not have been by preference the cord was not overly long and I felt
> very uneasy still being connected and contracting. The midwives later
> said they were happy to hear me quite anxious about all of this, as it
> was a clear sign that baby 2 was very near.
>
> My midwife announced there was "a foot' and I very clearly thought "OK
> here's our little breech babe, just remember her head will be last,
> brace yourself! I had no fear about her being breech. Her birth was
> easy. I do concede however, that she was a twin with a smaller head
> than most (33cm) and I had just birthed a baby. My midwives were
> remarkable. One simply gave baby 2 a gentle push back towards me (as
> the weight of her head prompted her to move up towards my back rather
> than the front). Both Paul and I then welcomed our 2 girls in the warm
> pool. Both babies were born with APGAR's of 9 and 9. I had a slight
> graze. I had a physiological 3rd stage, birthing a vary large and
> healthy placenta 45 minutes later. I had minimal blood loss and
> recovered beautifully
>
> The photo on the front cover was taken 8 minutes after our second baby
> was born. I guess it says it all really. Our baby's entrance into
> the world was sacred and safe. In comparison they could have been cut
> or pulled from me before they were ready most likely with worse
> results. The irony is that the latter choice is seen to be 'safer'.
>
> It is time to re-think risk. I have explored twin birth through my
> own experience. VBAC and single vaginal breech birth are other 'risk'
> categories that need to be examined. The fear that surrounds VBAC is
> totally unwarranted. I believe the majority of women attempting VBAC
> are set up to fail, vaginal breech is so rare in the hospital system
> that I believe it is unsafe. Not unsafe itself but unsafe due to
> totally inexperienced practitioners. Other than independent midwives
> I know of one Obstetrician experienced in breech birth with a gentle
> 'hands-off' approach.
>
> In relaying this story I do not believe that all twins, some VBAC's or
> breech babies can or should be born at home. What I have learnt via
> research and through practical experience is that 'risk' is a
> conjecture from practitioners who have little if any understanding or
> faith in normal birth. Unfortunately birth in Australia is dominated
> by medical practitioners. These practitioners create labels of 'risk'
> often with little regard for research evidence. On the whole these
> practitioners only believe in the safety of birth after the event. To
> me this is most telling and explains our huge rates of intervention,
> and resultant morbidity.
>
> If the pilot responsible for flying the plane you travelled on was
> only convinced air travel was safe after he had safely landed the
> plane what would you think? Would you doubt his competence as a pilot?
> Think perhaps he should get another job. Would you doubt the safety of
> the actual aircraft? Sadly most women do the latter, they allow
> medical practitioners to convince them that their body is faulty. Why
> not question the practitioner? After all most Obstetricians are male
> with no real way of truly understanding pregnancy and birth.
>
> Post Script: As I write this our twins are 7 weeks old. I am happily
> breastfeeding them, they have grown beautifully 1.2 and 1.3 kg since
> birth! Raising twins is certainly hard work but the support I
> received from my midwives gave me such a huge head start. Thank you
> to Betty Vella, Robyn Gasparotto and Margie Perkins for your courage
> and commitment.
>
> Justine Caines
>
>