Facts and Figures
|Births per year||1883|
|Rate of episiotomy (perineotomy) in natural birth||19.5%|
|cesarean section rate||30.1%|
|Percentage of primary (planned) caesarean sections||44.2%|
|Percentage of secondary (unplanned) caesarean sections||55.8%|
|Rate of peridural/spinal anaesthesia (spinal block) during caesarean section||84.8%|
|Besides doctors, carers and midwives, which other salaried personnel does your team feature?||available|
|Birth preparation courses|
|Psychological / psychosomatic walk-in clinic and counselling|
|Individual discussions with midwives|
|What is the standard of equipment?||available|
|own wetroom / WC|
|Are midwives able to assist with delivery in your department?|
|Are midwives of the patient's choice able to assist with delivery in your department?|
|Is there a neonatologist on site round the clock?|
|Is a peridural or spinal anaesthesia possible at any time?|
|Clinical baby examination|
|Laser treatment for sore nipples|
|Psychological care for post-partum problems|
|Single or double rooms||1|
|Rooms with three or four beds||5|
|Five or more beds||1|
1. Please describe your department’s obstetric philosophy
Our obstetric philosophy: As naturally as possible, as safe as necessary (we have all the facilities for perinatal-neonatal emergency medicine). Even in a high-tech delivery room, birth is a unique and exhilarating experience for mother, father and the whole family. As such it is an essential condition for successful bonding, a good early mother-child relationship.
So, for example, in a comprehensive package, we offer management of breech presentation (breech birth) according to the wishes of the pregnant woman including abdominal version and also natural birth at the request of the woman and with the appropriate medical conditions.
We want to support women in giving birth, to facilitate their empowerment. This applies not only to the avoidance of unnecessary intervention and invasive procedures during the course of the birth, but also to sustainability in the entire life of a woman and her child.
We have a psychosomatic attitude and see our medical treatment as managed by indications, i.e. there must be a medical reason for medical intervention even in the delivery room.
Procedures are associated with risks and consequences. We want to keep these as low as possible.
Previous caesarean sections can have consequences:
• With regard to fertility (it becomes more difficult to fall pregnant again in some circumstances).
• With regard to the courses of subsequent pregnancies and births (failure to implant of the placenta and risk of rupturing of the mother due to scarring.
• Postoperative as well as prolonged pain.
It is our purpose to enable a safe birth and at the same time to avoid long-term negative consequences.
2. Please describe the process of a problem-free birth in your department, preferably from the woman’s point of view.
Birth is a process hormonally coordinated by nature which is controlled by a complex interaction of messenger substances which are formed partly by the mother and partly by the child. They include, for example: Oxytocin and endorphins which dull pain and provide energy. They also have a relaxing effect, reducing stress and for some women even a euphoriant effect. They help the woman to handle contractions. They also support the child in adjusting to the outside world after birth. They set milk production into motion for breastfeeding and encourage bonding between mother and child.
But hormone production is also liable to disruptions and requires important conditions for its functioning: Self-confidence of the woman as well as confidence in midwives and obstetricians in a calm and relaxed atmosphere.
This means specifically:
After the examination on admission (=assessment from the beginning of birth) the woman can choose with the accompanying person between various relaxation methods, where the desire for freedom of movement and other individual wishes are taken into consideration. Foetal heart sound checks are carried out at regular intervals, vaginal examinations of the woman when necessary in order to be able to determine the progress of labour.
3. How does your department handle caesarean deliveries on maternal request (CDMRs)?
We explain in detail the consequences of surgical procedures, particularly Caesarean sections, about later difficulties of becoming pregnant again, and about more difficult subsequent pregnancies and births.
4. How is the birth companion included during the labour (incl. caesareans)?
It is important to us to allow the birth to be a completely successful occasion for mother, child and father.
The presence of a companion is welcomed by us. A trusted caregiver is very important for the woman during the birth. In principle, continuous presence is possible, in exceptional cases such as in medically delicate situations (for example, in the event of carrying out an epidural anaesthetic) or at the individual request of the woman it also happens that the accompanying person must leave the delivery room.
If the accompanying person is a doula, we comply with the specifications which are stated on the doula website. In order to avoid communication problems between midwife and doula, we have prepared a pamphlet for a successful doula companion. We request any doula to abide by this.
After the birth the accompanying person may cut the umbilical cord if desired and be present at the first care of the newborn by the midwife after bonding has occurred.
At a caesarean section, the presence of a companion in the operating room is also possible, however she must sign a declaration form concerning behaviour in the operating room. In the event of a desired or medically necessary general anaesthetic, this is no longer possible.
If possible, we also implement early bonding with caesarean deliveries.
5. To what extent is the woman free to choose the birthing position?
All birthing positions are offered in our department with the exception of water births (at the moment there are no birthing tubs available).
We respect the wish of the woman for mobility and well-being and support her from the beginning in finding the ideal birthing position for her.
Sometimes it may be necessary for the obstetric team to suggest a specific birthing position – in order to achieve a steady labour progression.
- Birthing stool
- Delivery on all fours
- Delivery on one’s side
- Delivery sitting, squatting, standing
- Delivery on one’s back
6. Please describe how pain is managed.
During the birth there is the option both for complementary medicine interventions as well as the administration of medication according to a step-by-step plan to bring about alleviation of pain.
Our teams pursue with dedication an important objective for many of our patients: “Painless Wilhelminenspital.”
We achieve this objective with three components: informed patients know the options for handling pain and rely on that. The treating team master their techniques to the best possible degree, the types of treatment are available at any time. We have staff available for this in our hospital at all times.
Pain management in the delivery room:
Our department is specialised in the administration of epidural catheters. We offer this option for painless delivery. Prior information about the possibilities and risks of this procedure is a requirement. This information is provided once a week in the anaesthetic clinic in Pav.27 specifically for pregnant women and their partners.
Pain therapy for caesarean sections and in the treatment of wound pains:
The greatest possible safety is as important to us for caesarean deliveries as the conscious witnessing of the birth. We therefore primarily offer spinal anaesthetic for caesarean deliveries. A caesarean section is pain-free and enables the birth to be experienced. The wound pains after the operation are taken seriously and treated in the recovery room with pain medication. For the rare occasion of very strong wound pains, a pain service is available 24 hours a day.
For the rare case of scar pains, our pain ambulance is available with great experience in this specialist field by prior appointment.
7. How is the “comfort factor” taken into account during the birth?
It is a particular concern of ours to protect the privacy of the woman. We therefore try to keep disturbing factors as minimal as possible (e.g. care processes and the number of people in the delivery room).
Modern delivery beds as well as balls, mats, birthing stools, wall bars and cloths secured to the ceiling enable the birthing mother to take all kinds of positions. According to the situation the woman receives suggestions from the attending midwife on which positions are particularly suitable for the corresponding phase of labour.
The offer of wireless heart sounds and monitoring of contractions facilitates freedom of movement during the birth.
Subdued light, the chance to play music as well as the homely atmosphere of the delivery room contribute to comfort during the birth.
Some midwives from our team are also qualified to ease birth for the women through acupuncture, aromatherapy, homoeopathy, massages, TCM and/or hypnosis.
Above all the partner or another trusted companion is important for the mental well-being of the woman and is therefore involved accordingly.
8. What is your department’s position on the use of complementary medical treatments (acupuncture, homoeopathy, aromatherapy etc.)?
Complementary medicine methods complete holistic care of the woman. So, acupuncture by certain midwives certified for this is offered by our department both as a measure for induction of labour and for support of labour and for alternative pain alleviation.
e.g. Moxa therapy for breech presentation of the child
At the moment we are trying to implement aromatherapy as a supporting measure in the department. The midwives trained in this are already available.
Likewise complementary medicine methods such as homoeopathy or craniosacral therapy are also being used in paediatrics (e.g. after difficult births such as vacuum extraction = ventouse delivery).
9. How does your department encourage bonding after vaginal delivery and delivery by caesarean section?
Bonding is the most natural beginning of the mother-child relationship with far-reaching and lasting effects on the health of mother and child, but particularly also the best condition for a good and long-term breastfeeding relationship. In the birth preparation, we point out the importance of uninterrupted contact of the baby with its mother after birth. The implementation of “skin-to-skin” (skin contact between mother and child) is discussed in advance with the expectant parents. Directly after delivery, the newborn comes to the breast of the mother if the condition of mother and child permits it which is the case for most births. We strive afterwards to maintain the bonding situation without interruption at least until the baby has nursed at the breast and afterwards has fallen asleep. All care or paediatric activities not immediately necessary such as bathing, measuring and weighing, blood sugar controls etc. are only conducted afterwards.
Bonding does not only takes place after a normal birth. Bonding is also particularly important with a difficult birth such as caesarean section or ventouse delivery, since the stress for mother and child is dissipated again with bonding. The mother also no longer has anxiety about the health of the child if she feels her child near her. Mother-child bonding can be built from the beginning in this way – despite the complicated situation.
10. What kind support does your department offer for women who experience psychological or social difficulties during or after the birth?
Further care of our mothers in rooming-in units leads naturally to continuation of bonding even after leaving the delivery room. Post-partum bonding in our obstetric department is therefore actively encouraged and supported by all professional groups (midwives, obstetricians, anaesthetists, paediatricians and paediatric nurses).
1.1.Welche Unterstützung gibt es an Ihrer Abteilung für Frauen, denen es während oder nach der Geburt psychisch oder sozial nicht gut geht?
A maternity ward lead by midwives enables professionally qualified care in a specific time. Daily conversations during the midwife visits support the women in dealing with their motherhood in early puerperium.
Additional support offers of our department:
- Clinical psychologist of the department (for inpatients)
- FEM parent clinic (for outpatients)
- GUT BEGLEITET- Frühe Hilfen Vienna
- Clinical bonding service of MAG 11
- For women with a psychiatric illness: Care in close collaboration with Dr. Rainer-Lawugger/OWS
In collaboration with the gynaecological-obstetric department, a psychological-psychotherapeutic special clinic, FEM parent clinic in Pavilion 20 offers, in connection to the obstetric outpatient options, a diagnostic investigation of possible psychological and social load factors during pregnancy or after birth. In terms of prevention of pre-, peri- and post-partum psychological disturbances suitable early measures in the form of orientation discussions, diagnostics, crisis intervention, load discussions as well as short-term companionship in outpatient scopes are subsequently offered. If necessary further intervention of long-term care forms. The objective of the FEM parent clinic is to recognise risk potentials for women and to offer swift and low-threshold psychological and social support (offer of consulting in several languages such as Turkish and Polish). Thanks to the very good connection to the pregnancy clinic and labour ward, the risk to pregnant women can already be ascertained at registration for birth and support offered during pregnancy. Through the psychological-psychotherapeutic presence in the maternity ward it is possible to receive direct contact with the young mothers in order to inform them about the offer of the parent clinic and to arrange a first meeting if necessary. Information folders are distributed to the women supplementing the personal conversations, in order to offer them the option to be able to find help for problems that occur later.
11. What is your department’s position on rooming in?
Rooming-in is naturally offered in our department since the advantages – such as better breastfeeding success – are uncontested. The mother is looked after competently, gently and individually in close collaboration with midwives and paediatric nurses in this first time of getting to know her baby. In this way the conditions for feeling safe in dealing with the baby and breastfeeding are set.
The actual use of our 24h offer depends on many factors such as the health condition of the mother and newborn as well as their individual needs. The newborn can then be cared for and fed in the nursery.
It is our objective to be able to discharge the mother well informed and strengthened in her maternal competence at home. We continue to be available by phone for queries.
12. What is your department’s approach to breastfeeding?
We plan to establish an in-house breastfeeding preparation group.
13. To what extent does your department accommodate cultural wishes/requests?
Birth is a personal, cultural experience.
In this respect is it important to take into consideration cultural standards and to support the woman as far as possible in her cultural desires.
For this reason, midwives as well as obstetricians invariably try hard to take this into consideration according to the possibilities.
The express wish for a female obstetrician is frequently taken into consideration according to our personal situation, but can not be guaranteed comprehensively around the clock.
It can not be guaranteed that a female obstetrician is always on duty.
The department places great value on respectful and culture-sensitive dealing with people with an immigrant background.
Wilhelminenspital tries to respond to cultural wishes/requirements with regard to nutrition, as follows:
- Admission diet without pork
- Breastfeeding diet without pork
14. How does your department handle foreign languages?
The obstetric team is characterised by its multicultural structure among other things.
So. the following foreign languages may be covered by the team:
We welcome the bringing along of an interpreter in principle.
15. What is your department’s position on outpatient birth and early (“premature”) discharge?
We encourage outpatient delivery or early discharge home. Within 48 hours paediatric diagnostics can also be processed.
The best place to spend the post-partal phase is at home – in a trusted environment – in the family circle, provided that appropriate support is available there.The guarantee of follow-up care by midwife and paediatrician is the condition for an outpatient birth – this must be declared to us by the mother.
We discharge early on the 2nd day after an uncomplicated natural birth and on the 4th day for uncomplicated progress after a caesarean section.
For an outpatient birth or an early discharge the mother has a claim to a house visit by a midwife. These visits can either be settled directly with the health insurance or on a midwife selection basis.
The pregnant woman receives a corresponding list as part of registration for birth or on the maternity ward.