Andrea’s Diary

It’s Christmas again - seems like a few months since the last one! It is hard to imagine how the year has slipped by so quickly. When I look over the diary for the year I can see it was very busy and although it seems like not a lot has been achieved (there is still a long way to go) there have been some notable wins and good, productive work carried out. I’ll write about some of this for my New Year’s message.

I am planning a break now until early January. I will stay home (what a treat!) and have some ambitious ideas of doing some writing…… the new edition of The Midwife Companion, an update for Preparing for Birth: Mothers and a completely new book for childbirth educators. Plus an article for The Practising Midwife on TENS and some new pages for our web site. I wonder how much I will actually achieve?

Meanwhile, the Christmas festivities await - a lovely Christmas Day with my two wonderful children, James and Jenny at James’ house- where he is cooking the lunch this year. What a treat!

I trust all of you have exciting plans for the Holiday Season and that they include rest, reflection, good company, good food, and above all, PEACE. I will be back with my Diary for the New Year and look forward to continuing my conversations with you then.

Some really interesting news to hand today - one of the largest private health insurance companies in Australia (Medical Benefit Fund - MBF) has agreed to offer a refund for midwifery services for homebirth of up to $3000.00, provided “that no obstetrician is consulted”.

This is good news indeed. Some of the smaller health funds are already giving rebates for midwifery care, but getting these big players to recognise the benefits of midwifery is a bonus. It has to have a financial benefit for them - their profits are already under pressure and the obstetricians are doing more and more caesareans mainly for their private (and insured) clients.

Perhaps it will be the health insurance industry that pulls these doctors into line - there seems little political will to make them behave more appropriately towards healthy labouring women and our community is bearing the costs of their rampant excesses in a number of ways.

Next year is shaping up as a watershed year for midwifery, and 2003 is not that far away now!

There has been quite a bit of publicity this week in the Sydney newspapers about a study that has been done looking at father’s reactions to their partner’s pregnancy and the changes it has wrought in their relationship. The study of 222 men at Nepean Hospital in western Sydney and Adelaide’s Flinders Medical Centre is the first in the world to look specifically at how men’s lives and moods change with the arrival of a baby.

It seems that many men are reacting poorly to the lack of sex, reduced support and attention from their partners, and many were finding it hard to bond with their babies, especially if the baby cried a lot or was “dull and uninteresting”.

It was the lack of sex that seemed to cause the most concern, and men were surprised that their partners were not as interested as before during the pregnancy and were even less interested after the birth. This is one are that could useful be addressed in prenatal classes, and although it won’t necessarily improve the outcome (in terms of how often men get the sex they want) it may at least help them to realise that a lack of interest in sex is rather typical.

Sex and sexuality as a topic for classes is one that many educators shy away from, even though talking about sex is popular and engages everyone’s interest. There are ways to make it easier, and I have written about how to incorporate this fascinating issue in the program.

The feedback I heard on one radio talk program was fun - several fathers said that the men who were interviewed should “get a grip”and “get into the real world” and stop complaining - fatherhood had so many pluses to outweigh the negatives that they should count their blessings instead of complaining.

There are lots of issues that fathers that would benefit from discussing in prenatal programs. There’s another article that I’ve written on how to include the men more that some of you might find useful. I certainly think that we should be including the men in all of the prenatal classes - after all they are half of the new family and we must include them at the very least, on that basis.

I met up again with my neighbour last night. Her baby had been breech and I had explained to her and her husband about using moxibustion to turn it into a head down position. As she was booked for an ECV, a few days later they decided to give it a try, and after 4 nights of treatment, they baby got the message and turned by itself. Needless to say, she was very pleased as it meant she could avoid the sometimes uncomfortable ECV procedure, and the spectre of a caesarean or vaginal breech birth had also disappeared.

We had a long talk about how she could now plan for a normal, natural birth. She is very health conscious and definitely wants to avoid using drugs. With her gentle approach to life, and positive attitude, she has a good chance of achieving a straightforward drug-free birth, even though she is booked with a private obstetrician. At least he has a good working knowledge of normal birth from much experience supporting home birth midwives in the past.

The baby is due around Christmas and they may decide to invite me to support them. It would make a lovely Christmas present for us all!

P.S. I am finishing off an article on how to do moxibustion for turning breech babies and it will soon appear on the Essential Parents pages of the website. I willlet you know when it is available.

I’ve been reviewing the articles that I have written over the years for the Practising Midwife and have discovered, to my surprise, that there are 16 pieces on various aspects of childbirth education and midwifery that I haven’t yet put onto our web site!

I was surprised there were so many - but I did contribute a 1500 word article every month for 2 years, so they do mount up. Many of these will be of use to those of your who are looking for ideas for your classes, so I am assembling them at the moment and will let you know when they are on the site. I know you are all looking for any ideas you can get….. so watch this space for news of the new releases.

A couple of weeks ago, a male hypnobirther contributed to the discussion on the ozmidwifery list about giving birth in water. He stated that this was “the stupidist idea he has ever heard of” and that women should “get out of the water and onto a chair where you belong”. This naturally led to more discussion during which he said that pain in labour is wrong and that it doesn’t have to hurt - if it does this is just women’s minds at work, expecting pain which they then experience.

These comments really stirred things up. I was very proud of my fellow Aussies that he wasn’t flamed for his assertions and outrageous remarks and that several women tried to gently open his eyes to the realities of birth. His male views and his self-righteous tone didn’t cut any ice with the women on the list but we tried to give him some insights.

Anyway, soon after I was taken to task by the anaesthetists who want to tell women in prenatal classes that their particular form of “rescue” will also save them from the pain of labour. No need to suffer if we place our faith and trust in their particular form of magic.

It all reminds me of the snake oil merchants who used to go around convincing people that their remedies would cure all manner of ills, with no scientific foundation whatsoever. They played on peoples fears and harnessed the power of the mind plus the placebo effect to sell their products (and make a lot of money in the process).

Many men seem incapable of accepting that women are able to be supremely creative and produce a baby without their input (apart from starting it off). It makes me mad when I hear a man tell me that he knows better than I do what my body is capable of when it gives birth. Men have no idea what it feels like to even have a vaginal examination, let alone push a baby out into the world - how dare they presume to know better than me what I need in order to birth a baby successfully and safely? Of course, I am far past childbearing age, but you know what I am getting at….!

Being able to give birth without the meddlesome antics of medical men (or pseudo clinicians) is, for me, the most basic feminist issue. Sure, we need their help sometimes, and be thankful for it, but until we call them in, please leave us alone! Don’t presume to know better than we do what is required. Abandon the arrogant stance of trying to better nature when it comes to perpetuate the species in the safest and most efficient way possible. There are plenty of things you can get your teeth into, like protecting us from unnecessary wars and saving the planet from environmental catastrophe. You work on those bigger issues and leave us to having the babies…… that way there will be plenty of happy healthy children to inherit a beautiful and peaceful world.

Time to get off my soapbox now!

Today I have received the application forms for joining The Australian College of Midwives Inc. In September 2001 it was moved and carried at the ACMI Annual General Meeting that consumers (that is, non-midwives) would be welcomed into the organisation as full members. A real breakthrough, that brings ACMI into line with the New Zealand College of Midwives, who have had consumer membership since its inception in 1991.

I am delighted to complete these forms and send them in, and look forward to being a part of this vibrant and vital professional group. At that same meeting in 2001 I was awarded an Honorary Fellowship of ACMI (their first!) so it is fitting that I am now able to join as a full member as a show of support.

I would urge all those who are concerned about the quality of maternity care in Australia to join with me - in numbers there is strength and a bunch of strong, committed women can achieve a lot. Details of how to join are on the ACMI web site.

The rising caesarean section rate is of concern to anyone who has a true interest in the health and welfare of mothers and babies. The present overall rates in Australia, as recently announced by the Federal Minister for Health, Kay Patterson, are 25% for the public sector and 35% in the private system - truly scandalous figures. Given that these are “averaged” over all hospitals, it means that half of all public hospital have higher rates than this - we already know that these figures for private hospitals are very conservative and are probably much higher in many cases.

In the midst of all this gloom, it is good to hear of trends in the other direction . At the Royal North Shore Hospital, the main maternity unit in the affluent northern suburbs of Sydney, a concerted effort by staff has seen the emergency caesarean section rate drop by 25% over the past few months. This has been achieved mainly by relaxing the strict guidelines for induction which is a well-proven route to caesarean birth for many women. They are also exploring other ways of reducing the rate, which has had a morale boosting impact on staff. The hospital honoured the Manager of Labour Ward with a citation for her efforts in encouraging these important changes.

Let’s hope that other units take note and start making conscious efforts to improve birth outcomes. We certainly need something to be done!

Today, just for a change of pace (and a bit of fun!) we are going to make a videotape introduction for those enrolling in our Graduate Diploma Course next year. Cassandra McBurnie, the Course Co-ordinator, and I have prepared a script and with the help of Jason Tunbridge, our General Manager (who has qualifications in video and film making - handy!) we’ll be hoping to get a useful program onto tape. I have already recorded a short insert piece from Fran Gallwey, our Manager and Grad Dip co-ordinator in the UK, that we will insert so that our UK students will be able to “meet” her too.

One of the problems with distance education programs, such as our Course, is that students feel the isolation and miss the regular contact with their peers. The email chat line we have established for them to use is getting a good work out, and we hope this video introduction will enable new students to at least put a face or two to the names they see on the paperwork.

The closing date for applications for next year is January 31st, so I am hoping that the editing studio can finish this fairly quickly for us. I am sure we will have a lot of fun doing this and let’s hope the finished product looks good too.

I’ve been off the air for a couple of days, while my trusty laptop has an upgrade. It is like trying to survive without one’s umbilical cord - I am gasping for a “fix”!

The debate about the anaesthetists and the epidurals is going strong at one hospital in Australia. I have been corresponding with two of the educators about this issue and will post here some of that conversation - perhaps some of you are in the same boat in your area. I am sure these tactics are nothing new. I will put their email messagein italics for clarity with my responses below:

Had our meeting at the hospital today - mind you, not one anaesthetist turned up! For now, Preparing for Birth has been withdrawn from CBE classes - but we are working on it.

Typical of the anaesthetists not to turn up -probably too busy putting in the epidurals and making money to be bothered! If parents still want the books, you can give them the web site address and we can send them from here….

Anyway, we presented all your references….. however some of them are from 1981, so they could be questioned. However, my colleague and I argued that if no further research has been done since then, are these references then not accurate???

Yes, the point is that no other research has been done - the date doesn’t make research any less valid, in fact the Sepkoski paper was done ten years after the Rosenblatt paper to replicate and check the results and they were the same.

There seems to be a view that if there is no research, there is no problem. Two problems with this (for starters) often research with poor results or unexpectedly negative findings doesn’t get published because people only want to good news, and research on the effects of drugs on newborns is expensive and time consuming to do - therefore it is often avoided. Doesn’t mean that there is no problem, just that it hasn’t been found or else written up. Parents have a right to know when there is no research - this also means that a treatment/drug etc can’t be shown to be safe, either. A good strategy for parents to use is for them to ask the doctor if they are prepared to give them a signed statement that the treatment being offered is “safe”. When this is refused, as it will be, this gives the parents a lot to think about…..

We are also going to spend a day perusing the drug book at the hospital, in an effort to find a correlation between different types of drugs used in epidurals, and the subsequent birth outcomes for the last 2 years. Apparently there is one drug, which gives a great epidural block, but “seems” to lead to fetal distress and emergency caesar. We are going to find out!

Epidurals typically are a mixture of an anaesthetic (usually bupivacaine) and an opiate (Fentanyl or pethidine or some others). It will be interesting to see what you turn up. See if you can get a copy of the package insert for the drugs check what it says about contraindications/side effects. Ask the anaesthetists how they feel about using a drug with these listed side effects and check if they are giving this information to the parents as part of the informed consent process. Management might like to know this too - the drug companies list this information to protect themselves in case of litigation, and the info is supposed to be taken on board by the doctors too. In the event of a case, there is little likelihood that a drug company will be effectively sued if they can show that the side effects and contraindications were made available for the doctors’ benefit so they could act appropriately regarding the use of the drug…..

The unit manager will meet with the doctors next week. She will present our findings and explain that your book cannot be touched. She will also lay down the law about their “guest speaking” and will let us know how she goes. She will also ask that they withdraw their comments about ambulent epidurals being the norm -what a complete lie!!! Nobody in this hospital has ever walked after an epidural!

Most anaesthetists are now recommending against walking around with a “mobile” epidural because of the risk that the woman might fall over due to the woozy head (opiate drug effect) and loss of sensory nerve feedback from her legs -numb feet make it hard to walk confidently). She might then sue them and hospitals are not willing to take this risk (risk management is all the go these days). Your guys have obviously not caught up with this latest advice! How are they going to “sell” mobile epidurals in light of these new recommendations, I wonder?

Interestingly, an obstetrician in this town is advising his clients not to attend our CBE classes…. says he has all the current research in his rooms and there’s no need to do classes elsewhere…. and his wife, his receptionist, talks to the clients about parenting! We will tackle him also!!!! Part of his CBE includes “I break the ladies’ waters for her at 4cm”, etc…. the list goes on. Surely he cannot understand anything about social networking, adult learning principles, informed choice and so much more.

This kind of behaviour could be construed as a “restrictive trade practice” ! Might be worth dropping that into the conversation!

This is not the end of this story…. it will have more chapters, for sure!