Thanks Christine - I really enjoyed that and couldn't agree more.

Michelle.
x
----- Original Message -----
From: "Christine Horner" <biff@...>
To: <SheffieldHomeBirth@yahoogroups.com>
Sent: Wednesday, October 17, 2007 12:59 PM
Subject: Re: [SheffieldHomeBirth] Interesting Article on High Risk Birth


> 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
>>
>>
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