Andrea’s Diary

For the last two days I have been presenting an Active Birth workshop in Queanbeyan for the Southern Area Health Service. Queanbeyan is right on the border of Canberra, and is therefore in some ways like a Canberra suburb. The group had to shrink at the last minute because of the terrible bush fires that are still burning in wide areas of the region, which requires hospitals to adopt special emergency status in case of evacuation of patients or an influx of casualties. Staff are placed on emergency 24 hour rosters and many midwives were therefore unable to attend. Some may have had difficulty reaching Queanbeyan anyway, as the fires can close highways are short notice, forcing long detours or abandonment of travel plans.

Amongst the group were four midwifery students who were graduating on the second day of the workshop. They were very excited by the prospect of joining the ranks and were warmly applauded by the group for their achievements. They will all make excellent midwives - caring, feisty, passionate and skilled - their tuition has been very broad and they have some wonderful experiences as part of their education. Two are already apprenticed to an independently practising midwife and plan to begin offering home births as soon as they can be accredited. Until this happens, all four will be working in the Queanbeyan hospital and they will make up a sizeable proportion of the entire staff, which is bodes well for lots of normal births for the women they assist. It will also be helpful for them to be working together as they will be able to support each other as they get used to working within the system and its limitations.

Once again I have had the pleasure of working with a great set of new graduates. It am really encouraged when I see the results of good tutoring and careful nurturing producing such promising midwives. I hope that they can stay focused and find niches that encourage and support their ideals rather than restrict and demoralise them.

Meanwhile, I hope the heat (Canberra was 40 degrees - a record) passes and that we get some rain everywhere. The country has never been so dry and dusty. We might be accustomed to hot summers, but this is ridiculous!

YesterdayI attended a meeting at the University of Technology School of Nursing and Midwifery, where we discussed the setting up of the Bachelor of Midwifery at UTS. Representatives of the University of Canberra and Southern Cross University (Lismore) were also there, plus representatives of the Australian College of Midwives, St George Hospital ( a partner with UTS in their Graduate Diploma of Midwifery program) , Independent midwives and intending students. I guess I was there as a “consumer” representative.

It was a dynamic and exciting meeting. Jill White, the Dean of the School, and her team, have obviously spent considerable effort in formulating the basic plans for the three year program that incorporates suggestions and feedback from other similar reference group meetings that have been held sporadically over the past 5 years. At last the culmination of these efforts is in sight, and the aim is to have the progam ready to roll as soon as possible after the NSW State Government passes the NSW Nurses and Midwifery Act. Once this legislation is on place (expected by mid year) there will be a mechanism for the registration of midwives that have no nursing background, an essential for B Mid students to practice, and for the University to approve the course.

The course will meet the new Accreditation Standards for Bachelor of Midwifery programs that have been established by the Australian College of Midwives. These standards have taken 3 years to develop and will ensure that graduates of all these programs across the country are not only able to meet the full definition of a midwife set by the ICM, but are capable move straight into independent practice, if they wish. This will be a huge step forward for midwifery in Australia.

There are a number of hurdles to overcome before the course is underway. Many practical details have to be sorted out, some involving the practical clinical experience that students will need in order to acquire their 40 births and 30 “follow through” experiences with women that form the core of the program.

One thing is for sure - there will be no shortage of applicants! To ensure that they know what they are taking on, it was recommended that they only be accepted after interview. With such a shortage of midwives, and the need for quality graduates who can help turn midwifery practice around on a broad scale, it is important that as few as possible drop out.

I look forward to further meetings as the nitty gritty of the syllabus is mapped out and overall program is fine tuned. It is a pleasure to be working with such an inspiring group of midwives!

Over the weekend, Dr Fiona Stanley, of Perth, WA, was named Australian of the Year for 2003. Many of you will have seen her name of research papers relating to maternal and child health, as she is an internationally recognised leader in this field. Her pioneering work in recognising the link between folic acid and neural tube defects and her research into the links between birth asphyxia and cerebral palsy are well-known. Dr Stanley showed that only 10% of cerebral palsy cases were caused by birth trauma, the majority having been caused by an event earlier in the pregnancy that affected the baby’s brain development, and perhaps made the birth more difficult as a result.

She has a passion for children and babies and is especially concerned about the plight of Aboriginal children, who often suffer from problems caused by poverty and poor living conditions. The Sydney Morning Herald reported that “she would use the ’soapbox’ of her position [as Australian of the Year] to campaign to improve the life expectancy and health of children in disadvantaged and Aboriginal communities. ‘Get it right for them and their future is going to be better’ she said.” This is a sentiment that could equally be applied to all children - the best start in life, both prenatally and during the birth itself, will enable any baby to live a happier and healthier life.

It is wonderful to have such a champion for maternal and child health recognised in this way. Congratulations are very definitely in order!

Today is Australia Day. It celebrates the day that Captain Arthur Phillip raised the British flag on his arrival into Farm Cove to signal the birth of a new colony. It is also a time when we take a look at ourselves as a nation and as a bunch of people, and celebrate those things that make us special and different.

There are always lots of events around the country, mostly fun activities, usually outdoors and offering something for everyone. Citizenship ceremonies are held in many cities and towns, where immigrants who like what we do here, take out Australian citizenship, as a mark of respect and of inclusion into our society. Everyone receives a lovely certificate and a native tree to symbolise their connection t our land. These events are very moving and are I think, a reason why our country is inclusive, accommodating and welcoming. It is one of our great strengths, that we are open to ideas, willing to “have a go” and accepting of other people’s backgrounds and beliefs. You can tell that I am fiercely proud of my heritage, can’t you?

People who have made outstanding contributions to our country in various ways are also recognised with “Orders of Australia”. These are equivalent to the British system of honours, but we don’t use the terms “Sir”, “Dame”, “Lord” etc - which tend to entrench a class system. We put OAM (Order of Australian Merit) etc after the name instead.

Despite our annual chest thumping festival, things are not all rosy here and we have much work to do to stay true to our ideals. This may be the last Australia Day that we have in peace for a while, if our Government decides to throw our lot into a fight between bullies in far off lands (despite overwhelming opposition from the people). We have pressing environmental issues that are threatening our way of life and there are many that need a better deal and a fairer go.

As I look at what we have accomplished as a nation in just over 200 years, I think we can stand proud and tall. There may not be many of us (around 19 million) but we can, and do, make a difference on the world scene. I’ll be celebrating today, and I look forward to sharing a few Aussie thoughts with you over the coming year through my Diary entries.

Cheers, Skol, Salut, Down the hatch, Bottoms up… whatever ! ( Clink of glasses of full-bodied Aussie red wine….)

There was a big response to my Diary entry about the use of moxibustion for turning breech babies. As a result, I have now completed an article (with photos) on how to undertake this technique which I hope with be useful and enable parents and midwives to try it out.

The summary of the research paper (the only randomised controlled trial) is also included for those of you who would like to chase up the details, and some other useful links.

Let’s hope that this technique does the trick and some women (and babies) avoid the almost obligatory caesarean birth that is so prevalent today.

Another week is coming to a close. The workshop in Traralgon will conclude today and it has been very successful. The Grad Dip Midwifery students from Monash that we have worked with have been a special bunch of women - very motivated, very woman centred, and enthusiastic to boot. If these are examples the midwives of the future, then birthing women will be very well cared for and the profession is in safe hands.

The School of Midwifery here in East Gippsland, Victoria, is unique in its approach. Most midwifery education in Australia takes place in the large city teaching hospitals where it can be difficult for students to get a rounded education, given that these institutions have set ways of working. Trish David, the Senior Lecturer in charge of this Monash program has negotiated with all the rural hospitals in this half of the State to mentor and support a student or two through their small country hospitals. Many of these may only have 60 - 120 births each year. The students have told us how the midwives and nurses in these units (many women work both roles) have gone out of their way to ensure that they have seen as many births as possible and been given the experiences necessary for their Course. The challenge of having a student has kept the staff on their toes and is a simple way for regular staff to be updated with the latest research and practises. A win all round, it seems.

Many of these hospitals have acute shortages of midwives and so they are encouraged to select nurses from their hospitals to enrol in the Monash program. The hospital helps with fees and provides support and resources and in return they know that in 2 years they will have a fully qualified midwife to add to their pool of staff.

Programs like these are also enabling the smaller units to stay open - they are now “teaching institutions” and this added status can be useful in justifying their retention. Labouring women are finding that they are getting their “own midwife”, perhaps a student, who will follow them through the pregnancy and be there for the birth. This extra, personalised care is very attractive to women and has been a deciding factor for some who have chosen to give birth in a small rural hospital rather than a bigger city or District hospital. This outcome is good for rural health, the midwifery students and of course the women themselves. Let’s hope that Trish David’s program becomes a model for other schemes in other States.

The National Maternity Action Plan (NMAP), as I have written about before, is the first really comprehensive push in Australia for universal maternity reform. It is a wonderful vision, with a good chance of being adopted, especially in the current climate of rising costs, litigation scares, rapid rises in intervention rates and increasingly demanding consumers who are looking for more choice.

When politicians are approached for support for NMAP, they invariably ask “what will it cost?” and “how would it be implemented”? The first of these questions is fully covered in the NMAP report itself. The second challenge has also been embraced and a full Implementation Plan has now been developed for the State of NSW, where an election is due in March. This is a very professional and extensive document, well worth reading as an example of a practical blueprint for change. It will be harder for the politicians to push NMAP to one side as “impractical” when this kind of detailed planning has been presented to them on a plate.

Congratulations to the team at The Maternity Coalition for preparing this document. Best wishes too for their campaign of political harassment as the political hopefuls step up into full election mode. This is our best chance of achieving change for many years and it deserves al the support it can get.

The Effective Prenatal Education Elective that we are presenting for Monash University in Victoria is going well. These students have completed one year of their Graduate Diploma in Midwifery and are undertaking this elective in their summer holiday, which is a great sacrifice of precious spare time!

This is the first time that we’ve had the opportunity to work with midwifery students in this way. We aim to give them a good grounding in the preparation and presentation of prenatal programs for parents and hope that they will feel better prepared to tackle this important part of their work as midwives.

On Friday we will be videotaping their presentations. As usual, everyone froze when we mentioned the “video” word, but this is a very simple and effective way to get valuable feedback on one’s facilitation abilities. They will have time tomorrow to prepare the necessary lesson plans (one of the assessment tasks) and their efforts on Friday will be a useful “dress rehearsal” for their other assessment task which will involve videotaping an actual session for parents on a topic of their own choice.

It will be fun to mark these assessments and to see how they have done. Most educational programs these days require that students present to their class mates, so students are often a lot more confident than I was when I first started working with parents. It is always a help when we stress that good quality parenthood education does not involve lots of lecturing (public speaking is a common fear for us all) and that success is best achieved by involving the parents in working through many of the issues for themselves. An educator is really a facilitator and a resource person, rather than a teacher (a term I try not to ever use).

I am looking forward to Friday for a day of fun and games as we all pretend to be in a prenatal class with a variety of presenters and topics to be tackled. It should be immense fun as well as educational all round!

It has been a very hectic week as we get back to work after the holiday season. Lots of catching up to do after the break and not all my staff on deck as yet, so extra tasks to do myself.

Apologies for those of you waiting to read the next installment of this Diary - promise I will catch up with more regular postings next week.

On Sunday I am travelling to Victoria (Traralgon in Gippsland) to present the first workshop of the New Year - a five day program on “Effective Education” for Monash University. It will form an elective for their Graduate Diploma in Midwifery. I am really looking forward to working with these students as I always find Midwifery students to be committed, passionate and enthusiastic. Perhaps that’s because they have not had time to be ground down by the health care system! I will let you know how it is going as we work out way through the week.

I’ve heard that there is a new version of the Barbie Doll coming to Australia soon - the Pregnant Barbie! Apparently she has a “baby” in a tummy that is attached by a magnet - now there’s a lesson on how easy it is to give birth - just pop off the tummy and there it is!

I have heard that this doll was removed from sale in the US because it was thought that it might encourage teenage pregnancies (!). The main issue in Australia will be the bottle that is included in the kit and the feeding information that mentions bottles but not breasts. That will have to go or the product will receive very bad press from all the breastfeeding activists here.

It will be interesting to see how they plan to market it here!