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Midwifery Led Care - what you need to know for your birth.

Having worked along many pre and postpartum mums, i've noticed a trend in their satisfaction with the hospital system here in Australia and how they felt about their birth experience, depending on what model of care they opted for.


There are several different options for birthing in Australia. For example, you might choose to have a home birth attended to by private midwife. You could also choose to have private midwives attend to you at a birth retreat or birth centre.



Another option is a private hospital setting where you are attended, generally, by your obstetrician or you could go for a public hospital setting where you could have a midwife, obstetrician or other medical staff.


Currently, the huge majority of Australian women birth in a public hospital setting (73% in 2015).


What's interesting about this is that almost ALL the current available research demonstrates that midwife-led care (care where you have the same midwife or team of midwifes care for you during your prenatal visits, birth and in the postpartum period) has much better outcomes for both mother and baby.


This especially raises eyebrows given that ONLY 2.1% of Australian women birth at home or at a birth centre and therefore with midwife-led care. On top of this, many of those women who would like midwife-led care at public hospitals, due to the clear benefits, are missing out on the opportunity.




So what are some of the reasons why midwifery care has better outcomes??


Continuity of care:

Women who have access to midwife-led care have the same midwives, or small team of midwives, provide care throughout the prenatal classes, prenatal appointments and checkups, labour and birth and the postnatal period. This enables consistency with each visit, which would generally mean less room for error as the same people are providing care.


Getting to know your team:

Research demonstrates that during labour & birth, unfamiliar environments, people and procedures can increase stimulation to the sympathetic nervous system and have adverse effects on dilation, effacement and birth outcomes. So it makes sense that having a birth professional you've gotten to know through your pregnancy may have better outcomes.


More control:

Research also shows that women who had access to midwifery led care felt that their voices were heard and that they were more in control during pregnancy, labour and birth.

This is one of the big ones with many of the women I work with. Lots of them feel as though things were happening TO them rather than them having a role to play in their own birth.


Differences in pain management:

Midwifery led care has been known to use lots of alternate or 'natural' methods in preparing mum for pain during labour and birth and also for managing said pain once it occurs.

Studies show that less pain medication is given in settings where midwives are providing care.


Lower rates of intervention:

This goes hand in hand with the pain management statistics. Midwives are often trained to use different maternal postures and positions, water, heat, pressure, massage etc to assist in progression of the labour & delivery, before encouraging mum to opt for intervention. This is particularly important when we note that many of these interventions come with a substantial risk to both mum and baby, when unnecessary.





***It's also important to note that there are lots of midwives who follow a more 'obstetric model' of care (or who have hospital policies and procedures preventing them from following the care they would like to provide). There are also many obstetricians who are up to date with the research and follow a more 'midwife-like' model of care.


What to do now?


If Midwifery led care is something you want to investigate further, start by looking for birth centres, finding out which public hospitals provide a midwife-led model of care (and how you get allocated to them) and asking for recommendations on home birth midwives nearby.


If none of these are available to you and it's looking like a hospital birth is your only option, we suggest writing a carefully detailed birth plan to take with you on the day and to discuss with the staff on duty. It can also be worthwhile having a support person, who knows your goals, attend the birth so they can focus on the nitty gritty while you and your partner (if you have one) focus on birth.


We hope you find the information provided helpful!


Enjoy!

- BBB x









References:

- http://www.health.gov.au/internet/publications/publishing.nsf/Content/msr-report~msr-report-keyissues~msr-report-access

- Homer, CS et al. Women's experiences of continuity of midwifery care in a randomised controlled trial in Australia. Midwifery. 2002 Jun;18(2):102-12.

- Sandal, J. et al. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Sys Rev 2016 Apr 28;4:CD004667. doi: 10.1002/14651858.CD004667.pub5.

- Ina May's Guide to Childbirth - Ina May Gaskin

- Meredith J McIntyre. Safety of non-medically led primary maternity care models:

a critical review of the international literature. Australian Health Review, 2012, 36, 140–147

- Australian Mothers & Babies: In Brief. Australian Institute of Health and Welfare

- Judith A Lothian. Healthy Birth Practice #4: Avoid Interventions Unless They Are Medically Necessary. The Journal of Perinatal Education | Fall 2014, Volume 23, Number 4 198-206

- Hannah Grace Dahlen et al. Rates of obstetric intervention among low-risk women giving birth in private and public hospitals in NSW: a population-based descriptive study. BMJ Open 2012;0:e001723.

- Hua J et al. Effects of midwife-led maternity services on maternal postpartum wellbeing and clinical outcomes in primiparous women under China's one-child policy. BMC Pregnancy & Childbirth. 2018 Aug 13;18(1):329


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