There's no milk like mum's milk - part 2

It was the third day after a caesarean birth in Melbourne's tertiary hospital which is also accredited as 'Baby Friendly'.

[For the first part of this discussion, click here]

Mother had received excellent midwifery support and care during and after the birth, and the midwife on duty had arranged to stay with the little family in the Recovery room so that baby could initiate breastfeeding immediately.

Baby breastfed well in the hour or so after the birth.

In the next 24 hours, baby made some effort at breastfeeding, without attaching and sucking. Midwives helped the mother massage her breasts, express colostrum and give it to baby. I visited them in hospital and encouraged mother in this plan.

The following day I was unable to visit, as I had come down with a nasty head cold which I did not want to share. I spoke to the mother on the phone. Baby was only about 30 hours old, and had had limited success at the breast. Mother was happy giving her expressed colostrum.

The next morning - the third day - the midwife announced that baby looked jaundiced, and was dehydrated. Baby was weighed, and of course had lost weight. Although the loss was not excessive, that did not seem to be taken into account in the new care plan. Without making any effort to support breastfeeding, the midwife announced that the baby needed a blood test for jaundice. This recorded jaundice at the lower limit of the range requiring phototherapy. The mother was informed that baby needed to go 'under the lights' and would be given formula milk to complement the expressed breast milk.

The parents reluctantly agreed to the formula - there was really no alternative. They asked that they be able to give it via a cup or syringe, to avoid using a teat. The nurse's response was that that takes too long, and there's no problem with a teat anyway!

...

That nurse undermined the good work by midwives and the medical team in the preceding days, who had worked to promote, support and PROTECT breastfeeding.

Not only did the mother receive conflicting advice; she had reached a point where she was no longer able to trust the guidance of the midwives and other hospital staff. Breastfeeding was compromised by the formula, which took away the baby's appetite and interest in the breast, the enforced separation that came about with phototherapy, and the use of a teat.

...

Someone may be asking, "What alternative plan was there?" "What would a truly 'baby friendly' maternity service have done in this instance?"

At the very least, giving the supplement by cup or syringe, as requested by the parents, would have minimised the risk of nipple confusion.

Secondly, there was scope for more effort to help the mother with breastfeeding, while continuing to observe the baby for any medical problems such as jaundice and dehydration. In this case there was no cause for concern: the baby was at term, and would not be harmed by a more conservative approach than was taken.

And finally, I need to challenge the acceptance of artificial formula as a suitable alternative to a mother's own milk. The first alternative is human milk from another mother - yet Australian health authorities have put their collective heads in the metaphorical sand. Human milk banking, providing donated and pasteurised human milk for human infants, is the best supplement when a mother's own milk is unavailable.

Yet babies are routinely exposed to the bovine milk, and all the other micronutrients derived from plant oils and any number of foreign and potentially allergy-forming sources, when donated human milk would be far more suitable.

"There's no milk like mum's milk!"

A landmark day for midwifery in Australia?

Yesterday the federal government's spin doctors announced that the passing of legislation through the Senate "provides long deserved recognition of Australia's highly skilled midwives.
... giving "midwives access to the Medical Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) for the first time."
... improving the "choices for Australian women to access high quality, safe maternity care as well as providing support for our talented midwives."
... establishing "a new Government-supported professional indemnity scheme for eligible midwives."

"Today marks a new era for our health workforce - ensuring smarter use of our skilled workforce, and more encouragement to work in multi-disciplinary teams.
This will help deliver better health and better results for patients.
"As a Government, we are extremely proud to be delivering these changes - providing new and innovative options for thousands of women and the community."

The Health Minister's press release makes it all sound great. BUT?

The Australian College of Midwives also welcomes the legislation.
"From 1 November this year, women will be able to choose to see a community midwife, and receive Medicare rebates for their visits to the midwife. The midwives will provide pregnancy and postnatal care in the community, and women may have the option of birth care in hospital from their chosen midwife.
“We welcome Nicola Roxon’s support for women to receive Medicare rebates when they choose the care of a midwife’ Dr Gamble said.
... ‘But we remain concerned to see that access to professional indemnity insurance becomes available for all midwives, including those providing professional care for women who choose to labour and birth at home.”

It's POSSIBLY a landmark day for SOME midwifery. But for miwives like me, who have chosen to be employed privately by women for homebirth or for other private midwifery services, the legislation gives us little to cheer about. Even the promise of Medicare and prescribing rights, to be implemented by November this year, appears to be so wound up in bureaucratic micro-management that we wonder if we will ever be able to meet the criteria. We are doubtful that the Medicare-funded midwife will be able to provide any service that is acceptable to clients, at the same time as providing a reasonable livelihood for the midwife.

The Greens Senator Rachel Siewert spoke up about the systematic discrimination against a small group of midwives and the women who employ us, declaring that "Major parties unite against midwives and homebirths.

"The Federal Government and Coalition have united to ensure that homebirth in Australia will be further marginalised by rejecting amendments to provide midwives with access to indemnity insurance irrespective of the location or venue of the births that they attend
...
"In addition the government chose to reject Greens amendments that would have taken away the power of doctors to veto aspects of midwifery practice, such as homebirth, that they are philosophically opposed to, despite the near universal evidence that safe low risk homebirth has positive outcomes for mother and child.

"We have consistently said that the Government amendments to their Midwives legislation give doctors too much control over midwives practice," said Greens health spokesperson Senator Rachel Siewert.

"It is extremely disappointing to see the major parties side together against the interests of midwives in refusing a Greens suggestion to broaden the scope of collaborative arrangements between midwives and medical practitioners to include health services, thereby ensuring that doctors can't veto homebirths."


Time will tell whether these legislative 'reforms' actually do what the government is claiming they will do, or if the culture of medical dominance is further strengthened.

There's no milk like mum's milk

You might have overheard a conversation in a playground in Melbourne's leafy Eastern suburbs.
"These are amazing pesticide-free organic bamboo nappies," said Jenny.
"All my baby's clothes are organic cotton with no artificial colours," replied her friend Jacqui.
"This baby sling is really the BEST"
...

Variations on this converstation are being played out across our land. The baby industry relies on youthful idealism when hawking its stuff to our new parents and parents to be. A new baby is the essence of newness and hope. Who would not want all that is good and pure and right for that little one?

Fabulous baby clothes, maternity fashions, prams, toys, books, and other consumables flood shops as well as the online market. Providers of products and services advertise their stuff by every possible means, lining up in booths at a baby expo, with glossy handouts and trivial gifts that will entice market share.


There is one product that cannot be bought or sold, yet its value to both mother and baby is beyond any dollar estimation.

There's no milk like mum's milk.

There's nothing in the market that comes within cooee of a mother's own milk, in terms of nutritional correctness for the individual child, disease prevention through antibodies and other unique biological substances, protection of the psychological bond between mother and child, optimal physical support of the growing child, protecting the mother's health, and much more.

There's no milk like mum's milk.

A couple expecting their first baby will have an impressive array of items ready to welcome their child. Family members and friends will contribute. The mother-2-B will lovingly wash and fold beautiful clothes and wraps in preparation for the birth.

They know breastfeeding is 'best', so they will plan that too.

Yet breastfeeding is an incredibly vulnerable entity, easily lost.

There is a discrete window of opportunity, around the time of birth, when breastfeeding is initiated and established. We have substantial relable evidence as to the maternity practices that either support or interfere with the establishment of breastfeeding. In simple terms, breastfeeding will be threatened when new mothers experience anything that interferes with their learning to breastfeed, such as:

• receiving conflicting advice
• not being able trust the guidance of the midwives and other hospital staff
• being unnecessarily separated from their newborn babies

Breastfeeding is a 2-way activity: a baby breastfeeds, and a mother breastfeeds, simultaneously.

Breastfeeding will be threatened when newborn babies experience anything that interferes with their learning to breastfeed, including:

• being given anything to suck that is not mother's breast (including teats, dummies, and fingers)
• not being able to satisfy their need for mother's milk when they feel hungry

Many maternity hospitals have, over the past 20 years attempted to change the way breastfeeding is supported and promoted and protected, for the wellbeing of babies and their mothers. The global Baby Friendly Hospital Initiative was established by World Health Organisation and UNICEF in response to the global threat to health that had arisen with the world-wide promotion of artificial milk formulas that are used as a substitute for mothers own milk.

Many Australian maternity hospitals have implemented the Baby Friendly Health Initiative (BFHI), and undergo periodic external audits by assessors appointed by the BFHI.

In my next post I will outline a case in which staff of a 'Baby Friendly' hospital failed to maintain the expected standard, and the impact that failure has on the mother and baby.

Maternity reform hijacked 2

Consumer choice
The women who employ midwives privately do so for many reasons. In most instances a midwife is employed with the intention of promoting and supporting physiologically normal processes in birth. Since midwives do not have visiting access/ practising rights at hospitals, planned homebirth is the main setting in which Victorian midwives practise. Some women employ midwives privately to accompany them to hospital for the birth. The main reason is that with a private midwife a degree of partnership and trust are able to be formed, and the woman's preference for continuity of carer. While no-one can predict the course of events, the process of making informed decisions in labour and birth can be enhanced.

Evidence from Victorian and other Australian data collections, and international peer reviewed publications supports the effectiveness and safety of planned home birth in the care of a midwife, with access to specialist medical services when the need arises.

Normal midwifery practice includes the ability to refer and make timely decisions about the need to transfer care from home to hospital, or from a primary care facility such as a birth centre or hospital that does not provide emergency obstetric surgery to a higher level hospital. Victorian independent midwives, who have demonstrated accountability and transparency in their private midwifery practice over many years, have exemplary statistics, as recorded by the Health Department's Perinatal Data Collection Unit (PDCU). Planned homebirth, with a midwife as the responsible professional in attendance, is at least as safe a choice in Victoria as planned hospital birth, and the rate of interventions such as caesarean or other operative birth is very low. For example, the PDCU Performance Indicator analysis for standard first-time mothers who planned homebirth showed that 6.5% have caesarean births (DoH Letter dated 15 October 2009) which compares favourably with the statewide public hospital rate of approximately 15%, and the statewide private hospital rate of approximately 27% for standard primiparae in 2007-08 [Source: Victorian Maternity Service Performance Indicators, 2009].

The end result of this reform is likely to be that private midwifery practice will be further marginalised, forced into a grey zone, on the edge of legal practice, or even underground. The outcome of unrealistic restriction to private midwifery practice is that women who plan homebirth may look to unregulated maternity care providers, who are prepared to work outside the law. This cannot be considered safe or acceptable.

Who will be held accountable for adverse outcomes that could have been prevented, with a little bit of a sense of fairness in protecting the choice of consumers who wish to plan to give birth at home?


Competition considerations
Under the Trade Practices Act, government is required to promote competition in health policy, to ensure reasonable choice for consumers and defensible cost for government; that regulations stand or fall on whether benefits can be shown to be greater than costs.

The privileged monopoly that has been granted by successive Australian governments to the medical profession is indefensible in maternity services. While midwives are quite capable of providing primary maternity services for the majority of pregnant women, continuing as the responsible professional carer throughout the labour, birth, and postnatal period, this model of care is largely unavailable in our communities.
There is no public funding for private midwifery care.
Funding arrangements between federal and state health departments fragment maternity care, which is not good practice.
Medicare rebates apply to services provided by GPs or specialist obstetricians, while there is no broad access to midwife led models of care.
The Medicare safety net uses public funds to further privilege the private obstetric market.
Tax rebates on private health insurance also privilege the private obstetric market.

Despite repeated calls by midwives' associations, there has been no serious attempt to apply a public benefit test to maternity-related policies which provide a monopoly for the medical profession, and stifle competition by midwives.

Competition considerations include the need for public funding for consumers who choose maternity services provided by a private midwife, equity and parity with doctors in access for midwives to public funding support for private indemnity insurance, which would likely lead to visiting access for midwives to practise in public hospitals.

Policies for which a public benefit cannot be demonstrated must be repealed or modified so that they do not reduce competition.

For more comment on this topic, go to
Part 1 Background
Part 3, Professional Indemnity Insurance, and Collaborative Arrangements

How amazing is this?

How does an intelligent, active woman who has experienced lots of freedoms and is highly respected for her employed work, change (overnight) into a mother who is satisfied with being just that: a mother?



And why is it that some new mothers don't quite find that place of satisfaction in the role, and long for the day when they can hand the mother role over to someone 'more qualified' in a purpose-built facility?


This amazing phenomenon is a metamorphosis that takes place under natural, physiological cues, and the result is a mother who is so focused on her new baby that she doesn't miss the late nights with friends, or the cafe culture of her previous job, or the mental stimulation of a challenging business meeting.

I assert that:

• Every baby needs a mother.
• There is no better mother than the one who gave birth to the baby, in almost every situation.
• Mothering is a demanding, challenging role, whether the role is filled by the biological mother or a substitute.

The amazing, awe-inspiring truth is that in God's created world both a mother and a child are the beautiful new creatures who emerge out of the coccoon of pregnancy. She takes her child into her arms and into her heart, and she recognises the uniqueness of her place in the life of that little one. Call it attachment, bonding, maternal instinct: it's one of the miracles that happens at birth.

As with birthing, there is no safer way, or more staisfying way, to be a mother than to find and follow the time-tested normal physiological path. As with birthing, our society today offers many alternatives that did not exist, or that existed to a lesser degree, in previous generations. As with birthing, most of us will at some stage fall short of some imagined ideal. That's life! And as with the rest of life, coming to terms with 'good enough', and doing our best with what we have, is a very reasonable goal.


A couple of days ago I was writing about families in communities - the supports and protection within communities that enable new mothers to find their feet, 'put down roots', and become resillient as individuals, and as families.


Today's new mothers have options for connecting with others that their mothers, and previous generations would not have imagined. Easy access to the Internet has opened up chat rooms, blogs, email, VOIP telephone connections, Skype with a webcam, all those *friends* on Facebook, and whatever you call your Twitter crowd. It's a generation of connectedness. How could anyone be lonely? There's a lot of self-analysis, informing the world of how you feel about the minutae - it's old fashioned navel gazing.

The mothers of today's new mothers (I'm one of them) had the radio or the 'box' to keep us company, if we chose. The background in homes included morning chat shows, the soapies, mostly from the USA: in all a recipe for domestic mindlessness. We had most of the other time-saving 'mod cons' that our mothers did not have. But if we wanted to speak to another person we had to be there in person, except for phone calls.  And there were no cordless phones or mobile phones. There was no virtual community.

I was living in Michigan, USA, when our first three children were born. We bought a house in a town called Haslett, which is near East Lansing. We had one car, which Noel usually drove to the university, so I must have had a lot of time at home. I don't recall being lonely, or dissatisfied in any way. The work of being a mother filled my life as long as the babies were small, and the next pregnancy followed once the breastfeeding demands on my body were reduced.

My own mother had been a great model for me to follow, and I am sure that being second of seven children prepared me in special ways for motherhood. But most of mothering is instinctual, going much deeper than the learning either in childhood, or from books or classes.

We know from laboratory animal work that the hormones of birth and breastfeeding set us up for mothering.  Babies and young children require an enormous investment on the part of the mother firstly, and then on the part of the father, family, and community, in order to successfully negotiate the often hazardous terrain of childhood.   Although there is no simple 'one size fits all' to this, the protection and support of a strong mother-baby bond sets up a family in a way that cannot be artificially immitated.

Families within communities

When a baby is born a family changes and develops. Today I am reflecting on the development of families within communities. How does a young mother, bringing her first child into her world, form linkages with other mothers in her community? How does a father make this transition?


The focus of midwifery is the mother-baby as a unit within a family. The midwife's scope of practice spans the pregnancy, birth, establishing breastfeeding and early parenting. We midwives often declare that, in the absence of complications these processes are normal, natural, physiological: that BIRTH IS NOT AN ILLNESS. We often point to the obvious similarities between the human mother and other mammalian mothers. No farmer would allow anyone to prod and poke the cows when they have separated themselves from the herd in preparation for giving birth. The farmer keeps a respectful distance, as do the other cows.

Lessons abound in nature.

As the simple drawing of trees suggest, today I am taking a lesson from trees.

Let's imagine the nuclear family unit, mother, father and children, as a tree. Some trees grow up in close proximity to others of their kind, while some are isolated. There is no one pattern that is right for all.

Families exist within communities, some are close and others more spread out.

A seedling tree - a new family - takes time to become strong. It sends down roots, and puts out branches and leaves.

Let's think about the roots of a tree/family. A young tree can be vulnerable to natural forces, as well as unnatural. It takes time and support for that tree to establish. In a garden we may put a stake next to a young tree, and possibly even a protective barrier around it. The tree will not thrive just by being propped up or protected. It has a lot of work to do itself, doing the work of a tree: its roots taking nourishment and water from the soil, and its green leaves photosynthesing light into plant energy.

A young family, similarly, has work of its own to do. The young family will not become strong merely by being placed in a supportive community with protection from difficulties.

Often after a storm we see trees that have been uprooted - destroyed in an instant. The huge canopy, and the system of limbs coming from the trunk can no longer be sustained. On the other hand a tree that has a tap root that penetrates deep into the soil is more able to withstand wind, storm, and drought.

In the tree/family analogy, that deep tap root could stand for strong values and standards that give resillience and a continuous supply of nourishment. A family that is secure in its beliefs, with clear principles to follow is able to stay whole in difficult times. Life's storms take many different forms; they may include illness or financial hardship or psychological threats. The family with good foundations, like the tree with strong, deep roots, comes through unharmed.


So, the question is, how does a new family establish roots in their community?

ABC TV: Q&A

For details of this program, link here.
Next Program: Monday 22 February 2010 at 9:35pm
Next Program's panellists

* Malcolm Turnbull - former Liberal leader
* Tanya Plibersek - Minister for Housing and Status of Women
* Mungo MacCallum - political commentator
* John Roskam - Institute of Public Affairs
* Jane Caro - social commentator


You can read questions submitted, and send your own question to the program.

My question could be put to several of the panellists, to answer from a social, political, or women's issues point of view. In maternity care throughout history the midwife has been the primary care provider who works with the woman. The government's new legislation is now set to give the medical profession veto power over which women can use midwifery services, potentially strangling private midwifery, and driving homebirth underground. Should this so called 'reform' be acceptable?

[ADDED LATER]
NOT ONE MENTION OF MATERNITY ISSUES, DESPITE HUNDREDS OF QUESTIONS BEING ASKED! Minister Plibersek looked unwell, and had a nasty cough - she should have stayed at home. A lot of time was given to Malcolm Turnbull; thinly disguised attempts to get him to speak against his replacement leader of the Opposition, and reignite the carbon debate. The show was not worth watching.

A birth story in pictures

Thanks to the family whose beautiful pictures tell the story eloquently.

 

 

Please note that midwives and other registered health professionals are not permitted to use testimonials to advertise our services.

what's in a midwife's bag?

A midwife sent a message to her colleagues who are members of a national email list, asking for people with experience to provide her a list of helpful herbal tinctures which may come in handy at a birth.

There were various responses, which can broadly be categorised into those who 'do' and those who 'don't'. Since I'm in the 'don't' group, I'll share my comments here. Readers are welcome to share your thoughts on the topic too.

THE DON'T GROUP SAID:

• Can I ask why a midwife would take herbal tinctures? If birth is not an illness, why do some midwives come along with a bag of 'medications', even if they are herbal or homeopathic or natural? 
• Of course a lot of my clients use natural remedies, and in most cases I don't see any harm in them. But there are times when I ask a woman to stop looking for remedies - whether naturopathic, or even a tub of water - and get on with the job.
• Midwifery is about being 'with woman' rather than being a therapist of any kind.
• Herbals can have alkaloids and other substances that have very real effects on the function of the human body. Many mainstream drugs were herbals once upon a time.  Unless the product is well tested for its potency and dose rate, it could cause unintended harm.
• Other 'natural' therapies, including homeopathy, may have a placebo effect, without having a direct medicinal effect.

My thinking on this topic has been influenced by Maggie Banks in Home Birth Bound: mending the broken weave, Chapter 9. She describes 3 traditions of healing: the scientific, the heroic, and the wise woman tradition. Of course life is not black and white in any situation, and as a midwife there will be times when I use the scientific (as in collecting cord blood and administering anti-D to a Rhesus negative mother), and times when I reach (in a small way) for the heroic modalities (such as vitamin B6 supplement for fluid retention); but underpinning it all is the wise woman tradition - the knowledge and skill of working in harmony with normal physiological processes.


I will not attempt to present the case for those who 'do' use alternative medicines as part of midwifery practice.  It's a complex and fascinating field of study.  Some midwives have studied aromatherapy, homeopathy, reiki, herbal medicine, crystals, meditation, and various physical therapies (to mention just a few).  At the end of the day the midwife's skill is in promoting health and harmonising her own life with that of the labouring woman, with the intention of supporting and protecting wellness in birth.

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