Wednesday, November 25, 2009
Medical dominance in birth
Society and cultural beliefs may not always agree with or understand the ‘promotion of normal birth’ which is, by definition, the duty of every midwife (ICM 2005). Many midwives who may have only practised under medical supervision, may not understand or have any skill in the promotion of normal birth. Regardless of the fashion of the day, and a midwife who does not possess skill in promoting normal birth should be challenged and supported in achieving competence, in the same way as a midwife is required to have competence in newborn resuscitation or any other basic midwifery skill. [Continued]
Wednesday, November 18, 2009
Learning from Dr Michel Odent
An excerpt from Michel Odent's Primal Health Research Newsletter Vol17 no3. The obstetrical implications of waterside hypotheses
WWW.WOMBECOLOGY.COM
Learning from birthing pools
In the early 1990s, when we became more familiar with the concept of antagonism between hormones of the adrenaline family (stress hormones) and oxytocin (the key hormone in parturition), I started to investigate the management of a common pathological situation in midwifery and obstetrics. It is the ‘failure to progress’ in the middle of cervical dilation, associated with intense lumbar pain. In this case, the pain appears as an obstacle to cervical dilation. I was considering non-pharmacological methods of pain relief. This is how I introduced the concept of ‘lumbar reflexotherapy’, based on the ‘gate control theory of pain’. Intracutaneous injections of sterile water in a precise zone of the lumbar region innervated by the posterior branch of the twelve dorsal nerve can block the visceral pain coming from the contracting uterus.32 I also proposed immersion in water at body temperature as a way to relieve pain, to reduce the level of stress hormones, and thus achieve more effective uterine contractions.
Taking into account the physiological perspective, and also the strong attraction to water expressed by many labouring women, I eventually bought a blue inflatable garden wading pool. Thus began the history of birthing pools in hospitals.33 As soon as the birthing pool was installed new strategies became possible. When a woman in hard labour was demanding painkillers, we had something else to offer than the injection of an analgesic drug (this was before the age of epidural analgesia). We could introduce the mother-to-be to the aquatic birthing room, so that she could observe and hear beautiful blue water filling the pool. The room was painted blue, with dolphins on the walls. From that time the question was no longer: "When will you give me a pain killer?" It was more often than not: "How long does it take to fill the pool?" The first lesson concerned the importance of the time when the woman in labour is anticipating the bath: the dilation of the cervix can already progress dramatically before water immersion—if the aquatic environment is associated with privacy. It is like the sudden release of brakes . We witnessed one of the many magic effects of water on human beings...a profound power that cannot be easily explained with the language of physiologists.34 At the time of the plastic pool (before we installed a solid pool), women were not influenced by the media or by what they read in books about childbirth. Their behaviour was spontaneous and thus we learned about the genuine effects of a water environment. A the typical scenario (with many possible variations) was the case of a woman entering the pool in hard labour around 5 cm, spending an hour or two in water and then feeling the need to get out of the pool when the contractions were becoming less and less effective. This going back to the dry land often induced a short series of irresistible and powerful contractions so that the baby was born within several minutes.
One day, a mother-to-be had not been in water for long when suddenly she had two irresistible contractions and the baby was born before she felt any need to get out of the pool. While giving birth, this woman was really "on another planet". Clearly, in that altered state of consciousness associated with hard labour, she intuitively knew that her baby could be born safely under water. There was no panic. It is as if a deep-rooted knowing could express itself as soon as the intellect and its knowledge was set aside. Such births happened again.34 From that time many journalists, reporters,and photographers were fascinated by babies being born in water. They were indifferent all other aspects of our unconventional practices. After a short period of surprise and even frustration, I concluded that good journalists are experts in Human Nature. They know how to attract the attention of their readers or their viewers. They have this intuitive knowledge that there is a special relationship between human beings and water. By referring to this historical phase of the use of birthing pools, we offer food for thought in the age of Waterside Hypotheses.
WWW.WOMBECOLOGY.COM
Learning from birthing pools
In the early 1990s, when we became more familiar with the concept of antagonism between hormones of the adrenaline family (stress hormones) and oxytocin (the key hormone in parturition), I started to investigate the management of a common pathological situation in midwifery and obstetrics. It is the ‘failure to progress’ in the middle of cervical dilation, associated with intense lumbar pain. In this case, the pain appears as an obstacle to cervical dilation. I was considering non-pharmacological methods of pain relief. This is how I introduced the concept of ‘lumbar reflexotherapy’, based on the ‘gate control theory of pain’. Intracutaneous injections of sterile water in a precise zone of the lumbar region innervated by the posterior branch of the twelve dorsal nerve can block the visceral pain coming from the contracting uterus.32 I also proposed immersion in water at body temperature as a way to relieve pain, to reduce the level of stress hormones, and thus achieve more effective uterine contractions.
Taking into account the physiological perspective, and also the strong attraction to water expressed by many labouring women, I eventually bought a blue inflatable garden wading pool. Thus began the history of birthing pools in hospitals.33 As soon as the birthing pool was installed new strategies became possible. When a woman in hard labour was demanding painkillers, we had something else to offer than the injection of an analgesic drug (this was before the age of epidural analgesia). We could introduce the mother-to-be to the aquatic birthing room, so that she could observe and hear beautiful blue water filling the pool. The room was painted blue, with dolphins on the walls. From that time the question was no longer: "When will you give me a pain killer?" It was more often than not: "How long does it take to fill the pool?" The first lesson concerned the importance of the time when the woman in labour is anticipating the bath: the dilation of the cervix can already progress dramatically before water immersion—if the aquatic environment is associated with privacy. It is like the sudden release of brakes . We witnessed one of the many magic effects of water on human beings...a profound power that cannot be easily explained with the language of physiologists.34 At the time of the plastic pool (before we installed a solid pool), women were not influenced by the media or by what they read in books about childbirth. Their behaviour was spontaneous and thus we learned about the genuine effects of a water environment. A the typical scenario (with many possible variations) was the case of a woman entering the pool in hard labour around 5 cm, spending an hour or two in water and then feeling the need to get out of the pool when the contractions were becoming less and less effective. This going back to the dry land often induced a short series of irresistible and powerful contractions so that the baby was born within several minutes.
One day, a mother-to-be had not been in water for long when suddenly she had two irresistible contractions and the baby was born before she felt any need to get out of the pool. While giving birth, this woman was really "on another planet". Clearly, in that altered state of consciousness associated with hard labour, she intuitively knew that her baby could be born safely under water. There was no panic. It is as if a deep-rooted knowing could express itself as soon as the intellect and its knowledge was set aside. Such births happened again.34 From that time many journalists, reporters,and photographers were fascinated by babies being born in water. They were indifferent all other aspects of our unconventional practices. After a short period of surprise and even frustration, I concluded that good journalists are experts in Human Nature. They know how to attract the attention of their readers or their viewers. They have this intuitive knowledge that there is a special relationship between human beings and water. By referring to this historical phase of the use of birthing pools, we offer food for thought in the age of Waterside Hypotheses.
Monday, November 09, 2009
Not happy, Julia!
[Pic: Melissa and I hand over some calling cards to the chap who was manning the front desk at Julia Gillard's office thismorning.]
An estimated 350 ordinary people, predominantly mothers and babies and little children, rallied in the heat thismorning outside Julia Gillard's Werribee office.
The message was clear - SHAME on you, Julia! Australia's first female Deputy Prime Minister, and you are allowing medical dominance over childbirth to be written into the laws of this country in an unprecedented way.
A couple of young police persons were in visible attendance from an hour before the rally commenced. I had a chat with them, and gave them some information about the rally and a link to this blog, and thanked them for looking after us. We also noticed an Australian Federal Police car parked near the rally. Two large men (not in uniform) who were standing on the footpath also kept an eye on us. These two men entered Julia's office after the crowd had left.
There was no melee. By midday there were a few crying children - little ones who are not accustomed to being out in the sun, listening to their mummies talking into loud speakers. They were probably wanting some mummy time, snuggled in her lap, and suckling at her breast.
As a member of this community I am outraged that Australian parents and children and midwives should even consider gathering on a public street to voice our concerns. Yet we have been driven to that extreme by a government that is being directed by the powerful medical union, the AMA, who has proudly claimed responsibility for the latest amendment to legislation.
Julia Gillard spoke to midwives in 2005, when she was the shadow health minister, in election mode. In that speech she said:
there are “limited opportunities [for midwives] to practise as primary carers and provide continuity of care to women”
and
“Unless and until the Government is shocked and shamed into realising that Australian women …"
and
“I believe that midwives … are key heath care professionals whose role in the care of women and their babies has yet to be fully realised in the Australian health care system”
Today we have reminded Julia of what she said before the Australian people voted Labor into office.
ps.
We have heard that about 400 rallied outside Kevin Rudd's Morningside (Qld) office, and 200+ outside Tanya Plibersek’s Surry Hills (NSW) office. The WA rally will be held outside Stephen Smith's office at 11.10 am local time.
pps. Perth had about 100 people. Rachel Siewert, Danielle Senini and Sally Westbury addressed the crowd. Very polite federal police attended. Channel 7 and 10 had news crews there. West Australian and Local papers interviewed and photographed the crowd.
For more pictures, please go to the MIPP blog.
Saturday, November 07, 2009
REMINDER: RALLY ON MONDAY
Monday 9 November 2009 from 10.30am (local time)
Rally points:
Brisbane:
Prime Minister
Kevin Rudd’s office
630 Wynnum Road
Morningside Qld 4170
Werribee:
Deputy Prime Minister
Julia Gillard’s office
Shop 2, 36 Synnot Street
Werribee Vic 3030
Sydney:
Minister for the Status of Women
Tanya Plibersek’s office
111-117 Devonshire Street
Surry Hills NSW 2010
Perth: at 11.10am Perth Only
Office of Stephen Smith (most senior Gov member in WA)
953A Beaufort Street
Inglewood WA 6932
[Our calling cards]
If you are unable to attend, please prepare your 'calling card' - a letter to Kevin, Julia, Tanya, or Stephen (or another member of the government), telling them who you are and why you can not accept maternity reform which prevents midwives from practising midwifery in their own right, and prevents women from giving birth in their homes with their chosen midwife attending them. Please email your letter to your midwife or someone else who is going to the rally, and ask them to give it to the MP concerned.
Anyone who would like their calling card to appear on this blog, please email it to joy@aitex.com.au
Rally points:
Brisbane:
Prime Minister
Kevin Rudd’s office
630 Wynnum Road
Morningside Qld 4170
Werribee:
Deputy Prime Minister
Julia Gillard’s office
Shop 2, 36 Synnot Street
Werribee Vic 3030
Sydney:
Minister for the Status of Women
Tanya Plibersek’s office
111-117 Devonshire Street
Surry Hills NSW 2010
Perth: at 11.10am Perth Only
Office of Stephen Smith (most senior Gov member in WA)
953A Beaufort Street
Inglewood WA 6932
[Our calling cards]
If you are unable to attend, please prepare your 'calling card' - a letter to Kevin, Julia, Tanya, or Stephen (or another member of the government), telling them who you are and why you can not accept maternity reform which prevents midwives from practising midwifery in their own right, and prevents women from giving birth in their homes with their chosen midwife attending them. Please email your letter to your midwife or someone else who is going to the rally, and ask them to give it to the MP concerned.
Anyone who would like their calling card to appear on this blog, please email it to joy@aitex.com.au
Friday, November 06, 2009
Thinking about vaginal breech births
I have put a comment about the screening of this video at the MIPP blog.
A point that was only touched on in the discussion after the showing was the disenfranchising and deskilling of midwives in breech births. It has become an obstetric consultant ‘act’, even though every midwife should be ready and competent in spontaneous breech births. Midwife Fiona Hallinan mentioned that Box Hill hospital is setting up consultant cover for breeches – it’s all about defensive medicine. RWH refuses to support a woman’s choice, and staff will bully her into compliance with their wishes to do an elective Caesar. I was told that this is because they can’t be sure someone is competent at all times. And as Lionel Steinberg pointed out, an obstetrician goes against the current ‘gold standard’ at his own risk. The insurance will pay out for a baby’s brain damage in an undiagnosed breech birth where the midwives haven’t got a clue what to do, but won’t support the obstetrician who goes against the rules.
The video ‘A breech in the system’ made the point that the woman was lucky that the obstetrician on call at the time was competent – had learnt about breeches in India and PNG. There was great rejoicing around that fact. It’s tragic that an obstetrician needs to be given ownership of a spontaneous birth that a midwife could just as well have attended.
There was a lot of padding in ‘A breech in the system’. Beautiful underwater footage, lots of Byron Bay alternative hocus pocus – none of which seemed to make any difference. ECV (external cephalic version) got some bad publicity, and it ‘didn’t work’ either!
In the current climate of serious threat to all midwives’ right to practise on our own authority, breech births are a bit of a distraction. This video is good in that it demonstrates spontaneous birth – something we need to value and hold on to.
A point that was only touched on in the discussion after the showing was the disenfranchising and deskilling of midwives in breech births. It has become an obstetric consultant ‘act’, even though every midwife should be ready and competent in spontaneous breech births. Midwife Fiona Hallinan mentioned that Box Hill hospital is setting up consultant cover for breeches – it’s all about defensive medicine. RWH refuses to support a woman’s choice, and staff will bully her into compliance with their wishes to do an elective Caesar. I was told that this is because they can’t be sure someone is competent at all times. And as Lionel Steinberg pointed out, an obstetrician goes against the current ‘gold standard’ at his own risk. The insurance will pay out for a baby’s brain damage in an undiagnosed breech birth where the midwives haven’t got a clue what to do, but won’t support the obstetrician who goes against the rules.
The video ‘A breech in the system’ made the point that the woman was lucky that the obstetrician on call at the time was competent – had learnt about breeches in India and PNG. There was great rejoicing around that fact. It’s tragic that an obstetrician needs to be given ownership of a spontaneous birth that a midwife could just as well have attended.
There was a lot of padding in ‘A breech in the system’. Beautiful underwater footage, lots of Byron Bay alternative hocus pocus – none of which seemed to make any difference. ECV (external cephalic version) got some bad publicity, and it ‘didn’t work’ either!
In the current climate of serious threat to all midwives’ right to practise on our own authority, breech births are a bit of a distraction. This video is good in that it demonstrates spontaneous birth – something we need to value and hold on to.
Wednesday, November 04, 2009
MOTHERBABY FUND 2009
This page will provide an ongoing tally of gifts that are made to global relief and development charities that assist needy women and their children.
I encourage all readers of this blog to join me in this special venture.
Donations are made directly to the chosen charity, and reported here, without identifying the donor. Please choose a charity that you believe is reputable, minimising overhead costs, and transparent in its reporting to donors. I encourage you to consider donations to the charities listed below. This list will be added to as information is provided to me, Joy Johnston begin_of_the_skype_highlighting end_of_the_skype_highlighting [joy@aitex.com.au].
The person(s) who donate money will receive a receipt from the charity, and the gift may be tax deductible. Please send me the information if you want your donation to be included in the MOTHERBABY FUND 2009.
MOTHERBABY FUND 2009
$895.00
Donations since 4 November
$200.00 to TEAR for establishing a women's self-help group
$60.00 to TEAR for training a village health worker/birth attendant
$85.00 to TEAR for HIV care and eduction
$35.00 to TEAR for Literacy Skills
$550.00 to TEAR for community school
$20.00 to TEAR
$20.00 to a local women's refuge
Other charities to consider:
Aboriginal Midwives Trust
World Vision
Christmas Child
Oxfam
Sunday, November 01, 2009
discovering enjoyment in breastfeeding
Of all God's wonderful provisions for a healthy relationship between a mother and her child, breastfeeding is enduring and powerful. It's part of the natural physiological continuum. I have a window sticker on my car that sums it up:
"There's no milk like mum's milk."
Breastfeeding, like normal birth, is by no means an easy option - especially in the early days and weeks of a baby's life.
Recently I visited a new mother who was having difficulies feeding her baby, who was about two weeks old. She was expressing her milk, putting it into a bottle, and giving it as well as some of the artificial powdered stuff to the little bloke.
Today I received an email from that mother.
"I just wanted to write and say a huge THANK YOU for teaching me how to enjoy breast-feeding : )
"I no longer see it as a burden or as a scary thing, but something completely natural and wonderful. I've grown more confident with feeding [BABY] in public and am now keen to take him places with me so that he can explore the world outside! Thank you!
"I'm also looking forward to being able to help other mums in future breastfeed their babies."
In a few simple sentences this mother has told me everything I want to know about their progress. I don't know how often the feeds are, or how many times the new parents get up at night. But I do know that this mother-baby pair have discovered enjoyment in breastfeeding. What's more, the mother is looking forward to sharing this wonderful gift with her peers.
I feel priviliged to have had a small part in this new mother's beautiful transformation.
"There's no milk like mum's milk."
Breastfeeding, like normal birth, is by no means an easy option - especially in the early days and weeks of a baby's life.
Recently I visited a new mother who was having difficulies feeding her baby, who was about two weeks old. She was expressing her milk, putting it into a bottle, and giving it as well as some of the artificial powdered stuff to the little bloke.
Today I received an email from that mother.
"I just wanted to write and say a huge THANK YOU for teaching me how to enjoy breast-feeding : )
"I no longer see it as a burden or as a scary thing, but something completely natural and wonderful. I've grown more confident with feeding [BABY] in public and am now keen to take him places with me so that he can explore the world outside! Thank you!
"I'm also looking forward to being able to help other mums in future breastfeed their babies."
In a few simple sentences this mother has told me everything I want to know about their progress. I don't know how often the feeds are, or how many times the new parents get up at night. But I do know that this mother-baby pair have discovered enjoyment in breastfeeding. What's more, the mother is looking forward to sharing this wonderful gift with her peers.
I feel priviliged to have had a small part in this new mother's beautiful transformation.
Saturday, October 24, 2009
More on caesareans and delayed childbirth - commentary by Judy Cohain
Regarding:
Smith GCS, Cordeaux Y, White IR et al (2008). The effect of delaying childbirth on primary cesarean section rates. PLoS Med 5(7): e144. doi:10.1371/journal.pmed.0050144.
Smith et al goes so far as to use dystocia, undefined by American College of Obstetrics and Gynecology (ACOG) or anyone else except as delayed labor, to make women feel guilty for delaying first childbirth. The authors found that at age 16, women have an average labour of 9.1 hours which rises slowly peaking at 10.4 hours from age 33 and above. The authors sampled myometrial strips obtained from 62 women and claim to have found a reduced degree of spontaneous contraction in older women. They used this supposed difference to define older women as having ‘impaired’ uterine function. This ‘impaired uterine function’ is then theorised to explain why women over 16 have labours that on average last up to 1.3 hours longer, explaining their increased rate of caesarean surgery. The authors did not analyse the reasons women in this study underwent caesarean surgery although as previously stated, the vast majority of caesareans are known to be due to ‘dystocia’. No one knows what would have been the outcomes if women were allowed to labour longer. Instead of the authors defining the arbitrary definition of dystocia as the problem, they blame the extra 1.3 hours that older women take to give birth and define the older uterus as dysfunctional rather than slower. Without evidence that a 1.3 hour longer average labour results in poorer outcomes, the term they use to describe older women as having a ‘dysfunctional’ uterus is, in polite terms, inaccurate. This surely is action bias in its most ageist/sexist form.
from:
Is Action bias one of the Numerous Causes of UnneCesareans? by JS Cohain, in press, MIDIRS Midwifery Digest Dec 2009
N.B. why would women who are in normal shape and state of mind, volunteer to let 'scientists' take strips of muscle from their uterus? Would you?
[Judy Cohain is a midwife in Israel]
Smith GCS, Cordeaux Y, White IR et al (2008). The effect of delaying childbirth on primary cesarean section rates. PLoS Med 5(7): e144. doi:10.1371/journal.pmed.0050144.
Smith et al goes so far as to use dystocia, undefined by American College of Obstetrics and Gynecology (ACOG) or anyone else except as delayed labor, to make women feel guilty for delaying first childbirth. The authors found that at age 16, women have an average labour of 9.1 hours which rises slowly peaking at 10.4 hours from age 33 and above. The authors sampled myometrial strips obtained from 62 women and claim to have found a reduced degree of spontaneous contraction in older women. They used this supposed difference to define older women as having ‘impaired’ uterine function. This ‘impaired uterine function’ is then theorised to explain why women over 16 have labours that on average last up to 1.3 hours longer, explaining their increased rate of caesarean surgery. The authors did not analyse the reasons women in this study underwent caesarean surgery although as previously stated, the vast majority of caesareans are known to be due to ‘dystocia’. No one knows what would have been the outcomes if women were allowed to labour longer. Instead of the authors defining the arbitrary definition of dystocia as the problem, they blame the extra 1.3 hours that older women take to give birth and define the older uterus as dysfunctional rather than slower. Without evidence that a 1.3 hour longer average labour results in poorer outcomes, the term they use to describe older women as having a ‘dysfunctional’ uterus is, in polite terms, inaccurate. This surely is action bias in its most ageist/sexist form.
from:
Is Action bias one of the Numerous Causes of UnneCesareans? by JS Cohain, in press, MIDIRS Midwifery Digest Dec 2009
N.B. why would women who are in normal shape and state of mind, volunteer to let 'scientists' take strips of muscle from their uterus? Would you?
[Judy Cohain is a midwife in Israel]
Thursday, October 22, 2009
Melbourne Midwives' Family Picnic
Saturday 28 November, at Elgar Park, Mont Albert (just off the Eastern Fwy – cnr Elgar Rd and Belmore Rd), 11am-4pm. [See Map of Melbourne]
Please check MIPP blog by 9am that day for alternate plan if weather is unsuitable.
Midwives and our families invite the families we know and serve to join us for a picnic lunch, to celebrate life, and birth, and mothering, and midwifery.
BYO everything – food, picnic rugs, hats, chairs &tables (if you want them), games, and your musical instrument and a song if you like.
Elgar Park has toilets, playground, lots of open space, bush areas, wetlands with boardwalk, walking tracks …
Please pass this message on to others who may be interested.
Joy Johnston
joy@aitex.com.au
04111 90448
PLEASE JOIN WITH ME IN MAKING A GIFT OF THANKS TO GOD FOR OUR CHILDREN
Anyone who would like to contribute to a group gift from TEAR Australia’s catalogue to help some of the world’s poor, such as tree seedlings ($10), or family health care ($40) or training a village health worker/ birth attendant ($60), or setting up a women’s self help group ($200), please contact me. The collection currently stands at $200. I will report back to all who donate to this project. Joy
Please check MIPP blog by 9am that day for alternate plan if weather is unsuitable.
Midwives and our families invite the families we know and serve to join us for a picnic lunch, to celebrate life, and birth, and mothering, and midwifery.
BYO everything – food, picnic rugs, hats, chairs &tables (if you want them), games, and your musical instrument and a song if you like.
Elgar Park has toilets, playground, lots of open space, bush areas, wetlands with boardwalk, walking tracks …
Please pass this message on to others who may be interested.
Joy Johnston
joy@aitex.com.au
04111 90448
PLEASE JOIN WITH ME IN MAKING A GIFT OF THANKS TO GOD FOR OUR CHILDREN
Anyone who would like to contribute to a group gift from TEAR Australia’s catalogue to help some of the world’s poor, such as tree seedlings ($10), or family health care ($40) or training a village health worker/ birth attendant ($60), or setting up a women’s self help group ($200), please contact me. The collection currently stands at $200. I will report back to all who donate to this project. Joy
Wednesday, October 14, 2009
Is the increasing rate of caesarean birth linked to the age of mothers?
An interesting discussion into the rise in caesareans took place on ABC Radio National's Health Report, 12 October. The transcript and the audio are available online.
The research team analysed data collected from all births in Scotland over a period of time, and identified women having an uncomplicated first pregnancy.
Here's a brief excerpt of concluding remarks in the interview:
Gordon Smith: There are a whole number of issues about caesarean section, and I think one of the things I would say it's about like the issues around hysterectomy 20 years ago, for a proportion of women a caesarean section is an extremely helpful and valuable intervention, but I think there is a general concern about it in terms of say health economics, that it's much more expensive to provide a caesarean delivery compared with normal delivery, from a philosophical approach that we should try to encourage normality and for many women we attach quite rightly a real importance to achieving a normal birth, and then there's also concerns about the long-term effects of caesarean section, effects on subsequent pregnancy, where there's certainly increased rates of complications. And particularly one of the things we're seeing now is women who've had high numbers of previous caesarean sections. They are a group of particular concern, because some of the most serious and life-threatening consequences that we see in obstetrics are occurring to women who are coming back with four and five previous caesarean sections where there can be real problems.
Norman Swan: The risk of rupture.
Gordon Smith: Risk of rupture, but also the risk of abnormal insertion of the placenta, particularly what we call placenta praevia where the placenta is in the lower part of the uterus and also what we call morbid adherence of the placenta, where the normal relationship, the way the placenta invades into the muscle is affected by the presence of scar tissue and in fact the placenta over-invades into the wall of the womb which can lead to life-threatening bleeding, which can be difficult to control even under optimal circumstances. So I think caesarean section has many advantages in a certain context, and particularly for those women who aren't planning many, many future births, but I think there's going to be an ultimate long-term consequence of increased rates of caesarean section which will become increasingly apparent over the next few decades.
Reference:
Smith GCS et al. The effect of delaying childbirth on primary caesarean section rates. PLoS Medicine 2008;5(7):e144
[Gordon Smith is Professor of Obstetrics and Gynaecology at the University of Cambridge.]
How does this sort of discussion inform a midwife, or a mother anticipating birth?
"Think globally"
Epidemiological research seeks to tease out information from large sources of data. The information we glean from this sort of research helps us to understand the big picture, but it does not influence the way we approach the maternity care of an individual woman. The big picture concern that Professor Smith has identified is that the women today who are having caesarean births will, in future births, face an increased risk of life-threatening haemorrhage.
The obvious conclusion that I draw is that regardless of the age of a woman, or the 'risk' of needing caesarean, the maternity service has a duty of care to do all it can to promote and support normal birth, and to use caesarean surgery judiciously.
"Act locally"
The midwife's professional advice to a woman in her care is finely tuned to that individual woman. The midwife takes into account the woman's whole self - physical, social, psychological, spiritual ... wellbeing, as well as outside factors such as the weather conditions that may have an impact on events. The woman who is working in partnership with a trusted midwife also has knowledge about herself that she shares with her midwife as her time to give birth approaches.
Every woman giving birth has elements of her situation that may enhance or detract from her chances of proceeding with physiologically normal birth. The skilled midwife acts to promote normal birth, taking into account the realities and risks, as well as the advantages that apply to an individual mother.
The research team analysed data collected from all births in Scotland over a period of time, and identified women having an uncomplicated first pregnancy.
Here's a brief excerpt of concluding remarks in the interview:
Gordon Smith: There are a whole number of issues about caesarean section, and I think one of the things I would say it's about like the issues around hysterectomy 20 years ago, for a proportion of women a caesarean section is an extremely helpful and valuable intervention, but I think there is a general concern about it in terms of say health economics, that it's much more expensive to provide a caesarean delivery compared with normal delivery, from a philosophical approach that we should try to encourage normality and for many women we attach quite rightly a real importance to achieving a normal birth, and then there's also concerns about the long-term effects of caesarean section, effects on subsequent pregnancy, where there's certainly increased rates of complications. And particularly one of the things we're seeing now is women who've had high numbers of previous caesarean sections. They are a group of particular concern, because some of the most serious and life-threatening consequences that we see in obstetrics are occurring to women who are coming back with four and five previous caesarean sections where there can be real problems.
Norman Swan: The risk of rupture.
Gordon Smith: Risk of rupture, but also the risk of abnormal insertion of the placenta, particularly what we call placenta praevia where the placenta is in the lower part of the uterus and also what we call morbid adherence of the placenta, where the normal relationship, the way the placenta invades into the muscle is affected by the presence of scar tissue and in fact the placenta over-invades into the wall of the womb which can lead to life-threatening bleeding, which can be difficult to control even under optimal circumstances. So I think caesarean section has many advantages in a certain context, and particularly for those women who aren't planning many, many future births, but I think there's going to be an ultimate long-term consequence of increased rates of caesarean section which will become increasingly apparent over the next few decades.
Reference:
Smith GCS et al. The effect of delaying childbirth on primary caesarean section rates. PLoS Medicine 2008;5(7):e144
[Gordon Smith is Professor of Obstetrics and Gynaecology at the University of Cambridge.]
How does this sort of discussion inform a midwife, or a mother anticipating birth?
"Think globally"
Epidemiological research seeks to tease out information from large sources of data. The information we glean from this sort of research helps us to understand the big picture, but it does not influence the way we approach the maternity care of an individual woman. The big picture concern that Professor Smith has identified is that the women today who are having caesarean births will, in future births, face an increased risk of life-threatening haemorrhage.
The obvious conclusion that I draw is that regardless of the age of a woman, or the 'risk' of needing caesarean, the maternity service has a duty of care to do all it can to promote and support normal birth, and to use caesarean surgery judiciously.
"Act locally"
The midwife's professional advice to a woman in her care is finely tuned to that individual woman. The midwife takes into account the woman's whole self - physical, social, psychological, spiritual ... wellbeing, as well as outside factors such as the weather conditions that may have an impact on events. The woman who is working in partnership with a trusted midwife also has knowledge about herself that she shares with her midwife as her time to give birth approaches.
Every woman giving birth has elements of her situation that may enhance or detract from her chances of proceeding with physiologically normal birth. The skilled midwife acts to promote normal birth, taking into account the realities and risks, as well as the advantages that apply to an individual mother.
Monday, October 12, 2009
who to trust?
"You need to decide now who to trust, Jenny. Me, or the hospital. I am going to offer you an alternative plan, which is quite different from the plan that has been offered by the hospital."
A case study.
A case study.
Friday, October 09, 2009
Thinking about the midwife
This past week I have been privileged to be midwife for two primiparous mothers who have given birth in their own homes. In attending these births I have worked alongside two younger midwives whose employment has been facilitated under my new private midwifery service model.
I won't tell the stories of these two beautiful births here. The focus of my reflections today is the midwives. Women who commit themselves to other women, and whose personal lives, families, and plans are interrupted from time to time, unpredictably, so that a baby can be born.
We midwives could not do what we do if it weren't for other members of our community, sometimes husband, or sister in law, or parent, or good friend, who is delighted to be the backup parent so that a midwife can go out for a birth. Midwives who are also mothers can only provide this level of full commitment to another mother when we know that our own children are safe and happy.
A midwife has a sister in law, who is a wonderfully energetic person who embraces her young nieces and nephews, so that their mother is happy to go out to a birth. The sister in law goes out of her way to give the children an especially happy time. When mummy comes home they are full of stories, and they have plenty to show, including the poster paint on their clothes as well as the pictures they have painted.
A midwife has a husband, who is deeply in tune with the moment by monent unpredictability that his life partner faces. He provides a cheerful and positive tone when answering the phone, and welcomes each new life as if the little one were a member of his own family. He recognises his mate's need for sleep after a night out, and makes the home a quiet and nurturing space for her. He knows when she would like a coffee, or when a relaxing cup of chamomile tea would be better.
A midwife has children, whom she nursed at her breast and nurtured throughout infancy. She has learnt a great deal of her midwifery from her own mothering experience, learning how to recognise a baby's cues, and how to encourage the little one to achieve. As the children grow, the emerging adult within the young child sees mummy in a different light. She is a midwife, who cares about others while planning and providing for her own. She has ambition to develop professionally. The emerging adult within the young child learns to admire the woman who previously was the personification of comfort and safety. From time to time the child needs that comfort and safety from mummy, and is reassured that those arms are as ready to embrace, and that the midwife is also in every aspect a mother. At times the child will be heard repeating advice about health promotion in pregnancy, or caring for a baby, or breastfeeding - and the mother recognises her own voice in those words of wisdom.
A midwife has friends, who respect her need to miss a tennis morning from time to time, or to be excused from another commitment at the last moment.
The whole community around a midwife supports and affirms her, enabling her to carry out the primally simple yet profound role of being 'with woman'. It's as though there is something of midwifery deep within the heart of each one, valuing the birth of a child above the small and relatively insignificant detail of their own plans at that time.
It takes a whole community - a village - to support a midwife, who in turn enables a mother to give birth to her child with confidence and strength. And the cycle continues, as a community moves in to support that family as they nurture that child.
Thankyou to the communities who support the midwives who are 'with woman' today.
I won't tell the stories of these two beautiful births here. The focus of my reflections today is the midwives. Women who commit themselves to other women, and whose personal lives, families, and plans are interrupted from time to time, unpredictably, so that a baby can be born.
We midwives could not do what we do if it weren't for other members of our community, sometimes husband, or sister in law, or parent, or good friend, who is delighted to be the backup parent so that a midwife can go out for a birth. Midwives who are also mothers can only provide this level of full commitment to another mother when we know that our own children are safe and happy.
A midwife has a sister in law, who is a wonderfully energetic person who embraces her young nieces and nephews, so that their mother is happy to go out to a birth. The sister in law goes out of her way to give the children an especially happy time. When mummy comes home they are full of stories, and they have plenty to show, including the poster paint on their clothes as well as the pictures they have painted.
A midwife has a husband, who is deeply in tune with the moment by monent unpredictability that his life partner faces. He provides a cheerful and positive tone when answering the phone, and welcomes each new life as if the little one were a member of his own family. He recognises his mate's need for sleep after a night out, and makes the home a quiet and nurturing space for her. He knows when she would like a coffee, or when a relaxing cup of chamomile tea would be better.
A midwife has children, whom she nursed at her breast and nurtured throughout infancy. She has learnt a great deal of her midwifery from her own mothering experience, learning how to recognise a baby's cues, and how to encourage the little one to achieve. As the children grow, the emerging adult within the young child sees mummy in a different light. She is a midwife, who cares about others while planning and providing for her own. She has ambition to develop professionally. The emerging adult within the young child learns to admire the woman who previously was the personification of comfort and safety. From time to time the child needs that comfort and safety from mummy, and is reassured that those arms are as ready to embrace, and that the midwife is also in every aspect a mother. At times the child will be heard repeating advice about health promotion in pregnancy, or caring for a baby, or breastfeeding - and the mother recognises her own voice in those words of wisdom.
A midwife has friends, who respect her need to miss a tennis morning from time to time, or to be excused from another commitment at the last moment.
The whole community around a midwife supports and affirms her, enabling her to carry out the primally simple yet profound role of being 'with woman'. It's as though there is something of midwifery deep within the heart of each one, valuing the birth of a child above the small and relatively insignificant detail of their own plans at that time.
It takes a whole community - a village - to support a midwife, who in turn enables a mother to give birth to her child with confidence and strength. And the cycle continues, as a community moves in to support that family as they nurture that child.
Thankyou to the communities who support the midwives who are 'with woman' today.
Sunday, October 04, 2009
*Framework* - the latest buzzword
There has been a lot of talk in midwifery circles lately about a *framework* that will enable eligible midwives to practise privately within the new environment promised under the government's package of midwifery reform. We have been informed that an "advanced midwifery credentialing framework" will be required for eligible midwives, who will also be "appropriately qualified and experienced"; "working in collaboration with doctors". [continued]
Wednesday, September 30, 2009
The safety of home birth: Is the evidence good enough?
There have been three recent papers published, giving strong evidence of the safety and acceptability of homebirth: a large study from the Netherlands (deJonge et al 2009), and two Canadian studies (from Ontario, Hutton et al 2009 and from British Columbia, Janssen et al 2009).
The paper by Patricia Janssen PHD and colleagues (link above) reports on Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. The study included all planned homebirths attended by registered midwives from 1 Jan 2000 to 31 Dec 2004 in British Columbia, Canada. The interpretation of the data is that "Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared withplanned hospital birth attended by a midwife or physician." (p337)
Similar findings have been reported in the other 2009 studies.
A Commentary by two Melbourne midwife academics, Helen McLachlan PhD and Della Forster PhD, titled The safety of home birth: Is the evidence good enough? was published in the same journal. My curiosity was sparked. Helen and Della have been active researchers on the local maternity scene, and from memory their work has included randomised controlled trials of breastfeeding interventions, and some on team midwifery. But I haven't seen anything from either of them about homebirth in the past.
The commentary gives wise, predictable thoughts about the debate surrounding homebirth. It gives a good listing of current references on homebirth.
The fashionable refrain from a section of the health/medical research community is that the evidence is not good enough unless it was obtained after randomisation of subjects. An interesting discussion is entered into, and the authors come up with the conclusion that "Better evidence on the safety of home birth is needed, ideally from randomized controlled trials".
The paper quotes professional discussion around the reported finding that an attempt in the Netherlands to conduct a randomised controlled trial was aborted, because women "were not willing to be randomly assigned to home versus hospital birth and declined participation because they had already chosen their place of birth."
This is a no-brainer (imho)! Of course. Yet the authors go on to discuss the importance of high quality evidence, as if another group of women - possibly those in public maternity care in Melbourne - will think differently. Why would they? How much evidence do we need in order to give a tick to spontaneous, unmedicated, un-interfered-with birth?
I can imagine the outcry if someone suggested seriously that we really don't know if conception of babies is safer in the hospital laboratory or in the home. Therefore a randomised controlled trial needs to be conducted. All eligible potential parents are to be randomly allocated to either treatment or control.
It might be difficult to enlist participants in this reseach, might it not?
Some of those who read this blog will have given birth at home; some are midwives who attend homebirths; while others are interested onlookers. If you have any knowledge of the terrain of physiologically normal birth, either in hospital or in the home, you will probably agree with me that the mother and all her support team need to be intentional about protecting normal birth. There is the intention to actively choose to work in harmony with your body; to be ready for and accept the work your body and mind must do; and to actively make decisions as events unfold. This is not the stuff of managed care and research protocols. It requires the deep and intuitive knowledge that a woman has because she is a woman, and it is best facilitated when the labouring woman knows and trusts the midwife who is responsible for professional decision making at the time.
The paper by Patricia Janssen PHD and colleagues (link above) reports on Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. The study included all planned homebirths attended by registered midwives from 1 Jan 2000 to 31 Dec 2004 in British Columbia, Canada. The interpretation of the data is that "Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared withplanned hospital birth attended by a midwife or physician." (p337)
Similar findings have been reported in the other 2009 studies.
A Commentary by two Melbourne midwife academics, Helen McLachlan PhD and Della Forster PhD, titled The safety of home birth: Is the evidence good enough? was published in the same journal. My curiosity was sparked. Helen and Della have been active researchers on the local maternity scene, and from memory their work has included randomised controlled trials of breastfeeding interventions, and some on team midwifery. But I haven't seen anything from either of them about homebirth in the past.
The commentary gives wise, predictable thoughts about the debate surrounding homebirth. It gives a good listing of current references on homebirth.
The fashionable refrain from a section of the health/medical research community is that the evidence is not good enough unless it was obtained after randomisation of subjects. An interesting discussion is entered into, and the authors come up with the conclusion that "Better evidence on the safety of home birth is needed, ideally from randomized controlled trials".
The paper quotes professional discussion around the reported finding that an attempt in the Netherlands to conduct a randomised controlled trial was aborted, because women "were not willing to be randomly assigned to home versus hospital birth and declined participation because they had already chosen their place of birth."
This is a no-brainer (imho)! Of course. Yet the authors go on to discuss the importance of high quality evidence, as if another group of women - possibly those in public maternity care in Melbourne - will think differently. Why would they? How much evidence do we need in order to give a tick to spontaneous, unmedicated, un-interfered-with birth?
I can imagine the outcry if someone suggested seriously that we really don't know if conception of babies is safer in the hospital laboratory or in the home. Therefore a randomised controlled trial needs to be conducted. All eligible potential parents are to be randomly allocated to either treatment or control.
It might be difficult to enlist participants in this reseach, might it not?
Some of those who read this blog will have given birth at home; some are midwives who attend homebirths; while others are interested onlookers. If you have any knowledge of the terrain of physiologically normal birth, either in hospital or in the home, you will probably agree with me that the mother and all her support team need to be intentional about protecting normal birth. There is the intention to actively choose to work in harmony with your body; to be ready for and accept the work your body and mind must do; and to actively make decisions as events unfold. This is not the stuff of managed care and research protocols. It requires the deep and intuitive knowledge that a woman has because she is a woman, and it is best facilitated when the labouring woman knows and trusts the midwife who is responsible for professional decision making at the time.
Tuesday, September 29, 2009
my summary of active labour and birthing
Labour and birthing is as individual as we are ourselves. I have made this simple summary to assist with discussion and planning, especially for a first birth. You can click on the picture to enlarge it, and if you Right-click you will be able to save it to your computer and print it out.
Please contact me if you have any questions. joy@aitex.com.au
Thursday, September 17, 2009
'Drive-through' birthing
Several followers of this blog have asked me how the mother and her twins are progressing, since their story was shared a few weeks ago.
I have the mother's permission to share with you the news of spontaneous labour and birth of these two babies. Our hearts are full of praise to God the giver and sustainer of life.
Labour commenced at about 7am, and was stronger than what the mother was used to for any of her previous births. We went to Box Hill hospital, and the obstetrician who had supported the plan for vaginal birth (twins, first breech) came in and worked with us.
Membranes ruptured spontaneously for Twin A, who progressed quickly to breech vaginal birth. Baby experienced some respiratory distress for most of the following hour, and we are thankful that the paediatrician kept the baby in the birth room after special request.
Twin B had turned to cephalic. Mother gave birth to the second baby about an hour after the first.
The family went home a few hours after the birth. Mother called it 'Drive through' birthing.
I have told this story as an example of a complex decision making process between woman, midwife, and hospital - without bullying or coercion, even though the 'hospital' advised elective caesarean surgery. I am glad I was able to work with the hospital in this birth, disagreeing with expert advice at times, and supporting the woman in her desire to give birth when her time was accomplished.
There is no 'one size fits all' in birthing. These births included some features which are categorised 'high risk'. Those risks were present, in slightly different ways, regardless of the birth plan. The plan to proceed under natural physiological systems was made after considering the risks and benefits of spontaneous birthing, and the alternative - planned, elective surgery. Another alternative was to change the plan at some stage in the labour, but that option was not needed.
With the benefit of hindsight I am sure that there was no better way to negotiate the uncharted and unpredictable journey of these births. In fact I think if there had been delays – such as epidural, stirrups, or a trip to operating theatre, the story could have been very different. The mother knew her babies needed to be born, and she just got down to the job of birthing – something she is very good at.
[For the birth plan, click here.]
I have the mother's permission to share with you the news of spontaneous labour and birth of these two babies. Our hearts are full of praise to God the giver and sustainer of life.
Labour commenced at about 7am, and was stronger than what the mother was used to for any of her previous births. We went to Box Hill hospital, and the obstetrician who had supported the plan for vaginal birth (twins, first breech) came in and worked with us.
Membranes ruptured spontaneously for Twin A, who progressed quickly to breech vaginal birth. Baby experienced some respiratory distress for most of the following hour, and we are thankful that the paediatrician kept the baby in the birth room after special request.
Twin B had turned to cephalic. Mother gave birth to the second baby about an hour after the first.
The family went home a few hours after the birth. Mother called it 'Drive through' birthing.
I have told this story as an example of a complex decision making process between woman, midwife, and hospital - without bullying or coercion, even though the 'hospital' advised elective caesarean surgery. I am glad I was able to work with the hospital in this birth, disagreeing with expert advice at times, and supporting the woman in her desire to give birth when her time was accomplished.
There is no 'one size fits all' in birthing. These births included some features which are categorised 'high risk'. Those risks were present, in slightly different ways, regardless of the birth plan. The plan to proceed under natural physiological systems was made after considering the risks and benefits of spontaneous birthing, and the alternative - planned, elective surgery. Another alternative was to change the plan at some stage in the labour, but that option was not needed.
With the benefit of hindsight I am sure that there was no better way to negotiate the uncharted and unpredictable journey of these births. In fact I think if there had been delays – such as epidural, stirrups, or a trip to operating theatre, the story could have been very different. The mother knew her babies needed to be born, and she just got down to the job of birthing – something she is very good at.
[For the birth plan, click here.]
Tuesday, September 15, 2009
thoughts on the afterbirth
The birth of the placenta or 'afterbirth' is known as the Third Stage or S3.
Midwives who promote normal birth are usually confident to proceed under physiological conditions through the third stage, working in harmony with the mother's natural birthing processes. The elements of physiological S3 include trust between the woman and her known midwife who is professionally responsible for conducting the birth, attention to a safe, non-stimulating birthing environment, cord not clamped prior to cessation of all pulsation, uninterrupted skin to skin contact between baby and mother - all following the spontaneous unmedicated birthing of a healthy baby by a healthy mother. The baby's instinctive movements in seeking the breast enhance the natural production of oxytocin, and the baby's pressure on the mother's abdomen encourages contraction of the mother's womb, ensuring the functioning of living ligatures within the uterine muscle wall at the placental site.
Midwives attending homebirths use oxytocics when clinically indicated.
[The attached tables show the rate of pph for homebirth mothers in Victoria each year 2002-2007. These tables do not indicate severity or degree of morbidity.]
Hospitals in Australia strongly promote active management of S3. This involves injection of a synthetic oxytocic, with or without an ergot alkaloid, soon after the birth of the baby, causing strong contraction of the uterine muscle. When there are signs of placental separation (cessation of pulsation and lengthening of the cord, and sometimes blood loss), the midwife or doctor exerts controlled traction on the cord while guarding suprapubically with the other hand, until the placenta and membranes have been delivered.
Postpartum haemorrhage (pph) is a serious and life threatening condition, which is one of the main causes of preventable maternal death globally. The International Confederation of Midwives statement on pph includes instructions for active management of S3.
[Click on the picture to enlarge - Summary of a paper by Carolyn Hastie and Kathleen Fahy, 'Optimising psychophysiology in third stage of labour: Theory applied to practice'. Women and Birth (2009) 22, 89-96. Australian College of Midwives.]
Efforts by midwives to describe a physiological approach to S3 underline the need for research into the effectiveness of such midwifery care. A recent paper by Hastie and Fahy (2009) [first page scanned above] reviews literature, defines key terms, and presents a theoretical framework of Midwifery Guardianship applied to the third stage. This paper adds to the writings of Michel Odent and others in the past couple of decades, exploring and explaining the neurophysiology of unmedicated, normal birth.
There is no 'one size fits all' in maternity. Each woman and each baby are individual, and decision making is an active process that continues throughout the episode of care. The midwife's toolkit includes the skill and knowledge to promote normal birth, and to work in harmony with the natural processes, when that is likely to lead to the best possible outcomes. The midwife is also able to intervene in a timely and appropriate manner, using current strategies that are supported by contemporary evidence, and critically reflecting on practice in an effort to continually learn and improve maternity care for mothers and babies.
Midwives who promote normal birth are usually confident to proceed under physiological conditions through the third stage, working in harmony with the mother's natural birthing processes. The elements of physiological S3 include trust between the woman and her known midwife who is professionally responsible for conducting the birth, attention to a safe, non-stimulating birthing environment, cord not clamped prior to cessation of all pulsation, uninterrupted skin to skin contact between baby and mother - all following the spontaneous unmedicated birthing of a healthy baby by a healthy mother. The baby's instinctive movements in seeking the breast enhance the natural production of oxytocin, and the baby's pressure on the mother's abdomen encourages contraction of the mother's womb, ensuring the functioning of living ligatures within the uterine muscle wall at the placental site.
Midwives attending homebirths use oxytocics when clinically indicated.
[The attached tables show the rate of pph for homebirth mothers in Victoria each year 2002-2007. These tables do not indicate severity or degree of morbidity.]
Hospitals in Australia strongly promote active management of S3. This involves injection of a synthetic oxytocic, with or without an ergot alkaloid, soon after the birth of the baby, causing strong contraction of the uterine muscle. When there are signs of placental separation (cessation of pulsation and lengthening of the cord, and sometimes blood loss), the midwife or doctor exerts controlled traction on the cord while guarding suprapubically with the other hand, until the placenta and membranes have been delivered.
Postpartum haemorrhage (pph) is a serious and life threatening condition, which is one of the main causes of preventable maternal death globally. The International Confederation of Midwives statement on pph includes instructions for active management of S3.
[Click on the picture to enlarge - Summary of a paper by Carolyn Hastie and Kathleen Fahy, 'Optimising psychophysiology in third stage of labour: Theory applied to practice'. Women and Birth (2009) 22, 89-96. Australian College of Midwives.]
Efforts by midwives to describe a physiological approach to S3 underline the need for research into the effectiveness of such midwifery care. A recent paper by Hastie and Fahy (2009) [first page scanned above] reviews literature, defines key terms, and presents a theoretical framework of Midwifery Guardianship applied to the third stage. This paper adds to the writings of Michel Odent and others in the past couple of decades, exploring and explaining the neurophysiology of unmedicated, normal birth.
There is no 'one size fits all' in maternity. Each woman and each baby are individual, and decision making is an active process that continues throughout the episode of care. The midwife's toolkit includes the skill and knowledge to promote normal birth, and to work in harmony with the natural processes, when that is likely to lead to the best possible outcomes. The midwife is also able to intervene in a timely and appropriate manner, using current strategies that are supported by contemporary evidence, and critically reflecting on practice in an effort to continually learn and improve maternity care for mothers and babies.
Monday, September 14, 2009
monthly review
Thismorning I have written my 'Monthly review' in the countdown to 1 July 2010.
I am not trying to sugar-coat anything - the future still looks bleak for independent midwives and for the women who we care for. I hope that by tracking the progress of the so called 'reforms', we will have hope that solutions can be found. Australians do have a belief in fairness and equality.
[Photo: That's me and Noel, with our first baby, the beautiful Miriam. If you look through her FB photos, you might even see the 70's kaftan on her!]
I am not trying to sugar-coat anything - the future still looks bleak for independent midwives and for the women who we care for. I hope that by tracking the progress of the so called 'reforms', we will have hope that solutions can be found. Australians do have a belief in fairness and equality.
[Photo: That's me and Noel, with our first baby, the beautiful Miriam. If you look through her FB photos, you might even see the 70's kaftan on her!]
Friday, September 11, 2009
What will Medicare rebates mean?
A guest editorial 'Medicare rebates for midwives: An analysis of the 2009/2010 Federal Budget' appears in the September issue of the Journal of the Australian College of Midwives [to read more, click here]
...
Medicare fragments care into 'items' - fragments a woman into prenatal, intrapartum, and postnatal care, as most Australian women today experience. Medicare causes buck-passing between federal and state health departments.
...
Holistic primary maternity care by comparison is woman-centred, meaning that the pregnant woman/mother-baby dyad are central throughout the continuum of care. Midwives providing woman-centred care work with caseloads, or at the very least in small group practices. Notions of partnership between a woman and her known midwife, promotion of normal birth, and preventative measures - all of which are fundamental elements in the international definition of the midwife (ICM 2005), are nigh impossible in fragmented models of MEDI-care.
...
BTW
Privately practising midwives have been told that the Minister is concerned at the lack of support (from us) for the maternity reform process.
I have to say from my persptective the feeling's mutual.
We're back to Alice's adventures in Wonderland - "curiouser and curiouser!"
...
Medicare fragments care into 'items' - fragments a woman into prenatal, intrapartum, and postnatal care, as most Australian women today experience. Medicare causes buck-passing between federal and state health departments.
...
Holistic primary maternity care by comparison is woman-centred, meaning that the pregnant woman/mother-baby dyad are central throughout the continuum of care. Midwives providing woman-centred care work with caseloads, or at the very least in small group practices. Notions of partnership between a woman and her known midwife, promotion of normal birth, and preventative measures - all of which are fundamental elements in the international definition of the midwife (ICM 2005), are nigh impossible in fragmented models of MEDI-care.
...
BTW
Privately practising midwives have been told that the Minister is concerned at the lack of support (from us) for the maternity reform process.
I have to say from my persptective the feeling's mutual.
We're back to Alice's adventures in Wonderland - "curiouser and curiouser!"
Thursday, September 10, 2009
waiting
Waiting is one of those basic requirements for normal physiological birth.
A mother who wants normal birth has to accept it, and a midwife who attends normal birth has to also.
In our organised world, with clocks and appointments and deadlines, waiting for the right time can be a challenge. You are feeling full and heavy. You go for a walk in the evening, and your womb is becoming very tight. You wonder if the baby will come tonight? You wake up in the morning - nothing happened! "Don't be disappointed," you say to yourself. "Baby will come at the right time." Then one morning you wake up and wipe away a bit of blood stained show. Aha! You know something is happening in there. Trying not to be too eager, you do those few last minute jobs that need to be done. You notice that the air feels different today. What a wonderful day to give birth to this precious little one.
I remember these beautifully deep feelings as I wait, this time as the midwife, the older woman, for a young woman to tell me she is ready to give birth.
The phenomenon of waiting for a baby to be born is as old as human existence. Many times as a child I heard the old language of the King James translation of the Bible, in the Christmas story. "Elizabeth's full time came that she should be delivered; and she brought forth a son." (Luke 1:57) "And so it was, that, while they were there, the days were accomplished that she [Mary] should be delivered. And she brought forth her firstborn son ..." (Luke 2:6,7)
Elizabeth's 'full time' came; Mary's 'days were accomplished': and they both 'brought forth' their children. Waiting for the time is in a sense passive, then the time comes for actively doing the job of 'bringing forth'. The women's knowledge passed down over millenia in these simple stories has informed my birth-giving, and my midwifery practice.
When anticipating physiological birth we experience the waiting as part of our nesting. I make the distinction here, because the only person who can do the physiological work of nesting, waiting, labouring, and birthing, is THE woman. Just as nesting can be interrupted by a sense of handing over to the 'expert', the waiting is also interfered with, deep in the mind of the woman who is unwilling to work with her body in birthing, who has given up her ability to reach her full time, to accomplish her days.
It is no wonder that this one may also experience difficulty in 'bringing forth' the child.
A mother who wants normal birth has to accept it, and a midwife who attends normal birth has to also.
In our organised world, with clocks and appointments and deadlines, waiting for the right time can be a challenge. You are feeling full and heavy. You go for a walk in the evening, and your womb is becoming very tight. You wonder if the baby will come tonight? You wake up in the morning - nothing happened! "Don't be disappointed," you say to yourself. "Baby will come at the right time." Then one morning you wake up and wipe away a bit of blood stained show. Aha! You know something is happening in there. Trying not to be too eager, you do those few last minute jobs that need to be done. You notice that the air feels different today. What a wonderful day to give birth to this precious little one.
I remember these beautifully deep feelings as I wait, this time as the midwife, the older woman, for a young woman to tell me she is ready to give birth.
The phenomenon of waiting for a baby to be born is as old as human existence. Many times as a child I heard the old language of the King James translation of the Bible, in the Christmas story. "Elizabeth's full time came that she should be delivered; and she brought forth a son." (Luke 1:57) "And so it was, that, while they were there, the days were accomplished that she [Mary] should be delivered. And she brought forth her firstborn son ..." (Luke 2:6,7)
Elizabeth's 'full time' came; Mary's 'days were accomplished': and they both 'brought forth' their children. Waiting for the time is in a sense passive, then the time comes for actively doing the job of 'bringing forth'. The women's knowledge passed down over millenia in these simple stories has informed my birth-giving, and my midwifery practice.
When anticipating physiological birth we experience the waiting as part of our nesting. I make the distinction here, because the only person who can do the physiological work of nesting, waiting, labouring, and birthing, is THE woman. Just as nesting can be interrupted by a sense of handing over to the 'expert', the waiting is also interfered with, deep in the mind of the woman who is unwilling to work with her body in birthing, who has given up her ability to reach her full time, to accomplish her days.
It is no wonder that this one may also experience difficulty in 'bringing forth' the child.
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