Articles by Month: March 2003

Reflections on this UK workshop tour

Today I am packing up in the UK ahead of returning to Sydney tomorrow. As I look back on this trip, it’s useful to reflect on what I have learnt from this trip:

The Birth Centre concept is finally being developed in the UK. However, disturbing trends are emerging - for example, I have just spent four days at Birmingham Women’s Hospital, where a new Birth Centre is under construction. It has been commissioned by the obstetricians, who have the majority on the decision making committees that are overseeing the staffing, design, construction and management of the new unit. The unit will be located in the obstetric unit and will have a double door access to the regular labour wards. Staff will rotate throughout all areas. In other words, this is a sham and a complete nonsense that appears to have an expansion of this highly medicalised unit as its primary purpose. I pity the poor midwives who will be trying to make it work for women. This is not an isolated event either, I heard of other examples of this kind of duplicity going on in the UK.

The Occupational Health and Safety people are developing into a police force that is hampering improvements and systematically undermining common sense. I have heard a long litany of ridiculous decisions they have made: women in supposedly home-like facilities not being allowed onto sofa beds (or similar comfy chairs) in labour because they cannot be easily cleaned; fathers not be allowed to make a cup of tea because they may burn themselves on the kettle; all birth balls removed from a unit afer a small mishap with one ball brought in from home by a labouring woman; towels for use with hot water being kept under lock and key; toast not able to be made in labour ward kitchens because it may set off the smoke alarms if someone is distracted and forgets to take it out of the toaster; etc etc. I should have made a list as I went along, but I was so gobsmacked (to use a local expression) that I didn’t write them down. Next time I will compile a dossier - it will make a great basis for an article in one of the midwifery journals!

On the other hand, I heard about dirty units, filthy floors, run down equipment and a general lack of facilities. It seems that the Infection Control Officers are not nearly as diligent as their OH & S colleagues!

The over riding impression that I have, however, is that this is a very “sick” culture, where women expect to be given drugs in labour and midwives offer them routinely because there is no real belief that women have the stamina or will power to labour without props of some kind. When I show birth videos I now make it clear that al the births midwives will see are ones where no drugs are being used of any kind. This is a rarity in the UK, even for home births. I think that this lack of trust in birth is contributing to the poor self esteem and low levels of confidence that are very evident amongst British women, which is hampering political action, personal improvement and change within the maternity services.

So, with a heavy heart at the lack of progress in British maternity circles, I head back home. Sometimes I wonder why I bother putting myself through considerable inconvenience to keep plugging away in the UK with the message about normal and natural births. There are midwives and women here that appreciate what I am saying and who have personal experience that backs my message. I just wish there were a whole lot more of them.....

Posted by andrea at 06:42 PM | Comments (4)

Birth in Kuala Lumpur, Malaysia

Today is the last day of my last workshop in the UK for this tour. It is an Active Birth workshop and is being held in the Birmingham Women’s Hospital.

I was delighted to welcome Christine Choong from Malaysia, into the group. Christine is a British midwife, married to a Chinese obstetrician an they live in Kuala Lumpur. She is a graduate of our Graduate Diploma in Childbirth Education and Lactation Consultant, and she offers prenatal classes, support services for parents and acts as a doula when asked. She has been campaigning for better births in Malaysia for many years and her husband, Kho Hsiang, is a keen supporter of natural birth.

When I last visited Kuala Lumpur I was able to visit several hospitals and was dismayed by the birth practices that I saw - shared labour wards with no privacy and routine lithotomy, episiotomy, shaves and enemas and a conveyer belt approach to care. Malaysia was a British colony in its past and there are still echoes of western systems in place. Malaysia does have midwives (unlike Thailand, for example) yet maternity services are mainly staffed by obstetric nurses.

Christine says that in the past few years several obstetricians have begun to support alternative positions for birth, although only if requested. She therefore emphasises that parents make very definite requests of their caregivers, whom they should choose with care if they want something different from the routine production line that normally operates.

Breastfeeding is well supported and the BFHI has been adopted enthusiastically by hospitals and family health care services. I well remember seeing a woman presented with her baby for immediate breastfeeding just after she had suffered the most inhuman birth practices! The connection between fewer birth interventions and easier and more successful breastfeeding is one that few caregivers anywhere in the world are keen to campaign around. It always seems to fall into the “too hard basket”.

Posted by andrea at 06:20 PM | Comments (4)

More silly hospital policies

I heard one of the silliest stories ever yesterday - it is a great illustration of how bureaucratic and idiotic hospital administrations can become.

One of the midwives in the workshop yesterday (from Taunton, Somerset) had attended an Active Birth workshop that I presented in Taunton a couple of years ago. She was interested in trying the hot wet towels for easing labour pain and found they were a great success. Some women, who had indicated in advance that they would want an epidural, found the hot wet towels were enough and they avoided using medications altogether.

Buoyed by this success, the midwife asked for the hospital to order some flannels that she could use for this simple treatment. Eventually they arrived and were locked away in a cupboard. Now, if she wants to use them for a labouring women, she has to get special permission from the unit manager to remove them from the cupboard! As she pointed out, the various drugs that midwives can use for labouring women are freely available without any trouble - they can be used without special permission being needed!

Have you ever heard anything so silly? These are not gold plated flannels, or specially manufactured small towels that are hard to come by - they are cheap, ordinary terry towelling squares that cost a few pence each. Someone here has comprehensively lost the plot!

Nevertheless, this midwife continues to use these towels because they are so effective and cheap. Eventually someone must get the message that this is a situation worthy of a student revue skit!

Posted by andrea at 05:41 PM | Comments (2)

Tackling the topic of Unexpected Outcomes

I am half way through a Teaching Skills workshop at Birmingham Women’s Hospital. As always, it is interesting to have a mix of NHS and NCT educators in the group and to hear how they organise their parenting programs in various parts of the country. Here they have cut back the classes to three sessions of 2 hours, just as has happened elsewhere. This is a very retrograde step, and we will explore ways of clawing back some of their funding, which is the usual underlying reason for the cut backs. Lack of educators is also a reason, and it is easy to see why midwives might not want to work in this area - several members of this group talked about their discomfort at public speaking and their lack of initial training.

I know that there are several topics that will come up today, that educators invariably find difficult to tackle. For those of you who want to know what we will be examining in more detail, you can read what I have written before in this article on Unexpected Outcomes and also on Pregnancy tests. This last issue came up yesterday when everyone did an activity that focuses on the usefulness of early pregnancy programs, and issue I must write more about on another occasion.

Posted by andrea at 04:50 PM | Comments (2)

The British version of a Birth Centre

One of the issues that came up in the London Active Birth workshop that I have just concluded was the concept of a “Birth Centre” as interpreted by the British. In the rest of the world, a birth centre is an autonomous midwifery unit that offers normal, natural birth with a small team of designated midwives. These centres are usually located within a hospital precinct, although many of the American centres are completely freestanding (I have visited US birth centres in office blocks) and in New Zealand, many midwives have clubbed together to convert residential houses into a birth centres.

Wherever they are physically situated, the basic principle is that women who choose that care are aiming for a completely natural birth, with no electronic monitoring (CTGs), drugs for pain, epidurals, inductions, ARMs, episiotomies etc and optional oxytocics for 3rd stage. Women will be offered baths and showers for easing pain, complete freedom of movement, open access for families and friends as birth companions and no limitations of food and drink in labour. Both the women using the unit an the midwives staffing it have a deep belief in the positive nature of birth and women’s capacity to handle it well without interventions of any kind.

In Britain there is a new movement gathering strength to establish birth centres across the country. It seems to be a re-badging of the “midwifery led units” that were a central plank of the Cumberledge Report that initially gave midwifery such a boost 10 years ago, but which has faltered since. These “birth centres” are springing up in many hospitals, but the way they are operating and the basic principles underlying their operation appears to be quite different from the kind of service defined by this term elsewhere in the world.

Firstly, there appears to be no commitment to drug free, natural births. Women can have pethidine and nitrous oxide (Entonox) on request and the majority use these medications freely. TENS machine are also encouraged. Whilst baths and showers are on hand, and water births are an option, these are sometimes being used togther with medications, a dangerous practice and poor midwifery as well.

The London workshop venue was in Guy’s and St Thomas’ Hospital, where they actually call their regular labour ward the “Birth Centre” and their “low risk unit” the “Home from Home Unit”. This is appalling and is a deliberate attempt to con women into thinking that they will be getting midwifery care when they will be subjected to regular obstetric management. I understand that the same tactic has been used at Kings Hospital as well, and this shameful situation needs to be exposed so that women are not being duped into accepting medicalised birth when they are expecting a birth centre approach. This duplicity will become more obvious as there is more publicity about birth centres and women begin to specifically seek out this alternative.

Other workshop participants told us about their attempts to get a “birth centre” established at Southend Hospital. After many years of struggle, they have been able to obtain 4 rooms within the labour ward area that will be designated as a birth centre. It will attempt to provide midwifery care, but they face considerable opposition to the midwifery guidelines they want to introduce, and a lot of retraining of the midwives who are not used to working without CTGs, for example. I have no doubt that these midwives have the women and their own profession at heart and will do their best in obviously difficult circumstances, but to call this service a “birth centre” is, I believe, a travesty of the concept that will undermine its effectiveness and debase the nature of this type of service.

There is to be a conference on Birth Centres presented by MIDIRS in April. I hope that this can at least establish some basic definitions of this type of care so that the British efforts can be brought into line with the approaches that have been used overseas for over 20 years. Consistency of purpose and the adoption of accepted definitions will strengthen their cause and provide a real alternative in hospital based birth, particularly when using the evidence from the many research studies undertaken in overseas birth centres to underpin their push for these centres.

If maternity services choose to accept the current watered down version of the birth centre that is being developed in Britain then there is a risk that these services will be no more effective than the midwifery led units they seem to be replacing, where women continue to use drugs, breastfeeding rates are still very low and a lack of continuity of both care and caregiver are often the norm.

Posted by andrea at 05:12 PM | Comments (3)

New birth website for Filipina women

Today I am off to present a workshop at Guys and St Thomas’ Hospital in London. This hospital is straight across the Thames River from the Houses of Parliament and Big Ben, and in today’s sunshine all their touches of gold will be glittering - a reminder of the power of Parliaments shape people’s lives (but not necessary a shining reminder of the sparking debate that goes on amongst politicians!).

The war in Iraq has been in progress now for several days. It is hard to know what is going on as the media are giving us a very massaged version of events. As the saying goes: “the first casualty of war is truth”. One outcome for me has been that 4 Israeli midwives who had registered for this workshop have had to pull out because there are no flights out of Israel for the time being. I hope I will be able to meet them another time.

In all the gloom about war it is nice to have good news. One of our Graduate Diploma in Childbirth Education students has just launched a childbirth website for Filipina women living away from their homeland. This is an exciting project and one I know she has worked very hard to achieve. Congratulations Rocellita on a fantastic effort!. Reaching out to your compatriots in this way is a wonderful community service and I hope it is widely used and appreciated.

Posted by andrea at 04:50 PM | Comments (3)

Midwifery in Jersey

Despite the warnings I had been issued about not mentioning water birth or home birth during my workshop in Jersey, the midwives here turned out to be similar to those everywhere else - keen to promote normal birth and wishing that they could offer more midwifery care (including water and home births) to women on this island.

Jersey is 11 miles by 7 miles and has a population of 88,000. It is closer to France than Britain, and the southern most island of the United Kingdom. The economy revolves around banking and tourism - Jersey is not a part of the European Union, has no VAT and is a tax haven with very low rates of personal tax. They are trying to limit immigration, as you can imagine!

The health system here is interesting. All medical care is private, and people pay £18 (approx AUD$54 ) per visit to see a GP. Those who cannot afford it are able to get care at the hospital. The GPs are keen to do most of the prenatal care (lucrative!) yet they are happy to let the midwives manage the births. This means that the midwives rarely know the women whom they will meet for the first time during labour. There is a midwives clinic at the hospital, so some women get midwifery care all along, and others are specifically asking for this, even though they could afford to see a doctor.

The rates for interventions are similar here to those elsewhere - caesarean section rates around 25% , high rates for epidurals and too many inductions. The familiar story from midwives everywhere I travel.

One midwife pointed out that the potential for litigation makes providing informed choice very important and that this could be useful in forcing change: if women know that services are available elsewhere (e.g. water births) they may well demand that they be offered here too. A very good idea - the need to make sure that women are aware of all the alternatives can be used not only to push changes, but also to protect midwives from censure and women from unnecessary intervention. It is a subtle idea and one that midwives are not always willing to adopt, but it is nevertheless an effective strategy.

I am looking forward to learning more about Jersey tomorrow. It is one place I would like to visit again, next time with a bit pf spare time to have a good look at the lovely old buildings and the countryside. It is a very attractive place!

Posted by andrea at 05:24 AM | Comments (2)

Waterbirths and the "nanny state" in Britain

There is an interesting article in the current issue of The Practising Midwife ( March 2003) titled “Women’s Experience of Waterbirth”. It describes the feedback that was received from 189 women in five different birthing centres who gave birth in water.

One of the main findings was that women demonstrated a strong desire for using water during labour and that they saw it as therapeutic. However, one astounding figure was that 88.3% used Entonox (nitrous oxide) during their waterbirth. There were even a couple of women who were given Pethidine or Meptid while using the bath.

I find this astonishing. Practitioners in other countries would find this high rate of drug use associated with waterbirth quite disturbing. There is always a potential for complications arising from the use of any drug and it could be difficult to manage a woman in a tub or bath should such an event occur. Some women, for example, become quite drowsy and even nauseous on Entonox, and a drowsy woman in a bath could pose quite a risk.

All this begs a basic question in my mind, however. The use of water is widely considered, and promoted, as an alternative to drug use in labour. This is certainly the message that women in countries outside Britain are given and it is understood by the woman as well. However, it is not an expectation amongst midwives in Britain. For example, I was shown the scavenger system for removing Entonox from the ambient air in the new Guys and St Thomas’ “Home from Home” Unit in London last year. They even had outlets for the system beside the bath!

I think that this study, and its results on the use of drugs in combination with water, is an example of the wimpish attitude of British women and midwives towards labour and dealing with pain. I see it as another manifestation of the “nanny state” that is such a feature of people’s expectations here. Women have such low expectations of their abilities in this country that they insist that they have as much help as possible in labour and whilst water is a useful tool for easing pain, they don’t consider it enough. It also reflects a widely held view that “Entonox is harmless” to the baby (although clearly a risk to the staff, hence the need to actively remove it from the labour room!).

I get so frustrated that midwives here are unwilling to encourage women to labour without any external props. If the midwives don’t think women can handle labour pain without “a little something” then women will never believe it of themselves. The result is that women get their drugs and never discover the powerful insights and strengths they could gain from labouring using just their own resources, and midwives fail to experience the true nature of midwifery.

People overseas see Britain as a bastion of midwifery practice. I wonder if it really is..... perhaps they still have a lot to learn about women’s abilities and inner strengths when it comes to birth. They are certainly busy devaluing the concept of Birth Centres that has been accepted in other countries.

Meanwhile, today I am travelling to Jersey for another Active Birth workshop,. I have been given strict instructions by the organisers that I am not to mention waterbirth or homebirth during the program. We shall see about that!

Posted by andrea at 09:39 PM | Comments (3)

Language (again)!

Back in the UK office today for a quick catch up before heading off to Jersey for an Active Birth workshop tomorrow. I really enjoyed the Leicester program and will be back there in October for another group, which is already about half full from the waiting list!

Once again language was a bit issue for these midwives. Its not just recognising that “confinement” and “trial of labour” are very un-woman friendly, there are the subtleties of how information is phrased and the non-verbal cues that are part of the communication. Even when I flag the obvious “delivery” for excision, it is impossible for them to take it out of their conversation. Changing habits is such a hard task, yet if we are to move to appropriate, individualised care that is precisely what we need to do - shake off the old routines and develop and awareness of our personal behaviours and how they are meeting our client’s needs..

I’ve written about this in the past and one of these articles on language is now on the web site. See what you think of my suggestions - could you change the way you communicate with women so that you are promoting woman rather than midwife centred care?

Posted by andrea at 12:33 AM | Comments (3)

Second guessing birth outcomes

It is Leicester today and another Active Birth workshop. Once again I am meeting midwives from a variety of maternity services, but most are either from the Leicester General Hospital or the Leicester Royal Infirmary.

At the General they are planning to open a Birth Centre and the at the Royal moves are afoot to re-establish the midwifery led programs that had were recently disbanded. This unit, with its various teams (the famous BUMPS team was a named centre of excellence in the “Changing Childbirth” report of 1991) had been a model for other units around the country and had achieved some enviable outcomes.

I well remember presenting a series of workshops for all its midwives (facilitated by Denis Walsh) many years ago now. The outcome of the workshop was audited, and they were able to increase their rate of women giving birth in upright positions from 18% to 43% in 12 months, once most of the midwives had attended the workshop. I was very pleased to have this kind of feedback on my work and chuffed that they were so keen to put it into practice.

Sadly, administration decided that due to shortages of staff all these teams would be disbanded and the whole unit revert to more traditional care. Now, the midwives are once again setting up more woman friendly options. Pregnant women will be graded as being low, medium or high risk and then cared for by a dedicated team assigned to each group. Whilst this is a step in the right direction, the need to categorise women at the outset with a risk factor is a shame, because it will lock women into a designated mode of care with little option for swapping. How can anyone foresee how a labour will develop, or whether a particular risk will become a reality? Women wanting a vaginal birth after previous caesarean, for example should really be seen by the midwifery team, but I suspect they will be banished to the high risk team and will therefore be more likely to end up with another caesarean.

I am against classifying or labelling women during pregnancy. I much prefer the approach of “wait and see” especially for place of birth. This is the big challenge for those trying to normalise birth: avoiding the making of assumptions about women’s abilities around labour and birth. As soon as we label a woman we set her up for a self fulfilling prophecy. No one will be surprised that a woman described as “high risk” has a complicated birth or a caesarean. What will be most unexpected is if she defies the outcome pre-determined for her and gives birth without trouble. I suspect that her only hope of this outcome is to avoid the whole system entirely and chose a home birth.

I hope that the midwives in Leicester are able to get their midwifery unit operating as well. I suspect that the need to second guess a woman’s birth prospects in advance will work well for those who are deemed to be of low risk, but will mean a lack of choice for those who don’t meet the rigid guidelines the midwifery service will be required to work under. This is a sad indictment of a health service that espouses “informed choice”. It will be the caregivers that get the choice and the women who will have to live with it - again.

Posted by andrea at 05:47 AM | Comments (2)

Taking stock as a childbirth educator

This weekend I am in Doncaster in the midlands area of the England. It is a Teaching Skills workshop, with an interesting mix of National Childbirth Trust educators and midwives who work in the NHS. This kind of variety amongst the participants is always very stimulating for everyone and really adds to the enjoyment and usefulness of the program.

Working in this field can have its frustrations. There is never enough time for our programs, for a start, and the idea that parents can be fully prepared for birth and parenting in perhaps 12 hours is patently ridiculous. Yet, that’s what we try to do.... and it can be stressful. I’ve written several articles on these issues, and made some suggestions about how it can be handled.

Evaluation is very important to obtain feedback on what you are doing and shape changes and improvements. There is also a need to take care of yourself as an educator, to avoid burnout and unnecessary stress. I always recommend that we reassess our work on an annual basis to keep the program fresh and provide new challenges to prevent boredom. We also need to keep an eye on the bigger picture of the maternity services as well, as we plan appropriate programs that reflect the changes going on in service provision.

I hope that you find these articles useful.

Posted by andrea at 06:46 AM | Comments (2)

Are pethidine and heroin in labour setting our children up for drug addiction?

When I am working in Scotland, the issue of pethidine and diamorphine for labouring women invariably comes up - mostly because I always work it into the program somewhere. It is a thorny issue and one that inevitably causes hackles to rise and some anguish forgroup members.

We talk about the link between exposure to opiate drugs during birth and the increased of the baby becoming addicted to opiates later in life and also the parallel research showing similar results for babies exposed to nitrous oxide and a later addiction to amphetamines. Use of these drugs is very common in Scottish hospitals and diamorphine (heroin) is particularly favoured. When I talk about the work of Jacobsen in Sweden and the research that has been done to date, there are always one or two in the group who try to dispute its quality and dismiss its findings. Whilst we certainly need more research, we cannot overlook the findings so far, even if it is just to acknowledge that drugs given to babies during birth will have an impact on the newborn and perhaps their later health and well being. I have written about this research and the information that parents need elsewhere.

Much money is being spent in Scotland to try and improve the breastfeeding rates, which are very low. Until they do something to reduce the opiates given to labouring women it will be very difficult (perhaps impossible) to have much impact on facilitating the establishment of breastfeeding. The links between early breastfeeding (the first hour) and long term milk supply, obstetric drugs and depressed newborn responses and labour medications and neonatal jaundice are well documented. We must see that pregnancy, labour, birth and breastfeeding are all part of a continuum, with each phase linking to and dependent on, the other stages of the process.

Midwives must put their own personal feelings aside when it comes to labour medications. Yes, it can be threatening to discover that the way one handled labour may have put the baby at unintended risk of later consequences. No mother willingly risks her baby and can only work with the information, knowledge and skills that she has at the time. We certainly know more now about the effects of obstetric medication that we did in the past and would probably make different decisions if we were faced with similar situations in labour today. What we may have done ourselves in the past certainly colours the way we perceive similar situations that others are facing - perhaps this is a very good reason to embrace what we now know about labour drugs and ensure that other women are not placing themselves and their babies at unnecessary risk (as we were forced to do because of general ignorance).

Posted by andrea at 09:43 PM | Comments (2)

Paisley (Glasgow) midwifery

I am in Glasgow for an Active Birth workshop. Lots of midwifery happening in Scotland, that’s for sure! Even so, the first midwife I spoke to referred to a “home confinement” she had attended, so that was a problem - language is central to woman centred care as far as I am concerned.

Home birth is still not common in Scotland - cultural beliefs are hard to overcome. Water births are becoming more popular and the new maternity unit to be built here in Paisley will have a pool and baths for women to use in labour. They are all up to speed on water birth practice event though the new unit won’t be open for a while yet.

It’s been a fun day - these midwives know what they want to do and are keen to get on with it. I’ll report some more when we finish up tomorrow.

Posted by andrea at 04:58 AM | Comments (2)

Are midwives a dying breed?

My musings over the past few days about the loss of midwifery skills in Ireland reflect a feeling that has been growing in me for some time. It seems that skills are slipping in lots of places as the march towards medicalisation of birth gathers speed, and it may be that soon, only the Birth Centres, midwifery-led units and independent practitioners will be keeping the profession true to its roots.

It is a very sad view, and being a very positive person, is one I hope will prove unfounded. However, I do fear that unless midwives take a good hard look at their individual practice, they will reach a point where reclaiming skills and re-dev eloping trust in normal birth is difficult. Some may feel it is not worth the effort. Even if the whole system is non woman and midwife-friendly, there is still much an individual midwife can do to humanise birth for each woman in her care. All that takes is willingness and sensitivity.

I wrote an article on this theme for The Practising Midwife (a British midwifery journal) over 12 months ago, and we have no added it to our web site. Have a read and let me know what you think..... where do you see midwifery heading?

Posted by andrea at 08:17 PM | Comments (2)

Reflections onthe Irish midwifery scene

Today I am back in the UK, and reflecting on my recent experiences in the Republic of Ireland. It is important to recognise that the Irish Republic is a very different country from Northern Ireland, even though they are so close togther and have many things in common (starting with that lovely Irish lilt in their speech!).

The contrast between the two Irelands is very noticeable in the field f midwifery, for example. Thirty years ago, I suspect that midwives in both countries worked in much the same ways, but the advent of O’Driscoll and his “active management of labour” protocol changed all that in the 70's. Midwives became subservient to obstetricians, who dictated exactly how labour would proceed and ensured that everyone fell into line with their thinking. Midwifery lost its status as a separate profession as well, and became a branch of nursing. An email list has now been set up to enable midwives to network as a group more effectively, but there is still no separate no College of Midwifery to provide a focal point for midwives.

I was astounded to learn that in the Republic, midwives are still using sterile drapes, swabbing down perineums (“must have a sterile field for birth”), performing routine V.E.’s every 2 hours and of course, rupturing membranes on admission. These things were accepted without question and I was surprised that there was general ignorance of the literature, research, education and standards of practice elsewhere. Some of the experienced midwives in the group knew of other ways of working, but seemed to have succumbed to applying these kinds of outdated practices to labouring women rather than risking challenging their appropriateness.

Irish women it seems, on the whole, are used to being told what to do and rarely step outside the boundaries established by their male-dominated society. They are hesitant and inhibited, and seem very compliant and malleable. I am sure they are not all like this, but it is as if feminism has passed Ireland by, in many respects.

It was therefore refreshing (and useful), to have midwives from Northern Ireland participating in the group I have just concluded. The Craigavon Maternity Unit in Northern Ireland is a model for midwifery led units everywhere, and if the rest of the group doubted what I was suggesting, the midwives from this unit quickly confirmed that these were ideas well known and practised in the North.

I love Ireland and the Irish people, but it some ways going there is like stepping back into a time warp. I feel sure they will catch up, and I hope rapidly, because there is a whole new world of midwifery awaiting women and their caregivers that I know they will find enormously rewarding.

Posted by andrea at 12:24 AM | Comments (3)

Midwifery led care in Ireland

There are some hopeful developments in Ireland in the battle to de-medicalise birth in this otherwise very civilised country. In the north east, some smaller district maternity units were closed about 2 years ago, without any notice and women are now required to travel up to 30 miles to the main hospital in Drogheda. There was an outcry from midwives and women, but the call came too late. Staff too were also relocated into Our Lady of Lourdes and found themselves working in a very obstetric service, which was a complete contrast to the smaller, low tech GP units they were used to.

Now, at last, a midwifery-led unit is to be established in Drogheda. It will be a six bed unit, physically located between antenatal and postnatal wards (which is causing some consternation) and will provide the first real alternative to obstetric care for women in this area. Whilst management has supported its development, there is concern that the reduced number of private beds (necessary to make the required space), and the resultant drop in income, will put financial strain on the maternity budget. The midwives are aware of this potential threat (even before they open!) so the whole project will be evaluated by a PhD student who will be involved from the start, to monitor all outcomes, including costs and savings. The evidence from similar units in other countries has demonstrated that midwifery care is at best cost saving or worse, cost neutral, but in this case it may be necessary to pay particular attention to the less tangible financial benefits to be gained through better breastfeeding rates, fewer later hospital admissions, reduced infection rates, reduced costs for epidurals and other medications etc. This evaluation will provide a rounded financial picture.

The first women will be booked into the new unit in June, and births will be occurring from September onwards. There is still much to be done to prepare the area physically and it may be a race against time to be ready. The inclusion/exclusion criteria are still being finalised as well.

There are some very experienced midwives now working in Drogheda, refugees from the smaller units that were closed. Their frustrations at the current services and their limited role is palpable, and many are hanging out until the new unit opens. They will be an important part in its success as a system of mentorship and preceptorship will be needed to support the younger, less experienced midwives as they learn to assist births without the routine trappings of “active management” that they have come to accept without question. I hope their dreams of once again working as midwives, rather than obstetric nurses, come to fruition. Irish women certainly need their eyes opened as well, and midwives can take a leading role in humanising birth here.

Posted by andrea at 05:44 PM | Comments (2)

Drogheda, Ireland

Yesterday was one of those “travelling days” as I made my way from Cork in south western Ireland up to Drogheda in the east, just south of the Northern Ireland border. I have been to Drogheda before, on the most recent occasion last year to present a “Teaching Skills” workshop.

This time we will be exploring “Active Birth”. I have heard that there are some changes underway at Our Lady of Lourdes Hospital ( the big hospital for this district) so I am keen to find out whether plans for more midwifery care have been realised.

More in the next Diary entry!

Posted by andrea at 06:31 PM | Comments (2)

Government funded home births in Ireland

The workshop in Cork has finished. It was quite a challenge because maternity services in Ireland are still very medicalised and midwives are still very involved with the active management approach. Midwives working in hospital settings have little experience of normal birth so many of the ideas we explored were quite new.

Some autonomy is being gradually acquired, but much of it is far from satisfactory. I was told that midwives could now choose when to rupture the membranes for example (the assumption being that they will always be ruptured not being challenged) and it appears that the fear of litigation has been so drummed into them that no-one would dare to circumvent the protocols, even of the woman insists she wants something different.

The obstetricians are all-powerful in Ireland and it seems their resultant rigidity and unwillingness to embrace evidence based care is the same old story. “It’s a cultural thing” was said several times during this workshop, and I would certainly agree. Change will come eventually when women and midwives stand up for each other and demand something better for mothers and babies.

One highlight of Cork is the government funded home birth scheme that has just finished as a pilot project and is being evaluated. The approval rating from the women is very high, as you would expect, and the midwives involved, several of whom I have now met, are doing magnificent work. In Dublin, the community midwifery program that the Government funded at Holles Street (the home of active management) has been disbanded, because it was overwhelmingly approved by the women. It seems they have been punished for their success by the powers that be (probably the doctors) and rather than extend what has proven to be a successful and popular service to a wider community, it has been deemed easier to “dumb down” the maternity services again. I hope the Cork project doesn’t suffer the same fate.

On to Drogheda tomorrow, for another Active Birth workshop. I wonder what has happened there since my last visit?

Posted by andrea at 07:06 AM | Comments (2)

Investigating the Irish maternity scene

Today I am travelling to Cork, in Ireland. Many years ago I presented some Active Birth workshops there, sponsored by the Irish Childbirth Trust. At that time there were a number of forward thinking people in the area and the maternity services were more flexible and less dogmatic than in Dublin (the home of the Active Management Protocol). There were a few home births taking place and the spirited support group that was the ICT at that time kept issues under the spotlight.

This time, I am being sponsored by the Area Health Board, so it will be interesting to hear what is happening now. Midwifery led care has finally arrived in Ireland, and given that Cork is a centre for the artistic and alternative lifestylers, I would expect these services to be popular in the area. More about them tomorrow!

Posted by andrea at 12:30 AM | Comments (2)

Breastfeeding in Parliament

I’ve been off the air for a few days while I have been travelling, first to Bangkok and then on to London. There’s also been some problems with email access which I have now sorted out as well - I feel completely lost these days when cut off from my email!

Over the past week there has been quite a lot of comment on the ozmidwifery list about Kirsty Marshall and her attempts to breastfeed her 11 day old baby during her first Question Time session in the Victorian Parliament, to which she has just been elected. She was asked to leave because “no strangers” are allowed in the House during Question Time, and there is also a “no eating or drinking” policy in place as well. The media when wild with this story, and the Speaker of the House ( a woman) said that Standing Orders were being revised, no doubt to ensure that they are not discriminatory.

I am amused to see a report that Breastfeeding is not allowed in the House of Commons in the UK (report from an NCT Newsletter). The Chamber, the Committees and the Public Gallery are all off limits to the breastfed baby. A challenge to this ruling has resulted in better facilities being provided for women else where in the building, but they are not budging on their ruling. It seems that while anti-discrimination laws that protect breastfeeding in public may be in place for the community generally, can be readily overlooked by those who make the laws themselves!

Posted by andrea at 10:51 PM | Comments (2)