Articles by Category: childbirth education

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

Childbirth education in Iran

The final day of the workshop was a bit crazy. The hunt was on for a woman that we could use to demonstrate a physiological birth and while we waited for someone to appear, we got on with discussing perineums and third stage.

In Iran, women (and obstetricians) believe that an episiotomy is important for preventing later prolapse and also for better sexual functioning after birth. Kirsten did a great job of explaining how cutting the perineum would have no impact on the pelvic floor muscles or the ligaments that support the uterus, as these structures are higher up and not in any way connected to the perineal tissues. She explained that it was the prolonged, over enthusiastic “push, push, push!” style of management that could cause the supporting ligaments to detach from the pelvic bones, leading to the vaginal tissues collapsing into a prolapse. We also talked about the impact of vaginal scarring on later sexual functioning, and the other potential problems associated with routine episiotomy (excessive blood loss, infection, increased pain and discomfort for the woman in the early post natal period etc).

Third stage is routinely actively managed and we spoke at length about how to achieve a physiologic third stage including the first contact between mother and baby.

There was still no sign of an appropriate woman in labour so after a break and another round of tea, we watched the film “Inner Strength”. Some of the scenes in this film were a revelation, causing some giggling, especially the close relationship between the mother and father during labour and the couple that do a lot of kissing and cuddling (a great way to raise oxytocin levels and increase the effectiveness of contractions!). The sounds the women make were also a surprise to many of our audience. As I pointed out at the end, the outcomes we listed for birth on our first day (healthy mother, healthy baby, increased self-esteem in the woman, low morbidity, good memories of birth etc) were clearly demonstrated in this film – this kind of immediate feedback that occurs in a natural birth requires no further exploration – the outcomes are obvious.

Just after morning tea it was discovered that a woman having her second child was in labour following a spontaneous onset. She was about 4 cm dilated with intact membranes. It was decided to offer her the chance to give birth in the new birth centre and she was moved to this area. A relative who works in the hospital was located as a companion (she got bored and didn’t stay in the end). Kirsten went to meet her and with the aid of an obstetrician and a midwife began the process of getting to know her.

The labour was not very well established and of course had slowed due to the transfer to hospital, so the group, who had been watching through a video link in an adjacent room decided to go and look at the area where the prenatal classes take place. Here are some pictures of the class rooms:

The exercise room.

Sign on the door of the video room for watching DVDs etc.

Each session concludes with a relaxation session on this carpeted area.

After lunch, the mother was still just labouring gently. She had been in the pool for a while, which she reported to be very soothing and was walking about. It was decided to carry on with our program, and although some people had left to catch flights back to the provinces, we looked at ways of achieving change in hospital settings and what would need to be done to implement physiological birth in hospitals. I also set out a selection of the wonderful Fotoset images for them to talk through.

Just as we were having our afternoon tea, the word came through the woman was now labouring well and would be getting back in the bath soon. She was 6 cms and powering along. Unfortunately, Kirsten and I had to leave to catch a flight to Isfahan for the weekend, so very reluctantly we left her in the capable hands of a midwife and supportive obstetrician. We will be very keen to hear how she gave birth when we return to the hospital next week for the next workshop.

Meanwhile, we have a couple of days off to explore Isfahan, a jewel in the crown of the Persian Empire and a city considered one of the most beautiful in the Muslim world.

Posted by andrea at 04:01 AM

Obstetricians workshop

Today was a very productive day at the workshop. We spent a lot of time exploring the practicalities of natural labour versus managed labour, challenging some entrenched practices and applauding some good management strategies.

On the plus side, pregnancy care is comprehensive and up-to-date and epidurals are rarely used in labour for easing pain. The hospital we are in has been designated as Baby Friendly since 1992, which is terrific. On the minus side, the induction and augmentation rate are at almost 100%, as hospitals struggle to manage large numbers of women through overcrowded, shared labour rooms. No privacy, shaving, enemas, restrictions on food and drink in labour, lack of a birth companion, routine episiotomy, lithotomy, and frequent separation of mother and baby at birth are common in all labours.

We spent time trying out comfort positions, using a chair, birth ball, and mat, the only equipment that would fit in the available space in most first stage rooms. Ideas for managing posterior labours were tried out (again not easy due to the coats and hijabs) and we explored how hot water in the form of wet towels could be utilised to ease labour pain. Most hospitals have no baths and showers are in short supply. Hot packs and hot, wet towels are a simple substitute.

The implications of the active management strategy being used here were also examined in detail, first using the “cascade of intervention” activity from the Essential Educator Kit and following up with group discussion around reasons for induction.

Second stage involved talking through normal physiology and demonstrating birth positions.

Here are some photos that Kirsten took yesterday and today:

Front entrance to the hospital with an orange banner announcing the new prenatal classes they have set up for pregnant women.

Workshop participants

Demonstrating how the pelvis works

The new labour and birth room. This room is not quite finished, and is due to open next week. The pool is terrific and there is plenty of space in each of the two birth rooms. An en-suite toilet and shower are also tucked into a corner. The lighting is very bright and will be replaced with dimmable lights (we were assured) and the flimsy plastic curtain separating the two rooms is to be replaced with a door to give better privacy.

The plan is that tomorrow we will try and facilitate a birth in this area as a demonstration to the group. We are hoping that a multip will be available in labour and be willing to give birth in this new area. Kirsten will supervise a couple of the midwives who will assist the woman, while a video camera feed to an adjacent room will make it possible for the large group to see what is happening without disturbing the labouring woman.

We also saw the regular labour rooms today, but were asked not to take photos. It was a dismal, old, cramped area with conditions that would be unimaginable in any hospital in Australia. There were three first stage rooms each with either four or five beds close together, with no curtain to provide even a modicum of privacy. In second stage women are moved to one of two rooms that have three delivery beds side by side in each. This is a Baby Friendly Hospital so at least mothers and babies are not separated at birth and spend either 24 hours together before going home (vaginal birth) or 48 hours in the hospital following a caesarean.

Tomorrow will be most interesting – I wonder if we will be able to show these obstetricians how natural birth can be achieved?

Posted by andrea at 01:06 PM

Translations for the Japanese

One of the participants in the Essential Educator workshop was Yumi Okoso, better known in Japan by her pen name – Nanako Oba. Yumi is a very well known childbirth educator and birth activist in Japan and quite a TV personality as well. She heads the Birth-Sense Institute, a private consultancy that provides classes and workshops for parents.

In addition, Yumi has set up the Japan Birthing Association, an alliance of midwives, doctors, educators and parents interested in promoting natural childbirth throughout Japan. The Association offers training courses for educators who work with children in schools, offer baby massage courses for new mothers and pre conception programs for couples. They also train educators for pregnancy programs for parents.

As the author of 10 books and the mother of five children (all natural births), Nanako (as she is known to her TV audience) is a frequent commentator in the media, promoting midwifery and natural births.

While she was in Sydney, Yumi and I met with Yoko Yuille who is translating on my books Preparing for Birth: Mothers and Preparing for Birth: Fathers into Japanese. Yoko is a Trainer in NLP, and is herself the author of a book on this subject. The plan is to have my books released in Japan by December, and they will be sold in department stores, classes and through midwives in much the same way as they are sold here. Two of my books The Midwife Companion and Empowering Women are already available in Japanese and are selling well.

We are also looking at ways of translating some of the individual activities in The Essential Educator kits into Japanese. A publishing house in Japan that specialises in medical publications is keen to produce some materials and workshops for those interested in childbirth education and the Kit elements would appear to be ideal. This will be our next project in 2008.

Posted by andrea at 07:47 AM

Teaching aids for Muslim women

Today I met an Australian midwife who works in the United Arab Emirates, in a small rural centre outside Abu Dhabi. She has been there for five years with her family and has plans to stay for another five to ten years. She loves her work as a midwife, working mainly with prenatal education and postnatal breastfeeding support. Her hospital is the only BFHI accredited hospital in the UAE and she is working towards the reaccreditation by the WHO that is coming up soon

She was looking for suitable DVDs and teaching aids for women with no English and fairly low levels of literacy in their own language. These materials also needed to be culturally acceptable in this Islamic country.

The breastfeeding topic was covered by the “Teaching Breastfeeding” pack which is one of the Essential Educator kit elements. The breast model and DVD that forms part of this pack she felt would fill the bill very well.

Finding a birth DVD was not so easy as most of our range are either water births or show a lot of nudity. In the end she took “What If….” which is short, doesn’t show the perineum during the birth and takes place in a hospital. We added “Hands Off Birth” as this is perfect to show in a country where episiotomy is almost routine and where changing beliefs that the perineum doesn’t stretch during birth can be a tough call. This DVD was made as part of the HOOP trial which proved that keeping one’s hands off the perineum does not mean more tears for women – it’s a very useful film. She also took “Giving Birth, Being Born” as the first half of this film has no spoken words just music to accompany the scenes of women giving birth in a hospital clinic. Again, there are no close up perineal views and the women are all clothed - important for this clientele.

It was fascinating to learn of her work in the UAE and of her happy lifestyle there. I hope she will visit again when she is next back home.

Posted by andrea at 05:46 PM

Labour pain

There was an interesting email in my in-box today from a woman who had started to read my article on “Pain in Labour”. This is what she wrote:

“Hi! I just read Robertson's article on pain in birth. I did not even want to finish it. It is discusting! I wonder if she had any children to suggest that we need pain in labour. Is she from the USA? Another born again Christian? When I had my child I was feeling like I was being cut to pieces for 9 hours! I have not had another child since then! Thank you very much Dr Robertson, you are a neo-nazi!”

Pretty strong words! My guess is that she is still suffering from post traumatic stress disorder and a lot of unresolved grief from the birth of her child. This is what I wrote back to her:

“Thanks for taking the time to give me some feedback on my article about labour pain. I am an Australian childbirth educator (did you check out any other parts of the website?) and have over 30 years of experience of working with women during labur and educating them in prenatal programs. I am certainly not a born again Christian!

I appreciate that you had a terrible time during labour and I know from the research, that many women who suffered terribly either delay future pregnancies for many years or decide never to try again. I also know that many suffer from post traumatic shock disorder, a condition that is rarely acknowledged in relation to birth.

Women are designed to give birth in a way they can manage and handle within themselves. Unfortunately, when the conditions they face are not right, their body naturally takes action to delay or prolong the labour until the conditions improve. This is often seen in the animal kingdom. Sometimes (rarely) there is a physical problem with the baby or the woman that makes labour difficult and a high degree of pain, in the absence of other trigger factors, is a signal that should not be ignored by caregivers. High levels of pain are certainly not normal and need effective remedies.

Perhaps you might consider reading the article again to reach the section where I talk about how birth can be managed to minimise the pain and promote the beneficial hormones that are released during labour.

I am sorry that you have such a difficult time giving birth, and can only hope that you understand that it is highly unlikely to have been a result of your actions, and much more likely to be a fault of the health care system, which failed to give you the nurturing and safety you needed to birth effectively without intervention.”

Labour is such an emotive issue and an event that a woman never forgets. I wish that all women had positive views about labour and that none were left with feelings like this mother’s – what a burden to carry for the rest of your life.

Posted by andrea at 05:48 PM

Childbirth education in Uganda

Many of you will have been following the adventures of Jill Moloney, the Australian midwife who works in developing countries where she spreads the word about physiological birth. Recently we sent her some teaching aids for use in the midwifery training in northern Uganda. Jill has sent me some pictures - I am glad the doll is one of our black models! It is going to be loved to pieces!

Here are some extracts from her email, and also her description of the photos:

G'day Andrea and Staff of Birth International,

I just wanted to thank you for the charts you included in the shipment of fetal doll and pelvis sets you sent to us in Uganda in December 2006. We finally received them here in Kalongo (in the North of the country) at the end of last week and they are already a huge hit in our location. I had one brown doll in my bag as I was walking through the town on Friday and took it out when I met a staff member who I thought would be interested in seeing it. She was delighted and couldn't believe the likeness to a newborn baby. When she finished inspecting it, I turned to go on my way, only to find that there was a huge crowd of people behind me, all eager to inspect the doll for themselves. S/he was passed from elders to grown men and women, teenagers and young children and they all were smiling and wishing for one of their own!!

I have my initial sessions with the staff of the midwifery school and regional hospital on Friday 2nd March and have delivered two doll and pelvis sets and the charts you sent to the midwifery school today. The head teacher and two other tutors were there and they were excited and absolutely thrilled with the quality. They are looking forward to our up-coming sessions about normal physiology of labour and making their services more woman-friendly.

These two men who wanted to see the fetal doll and they played with it for some time. They are sitting in the corner of a restaurant and yelled out to me as I walked past with “Africane” (pronounced Africarn) as the doll has been Christened!

This photo is of Florence, one of our recent recruits in the Public Health Programme. She assists Josephine, our midwife and Traditional Birth Attendant Supervisor, and she is pictured with a TBA who attended a workshop about supporting normal physiology in labour. This part of the workshop was about supporting women in a position of comfort and she demonstrates supporting a squatting position when the mother is pushing, but from a standing start.

Here is Josephine supervising TBAs in the workshop they are “practising” their old skills of supporting women to give birth in a squatting or kneeling position.

Josephine is teaching TBAs about the mobility of the pelvis (lesson taken from your “Empowering Women”book). I am in the photo and have my back to most of the TBAs as I have trousers on and it made it easier for them to see where to place their hands during this exercise.

This photo is taken further into the pelvic mobility part of the workshop where the TBAs are feeling the movement of the ischial tuberosities.

Posted by andrea at 01:42 PM

RODA: Parents in Action

At the end of the two days, I felt as frustrated as my group members. I had no quick fixes I could offer, as many of the roots of these problems lie in the remnants of the totalitarian regime the people have lived under in the past. These repressive regimes have left many people feeling helpless, believing can’t do anything to change conditions.

This visit was sponsored and hosted by a wonderful group of women who have formed RODA - Roditelji u akciji (“Parents in Action”). They are refusing to buckle under and have been fighting for many years to influence change. Their conversations with doctors regarding birth practices have met with little success (like doctors everywhere, they will resist change to the bitter end) but they have had some rewards for their efforts, especially with breastfeeding.

The city authorities in Zagreb have given them access to rooms in a city building for a very nominal rent. It was in desperate need of renovation, so they got stuck into it and have produced some stylish and comfortable results. This space is used for meetings, groups, classes and as a general drop in centre for pregnant women and new mothers.

Some of the core members of the RODA group outside their headquarters: (L to R) Anita, Vedrana, myself and Saradadevii.

Photos showing the condition of the room before renovation.

Transformed into a very comfortable space, this is RODA’s “nest”.

Breastfeeding is a topic they have been pursuing recently, especially the problems associated with the routine early separation of mothers and babies in the maternity hospitals. With the help of some supporters and a friendly billboard company, they have managed to have these huge signs erected in many places around the city, often in very eye-catching places. The message is about the non separation of mothers and babies and translates loosely to “mothers need their babies and babies need their mothers”.

We had some serious fun thinking about billboards that would highlight the plight of women during labour. Getting a camera into a labour room would be very difficult, but with the increasing availability of mobile phones with inbuilt cameras perhaps it will not be so hard. Pictures tell a thousand words, and I explained how the images published by Suzanne Arms of labour rooms in the US in the 1970s were a major breakthrough in exposing the terrible practices being inflicted on women there at that time.

Croatian women also need better access to good information about childbirth and RODA are beginning to work on setting up some prenatal classes in the community. Hospital based programs are part of the coercion process and offer few options and no choices. I am hoping we can work together to devise some appropriate programs that will help inform and prepare women for birth and provide some strategies for getting what they need during labour.

The requirement to adopt EU standards for women’s health, patient’s rights, non-discrimination and human rights will also provide useful tools for RODA. There is no doubt in my mind that improving conditions overall must be seen as feminist and human rights issues, and that this might offer the best change of systemic change.

I can imagine a billboard with a picture of labouring women, lying in a row, with no privacy, little dignity, nothing of their own around them and no company, over a slogan that says “look at this - we wouldn’t do this to animals, why are we doing it to our women?”

Posted by andrea at 06:28 AM

Aiming for a VBAC

My first workshop in the UK was once again in Hull. It was primarily intended for the incoming group of doulas who have joined the very successful team of volunteer doulas that are matched with vulnerable women for support during pregnancy, labour and the post partum period. This is my third trip for this program and they are achieving some excellent results. It is a very good example of how social support can improve birth outcomes, especially amongst the disadvantaged.

There were two pregnant women in the group as well and a number of midwives from various hospitals in the area and from further afield. One of the pregnant women was hoping for a VBAC so I had a chat with her about how she might achieve her goal. Changing consultants to a known advocate of VBAC would be an important first step - the vague support offered by the Registrar in the clinic that her wishes would be respected is too tenuous to rely on. When a VBAC is planned, the most important step towards achieving this outcome is, I believe, finding a support team who are positive and enthusiastic for vaginal birth after previous caesarean. Many women are paid lip service on this issue during pregnancy only to find, when it is to late to change doctors easily, that they are being carefully and inexorably pushed towards a repeat caesarean. A few scary words, a hint of a problem with the baby, a throwaway line about the size of the baby and all too soon women find they are back on the operating theatre table with another incision being made. I encouraged the woman in my workshop to shop around and keep her options open. Trust in her own body and belief in her ability to give birth well is important as well. I hope she succeeds, and as a result lays to rest some of the doubts about her capacity to give birth.

Several of the doulas in the group recounted their own birth experiences, which were not always positive. One said that she had now realised that she must deal with her own disappointment with birth before she could properly support another woman through the birth experience - she realised that this had to be the woman’s journey and not her own. I was impressed by the degree of insight and maturity in this comment, and I feel sure that now she recognises her own vulnerability and needs she will take the appropriate steps her help resolve her own issues before she works with other women.

I wish that health professionals (midwives and doctors) would adopt this approach and acknowledge that many of their management strategies and behaviours for labouring women have their roots in their own personal disappointments and griefs about birth.

I’ve moved on to Huddersfield now and will have the opportunity to work with midwives in this area over the coming weekend. But first, another Essential Educator presentation for CBEs in this area.....

Posted by andrea at 05:14 AM

The quality of prenatal classes

I have been spending the last few days marking the final Observations assignments for the final group of students completing the Graduate Diploma in Childbirth Education (which was phased out on December 31st).

A number of these assignments have been reports from observing prenatal classes. The student is required, in part, to sit in on classes being provided in her community, report on the details of their structure and presentation and offer some reflection on their effectiveness and style. Marking this work gives me the opportunity to review what is happening in the hospital system, the prenatal classes and in community health facilities in a number of areas around the country, and it has always been an interesting way to keep up with developments.

The classes that these students have been observing leave me feeling very concerned. Many programs are clearly still based on lectures designed to force feed pregnant parents with as many facts and details as can be crammed in to the short time allotted (usually a series of 2 hour sessions). Many educators are using overheads, even Powerpoint (!!) to present their material and very few offer any opportunity for parents to practice practical skills, especially for labour. The facilitators of these program are no doubt doing their very best to engage the parents and offer useful information. It seems though that the guiding principle is one of “let’s tell them everything we know they will need” rather than enabling parents to take some responsibility for their own learning and offering opportunities for them to develop vital self-help skills. A class that is taught as a series of lectures, especially with overheads or Powerpoint slides is not based on adult education principles and is impossible to evaluate effectively. This is very poor practice, is not evidence based and is probably a waste of time. Many class groups report falling numbers as the weeks roll on, very likely a sign of dissatisfaction.

Some topics within these programs are being taught by educators with little direct experience. For example, in many programs, the sessions on positions and comfort aids for labour are taken by physiotherapists. From my observation, very few physiotherapists have ever spent time in labour wards (apart from having their own babies) and have scant experience of using these techniques as support people for labouring women. These are topics that should be covered by midwives, who have a vast knowledge base of labour from which they can offer suggestions.

There seems to be a perception that using group activities that involve parents “will take too much time”. In reality, a well designed group activity that includes practical work, problem solving and discussion can save a lot of time, because many issues can be addressed in a short time. Those educators who shy away from this approach probably do so because they fear they either won’t cover the allotted material or are inexperienced at facilitating groups. It is easier to lecture when you have few skills at working with groups, and very few educators working in the hospital system have any qualifications or training in working with adults.

I have always been appalled at the overall quality of the classes offered to parents in the hospital system. The standards are low, not from want of trying (many educators are enthusiastic and dedicated to this work) but because of the lack of training and support for programs that are better structured and more appropriate to expectant parent’s needs. The lack of practise time for self-help skills for labour (positioning, massage, use of heat etc) is especially worrying, because without a clear idea of how to help themselves, parents will feel helpless and be more likely to opt for drugs (especially epidurals with their promises of complete freedom from pain). A brief discussion, viewing a poster or two and watching a demonstration of various positions (either by the educator or on video) is completely inadequate for preparing women and their partners to manage labour by themselves. The practical session involving self help should be a central theme of the entire program and used as an opportunity to build confidence and positive attitudes to managing labour. The concept of “informed choice” is also lacking – without practice in making decisions, and a chance to work out solutions for themselves, parents will not have the necessary skills to navigate their way through the rigid construction of protocols and policies that operate in most hospital labour wards.

These kinds of deficiencies, which I have been observing over the last 30 years, are the underlying reason why I developed The Essential Educator. I know that educators try their best to pack as much in as possible into the limited time they are given for their classes. I know that they want to do their best. I know that they are given few resources, let along training, in how to facilitate groups and incorporate fun, practical sessions into their programs. The teaching package that I have developed enables educators to do all of these things, using professionally prepared materials and proven activities. Each activity has guidance notes for effective presentation, an in-built evaluation strategy and automatically incorporates the principles of adult learning. Anyone can use this pack from scratch, if necessary, to present an effective program that will not only give parents the information they need, but most importantly build their confidence and trust in the natural process of labour.

Powerpoint presentations and set of slides or overheads are no substitute for practical sessions that focus on the parent’s needs rather than the system’s. The quality of much prenatal education is so poor (from my observations) that most parents would be better off without it. Much of it, as it now stands, will unwittingly set parents up for accepting inductions, drugs, epidurals and caesareans.

Prenatal education programs are a gift – a rare opportunity to work with a group of motivated adults (they have made the effort to attend) at a time in their lives when they can hone the life skills that will be vital for taking care of themselves and their babies. That so many educators (and parents) miss out on this golden opportunity seems almost criminal to me. It could be so much better …..

Posted by andrea at 02:14 PM

Birth education in Papua New Guinea

I've been very slow to upload Diary entries over the past few weeks and apologies to my faithful readers who have been wondering what I have been doing. I hope to get some detials to you soon.

In the meantime, here is a good news story I had to tell you about straight away.

We recently sent some spare charts and equipment to Marg Docking, an Australian midwife who works, from time to time, in developing countries as a volunteer. Here is the message we received today. Love the "classroom"!

Dear Andrea,

A huge thankyou for the donation toward the educational charts. I took them all to PNG as well as doll and pelvis through customs and xrays ! They were such a hit! They were well used and actually instigated some village trips where babies had died as a result of poorly tied cord! We were welcomed with garlands of flowers and fed fruit. The education took place under trees and houses and one time included a pig and piglets. Many good questions were raised about abortion, malaria tablets, cord cutting and family planning.

I am also going to purchase another black doll and pelvis and placenta to take to Africa. I am going to a maternity clinic in Uganda but also slum work in Kenya with the mission African enterprise. I will leave the posters and pelvis over there as I did in PNG.

Any donations would be gratefully received again.

Thankyou. I leave 15 Dec.

Marg Docking

We will see what charts we have available to send Marg - she deserves all the support we can offer her.

Posted by andrea at 12:18 PM

No comment

Some of my comments on the situation in Ireland have caused a storm of comment on some of the Irish chat lines available to parents through other websites. One person responded that it was significant that I didn=t allow comments to be posted to My Diary - I think she saw this as some kind of measure to protect myself from criticism.

This is not the case at all. When I set up this Diary (4 years ago now) I had a comments facility available and many people wrote in and added to the discussion. About 2 years ago now, the spammers moved in as well and my entries was suddenly being inundated with hundreds of comments each day. At first I diligently removed each one singly (there was no easy way of doing this) but eventually it became too much as was taking an hour each day to clean up the entries. Reluctantly I had to turn off the comments facility, for my own sanity. If you check some of the entries from 2002/2003 in the archives, you'll see the kind of garbage that was being posted in the comments section (and I don't mean the genuine comments!).

I enjoy hearing from readers and allowed all real comments to be posted, especially when they offered and opposising viewpint. l will again pursue the software company that I use to see if they have added spam blocking mechanisms to the blogging software that I am using. If I change to another form of software, I will lose the archive and that would be a shame - I have written several books worth by now and don=t want this to disappear.

I=ll keep you posted.

Posted by andrea at 02:48 PM

What images should pregnant women view?

This week has been a hectic round of presentations in the UK to showcase the Essential Educator teaching packages for childbirth and parenting educators.

On Tuesday I was in Dublin as I noted in my last Diary entry. The next day I hosted a group in London who were very enthusiastic. One interesting topic of discussion was the DVD we have included in the labour and Birth kit called “The First Breath”. This is a wonderful collection of images of dozens of women, in all stages of pregnancy, labour, birth and immediately afterwards, with their babies. The gentle music complements the pictures and as there is no spoken commentary, this offers the opportunity for personal comment or interpretation of the various images.

A couple of the midwives were concerned that these images would not be acceptable to the women who attend their programs. I found this interesting for a number of reasons: first that they would make assumptions about what the women would or would not want to see; second that they would contemplate censoring the images to fit their own personal expectations; and the idea that women would not appreciate these magnificent picture of women giving birth in powerful, masterly ways with midwifery help.

Where do women get their ideas about birth anyway? Often from TV, films and the print media. The message of many of these shows is often quite disturbing with women in agony, lots of technology to the rescue and doctors in control of the situations. Why not show women something that is gentle, normal, empowering and completely woman centred? Perhaps it would help to change perceptions of what birth is all about - at least we should give women the option. If they are then disturbed or upset by what they see, clearly some sensitive discussion will be necessary to help resolve their feelings.

I love this DVD - you can buy it separately form the kit. I can see many ways of using it in classes - short snippets to illustrate various aspects of physiology or women’s reactions; as a way of setting the scene at the start of a group; during refreshment breaks to continue the story of natural birth. Why not check it out yourself?

Posted by andrea at 03:51 AM

Is labour pain different to other pain?

I am back on deck this month, after a few anxious weeks caring for my elderly mother, who out of the blue, was discovered to have a major heart problem that needed surgery. She is now recovering well and I can turn my thoughts back to my work.

One thing I will say, is that having spent the best part of a month in close contact with our health care system, I have now greater insights into its strengths and weaknesses. I also know that I have seen enough of Emergency rooms to last me a life time!

I have always said that you can learn from every situation. For me, in this case, it was how I was reacting to someone else’s acute pain, especially when it concerned someone very close to me. The anxiety and helplessness I felt, and the overwhelming need to find a cure for the pain was stressful in the extreme. At one point, my daughter said to me that I should use some of the skills I have developed to deal with the pain being felt by the women whom I have been supporting during labour. At that moment, I realised that this was quite a different situation - a woman in labour is having normal, healthy pain that is productive and useful and therefore not something that is frightening or needs fixing. Watching someone experience severe heart pain is quite a different story, as it signals pathology and an urgent need for a cure. I am not stressed at all when I work with a women during labour - in fact I feel very calm and even buoyed by what I am observing. The experience I have gained from being with many women during birth was no preparation for being with someone acutely ill with a life threatening condition, who also needed my support and assistance.

Looking back, I can see how many women will approach labour pain - basing their fears on perhaps their own direct experience of pathological pain, or of witnessing and trying to alleviate the pain and suffering of some close to them. No wonder they are scared and uncertain about how they will handle the inevitable pain of labour and it is no surprise that many will resort to pain-killing drugs at the first opportunity.

It once again highlights the enormous gulf between the medical model for birth (based on an illness model) and the midwifery model of care (based on normal bodily functions). There is still an enormous amount of work to be done in educating women to the difference between these two approaches to birth......

Posted by andrea at 10:30 PM

New workshop for educators

I have put together a new program, on the theme of “The Essential Educator” in response to requests for a one-day program on teaching skills for childbirth educators. This workshop will focus on some of the basics and also serve as an introduction to the new teaching kits that we have developed for use in parent education programs. Those who have already purchased one of these innovative kits will be able to attend this workshop for free and those who pay will receive a voucher to the value of the workshop registration for use when they purchase one of the kits. This effectively means the workshop is free to those who will be using the new Essential Educator kits.

The feedback we have had since the launch of The Essential Educator kit last month has been wonderful. I can almost hear the sighs of relief from educators at the thought of having professionally produced handouts and materials for use in their programs and some clear guidance about facilitating group work and practical sessions.

I’ve been asked if some of the component parts are available to purchase separately and the answer to this is no. The components of the kit are integrated and need to be used collectively - this is especially true of the Birth Day panels. These magnetic boards (and their magnets) work in conjunction with several other activities (the Positions Scenarios, self-help practical sessions, Obstetric Intervention and Medication Templates and the various charts) and without these additional materials the effectiveness of the Birth Day panels will be diminished.

If you haven’t had a look at these kits in detail, check them out on the website. The full day workshops will be scheduled in various cities over the coming months, initially around the UK and Australia, but also further afield.

We are also offering some “showcase events” that basically just explain the kits and provide an opportunity for midwives and educators to see what they offer. These are free half day events and at present are only scheduled for the UK ( in September). Registration is necessary as places are limited.

The website has all the details.

Posted by andrea at 04:08 PM

"The Essential Educator" is launched in the UK

The Essential Educator Kit has been launched in the UK with a very successful event in Wales. Having worked constantly on this huge project for the last six months I have been so close to it all that I was a little nervous about how others would receive it. I need not have worried – the group of midwives, University Lecturers and childbirth educators who came to the free demonstration were bowled over!

One asked me how long it had taken me to write, produce and assemble the Kit and when I said “six months” another person added “and the last 30 years!”, which is not exaggeration as I have poured all my experience of childbirth and parenting education into this project. Several commented that the cost was extremely reasonable, given what the Kit contained and the quality of the products. The diversity, scope and innovation of the inclusions was praised and also the flexible way it can be used in either existing programs or to launch a new educator into the field.

Those who purchase a Kit are entitled to a free place in a one-day workshop that will help them get the most from their Kit and provide extra training in group management and presentation. These workshops are being scheduled for Australia in late August and for the UK in September, with more to follow in early 2007. The first one on the UK will be inwales, to follow on from last week’s event. The dates will be added to the website in the coming weeks.

I am very proud of this Kit and hope that others will find it practical, useful and very professional. You can find out more about The Essential Educator on our website where the full details are now displayed. I am looking forward to feedback from the first Kits to go out to those who have already purchased – I’ll be talking to them when I get home.

It’s back to Australia today, after a very interesting and useful time in the UK. Lots awaiting me as usual but as ever, it will be good to be home.

Posted by andrea at 05:56 PM

The value of prenatal education

During my conversation with Fran Gallwey in our UK office last night, we were discussing the forthcoming Preparing for Birth and Parenthood Conference (naturally!). Some people like to register by phone and this gives Fran a chance to chat to them about what is happening in their area.

One educator told her yesterday that where she works near Manchester, the parent education program has been cut back to one session! I wonder how they have justified taking this action when there are so many compelling reasons why they should be expanding, not contracting these services? Have they considered that:

These are the first thoughts that spring to my mind when I hear that parent education programs are being slashed. Short sighted decisions such as these deserve to be questioned. The parents in our communities deserve better treatment than being fobbed off with one class.

Posted by andrea at 04:31 PM

New pregnancy charts

While I was in the UK, I had an opportunity to get together with the artist whom we have commissioned to produce a wonderful new set of pregnancy charts. This series will replace several sets of charts we currently stock and be more useful for educators, who won’t have to buy so many separate chart series. It will also have no words, making it useful for educators who work in languages other than English.

The charts will be part of the next release in “The Essential Educator” series. The first two packages in this unique series will be available next month and the third set, on the theme of Pregnancy, will be released in July. The Pregnancy Charts are the centrepiece of this package and will offer a wonderful visual aid to help women understand fetal growth, the changes in their body from conception to birth, and the development of twins.

Meeting with Joanne Acty, the artist who also drew the “Giving Birth” chart series, was terrific and we discussed the finer details of the project. She had some of preliminary work to show me and it is looking fabulous. Instead of using coloured pencils to painstakingly create layers of colour as she did for the “Giving Birth” series, this time she is using the computer and some special techniques to develop images that are similar to drawings but easier to replicate.

She is a very talented artist and runs her own art school where she works with adults and children to enable them to develop their creativity. Joanne has had home births herself, so she is very familiar with the philosophy that underpins everything we do at Birth International and it is a pleasure to work with her. Can’t wait to get my hands on the finished product.......

Posted by andrea at 05:28 PM

Conference - shaping up well!

This past week I’ve mostly spent in the UK office. It’s been a pleasant change from dashing around the countryside and its given me time to work through the final details for the Preparing for Birth Conference at Reading University in July. The publicity is out now and the registrations are rolling in - it looks like being a very popular event.

One of the messages we were given on our evaluations last time was that there was still some unresolved feelings between the community based educators and the hospital based people. This Conference is a great way of bringing these two groups together, to discover what each group is doing and learning about other ways of working. Educators based in the community often tend to work with rather homogenous middle-of- the road couples and could benefit from learning about the more diverse groups their colleagues in the NHS have in their programs, and vice versa.

As an icebreaker for these two groups, we’ve devised some fun activities for everyone after dinner on the two evenings when we are all staying on campus. I won’t reveal what’s in store, except to say we have something very different up our sleeves which is guaranteed to give everyone a great deal of fun.

The list of speakers is impressive (even if I do say so myself) and we’ve covered the topics most requested by everyone who came last year, plus some new issues of interest to educators and midwives. For full details, click here.

I have also just finalised the speaking team for the next Future Birth tour in Australia which will happen between March 20 and 27, 2007. Watch for the announcements soon on our website and through our E Bulletins - this is an iconic event for us in Australia and one that midwives never want to miss. It seems a long way off right now, but we are racing through this year already!

Posted by andrea at 12:52 AM

The Japan Birthing Association

This visit to Japan culminated in the birth of the Japan Birthing Association. The brainchild of Nanako Ooba, a well-known childbirth educator in Japan, the Association will bring together all those who are interested in promoting natural childbirth in Japan. The launch event was an all-day seminar and planning meeting, with speakers in the morning and discussion during the afternoon. Over 130 people came to find out more and get involved, and it is clear that there is wide interest amongst a diverse group - midwives, mothers, fathers and others all came together in a common cause.

The morning session opened with a presentation from me on “World Childbirth and the future of childbirth in Japan”, which was a Powerpoint presentation, ably translated by my two interpreters, Yoko and Tomoko. I gave the current statistics for caesarean section in various countries as a starting point then described how we had to help women overcome their fear of childbirth and the ubiquitous spread of epidurals. I spoke about the ways that midwives were taking the lead in reducing both fear and pharmacological pain relief through better midwifery services and gave them a quick summary of what a natural birth involves.

Then came Dr Tomoko Saotome (see my previous Diary entry) who spoke passionately about women’s sexuality and how this is challenged and disturbed by interventionist birth. In a country where episiotomy is universal, except for a very few women who seek independent midwifery care, this was a wake up call to the midwives in the audience who routinely carry out this procedure without much thought.

Hatsue Miyake then spoke about her practice as a midwife. She works a weekly shift in a Midwife House and also does home births. An active member of the Japan Midwives Association, she finished with the invitation for all midwives to join their professional organisation, to strengthen its membership and help get its voice heard.

The afternoon included small group discussions where the theme was exploring ways of drawing attention to, and stopping, the closure of small maternity units as the centralisation of midwifery services continues in Japan. It seems that obstetricians are aging and leaving the workforce and the Government’s response has been to concentrate services in larger district units, which are quite different to the traditional network of smaller community based birth facilities. It was clear to me that everyone was passionate about birth and wanted something to be done about this situation but had few ideas of how to begin. I gave them a quick list of strategies for political action (mentioning some of the events and ideas that had been used successfully in Australia) and although they were glad to have some direction, I am not sure of they have the drive and persistence to carry out these ideas as yet.

In time I am sure that this will develop - after all, this was the first of what I hope will be many such meetings. It was good to be at the birth of another consumer/midwife alliance and exciting to think that the groundswell of change towards better births for women is starting to get organised in Japan. I am looking forward to learning of some progress when I next visit in 2006.

For those who would like to contact this new group, here are the details:

Japan Birthing Association

Address: 1-0-16-504 Tomigaya, Shibuya-ku,

Tokyo 151-0063

Tel: +81-3-5454-8210

Fax: +81-3-5454-8212

www.tanjo.org

Posted by andrea at 09:14 AM

November 26, 2005

The innate sexiness of birth

I received a copy of the Spanish birth Journal “Ob Stare” this week, which has the theme of sexuality and childbirth. Of course, not being able to read Spanish I am at a disadvantage, bur I have two fluent Spanish speakers in my Sydney office and the convenience of having two translators on tap.

This edition of “Ob Stare” includes a translation of my article on presenting sex and sexuality in prenatal programs that appear on our website. This topic came up on the final day of the Effective Pre-natal Education program that we have just concluded, as one of the participant’s presentations was on this topic. It is not always easy to incorporate this thread, especially as it can be sensitive and embarrassing. However, giving birth is the central point around which a woman’s whole sexuality revolves, so to avoid the issue is to deny this aspect of her being.

Ignoring the innate sexuality of pregnancy and birth is, I believe, one of the reasons why so many women find giving birth traumatic. For many women, giving birth is like a rape, with the same kinds of actions and words that would be experienced in a sexual assault. We don’t often talk about this, and I am sure that many women bury the memories as deep as possible, but it is also a potential cause of ongoing post-traumatic stress disorder.

As childbirth educators we can at least acknowledge the close ties between self-esteem, sexuality, pregnancy and birth by finding ways to explain how they are linked, during our pregnancy programs. Women need their strength, innate creativity and sexual power to be acknowledged and celebrated and we can play a part in this during one of the sexiest times of their lives.

Posted by andrea at 07:39 AM

September 27, 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

September 12, 2005

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

August 22, 2005

Could hypnotherapy work for labour?

There was a very interesting segment last week on Catalyst, the weekly science program on the Australian Broadcasting Corporation (ABC). It concerned hypnosis, and the way it can be used to cure phobias, change personal behaviours and reduce the experience of pain. At one point, they showed a woman who had an acute allergy to anaesthetics, undergoing abdominal surgery with just hypnosis to block the pain.

There was a very brief suggestion that it could be used for labour and birth (really nothing more than an image of woman in labour) but it got me thinking. For years I have been very sceptical of hypnobirthing, given that there is no hard evidence that it works, and that it has the potential to create false expectations that may not be fulfilled.

The TV program made it clear that there are discernable differences in brain function when a person is hypnotised. Using brain scanning techniques, researchers showed that the bran received and registered sensations in a different way when the subject was under hypnosis, and that in some people this could be enough to block acute sensations such as pain.

It was also explained that hypnosis does not work for everyone. Ten percent of people are highly susceptible to hypnosis, an other ten percent will find they cannot be hypnotised at all and the rest will be somewhere in between. If hypnosis is to be used for any treatment, it is important to identify in advance those for whom the technique won’t work, before the treatment is begun. There will also be a number of people who may find it is not as effective as hoped.

The other important point that I noted was that the subjects had been fully hypnotised before the post-hypnotic suggestions were made. The hypnosis was administered by fully qualified medical or forensic hypnotists, who were trained professionals and very experienced.

The reason I am still sceptical about hypnobirthing is that as I understand it, the subjects (pregnant women) are not put under full hypnosis but undergo training where suggestions are made and affirmations are learned and absorbed. This may be enough for the very suggestible (the ten percent who are very easily hypnotised) but may work less well for the majority. I also question the qualifications of the “therapist” in these sessions - I am not aware of any locally who are medically qualified or professionally trained (in the sense of having an accredited, professional qualification).

Perhaps hypnobirthing will work for enough people to justify its hype and promotion - there seem to be enough “testimonials” to keep business turning over. If it works, then some women will find labour is manageable without medications. If it doesn’t then there is the risk that women will blame themselves (“ I didn’t believe in it enough”, or “I didn’t practice enough”) rather than the technique or its avid promoters. A result like this could very easily undermine a woman’s self confidence, right when she needs it most.

Posted by andrea at 03:05 PM

August 08, 2005

A workhop in Tehran?

Last week I received an invitation to visit Iran, to present a workshop on childbirth education for the Ministry of Health. This came about through email conversations I have been engaged in with a midwife/educator who is researching parent education for a PhD. Her specific interest is on “training women in ways of managing labour pain” and we have had a lively discussion about the issue of “training” women for anything to do with managing labour. I have also flagged the broader issue of the influence that the care giver exercises over birth outcome and pointed out that there is no evidence that any “training method”, no matter how well rehearsed by women prenatally, will be used in labour unless there is good support from the midwives and doctors involved in the birth itself. Several studies have shown that women usually abandon their chosen method of managing labour as soon as they reach the hospital - it is the attitude of the first midwife they meet in the hospital that makes the difference.

I have tried to explain this to my Iranian friend, to alert her to other approaches rather than the breathing techniques she has been pursuing. “The breathing” is still encouraged by many despite any evidence of its effectiveness and its potential to cause chemical imbalances in the woman’s blood stream that may be detrimental to her and her baby’s health.

Funding is being made available for a training workshop for parent educators in Iran, hence the invitation to me to speak, but I have suggested that they wait until they see what I have written in my books (I have sent them a set of my publications) before they decide if this is what they want. I have explained that I know nothing about the Lamaze or Bradley methods, that these are American ideas rarely used outside the US and that women in the rest of the worked have developed other ways of handling pain, based on their own physiological needs rather than a learned response.

It will be interesting to see whether they come back to me to discuss a workshop further. I will quite understand if they decide to invite someone else. Whether I decide to travel to Tehran is also something that I will have to consider.....

Posted by andrea at 05:53 PM

July 20, 2005

Mary Nolan to visit Australia

Next February, from Friday 24 to Sunday 26, Birth International will be hosting the major event for childbirth and parenting educators in Australia in 2006 - a Conference at Sydney University. The program is being finalised at the present time and the full details will be on the website in a few weeks, but I am delighted to announce that Mary Nolan will be one of the key overseas speakers.

Mary is a senior tutor for the National Childbirth Trust in the UK, the author of a number of books on the subject of parenting education and a well known speaker in the UK and Europe. She will be presenting several workshop sessions during te Conference , where participants will be able to hone their skills and try out various teaching strategies.

The whole program is being geared towards the practical and away from the “talk fests” that so often characterise conferences these days. Working with parents in ways that will enable them to increased their skills requires educators who can model the skills themselves as part of a program that is interactive and experiential. This Conference will offer the chance to explore ways of tackling those topics that are often difficult to present well, such as pain in labour; unexpected outcomes; obstetric complications; informed choice; involving dads and sexuality. Special sessions will look at the needs of teenage parents; women wanting a VBAC, and program planning for special needs groups.

This will be the flagship event for those involved in childbirth education around the country, so make a diary entry now. More details soon - watch this space!

Posted by andrea at 12:00 PM

July 08, 2005

Who should facilitate parent parent education programs?

Several times during the workshop in Dublin I was approached by group members asking about using a team approach for the presentation of pre-natal education programs. There are pluses and minuses about using a number of facilitators for a group and I explained what these were. In general however, from an educational standpoint and to promote continuity of care and information, having the one presenter facilitate the entire program works best. This approach presumes, of course, that the facilitator is competent to cover all the possible topics in a pre-natal program. As for the question of which professionals should be involved, I have always maintained that the background of the presenter should not be an issue, providing they are skilled, competent and knowledgeable.

I have been forced to have a major re-think of these beliefs in light of my experience in Dublin. It was clear from the start that most of the group were public health nurses, well used to telling parents how to manage the post-natal period, but most were very unfamiliar with the needs of pregnant parents and the hospital system. I was astounded that no-one in the group could tell me any of the disadvantages for the baby of epidurals, for example, beyond the possibility of a forceps birth. The physiology of pain, or indeed that pain is a normal part of the birth process, was news to most as well. An exercise that explored their own beliefs regarding labour revealed that most saw it is a negative, painful experience that could best be managed with drugs.

At another point, I was roundly challenged by several group members who proclaimed that they would never allow their personal feelings to colour the information they gave to prospective parents, yet at other times they cited their own experience as the basis for the advice they gave. The language they used (“patients”, “delivery”, “fetus” etc) displayed a lack of awareness of the impact of their words and some were very sceptical of encouraging parents to “join in” so that better learning could occur. One person loudly stated that a lecture followed by a question time was, in her experience, very well received by parents, yet when challenged as to how she would evaluate whether any actual learning had occurred she had no ideas, other than that they “would ask questions”.

I came to the conclusion that public health nurses may not be the next people to work with pregnant parents, unless they had recent and on-going contact with hospital maternity units, found ways of getting feedback from parents (for example, through organising a group reunion) and spent time in the hospital rooms with labouring women. It is very easy to get out of touch unless a conscious effort is made to keep current with the research, the services and the birth process itself. It is not good enough to rely on one’s professional education of some years ago, or one’s own personal birth and parenting experiences, as a basis informing expectant parents. This is especially so when so many of those personal experiences have been negative or even traumatic.

I have to admit that if a pregnant woman asked me if she should attend the classes run by some of these educators I would have to express doubts as to their worth. It could be that these parents would not be fully informed, may receive out of date information and be subjected to subtle messages that reflected the presenters attitudes and beliefs. I think that sometimes pregnant parents are better off with no education than poor quality education.

There were some educators in this group who clearly had a good grasp of the complexities of pre-natal education, did make an effort to provide learner centred programs, and were flexible in their attitudes and general approach. I just wish there had been more of them, for the sake of pregnant Irish women

Posted by andrea at 11:00 PM

July 07, 2005

A new style of prenatal education for Ireland

I have had a very interesting day today, facilitating a workshop for those involved in parent education throughout Ireland. Many in the group are public health nurses, most are midwives and there are a sprinkling of others, including physiotherapists.

The suggestions I have made, primarily to switch from lecture style classes to facilitated, interactive programs that encourage skills development through participation and practise, have been largely welcomed as different and innovative. Not everyone has agreed - there are always those that see change as threatening and difficult, and who prefer to lecture to parents. Some of the interactions in the group have been lively and instructive for those wanting to know how to manage the group process. One group member was a midwife I met years ago in a workshop in London. She had been inspired by the content of those programs (she had attended both the Active Birth and the Teaching Skills workshop) and had used the information for the births of her children. The first was the standard “active management”, the second was a domino birth with a midwife and the last was a home birth, all in Ireland. It is always very humbling to know that your work has been of practical use to someone and I was thrilled she had found my books so useful too (she said she had read The Midwife Companion about 10 times!).

More importantly, she told me that her midwife didn’t quite make it to the home birth, missing it by about 3 minutes. She had been beating herself up about this for months - perhaps she should have called her midwife sooner, perhaps she should have better recognised the transitional stage of labour and been more aware of where she was up to, etc. I pointed out to her that the late arrival of her midwife could be seen in another way - that she really didn’t need the midwife to be there for the birth, that she was quite capable of giving birth herself, without assistance. If there had been a delay, her midwife would have made it and been on hand to help. This midwife has learned a lot about birth and herself through the births of her babies and this final lesson may be the one she needed to cement her belief in women’s abilities to birth safely and joyfully.

Life has a way of unfolding that gives us many opportunities to learn more about ourselves. As childbirth educators, we have to be aware of the enormous potential we have to support and encourage parents to take that journey of self discovery - and no amount of lecturing them will achieve this.

Posted by andrea at 05:29 PM

April 26, 2005

Educator's personal experiences

One of the issues that arose during the workshop in Ireland is the way that personal attitudes, beliefs and philosophy affect the content of the program that an educator facilitates.

Women today have been sold the idea that labour is so painful that an epidural will be needed. In providing the full story about epidurals and other ways of handling the pain of birth, a childbirth educator needs to be able to “sell” other options, such as the use of water, movement, creating an effective environment for birth etc. Getting these ideas across is much easier if they stem from the experience of the educator herself, and if she is familiar with the way these alternatives work in practice.

When an educator has had a difficult birth, or has been the victim of a rigid medicalised birth system herself, it could be hard for her to be confident about using these alternatives or convincing in her “selling” of these ideas. Tied up in this could be an unwillingness to be seen as a “failure” herself and a concern about creating expectations that women can achieve a non-medicalised birth when her own experience tells her this is very difficult or impossible. Whilst this approach may be understandable from a personal emotional perspective, there is a risk that with holding information may serve to perpetuate a brutal system that exploits women during the birth process.

In making these comments, I don’t mean to imply that only women who have natural, non-medicalised births should lead prenatal programs. My point is that educators need wide experience, and this can be gained by attending births, acting as a support person, visiting hospitals and birth centres and by talking to women to have had a variety of labour experiences.

Educators who have unresolved feelings about their own births must recognise that they have unfinished business that needs attention, to avoid their feelings unconsciously colouring the messages they give others. Women seemingly delight in recounting horror stories about labour to each other, and this is something an educator must avoid doing at all costs, even in a subtle or subliminal way, when she is facilitating a program for expectant parents.

Some of the comments that were made in Dublin by some of the educators indicated that they had personal issues around their own births that may well be affecting what they are saying to pregnant women. Many had little current experience of labour ward practice and most had never seen anything other than routinely actively managed births. Their attitudes and beliefs were reflected in the language they used, the comments they made and their reactions to my suggestions for teaching strategies. I felt that many found my ideas a little uncomfortable, and therefore they would not be pursuing them.

Parents gather their ideas on labour and birth from many sources and they respect that their childbirth educator as a professional with expertise on the subject. It is therefore the responsibility of the educator to put personal feelings aside and to strive for the best educational opportunities for the parents in their programs. If this means the educator stepping outside of her comfort zone to gain a wider appreciation of birth choices and options, then this is something she has to undertake. It won’t be easy in the Irish context, but every effort needs to be made, if the system is to be challenged as it surely and sorely needs.

Posted by andrea at 09:31 PM

April 24, 2005

Giving birth in Dublin

My trip to Dublin this week has left me with very mixed feelings. Whilst I very much enjoyed being with this group of Irish midwives and public health nurses, I was dismayed by what they told me about the state of maternity care in Ireland, especially in Dublin. I guess that in some ways I was not surprised by this - Dublin is after all the home of the “Active Management of Labour” protocol that forces women to accept a predetermined management plan for their labours, whether they like it or not.

The most disturbing aspects of the workshop discussion for me were the group’s acceptance of the status quo, their unwillingness to consider the suggestion that this could be challenged to any degree and the outright fear of labour that these educators, on the whole, expressed.

The rigid management of labour, as set down by the Master of each hospital in Dublin, requires that women spend no longer than 12 hours in the first stage of labour and one hour in the second stage. This is achieved by the routine use of rupturing membranes, liberal use of oxytocic drugs and instrumental deliveries if the birth is delayed beyond the given time frame. Whilst there is a pretence of “allowing” choice, “informed consent” is often obtained under duress, such as in the transition phase of labour when a women is required to listen to the anaesthetist explaining the pros and cons of epidurals before requiring her to sign a consent form. If a woman decides that she doesn’t want a standard procedure, or questions a policy in any way, she is labelled a trouble maker and will be subjected to verbal abuse, intimidation and harassment during labour. It is no wonder that given these circumstances, childbirth educators are unwilling to encourage women to speak up for themselves during labour and that preparing for this regime is seen as preferable to leaving women potentially vulnerable in labour.

I was surprised that so many of these educators were frightened of birth. Given that they will have had their babies withing this system themselves, much of this fear will have come from personal experience. Quite a few were public health nurses, and would not have had any direct experience of maternity care for some time, and this places them at a disadvantage, as they have to reply on their colleagues who work in the maternity hospitals to relay information. What they are being told to pass on are the policies and procedures that the hospital want women to accept without question. Very few of these educators were aware of the evidence surrounding birth issues or used the research in their classes as a basis for encouraging informed decision making. Parent education programs were typically 3 or 4 sessions of 2 hours each - far too short to provide any real educational experience for parents, but enough time to explain the procedures they would face.

It is hard to know what will stimulate change in the Irish system of maternity care. Given the subjugated position of pregnant women, I think it is unreasonable to expect them to force change through their questioning or requesting of alternatives - they fear very real retribution, and no woman wants to risk this when she is at her most vulnerable during labour. The midwives have seemingly given in as well - no doubt because of similar threats - and appear to have lost touch with their professional role as the protectors of normal birth. They don’t seem to have appreciated the fact that they are colluding with the doctors in the shameful exploitation of pregnant women when they fail to challenge what is going on.

The doctors will not force change - they are making squillions of Euros each and sit very comfortably at the top of a chain of command that bestows huge power over women (both the pregnant and the professional) and the health care system. My good friend Doris Haire, American birth activist extraordinaire, suggests that the best solution is to “sue the pants off them” as money si the only language obstetricians understand. Given the amount of emotionally and physically damaged women will be leaving these birth factories, perhaps this is a likely solution. The litigation rate in Ireland is certainly very high.

I am returning to Dublin in June to present another Teaching Skills workshop for a further group of educators. I wonder if there will be any fall out from my visit this time, and whether the next group will have many of the same characteristics as this one. I am not blaming these women for their approach to parent education, I am just sad that they have not been given any opportunity to embrace and pass on the joys of birth to the women they serve and to use the influence they have to encourage and stimulate change. I will try and get these messages across with my next group.

Posted by andrea at 07:30 PM

April 21, 2005

Off to Ireland

Today I am off to Dublin to present a Teaching Skills workshop for the Irish Nurses Association. It is the first of two programs (the next one is in June) and I note from the list of attendees that many different hospitals will be represented.

I am looking forward to using this opportunity to find out what is happening in the Irish maternity services, especially now that midwives are starting to develop a higher professional profile. Health care in Ireland has long been dominated by the obstetricians, and it is the only country where the chief obstetrician in the major hospitals of Dublin are known by their title of “Master”. Not Doctor, not Mister (as they do in the UK) but “Master”. It says a lot about the way they, and others, see their role.

One of the main themes of this workshop will be enabling parents to develop their skills in dealing with this kind of health care system. The issue of informed consent will be a major topic for discussion and exploring women’s rights, responsibilities and capabilities will no doubt feature.

The Irish can be a feisty lot, full of fun and willing to take a chance. I wonder if these qualities will come out in this group of midwives/nurses?

Posted by andrea at 11:29 PM

April 10, 2005

UK Conference - a huge success

The Conference in the UK has been a huge success. The venue at Reading University was perfect and the program rolled out without a hitch. The speakers were outstanding and the participants have given us glowing feedback. We will certainly be offering an expanded program next year, although a little later, so it is not so cold! It snowed one evening - quite a novelty for me, of course, but rather unusual for April.

The format of workshops, with short plenary sessions at the beginning and end of the days, worked very well. The video screening was well received, especially after our “happy hour” of wine (Australian!) and nibbles that had everyone in the right frame of mind for a night of mixed videos on birth and parenting themes.

One aspect of the Conference that was especially pleasing was the good mix of NHS educators and physiotherapists, craniosacral therapists, NCT, Active Birth, Yoga and other educators in the audience. It is so important to get all the various parent educators together in this way, to share experiences, learn more about each other’s work and to break down some of the misconceptions and perceptions that can be rife.

We had deliberately invited a number of international speakers to facilitate workshops, because we wanted to expose the UK health professionals to other ways of doing things. This worked very well and again the feedback was very positive. As I was screening the videos I suddenly realised that most of them were Australian in origin - and I apologise to the group, although as I pointed out, we do make a lot of very good videos on childbirth, breastfeeding and parenting themes in OZ.

I have had a wonderful time and I know that my team of helpers did as well. Fran Gallwey, who manages our UK office did a magnificent job and was able to meet many of the people she had spoken to on the phone. Our helpers, all students or people who had worked with us before in planning and presenting my workshops around the country, made everyone feel welcome, and were a key element in the smooth running of the event.

We’ll be closely evaluating the feedback and gathering the ideas offered as a basis for planning the next one. We have a similar event on the drawing boards for Sydney early next year and I hope that it is as successful. Watch this space for details later in the year.

Posted by andrea at 08:42 PM

February 15, 2005

Educating women about caesarans

This past week has been extraordinarily busy for me and I apologies for the lack of Diary entries - it is not as though there isn’t enough to talk about!

For example, I received this note from a friend in the UK:

“One of our friends from work had her baby last week. She had a 10lb baby boy, and they gave her a Caesarean section, cutting a major artery during the operation. Apparently she nearly died and they have had to give her a hysterectomy as a result.

I just hope the Caesarean section was absolutely necessary - probably the reason given was Preparing for Birth: Mothers the size of the baby. We had given her a some time ago but I don’t think she read it. She didn't want a birth plan, was sure the hospital and midwives would know best and was happy to go along with anything (pretty much like 90% of pregnant women in the UK I think).”

This is a sad comment, but one that I fear is very true. So many women take the their health for granted and put their faith completely in the system, sometimes to their detriment. By way of contrast, there has been a huge kerfuffle in Queensland recently over a woman who wanted a vaginal birth after two previous caesareans,

This woman was receiving care through the largest Women’s hospital in Brisbane. She was advised that another caesarean would be required because of her history, even though she had stated clearly she didn’t want one and was very confident that she could achieve a VBAC (vaginal birth after caesarean). Much pressure was applied by various staff, so she sought a second opinion at another smaller hospital where she was given every support for her decision to have a vaginal birth. The first hospital got wind of this, and demanded a meeting with her. There were five staff to “interrogate” her, including a lawyer, and they asked her to sign a statement that she would undergo the surgery. She declined, saying she would take the document home to read first. When she failed to appear at the next scheduled appointment, the hospital phoned the Department of Community Services, who sent around an officer to check up on her (this is the agency that is charged with protecting children at risk). Her unborn baby had been deemed to be at serious risk, despite our laws that clearly state the unborn baby has no “rights” until it leaves the mother’s body.

In the end, the woman (very sensibly) declined to be “assisted” by this major hospital, and went on to have a perfectly straightforward vaginal birth in the smaller unit, with two lovely midwives who were delighted to be of service.

This case is still reverberating around Queensland. The fact that the Government can intrude on a woman’s rights to this extent, the lack of empathy, caring and support from the major hospital in Brisbane, the pressure from supposed health professionals, all illustrate the sad state of affairs in some areas of the maternity services. There is a Ministerial Review of Maternity Care in progress in Queensland, and it is to be hoped that it recommends sweeping changes so that women’s retain their rights and have better choices available.

There is no evidence that a woman cannot have a vaginal birth after one or more caesareans. Few studies exist, but many anecdotal stories attest to the success of VBAC, when women prepare well and have good midwifery support. This major teaching hospital was more concerned about “risk management” than following the evidence, providing individualised care and offering compassionate support for this woman’s needs. It has been a shameful episode in their history.

Meanwhile, for women who do want to know the risks of Caesarean births, a new publication from the Maternity Center Association in the US has been added it to our range, and you can check it out by clicking here.

Posted by andrea at 06:26 AM

February 07, 2005

Conferences

I have had to decline an invitation to present workshops at a conference in Barcelona in October. It is rare (in fact It’s never happened before) that I decline an invitation, because I am always keen to spread the word and do what I can to further the cause of natural birth.

In this case, I was asked to do 6 workshops of 1 ½ hours each over the course of one day, all on the same topic, with groups of up to 50 people each time. There would be two short breaks and lunch, and the day would have stretched to 12 hours of work. I have decided that this is unacceptable, for me and for those attending - no-one can be at their best when working like this. I also question whether the participants are capable of taking much in during days packed out like this. Perhaps, if the organisers change their format another time, I can contribute, which I will be very happy to do on a more professional basis.

Organising conferences is quite an art. I have done this a number of time over many years and know that they are exhausting for the participants, as well as for the organisers and speakers. I believe that a Conference presents the professional face of an organisation and that this image is important. Behind the scenes it is vital to carry this theme on - paying speakers well for their time, providing them with good audiovisual and venue support, making sure that they are comfortable, accommodated and valued. This costs money, and the expenses incurred must be covered by the costs of the event. If that means participants paying a little more, then they must realise that they are privileged to have access to so much expertise in the one place - something they could never achieve otherwise.

I’ve given years of free time to promoting better midwifery and great births for women but as I get older (sigh!) I am realising that it is time to take stock of the time I have available and to use it wisely. It is a hard juggling act - balancing community support and the need to provide viable professional services - but I am going to get plenty of practise, it seems.

Posted by andrea at 07:05 AM

January 27, 2005

Birth outcomes in NSW

A closer look at the birth outcome statistics for New South Wales (2003) reveal some interesting facts and confirm what has been proven by previous analyses. In simple terms, if you want to have a great birth with a minimum of interference, choose a country hospital and use the public health system. Avoid a city hospital, especially if it is a teaching hospital and don’t choose private care at a private hospital unless you are prepared to pay for it, with your dollars and also your body. A few figures will explain these statements.

The best hospital for normal natural birth in 2003 was Wyong, just north of Sydney. This unit is run by midwives and some selection criteria apply, but once accepted you have a 92.1% chance of a straightforward, uncomplicated birth. It could be argued that this outcome would be expected under these conditions, and that any other result would be unacceptable, but it does prove that the majority of women, when cared for by midwives, do well during labour.

Other hospitals, without the ability toscreen their clients, have also done well. Armidale Hospital (77% normal birth rate) and Kempsey (77.6%) stand out but smaller hospitals in the Northern Region also achieved high rates of almost 80% uncomplicated births.

Some city hospitals did well too. The western suburbs of Sydney, an area where many migrants and poorer people live stood out: Fairfield (71.6%) Canterbury (71.4%) , Auburn (78.8%) and Camden, which is again under threat of closure, had a normal birth rate of 85%. All of these hospitals can handle emergency caesareans and all, except Camden, are teaching hospitals. There will be very little private obstetric care in these units and they are good indicators of a public system that is working well.

At the other end of the scale are the private hospitals. These places should hang their heads in shame - their clients are from the wealthy end of town, well nourished, healthy and with few underlying health problems. Yet they achieve deplorable birth outcomes: Hurstville Community Hospital (43.8%) and Kareena Private Hospital (38.5%) take top honours here, with the majority of their clients (44% at Kareena and 37.4% at Hurstville Community) having a caesarean birth. This is outrageous and gives a good indication of the risks that come from choosing obstetric care - only an obstetrician can do a caesarean!

The larger Regional referral hospitals don’t do so well either, but they will have a higher than average number of women with problems, especially if the system is working as it should and those with complications are referred for specialised care. The figures from Bathurst Base Hospital (59.6% normal births and 34.2% caesareans) and Goulburn Base Hospital (53.4% normal births and 28.4% caesareans) illustrate this point. These figures for caesareans are still high, according to the WHO, who say that even if all the women admitted to the hospital had complicated pregnancies the caesarean rate should be no more than 15%. I suspect it is once again the presence of obstetricians in these centralised referral units that tip the balance towards surgical birth, even when it may not be absolutely necessary. Next, I’ll have a closer look at the rates for epidural and drug use in labour.

Posted by andrea at 07:08 AM

December 16, 2004

Birth outcomes in NSW

The latest figures on birth outcomes in the State of New South Wales (2003) have just been released. This State is the only one in Australia that makes all the figures, for both public and private hospitals, freely available to the public and it is a goldmine of information.

Once again it underlines what we already know is happening: the caesarean section rate has risen from 19% in 1993 to 27% in 2003 and most of this rise is concentrated in the private sector, where the obstetricians rule the roost and the women have the money to pay them.

At the other end of the scale, this report has the figures on the first midwifery led units, and the Birth Centres, listed separately. Women who choose this kind of care have a 95% normal birth rate, which is impressive, but then this is to be expected as they work with a carefully selected low risk population. If the figures were any worse than this, there would be questions to ask.

The vaginal birth after previous caesarean (VBAC) rates are shocking. Only 20% of women i