Articles by Month: October 2005

Knickers

The conversation turned to knickers on the last day of the workshop in Northern Ireland. We were talking about how we can help women feel safe in the hospital environment, so that their adrenaline will be as low as possible during labour, and their oxytocin and endorphin levels will remain high for a comfortable and efficient labour.

We were compiling a list of things that a woman may want to bring with her from home to make the hospital labour room more like home, and the issue of what she would wear during labour in was raised. Someone mentioned that nighties were preferred by women and I suggested that this would instantly make the woman feel like a hospital patient. How about an old T-shirt, or an old button up shirt, I suggested?

It then transpired that women were usually asked to take of their knickers when they were admitted and they were then left off for the duration of the labour. I was astonished. It was explained that this was necessary for the initial vaginal examination (mandatory) and then the rupturing of the membranes (also routine). When I asked how women then mopped up the inevitable dripping amniotic fluid that would appear with every contraction, I was told they would be asked to hold a sanitary pad between their legs! No wonder they stay on the bed and didn’t like to walk around, I suggested - how could any woman feel safe and at ease while trying valiantly to keep a possible soggy pad between their legs to prevent making a mess on the floor?

They were a bit stunned at this thought - I don’t think anyone had really considered the implications of this simple requirement for women to shed their knickers in labour. It is a good example of how routines can get established and be accepted without any consideration or re-evaluation. So many simple hospital practises fall into this category, of being performed by rote, on the basis of “it’s what we always do”.

I trust that these midwives, who were caring and considerate, will take another look at everything they do and put themselves into the position of the women in their care. Once you see things from the labouring woman’s perspective, it is easy to appreciate how a simple measure like asking her to keep her knickers on can make a huge difference to the way the labour unfolds. Of course, the routine vaginal examination and the rupturing of membranes was another topic for animated discussion, and that was another whole story!

Posted by andrea at 05:40 PM

Birth environments

Many years ago, I heard Michel Odent famously say “the right place to give birth would be the right place to make love”. At the time I was little surprised, but I realised he was right - the same hormones that are working to make a fantastic love making experience are also working during the birth process to make it work well too.

This issue came up today, at the workshop I am facilitating in Northern Ireland. We had been watching a video “Giving Birth-Challenges and Choices” and afterwards a comment was made that is was “very American”. When I probed this reaction, it was explained that “Irish women wouldn’t take off their clothes like they did in the video”. In fact the woman in this video is fully clothed throughout and there are no intimate views. It transpired that some in the group felt that Irish women would never be as uninhibited as those in many videos, so I challenged them on this.

Reminding them that being instinctive is the basis of a physiological birth, and of the preceding discussion on the role of the hormones, especially oxytocin, during labour, I suggested that it was the environment that was at fault. I offered the observation that when women did feel safe, and undisturbed during labour they would, in many cases, quite naturally shed their clothes, just as they would when making love. There can come a point that clothes are a hindrance to spontaneous reaction and response, just as they are when making love.

One midwife said that she noticed this did happen when women gave birth at home. If we could create the right setting, women who had elected to go to hospital for labour may also be able to achieve the same freedoms and comfort that the home environment provides without effort. One thing that will definitely need to change, however, are some of the attitudes of hospital staff, who are uncomfortable, or perhaps unfamiliar with women’s instinctive labour behaviours.

We’ll explore the many ways that hospital environments can be modified to meet the needs of women during the program tomorrow. I’ve left the group with much food for thought tonight!

Posted by andrea at 05:49 AM

Fathers at the birth

There has been some interesting discussion on the ozmidwifery list amongst Aussie midwives (and others) about immediate postnatal routines, including when to cut the cord.

While reading the contributions about routines in various hospitals, it has become clear that dads usually cut the cord and that in many units, dads also catch the baby when it is born. This was an issue that arose in several of the workshops I have facilitated on this UK tour. I have discovered that it is very rare for dads to catch the baby, even in home births, in the UK, and the very idea was new to most midwives. Few have ever heard of a Lotus Birth either, something else we have been doing for years in Australia, when requested by parents.

My guess is that British midwives feel they must play a central role in all the births they attend, and that to encourage the baby’s father to be involved would be seen as giving up some of their territory. I must ask other groups about this - I expect I will be given various excuses such as “the men in this area wouldn’t want to do that”, “the fathers around here are useless and don’t want to get involved”, but I may be wrong and we will see.

I’ve found that attitudes to fathers are very poor overall in the UK. Men are seen as a “useless waste of space” (as I have been told a number of times) but then again they are routinely offered very limited prenatal preparation, so my guess is that the men would feel helpless in a hospital setting.

I now include one of the segments from that lovely video “The Art of Birth” in my workshops, specifically to draw attention to the impact that birth can have on fathers. The comments made by one dad illustrate beautifully how a great birth experience, where the dad has been fully included and supported, can have a powerful and lasting effect on his attitudes to women, birth and his own capacity to be a dad. We must never forget that the dad is half of the parenting team, and we must find ways of recognising his role and encouraging him to fully participate. Catching his baby at the birth is a great way to start.....

Posted by andrea at 02:56 AM

Caesarean birth and MRSA infection

While I have been here in the UK over these past three weeks, the issue of MRSA infection in hospital has come up several times in the British press. This infection is present in many units and vigorous efforts are being made at many levels to eradicate it, or at least contain it as far as possible.

One hospital I have visited had a stand at the front entrance with dispensers for an antibacterial gel that everyone entering was required to wipe over their hands to kill potential pathogens, and thus keep them out of the hospital environment. I couldn’t help thinking that I would want to use it on the way out as well, so that I didn’t take home one of the hospital’s potentially hazardous bugs!

The patients most at risk of an MRSA infection are those undergoing surgery. I wonder how long it will be before those women who are electing to have caesarean surgery are made fully aware of the added risks they are now facing from antibiotic resistant bacteria that they may pick up in hospital? The risk of infection following caesarean births has been known for many years, and has to be balanced against the life-saving potential of caesarean birth when an emergency does occur. However, the possible implications of an elective procedure, especially when a vaginal birth could avoid or reduce the morbidity associated with chronic infection, must be publicised so that women can make informed decisions.

Eventually, the presence of antibiotic resistant infections in hospitals may prove to be a selling point for home births. I remember the 1970s, when the advent of rooming-in in maternity hospitals was precipitated by Golden Staph infections found in the central nurseries on the post-natal wards. Maybe this will be another of those pivotal moments, and home will again be seen as a much safer place to give birth than the hospital. I await the first media report along these lines, but I am not holding my breath!

Posted by andrea at 10:29 PM

One-to-one midwifery

This has been a thoughtful group of midwives in Nuneaton, who between them have many years of experience and have seen many births. There was a lively discussion about the goal of “one woman, one midwife” that is a current campaign here in Britain.

One excuse given by Health Authorities in the UK for not actively encouraging home birth in many areas is that there are too few midwives to provide this service. They claim that if midwives are re-directed from the wards to home births, then women giving birth in hospitals will be at risk because of reduced levels of care.

Two midwives are required for a home birth in Britain. One takes care of the woman for the duration of the labour and the other is called when the birth is imminent. The principle is one midwife for the woman and another for the baby, in case there is a problem. This approach must assume that there is no other adult in the house, whereas usually there are several adults present who could call an ambulance, hold equipment, and assist the midwife in the unlikely event of a problem. In other countries, such as Australia, home birth midwives usually work on their own, and will call on others in te house to help should it be necessary. Why does the British system require two, when the rest of the world has shown that one can manage very well?

Another factor to consider is the dependence on the midwife that seems to have developed amongst British women. There is a view that the midwife needs to be present for the whole labour and I believe this is not healthy, for the midwife or the woman. In The Netherlands, Dutch homebirth midwives spend few hours at a home birth, coming and going during labour perhaps several times and then staying for a couple of hours after the baby arrives. Dutch women have learned they can manage labour themselves, without any drugs and relying solely on their own internal resources (endorphins) to get them through.

This issue of dependence needs consideration: women would benefit from learning they are capable, competent and strong, and labour provides the ideal opportunity for them to make this discovery. If the midwife is constantly hovering, listening to the fetal heart every fifteen minutes (slavishly following the non-evidence based NICE guidelines), making themselves indispensable to the woman and her family, is this healthy? Are we breeding a generation of women who are weak, lacking self-confidence, with low self esteem and a “poor me” mentality? Do the midwives (from a similar cultural background) need to be needed to boost their own egos and position?

I believe that women should be encouraged to labour by themselves (I don’t mean alone), using self-help strategies rather than developing a drug dependence and supported by a midwife who shows her trust in the process and the woman by keeping her distance. Women don’t need to be closely “monitored” when they labour physiologically, and the resulting boost to confidence and the realisation of one’s strength and capability is exactly what every new mother needs to kick start the nurturing of her new baby.

Posted by andrea at 08:28 PM

More on doulas

The issue of doulas came up again today, this time with the group in Nuneaton. These are experienced midwives from a number of hospitals, very well versed with active birth and familiar with homebirth and midwife led units. As I commented at the end of the first session - this may be one of the easiest programs I have ever facilitated!

One midwife raised the issue of doulas after we had viewed a video that includes comments from an American doula. Her feeling was that if the doula movement becomes established in the UK, then midwives will lose out, as the care offered by a doula was traditionally part of the midwife’s role and that if this is relinquished to a doula then the midwife will end up being little more than an obstetric nurse. There was general acceptance of this view within this group, although when I explained about the service being established in Hull, they readily agreement that this was a different situation altogether and was a very promising development for those in genuine need.

It seems that some women today feel that paying for personal care during labour could be seen as a status symbol - “look what I can afford”. Employing someone to pamper and attend to personal needs during labour is a statement about wealth, in much the same way as employing a servant. This may not be the overt intention, but may be a factor in the decision to engage a paid person rather than calling on friends and family, as has been the traditional way. I know that many women will say they have no family on which they can rely and that friends are too busy to help and that may be the case - we live in affluent times that enable us to travel, move easily and find work far from our childhood roots.

I also know that many women need a friend, someone with a genuine and long lasting interest in their well being. I am not sure that buying the services of a doula for a few weeks or even months will meet that need completely, but then some families will hire a nanny or place the children in child care and return to work, where friends abound, as the next step.

The role of the doula is a thorny and complex issue. These are a few random thoughts, amongst many mixed feelings. I can appreciate the sensitivities of midwives who feel supplanted by doulas and I understand that for some women, paying for social services and practical help is part of their approach to life. I will always promote the idea that babies are born into an extended family, and that finding ways of drawing in their ongoing support and experience is essential in building communities and a stable, caring society. I expect that others will hold different views, and so be it........

Posted by andrea at 08:25 PM

The Hull Volunteer Doula Project

I’ve been learning more about the Hull Volunteer Doula Project, which has just been launched. The program will train volunteer doulas who will be buddied up with vulnerable women in need of friendly support through their pregnancy, birth and post-partum period.

There is a high level of need for a service sch as this in Hull, and the impetus for setting it up has come from women and midwives in the area. It is co-ordinated through Sure Start, but will also work closely with the local maternity hospital and the community midwives in Hull.

To recruit the doulas, an advertisement was placed in the local newspaper. Free training, on-going support and the satisfaction of volunteer work was the carrot, and over 60 people applied for the first 10 positions. The final number in the first intake ended up as 11, and they had their first meeting last week.

The training will take place over two months, with my Active Birth workshop and 8 two hour sessions to follow. The doulas will be given training in pregnancy support, labour assistance and post-natal care. Once the training is complete and they have been assessed, they will be allocated to chosen women who are around six months pregnant, to follow them through for the rest of their pregnancies and then on into the early months with the new baby.

A second intake is planned for March next year, with both groups fully funded through Sure Start. It is an ambitious project and it will be interesting to see how it works. These doulas will not be paid for their work - it is a fully voluntary program, aimed at those who need support and have few financial resources. In this respect it is unique - all the other doula programs in the UK are geared for those who can pay for this service. These Hull doulas are also receiving more training that other doulas, which will be important as the women they will work with will have considerable needs.

Supporting other women during pregnancy and birth was always a traditional role for women in the village and it is good to see that these concepts are being resurrected, especially in an age when paying for services has become the norm. I hope this project is very successful and will make a difference to the women who receive the support as well as the doulas themselves.

Posted by andrea at 06:23 PM

Managing the transitional phase of labour

I have been very impressed by the midwives in Yeovil. This small hospital, where around 1200 babies are born each year, has a fine tradition of midwifery. Too small to have a neonatal intensive care unit, women with known complications before labour tend to book elsewhere, making the majority of women using this facility “low risk”.

The midwives seem to be a close knit group, well versed in midwifery know-how and keen to retain their skills and woman-centred approach. This would be an ideal unit for “midwifery-led”status.

One area we explored in some detail today was the management of the transitional phase of labour. We talked about the benefits of with holding medication during this turbulent and trying time in labour in favour of nudging women along, taking each contraction as it comes, in a “buying time” exercise. It can be hard to ignore loud demands for drugs and stay calm in the face of anxious and agitated dads.

The benefits, however, ca be amazing, as the woman struggles through the overwhelming sensations within her body to emerge ready, willing and able to tackle the second stage of labour. The moment of triumph straight after the birth, as she realises that she has mastered the hard-yards of labour is something to see, and the boost to her self confidence makes it all worthwhile.

Knowing that this outcome is possible and enabling it to happen is a cornerstone of midwifery care. I cannot imagine a better gift for a new mother: the knowledge and self-belief achieved through overcoming the rigours of labour. This is a gift that perhaps only midwives can bestow on birthing women - I hope they realise the importance of what they are offering and use every opportunity to make it happen.

Tomorrow I have a day in the office, then it is off to Hull for another workshop at the end of the week. I have been to Hull before and I am looking forward to hearing how they are doing in their new, combined midwifery unit.

Posted by andrea at 08:15 PM

Restricting food and fluid in labour

There was an opportunity to visit the Labour Ward in Yeovil Women’s Hospital after the workshop today. The labour rooms are large and well appointed, but it was a smaller area that was a little separate from the rest of the unit that really caught my attention.

This room, much like the other labour rooms, had its own en-suite bathroom, with the most amazing bath. This was a large, standard bath on a hydraulic lift, that could be raised an lowered (full of water and a labouring woman!) to a useful height for the midwife. Apparently this style of bath is used for the elderly, but it seemed ideal to me for use in labour, even though a slightly larger pool would be even better.

I also spied a wonderful sight - a tea tray set with a kettle, cups and tea bags/coffee sachets. This is intended for the support people in labour, and the mother too, if she wishes. In this unit, there are no restrictions on what the mother can eat and rink during labour and the simple facilities the midwives have provided is a very welcoming and normalising gesture.

Many times I have been told of hospital rules stating “fathers can’t use kettles in labour wards because they might burn themselves”. This is complete nonsense, of course, but makes a convenient excuse for enforcing measures that keep parents dependent and uncomfortable in the hospital setting.

It is the anaesthetists who impose the restrictions about eating and drinking in labour, even though there is no evidence to support their rules. The research clearly states that limiting access to food and fluids increases the likelihood of caesarean birth, and that the few anaesthetic accidents that have occurred (aspiration syndrome) during prepping for caesarean surgery, are due to poor technique. These few emergencies, the result of incompetent practise, have resulted in millions of women worldwide being denied nutrition in labour, to their detriment.

I will be using the Yeovil example in future workshops - if they can provide simple sustenance to labouring woman and their partners without problems, why can’t other hospitals adopt this idea?

Posted by andrea at 06:30 PM

Contrasting midwifery care

What a difference a (few) days make. I am back in England, and have travelled down to Yeovil, Somerset, in the south west of the country.

In the UK, midwives are respected and supported by Government regulations and legislation and also by the obstetricians and hospital administrations. I have yet to see the Yeovil unit, but I am here as the guest of the Royal College of Midwives local Branch and will be working with midwives from this hospital and others in the surrounding areas. I have been told that the midwives here work in teams, offer home births and that they have applied for (and received) extra money to equip the hospital with mats, birth balls and birth stools. I am looking forward to finding out more.

This is such a contrast to the conditions that prevail in Ireland. There, midwives struggle under the oppressive rules of the obstetricians, who have established a largely privatised system that is primarily of benefit to themselves. The midwifery students I worked with last week will never have the opportunity to develop the full range of their practice unless they travel overseas and work in health care systems that accept midwifery as central to safe birth outcomes. I hope that many will take the plunge and find their feet elsewhere.......

Posted by andrea at 05:41 PM

The "rest and be thankful" stage of labour

There was an interesting discussion today’s workshop about the “rest and be thankful” (as Sheila Kitzinger named it so long ago) stage of labour. This is the lull, the quiet time between the end of the first stage and the beginning of the second stage of labour.

So often this natural phenomenon (more common in first time mothers) is misinterpreted either deliberately, to keep labour moving, or accidentally, because of a lack of understanding of the physiology underlying this condition.

After a turbulent transition, the woman and her unborn baby need time to rest and recuperate. The baby may have been feeling the effects of the long, hard contractions that come very close together in transition. The mother may feel exhausted by the effort of dealing with these fast and furious contractions - there is no doubt this is the most difficult part of the labour for her to handle.

The group today had rarely seen this pause for more than five minutes. They believed that if the contractions stopped it was necessary to put up a drip and use syntocinon to make the uterus continue its work without delay. They were very surprised when I explained that this lull, with no contractions at all, can last on average 20 or so minutes. On some occasions, it may last several hours. When the pause comes, the midwife needs to check that the mother is well, the baby is fine and then be patient.

It also helps if the midwife refrains from doing an internal examination of the cervix during transition. Many practitioners assume that once the cervix is fully dilated, the second stage has begun, and become anxious if there are no pushing contractions to start the baby on its journey into the world. Full dilatation just means that the first part of labour is complete. Second stage cannot be said to be underway until the classic signs of descent are visible and the mother has an urge to push.

Midwives generally know that this is the case, and can buy time for the women if they avoid discovering that the cervix is fully open. The canny midwife waits to observe the woman’s behaviour to tell her that she is ready to give birth, she doesn’t meddle with her fingers to find out what is going on.

All this was news to this group, who were mostly students. Unfortunately they are unlikely to see these normal physiological signs of labour progress because of the prevailing active management strategy and the high rate of induction/epidurals that occur here. I hope they remember some of what we discussed in this workshop, so that when they graduate and can work in less medicalised settings, they’ll have a chance to discover the wonders of women’s bodies and how well they are designed to get babies born safely, without the need for routine interventions.

Posted by andrea at 08:20 PM

Creating suitable labour rooms

Yesterday I had a quick look through the labour ward here in Limerick, ahead of the practical session we will have this morning in the workshop.

I noticed that they have similar problems in this maternity unit to many others - a lack of storage room for equipment and very few bathroom and toilet facilities.

Lots of older hospitals have these problems - no-one anticipated, when these units were built, that warm water, showers and baths, would be so beneficial for enabling women to labour well. A bath was offered to women on admission in many places so that women were clean (no doubt the needs of the midwife were the main concern) but showers were not so common and were often small cubicles with little room to move. These days, when renovations are planned, putting in plumbing is the most important item to consider, as it is expensive and hard to add or change at a later date.

The lack of storage is another chronic problem. The arrival of resuscitation units, humidicribs, CTG machines, and other medical paraphernalia, not to mention patient controlled TV wall units, casual chairs, birth balls, floor mats, bean bags and birth stools all add to the clutter in many labour wards.

There is no need for a labour ward to contain any equipment that may not be needed at all, or at least not until the baby arrives. The resuscitation unit and humidicrib should be stored elsewhere, and only brought into the room if and when needed. Continuous electronic fetal monitoring is not now recommended for health labouring women, so that machine should also go elsewhere, replaced by the neat, pocket dopplers or Pinards stethoscopes that midwives can easily carry.

The labour rooms in Limerick were classic examples of clutter and little space. Some new rooms have been built and will come on line soon, but these have replicated the existing rooms and no extra bathroom or toilet facilities have been added - now there will be fewer facilities overall for their labouring women. No extra storage space has been made available either, so each room will continue to offer a very clinical, medicalised uncomfortable labouring environment for women. We’ll tackle these problems today and see if we can come up with some simple measures that could be used to create a more home-like space for women giving birth in this local hospital.

Posted by andrea at 06:40 PM

Another visit to Limerick

This afternoon I am going back to Limerick for another workshop with midwifery students, plus other midwives from the local hospital. I always enjoy working with students - their enquiring minds, enthusiasm and energy are always invigorating.

Next year the Direct Entry Midwifery program is due to commence, after many years of planning and anticipation. No doubt I will hear more about this in the coming days.

Posted by andrea at 01:09 AM

VBAC information booklet

Women whose babies have been born by caesarean need really good information if they are to consider a vaginal birth for their next pregnancy. The research says that women have around an 80% chance of success, even after more than one caesarean, yet the figures for vaginal birth after caesarean (VBAC) are usually much lower than this, even in hospitals where VBAC is encouraged.

Obtaining the information is the hard part. Often women are given part of the story, those facts that are “convenient” for the caregivers and hospital policies. Sometimes the risks of the vaginal birth and the incidence of scar separation or rupture are over emphasised and the risks of repeat surgery are downplayed. It can be hard for women to get accurate, unbiassed details that can form the basis for making a good decision and for finding the necessary care they will need.

CARES SA has produced a booklet that is designed to bring all the facts together to enable expectant parents, and their caregivers, to make considered decisions. This 80 page booklet has been compiled using the research and feedback from women and is a very worthwhile resource. The response in Australia has been overwhelming and as a result CARES has decided to put the booklet on a CD ROM so that it can be posted more easily.

The contents of the book are:

South Australian Perinatal Practice Guidelines

Best Available Research Comparing Risks of VBAC (Vaginal Birth After Cesarean) and of Planned Repeat C-Section

Women’s Satisfaction with VBAC

VBAC After two Caesareans

Midwifery Care and VBAC

Preparing for a Vaginal Birth After Caesarean

Frequently Asked Questions

I was told…

Homebirth After Caesarean

Uterine Rupture Another Caesarean

Recommended Reading List

Statistics

Glossary

CARES is a not for profit organisation with no funding other than memberships and fundraising. Purchase of this CD will go towards providing VBAC education workshops for women.

The cost is AUD$15.00 including postage within Australia. Add AUD$10.00 for postage overseas. Personal cheques (Australian Banks are acceptable) but for those outside Australia a Bank cheque in Australian dollars will be necessary. Credit card facilities are not available. Cheque or money orders made out to CARES SA Inc.

CARES SA

PO Box 1013

Nairne SA

Australia 5252

Posted by andrea at 09:48 PM

Fathers at caesarean births

This weekend I am visiting friends who spend their time between Bangkok and Britain. They told me that they had been contacted by a woman in Bangkok who was wanting to ensure that if she had a caesarean birth in the private hospital where she has booked, her husband can be with her in the theatre.

This request has caused some mayhem, it seems. The hospital’s response was to quote a recent policy change that husbands could not now accompany their wives to theatre for the birth of their baby by caesarean. This woman then contacted the rival private hospital, to be told that they had an “open door “ policy. When this information was conveyed to the first hospital they reconsidered their position. The need for secrecy about what goes on in hospitals is becoming more of a problem. The usual reason given (perhaps indirectly) is that if you have family members in the theatre (or extra people in the labour ward) then they may become concerned about what is going on, and sue the hospital. Hospital administrators reason, apparently, that if you keep the people in the dark, they won’t become alarmed and will take on trust what they are told about events that occur during hospital stays.

An alternative way of looking at this would be to encourage the partner into the theatre, or the extra family and friends into the labour ward, so they would be witness to everything and could see for themselves what was done to save the mother and baby from harm. It could be argued that being open and forthcoming heads off potential law suits, because it is clear that there is nothing to hide and that every effort has been made to achieve a good outcome in an emergency situation.

Of course, sometimes people will make mistakes and the system won’t work as well as it should - that’s life. Being honest and open, however, may help those involved to come to terms with these events better than trying to cover them up and obfuscate under questioning.

As far as I know, most hospitals in Australia (and probably Britain) do enable fathers to be in the theatre when their baby is born via caesarean, unless there is a true emergency with no time to equip him being in the theatre. This is something I will ask midwives about during workshops, because it may be another reason why men are so often traumatised by the drama of the caesarean and subsequently encourage their partners to accept an elective caesarean for future births. Being present for a surgical procedure must carry the potential for trauma for the uninitiated, but surely excluding people and thus creating mystery could contribute as well.

Posted by andrea at 08:16 PM

How to restrict epidural use

Back in Ireland again for the last two days - another Active Birth workshop for the Irish Nurses Association. Once again we had a good cross section of midwives from various parts of the country.

The midwives from Donegal (right up in the north) floored everyone when they said that in their unit, which has about 1700 births each year, the epidural service is only available for one woman at a time. Women know this well in advance, so they are not surprised if they find they have missed out in labour. Because it is hard to organise, most women are about 6 cms dilated by the time it goes in, so the outcomes are quite good - the labour is well established and the birth not too far away. This news was received with incredulity - many of the other midwives in the group reported that epidurals were very much available in their units, usually demanded by the women. It was a good example of how a demand can be created, when there are anaesthetists looking for work.....

Meanwhile, there is still an almost uniform policy in Ireland that women can only have one support person with them in labour. There are moves afoot to lobby for changing this outmoded policy, but it is tortuously slow process and the people most resistant to the change are often the midwives. Restricting information to women seems to be common as well - in the National Maternity Hospital (known locally as “Holles Street”), they have abandoned doing labour ward visits. It is no longer possible to see the labour ward in advance - the first glimpse comes when you arrive in labour! Makes you wonder what it is that they don’t want women to see until it is too late...

We had a good workshop and lots of positive energy and ideas flowed. I will be back in Ireland next week, this time in Limerick.

Posted by andrea at 11:49 PM