Articles by Month: January 2004

Nigerian workshop registration?

Lots of people who use email will have now received one of those priceless “Nigerian scam” proposals, usually offering huge amounts of money in return for just helping some poor “down on his luck” millionaire to access money in a foreign bank account. They offer a moment of light relief in the day and make entertaining reading before they are assigned to the Trash.

Today I received our first workshop registration from a Nigerian. It seems unlikely that someone would trek half way across the world to attend a program on Water Labour, Water Birth, even if it will be a valuable skills based program for midwives wanting to encourage the use of warm water in labour as a way of making birth easier. It would be a long haul journey for the one day, although they could have had the pick of venues: Sydney or Melbourne.

Reluctantly, this registration was Trashed. It would have been interesting to find out about birth in Nigeria and to discover if they have ever used water as a medium for labour. Sadly, we will never know......

Posted by andrea at 01:30 PM | Comments (0)

Other uses for Pinard stethoscopes

Just after I arrived at work this morning I had a phone call from California from a man wanting to buy a Pinard Stethoscope. He told me that he was a movie actor and that he was involved in programs for the History Channel. He had recently been working on a western, and was required by the script to check that a man who had been hanged was really dead. A Pinard stethoscope had been produced to perform this task!

Since he sometimes provided his own props, he felt it would be worthwhile buying his own Pinard for future use. He said that the small Pinard we stocked ( a lovely dark coloured wooden model) was exactly the same as the one he had used for the movie.

We’ll be shipping his Pinard off today and he will have it in 4 - 5 days. We certainly receive some interesting calls around here!

Posted by andrea at 08:50 AM | Comments (0)

Feeling pessimistic

I’ve just finished another contribution for the Midirs Midwifery Digest - that wonderful resource that no midwife should be without. The Digest comes out four times each year and I have been sending a “Letter from OZ” for some time. I usually try to sum up the happenings in Australia for the wider world audience that forms the Midirs readership and it seems that I am always writing about the various struggles that midwives are engaged in as we try to reform midwifery services in this country.

Today’s effort was rather pessimistic, which is a bit out of character for me. The number of closures of smaller maternity units and birth centres across the country is alarming and many of us are feeling depressed and anxious at this turn of events. Lots of factors are driving this trend:

and so on......

I still believe that the economics of midwifery versus obstetrics will be the telling point, once the politicians begin to believe the evidence and stand up to the strong medical lobby groups. For too long now, the doctors have run our maternity services to suit themselves - financially, geographically, politically. Many of my midwife friends are becoming weary of the battle, which never seems to end, even though we occasionally win a skirmish or two.

Perhaps what we need are a few well publicised medical disasters, tragedies due to epidurals or unnecessary caesareans, or scares related to drugs. These kinds of headlines are the ones that grab attention and force change. The NSW State Government is under pressure to establish a Royal Commission to investigate the sad state of our health system - if this was to happen there would be a safe haven for whistleblowers to tell their stories of bungles and mismanagement. Perhaps it’s what we need to highlight the appalling mess that over- servicing by obstetricians is wreaking on women and babies.......

Posted by andrea at 02:03 PM | Comments (1)

The best and worst of Sydney maternity hospitals

The publication released each year by NSW Health, The New South Wales Mothers and Babies Report, always provides fascinating reading. Using standardised data collected by midwives for every birth in the State for the calendar years, the Report gives the birth outcomes for a multitude of variables. Births are analysed by location, parity, country of origin of the Mother, Region, type (caesarean, forceps, normal etc), drugs used, age of mother, pregnancy complication and a whole host of other variables. The babies’ outcomes are analysed by gestation, birth weight and perinatal outcomes.

There is a lot to digest and we are lucky that our State Department of Health puts this information in the public domain. The data is collated for all maternity units but only those with over 200 births per year are included in the tables. All the rest are collectively reported as “Other hospitals”under each regional heading. I am always keen to check out the hospitals individually and to see how they are doing.

Here are the best and worst of maternity hospitals in Sydney from the recently released report for 2002:

Best: Auburn District Hospital

Worst: Kareena Private Hospital (Caringbah)

round the teaching hospitals in Sydney, the normal birth rate varies quite a lot, so gaining confidence and experience with normal births will depending on where you are trained.

The rates for use of drugs for pain in labour vary enormously. The lowest use of drugs for labour pain was Queanbeyan (near Canberra) where 34.6% of women needed no drugs for pain, and in the city, Auburn again did well, with 21.3% of women labouring drug free. You can guess which was the worst hospital - at Kareena Private, only 1.4% of women did not receive any drugs for labour pain!

It really pays to shop around. The main distinguishing characteristic of Kareena Private Hospital is that it is run by obstetricians for women with private health insurance. Auburn has a high percentage of women who were not born in Australia and it is located in a less affluent area of the city. Being poorer and not speaking the language too well can be an advantage when it comes to getting the best birth, it seems.

Posted by andrea at 01:15 PM | Comments (2)

I will be “off the air for the next few days whilst my laptop gets an upgrade, so before I sign off until next Tuesday, I wanted to share another holiday discovery with you.

Being involved in the only accredited training course (in the world) for childbirth educators - the Graduate Diploma in Childbirth Education - you can imagine that I am right on top of competency based training. When I was on holiday in Cambodia recently, I went to visit the training facility where young men gain skills in the crafts of stone carving, wood carving, enamelling etc that are traditional in Cambodia. It was a lovely facility, situated in well tended gardens in a quiet corner of Siem Riep, the nearest town to Ankor Wat.

I was very surprised to find a large chart on the wall outlining the various levels of competency to be achieved, the modules of the courses and the basic educational principles of their program. Even in this struggling, developing country they have set up a system of competency based training! I tried to photograph these charts as best I could and here they are:

It would be a major breakthrough if the various hospitals in this country accepted the need for competency based training for the educators that facilitate their prenatal classes. At present, anyone can lead programs for expectant parents, often without any formal training at all, This is a situation that would not be acceptable in any other educational setting, yet it is deemed that expectant parents do not merit a qualified educator for these vital programs.

For those of you who are serious about the work you do as an educator, you should look to obtaining a recognised post-graduate qualification. It will not only enable you to work effectively, but graduates have received pay increases and obtained better jobs as a result of having this educational qualification.

We have students from a number of different countries as it is a distance learning package. The main workshop (mandatory) will be held in Sydney, and if enough students apply from the UK/Europe, in London as well, both at the end of 2004. The web site contains a wealth of information about the Course, feedback from students, FAQs and all the application details, but you will need to hurry - applications for this year’s intake of students closes on January 31st.

Posted by andrea at 10:17 AM | Comments (0)

Spam havoc

My Diary entries have been hit by a major spammer - I estimate that there are about 250 spam comments on many of the entries - mostly for a casino website.

I apologise to my readers. Steps are being taken to stop (or at least, significantly slow) this antisocial behaviour and I hope to have a blocking mechanism in place very soon.

Meanwhile, deleting each message is a laborious process as they have to done individually. I'll do my best, but it will take time. While I am doing this, please ignore many of the comments - you'll know what I mean when you see them.

Posted by andrea at 09:19 AM | Comments (0)

Let's try not to give up hope....

This last weekend spent in Wollongong was very enlightening. The local Area Health Service operates Wollongong Hospital and Shellharbour Hospital as a single entity spread over the two campuses ( Shellharbour is about 25 minutes drive from Wollongong). It has operated a very obstetrically dominated maternity service for many years, especially after the Birth Centre at Bulli (about 30 minutes away) and smaller units at Kiama and Port Kembla were closed to consolidate obstetric care in one centre. The Birth Centre at Wollongong was also closed not long ago as part of the “renovation” of the hospital.

Shellharbour maternity unit has been under a cloud for some time. It has always had a midwifery model of care valued by the local community, but around a year ago, the obstetricians announced that they would no longer travel to Shellharbour and the Region’s Administrators announced the maternity service would therefore have to close down.

An opportunity was seen for the establishment of a midwifery unit, along the lines recommended in the NMAP Report. Representations were made to the relevant authorities and the State Government indicated that this would be a pilot region for the new models of midwifery care. The midwives were very excited about the prospect and began planning. Then the obstetricians reared their ugly heads again and announced they would not provide any backup for the new unit and the local Regional boffins bowed to the pressure and said the Shellharbour unit would operate as a midwifery unit but only offering pre and post natal care - the women would have to give birth in Wollongong itself.

Having fought long and hard the local midwives are feeling very demoralised. Nine left Wollongong at Christmas with three more to leave soon - they cannot tolerate the high levels of obstetric intervention and the lack of alternatives for women and midwives any longer. This is a huge blow to those who are left and places more pressures on them. The hospital is seeking to fill the vacancies created by hiring enrolled nurses - a recipe for lowered standards of care and higher potential for “incidents” around patient safety.

This morning I logged onto the ozmidwifery list and read that other smaller units around Australia are also being closed - every State is seeking to centralise maternity services in larger and larger hospitals - partly because of the lack of staff, and partly because the obstetricians won’t work in smaller hospitals where they might not be able to see a range of clients (to make their work more interesting and lucrative). The disappointment and depression amongst midwives in Australia is almost palpable, and it is hard for even me to keep a positive outlook.

Just when I was feeling a bit low, I had a call from my good friend Lynne Staff at Selangor Private Hospital in Nambour, Queensland. In a state not known for its progressive ideas, this maternity service stands like a beacon in a sea of mediocrity. Their outcomes are the best in the country and their dedication to woman centred care is exemplary. They don’t just talk about it - they practice it every day.

Lynne told me that yesterday they had another vaginal breech birth and today they’ve assisted at a vaginal twin birth. These are norms for their unit but are almost unheard of elsewhere. This good news has cheered me - as I said to Lynne it may be that in the future midwives will need to travel to Selangor to get some practical experience of these basic midwifery skills....

Meanwhile, Lynne and a colleague who also does some shifts as Selangor, Vicki Chan, are scheduled to speak at the Midwifery Intensives program that will be touring Australia in May. I can’t help feeling that this event is very timely and that we will need to keep them coming so that midwives have a chance to maintain their confidence and competence at managing normal births. It is all very well to talk about “keeping birth normal” but midwives need to know the practicalities of making this work. This program should help.

Meanwhile, I’ll try not to give up hope of every seeing midwifery models of care rolled out around the country.......

Posted by andrea at 03:04 PM | Comments (0)

The end of the week

This has been a very busy first week back after the holidays. We have finalised the new catalogue that will be published and mailed in about 2 weeks and completed the last details of the workshops we will be offering in the next six months.

This year brings two important anniversaries: it is 20 years since we began our independent consultancy in Australia and 10 years since we launched our UK company. The catalogue will contain some interesting archival photographs that plot our progress and success over these years, which have slipped by very quickly.

There are a number of interesting reports awaiting attention on my desk and one of these is the NSW Mothers and Babies Report for 2002, which contains all the data collected about birth outcomes in this State. It is always fascinating reading, and I will include some snippets in my Diary entries over the next few days.

This weekend I am presenting the first workshop of the New Year for midwives in the Illawarra Area Health Service, about an hour’s drive south of Sydney. One of their smaller regional maternity units at Shellharbour has been under threat again - its been opened and closed more times than you would think possible. I know there have been moves to establish it as a midwifery only unit so it will be good to meet with some of their staff this weekend and to find out what is happening at the present time.

Posted by andrea at 03:10 PM | Comments (0)

When I was in Thailand on holidays over Christmas, I was given the first copy of the Thai edition of my book “Preparing for Birth: Mothers”. This has been an ongoing project over a number of years, and became a team effort as two midwives and an obstetrician worked to create a Thai version. The format has been altered slightly to make it suitable for sale through bookshops but otherwise, it is the same, with the illustrations etc as in the earlier English edition.

I was very surprised to be in a small supermarket complex in Chiang Mai and to discover stock of it on the shelves in the small bookshop. Enquiries revealed that it is selling very well - very heartening for the Childbirth and Breastfeeding Foundation of Thailand who will benefit from the profits generated from sales.

I will be going back to Bangkok at the end of February for the official launch and we hope to generate a lot of publicity so that Thai women learn of this book’s existence. There is certainly nothing like it there at present!

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

Birth in 11th Century Cambodia

Today I am going to try something new - I am going to give you a picture!

During my recent holiday I was fortunate to spend time in Cambodia, exploring the ruins of Ankor Wat and Ankor Thom (amongst a number of other temples). Both were quite amazing, for their size, vision, inspiration and beauty and the surrounding area, near Siem Reap in the north of the country is still delightfully rural (although that is about to change fast as the multitude of big tourist hotels under construction start to fill up with visitors.

I was particularly looking forward to locating the birth scenes carved into the stone as part of the temple walls that surround the Bayon Temple inside Ankor Thom. I has been alerted to their existence some years ago by an Australian midwife who was working in the area on an aid project.

The Bayon Temple is about 900 metres square, surrounded by a roofed gallery. One side of this gallery is open to the outside and the other wall is decorated with beautifully preserved intricate stone carvings, that run along the entire length of the complex. They are divided into three sections - the main middle section depicts either battles that have been fought or religious stories with a Buddhist flavour. The bottom section contains scenes of everyday life of the people of the time (11th Century).

Amongst the scenes of eating, hunting, farming, buying and selling, family life etc there is this tableau showing birth:

The father is on the left, heading out of the house with his mate, to hunt with bow and arrow. Inside the house, the women gather around the labouring woman who is in an upright supported squatting position. The midwife is attending to her needs. It all looks very straightforward.

Home birth is obviously the norm!

(Love this new picture facility!)

Posted by andrea at 12:57 PM | Comments (0)

Feedback for VETAB

The Certificate that verifies our status as a Registered Training Organisation arrived today. It has been nine months since we formally applied for re-registration. There was a delay of 6 months before the Vocational Education and Training Accreditation Board (VETAB) even began assessing our application but once it was handed to the independent auditor, everything went smoothly.

The audit that she undertook showed we were performing well and the only major sticking point was the obtaining of professional indemnity insurance for our trainers. This we have now achieved - even though we felt it was an unnecessary impost. It has meant an increase in fees for our students however, which is a shame.

Now that we have achieved both re-registration and re-accreditation (what a year that was!!) we decided to write to VETAB and offer them some feedback about the process we had to undergo. Given that we had to go through a number of hoops we felt they would benefit from some constructive feedback about their performance, especially given that the requirements for re-accreditation of all courses are being beefed up at the present time. I hope they will take some of our suggestions on board and I look forward to receiving a response from them.

Posted by andrea at 03:49 PM | Comments (0)

The Ten Steps of the Mother Baby Friendly Childbirth Initiative

This will be my first Diary entry for the year. For the last three weeks I have been enjoying a holiday in Thailand and Cambodia, and although I wasn’t at all focussed on work, there were a number of times that childbirth and related issues popped up.

In Thailand I had the opportunity to catch up with the other members of the Board of the Childbirth and Breastfeeding Foundation of Thailand at a party to celebrate the year’s achievements (more about this later). The Foundation has begun to be recognised in other South East Asian countries and is leading the movement for the reform of outdated birth practices and in the promotion of breastfeeding.

Using the Better Birth Initiative developed by Justus Hofmeyr in South Africa as a starting point, the Foundation has produced a workbook and program to encourage the adoption of evidence based practices in maternity care. Groups of midwives and doctors, having participated in practical sessions and discussions, fill out the workbook, answering basic questions that reinforce their new skills and provide evidence of their learning. It is an innovative approach that would have broad application in many settings.

Word is already spreading - the Foundation has facilitated programs in several centres in Vietnam and this week are presenting a program in Laos. The Laotian sponsors also wanted a statement they could use as a basis for initiating reform, so putting our heads together last week in Bangkok, the following statement was formulated:

The Mother and Baby Friendly Childbirth Initiative

The health of mothers and babies is of fundamental importance to well-being of the family, the community and society. The ability of a country and its health services to provide optimal care for pregnancy and birth demonstrates their commitment in this area, which can have a profound effect on future health of a population, economic stability and social cohesion of its society.

Given that