Dr. Nel Shah Analysis

Giving birth to a baby is the most amazing and miraculous experiences for parents and their loved ones. Every woman’s birth story is different and full of joy. Furthermore, the process from the moment a woman knows that she’s pregnant to being in the delivering room is very critical to both her and the newborn baby. Prenatal care is extremely important and it can impact greatly the quality of life of the baby. In this paper, the topic of giving birth will be discussed thoroughly by describing the stories of two mothers who gave birth in different decades and see how their prenatal cares are different from each other with correlation of the advancement of modern medicine between four decades.

Within Victoria there are multiple models of maternity care available to women. An initial discussion with the woman’s treating GP during the early stages of her pregnancy is critical in her decision-making about which model of care she will choose and this key discussion is essential in allowing a woman to make the first of many informed decisions throughout her pregnancy. According to a survey conducted by Stevens et al. (2010) only 43% of women felt ‘they were not supported to maintain up-to-date knowledge on models of care, and most reported that model of care referrals were influenced by whether women had private health insurance coverage.’ Many elements of these models of care differ: from location of care, degree of caregiver continuity, rates of intervention and maternal and infant health, outcomes access to medical procedure, and philosophical orientation such as natural or medical (Stevens, Thompson, Kruske, Watson, & Miller, 2014). According to the World Health Organization (1985) and Commonwealth of Australia (2008) there is a recognition that ‘85% of pregnant women are capable of giving birth safely with minimal intervention with the remaining 15% at potential risk of medical complications’ (McIntyre & Francis, 2012).

Childbirth is one of the greatest privileges on the earth anyone could have and we, as women, should feel proud to be major contributors for it. Thus, a mother has to play a key role in aiding the healthcare workers to mitigate the health crisis associated with childbirth by performing her duties faithfully. One such associated health crisis is “Premature (preterm) birth” which occurs when the baby is born too early, before 37 weeks of gestational period (CDC, 2015). The rate of preterm birth ranges from 5% to 18% of babies born across 184 countries (WHO, 2015).

However, Ricki Lane, the producer of the film, “The Business of being Born,” hopes that viewers will see that economically, births out of hospitals and at home is cheaper with a midwife, who will charge their patients only $4,000 for everything, including post-natal care. Whilst, a normal vaginal birth can cost up to $13,000, and a birth with multiple drugs involved, which typically leads to C-Section costs up to $35,000. However, with the American Medical association’s relationships with the hospitals and insurances, they are actually discouraging home births and midwifery, when the truth is that, statistically, it is safer and cheaper with home births and midwifes. It kind of makes you wonder just what exactly is on their agenda when it is a common practice to give births at home in both, developing and under developing countries, and has been for hundreds of years.

The author is a nurse in a level two trauma facility in a community of approximately fifty thousand people in Oregon. The community is a college-town surrounded by a large agricultural area. There is a minimal ethnic diversity within the community. The diversity present occurs mainly from internationally students and faculty from the college. There is a growing population of women who desire low interventional births in the community. The author has worked on the labor and delivery unit of the hospital for the last 14 years. The hospital is the only one in the area to offer trial of labor services to women who have previously undergone a cesarean section. The unit on average experiences around 1000 deliveries annually.

The intent of this paper is to examine effective solutions for reducing cesarean deliveries. Cesarean deliveries involve more risk to both the mother and baby than vaginal births do. Cesarean deliveries have a higher potential of complications than vaginal births. Cesarean deliveries cost more, require longer hospital stays, and require more resources—both human and systemic—than vaginal births.

Over the years birthing methods have changed a great deal. When technology wasn’t so advanced there was only one method of giving birth, vaginally non-medicated. However, in today’s society there are now more than one method of giving birth. In fact, there are three methods: Non-medicated vaginal delivery, medicated vaginal delivery and cesarean delivery, also known as c-section. In the cesarean delivery there is not much to prepare for before the operation, except maybe the procedure of the operation. A few things that will be discussed are: the process of cesarean delivery, reasons for this birthing method and a few reasons for why this birthing method is used. Also a question that many women have is whether or not they can vaginally

Due to cesarean section, it is proven that c-section birth causes infants to be at greater risk of developing a host of illnesses such as, asthma, type 1 diabetes, as they progress and grow older; As Australia has one of the highest c-section rates in the world with now at 32% of the population having a cesarean birth (s. McCulloch, 2018). Indigenous mothers are more likely to experience more long-term issues and even perinatal death compared to the 0.7% of non-aboriginal and non-Torres Strait islander mothers (The Department of Health, 2011).

Home birth versus hospital birth is one of the more controversial topics in the world today. It is a delicate topic because the safety and well-being of mothers and babies is in question. The majority of the information out there is subjective, making it difficult to reach an unbiased conclusion.

“Today, many if not most obstetricians do not attend births: they perform fetal extractions through the vagina or through an abdominal cut.” Faith Gibson (p.37)

According to “Human Sexuality: Diversity in Contemporary America,” women and couples planning the birth of a child have decisions to make in variety of areas: place of birth, birth attendant(s), medication, preparedness classes, circumcision, breast feeding, etc. The “childbirth market” has responded to consumer concerns, so its’ important for prospective consumers to fully understand their options. With that being said, a woman has the choice to birth her child either at a hospital or at home. There are several differences when it comes to hospital births and non-hospital births.

Also in the year 2008, despite declining to 4.2 million total births from a high of 4.7 million births in 2007, most of these (67%) were delivered vaginally, and the majority of vaginal deliveries (84%) occurred without complications or serious procedures in hospital births.

Unfortunately, this system of disease management includes obstetrics and thus often pregnant women are treated as if they have a disease, not that they are experiencing a normal process. Women are often not satisfied with the care that they receive within the healthcare system because they feel as if they have little to no control of their body, are essentially forced into giving birth in a specific way (convenient for the doctors, but not as pleasant for women), or their opinions are not considered. Therefore, as an individual aspiring to enter into a field that often limits a woman’s choice, it will be imperative for me to attempt to overcome such practices and provide care that is highly accessible for all patients that offers a wide range of services such as birthing classes, referral to other alternative medicine practitioners, and coordinates the care of the patients. I must also provide care and services that ensures that the macro and micro factors that may threaten my patients’ health are minimized. Additionally, it will be imperative for me to have measures in place, such as patient and staff review to ensure that I am delivering effective quality care to the women that come to my practice. In the future, I aspire to run a successful practice, within a community that already has one OB-GYN practice that has a monopoly on the discipline currently. Therefore, I will have significant competition, but If I ensure that I place the patient first, a factor that Don Berwick cites as being vital to help our system, then I will be able to run a successful practice that maximizes patient satisfaction and helps provide obstetric and gynecological services back to the community that raised me (Conaboy). At the end of the day, under the current system and how many practices are

According to the American College of Nurse-Midwives (ACNMb) (2015), home births account for 1.4% of all births in the U.S. In eight years the number of home births in the US increased by 41% (ACNM, 2015b). Providing home births falls within the scope of practice of midwives and is supported by the American College of Nurse-Midwives (ACNM, 2015b). A mother can have the option of a home birth as long as the home birth follows regulations set in place by the state and can provide a favorable safe environment for both mother and newborn (ACNM, 2015b). Both the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) state that the ultimate decision of having a home birth is a patient’s right, especially if she is medically well informed (Declercq, & Stotland, 2016).

Vaginal birth after caesarean (VBAC) is the name used for identifying the method of giving birth vaginally after previously delivering at least one baby through a caesarean section (CS). A trial of labour (TOL) is the term used to describe the process of attempting a VBAC. An elected repeat caesarean (ERC) is the other option for women who have had a caesarean in the past. The rates of women choosing to deliver by means of an ERC has been increasing in many countries, this is typically due to the common assumption that there are too many risks for the baby and mother (Knight, Gurol-Urganci, Van Der Meulen, Mahmood, Richmond, Dougall, & Cromwell, 2013). The success rate of VBAC lies in the range of 56 - 80%, a reasonably high success rate, however, the repeat caesarean birth rate has increased to 83% in Australia (Knight et al., 2013). It is essential to inform women of the contraindications, success criteria, risks, benefits, information on uterine rupture and the role of the midwife in relation to considering attempting a VBAC (Hayman, 2014). This information forms the basis of an antenatal class (Appendix 1) that provides the necessary information to women who are considering attempting a VBAC and can therefore enable them to make their own decision regarding the mode of birth.