Andrea’s Diary

There can be few doubts that midwifery as practised in New Zealand, offers the best options in the world for the care for pregnant women and midwifery practitioners. They seem to have grasped the whole philosophy of normal birth with a broad stroke of the brush and backed it up with the necessary structural services and underpinning legislation. Working as a midwife in New Zealand would b a goal of many of the midwives I meet in my travels!

A few years ago, we invited Maggie Banks to participate in one of our Future Birth tours. She was a sensational speaker, gently encouraging us to trust and believe whilst showing how breech births could be managed safely using midwifery principles. Her book Breech Birth, Woman Wise is easily the best practical manual on vaginal breech birth around, and a copy should be in every midwife’s possession in readiness for the day when an undiagnosed breech birth presents itself.

We have again invited Maggie to participate in one of our programs - this time a series of workshops that will be scheduled around Australia. More about this exciting program later - it promises to be a very practical, hands on event, led by experienced midwives who want to share their know-how for the betterment of midwifery and birth for women. There will be details on our web site in the next few weeks.

Meanwhile, you may like to check out some of Maggie Banks’ work - her website has some interesting articles and her new “Intensives” will be of interest to many. They will provide a good alternative to the ALSO Courses that are very medicalised in their approach and philosophy. Maybe going to one of these courses with Maggie will provide the excuse you need to visit Kiwiland!

I’ve been talking to day to Susan Ross, a midwife and childbirth educator whom I have known for about 20 years. She’s worked in several hospitals, mainly as an educator, but is now working independently.

Her current project is a book she is writing, titled “Doing it Your Way”. It is intended for expectant parents and she has been interviewing key people in the birth field and parents who are all contributing their thoughts on what it is like to give birth to a baby in today’s world. She had come to interview me for the book and to explore some of the issues that are impacting on the birth scene today, as well as my own personal involvement over the past 30 years.

Talking to Susan was easy - we have many shared experiences and have seen many changes over these past years. It was interesting, for example, to discuss the current demands for epidurals and caesareans. There is no doubt that women today are older, smarter and more life-experienced than ever before and that we live in a world where technology is kind and education is highly prized. What is fascinating is the way labour pain has been “sold” as a problem that can be solved by technology (machines and drugs) and the way women have embraced this approach without question. For an educated bunch, they seem to ask few questions. We threw lots of thoughts around about the role of obstetricians in driving these demands and the various vested interests involved and considered what might eventually drive changes back towards normal, unmedicated birth (but we didn’t find the definitive answer to this one!).

We also chewed over the problem of doulas and their impact on women, midwifery and the health care system. I am still very unhappy about the concepts that underpin many of the doula services that are springing up and the motivations that are driving people to take on the role of a doula. I can see how they are popular with women who are looking to buy services: a cleaner for the house, a doula for the birth and a nanny for the baby. Where will it all end?

Back at the desk today after my short holiday - and hundreds of emails to catch up with, including several new postings to my entry on moxibustion to turn breech babies. This is obviously a topic that is of vital interest to a specific group of pregnant women and it is clear that detailed information is needed about how to turn the baby into a more favourable position.

In the Diary entry I wrote before, is clearly states that more info is available on our web site and gives a direct link to the page in question. It seems that people don’t understand how to do this simple task, so I will again give you the link: all you need to do is point your browser (the little arrow) on the part underlined and it will take you to the page you are looking for. Click HERE for info on moxibustion to turn breech babies. Please feel free to print these pages off and circulate wide and far - it may help many women to avoid the almost obligatory caesarean births they are now under duress to accept.

A quick note to you all to today, to say that I am taking a break for a week - a much needed holiday. I am looking forward to spending some time in the beautiful forests of the north coast of New South Wales, in an area where there are abundant national parks, wildlife, birds, bushwalks, beaches and complete peace and quiet.

A few days contemplating nature will be just the ticket right now, and I know I will be back with renewed energy and a head full of ideas…….

One of the best ways we could change attitudes to birth in our community would be to improve the information about pregnancy and birth in the high school curriculums. It is a strategy that is often mentioned in my workshops, and here and there I here about midwives who have accepted invitations to speak to high school students about birth and breastfeeding.

Core of Life is a magnificent project that was started in 1999 by two midwives at Rosebud Hospital in rural Victoria. The program takes 1 ½ hours, and involves the children in an interactive, multimedia, “hands on” session that covers the topics of pregnancy, birth, breastfeeding and parenting. It aims to enable these young people to make informed choices about these issues and to take responsibility fort heir own health and well-being.

From a humble start, it has now spread to many regions of Victoria. A facilitator training package has been developed and funding has been received to enable further expansion. The evaluations o f the program and the feedback received from participants, parents and teachers have all been overwhelmingly positive, and considerable changes in knowledge and attitudes have been noted. For example, 94% of males and 89% of females completing a post-evaluation questionnaire stated that they would like their children to be breastfed in the future.

This is a wonderful program, and a great example of midwifery in action, this time as part of community education. As major suppliers of educational materials fore these programs we salute the initiative demonstrated by these dedicated midwifery leaders and look forward to continued support of their efforts in the future.

Please check out their website by clicking on their name above. Could you extends this program to the students in your area?

Today I have spent some hours reviewing an article on Pain Relief for labour that is intended for a Pregnancy edition of Cosmopolitan in October. I was pleased to have been asked to check this before it went to print because it had a number of inaccuracies and some vital information had been omitted.

I asked the journalist where she had obtained her material and she said that it has mostly come from the Internet. This would have accounted for some of the errors - drugs not used in Australia, procedures no longer carried out here and details that were not relevant.

I avoided getting on one of my many soapboxes (there were several that would have been appropriate!) and just tried to correct mistakes and clarify various points. I did add a whole thread on keeping mobile and upright and I did change the “Breathing and Relaxation” to plain “Relaxation” with the emphasis on support and environment. Endorphins were mentioned several times by the time I finished too.

It took me several hours (all unpaid, of course) and it will be interesting to see what they do with it. I don’t think the journalist has given birth herself. If she had, I suspect she would have been a lot more positive about the various drugs that were on the list (particularly epidurals) as so often happens with these kinds of stories. I sometimes think that media articles on birth should be written by men - at least they don’t carry so much personal baggage that can get in the way of the truth. Anyway, let’s see what Cosmo manage to tell women in their October issue.

One advantages of working in this office is that you get to see the new book releases before anyone else. We are constantly working with publishers and authors regarding new titles and a steady stream of books arrive for review and consideration almost every day.

We choose the books and products for our range with some care. Any textbook on midwifery will be automatically included, as will most texts on breastfeeding. Books for the Essential Parent section of our list will require careful scrutiny, because we try to provide sensible, practical, baby friendly titles, just as we look for woman friendly titles for pregnancy and birth. Some books for parents have such wacky ideas that they fail to measure up to our standards (the current fad for “controlled crying” is one notable example) and these are rejected.

Two books caught my eye today, “Fresh Milk” and “Midwives of the Black Soil Plains”. Apart from the very attractive cover, Fresh Milk takes a quirky look at all the “other” aspects of breastfeeding, apart from the purely mechanical and physiological. It is very unusual in its approach and highly entertaining. There is plenty of material here that will resonate with women who have breastfed their babies and a lot you won’t find anywhere else.

In “Midwives of the Black Soil Plains”, the stories of the pioneer midwives are retold, complete with photographs, maps, extracts from public and private records and many anecdotes. The situations in which these midwives found themselves are truly amazing, and their inventiveness, resourcefulness and determination (not to mention skill) could make working as a midwife today seem simple, by comparison. However, although some aspects may have changed for the better, conditions for midwifery are still poor, but in different ways. In bygone days, the midwife worked by herself and did what she could in often trying and even dangerous conditions. Today, many midwives would love to work by themselves, without the meddling medical strictures that so-called “progress” has forced upon them. Conditions may be less hazardous in some ways (travelling by horseback through fire and flood for example) but more so in others: the heavy threats of litigation, for example. In the early days, women were grateful for anything the midwives could do to help and were not expecting everything to be “perfect”. How things have changed today - women seem to want the midwife to do everything and threaten action if expectations are not met.

People often yearn for “the good old days” when life seemed simpler and people friendlier and less stressed. Yet life today offers so much more for woman than ever before, if we can just stand the strain of having to deal with all our options!

A had a call today from a pregnant woman who was looking for an independent midwife. She was initially thinking of a midwife who could attend her in a Birth Centre and when I mentioned home birth, she was surprised. She had been told that at age 34 she would never be considered for a home birth as she was “too old”!

This “ageist” stuff is really silly. When I was giving birth to my children, I was considered to be a bit on the “old side” as I was in my mid 20s. Anyone over the age of 30 had “elderly primigravida” written on the top of their notes and was treated as a walking time bomb.

Now that women are choosing careers ahead of babies and the average age of first births has risen to 30 years (which means that more than half of all women are having their first child will be older than this), these arbitrary definitions have had to be re-written. “Elderly” now refers to anyone over the age of 35, or even 40

It is all meaningless, of course. General health is a much better indicator for a good birth outcome and many women in their 30s and 40s are in very fit condition ( not like many of the rest of us!). It won’t stop people (often doctors) from trying to scare women about potential problems because of their “age” however, and the barrage of tests and technology they will be subjected to will not necessarily enhance their confidence.

I was pleased to be able to at least put one woman’s mind at rest today. She was certainly interested in a home birth but had almost ruled it out - I hope she takes the common sense approach and leaves the final decision about birth place until the labour is underway. Given the right midwifery support, she can safely leave her options open right until the last minute.

I have just heard that Dr Barbara Vernon has been appointed as the Executive Officer of the Australian College of Midwives (ACMI). This is a landmark appointment and one that will send a strong message that ACMI is serious about the partnership between midwives and women and the importance of having a voice in national affairs.

Barb Vernon has been President of the Maternity Alliance in Australia for the past few years. She has a background as a statistician for the Commonwealth Public Service and a strong history of organisation and lobbying. Having had home births, she discovered the magic and importance of birth and became a passionate and effective spokesperson for the maternity reform movement. The National Maternity Action Plan was co-ordinated and co-authored by her and, having undertaken this thorough review of the status of birthing services in this country, she is well placed to understand the national health care system and its relevance to maternity care.

What a coup for ACMI! Barbara was to return to her work for the Government, but was very unwilling to put aside her work for midwifery, women and health care. Her appointment to this prestigious position will give her a chance to further extend her considerable skills at the same time as giving the ACMI a very effective lobbyist and champion organiser. No doubt there will be some eyebrows raised at the appointment of the first non-midwife to this position and it is to the credit of the Executive that they have taken this bold step to signal their commitment to working “with women”.

Congratulations to Barbara and to the ACMI on this exciting new approach, and best wishes for productive and successful years ahead.

We sometimes have a good giggle at the items that come through our book sales subsidiary, ACE Graphics. We have a very useful teaching kit for pre and post natal educators called The Contraceptive Kit, which contains samples of a whole range of contraceptive devices plus reference materials. It has proven very popular.

Recently, a customer contacted us to say that their kit was missing its “banana penis” when it arrived. We immediately offered to obtain the missing part and today it duly arrived. I wondered what on earth I was unpacking, as I helped out with the post this morning!

We have now sent of one “banana penis” to our client. Fortunately we didn’t have to declare the package contents on a customs slip as this was going locally, not overseas. Not sure how customs people in some countries would regard such an item……

Wonder what will turn up next?

http://www.birthinternational.com/product/cbe/cbe004.html