Why Not Home In New Zealand?

“Why not Home?:The surprising birth choices for doctors and nurses” is a new and beautifully produced US documentary exploring the experiences of several family nurse practitioners, obstetrically trained doctors and midwives who choose to deliver (as they call birth) their babies at home, rather than in a hospital. This film reviews the history of birth moving from home to hospital in the USA, the rising and internationally high US caesarean section rates and 2 sets of research about the safety of home birth compared to hospital delivery; all of which are some of the reasons behind these US health professionals asking “Why Not Home”.

The interviews in this film; of the health professionals, their caregivers and partners reveals practical and emotional reasons why they chose to birth at home rather than in a hospital, but none mention the negative impacts of the external and, or internal environment of labour, on the production of the birthing hormones; Oxytocin, Endorphins, Adrenaline/Noradrenaline and Prolactin. Nor do any of the additional maternity experts even suggest that the flow of vital substances like Oxytocin,“the shy hormone”, can be helped or hindered by environmental factors such as bright lights, noise and activities including care-giver practices or a labouring woman’s fears and behaviours. All these factors can block a labouring woman’s ability to make the essential birthing hormone cocktail and thus labour stalls in all sorts of environments but especially in unfamiliar hospitals where bright lights and noises are common along with the all hours monitoring and treatment of their ‘patients’.

The labours and births shown in this film are very similar to those which result in hospital vaginal deliveries in New Zealand, with the women mostly in positions that permit a midwife or doctor to ‘deliver’ the baby and immediately lift the baby onto their mother’s chest. This hands-on, directive style contrasts that of homebirth midwives I work with, who encourage women to birth their babies in the way that facilitates the mother’s “Fetus Ejection Reflex” and the efforts of their baby to be born. This can happen when  labour is disturbed as little as possible and the woman is confident, connected and works with her baby and body birthing instinctively as nature intends. For labour and birth to be an involuntary, instinctive process, the environment and all present during labour and birth need to protect, support and encourage the flow of birth hormones which orchestrate the ‘dance’ between mother and baby. Such natural or physiological birth is most often achieved when women, like other creatures nest, hence the better outcomes and greater satisfaction of women who birth at home compared to those who have more disturbed or managed labours and deliveries in hospital.

Not shown or discussed in this film is the natural option of gentle, spontaneous birth of the baby’s placenta, which usually results within half to an hour after the baby’s birth when this transition period is undisturbed, so the hormones flow optimally to complete the birth process. However I suspect that the women in this film had active management of this ‘stage’ including an injection of synthetic oxytocin followed by clamping and cutting of the cord before it had ceased its pulsations. Active management or placental delivery is done “to reduce bleeding” however statistics and experiences of  hands-off midwives is showing that when nature is supported and protected mothers bleed less and babies retain most of their (uterine) circulation making them optimally healthy for life outside the womb.

New Zealand women, unlike those in the USA have access to continuity of care by a midwife, and this is one of many countries in the world who have better infant and maternal mortality rates than the US. However, New Zealand birth outcomes do not support the expressed belief of Prof Eugene DeClerq “that wider use of midwifery” is the single change needed to address rising rates of caesarean section. Here in New Zealand over 90% of women have continuity of a care by midwife through pregnancy, birth and afterwards, yet from 2009 to 2014, as in previous years, there has been an increase in the rates of Caesarean section, and other interventions with no correlation with increased clinical need. For example healthy first-time mothers, with no obstetric indications, aged 20–34 years old, in labour at term (37–41 weeks) with a single baby, presenting head first, have had a decrease in spontaneous vaginal births from 2009 to 2014. In addition, the latest and previous annual MOH report shows that the vast majority (87%) of women gave birth with their midwife at a secondary or tertiary maternity facility, whilst only 3% birthed at home.  Also, half of all New Zealand women who birthed in 2014,  mostly in the care of a midwife and in a hospital, had at least one form of intervention during their labour and, or birth (24% – induction, 26% – augmented labour, 27% –  epidural, 15% – episiotomy).

The national caesarean section rate in 2014 was 27.4%, but 17.8% in 1999 when New Zealand women were first able to choose government funded maternity by the midwife of their choice. This rate was highest amongst women from the more affluent neighbourhoods who again would have a lower clinical need. Also, outcomes for women and babies varied between district health boards (DHBs) and between individual hospitals, all of which is consistent with the explanation in the “Why Not Home” film that; what practitioners experience influences their ‘world view” and what they professionally do and believe!

The women and community of New Zealand are generally unaware that local research indicates “that for women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother”. as reported by the UK Birthplace study, UK media, and supported by the Royal College of Obstetricians.

The Ministry of Health, Royal Australian and New Zealand College of Obstetricians, Midwifery Council and College of Midwives need to explore and act on last year’s research by New Zealand born and now ex-pat Dr Sarah Buckley about the evidence on innate hormonally-mediated physiologic processes in women and foetuses or newborns during childbearing, and possible impacts of common maternity care practices and interventions on these processes, focusing on four birth hormones.

Finally the world would  benefit from a Kiwi centred documentary which examines all the options, knowledge and issues of “Why Not Home In New Zealand?”

“Bump: How to make, grow and birth a baby” by Kate Evans

Beginning with a cheeky baby on the cover, ‘Bump’ is packed with wonderful cartoons; many laugh-out-loud funny ones, some hauntingly beautiful which accompany an at times irreverent yet sensitive, evidence based and yet visceral text; a combination which authentically depicts many of the roller-coaster rides of womanhood today. In “Functions of the Orgasms” Michel Odent said “the function of joy in pregnancy is to protect the unborn child against the effects of the harmful stress hormones”, and “to transmit from generation to generation the capacity to be joyful”, thus I recommend this book to all but especially to pregnant women. “Bump” covers the full gamut of reproduction issues; through pre-conception to trying to, or not trying to conceive, early to late pregnancy development and possible losses, preparing for the baby, birth options and rights.   Continue reading

How Birth Matters!

A midwife explains labour and birth from a baby’s perspective!

The knowledge about how to give birth is within every woman.

The knowledge about how to be born is within every baby.

Labour is an instinctive dance between mother and baby !

Birth is a ‘pas de deux’!

Connection is Everything

Growing knowledge and awareness about the physical and emotional implications of the mother-baby connection, and how our actions from conception to early childhood can help or impede this relationship, is resulting in promotion of practices which support this relationship.

In Pregnancy.

Authorities are beginning to acknowledge that parenting begins before birth, and possibly before pregnancy. There is mounting evidence from scientific experiments, and personal stories of children and adults about their experiences before birth, which makes us realise that memory, learning and communication begin in the womb; a long time before we acquire language. Babies in the womb have a fast developing sensory system which allows them to react to individual voices, stories, music, and even simple interaction games with the mother from about the second month (8 weeks) of pregnancy.Therefore the quality of the emotional, as well as the physical uterine environment is affected by the parents, their behaviours and their lives.

Most women become aware of their baby’s movements from about 16 to 22 weeks of their pregnancy, depending on various things like; is this their first baby or not, is the placenta at the front of the uterus which may also be well covered with fatty layers, both form padding which can lessen the sensation and awareness of baby’s movements. These days many women do not notice the time of the first, or subsequent movements as they are busy working long hours, this lack or late perception maybe a sign that a mother needs to slow down, rest so she can connect with and nourish her baby, to help it grow emotionally, as well as physically. Those who study stillbirth in Australia and New Zealand, encourage mothers to be mindful of their baby’s behaviours, advising that as the baby grows the number and types of movements will change depending on the mother’s activity. They also warn that “a change in the number or pattern of movements may be an early sign that the baby is unwell and should be checked” with their maternity care provider, rather than waiting for the next appointment or monitoring. Sleeping on her left side during the last weeks of pregnancy will also helps to nourish and maintain its growth by not compressing her blood vessels which give the womb and baby its blood supply. Drugs like smoking, alcohol and strong pain killers are known to alter a baby’s behaviour, and this is why we need to decrease the exposure of pregnant women to noxious substances such as car fumes and cigarette smoke. Continue reading

Giving birth in a stable might be better than a labour ward

From  on Tuesday, Dec 23 2014 with New Zealand modifications by Denise Hynd

The ‘greatest birth story ever told’ has a lot to teach 21st century policy makers, writes Milli Hill

baby with a santa hat and green background

© Getty Images

When it comes to giving birth, maybe newer, shinier and more technological isn’t necessarily better. The world was baffled recently when new UK guidelines for pregnant women stated quite clearly that hospital was the LEAST safe place to give birth – how very mysterious! Could it be that those beeping machines and vigilant docs, which we’d all been led to believe epitomised progress and were so very essential to our labours, were actually making things worse?!

It seems like the world is finally waking up to the fact that birth is something so fundamentally human – like eating, sleeping, making love – that it does not benefit from the interference of modern technology. With birth, we need to go back to basics, and to allow ourselves to be mammals. And so, although the straw might be a little spiky on the knees, a stable might be just the place to have a baby. Here’s why: Continue reading

Microbirth

More Auckland screenings of Microbirth  will happen in 2015 -if you would like to host one please contact Denise 

“Microbirth” examines evidence which links modern delivery practices with the reduction and loss of some critical biological processes making our children more susceptible to non-infectious diseases through-out their lives. For example recent studies have shown that babies born by Caesarean have an increased risk of developing asthma, type 1 diabetes, obesity and other diseases linked to the immune system;up-to 30% higher than children born vaginally. Other research also shows that the process of vaginal birth which involves a cocktail of hormones for mother and baby in labour, sets the best beginnings for our immune system and subsequent health. International experts in the film also forecast that the current escalation of these non-communicable diseases is a potential world health catastrophe which could bankrupt many nations!

Auckland hospitals Caesarean Section rates in 2013 are; National Women’s 30%, North Shore 30%, Waitakere 24.6%, Middlemore 22% !

Further explanation of the Microbiome and its implications on pregnancy is here; Midwifethinking

Placenta Birth Choices.

The placenta and its care is a vital part of a healthy pregnancy and birth, as together with the baby’s cord, amniotic fluid and 2 membranes or sacs, it is “The Fetal Life Support System” until the baby is living outside the womb.

Each baby and its placenta, cord, amniotic fluid and membranes develop simultaneously following the union of the ovum (egg) and sperm. Placental function begins from implantation until the baby has moved to life outside the womb, if we allow it to complete its work. Continue reading

Love and Fear.

There are only two feelings: Love and Fear

There are only two languages: Love and Fear

There are only two activities: Love and Fear

There are only two  motives, two procedures,

Two frameworks, two results : Love and Fear,

Love and Fear.

Michael Leunig

 

NZ Media and Caesarean Realities.

This Friday 13th (September 2013) saw TVNZ One News coverage of the Women’s Health Research Centres’ report on the rising Caesarean Section (C/S) rates in NZ, ignore and, or misrepresent the following facts;

1)  There was no suggestion let alone reference, or hint by TVNZ of growing international evidence and experiences which show that a surgical delivery has more risks for both mother and baby compared to a vaginal birth, in all the examples to which they referred. However the viewpoints offered by TVNZ about those situations suggest that Caesarean delivery is an equal, acceptable or even better birth option for these mothers and their babies.  Continue reading

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The greatest joy is to become a mother; the second greatest is to be a midwife. — Norwegian proverb
No other natural bodily function is painful and childbirth should not be an exception. — Grantly Dick-Read
We need to have their hearts before we can open their minds. — Dr Gordon Neufeld
All change is not growth, as all movement is not forward. — Ellen Glasgow
Without deviation from the norm, progress is not possible. — Frank Zappa
I can promise you that women working together - linked, informed and educated - can bring peace and prosperity to this forsaken planet. — Isabel Allende
Nothing in life is to be feared it is only to be understood. Now is the time to understand more so we can fear less. — Marie Curie
Trust children. Nothing could be more simple, or more difficult. Difficult because to trust children we must first learn to trust ourselves and most of us were taught as children we could not be trusted. — John Holt
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
A loving heart is the truest wisdom. — Charles Dickens