Articles by Month: June 2005

Midwifery in Salford

I’m travelling back to London tonight, on a delayed train (what’s new?). The workshop in Salford was a challenge in some ways - most of these midwives seemed really challenged by the ideas I presented and expressed little faith that women can give birth without their assistance, usually in the form of drugs for the pain. There were several times when they fell into that trap of making excuses for their attitudes: “our women are not like that - they expect something for the pain”, “the women we get are not capable of managing without help”, “the women we have in our unit are not prepared for birth - they expect us to take over” etc. It is hard not to be totally frustrated by this negative, patronising and insensitive attitude, but I hope I have managed to inspire them to give it a try. .

We talked about the idea of “with holding” assistance in transition - where midwives acknowledge and accept the this is the hardest part of labour and gently nurture women through the hard yards whilst not yielding to the temptation of giving drugs. I pointed out that the giving of drugs was the medical model of care, a remedy offered by people who had nothing else to offer. We talked about the normality of women “losing it” in at this time, and the welcome signs of progression in labour, even if they seemed turbulent and out of control. The impression I had was that whilst most of these midwives knew what I was talking about, they lacked the confidence and trust in women to try this tactic, even if they knew the benefit for women in achieving a natural birth would be worth the effort.

Some of these midwives were very familiar with homebirth, although the giving of Entonox at home births was an accepted practice. One midwife told me how she was prepared to place herself on call as back up for other community midwives in her area who attended home birth because some of them tried to practice midwifery in the home as thought they were in hospital. She talked about going through their “delivery” bags and tossing out all the hospital paraphernalia they had included for “just in case” She was concerned, and knew from a lot of personal experience that you can’t manage a birth at home as though it was a hospital - this was a recipe for creating problems.

Another midwife in the group told me about her work with the refugees that are housed in nearby Salford reception Centre. This is one of the main places that newly arrived immigrants are sent when they come into the country. They are held for two weeks while being assessed, and then sent on to other centres for rehousing or reprocessing. Quite a few of these women are pregnant, usually as the result of rape, by one or several men. If they are well advanced in the their pregnancies, her team requests that they stay at Salford where the team can continue to take care of her, thus removing the need for the woman to get to know a new group of health professionals. This midwife was very concerned that the way these women may be treated in labour may be interpreted as another form of rape - incarcerated in a strange environment, surrounded by people (sometimes men) who don’t speak her language and subjected to procedures that could be interpreted as hostile and unfriendly. The cultural needs of refugee women need to be respected and their terrible histories treated with sensitivity, so that the birth of the baby can be a time of healing, not of further humiliation. Homebirth seems the best option for these women - keeping them out of the system, in a place that although is not their real home at least is more familiar and comfortable and where she can be accompanied by friends or others from her community. I was very impressed by this midwife’s grasp of the importance of birth to women and these ones in particular and I hope she is able to implement to services they require.

I feel sure I have left this group with much food for thought. It will be interesting to read their evaluations when I get to London and to see what they have learned from these two days.......

Posted by andrea at 05:11 PM

The dreaded "d" word

This trip to Britain is proving as interesting as ever. I’ve been keeping in touch with developments at home via the ozmidwifery mailing list and this has been very useful . Several times I have been able to tell British midwives the story of how Mareeba Midwifery Service was saved and also about the Townsville Birth Centre - the idea of women working with midwives is still very “foreign” here and to work so effectively to save or implement new services would be unheard of. When I told one group that the women had actually drawn up the architectural plans for their own birth centre (Townsville) they were amazed.

The group here in Salford (Manchester) have a variety of experience, but mostly in this area. Many work in the community and there is also a Birth Centre in Salford which sounds very good. They still use Entonox however, and as one midwife said “they didn’t think they could manage without it”. Once again I was astounded that midwives who profess to be working in a Birth Centre would consider that the use any drugs was acceptable. This was the moment to tell them the story about the hazards of nitrous oxide. The article I have written for The Practising Midwife on the risks to midwives of using nitrous oxide is at the final page proof stage and will be published in a few weeks.

We had the usual discussion about the use of language and the need to be “woman friendly” and “woman centred” in midwifery care. Even when we have talked extensively about the implications of the word “delivery” and the need to drop this in favour of “birth”, British midwives seem incapable of making any changes. One day I will start a system of penalties, and ask everyone to put 50 pence in a jar every time they use the “delivery” word during the program. The profit (and I anticipate a healthy sum) I can give to an appropriate charity.

Posted by andrea at 04:08 AM

Home from Home in Drogheda

During the lunch break on the second day of the workshop in Drogheda I had an opportunity to see the new Midwifery Led Unit (MLU). It was delightful!

It is accessed at the end of the regular labour ward. A pair of double doors open into the Unit, and the contrast is immediate and uplifting. The main labour ward offers the usual rather clinical appearance, typical of most I have seen. The MLU is decorated in shades of lemon, giving a bright and airy feel. The furniture is all colour co-ordinated, with simple wooden pieces and comfy lounges.

There are two birthing rooms, each has a large oval pool and en-suite bathroom with toilet and shower. Birth stools, birth ball and mats are all handy and it all looks very cosy. The only thing missing are some tea-making facilities and a fridge, so that some food can be kept for labouring women and their support people. It seems that the Occupational Health and Safety people have been busy in Drogheda, banning adults from using kettles and microwaves - goodness, they might scald themselves!

A Birth Centre aims to be as home like as possible - how on earth can this be achieved if there are no food and drink preparation facilities? I feel sure that the midwives in Drogheda will find some way around this silly impasse - it is the last thing that they need to put in place.

I really enjoyed my brief stay and I wish them every success in this new venture. I know that the rest of Ireland is watching their progress and when women elsewhere see what is available to labouring women in Drogheda, there will be demands for more units of this kind.

Posted by andrea at 12:17 AM

The Midwifery Led Unit in Drogheda

It was exciting to hear that the Midwifery Led Unit (MLU) is finally operating here in Drogheda. This project has been under discussion for a number of years and each time I have visited they have been hoping that it would be starting “soon”. It is now open in two centres, Our Lady of Lourdes Hospital in Drogheda and the Maternity Unit in Cavan, a town nearby. They are approaching their 100th birth in Drogheda and 40th birth in Cavan.

This project is rather unusual, in that it has been set up as a randomised controlled trial. Women who meet a very strict criteria for entrance are randomly allocated to standard care or MLU care and the aim is to recruit around 1800 women into the study. If the results provide positive, the intention is to roll this type of service out across the country, enabling some of the smaller hospitals to stay open, as midwifery services.

In preparation for the study, two birth rooms were prepared in Our Lady of Lourdes Hospital, so that women could labour in “birth centre” surroundings. I haven’t seen these as yet, but may be able to sneak a look today before I leave.

Although this style of care is proving popular wit the women, there are some real problems. The hospital in Drogheda is experiencing staff shortages, and the midwives in the MLU are regularly being taken away from their centre to staff other areas of the maternity unit. This means that there are times when there are too few midwives staffing the MLU - surely a potential risk, both in absolute terms and also for the effectiveness of the study. Many of the midwives I’ve spoken to have expressed concern at this policy, and resent the lack of support from mainstream hospital managers.

The other major problem is that this is a study project, with a limited time frame and a separate budget. Unless there is a very firm commitment from the Government, the Hospitals and the Department of Health, there is a strong chance that the funding will be withdrawn and the MLU will close as soon as the study is complete. This was a common outcome in the UK, when the many pilot projects established after the release of the Cumberledge Report in 1992 were closed as soon as their funding ran out. Many pregnant women found themselves suddenly without a promised service, and many midwives were pitched back into mainstream midwifery when they were beginning to establish themselves as autonomous practitioners in their own dedicated units.

It would be a tragedy if this was to happen in Ireland, a country not known for its innovative approach to maternity services. This project is a worthwhile first, and even if the results are outstanding (in terms of birth outcomes and satisfaction of the women) it seems to already be subject to resistance at top levels. The midwifery team and the doctors who are part of the study are enthusiastic, but this may not be enough to save them when it comes to finding the money to keep the service open once the study is complete.

I have suggested that the midwives become politically active, collecting and cultivating support at the highest levels possible. This “insurance” may become necessary, and it is useful to let management know that the community wants this service to continue, right form the start. The women who have used the MLU will be best source of support and the planned party to celebrate the first 100 births will be a good opportunity to enlist their support.

I have also encouraged them to learn from the experience of other midwifery services who have faced similar problems. There have been many, and picking up a few tips from them would make sense. It is hard to re-establish a closed service - better to prevent it from being closed in the first place.

Posted by andrea at 05:50 PM

A midwifery student Conference in Ormskirk

The Conference in Ormskirk was titled “Investing in Students: The Future of Midwifery” and was billed as the first of its kind. It was terrific to see 140 bright and eager students, together with their lecturers and mentors gathered in the beautiful setting of the Edge Hill Faculty of Health Sciences.

The program had been planned around three guest speakers (myself, Jo Alexander from Bournemouth University and Thelma Sackman, a Health Visitor) with a number of students presenting their work in a variety of areas.

The quality of the student presentations was outstanding. Apart from their very adept use of the technology (very smart Powerpoint presentations that put mine to shame) they covered areas that were of general concern to all: Effective ways of managing early labour at home; student advocacy, the use of partograms, mental health for postnatal women and a lively debate on the topic “That women are able to make an informed choice in childbirth”. Perhaps, not surprisingly, the debate was won by the negative, although the positive case was put persuasively. I think that experience, rather than the quality of the presented arguments, was the deciding factor here.

I came away feeling that if the future of midwifery rests with students of this calibre, then we have little to fear about the future of the profession and much to look forward to. It was a very well run and exciting day.

It’s back to Ireland next - to Drogheda, a place I have visited many times before. I wonder what this visit will reveal?

Posted by andrea at 06:08 PM

A small peep into birth in Uganda

This weekend I have been working with a group in London. As often happens, this central location attracts people from everywhere, and this group was no exception - we had many hospitals represented. One childbirth educator had travelled from Uganda, on her way home to Seattle in the US for a holiday.

She had been working as an educator in Uganda for 11 years, staying on after her first visit to assist in an immunisation program. She had some very interesting stories to tell about Uganda, where the epidural rate is zero (except for Caesareans). Women labour without drugs on the whole (pethidine is sometimes offered) and are encouraged to drink warm sweet black tea during labour.

This raised some amused reactions from the others in the group, especially those where restrictions on food and drink in labour are still rigidly enforced. As in most developing countries, women labour in communal labour rooms, where privacy is hard to come by and packing safety pins to keep the scanty curtains closed is a must. This educator was surprised to learn that all women in Britain, for example, can expect to have their own room for labour and birth. Many of the ideas we discussed about ensuring that women get the privacy they need to labour comfortably would be hard to implement in places like Uganda, but then again, they are not used to it and may in fact gain comfort from having other women nearby. I have even heard of women egging each other on, when labouring in small groups like this. Unthinkable in Britain!

My next stop is in Ormskirk, near Liverpool, where I will be presenting a paper at a Conference for student midwives. This will be fun - it is always a pleasure to be amongst the bright-eyed and bushy- tailed student group, eager to change the world of midwifery.

Posted by andrea at 07:03 PM

Birth in Palestine - checkpoint tragedies

It seems that giving birth in Palestine is a very uncertain proposition. The midwives I worked with in East Jerusalem were lovely, but having great difficulty in offering the kind of services they wanted, not only because of the domination of the medical profession, but also because of the political situation. The day I was there was the last of a four day Jewish religious holiday, and the Israelis has closed down the entire Gaza strip, so that no-one could leave that area. There was also a major clamp down in the West Bank, restricting travel severely. Consequently, no midwives could come from Gaza and many from West Bank towns were late because of the lengthy delays at checkpoints.

The heavy handed operation of the checkpoints, especially as it affects pregnant women, has been widely criticised. For many women, their nearest hospital is now located on the other side of the infamous wall that Israel has build around their country, so to receive pregnancy care, or to give birth, negotiating the checkpoints becomes a necessity.

I have been given a copy of a report on the situation entitled “Birth and Death at Checkpoints” prepared by the Foundation for Health and Social Development. It is harrowing reading, as it documents the violations of the human rights of pregnant and labouring women in the period between April 2002 and October 2002, when the Occupation Forces of Israel started invading the cities in Palestine and isolating them from their surroundings. Reports started coming in of women giving birth at the checkpoints because they were not being allowed through and of ambulances being stopped from passing. As these news stories broke in the media, the Foundation started a survey, targeting all the Reproductive Health Workers, and used their feedback to compile the report. From this data is was discovered that 54 women had given birth at checkpoints and at least 22 newborns had died at checkpoints during this period.

The Report lists the provisions in the 1951 Fourth Geneva Convention that relate to the safety of the sick, wounded and expectant mothers. This Convention was signed by Israel, but it now claims that it does not apply to the Occupied Territories, and as a result they have violated every one of the provision designed to protect citizens in a time of war. For the pregnant women, the results have been disastrous.

A number of individual stories are included in the report. I will give you just two, to illustrate the kind of terrible conditions that these women are being forced to bear:

”In Alyasamina Neighbourhood in the Old City of Nablus, we heard the story of “Wisam”. She is a 20 year old woman. In April 2002, during the first Israeli incursions into the area, the young mother went through labour as the whole area was placed under strict curfew. Israeli solders with fearful voices and gloomy faces, thirsty to kill and destroy, filled up the streets with their heavy arms. “Wisam” went out of her house with unbearable pain heading towards the solders hoping to find a compassionate reaction to her situation. But, no way.... A soldier shouts at her, ordering her to go wherever she came from; “I do not care what you are going through”, he yelled... she ties again and again, begging them to let her walk to the healthcare centre while her pains mountain. She falls to the ground unable to endure the pain.... Finally she is allowed to go, but the ambulance is not permitted to pick her up. She walks to the hospital about one and a half kilometres away; arrives there exhausted to deliver her baby through a caesarean operation”.

”On June 10, 2002, “Nisreen”- who was none months pregnant - decided to visit her family in Ramallah. This was bad timing; the whole area was moaning under curfew...Even hospitals were surrounded with Israeli military machinery.. Every single soul was encircled. It was forbidden to get into Ramallah from outside, under any circumstance. With hearts of steel, tanks do not move. The baby inside is calling for her right to life. This child rushes out... she does not want to wait. The mother’s water broke, announcing the time of the delivery. Like any other family in this situation, an ambulance is called to transport the mother and child to the nearest hospital and there are many hospitals in Ramallah. At that moment they were all distant.... The curfew was strict rendering the whole city as a city of ghosts. Ambulances were parked with no paramedics or doctors. They were paralized, prevented from moving a single inch. “Nisreen” could not find any lift to hospital. Fears grew until and ambulance was finally allowed to take her to the obstetrician clinic in Qalandia. Arriving there, the care centre was empty. No doctor or nurse was allowed to enter. Perplexed, the ambulance driver - with wishful thinking - thought that delivery is an emergency case that would be allowed to cross the detestable checkpoints and go to Almaqased hospital. They arrive at the checkpoint. Soldiers stop them under the pretense that the car has no entry permit. All attempts to cross failed. The baby - at this very moment - pushed her feet out of the mother. The mother’s condition became critical. The ambulance went round the empty streets. At the entrance to Qalandia Refugee Camp, another ambulance was waiting for a martyr or a wounded or an expectant mother in serious condition. They asked the driver about the permit and the driver said he had one. In a sigh of relief, the mother is transported from one ambulance to another and reaches the stubborn checkpoint another time...she is still denied access... till, with all the shyness of the world, had to uncover the baby’s arrival. She had to show her baby that was persisting to come to life, there at the very checkpoint. She is finally allowed to cross.”

These stories are two of a number that are included in the report. They include tales of babies dying because their mothers could not get help for them, and women bleeding to death because they could not be transported to a hospital. It is unthinkable that these women should be denied care and these tragedies should be allowed to happen.

In Israel, everyone must complete two years (girls) and three years( boys) military training, right after they complete high school. I imagine that many of these solders at checkpoints are therefore young, probably aged 18, 19 or 20. What kind of effect must this kind of brutal behaviour have on them? How can they deal with this kind of horror? I wonder how women feel about their children committing these kinds of atrocities against women - this must surely have an impact on the dynamics within a family, let alone the community as a whole.

It is a sad commentary on the way humans can treat each other, especially in a land that proclaims to be a cradle of Christianity......

Posted by andrea at 08:49 AM

Getting labour started in Israel

It has been a very busy and productive week, spent in Israel. I have had a wonderful day with a group of Palestinian midwives in East Jerusalem (more on this in the next Diary entry) and presented a paper on “The Power of Undisturbed Birth” at a conference in Nazareth on the theme of pain in labour, hosted by the Israeli Childbirth Education Association.

There was also a two day workshop for educators, doulas and midwives on “Active Birth”., also in Nazareth. I have learned much about women and birth in Israel (again!) and have enjoyed my interaction with educators and midwives from Jewish, Muslim and Arabic backgrounds.

One interesting technique that was discussed by the midwives was the use of the “ATAD”, a balloon device that is inserted into a woman’s cervix to initiate labour. The balloon is inflated to open the cervix to a certain point (not sure how far - this was not indicated) and then she is left to wait for the labour to start on its own. The device has a “tail” that is attached to her leg. If the technique is effective, the device will fall out when the cervix is larger than the balloon - this may take a number of hours. It is apparently painful for the woman initially, but avoids the use of prostaglanden gel, which is considered to be more risky. I was told that women tolerate this technique (named after the man who invented it), and that it is in common use.

I also learned that dates are considered to have oxytocic effects, and that women in early labour often feast on dates to stimulate their contractions. Now this sounds like a much more pleasant way to get labour going!

Posted by andrea at 02:00 AM

En route to Israel, via London

Back in London this weekend, at the start of another month of workshops around the UK. Once again, I am staying with my old friend Caroline Flint, who has been terribly ill with a form of hepatitis for the last 6 weeks, Those of you who know this energetic wonder-woman and her busy midwifery practise would be surprised to hear that she has had to spend the last six weeks in bed, as she fights the effects of the hepatitis. At this stage, medical science has not yet identified what kind if hepatitis it is, but at least the scans she has had have not revealed anything sinister and at this stage it is thought that she is probably suffering from a viral form of hepatitis, possibly picked up in a hospital.

Meanwhile, I am recovering from the trip for 24 hours before heading back to Heathrow for the overnight trip to Israel, where I will be presenting at a Conference and facilitating two workshops, one for Palestinian midwives and the other for Israeli educators, doulas and midwives. This promises to be a fascinating week, and one where I hope to gain a lot of insight, especially into the Palestinian situation, which I have heard is far from good for labouring women. I’ll let you know what I discover.

Posted by andrea at 03:03 AM

Creating risks at twin births

I had a long conversation today with a woman who was 33 weeks pregnant and expecting twins. At this stage, both babies were thought to be breech and she had read the article I had posted on the website regarding turning breech babies, an decided to phone me to disucss it further.

This woman, well read, articulate and clear in her feeling that everything would be normal with this labour and birth, was meeting the usual negativity from the doctor at the hospital. She had chosen this maternity unit with care, liking its small size and the positive attitude of the midwives on the staff. The larger referral hospital, which is actually closer to her home, she felt was too large to enable personal care and she wanted to avoid finding herself on a treadmill of obstetric policy and medical management.

Her first battle was to negotiate being able to see the midwives for pregnancy check-ups not just the doctor. Her twin pregnancy has tipped her into the “high risk” category and it was assumed that she would just follow the normal path - obstetric care and an elective caesarean. This is precisely what she wants to avoid, and she is receiving good support from the midwives, who have stated that if all is well, she can expect to have a straightforward vaginal birth (as long as she avoids the one doctor in the unit).

The doctor’s attitude has been to emphasis that the babies need to be carefully looked after, especially at the birth and that is why a caesarean is recommended, because a full team of specialists can be guaranteed. I explained (in fact she already knew) that if she went into labour naturally, she would avoid the first major obstacle that most twins face - that of prematurity. The labour contractions themselves would help to ready the babies’ lungs for breathing spontaneously (a second major hazard, and a common problem after elective caesareans), and so she thought, quite reasonably, that if had a spontaneous vaginal birth she would have much less chance of needing the full paediatric team. If an emergency did occur, help would be found, as it always is in a hospital, and if there was some delay, then that was a risk she was prepared to take.

The doctor was also insisting that she have serial ultrasounds to check on the babies’ growth. I explained that no test should be undertaken unless the results were likely to alter the management plan, and that just “having a look” was a poor reason for overexposure of the babies to unnecessary ultrasound. She agreed, having researched this topic herself in some detail.

We discussed the issue of encouraging the baby to turn, and I suggested that she consider using the Moxa Sticks to achieve this outcome. This is worth a try, and if successful, should eliminate the pressure for the elective caesarean. We also talked about her need to surround herself with people who are confident and supportive, and if that means missing a few visits to the doctor (whilst keeping her midwifery appointments) then that was an option she could consider. She liked the sound of that idea.

Why is such a fuss made about twin births? This woman became pregnant at the first try, is in excellent health, the babies are growing well and she is confident and happy about having two babies instead of one. She is knowledgeable and trusting of herself and nature. Yes, her babies may be breech now, but they may turn, and it is too early to know what will happen as her pregnancy nears term. It is morally unacceptable that she be coerced into the medical model of care when she neither wants or needs it. I hope she can stay strong and that everything turns out as it should - a normal vaginal birth with midwives doing the honours. As I said to her, she will have quite a story to tell after this is all over!

Posted by andrea at 05:39 PM

Midwives and obstetricians at loggerheads again in Queensland

Over the past two weeks there has been an amazing media stoush between Dr Molloy, the past President of the Queensland State Branch of the Australian Medical Association and midwives, primarily those working in the Birth Centre at the Royal Brisbane Women’s Hospital. Dr Molloy is known as the most vocal Australian proponent of caesarean births for all women and reportedly has a 100% caesarean section rate in his private practice.

A bit of background - this is the only Birth Centre in Brisbane, Queensland, the last state to get such a unit. The local obstetricians have fought the development of midwifery services in this State over many years and have waged an active campaign to discredit midwives, especially those who have offered home birth services. This “witch hunt” has been well documented and has given rise to many clashes in the media and some colourful public protests, such as the time a washing line of baby’s clothes was strung across the front of the Government House as part of a protest march.

Recently, Dr Molloy issued a statement that the Birth Centre at the RBHW was a “killing field” and the centre was being very poorly run, placing mothers and babies at risk. This was hotly refuted, and after pressure was applied (no doubt by his colleagues) he retracted the statement, saying that he was “just repeating what others were saying”.

Eventually, a Press Release came out from the State Branch of the Australian College of Midwives, following the release of a report into the running of the Birth Centre. It is worth reproducing the Press Release here, as it highlights very clearly the antics that go on behind the scenes when the medical establishment and hospitals collude to restrict options for birthing women. Jenny Gamble is a midwife (with a PhD), and is State President of ACMI in Queensland.

The report highlights “That there were widespread system issues and a culture that is actively unsupportive of a midwife-led service that meets consumer expectations and demands”. This has been occurring despite there being significant unmet consumer demand for continuity of care by midwives with 3 times as many women being turned away from the Birth Centre than are accepted.

Problems highlighted by the report include inadequate allocation of resources to the Birth Centre, lack of support by management for evidence based clinical guidelines and policies, and lack of commitment within the wider hospital to the collaborative approach necessary to ensure the Birth Centre is able to provide the best possible care to all women.

“Birth Centre Midwives have been alerting management for years to the lack of collegiality and respect from some obstetricians and trainees towards Birth Centre midwives and the women they care for” Dr Gamble said. “The College understands that formal complaints about some obstetricians refusing to treat a labouring woman referred to them by Birth Centre midwives have never been responded to.”

“We call on Queensland Health to ensure the recommendations are fully implemented” Dr Gamble said, “Midwives at the Birth Centre have been calling for many of the recommendations to be implemented for many years, but have been repeatedly ignored” “For example, midwives have been keen to provide care to women from early in pregnancy until a month after the baby is born as the Report recommends, but have been prevented from doing so.” said Dr Gamble. ”Midwives have also been urging management to adopt evidence based policies and guidelines, like national referral guidelines, without success.”

Lack of management transparency is another problem flagged in the report. “At the moment it looks like implementation of the recommendations will be managed unaccountably by RBWH Executive, when it is on their watch that these problems have persisted” Dr Gamble said.

“Only with a transparent and consultative process for implementation, that includes representatives of consumers, Birth Centre midwives, obstetricians and Department of Health officials--not just senior RBWH management--will the public be able to have confidence that we’re not just in for more of the same” Dr Gamble said. “The Report has confirmed that the service at the Birth Centre is safe, cost effective and popular with women.”

“In line with Dr Cherrell Hirst’s recent recommendations for state-wide maternity services [the recently released State Government Enquiry into Obstetric Services in Queensland- ed], it’s time the Birth Centre at the Royal was properly resourced, supported and respected so that women who seek continuity of care from midwife can be confident of the highest standards of care whether or not they experience a straight forward labour and birth” Dr Gamble said.

The battle goes on.....

Posted by andrea at 06:24 PM

Birth videos for black women

A customer in Malawi has been in touch regarding some videos that she ordered. She was happy with some, but not all of the tapes we sent her, and her main complaint was that none of the birth videos showed black women giving birth. She used one tape with a group, who quickly became bored when the film only showed white women giving birth, and she felt that this was a problem that the film makers should have addressed.

In responding to her, I explained that finding any woman who would allow a camera into the birth was a rarity, especially if the finished film was to be used for public screenings. Her assumption that a video made in Australia would contain black women because we are “pretty multi-ethnic” was perhaps reasonable, except that we have very few black people in Australia and they are very protective of their birth culture. It is completely off limits to men, and women outside their immediate family. Filming them would be impossible and inappropriate.

We are always on the lookout for products that will be of use to our clients. If anyone knows of a good birth film, that shows black women giving birth naturally, and preferably with midwives, please let me know!

In the meantime, I have assured our client in Malawi that she can return the video for a credit or refund, as is our policy. I would dearly love to be able to send her a suitable substitute......

Posted by andrea at 02:30 PM

Celebrating ultrasound?

We save stamps in our office, for a charity that uses them for fundraising. As I was retrieving some stamps this morning, I cam across a new one I hadn’t seen before. It is obviously part of a series called “Australian Innovations”, and it carries the picture of a headless pregnant woman and the message “Ultrasound Imaging Equipment 1976".

I don’t know that Australia can lay claim to this innovation, as this stamp seems to imply, but it is interesting to think how ubiquitous this technology has become in maternity care over the last 30 years. It seems that every woman today has her pictures for the baby album, proudly taken before the child was even born. She may already know its sex and details of its health, which may or may not help her to prepare for the arrival of the baby.

There are fewer handicapped babies born these days, due to elective terminations of pregnancy. This has implications for our society in any ways, including reduced burdens of care for families and expensive health care support for the community. It may also alter the way we accept each other, adding emphasis to the perception that everyone must be “beautiful” and conform to some predetermined perception of what is acceptable in appearance and functionality in our society.

Ultrasound has also altered the way pregnancy is managed, with “due dates” forming the basis for the entire pregnancy management program. Millions of women are induced every day, because according to the ultrasound scan, they are “overdue”. Thus they join the cascade of intervention that inevitably unfolds, often at great detriment to themselves and their babies. Nothing much is left to chance and Nature these days!

Ultrasound has certainly opened up a whole new world. For those who would like to know more about the implications of ultrasound scanning on the unborn, the book Ultrasound Unsound is a good place to start.Who would have predicted that a technology, originally developed for use in submarines, would have such huge implications for the future of our society?

Posted by andrea at 12:02 PM