Articles by Month: May 2004

The next UK trip

I am setting out today for the UK. This next round of workshops will take in Northern Ireland (Belfast and Derry), Hemel Hempstead (just north of London), Nottingham, Burton on Trent, and Solihull (Birmingham). There is also a week in Spain, with two workshops scheduled, one near Alicante at the Acuario Birth Centre and another in Murcia, about 2 hours further south.

In the middle, I will have a few days with my good friends the Habananandas from Thailand, who spend part of each year in Bournemouth. We will be discussing how we can set up a training program for childbirth educators in Thailand, as part of the work of the Childbirth and Breastfeeding Foundation of Thailand’s work. Birth International will be consultants for this project.

There will also be a day out with my office manager in the UK, Fran Gallwey, to inspect the proposed site for our big conference on childbirth education next year. We will be checking out the facilities at Reading University, which are looking promising. This will be a landmark event for the UK, not only for Birth International, but also for childbirth education, as no-one has offered a program such as the one we have planned, which will ensure that all participants are able to attend 6 workshop sessions on specific educational topics over the two days. There sill also be Plenary Speakers (of note!) and a video evening, where all the new releases will be shown. During my visit to the UK, we will be finalising the program and speakers, so keep an eye on our Web site for the details, which we plan to have available in July.

OK, now to finish the packing.....

Posted by andrea at 10:34 AM | Comments (0)

Vaginal examinations during labour

Midwifery students often have a hard time when they venture out into the hospital system to undertake the practical components of their education. They learn some exciting things in the University and then discover that the “real world” of practise is very different, creating confusion and in some cases, despondency.

A student contacted me today after she had attended one of my Active Birth workshops. During that program she learned about performing vaginal examinations while women were upright, rather than lying down on a bed. We had talked about the impact of performing this invasive procedure on women and the need to help them feel more in charge of the process and less vulnerable, on those occasions when it is really necessary to check the cervical dilatation.

The student had reflected on this, and changed her practice, receiving positive feedback from the women. Her hospital based clinical supervisor, however, had other ideas and challenged the validity of performing a vaginal exam in this way. She wanted the evidence before she would support this student and also challenged the occupational health and safety issues for the midwife of working like this.

Amazing but not surprising! As I pointed out to this student, it sounded like this midwife was very challenged by the student’s perceptive ideas and felt uncomfortable supporting her (she probably had never tried this technique herself). The crux of this matter is that it is the woman who is central here, not the student nor the supervising midwife. If the woman is happier off the bed, then the midwife must follow her lead and be of service to her in the most appropriate way. Yes, there could be issues for some midwives with bad backs etc, but as I demonstrated at the workshop, these concerns can easily be overcome if the midwife sits down on a low stool, or kneels on one knee. If this is beyond the midwife’s capabilities, then perhaps she should either abandon the procedure (a great idea!) or else find someone who is fitter for the job to take over.

People who feel threatened by new techniques often react by demanding “show me the evidence”. I suggested to the student that she ask her clinical supervisor to find the evidence that performing a vaginal examination on a recumbent woman does not cause distress, discomfort or anxiety. It is a technique that midwives have been undertaking for years, and is a basic skill that hardly needs evidence to support it - just practise!

Posted by andrea at 05:55 PM | Comments (2)

The future for independent childbirth education

Its been a quiet week for me - quite a change from my usual hectic pace and a nice lull before I head back to the UK next weekend. Midwifery issues also seem to be bubbling along and there have been few issues of note worthy of comment.

The childbirth education field has generated some discussion amongst some of us, however. I was asked recently by a pregnant woman on the phone for the name of an independent educator in her area. Several years ago this would have been an easy question to answer, as there was a network of educators in and around Sydney that provided community based classes. Over the past couple of years, this number has dwindled and now it is almost impossible to provide a contact for most part of Sydney.

The demise of the independent educator is an interesting phenomenon, caused no doubt by several underlying causes. One major reason for their move out of this area of interest has been the difficulty in attracting clients, which poses risks for the viability of their (very) small businesses.

Hospitals, who are routinely unable to provide enough classes for their own clientele, could refer to community based programs, but usually fail to do so. One likely reason may be that booking clerks in the maternity units and other involved hospital staff are unaware of the programs available elsewhere. Better communication, publicity and collaboration would solve this problem.

Another reason for lack of referral may be suspicion about the content of these programs, especially as many are perceived to be “anti hospital” in their message when really they are just advocating for consumer rights and informed choice. Some of the educators that I know have been active in the community are fairly “invisible” within wider maternity circles (for example, they don’t attend workshops or seminars where they could meet with midwives) and this may contribute to their isolation, and perhaps misunderstandings about their role.

Some hospitals have been reported as actively discouraging referrals to programs outside the hospital setting. This is nothing new, of course, as I can remember 20 years this was the case in the northern suburbs of Sydney (a very affluent area). These behaviours are usually instigated by the doctors, who want to restrict information given to parents so that awkward questions can be avoided and policies will not be challenged. There is a suggestion that in one area of Sydney the directive to not refer parents to “outside” classes has actually come from the Parenthood Education Department itself, perhaps because they resent the quality of the programs on offer elsewhere or again because of internal pressures from doctors.

Community based classes offer the best chance for parents to gain unbiased, comprehensive, consumer orientated in formation in an appropriate adult education setting where individual needs can be met. Setting up these programs takes initiative, perseverance, effective networking and good marketing. The rewards are there for the successful educator, but it takes time and energy and rarely offers enough financial reward to make it a viable career choice in itself.

I hope that the role of these educators can be preserved. In a similar way to that of home birth in relation to hospital birth, they keep birth education “honest”, maintaining high standards and offering real choice to expectant parents. Many of the childbirth groups that once flourished have now disappeared as a result of a lack of volunteers, the changing roles of women in our society and the perception that paid work is more necessary/fulfilling/valued by society. Many independent educators would have once aligned themselves with such groups, either as casual employees or in collaborative referral arrangements. Now, they are being forced to work on their own and they must make extra effort to stay in the loop - with parents, with maternity care workers and with hospital departments. Having spent many years in this role myself, working from home and loosely aligned with other educators across the city, I know that this work is important and very necessary. Parents have a right to an independent view and unbiased information.

Posted by andrea at 04:13 PM | Comments (0)

Suggestions for pregnant British expats in Spain

An English journalist, living in Barcelona and writing for expats who live in Spain, has approached me for information regarding maternity care in Spain as she is writing an article for women who are expecting babies. She found my earlier comments in earlier Diary entries regarding the Acuario Birth Centre and the birth scene generally in Spain. She thought I could shed some light and provide tips for women planning to give birth in the Spanish hospital system.

I felt unable to give expats in Spain any real hope of having a birth experience similar to women in the UK - the system in Spain is so medicalised and the concepts of choice for women, informed consent for procedures and treatments and evidence based care seem to have been overlooked, from what I have been hearing from the midwives (obstetric nurses) who work in Spanish hospitals.

I was asked if it was worthwhile paying for private care if it could be afforded and I was emphatic in my “NO!”. There is overwhelming evidence , from every western country in the world, that hiring a private obstetrician is asking for unnecessary intervention in birth, frequently leading to caesarean section, high costs and worse outcomes for mothers and babies. The problem for women, however, is that in many countries there are few alternatives available. Midwifery care in hospital, home birth, water birth, birth centres, midwifery-led units are all rare, if they exist at all. Even though “midwives” may be working in hospital, because these institutions are so doctor-dominated and birth is so medically managed, midwives may have no experience of natural birth or confidence in managing labour without the trappings of a hospital labour ward or theatre.

The best suggestion I could offer this journalist was to encourage expat women from the UK that they find a way of returning home for the birth to seek midwifery care there. Although this might be expensive, inconvenient and difficult, the birth of a baby is too precious an experience to squander in a hospital where shaves, enemas, hourly vaginal examinations, drips, drugs, stirrups and routine episiotomy are all routinely performed, without question.

Meanwhile, I will be back in Spain in two weeks, to present two workshops for midwives. The first issue we will tackle will be “what is a natural birth like”“ and to answer this I will start by showing them the beautiful video “Inner Strength”. I know from my previous visits that this will blow them away - they will probably never have seen women labouring like this and giving birth so ecstatically. Once they have an idea of what to aim for, we can start exploring ways they can help women achieve this magnificent outcome and how they can take on the role of midwife, rather than obstetric nurse. It will be a challenge for us all!

Posted by andrea at 05:28 PM | Comments (0)

Suggestions for expat pregnant Brits

An English journalist, living in Barcelona and writing for expats who live in Spain, has approached me for information regarding maternity care in Spain as she is writing an article for women who are expecting babies. She found my earlier comments in earlier Diary entries regarding the Acuario Birth Centre and the birth scene generally in Spain. She thought I could shed some light and provide tips for women planning to give birth in the Spanish hospital system.

I felt unable to give expats in Spain any real hope of having a birth experience similar to women in the UK - the system in Spain is so medicalised and the concepts of choice for women, informed consent for procedures and treatments and evidence based care seem to have been overlooked, from what I have been hearing from the midwives (obstetric nurses) who work in Spanish hospitals.

I was asked if it was worthwhile paying for private care if it could be afforded and I was emphatic in my “NO!”. There is overwhelming evidence , from every western country in the world, that hiring a private obstetrician is asking for unnecessary intervention in birth, frequently leading to caesarean section, high costs and worse outcomes for mothers and babies. The problem for women, however, is that in many countries there are few alternatives available. Midwifery care in hospital, home birth, water birth, birth centres, midwifery-led units are all rare, if they exist at all. Even though “midwives” may be working in hospital, because these institutions are so doctor-dominated and birth is so medically managed, midwives may have no experience of natural birth or confidence in managing labour without the trappings of a hospital labour ward or theatre.

The best suggestion I could offer this journalist was to encourage expat women from the UK that they find a way of returning home for the birth to seek midwifery care there. Although this might be expensive, inconvenient and difficult, the birth of a baby is too precious an experience to squander in a hospital where shaves, enemas, hourly vaginal examinations, drips, drugs, stirrups and routine episiotomy are all routinely performed, without question.

Meanwhile, I will be back in Spain in two weeks, to present two workshops for midwives. The first issue we will tackle will be “what is a natural birth like”“ and to answer this I will start by showing them the beautiful video “Inner Strength”. I know from my previous visits that this will blow them away - they will probably never have seen women labouring like this and giving birth so ecstatically. Once they have an idea of what to aim for, we can start exploring ways they can help women achieve this magnificent outcome and how they can take on the role of midwife, rather than obstetric nurse. It will be a challenge for us all!

Posted by andrea at 05:26 PM | Comments (0)

Dressing for the part

There was a moment during yesterday’s workshop in Melbourne that we were able to reflect on the unique nature of Australia and Australians.

Some of the midwives in the group work in rural areas and they started sharing stories about they way they work with the GPs, who provide emergency back up for their maternity units. Most of the time the births are capably managed by the midwives, but when a problem occurs they call the local GP who comes to assist. Birth being unpredictable, these calls can interrupt the doctor at unexpected moments and we heard of occasions when one doctor turned up wearing pyjamas, another arrived in bike shorts and cyclists helmet, and another time when the doctor arrived wearing muddy Wellington boots and farm overalls.

One midwife, when she was new to the unit, asked a man sitting in the waiting room wearing trackie pants, a “Quicksilver” T- shirt and very old trainers, if he needed assistance. “No” he said, “I’m the anaesthetist”!

These midwives know to warn the labouring woman that the man who will becoming is the doctor - so they will be prepared for whatever he looks like. In an emergency, no-one is worried about sartorial elegance, just professional competence, but it must cause a few giggles when the crisis is over.

I couldn’t help thinking of the fanatical zeal with which some infection control and occupational health and safety people stalk the hospitals seeking our “transgressions”. I wonder what they would make of this casual, yet practical approach adopted in Australian rural areas!

Posted by andrea at 11:41 AM | Comments (0)

Tips for facilitating difficult births

Several people have asked me, via Diary feedback and emails, about the “towel trick” and the “pencil in the vagina” suggestion that Vicki Chan offered during the Midwifery Intensives tour, as ways of facilitating difficult births. These were just two among many suggestions that Vicki had compiled for working with OP labours, but they were some of the most intriguing.

The “towel trick” was a idea she had picked up from the Internet, and had used successfully during hard labours. It is a variation of a strategy that can be adapted in several ways for making it easier for the woman to push out her baby. The woman adopts a deep squat, holding the ends of a towel that has been rolled up into a loop. A partner or support person holds the towel in the middle, and as the woman pulls on the towel, the partner pulls back. I hope you can get the picture!

Variations would be to have the woman pull against a rope, a bar fixed to a wall, or even the end of the bed. The advantage of using a towel is that it can be done anywhere, being completely portable. As the woman bears down in this squatting position, with her upper body stabilised by pulling on the towel, her pelvis will tilt under, curving the birth canal. For some babies this change of drive angle may help them into the world.

The “pencil in the vagina” was an idea that Vicki suggested to encourage women to wiggle their pelvis more effectively. Pelvic rocking is a well known strategy for jiggling the baby into better alignment, but sometimes women can’t quite get the hang of how to do it, and sway on their legs to circle their pelvis around, rather than moving just the pelvis while keeping their legs relatively still. Imagining that you are holding a pencil in the vagina and drawing small circles on the floor makes it easier to visualise what is needed.

At one point on the tour, amid much laughter as everyone practised this manoeuvre, Vicki announced that I would give anyone who could complete their evaluation with the “pencil in their vagina” a discount on the next workshop! Although some of the writing on the evaluations was hard to read, I decided that all had been completed by hand, and no discounts were necessary.

Sharing ideas like these in workshops is always useful. If anyone has any similar tips and tricks, please share them with us via a comment on this Diary entry.

Posted by andrea at 08:35 AM | Comments (0)

Cutting the cord

Back in Melbourne again this week, this time for an Active Birth workshop. This group is full of bright young things - all these midwives are well under the average age for midwives in this country (47 years) and there are several students here as well.

We were talking about complications that can occur during birth and how these could be handled. Although very rare, the problem of a very tight cord around the baby’s neck that impedes further progress was one such issue. I asked the group what they would do if faced with this situation. Most said “clamp and cut the cord”. So I followed with the question “what are the risks of taking this action?” and they replied “danger for the baby is there is further delay, for example from a shoulder dystocia”.

I commented that midwifery students these days are being taught not to ever cut and clamp the cord and showed them how the baby will tumble out itself, often very quickly, if necessary, as though nature detects the baby’s distress and lends a helping hand. One of the more experienced midwives in the group told us that she had witnessed this herself and now was not at all concerned about leaving the cord intact, even when it was very tight.

One of the students said that they had raised this issue with one of their tutors. They asked what they should do when the cord was tight and the baby appeared compromised. The tutor replied that it should always be clamped and cut. When the students questioned this practice, and mentioned the possibility of shoulder dystocia creating further problems, the tutor had replied that “if shoulder dystocia occurs then the baby is gone anyway”! Needless to day, the students were a bit stunned at this reply. I do hope that they have misinterpreted this comment. Cutting the baby’s oxygen supply prematurely can never be a good idea, surely?

Posted by andrea at 07:10 PM | Comments (0)

Reflections on the tour

The Midwifery Intensive workshops are over. We had a great time and it is clear from the evaluations that we really achieved an enormous with the program.

I learned a lot as well. Let me share some of the insights I gained from our wonderful presenters.

From Vicki Chan:

Her vision of a future where

“Midwives have been reinstated as the custodians of normal birth and most obstetricians have found themselves honest employment”.

The towel trick for facilitating pushing and the “pencil drawing” for encouraging pelvic wiggling were unforgettable.

She reminded us of the protective nature of the long labour where a baby who was malpositioned, or whose cord was short or tight, would have time to adjust to the labour without undue stress.

From Maggie Banks:

The Muriwai-Beetham manoeuvre for facilitating breech births. {I will write this up further in a later posting, as it really needs a picture to explain it clearly).

“See one, do one, teach one” as a basis for gaining experience in unfamiliar techniques.

Her reminder that many of the problems that babies encounter during their births are due to them being frightened “out of their tree” as the labour progresses. For example, fiddling with the breech baby (bringing down the legs and arms etc) can startle the baby, who flings its head back, increasing the risk of entrapment of the head.

Her suggestion that we re-name the “failure progress” syndrome as the “failure to be patient” syndrome. She explained that midwives in New Zealand are working to re-name many obstetric procedures and techniques in more midwifery oriented and woman friendly terms.

“Rumping” of the breech baby - the equivalent of “crowning” in the vertex baby.

From Lynne Staff

“Enforced home births” that some women undertake because they cannot get what they want in hospital.

“Enforced elective caesareans” when women can’t find support for a VBAC.

These are just a few of the gems we all gained from these outstanding midwives. Here’s a picture of the four crones on the tour (note the initials on the hats). The caption reads:

”They tell me that you’ll lose your mind when you grow older. What they don’t tell you is that you won’t miss it very much.”

Posted by andrea at 10:25 AM | Comments (1)

normalising breech birth

Brisbane was the venue for yesterday’s Midwifery Intensive event. It was a very rainy day, which was a treat, coming from Sydney where the drought is tightening its grip, but it didn’t dampen the enthusiasm of the large group of midwives who gathered to explore the issues around “keeping birth normal.”

The topic of breech babies seemed to especially catch their attention. Some hospitals in Brisbane have caesarean rates of over 60% and there are obstetricians in this city who will only do caesarean births (labour is “so unnecessary”!), so there is a desperate need for some midwives to reclaim their skills and find their own strengths in this face of this kind of opposition.

Because of the size of the groups who are attending, this program is not able to offer midwives practice sessions with dolls and models. However, as Maggie Banks, the wonderful midwife from New Zealand points out, a baby coming by the breech is not all that different from a baby who is head down: what is needed is time, no handling and freedom for the woman to move and the baby to wriggle out. One of the most interesting aspects of her presentation are her summaries of the risks of bed-birth, particularly as it restricts the pelvic capacity and the woman’s ability to move as needed. All our speakers have emphasised the dangers of labouring on the bed and the ease with which complications and interventions can be avoided when women have space and freedom to move during labour.

Maggie showed, using a series of lovely slides, the role that the breech baby plays in getting itself born. The baby needs space to wriggle and cycle its legs, to release it own arms and align its body within the pelvis for the birth of its head. Touching the baby can disrupt these actions. Having the arms brought down by the midwife or doctor can present special problems - the positions of the baby’s arms and hands up beside its head and face, provide a splinting action, helping to keep the head well flexed. If a baby is startled by someone handling its body or pulling on its arms, there is a great risk that the baby will thrown its head backwards (seen in the “startle reflex”) as a natural reaction, and perhaps find its head trapped within the cervix. Maggie has great respect for women and babies and complete trust that given the right conditions, a calm midwife and trust in the natural process, breech birth need be no more hazardous than vertex birth.

I wish that obstetricians would take heed of these wise words and stop being frightened of breech birth. Women can manage this kind of birth as well as any other.

Posted by andrea at 01:53 PM | Comments (1)

International Midwives Day

May 5th - Happy International Midwives Day!

This is a major event in Australia and midwives use it to promote their profession and normal birth. Rallies, displays, special dinners and awards will all be happening today and over the rest of the week. Next Sunday is Mother’s Day, which is also a neat tie in to a week of celebration for women and their midwives.

I am proud to be associated with this group of feisty and caring professional women, as a consumer member of the Australian College of Midwives Inc. I hope that they achieve their goals of universal access for women across the country to midwifery services and free home birth for women choosing that option. Their commitment to the on-going struggle for recognition, equity and access is outstanding and worthy of both formal and informal acknowledgement.

Lots of special events will unfold. In Brisbane next weekend there is a huge rally planned on the theme of Universal Suffrage with women dressed like the Suffragettes who fought hard to achieve the vote for women all those years ago. It will make for great television and good publicity!

My best wishes on this special day to midwives wherever they are - celebrate your unique gifts to women and stand tall amongst health professionals. You have the capacity to bring great joy to families, to enable women to discover their own power and strength and to create the best possible conditions for babies to enter this sometimes troubled world. Wonderful women!

Posted by andrea at 10:49 AM | Comments (0)

How to reduce the epidural rate

Tuesday May 4, 2004

The Perth event today was another winner. The group was touched by the emotion of the videos and enthused and inspired by the presentations and workshop sessions. Many of the midwives here in the West are very stressed from fighting running battles with obstetricians, constant uncertainty about the Community Midwifery Program (CMP) and lack of support from many hospital administrations. They are doing a sterling job, despite these problems, and have shown the rest of Australia a number of innovative ways of working, especially through the CMP.

I was able to catch up with a group of midwives from Geraldton, a major centre north of Perth. Last year I was asked to present an Active Birth workshop for their staff, which I was delighted to do. They were a committed bunch, already well on the way to providing an excellent midwifery service and just needed a little encouragement and a few more ideas. Yesterday I had some great feedback. After my visit, the group consolidated their own goals and immediately began offering a less interventionist approach to supporting labouring women. They don’t have a pool or tub, but encouraged the use of hot packs and hot wet towels as substitutes.

I was told that their epidural rate had dropped dramatically, to the point that the anaesthetist had enquired if someone else was doing the epidurals, as he wasn’t being called any more. The midwives were thrilled to be able to tell him that women weren’t asking for epidurals, and his services were rarely needed. Their use of pethidine has also dropped dramatically and women are receiving real midwifery care instead. The midwives were well supported by their obstetrician, who encouraged VBAC and valued midwifery.

At one point the midwives asked if they could have some funding for further staff development. They were told that “they had blown the entire budget on my workshop (I am not all that expensive - their budgets are really quite small!). In response, the Clinical Midwifery Consultant totted up the money the hospital had saved from the drop in drug use and epidurals, to prove how valuable an investment this workshop had been. Even though the savings had been substantial, administration would not award them more money is that financial year for staff development - a very short sighted move.

Meanwhile, their wonderful obstetrician was poached by the main hospital in Perth. Being a rural area it is hard to get doctors, and they have had to put up with a series of consultants being flown in for a few days at a time while a permanent obstetrician could be recruited. Last month, as a result of this terrible policy, their caesarean birth rate shot up from the 9% they had achieved for years, to an alarming 48%! I am told that they are hopeful than a new obstetrician from the UK will be appointed and that their midwifery model will be supported again, with a drop back to outstanding low level of intervention they enjoyed before.

This example proves what can be done when a committed bunch of midwives share a vision of natural birth and work together to support women achieve their dreams. Geraldton is now investigating other ways for furthering these outstanding results through the introduction of new midwifery programs. A new maternity unit is to be built and it will have a pool available. They are an inspiration to us all and it will be good to hear of their progress in maintaining and developing what is clearly an outstanding example of midwifery care.

Posted by andrea at 10:47 AM | Comments (0)

Midwives needs versus woman's needs

Monday May 3

The Midwifery Intensives event in Adelaide was wonderful. The midwives who attended were a dynamic bunch, delightedly sharing stories and comments that reflected their commitment to women and natural birth. They readily embraced the idea that we make too much of the “complications” of breech, OP labour and vaginal birth after previous caesarean and should regard these as variations rather than dreaded circumstances that spell difficulty and force compromise.

During the workshop session on practical measures to facilitate OP labours, one midwife asked, somewhat cautiously, “but what about ourselves - we must take care not to harm ourselves if we try these measures”. This is a reaction that I have often heard, in workshops in many places, particularly in the UK. These midwives are reflecting the stern warnings that are often dished out by the Occupational Health and Safety Officers who patrol hospitals looking for any actions that might, just might, land administration in a legally difficult position if a nurse/midwife is injured “in the line of duty”. Whilst their concerns are justifiable in some circumstances, often common sense and basic caring are the first casualties when their dictums are applied wholesale.

I understand their concern, and of course no one wants midwives suffering back problems etc. as a result of doing their jobs in labour wards etc. However, potential problems can easily be avoided if staff remember basic back care measures and pay attention to their posture etc. What sometimes happens is that OH &P concerns are used by some midwives to avoid getting involved with women, on the grounds that they “might damage their backs” or “can’t work on the floor”. I have had midwives state bluntly that hot packs, hot towels, warm water baths, even cups of tea for support people, have been outlawed because they present safety hazards and the “policies of the unit” ban them. If this is indeed the situation, then these hospitals should be ashamed of themselves for creating a climate of fear, restricting labouring women’s rights and freedoms and treating adults as children.

If midwives are using these sometimes non-existent “policies” as a means to avoid being “with women” then they should be banned from maternity units on the basis that they are failing to fulfill the most basic requirements of their job. A midwife who is unwilling to touch a woman, hold her, support her and get in tune with her emotions as well as physical needs has no place in labour rooms. If midwives feel uncomfortable performing these basic caring functions, then they might be better deployed to nursing duties where keeping an emotional distance, using instruments and equipment instead of hands to touch people, and not showing feelings is more acceptable (although I think that the power of human touch is often overlooked in nursing as well).

The midwives who are attending our current program are certainly being asked to get in touch with their feelings and attitudes around birth and most are thoroughly revelling in this challenge. The Perth group will have their chance to explore the deeper meanings of birth at their event today.

Posted by andrea at 10:45 AM | Comments (1)

Intense midwifery

There have been problems with our web site which have affected my ability to upload Diary entries. There are several I am adding today, that I have written over the past week. I will date them according to the day I wrote them.

Sunday May 2, 2004

The Midwifery Intensive event in Melbourne yesterday was quite a day. It was a very large group, much larger than we had originally expected when we were planning the program, and this presented some problems, including a change of venue to accommodate the crowd. This proved disastrous, as the alternative venue we were given was completely inadequate in many respects and we struggled to provide the level of professionalism for which Birth International is noted. However that is another story.

The program begins with a touching, emotional, heart-wrenching tribute to midwifery that reminds us what birth is about - the woman and her power, capabilities, potential, and innate instincts for birth and the nurturing of her baby. The visuals are stunning and Vicki Chan’s words are extraordinary. They remind us of the connectedness of midwives to women, and the complementary role each play in safely guiding the new baby into the world. Without this basic understanding of their role it is impossible to truly midwife a woman through this often tumultuous and sometimes difficult life event. Once these fundamentals are embraced and embodied by a midwife, her approach to those labours where occipito posterior (OP) or breech positions are involved or where a woman is labouring towards a vaginal birth after previous caesarean(s), becomes much easier: these are variations on birth, not potential disasters.

These days much fuss is made about OP positions and as Vicki herself says, for some it becomes “an Olympic event” to get the baby to turn, because of the dread that has been instilled by the thought that this baby is “wrongly placed” for a straightforward birth. Similarly with breech babies. In times gone by, midwives facilitated breech births as a matter of course, not in fear and trepidation as often happens now. The rush to theatre has robbed midwives and doctors of the opportunity to maintain their skills in handling breech births and this has added to their fears. Women wanting VBAC are often discouraged from pursuing their goals by caregivers who play on emotions using threats and poor science to exaggerate the dangers of vaginal births over the much more risky repeat caesarean.

All of these themes are explored and discussed during the day long program. The feedback has been overwhelming in its praise for the speakers and their ability to affirm, reassure, inspire and provide practical suggestions.

I was totally unprepared for the sudden departure of three midwives just after lunch, whose evaluations (written after half of the program had been completed) contained comments about it being “too airy-fairy” “unrealistic” and many more less flattering remarks. As they scuttled down the stairs, having flung their vitriolic, rude and insensitive evaluations down at the door, my first reaction was anger at their unprofessional behaviour and rudeness towards our speakers. These were not midwives but obstetric nurses of the very worst kind and they are a disgrace to their profession. I can only pity women who might encounter them in a labour ward - it seems they have their minds made up, that they are closed and rigid in their thinking and they have no ability to look beyond their narrow world. They certainly appear to be a completely lacking insight into the potentials of birth for women and midwives.

How can they have become so brutalised - surely they didn’t enter midwifery with these ideas and attitudes? What is happening to some midwives that they end up like this?

Posted by andrea at 10:43 AM | Comments (0)