Andrea’s Diary

This morning I was able to talk on the phone to Lennart Righardt, the Swedish paediatrician who has been promoting breastfeeding and normal birth for many years. Lennart was in Sydney, as part of a 5 month long round-the-world holiday he is enjoying now that he has retired.

I first met Lennart many years ago when he attended an Active Birth workshop in London, and we discovered we had many beliefs and concerns in common. Later, when he visited Sydney to see his daughter who lives here with her family, we also had time together discussing mutual concerns and sharing ideas.

Lennart has produced a CD with music and spoken word that is designed for expectant parents to listen to as they prepare for the birth of their baby. He has also made a video on delivery self attachment that shows how a baby can crawl to the breast and latch by itself (if necessary) and the way that drugs given to women during birth block this natural instinct and may therefore delay the initiation of breastfeeding. All very interesting. The video Breastfeeding: The Baby’s Choice also from Sweden, is very similar.

Lennart has always been a champion for natural birth and now that he has retired, his input will be missed. I wish him well for a peaceful life (and feel envious of the ability to take a 5 month holiday in interesting parts of the world!)

A busy day today - finalising a submission for a big project we are hoping to undertake later in the year (more on this later) and also tying up loose ends before setting off for the UK in two days.

A colleague in Queensland contacted me about the horrible time she is having trying to practice midwifery in her local public hospital. It seems that the concept of “corporatisation” has taken hold and the hospital is trying to emulate big business by badging their products and services rather than focusing on health care.

This has resulted in more attention being paid to the image and indoctrination of the staff than the needs of the patients. In the maternity unit the caesarean section hovers between 30 - 60% depending on the day of the week and inductions are the way most labours start.

What is the point of all this? Why would a hospital try to look like a big business? People who are sick just want to get better and receive good care from someone whois more interested in helping them than how their uniform stands up to scrutiny. I can see the need to have staff training sessions on public relations - how to make people feel welcome, how to communicate well, learning how to smile under pressure etc, but this is surely just common sense and basic good manners.

Private hospitals are all about marketing a name and business-like functioning. They are also the places where the most important people are the doctors (who bring in the money, sorry, clients) and where the patient is the lowest one on the totem pole. This approach is especially inappropriate for pregnant women, who are not sick and should not have to be there in the first place. However, many of them come from the corporate world themselves and I guess they feel right at home! The dazzling image must also be clouding their judgement - why else would they accept the unjustifiable rates of interventions in their births that occur in these money making shrines?

Well, the National Association of Childbirth Educators Conference (NACE)is over for another 18 months - three days of listening, debating, enlightenment, networking and catching up with colleagues. Lots of highlights, but a few stand out in particular:

Sheila Kitzinger, on what will probably be her last visit to Australia. She has been unwell and looked very frail, but her passion, her ability to command attention with her voice and the overwhelming relevance of her message are as strong as ever. Her keynote address looked at the history of childbirth and its intrinsic centrality to women’s lives, illustrated by a wonderful collection of pictures from all over the world. Much of what she spoke about is contained in her lovely book Rediscovering Birth, a must on your bookshelf for those days when you are feeling a bit low and demoralised.

Today she presented a smaller workshop session on the theme of birth as rape, again illustrated with women’s words and Sheila’s own compassionate insights. Real stop-you- in- your- tracks stuff.

Yesterday’s program featured fathers, with wonderful presentations by Paul Pritchard and Richard Fletcher, both of whom are facilitating men’s groups on parenting, in different parts of the country. As most childbirth educators are women it can be difficult to try and put ourselves in men’s shoes so their needs can be met in our pre-natal programs. Paul and Richard had a very simple answer to this dilemma - give the men space an let them explore these issues for themselves. An obvious solution but one that is not offered nearly enough.

The Hypothetical facilitated by comedienne, radio personality and all-round good gal Julie McCrossin was a hoot. A panel of speakers addressed various aspects of the question that women should be allowed to choose an elective caesarean section. A popular topic for debate, perhaps made more popular as a choice by debates such as these!

As usual there were a multitude of smaller workshops and seminars available, requiring difficult decisions to be made. I didn’t get to any of these because I was staffing the Birth International display, but at least I can catch the summaries in the proceedings.

Only one quibble from me - everyone kept talking about “antenatal” programs, classes etc. This language really grates every time I hear it because of its unintentional negative overtones. I much prefer to use the word pre-natal, which seems logical to me as a natural precursor for the post-natal period.

The next event will be in Tasmania in October 2004. Not sure that I will be there as I am always in the UK in October, but I certainly enjoyed being part of this event as I feel sure that everyone else who attended had a fine t ime. Congratulations to NACE on an event that was well organised and very professional.

I was shocked to hear today about the state of affairs ion one of Sydney’s best known Birth Centres. Apparently the midwife shortage is so acute that many are having to work double shifts. In order to get some sanity into their lives by not working too many nights, the midwives are routinely rupturing membranes at around 8 cms, announcing that there is meconium in the liquor and then transferring women to he labour ward for the birth. This is now so common that there have been no births in the Birth Centre in the last month.

Can this really be true? I heard it from a reliable source who is a regular supporter of women (doula) giving birth in that hospital. I have no reason to doubt her word and I know that the Birth Centre manager has left and has not been replaced as yet.

Can midwives really be behaving like this? What are they doing about it, apart from taking out their frustrations on the women? Staff shortages should not be the reason for rupturing membranes! This is an outrageous situation, and one that needs direct and effective action. It is enough to make you weep….. where are we heading, indeed?

If I was a cynical person, I would say that the doctors are being kept happy with enough midwives to manage their private clients, and that the Birth Centre is being seen as expendable and starved of midwives when shortages occur. Years ago women marched to protest the proposed closure of this Birth Centre - maybe another march is needed now.

Today, I will be setting up the Trade Display for Birth International at the National Association of Childbirth Educators (NACE) Conference in Sydney. These events have been held every two years for a long time (15 years?) and are rotated around the various capital cities in Australia - we are back to Sydney at last!

I am not always involved very much - by now, with 30 years of experience in this field, I don’t feel it is appropriate for me to be submitting abstracts and asking to be included, so I usually wait to see if I am invited to participate. This year I will be giving a 15 minute presentation (!) as part of a panel discussion, and I have chosen the topic of “The Future of Childbirth Education - educating for choice or compliance?” I will only be able to give this important topic a very cursory outline in the time available, but hope to at least raise some issues.

There are a number of interesting speakers on the 3 day program, headed by Sheila Kitzinger, who last visited us in 1992. This may be her last visit to our country, so I am sure everyone will be keen to hear her. Susan Maushart is the other major speaker, on the topic of “Motherhood as a subversive activity” - should be stirring and popular!

There are lots of concurrent workshops and seminars from which to choose, making for very difficult decisions because all of them sound relevant and engaging. I’ll feed back useful information through Diary entries over the coming days.

For the last 10 years, Michel Odent has been publishing his excellent “Primal Health Research Newsletter”. It comes out quarterly, and each issue explores an aspect of pregnancy and birth care that has implications for the future health of babies and mothers.

The latest issue, Volume 10, No. 3 examines the advisability of routine pregnancy care for the majority of women and comments on the many studies and randomised controlled trials that have proven that routine ultrasound scans, haemoglobin testing, glucose tolerance tests and even the taking of blood pressure do nothing to improve the outcome of the pregnancy. As always, Michel raises interesting questions and propositions, and in this newsletter he suggests that the emphasis should be on preconception care rather than pregnancy care. The references that back up his assertions are included and will be useful for students and midwives interesting in providing more cost effective and beneficial pregnancy programs for women.

You can obtain the newsletter by emailing Michel Odent at Modent@aol.com. The research papers can be found on the Birthworks website, where all the data accumulated by the Primal Health Research Centre can be located.

This weekend has seen huge numbers of people massing to protest the war that seems to be inevitable. As I write this, hundreds of thousands of Sydneysiders are massing in the city to vent their anger and frustration with our Prime Minister who seems to be hell bent of supporting the American President, ahead of his own people. Australia is a peaceful and peace loving place, with tolerance and the concept of “a fair go” firmly embedded in our national psyche. The idea of fighting someone else’s war, on the other side of the world, at the behest of a deeply suspicious, belligerent, right-wing cowboy is anathema to me and millions of my compatriots. There are other ways to deal with tyrants apart from dropping bombs on them. Perhaps the American President will find himself subjected to some of these measures in the end, because people perceive his bellicose and posturing behaviour as tyrannical as well.

The NSW Midwives Association is marching in today’s protest and had I been in better health, I would have joined them. My heart is with these women, who, as midwives, know that the way one begins life can have a profound impact on the mental and emotional (as well as physical) health of people. We must humanise birth if we are to produce reasonable human beings.

I wonder how George W Bush was born? Was he “untimely ripped” from his mother’s womb, or dosed with drugs that have impacted on his capacity for love and respect? I have always believed that the babies born today will be making the decisions that affect us all in the future and that we should therefore recognise the impact of our actions on these sensitive beings in the precious and important hours around birth. We need our children imprinted with love and sensitivity, not aggression or survival anxieties.

It may be too late to save the American President. However, there are good and rational people in the world and with luck they will prevail over the war mongers and blinkered egomaniacs that seem to be leading us at present.

We may feel helpless and sometimes hopeless when viewing the antics that are leading us down self-destructive paths. Even if we can’t do much to impact the bigger picture, we can influence the smaller picture, in the hope that the future will provide a safer and more respectful, tolerant home for us all. The next time you are journeying towards birth with a labouring woman, remember that her child may hold your future in his/her hands. Be gentle, be kind, be patient and loving. These are lessons we can pass on to the next generations through our direct action and heartfelt example.

Peace be with us…….

You may recall the fun and games I had when attending a birth at a hospital near where I live in Sydney (Diary entry for January 6). I followed up with a letter to the Unit Manager in which I detailed the problems we had encountered and our impressions of the Unit and its staff. This letter was not about the woman whose birth I was attending, but about the bigger picture of Unit policies, staff attitudes and skills and their willingness to be “with women” rather than “with the institution”. Their inflexibility, rudeness and lack of care for the woman’s needs during labour were also of concern.

There was quite a bit of discussion on the ozmidwifery list about this Diary entry, the main thrust of which was “shooting the messenger” because I had the temerity to point up some deficiencies, as I saw them, in this Unit. There was also the inference that I was really just touting for business (that is, running a workshop for their staff). Of course, their staff should be having a series of on-going in service sessions on how to be “with women” and the midwives we met early on certainly had no idea how to use a CTG or do a vaginal examination with the woman off the bed! It doesn’t matter who facilitates this practical skills training as long as they receive it and I certainly am busy enough not to be actively seeking work!

Finally, a letter of response has arrived today. It details the training that the staff have now received on the use of water during labour and birth, especially as it relates to the needs of the midwife. It says that my concerns “have been discussed at both ward and departmental level”. That’s all. I’ll bet they were discussed, and also the incident report that was generated on the night in question! The interesting thing is that the letter does not state that any action has been taken or is planned, or even that they have any comments on the issues that I raise and nowhere in the letter are the labouring women who might use this Unit mentioned.

The way this matter has been treated indicted to me that this unit does not have a woman-centred philosophy of care, that they are not listening to women (users of the service or their support team) and that they are unwilling to address any comments or suggestions that might improve the care they offer women. Given that this unit holds itself out as a “showpiece” in Sydney, I find this kind of arrogance very sad. What a missed opportunity for great public relations and positive publicity!

I will be closely following the experiences that several of my younger friends have when they give birth there in a few months time.

For those of you who have been following my Diary entries about the NSW Birth Statistics, you may want to know more - these statistics are very useful to show to parents in prenatal programs, for example. The information is contained in the

NSW Public Health Bulletin Supplement

Volume 13, Number S - 4 December 2002

ISSN 1034 7674

“New South Wales Mothers and Babies 2001″

It is a free publication and can be ordered from

Centre for Epidemiology and Research

Public Health Division

NSW Department of Health

Locked Bag 961

North Sydney NSW 2059

For those of you in other States who are looking for similar information on birth outcomes in your area, you will not be so lucky. The NSW Department of Health has been producing these reports for years, but is the only State to do so. The others have much smaller reports, often just no more than a few tables (Victoria, for example) or make nothing available in print at all (Queensland). This is a very unsatisfactory state of affairs: as taxpayers propping up our health care system we have a right to know how our money is being spent; as expectant parents and families we have a right to know what is going on in our hospitals and how they are performing; as caregivers we need to know how our hospital compares with others in the region and across the State as a whole.

It would be worthwhile calling your local Department of Health and requesting the information they have. Mention the NSW Report and ask for similar information to be made available where you live. If we don’t ask for this, we will never get it!

We all know that more women today are requesting epidurals for labour pain than ever before. Therefore it has been interesting to review the percentage of women at various hospitals in NSW (for the year 2001) who are given epidurals. As expected, women choosing to use a private hospital for the birth have every likelihood of ending up with a bill from the anaesthetist for your epidural.

The highest reported rate of epidural use was at Kareena Private Hospital - 76.4%, just pipping Prince of Wales Private Hospital in Sydney which had a rate of 76%. The Mater Mothers Hospital in North Sydney had a rate of 62.7% and Hurstville Community 65.2%.

At the other end of the scale were Wyong (see my previous Diary entry) whose rate was 0.0%, Inverell Hospital with 0.8% Mudgee 2.3%, Broken Hill Base Hospital 9.6% and Armidale Hospital 4.5%. Of course, these are all country units and there is probably not an anaesthetist available to offer epidural for anything other than caesareans. Where epidurals are not on offer, pethidine or nitrous is used instead, and this is reflected in the figures: Wyong for example has a whopping number of 44% of women using nitrous and 21.9% using pethidine and only 1.6% of women giving birth in that midwifery unit escaped with no pain medication at all. Makes me wonder what has happened to the skills of those midwives working in Wyong!!

Reviewing the figures for “Nil” use of pain relieving drugs makes sorry reading. Again, the private hospitals have dismal outcomes: Kareena Private with 2.6%, The Mater Mothers in North Sydney, just 1.8%, Hurstville Community 7.25%, St George Private 4.0% and Prince of Wales Hospital 2.8%.

The hospital with the lowest rate of women labouring without drugs was Gosford (in the same area as Wyong), with a pathetic outcome of just 0.9%!. 50.2% of women there get nitrous oxide, 38.9% have pethidine and 25.3% have an epidural. They seem to have lost the plot completely.

The best hospitals could only manage rates of 28.3% (Muswellbrook), 24.7% at Inverell, 25.6% at Moree and 29.8% at Queanbeyan. Much better than most but still falling a long way short of ideal.

We have a lot of work ahead if we are to turn this around. Almost all babies born in NSW will be exposed to one or more drugs during labour and birth and will have on-going effects from this exposure for days and perhaps much longer. The work of Jacobsen suggests that it may be many years before the insidious effects show up, perhaps as drug addictions or other antisocial behaviours.

Midwives have got to ger their acts together over this. They are the ones who are offering the pethidine and nitrous oxide instead of using their skills to enable women to manage in other ways. Perhaps midwives could be counted amongst the biggest drug pushers in our State!