Articles by Month: July 2003

Maggie Banks and New Zealand midwifery

There can be few doubts that midwifery as practised in New Zealand, offers the best options in the world for the care for pregnant women and midwifery practitioners. They seem to have grasped the whole philosophy of normal birth with a broad stroke of the brush and backed it up with the necessary structural services and underpinning legislation. Working as a midwife in New Zealand would b a goal of many of the midwives I meet in my travels!

A few years ago, we invited Maggie Banks to participate in one of our Future Birth tours. She was a sensational speaker, gently encouraging us to trust and believe whilst showing how breech births could be managed safely using midwifery principles. Her book Breech Birth, Woman Wise is easily the best practical manual on vaginal breech birth around, and a copy should be in every midwife's possession in readiness for the day when an undiagnosed breech birth presents itself.

We have again invited Maggie to participate in one of our programs - this time a series of workshops that will be scheduled around Australia. More about this exciting program later - it promises to be a very practical, hands on event, led by experienced midwives who want to share their know-how for the betterment of midwifery and birth for women. There will be details on our web site in the next few weeks.

Meanwhile, you may like to check out some of Maggie Banks’ work - her website has some interesting articles and her new “Intensives” will be of interest to many. They will provide a good alternative to the ALSO Courses that are very medicalised in their approach and philosophy. Maybe going to one of these courses with Maggie will provide the excuse you need to visit Kiwiland!

Posted by andrea at 09:44 AM | Comments (1)

Interview for a new book

I’ve been talking to day to Susan Ross, a midwife and childbirth educator whom I have known for about 20 years. She’s worked in several hospitals, mainly as an educator, but is now working independently.

Her current project is a book she is writing, titled “Doing it Your Way”. It is intended for expectant parents and she has been interviewing key people in the birth field and parents who are all contributing their thoughts on what it is like to give birth to a baby in today’s world. She had come to interview me for the book and to explore some of the issues that are impacting on the birth scene today, as well as my own personal involvement over the past 30 years.

Talking to Susan was easy - we have many shared experiences and have seen many changes over these past years. It was interesting, for example, to discuss the current demands for epidurals and caesareans. There is no doubt that women today are older, smarter and more life-experienced than ever before and that we live in a world where technology is kind and education is highly prized. What is fascinating is the way labour pain has been “sold” as a problem that can be solved by technology (machines and drugs) and the way women have embraced this approach without question. For an educated bunch, they seem to ask few questions. We threw lots of thoughts around about the role of obstetricians in driving these demands and the various vested interests involved and considered what might eventually drive changes back towards normal, unmedicated birth (but we didn’t find the definitive answer to this one!).

We also chewed over the problem of doulas and their impact on women, midwifery and the health care system. I am still very unhappy about the concepts that underpin many of the doula services that are springing up and the motivations that are driving people to take on the role of a doula. I can see how they are popular with women who are looking to buy services: a cleaner for the house, a doula for the birth and a nanny for the baby. Where will it all end?

Posted by andrea at 05:10 PM | Comments (2)

Finding the information on moxibustion for turning breech babies

Back at the desk today after my short holiday - and hundreds of emails to catch up with, including several new postings to my entry on moxibustion to turn breech babies. This is obviously a topic that is of vital interest to a specific group of pregnant women and it is clear that detailed information is needed about how to turn the baby into a more favourable position.

In the Diary entry I wrote before, is clearly states that more info is available on our web site and gives a direct link to the page in question. It seems that people don’t understand how to do this simple task, so I will again give you the link: all you need to do is point your browser (the little arrow) on the part underlined and it will take you to the page you are looking for. Click HERE for info on moxibustion to turn breech babies. Please feel free to print these pages off and circulate wide and far - it may help many women to avoid the almost obligatory caesarean births they are now under duress to accept.

Posted by andrea at 03:56 PM | Comments (1)

Taking a break

A quick note to you all to today, to say that I am taking a break for a week - a much needed holiday. I am looking forward to spending some time in the beautiful forests of the north coast of New South Wales, in an area where there are abundant national parks, wildlife, birds, bushwalks, beaches and complete peace and quiet.

A few days contemplating nature will be just the ticket right now, and I know I will be back with renewed energy and a head full of ideas.......

Posted by andrea at 09:28 AM | Comments (1)

Education about birth in high schools

One of the best ways we could change attitudes to birth in our community would be to improve the information about pregnancy and birth in the high school curriculums. It is a strategy that is often mentioned in my workshops, and here and there I here about midwives who have accepted invitations to speak to high school students about birth and breastfeeding.

Core of Life is a magnificent project that was started in 1999 by two midwives at Rosebud Hospital in rural Victoria. The program takes 1 ½ hours, and involves the children in an interactive, multimedia, “hands on” session that covers the topics of pregnancy, birth, breastfeeding and parenting. It aims to enable these young people to make informed choices about these issues and to take responsibility fort heir own health and well-being.

From a humble start, it has now spread to many regions of Victoria. A facilitator training package has been developed and funding has been received to enable further expansion. The evaluations o f the program and the feedback received from participants, parents and teachers have all been overwhelmingly positive, and considerable changes in knowledge and attitudes have been noted. For example, 94% of males and 89% of females completing a post-evaluation questionnaire stated that they would like their children to be breastfed in the future.

This is a wonderful program, and a great example of midwifery in action, this time as part of community education. As major suppliers of educational materials fore these programs we salute the initiative demonstrated by these dedicated midwifery leaders and look forward to continued support of their efforts in the future.

Please check out their website by clicking on their name above. Could you extends this program to the students in your area?

Posted by andrea at 05:45 PM | Comments (1)

Helping out the media

Today I have spent some hours reviewing an article on Pain Relief for labour that is intended for a Pregnancy edition of Cosmopolitan in October. I was pleased to have been asked to check this before it went to print because it had a number of inaccuracies and some vital information had been omitted.

I asked the journalist where she had obtained her material and she said that it has mostly come from the Internet. This would have accounted for some of the errors - drugs not used in Australia, procedures no longer carried out here and details that were not relevant.

I avoided getting on one of my many soapboxes (there were several that would have been appropriate!) and just tried to correct mistakes and clarify various points. I did add a whole thread on keeping mobile and upright and I did change the “Breathing and Relaxation” to plain “Relaxation” with the emphasis on support and environment. Endorphins were mentioned several times by the time I finished too.

It took me several hours (all unpaid, of course) and it will be interesting to see what they do with it. I don’t think the journalist has given birth herself. If she had, I suspect she would have been a lot more positive about the various drugs that were on the list (particularly epidurals) as so often happens with these kinds of stories. I sometimes think that media articles on birth should be written by men - at least they don’t carry so much personal baggage that can get in the way of the truth. Anyway, let’s see what Cosmo manage to tell women in their October issue.

Posted by andrea at 06:05 PM | Comments (1)

Interesting book titles

One advantages of working in this office is that you get to see the new book releases before anyone else. We are constantly working with publishers and authors regarding new titles and a steady stream of books arrive for review and consideration almost every day.

We choose the books and products for our range with some care. Any textbook on midwifery will be automatically included, as will most texts on breastfeeding. Books for the Essential Parent section of our list will require careful scrutiny, because we try to provide sensible, practical, baby friendly titles, just as we look for woman friendly titles for pregnancy and birth. Some books for parents have such wacky ideas that they fail to measure up to our standards (the current fad for “controlled crying” is one notable example) and these are rejected.

Two books caught my eye today, “Fresh Milk” and “Midwives of the Black Soil Plains”. Apart from the very attractive cover, Fresh Milk takes a quirky look at all the “other” aspects of breastfeeding, apart from the purely mechanical and physiological. It is very unusual in its approach and highly entertaining. There is plenty of material here that will resonate with women who have breastfed their babies and a lot you won’t find anywhere else.

In “Midwives of the Black Soil Plains”, the stories of the pioneer midwives are retold, complete with photographs, maps, extracts from public and private records and many anecdotes. The situations in which these midwives found themselves are truly amazing, and their inventiveness, resourcefulness and determination (not to mention skill) could make working as a midwife today seem simple, by comparison. However, although some aspects may have changed for the better, conditions for midwifery are still poor, but in different ways. In bygone days, the midwife worked by herself and did what she could in often trying and even dangerous conditions. Today, many midwives would love to work by themselves, without the meddling medical strictures that so-called “progress” has forced upon them. Conditions may be less hazardous in some ways (travelling by horseback through fire and flood for example) but more so in others: the heavy threats of litigation, for example. In the early days, women were grateful for anything the midwives could do to help and were not expecting everything to be “perfect”. How things have changed today - women seem to want the midwife to do everything and threaten action if expectations are not met.

People often yearn for “the good old days” when life seemed simpler and people friendlier and less stressed. Yet life today offers so much more for woman than ever before, if we can just stand the strain of having to deal with all our options!

Posted by andrea at 04:45 PM | Comments (1)

Ageism and birth

A had a call today from a pregnant woman who was looking for an independent midwife. She was initially thinking of a midwife who could attend her in a Birth Centre and when I mentioned home birth, she was surprised. She had been told that at age 34 she would never be considered for a home birth as she was "too old"!

This "ageist" stuff is really silly. When I was giving birth to my children, I was considered to be a bit on the "old side" as I was in my mid 20s. Anyone over the age of 30 had "elderly primigravida" written on the top of their notes and was treated as a walking time bomb.

Now that women are choosing careers ahead of babies and the average age of first births has risen to 30 years (which means that more than half of all women are having their first child will be older than this), these arbitrary definitions have had to be re-written. "Elderly" now refers to anyone over the age of 35, or even 40

It is all meaningless, of course. General health is a much better indicator for a good birth outcome and many women in their 30s and 40s are in very fit condition ( not like many of the rest of us!). It won't stop people (often doctors) from trying to scare women about potential problems because of their "age" however, and the barrage of tests and technology they will be subjected to will not necessarily enhance their confidence.

I was pleased to be able to at least put one woman's mind at rest today. She was certainly interested in a home birth but had almost ruled it out - I hope she takes the common sense approach and leaves the final decision about birth place until the labour is underway. Given the right midwifery support, she can safely leave her options open right until the last minute.

Posted by andrea at 04:19 PM | Comments (1)

Dr Barbara Vernon appointed to top positon at ACMI

I have just heard that Dr Barbara Vernon has been appointed as the Executive Officer of the Australian College of Midwives (ACMI). This is a landmark appointment and one that will send a strong message that ACMI is serious about the partnership between midwives and women and the importance of having a voice in national affairs.

Barb Vernon has been President of the Maternity Alliance in Australia for the past few years. She has a background as a statistician for the Commonwealth Public Service and a strong history of organisation and lobbying. Having had home births, she discovered the magic and importance of birth and became a passionate and effective spokesperson for the maternity reform movement. The National Maternity Action Plan was co-ordinated and co-authored by her and, having undertaken this thorough review of the status of birthing services in this country, she is well placed to understand the national health care system and its relevance to maternity care.

What a coup for ACMI! Barbara was to return to her work for the Government, but was very unwilling to put aside her work for midwifery, women and health care. Her appointment to this prestigious position will give her a chance to further extend her considerable skills at the same time as giving the ACMI a very effective lobbyist and champion organiser. No doubt there will be some eyebrows raised at the appointment of the first non-midwife to this position and it is to the credit of the Executive that they have taken this bold step to signal their commitment to working "with women".

Congratulations to Barbara and to the ACMI on this exciting new approach, and best wishes for productive and successful years ahead.

Posted by andrea at 04:54 PM | Comments (2)

Things that turn up in the post

We sometimes have a good giggle at the items that come through our book sales subsidiary, ACE Graphics. We have a very useful teaching kit for pre and post natal educators called The Contraceptive Kit, which contains samples of a whole range of contraceptive devices plus reference materials. It has proven very popular.

Recently, a customer contacted us to say that their kit was missing its "banana penis" when it arrived. We immediately offered to obtain the missing part and today it duly arrived. I wondered what on earth I was unpacking, as I helped out with the post this morning!

We have now sent of one "banana penis" to our client. Fortunately we didn't have to declare the package contents on a customs slip as this was going locally, not overseas. Not sure how customs people in some countries would regard such an item......

Wonder what will turn up next? http://www.birthinternational.com/product/cbe/cbe004.html

Posted by andrea at 02:15 PM | Comments (1)

"Minifisms"

This wonderful term was first brought to my attention by my colleague Lynne Staff. She had come across it in a book entitled "Behind the Screens - Nursing, Somology and the Problem of the Body" (Churchill Livingstone, 1991). Lawler offers this defininition:

"Minifisms can be verbal and/or behavioural techniques which assist in the management of potentially problematic situations by minimising the size, significance, or severity of an event involving a patient. They are also methods of bringing a situation under control..." p 166

I was reminded of this useful term when I was talking to a colleague who described a class she had attended facilitated by a midwife. Parents were told that an episiotomy is "just a little cut - nothing to worry about" and that "if you need a little bit of help, then forceps or a vacuum may be used". I wonder what impression these deliberate minifisms created in these vulnerable women's minds?

I have heard midwives say to women "you've had a bit of a bleed", "just going to have a little feel", "you've made a bit of a mess", "just have to give you a bit of help with these contractions" during labour. The idea is to try an reassure the woman about a problem that is causing concern, or to spare her a perceived embarrassment. This result might be achieved or the opposite could occur, where false hope is created, a serious situation is misunderstood, or an alarming outcome is covered up.

If the baby is in trouble, the situation changes, and instead of using minifism, a "maxifism" (not sure of this term, so my creation this time) may be employed to get the woman's compliance. The initial comment "Just a bit of a dip in the baby's heart rate" might be followed by "we have to get this baby out right now" or "we have to do ... now - you don't want to jeopardise your baby, do you?" What was seen as a "bit of a problem" becomes a major crisis in the next minute.

What's wrong with good plain English and straight up honesty in our dealings, in particular with labouring women? It is hard to be the bearer of bad news but women have the right to know what is happening and might welcome some straight talking, especially if there is a genuine problem. Given the desire to be "helpful" "caring" and "woman-friendly", we seem to have developed a whole second language of (almost) baby-talk, platitudes and minifisms that coat our messages in a layer of obfuscation that may hinder rather than help.

We have to learn better communication if we are to be effective with our messages, especially in educational settings with expectant parents. They need to know the truth and we have an obligation to give it to them.

Posted by andrea at 05:14 PM | Comments (1)

"Informed consent" and "informed choice"

I've written before about the way that prenatal classes are often used (sometimes unwittingly) to set women up for routine procedures carried out by hospital staff during labour. This is one area where educators need to have a very clear concept of their role and the impact/potential of their work if they are to be effective, especially in ensuring that women make informed choices about the care they receive.

It is important to be clear about the difference between "informed choice" and "informed consent". "Informed choice" suggests that various options are under consideration and a decision will be made about which one to adopt in a given situation. "Informed consent" means being asked, having been given the pros and cons, if a specific action or option is acceptable.

In maternity care, choosing a birth place would be an example of "informed choice" where expectant parents canvass the various hospital and home birth service available and decide where they wish to have their baby. An example of "informed consent" would occur when a midwife, having explained the advantages and disadvantages of the procedure, asks a labouring woman if she consents to her membranes being ruptured.

These are important distinctions to get across in classes to parents. Obtaining consent does not mean making sure that parents are told what is going to happen to them. It does not mean explaining a procedure and then asking if it is now alright to go ahead with it.

I believe that both "informed choice" and "informed consent" are myths in our present maternity care system. Parents are rarely aware of all the choices available (and sometimes inconvenient options are deliberately withheld), making informed choice impossible. In addition, requests for permission to proceed with a treatment or intervention are often couched in friendly terms or dressed up with a smile in such a way that refusal is made difficult. Sometimes these requests will be made of women under extreme duress or in situations where rational thinking is impossible ( established labour, for example), making a mockery of the whole concept of informed consent and leaving caregivers in a vulnerable legal position.

Childbirth educators have a vital role in reducing the amount of coercion going on in our maternity hospitals. They are the people who can take the necessary time to explain options and explore alternatives, have the necessary information at their fingertips and make sure that parents understand the information being presented.

Demonstrating a clear understanding the difference and importance of these terms is a vital first step in offering quality prenatal education and should be a prerequisite for all those presenting education programs for parents. Without this, educators could easily be accused of colluding with the establishment to maintain the current coercive practices that many women encounter when they give birth to their babies.

Posted by andrea at 04:52 PM | Comments (1)

The paper trail

We had another phone call from someone who is compiling a record of her achievements in midwifery and wanted a copy of the attendance certificate from a program of ours that she had attended - "one of Andrea's workshops". She didn't know what year, or where, or what the topic was, just that she'd been to one of our programs!

Just as well we have a company policy here of "never throw anything out"! We do keep good records of the attendances at all the many workshops we have presented over the years, which must be close to 1,000 by now, given that we started in 1984. Each year I do around 50 two-day events and then there are the many tours that usually involve a whole string of one-day seminars.

Right now we are having a spring clean, even though it is the depths of winter, because we will be moving in a few weeks (more on this later). We are going to have a cull and anything that is more than 7 years old is going out. Of course, the students enrolled in our Graduate Diploma in Childbirth Education will have their records archived for 30 years (a requirement for Registered Training Organisations) and we will keep the attendance lists for all our workshops, but a lot of other accumulated paperwork will see the inside of the re-cycling bin or our new, larger, paper shredder. Quite a lot of the artwork we have will go onto CD ROMs for storage - very simple and very safe, once we get the scanning done.

I like the idea of starting afresh, but don't relish the hours it will take to review the insides of all the filing cabinets so I can make the necessary decisions!

Posted by andrea at 05:07 PM | Comments (1)

Birth International Agencies

The half-yearly Birth International catalogue is about to be released - another great effort by our dedicated team. It has the usual range of new products and details of the new edition of Preparing for Birth: Mothers. There is also a mammoth stocktake sale with some products up to 80% off - now that's a bargain!

We've also included the details of our agents in other countries as some customers may prefer to order direct from them so they can get prices in local currencies, rather than having to convert to either Sterling or Australian dollars. These agents are:

New Zealand

Birds and Bees,
PO Box 34 406, Birkenhead, Auckland
Phone: 09 480 1451
info@babyshop.co.nz
www.babyshop.co.nz

Canada

Canadian Childbirth Teaching Aids
11716 267 Street, Maple Ridge, BC V2W
Phone: 604 462 0457
ccta@childbirthedu.com
www.childbirthedu.com

South Africa

Baby Talk Consulting
PO Box 15047, Lambton, South Africa 1414
Phone: 011 827 4810
babytalk@mweb.co.za
www.babytalk.co.za

USA

Perinatal Education Associates
98 East Franklin Street, Suite B, Centerville, OH 45459
Phone: 937 312 0544
info@birthsource.com
www.birthsource.com

Posted by andrea at 04:16 PM | Comments (1)

What anaesthetists (don't) want women to know

One of my colleagues contacted me again today regarding the battle she is having with the anaesthetists in her area and the information they (don't) want women to have regarding epidurals. I have written before about this issue (December 12, 2002) and these guys are still being difficult.

They had banned my book "Preparing for Birth: Mothers" because they didn't like some of my information. I took note of their concerns when preparing the new edition, which is out now and I have sent a copy of it to my colleague so she can show them what it now says. In this updated and expanded edition I have included a new anatomically correct (rather than schematic) diagram of the spinal cord that shows exactly where the various anaesthetic injections are inserted. I have also included information on how to obtain the references I have used to compile the details (all available on our website), and have made some small alterations in the text to clarify some of the points about spinal anaesthetics, which were not very clear before. I will be interested to see what they have to say!

Also new are sections on ideas for labour where the baby is in a posterior position, using water for labour and birth, suggestions for staying upright when technology needs to be used and a new diagram of the "cascade of intervention". Many of the illustrations are new too. It is now 60 pages and has additional space for the writing of personal notes - useful for class use.

This is easily the most popular handout for prenatal education programs in Australia and the only one that offers information in depth that is accurate and evidence based. It is hard to see why anyone would object to its being used as a class resource, but it seems that some doctors are feeling sufficiently threatened by its contents to take the dramatic step of having it banned. It must be really good!

Posted by andrea at 04:57 PM | Comments (1)

Are poor birth outcomes linked to falling birth rates?

From time to time, the Australian Government spouts platitudes about putting "families first" and encouraging women to have babies. There is concern that the birth rate is falling and this has many negative effects on a country's economy and big implications for the community as a whole.

I've been thinking about possible links between the way birth is managed and its impact on women, and wondering if these form part of the story. In Australia the birth rate is about 1.7 children per family and it is about the same in the UK. Ireland and Italy are lower and Spain is 1.2. The average age of women in western countries having their first baby is now 30 years, which means that half of first time mothers are over this age.

Given that research has shown that when birth is traumatic for a woman, she waits for an average of four years before having another child, this fact, in combination with the high average age of first time mothers, may be significant. For example, if a woman was to have her first baby at age 32 years and the birth was traumatic ( a strong chance given that better educated "career" women are more likely to choose obstetric care, with its well documented risks) she may need four or more years to recover to the point where she will consider another pregnancy. A woman's fertility is falling as she ages, so that may then impact on her ability to conceive in her late 30s. If this does take time, she may then decide to give up and leave her family at one child.

Women who have good births are often keen to have more children. This may be anecdotal evidence, I know, but seems logical to me. Perhaps if research could be undertaken that explores the links between poor birth outcomes, delayed conception, reduced fertility and resultant smaller families, we might have strong evidence from a different to convince Governments that ways must be found to reduce birth interventions. Every little bit helps to promote midwifery.....

Posted by andrea at 03:23 PM | Comments (1)

Lessons learned in Europe on this trip

Today I start my trek home, after 5 weeks of touring around the UK and Spain. It has been an interesting trip, taking in England, Scotland and Wales and the program included the “Essential Midwifery” Program with Lynne Staff and the usual mix of Active Birth and Teaching Skills workshops. As I prepare to leave, I am thinking about what I have learned from this visit:

• Scotland has more midwives than it needs and some can’t get jobs, while in England there is an acute shortage.

• Wales is forging ahead with midwifery targets and initiatives that will give midwives there a higher profile and better working conditions. Their new Clinical Pathway tool will reduce the paperwork involved in caring for a labouring woman and hopefully enable births to be classified as “normal” more often.

• Many of the larger teaching hospitals in England have abandoned the CTG trace on admission but have instituted 15 minute FHR readings throughout first stage instead. This seems a sure way to disrupt normal labours and create more work for midwives and potential anxieties for labouring women.

• Midwives in Spain happily work 24 hour shifts, as they have always done, while midwives in the UK are being told they cannot work a minute past 12 hours maximum because of European Union Working Time directives. Both countries are members of the EU.

• Spain has the lowest birthrate in Europe (1.2 births per woman) and some of the most antiquated maternity care practices. It is a staunchly Catholic country.

• There is a need for midwives in England to gain skills in team building if they are going to be successful in creating the many birth centres (born again midwifery-led units) they need to create genuine options. Bullying is rife and counterproductive behaviours abound in midwifery circles.

• The National Childbirth Trust is still stuck in its very middle-class attitudes, and while it does an excellent job with parents in this demographic, their teachers and leaders have no idea what it is really like at the coal-face for the majority of educators in the UK, who work within the NHS. The NCT have little chance of expanding further into the community without better leadership and closer working relationships with midwives and parents on a broader scale.

• Prenatal education programs are being cut back within the NHS in many areas and there are still hospitals in the UK that have no programs for expectant parents at all.

There is much more to think about and I will expand on further thoughts in future Diary entries. It will be a couple of days before my next entry - the trip home will take 24 hours of travel time. Back to you soon after!

Posted by andrea at 05:38 PM | Comments (2)

The Acuario Birth Centre

Acuario is a very special place. It was set up by an obstetrician as a natural birth centre with the help of an English midwife, Rachel MacLeod, who had been living in Spain for some years. Initially it functioned in an unusual birth house, where families could come and live at the end of the pregnancy, give birth to the baby, then remain for a few days before returning home. When the demand for this service outstripped the accommodation, a small maternity unit was set up, with two birth rooms and a postnatal area. Today, it has expanded further still and now has an operating theatre and small intensive care unit and it now also operates as a small general surgical unit.

Each birth room is cosy and well equipped - they both have a large pool, and a specially built corner bed platform that is triangular. This does not look at all like a bed and has throw cushions and a large square fabric covered foam block that can be positioned for support anywhere the woman wants to be. It does have two holes for stirrups, hidden under the edge of the mattress, should a ventouse become necessary, but this is rarely used. In addition, there is a birth ball, birth stool, a rope ladder from which woman can hang, and the usual dim lights, music and homelike decor.

There are now four obstetricians who use Acuario. Since the operating theatre was added, the clientele and possible birth options has expanded, (they can now do caesareans, for example) but the emphasis is still on natural physiologic birth as a primary aim. The buildings are located in a quiet village about an hour south of Valencia, towards Alicante and the grounds have gardens and a row of ancient pine trees, which add a special ambience.

Several languages are spoken amongst the staff, and this has encouraged women from other countries to go to Acuario for the birth of their babies. Some may have travelled many hundreds of kilometres from Madrid or even Barcelona to give birth, and they will stay nearby in the village until the time comes for the birth. Prenatal classes are available for everyone who uses the centre and each month a long weekend program is offered for those from out of town.

The midwives work a 24 hour shift when they are on duty at the centre. This enables continuity of care and makes it practical for those who live some distance away to join the team. Rachel lives an hour away, and apart from her weekly shift sat the centre, she also offers home births in Valencia, runs prenatal programs for parents and does the occasional shift at her local hospital. Her caseload is usually four to five home births each month in addition to her work at Acuario.

The philosophy and dedication of the staff who work in this unique centre is impressive. In common with similar units in other countries, they have attracted people who share common goals and attitudes and who feel strongly about the normality of birth and its importance for mothers and babies. I really enjoyed the relaxed attitude and friendliness of the people and am looking forward to coming back again in October for the next workshop.

Posted by andrea at 01:27 AM | Comments (8)