7:20pm Thursday 12th February 2009

MUMS have helped to deliver awards to two Newport midwives for “going the extra mile”.

Hayley Pennells and Margaret Sullivan were among a number of staff recognised by the Gwent Healthcare Trust.

Most were nominated by their managers but the two midwives received citations from grateful mothers.

Mrs Pennells is a community midwife who actively promotes home births.

She helped Ann Gunther, who already had a son Caleb, bring baby Lilly into the world.

“I got to know Hayley really well, we built a good rapport and she was always there for advice. She really supported me to get a homebirth and I felt confident.”

She added that Mrs Pennells was not on shift when Lilly began to arrive but still came to her home for the birth.

“It’s a vocation for Hayley, not a job. She really deserves this award.”

Mrs Pennells had the youngest of her three children at home said helping with home births was the most enjoyable part of her job and the most rewarding.

Mrs Sullivan was both her mentor and her midwife.

She is also a community midwife who has dedicated more than 30 years to women and families in Newport.

Her commitment to her vocation is such that she decided not to retire completely last year and now continues her caring role on a part-time basis.

Mrs Sullivan even became godmother to one child who was born at home. His mum described her as “just a gem”.

By Jamie Buchan

Published: 14/02/2009

A pioneering support group which offers advice and help to expectant mothers who want to give birth at home is poised for expansion.

The group was launched just after new year by Peterhead mums Amber Sebold and Charlie Paris. They hoped to give women in the north-east more informed choices about where they want their babies born.

The Homebirth Support Group, the first of its kind in the north of Scotland, has met twice at Peterhead since January and has already attracted mothers and mothers-to-be from as far afield as Banchory and Fraserburgh.

Now the group, which has won the backing of NHS Grampian, hopes to launch a new support service in Aberdeen, while keeping the Peterhead branch running.

It is hoped that funding can be secured to open a lending library.

Mother-of-two Miss Paris said: “We’re really pleased with how successful the group has been in the space of just a few weeks.

“People have been coming from all over the north-east, even despite the awful weather.

“We are now looking at setting up regular meetings in Aberdeen to try to include even more people.”

The 24-year-old, who stays at Prunier Drive with partner Jereon Raemakers, was advised against a home birth when she was pregnant with Ruben, now 18 months old.

She used natal hypnotherapy for a pain free birth. After she was examined by a midwife at her home, it was agreed that she was not in full-blown labour and the midwife went home.

Ms Paris ended up giving birth to Ruben on her hall landing with the help of her partner. She stressed she was very happy with the service provided by midwives in Peterhead.

Mrs Sebold moved to Scotland from Missouri in America, where – until recently – it was illegal for midwives to deliver children.

Mother to three-year-old Calvin and Corah, aged four, she is now planning her first home birth in May.

A date has yet to be set for the launch of the service in Aberdeen.

The group meets at Peterhead Hospital’s maternity unit on the second Tuesday of each month at 6.30pm.

For more details about the group visit www.bebo.com/grampian homebirth

The singer and her boyfriend provide too much information

Erykah Badu and her boyfriend, Jay Electronica, have taken “sharing” to a whole new level — by guiding their fans through every minute detail of Badu’s homebirth via Twitter. She logged on first: “Morning! I’m in labour!” He then took over: “Everybody stand back. We’re waiting for the midwife to show” (at which point, you might think, he’d put the keyboard down). Next, the public were kindly informed he was “doing foot rubs when the contractions hit”. Then, newsflash! She was “dilated to 8½cm!”, and soon he was announcing to the world, “I see the head! It’s covered in hair!” (Electronica, lose the keyboard — you’ll drop the baby). Never mind the eeew factor — how annoying must it have been to receive constant updates from a man you don’t know direct from his girlfriend’s birthing pool? Probably almost as annoying as the whole thing was for Badu, who felt so moved by her beau’s global posts on the state of her cervix that she named her baby Mars Merkaba.

5:00pm Wednesday 18th February 2009

A COUPLE got a big surprise when their baby daughter was born at home, weighing a whopping 11lb 8oz.

Baby Lilyrose was delivered at the Southend home of Georgina and Daniel Holmes, and midwives who helped deliver the heavyweight tot said she was the biggest they had ever seen during a home birth.

But the drama was not over once she had arrived, as after having got stuck at the shoulders in the final stages of delivery, Lilyrose had to be resuscitated immediately after birth.

Mrs Holmes, 31, of Leamington Road, said: “Watching them resuscitate her was just terrifying. It felt like a lifetime before she came round, but the midwives were amazing.

“Lilyrose was a big surprise, quite literally! It wasn’t until her head was delivered that anyone had any idea of her size, and then everyone’s faces just changed colour – they couldn’t believe it.”

Mrs Holmes, who had only gas and air during the birth, said the new arrival was settling in well, but added her size was causing a few teething problems.

“It’s been tricky because she doesn’t fit into anything we bought for her, so we’ve had to buy lots of new things,” she said.

Four midwives attended the birth and the couple paid tribute to the team’s calm professionalism, as they managed the delivery and revived the newborn baby.

Mr Holmes, 33, said: “Our midwife did an extremely good job and we are so grateful to her.”

Lilyrose was taken to Southend Hospital for a check-up, but is now back at home with siblings Finley, 18 months, and Oliver, eight.

Her proud parents were told that Lilyrose was the largest baby anyone in the midwifery team could remember delivering in a home birth.

• Julie Robotham Medical Editor
• February 21, 2009

MIDWIVES would be allowed to prescribe medicines and their services could, for the first time, attract a Medicare rebate under reforms to maternity provisions proposed in a national review of birth services.

The review was conducted amid rising caesarean rates and widespread closures of small birth units. Its recommendations would allow midwives to open private group practices, or contract their services to hospitals - improving choice for women and easing a shortage of people trained to deliver babies.

But the report, authored by the Commonwealth’s chief nurse and midwifery officer, Rosemary Bryant, and to be published today, says midwives should undertake advanced education and accreditation before being eligible for such funding. And it stops short of recommending Medicare funding for home-births attended by midwives.

The report seeks to ease friction between midwives and obstetricians, with concessions to both groups. Specialist doctors have pointed to Australia’s excellent safety record for mothers and babies as evidence in favour of the status quo and have strenuously resisted moves towards home birth. Midwives have accused obstetricians of hijacking normal birth and being responsible for a surgical delivery rate that has soared to one in three.

Ms Bryant said there was “a lack of unanimity within and between some groups of the medical and midwifery professions on the issue of how to deal with risk and consumer preferences”. Safety was paramount, she wrote in the report’s preface, but most pregnancies and births were uneventful, and safety concerns should not “prevent us from acting on evidence that supports change to practice”.

Midwifery-led birth has consistently been proven safe and preferred by women - particularly if they build a rapport during pregnancy with a midwife who assists them during the birth and afterwards.

The Government should examine expanding dedicated birth services for indigenous women and instituting a national telephone support line for pregnant women, Ms Bryant said. A solution should also be sought to the inability of independent midwives to acquire indemnity insurance - which prevents them attending private clients in hospitals. She said that many of the initiatives would need support from states and territories, which run public hospitals and community health services.

Ms Bryant said she had been struck by the volume of responses to the review: 407 submissions from individual women, many of whom had been dissatisfied by their hospital birth experience.

Chloe Coulthard’s third son, Galileo, was delivered at her Dundas home last Friday by midwife Sonja MacGregor. This was her only option for a vaginal birth after the caesarean deliveries of Orlando, 4, and Fox, 2. Ms Coulthard, 26, said the first operation could have been avoided.

“When I read my medical notes it became clear it was not a failure of my labour to progress. It was a failure of the hospital to wait for my labour to progress. It’s pretty upsetting.”

She was happy to pay Ms MacGregor’s full $4000 fee, which includes multiple home visits during pregnancy and afterwards, as well as the birth.

The Health Minister, Nicola Roxon, said: “I’m determined that our kids are given the best start in life. That means giving women the choices they need, wherever they live.”

• Nick Miller and Leo Shanahan
• February 20, 2009

NICOLA Roxon made a New Year’s resolution not to sweat the small stuff. Little annoyances like announcements on planes when they’re delayed — “we thank you for your patience” — so patronising, the federal Health Minister fumes — but, this year, she’s determined to let them pass her by.

Which is wise, as there’s plenty of big stuff to worry about. This could end up being Australia’s biggest year of health reform since Medicare. Blueprints in the pipeline cover everything from support for home births to a new relationship between patients and GPs. The reforms could change how our hospitals are run, and how food and alcohol are packaged, promoted and sold.

“It’s going to be the critical year for health reform,” Roxon says. “(Major reform) is going to take up an enormous amount of my time this year and is very exciting — it’s what all politicians want to be in government to do.”

Her chickens are coming home to roost. First to flap in, on Monday, was the interim report from the National Health and Hospitals Reform Commission, a hefty 392-page “to do” list.

Today, the Maternity Services Review arrives, tackling passionate, divisive debates over home birth, the rise in caesareans and the role of midwives.

Meanwhile, Roxon is swapping ideas with her Preventative Health Taskforce, looking at ways to force, cajole or bribe the country to eat better, drink less, exercise more and quit the ciggies.

Coming up is a review of primary health care — likely to prove very unpopular with the medical establishment. It could open up GP clinics and Medicare funds to dietitians, physios and others.

In the year the surplus vanished, this 41-year-old Victorian (who is also the mother of a three-year-old) is filling her bookshelf with a library of big ideas to fix the country’s health system — ideas that she asked for but will be expensive, or controversial, or both.

The National Health and Hospitals Reform Commission interim report arrived on Roxon’s desk on Christmas Eve, and it was unveiled on Monday. It proposes everything from the creation of a national indigenous health authority to the building of centres to monitor mental illness in young people.

But three main proposals have attracted all the attention and would mean real and substantial change: the Federal Government would take control of primary care, introducing one-stop local clinics with patient enrolment; a Medicare-style dental scheme; and the possibility of the Commonwealth wresting control of hospitals from the state governments.

Proposals for the Federal Government to control the funding and delivery of health professionals and services falling under the loose term “primary care” are not a significant departure, but it would mean an end to piecemeal funding for community health services such as alcohol and drug treatment, sexual and reproductive health, school health and maternal and child health services.

But big multi-service community health clinics in which locals are asked to enrol could mean an end to the old-style GP clinic as a sick person’s first port of call.

Roxon has been keen to highlight the similarities of this proposal with the Government’s GP super-clinics plan, and the policy to open Medicare to non-doctor health professionals.

Of all the recommendations of the NHHRC, Denticare would have the most widespread public appeal. It aims to provide Australians with universal dental care with Medicare-style bulk billing, costing Government an extra $4 billion a year and taxpayers a 0.75 per cent increase in their Medicare levy.

The Australian Dental Association has already attacked the plan, aware of the effect on the workload and incomes of GPs since bulk-billing was introduced.

But the three governance options for hospitals proposed by the commission represent the most drastic change to our health-care system, with two of them calling for a total takeover of hospitals by the Federal Government.

The first takeover proposal would have state administration of hospitals replaced by local regional bodies entirely funded by the Commonwealth who would compete for extra funding based on performance.

The second takeover option — by far the most radical — would have Medicare abolished, with all Australians enrolled in health funds, mostly likely privately run. The Government would transfer 14 per cent of income tax into the funds to pay for universal coverage.

“We wanted them to think big,” Roxon says of the commission’s work. “This directions paper will give people an opportunity to express their view as to whether some of the ideas are radical and vital, or radical and hare-brained.

“In some areas, they are proposing pretty ambitious things that are way, way ahead of where I or the Government’s thinking might be.”

For example, Denticare. “The proposal is a very ambitious one. We can’t keep doing what we’re doing now, because it’s not providing services equitably to people.

“But the type of model that they’ve proposed, and the way it’s funded, is something that’s new.”

As for the federal takeover of hospitals, Roxon hints that her department is already picking apart the commission’s three options, in order to talk turkey with the states. However, the official line remains: a takeover will happen “if the states and territories are not interested in reforming their health systems to the extent that we think they need to”.

It comes across as a threat, but judging by the Council of Australian Governments meeting late last year, there is an orgy of agreement, rather than a high-noon showdown, between the federal and state governments on health at the moment.

Anyway, sceptics in Canberra wonder whether the federal budget has any room left for real reform.

Dr Paul Gross, a health economist, doubts there will be any money left over given the amount just spent heading off economic disaster — with not a mention of health infrastructure.

“The Government has let loose five review committees on my count,” says the director of the Institute of Health Economics. “They are all over the place with timing and terms of reference and their relevance.

“While we go on writing general reports of wish lists, the really hard work is still ahead. This system is in a bit of a mess (but) it is bereft of funding at the wrong time.”

Roxon, of course, disagrees. “I think the timing is right to talk about big-picture reform when you’ve got a government that’s got the political will to make some difficult decisions,” she says. “It would be long-term … Health is such a fast-growing component of the budget, if we don’t plan for the future, we are going to have large extra costs in any case.”

Sometimes, relatively small investments can have big consequences. That’s the reasoning behind Roxon’s push to head off chronic disease such as diabetes and cancer — the nation’s biggest and costliest health problems. The logic is fired by personal experience — her father, a smoker, died of lung cancer.

Further evidence of prevention’s potential came a few weeks ago. Roxon and husband Michael were “gobsmacked” when their daughter, Rebecca, got in the car and started singing a song to the tune of Twinkle, Twinkle, Little Star about the importance of doing up your seatbelt and scolding your parents about it.

Roxon says she was impressed by the power of education to instil a public health message. She sees preventative health as an “obvious thing” to focus on, and somewhere she can lead the debate.

“As a mother with a young child, you hope that you are going to help your children grow up with good habits, you’re very conscious of it,” she says.

“And I had a parent who died at a very young age from smoking. That is classically preventable and that does form your view as to how strongly you try to pursue these issues.”

But it can be a sticky area. Evidence for what kind of action really makes a difference varies from very strong (smoking), to fairly weak (obesity). The Government’s first steps are likely to be “suck it and see” pilots rather than wholesale change.

In preventative health, too, you often get suggestions that are political cyanide.

VicHealth chief Todd Harper says government must swallow the poison pill: taxing unhealthy options. In other words, make beer, cigarettes — maybe even Big Macs — more expensive.

“Price is one of the best ways to influence people’s choices,” he says.

“We need to start to reassess the tax system as not just a mechanism to raise money, but an opportunity to encourage healthy behaviour.”

Harper predicts the Preventative Health Taskforce will recommend bans on junk-food advertising, alongside money to promote healthy alternatives.

This will help head off the health challenges of tough economic times, when people turn to cheap and filling junk food, or worse.

“In times of economic recession, the stocks you traditionally want to buy are tobacco and alcohol,” Harper says.

“We need to get ahead of the situation. The taskforce is the best chance we have had in decades, and a health minister with a passion for prevention is something to be treasured.”

A tax rise is unlikely to be hailed as political genius — Exhibit A, the ruckus over alcopops. But it is primary health care and workforce reform that has so far stirred up the most anger against Roxon.

In her “light on the hill” speech last September, Roxon threw down the gauntlet to doctors, lumping them with the Liberals as the enemies of essential health reform.

She blames conservative resistance similar to the opposition faced by Chifley and Whitlam in building the foundations of the Pharmaceutical Benefits Scheme and Medicare for a modern health system that is the “notorious ambulance at the bottom of the cliff, not the fence at the top”.

The problem is that the system “is organised almost entirely around doctors, despite the fact that many services are now safely and ably provided by other health professionals — nurses, psychologists, physiotherapists, dietitians and others.”

The national secretary of the Australian Nursing Federation, Ged Kearney, goes further. “At the moment, all funding follows the doctor. So, really, the only person who has access to the primary health care system are GPs.

“Now that inherently has caused, in my opinion, all the problems with the health care system.”

This kind of talk will infuriate the Australian Medical Association. Its federal president, Rosanna Capolingua, insists she’s not just protecting doctor’s hip pockets, it’s about what is best for patients.

“GPs are the most effective gatekeeper in primary health care,” she told the National Press Club last year.

“Only doctors can take a history, examine and put together the whole person when making a diagnosis … Without GPs in the clinical co-ordination role, patients run the risk of being tossed back and forth without any co-ordination of their care.”

Roxon also wants a bigger role for nurses in maternity services — an argument that the review’s report, released today, supports. The review ignited angry debate between independent-minded midwives, and doctors who fear mothers could be put at greater risk. It sparked a torrent of submissions, not just from the usual lobbyists, but from mothers telling personal stories. “People who have a bad experience feel very passionately about making sure that others don’t, and people who have had a good experience are passionate that everybody have that experience,” Roxon says.

“We should … make sure health professionals work together to give women as many options as possible, and make sure they are safe.”

As the year of reform unfolds, and all Roxon’s committees report, any failure to deliver will be eagerly highlighted by Opposition health spokesman Peter Dutton, the tough-talking ex-policeman from Queensland.

“Clearly the biggest problem for Nicola Roxon at the moment is that she has ramped up expectation with the amount of inquiries she has undertaken,” he says.

“When the Government first made the referrals to these inquires, they were still in a strong surplus situation. Now whatever the Government does has to be seen as a compromise.”

Dutton says the inquiries and taskforces are a shameless three-year stalling tactic — “a media strategy and a holding pattern so they could time the Government response to these inquiries around the next election”.

But Roxon insists that action will follow reflection. “It’s always politically safer to do nothing, but the community suffers,” she says.

“I am going to look at all these ideas and say, ‘Will this improve health outcomes in the community?’ If it does, I won’t be afraid to prosecute that case.”

So what does Roxon see as her biggest challenge this year?

“The hardest thing will be seeing my family enough.”

Friday, 20 February 2009 20:00

New moms don’t often have positive things to say about the process of giving birth, but Lotus Snook is a vocal exception.

“It was amazing,” said Snook, 25, when describing her water birth at South Coast Midwifery, a birth center in an Irvine strip mall. With a midwife and her husband, Charles, by her side, Snook endured labor in a tub of warm water with no anesthesia and no medical intervention, and gave birth to baby boy Ty on Feb. 12 without a single minute spent in a hospital.

Snook’s family members greeted her nontraditional birth plan with skepticism.

“Everyone thought we were crazy, and it wasn’t safe, that it would be better to give birth in a hospital,” said Snook, as she cradled her baby. “But the birth center staff was so awesome and the environment was so positive. I definitely felt safe.”

The American College of Obstetricians and Gynecologists has long opposed home births, arguing that monitoring of the mother and baby during labor and delivery and access to a hospital are essential because complications can arise with little or no warning.

The group does support accredited birth centers and South Coast Midwifery was recently accredited by the Commission for Accreditation of Birth Centers, making it the third in California and one of 40 nationwide. But Lorri Walker, a certified nurse midwife and owner of South Coast Midwifery, believes home births are just as safe, and more than half of her patients choose to give birth at home.

More and more moms-to-be are following Snook’s lead and opting to labor in a birth center, or at home with the assistance of a midwife. Midwives have likely attended births since the beginning of human civilization, but the modern midwife is a highly trained registered nurse with additional training. The midwife’s goal: to provide holistic care before, during and after the birth of a child, with as few interventions as possible.

“A woman’s body knows what to do,” said Walker, summing up the philosophy behind midwifery. “Only occasionally will she need help.”

During her 20-year career, Walker has “caught” more than 1,300 babies. Hers is the only birth center in Orange County, and demand for her services is stronger than ever.

“We are turning people away at this point,” said Walker, who together with fellow midwife Angela Watson attends to about 100 births per year. “There’s only so much the two of us can do.”

Home births were once common in the United States but declined throughout the 20th century as hospital births attended by obstetricians became more prevalent. Today, fewer than 1 percent of all births in the United States take place at home, according to statistics from the Centers for Disease Control, but midwives across the country are reporting a recent surge in demand for their services.

Reality shows depicting birth, documentaries on home births and a growing emphasis on green and natural living are all contributing to the increased interest, Walker said.

Her patients tend to be educated, affluent and older than the typical first-time mom, but she also treats medical professionals, same-sex couples and young mothers planning to adopt out their babies. They all share a common thread.

“They don’t want what’s offered in a hospital,” Walker said. “They want their birth to be an experience, and to reflect who they are.”

Dawnielle Selden, a longtime vegan from Costa Mesa, is used to marching to the beat of her own drummer.

At nearly 7 months pregnant, she was prepared to give birth at Hoag Hospital and presented her obstetrician with a requested birth plan: no Pitocin to stimulate labor, no Demerol to ease her pain, and no episiotomy, a vaginal incision meant to assist childbirth.

Her doctor grew defensive, Selden said, and said he had a list of acceptable requests during labor.

“It became clear I would have no control over the delivery,” said Selden, who will become a mom for the first time at age 33. Her due date is April 5.

“The doctor demanded that I respect his authority and expertise,” she said, “but it was clear that he didn’t respect me at all.”

Selden began researching other options and was surprised to learn that under her health insurance, out-of-pocket costs for a hospital birth and a home birth are roughly the same. Many types of health insurance cover midwife-assisted births, and Walker said she typically charges $5,000 to $6,000, which includes pre-and post-natal care.

An uncomplicated hospital birth without anesthesia costs about $8,000, according to the March of Dimes; at St. Joseph Hospital in Orange, a normal vaginal delivery with a 2-day hospital stay costs an estimated $7,310, said spokeswoman Ashley Dinelli.

Not every delivery goes as planned. In 2008, 8 percent of Walker’s patients ended up transferring to a hospital and having a C-section; nationally, the C-section rate is more than 31 percent.

Selden is now planning to deliver her baby at Walker’s birthing center, which sits above a Barnes & Noble bookstore in Irvine’s Woodbridge Village Center. She hopes to talk her husband into giving birth at home, but will happily settle for the cozy birthing rooms at the center, which are dimly lit and resemble typical bedrooms. There are no medical instruments in sight.

“When I picture birthing here I know it’s going to be a beautiful experience compared to the hospital,” she said. “I was terrified before, and now I’m not.”

By Melissa Jenkins | February 21, 2009