Andrea’s Diary

I was pleased with my presentation at the Conference today. I spoke about the “Rich History of Birth Activism in Australia - lessons learned” and offered a snapshot of a few heady years in the late 1970s when Parents Centres Australia set out to expose the awful conditions in which women were forced to give birth in Australia. We learned a lot through our activities and I offered some personal insights into campaigning strategies and tactics.

PCA was a very effective pressure group, initiating the campaigns for breastfeeding support, rooming in, fathers in the labour ward, support for home birth and the establishment of birth centres, amongst other issues. Women in Australia were very ignorant and complacent when it came to having babies - they accepted the indignities and humiliations routinely handed out (soap and water enemas, full pudendal shaving, routine episiotomies, separation from their babies, four hourly feeds etc) as “the way things are done” and stoically put up with it all. PCA, with its outspoken methods, really shook things up. The hospitals were favourite targets and the doctors were regularly lambasted for the pompous, arrogant subjugation of their “patients”. The media were helpful and regularly published quotes and letters and many useful articles were written up supporting the call for change.

Demonstrations were another effective tactic and public displays offered a chance to educate and well as publicise the cause. I was able to obtain a wonderful collection of images of early rallies newspaper cuttings and reports to show this modern day audience how we challenged the system and created an awareness that birth could be better for both mothers and babies. Elaine Normling, an early President of PCA was a fanatical archivist, carefully creating a record of everythign we did. Much of the PCA material is now held in the Jessie Street Library in Sydney (which specialised in women’s issues), but Elaine still holds many of the scrapbooks she collated and generously helped me assemble a collection of images of r this presentation. Here are some that I presented:

One of the first rallies we held was in support of breastfeeding. A number of us set up a display in Australia Square, giving away inflated breast shaped balloons that carried the message “Breasts - not so much the container but what it contents” to a very amused and interested lunch time crowd.
All the media came to film - the balloons with their clever message guaranteed us a place on most TV News programs that night.

The doctors and hospitals information service was another innovation. Using information gathered from the parents who attended our prenatal classes and some surveys we conducted ourselves, we provided useful information to expectant parents about doctors, hospitals and their practises and also revealed hospital policies.

Conferences became regular events. Following the first Conference ever held on breastfeeding in NSW, PCA offered annual events on the themes of birth, breastfeeding and parenting. These enabled us to educate parents and the community while making enough money to support our activities, newsletters, publications etc for the following year.

The full story of PCA, the CEAs and the early history of the Nursing Mothers Association in Australia is well documented in the book “Our Bodies, Our Babies” by Kerreen Reiger. It offers a well crafted account of those turbulent and exciting times that kicked off the birth reform movement in Australia.

The rest of the Conference was a mixed affair. Some of the speakers, especially Justine Caines, offered practical suggestions and exciting possibilities for furthering the cause of birth reform and others were just out to sell a product (the Pink Kit). Needless to say, people were looking for ideas and tips for making a contribution to the promotion of birth and breastfeeding, and became quite hostile to speakers who were into blatant self promotion.

I hope that those who did come to this event will go on to maintain their interest and passion for better births and birth support, for both women and midwives.

This weekend I am at the Australian Birth and Post natal Services Conference being held in Melbourne. This event is the brainchild of Kelly Zantey who has assembled a program of business and birth services speakers that is designed to inspire and uplift, while providing some basic pointers to those who want to become more involved in birth activism.

The audience is a mix of midwives, midwifery managers, childbirth educators and doulas with a few pregnant women as well. It is an ambitious event, and although registration numbers are less than Kelly had hoped, I am sure those who have come will hear some useful information and go away with some new perspectives. Much of the first day has focussed on change and change management, especially in oneself. Being willing to embrace change is a prerequisite to being able to support and influence others to accept and incorporate change into their lives or workplaces. Several speakers offered tips on how to manage stress, develop one’s emotional intelligence, recognise helpful and unhelpful behaviours and understand natural reactions to being verbally attacked.

I was amused how “what goes around, comes around”. At the end of the day we viewed a long film called “The Secret” which was a series of talking heads describing the benefits of what we used to call, in my day (there that’s showing my age!) , “the power of positive thinking”. It was dressed up for the current times in a slick marketing package, and was full of psychobabble, but it basically had a good message - that you are what you think (that’s the “secret”) and if you visualise what you want to achieve, clearly articulating your desires and thinking about the positive things in life, rather than focussing on the negatives (what you wish you didn’t have), then the “universe” will provide the outcomes you desire. It was a message that would resonate with many in a western lifestyle, especially these days with its emphasis on materialism and personal success, but I was disturbed by its egocentricity.

There was no mention of how these insights could be applied to others in the form of service or actions that would benefit the wider world or humanity. The emphasis on getting what you want for yourself is fine, but what about the costs to the community, the environment and the planet that this selfish pursuit of high flying goals (there were lots of expensive gas-guzzling cars shown as commendable “prizes” to be lusted after)? There was no mention of helping the less fortunate, of using one’s influence and skills to obtain better lives for others, or contributing in other selfless ways to the local or broader community.

I would have felt much better about this program if it has included footage of others who had turned their good fortune of being born into western affluence to the betterment of mankind as a whole. Even Bill Gates and Warren Buffet give away a lot of money to worthwhile causes for the benefit of the planet and its people, and while they have almost obscene amounts of money and wouldn’t miss a few billion, it is the principle of sharing what we have with the less fortunate, no matter what our circumstance, that seems to be missing these days.

Kelly Zantey has said that it was this film that inspired her vision of a Conference that would inspire and uplift others to continue to fight for better maternity services. This is a wonderful example of what one person can do in the name of a wider cause. If “The Secret” has enabled her to formulate her plan for this event then it has clearly had the desired effect for her. I just hope that others see the wider application of its message as well.

A recent request on the ozmidwifery mailing list (anyone can join in this fantastic conversation between midwives and others) asked midwives about their frustrations with their work. The response was quick and extensive. Many midwives responded, often with similar gripes, sometimes relating to where they worked in a regular labour ward, a midwifery service (team, caseload or midwife led unit) or due to their geographical location (city/rural).

I thought I would share some of these with readers because midwives I meet in other countries often think that the conditions they struggle with are unique to them, when in reality midwives the world over often share similar situations. Australia may be seen as progressive in many ways and it is true that we have a number of birth options available for women, many more than we had ten years ago, for example. Expanding these services, and making sure they are immune from political whims is a constant battle requiring vigilance and dedication. The age-old territorial struggles between obstetricians and midwives also continue, and no doubt will be a feature of the maternity services landscape for years to come.

Here are some of the issues frustrating Australian midwives:

In Hospitals

• Outdated policies

• Policies based on some, often unknown, persons preferences and not on best practice
• Staff who do not keep their skills/knowledge up to date (Midwife)

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• I hate the language used in the hospital where I work: “will try to breastfeed”, “Has lost nearly 10 percent”.

• Women who appear to expect things to turn out badly.
• The constrained role of the midwife and lack of belief in all going normally. It too often seems staff are looking for problems rather than emphasising positives. Where I work that means both midwifery and medical staff.
• I loved having babies and breastfeeding, it was truly enjoyable and gave me pleasure. Here the women come in expecting grim times ahead. Perhaps while expectations are so low this will continue. I relish when I get to meet pregnant women and talk of parenting and birth in a positive light, as it seems so rare these days.

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• the lack of respect for the role of the midwife

• the practice of non - evidence based medicine
• that we are teaching student midwives to work in this way

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• lack of evidence based practice

• lack of trust in women’s body/birth
• lack of autonomy as a midwife

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• The word ‘allowed’ should definitely NOT be allowed. Since when has any medical professional ever had the power or the gall to allow, or disallow a woman to do something? They have somehow mistaken their role as advisor or guide, for role of rule maker and enforcer. This awful paternalism by (mainly male) Dr’s and carried through by(mainly female) midwives, and disrespect shown to women at a time of their lives when they are doing the very thing that qualifies them for womanhood, is just sickening. The implied power and control that telling someone that they are or aren’t allowed is criminal.

• Condescending ‘talks’ used to manipulate women and their partners into capitulating for the greater good… The “martyr” talk, the “you’ve got a big baby” talk, the “you’d better have some pain relief now, you’re not really coping talk”, the “you wouldn’t want to put your baby at any risk”
  talk (as was said, there is no situation without risk), the “don’t be a silly girl now” talk…do I need to go on? I’ve even been witness to the “you’re a selfish bitch” talk, in those very words to a teenager who wouldn’t consent to antibiotics because she was of unknown GBS status…makes me want to cry. None of us have the right to talk

• Our inability as midwives to band together, get some professional backbone and see [how] all the awful divisive, nasty, bitchy, horizontal violence we throw at each other because of our different vested interests means ultimately our inability to see the woman as a self determining and intelligent human being [who] deserves to be given the information. The AMA [Australian Medical Association] will never have to put too much effort in keeping us in check, we do it for them.

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Birth Centre

• Lack of professional indemnity insurance for midwives

• Horror stories. Young women are so scared to birth because……..
• Lack of trust in women’s bodies to birth without epidurals and other interventions

Small rural hospital

• Unnecessary intervention, eg induction for post-dates such as 7 - 10 days past due date (usually ends up with the well-known cascade), or augmentation of labour instead of waiting (also usually ends up with epidural and assisted “delivery”.

• Lack of belief in women’s bodies to do what they are designed to do, both by doctors and midwives (linked with the above item).
• Use of CTG’s in a low risk unit despite evidence to the contrary.

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• My first thought is the excessive number of ultrasounds done. We can have women booking at 12 weeks and they have already had 2 or more for no discernable clinical reason. So many think it is ok etc and ask for more as the pregnancy goes on.

• My next thought is the word “need”. You need this intervention, you need that intervention etc, etc. Similarly “have to have”.
• Related to the above is the expression some women use “they gave me” a c/s or some other intervention. Like a present. Like something nice.

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Home birth

• professionals who don’t appreciate that the woman has a right to chose, her care provider her birth space and how her birth happens. Regardless of risk, as long as a woman is well informed and has chosen the set of risks she wishes to accept ( because nothing is without risk), it is our role as midwife is to be with woman, not judge them or try to control them.

• People who make sweeping untrue statements to intimidate women into a choice they think is acceptable or who advise care based on policy and guidelines instead of evidence based research.
• People who think that all the crap we dish out we did because the woman wanted it or asked for it or it was their own lack of education on birth that lead them into this trouble. In reality in an ideal world why should women have to arm themselves with reading education, and a doula before going to birth their baby? Why can’t they just believe they can do it and go and rely on the system to hold the space for a great birth?
• I have one more. I get so frustrated that people think homebirth midwives are mad lefty hippy’s when in reality we are well educated professionals with passion and conviction to stand up for what we know to be right and support women to birth gently and safely. The hospital system treats us with contempt and advocating for women rights, even if it’s not the system’s decision or even the best decision, is what all midwives should be doing.

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There are some powerful feelings being expressed here. It is important to find a means to express these frustrations as this is a first step to finding some solutions. Some of these issues will be addressed at a forthcoming conference to be held in Melbourne from April 27 - 29. The program for the Australian Birth and Post-natal Services Conference lists a number of speakers who will offer their experience from the business and political worlds in an effort to explore new ways of promoting midwifery, implementing better services and surviving the struggle. I will be there, to speak and meet people and perhaps I will some of my readers?

During the Future Birth tour, the team took time out to visit Selangor Private Hospital in Nambour, about an hour north of Brisbane, Queensland. This unit is unique within the private health care system in Australia and also, I believe, within the health care system as a whole. It works on a collaborative model of care between obstetricians and midwives and has long been th leader in offering VBAC, vaginal breech and twin births and birth in water. For a hospital that has no screening, accepts all-comers and has a higher than average “at risk” clientele (because women will travel from all over to be given the chance of a normal birth) they have excellent outcomes.

A report and photographer from the local newspaper joined us and wrote up this article. We should have checked that the report knew how to spell!