Andrea’s Diary

This will be my last Diary entry for the year - I am taking a three week break to rest and recuperate before launching into a very busy 200 on January 14.

It has been a very productive and busy year, with a number of stand out highlights for me:

No wonder I feel in need of a holiday! Next year promises to be even more hectic, with some major new initiatives in the pipeline and a pile of projects waiting to get started.

Thanks for reading my Diary entries during the past year. I look forward to sharing more thoughts with you over the coming months. I will be back at my desk on January 12.

Have a wonderful Holiday Season and I hope that all of you have a peaceful, healthy, happy and fun 2004!

It seems that spammers have found a way to add comments at random to Diary entries. I’ve just spent quite some time eliminating my second series of junk comments posted to various entries on my Diary.

Whilst I don’t expect that many of you will ever read back through the comments and find these meaningless messages, it is annoying for me to find that amongst the very welcome comments many of you add to my thoughts, there are stupid messages that are just random junk.

I will try and find a way to restrict access for these pests. Having just installed the most comprehensive firewall and internet security on this laptop, there may be a way of utilising that to do the trick.

Meanwhile, I really apprecicate the comments and extra information that my readers contribute. I don’t always have time to reply to everyone, but where I can, I try and email you privately if you need a specific contact, for example.

We received a lovely new poster today on the theme of “Women’s Business”. It comprises a collection of wonderful photos of Aboriginal women, collected by Sue Kildea, a midwife who has been working on and researching Aboriginal health issues in the Northern Territory for some time now. It is a large poster which would grace the walls of any health centre - the full details will be in the new catalogue which will be out in January (and also on the web site at that time).

The arrival of this colourful chart started a spirited discussion about Aboriginal health issues amongst our office staff. One of the team has a friend (English) who, together with her husband, now lives in the Northern Territory as an accepted member of an Aboriginal group. She and her family live amongst the people and share their lifestyle completely - her job is teach them how to cut hair!

Another staff member recounted the story of trying to gather material for a newsletter on Aboriginal issues. When she contacted the ATSIC (Aboriginal and Torres Strait Islander Commission) to ask how she could go about including some information and news items about the Aboriginal culture she was roundly abused by the person at the end of the phone - “you people think you can take what’s ours and just use it” etc in a very belligerent tone. Thoroughly shocked by this outburst, she apologised for asking and was then told “now you want to say sorry!!” She gave up at this point and has not attempted to talk about Aboriginal issues in any way since.

Aboriginal Health is a thorny and sensitive issue in Australia. It seems the more we try to help the worse conditions get and the records sow that in this very affluent country our native people have health outcomes that are equivalent to the worst of third world countries. Midwives like Sue Kildea have been working hard over many years to make some inroads into this appalling state of affairs and this new poster celebrates some of their achievements.

The year is slowly (quickly!!) coming to an end and this week I will be starting to tidy up loose ends before we close our office down for the Holidays and I take a much needed break.

One task to complete is to edit the English text for a new video that has been produced in Brazil to promote breastfeeding. Of course I can’t see the visuals, but from reading the text is sounds lovely - and I will be keen to see the English version when it is ready. The translation is OK but could do with a bit of editing to make it a little less cumbersome.

Another job to be completed this well will be the finishing touches to the workshops program for the first part of next year. I have just decided to schedule some Water Birth workshops because it seems that many midwives are holding back from enabling, let alone encouraging water births because they lack confidence. I have asked Shea Caplice to facilitate these for us and I hope to get these dates finalised in the next few days.

The last changes/additions to the next Birth International catalogue are being completed as well, with the aim of having this ready for printing mid January when everyone is back at work. It will be an Anniversary Issue: 20 years for Australia and 10 year of operating in the UK. Quite some milestones!

Not to mention the Office Christmas Party - this year being combined with a “House warming” to celebrate our great new office space. It will be fun to catch up with many of our local suppliers and customers on Thursday afternoon.

The last workshop of the year - for the central Coast Area Health Service, at Gosford Hospital. A full group, representing all the hospitals in the area, including the Private Hospital and the Community Midwives Program.

When we compiled a list of agenda items, I was asked to include hypnobirthing and acupuncture. I pointed out that I was not an expert in either of these areas, but I was willing to discuss them in the broader context of strategies for easing pain in labour. I was also asked to include some ideas on how we could change the prevailing culture of birth that has left women feeling completely inadequate and unable to manage labour without help (usually an epidural).

I couldn’t help thinking that these two areas were linked. The more that “complementary therapies” of all description as promoted, and I would include acupuncture, reflexology and hypnobirthing in this category along with other methods, it creates the impression that women are not able to manage labour without some kind of “aid”. I agree that these alternatives are often a lot less invasive and potentially risky than an epidural, especially in terms of their physical impact on women and babies. However, if we consider their influence on the cultural beliefs about birth, in many ways they are damaging, as they feed into the notion that women are weak creatures, unable to overcome their fears and that they require help (often expensive) to achieve a normal birth.

A little later on, one midwife commented , in relation to the use of doulas, that many women just didn’t have access to anyone who could mind other children while she laboured, let alone act as a support person. Even if there was a doula service (as there is on the Central Coast) these were the women who couldn’t afford to pay their fees either. Once again it seems that the socially and economically deprived just have to “get on with it” while their more wealthy sisters have to pay for help so they can cope. It is quite crazy, but instructive.

All these women are the reason why a community based, publicly funded caseload midwifery service is desperately needed. If all women had access to their own midwife during pregnancy and labour, women would learn they can manage birth without the “extras” and those who have social problems would find ways around them with the help of the midwife - perhaps a home birth?

Ah, Utopia!

The last workshop of the year - for the central Coast Area Health Service, at Gosford Hospital. A full group, representing all the hospitals in the area, including the Private Hospital and the Community Midwives Program.

When we compiled a list of agenda items, I was asked to include hypnobirthing and acupuncture. I pointed out that I was not an expert in either of these areas, but I was willing to discuss them in the broader context of strategies for easing pain in labour. I was also asked to include some ideas on how we could change the prevailing culture of birth that has left women feeling completely inadequate and unable to manage labour without help (usually an epidural).

I couldn’t help thinking that these two areas were linked. The more that “complementary therapies” of all description as promoted, and I would include acupuncture, reflexology and hypnobirthing in this category along with other methods, it creates the impression that women are not able to manage labour without some kind of “aid”. I agree that these alternatives are often a lot less invasive and potentially risky than an epidural, especially in terms of their physical impact on women and babies. However, if we consider their influence on the cultural beliefs about birth, in many ways they are damaging, as they feed into the notion that women are weak creatures, unable to overcome their fears and that they require help (often expensive) to achieve a normal birth.

A little later on, one midwife commented , in relation to the use of doulas, that many women just didn’t have access to anyone who could mind other children while she laboured, let alone act as a support person. Even if there was a doula service (as there is on the Central Coast) these were the women who couldn’t afford to pay their fees either. Once again it seems that the socially and economically deprived just have to “get on with it” while their more wealthy sisters have to pay for help so they can cope. It is quite crazy, but instructive.

All these women are the reason why a community based, publicly funded caseload midwifery service is desperately needed. If all women had access to their own midwife during pregnancy and labour, women would learn they can manage birth without the “extras” and those who have social problems would find ways around them with the help of the midwife - perhaps a home birth?

Ah, Utopia!

Today has seen some milestones achieved.

I have had confirmation that Childbirth Graphics in the US ( the largest supplier of teaching aids and equipment for birth and health educators in America) will stock copies of my book “Preparing for Birth: Mothers” for sale through their extensive mail order catalogue. This is good news indeed as it will make this information available to parents in the US and I know there is no other publication of this quality available there now.

I have finalised the text and commissioned the new cover artwork for the next edition of “The Midwife Companion”. Finding the time to get this project completed has been a real challenge and to have it almost ready for press is great, especially before Christmas. It will be available in mid-February (might aim for a birthday present for myself!) and there will be announcements on the website about a special price for advance copies ordered on-line, so watch for those.

We’ve finalised almost all of the last requirements for our Re-registration as a Registered Training Organisation. Following our audit there were a few small items we needed to update and this has now been completed, thanks again to Cassandra, my trusty Course Co-ordinator!

The Midwifery Intensives program information is to be launched on the web site today - click on the Events listings to find the details. This will be a series of “must do” workshops, and you will want to attend one if you can. We have our usual group booking discounts and a special price for students. We have some other workshops in the pipeline as well - I will let you know when these are finalised too.

All in all, a productive day. Thank heavens that a holiday is looming - I am very ready for a break from the intensity of the last few months!

The question of what constitutes a “Birth Centre” has come up. Last weekend when I was at Sutherland District Hospital, the midwives told me of their plans to set up a Birth Centre in the labour ward area. They asked me for some ideas about how they could make it different from the main labour room area, all of which is newly constructed with an en-suite bathroom (with tub and shower) for each labour rom. At the present time, two rooms have been set aside for the “Birth Centre” and these have been equipped with very expensive hydraulic double beds, other wise they are almost identical to the regular labour rooms.

When Birth Centres were first established in Australia (almost 20 years ago now), the concept was a place in which a natural birth could take place. The decor wasn’t all that wonderful in many cases, as usually the area allocated was a re-cycled facility rathe than a purpose built one. However, with a bit of imaginative decoration they came up quite well, and emulated a home like setting, with regular pine furniture, settees (sometimes fold away double beds) kitchen type table and chair settings and an en-suite bathroom. The baths were usually like those at home, not the large tubs that came later, but even then some babies were born in water - it was no big deal.

What made Birth Centres different was their philosophy that no drugs would be offered or used and that women would need to use other means, such as heat and water, to ease their pain. Friends and family were welcomed (even necessary) and attendance at a quality prenatal class was mandatory, so that parents felt confident in being able to “look after themselves” as much as possible. The women able to use these facilities were all deemed low risk and the transfer rate was fairly high, because strict limitations were imposed by the obstetricians who were doubtful about normal births and felt threatened by the Birth Centres’ increasing popularity.

A lot of experience has now been accumulated in Birth Centres and a lot of research has focussed on their outcomes. We know they work well, that women like them, and that babies do better when born in these kinds of facilities. Given all that, the transfer rates are still high, although some of the acceptance criteria have been dropped. Many Birth Centres now support VBAC (Vaginal Birth After Caesarean) and the age limitations have been relaxed.

It seems that the use of water, however, has become more limited. I have learned, in the past few weeks, that many of the Birth Centres in Australia are now not “allowing” water births. Women may be encouraged to use the tub for labour but are asked to get out for the birth. I have been told, that the reasons for this restrictive practice, are that “the hospital doesn’t have a policy on water birth” and “the staff have not had training”.

These days, it seems that even sneezing in hospital requires a policy ! Given that there are plenty of guidelines around such as Sheila Kitzinger and Ethel Burns excellent manual, it is hard to imagine why hospitals can’t quickly establish a set of policies. As for staff training, this is also easy - midwives just have to learn to keep their hands off!

For women arriving into hospital in labour and spying a large inviting bathtub it must be very unsettling to know that it can only be used for the labour and that they will have to struggle out when the birth is imminent. This is not only dangerous, but just plain silly. One women, booked to give birth in a hospital in the north of the State, took matters into her own hands. She arrived in labour with a letter that she handed out to everyone, clearly stating that if she wanted to give birth in the bath and someone pulled the plug to prevent a water birth, she would personally sue the doctor, the hospital, and the Regional Health authority. That Region had a policy in place within a week. I feel sure that this could be achieved elsewhere - it just requires a concentration of the mind.

As for training the of staff, these are skills that must be learned “on the job”. We will be offering some water birth workshops early next year to show midwives how easy and useful it is to facilitate a water birth - let’s hope that then our Birth Centres can get up to speed with the care that women are wanting.

Today I began a two day workshop for the staff at Sutherland Hospital. A small but dynamic group which includes some students and prospective students - now that’s encouraging!

The issue of water births came up and it transpired that at this unit they are not “allowed” to do waterbirths because they have no “policy”. However, if a woman is in the bath and wants to stay there, they are to facilitate the birth, even if it means a waterbirth occurs. Unofficially water birth accidents are occurring, but this is far from satisfactory.

The need to have a policy for everything that happens in a hospital is depressing - there goes the spontaneity, the individuality and unless we are careful, the woman centred care. This is not unique to Sutherland, let me hasten to add - I have encountered these restrictions in many units, both here and overseas. It is impossible to have a policy for everything that a woman may want to do in labour - this is like trying to lay down guidelines for people to follow for every act in their daily lives. If hospital administrations think they can protect themselves legally through this requirement, they may find, in the end, that this is a false hope, especially if a woman decides to sue because a policy was discriminatory or unduly restrictive of her rights and freedoms.

Common sense has almost disappeared from maternity units in western countries (it is not a problem in most of the world, where expediency and practicality usually govern what is possible, rather than legal niceties). I must start compiling a list of ridiculous strictures being put on healthy, educated, thinking adults that find themselves in maternity units - it will make for entertaining reading one day!

Meanwhile, it seems that Sutherland is not the only unit that has the baths but not the policies that enable women to freely utilise water for the birth of their baby should they so wish. I’ll have to organise some in-service programs to get the staff up to speed on this issue, which seems to have fallen into a hole. It seems that administrations are slow to get organised and women, meanwhile, may be missing out.

I am just back from the Channel Nine television studio where I appeared as a guest commentator on the Today program, a very popular breakfast show that goes out live across Australia.

To celebrate Australia reaching a population of 20 million, which will occur today apparently, they had decided to show a caesarean birth live, with crosses between the operating theatres at North Shore Private Hospital and the studio. They began publicising this event several days ago and have been inundated with emails from women, around 90% berating the program for such a tasteless and inappropriate program choice. Hence the phone call to me yesterday, seeking someone to appear to put “the other side of the story” so they could be shown to be achieving some kind of “balance”.

The obstetrician, Rick Porter, is a regular on the show, and as I waited with the show’s host Steve Leibman in the studio, he was shown in the operating theatre, waiting for the spinal anaesthetic to be inserted (we didn’t see this in close up, thank heavens!). He was enjoying himself hugely, and gleefully explained the procedure - the administration of the anaesthetic, cutting of the various layers, then it “:would be on for young and old” as the baby was “squeezed out like toothpaste”. I nearly fell off my chair! Even Steve was shocked by his cavalier attitude and insensitivity. Porter tried to redeem himself by saying that “it was just a job for all of them in the theatre but always special for the parents”.

Then I had about 3 minutes to put the “other side”. The questions were helpful in this regard but I was given very little time to answer them. I kept talking long after I was given the message to stop…… and I tried to do my best. Afterwards I said to Steve that this kind of show was glorifying an unnecessary medical procedure in most cases and that it deserved better coverage of the issue. He agreed and said they would be following it up.

As I left (having removed a half inch layer of heavy makeup) I got the distinct impression that the staff on the show were almost unanimous in their disapproval of this television “event”. There was one positive from my angle though - I was able to talk to one of the staff in the make up room who is expecting twins. I explained her options and encouraged her to find out as much as she can about vaginal birth, and avoiding epidurals and private obstetric care.

I left the researchers and producer with copies of Sally Tracey’s papers on the rates of intervention in births in NSW and the costs of this cascade. They also have copies of Preparing for Birth Mothers and Fathers, which I hope will give them some “simple” reading matter on the broader issues.

When I returned home, I caught the last comment from Steve on this television spectacular - he was saying that although they had received a lot of criticism for presenting this story, and live to air, they were now getting a lot of positive emails saying how lovely it had been. He was clearly relieved!

These programs are always frustrating. In the end, it is the sensational story that counts and token gestures to make it appear that they are giving a balanced view are all that are tolerated. Perhaps they will follow this up - I offered to do a live debate with the obstetrician on this issue if they dare to tackle it. We shall see…..