Articles by Month: April 2008

Promoting breastfeeding in Thailand

There was small paragraph in the Bangkok Post Newspaper that caught my eye the other day. It was reporting the low rates of breastfeeding in Thailand and the Ministry of Health’s concern that only 5.4% of babies are being exclusively breastfed at 6 months of age.

This low rate probably reflects the growing need for mothers to return to work after the birth of their babies, and perhaps other factors as well, and is probably not very different fro the situation in many other countries.

What attracted my attention was the proposed solution for improving these figures: a publicity campaign to be headed up by a “Miss Breast Milk” (!). My mind immediately wandered to the possible images that might accompany such a campaign…..

Posted by andrea at 02:31 PM

Midwifery education in Thailand

Midwifery in Thailand (as opposed to obstetric nursing) has received a boost with the availability of a new course at Burapha University in Chonburi. Until recently, all nursing courses included six months of obstetrics and this has formed the basic qualification of those wanting to specialise in midwifery.

Burapha University has introduced a new post graduate course that will focus solely on midwifery, providing an avenue for those who want to upgrade their basic nursing skills and develop a midwifery philosophy rather than an obstetric orientation in their practise. This is exciting news and will eventually mean more options for birthing women, who will be able to choose midwifery rather than obstetric care for their pregnancy.

Other Universities may follow Burapha’s lead – this course is proving very popular with many applicants for its limited places. Perhaps the next step will be a professional organisation for midwives, that enables them to develop a real identity and voice as health care providers. Knowing about the slow pace of change in Thailand, I won’t hold my breath waiting for that development, but this new course is a very definite step in the right direction.

Posted by andrea at 02:23 PM

Childbirth options in Thailand

The birth scene in Thailand is at last changing from one dominated by private obstetrics to one where alternatives, and especially midwifery care, is becoming more available.

I’ve spent the weekend catching up with my friends in Bangkok and learning of the latest developments with the Childbirth and Breastfeeding Foundation of Thailand. This group has been working for some years to promote natural birth and better breastfeeding rates, and although often frustrated by the slow rate of change in this country, they are pleased that their message is being heeded in some hospitals, with outstanding results.

As in most countries, there are two levels of maternity care – the private system and the public health system. In the private sector, the outcome of the birth will depend almost entirely on the practises and attitudes of the chosen obstetrician. With a supportive obstetrician, natural birth is possible, or at least many of the routine obstetric interventions can be avoided. From the information I have gathered this weekend it seems that women wanting to negotiate natural birth options in Bangkok will have the best chance at Rajvithe Hospital in Bangkok (Dr Ekachai), Bangkok Phuket Hospital in Phuket (Dr Suppakit) and at the Samitivej Sukumvit Hospital, also in Bangkok,(Dr Yawaluk, who is a woman doctor).

I have written about the Samitivej Hospital before in My Diary as they have the only Birth Centre in Thailand, but their recent statistics show that support for water birth and physiological management is decreasing, which is both disappointing and alarming. This is probably due to reduced support for normal births from several of their doctors, and it seems that Dr Yawaluk is offering the most flexible approach at present.

In the public sector, there is encouraging news. Smaller community hospitals in rural areas are having great success with upright births (squatting, kneeling etc on floor mats) and mobilisation during first stage. Fathers or other companions are being encouraged to attend and their midwives are very pleased with the good outcomes they are achieving. I have heard great stories about natural births at the Bangnampreo Hospital (in Chachongsao Province, 1 ½ hours east of Bangkok), Somdej-na-Sriracha Hospital (in Sriracha, Cholburi), and Bangtarad Hospital (in Kalasin, in the north east). As often happens, smaller units that are not teaching facilities and where staff have more freedom often produce great results. If a pregnant woman in Bangkok was not able to obtain the care she needed from her private obstetrician, she might want to consider travelling a few hours to get quality midwifery care and the opportunity for a better birth.

The facilities in these small community hospitals may be very basic, with none of the pretty decorations and gleaming technology found in the private city hospitals, but in the final analysis, women in labour are less worried about the décor than the attitude and philosophy of the caregiver who is assisting them. As women discover the benefits of midwifery care over routine obstetrics, and as the successes in these community hospitals become known more widely, it will help drive change elsewhere in Thailand.

Posted by andrea at 02:10 PM

Midwifery in the UK

I have just left the UK after a brief (for me) visit of 10 days during which I presented some workshops and had a short break with friends in Wales. I also spent time with Caroline Flint in London enabling me to catch up with her successful midwifery practice based around The Birth Centre in Tooting.

This Birth Centre was the first one ever established in the UK and has provided a lovely birth place for many babies over the years. As a model for midwifery care it is unequalled – being independent of the NHS system offers women complete freedom to have the birth and care they want without any of the restrictions that must be applied to those birth centres attached to maternity hospitals. It is just a shame that more centres like Caroline’s have not been established elsewhere and crazy that her achievements as a pioneer of the birth centre philosophy in the UK is rarely acknowledged by her peers. The “tall poppy” syndrome that we are so familiar with in Australia seems to have taken hold in the UK as well.

My impressions of UK midwifery, formed on this visit, is that is seems in the doldrums. The midwives I met this time talked about the chronic staff shortages, which have been going on for some time, but this time there seems to be a feeling that the problems will never be fixed. With the mass resignations looming as the average age of midwives advances, many were gloomy about the prospects for midwifery in the future and fear that births will become concentrated in the large hospitals as the only practical way of staffing maternity care. Too many doctors working in obstetrics are having a big influence on the way births are managed and the imposition of strict rules and guidelines (formulated by doctor dominated bodies like the National Institutes for Clinical Excellence – NICE) are overriding the expertise of midwives in facilitating normal births, leading to more and more caesareans. The once proud record of natural births that was the hallmark of British maternity services is under serious threat and the only way to escape the increasing production line approach seems to be having a home birth (if a woman is lucky enough to live in an area that will provide this mandated option).

More dynamic leadership of the Royal College of Midwives might also help. With morale amongst midwives at a very low point, the RCM has a big task ahead if it is to lift the spirits of midwives and take the strong political role needed to get the working conditions improved to attract and retain midwives in the system. What is needed is not just pay rises for midwives, but assertive efforts to have the voice of midwives heard equally with their medical colleagues as policies are formulated and services are planned and implemented. The RCM could also take the lead in establishing strong supportive structures to stamp out the horizontal violence that is endemic in many hospitals. I understand that the leadership of the RCM is about to change and that (gasp!) a man is even being considered for this post. What a refreshing change that might be – will the College be bold enough to take this idea on? The Australian College of Midwives employed a non-midwife as its CEO several years ago and it revolutionised their organisation, giving it new energy, a strong lobbying voice and better internal systems. Will the RCM look “outside the square” on this occasion?

Posted by andrea at 06:52 PM

An exciting event for childbirth educators

The Birth International Conference in Sydney followed the same basic format as the event in New Zealand, except that to began on Friday afternoon and finished early on the Sunday afternoon. Since most participants were from interstate, this format made travelling easier and also provided for some extra downtime.

The speaking team was much the same as in New Zealand, but there were some variations:

Mary Nolan PhD, Professor of Perinatal Education at Worcester University, UK. Her Plenary presentation was “Childbirth Education – inclusive or exclusive?” and she facilitated workshop sessions on “Putting the WOW! Factor into classes” and “Managing cultural diversity”.

Penny Simkin, Physical Therapist and well-known international author and speaker. Her Plenary addressed the issue of “When sexual abuse survivors give birth” and her workshops were on the themes of “Pain in labour” and “Working with abuse survivors”.

Lorna Davies, Midwifery Educator and author from Christchurch, presented a Plenary on “The art of childbirth education” gave workshop sessions on “Creativity and self expression in prenatal programs”.

Paul Prichard, from Good Beginnings, presented a Plenary session on “Realising the potential of expectant and new fathers” and also facilitated workshops on “Inside the mind of the expectant father”.

Shea Caplice, Midwife and film maker, presented the film “Hannah’s Story” in one of the Plenary sessions.

Judy Cottrell, Midwifery educator from Auckland, presented her workshop on “Action teaching.”

Andrea Robertson, Director of Birth International ran workshops on “Beating educator burnout” and “Teaching birth basics: making birth easier”.

Julie Clarke, independent childbirth educator from Sydney gave workshops on “Getting started as an educator” and “’I can do this!’ – teaching second stage”.

Allison Hilbig, Women’s health physiotherapist from Melbourne, gave two sessions on “Linking sexuality and birth”.

Lina Clerke, Midwife and childbirth educator, facilitated two workshops on “From fear to excitement about birth – changing mindsets”.

Alesa Koziol, childbirth educator from Melbourne, facilitated the workshops on “Teaching birth basics: drugs and interventions.”

Deb Galloway, Parent Education co-ordinator from John Hunter Hospital, Newcastle, ran the workshops on “Making connections with early parenting”.

Overall impressions of the event:

Once again, this was a very successful event. There were over 100 participants, who offered very positive feedback about the program, speakers and overall organisation.

The venue was praised for its location and setting by the beach, although some would have liked a more central venue so they could go shopping! The cost of t he accommodation was mentioned by some as expensive, but people appreciated the food and general atmosphere.

Some of the general comments included:

“This has really brought me back to the core essence of being woman and birthing with power!!”

“Brought everything into perspective and gave me ideas to work with.”

“Considering the cost, would have preferred to stay a few more hours to get to all the sessions.”

I enjoyed this…”because I learned so much gained new ideas as well as met so many amazing people.”

“The company of so many like-minded midwives – what’s not to enjoy, surrounded by all their enthusiasm. Always glad to hear how other people do things.”

“Catering magnificent”

“Expensive for the value, poor dietary choices.”

“Nice hotel but could have been in a cleaner area of Sydney.”

“Thanks for a wonderful weekend. I feel proud to be a midwife and childbirth educator. And now, even better equipped to care for women.”

“I’m so glad I came along.”

The Plenary sessions

These were enjoyed by everyone – many mentioned the moving film made by Shea Caplice of “Hannah’s Story”. Feedback included:

“Every student midwife and midwife needs to see Hannah Dahlen’s film – I will recommend this at work.”

“Congratulations on Hannah’s Story. Loads of admiration for all concerned.”

The workshops

Every workshop group is different and this can colour both the learning and the overall impression of the program. Many asked for a longer program another time so that all workshops could be attended – people don’t like to feel they have missed out on anything.

The program for Sydney had been devised in two streams, one for “beginners” and the other for more experienced educators. This attempt to tailor the workshop content to the needs of the participants seems to have been largely lost in translation – no-one mentioned that they had taken advantage of this strategy. I had listed learner outcomes for each session as a guide to both presenters and participants – this didn’t appear to work in all cases.

The feedback was very similar to the comments from the New Zealand group. People loved the diversity of programs yet the common themes that were present in the workshop sessions. The opportunity to try various teaching activities was appreciated and there was much praise for the skill, passion and expertise of the presenters.

This was a wonderful weekend for everyone concerned and we felt very pleased to have made such a professional, relevant and enjoyable event possible.

Posted by andrea at 09:19 AM

Childbirth Education Conference - a first for New Zealand

The first Conference that Birth International has presented in New Zealand was held on the weekend of March 8 and 9, 2008. The team of speakers, and their topics were:

Mary Nolan PhD, Professor of Perinatal Education at Worcester University, UK. Her Plenary presentation was “Childbirth Education – inclusive or exclusive?” and she facilitated workshop sessions on “Putting the WOW! factor into classes” and “Managing cultural diversity”.

Penny Simkin, Physical Therapist and well-known international author and speaker. Her Plenary addressed the issue of “When sexual abuse survivors give birth” and her workshops were on the themes of “Pain in labour” and “Working with abuse survivors”.

Andrea Robertson, Director of Birth International, closed with the Plenary session on “New challenges for childbirth educators” and ran workshops on “Beating educator burnout” and “Teaching birth basics: making birth easier”.

Bronny Handfield, independent educator from Melbourne, showed her DVD on “Birth in the Media” that forms part of her PhD thesis, and also facilitated workshop sessions of “Teaching birth basics: drugs and interventions”.

Julie Clarke, independent childbirth educator from Sydney gave workshops on “Parenting 101” and “’I can do this!’ – teaching second stage”.

Lorna Davies, Midwifery Educator and author from Christchurch, gave a session on “Creativity and self expression in prenatal programs”.

Deb Pattrick and Tracy Smith, the midwives who form the Core of Life program in Australia, facilitated sessions on “Working with the young and pregnant.”

Allison Hilbig, Women’s health physiotherapist from Melbourne, gave two sessions on “Linking sexuality and birth”.

Judy Cottrell, Midwifery educator from Auckland, presented her workshop on “Action teaching.”

Gerry Smith, midwife and IBCLC from Auckland, offer a program on “Motivating women to breastfeed.”

Overall impressions of the event:

The overwhelming response from participants was that this was an exciting, stimulating event that reignited enthusiasm for childbirth and parenting education and offered many helpful ideas and teaching tips that would be used in future programs.

The Heritage Hotel was a popular choice, and the facilities and food (with the notable exception of the soup on Saturday!) was praised. One person thought the chairs were too uncomfortable and a number of people commented they would have preferred chairs and tables for lunch.

The awful glitch with the A/V equipment on Saturday evening was remarkably well tolerated, no doubt helped by the glass of wine that was available, but this meant the program ran very late, causing problems for some. Saturday was certainly a long day.

The cost was a factor we could do little about – running quality events with overseas speakers is an expensive exercise. Several participants commented that Kiwis don’t mind “roughing it” to get a cheaper event, however I feel that this perpetuates the perception that childbirth educators are “not worth much”, and I prefer to offer as professional event as I can, within reason.

Plenary sessions

These were all praised as being worthwhile. Mary and Penny were applauded for succinct summaries of major issues and opened up conversations that could be continued later in workshops.

“Mary’s talk reduced me to tears in a very heart-warming way. I really appreciated her sharing her family’s story.”

“Interesting. Loved Bronny’s video.”

“Absolutely great closing speech, Andrea. Thank you.”

Workshop sessions

These were very popular and everyone enjoyed the many varied presentations. Speakers were asked to prepare an interactive session that enabled participants to gain skills and try new ideas. Feedback was extensive – here are some examples:

“The talk gave us some great tips on several topics that are often difficult to take – reinforced and revisited learning types – things we knew – but it is always good to be reminded of.”

“Absolutely fantastic looking at diversity and facilitation rather than teaching to or at.”

“Excellent course facilitation of session. Good ideas”

“Great! We are taking her principles straight back to classes! Fab presentation.”

“Very thought provoking. It gave me a new perspective on class participants and ideas.”

“Great. I got to sit in on one of my (s)heros! Great practical information that will really add substance to my classes.

“A very different and interesting session. Stimulating – great ideas. Loved the suggestions for using music, Pictionary etc - thank you. Loved the way you demonstrated your ideas.”

“Great workshop – very concise – they knew their stuff and kept to the point.”

“Wow! Great stuff – very motivating.”

“Good workshop. Definitely will make me tackle this issue more confidently in my classes.”

The event was a huge success, and as we packed up, we were anticipating a similar experience in Sydney, which was scheduled for the following weekend. We were not disappointed…..

Posted by andrea at 08:46 AM