The Birth Project - Our ABC

 Our ABC is investigating giving birth in Australia!

Despite Australia having one of the lowest maternal and infant mortality rates in the world, too many women are emerging from the birth system feeling hurt and damaged. Induction and caesarean section rates are soaring but there is no change in key indicators such as stillbirth. Meanwhile, physiological birth and breastfeeding rates plummet. 

Please share this request for birth stories with all your friends and neighbours!

 

 

Here is more information and the links:

https://www.abc.net.au/news/health/2022-11-03/birth-project-australia-abc-investigation/101574750 

Use this form to send the ABC your story about birth.

They want to hear about your experiences of pregnancy and birth – and from those of you who provide maternity care.

What's working? What's not? And what can we do better?

The Birth Project is running from late 2022 into 2023. Here are some of the stories they've told so far:

• Birthing a better way: Statistically, Australia is a very safe place to give birth, but the care families receive is a lottery. Three women who live less than 90 minutes apart had very different experiences, by choice, chance and necessity. Their stories reveal a complicated system crying out for change.
• Revealing the impacts of birth trauma: While she was pregnant, Amy dreamed about the time she'd spend with her first son Bobby. She didn't imagine incontinence, therapy and surgery — and Amy's experience is all too common, according to the results of a new survey.

Looking forward to ABC being provided with many stories explaining what happened, what worked for you and what didn't work for you.  

Would love to read your thoughts.

 

Thirty years of the World Health Organization’s target caesarean section rate. It’s time to take it seriously.

Australia, like much of the western world faces burgeoning numbers of women having caesarean sections along with increasing rates of postpartum haemorrhage, postnatal depression and other morbidities. There are many who argue for surgical birth, saying childbearing women are older, fatter and sicker and therefore require the life-saving operation. Others are critical of the increase. Then there are those who examine the literature and seek the truth of the matter.

Today's blog post is by Dr Kirsten Small, an Obstetrician and Gynaecologist who teaches in the School of Nursing and Midwifery at Griffith University in Queensland, Australia. 

Kirsten has a research interest in examining the mismatch between the evidence base and what happens in clinical practice in maternity care.

In line with her research interest, Kirsten provides the following thought provoking lens on a recently published review of the World Health Organisation's target caesarean section rate. Read on, I think you'll find what she has to say fascinating.

The Medical Journal of Australia recently published a narrative review, titled “Thirty years of the World Health Organization’s target caesarean section rate: It’s time to move on.” (link: https://www.mja.com.au/journal/2017/206/4/thirty-years-world-health-organization-s-target-caesarean-section-rate-time-move).

Authors Stephen Robson and Caroline DeCosta argue that the “ideal” caesarean section (CS) rate proposed by the World Health Organization in 1985 is “too low” (Robson & DeCosta, 2017, p 184).

By selective use of published literature, they generate a narrative to support this argument, and somewhat obtusely recommend that “in Australia, we should be aiming to provide CS to all women in need” (Robson & DeCosta, 2017, p 184). It is difficult to disagree with this point, but the high Australian CS rate would suggest that we are also providing CS to women who have no need for it, and who may not desire it.

The key points of their paper are presented in a summary as Figure 1 below. 

 Figure 1: Summary Robson & DeCosta, 2017, p 181

It is possible however, to use the published literature to create a different narrative, one that supports the contention that Australia’s CS rate is not appropriate.

An alternative summary of the evidence is:

• It has been two years since the WHO reaffirmed its longstanding position that the ideal CS rate is under 20% (Betran, et al., 2015).
• CS rates, particularly in wealthy industrialised countries continue to rise, with no evidence of associated improvement in perinatal outcome (Betran, et al., 2015)
• The strongest predictor of CS birth for the first infant is birth in a private hospital (Dahlen et al., 2012).
• Women whose first baby is born by CS find it difficult to access a care provider who will support them to achieve a vaginal birth in subsequent pregnancies (Toohill, Gamble, & Creedy, 2013).
• Outcomes that interest the patriarchal medical model typically exclude those that reflect women's experience of their care (Parry, 2008).
• Longer term outcomes for the neonate are better following vaginal birth rather than CS (Hyde, Mostyn, Modi, & Kemp, 2011).
• Pelvic organ prolapse and incontinence are not strongly correlated with mode of birth (Bozkurt, Yumru, & Şahin, 2014). Surgical procedures for these conditions are increasingly safe and carry low risks of complications (Ogah, Cody, & Rogerson, 2011).
• Serious complications of CS such as placenta accreta, while rare, are of increasing concern to health care systems, given the large number of operations performed annually (Cheng, Pelecanos, & Sekar, 2016).
• We should aim to provide all women with evidence based care that achieves high rates of vaginal birth (Caughey, Cahill, Guise, & Rouse, 2014). All women should be involved in decision making regarding their birth options, to the extent that they wish to be.

Conclusion: There are ingrained systemic reasons why the medical model presents CS as the safe, easy option for women (Bryant, Porter, Tracy, & Sullivan, 2007). The evidence is clear – there is no population benefit for a CS rate of over 15%. Clinicians should focus on applying evidence to the care of individual women in order to achieve the best outcomes for them and for their infants.

References

Betran, A.P., Torloni, M.R., Zhang, J., Ye, J., Mikolajczyk, R., Deneux-Tharaux, C.,Gülmezoglu, A.M. (2015). What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reproductive Health, 12(1), 57–57. http://doi.org/10.1186/s12978-015-0043-6

Bozkurt, M., Yumru, A. E., & Şahin, L. (2014). Pelvic floor dysfunction, and effects of pregnancy and mode of delivery on pelvic floor. Taiwanese Journal of Obstetrics and Gynecology, 53(4), 452–458. http://doi.org/10.1016/j.tjog.2014.08.001

Bryant, J., Porter, M., Tracy, S., & Sullivan, E. (2007). Caesarean birth: Consumption, safety, order, and good mothering. Social Science & Medicine, 65(6), 1192–1201.

Caughey, A. B., Cahill, A. G., Guise, J.-M., & Rouse, D. J. (2014). Safe prevention of the primary cesarean delivery. American Journal of Obstetrics and Gynecology, 210(3), 179–193. http://doi.org/10.1016/j.ajog.2014.01.026

Cheng, H. C., Pelecanos, A., & Sekar, R. (2016). Review of peripartum hysterectomy rates at a tertiary Australian hospital. Australian and New Zealand Journal of Obstetrics and Gynaecology, 56(6), 614–618. http://doi.org/10.1111/ajo.12519

Dahlen, H. G., Tracy, S., Tracy, M., Bisits, A., Brown, C., & Thornton, C. (2012). Rates of obstetric intervention among low-risk women giving birth in private and public hospitals in NSW: a population-based descriptive study. BMJ Open, 2(5), e001723–e001723. http://doi.org/10.1136/bmjopen-2012-001723

Hyde, M. J., Mostyn, A., Modi, N., & Kemp, P. R. (2011). The health implications of birth by Caesarean section. Biological Reviews, 87(1), 229–243. http://doi.org/10.1111/j.1469-185X.2011.00195.x

Ogah, J., Cody, D.J. & Rogerson, L. (2011). Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women: A short version Cochrane review. Neurourology and Urodynamics, 30, 284–291. doi:10.1002/nau.20980.

Parry, D. C. (2008). “We wanted a birth experience, not a medical experience”: exploring Canadian women's use of midwifery. Health Care for Women International, 29(8), 784–806. http://doi.org/10.1080/07399330802269451

Robson, J., & de Costa, M. (2017). Thirty years of the World Health Organization's target caesarean section rate: time to move on. The Medical Journal of Australia, 206(4), 181–185. http://doi.org/10.5694/mja16.00832

Toohill, J., Gamble, J., & Creedy, D. K. (2013). A critical review of vaginal birth rates after a primary Caesarean in Queensland hospitals. Australian Health Review, 37(5), 642–7. http://doi.org/10.1071/AH13044

Australian Government acts to give women greater access to midwives and improve care!

An important update on the outcome of the Standing Committee on Health in regards to midwifery care.  So exciting to see this sensible development.  I know many people have been working tirelessly on getting the government to understand the issues.  My deepest gratitude to you all.

MEDIA RELEASE: 11 August 2012
Contact: Liz Wilkes 0423 580 585

Standing Committee on Health Decision will give women greater access to Midwives and improve Care.

Today’s decision by the Standing Committee on Health to enable midwives to collaborate with hospitals rather than individual doctors provides a welcome relief to Medicare provider midwives struggling to provide Medicare funded care to women.

“Until now government policy designed to provide women with Medicare access to private midwifery care has been to date severely restricted by obstetricians not wanting to be involved” said Liz Wilkes President of Midwives Australia.

“The recognition from every Health Minister across the country that midwives work collaboratively with doctors in hospitals and do not need individual doctor sign off is entirely appropriate. We applaud the sense they have shown” said Ms Wilkes

Midwives Australia has seen the legislation requiring midwives to collaborate with individual doctors has created unnecessary administrative burden and has created opportunity for medical veto over women’s access to Medicare rebates.

“What we are seeing here is the opportunity for midwives to develop license agreements and contracts with hospitals which enable true collaborative practice to continue”

“The whole hospital system relies on obstetricians being in the right place to deal with referrals of women. It is not a change in safe practice.”

“Midwifery care should not and does not require the presence of an individual doctor at a tertiary hospital when many other doctors are on staff, what matters is that there is a doctor present who is able to accept referral and transfer as doctors are employed to do this on a daily basis.”

“This week a Melbourne study found the care of a known midwife reduced the need for a caesarean section and actually improved outcomes. It is comforting to know that all Health Ministers agree on the need to make the care of a known midwife more accessible to Australian women.” said Ms Wilkes.

 We hope you will find it informative.

Best regards,
Midwives Australia

Thanks Liz Wilkes for this update!