What should we eat in pregnancy?

or the other question, what should we not eat?

I often counsel women to eat well. Eat the best food you can access.

Here's a blog with some good advice. (BTW I have no idea what link there is between phlebotomy - taking blood from veins - with a healthy diet in pregnancy.)

It's a good list. You'd have to be a pretty fussy eater not to be able to satisfy yourself from this.

Have a look at the list, and let me know if your favourite is not included. One I would add is dates. They are good, and take care of sluggish bowels at the same time. Anyone watching sugar intake would need to limit the number of dates you eat: they are very sweet.


You may also enjoy checking out the Food Standards Australia and New Zealand (FSANZ) website page Thinking about getting pregnant in 2010 – vital information about what's good to eat and drink.

Also the brochure
and the web videos
and translations

Babies who need to be born at night

I was heading West along Burwood Highway in the morning traffic at about 8am, coming up to Springvale Road about 5 minutes from home when the dreadful realisation hit me in slow motion. I was heading for a post.

A near miss, I am thankful to report.

But this is an experience which is an integral part of the life of any midwife who accepts the need of women in her care to come into spontaneous labour, at any time of the day or night. The small number of midwives who practise privately in my part of the world, and the small number of women who plan homebirth, adds distance to the midwife's work terrain. A midwife has to accept travel: our 'village' is a virtual space that links the homes and lives of our clients with our own.

Those micro-second sleeps can kill. The risk potential is increased by the fact that I have a bottle of oxygen in the boot of the car, and other road users could also be at risk of fire in a collision.

The scenario about which I am reflecting now had several points of increased risk that were specific to this particular birth: I had been called out before midnight, and the mother had given birth around 5 am. The home was about 50 minutes' drive from my home. I followed my usual precautions for driving after a night's work: slowly eating an apple to keep some energy going into my body; listening to the radio; having the fan blow on my face ... After the 'scare' I phoned Noel and we talked until I drove into our yard.

I have no way of predicting which mothers will labour and give birth at night, and I discourage my clients from trying to 'know' this. One mother told me her five children had all been born in daylight hours. Her sixth was not!


This risk of falling asleep at the wheel is not about private practice or home birth. I remember a similar near miss about 25 years ago, when I was driving home after a night shift at the Women's hospital. That experience prompted me to explore ways of keeping my mind active and functioning when driving home after a 'night out'.

What have I learnt from this experience?

When I encounter combined risk factors of distance and sleep deprivation after a birth, I will consider other ways of getting home. This could include a taxi, or another person (who has slept the night) driving, or finding a place to sleep for a few hours before heading home.


I hope this post supports other midwives in their own understanding of our work, and planning for our own safety as well as that of mothers and babies in our care.

"We are dealing with human biology, so ...

... inevitably things will not always go to plan."

This statement is attributed to Professor Euan Wallace, head of obstetric services at Southern Health (Melbourne) in a recent special report, 'Birth Pains' in the Age.


This seemingly innocuous comment by a respected obstetrician is in fact a significant example of a major difference in the philosophy of obstetric/medical maternity care, compared with midwife led maternity care.

It's an interesting perspective.
"inevitably" - there's nothing you can do about the inevitable
"things will not always go to plan" - nothing specific to human biology there!


My comment would be, "We are dealing with human biology (in birth), so our skills and systems need to be finely tuned to working with, and not against, the natural physiological process."


Medically managed maternity care treats the birthing woman+child as a potential disaster area. Strict surveillance is relied upon, using technology rather than 'fallible' human feelings. As the woman was told in Monty Python's classic 'The Meaning of Life', she can't do anything, because "You're not qualified."

It is no wonder, under these conditions, that human biology in childbearing can not be trusted.


The midwife who is skilled in promoting and protecting normal physiological (biological) processes in the birthing continuum engages in a partnership with the woman+child/ mother+baby, and seeks to work in harmony with human biology. This midwife knows that on occasion "things will not always go to plan-A", and has plan-B within reach. But the midwife does not have a defeatist attitude: there is nothing inevitable at all about the change of plans from A to B. That's just the way it works.

In childbearing we are dealing with human life, at its most basic and most rewarding.

What does the new year have on offer for midwives?

And the linked question is, what does the new year have in store for women and families who want to access professional midwifery services?

I don't have time today, on the eve of the new year, to explore these questions at any depth. But I do want to encourage anyone who is contemplating the birth of a baby to be strong and value your knowledge of pregnancy and birth as quintessential events in a woman's life; a series of events that have powerful social and personal implications in your family and community.


What does the new year have on offer for midwives?

For me, I am looking forward to:

* being 'with woman', learning to work with and share trust with the women and their families, as we prepare for birth, work in harmony with and engage with the amazing God-given natural ability of a woman to give birth and nurture her infant.

* being a part of a complex professional team that provides expert maternity care for mothers and babies who experience complication and illness in their pregnancy-birth continuum.

* being a teacher and mentor to other midwives and women who seek to understand authentic midwifery.

* being a part of the midwifery profession, working through challenges as they arise in a time of major reform by both federal and state government in the regulation of midwives.

* being a life-long learner, willing to reflect on each experience, and apply the learning to my life.

* giving love to, and receiving love from, those around me.


And, what does the new year have in store for women and families who want to access professional midwifery services?


This will be dependent on where those women live, and what they are able to access. The standard options accessible to women in most Australian cities and large towns may provide maternity services, prenatal checks, hospital bookings and medically managed births, without any understanding of promotion of health through working in harmony with the woman's own healthy natural processes.

Basic midwifery care that is matched to each woman, with the midwife being committed to being the coordinator of the whole episode of care, and personally in attendance for birth, is not widely available.

My New Year's resolution is to continue working to improve access for women to basic midwifery services that promote and protect physiologically normal birth, and support women in making appropriate decisions when the natural process may not be likely to lead to good outcomes.

Christmas greetings

Our loving greetings this Christmas, and with a prayer for God’s blessing on you in the coming year.

Joy and Noel

[Photo: These painted plaster figures have provided our family's Christmas montage for many years now. Joseph now wears a blu-tak collar to keep his head on. The 'hay' is sugar cane mulch. This year we have added three 'Kaper Kidz' dolls, representing Granny, Grandpa, and our Poppy.]

NEWS FROM AIMS

ASSOCIATION FOR IMPROVEMENTS IN THE MATERNITY SERVICES
5 Ann’s Court, Grove Road, Surbiton, Surrey, KT6 4BE
Tel: 020 8390 9534 email: chair@aims.org.uk
www.aims.org.uk

PRESS RELEASE

Immediate Release - 7th December 2009


SAFETY OF DISADVANTAGED WOMEN AND BABIES IS THREATENED BY KING’S CLOSURE OF THE ALBANY MIDWIFERY PRACTICE

King’s College Hospital has abruptly severed its contract with the Albany Midwifery Practice with no prior consultation with women – and without proper provision in place to replace the service – leaving expectant and new mothers in the lurch and anxious about receiving appropriate care.

The Albany Midwifery Practice has been shown to offer the Gold Standard of care to around 200 women in Peckham each year. It provides an outstanding service which enables women to be cared for by a midwife they know. Women who use this service are enabled to make their own decisions about the place to birth. It is unacceptable to withdraw such a safe and much needed service from the poorest women in society.

The Albany Midwives’ care has provided women-centred care for women from deeply disadvantaged backgrounds for twelve years. Peckham ranks as the fourteenth most deprived district of 354 districts in England.

The statistics speak for themselves:
Albany Midwifery Practice [King’s College Hospital]

Caesarean section rate 14.4% [24.1%]
Breastfeeding rates 80% at 28 days [35% at 7 days]

Perinatal Mortality 4.9 per 1000 (1997-2007) [7.9 per 1000] (England and Wales 2006) 11.4 per 1000 (Southwark 2003-2005)


The Practice offers women a chance to have care from a midwife they know and to have their full attention throughout labour. Between 40% and 50% of these women choose to have their babies at home.

‘I feel blessed and truly privileged to have had the Albany midwives care for me during my pregnancy. They are an amazing group who go out of their way to treat their women (and our families) with the care and consideration we deserve during our pregnancies. I know for a fact that I wouldn’t have had the confidence to resist an instrumental delivery if I had not been so well informed and supported during my pregnancy and labour. I also know that I wouldn’t be the confident mother I am today if I had not met the Albany midwives. They have made a profound impact on my life and if I am blessed with a further pregnancy I wouldn’t hesitate in trusting them again with my care. ‘(Serra)

The Association for Improvements in the Maternity Services (AIMS) is concerned that these women may well find themselves in hospital where one-to-one care in labour is not offered. The Health Care Commission Report showed that over a third of women in King’s were left alone in labour or shortly after birth and were frightened. Already the UK maternal death statistics show that women in these disadvantaged groups are more than six times more likely to die in childbirth. All these deaths took place in hospital.

In order to justify the suspension of the service King’s College Hospital appears to be trying to make the case that the service is unsafe. They have looked at a selected number of Albany cases admitted to their Special Care Baby Unit and asked the Centre for Maternal and Child Enquiries (CMACE) to investigate.

We understand, however, that they have not examined the deaths of babies that have occurred in the King’s unit nor the babies from there who were also admitted to the Special Care Baby Unit. Nor do we have what AIMS believes is crucial data – comparative rates of mental illness after childbirth, where we believe the Albany is likely to have far better results.

This action mirrors the attempt, in 1985, by obstetricians at The London Hospital to strike off Wendy Savage, a consultant obstetrician, who provided the kind of care that women wanted and who also had a far lower caesarean section rate than her colleagues.

‘The suspension of one of the Albany Midwives and cessation of their practice reminds me of my own suspension in 1985. The same intolerance to alternative ways of providing maternity care, despite comparable outcomes for the babies and lower Caesarean section rates, the same technique of selecting cases with adverse outcomes without looking at the overall care, and the same refusal to look at what the women themselves want. I hope that King’s will listen to those who consider this suspension an outrage and reinstate the midwife and the service immediately.’
Wendy Savage MBBCh MSc HonDSc FRCOG


King’s has claimed that it has suspended the service because it has the safety of the mothers and babies at heart. The Albany Midwifery Practice has long been acknowledged as a centre of excellence, yet King’s management is unwilling to provide this standard of care for more women, and instead is trying to remove it so that women have no choice but to accept medicalised care.

The reality is that King’s College Hospital’s action in withdrawing the Albany Contract has put women and babies at increased risk.

AIMS demands that King’s College Hospital releases the CMACE Report and the comparable statistics for its own consultant unit so that data from both services can be examined objectively.

Contact: Beverley Beech, Email: Chair@aims.org.uk
Phone: 020-8390-9534 Mobile: 07790-312297
Debbie Chippington-Derrick Phone: 01276 510575

www.savethealbany.org.uk
AlbanyMums on Facebook
www.gopetition.co.uk/online/32641.html

postnatal complexities

I drove to the home for the postnatal visit in the late morning. The baby had been born at home two nights previous. It had been a quick, powerful birth. The mother told me she knew her labour had commenced when she was putting her children to bed because she felt the urgency to settle them, and get on with her work of birth without distraction. She asked me to come without delay. I arrived at about 10pm. Labour was strong. The baby was born at 10.30, and welcomed lovingly into his mother's arms. The placenta came away soon after.

The mother greeted me at the door. She had obviously been crying.
"Are you alright?" I asked.
"The rabbit has died", she explained, "and I think I am having my third day blues."

We sat down together, had a cup of tea, and chatted. The baby was perfect. He was sleeping in his bassinet in his parents' bedroom. Feeding well at his mother's breast, skin colour good, passing urine and meconium - what more could a midwife want? Mother was strong, and her physical recovery from birth was progressing normally.

Our chat was interrupted by an urgent cry of pain from the toddler. Her little toe had been jammed in the door accidentally by her older brother. The mother's attention was diverted as she soothed her little one, the way mothers do.

A mother expects these minor crises to present unexpectedly, and she deals with them. It's part of being a mother. Mothers who choose homebirth, and who intentionally maintain their strong attachments with older babies in the early postnatal days demonstrate strength and courage in their mothering. Complexities of life don't somehow disappear because a new baby has been welcomed into a family.

I have been priviliged to attend this family for the births of several of their children. That continuity of care, not only through a pregnancy, but also in the continuum of a family's development, is precious. This is 'village' midwifery.

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]

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.

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.

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

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.

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

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.

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]

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

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.

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.

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.

*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]