Articles by Month: December 2002

Christmas wishes

It’s Christmas again - seems like a few months since the last one! It is hard to imagine how the year has slipped by so quickly. When I look over the diary for the year I can see it was very busy and although it seems like not a lot has been achieved (there is still a long way to go) there have been some notable wins and good, productive work carried out. I’ll write about some of this for my New Year’s message.

I am planning a break now until early January. I will stay home (what a treat!) and have some ambitious ideas of doing some writing...... the new edition of The Midwife Companion, an update for Preparing for Birth: Mothers and a completely new book for childbirth educators. Plus an article for The Practising Midwife on TENS and some new pages for our web site. I wonder how much I will actually achieve?

Meanwhile, the Christmas festivities await - a lovely Christmas Day with my two wonderful children, James and Jenny at James’ house- where he is cooking the lunch this year. What a treat!

I trust all of you have exciting plans for the Holiday Season and that they include rest, reflection, good company, good food, and above all, PEACE. I will be back with my Diary for the New Year and look forward to continuing my conversations with you then.

Posted by andrea at 12:44 PM | Comments (2)

Insurance rebates for home births

Some really interesting news to hand today - one of the largest private health insurance companies in Australia (Medical Benefit Fund - MBF) has agreed to offer a refund for midwifery services for homebirth of up to $3000.00, provided “that no obstetrician is consulted”.

This is good news indeed. Some of the smaller health funds are already giving rebates for midwifery care, but getting these big players to recognise the benefits of midwifery is a bonus. It has to have a financial benefit for them - their profits are already under pressure and the obstetricians are doing more and more caesareans mainly for their private (and insured) clients.

Perhaps it will be the health insurance industry that pulls these doctors into line - there seems little political will to make them behave more appropriately towards healthy labouring women and our community is bearing the costs of their rampant excesses in a number of ways.

Next year is shaping up as a watershed year for midwifery, and 2003 is not that far away now!

Posted by andrea at 03:50 PM | Comments (4)

Survey of men's adaptations to parenthood

There has been quite a bit of publicity this week in the Sydney newspapers about a study that has been done looking at father’s reactions to their partner’s pregnancy and the changes it has wrought in their relationship. The study of 222 men at Nepean Hospital in western Sydney and Adelaide's Flinders Medical Centre is the first in the world to look specifically at how men's lives and moods change with the arrival of a baby.

It seems that many men are reacting poorly to the lack of sex, reduced support and attention from their partners, and many were finding it hard to bond with their babies, especially if the baby cried a lot or was “dull and uninteresting”.

It was the lack of sex that seemed to cause the most concern, and men were surprised that their partners were not as interested as before during the pregnancy and were even less interested after the birth. This is one are that could useful be addressed in prenatal classes, and although it won’t necessarily improve the outcome (in terms of how often men get the sex they want) it may at least help them to realise that a lack of interest in sex is rather typical.

Sex and sexuality as a topic for classes is one that many educators shy away from, even though talking about sex is popular and engages everyone’s interest. There are ways to make it easier, and I have written about how to incorporate this fascinating issue in the program.

The feedback I heard on one radio talk program was fun - several fathers said that the men who were interviewed should “get a grip”and “get into the real world” and stop complaining - fatherhood had so many pluses to outweigh the negatives that they should count their blessings instead of complaining.

There are lots of issues that fathers that would benefit from discussing in prenatal programs. There’s another article that I’ve written on how to include the men more that some of you might find useful. I certainly think that we should be including the men in all of the prenatal classes - after all they are half of the new family and we must include them at the very least, on that basis.

Posted by andrea at 12:26 PM | Comments (2)

Success with moxibustion

I met up again with my neighbour last night. Her baby had been breech and I had explained to her and her husband about using moxibustion to turn it into a head down position. As she was booked for an ECV, a few days later they decided to give it a try, and after 4 nights of treatment, they baby got the message and turned by itself. Needless to say, she was very pleased as it meant she could avoid the sometimes uncomfortable ECV procedure, and the spectre of a caesarean or vaginal breech birth had also disappeared.

We had a long talk about how she could now plan for a normal, natural birth. She is very health conscious and definitely wants to avoid using drugs. With her gentle approach to life, and positive attitude, she has a good chance of achieving a straightforward drug-free birth, even though she is booked with a private obstetrician. At least he has a good working knowledge of normal birth from much experience supporting home birth midwives in the past.

The baby is due around Christmas and they may decide to invite me to support them. It would make a lovely Christmas present for us all!

P.S. I am finishing off an article on how to do moxibustion for turning breech babies and it will soon appear on the Essential Parents pages of the website. I willlet you know when it is available.

Posted by andrea at 03:57 PM | Comments (2)

New articles for the web site

I’ve been reviewing the articles that I have written over the years for the Practising Midwife and have discovered, to my surprise, that there are 16 pieces on various aspects of childbirth education and midwifery that I haven’t yet put onto our web site!

I was surprised there were so many - but I did contribute a 1500 word article every month for 2 years, so they do mount up. Many of these will be of use to those of your who are looking for ideas for your classes, so I am assembling them at the moment and will let you know when they are on the site. I know you are all looking for any ideas you can get..... so watch this space for news of the new releases.

Posted by andrea at 03:47 PM | Comments (2)

Saving ourselves from meddlesome men

A couple of weeks ago, a male hypnobirther contributed to the discussion on the ozmidwifery list about giving birth in water. He stated that this was “the stupidist idea he has ever heard of” and that women should “get out of the water and onto a chair where you belong”. This naturally led to more discussion during which he said that pain in labour is wrong and that it doesn’t have to hurt - if it does this is just women’s minds at work, expecting pain which they then experience.

These comments really stirred things up. I was very proud of my fellow Aussies that he wasn’t flamed for his assertions and outrageous remarks and that several women tried to gently open his eyes to the realities of birth. His male views and his self-righteous tone didn’t cut any ice with the women on the list but we tried to give him some insights.

Anyway, soon after I was taken to task by the anaesthetists who want to tell women in prenatal classes that their particular form of “rescue” will also save them from the pain of labour. No need to suffer if we place our faith and trust in their particular form of magic.

It all reminds me of the snake oil merchants who used to go around convincing people that their remedies would cure all manner of ills, with no scientific foundation whatsoever. They played on peoples fears and harnessed the power of the mind plus the placebo effect to sell their products (and make a lot of money in the process).

Many men seem incapable of accepting that women are able to be supremely creative and produce a baby without their input (apart from starting it off). It makes me mad when I hear a man tell me that he knows better than I do what my body is capable of when it gives birth. Men have no idea what it feels like to even have a vaginal examination, let alone push a baby out into the world - how dare they presume to know better than me what I need in order to birth a baby successfully and safely? Of course, I am far past childbearing age, but you know what I am getting at....!

Being able to give birth without the meddlesome antics of medical men (or pseudo clinicians) is, for me, the most basic feminist issue. Sure, we need their help sometimes, and be thankful for it, but until we call them in, please leave us alone! Don’t presume to know better than we do what is required. Abandon the arrogant stance of trying to better nature when it comes to perpetuate the species in the safest and most efficient way possible. There are plenty of things you can get your teeth into, like protecting us from unnecessary wars and saving the planet from environmental catastrophe. You work on those bigger issues and leave us to having the babies...... that way there will be plenty of happy healthy children to inherit a beautiful and peaceful world.

Time to get off my soapbox now!

Posted by andrea at 06:51 AM | Comments (2)

Joining the Australian College of Midwives

Today I have received the application forms for joining The Australian College of Midwives Inc. In September 2001 it was moved and carried at the ACMI Annual General Meeting that consumers (that is, non-midwives) would be welcomed into the organisation as full members. A real breakthrough, that brings ACMI into line with the New Zealand College of Midwives, who have had consumer membership since its inception in 1991.

I am delighted to complete these forms and send them in, and look forward to being a part of this vibrant and vital professional group. At that same meeting in 2001 I was awarded an Honorary Fellowship of ACMI (their first!) so it is fitting that I am now able to join as a full member as a show of support.

I would urge all those who are concerned about the quality of maternity care in Australia to join with me - in numbers there is strength and a bunch of strong, committed women can achieve a lot. Details of how to join are on the ACMI web site.

Posted by andrea at 01:30 PM | Comments (2)

Reducing caesarean section rates

The rising caesarean section rate is of concern to anyone who has a true interest in the health and welfare of mothers and babies. The present overall rates in Australia, as recently announced by the Federal Minister for Health, Kay Patterson, are 25% for the public sector and 35% in the private system - truly scandalous figures. Given that these are “averaged” over all hospitals, it means that half of all public hospital have higher rates than this - we already know that these figures for private hospitals are very conservative and are probably much higher in many cases.

In the midst of all this gloom, it is good to hear of trends in the other direction . At the Royal North Shore Hospital, the main maternity unit in the affluent northern suburbs of Sydney, a concerted effort by staff has seen the emergency caesarean section rate drop by 25% over the past few months. This has been achieved mainly by relaxing the strict guidelines for induction which is a well-proven route to caesarean birth for many women. They are also exploring other ways of reducing the rate, which has had a morale boosting impact on staff. The hospital honoured the Manager of Labour Ward with a citation for her efforts in encouraging these important changes.

Let’s hope that other units take note and start making conscious efforts to improve birth outcomes. We certainly need something to be done!

Posted by andrea at 06:59 PM | Comments (2)

Grad Dip video

Today, just for a change of pace (and a bit of fun!) we are going to make a videotape introduction for those enrolling in our Graduate Diploma Course next year. Cassandra McBurnie, the Course Co-ordinator, and I have prepared a script and with the help of Jason Tunbridge, our General Manager (who has qualifications in video and film making - handy!) we’ll be hoping to get a useful program onto tape. I have already recorded a short insert piece from Fran Gallwey, our Manager and Grad Dip co-ordinator in the UK, that we will insert so that our UK students will be able to “meet” her too.

One of the problems with distance education programs, such as our Course, is that students feel the isolation and miss the regular contact with their peers. The email chat line we have established for them to use is getting a good work out, and we hope this video introduction will enable new students to at least put a face or two to the names they see on the paperwork.

The closing date for applications for next year is January 31st, so I am hoping that the editing studio can finish this fairly quickly for us. I am sure we will have a lot of fun doing this and let’s hope the finished product looks good too.

Posted by andrea at 09:11 AM | Comments (2)

Anaesthetists antics in prenatal classes

I’ve been off the air for a couple of days, while my trusty laptop has an upgrade. It is like trying to survive without one’s umbilical cord - I am gasping for a “fix”!

The debate about the anaesthetists and the epidurals is going strong at one hospital in Australia. I have been corresponding with two of the educators about this issue and will post here some of that conversation - perhaps some of you are in the same boat in your area. I am sure these tactics are nothing new. I will put their email messagein italics for clarity with my responses below:

Had our meeting at the hospital today - mind you, not one anaesthetist turned up! For now, Preparing for Birth has been withdrawn from CBE classes - but we are working on it.

Typical of the anaesthetists not to turn up -probably too busy putting in the epidurals and making money to be bothered! If parents still want the books, you can give them the web site address and we can send them from here....

Anyway, we presented all your references..... however some of them are from 1981, so they could be questioned. However, my colleague and I argued that if no further research has been done since then, are these references then not accurate???

Yes, the point is that no other research has been done - the date doesn't make research any less valid, in fact the Sepkoski paper was done ten years after the Rosenblatt paper to replicate and check the results and they were the same.

There seems to be a view that if there is no research, there is no problem. Two problems with this (for starters) often research with poor results or unexpectedly negative findings doesn't get published because people only want to good news, and research on the effects of drugs on newborns is expensive and time consuming to do - therefore it is often avoided. Doesn't mean that there is no problem, just that it hasn't been found or else written up. Parents have a right to know when there is no research - this also means that a treatment/drug etc can't be shown to be safe, either. A good strategy for parents to use is for them to ask the doctor if they are prepared to give them a signed statement that the treatment being offered is "safe". When this is refused, as it will be, this gives the parents a lot to think about.....

We are also going to spend a day perusing the drug book at the hospital, in an effort to find a correlation between different types of drugs used in epidurals, and the subsequent birth outcomes for the last 2 years. Apparently there is one drug, which gives a great epidural block, but "seems" to lead to fetal distress and emergency caesar. We are going to find out!

Epidurals typically are a mixture of an anaesthetic (usually bupivacaine) and an opiate (Fentanyl or pethidine or some others). It will be interesting to see what you turn up. See if you can get a copy of the package insert for the drugs check what it says about contraindications/side effects. Ask the anaesthetists how they feel about using a drug with these listed side effects and check if they are giving this information to the parents as part of the informed consent process. Management might like to know this too - the drug companies list this information to protect themselves in case of litigation, and the info is supposed to be taken on board by the doctors too. In the event of a case, there is little likelihood that a drug company will be effectively sued if they can show that the side effects and contraindications were made available for the doctors' benefit so they could act appropriately regarding the use of the drug.....

The unit manager will meet with the doctors next week. She will present our findings and explain that your book cannot be touched. She will also lay down the law about their "guest speaking" and will let us know how she goes. She will also ask that they withdraw their comments about ambulent epidurals being the norm -what a complete lie!!! Nobody in this hospital has ever walked after an epidural!

Most anaesthetists are now recommending against walking around with a "mobile" epidural because of the risk that the woman might fall over due to the woozy head (opiate drug effect) and loss of sensory nerve feedback from her legs -numb feet make it hard to walk confidently). She might then sue them and hospitals are not willing to take this risk (risk management is all the go these days). Your guys have obviously not caught up with this latest advice! How are they going to "sell" mobile epidurals in light of these new recommendations, I wonder?

Interestingly, an obstetrician in this town is advising his clients not to attend our CBE classes.... says he has all the current research in his rooms and there's no need to do classes elsewhere.... and his wife, his receptionist, talks to the clients about parenting! We will tackle him also!!!! Part of his CBE includes "I break the ladies' waters for her at 4cm", etc.... the list goes on. Surely he cannot understand anything about social networking, adult learning principles, informed choice and so much more.

This kind of behaviour could be construed as a "restrictive trade practice" ! Might be worth dropping that into the conversation!

This is not the end of this story.... it will have more chapters, for sure!

Posted by andrea at 02:44 PM | Comments (2)

Anaesthetists and their antics in prenatal classes

I’ve been off the air for a couple of days, while my trusty laptop has an upgrade. It is like trying to survive without one’s umbilical cord - I am gasping for a “fix”!

The debate about the anaesthetists and the epidurals is going strong at one hospital in Australia. I have been corresponding with two of the educators about this issue and will post here some of that conversation - perhaps some of you are in the same boat in your area. I am sure these tactics are nothing new. I will put their email message in italics for clarity with my replies to them below:

Had our meeting at the hospital today - mind you, not one anaesthetist turned up! For now, Preparing for Birth has been withdrawn from CBE classes - but we are working on it.

Typical of the anaesthetists not to turn up -probably too busy putting in the epidurals and making money to be bothered! If parents still want the books, you can give them the web site address and we can send them from here....

Anyway, we presented all your references..... however some of them are from 1981, so they could be questioned. However, my colleague and I argued that if no further research has been done since then, are these references then not accurate???

Yes, the point is that no other research has been done - the date doesn't make research any less valid, in fact the Sepkoski paper was done ten years after the Rosenblatt paper to replicate and check the results and they were the same.

There seems to be a view that if there is no research, there is no problem. Two problems with this (for starters) often research with poor results or unexpectedly negative findings doesn't get published because people only want to good news, and research on the effects of drugs on newborns is expensive and time consuming to do - therefore it is often avoided. Doesn't mean that there is no problem, just that it hasn't been found or else written up. Parents have a right to know when there is no research - this also means that a treatment/drug etc can't be shown to be safe, either. A good strategy for parents to use is for them to ask the doctor if they are prepared to give them a signed statement that the treatment being offered is "safe". When this is refused, as it will be, this gives the parents a lot to think about.....

We are also going to spend a day perusing the drug book at the hospital, in an effort to find a correlation between different types of drugs used in epidurals, and the subsequent birth outcomes for the last 2 years. Apparently there is one drug, which gives a great epidural block, but "seems" to lead to fetal distress and emergency caesar. We are going to find out!

Epidurals typically are a mixture of an anaesthetic (usually bupivacaine) and an opiate (Fentanyl or pethidine or some others). It will be interesting to see what you turn up. See if you can get a copy of the package insert for the drugs check what it says about contraindications/side effects. Ask the anaesthetists how they feel about using a drug with these listed side effects and check if they are giving this information to the parents as part of the informed consent process. Management might like to know this too - the drug companies list this information to protect themselves in case of litigation, and the info is supposed to be taken on board by the doctors too. In the event of a case, there is little likelihood that a drug company will be effectively sued if they can show that the side effects and contraindications were made available for the doctors' benefit so they could act appropriately regarding the use of the drug.....

The unit manager will meet with the doctors next week. She will present our findings and explain that your book cannot be touched. She will also lay down the law about their "guest speaking" and will let us know how she goes. She will also ask that they withdraw their comments about ambulent epidurals being the norm -what a complete lie!!! Nobody in this hospital has ever walked after an epidural!

Most anaesthetists are now recommending against walking around with a "mobile" epidural because of the risk that the woman might fall over due to the woozy head (opiate drug effect) and loss of sensory nerve feedback from her legs -numb feet make it hard to walk confidently). She might then sue them and hospitals are not willing to take this risk (risk management is all the go these days). Your guys have obviously not caught up with this latest advice! How are they going to "sell" mobile epidurals in light of these new recommendations, I wonder?

Interestingly, an obstetrician in this town is advising his clients not to attend our CBE classes.... says he has all the current research in his rooms and there's no need to do classes elsewhere.... and his wife, his receptionist, talks to the clients about parenting! We will tackle him also!!!! Part of his CBE includes "I break the ladies' waters for her at 4cm", etc.... the list goes on. Surely he cannot understand anything about social networking, adult learning principles, informed choice and so much more.

This kind of behaviour could be construed as a "restrictive trade practice" ! Might be worth dropping that into the conversation!

This is not the end of this story.... it will have more chapters, for sure!

Posted by andrea at 02:33 PM | Comments (2)

Those anaesthetists again!

I’ve been off the air for a couple of days, while my trusty laptop has an upgrade. It is like trying to survive without one’s umbilical cord - I am gasping for a “fix”!

The debate about the anaesthetists and the epidurals is going strong at one hospital in Australia. I have been corresponding with two of the educators about this issue and will post here some of that conversation - perhaps some of you are in the same boat in your area. I am sure these tactics are nothing new. I will put their email message italics for clarity:

Had our meeting at the hospital today - mind you, not one anaesthetist turned up! For now, Preparing for Birth has been withdrawn from CBE classes - but we are working on it.

Typical of the anaesthetists not to turn up -probably too busy putting in the epidurals and making money to be bothered! If parents still want the books, you can give them the web site address and we can send them from here....

Anyway, we presented all your references..... however some of them are from 1981, so they could be questioned. However, my colleague and I argued that if no further research has been done since then, are these references then not accurate???

Yes, the point is that no other research has been done - the date doesn't make research any less valid, in fact the Sepkoski paper was done ten years after the Rosenblatt paper to replicate and check the results and they were the same.

There seems to be a view that if there is no research, there is no problem. Two problems with this (for starters) often research with poor results or unexpectedly negative findings doesn't get published because people only want to good news, and research on the effects of drugs on newborns is expensive and time consuming to do - therefore it is often avoided. Doesn't mean that there is no problem, just that it hasn't been found or else written up. Parents have a right to know when there is no research - this also means that a treatment/drug etc can't be shown to be safe, either. A good strategy for parents to use is for them to ask the doctor if they are prepared to give them a signed statement that the treatment being offered is "safe". When this is refused, as it will be, this gives the parents a lot to think about.....

We are also going to spend a day perusing the drug book at the hospital, in an effort to find a correlation between different types of drugs used in epidurals, and the subsequent birth outcomes for the last 2 years. Apparently there is one drug, which gives a great epidural block, but "seems" to lead to fetal distress and emergency caesar. We are going to find out!

Epidurals typically are a mixture of an anaesthetic (usually bupivacaine) and an opiate (Fentanyl or pethidine or some others). It will be interesting to see what you turn up. See if you can get a copy of the package insert for the drugs check what it says about contraindications/side effects. Ask the anaesthetists how they feel about using a drug with these listed side effects and check if they are giving this information to the parents as part of the informed consent process. Management might like to know this too - the drug companies list this information to protect themselves in case of litigation, and the info is supposed to be taken on board by the doctors too. In the event of a case, there is little likelihood that a drug company will be effectively sued if they can show that the side effects and contraindications were made available for the doctors' benefit so they could act appropriately regarding the use of the drug.....

The unit manager will meet with the doctors next week. She will present our findings and explain that your book cannot be touched. She will also lay down the law about their "guest speaking" and will let us know how she goes. She will also ask that they withdraw their comments about ambulent epidurals being the norm -what a complete lie!!! Nobody in this hospital has ever walked after an epidural!

These days most anaesthetists are now recommending against walking around with a "mobile" epidural because of the risk that the woman might fall over due to the woozy head (opiate drug effect) and loss of sensory nerve feedback from her legs -numb feet make it hard to walk confidently). She might then sue them and hospitals are not willing to take this risk (risk management is all the go these days). Your guys have obviously not caught up with this latest advice! How are they going to "sell" mobile epidurals in light of these new recommendations, I wonder?

Interestingly, an obstetrician in this town is advising his clients not to attend our CBE classes.... says he has all the current research in his rooms and there's no need to do classes elsewhere.... and his wife, his receptionist, talks to the clients about parenting! We will tackle him also!!!! Part of his CBE includes "I break the ladies' waters for her at 4cm", etc.... the list goes on. Surely he cannot understand anything about social networking, adult learning principles, informed choice and so much more.

This kind of behaviour could be construed as a "restrictive trade practice" ! Might be worth dropping that into the conversation!

This is not the end of this story.... it will have more chapters, for sure!

Posted by andrea at 08:11 AM | Comments (0)

Counteracting the anaesthetists

It seems that anaesthetists are really trawling for business in some prenatal classes (see response to my Diary entry No 90).

Perhaps one way to tackle them is to request that they provide the research on which they are basing their comments - you'll need to attend the classes and note down everything that they say and then ask them for their references (perhaps in front of the class as well, so that the class couples can be a part of hte process).

The video that they are using is a piece of straight propaganda, made by the drug companies. Lots of childbirth educators have binned the free copy they received in the mail because of its bias and lack of full disclosure.

Meanwhile, I am preparing a detailed list of references for the epidurals section of Preparing for Birth: Mothers and will post them on the web site when they are ready, in a few days. For those of you who cannot obtain copies of the actual papers via your own libraries, if you email me I will send you photocopies. I may have to make a charge for this, depending on where I am sending them, but will let you know privately. My email address is:

andrea@birthinternational.com

It's amazing how doctors think they can get away with massaging , filtering or censoring infromation that women receive. They should be jsut as accountable as the rest of us, so demand to see the actual papers they are using as a basis for their statements!

Posted by andrea at 08:45 AM | Comments (2)

Anaesthetists speaking in pre-natal classes?

The posting to my Diary entry on Anaesthetists poses an interesting question that frequently comes up in workshops for educators.

The anaesthetists mentioned in the posting may well be the ones who contacted me and asked me for the references. I replied, giving the main references that I used and asking them to be more specific - they had just asked for "my references". I have given them the references I have used, including the book “Epidurals” by Anne May (which is a textbook for anaesthetists) and have pointed out that the references are listed on this web site in the relevant sections in the Essential Parents pages. I also asked them to send me their references if they were concerned that I had missed something but I have not heard anything from them as yet.

I would be very wary of allowing them time in a prenatal program program. The selling of epidurals is insidious and subtle and these practitioners often give a very biassed account, that makes little, if any reference to the down side of epidurals. Communicating information sensitively and in a neutral fashion to groups of expectant parents in a class setting that few, if any, doctors possess. They have a vested interest to protect as their income rests on getting a good level of business, and they are also the most sued group of medical practitioners (just ahead of the obstetricians). Many times I have heard an anaesthetist tell women (and even professionals at Conferences) that “epidurals are safe for the baby”, which is not only untrue but dangerous, in terms of avoiding litigation!

I will be reviewing the content of Preparing for Birth Mothers soon, in preparation for another edition, so if there is anything they want specifically changed, they can let me know. I am aware that there are a couple of disadvantages for epidurals that I have omitted and also that I may have described spinal anaesthetics too simplistically. There will also be more on how to handle posterior labours so that an epidural can be avoided.

If they are concerned about the information you are giving, then they can always make arrangements to see women for a consultation before they go into labour to provide the information necessary for informed consent to be given, or they can prepare an accurate handout that can be given to women in advance of labour. Make sure you read any such literature and know what it says, because it can be very biassed. Literature must include the disadvantages for the baby, for example, and information on alternatives or else it will not be complete.

I am always happy to enter into discussion about anything I write. If I have made a mistake, I will correct it. If I have left something out I will try to include it when new edition is being prepared. Preparing for Birth: Mothers is not intended as a textbook with full references, it is a simple guide intended, as it states very clearly on the cover, to be “Background notes for pre-natal classes”. Educators may be asked for references and you will need to supply further details if requested. If you are not already aware of this information yourself (and you should be if you are properly prepared), ask me for the references - you will need to have them on hand for these very occasions.

Posted by andrea at 03:36 PM | Comments (3)

Uverdone ultrasounds

Had an interesting conversation today with a midwife who has been in practice many years. One of her biggest concerns is the overuse of ultrasounds and the de-skilling of midwives and doctors that is resulting from their use. She told me the story of two friends who recently went overdue with their first babies. In both cases the obstetrician ordered another ultrasound “to check that the baby was OK”. The mothers reported that the baby moved around a lot during the procedure and subsequently when they went into a labour soon after, both were found to be malpositioned, resulting in caesarean births for both women.

This midwife feels that the babies may well have been affected by the ultrasound itself, causing them to move into a compromised position. The logic behind this suggestion seems reasonable to me. Another question is also raised by these cases: what were they looking for? Presumably there was concern about reduced liquor, which can be a measure of fetal well-being, but this can be determined by palpating the mother’s abdomen. Of course, with ultrasounds now being used freely this skill will be lost, just as listening to the baby’s heartbeat using a Pinard is a dying art because of the use of sonicaids (more ultrasound!).

Many questions have been raised by concerned consumers regarding ultrasound and very little research is being undertaken. Parents may be concerned to limit ultrasound exposure as a result of some studies, but avoiding it altogether is becoming more difficult. Parents don’t always realise that the doctor’s (or midwife’s) sonic aid, the CTG ordered during pregnancy and the electronic fetal monitoring used during labour all use ultrasound to obtain the necessary data. Following the guidelines to limit ultrasound exposure during pregnancy is usually interpreted as avoiding more than one scan, when in fact the baby may be exposed to much greater levels of ultrasound, and for longer periods of time, through use of these other technologies. Keeping baby safe during pregnancy (which of course means the labour as well) just gets harder and harder for the diligent mother.......

Posted by andrea at 02:56 PM | Comments (2)

A breech baby next door

Last night I discovered that my almost next door neighbour is expecting a baby in 3 weeks. I was surprised as I didn’t know she was pregnant, but we both work and I have been away a lot over the past 3 months, so there have been few opportunities to talk to anyone!

She told me that her baby is in a breech position. My heart sank, as I know that these days the likely outcome will be a scheduled caesarean section, but she said that she was booked in for an external cephalic version (ECV) next week and that she was hoping for a natural, drug free birth. My spirits lifted further when she said that her obstetrician had said he would offer her a vaginal birth is she “would sign some papers” - he is a man I have known for years and is familiar with home birth and supportive of its concepts.

My neighbour was just off to her pre-natal class with a local independent educator when we met outside my front door, so we didn’t have time to talk. She said that the baby seemed to be trying to turn itself, but “giving up” so she thought that the ECV might work. We have agreed to meet tonight and I will explain how moxibustion works and give her some sticks to use if she wants.

I was also delighted to discover that she already had copies of my books Preparing for birth: Mothers and Preparing for Birth: Fathers. She was amazed to find that the author lived almost next door! I will be following her progress with considerable interest now I know there is a baby coming soon, and it will be lovely to have a newborn nearby in just a few weeks.

Posted by andrea at 06:38 AM | Comments (2)

Hang ups for labour

Have received a simple request via an email - “do you have any suggestions for a rope for labour?”

I am imagining that this request has come from someone who has either seen pictures depicting women hanging onto a rope for birth, or else they have seen the Austrian video “Giving Birth, Being Born” which at one point shows a woman hanging onto a rope suspended from the ceiling as she labours.

Certainly in bygone eras women often used something to hang onto while they pushed, and a simple rope slung from a hook or over a beam above her head would have been a simple solution. It makes sense to provide a strong handhold against which a woman can pull as in second stage there is a strong grasping reflex and women find pushing easier if they have a way of stabilising their upper bodies so they can exert effective downward pressure.

In today’s labour wards, a soft, thick rope could easily be suspended from a large hook or eye bolt in the ceiling. It could be knotted at intervals to give a better grip and prevent her hands from sliding down the rope. Positioning it above a soft mat on the floor would make sense, but I guess it could be hung over a bed as well - perhaps several anchor points to provide a degree of flexibility would be useful.

It would be an ideal addition to the array of self-help equipment such as mats, bean bags, birth balls etc that our birth centres and progressive labour rooms provide. If any hospital has already installed such a gadget (apart from the clinic in Vienna where the video was filmed) I would love to have news of this, and perhaps a photo for the web site.....

Posted by andrea at 02:34 PM | Comments (4)

A Conference on NMAP?

The National Maternity Action Plan (NMAP) is still very much on the agenda and a lot of “behind the scenes” meetings etc are taking place to ensure that it is on the political agenda. The future is looking hopeful, but not assured and there is a huge need to keep pushing the central issues of reform and freedom in the maternity services in Australia so that the grand plan can come to fruition.

It has been suggested that a national conference be staged, to bring together those who will need to be influenced to accept NMAP and have it implemented. The Maternity Coalition would be the main sponsoring body and I have offered the services of Birth International to provide the organisational expertise and necessary infrastructure. It will probably be in about 12 months (early 2004, is a likely timing) and we will have to get cracking to get the basics in place.

This could be a most exciting event, that could attract a huge amount of publicity and exposure for midwifery in Australia. Already ideas are forming in my mind of the main thrusts of the program and who we will invite to speak. I look forward to hearing from the others who will be working with us on this project.

As this event takes shape, I will keep my Diary readers informed.

Posted by andrea at 06:55 AM | Comments (2)