Articles by Month: February 2004

Book launch in Bangkok

The Thai edition of “Preparing for Birth” was launched yesterday at a press conference arranged by the Childbirth and Breastfeeding Foundation of Thailand. There were a small group of journalists present and they were very keen to explore the concepts of natural birth and what was happening in Thailand as well as Australia. Most press conferences that I have been involved with last only a short time, but these people kept us talking for 3 hours! I was rather exhausted by the end, as I was jet lagged and it was way past my biological bed time by the time we finished.

None of the journalists had given birth themselves and they were very interested to learn more about it. At one point we showed them a video (one of the Dutch videos) so they would be able to see what we were describing. Two of the young women literally peeped between their fingers, scared they would see a lot of blood. The staff at the hotel we were using were all lined out outside the room watching in avid fascination!

We were asked how this kind of birth could become more available in Thailand and what would be needed. It was very tempting to say “get rid of the obstetricians!” because here all births are conducted by doctors as there are only obstetric nurses and no midwives. Up to now, the main thrust of the Foundation’s work has been aimed at convincing the doctors and nurses to try new approaches and there have been some success (although only in a few places). The use of water for labour and birth has been so successful in the birth centre at the Samitivej Hospital in Bangkok that their rates for caesareans, forceps, epidurals and pethidine have dropped dramatically. Those women able to afford private health care and who choose this progressive unit have a very good chance of a normal, uncomplicated birth.

For the vast majority of women who use the public system, the picture is not so good. Women labour alone, in communal labour rooms and give birth in lithotomy strirrups, having had a shave and enema before the inevitable episiotomy. Caesarean rates are high, and women frequently request elective surgery so their baby can be born on an auspicious day, such as the King’s Birthday, or an important date on the Chinese calendar. Bringing change to this system will be very difficult, for without midwives to catch the babies, the system must use doctors, who are keen to maintain things as they are - they know no other way of delivering babies.

The availability of “Preparing for Birth” in Thai is the first step in making information about alternatives available to women. It is being sold in bookshops across the country and early indications are that sales are brisk.

I feel sure that once women start to learn of other options they will want more ideas and support. We’ve been discussing how the Foundation might set up prenatal classes to facilitate further educational opportunities for women. It will mean training leaders and devising a program that can be rolled out in major centres. Fortunately there are several graduates of our Graduate Diploma in Childbirth Education in Thailand, and these women can form the core trainers for the new educators.

One stumbling block will be that these new educators are most unlikely to have ever seen or experienced a natural birth, so ways will have to be found to expose them to this approach so they can confidently explain the options to the women in their classes. One way to achieve this might be to adopt the “follow through” system that the Australian B Mid students use to gain their experience. For these educators, it might mean teaming up with pregnant women and following them through their pregnancy care, birth and postnatal weeks. Observing natural births will be the problem, but if a way can be found for educators to team with women using the Samitivej Hospital’s birth centre, they would very likely witness natural births, including many in water. If Thai women know of other ways of giving birth it will encourage the doctors to experiment and provide them with better learning opportunities as well. It’s a plan......

Posted by andrea at 07:14 PM | Comments (0)

Setting off again

Packing up today ahead of my next trip to the UK. On the way I will have two days in Bangkok where the Thai version of my booklet “Preparing for Birth: Mothers” is being launched, along with the new Birth Room at the Samitivej Hospital.

Then it will be London to begin one of my treks around the countryside: Leeds, Hexham (near Newcastle on Tyne) and Dumfries (Scotland, south of Glaasgow) in the first week. Then it will be over to Ireland, for a program in Drogheda (my fourth visit) and a workshop for the Irish Childbirth Trust in Dublin. After that comes Norfolk, a workshop in London and then the final round: Manchester, Birmingham and Bristol (Phew!). I will be back in Sydney on April 1st.

I will be facilitating a mix of Active Birth and Teaching Skills workshops, which are always in demand. There will also be a few days in our UK office to plan future events with our UK Manager, Fran Gallwey.

As I travel about, I’ll keep you updated with observations on the midwifery and birth scene in the UK. The MIDIRS Digest and The Practising Midwife journal are helpful in staying abreast of maternity issues but there is nothing like hearing what is going on from those directly involved, and these workshops are a great opportunity for sharing stories and reporting on developments.

But first, to the book launch tomorrow, in the very different birthing climate of South East Asia

Posted by andrea at 10:08 AM | Comments (1)

Curriculum Advisory Committee gives the thumbs up

Last night we had a meeting of our Curriculum Advisory Committee for the Graduate Diploma in Childbirth Education. It is a select bunch, each member representing one of the stakeholder groups involved in prenatal education: Hospital Administration, Co-ordinators of Parenting Programs for hospitals, the Australian College of Midwives Inc, the National Association of Childbirth Educators (NACE) , the student body and last (but by no means least), Maternity Coalition - representing the users of maternity services.

We had a very productive meeting, reporting on the current standing of the Course, reviewing the Handbooks and Study Program and generally discussing the role this Course plays in the childbirth scene in Australia. A number of suggestions were made regarding improvements to the Study Program and Handbook - it is always very helpful to have others with working knowledge of the scene cast and eye over these materials.

The need for nationally accepted Competencies for Childbirth Educators was also discussed. Next time our Course is accredited (in five years) we will be required to relate our Course to stated Competencies, which at this time, don’t exist in this country. Given the complexity, cost and time that will be required to establish these and have them approved, I feel that Birth International will have to undertake the work involved, at least initially. The first steps will be a consultative process with stakeholders and discovering the process set down by the Vocational Educational Training Accreditation Board (VETAB) for the approval of Competency Standards. I am told it is a very bureaucratic and expensive process, so I can’t wait to get started (!!). It will probably take years, so we will have to begin soon.....

Once Competency Standards are in place it will be easier for other providers, and ourselves, to develop short courses and training programs that are clearly related to specific Competencies. There will also be incentives for educators to undertake training as modules will assessable and count towards other accredited courses they may undertake. For hospitals, who are increasingly demanding higher educational standards for their staff and proven qualifications for their own accreditation, it will be easier for them to set standards for their prenatal programs.

The meeting ended on a high note with the group congratulating us on the high standard of this Course. Naturally we are always wanting to do better, but it was clear from their feedback that what we are offering now is way ahead of anything else available in Australia (and I suspect, the rest of the world). It is good to know this.

Posted by andrea at 03:36 PM | Comments (1)

How to have a "blissful" birth

The proven way to ensure that you have the best chance of a normal, natural birth is to find a good midwife for your pregnancy and birth care. The evidence, reported in The Cochrane Library of Randomised Controlled Trials, shows overwhelmingly that it is the attitude, practises and philosophy of the primary caregiver that will shape the final outcome for mother and baby, on the day of the birth. It is not (sadly) the mother who dictates what happens during those hours, but the responsible health professional who will make the decisions that influence the final outcome.

The main difference between midwifery and obstetric care is that midwifery works from the assumption that birth is a normal event for women. It has many variations according to the mother’s responses, needs and bodily reactions and it generally goes well, if left alone. The obstetric model, based on a medical philosophy, views birth as a potential disaster that requires careful surveillance and well timed intervention. Midwifery is reactive (when there is a problem, then act) whereas obstetrics is proactive (in case there is a problem, let’s act now).

When women labour well, discovering their own inner strengths and using their own instinctive responses, there will almost always be a supportive midwife in the background. She may not be doing much, just acknowledging that the woman is doing well, occasionally listening to the baby, keeping a low profile and making sure that disturbances are kept at bay. In these circumstances, women release the necessary hormones for a straightforward labour: high levels of oxytocin for strong, effective contractions and high levels of endorphins to ease the labour pain, help her stay focussed and remain calm.

A woman does not need to study, to learn breathing techniques, practice relaxation strategies, exercise religiously or pay for tuition to achieve a good birth outcome. She does need to find a good midwife, one who trusts women to discover their own ways of giving birth and who is comfortable with the process. This midwife will not need to offer rescue through various means such as drugs or special relaxation techniques: she will make sure that appropriate measures for improving comfort, such as abundant warm water, heat packs, soft cushions, suitable chairs or other furniture are handy during labour, should the mother want to use them. This midwife will not lead (“I think you should ....”, “I would advise that...”, “If I was you I would...”, “in my experience...”) but may offer ideas, drawn from her experience (“some women find that...”, “how would you feel about trying...”, “have you considered...”) that enable the woman to stay at the centre of the event.

Finding such a midwife is not easy. Most will be working in the community, offering home birth services or as part of a community based team that can provide care in the hospital or at home, depending on the woman’s needs. Some will be working in hospitals, most often in Birth Centres but also in labour wards. Hospital based services often place limitations on how a midwife can work, which can be frustrating for woman as well as the midwives themselves, and learning how to “get around the protocols” is an important skill for women to learn during the pregnancy.

Every time you hear, or read, of a woman who has had a “blissful” birth, check who was the lead caregiver - it will most likely have been a midwife. Obstetricians rarely, if ever, feature in such accounts.

Pregnant women often need the full nine months to mentally prepare for becoming a mother. These days, the full nine months might also be needed to find appropriate care so that birth is the joyous and fulfilling event that nature intended. Instead of wasting time on learning how to “breathe” (a ridiculous concept - women already know how to perform this basic function!) or to “relax”, spend time in seeking out a decent midwife - the results are far more predictable, and the evidence will support your choice.

Posted by andrea at 02:28 PM | Comments (2)

Endorphins - Nature's solution for labour pain

In all the comments about “painless labour” that have been flooding in to my Diary recently (see comments posted to any of the entries on “Hypnobirthing” for example), it has been notable that the role that natural endorphins play in easing the pain has not been mentioned. The “hypnobirthers” describe blissful states where they are “in tune” with what is happening but not feeling any pain. This state is being attributed to the birthing method when in fact, it is the body’s own endorphins that create this effect.

It is this ability of the body to produce its own pain killers that the Dutch women rely on (see my previous entry) and they discover this for themselves as labour progresses. Anyone in a relaxed state, where adrenalin is low, will produce endorphins in labour. In fact, endorphins can be found in a pregnant woman’s system from about 12 weeks of pregnancy, gradually increasing as the months go by until they are at quite high levels in the last weeks before the birth. Women notice their effects, even before the labour starts: they feel less energetic (after the last rush of getting everything ready); their sleep patterns may be disturbed by periods of wakefulness and possibly wild, even frightening dreams; they spend more time “navel gazing”, becoming more inwardly focussed and self aware; and most commonly, they are forgetful and vague, which can be very annoying.

When labour starts, the endorphins are already present and as the uterus begins to work harder, they are stimulated to even higher levels. It is easy to see these higher levels as labour advances: she withdraws (eyes closed, head down, no talking); is less physically active (snuggles down into a supported, upright position); needs to concentrate (inwardly focussed, trance like state) and feels more positive ( “I can do this, I am doing this”).

These effects are the direct biological effect of this hormone that all human produce, including pregnant women. Once endorphins are in her system, a woman has the capacity to ride with the contractions as they build, managing them as she needs to (shifting position, automatically adjusting to her own needs) and once the birth is over, experiencing the natural euphoria and sense of achievement (and forgetting the worst parts) that they produce.

When I wrote that women had the innate capacity to birth without needing to use external “birth methods” or “training”, I was referring to her ability to produce endorphins that would get her through this experience. When women are disturbed, frightened, fearful, physically restrained (e.g. on a bed) or mentally active (remembering her breathing, consciously relaxing), her endorphin production will be compromised by the automatic release of adrenalin, designed to protect her from harm, threat (real or perceived) and distraction. Research by Niles Newton as far back as the 60s clearly demonstrated these biological links. Michel Odent has written extensively about them in more recent times.

Some women need help to find a relaxed and conducive environment for birth, where they feel safe and protected and where no disturbance will inhibit the flow of oxytocin and endorphins. Midwifery care, home birth, immersion in warm water and protective support from caring others can help create such a place. Some women may need more help to overcome their fearfulness and I guess this is where “hypnobirthing” or some of the other structured techniques come in.

Whatever “method” that women choose to use, their success in achieving a natural birth, without drugs or interventions will be the result of good endorphin and oxytocin production within their own bodies. To attribute success to the application of a method, sells themselves short, and a failing to appreciate the way that Nature has provided for women’s needs in labour.

When I have presented workshops to midwives and educators in the USA, I have been surprised by the blank looks I have received when we talked about endorphin production. Perhaps several generations of managed births with drips, drugs, monitors etc has so restricted opportunities for the observation of natural births and the way the hormones naturally work during the process that women have forgotten about, and no longer trust, basic birth biology. This is certainly the message I am getting from the many comments posted to my Diary entries over the past week or so.

Midwives in most other countries know exactly what I am talking about because they see women exhibiting endorphin-driven behaviours as part of their daily work. I think I will stick with Nature, and leave the “birth preparation methods” to those who must rely on them, for whatever reason, to get them through labour. It seems a sad reflection on birth today, that many women will place their faith in a learned behaviour rather than their own instincts and innate abilities. It is all about having faith in Nature and a trust in women......

Posted by andrea at 02:29 PM | Comments (3)

Embracing labour pain

I have been reflecting on the many comments about how women “didn’t need to have the pain” in labour that were sprinkled through the comments from the “hypnobirthers” (if you want to check out these comments, and have the time to read them all, see the entry for February 4 - “More Questions about Hypnobirthing”).

The attitudes expressed by many of these contributors seem so at odds with what we know about the nature of pain in labour and its purpose - a concept that is well understood in those countries where midwifery is the norm for all labouring women, such as Europe, the UK, New Zealand and Australia.

In September last year, Beatrijs Smulders was the Keynote Speaker at the Australian College of Midwives Conference in Darwin. She is a delightful midwife, a leader in The Netherlands and vastly experienced with birth in a country with some of the best birth outcomes in the world. A report of her presentation appeared in the Australian Midwifery News (Vol 3, No 4, November 2003) and some of her comments are very pertinent to the discussion about the attitudes we have towards labour pain. Let me quote:

“Midwives in The Netherlands take a “tough” approach when caring for birthing women and teach them to be autonomous, which empowers women. The attitude that ‘the midwife has left me to labour - I must be OK’ assists women to view and experience labour and birth as a normal, though challenging, and at times fearful, life event. Midwives encourage the woman to take control of her labour and pain and only call the midwife when she is in established labour.

Different attitudes to pain are part of the Dutch approach to birth. Pain is not attached to fear but rather to safety. ‘Strong pain keeps birth safe’. The need for pain relief, especially epidural, indicates a complication that requires hospital admission. The perception, attitude and expectation of pain is different. Pain does not equal fear, rather it is seen as a challenge.

’The birth menu (birth plan) does not exist’, she said. ‘The safest birth is the one with the least intervention. Women don’t want lots of information, they want to know “Am I alright and is my baby alright?”. Women don’t need to use their brain to labour well’.

Dutch midwives use a number of sayings to help a labouring woman accept the pain: ‘Yes pain hurts, but it doesn’t hurt you’, ‘Don’t feel sorry for yourself, don’t lose your temper. There is no rainbow without rain, and no baby without pain’. ‘The more pain the stronger the labour - welcome it’. Beatrijs also talked about the need to be realistic when talking to women about pain - it will be very hard at times and also very fearful at times. Birth is a very big experience which will include fearful moments and this is normal.”

There is no doubt that the Dutch know what labour is all about and they have strong women and great birth statistics to prove it. We can all learn much from them about how to keep birth normal and to truly empower women through accessing and using their own innate natural talents for giving birth. As the saying goes “There is no gain without the pain” and birth has to be one of the best examples of this old saying.

Posted by andrea at 01:54 PM | Comments (3)

"Hypnobirthers" have their say

Once again I am hoeing into the debate about “hypnobirthing”. A number of comments have been posted to my previous entry on this subject (they are an organised group, these hypnobirthers!) which have been welcome.

In reading through this passionate feedback, several facts stand out. First, all these comments have come from those who have used the technique (usually referred to in these comments as a “birthing method”) and found it useful. I have not received any feedback from those who have used it and found it didn’t work, so these comments represent a biassed sample of users.

It is abundantly clear that all of these women had a deep sense of trust and faith that they could give birth without drugs etc. They may have needed the input of the “hypnobirth trainer” to be convinced of this over several sessions prenatally, or they may have used this technique to reinforce a belief they already had but which was being stifled by messages they were receiving from health professionals, the media, friends, family etc. I think it can be very hard to retain a sense of belief in one’s own birth abilities in the current climate of fear being created by the medical professional, drug companies, equipment makers and other vested interests. If “hypnobirthing” has strengthened these women’s belief in themselves and their own capacity, then great - I have no argument with it at all.

However, it seems sad that they have had to go to such lengths to discover what they had within themselves all along. The majority of the world’s women would think that having to learn how to give birth using a method of any kind is crazy - they know that you just get on with when the time comes. The women contributing to this discussion are clearly well educated and articulate and leaning about giving birth may fit comfortably with their attitudes towards learning and education in general. I would just point out that if the survival of our species relied on women learning a technique or adopting prescribed behaviours during labour and birth, we humans would have died out long ago! Women have been managing perfectly well for millions of years, long before hypnobirthing or any other method was invented.

I am amused that many of the comments being made by the “hypnobirthers” could equally be trumpeted by the women who are choosing epidurals - there seems to be a need to justify a need for something to get through labour and birth.

Many of the comments that have been made are reminiscent of the claims and endorsements made for those other great “inventions” for achieving painless labour - psychoprophylaxis and Lamaze - that were made in the 70s. I well remember the passionate statements, the training that women underwent, the almost religious fervour that was reflected in the literature and the classes. No evidence (randomised controlled trials) have been produced to show that these approaches improve birth outcomes, reduce the need for pain killing drugs or that they are even safe. Elizabeth Noble in her pioneering work “Childbirth with Insight” (published in the early 80s and now out of print) pointed out that encouraging women to breathe in any pattern other than her natural rhythm had the potential to alter blood chemistry. Reading this comment was a powerful wake up call to me at that time and was the basis for dropping all forms of “teaching about the breathing” from our educators training course and classes in 1984. My discovery, at about the same time, from observations of women labouring in their own homes, that they didn’t use any “methods” and gave birth really well, was also an important revelation. These two factors formed my underpinning faith in women and that we had the capacity for safe and effective labour all along - we had just forgotten to trust our instincts.

I must also point out that, like the Lamaze business in the USA today, many of the proponents of the hypnobirthing technique have a vested interest too (I notice they have registered it as a trademark!). They need to attract willing clients and promote success stories for their own purposes. It is notable that psychoprophylaxis (the basis of the original Lamaze training) is a very American concept - its techniques were abandoned many years ago in most other countries, if they were every adopted in the first place. Could this new phenomenon be another manifestation of the American way of birth?

In the past 20 years, western cultures seem to have strayed even further from our instinctive natures. As a result pregnant women may well be finding it difficult to find someone or something to use as a foundation to explain/validate/justify their needs and desires for natural birth. Some will choose “hypnobirthing”, others will rely on TENS, some will choose aromatherapy, reflexology, yoga - whatever. If this helps, then wonderful - at least these “birth methods” will not alter blood chemistry, fill the unborn baby with drugs, or compromise their hormonal flow during labour and birth. There is no hard evidence that they work, and if they are effective, it is probably as a placebo. What I do find sad, is that those who choose these strategies place their faith in the method when their success was most likely doe to their own body’s capacity and their natural physiological and biological functions working well.

Please don’t sell yourself short as a woman - you have what it takes to give birth well and, just as millions of women have done before you down the years, you can be successful. Find those who will support your needs and choose a safe and comfortable birthplace. Find a supportive midwife at the hospital and use her to shield you from medical intervention whilst enabling you to give birth yourself. If you can’t find a midwife in the hospital (perhaps you live in the USA) then look outside the hospital system and choose appropriate alternatives. I believe that with a caring midwife and an appropriate environment, women will discover they don’t need props and “birth methods” - they will discover their own power and pleasure in birth all by themselves.

Meanwhile, I expect there will be more comment from readers on this issue and I look forward hearing from those who have tried “hypnobirthing” and found it lacking - some balance will make the claims for this technique more believable.

Posted by andrea at 10:30 AM | Comments (6)

Rural midwives inspire

My faith in midwifery has been restored these past two days - I have been working with midwives from the rural areas to the east of Adelaide, who have been attending an Active Birth workshop in Mt Barker. These women come from a variety of small hospitals and most of them perform dual roles as nurses and midwives within their hospitals. There are also some of the Bachelor of Midwifery students from Flinders in the group and students always liven up the group with their challenging, probing and energising inputs.

Mt Barker has an exceptional maternity unit, where they have many natural births (no drugs for pain) and where breech babies and twins can be born vaginally. They do well with VBAC too. Their success comes down to the vision of their leaders, such as Cate Goodall, and the willingness of their obstetrician to trust women (both those giving birth and those assisting them). He is from The Netherlands, which has no doubt shaped his views.

There is also an active support group in the Adelaide Hills for women who have had a caesarean birth and want to achieve a vaginal birth the next time. CARES SA is led by Jo Bainbridge and I will meet up with her for lunch today.

Community support groups are vital for midwives who want to improve or change birth services. They are able to make noise, create publicity, lobby and agitate very effectively and they have a lot of influence. Midwives are important allies, as they can feed the background facts and information to these groups, who can then organise to bring the necessary pressure to bear on decision makers.

I have been inspired by these midwives, who are able to juggle dual roles, yet maintain their midwifery focus. Away from the big city influences of large impersonal hospitals, the needs of doctors in training and the politics of large institutions, it is easier to develop a common philosophy and good communication in a team atmosphere. There is always room for improvement as they appreciate, yet it seems much more likely that it will occur in these rural units.

It would be wonderful if city midwives could spend time on a rural rotation to see how it can be done. It would help them to refocus on the important issues and to get back in touch with their midwifery roots, both much more difficult to maintain in city teaching hospitals, as I have noted over the past few weeks.

Posted by andrea at 08:19 AM | Comments (1)

Valuing pioneering research

Recently, I was challenged about the relevance of referring to 25 year old research to support statements I was making in the Active Birth workshop - the implication being that anything that old was irrelevant and should not be used. This is an interesting topic to explore further.

The specific research being questioned was the work of Roberto Caldeyro-Barcia, who studied the effects on the fetus of prolonged breath-holding and closed glottis pushing during the second stage of labour (the so-called “cheer squad” pushing routine). He showed that this practice was dangerous because it had the potential to reduce blood flow to the placenta and to reduce the oxygen concentration of the blood that was available to the baby (both effects compounded if the woman is lying flat on her back to give birth). This pioneering work, done by an obstetrician who was, at that time, the President of the International College of Obstetricians and Gynaecologists, received widespread reporting 25 years ago, the result of his publishing in several journals and speaking at a number of Conferences. Sadly, his message does not seem to have penetrated some practitioners approach to birth, and this over zealous management of second stage still goes on.

Is a study, done so long ago, still relevant? Yes, of course it is. There seems to be a view, often drummed into midwifery students, that the only research that is relevant are studies that are less than three years old. Books and journals that are older than this are not considered appropriate and are discounted and taken off reading lists. This approach overlooks the huge body of work that was done many years ago and that does not need to be repeated: we know that it works/doesn’t work and we don’t need more funds spent on replicating this research. The Cochrane Library has a list of treatments or management strategies that are already proven beyond doubt to be either advantageous or dangerous. Interestingly, the placing of time limits on second stage (often the excuse for the “cheer squad” in the first place) is considered dangerous.

Michel Odent has written about “circular epidemiology” - the practice where the same studies keep being done because they give good results or are easy to undertake, even though the outcome is already proven. He also talks about “cul-de-sac” epidemiological studies - those that end up not being pursued further because the results might be unwelcome to practitioners. We’ve all come across yet another study on a topic that has been well proven in the past (the value of support during labour, for example). Doing further research on topics like this is a waste of precious resources and should be discouraged.

If academics and some practitioners maintain their stance that relevant evidence must be less than three years old, it leads to the conclusion that the entire body of research evidence needs to be replicated on a regular cycle - clearly impractical and wasteful. Many wonderful pioneering studies could be overlooked (the work of Caldeyro-Barcia falls into this category) and important research that need to be done could be quietly avoided (such as the effects of exposure of the unborn baby to nitrous oxide during labour - a topic that has never been investigated).

Keeping up with the research is hard work. It requires constant reading, dedication and an open mind. As we embrace the important work being published now, we must not overlook the valuable lessons from the past. Just because a reference has an “old” date on it, doesn’t mean it is worthless - many of them are in fact, priceless.

Calderyo-Barcia R. The influence of maternal bearing-down efforts during second stage on fetal well-being. Birth and the Family Journal, Vol 6:1, Spring, 1979.

Posted by andrea at 10:48 AM | Comments (2)

Ultrasound exposure

The issue of ultrasound exposure for the unborn baby came up in conversation last week. The woman I was talking to was around 16 weeks pregnant and had just had her dating scan, which she showed me. She said this would be the only scan she would have, as she was concerned about unnecessary exposure of her baby to ultrasound. Some of her friends had undergone multiple scans during their pregnancies, often almost as a routine, and they didn’t seem to be aware of the potential risks to their baby of this invasive procedure.

I came across this useful document recently and thought is was an excellent idea. The evidence for safety of ultrasound to the unborn baby is still not conclusive, so until we know what levels are safe it would seem sensible to at least have a record of the baby’s exposure to ultrasound, for future reference. Ultrasound machines vary in their strength and must be well maintained. Different procedures will require differing levels of exposure, so some babies will accumulate greater exposure than others. Babies with specific problems or questionable development may have the most scans of all, which may contribute to their overall problems. We just don’t know enough yet to be certain. Download file

This document was produced by The Association for Improvements in the Maternity Services (AIMS) in the UK. It can be reproduced providing their name appears on it. It would make a good handout in prenatal clinics, prenatal classes and doctor’s waiting rooms. AIMS can be contacted by email : Chair@aims.org.uk and their web site is www.aims.org.uk

Posted by andrea at 12:46 PM | Comments (0)

Midwives with "attitude"

I’ve just completed the last of three Active Birth workshops organised by one of our metropolitan Area Health Services. .

The workshop was full - and many missed out. The group was made up of midwives who work in Birth Centres, team midwifery projects and the labour wards of three hospitals in the Area and 10 aspiring midwives who are due to start their education in a few weeks.

It was clear from the start that some of the midwives didn’t really want to be there. This happens from time to time and it is always a mystery to me why they come, unless they have been “sent” for the opportunity to reflect on their own practice. My approach to this is to ignore their antics - their behaviour is their choice. I must admit that I do get annoyed if their attitudes and reactions interfere with other people’s participation, and usually I will manage the group dynamics to deal with this.

The feedback on their evaluations was enlightening. It seemed they took exception to my qualifications for leading such a program (?) and remarked that as a non-midwife I would have to be “out of touch with what goes on in hospitals”. Having made this judgement, it enabled them to opt out of participating, and to miss several important explanations about the reasons for my specific, chosen style of presenting - I was role modelling how midwives might communicate with women, not trying to “talk down to them”.

Such blinkered views, arrogant and rude behaviour in a group of professional women who claim to be “woman centred”, open-minded and flexible, is worrying. They didn’t provide very positive role models frothe soon-to-be midwifery students either. It seems they gained very little, if anything, from the program, and it was a complete waste of their time. What a shame that they blocked places of a number of people who wanted to be there and that they missed the whole point of my presentation. They certainly stated that they didn’t gain anything they could use in their own practice. A sad comment, when something can be learned from every experience in life.

Posted by andrea at 07:41 AM | Comments (1)

More questions about hypnobirthing

Those of you who have read my previous entries on hypnobirthing will know that I am not a fan of this approach to childbirth preparation, because it encourages the woman into a deep meditative state that “removes” her from the birth process. I accept that many women have used it with success and that it may have a place for women who are phobic about labour pain, but I still question its evidence base and the psychological implications of it as a practice.

An independently practising midwife colleague was telling be about a birth she attended (at home) just before Christmas where the mother utilised hypnobirthing. She reached such a stage of disassociation from the labour pain that she was unaware that the baby was about to be born, and that it was coming breech. The midwife was called but was too far away to get there in time and the woman and her parents (who were supporting her) were left to deal with the unexpected breech birth, with tragic results - the baby died.

The midwife told me that she discussed this event with other independent practitioners and two of them had also been involved with births where hypnobirthing left the mothers completely unaware of what was happening in their bodies, especially the imminent arrival of the baby. If a woman is so out of touch with what it going on that she fails to recognise the signs of advancing labour there is a real risk that the midwife may not arrive in time. For some women this will just mean an unattended birth, but as birth always carries an element of unpredictability, having professional help at hand in case of need is a sensible and desirable precaution.

I understand that these three local independent midwives will be reviewing their advice to women who want to use hypnobirthing, so that they are called as soon as labour starts.

I think that one of the most useful aspects of an unmedicated labour is that a woman is able to stay much more closely in touch with her labour and can often tell the midwife what is happening during the birth. One of the main functions of labour pain is to give the woman (and midwife) a biofeedback mechanism that can often be diagnostic, especially when problems are developing. For example, a woman may be able to tell the midwife that she cannot feel any descent of the baby in second stage, or alternatively, that the baby is coming.

If hypnobirthing removes or diminishes this biofeedback mechanism this is a disadvantage that women need to be made aware of and midwives also need to recognise. These stories from my midwifery colleagues only reinforce my own doubts about the widsom of encouraging women to disengage from their labour and I will continue to be sceptical about the necessity (and now safety) of hypnobirthing.

Posted by andrea at 03:56 PM | Comments (13)

Updating educators at Flinders Medical Centre

As we talked about the rest of the program we canvassed some of the common problems faced by hospital-based programs, such as the one at Flinders. The main aim is often to tell parents what services the hospital offers and what their policies are on a number of birth related issues. This seems a very obvious aim, and is worthwhile, providing that it is not done is a way that could be seen as “coercive”. From a hospital’s point of view, having non-complaining, compliant clients is a worthy aim, but administrators (and educators) must also realise that unless they present all possible options, they may be leaving themselves vulnerable legally to the charge of not gaining full consent for the various procedures that they are undertaking. Parents may (rightly) object later, if they discovered that a hospital deliberately withheld information about other options they could have requested.

The midwifery educator I spoke to understood these issues, but was hampered in providing appropriate education for her staff by lack of funds and a lack of understanding by management of the importance of parent education.

Some of this could be overcome if the individual educators had better background knowledge themselves. I have often found that midwives didn’t, for example, know the effects of labour pain drugs on the unborn, and newborn, baby. If they don’t know these facts, they can hardly pass them on to parents so that informed decisions about epidurals etc can be made. The educator said she was aware that many of the educators on her team were not well acquainted with the research and she planned a session where this would be discussed. She was intending to give them each a copy of some research done in Victoria that showed that parents felt that pre-natal education was a “waste of time” because it didn’t give them what they wanted or needed. This kind of research never surprises me - so many programs for expectant parents are poorly run and far too short to achieve even the simplest of aims.

I have recommended that this educator approach one of our (almost) graduates of the Graduate Diploma in Childbirth Education who lives in Adelaide. This woman, a very well known consumer activist and independent educator will certainly run a lively session for these Flinders staff and leave them with some food for thought. She will bring a wealth of knowledge to this task and a very definite consumer perspective. I look forward to hearing how it all goes.

Posted by andrea at 04:02 PM | Comments (0)

Fun model for teaching about pregnancy

The photos for the new Pregnancy Belly came back today and we’ve selected one for the new catalogue (out soon) and the web site.

This is such a fun model, ideal for using with high school students and dads in prenatal programs. I’ll give you a sneak preview:

We’ve often been approached by media outlets for a pregnancy model for use in various shows and up until now we’ve had to refer them to the US where there is a model available. It is very expensive, quite out of the reach of the average midwife or educator, so very few have been brought to Australia. The model we have developed is much cheaper but just as realistic and practical for enabling people to “get a feel” of what it is like to be pregnant.

The details will be on the website very soon, and also in the catalogue which will be out in a week or so. If you are not on the mailing list for the catalogue, you can request a paper copy on the home page of this web site.

Posted by andrea at 04:00 PM | Comments (1)