Articles by Month: January 2003

Heat, bushfires and workshops

For the last two days I have been presenting an Active Birth workshop in Queanbeyan for the Southern Area Health Service. Queanbeyan is right on the border of Canberra, and is therefore in some ways like a Canberra suburb. The group had to shrink at the last minute because of the terrible bush fires that are still burning in wide areas of the region, which requires hospitals to adopt special emergency status in case of evacuation of patients or an influx of casualties. Staff are placed on emergency 24 hour rosters and many midwives were therefore unable to attend. Some may have had difficulty reaching Queanbeyan anyway, as the fires can close highways are short notice, forcing long detours or abandonment of travel plans.

Amongst the group were four midwifery students who were graduating on the second day of the workshop. They were very excited by the prospect of joining the ranks and were warmly applauded by the group for their achievements. They will all make excellent midwives - caring, feisty, passionate and skilled - their tuition has been very broad and they have some wonderful experiences as part of their education. Two are already apprenticed to an independently practising midwife and plan to begin offering home births as soon as they can be accredited. Until this happens, all four will be working in the Queanbeyan hospital and they will make up a sizeable proportion of the entire staff, which is bodes well for lots of normal births for the women they assist. It will also be helpful for them to be working together as they will be able to support each other as they get used to working within the system and its limitations.

Once again I have had the pleasure of working with a great set of new graduates. It am really encouraged when I see the results of good tutoring and careful nurturing producing such promising midwives. I hope that they can stay focused and find niches that encourage and support their ideals rather than restrict and demoralise them.

Meanwhile, I hope the heat (Canberra was 40 degrees - a record) passes and that we get some rain everywhere. The country has never been so dry and dusty. We might be accustomed to hot summers, but this is ridiculous!

Posted by andrea at 08:42 PM | Comments (2)

Direct Entry Midwifery Course for UTS

YesterdayI attended a meeting at the University of Technology School of Nursing and Midwifery, where we discussed the setting up of the Bachelor of Midwifery at UTS. Representatives of the University of Canberra and Southern Cross University (Lismore) were also there, plus representatives of the Australian College of Midwives, St George Hospital ( a partner with UTS in their Graduate Diploma of Midwifery program) , Independent midwives and intending students. I guess I was there as a “consumer” representative.

It was a dynamic and exciting meeting. Jill White, the Dean of the School, and her team, have obviously spent considerable effort in formulating the basic plans for the three year program that incorporates suggestions and feedback from other similar reference group meetings that have been held sporadically over the past 5 years. At last the culmination of these efforts is in sight, and the aim is to have the progam ready to roll as soon as possible after the NSW State Government passes the NSW Nurses and Midwifery Act. Once this legislation is on place (expected by mid year) there will be a mechanism for the registration of midwives that have no nursing background, an essential for B Mid students to practice, and for the University to approve the course.

The course will meet the new Accreditation Standards for Bachelor of Midwifery programs that have been established by the Australian College of Midwives. These standards have taken 3 years to develop and will ensure that graduates of all these programs across the country are not only able to meet the full definition of a midwife set by the ICM, but are capable move straight into independent practice, if they wish. This will be a huge step forward for midwifery in Australia.

There are a number of hurdles to overcome before the course is underway. Many practical details have to be sorted out, some involving the practical clinical experience that students will need in order to acquire their 40 births and 30 “follow through” experiences with women that form the core of the program.

One thing is for sure - there will be no shortage of applicants! To ensure that they know what they are taking on, it was recommended that they only be accepted after interview. With such a shortage of midwives, and the need for quality graduates who can help turn midwifery practice around on a broad scale, it is important that as few as possible drop out.

I look forward to further meetings as the nitty gritty of the syllabus is mapped out and overall program is fine tuned. It is a pleasure to be working with such an inspiring group of midwives!

Posted by andrea at 05:46 AM | Comments (33)

Dr Fiona Stanley - Australian of the Year

Over the weekend, Dr Fiona Stanley, of Perth, WA, was named Australian of the Year for 2003. Many of you will have seen her name of research papers relating to maternal and child health, as she is an internationally recognised leader in this field. Her pioneering work in recognising the link between folic acid and neural tube defects and her research into the links between birth asphyxia and cerebral palsy are well-known. Dr Stanley showed that only 10% of cerebral palsy cases were caused by birth trauma, the majority having been caused by an event earlier in the pregnancy that affected the baby’s brain development, and perhaps made the birth more difficult as a result.

She has a passion for children and babies and is especially concerned about the plight of Aboriginal children, who often suffer from problems caused by poverty and poor living conditions. The Sydney Morning Herald reported that “she would use the ‘soapbox’ of her position [as Australian of the Year] to campaign to improve the life expectancy and health of children in disadvantaged and Aboriginal communities. ‘Get it right for them and their future is going to be better’ she said.” This is a sentiment that could equally be applied to all children - the best start in life, both prenatally and during the birth itself, will enable any baby to live a happier and healthier life.

It is wonderful to have such a champion for maternal and child health recognised in this way. Congratulations are very definitely in order!

Posted by andrea at 10:07 AM | Comments (3)

Australia Day - January 26

Today is Australia Day. It celebrates the day that Captain Arthur Phillip raised the British flag on his arrival into Farm Cove to signal the birth of a new colony. It is also a time when we take a look at ourselves as a nation and as a bunch of people, and celebrate those things that make us special and different. There are always lots of events around the country, mostly fun activities, usually outdoors and offering something for everyone. Citizenship ceremonies are held in many cities and towns, where immigrants who like what we do here, take out Australian citizenship, as a mark of respect and of inclusion into our society. Everyone receives a lovely certificate and a native tree to symbolise their connection t our land. These events are very moving and are I think, a reason why our country is inclusive, accommodating and welcoming. It is one of our great strengths, that we are open to ideas, willing to “have a go” and accepting of other people’s backgrounds and beliefs. You can tell that I am fiercely proud of my heritage, can’t you?

People who have made outstanding contributions to our country in various ways are also recognised with “Orders of Australia”. These are equivalent to the British system of honours, but we don’t use the terms “Sir”, “Dame”, “Lord” etc - which tend to entrench a class system. We put OAM (Order of Australian Merit) etc after the name instead.

Despite our annual chest thumping festival, things are not all rosy here and we have much work to do to stay true to our ideals. This may be the last Australia Day that we have in peace for a while, if our Government decides to throw our lot into a fight between bullies in far off lands (despite overwhelming opposition from the people). We have pressing environmental issues that are threatening our way of life and there are many that need a better deal and a fairer go.

As I look at what we have accomplished as a nation in just over 200 years, I think we can stand proud and tall. There may not be many of us (around 19 million) but we can, and do, make a difference on the world scene. I’ll be celebrating today, and I look forward to sharing a few Aussie thoughts with you over the coming year through my Diary entries.

Cheers, Skol, Salut, Down the hatch, Bottoms up... whatever ! ( Clink of glasses of full-bodied Aussie red wine....)

Posted by andrea at 06:36 AM | Comments (3)

Instructions for moxibustion for turning breech babies

There was a big response to my Diary entry about the use of moxibustion for turning breech babies. As a result, I have now completed an article (with photos) on how to undertake this technique which I hope with be useful and enable parents and midwives to try it out.

The summary of the research paper (the only randomised controlled trial) is also included for those of you who would like to chase up the details, and some other useful links.

Let’s hope that this technique does the trick and some women (and babies) avoid the almost obligatory caesarean birth that is so prevalent today.

Posted by andrea at 12:48 PM | Comments (3)

Innovative midwifery education in rural areas

Another week is coming to a close. The workshop in Traralgon will conclude today and it has been very successful. The Grad Dip Midwifery students from Monash that we have worked with have been a special bunch of women - very motivated, very woman centred, and enthusiastic to boot. If these are examples the midwives of the future, then birthing women will be very well cared for and the profession is in safe hands.

The School of Midwifery here in East Gippsland, Victoria, is unique in its approach. Most midwifery education in Australia takes place in the large city teaching hospitals where it can be difficult for students to get a rounded education, given that these institutions have set ways of working. Trish David, the Senior Lecturer in charge of this Monash program has negotiated with all the rural hospitals in this half of the State to mentor and support a student or two through their small country hospitals. Many of these may only have 60 - 120 births each year. The students have told us how the midwives and nurses in these units (many women work both roles) have gone out of their way to ensure that they have seen as many births as possible and been given the experiences necessary for their Course. The challenge of having a student has kept the staff on their toes and is a simple way for regular staff to be updated with the latest research and practises. A win all round, it seems.

Many of these hospitals have acute shortages of midwives and so they are encouraged to select nurses from their hospitals to enrol in the Monash program. The hospital helps with fees and provides support and resources and in return they know that in 2 years they will have a fully qualified midwife to add to their pool of staff.

Programs like these are also enabling the smaller units to stay open - they are now “teaching institutions” and this added status can be useful in justifying their retention. Labouring women are finding that they are getting their “own midwife”, perhaps a student, who will follow them through the pregnancy and be there for the birth. This extra, personalised care is very attractive to women and has been a deciding factor for some who have chosen to give birth in a small rural hospital rather than a bigger city or District hospital. This outcome is good for rural health, the midwifery students and of course the women themselves. Let’s hope that Trish David’s program becomes a model for other schemes in other States.

Posted by andrea at 05:26 AM | Comments (2)

Implementing the National Maternity Action Plan

The National Maternity Action Plan (NMAP), as I have written about before, is the first really comprehensive push in Australia for universal maternity reform. It is a wonderful vision, with a good chance of being adopted, especially in the current climate of rising costs, litigation scares, rapid rises in intervention rates and increasingly demanding consumers who are looking for more choice.

When politicians are approached for support for NMAP, they invariably ask “what will it cost?” and “how would it be implemented”? The first of these questions is fully covered in the NMAP report itself. The second challenge has also been embraced and a full Implementation Plan has now been developed for the State of NSW, where an election is due in March. This is a very professional and extensive document, well worth reading as an example of a practical blueprint for change. It will be harder for the politicians to push NMAP to one side as “impractical” when this kind of detailed planning has been presented to them on a plate.

Congratulations to the team at The Maternity Coalition for preparing this document. Best wishes too for their campaign of political harassment as the political hopefuls step up into full election mode. This is our best chance of achieving change for many years and it deserves al the support it can get.

Posted by andrea at 08:42 AM | Comments (2)

Monash University Midwifery Elective

The Effective Prenatal Education Elective that we are presenting for Monash University in Victoria is going well. These students have completed one year of their Graduate Diploma in Midwifery and are undertaking this elective in their summer holiday, which is a great sacrifice of precious spare time!

This is the first time that we’ve had the opportunity to work with midwifery students in this way. We aim to give them a good grounding in the preparation and presentation of prenatal programs for parents and hope that they will feel better prepared to tackle this important part of their work as midwives.

On Friday we will be videotaping their presentations. As usual, everyone froze when we mentioned the “video” word, but this is a very simple and effective way to get valuable feedback on one’s facilitation abilities. They will have time tomorrow to prepare the necessary lesson plans (one of the assessment tasks) and their efforts on Friday will be a useful “dress rehearsal” for their other assessment task which will involve videotaping an actual session for parents on a topic of their own choice.

It will be fun to mark these assessments and to see how they have done. Most educational programs these days require that students present to their class mates, so students are often a lot more confident than I was when I first started working with parents. It is always a help when we stress that good quality parenthood education does not involve lots of lecturing (public speaking is a common fear for us all) and that success is best achieved by involving the parents in working through many of the issues for themselves. An educator is really a facilitator and a resource person, rather than a teacher (a term I try not to ever use).

I am looking forward to Friday for a day of fun and games as we all pretend to be in a prenatal class with a variety of presenters and topics to be tackled. It should be immense fun as well as educational all round!

Posted by andrea at 05:42 PM | Comments (2)

Catching up

It has been a very hectic week as we get back to work after the holiday season. Lots of catching up to do after the break and not all my staff on deck as yet, so extra tasks to do myself.

Apologies for those of you waiting to read the next installment of this Diary - promise I will catch up with more regular postings next week.

On Sunday I am travelling to Victoria (Traralgon in Gippsland) to present the first workshop of the New Year - a five day program on “Effective Education” for Monash University. It will form an elective for their Graduate Diploma in Midwifery. I am really looking forward to working with these students as I always find Midwifery students to be committed, passionate and enthusiastic. Perhaps that’s because they have not had time to be ground down by the health care system! I will let you know how it is going as we work out way through the week.

Posted by andrea at 02:57 PM | Comments (2)

Pregnant Barbie!

I’ve heard that there is a new version of the Barbie Doll coming to Australia soon - the Pregnant Barbie! Apparently she has a “baby” in a tummy that is attached by a magnet - now there’s a lesson on how easy it is to give birth - just pop off the tummy and there it is!

I have heard that this doll was removed from sale in the US because it was thought that it might encourage teenage pregnancies (!). The main issue in Australia will be the bottle that is included in the kit and the feeding information that mentions bottles but not breasts. That will have to go or the product will receive very bad press from all the breastfeeding activists here.

It will be interesting to see how they plan to market it here!

Posted by andrea at 03:33 PM | Comments (17)

Independent midwifery

Had dinner last night with two good friends who are independent midwives. The conversation roamed around births (as you would expect!) and eventually we came to the hassles that they encountered when transferring women to hospital. So often independent midwives are met with hostility and suspicion when they need to transfer a woman during a birth, sometimes in ways that could jeopardise the labouring woman (for example, when the receiving midwife or doctor disputes the diagnosis made by the independent midwife, resulting in unnecessary delay).

I guess many of us feel a bit intimidated when we are confronted by a professional who is obviously competent, in charge of the situation and willing to take responsibility, especially if we are feeling a bit unsure of our own skills in some way. Many of the attempts to restrict the scope of practice of these midwives probably stems from feelings of inadequacy by those who feel they should be in control, or who feel that their territory is being threatened by an “interloper”.

If the NSW Government grasps the nettle and decides to introduce models of midwifery care that will enable and support home birth options (amongst other innovative schemes), they will need willing midwives to take up the challenges of providing the necessary services. If these new schemes come at a price of curtailing the autonomous practice that has been the hallmark of the independent midwives, then I think few will want to be a part of the new ways of working, and may leave the field rather than subject themselves to restrictions on their work. My friends were certainly of this view. If anyone tried to impose guidelines or limits on the services they could offer women, they would rather leave midwifery than submit. This is even if the Government offers to cover their professional indemnity insurance as part of the bargain.

I hope that some equitable system can be hammered out that leaves everyone a winner. Many women want to do their own thing with birth and engaging an independent midwife is the only possible way of achieving this without hassles. Hospital based midwives need the strong example of home births to remind them of the beauty of birth as well as its normality. Fear and vested interests are again likely to prevail when it comes to Government decision making - unless we can be sensible about this there is a risk that we will lose some of our best examples of midwifery practice in this country. This must not happen!

Posted by andrea at 03:48 PM | Comments (3)

Lotus Birth

Attended another birth this week, this time at home, at the request of parents who wanted the event videotaped for posterity. A second baby, and all went very well. The mother had decided that she wanted a water birth and a lotus birth. In the end, there wasn’t time to fill the pool and although there was about 30 cm of water in the pool which she did use for comfort (to an extent), the baby wasn’t able to pass through it on his way to his mother’s arms.

The lotus birth aspect is interesting. This is not something I have ever had much to do with and although there is a very interesting book on the subject most of the information about this approach to third stage management has been anecdotal.

I have videotaped the placenta is detail and have already visited to see how things are going after the first 24 hours. I will check again tomorrow. If the videotape footage is OK, we might consider making it into a short instructional video for midwives and parents. Will keep you posted.

Posted by andrea at 02:36 PM | Comments (2)

WHO, Safe Motherhood and human rights

Provision of appropriate maternity care tailored to the needs of the individual woman should be a basic human right. Of course, it is hard to achieve this when a health care system is trying to manage a multitude of women utilising their services at any one time. This is where the routines and protocols come in as a way of attempting to get some kind of order into what could become chaos, especially in hospitals where women must be cared for by staff they have never met and in conditions that are far from personal, let alone intimate.

The World Health Organisation has a useful free publication that explores the issues of human rights in the context of the necessity for health systems to operate with some degree of efficiency and safety. Called “Advancing Safe Motherhood through Human Rights” it has been produced with “the intention .... to facilitate initiatives by governmental agencies, non-governmental groups and, for instance, international organizations to foster compliance with human rights in order to protect, respect and fulfil women’s rights to safe motherhood.

Well worth a read.

Posted by andrea at 03:28 PM | Comments (2)

"Us and them" attitudes amongst midwives

I’ve been reflecting today on the experiences that I’ve had at births over the past few weeks. In particular I’ve been thinking about the attitudes of the midwives that I have encountered, and specifically the differences between midwives working in labour wards and birth centres.

We are all aware that birth centres operate as a midwifery model of care, where the needs of the labouring woman and her baby are the pivotal point around which everything revolves. Whatever she needs is made available to her and her strength and ability is never doubted until there is a proven complication.

In labour wards, the attitude appears to be that the staff’s and hospital’s needs are paramount and women labour according to the protocols, with their wishes being largely discounted. This was starkly played out last week at the birth I attended in the brand new labour ward of my local hospital. The parents have since called the midwife that met us as “the Russian Hitler” which was pretty perceptive.

The woman was told firmly that she must get onto the bed for the CTG and when I queried this, the response from this midwife was “she had to locate the baby first (palpation and a VE) and this could only be done on the bed”. While I was challenging this, the woman was obediently getting onto the bed and ready for the ordeal of examination so the debate became academic. The examination was painful, and the midwife immediately said “do you want to gas?”. This exposed the midwife’s poor level of skills in easing women’s discomfort without drugs - why on earth is a midwife with this attitude allowed to work with labouring women? I guess this is the result of chronic shortages - hospitals will employ anyone they can get.

As soon as we could, we helped the woman into the shower. I requested a birth ball for her to sit on - the raised eyebrows spoke volumes and after a while, when it hadn’t arrived I went in search of it. Locating it languishing in the hall, I helped myself - being a brand new unit I wasn’t yet familiar with where to find the things we need (but I am now!) and much later when the midwife came back, she was surprised to find it in use.

Meanwhile I was working out how to stop up the plug hole so we could use the bath (see my earlier Diary entry). When this was challenged, I was told very firmly that “we don’t do this kind of thing in the labour ward”. Why ever not? This “us and them” demarcation has got to stop - women should not be subjected to discrimination because they have chosen a labour ward instead of a birth centre.

Twenty years ago, when the Birth Centre opened at the Royal Hospital for Women in Paddington, Sydney, I remember seeing midwives from the Birth Centre scuttling furtively into the labour ward to collect supplies. They were clearly unsettled by being in a hostile environment where they were frequently subjected to ridicule. As the plaudits accumulated for the Birth Centre, the midwives in the labour ward finally woke up and realised that they too could be getting similar positive press. Instead of sneering at “those women” who chose the Birth Centre, they began boasting that “we can do everything here in the Labour Ward that they do in the Birth Centre”. Whilst it wasn’t quite true, because of the lack of physical facilities, it made a big difference to staff morale and enabled women to be more comfortable with transfers and regular Labour Ward admissions.

It is time that the staff in my local unit woke up to the potential of their brand new facilities. They could be leaders in the field instead of terrified that they will be stepping out of line if they put the woman first. This new unit could be a showpiece, with better statistics than similar units, if the baths were used and basic midwifery skills were employed. I shall be writing to the hospital making these suggestions. I will also point out that women’s rights must not be trampled because of staff inadequacies and poor skill levels. They have a responsibility to get it right.

Posted by andrea at 11:06 AM | Comments (5)

"Us and them" attitudes amongst midwives

I’ve been reflecting today on the experiences that I’ve had at births over the past few weeks. In particular I’ve been thinking about the attitudes of the midwives that I have encountered, and specifically the differences between midwives working in labour wards and birth centres.

We are all aware that birth centres operate as a midwifery model of care, where the needs of the labouring woman and her baby are the pivotal point around which everything revolves. Whatever she needs is made available to her and her strength and ability is never doubted until there is a proven complication.

In labour wards, the attitude appears to be that the staff’s and hospital’s needs are paramount and women labour according to the protocols, with their wishes being largely discounted. This was starkly played out last week at the birth I attended in the brand new labour ward of my local hospital. The parents have since called the midwife that met us as “the Russian Hitler” which was pretty perceptive.

The woman was told firmly that she must get onto the bed for the CTG and when I queried this, the response from this midwife was “she had to locate the baby first (palpation and a VE) and this could only be done on the bed”. While I was challenging this, the woman was obediently getting onto the bed and ready for the ordeal of examination so the debate became academic. The examination was painful, and the midwife immediately said “do you want to gas?”. This exposed the midwife’s poor level of skills in easing women’s discomfort without drugs - why on earth is a midwife with this attitude allowed to work with labouring women? I guess this is the result of chronic shortages - hospitals will employ anyone they can get.

As soon as we could, we helped the woman into the shower. I requested a birth ball for her to sit on - the raised eyebrows spoke volumes and after a while, when it hadn’t arrived I went in search of it. Locating it languishing in the hall, I helped myself - being a brand new unit I wasn’t yet familiar with where to find the things we need (but I am now!) and much later when the midwife came back, she was surprised to find it in use.

Meanwhile I was working out how to stop up the plug hole so we could use the bath (see my earlier Diary entry). When this was challenged, I was told very firmly that “we don’t do this kind of thing in the labour ward”. Why ever not? This “us and them” demarcation has got to stop - women should not be subjected to discrimination because they have chosen a labour ward instead of a birth centre.

Twenty years ago, when the Birth Centre opened at the Royal Hospital for Women in Paddington, Sydney, I remember seeing midwives from the Birth Centre scuttling furtively into the labour ward to collect supplies. They were clearly unsettled by being in a hostile environment where they were frequently subjected to ridicule. As the plaudits accumulated for the Birth Centre, the midwives in the labour ward finally woke up and realised that they too could be getting similar positive press. Instead of sneering at “those women” who chose the Birth Centre, they began boasting that “we can do everything here in the Labour Ward that they do in the Birth Centre”. Whilst it wasn’t quite true, because of the lack of physical facilities, it made a big difference to staff morale and enabled women to be more comfortable with transfers and regular Labour Ward admissions.

It is time that the staff in my local unit woke up to the potential of their brand new facilities. They could be leaders in the field instead of terrified that they will be stepping out of line if they put the woman first. This new unit could be a showpiece, with better statistics than similar units, if the baths were used and basic midwifery skills were employed. I shall be writing to the hospital making these suggestions. I will also point out that women’s rights must not be trampled because of staff inadequacies and poor skill levels. They have a responsibility to get it right.

Posted by andrea at 11:06 AM | Comments (2)

The Mackay Birth Centre

I have had an email from Suzanne McLauchlan, an old friend of mine in Mackay, Queensland. She has been actively campaigning for better births for women for many years and has led several spirited campaigns to firstly establish, and then maintain the Mackay Birth Centre. When this was first established, it was in the former Matron’s home at the hospital, a three bedroom cottage in the grounds. It was perfect and very popular. There have been several attempts, over the years, to either incorporate the service into the Labour Ward or to demolish the program (and the building) altogether. However, the women of Mackay will have none of it and they have become very skilled at coordinating appropriate campaigns that have saved the day. She has now written to me again:

"In late November and early December just when we (midwives and mothers on the Reference Group for the MBC) believed we really did not need to meet monthly the administrators started indicating that they were considering relocating the birth centre form the free standing building into the Women's Health Unit of the Mackay Base Hospital. Our mighty lobbying machine in conjunction with lobbyist for NMAP quickly moved into action alerting the community and the admin staff that we would never tolerate such a move. All is well at the moment. We find the bureaucratic behaviour interesting and cyclic. Six years ago at the same time of the year when everyone is preparing to wind down from work and preparing for Christmas there was talk of demolishing our first birth centre. We now have more empowered men and women. However as you and I both know there is still so much work to be done to decrease the intervention rates and return birthing to women minus all the myths and fears that are perpetuated daily if not hourly".

Vigilance is imperative to make sure we retain those services we now have whilst we campaign for more choice. These birth centre programs are just too successful and popular and perhaps this is why they are often put at risk: if everyone wanted such good care then maternity services as a whole would need a radical overhaul. Rather than aiming high, it is often easier to dismantle the best services, so that they don’t show up the mediocre alternatives. Fortunately, women and midwives are forming better alliances today than they ever have in the past, and with the immediacy and convenience of email to coordinate campaigns and keep everyone informed, swift counter campaigns can be mounted with ease.

I just love the power of the internet to cross borders, promote communication and spread important information. We can use this wonderful tool to very good advantage when we feel our rights are being threatened.

Posted by andrea at 12:06 PM | Comments (2)

Fun and games in Sydney's newest maternity unit

I’ve just come back from my first experience of the new Prince Alfred Women and Babies Unit (formerly the famous King George V Hospital) in Sydney. I was supporting my friend Lisa during her first labour and she had chosen a private obstetrician and the labour ward.

The birth went very well, and although it was very hard and painful for Lisa, she did it all by herself, without medication, and gave birth, after 8 hours, to a lovely little girl.

The fun and games started when we arrived at the hospital. I won’t go into details about the staff we initially met or their insistence on routines, or their task rather than woman orientation - these behaviours will be added to my reference material for workshops! The midwife who was finally allocated to Lisa’s care was a New Zealander, and sensitive, flexible and very calming - a real bonus and she facilitated the birth beautifully.

The new facilities are spacious and well equipped. Plenty of room to move about and a generous bathroom area with a deep bath in the middle, a flat floored shower area and three shower heads (two on flexible hoses). The first thing I noticed was that there was no bath plug. Since Lisa always enjoyed baths, and I wanted to get this set up so it was available should she want to use it. I asked for the plug and was met with horrified looks and stern commands “the policy of this hospital is that no-on will use the baths!”. I couldn’t believe it - I immediately thought of the Royal Women’s Hospital in Brisbane where the plugs were all taken away - could this still be happening? Not to be deterred, I found a plastic bag and screwed it up and jammed it into the plug hole. Then I discovered that the water pressure is so low that to have more than one shower running at a time reduced the flow to a trickle. The bath was going to take about an hour to fill! The first midwife came back, noticed the very slowly filling bath and called for reinforcements. The charge midwife arrived on the scene and attempted to read me the riot act. She was flapping about in such a state - “the policy of this hospital is not to use the baths”, “we don’t do this kind of thing here - if you want this you have to go to the birth centre” and “none of us are trained in how to use water, so it can’t be used”. I enquired about the policy - it was not written down, just a verbal instruction, so I said that if it was not written down, then there was in fact, no policy, and we could therefore do as Lisa wished. I also explained that Lisa was a private client and that we would consult with her obstetrician about this decision as well. Of course Lisa overheard this conversation (which was in the next room) and in the way that women do to appease professional angst, said she would not use the bath if this wasn’t encouraged. Ridiculous - where is the woman centred care, I wondered?

A little later, her obstetrician arrived. I knew he had had a long history of supporting home birth midwives and was very relaxed and familiar with water births. He agreed that this was a ridiculous situation that had to be dealt with. However, not tonight!

Our kindly midwife said that the staff had fought long and hard to get the baths installed, but until the midwives were “trained” they were unwilling to try them. We were not asking about water birth, I should add, just getting into a bath to ease the labour pain, but no, that was taboo. How do they intend to get experience without giving it a go?

This hospital has been on the drawing boards for years and has taken a long time to construct. You would think that knowing there would be baths available when the new unit opened, that the staff would have prepared with a suitable water birth workshop, or at least visited their own Birth Centre, where water births have been done for years! The lack of planning and foresight is so typical on bureaucracies, but is infinitely frustrating for women.

No doubt things will settle down in time and these facilities will eventually be fully utilised. I hope the “us and them” attitude that is also apparent between the Labour ward staff and the Birth Centre will also disappear - I was pretty shocked by the “we don’t do that sort of thing (normal births?) in this unit - you have to go to the Birth Centre for that”. Perhaps that was why the new unit has prominent labels everywhere - “Delivery Suite” - Lisa gave birth in Delivery Room 8 - funny really - I saw her give birth to a baby, not a parcel!

I will be writing to the hospital with some feedback and the suggestion that they do some staff retraining as soon as possible. They could also use an “active birth “ workshop - some of their staff have forgotten what woman centred midwifery care is all about as well.

Posted by andrea at 11:03 AM | Comments (2)

Resolutions for the year 2003

2003 has arrived, and with it, many mixed emotions. There are forebodings of war and anxieties about the skills of our world leaders to maintain the peace that we all so desperately crave. There is a rising level of cynicism about the motives of big business and their control over world affairs, both at a broad political level and at the microlevel of our daily lives. Tensions between personal rights and community benefits are becoming more apparent. As we all find ourselves in an increasingly hectic and soul sapping working environment the struggle to achieve some balance between work, play, family commitments and community responsibilities grows sharper and more urgent.

With this background, what can we look forward to with some degree of certainty? The one basic fundamental that touches all of us involved with maternity care is that life, indeed, does go on. Women will continue to get pregnant, and babies will be born. The needs of those mothers and babies for safety and security is as desperate as it has ever been and we must continue to find ways to give them the best possible start in life. The future of us all rests with those mothers and babies, for it is those children who will eventually be making the decisions that will affect the health and well being of the planet we all inhabit. We must make as sure as we can that they start life gently, in a loving and calm environment where they can develop the trust that will underpin their endeavours in life and affect their view of humanity and the world.

It’s the time of year for New Year Resolutions, and bearing these thoughts in mind, I am setting some goals for myself this year:

• To do more to make sure that there are viable options for women giving birth
• To continue to foster midwifery care as the best model for ecological births
• To reach out more to midwives in Australia to remind them of their skills and to re-awaken their basic philosophical beliefs in natural birth (having done so much work overseas in the past few years, I want to make sure that the message is being reinforced at home too)
• To support those political campaigns, such as NMAP, that hold huge potential for systemic change for the benefit of the entire community
• To work towards making sure that women are aware of their options for birth and are able to make informed choices.

At a practical level, my objectives to achieve these goals will include:

• Publishing a new edition of The Midwife Companion and an updated edition of Preparing for Birth: Mothers
• Finishing a new book for childbirth educators
• Expanding our web site to include more information for parents (and hopefully a new book for pregnant women)
• Doubling the number of workshops that I present in Australia whilst not cutting down on the many programs we have scheduled for the UK
• Taking my message to Europe (there are already plans for Spain and Italy in the pipeline)
• Having my books The Midwife Companion and Empowering Women translated into Portugese, primarily for the Brazilian nurse-midwives.

There are other big plans afoot that are taking shape as well and more of these later. In the meantime, I intend to start this ambitious program by using the next week of my holidays to get really stuck into the writing before the workshops start in late January!

I hope that you have made some birth-related resolutions for 2003 too, and that you can start planning soon to bring them to fruition. No matter what the rest of the world is getting up to, the babies that will be born this year need all the love and care they can get, we all have a responsibility to make this happen, in one way or another.

Happy New Year!

Posted by andrea at 11:45 AM | Comments (3)