Melbourne Doula

Welcome to 'Melbourne Doula', the place where I share what birth work is teaching is me, and what I am learning from the wonderful families who have invited me to share this most special season of their lives. Here you will find information about me and the doula services I provide, birth stories from remarkable women and their loved ones, as well as all kinds of resources to enrich your own journey of discovery. And welcome also to BLISSFUL HERBS, the home of beautiful herbal teas and bath herbs to support wellness through every season of life.


Every now and then, new research comes out in support of evidence-based care for childbirth. I've found it difficult at times to find relevant research and to keep track of it. (Sometimes it looks fascinating but might as well be ancient Greek for the sense I can make of it.) So, here is my humble collection, which as well as helping me to keep this vast body of knowledge *somewhat* organized, might also help you as your prepare your birth plan or seek answers in your own learning curve. Your thoughts and suggestions, as always, are most welcome.

* 2019 Maternal and perinatal outcomes by planned place of birth in Australia 2000 – 2012

Conclusions: This is the first Australia-wide study to examine outcomes by planned place of birth. For healthy women in Australia having an uncomplicated pregnancy, planned births in birth centres or at home are associated with positive maternal outcomes although the number of homebirths was small overall. There were no significant differences in the perinatal mortality rate, although the absolute numbers of deaths were very small and therefore firm conclusions cannot be drawn about perinatal mortality outcomes.

* 2018 Planned private homebirth in Victoria 2000–2015 
"Regardless of risk status, planned homebirth was associated with significantly lower rates of obstetric interventions and combined overall maternal and perinatal morbidities. For low risk women, planned homebirth was also associated with similar risks of perinatal mortality ..."

* 2013 Cochrane summary on benefits of hospital and homebirth:

* Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study

11 November 2011

"The results support a policy of offering healthy women with low risk pregnancies a choice of birth setting. Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes. For nulliparous women, planned home births also have fewer interventions but have poorer perinatal outcomes."
  • For healthy women with low risk pregnancies, the incidence of adverse perinatal outcomes is low in all birth settings
  • For healthy multiparous women with a low risk pregnancy, there are no differences in adverse perinatal outcomes between planned births at home or in a midwifery unit compared with planned births in an obstetric unit
  • For healthy nulliparous women with a low risk pregnancy, the risk of an adverse perinatal outcome seems to be higher for planned births at home, and the intrapartum transfer rate is high in all settings other than an obstetric unit."

* Science and Sensibility - A Research Blog About Healthy Pregnancy, Birth & Beyond. This blog provides up to date information on all the latest research, by Midwife Amy Romano of Lamaze International.

* Meta-analysis of the Safety of Homebirth

This 2008 study of 24,000 women revealed that homebirth is an "acceptable" option for low-risk women and that it leads to reduced medical interventions. It states that planned homebirth is 'controversial'. However, the study then demonstrates some interesting facts:
* homebirth is not more dangerous than in-hospital births. The rate of infant deaths for both groups was similar. No mothers among the 24,000 died.

* the number of babies born in poor condition (with low APGAR scores) was actually less in the homebirth group

* the number of mothers with severe lacerations was less in the homebirth group

* the homebirth group had fewer medical interventions such as induction, syntocinon augmentation of labour, episiotomy, instrumental vaginal birth (like forceps or ventouse), and c/section.

* Perineal Outcomes in a Homebirth Setting
This study of 1068 women showed that 70% of women planning a homebirth had an intact perineum, without serious tears requiring stitches. In first time mothers, it showed that if you are of lower socio-economic background, and you give birth either kneeling or on hands and knees, and your perineum is supported manually by the midwife, you are less likely to tear; and that perineal massage while you are pushing out the head actually increases the likelihood of damage to the perineum. For mothers who have given birth before, it showed that being of lower socio-economic status increased the chances of an intact perineum; and these factors increased the likelihood of damage: being aged 40 or over; weight gain over 18 kg; previous episiotomy; and the use of oils or lubricants.

So, if you are keen to avoid tears and damage to your perineum and vagina, consider these factors:
- birth at home
- make sure you are less than 18 kgs overweight
- give birth on hands and knees or kneeling (I would also suggest in a birth pool)
- don't bother using oils or lubricants
- have your midwife support your peri if you're a first timer (the water does this for you if you're in a birth pool.)

* Australian Birth Centres are as Safe as Hospitals
This recent study of more than a million births shows that although outcomes at birth centres compare favourably with hospitals, only 2% of Australian women have access to low-tech, midwife-led birthing centres where gentle birth techniques are employed. It concluded that the overall rate of perinatal mortality was lower in alongside hospital birth centers than in hospitals irrespective of whether the mothers were giving birth for the first time or not.

* Better Births Feature Continuous Care for Labouring Mothers and "Kangeroo Care" for Babies
This article highlights some simple common sense that many people have known for eons - that continuous comfort and encouragement from a woman known to and trusted by the birthing mother helps mothers to birth safely and well. And that close, uninterrupted contact, especially skin-to-skin helps babies, especially fragile babies, to thrive.

* Here is a site by Lamaze International which reviews several studies on various subjects to do with birth - enough to make you really think: is standard obstetric practice, that we have come to expect, really scientifically sound?

This quote is by Henci Goer, from the website:
"In order to offer evidence-based maternity care, we need to keep up with the current research. Unfortunately, some research studies are poorly designed or biased - even when published in respected peer-reviewed journals. Making matters worse, some of these flawed studies receive heavy publicity, including editorials and press releases that exaggerate and misrepresent their findings. Because of that publicity, these studies have resulted in rapid, widespread changes in practice.

This problem makes our job of promoting evidence-based care more difficult. We often encounter policies, practices, and protocols based on poor-quality or misinterpreted research, yet critically reviewing the evidence takes time and specialized knowledge.

The Lamaze Institute for Normal Birth has developed brief critiques of some influential studies that have shaped policy and practice. These critiques are meant to help childbirth professionals evaluate the quality of evidence on these important topics."

Read more here
Topics include Breech Birth, Epidurals, Homebirth, Inductions and VBAC.

* Midwife-led care versus other models of care
In New Zealand, nearly 80% of women received midwife-led care. They collaborate with obstetricians when necessary - but are not under an obstetric hierarchy in which they would be reduced to functioning as obstetric nurses - and they have professional autonomy to provide midwife-led, woman-centred care. Women are referred for obstetric help only if complications arise during pregnancy or labour.

But in Australia, less than 2% of women receive midwifery-led care. Many have midwives caring for them, but it is the obstetricians who are in charge of their care, and the midwives have to conform to policies set by obstetricians. They have much less autonomy to offer women care according to the values and practices of the midwifery model, which supports natural birth.

Check out these quotes:

In New Zealand, the last stats (2007) from the NZCOM said 80% of women had a midwife as their LMC- lead maternity carer. We are so behind the times.
- an Australian Midwife

76.7% of NZ women are cared for by midwives … 3.18% of Australian women are cared for by midwives. Are Australian women sick? Only 12% of Australian women fit the medical\obstetric complication criteria.
- Rafferty, Ball & Aiken, Quality Health Care Journal, 2005

Do you think it would be safe for healthy women to be seen only by midwives, and be referred to obstetricians only when necessary, instead of having obstetricians oversee 98% of Australian maternity cases?

See what this study reveals.

* Does Routine Induction at 41 Weeks Reduce the Caesarean rate?
Standard Obstetric practice contends that inducing women past term reduces the rate of caesarean section. In this study, the researches challenged this belief that routine induction of labour at 41 completed weeks of gestation reduces, or at least does not increase, a woman's chance of caesarean section, compared with expectant management (waiting until labour starts naturally.) They found that 16% of women who started labour naturally had caesareans, and 25% of those who were induced had caesareans.

A study on planned homebirths with Independent Midwives in Victoria
This study concluded that "planned home birth with a qualified midwife remains a demonstrably safe option for women who choose this model."
For more studies pertaining to homebirth, see this post, "Is homebirth a safe and responsible option?"

1 comment:

Selene said...

Many thanks for collecting this research, Julie! Very helpful!