Sorry...I'm going over some very old posts......WA....where is this. And
someone else once asked what is a Domino Birth? I never saw the answer.
Thanks, Sue
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> From: Carol Thorogood <[log in to unmask]>
> To: [log in to unmask]
> Subject: Re: WA homebirth midwives reply
> Date: Friday, July 23, 1999 12:49 AM
>
> Dear Yvonne et al
>
> The midwives in the ABSP study/project were all RNs and midwives. I think
> they'd argue that they practice using a midwifery model. The two 'senior'
> ones are British trained and also RNs/RMs. It's near impossible for
direct
> entry midwives to register or practice in Australia and there are no (as
> yet) direct entry courses. There are only about 100 homebirths a year in
WA
> so unfortunately all student midwives do have to have
institutionally-based
> medically oriented education and training. Somehow they manage to escape
the
> propaganda and take the best from two worlds. Usually neophyte homebirth
> midwives (already registered) apprentice themselves to an experienced
> homebirth midwife until they are competent and confident to go out on
their
> own.
>
> In the WA project the other midwives, (about 11) are all RNs/RMs and
since
> it is based on a midwifery model of care they follow suit. The program
> enables two midwives a year to work with a 'senior' midwife so that they
can
> adapt to community midwifery practice and become accredited with the
College
> of Midwives. The others are all experienced community practitioners and
left
> the medical model years ago!
>
> Our outcomes were very positive. But, of course the numbers are so small
> (about 70 year) that it's really dificult to make really firm conclusions
> about homebirth per se. We need a RCT and that'll be almost impossible to
> design given the difficulties with sample size, selection criteriaetc!
An
> earlier study (1988) by Hazel Woodcock et al found that in WA home birth
> outcomes for 'low risk' women were very positive.
>
> Because of the 'experimental' nature of this ABSP program the
> selection/exclusion criteria etc were very strict and all women classed
as
> 'high risk birthed in hospital with their midwife. The midwives also did
> 'domino' births. The risk criteria are 'medically oriented' and I share
the
> midwives' concens about this but the 'eyes' are upon us and I don't think
we
> have much choice - yet.
>
> I won't comment 'on air' about the article in the BMJ since it has been
the
> subject of threats of legal action. However, I believe that there were
some
> methodological flaws which we can discuss privately. In Western Australia
> our outcomes for homebirths bear little resemblance to the findings in
> Bastian and Keirse's (1998) study. The midwives in WA did not provide the
> researchers with all their data so it was difficult for them to arrive
at
> firm conclusions. Having said that in Australia, when so-called
'high-risk'
> births occur at home and only in some areas, the perinatal mortality
is,
> in comparison to other countries, unacceptably high. But, the samples
are
> small, the forms of practice so disparate and there is no systematic way
to
> collect the data, etc etc so who knows what is really going on.
> Carol
>
>
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