Articles by Month: July 2004

Staff development

Had our regular staff meeting today where we reviewed the happenings at Birth International and talked about our forthcoming events and projects. One of the topics we discussed was the content of our next in-service program for our staff and Graduate Diploma faculty members. This meeting will be in November, over a weekend, and we will fly in our Course Supervisors who are interstate and round up our local people for one day of professional development activities and a second day for Course discussion.

This year we will involve our clerical and support staff as well. It is important that we all reflect the same philosophy and undertake our jobs with confidence and competence. The final program for the weekend is not yet finalised, but will include developing communication skills, offering feedback, working with clients and team building exercises.

It is a shame that Fran Gallwey in our UK office is unable to attend this event - it is a long way for her to come, but perhaps one year we can arrange it. Right now she is getting ready for her annual holiday, and like most people in Europe, she will be on holiday for the first two weeks of August. Our UK office will be closed during this time, however, you cam always reach us by email: info@birthinternational.com

Posted by andrea at 04:14 PM | Comments (0)

Grantly Dick-Read and the foundations of hypnobirthing

A CD came my way recently - a documentary record of the birth of a baby delivered by Grantly Dick-Read. Having just read the proofs of a new edition of his last book (written in 1957, just before his death) I was keen to hear him in action, to get a better feeling for the man and his work. The hypnobirthing movement has relied heavily on his writings and philosophy as the basis for their claims, and this was another reason to explore his approach further, especially given my feelings about hypnobirthing as a management strategy for labour.

The sound quality of the recording was very clear, picking up every detail of the final contractions in first stage and the birth itself. It is not clear if the recording has been edited - it lasted 50 minutes, which for a first birth is rather fast. What was clear was the orchestration of the whole event, which is definitely “conducted” by Dick-Read, the chorus being provided by a midwife.

The mother remains anonymous, her name is never mentioned, although we do learn that she will call her baby David. She has been well prepared, having learnt “the breathing” techniques taught by Dick-Read’s wife and she also talks about seeing a film. There is no mention of the father, apart from the comment made by Dick-Read in his introduction that the father had been present in the early stages, and a wistful remark from the new mother at the end, that the baby has the father’s nose.

We are told that the woman is lying on her right side and is “well controlled” from the start. She mentions back pain and is given some back rubs. In response to two requests for warm water and honey she is given water to sip and at one point she asks for a blanket because she is shivering. The entire labour is carefully stage managed by Dick-Read and the midwife, who issue copious instructions throughout.

Instinctive behaviour is not encouraged. At one point the woman says “I want to push, at the end of the contraction” and she is firmly told “you are not yet fully dilated, so don’t put any weight into it”. A little later she is asked “do you want to push?” and when she says, rather forcefully “Oh, yes!”, she is told again she is not yet ready and must keep breathing instead of giving in to the urge. No internal examinations are performed, and the midwife explains that until she pushing urge is overwhelming she must wait. In reply, the mother asks “why are you stopping me from pressing down?”and she is told again “you are not yet ready”.

Other instinctive behaviours are also ignored. As the pushing urge begins to be felt, the woman is told she will be turned over into the delivery position “that you already know - 45 degrees with cushions”. The woman is much relieved and states that now the back pain has gone and she feels much more comfortable. She is instructed to keep her eyes open, and when she is surprised by this (“I want to shut them”) she it told that having her eyes open is important “ to keep you with us in case we want to make any suggestions”. This is reinforced later by the comment “keep your eyes open - I like to have a look at you at this stage”, to which the woman responds weakly “don’t you remember me?”

Dick-Read constantly feeds words into her mouth, anticipating and even dictating what she is either feeling now, or will feel very soon. Several times he asks (I thought, rather anxiously) “Are you feeling any discomfort? “ One time, just as second stage is starting, when the mother says “I can feel the baby moving down a bit, he replies “...very unusual, but quite reasonable”.

The language throughout would make a woman of today cringe. Of course, this was recorded about 50 years ago, and women then were clearly in awe of the doctor and very willing to be told what to do. Dick-Read carries on a semi-scientific explanation of what is happening with the uterine muscles and what will happen next, but carefully refers to “down there” and “back passage” when necessary. The woman, just before the baby crows says “I thought I was being polite” and she is reassured that indeed she is behaving well.

There are lots of “breathe in, breathe out” instructions and “in and out, dear“, “a little more relaxed” “take longer to breathe out” become a regular chorus from the midwife. Dick-Read chimes in constantly “good girl”, “very nice indeed”, “keep level and controlled” and when she seems unsure, issues clear instructions “try and time this one a little better”. As the baby starts to appear, the message becomes: “now fill up, hold it, come along, come along, one more, down here, like this.....” , “determination, right on top of it, come on.. doing well...downwards here... hard work!” and when she succeeds, she is rewarded with the comment “now that’s more like it, good girl, working like a Trojan!”.

There comes a moment when the woman protests “I can’t push any more at the moment” and then asks “how much longer”, to which Dick-Read replies, “still work to do but you don’t mind hard work”. A further protestation “I must stop, I can’t do any more now” is greeted by the remark “I like that spirit!”. The mother then comments “it seems odd that frail women have to do this - look at me, I am very strong and I find it hard.” A few more pushes and she says, when told she mustn’t waste the contraction, she “is just lacking the benefits of a good square meal”.

Insights into the routines of the time are apparent as well. Although no internal examinations are performed, the mother is dressed in “Swiss stockings” (what on earth are those?) and she is told not to put her hands on the sterilised towel covering her tummy. The midwife offers her the gas, and Dick-Read ignores this, quickly saying to the woman, “now watch me, fill up... very nice... lift up now.... come on.... that’ll do, almost there”. Then comes the inevitable “don’t push, let the uterus do the work, we’ll have the head this time”, and then David is born, his sex loudly announced by the doctor. And what is the woman’s comment at the end? “Oh doctor, that’s beautiful. That moment at the end, it is worth all the effort”.

I found this recording fascinating. It was a wonderfully stage managed piece, with the woman’s needs and wishes completely overshadowed or ignored in favour of the doctor’s desire to produce a natural birth. My feeling was that not much has changed, the only reason that Grantly Dick-Read has retained his fame is that he was striving for a “natural birth”. His passion for nature is not that different from many current doctor’s passion for epidurals. The women were a means to an end, and whilst they may have achieved a drug free birth, they were subjected to patronising behaviour that took no account of instinct or individual needs.

At that time, endorphins had not been discovered, so the entire credit for the success of his approach was claimed to be because of the training. In such a forceful presence as Dick-Read, I doubt that many women would have dared to let their feelings show or to show any individuality, especially during labour a nd birth. They were a self-selected group, clearly used to taking orders and to being treated with a degree of condescension we would find completely unacceptable today.

Listening to this CD has given me new insights into this man and done nothing to shift my view that modern interpretations of his methods, such as hypnobirthing, also rely for their claimed successes on domination, brain washing and suggestible personalities in pregnant women.

Posted by andrea at 05:01 PM | Comments (1)

Breastfeeding and world peace

Several months ago, I was asked by a Brazilian friend if I would help with the English translation for a video they were making to promote breastfeeding. The project was a joint effort between various Government Departments and support organisations and they had recruited a number of women, including some well-known personalities to convey the benefits of breastfeeding.

Having sent off the prepared script, I was keen to see the finished product, since I had no idea of the visuals that went with the story. In due course the video arrived and I have now had a moment to play it. It is a delightful film, full of babies nursing contentedly while their mothers explain their reasons for breastfeeding and the benefit it bestows on themselves and their children. I was particularly taken by the message, delivered unequivocally in a gentle, caring manner, that breastfeeding babies contributes to world peace, through helping babies experience a loving, nurturing relationship at the beginning of their lives.

This thought, of the link between early mothering and calmer, more peaceful adults is not new (Michel Odent has spoken of this in his many books) but it is the first time I have seen it used to underline the benefits of breastfeeding. Perhaps some film makers don’t want to “tread on any toes” of the bottle feeding mothers, or perhaps we just don’t think about the longer term benefits of the close intimate relationship that is an essential and automatic ingredient of the mother/baby nursing couple.

It is great that the Brazilians have tacked this one - perhaps we should take a leaf from their book and move away from all the daunting, technical “you must get the baby latched correctly” breastfeeding videos and instead look towards motivating mothers through exploring the wider implications of this gift to their babies.

Posted by andrea at 10:06 AM | Comments (0)

Taking some leave

I don’t seem to be finding much time to do my Diary entries at the moment. In fact, I am supposed to be on “long service leave” for the next 5 weeks, but I plan to keep writing my entries from time to time and to keep responding to emails. There are a couple of writing projects that I plan to finish off as well (the article on Entonox is one) as soon as I can.

Over these next weeks, I will be moving house and trying to “get a life” beyond the birth scene. This job is so all consuming, what with the workshops, writing, managing Birth International, planning Conferences, developing new projects etc that at times it is seems to be all that I do. The next few weeks will give me the space to catch up with long lost friends, get started on some new hobbies/interests and generally re-charge my batteries.

I’ll stay in touch with you all from time to time.

Posted by andrea at 05:42 PM | Comments (0)

Risks of exposure to Entonox

I have started reading the research regarding the use of Entonox and its impact on care givers, in preparation for writing an article for publication. It is clear that there is increasing concern about the impact of exposure to this chemical (Nitrous Oxide) by midwives, with evidence from several studies revealing that the majority of midwives, where Entonox is used, have chronic levels in their system, even when they are not directly exposed through contact with women using it in labour. It seems that Entonox does not disperse easily in the air, and tends to form “clouds”, especially in areas that are not well ventilated such as many labour rooms. Once I have the full article written I will publish it on our Web site and let you know when it is available.

None of the research studies that I have read mention the potential impact of Entonox and Nitrous Oxide on women and babies, although the package inserts available from BOC Gases (the major manufacturer of this product around the world) state that there are potential hazards for the woman and her unborn baby. It seems that once again, the pregnanct woman and her child are invisible.....

One alarming note that I read in the information supplied by BOC Gases states forcefully that Nitrous Oxide and Entonox should NEVER be carried in a car because of the risk of leaks and the potential to cause a fire if there is an ignition source. This is something that British midwives will need to note carefully because they routinely take Entonox to home births, transporting it with their other equipment in the boots of their cars.

Of course, none of this will be of any interest to midwives in Europe or the Americas. Nitrous Oxide has never been used in obstetric or maternity care in those countries. Which begs the question, if women don’t have it available (especially in home births) they manage in other ways. This would seem an obvious solution to the potential problem for midwives of exposure to this chemical s well - just say “Entonox is not available” and use other safer means to ease labour pain, such as water, heat etc. A simple solution?

Posted by andrea at 11:58 AM | Comments (0)

An election in the air

Although the next Federal election has not yet been announced officially, all the indicators are that it will occur in October, before the US Presidential election in early November. The unofficial campaigning is well underway, and the politicians are already on the hustings, promising new programs, making sudden back flips on unpopular policies and dishing out money from some bottomless pit (our taxpayer pockets).

This time there is a strong feeling in the air that the Government may change, driven by anger over our forced involvement in an unpopular war (Iraq), huge scepticism over the “honest” credentials of the current government and a feeling that it is time for a change, especially of our Prime Minister.

Australian midwives have developed a canny nose for a political opportunity, spurred on by some passionate consumers, such as Justine Caines, the President of the Maternity Coalition, and Barb Vernon, the Executive Officer of the Australian College of Midwives. Tactics have already been discussed and the campaign prepared. Senior members of both major political parties have been targeted and meetings have been set up with Ministers and Shadow Ministers, especially those with influence in health matters. Some of the minor parties, notably the Greens and the Democrats have already pledged support for better access to midwifery care for women and families. The perception that Labour offers a younger, more family orientated approach to managing health also offers hope that change may bring real results, especially as and election of a Federal Labour Government would mean all Governments in this country were of the same political persuasion.

A petition is being circulated to gather support for midwifery programs as outlined in the National Maternity Action Plan. Midwives are being encouraged to set up appointments with their local member of Parliament and to chew their ears about the need for better choices for women. There is a real feeling this election may be our best hope yet of achieving significant reform of maternity services and long-awaited recognition of midwifery care and midwives as professionals.

At Birth International, we are preparing to do out bit towards getting the message across, but more about these plans later!

Posted by andrea at 03:13 PM | Comments (0)

Spanish midwifery email discussion list

Today I have been working on establishing an email discussion list for midwives, students and others in Spain, so they can “talk” to each other about birth and midwifery care. There are several email lists operating already in Spain, but these tend to specialised, and I felt, after my last visit to Spain, that there needed to be a more general forum where people can contribute to talk about maternity care in the widest sense.

The main aim of the list will be to promote midwifery and natural birth. At the moment, birth in Spain is very medicalised, although there are some midwives offering home births in some locations. I hope that by encouraging people to talk to each other about what is happening around the country, a better sense of midwifery care will develop and that effective networking can help midwives create a pressure for change, whilst supporting the efforts being made.

The list will operate mainly in Spanish. Over recent years there has been a huge influx of English speaking people into Spain (the weather is very nice!), and some of these have been midwives. I hope they will also contribute to the list discussions, in either English or Spanish as the language of birth is universal and women’s needs are much the same everywhere.

For the time being, we will support this list from our base in Sydney. Eventually I hope that a local midwife will take over the administration of the list (there is not much required) mainly because I don’t speak Spanish! At the present time I have a staff member, Patricia, who is a fluent Spanish speaker and qualified translator, so getting my message across in this foreign language is easy. This list is intended for Spanish midwives, so it would be good for them to take ownership when they are ready and willing.

In the meantime, I will be encouraging everyone with an interest in midwifery in Spain to join the conversation. This can be done quite easily:

1. Send an email message to: parteras-subscribe@yahoogroups.com Leave the subject line and the message area empty.

2. After your subscription has been confirmed, to contribute to the list, send your messages to: parteras@yahoogroups.com

3. To unsubscribe the list, send a message to: parteras-unsubscribe@yahoogroups.com, leaving the subject line and message area blank.

If you are having problems with any of this, you can contact the list owners via regular email at: parteras-owner@yahoogroups.com

Posted by andrea at 03:33 PM | Comments (0)

Mother-Friendly Chilbdirth Services

The Coalition for Improving Maternity Services (CIMS) is a collaborative group of broad spectrum maternity care providers in the USA. They have been working to develop better services through the use of a tool “The Ten Steps of Mother Friendly Care” loosely modelled on the UNICEF breastfeeding program of a similar name.

Whilst this tool is geared for birth in an American context, it has wide applicability to other western countries and also many developing nations that have used American birth practices as a model for implementing birth care. CIMS suggests that other countries adapt the tool to include issues relevant to their own services, for example, by inserting a substitution for Step 9 which concerns circumcision, a procedure that is very uncommon in most of the world, but very prevalent in the US.

CIMS has some very useful handouts that can be downloaded for use in prenatal programs and several questionnaires that can be used to evaluate the Mother-Friendliness of various services. The most recent evaluation “Is your perinatal practice Mother-Friendly?” is described in detail in the latest edition of Birth (BIRTH 31:2 June 2004) but is yet to appear on the CIMS web site. Keep an eye out for it - it offers excellent food for thought.

Posted by andrea at 04:54 PM | Comments (0)

Accredited courses for childbirth educators

I’ve become aware that there may be some confusion developing between ourselves (Birth International) and another business with a similar name (Childbirth International). This company is located in Singapore and it offers training courses in childbirth education, classes for expectant parents and doula services for pregnant parents in Singapore.

Birth International is a Registered Training Organisation in Australia, that has been in business for 20 years. Our Graduate Diploma in Childbirth Education is recognised as the only accredited course in Australia. As a distance learning package, we have students enrolled from several countries, including Singapore and other South East Asian countries.

Soon we will be offering shorter courses, also fully accredited, that can be undertaken in a distance education format. These courses are all modules of the Community Services and Health Training Package - one of several sets of nationally endorsed standards and qualifications for recognising and assessing people’s skills. These packages form part of the Australian Qualifications Framework (AQF) that sets the standards for all training in the country, from Certificates through to Doctoral Degrees. The short courses we will be offering will enable childbirth educators to hone skills in specific areas such as group work, presentation, and facilitation, in a convenient, flexible format.

Those who complete one of the short courses we will be offering will be issued with a Statement of Attainment and will acquire a qualification that is recognised across all industries and workplaces in the country. They will also acquire a qualification that can count as credits into the full Graduate Diploma.

Whilst I have no objection to others setting up training courses and even using a similar name to ours (imitation is, after all, the sincerest form of flattery!), I am concerned that people who enrol in courses offering “certification” need to be aware their programs have no validity or acceptance in the wider sphere of education or employment. They may enable aspiring educators to gain some skills development, but will be no real substitute for quality, accredited courses that are underwritten by the Australian Government through its AQF. One simple guide to quality are the fees being charged and the transparency of their programs. This information should be freely available to enable quick comparison and honest evaluation.

If you are serious about childbirth education, as I hope you are, then check out the programs we are offering. Click here to take you to our Web site information and stay in touch for the details of the new shorter courses we will be offering in a few weeks.

Posted by andrea at 03:36 PM | Comments (0)

Midwifery job vacancies in Australia

Back at the desk in Sydney today! One big advantage of email is that I can keep up with requests, correspondence, workshop and event planning etc while on the road, and I don’t have a huge in-tray to wade through when I get back.

There were a number of Journals to read, including the Australian College of Midwives Midwifery News. This is the magazine used by the various Braches of the ACMI to stay in touch, report on activities and celebrate successes. One interesting snippet was the announcement of a new section of the ACMI Web site, listing midwifery jobs in Australia. This is a free service, and I am sure one that will be utilised by hospitals and midwifery services to attract and recruit staff.

I am frequently asked by midwives, especially in the UK, about job opportunities in Australia. Midwifery has been designated as a “preferred occupation” by our Immigration Department, making it much easier to obtain work and resident visas for those wanting to either come for a while or settle permanently.

There are active recruiting drives by many of the Agencies that offer to arrange work overseas, often poaching from each other’s countries. Enrolling with an Agency may make it easier to handle the paperwork, but being indebted to them for a period (often 12 months) means that you will work where you are sent. Agencies are frequently used by hospitals that are having problems attracting or retaining staff, often the Private Hospitals, and whilst work is guaranteed, many midwives will find it rather soul destroying. One plus is that permanent positions are not usually offered, so there is the opportunity to experience working in a number of settings, enabling “shopping around” before making any decision to settle in an area or become part of a specific hospital’s staff.

This new web site service from the ACMI may help those midwives in other countries who want to come here and work, and also retain some measure of independence. I often recommend that the rural maternity units be considered by visiting or immigrating midwives because they offer some of the best midwifery in the country and the friendly life style of country towns is a great opportunity to get a close up view of the Australian way of life. I hope that some of the smaller units use this new service to advertise their vacancies.

If you are interested in exploring working in Australia, then click here to go to this new web site service.

Posted by andrea at 12:41 PM | Comments (0)

Have ticket, will travel

It is time for me to go home, after four weeks of hectic travel around the UK. The time seems to fly past and before I know it I am heading back down that gangway to board another Qantas flight home.

It has been the usual mix of workshops, midwives, places and faces, across a wide range of locations. Ireland was revealing and Spain was dismaying and Britain offered its usual variety, from innovative birth centres and rigid routines and protocols in busy hospital “delivery suites”.

I will be “off the air” for a few days, while I travel and then recover over the weekend. I will be keen to see what awaits in the Sydney office on Monday.....

Posted by andrea at 01:37 AM | Comments (0)