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Dr Belinda Maier - Midwife 
 Maier.Belinda@yahoo.com.au
Navigating Birth Choices 
 What I wont be telling you is which way is best for you! I 
will be talking about best practice, evidence and how to 
decide how you will navigate negotiate and demand for 
yourself so your choices are your own 
 During this workshop I will be asking you to be engaged 
and ask questions  make sure you get what you need 
from today
 Birth is not only about making babies. 
Birth is about making mothers ~ strong, 
competent, capable mothers who trust 
themselves and know their inner strength. 
 Barbara Katz Rothman
If only there was a list of options! 
Menu 
Mains 
Medical clinic 
Midwives clinic 
Midwifery led care 
GP shared care 
Private obstetrician 
Private midwife 
Side order 
Water birth 
Epidural 
Cesarean 
Home 
Hospital 
Drugs 
Massage 
hypnotherapy
Are women making choices? 
 Are they informed  by what ? who ? When? 
Where ?
 family
 experience
 stories
 Health care provider, 
midwife or doctor
 information
Is there a choice? 
 What are we talking about today? 
 Medical model midwifery model birth 
centre, labour ward delivery suit private 
public homebirth drugs no drugs pain 
relief no pain relief partner mother 
father mother in law arghhhhhhhhh
Medicine and Midwifery do not 
need to be exclusive of each 
other!!!!!
 Healthy birth  what 
does it mean 
 Is it normal, 
intervention free, 
vaginal, cesarean?
 Why not a cesarean? Organised, no 
labour, on time, manageable????? 
 More and more and more woman are 
having a cesarean  that's a choice???
 Vaginal birth  is it 
normal birth
Lets talk pain
How can I manage/cope?
Midwifery care
Water birth
induction
monitoring 
 CTG 
 Doppler 
 Scalp clip 
 pinnards
When to come in, when to call your 
midwife !!!!!!!!
Navigating birth choices beautiful birth 2011
Dont know what you want? 
Do you have to choose now
NOOOOOOOOOO
Give it a go!!! 
 But be determined 
 Be determined but dont be inflexible 
 Be flexible but dont be compliant
 Do or do not... there is no try. ~ Yoda
 Where to find help and information?
 Special interest groups i.e. Australian 
College of Midwives, Maternity Coalition, 
Baby Friendly health Initiative, Homebirth 
Australia, Australian Private Practice 
Midwives Association, Midwives Australia, 
Australian Breastfeeding Association, 
Cesarean Awareness Resource and 
Education (CARES).
 Midwives 
 Doctors 
 Hospitals 
 Networks 
 Other women 
 Surf the net!
 How to handle the net!!!!! 
 What information is good quality 
 What is opinion 
 When to stop!
So how to be flexible but not 
compliant? 
 know what you prefer/want 
 Understand your options 
 Make sure the people around you 
understand your preferences and WILL 
support them 
 Remember partners and support people 
can be scared too
 Will you be annoying if you ask?
 Keep asking until it makes sense to you!
remember 
 Childbirth doesnt have to be a drama 
even though it sometimes is 
 Avoid interventions unless you are 
comfortable with why you need them
Last thought 
 There is nothing 
better in this world 
than the smell of your 
own newborn baby

More Related Content

Navigating birth choices beautiful birth 2011

  • 1. Dr Belinda Maier - Midwife Maier.Belinda@yahoo.com.au
  • 2. Navigating Birth Choices What I wont be telling you is which way is best for you! I will be talking about best practice, evidence and how to decide how you will navigate negotiate and demand for yourself so your choices are your own During this workshop I will be asking you to be engaged and ask questions make sure you get what you need from today
  • 3. Birth is not only about making babies. Birth is about making mothers ~ strong, competent, capable mothers who trust themselves and know their inner strength. Barbara Katz Rothman
  • 4. If only there was a list of options! Menu Mains Medical clinic Midwives clinic Midwifery led care GP shared care Private obstetrician Private midwife Side order Water birth Epidural Cesarean Home Hospital Drugs Massage hypnotherapy
  • 5. Are women making choices? Are they informed by what ? who ? When? Where ?
  • 9. Health care provider, midwife or doctor
  • 11. Is there a choice? What are we talking about today? Medical model midwifery model birth centre, labour ward delivery suit private public homebirth drugs no drugs pain relief no pain relief partner mother father mother in law arghhhhhhhhh
  • 12. Medicine and Midwifery do not need to be exclusive of each other!!!!!
  • 13. Healthy birth what does it mean Is it normal, intervention free, vaginal, cesarean?
  • 14. Why not a cesarean? Organised, no labour, on time, manageable????? More and more and more woman are having a cesarean that's a choice???
  • 15. Vaginal birth is it normal birth
  • 17. How can I manage/cope?
  • 21. monitoring CTG Doppler Scalp clip pinnards
  • 22. When to come in, when to call your midwife !!!!!!!!
  • 24. Dont know what you want? Do you have to choose now
  • 26. Give it a go!!! But be determined Be determined but dont be inflexible Be flexible but dont be compliant
  • 27. Do or do not... there is no try. ~ Yoda
  • 28. Where to find help and information?
  • 29. Special interest groups i.e. Australian College of Midwives, Maternity Coalition, Baby Friendly health Initiative, Homebirth Australia, Australian Private Practice Midwives Association, Midwives Australia, Australian Breastfeeding Association, Cesarean Awareness Resource and Education (CARES).
  • 30. Midwives Doctors Hospitals Networks Other women Surf the net!
  • 31. How to handle the net!!!!! What information is good quality What is opinion When to stop!
  • 32. So how to be flexible but not compliant? know what you prefer/want Understand your options Make sure the people around you understand your preferences and WILL support them Remember partners and support people can be scared too
  • 33. Will you be annoying if you ask?
  • 34. Keep asking until it makes sense to you!
  • 35. remember Childbirth doesnt have to be a drama even though it sometimes is Avoid interventions unless you are comfortable with why you need them
  • 36. Last thought There is nothing better in this world than the smell of your own newborn baby

Editor's Notes

  • #3: The following presentation will discuss the myriad of choices and options available to women when considering antenatal, birth and postnatal care, in or out of hospital facilities. There is a lot more to choice than simple making a choice based on evidence or information. Women, partners and families need skills to help them manage and navigate the choices they make within evolving, emotive and contentious beliefs about women, birth and babies.
  • #6: It would appear that women in Australia can make many choices and that maternity care provision has a sound basis in evidence and research. However with soaring cesarean sections rates coupled with rising associated morbidities and postnatal stress disorders it would seem that effectively navigating choices is problematic. I will present some of the various ways that women can make informed decisions based on choices that suit their own needs and desires, but also within the dominance of medicine and the hospitalisation of maternity care. This aims to be meaningful to all women regardless of the options of care they choose, because ultimately individual choice based on sound evidence and having support therein is what matters.
  • #7: Religion Custom History
  • #8: Personal experience during birth or with others at birth
  • #9: Whoooo these are soo very important
  • #10: Pleaswe excuse the sexist nature of male doctor and female midwife but statistically I am not far wrong
  • #12: Lupton (1993) describes risk as being ideologically loaded and discursively constructed to produce control over the social and personal body.
  • #13: Choosing one does not exclude the other. There is always a midwife at every birth. There is always a doctor available if you require medical attention We are not aliens
  • #14: Is it just health mother healthy baby What is health Australian women are experiencing an obstetric cascade starting with overuse of drugs for induction and augmentation leading to the excessive use of epidural block inevitably resulting in the extreme rates of forceps and vacuum extraction found in Australia---the highest rates recorded anywhere in the world. How can it be that a third of babies born in Australia must be pulled out of their mothers? Such aggressive extraction results in damage to the neonate including swelling and bruises of the head. Using a surgical instrument also means frequent episiotomy and all these invasive surgical procedures on the woman results in damage to the woman still evident six months postpartum including 54% with perineal pain, 18% with urinary incontinence, 19% with bowel problems, 36% with haemmorrhoids and 39% with sexual problems. This is why it is appropriate to define rates of episiotomy over 20 % as female genital mutilation. First, there can no longer be any doubt that midwives are the safest birth attendant for low risk birth. One meta-analysis of 15 studies comparing midwife-attended birth with physician attended birth found no difference in outcomes for women or babies except for fewer low birth weight babies with midwives.[23] Two randomized controlled trials (RCT) in Scotland[24,25] and 6 RCTs in the US all found no increase in adverse outcomes with midwife attended birth.[13] Qld stats as of 2008 34% not augmented 93.9% cephalic presentation 56.9% nvb 35.8% no drugs 50% no analgesia for birth 20.5% non induced augmented vbac 68% re section rate 24% precipitate labour 42.8 not continuously monitored 23.4% episi 3.4% episi and laceration
  • #15: Is it a choice when it is based on fear or misinformation Medical intervention in childbirth is fine when it is needed. There's no doubt it can save the lives of some mothers and babies. But we now have way too much of a 'good thing'. There is risk with CS --- maternal mortality even for elective (non-emergency) caesarian section is 2.84 fold or nearly three times higher than for vaginal birth.[3] For fifty years the maternal mortality ratio came down. Then in the 1980's the maternal mortality ratio began to rise and, according to the US Centers for Disease Control and Prevention, it rose from 7.2 in 1987 to 10.0 in 1990.[4] While this ratio continued to decline in other industrialized countries, in the US the maternal death rate continued a slow but steady rise through the 1990s and according to the World Health Organization is now higher than at least twenty other highly industrialized countries.[5]
  • #16: it is estimated that less than 25% of women do not have some form of pharmaceutic intervention and Australia wide 57.9 women birth without instrumental intervention what is normal anymore? Vaginal birth is normal birth for the majority of women. However not normal doesnt necessarily mean bad! This is key to our language and framework for the value of women's experiences and women must take ownership of their choices. An elective cesarean is not normal birth but for a woman that may not be bad as such. A normal birth in hospital or at home is one more normal than the other?
  • #17: The big one Yes birth is painful and no birth isnt painful Birth pain is both pain and not pain It is most importantly normal physiological work the body does and fear is the key factor as to how you responds to approach and make choice for birth care This doesnt mean that its your fault that you fear therefore experience pain it means that overwhelmingly we have one language for pain in labour. We could say pain is a very strong sensation that you have to work very hard on. It could be that it is excruciatingly horrendous. Which way makes you approach it more positively. Language is powerful My experience
  • #18: Options are vast What do you feel do you like alternate therapies, water, heat, smells Movement Support being known Touch environemnt
  • #20: Can be anything!!!!
  • #23: The later the better Evidence shows that