Andrea’s Diary

The full program and registration details for the “Preparing for Birth” Conference next year in the UK are now up on the web site.

Check out the speakers and the program - this is a very innovative approach for the UK, and the first time a two day event of this kind, with a predominance of workshops rather than short papers, have been offered to those involved in prenatal parent education.

Numbers will be limited and if the expressions of interest we have received already are any indication, achieving our target will be easily achieved. We hope not to turn anyone away, but we also want to make the workshop sessions manageable in size so that practical exercises and activities can be undertaken in comfort.

Those who register on line will have a bonus of a discount over posted registrations. Click here for the relevant information about the Conference and to access the registration details. This is one event you will not want to miss, especially if you have any role in pregnancy education for parents. See you there!

The first of what I hope will be many Midwifery Intensive workshops has just been completed in Sydney. A group of midwives, very ably led by Maggie Banks and her assistant Cath Knox, worked through emergency procedures that midwives may encounter in their practise over two and a half days. This workshop, similar in content, yet very differently focussed from the ALSO course, enables midwives to gain confidence when faced with reasonably common crises, such as shoulder dystocia, breech birth and resuscitation scenarios. Other topics such as suturing were also covered in a format that incorporated hands on practise with models, sharing of stories and affirmation of midwifery models of care.

This first program was a huge success and will be the first of many. Maggie and I have identified some dates for next year and planning will now start on finding a suitable woman friendly, cloistered environment where birth issues can be freely canvassed and intimately shared. We hope to be able to offer a program in Melbourne and another in Sydney, around the middle of next year.

Whenever I have the opportunity to talk to Maggie about birth in New Zealand, where she is based, I am always both impressed with the Kiwis and envious of their achievements. I have to remind myself that a small country with one jurisdiction (one Government and one court system, for example) is beneficial when proposing change and that Australia, with seven Governments, enormous differences and many more vested interests, is at a disadvantage in this respect. However, New Zealand provides some shining examples of what can be achieved and some notable successes that we would do well to emulate. Their midwifery presence gives us hope and inspiration and examples that are hard to avoid.

One day we will achieve similar outcomes for women and babies. Let’s hope that the long wait will have been put to good use and that whatever we finally manage to put in place for birth services will draw not only the good aspects of our Kiwi cousins’ maternity services but will have drawn on the lessons they have learned. Not everything that New Zealand has achieved was easy, and in fact the struggle is constantly going on to ensure that the drive for medicalisation does not overwhelm the services that midwives have established. They are a long way ahead of us, yet we are getting closer every day.

Over these past weeks the amount of spam that I receive each day has grown to unmanageable proportions and it is taking me up to 30 minutes each day to delete it from my Diary entries. The spam comes in via the “Add Comment” option that I have available for those who wish to add their thoughts on a subject.

Reluctantly, I am going to have to turn off this facility in the short term, until I can find a way to delete all span from the site. This may be possible with later versions of the software that I am using, but there are issues with installing this and migrating the current Diary entries over, so until I can be assured that none of the current entries will be lost in the update, I will stay with the current software.

The time I need to delete the spam is time I usually devote to writing the Diary entries, so I have decided that these are more useful than the comments. I will be arranging for this option to be turned off in the coming days.

If anyone wants to give me feedback directly, I am always available by email and I can include comments sent in this manner in new Diary entries. My email address is: andrea@birthinternational.com.

Today there was another of many emails that we receive from students seeking information on a specific topic. Invariably they say that they haven’t been able to find much material on the issue and can we recommend some web site where they can find the details they need. There was a similar request on the ozmidwifery mailing list the other day.

More and more students seem to be relying on Internet searches for the references and background that they need for assignments and bypassing printed materials. I guess this reflects the modern generations’s comfort and familiarity with the Net and their belief that anything can be found on-line. Sometimes, this will work, but not always.

The student that contacted me today was looking for information on prenatal care for women in different cultures. I doubt that this would be found on a web site (but I could be wrong!), and if it was available, it may take much searching to find useful material. On the other hand, I was able to give her a list of several books on this subject and I suggested that she check her University Library.

Information on many of the social issues (as well as practical topics such as prenatal care) will not have been the subject of research that would enable it to find its way onto the Internet. People with these kinds of interests often write about their experiences and offer practical guidance, and this is best explored in a book format.

The way students study is certainly changing, however if they make their computers their primary oracles they may miss out on some valuable resources.

At last., some great news about independent midwifery in Australia. A few months ago, as I wrote in a previous Diary entry, the Northern Territory brought in legislation that unintentionally precludes midwives from practising independently unless they had professional indemnity insurance. Suddenly, without warning, a number of women who had planned home births in the coming months were left without a caregiver, and those midwives offering home birth services were barred from working in that field.

There was a huge outcry, led by the women of the Maternity Coalition, ably backed by the midwives and several local politicians, who were aware of the problem and keen to have it rectified. The resultant decision is a triumph for people power and for women of conviction.

On November 18, the Northern Territory Minister for Health announced that there would be a revue of maternity services in the NT, and that midwives would be able to continue offering homebirths, covered by the Government’s own insurance scheme. The details are to be put in place, but it appears the current crisis is over.

The smallest of our States and Territories is leading the way in Australia, and it is to be hoped that other States sit up and take notice. Earlier in the week, an Upper House Committee in Western Australia recommended that the current arrangement in WA for the funding of 150 home births per year through the Community Midwifery Program be extended so that more women could choose this option.

There is still talk of funding for home births in NSW through the Department of Health, with the Government providing indemnity insurance for midwives. This policy was announced in February of this year, but the departure of the Chief Nurse, who was a firm advocate for this service, seems to have stalled the plans.

Eventually, I feel sure we will have publicly funded home births and independently practising midwives will have their indemnity insurance covered by the Government (either State or Federal) so that home birth will be an option for women everywhere across the country. Small steps towards this goal have been taken this week, and the journey may seem endless, but I believe we will get there!

I’ve been very remiss in not keeping up with my Diary entries over this past week. I could cite computer problems (now rectified), incredible amounts of spam Diary comments that I am being flooded with daily and which take an extraordinary time to eliminate and block, or I could mention trying to do two and a half jobs as I assist one new member of staff with their learning curve and try to do the job of General Manager (now vacant) and my own work at the same time

However, the main reason has been that over the past week I have also been involved in the facilitation of the six day workshop for the Graduate Diploma in Childbirth Education.

This group, on paper, seemed very diverse: one from England, another from Taiwan; several from other States; some home birth midwives, some hospital based midwives; a consumer activist and three from Tiwi Island (close to Darwin) including two Aboriginal Health workers. Given this wonderful mix of skills and talent, we wondered how they would gel and develop as a group. In the event, they have formed some close bonds and have supported each other well during the many and varied tasks they have been asked to undertake as part of the program.

I have been particularly interested to observe how the Aboriginal women and the Taiwanese educator have adapted to our workshop format. Learning styles are very different in those cultures and there was great potential for them to feel uncomfortable or overwhelmed by the way we have approached the workshop and its content. My impression so far is that they have learned a lot about different ways of doing things and that this discovery may change the way they tackle the tasks of preparing and presenting their own programs.

It is easy to slip into stereotyping people and cultures. Assumptions are made about how people from often unfamiliar cultures prefer to learn and what they expect when attending educational programs. Of course it is important to select teaching activities and strategies with care and to be mindful of individual’s and the group’s reaction to various presentation ideas. I believe that adults from any culture like being involved in their learning and enjoy involvement and exploration, where they can bring their own resources to the program as part of the learning environment. Just because they may never have learned in the way being suggested does not mean they may not like it, and perhaps even prefer it, when given the opportunity to try.

I am hoping that everyone in this group will take away many new ideas and be willing to risk introducing them into their educational programs. This is the best way for everyone to learn, through trying, evaluating and adapting. It certainly means more learner centred rather than educator centred programs and stimulation that can help prevent burnout for educators. It may also encourage more parents to join groups where they feel their needs will be met, fun can be had and learning is relevant and useful.

Tomorrow is our last day and a big one: student presentations, where they each have a chance to present a given topic in an appropriate way while managing group dynamics and dealing with individual needs. It is challenging yet fun and I am sure we will all have a great day (and be glad when it is over!).

Finding time for writing Diary entries this week has been a challenge….. someone needs to invent a way of adding extra hours to those days when things are very hectic.

One item of news that has again been getting the attention of the media in Australia this week, is the issue of professional indemnity insurance for midwives. The Northern Territory Government has legislated that professional people must have indemnity insurance in order to practise. Many different groups are affected, such as builders, and it has caught up independent midwifery in its net. Quite suddenly, those midwives offering home births in the NT were unable to work, leaving about 12 women who had booked with them for home births, high and dry in the weeks leading up to Christmas.

This was not the intended outcome of the legislation, it seems. I was phoned by a staff person of one of the members of Parliament in the NT, and she explained that this situation had not been anticipated, and that steps were to be taken to relieve midwives of this pre-requisite for practice. Changing the legislation might not be easy now it has ben gazetted, and so other means would have to be found to support midwives offering home births. There are models from other States where the Government has extended their employee insurance to cover independent midwives (The Community Midwifery Program in Perth is the best example of this arrangement) and I suggested that this avenue be explored.

This problem may yet extend to other States. Women will have fewer options than they have now and independent midwives may find themselves out of a job. Efforts are being made a t a number of levels, targeting State and Federal Governments and also Area Health Services, to see if a solution can be found. It seems that the struggle for equality and equity for midwifery services for all women around the country is a never-ending fight, yet one that has to be continued. One day……

The Childbirth Educators of New Zealand (CENZ) have asked me to write an article for their next newsletter on the relationship between doulas and midwives. As soon as the word “doula” pops up, my mind goes into overdrive and so I have just spent the last hour and a half furiously writing down my initial thoughts on this very contentious subject.

Whenever I write about doulas I get considerable response. Their arrival on the birth scene in a fairly recent phenomena - originally the term “doula” was coined by anthropologist Dana Raphael in her book “The Tender Gift - Breastfeeding” published in 1973, to describe the a supporter (usually a friend or family member) who cared for a women post-natally during the “lying-in” period. Over the past few years, the emphasis has shifted and now doulas see themselves a primarily birth supporters and prenatal educators, leaving the daily visiting and care of women after the birth to others.

The concept of the doula would probably not have appeared on Australian radar if it had not been the organisation and promotion of doulas in the US. American ideas always seem to be exported, even if they may be inappropriate in other cultures. In the US, there are doula training courses, special doula organisations and many private businesses offering doula services to pregnant women. All this may be necessary in a society of fractured family groups, individualised and isolated lifestyles and where the health care system provides no mainstream midwifery options.

In our country with its different cultural patterns, better health care systems and universal midwifery care in maternity units, I believe that doulas, especially as a paid up member of the health care team, are not necessary. Women should be encouraged to have close friends, family or significant others at the birth of their babies. Paid for social support services have the potential to undermine the community values we have always valued in Australian society - of helping each other out in times of need has been an underpinning fiundation of the Australian way of life.

Yes, I know that midwives in hospitals are stretched and often under great pressure, and that in this situation a some extra helpers for the labouring woman might be useful Yes, I know that we have a shortage of midwives. Yes, I recognise that not all women have someone close they can ask to help out during labour (although I find this very hard to believe). Yes, I know that some midwives will welcome a doula because it mean less work for themselves, work they perhaps are unwilling to be involved in. I also know that there is a risk that hospitals could see doulas (especially one paid for by the parents) as a “free staff members”, useful when midwives are scarce on the unit.

I would prefer that we look for ways to increase the numbers of midwives so they can provide better midwifery care for all women. I also want women to encourage their close friends and family to help out during birth, just as they traditionally have done. Perhaps all the doulas could consider enrolling in the direct entry midwifery programs that are now available so they can take on a recognised professional role and help fill the gaps in hospital staffing levels. Alternatively, they could focus their energies on becoming childbirth educators, with recognised qualifications.

At the moment the role of the doula is blurred and complex. No doubt there will be many responses to my comments here, as there usually are when I raise this thorny issue. Meanwhile, when I have the article written and published in the CENZ newsletter I will post it on the web site so you can read my full opinion on this issue.