Articles by Month: September 2005

THE Childbirth eduction Conference for Australians

Birth International has just announced the first Preparing for Birth and Parenthood Conference is being held in Sydney in February 2006. Modelled on their similar program presented in the UK in April 2005, the unique format of this event offers participants the chance to develop their skills in “hands-on” workshop sessions on six topics of their choice. Intended to avoid the “talk-fest” that characterises most Conferences, this program aims to give educators to chance to experience new strategies they can use in the education of expectant parents.

There will be some short plenary sessions and we have invited some special speakers to address issues vital to the development and success of antenatal courses for parents.

Mary Nolan is well known in the UK as a leading educator and has written a number of best-selling titles on the theme of parent education, which she has studied extensively.

Sherokee Ilse is a leading educator in the field of loss and bereavement in the US, where she has presented hundred of workshops for health professionals who must deal with stillbirth, miscarriage and neonatal death as part of their professional lives. She too has written many books, for both parents and their care givers, and while she is in Australia there will be some additional workshops available for midwives dealing with these issues.

The other speakers have been chosen for their proven expertise and extensive experience in facilitating parent education and also in the training of new educators. All have teaching qualifications in addition to their midwifery or health education backgrounds and their contributions will guarantees top quality workshop content.

This will be the highlight of the year for childbirth and parenting educators in Australia.

Posted by andrea at 08:44 AM

Let's get the language right

Last night the ABC’s 7.30 Report has a long awaited item on the battle between midwives and obstetricians. The report stemmed from a Conference held in Newcastle a couple of weeks ago, where the arguments for birth centres and midwifery-only hospitals were forcefully presented by a team of midwives. A number of obstetricians were in the audience as well, and I gather it was a lively affair, with the midwives clearly winning over many sceptical obstetricians to the idea that maternity hospitals staffed only by midwives were not only safe, but a necessary option so that women could have true choice in how they gave birth.

As these developments gain pace in Australia, I am concerned about the adoption of the term “midwifery led units”to describe a service run entirely by midwives. This terminology has come from the UK, where it is widely used to describe services we have always called “birth centres”. In the UK a Birth Centre has come to mean anywhere that women have babies and the term has been co-opted to convey a false sense of security and promise, especially when applied to regular hospital labour wards, as it does, for example at Guys and St Thomas’ Hospital in London. The British are not particularly sensitive to the nuances of the impact of language and seem incapable and unwilling to adopt more woman friendly terms such as “birth” instead of “delivery”. Their use of “midwifery led units” seems to me to reflect their obsession with power and status in the wider sense and the need for midwives to see themselves at the top of a tree, alongside the doctors (and perhaps at women’s expense).

My beef about the term “midwifery led unit” is that it once again puts the emphasis on the midwife and not the woman. It gives status and power to midwives this time, instead of the doctors who normally preside over “delivery suites”. I know that those developing these new maternity services are not intent on taking the control away from women, and I know that they are motivated by very woman-centred philosophies. I am therefore making a plea that we adopt some other term in Australia, as recognition that these new maternity units are of benefit to ALL women, both the pregnant ones and those caring for them.

Could we not continue with our traditional term of “Birth Centre” or just use “Maternity Unit”, or perhaps something else?

Posted by andrea at 08:45 AM

Midwifery legislation in South Australia

Sandra Kanck is a politician (Democrats) in South Australia who really understands midwifery. For many years she has championed their cause, attending their functions, officiating at special midwifery events and working hard in the Parliament to have midwifery recognised through legislation.

Today I have received a Press Release from her office, announcing a very important step forward along the road towards the acceptance of midwifery as a mainstream healthcare option for women in SA. This is what is says:

Wednesday 14th September 2005

OF MIDWIFE BORN

In a "cut to the chase, Minister" move South Australian Democrats Leader, Sandra Kanck, will today introduce the Midwives Bill 2005.

"This legislation is long overdue," says Ms Kanck.

"South Australian women want and deserve better access to midwifery services and this legislation is needed to ensure that happens. Witness the number of women clamouring for the limited places in the WCH Midwifery Group Practice.

"Further it makes sense, from a public policy perspective, for an increasing number of births to be managed by midwives rather than obstetricians

"Obstetricians are the experts best able to handle high-risk, abnormal and complex births. Midwives provide expert, highly cost-effective care to healthy women during pregnancy, birth and during the post-partum period.

"Since the beginning of this year South Australia has had a group of Midwives who are licensed to practice under the Nurses Act but who are not trained as nurses; they are graduates of direct-entry midwifery courses.

"The Bill provides for the registration of midwives and midwifery students; to regulate midwifery for the purpose of maintaining high standards of competence and conduct by midwives and midwifery students in South Australia; and for other purposes.

"It's not really controversial yet getting the Rann Government to support this legislation has proven a most difficult birth process.

"This Bill will pave the way for SA's own purpose-trained midwives to be registered, recognised and regulated in their own right," said Ms Kanck.

I am not sure how long it will take for this legislation to pass (let’s hope that it does), but it is wonderful step forward. South Australians are lucky to have such support in the Government.

Posted by andrea at 04:56 PM

Caesarean Awareness Day

I had a day trip to Adelaide yesterday (Sunday September 11) for the National Caesarean Awareness Day event organised by CARES SA. Every year, a national campaign is mounted to alert the community to the incidence and implications f caesarean birth, and to encourage women to think about VBAC as an alternative.

CARES (Caesarean Awareness Recovery Education and Support) is an active group in South Australia who also work to co-ordinate a number of activities around the country. The event in Adelaide was a one day seminar, that featured a local obstetrician, Dr Brian Peat and a midwife from the Women’s and Children’s Hospital, Megan Farnhill in the morning and myself doing a three hours active birth program in the afternoon.

Brian Peat spoke about the statistics surrounding Caesarean rates (now 30% in Adelaide), VBAC, and their attendant risks. He produced a graph showing that after 39 weeks, the rates of complications for birth and babies rose in an almost vertical line. The figures had been compiled from reviewing a number of trial and studies and he used it to suggest that perhaps all births should be induced at 39 weeks, if the best outcomes for all were to be obtained. This was an alarming suggestion that had the audience of expectant parents wondering what was going on. On the other hand, he said several times that women should be left to decide for themselves what they wanted and that he was very supportive of VBAC, midwifery care and natural births. His argument was that it was his role, as an obstetrician to give the facts and statistics to those who asked, and in his opinion, these were the figures that he felt obliged to reveal when questioned. Most women, if faced with this information would be more willing to be induced, especially if it was stated that this would result in better outcomes. Of course, the whole argument rests on being able to accurately predict due dates, which in itself is a very inexact science, and may well contribute to the unexpectedly poor outcomes for some babies who might be premature as a result of such a policy of routine induction at 39 weeks.

Fortunately, Megan was able to show that midwifery care gave much better results than care by obstetricians, especially when women were able to have their own midwife, as now happens withing the team program that operates at the Women’s and Children’s Hospital. This program, which has now been going for 18 months has been an outstanding success. One of its biggest advantages is that they will accept women with all levels of risk, overseeing their care and continuing even if medical help is required. The team midwifery service has proven to be enormously popular, and it is hoped that more midwives will join the program so that the many women who are turned away each month can be accommodated. It is certainly a service that women want.

The afternoon was fun, and we explored how women can give themselves the best chance of having a natural birth through taking action in four areas:

1. Trust your ability to give birth and trust your baby.
2. Choose a caregiver wisely - they will have the greatest influence over what happen on the birth day.
3. Stay upright to maximise mobility and enable the body work as it is designed to do.
4. Take no medications - they will affect mobility, impact on the ability to behave instinctively and affect the baby’s well being.

We had some fun exploring these four steps and experimenting with different positions and of course, working out how to use the pelvic to best effect during labour and birth. Armed with a few ideas and the support of CARES, friends and family, I feel sure that the many expectant parents who came along will go away thinking more positively about planning for a natural birth. I am sure that most will achieve this as well. A great day out!

Posted by andrea at 08:49 AM

Midwifery aid projects in Ethiopia

I have received the following letter from Zeshi Fisher in South Australia, and she has given me permission to reprint it here, so that others may learn of the humanitarian work being done in Africa.

"I am a 3yr bachelor of midwifery student in my final year at the Flinders University of South Australia. Over the summer period December 2004 – February 2005, I was involved in the creation and development of a health post and education centre in the northern desert regions of Ethiopia, known as the Afar. Four friends and I initiated the project and completed it with the help of financial support through private donations and other small-scale fundraising activities.

The Afar is a place of extreme need in all aspects of health and education. It was our hope to provide a place from where a women’s extension worker (WEW), and/or community health worker (CHW) could provide basic health care and education to the nomadic communities who live in the region. The health of Afar women is especially fragile. Female genital cutting (FGC) is performed on almost every young girl, causing her to suffer multifaceted implications for the rest of her life. The maternal and infant morbidity and mortality is devastating, with each woman facing a 1 in 7 chance of dying in childbirth. These women predominantly birth in their villages accompanied by traditional birth attendants (TBAs) or relatives, and receive no or very little care before and after the birth.

An Australian midwife, Valerie Browning, has been working to improve the well-being of Afar women for many years. She has founded an NGO called Afar Pastoralist Development Assn. (APDA), which is instrumental in the development of health and education strategies for the Afar people, particularly through their work with women as a central aspect of functional and healthy communities.

One important aspect of APDA’s work is the training of WEWs and TBAs from the community to enable them to take skills and travel with their nomadic families. In order to provide the birth attendants with an understanding of the birth processes, I would like to take 15-20 foetal model dolls (dark brown) and pelvises to Ethiopia to give to APDA for the purpose of enhancing their training programs. At present they have little if any educational tools with which to work.

I am hoping to raise the money needed to purchase these dolls, and I am aware that Birth International sells model pelvis & foetal doll sets for AUS$175. It is my hope that Birth International may be able to provide me with a reduction of price if not a donation for the purpose of this cause. It would be enormously appreciated not only by myself, but also by the birth attendants and birthing women of the Afar Region of Ethiopia who will subsequently be able to enjoy improved care and birthing outcomes as a result of this education".

Of course Birth International will help her with this project, as we have with others of this nature. When you look at the conditions in which women and babies have to live in many parts of the world, it seems the very least that we can do. It is especially uplifting that our midwifery students are involved in projects of this kind - a mighty effort, given their study workloads.

Posted by andrea at 12:34 PM