Articles by Month: November 2002

Anaesthetists query information given to parents

I have had an irate email message from an anaesthetist challenging some of the statements that I have made in “Preparing for Birth: Mothers”. Without being at all specific he demands to know my references for my “highly contentious statements without mention of conflicting evidence”.

I love these queries - and love the moral indignation that seeps through the message (which he has also copied to a whole pile of his colleagues). I have given him the list of references I have used, such as “A Guide to Effective Care in Pregnancy and Childbirth” , “Pursuing the Birth Machine” and The Cochrane Library and also threw in the list of references regarding teenage addiction following exposure to opiates or nitrous oxide during labour. He didn’t ask for these addiction references but I figured they might as well have them!

Since my correspondent seems to think I am lacking background information, I have invited him to send me copies of any research that he has that contradicts the very simple and basic information that I have included in my book. There is very little quality research on epidurals, for example, and few randomised controlled trials have been carried out. Anaesthetists have been quoted as saying that doing such research these days would be unethical because it would mean that some women would have to forego an epidural so they could make up a control group. This is a very convenient way of dodging the issue of providing evidence for the use of these techniques!

I am sure that this conversation will continue and I will report the next instalment in my Diary. What is it that has got them so steamed up? What research will they proffer to support their concerns? I will let you know the answers.......

Posted by andrea at 01:08 PM | Comments (4)

The Six Day Workshop

Our Graduate Diploma Six Day workshop is over. What a week! The last day was spent with the participants doing their presentations, which is usually viewed by them as the hardest part of the program. This year we included video feedback - we wanted everyone to see how useful this can be and that seeing oneself on the video screen is not as bad as you might think.

Each participant was required to prepare a 15 minute session on a given topic (one that is usually included in the prenatal program). They have to formulate their learner outcomes and devise a teaching activity that will appeal to a variety of learning styles whilst enabling the other group members to achieve the stated outcome. As well as this, they must deal with the group’s interactions and responses, using the principles of adult learning and the group work skills that were explored earlier in the week. It is a tall order, and one they all tackled with a great deal of commitment.

There were many laughs along the way and some very valuable learning occurred as we viewed the tapes and gave each other feedback on the various performances. So much of the effectiveness of prenatal education is tied up in the ability of the group leader (educator) to handle the needs of the group members, whilst effectively covering the information is clear, concise and non-threatening ways. These are skills that come with practice, built on a foundation of awareness of their importance, and I hope that these participants have now grasped some of these essential basics. The day was a most successful and capped a very stimulating and exciting week. A long rest will be next on the agenda for us all, to let the lessons learned sink in and to give everyone a chance to catch our breaths.

For Cassandra McBurnie, my co-presenter, and myself, next week we start preparing for our next week long workshop in a similar vein - this time for the Bachelor of Midwifery students at Monash University, for whom we are providing a full elective on Childbirth Education. This workshop is in January, and we are looking forward to this next challenge with gusto.

Posted by andrea at 07:04 AM | Comments (2)

Our Malaysia students, part two

Our Malaysian students had a wonderful time on the weekend. Their visit to the Royal Hospital for Women in Randwick, Sydney, was a great success. As luck would have it, they were able to sit in on two prenatal classes facilitated by Julie Clarke, a very experienced educator who is about to join our Graduate Diploma faculty as a Supervisor. Julie has a special gift for involving fathers in her program and our two students were fascinated to see how this can be done so very effectively with two different groups of parents. Julie has developed a particular activity called “Fatherhood” that enables open and honest discussion about a range of issues selected by the men. (I’ve suggested that we market this through Birth International so watch this space!).

In between the two prenatal sessions our students were able to explore the hospital and they visited the Birth Centre, Labour Ward and the Intensive Care Unit. They really appreciated the chance to observe an approach that is entirely different from the one they are familiar with in Malaysia.

Cross cultural visits are very valuable to everyone involved and we are enjoying having these students in our midst - they constantly provide a challenge to our ways of doing things and help raise our awareness of differences we must take into account with our own class groups.

Tomorrow we tackle ways of presenting labour and birth to expectant parents. I anticipate lively discussion on several topics, particularly around medications during labour and the whole issue of pain in labour. It will be two days before I can report on the outcomes for this group, as I have other commitments tomorrow and won’t be able to prepare a Diary entry, but by the time I am able to do my next Diary entry, the workshop will be over and I will be able to reflect on the whole intensive six days.

Posted by andrea at 08:11 PM | Comments (2)

Malaysian students in our Graduate Diploma

This week we began the Six Day workshop module of the Graduate Diploma in Childbirth Education. This program runs from a Wednesday to a Wednesday with the weekend free (rest and recuperation!) and comes at the end of the first year of the Course.

The group is small this year (a number of students did not complete the required study units in time) but is a varied and interesting bunch. There are two students from Malaysia and others from interstate. Because the number of our students was small we were able to open up the program to others who just want an intensive workshop without the added study required for a qualification and this has brought us participants from Western Australia and Tasmania.

Having participants from a completely different culture (Malaysia) has put everyone on their toes. The way Australian interacts, share ideas, speak all the time (!) and generally get stuck into group work has been a real eye-opener for them, as this is a complete contrast to their way of learning. In Malaysia, as they explained, it is most normal for the teacher to do the talking, the group to listen politely and answer with a single short sentence when asked. They would not normally add further thoughts or share in a conversational way between members of the group. If the teacher doesn’t “teach” then they are considered a “bad” role model.

We discussed some of these differences on the first day of the program because I wanted to make sure they felt comfortable and knew that we understood they had a different way of relating to the group. The contrast by day three has been remarkable - they are chipping in, adding comments and generally getting involved just like everyone else and they are obviously enjoying this different way of doing things. Give women a chance to talk, no matter where they are from, and they will be hard to stop!

This weekend they are out observing Birth Centres and prenatal classes run by an independent educator in a hospital setting - more learning opportunities! The whole concept of “active birth” is unknown in Malaysia and they are keen to learn as much as they can while they are here. There are still some home births in rural areas of their country (supervised by traditional birth attendants) but birth in the hospitals is very regimented with the doctor in complete charge. Concepts of informed choice, consumerism and options for birth care are very foreign notions and are a long way off in Malaysia. They were asked if they thought these ideas may surface in time, and they felt that they might, because of the growing worldliness of the population and the fact that many young people have a foreign education and have travelled.

It takes a long time to overcome entrenched attitudes and beliefs (as we know from efforts in Australia to change the birth culture) however change is inevitable, even if slow. I hope they enjoy their visits to our hospitals this weekend and I am looking forward to hearing of their adventures when the group meets again on Monday morning.

Posted by andrea at 02:24 PM | Comments (2)

Vaginal Birth after Caesarean

Why are rates for vaginal birth after caesarean section (VBAC) so low in our hospitals? This question has come up in workshops quite frequently and has also featured on the ozmidwifery list as part of a discussion around fear and its effect on labour.

As I see it, there are two main reasons why VBAC rates are hovering around 30% (or worse) when they should be around 80% according to the evidence.

The first reason is that women are left with many emotional and psychological scars after an unexpected caesarean and these are rarely dealt with adequately so they can be resolved. A woman who has been told that her body didn’t work well, that it was “too small” or “too slow to dilate” or “failed” in some way will have had a severe dent put in her perceptions of herself as a woman. Birth is the central pivotal point around whish a woman’s whole notion of herself as a sexual being revolves. If she is judged to be inadequate or a “poor performer” in this area she may well be unwilling to give a vaginal birth a try next time, because of the impact a further “failure” may have on her psyche. It may be emotionally safer to opt for an elective caesarean which is planned and predictable than to risk the potential for further psychological trauma.

A second factor is the caregiver. It is well known that it is the attitudes, practices and beliefs of the caregiver that shape a woman’s birth experience. In the case of a VBAC there are many vested interests at work : the doctor’s desire for an ordered life; the hospital’s need for scheduling and throughput of clients; the money to be made from surgery, epidurals, drugs, equipment etc. Most doctors also lack the skills and willingness to sit with women in a supportive, positive way while they labour naturally. Time is money and a caesarean takes little time in contrast to vaginal birth.

Another factor, often overlooked, is the fear and grief experienced by fathers who have been caught up in a dramatic caesarean birth. They are rarely counselled or de-briefed afterwards, and their unresolved trauma may cause them to pressure their partner for an elective caesarean the next time.

All of these issues could be dealt with in a useful way through special pre-natal programs for potential VBAC parents. Small groups, with both parents, under the leadership of a skilled facilitator could explore these and other important issues associated with caesarean births and VBAC. I am convinced we need a lot of these programs around the country and they may be a key factor in lowering the ever-climbing caesarean birth rate.

A useful resource on these kinds of classes is The VBAC Source book and Teaching Kit - an excellent outline for such a program packed with teaching strategies and factual information.

Posted by andrea at 03:49 PM | Comments (2)

Putting maternity reform on the political agenda

Now that I am back in Sydney, I am catching up with the very exciting developments that are happening around midwifery in New South Wales. There is much going on!

The Maternity Coalition have compiled a wonderful document that outlines how autonomous midwifery can be implemented in NSW within 3 years. It forms a companion piece to the National Maternity Action Plan (NMAP) that was launched in September and is designed to show that they have not just come up with a great idea, but also have worked out the means to implement it (an essential strategy if NMAP is to succeed, because if left to the politicians/bureaucrats to implement we would be waiting forever).

There will be an election in NSW before the end of March 2003, so the time is right for getting maternity services reform onto the political agenda. The Greens and Democrats have already endorsed NMAP and will incorporate it into their election platform, so the pressure is already starting to mount on Labour, who have been in power for many years and are due for a shake up.

Premier Bob Carr was effectively ambushed at the recent opening of a new hospital in Camden where the media chose to focus not on the new hospital, but on the brand spanking new Birth Centre that was not allowed to have any births because the obstetricians would not co-operate. The very vocal and colourful collection of mothers and babies demanding better services were a heady mix for the media. Apart from putting the Health Minister, Craig Knowles, firmly on the spot for this silly bureaucratic bungle, it also highlighted the general dissatisfaction at the lack on consultation with maternity care users over the broader plans for hospital closures and reorganisations across Sydney. The moves to close several smaller maternity units were immediately scrapped and the Health Minister who has been reluctant to consider midwifery up until now, is about to consult with the Maternity Coalition about their implementation plan for comprehensive one-to-one midwifery across the whole State.

Justine Caines, Sally Tracey, Denise Hynd, Barb Vernon, Jan Robinson and a host of others have all contributed mightily to this effort. They are amazing women and they have every right to expect that their efforts will succeed. Hats off to them!

Posted by andrea at 02:27 PM | Comments (3)

Videotaping my first birth

Yesterday I filmed my first birth. Bronte Fenwick , weighing 3.9 Kg arrived, face to pubes, at 6.50 a.m. after a 2 hour labour. Tracey, her mother was amazing - lots of back pain but a really fast labour, no doubt assisted by being her third baby. This was the first girl born into her father, Stuart’s, family for 85 years, so she will be especially treasured.

Videotaping this birth is the first step in producing some new birth videos for use in midwifery education. I have a number of potential topics in mind, but will have to see what I can videotape before deciding which issues to tackle first. The wonderful staff at the Birth Centre in St George Hospital, Kogarah, are helping by canvassing women for me and I am really enjoying working with this dedicated team.

It was rather special to have a baby born posterior for my first effort! This is not all that common and to have a completely natural birth, with no medications and an intact perineum was a treat. I hope to tape some more births over the next three months, when I am mainly in Sydney, and therefore available. Whilst I have no experience of videotaping, I do have a “fool proof” camera and one which will record in the dark if necessary. I hope to be an “invisible” as possible during the birth to keep the intrusion of the camera to a minimum. The hardest part was not getting involved with Tracey and Stuart. Not saying anything was OK but keeping my hands off her aching back was hard!

I wonder what the next one will be like?

Posted by andrea at 03:40 PM | Comments (3)

Events for 2003

It's been a catch up day today. This time of year means putting the final touches together for our program for the first 6 months of the next year and planning the broad outline of the remaining months of 2003. I keep saying that I “will cut down a bit” and “take a holiday” but it never seems to happen - there is so much to be done!

The timetable is shaping up well for the first half of the year:

January

Childbirth Education module for the Monash University Graduate Diploma in Midwifery students (and others) in Traralgon, Victoria - 5 days plus assessments

February

Active Birth workshops
NACE Conference in Sydney

March

UK visit - 10 two-day workshops in various parts of the country

April

Future Birth tour around Australia
Active Birth workshops
Managing Midwifery workshop (Sydney) - a new program for this popular event

May

Active Birth workshops around Australia

June

UK visit - 6 Active Birth workshops (including one in Spain)
Essential Midwifery tour in the UK - 6 events around the country

All this is just for starters.......

Later in the year there will be more workshops in the UK (October) another Conference presentation in Barcelona, Spain and a series of Dynamic Education workshops in Australia. We also have plans to offer the Childbirth Education elective for other University midwifery programs in several states.

All the details of these events are on our website, so have a browse around - I would love to meet you all for a catch up somewhere next year.

Posted by andrea at 03:17 PM | Comments (2)

Nepal Midwives Initiative

Back in Sydney, at last. There is always an interesting pile of material in my in-tray after I have been away and this time I have information about the Nepal Midwives Initiative and the work that midwife Beatrice Carla is doing to introduce Birth Centres into Nepal.

She has been volunteering her services for the past eighteen months and has generated much interest and enthusiasm for natural birth. Her newsletters describe the current scene where maternity services are largely managed by Traditional Birth Attendants in rural areas or by obstetricians in private clinics. As in many developing countries, maternity services have been modelled on early ideas from the west (American, sadly) but because of a lack of funds, further training and updating has not been possible. Women are subjected to antiquated practices that are now discredited, such as routine episiotomies, enemas, confinement to bed, lithotomy and routine suctioning of newborns.

Beatrice has set up the Nepal Midwives Initiative, with these aims:

to raise awareness about the potential hazards of western-introduced but now outdated birth practices

to demonstrate the safety of a less prescriptive and interventionist approach to birth care

to share our current knowledge and experience with Nepali colleagues

to support Nepali colleagues’ efforts to organise as midwives.

If you want to know more about this wonderful initiative, or better still, could send her a donation of money or resources, she can be contacted at:

Beatrice Carla, Nepal Midwives Fund, c/- 7 (Gf1) Rossie Place, Edinburgh EH7 5SF

Posted by andrea at 03:17 PM | Comments (2)

Educating for compliance or choice?

In his response to my Diary entry about Unmotivated Educators, John Lee asks if we should be teaching parents about options that are unavailable. This is an interesting question and one that often comes up in Teaching Skills workshops.

The issue boils down to: do we teach for compliance or do we teach for informed choice? Many educators take the position that if a service is not available in their unit (e.g. water birth) or Trust area ( e.g. homebirth) that there is little point in alerting parents to these options because they won’t be able to get them. Others believe that if the options exist, then parents should know of them, even if it will be difficult or impossible to get them in their area.

The changes that have come about in maternity care over the years have been consumer driven - think of fathers in the labour ward, rooming in, water birth and birth centres. None of these would have been introduced by the obstetricians or hospital administrations (although they have been able to introduce widespread use of CTGs and epidurals!) and it has been dogged perseverance by parents that has forced these services to be provided. They heard about these options from various sources - their own reading, from other parents and from childbirth educators.

If parents know of a service that is not available where they live, but could be obtained elsewhere (perhaps even in the next Trust area) then they have a right to request the same level of care. If the health service is not asked to provide a service they may conclude that nobody wants it. Therefore, as drivers of change, parents and educators play vital roles in improving services and pushing reforms through.

I believe that educators have a duty of care to explain all possible options to parents. It is up to the parents to find out what is available and to take the necessary steps to get what they want (even if this involves some inconvenience). Teaching for compliance may make life easier for the hospital staff, but goes completely against the basic principles of informed choice. But that is a myth anyway, isn’t it?

Posted by andrea at 10:49 AM | Comments (2)

Reflections on this UK visit

Today is my last day in the UK for this tour. It has been hectic, to say the least, and I am looking forward to 24 hours on a plane, far away from people, phones, faxes and emails!

The overwhelming impression I have formed from my contact with some hundreds of midwives and educators at workshops and conferences during this visit is that midwifery is steaming ahead in some areas and in the doldrums in others. Midwives are stretched everywhere and morale is low, except in those pockets where home birth rates are high or midwives are working in successful team/caseload practices. I’ve met midwives who do many home births, and others who are setting up birth centres with woman centred philosophies. I’ve met innovative educators and heard about wonderful prenatal programs tailored to meet the needs of parents rather than those of the system.

I have also come across a few midwives who still want to retain power over women, think nitrous oxide is akin to “having no drugs” in labour, are convinced that TENS increases endorphin levels in labouring women (despite no evidence for this statement) and that diamorphine is God’s gift to womankind. There have been eductors who only do the classes because they are forced to and others struggling under impossible conditions to provide any kind of half-way decent service. I guess this kind of mix is to be expected in a country with a population of 60 million and a health system groaning under its own weight.

Tonight, as I set out for home, I wonder what awaits...... bush fires, heat, dust and a parched landscape. There is also the energy of the NMAP team, the hustle and bustle of various election campaigns (and opportunities for pushing birth reforms) and exciting developments with our own Birth International workshops and Grad Dip program. It is going to be a long, hot summer and I am looking forward to the challenge. Next stop - Sydney!

Posted by andrea at 12:17 AM | Comments (2)

Childbirth education in Norwich

This weekend I am presenting a Teaching Skills workshop in Norwich, in East Anglia. Again a very different group (I’ve done three of these workshops in three different places in the last week) with a variety of needs and interests. Lots of skill and experience levels and a very pleasant bunch of people.

Heard one astounding piece of news however - in the Government’s “Changing Childbirth” report, Norwich Hospital was named as a centre of excellence for its parent craft education department. They had a dedicated co-ordinator and a variety of programs that were singled out for praise. So, what did the hospital do after the report was released? Yes, they closed it completely!

This sounds like the “dumbing down” process in action again - to discourage people wanting better services, close those beacons that provide outstanding results so that everyone will stop demanding the same and the service can return to a level playing field of mediocrity. This is what happened to some of the midwifery team projects that were started as a result of the Changing Childbirth Report - they were funded for a brief period and just when they were getting up to full speed, producing enviable results and the women were learning how good they could be, they were closed down, often because of a “lack of funding” but in reality because there was not the political will to duplicate the services more broadly so that women could benefit.

There have to be consistent policies about the provision of maternity services across this country. The way things stand now, there is too much variation of services between the various Trusts and little consistency, which leaves women with either a lot of choice or little at all, depending on where they live. In this Norwich group there is a midwife who has a 20% home birth rate in her area and another who has a 10% rate. Both outstanding in comparison to the national rate of 4% but shouldn’t this be a possibility across the whole country, not just in some enlightened pockets?

Posted by andrea at 06:09 PM | Comments (2)

You've got to want to educate.....

My comments about the motivation levels of some of the participants in recent Teaching Skills workshops have elicited some spirited reactions. As I pointed out in a reply to one respondent, I did not name anyone or even state where they worked ( I am mindful of my commitment to confidentiality within these groups) but it appears that the identity of the people concerned is assumed to be known by others, resulting in some distancing and “not me” behaviours which are quite understandable. In fact, the replies may have revealed identities that I was careful to protect....

However, aside from that, the real issue is that yes, I understand that some people don’t want to have to teach these classes and I am appalled that they are being made to do this work, if they are so reluctant and unwilling. This is not only unfair on them, but a shocking disregard of the parents’ needs by an uncaring management. Everyone who works with parents must have as much commitment to this task as we would expect of those who teach our children. When members of any prenatal education team are “doing it because I have to as part of my job” they are not only disrespectful of the parents in their groups, but are unsupportive of their own colleagues.

There is a need to raise the profile of the importance of prenatal education, especially as a vital part of “health promotion” that is such a buzz concept at the moment. For this to happen, those who are part of the education team will need a consolidated, focussed approach and a unified stance. I know that many of you are doing really good work out there, working hard to provide parents with the best that you can. Perhaps you need to consider what to do about those on your team who are not so keen or who don’t share your love of this work and are undermining your efforts. I’ve run into this problems many times over the years - please don’t think that the issues that surfaced in the workshops in Scotland were unique to that part of the world!

Posted by andrea at 06:21 AM | Comments (3)

CBE workshop in London

What a different group I have in the London Teaching Skills workshop that I am currently presenting! In complete contrast to a number of the participants in the Perth workshop earlier in the week, these people are experienced, articulate, enthusiastic and willing to try anything. I am therefore enjoying leading this group immensely.

There are two very experienced NCT leaders (one about o become a Tutor), two co-ordinators of antenatal classes for their hospitals, one independently practising midwife, two NHS homebirth midwives, and the rest have quite a bit of experience between them. Lots of good ideas have already been floated and today I will challenge them with a couple of ideas I don’t think they will have tried before.

I am becoming convinced that the NCT attracts kinaesthetic leaders/learners because they are very comfortable with participation and like lots of activities. This may also explain the prevailing view that I hear frequently from NCT people that “you must change activities every 20 minutes” when leading a group. I don’t hold with this kind of dogma, and believe that whilst this may be a useful guide, many adults can stick with an activity for much longer than this, if they are engaged and enjoying it. Of course, assessing this will be up to the leader. If there is an opportunity to discuss this with the NCT leaders in my group today, I will, because I always enjoy their thoughtful perceptions.

Tonight I am off to Norwich for the last workshop of this tour. This will be another Teaching Skills workshop, so it will be interesting to compare that group with this one.

Posted by andrea at 04:43 PM | Comments (2)

Professional indemnity insurance and registration as a midwife in the UK

The hot news here today is that the Nursing a nd Midwifery Council (NMC), the registration body for midwives and nurses in the UK, have decided not to introduce, at this time, a clause into the Code of Professional Conduct, making it mandatory for all nurses and midwives to hold professional indemnity insurance. Up until 1994, this has not been an issue, as midwives had PI insurance through their membership of the Royal College of Midwives (RCM). In 1994, the College withdrew their cover for independent midwives because they felt it was too expensive, leaving indeondent midwives to find their own insurance cover. This was possible through a verty few companies until March of this year, when this options was withdrawn.

Had the NMC decided to introduce this clause, it would have meant an immediate end to independent midwifery in the UK. Thankfully they have recognised that the insurance situation is beyond the control of the midwives and acted appropriately. Now is the time for the RCM to get off its backside and organise the necessary insurance as part of its membership (as they should have done in 1994). Many midwives left the RCM after their disastrous decision inf 1994 and joined Unison (the general union for health workers) in protest at the disenfranchisement of independent practitioners. In the UK, midwives must be a member of a union and the RCM had, up until 1994, been the union of choice.

Will the RCM be up to this challenge? On present indication the answer would have to be no - the message I hear loud and clear from midwives in workshops across this country is that the RCM is not taking up these issues and is focussing on pay rates rather than working conditions. They appear to be quite out of touch with midwives in the workforce. Perhaps a few of them should get back to work in hospitals and the community to find out what is really going on for midwives. Of course, being a member of the RCM executive seems to be a good way to become a Dame or get another gong from the Queen. Ah, the Royal touch........

Posted by andrea at 04:18 AM | Comments (2)

Unmotivated educators

I am glad that the Perth workshop is over. It was a difficult group - a mix of people who were, on the whole, reluctant to join in (the Scots can be very reticent and shy) dominated (intimidated?) by a group of midwives/educators who were very disruptive. I was able to give a lot of on-the-job training in how to handle negative, opinionated people as the group struggled to imagine how people with such dogmatic and rigid views could be let loose on unsuspecting parents!

I took a couple of them aside and suggested that if this program had proven to them that really didn’t like this work then that was a positive outcome, especially if they accepted that fact and resigned from the education team.

Whether this will happen will be down to their managers and administration. I was told that their attitude is that presenting the classes is a part of the midwife’s job and that anyone can do it. I am not sure whom they think will benefit from this approach - certainly the parents should not be subjected to a program that is presented by the untrained, unwilling and hostile staff they may now encounter.

All of these negative people worked togther, which makes things worse. They have no evaluation processes in place for their classes (just as well!) and were adamant that they get no negative feedback and that people still keep coming along. That parents accept this state of affairs either says that they have very low expectations or that they are desperate and will put up with educators like these to get any shreds of information that may be useful.

It’s a sad situation all round really.

Posted by andrea at 06:10 AM | Comments (5)

Childbirth education and midwives attitudes

A fascinating day today. I am facilitating a “Teaching Skills” workshop for prenatal educators in Perth, Scotland. Once again I discovered that programs in this area are very restricted - typically just four sessions of 2 hours with an extra breastfeeding workshop in some cases. Once again I heard that midwives are often doing it “because it is part of the job” and that a number felt they had to do it, even though they didn’t like this aspect of their work. At one point someone said that “women in Scotland are different” and I have to agree with them..... a lot of very definite views were expressed that would have clearly conflicted with the aim of providing women with “freedom of choice”!

There is a distinct culture of “telling women” here and very little interaction in their groups. Men are often completely excluded or else viewed with deep suspicion. Many educators complained of the difficulty of getting people to participate, yet it was revealed that they don’t provide name tags for people and don’t do any warm up or introduction activities “because they themselves don’t like them”! Very few evaluate their classes - they might be surprised to discover what people think of them.

Several times arguments broke out about what constituted “informed choice”. It seems that it is considered quite acceptable to only mention those options that fit with hospital services and protocols on the basis that if women wanted something else they would have gone somewhere else by the time they arrived at the classes in the late stages of their pregnancy. Never mind that women may not have known of any other options because they had not been given the information or that the system actively discourages women moving about from one hospital or service to another. Homebirth was disliked by well over half of the group and water birth... forget it, women were not going to be given ideas about these possibilities. The view was that until the system was prepared to support these options women would not be told about them, and when I suggested that it has been women themselves who drive such changes once they know of alternatives, there was frank disbelief.

After listening to midwives all day using words like “delivery”, “confinement”, “letting her...”, “”allow” etc I finally could take no more and raised the issue of the language we use in our programs (you know what a passion I have about this...!). I was surprised at the attitudes of several midwives, who were vehement in their opposition to changing the way they talk to women, because they believed that what they were saying was acceptable. They were unwilling to see how influential our words might be in shaping beliefs and attitudes amongst pregnant women. Fascinating stuff!

I’m starting to think that midwives would benefit from “getting out more” to visit other parts of the country where different ways of working can be found. When it is as parochial and incestuous as this, it is hampering progress towards the empowerment of women and the elevation of midwifery. I am hoping that a good night’s sleep with enable them to see things in a slightly different way.

Posted by andrea at 03:38 AM | Comments (3)

Private insurance for caesarean births

It has just been reported on the BBC evening News that the AXA Insurance company is to stop paying out for caesareans carried out privately for those people who have private health cover with their company. The reason given is that they cannot tell which caesareans are being undertaken for genuine medical reasons and which are being done as “lifestyle choices”. As a result they will pay our for none.

This may be the breakthrough we need to get the caesarean section rate down. AXA are a huge international company and offer health cover in a number of countries. If we can pressure them to make the same decision in Australia, then other insurance companies may follow suit. Wouldn’t that put the cat among the pigeons?

I will try and follow this up and see what is in the newspapers in the morning. This news has really made my day!

Posted by andrea at 03:40 AM | Comments (6)