After five years of Towards Normal Birth in NSW, are mothers better off?

“Don’t underestimate what your body can do,” says new mum Libby Nathan, who gave birth to her baby boy this week at the Royal Hospital for Women. Photo: Louise KennerleyIt was picture-perfect: Intense, emotional and “excruciatingly painful” but also everything Libby Nathan hoped it would be. This week the 36-year-old gave birth in the Royal Hospital for Women to her little boy – the first baby for her and husband Jeremy.
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“It was a very empowering experience and I’m proud that as a team we were able to do it,” she says.

The team Nathan is referring to didn’t involve a doctor. It consisted of her, her husband, midwifery practice at the Royal, and her privately hired doula, or birth support companion, who, she said, was “agreed to and embraced by” her midwives.

Nathan is the face of a shift in obstetrics in NSW. She delivered her baby without medical intervention, which is what she had wished for, but she also benefited from the high level of care available from the hospital, which is leading the push towards natural birth among the state’s major hospitals.

Ten days before giving birth she was knocked over, and needed special monitoring in the lead-up.

“It was a good lesson in things not always going to plan,” she says. “We always knew things don’t always go to plan, but we wanted to maximise our chance of a natural birth.”

As it happened, she was in hospital getting test results when midwives suggested she might be in labour. By 3pm her waters had broken and by 7.45pm her baby was born.

She says despite the fact she had coped with the pain and felt positive about the birth, she doesn’t judge woman who seek medical intervention.

“Even with my shorter labour it was just exhausting,” she says. “With my holistic philosophy I believed I was capable of it. But every situation is different, and I know women who were also so geared for a birth like that. But then they are in labour for 30 hours and it’s just not progressing.”

Amid spiralling use of medical interventions such as caesarean section, and a continuing fight from women’s rights advocates to give women more control, five years ago NSW’s Towards Normal Birth policy was launched.

Its aims were ambitious – expecting more than 80 per cent of women to give birth vaginally, and 60 per cent of women who had already had one caesarean to give birth to their second baby vaginally by 2015 – and signalled a landmark policy change to birth in NSW.

But today, on paper at least, the policy has not achieved its goals. Data released by Health Statistics NSW on birthing outcomes in NSW to 2013 (the most recent year for which information is available) show under 57 per cent of mothers in NSW have a normal vaginal birth, down from 58.2 per cent five years previously.

Only half of all first-time mothers now have a spontaneous vaginal birth, while there has been a large spike in women being induced to nearly 39 per cent of first-time mums, a 15 per cent increase on 2009, and more women are having major haemorrhages after they give birth.

The community of people involved in birth, from mothers to midwives, doulas to doctors, is divided over the right response. Why can’t we meet the targets, and should we even try?

It’s a minefield. Every woman’s experience is different and so are her values. Beliefs vary from wanting a vaginal delivery more than anything else, to deciding the pain and potential side-effects are an unnecessary evil best avoided.

Language drips with normative value – from talk of risk and choice, to words like “achieving” and “natural” – that seemingly politicises every aspect of birth.

Against this background, debate can be difficult. But the head of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Michael Permezel​, says the fact NSW has not met its targets is not necessarily bad.

“The most important thing is it’s not health administrators who write policies that are determining the mode of birth, it’s really the women themselves,” he says. “The reality is in Western countries the rates are remarkably similar, and women are voting for caesarean section rates of around that 25 to 30 per cent mark mostly.”

He says women are becoming more risk-averse, so as they get older and heavier, which makes birth more risky, they are less likely to opt for a vaginal birth.

For example, while NSW has seen spiralling rates of labour induction, NSW Kids and Families, the ministry in charge of Towards Normal Birth, says one explanation could be that in NSW the percentage of mothers aged over 35 years (24 per cent in 2012) was almost twice that of the national average (14 per cent).

“If a vaginal birth is completely safe, of course most women will chose that option, but the surveys are very clear that where there is added risk from vaginal birth, most women will choose a caesarean section,” Permezel says.

He fears insisting on strict targets could be dangerous.

“When health services perhaps decide on the caesarean section rate first, and then try and fit the women to that caesarean section rate, it might lead to some inappropriate decision-making,” he says.

St George Hospital in Sydney’s southern suburbs stands as an example of how targets that look good  on paper can be difficult to achieve.

The rates of women there who had a vaginal birth for their second baby after previously having a caesarean were low – only about 17 per cent of cases – compared with the Towards Normal Birth target of 60 per cent by 2015, when the hospital set out to make a change.

But Trent Miller, the clinical director of obstetrics and gynaecology, says it wasn’t the target that motivated them as much as feeling their low rates meant women were not getting the best possible care.

“We went into it being quite pro vaginal birth … we wanted to be pretty liberal in offering it to everyone because most women can have a go,” he says.

The team found despite strong evidence it is safe to have a vaginal birth after a caesarean (and that repeated caesareans put both mother and baby at risk), many women were reluctant.

“A lot of the time it is the poor experience from the last birth – they are scared. They were traumatised by what happened and they don’t want to go through that again,” he says.

“And then there was another group of women who had had a caesarean, but didn’t really mind that was what had ended up happening – and that second group is actually much harder to convince.”

Smaller teams, ensuring the advice given was consistent, and helping those women deal with their bad experiences, did have strong success – increasing their VBAC (vaginal birth after caesarean) rates to 27 per cent.

But there were also some tragedies. Two women had uterine ruptures, and in one of those cases the baby died. Another woman had a stillbirth.

The relatively high number of terrible events in that time was a statistical aberration – Miller says there have been no such deaths since they published the results of their efforts in the Australian and New Zealand Journal of Obstetrics and Gynaecology last year.

But it highlights the high stakes. The team needed to warn women clearly about the risks, but make it clear they are very rare and outweighed by the benefits.

“There are some women who will take that and say ‘that’s not for me’, and for some women that is absolutely fine,” he says. “We are not there to convince women to do something they don’t want to do”.

But the truth is, Miller says, that without forcing some to have vaginal births, it simply would not be possible to reach the 60 per cent target in Towards Normal Birth. Stop ‘blaming women’ for systematic failures, midwives say

Hannah Dahlen​ is on the front lines of the push towards normal birth in NSW. The spokeswoman for the Australian College of Midwives and professor of midwifery at the University of Western Sydney was involved in the development of the NSW policy, and rejects the idea it is unachievable.

She says smaller hospitals that tend to have lower-risk patients in particular are seeing incredible results, citing Fairfield Hospital as just one success story, where vaginal births were above 78 per cent in 2013.

But the private sector, she says, has got “so much worse”. Induction in private hospitals is also high, at around 50 per cent.

“We are doing it all to save babies apparently, but there has been no change in the perinatal mortality rate over the past decade – none,” she says. “But we have escalated and escalated and escalated the intervention.”

“We are ending up with so many women who are traumatised by their birth. Then these women say ‘I’m not walking back into a hospital’ and they make dangerous decisions like deciding to freebirth.”

Dahlen says there is still not enough support available to ensure women can give birth naturally, particularly first-time mothers, which then triggers more intervention down the track.

“I agree mothers are older, women are overweight, but it’s not enough of an excuse for us to keep blaming mothers,” she says.

Nordic countries have similar rates of maternal risk factors but manage to have much lower caesarean rates, she adds.

Dahlen says private obstetricians should be forced to publish their individual caesarean section rates, and women should use the NSW health statistics to research what hospital they give birth in.

“If you go out and buy a fridge or a washing machine you would do research, so why wouldn’t you do it when you are having a baby,” she says.

Dahlen believes an increased number of dangerous bleeds  which appears to be occurring recently could be related to a lack of respect for the “third stage” of labour when the placenta is delivered, with research showing increased interventions such as induction can lead to haemorrhage.

But the haemorrhage issue provides just one case study of the divided opinions about what is happening in NSW. NSW Kids and Families says that the apparent rise is small enough that it might not be a trend.

And while Dahlen believes it is likely linked to increasing intervention and medicalisation, Professor Hans Peter Dietz has a different idea.

The obstetrician and gynaecologist spends his days fixing the pelvic floor damage women have experienced in childbirth.

He worries that the increasing push towards natural birth is having the unintended consequence that more women are having longer, more difficult labours.

“In the past it was two to three hours of unsuccessful pushing before obstetricians intervened, now it may be six,” he says. “It has the advantage that some women will push their baby out, but the risk that some will be left with a post-partum haemorrhage.”

(NSW Kids was unable to say what proportion of caesarean haemorrhages occurred after the type of situation Dietz is describing, which would have required an emergency, rather than elective caesarean.)

Dietz is also concerned by an increasing trend towards doctors using forceps.

As an example, he cites the Royal Hospital for Women, one of the only major hospitals that has lowered its caesarean rate, by  10 per cent between 2007 and 2013, and is considered a leader in the field in NSW. But in that same period, its forceps rate increased by  more than 50 per cent. He estimates that for every  10 caesareans prevented, it is likely that four additional tears to a woman’s levator muscle – which holds the pelvic organs and bowel in place – occur, and four additional sphincter tears.

“Of those eight additional tears (in about 6 women), it is very likely that only one or two are even diagnosed at birth, and even when diagnosed, such tears are often not well repaired, which means the damage is major and permanent in about five women for every 10 caesarean sections saved,” he says.

“Obstetricians and midwives are often blissfully unaware of the additional damage done in the quest to reduce caesarean rates, especially as most of the damage only causes symptoms, [such as] urinary and fecal incontinence, prolapse, sexual dysfunction, years or decades later.”

Dietz says the goal of vaginal birth is important, but to achieve it as mothers get older and more overweight you have to shift the goalposts of what you think is an acceptable level of risk. And, he says, the goalposts are clearly placed differently depending on what hospital you give birth in.

“It’s as if there are two different philosophies, and we are making decisions for these women without ever informing them properly,” he says.

“In my entire clinical life, how many women with major later life health problems due to caesarean have I ever seen? I can’t remember a single one. How many after forceps will I see? Several a week, at least 100 a year, maybe 200 a year,” he says. Balancing fear vs information

Let’s get one thing straight: you are probably going to be fine. Most women can come through a vaginal birth (or a caesarean section) relatively unscathed.

But what happens to those who don’t? For women who feel robbed of natural birth by hospital interventions, the disempowerment and painful memories can last a lifetime.

But there is also another, largely silent group of women: those who may “achieve” a normal birth, but at great physical and emotional cost.

Liz Skinner is a registered nurse and midwife of  more than 20 years’ experience.

As part of her PhD project undertaken with Professor Dietz, Skinner has interviewed 40 women who experienced major pelvic floor trauma.

Her findings paint a disturbing picture of the care given to women with birth trauma.

Two-thirds of the women showed symptoms of post-traumatic stress disorder, and many couples were experiencing sexual and emotional problems.

Every woman interviewed had had her pelvic floor muscles pulled entirely off her pubic bone and pelvic side wall. Yet not one had been identified as suffering this major trauma after their birth.

Only five of the 40 had been diagnosed with major anal sphincter tears, yet further examination revealed 55 per cent had them.

“Health professionals were not attentive to any of this – I felt alone, I still do,” one respondent said.

Two-thirds said their doctors and midwives had dismissed the symptoms they experienced after birth, while nearly 90 per cent said they had got confusing and conflicting information from their treating team before, during and after the birth.

Skinner says she was shocked by both the suffering, and lack of support.

“It’s a hidden issue and they are not talking about it because it’s women’s business to have babies,” she says.

While feminists previously fought to  return control to women  giving birth, Skinner sees the new feminist issue as ensuring that women are correctly assessed for their risk of complications, given full and frank information and support if things go wrong.

“This issue of scaring women is the elephant in the room. But if you were going for heart surgery they give you lots of information before you go into the room, including the risk you might have a heart attack or stroke. Should we not tell you that? It’s the same with any medical intervention, so why is information about complications not given to mothers?” So what are hospitals doing to lower intervention?

But Andrew Bisits​, the medical co-director of maternity services at the Royal Hospital for Women, says in his hospital, encouraging women towards normal birth is never about encouraging them at any cost.

“It’s really about responsible, appropriate use of intervention,” he says.

He credits the Royal’s success in decreasing intervention to ongoing, systematic reviews of every birth.

But he believes all interventions at the hospital, including its forceps use, should still be lower.

Even the Royal is a long way off meeting the state targets, but  Bisits thinks they are achievable, if a little ambitious.

“I think there is a substantial quantum of enthusiasm in this area for women to have natural birth,” he says. “I can’t really say that has increased [over the past five years] but I think our enthusiasm for it and willingness to support that in a responsible way has become more explicit.”

Yet the team often comes up against a high degree of fear, and a lot of misinformation promoting caesareans.

“People forget that a caesarean is a relatively major operation. It’s an instant trauma to the body. It’s anything but keyhole surgery,” he says. “I think that fact sometimes gets lost and people forget that you can get through a normal birth with no scratches or just a few scratches.”

There is also increasing evidence that the process of childbirth is important to the child’s long-term wellbeing, as it transfers vital bacteria to the baby, decreases the risk of conditions such as asthma, and encourages bonding between mother and child.

For new mum Libby Nathan, who spent a few days at the Royal bonding with her new baby, the key is confidence – she avoided all negative stories about birth and focused on positive thinking.

“The only thing I would say is, don’t underestimate what your body can do,” she says. “But also don’t be too proud or hard-headed to change the plan if you need to.”

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Higher-end vendors holding fire

Agent and auctioneer Bill Karp of Barry Plant looks for a bid at the auction of an Essendon home on Saturday. Photo: SuppliedMore than 700 properties were auctioned on Saturday but prospective sellers of mid- to high-priced homes in Melbourne’s inner-east and key bayside suburbs largely held fire.
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Only 70 inner-east properties went under the hammer, a lower-than-normal listing ratio that indicates many $1.5 million-plus vendors – and buyers – are holding off until spring.

Real estate agents say the bayside and southern suburbs are also seeing an “unseasonably low” level of winter listings.

The Domain Group posted a clearance rate that continued the trend of below 80 per cent through winter, clocking in at 76 per cent from 557 auctions. There were 178 unreported results.

Tap here for Saturday’s auction results.

Tap here for the Market Snapshot.

Melbourne recorded five consecutive weekends with auction clearance rates below 80 per cent. This followed 10 weekends through April, May and into June when clearances spiked up above 80 per cent.

Some agents expect a moderating influence on prices as listing volumes surge in August and September.

“I think the market, price-wise, has had its run,” Greg Hocking, of the nine-office Greg Hocking Real Estate, said on Saturday.

“There are still spot fires going off here and there but the real push in general price rises is not sustainable – not in the next period because we’re going to get a bump-up in volume.”

Hocking said price growth had been high, “if not surging” in bayside areas but this would change as more supply came on.

It’s difficult to get a firm reading on what the likely state of play will be for the spring market until more high-quality homes are listed for sale in September.

Domain Group senior economist Dr Andrew Wilson said in recent weeks that clearance rates had slipped in the inner-city and St Kilda.

“There has been an improvement in the west and the north, amid signs of a solid revival in the local economy,” he said.

“That’s part of the equation now, particularly with the building boom in the city, which is providing jobs for people in the western and northern suburbs.”

The Domain House Price Report, released last week, shows how the Melbourne market has defied expectations this year.

In the three months to June 30, house prices grew 3.5 per cent to a median of $668,030.

This brings the total growth for 2014-15 year to 10.3 per cent, or more than $62,000.

The report says the latest quarterly rise is the strongest result since December 2013 and coincides with Sydney’s median house price reaching $1 million after shooting up 8.4 per cent.

James Buyer Advocates principal Mal James said the market in September was often unusually strong because buyers had come in after a winter lull. It would take about six weeks to identify any change trends, he added.

Both James and Michael Ramsay, of The Advocates, believe Melbourne property is now firmly an international buying market.

Ramsay said the extent of overseas buying of $2 million to $10 million properties hadn’t been affected by new state and federal government restrictions and charges for international buyers.

“The way the market is travelling is unsustainable for any length of time, such as for another five years,” Ramsay said.

“But I can’t see that the market is going to slow down significantly because of the amount of people coming into the state and the amount of wealth that seems to be still out there.”

Yet obtaining approval to borrow funds isn’t getting any easier. Last week, the ANZ and Commonwealth banks both increased interest rates for housing investors by 0.27 percentage points in a bid to limit borrowing by landlord buyers.

Property advisers and mortgage brokers also say lenders are becoming more conservative in valuing the properties they advance loans on.

Broker Ashley Playsted​, of Wealthie​, said the stricter valuations were mainly affecting apartment buyers.

Low interest rates continue to be the big drawcard for all kinds of buyers. Playsted said high-net-worth buyers rarely paid cash and were just as motivated by low-rate deals as other borrowers.

“They are concerned about getting the right loan product at the right rate but are less concerned about rates going up by half a per cent because their financial position gives them a greater degree of immunity,” he said.

There are 623 auctions scheduled for next weekend. Domain Read More …

Fusion home in Northcote sets a price record for suburb

The sale of 11 Mitchell Street, Northcote, has set a suburb price record. Photo: Supplied The glistening, modern extension at the rear of 11 Mitchell Street, Northcote, which sold for $2.82 million on Saturday. Photo: Supplied
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The owners of 11 Mitchell Street in Northcote created a surprising home that fused period and contemporary. Photo: Supplied

The winter market continues to see properties with outstanding selling features draw multiple bidders.

An impressive fusion of a polychrome brick Victorian and a cutting-edge two-storey glass and steel rear extension delivered $500,000 over reserve.

Some 350 people saw three local families wrestle for the five-bedroom house at 11 Mitchell Street, Northcote. The winners paid $2.82 million, against a reserve of $2.3 million.

Hocking Stuart auctioneer Sam Rigopoulos​ said this was a record price, both outright and per square metre, for the suburb.

Another polychrome brick Victorian, on just 130 square metres, had been held for the last 60 years.

It offered the only slot in tightly held Princes Hill apart from one other property which was asking $5 million-plus. Interestingly, the niece of the first owner of the tiny, 112-year-old two-bedroom terrace at 361 Pigdon Street said on Saturday that during the Depression, 12 people were living there.

At auction, five out of nine interested parties put their hand up. Woodards’ Quentin Hinrichs sold it for $973,000 against a “conservative” reserve of $800,000.

In Hampton a first-home buyer with her parents fought off four investors for the keys to a two-bedroom, first-floor apartment, close to Hampton Street’s shops and station. She had to ante up $753,000 to Hodges auctioneer Stephen Wigley for 15 Foam Street. The reserve was $680,000.

The sale of a “war service” home with three small bedrooms, built economically on a generous 722 square metres, showed the surging interest in demolition for multi-unit development in Preston, Coburg and North Coburg, said buyers advocate Bruce Renowden. Four bidders, all developers, heard 19 Belgrove Street, Preston, was on the market at $730,000 and they took it to $810,500 for Barry Plant.

Call Auction Action with your auction results, tips and comments on 8667 1147 between 11am and 4.45pm on Saturday, or email [email protected]上海夜网m.auDomain Read More …

Tom Parker Bowles takes a date with Kate Waterhouse

Tom Parker Bowles confesses he loves McDonald’s takeaways as much as he loves fine dining. Photo: Nic Walker Photo: Nic Walker.British food writer and critic Tom Parker Bowles is the son of Camilla, Duchess of Cornwall  and a judge on the Australian cooking reality television series The Hotplate, which premieres on Channel 9 on July 28.
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Kate Waterhouse caught up with the 40-year-old to chat about how he critiques a restaurant, his favourite places to dine and how his mother’s cooking influenced his career.

 Tell me about your time in Australia.  I was here for three months filming The Hot Plate … Australia gets into your soul. It gets into your bones. There are certain things I miss [when I’m back in London] – things like chicken Twisties, Tim Tams and the lollies and that sort of stuff. And those fries at Red Rooster with chicken sauce. It’s those sort of things I miss and I find myself slipping into calling everything “heaps good”.

 For work, you must eat at fine dining restaurants. Do still appreciate junk food? [Yes] I like all level of food. I never have guilt about food. If I want to go and have McDonald’s I have McDonald’s. I love crap food and I love beautiful food. I love street food and I can’t bear those restaurants where – my wife calls them “cling cling” restaurants because all you hear is a “cling cling” of the glass on the table – where everyone is so scared to be in there and scared to eat.

Where did your love of food come from?  It started with greed, really. I’m the greediest person. I really love eating. My father is very greedy and he was a good gardener. We grew up in a farm. So we all knew about seasons and where our chickens, our beef and vegetables came from. In those days, there weren’t many supermarkets in the ’70s, when we were in the country. And my mother was a good cook.

Did your mother’s cooking have a big influence on your career?  Probably subconsciously. She brought us up along with my father to appreciate good food … She is very good at cooking a roast, roast chicken or roast beef or pies … She still cooks. She is much busier now, obviously … But we argue in the kitchen! She says, “Why are doing that? Why are doing this?” but if she came into my kitchen I’d do the same, so we actually cook separately now [laughs].

 How did you become a food critic? Out of university, I didn’t know what I wanted to do. I was sacked from pretty much every job I did. There’s a magazine called Tatler and I was a bit pissed at a party and I wobbled up to [the editor] and said, “Can I write a food column?” He said, “Send me 800 words”. So I did a food column with him for Tatler for eight years. Then I moved to GQ and then to Esquire and then The Mail on Sunday. Suddenly it became my life to write about food. I find food endlessly fascinating. It’s not just lifestyle; it’s a prism through which you can see history, economics, health, wealth, happiness. Everything comes down to food. Food is the one experience we all share, so everyone has an opinion on it and it’s very relatable.

When you dine at a restaurant, how do you critique the food?

Basically, in 850 words I like to bring in the person…. you want to give the reader an idea of what sort of restaurant it is. So it’s everything from the service to the feeling. How it is put together is as important as the food.

What are some of your favourite Australian restaurants?

I think Estelle [The Hot Plate co-judge] Scott [Pickett’s] restaurant is stunning. I also absolutely love North Bondi Fish with the kids. I love Spice I Am. I was obsessed with Apollo. Then Melbourne has Chin Chin, and Flower Drum, which I love.

What is it about Australian cuisine that you love?

What I love about Australian cuisine is, because you have such a big Asian population here, the ingredients are very authentic Thai or Vietnamese food and the flavours are all zinging. With modern Australian – which is a dodgy term that I don’t really like – but what I like about Australian chefs [is] there’s a sense of freedom. There’s a sense of not being restricted by the past. It’s not like being a French chef who says, “You have to do this, you have to do that.” There’s no fear.

When your mother married Prince Charles, did that make a big difference to your life?

Not really to my life. To her life, I think it did. But you know, she was a mother. She didn’t have a full-time job; she was a full-time mother. But suddenly she was working 10 to 20 engagements a day. I have nothing but amazement and respect for how [the Royals] all do it. I could never do it. I could never be that nice and friendly and interested. She is always interested and she is good with people. When you have to have every bit of the day absolutely scheduled, it’s incredible. I think when she goes back to her house – where we all grew up – that’s where I think she can sort of chill out and perhaps maybe have dinner in her dressing gown! But she’s happy and that means we are happy. She is really excited to come out to Australia later in the year.

There is so much written about your mother and your family. What is the biggest misconception about your mother?

I’ll tell you what pisses me off: I saw in the paper the other day, “Oh, she has just given up smoking.” She gave up smoking 20 years ago! It pisses me off … the bullshit [that] is written. The papers make up shit sometimes but you just get used to it.

You are also a chef. What’s your signature dish at home?

It’d probably be something with tons of chillies that only my wife could eat. Because we always have friends over, we cook stir-fries or all sorts of Thai or Mexican dishes. But our chilli  capacity has gone up so much.


WE WENT TO The Four Seasons Hotel, Sydney.

WE ATE Ocean Trout ‘Ham from the Sea’; yellow fin tuna, watermelon and ginger; broccolini, fermented chilli, almond.

WE DRANK Sparkling mineral water.


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Barrister turned novelist John Tesarsch reveals battle of wills

Balancing the setbacks: Author John Tesarsch. Photo: Joe ArmaoThe Last Will and Testament of Henry Hoffman by John Tesarsch.
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Balancing the setbacks: Author John Tesarsch. Photo: Joe Armao

Balancing the setbacks: Author John Tesarsch. Photo: Joe Armao

The Last Will and Testament of Henry Hoffman by John Tesarsch.

Balancing the setbacks: Author John Tesarsch. Photo: Joe Armao

The Last Will and Testament of Henry Hoffman by John Tesarsch.

The Last Will and Testament of Henry Hoffman 

By John Tesarsch

Affirm Press, $24.99. Buy now on Booktopia

Conflict over an inheritance can bring out the worst in families, from the Rineharts to those with only their childhood home to fight over. “People are turned inside out by the hurt and pain, people who are otherwise reasonable lose all perspective,” says Melbourne barrister John Tesarsch.

As a barrister in Melbourne, Tesarsch has “come across some horrendous family disputes” and finds them draining, so he sticks mostly to commercial work. As a novelist, however, he is drawn to the tensions and moral challenges sparked by wealth, death, wills and secrets.

In 2010 his first novel, The Philanthropist, observed the fallout from a tycoon’s decision to leave his fortune to charity, and brought Tesarsch to attention as a impressive late starter.

His new book, The Last Will and Testament of Henry Hoffman, returns to the same territory with even greater nuance and human insight in a story told from five perspectives.

When Hoffman shoots himself dead rather than go into a nursing home, his three adult children must negotiate his unfair will, and another secret will that leaves everything to a stranger, while grappling with their own work, love and financial problems.

“Issues of jealousy and resentment can be bubbling under the surface and when you put people under pressure they come out,” Tesarsch says, adding that he tries to be sympathetic to all his flawed characters.

“I started the novel five or six years ago, with the image of old Henry as a fellow burdened by the past and unable to relate to his kids. It was some kind of warning to myself of what not to become.”

At 47, Tesarsch has two young sons with his wife Dinusha​ but following a serious illness, he says, “Overnight I aged from 31 to 81 in terms of what mattered to me.”

He has had misfortune with his health. At school he began playing the cello, which “became the focus of my plans and my identity”. He won a scholarship at 18 to play in Vienna for a year, but his musical career ended at 22 when he developed a skin allergy to the rosin he rubbed on his bow.

“My whole life crashed into nothingness in the blink of an eye, and I had to rediscover myself,” he says. He had studied music and law at university “as something to fall back on” – and he did, working full-time as a lawyer until illnesss struck again.

In 1999 he developed tongue cancer and had surgery and chemotherapy, followed by reconstruction that turned his tongue sideways. He had to learn to talk again and while he was off work he read voraciously.

“All that reading kicked a lever in my head. I turned to writing to express my thoughts.”

He had written a few poems in his youth. Now law and writing are “a nice diversion from each other”, and though he often writes at night it energises rather than tires him.

He had three unpublished novels written before he was ready to go public, and now a couple of new ideas are competing for his attention.

Tesarsch grew up happily among the apple orchards of Doncaster in suburban Melbourne. His German father had come to Australia in 1950 and became a successful small businessman. But he lost his retirement savings in the 1990 collapse of the Pyramid Building Society and died at 64 from motor neuron disease. Tesarsch’s Australian-born mother – possibly related to a Dane who brought the first elephant to Gippsland – died of cancer at 74.

“It was very traumatic in both cases,” Tesarsch says. However, his parents’ straightforward wills caused no fights. Tesarsch is close to his older brother, who is also a lawyer, and he recalls, “The last thing my mother said to me in hospital when she passed away was, ‘You’ve been wonderful boys. I love you both the same.’ “

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