Andrea’s Diary

Here’s a great idea for easing breast pain due to engorgement in those early days with breastfeeding. A simple device, but cleverly crafted for ease of use and maximum comfort, The Breast Aura offers a quick remedy that will be appreciated by new mothers everywhere.

It has other applications as well - some women suffer breast tenderness in early pregnancy, others when menstruating. The Breast Aura offers a simple solution to these problems as well.

When we exhibited the Breast Aura prototype at the International Congress of Midwives in July 2005, there was a lot of interest and we promised to let everyone know when it would be available. Production problems have caused unanticipated delays, but it is now available, exclusively through Birth International.

You can get further information about this wonderful new product here.

A couple of weeks ago, on ABC television’s program “The Inventors”, a new simulator for teaching practitioners how to administer epidural anaesthetics was showcased.

The inventor of this teaching tool explained that until now, doctors learning the techniques of epidural insertion had to practice using oranges or latex rubber blocks as crude substitutes for simulating the important feedback reactions of the human body as the needle is inserted into the epidural space surrounding the spinal cord. This learning method was very unsatisfactory, and usually after just a few practice runs on an orange, the doctor would resort to using human guinea pigs (women in labour?) to hone their skills. This is clearly an unacceptable situation, as inserting an epidural successfully takes a high degree of skill and accuracy if unwanted side effects are to be avoided.

All this was explained in graphic detail by the inventor of this training model. Using a combination of real time visual feedback monitoring, an appropriately constructed humanoid dummy and even audible signals (”OUCH!” if the needle was inserted incorrectly) the learner can now master the necessary techniques without ever going near a real person.

This was a fascinating segment of very popular television show. The inventor of this device was very frank and open about the side effects and possible consequences of a poorly performed epidural (he mentioned spinal headaches, and even paraplegia) while explaining the virtues of gaining the proper skills using his clever simulator.

It also highlighted that one of the major risks with an epidural is the level of skill of the anaesthetist and that this is not a procedure to be undertaken lightly. I sincerely hope that this new invention will quickly gain universal acceptance and that women in labour will no longer be used as “real time” learning tools.

Here is a wonderful piece of marketing! The Queensland State Government inAustralia has sponsored the Australian Breastfeeding Association to in a campaign of displaying large pro-breastfeeding posters in bus shelters across the State. The posters will go on display from July 24 - August 7 .

This is clever and delightful. You can download a copy of the poster for yourself here. How about printing some up and putting them up on notice boards in your local area?

Using warm water (in various forms) during labour had been around a long time and has a proven record in enabling women to manage labour pain effectively and safely. Water birth has also long been a reality, since Michel Odent first tried this technique in the early 1980’s in France. Most home births these days involve water, either for easing pain or the birth itself, and many hospitals have also adopted the idea, installing baths or pools for women to use during labour if they want.

Some hospitals, however, have been reluctant to provide water options, fearing that water birth requires special training of staff and presents special risks for care givers (bad backs, infection). The reality is that water births are very easy for staff - they need to do very little during the labour and birth, apart from regularly checking the baby’s heartbeat. It is the woman who does the work and gives birth unaided, into the water. The caregiver then helps her to lift the baby to the surface.

A beautiful new DVD, “Birth In Water“, shows how this can be achieved in a big public hospital. Dr Andrew Davidson has long seen the potential for warm water immersion during labour and birth under water and has actively encouraged its use st John Flynn Hospital in Queensland. Now he has made a video explaining the techniques and offering practical suggestions about implementing this approach, based on the experience of his team. There are several water births shown (not all at his hospital) and the women and midwives share their experiences as well. The story told by one midwife of her first water birth is amazing and amusing, and shows what can be done if one is prepared to watch and wait and let nature take its course.

This video adds to the growing number of films on this theme. This one, intended primarily for parents, will also be valuable for professionals who want to know more about this gentle option for birth can be implemented in their own hospitals.

The WHO Reproductive Health Library is an alternative source of information to the Cochrane Library. It focuses on all areas of reproductive health in a multimedia format, from fertility regulation, through pregnancy and childbirth, HIV/Aids, newborn care, infertility and more. The April 2006 release includes new editorials, commentaries and systematic reviews, as well as a new practical video demonstrating how to do a vaginal breech delivery (which unfortunately has the labouring woman lying on her back).

The RHL is prepared by an editorial team based in the WHO Department of Reproductive Health and Research and was established in 1997 in collaboration with other agencies worldwide.

The website is easy to use and well laid out. I think it is more user-friendly than the Cochrane Library and because it has other input apart from the randomised controlled trials, is more geared to the practical application of the research.

For more information and to subscribe (from as little as £47 per year) click here. There is also a free trial service and a demonstration that explains what is in the Library and how to use the various sections. Subscriptions are subsidised for those in developing countries.

This is another very useful source of information for midwives, educators and others keen to see better maternity services worldwide. You will want to bookmark this site in your browser.

Women whose babies have been born by caesarean need really good information if they are to consider a vaginal birth for their next pregnancy. The research says that women have around an 80% chance of success, even after more than one caesarean, yet the figures for vaginal birth after caesarean (VBAC) are usually much lower than this, even in hospitals where VBAC is encouraged.

Obtaining the information is the hard part. Often women are given part of the story, those facts that are “convenient” for the caregivers and hospital policies. Sometimes the risks of the vaginal birth and the incidence of scar separation or rupture are over emphasised and the risks of repeat surgery are downplayed. It can be hard for women to get accurate, unbiassed details that can form the basis for making a good decision and for finding the necessary care they will need.

CARES SA has produced a booklet that is designed to bring all the facts together to enable expectant parents, and their caregivers, to make considered decisions. This 80 page booklet has been compiled using the research and feedback from women and is a very worthwhile resource. The response in Australia has been overwhelming and as a result CARES has decided to put the booklet on a CD ROM so that it can be posted more easily.

The contents of the book are:

South Australian Perinatal Practice Guidelines

Best Available Research Comparing Risks of VBAC (Vaginal Birth After
Cesarean) and of Planned Repeat C-Section

Women’s Satisfaction with VBAC

VBAC After two Caesareans

Midwifery Care and VBAC

Preparing for a Vaginal Birth After Caesarean

Frequently Asked Questions

I was told…

Homebirth After Caesarean

Uterine Rupture
Another Caesarean

Recommended Reading List

Statistics

Glossary

CARES is a not for profit organisation with no funding other than memberships and fundraising. Purchase of this CD will go towards providing VBAC education workshops for women.

The cost is AUD$15.00 including postage within Australia. Add AUD$10.00 for postage overseas. Personal cheques (Australian Banks are acceptable) but for those outside Australia a Bank cheque in Australian dollars will be necessary. Credit card facilities are not available. Cheque or money orders made out to CARES SA Inc.

CARES SA

PO Box 1013

Nairne SA

Australia 5252

The most popular items at the ICM were charts, videos and some of the new book titles.

There is no doubt that our series of “Giving Birth Charts” are unique - there are no other charts showing women upright birthing their babies, anywhere in the world. We had lots of interest in these beautiful charts.

The ACE Graphics Technical Series also proved very popular, especially the “Cascade of Intervention” char and many were bought with the express purpose of displaying them in labour wards, in front of doctor’s noses. This chart is also reproduced in “Preparing for Birth: Mothers” and the second edition of “The Midwife Companion - the art of support during birth”. It is important to have a consistent message across all the material that is used by midwives, and women.

In the Technical Series, we also take care to depict women in upright positions (see the Pelvic Floor Chart as an example). Almost all the other charts available from other suppliers around the world have women in recumbent, un-physiologic positions, signalling that women should be passive and compliant during birth, for the benefit of the caregivers. The “Progress in Labour” chart does not have any time indications for labour, also an important consideration.

We are working to produce these useful charts in a desk size format so use with individuals, rather than groups. We will let you know when they are available.

Amongst the videos, there was a lot of interest in Psalm and Zoya (available only on DVD) and also “Working under restraint: Monologues from the Delivery Room “(DVD only). The birth videos “Giving Birth, Being Born”, >”Inner Strength”, “Mila’s Journey” and “Birth Day” attracted a lot of interest. The first two have no spoken words in English, which is useful for those who just want images. “The Art of Birth” was also popular, especially for educators looking for lovely waterbirths on film. The inspirational short film “In a simple way a child is born” is now out of DVD, and the few copies that arrived in time for the Congress were snapped up instantly.

Amongst the books, some of the new titles sold like the proverbial hot cakes. The most popular were:

25 Ways to Awaken your Birth Power

Breech Birth - what are my options

Gentle Birth Method

To Mother with Love

Labour of Love

Ina May’s Guide to Childbirth

Normal Childbirth Evidence and Debate

Water Labour Water Birth

The Water Birth Book

There was considerable interest in the launch of a new title at the ICM - “Midwives’ Tales”, but I will write more about this in a later entry.

Birth International has appointed a new agent to handle our products in Japan. Yumi Osako is a very well known childbirth educator in Japan, who regularly appears in magazines, on television and in the mainstream press. I first met her many years ago when I presented a training program for Japanese Childbirth Educators in Tokyo, and then again at the Birth Without Borders Conference in Chaing Mai in Thailand (1997). Yumi was also responsible for having my book Empowering Women translated into Japanese - this has become a best seller amongst the general population.

The addition of this new agency expands our local suppliers across several continents. ACE Graphics products can now be obtained locally from suppliers in New Zealand, Canada, the USA, South Africa and now Japan. The full list of their contact details is in our paper catalogue.

Readers in Japan may like to contact Yumi through her company - they have a whole range of interesting and useful information, products and services available:

Birth Sense Institute Co. Ltd

504# 1-9-16 Tomigaya Shibuya-ku

Tokyo

Japan 151-0063

TEL 813-5454-8232

FAX 813-5454-8212

I’ve been taking a few days of leave with some friends in Bournemouth. While I was there, I was reminded of meeting Jo Alexander, a midwifery lecturer at Bournemouth University. We were both on the program for the Conference at Ormskirk a few weeks ago.

During her presentation, Jo revealed a new website that is well worth adding to your list of favourites. It is the DIPEx site, where personal stories of health and illness can be found, together with evidence based information about the conditions being discussed. There are video clips from patients that describe their feelings, their condition (including signs and symptoms, the treatments they have undergone and their reactions and how their condition has affected heir everyday life. Written transcripts are also available, as well as question and answers, and an area where contributions from the pubic can be added.

It is an innovative site, sponsored by an Oxford-based charity and it has won an award for its outstanding presentation and content. For those who want access to information “out of hours” or to hear what others have experienced, this is a useful starting place.

Personal experiences currently included cover cancers, screening tests, heart disease, neurological conditions, mental health, sexual health and chronic illness. There also sections on pregnancy and women’s health.

A customer in Malawi has been in touch regarding some videos that she ordered. She was happy with some, but not all of the tapes we sent her, and her main complaint was that none of the birth videos showed black women giving birth. She used one tape with a group, who quickly became bored when the film only showed white women giving birth, and she felt that this was a problem that the film makers should have addressed.

In responding to her, I explained that finding any woman who would allow a camera into the birth was a rarity, especially if the finished film was to be used for public screenings. Her assumption that a video made in Australia would contain black women because we are “pretty multi-ethnic” was perhaps reasonable, except that we have very few black people in Australia and they are very protective of their birth culture. It is completely off limits to men, and women outside their immediate family. Filming them would be impossible and inappropriate.

We are always on the lookout for products that will be of use to our clients. If anyone knows of a good birth film, that shows black women giving birth naturally, and preferably with midwives, please let me know!

In the meantime, I have assured our client in Malawi that she can return the video for a credit or refund, as is our policy. I would dearly love to be able to send her a suitable substitute……