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A Fine Balance: A Mother's Satisfaction And A Baby's Safety

Australia is one of the safest countries in the world in which to give birth and to be born, largely due to the many advances in obstetric and neonatal medicine over the past 50 years, according to an article published in the current issue of the Medical Journal of Australia.

But the authors, Professor Caroline de Costa and Dr Stephen Robson,  say that while Australian women are now 40 times less likely to die during pregnancy or childbirth than they were immediately before the Second World War, the "medicalisation" of birth has tended to diminish women's satisfaction with their experience of childbirth.

A survey of Australian women found that their main sources of dissatisfaction with birth were perceptions of a lack of involvement in decision-making, having "obstetric interventions", and "unhelpful caregivers".

With one in four children being born by caesarean section, many women, their families, midwives and some doctors are understandably seeking a more "natural" environment for uncomplicated births. Increasingly, emphasis has been placed on the quality of a woman's birth "experience".

It has been shown that women are most satisfied by care from a single practitioner, and when they themselves have input into decision-making.

But although maternal satisfaction is important, it should not be promoted at the expense of the health of mothers and babies, say the authors. Sometimes intervention is necessary for the safe arrival of a healthy infant.

Studies confirm that the increase in the number of caesarean births is strongly associated with fewer deaths in normally formed babies weighing over 2500 grams.

While data are scarce on the 0.3 per cent of babies born at home in Australia, home births increase the risk of perinatal death and neonatal respiratory difficulty. Water births are also associated with lower Apgar scores, lower cord pH at birth and increased rates of infection in babies.

Home births and water births strongly promote maternal satisfaction, but the safety of the baby under these circumstances is difficult to evaluate because of a lack of data. While birthing centres within hospitals might be a safer option, there are still significant risks involved.

Antenatal education should be realistic in informing women and their partners about the likely outcomes during labour and birth, so that both maternal satisfaction and good perinatal outcomes can be achieved.

"Within the hospital settings that most Australian women currently choose for the births of their babies, maternal satisfaction will be the greatest, and outcomes for mothers and babies best, when midwives and obstetricians work in a complementary way," say the authors.

CONTACT      Professor Caroline DE COSTA                         0407 010 015 / 07 4032 2695 (weekend)

                        Judith TOKLEY, AMA Public Affairs,               0408 824 306 / 02 6270 5471

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