Articles by Category: People and places

Labour wards in Iran

I am working on the report for the Iranian Ministry of Health and Medical Education and the UNPFA following our mission to Iran. We will be making a number of recommendations and suggestions regarding the provision of maternity care that will include: ideas for further training for midwives and obstetricians; the development of new birth centres; the implementation of prenatal education programs; access to research evidence and more appropriate reference books; provision of simple equipment to better enable physiologic births to take place in the current labour wards; and ultimately the reconstruction of maternity hospitals.

This last goal is a long term one, but we have been told that new hospitals are being built now and we have been asked to provide some information on building guidelines and service provision in Australia to help shape thinking in Iran.

The photos below illustrate the urgency of the problem. Until conditions like these are improved, there is very little hope that normal physiological births will occur in current labour wards. The main issue is the complete lack of privacy, which affects both women and midwives alike. Everything being done is on view and while this is a major problem for the labouring woman, the midwives and obstetricians are also vulnerable to being watched over by their peers and supervisors.

The hospital in which these photos were taken is typical of labour wards in public hospitals across Iran.

This is the entrance to the labour ward area.

The nurses station in the centre of the unit. The first stage rooms are on the right and left with the second stage room on the right at the end.

There are five beds in this room. A woman is labouring in the bed on either side of the one shown, behind the curtain. There are two other similar rooms in this unit.

Once on second stage, the mother is moved to this room, where three beds, side by side, are used for managing second stage. In this hospital, which has 1,000 births per month, it is common for two or three women to be giving birth at the same time in this room.

Fathers and relatives wait in this area while the birth is in progress. It was a busy waiting room, opening directly onto the road at the entrance to the hospital. Fathers will see their new baby in the post-natal ward, where women stay for 24 hours (uncomplicated birth) or 36 hours (caesarean birth) before discharge home.

Posted by andrea at 08:50 AM

Birth activism in Australia

I was pleased with my presentation at the Conference today. I spoke about the “Rich History of Birth Activism in Australia - lessons learned” and offered a snapshot of a few heady years in the late 1970s when Parents Centres Australia set out to expose the awful conditions in which women were forced to give birth in Australia. We learned a lot through our activities and I offered some personal insights into campaigning strategies and tactics.

PCA was a very effective pressure group, initiating the campaigns for breastfeeding support, rooming in, fathers in the labour ward, support for home birth and the establishment of birth centres, amongst other issues. Women in Australia were very ignorant and complacent when it came to having babies - they accepted the indignities and humiliations routinely handed out (soap and water enemas, full pudendal shaving, routine episiotomies, separation from their babies, four hourly feeds etc) as “the way things are done” and stoically put up with it all. PCA, with its outspoken methods, really shook things up. The hospitals were favourite targets and the doctors were regularly lambasted for the pompous, arrogant subjugation of their “patients”. The media were helpful and regularly published quotes and letters and many useful articles were written up supporting the call for change.

Demonstrations were another effective tactic and public displays offered a chance to educate and well as publicise the cause. I was able to obtain a wonderful collection of images of early rallies newspaper cuttings and reports to show this modern day audience how we challenged the system and created an awareness that birth could be better for both mothers and babies. Elaine Normling, an early President of PCA was a fanatical archivist, carefully creating a record of everythign we did. Much of the PCA material is now held in the Jessie Street Library in Sydney (which specialised in women’s issues), but Elaine still holds many of the scrapbooks she collated and generously helped me assemble a collection of images of r this presentation. Here are some that I presented:

One of the first rallies we held was in support of breastfeeding. A number of us set up a display in Australia Square, giving away inflated breast shaped balloons that carried the message “Breasts - not so much the container but what it contents” to a very amused and interested lunch time crowd. All the media came to film - the balloons with their clever message guaranteed us a place on most TV News programs that night.

The doctors and hospitals information service was another innovation. Using information gathered from the parents who attended our prenatal classes and some surveys we conducted ourselves, we provided useful information to expectant parents about doctors, hospitals and their practises and also revealed hospital policies.

Conferences became regular events. Following the first Conference ever held on breastfeeding in NSW, PCA offered annual events on the themes of birth, breastfeeding and parenting. These enabled us to educate parents and the community while making enough money to support our activities, newsletters, publications etc for the following year.

The full story of PCA, the CEAs and the early history of the Nursing Mothers Association in Australia is well documented in the book “Our Bodies, Our Babies” by Kerreen Reiger. It offers a well crafted account of those turbulent and exciting times that kicked off the birth reform movement in Australia.

The rest of the Conference was a mixed affair. Some of the speakers, especially Justine Caines, offered practical suggestions and exciting possibilities for furthering the cause of birth reform and others were just out to sell a product (the Pink Kit). Needless to say, people were looking for ideas and tips for making a contribution to the promotion of birth and breastfeeding, and became quite hostile to speakers who were into blatant self promotion.

I hope that those who did come to this event will go on to maintain their interest and passion for better births and birth support, for both women and midwives.

Posted by andrea at 08:28 AM

The Australian Birth and Post natal Services Conference

This weekend I am at the Australian Birth and Post natal Services Conference being held in Melbourne. This event is the brainchild of Kelly Zantey who has assembled a program of business and birth services speakers that is designed to inspire and uplift, while providing some basic pointers to those who want to become more involved in birth activism.

The audience is a mix of midwives, midwifery managers, childbirth educators and doulas with a few pregnant women as well. It is an ambitious event, and although registration numbers are less than Kelly had hoped, I am sure those who have come will hear some useful information and go away with some new perspectives. Much of the first day has focussed on change and change management, especially in oneself. Being willing to embrace change is a prerequisite to being able to support and influence others to accept and incorporate change into their lives or workplaces. Several speakers offered tips on how to manage stress, develop one’s emotional intelligence, recognise helpful and unhelpful behaviours and understand natural reactions to being verbally attacked.

I was amused how “what goes around, comes around”. At the end of the day we viewed a long film called “The Secret” which was a series of talking heads describing the benefits of what we used to call, in my day (there that’s showing my age!) , “the power of positive thinking”. It was dressed up for the current times in a slick marketing package, and was full of psychobabble, but it basically had a good message - that you are what you think (that’s the “secret”) and if you visualise what you want to achieve, clearly articulating your desires and thinking about the positive things in life, rather than focussing on the negatives (what you wish you didn’t have), then the “universe” will provide the outcomes you desire. It was a message that would resonate with many in a western lifestyle, especially these days with its emphasis on materialism and personal success, but I was disturbed by its egocentricity.

There was no mention of how these insights could be applied to others in the form of service or actions that would benefit the wider world or humanity. The emphasis on getting what you want for yourself is fine, but what about the costs to the community, the environment and the planet that this selfish pursuit of high flying goals (there were lots of expensive gas-guzzling cars shown as commendable “prizes” to be lusted after)? There was no mention of helping the less fortunate, of using one’s influence and skills to obtain better lives for others, or contributing in other selfless ways to the local or broader community.

I would have felt much better about this program if it has included footage of others who had turned their good fortune of being born into western affluence to the betterment of mankind as a whole. Even Bill Gates and Warren Buffet give away a lot of money to worthwhile causes for the benefit of the planet and its people, and while they have almost obscene amounts of money and wouldn’t miss a few billion, it is the principle of sharing what we have with the less fortunate, no matter what our circumstance, that seems to be missing these days.

Kelly Zantey has said that it was this film that inspired her vision of a Conference that would inspire and uplift others to continue to fight for better maternity services. This is a wonderful example of what one person can do in the name of a wider cause. If “The Secret” has enabled her to formulate her plan for this event then it has clearly had the desired effect for her. I just hope that others see the wider application of its message as well.

Posted by andrea at 07:35 AM

Overseas visitors check out Selangor Private Hospital

During the Future Birth tour, the team took time out to visit Selangor Private Hospital in Nambour, about an hour north of Brisbane, Queensland. This unit is unique within the private health care system in Australia and also, I believe, within the health care system as a whole. It works on a collaborative model of care between obstetricians and midwives and has long been th leader in offering VBAC, vaginal breech and twin births and birth in water. For a hospital that has no screening, accepts all-comers and has a higher than average “at risk” clientele (because women will travel from all over to be given the chance of a normal birth) they have excellent outcomes.

A report and photographer from the local newspaper joined us and wrote up this article. We should have checked that the report knew how to spell!

Posted by andrea at 08:23 AM

Future Birth Tour 2007

The “Future Birth - exploring new paths to birth” tour has been a huge success. The tour took in six major cities around Australia in eight days - a real travelling circus - and was universally praised on all fronts. The four fabulous speakers provided a wonderful array of ideas, insights and experience that werre appreciated by everyone who attended. Underpinning their presentations was an obvious and deep commitment to women, babies and health and a passion for midwifery that was engaging and inspiring. You can tell that I had a wonderful time, can’t you?

Our tour group: Andrea, Marcos, Polly, Sandy and Sarah

Polly Ferguson opened the day with a clear description of the All Wales Pathway for Normal Birth. This clinical care plan, agreed between all midwives and doctors in Wales, has been responsible for lowering intervention rates, reducing caesarean births and promoting midwifery care through their country. After a long (and exhausting) process of collaboration and discussion, the basic fundamentals of normal birth were agreed and are now applied to all women who want to have a normal birth. In a neat turnaround, midwives assume that a woman who asks to have a normal birth will be offered care described in the pathway, and they will not discuss any alternatives unless there is clearly a medical problem developing in the pregnancy and labour. Recording the woman’s progress is simple - all the midwife needs to do is initial and date each step along the printed Pathway, and make a mark on the partogram during labour - no notes need to be written unless there is a need to explain a deviation. It is a simple strategy that assumes normality from the start, reduces the paperwork during labour and enables the midwife to be much more “with woman”.

Polly will be sending me the evidence underpinning the Pathway that was hammered out during discussion between all stakeholders. Once I receive this, I will upload the Pathway and the evidence onto our website.

In her closing remarks, Polly described how most midwives are “up in the stands” shouting complaints, instructions and sometimes abuse to those playing on the field below. She pointed out that this wasn’t much help and that it was much more fun to be “on the field”, tkaing part in the game. She encouraged everyone to “get their boots on and start playing” - a message that will be taken up by many who will now consider using the Pathway in their own units.

Dr Marcos Dias offered us a rare glimpse into the workings of the maternity health care system in Latin America. He described typical birth outcomes in many of the countries in this region, and what is being done to provide a more humanised experience for women. Marcos is passionate about public health (rare for am obstetrician) and he has committed himself to improving birth outcomes, especially in Brazil. He built the first birth centre in Brazil, in Rio de Janeiro, where midwives are responsible for the care of labouring women. He told us how he had to go to court three times to fight off the doctors (“mothers will die, babies will die”) before it was allowed to open.

Marcos Dias presenting his paper at the Brisbane seminar.

Midwifery as we know it is a very new profession in Brazil, as most women have either obstetric care in the cities, or are assisted by a traditional birth attendant in the poorer rural areas. Marcos is a founding member of REHUNA, the organisation for the humanisation of birth, and was involved in the first two birth conferences on this theme held in Brazil. The first of these was in Fortaleza in 2000 (where I first met him) and then again in 2005 in Rio de Janeiro. There will be a similar event in October 2008, again in Rio, and once more it is expected that around 2,000 people will attend.

Everyone was deeply impressed by this modest man, who is totally committed to women’s health and who is making bold moves to shake up the system through his work as an advisor to the Brazilian Minister of Health. His paper will be on the website very soon.

Dr Sarah Buckley is an Australian GP and mother of four home birthed children who is also a passionate advocate for better birth. Her main concern is the health and well-being of the baby and the emotional, psychological and physical health of the birthing woman. She spends much of her time checking the evidence and scouring the research, assembling an awesome array of scientific data to support her call for undisturbed, ecstatic birth. Her paper was universally acclaimed for its insights and detail, and participants went away with a detailed outline of the impact that birthing practices have on the delicate balance of hormones that are necessary for a successful birth.

Her paper will also be on the website soon, and her book Gentle Birth, Gentle Mothering is a wonderful collection of her writings on this subject, gathered from the many publications to which she contributes regularly.

Sandy Kirkman’s appearance on the program was eagerly anticipated by those who had heard her on the last tour. Sandy is a brilliant speaker, using a hilarious blend of humour and stories to illustrate her message (on this tour) about gender influences on communication. She explained how the different ways that men and women behave and the way they use language can lead to all sorts of misunderstandings, sometimes with unfortunate results.

This can be a particular problem between midwives and obstetricians, who view the world from different gender paradigms. She left us all with some simple instructions that could assist in better collaboration and co-operation, especially in labour ward settings. The first was “never ask an obstetrician for help unless you want him to fix the situation” and “avoid using the word “yes” as a conversation encourager - be direct and simple in your communication with men”. She had some side-splitingly funny stories to illustrate her observations, which left us all uplifted at the end of the day.

Everyone went home laughing, with a broad smile on their face - a rare achievement at a seminar (except ours, of course!).

I am now thinking about the next event, due in two years.....

Posted by andrea at 04:25 PM

Moving on

It is time to get back on the plane for the trip home. This has been a fascinating tour of duty - each of the workshops that I have presented have been completely different: even though the subject was always “active birth”, the composition of each group varied considerably.

The first program in Hull was for the community doula project and the group was mainly made up of volunteer doulas who will be matched up with vulnerable women at risk to support them through their pregnancy, birth and postnatal period. Although some had given birth themselves, they basically had very little knowledge of childbirth, so I had to balance the content to meet their needs as well as the interests of the midwives who were also in the group. Working with non-professionals always presents a different set of challenges and keeps me on my toes!

The next group was in Halifax/Huddersfield, and were midwives from two different hospitals with very different practices. They are in the process of merging campuses, which also involves establishing a new birth centre program. The two groups were a bit suspicious of each other, having heard plenty of “rumours” about each other’s practices. In the end, some new relationships were forged and new understandings emerged - as one said at the end “we all have the same problems, really”. I was very pleased with how this group worked - they went away energised and ready to try new ideas, with a firm commitment to women and their needs above all.

From there I went to Limerick to work with the second year students in the midwifery course. This has become a regular event for me, and it is always stimulating to be around students. Their main gripe was that they were not seeing the kind of care we were exploring in their practical placements - a few had seen birth off the bed, for example, but most were seeing the usual ritualised “active management”style of birth. This was disappointing, as I have done a number of workshops for midwives working in the local hospitals (but not all staff) so I suggested they keep asking the questions that students are entitled to ask - “is this really necessary?”, “is there some evidence you can point me to, to support this practice?” etc. I’ll be back there in 2008 for the next batch of students, so we will see what they have to say about progress.

Next was the Croatian trip, which you can read about above. I am hoping to go back there as well, perhaps to work with the midwives. I would love to be able to give them some more help.

My final workshop was in Wales, on the theme of “The Essential Educator”. The Welsh have really taken to the teaching kits I have developed and have ordered a number of them. This program was for the educators who will be using them, to take them through some of the activities, explain how to make the best use of the materials the kits contains and provide some additional training on group work etc. I’ll be back there later this year as well, as they are buying some more kits and will want further training for their staff.

Wales seems to be the one place in the UK where birth is going ahead in a positive way. Their “Pathway for Normal Birth” record keeping system has been instrumental in reducing midwives’ writing time and freed them up to spend more time “with women”. Their caesarean birth rate is not as high as elsewhere and they have developed some great 1 - 2 -1 midwifery programs in the community and through birth centres. Much of this has been driven by Polly Ferguson, the dynamic and passionate Midwifery Advisor to the Welsh Assembly - you can meet her and get your own copy of the Pathway documents at the Future Birth event in a few weeks. We can learn a lot from the Welsh!

Not a bad series of workshops for a rushed 2 week period! Time for home now, to get ready for the Future Birth tour and make plans for my next foray overseas, which looks like being another trip to Iran, in May.

Posted by andrea at 04:29 PM

2007 off to a busy start

The year has begun with a rush. After the hard work of putting the 2007 Birth International catalogue together (click here if you would like a copy posted to you), we quickly geared up for the first workshops.

The first program was an Active Birth workshop in Darwin. The “Top End” is a fascinating part of Australia, firmly within the tropics and at this time of the year, a wondrous mix of storms, heavy rain squalls and ever present heat and humidity. The gardens are lush and green, growing rapidly while you watch!

Because of its isolation, the people in Darwin fall into one of two main groups: those who are visiting on extended travels (often work related) and those who have made it their home. The population is young, with lots of children and young families, and the birth rate is quite high by national standards. A number of midwives in the group were in Darwin for a short period, working and chilling out whilst deciding where to move to next.

One thing that is very noticeable in the Northern Territory is that there seems to be plenty of Government money available to support a variety of community groups and programs. There were people from both the YWCA and Anglicare in this group, who are working with the young and pregnant as part of funded initiatives. They were not midwives, but experienced youth workers and they were looking for specific detail to include in their groups for expectant mums.

I also had midwives who worked with the Aboriginal population. Pregnant Aboriginal women are routinely sent in from outlying stations and towns to give birth (a dreadfully disruptive plan, that has major social ramifications for their families) and they congregate in various hostels awaiting the birth of their babies. Many have health problems brought on by inappropriate lifestyles (often the result of intrusion by the white population) and the perinatal mortality and morbidity in this group is disgraceful - real third world standards. Many efforts are being made to address this problem and the training of Aboriginal health works has been a practical solution that is improving results. It is hard to escape the fact that a lack of midwifery care, including birth services, in their own communities must be a major contributing factor.

On my final day in Darwin, the Childbirth Education Association sponsored an opportunity for me to present an Essential Educator showcase for a group of women who are providing prenatal programs in Darwin. CEA Darwin has been very active over many years, and has received finding to set a variety of parent support groups in the city and nearby satellite towns. Their energy and commitment are outstanding!

There was a lot of interest in the extensive contents of this kit, and many agreed that the quality and scope of the activities and resources included would be very useful for their work. Many educators don’t have access to specific CBE training, however using this kit will enable them to offer appropriate and effective group activities that enhance learning for participants.

We had quite a bit of fun trying out some of the activities, especially the Epidural Role Play and the Cascade of Intervention. Everyone felt that these were brilliant for making sure that women were fully informed about these options and these educators could see the potential for using them in their classes.

I left the group to work together on the development of new programs for parents in Darwin, and made my way to the airport to catch a flight to London, via Singapore. After the heat and humidity of the tropics, the cold and wet of a freezing Britain was quite a contrast!

Posted by andrea at 04:28 AM

2007 off to a busy start

This year has begun with a rush. The usual hard work in putting the Birth International catalogue together (click here if you want a copy posted to you) has been followed with the first “tour of duty” workshops.

My first program of the year was for a group of midwives and eductors in Darwin in the Northern Territory of Australia. It is tropical monsoon season in the north right now, a very spectacular time of massive storms, lots of heavy, sharp rain showers and high humidity. Everything is very green and lush – you can almost see the plants growing as you watch!

The first workshop was on Active Birth. In this part of remote Australia, there is a largely transient population, with many people staying for a period of around 2 years and then moving on. There is a stable group of “old timers” who have made this part of the country their home for many years and one result of the isolation of this region is that there is a tendency for these stalwarts to get stuck in a routine, unless they get regular exposure to developments in other parts of the country. This is true of maternity care to an extent, although as a reaction to the rather medicalised hospital birth system, there is a flourishing home birth population, who have been assisted by a fantastic team of midwives, who have extensive experience of home and water births.

One thing that is always notable about the “Top End” is that there seems to be plenty of Government funding for community based projects. The Territory has a young population, and a high percentage of children and young couples. Community services are available for a whole range of needs and my group had representatives from the YWCA and Anglicare, both of whom are providing programs for the young and pregnant. These women were well trained in group work and group facilitation, and were looking for specific birth information and activities to incorporate into their work.

The Childbirth Education Association in Darwin has been energetically and comprehensively supporting pregnant and post natal women for many years and is well funded by the Government. They have undertaken a number of outreach projects, including establishing new groups in nearby satellite towns, whilst leading the push for better birth services in Darwin itself, offering a range of pregnancy and birth classes and a comprehensive postnatal services.

The new Birth Centre is being constructed at the Darwin Hospital and is due to open in a few months. The policies that will underpin its services are still to be finalised, but it will at last offer a real choice for women who want neither a home birth or a birth in the private or public hospital. I should think it will be especially popular with Aboriginal women who can meet their entry criteria (many have underlying health issues that would exclude them from using the service), as for this group, giving birth near the land rather than on the 6th floor of a tower block is very important. I look forward to checking it out when I next visit.

The final day in Darwin offered me the chance to make a presentation on The Essential Educator kit which many educators have been keen to see. I took them through the extensive components of the pack and there was general agreement that this comprehensive set of teaching materials would be invaluable for many of the programs that are being run in Darwin. Many facilitators don’t have formal training in either childbirth (midwifery) or group facilitation, so a package that enables them to effectively present a variety of teaching activities (with full instructions and scripts) is very attractive and practical.

After a great morning with an enthusiastic bunch of childbirth educators, I headed for the airport and the long trip to the UK.

Posted by andrea at 06:37 PM

Are Irish women wimps? - part two

I had little reaction to my Diary Entry (September 20) about Irish women opting for epidurals. Perhaps people are too annoyed to talk to me, or perhaps they are just muttering between themselves rather than communicating openly. Or else they are not bothered at all.....

However, I did receive this reply and have permission to reprint it here:

Dear Andrea

I recently read the article you posted 'Irish Women are Wimps' and was deeply offended by it. I do agree with your views on epidurals and so forth I just take issue with how you present the arguments and with some of your statements. For example I studied Irish womens' history and therefore am aware of a number of vibrant women's movements that challenged the patriarchy of the State since the 19th century. Also as far as I am aware despite a vibrant women's movement in the US, the epidural and caesarean rate is still very high so by this definition are American women wimps as well. I dislike sensationalism and I feel that is what you were trying to do with this statement, it is a very blanket one and I feel it takes from your very valid argument concerning intervention in childbirth. As i said I agree with a lot of what you say, but having first read the headline, I read the article feeling annoyed and angry.

Yours

Mary Tighe (a Irish feminist!)

I responded to Mary as follows:

Dear Mary,

Thanks for the feed back. Yes, I was sensationalist - I wanted to attract attention and get women thinking. I sometimes put a post onto the Irish Midwifery E list, but this is a very "closed" list where midwives and others are afraid to speak out because they fear retribution. Therefore I decided this time to write on my Diary.

There are some wonderful women in the US speaking out, as you say, and I particularly think of Doris Haire, Robbie Davis Floyd and Ina May Gaskin (amongst others). The fact that they have not changed the outcomes in the US is because of the health care system and the vested interests of the doctors and HMOs, but that does not stop them constantly speaking up in the media etc. And yes, I would say that many American women are wimps as well!

In Ireland, I see very little evidence of Irish women speaking out in the mainstream media, for example, about the chronic abuse of women in the maternity care system and the lack of choices for women. There are a few, but they receive little support from their own colleagues, and there is often an orchestrated campaign to undermine what they are saying. Where are the media stories of the shocking abuses that went on in Drogheda? Where is the debate about real choice for women regarding birth place? Where are the voices publicly talking about home births, water births, birth centres and doulas?

What I hear when I visit Ireland (several times each year) are women whispering behind closed doors, afraid to speak out even amongst their colleagues because they fear they will be reprimanded, censured or especially lose their jobs. Until women in Ireland make themselves heard and work collectively and collaboratively to achieve change, then women in the community will not hear of any other ways of managing birth other than the mainstream medical views.

Regards,

Andrea

Does anyone else have any thought to share on this issue?

Posted by andrea at 12:19 PM

Off to Iran

Tonight I am heading off to Iran, to present a three day workshop for the Ministry of Health. This trip has taken quite a while to organise, involving joining the United National Consultants list, negotiating the program and then obtaining the necessary Visa (which has taken some doing!).

The plan is to provide some in-service training for those making decisions about maternity care in Iran. I have asked for the group to be primarily midwives, as the primary goal is to encourage the development of skills that may assist in lowering the caesarean section rate. Obstetricians are not much help in this regard, as they are usually behind the rising rates of surgical births and are often very reluctant to change. I have requested that the group consist of midwives, policy makers and midwifery educators and it will be interesting to learn who is in the group and how they work in the Iranian maternity services.

I haven’t much idea of what is happening in the Iranian birth scene, but tomorrow I will visit one of the hospitals, so that should be illuminating. I am hoping I can take some pictures, that I can share with my readers when I get home.

My global roaming facility for the internet is not set up for Iran, so there will be no email or Diary entries from me until I get home to Sydney at Easter. By then I hope to have accumulated a number of entries and I will upload them all, along with some pictures, for you to read.

I have been feeling a bit nervous about travelling to Iran, because I know so little about it, but now I am getting quietly excited, and anticipating an extremely interesting week.

The last two days have been spent with a bunch of midwives and educators from all over Cornwall, exploring teaching skills for prenatal programs, and tomorrow I am Iran, exploring birth in a very foreign land. The wonders of modern travel!

Posted by andrea at 03:31 AM

Irish medical scandal enquiry report released

Irish maternity (or should I say Obstetric) services are under the microscope at the moment. For many women in Ireland, having a private obstetrician’s care for pregnancy and birth has been regarded as synonymous with status, prestige and excellent medical care. That may be under challenge now that a report into the shameful behaviour of one obstetrician has been released.

The story began some years ago, when a consultant at the Our Lady of Lourdes Hospital in Drogheda began exercising his own form of retribution on young, unmarried women giving birth. He began performing hysterectomies on these women following caesarean sections, without their consent. These unfortunate women would wake up from their anaesthetic to be told that they had lost their uterus and, in often patronising and demeaning terms, be told they should now go home and care for their baby as it would be the only one they would ever bear. The ultimate irony was that these women were primarily his private clients - those women in the public system but under his care, largely escaped his sadistic surgery, because hospital staff, who knew what was going on, were better able to protect the women from harm.

The whistle was finally blown by a midwife, who could not in all conscience, stand by and watch him remove another uterus without consent, just because the young unmarried woman had become pregnant. The complaint reached the Medical Council, who eventually struck him from the medical register and the doctor, having re-organised his finances so that he would be protected from potential lawsuits, escaped to Spain where he now lives.

The Government set up a public enquiry, headed by a Judge and it is his report that was released last week. The fallout has been inevitable: the case has attracted considerable media attention and the Department of Health is under pressure to make sure that policies and procedures are changed to protect women from such assault in the future.

All maternity hospitals have been sent a document that sets out a number of changes to be immediately implemented. Practice audits of are to be carried out on a regular basis; policies are to be reviewed and updated, and collaboration between doctors and midwives on all committees etc is to become standard. Outcomes will have to be justified and rigorous checks made to ensure that some transparency will finally enter the system as a whole.

These changes have been sorely needed in Ireland for a long time. For too long the midwives and women have been ruled by a tight knit obstetric fraternity, led by “the Masters” of the main maternity hospitals in Dublin. Just the existence of a person who is referred to only as “The Master” says it all really - such a situation would not be tolerated in any place outside Ireland. Perhaps a change of title will be one change that will result form the sweeping overviews that is now being demanded by the Government.

Meanwhile, the women of Ireland are getting a wake-up call. In the past, I suspect that Irish women would have tended to protect and defend their obstetricians when a scandal such as this one broke. Modern women may not be so inclined to be charitable, given that they are more worldly wise and more demanding of value for money.

It will be interesting to see how the ripple effects of the shocking revelations play out. Will midwives seize the day and demand support and recognition so they can protect women from unnecessary surgery and medical meddling? Will the women rise up and demand more choice in maternity services? Will the Government set in place genuine reforms that guarantee some transparency of the services the taxpayers are underwriting, so that, for example, all birth outcomes are published and freely available for public scrutiny? Will midwives et up their own College, breaking away from the Nurses Association to create their own autonomous professional organisation? Will the doctors start treating midwives as professional equals and work happily in collaborative ways to ensure clinical excellence for women and babies?

None of these issues are being discussed amongst midwives on their Irish Midwifery Mailing list, so it seems they have either not been registered on midwives’s radar (which I would find hard to believe), or else the topic is too “hot” to handle or broach publicly. This could be the greatest rallying point that midwives in Ireland have ever had. I hope they see the potential and get their acts together. Midwifery in Ireland could finally come of age as a result of this terrible tragedy where dozens of women’s reproductive lives were sacrificed for one doctor’s desire to play God. It would be some small consolation for their terrible losses.

Posted by andrea at 02:42 PM

Up, up and away

Today I am leaving for another trip to the UK. My first stop will be in Ireland where I will be once again presenting an Active Birth workshop for the midwifery students in Limerick (and others). This is my fourth visit to Limerick and talking to students there has become a regular event. The first workshop in Limerick happened as a result of a request from Kiwi student, who wanted some input on normal birth in her training. She finished her course, and after some months consolidation in Ireland, has now moved, with her family, to Derby in Western Australia. I can’t think of a greater contrast - from green Ireland to dry, dusty Derby! I am sure that she will get wonderful all round midwifery experience in Derby as it is in one of the most remote parts of this country.

After Ireland, I have workshops in a number of places in the UK. They are all listed here and promise to be an interesting series of events.

On the way home from this trip I will be detouring to take in Iran, where I will be presenting a three day workshop for the Iran Ministry of Health and the United Nations. They are concerned about their rising caesarean section rate (just like the rest of the world) and are looking for ways to keep birth normal. Working with the Iranians will be a challenge and also very exciting. I have been reading about this ancient land and am looking forward to meeting the people and learning a little about their culture and lifestyle. I’ll post some pictures when I get home.

Posted by andrea at 12:59 PM

The drought is over.....

It’s been quite a while since I wrote up My Diary. I have never been busier than I have over these past two months, mostly with writing projects, so finding a moment to update here has been in the “too hard basket”. However, things are settling down now and I can get back to recording what’s going on more regularly.

There have been two major projects taking my attention. The first is a new initiative that is a world first - "The Essential Educator”. This is a teaching kit for parent educators that provides everything they need for facilitating effective parent education programs. It is in production at the moment and will be available in May. There are details of this comprehensive teaching kits on the website, so click on the link to find out more. As the project gathers pace, we’ll add more specific information about the component parts.

The other project has been the first Birth International Conference for Childbirth Education to be held in Sydney. This event was last weekend at Sydney University and we had a wonderful time, with 160 people participating in Plenary sessions and workshops on a variety of topics. The program has two international guest presenters - Mary Nolan from the UK and Sherokee Ilse from the US and both were sensational. I am delighted that they will both be appearing on our similar program in the UK in July - those who attend are in for a real treat.

We had many other presenters at the Conference, most of whom have been involved in our Graduate Diploma in Childbirth Education. They offered a host of practical teaching tips and activities that the participants can incorporate into their own classes and all the workshops were lively affairs.

Some of the Plenary papers will be available on our website in the next few days and I will let you know when you can access them. The workshops, being based on experiential learning, don’t lend themselves to written outlines that make much sense - you have to be there to understand what they are all about.

A number of the speakers on the Sydney program will be part of the presentation team at the preparing for Birth and Parenthood Conference at Reading University in July. The “Core of Life” team have a wonderful workshop on working with pregnant teens that was highly praised and Julie Clarke will be facilitating several workshops on small groups work.

Bronny Handfield will be showing her fabulous hour long DVD on the media’s interpretation of birth. These clips, taken from many well known television shows explain how women form their views about childbirth (often making it very hard for educators to debunk various myths). Some of it was quite shocking (remember that terrible episode of “ER”?) and a lot of it was very funny - it is a marvellous mix that was entertaining and also illuminating about where community attitudes are formed. I am sure it will be resonate with British audiences as well.

Full details of the UK Conference are now on the web site and I recommend early registration to make sure you get your workshop choices. We already have a long list of people waiting for the details to be posted so they can register, so as they say, “first in, first served”.

Posted by andrea at 10:20 AM

The best maternity hospital in the world?

The highlight of my visits to Japanese birth facilities was the Fureai Hospital in Yokohama, a city of 4 million people adjacent to Tokyo. The early immigrants to Japan settled in Yokohama because it was the entrance port to Japan and it has a reputation for a more cosmopolitan atmosphere (not all that readily apparent to the untrained eye!). However, it is seen locally as more progressive in many ways and this hospital is a good example.

The hospital is a converted modern hotel and offers a range of medical services along with a small birth unit which is located on the 8th floor. There was no hint of “hospital” in the lobby area downstairs and as I stepped out of the lift to visit the maternity unit, I could have still been in a hotel. Pastel shades of wallpaper, pretty dados, not a single poster or sign on the wall (“wash your hands!” etc) - just an airy light atmosphere and a pervading sense of peace.

The unit is the brainchild of Dr Tomoko Saotome, an obstetrician who specialises in women’s health and sexuality. She is a wonderful woman, with a sensitivity and insight that has no doubt been influenced by spending time in the West and the birth of her own two children. She has created the best maternity unit I have ever seen.

There are the usual birth rooms, which are large and sun-filled and women stay in the same room for labour and birth (unusual for Japan). The postnatal rooms on the same floor are also very low key and homelike, with warm colours and comfortable furniture. A small nursery (now used as a storage area!) and bathrooms complete the picture.

The most striking feature of this unit is the area to one side, where they have set up a birth room in what was thought to be the traditional Japanese restaurant area of the former hotel. A series of interconnecting small rooms, complete with tatami matting, sliding paper screens and bamboo walls and ceilings have been left untouched, and in place of the tables and seating, futons and cushions offer a comfortable space for labour and birth. A small room once used for Tea Ceremonies is also sometimes used for birth and this room has a wonderful view through sliding screens onto a well established Japanese roof garden, complete with trees, a stream and numerous plants and shrubs. Access to this garden is also possible through a small passageway with stepping stones set in gravel in the traditional manner.

On the morning of our visit there were three futons set out in the birth room and a breastfeeding clinic was about to get underway. Women with breastfeeding babies could visit and seek advice from a midwife or just meet and socialise with other breastfeeding mothers. One new mum was having her breasts massaged as she fed her baby, and other babies happily crawled around. The midwife who was in attendance is in independent practice nearby, and offers home births, her midwife house for births and postnatal clinics in this hospital.

The maternity unit caters for a limited number of clients to ensure that each woman receives the best of care and is able to achieve a peaceful birth. Around 30 women each month give birth there, under the supervision of the midwives and Dr Saotome. This small number has become a problem because the hospital’s owners want to make more money by making the facilities available to more women. Dr Tomako is insistent that if this happens the special nature of this unit will change and she is fighting to save it as it is.

Most hospitals that I visit have a sameness about them and a predictable arrangement of medical equipment and clutter that all scream “hospital”. This maternity unit was completely different and an outstanding example of what can be achieved when a person of vision has the chance to follow through in all aspects. It should be used as a showcase for others in Japan to follow and Dr Saotome deserves wide recognition for her achievements. The managers of this Hospital perhaps don’t yet realise what a public relations bonanza they have on their doorstep!

I’ll include some pictures in the Photo Gallery at the end of these articles on Japan.

Posted by andrea at 09:32 AM

Chichester Home Birth Conference

Next March, the Chichester Homebirth group is presenting one of their special Conferences, this time in Bristol, UK. These are a very popular event and offer an opportunity for midwives, parents and others interested in home birth to gather and share ideas.

Next year’s event is titled “Home Birth: A new concept?” and all the details are now on a web site, that has information about past events and a down-loadable registration form for this coming Conference.

The main speakers will be Mavis Kirkham, Mary Cronk, Jonathan Montgomery, Lynne Leyshon and myself. We’ll be tackling a variety of topics related to home birth and I have been asked to address: “Have women changed?” An interesting challenge!

Providing home birth options is Government policy in the UK, yet its availability depends on the attitudes and capacity of the various Area Health trusts and PCTs to implement. This has been successful in some areas and a failure in others - the lack of staff to provide the service being the most often quoted problem. I am sure these issues will come up next March and that there will be lively discussion on how to make the home a more often chosen birth place by women.

Will I see you there?

Posted by andrea at 01:56 PM

The diversity of birth

The Effective Pre-natal Education workshop is proving most enjoyable. With such a diversity of people in the group, there is lots to discover and share, quite apart from the useful work we are doing on how to organise and present dynamic education programs for expectant parents.

We have two from New Zealand, for example, both midwives. They were surprised to discover that in Australia, women don’t have a known midwife for their pregnancy and birth. Here, women will meet the midwife usually when they arrive at hospital in labour, and they have to take pot luck that this midwife will follow their wishes. In New Zealand, every woman must choose her own caregiver once she is pregnant, and so she has that wonderful continuity that everyone else around the world strives for.

The educator from Finland described how one hospital there (and perhaps more) have fitted each labour room with a bank of monitors that enables the midwife to keep track of the CTG trace coming from all the woman in labour ward at the time. She said that the fathers often watch this bank of monitors: “Look how well the labour is going in Room X. You’re not doing much by comparison”. We were all horrified at this breach of patient confidentiality, apart from the concept of spying on women in this way. I’ve never heard of such a system anywhere else, but perhaps it exists. What away to reduce the intimacy of giving birth to a minimalist set of data! And voyeuristic too - a bit like a camera being set up in the foyer of a brothel so guests could check on progress being made in the various rooms of the establishment.....

The difference between country and city hospitals in Australia has also become apparent from various anecdotes and personal experiences shared by some of the Australian group members. There is no doubt that in country maternity units, largely as a result of the lack of obstetricians or GPs willing to offer maternity care, women have a better chance of receiving midwifery care. Sometimes this can backfire if the midwives are unwilling to try “new” ideas such as waterbirth, or giving birth on a mat on the floor, but generally midwives are flexible and willing to help.

Today we will be tackling program planning and I will be encouraging the group to think outside the traditional models of parent education to explore other program structures that might better meet the needs of parents.

Posted by andrea at 06:15 AM

Getting ready for Japan

These past few days I have been preparing my presentation for a trip to Japan that will take place in early December. It’s been eight years since I last visited Japan (the time just flies!) and I am looking forward to discovering what had changed in the Japanese birth scene since my last visit.

I remember being impressed last time by the lack of concern about the length of labour, as long as all was well and some progress was being made (partograms were not much in use), and of course, the stoical Japanese attitude to labour pain. Dealing with pain of all sorts, without complaint, has been a hallmark of Japanese culture for centuries, and noisemaking in labour has been frowned upon as an outward show of not being about to cope, and therefore a display of weakness.

I gather, from the information that my hosts have sent me that the epidural is now being promoted for use in labour. I don’t as yet know how widespread it is it, or what local attitudes to it are, but I will be investigating this as soon as I arrive. Japan has always had very low perinatal mortality statistics and low rates for caesarean birth too, and I wonder if these are being influenced by the more aggressive medical approach that I understand is taking hold.

I will be present a one-day training course for educators, another day long workshop for midwives and doctors and then participating in a forum for parents with a group of obstetricians and midwives. Three very different programs that will give me a chance to learn a lot about their country, as I explain what is happening in the west and how we can “keep birth normal”. More later.

Posted by andrea at 06:41 AM

"Englishness" and maternity care

It’s my last day in the UK for this trip. In reflecting on this visit, as I try to do each time, it is interesting to see what the big issues have been and what I have learned from the many midwives I have met and the many hospitals I have visited.

While I have been travelling about, I have been enjoying a book “Watching the English - the hidden rules of English behaviour” by Kate Fox. This is a delightful book, written by a social anthropologist, in which she explains why the English behave as they do.

The core characteristic she describes is “social dis-ease”, the chronic inhibition that underlies all social interaction, leading to “embarrassment, insularity, awkwardness, emotional constipation, fear of intimacy and general inability to engage in a normal and straightforward fashion with other human beings.” This may sound rather harsh, but it in fact leads to a very polite society, an obsession with privacy and a multitude of coping strategies that are familiar, such as “don’t make a fuss”, “mind your own business”, “don’t draw attention to yourself” etc.

Kate Fox also explains many other cultural habits that define Englishness such as their wonderful use of humour, their addiction to moderation, class consciousness, courtesy and sense of fair play. I recommend this book to anyone who ever travels or works in England - it will enable you to understand and appreciate what makes this country so interesting and different.

The book also explained some of my frustration, at times, in working with the midwives here. They know so little about what goes on in other parts of the country, even towns or cities close as a few miles away, and seem reluctant to try new ideas or strategies. I can see now that this is in part the English “drawbridge” strategy of retreating into the familiar home or workplace to avoid social contact and potential embarrassment.

Moaning is a national pastime, and often forms the basis of conversation. It is not acecptable to boast or promote oneself and constant complaining is much referred. It is therapeutic and part of the bonding process and is usually humorous in tone and seen as an enjoyable pastime. The down side is that when people write about a new service, such as a Birth Centre, or a caseloading midwifery practice, other perhaps interpret this as “showing off” or being too earnest about their successes - a definite no-no in this country. Moaning about a lack of services etc is much more acceptable, and absolves the complainer from having to do anything about improving them.

There is also the “keeping up with the Jones” element, a manifestation of the class system that pervades British society. A NHS Trust may not want to know what is happening in the next Trust area in case it shows up some deficiency that would put them in a bad light. It almost as if they say “if we don’t know what others are doing, and everyone keeps to themselves, we won’t be embarrassed by scrutiny of our service provisions”. There is certainly little consistency in either services, standards or quality from one NHS Trust to another, even if they are just a few miles apart. It is called the “postcode lottery” here and affects all areas of health care. It can mean that a woman on one side of the street, in one Trust area, can have a home birth, whereas her neighbour over the road, in another Trust area, has no homebirth service available to her.

The “social dis-ease” that Fox describes is also apparent in my workshops. I regularly broach embarrassing topics (the sexuality of childbirth for example) or ask participants to engage in uncomfortable activities (such as introduction games) to show that these things can be done, usually with humour and fun, and that once we overcome their discomfort, much useful interaction can occur.

I understand where they are coming from, and have many of the same English characteristics myself (being an Australian of English descent). However if we are to move forward and get better maternity services for women, some of these natural inhibitions will need to be challenged. It will mean “making a fuss” and “drawing attention” to new and notable programs, lowering the drawbridge to let in new ideas and seeking valuable conversations and interaction with colleagues in other places.

It’s been an interesting month, and I have learned much, as usual. There are many good things happening here with maternity care, but they need trumpeting, celebrating and publicising, so they can be embraced by others and not ignored or sidelined. Perhaps that is my main role in criss-crossing the UK on seemingly endless train and plane journeys - to be the messenger, mediator and communicator that helps to link these groups and individuals up. My next attempt at this feat will not be until March 2006. Meanwhile, I have a huge workload awaiting me in Sydney, where I will land in 2 days time.

Posted by andrea at 01:51 AM

The Hull Volunteer Doula Project

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

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

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

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

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

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

Posted by andrea at 06:23 PM

Midwifery aid projects in Ethiopia

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

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

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

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

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

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

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

Posted by andrea at 12:34 PM

Men at birth

There is an article about the impact on fathers of being at the birth in the main Sydney newspaper today. Written by a psychologist who sees men in therapy sessions, he describes how some are traumatised by seeing their partner give birth, especially when episiotomies are cut, or forceps are used.

For some men, seeing their partner giving birth deeply affects their view of her as a sexual being, especially if they had a full view of the baby emerging, perhaps through a vagina that had been cut open. The scarring that is left after an episiotomy may be a turn off too - a reminder of the genital mutilation (my words) that has been witnessed. Such intimate views can expose the mystery of a woman’s body goes, and perhaps remove the sexual allure that had attracted her partner.

I can vividly remember a birth in a hospital, now some years ago, where the father witnessed the obstetrician cutting a large episiotomy as the baby was born. His wife’s legs were then put into stirrups and the whole area, normally tucked away in a very private place, was laid bare, with a gaping wound seeping blood. His face showed his shock, and I remember wondering how he would later view his wife after seeing her in this undignified and very unromantic position.

I posted this link onto the ozmid list this morning to see what others thought of this issue. Several replies stated they thought that the basic problem was that the births being described took place in hospitals, a place where intimacy, romance and privacy are impossible to obtain. Men often feel uncomfortable in hospital settings at any time, and may feel much worse when placed in a position of impotence and then confronted by these kinds of brutal images. When birth takes place at home or other place where couples can work together to bring forth the baby, the lasting impression for the man might be more positive. In these situations it is unlikely that he will be a bystander and observer and much more likely that he will be closely involved in the birth, providing physical support and comfort. In a situation like this, it is also unlikely that the man will be left on his own, staring at his partner’s body being manhandled.

Michel Odent has suggested that women might want to maintain their sexual allure by keeping their men at a respectful distance during birth. This was always the case in the past, when birth was very much “women’s work”. I don’t think we should make any kind of blanket rule about men at birth because every couple and birth will be different. However, I do think we need to recognise that men can be severely traumatised by some aspects of birth management and they may need help in dealing with this. Left unrecognised and unacknowledged, his fears and concerns may hold sway over the choices his partner makes regarding her next birth. Many men have encouraged elective caesareans so they can avoid traumatic emotional and psychological reactions. This need may be unconscious or even openly expressed - either way it must be recognised and understood.

Posted by andrea at 05:26 PM

Home from Home in Drogheda

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

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

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

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

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

Posted by andrea at 12:17 AM

En route to Israel, via London

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

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

Posted by andrea at 03:03 AM

Children's shoes for Thailand

The tsunami disaster in South-East Asia touched everyone in some way and has led to a massive outpouring of aid for the devastated people of the region. An email reached me today from a reader of this Diary who wanted to locate an orphanage in Thailand as she had two cartons of children’s shoes from Clarks that she wanted to give to children in need in the area. As an ex-school teacher she also had time available, if anyone needed help.

I have replied to her privately, because at the moment I am unable to offer the “comments” facility on My Diary because of problems with spam, and this woman had found me through our general feedback section on the website.

I have given her the contact details for Bangkok Mothers and Babies International (BAMBI), a group for expatriate women with young families from all countries. This group has been meeting and supporting each other in Thailand for almost 25 years, providing not only assistance to each other, but support for several local charities, including schools. I know they have been actively involved in providing tsunami relief in the south of Thailand as well.

If any of you have a comment to make on anything that I write, please email me privately for the time being: andrea@birthinternational.com. Messages sent to info@birthinternational.com or via the Webmaster button on the home page will also eventually reach me, via my Sydney staff.

Posted by andrea at 10:20 AM

The first UK trip of the year

I have arrived into the UK, in readiness for the first round of workshops for 2005. It is going to be a momentous week - the Pope has just died, Price Charles is getting married on Friday and a general election has just been announced for early May.

My focus, however, will be on the Conference which we are presenting on Friday April 8 and Saturday April 9. This program will embrace a lot of firsts: the first Conference that Birth International has hosted in the UK; the first two day Conference for childbirth and parent educators ever stagged in the UK; and the first time an “all workshop” format has been offered as an alternative to a straight “talk-fest”.We are very excited about it, and know that the many who have registered will have a great time.

Straight after we finish at Reading University, the venue for the Conference, Lynne Staff (who will be coming from Australia later this week) and I will be off to Wales and then Glasgow to present a one-day workshop for midwives on the theme of Perceptive Midwifery. It will be similar to a series of successful workshops we did here about 18 months ago and will offer midwives the chance to delve a little more deeply into ways of really connecting with women during labour.

I am once again staying with Caroline Flint while I am in the UK. She feels that midwives here are at a low ebb, with morale not good and working conditions creating stress and frustration. Her own practice is thriving, in complete contrast, and she now has 12 midwives working in her independent practice, offering a range of home and Birth Centre options for pregnant parents. She recently hosted a one-day Conference on “Powerful Midwifery” to gee midwives up and show them alternative ways of working. Those that attended were delighted with the speakers and the possibilities presented, and went away feeling inspired and energised.

This is an outcome we are planning for our Conference as well. Pregnant women pick up on the mood of midwives very easily and this can dent their confidence and undermine their belief in their own capacity to give birth successfully. Good quality parent education can help overcome this, but this means that educators and group facilitators need to be feeling positive and resourceful with strategies and ideas for empowering women to get the best from the health care system. Many educators are also midwives, and run the classes as part of their job description. If all goes to plan, midwives will find that this Conference not only gives them a boost for the educational side of their work, but also uplifts their midwifery role as well. We shall see!

Posted by andrea at 03:44 PM

The Future Birth tour begins

The “Future Birth: With woman, with child” begins to day in Darwin. Our speakers have assembled from around the world: Susanne Houd from Greenland via Copenhagen, Michel Odent from London, Sandy Kirkman from Wales and Sally Tracy from Sydney. I know that this is going to be a fabulous program and everyone on the team is eager to start.

Darwin is a small city and very remote with Australia, yet 54 midwives have registered! There won’t be too many left to attend to the needs of the women in this town today.

From here we will be travelling to Perth, where a huge contingent awaits us. It will be good to start slowly with a more intimate group as we explore a number of issues that have particular relevance to this part of the country: meeting the childbearing needs of remote, indigenous populations and how woman-centred services can be provided within the public health system.

Posted by andrea at 05:42 AM

Australia Day

Happy Australia Day to all my colleagues around the country! This is a big day in Australia, as we celebrate the founding of our nation and take time out to party. Lots of people are awarded special Australian Honours for service to the community ( a bit like the system in Britain where some people get Knighted or made Dames etc) and also it is a day when many people take out Australian Citizenship at special ceremonies around the country.

There are no midwives amongst the recipients of special awards this year, as far as I know, but that’s not for want of trying. Midwives here keep the struggle for better births and alive, and for many the best form of recognition would be the underwriting of a free home birth service and community based midwifery by each State Government. Every year this goal gets closer and perhaps 2005 will see the first programs firmly in place. I am ever the optimist!

I was talking to Dr Barbara Vernon, the Executive Officer of the Australian College of Midwives and she told me that this year, a priority is to establish a link between registration as a midwife and on-going professional education. This will encourage midwives to undertake further education to develop their skills and to have their efforts recognised when they do. The Registration Boards in each State are in favour of such a scheme , and it is a matter of setting up the necessary infrastructure to award credits or points for courses, events, studies etc undertaken by midwives each year. This is a development that is sorely needed in Australia, where a midwife can qualify and then attend nothing during her entire career while still continuing to practice. At present there is no need for her to demonstrate any efforts to maintain her competence, knowledge or specific skills and this is a major weakness in our system. I hope that the Australian College of Midwives succeeds in its plans for rectifying this gap in our maternity services and I wish them every success.

Posted by andrea at 05:48 PM

A hectic week

This has been a very hectic week. We have interviewed and appointed a new Administration Assistant/PA to help us all out, and finalised the Birth International catalogue, which will go to press early next week. The new products are all ready to be uploaded onto the website (you’ll want to check this out at the end of next week). All the main workshops for the year have been finalised so their details could be included in the catalogue and website as well, and we have been processing dozens of individual and group bookings for our Future Birth tour around Australia in March.

The NSW Mothers and Babies Report from our Department of Health arrived on my desk yesterday and these are interesting figures, some of which I will share with you in a forthcoming Diary entry. Birth in NSW seems to have polarised, with women having stark choices: a high degree of success with natural births in rural areas or a caesarean section in the cities. This is a simplistic view, I know, but the figures tell the story. More later.

There have also been developments with our Graduate Diploma in Childbirth Education and I will detail these in the next Diary entry.

Posted by andrea at 02:59 PM

Getting ready for 2005

The end of the year is rapidly approaching and for me this means finalising all the plans for next year (at least the first six months) and reviewing the programs we are developing at Birth International in readiness for their implementation in the New Year. It is also the time we decide on the new products we will be including in our range next year and get our catalogue ready for publication.

The main events on the horizon at the “Future Birth: With woman with child” tour that will travel around Australia in March and the “Preparing for Birth - new approaches in antenatal education” Conference in the UK in April. The full details of both of these major events are on the web site, along with the details of how to register and how to save money by registering as a group, or early (or both). We also have special student rates. Click on the titles to take you to the appropriate information.

The workshops that I will be offering are also being finalised. Some will be available in February in Australia, but most will be in the UK or Europe in April, Australia in May and in the UK again in June/July. There are a few dates for UK/Europe programs in the mid year round still available and if anyone is interested in hosting such a program, they can find the details on how to do this by clicking here.

I have had a lot of fun reviewing the new products for our extensive mail order range. There is a large number of new items, from books, CDs, DVDs Educational packages, charts and of course videos that you will be able to choose from. There will be something for everyone in this collection, which will be announced at the end of January when the catalogue is released. If you would like to receive a paper copy, click here, to send us your details.

Meanwhile, we have our office Christmas “party” tonight and this year we are going to the theatre for a night of laughs and fun at a brilliant satirical show featuring politicians and larger than life Aussie characters. We’ll all enjoy this I am sure - the show has been widely praised and there are never enough laughs in life......

Posted by andrea at 03:33 PM

Amazing what you can learn here......

It was the last day today for our General Manager, Jason Tunbridge, who has been head-hunted for a job elsewhere. As I pointed out my last Diary entry, you can learn a lot from working here, and sometimes find yourself talking about things you never dreamed you would be discussing.

Over our farewell lunch for Jason, the Epi–No came up in conversation. At the ACMI Conference in Perth, Jason had one of these devices on display and was asked about it by many of the people who visited our stand and it seems that people either like it or hate it. Explaining how it works, however, led to several hilarious discussions - one of the hazards of being a man in a woman’s world is having to deal with this kind of task. Jason, with his wicked sense of humour, handles this kind of thing really well, as I am sure the midwives concerned discovered.

We will miss him in our office. As he pointed out, when he joined Birth International he knew nothing about childbirth, apart from being present for his son’s birth, and now he can provide basic information on a whole range of topics, including the Epi-No! We wished him well with his new venture, and hope that he can find some ways of using all this new found knowledge, gained over the last four years. He’ll be a hard act to follow.....

Posted by andrea at 05:47 PM | Comments (2)

Preparing for the next trip

Tomorrow I am leaving for Italy and a workshop in Padova (not far from Venice). This will be the first time I have worked with Italian midwives and I am looking forward to the challenge. Piera Maghella will translate for me and it will be fun tot work with her in this way. She was the organiser of the very successful Conference last year on the theme of waterbirth and she is a well known author of books for expectant parents in Italy.

There are always loose ends to tie up before I travel for an extended period. A request has come from Armenia asking us to tender for a US Aid funded project to train childbirth educators for a pregnancy education program that is to be rolled out across the country. The scope of work I was emailed is very detailed - they are hoping to achieve a frankly impossible amount in the space of a three day in-service, and after that the people in this initial group are supposed to then go out and train everyone else. When I think of the time and effort that goes into making a basic educator in this country, and what it takes for us to “train the trainers” I doubt that this program will achieve its stated goals. However, good luck to them - I won’t be submitting a tender, but I will give them some feedback on their proposal. I wonder what Armenia is like..... I guess I will never know!

I have also been approached by a midwife from my recent Israeli workshop group who is keen to translate my book “The Midwife Companion” into Hebrew. That would be exciting ! I suggested she explore publishing possibilities before we get too far into this project, but it would be great to have it available in yet another language. Let’s hope this propject can go ahead.

My neighbour seems to be in early labour today, so I may be at a birth tonight... that would be a lovely way to get “in the mood” for my next round of travels.

Posted by andrea at 05:20 PM | Comments (0)

Back to work

Back at work today after my “long service “ break. There is certainly a lot happening at the moment, both within Birth International and in the wider world. I will be catching up this week and will update readers as I check out what is going on.

My first task has been to address several requests for workshops in 2005 that were waiting in my in-tray. I’ve also updated the information pack on hosting these events, to give sponsoring groups an outline of what is involved. We try to make it as easy as possible for hospitals or community groups to arrange one of our programs by providing a lot of back up support through administration, publicity etc. There are also special deals and subsidies available for private sponsors that are worth checking out. If anyone wants to know more about these, please email me at: andrea@birthinternational.com and I can forward you the package of information. I can travel anywhere, and overseas locations can be built ino my regular round-the-world trips that I take three times each year.

My next trip is on Saturday, when I take off for Israel for two Active Birth workshop programs.

Posted by andrea at 01:36 PM | Comments (0)

Staff development

Had our regular staff meeting today where we reviewed the happenings at Birth International and talked about our forthcoming events and projects. One of the topics we discussed was the content of our next in-service program for our staff and Graduate Diploma faculty members. This meeting will be in November, over a weekend, and we will fly in our Course Supervisors who are interstate and round up our local people for one day of professional development activities and a second day for Course discussion.

This year we will involve our clerical and support staff as well. It is important that we all reflect the same philosophy and undertake our jobs with confidence and competence. The final program for the weekend is not yet finalised, but will include developing communication skills, offering feedback, working with clients and team building exercises.

It is a shame that Fran Gallwey in our UK office is unable to attend this event - it is a long way for her to come, but perhaps one year we can arrange it. Right now she is getting ready for her annual holiday, and like most people in Europe, she will be on holiday for the first two weeks of August. Our UK office will be closed during this time, however, you cam always reach us by email: info@birthinternational.com

Posted by andrea at 04:14 PM | Comments (0)

Taking some leave

I don’t seem to be finding much time to do my Diary entries at the moment. In fact, I am supposed to be on “long service leave” for the next 5 weeks, but I plan to keep writing my entries from time to time and to keep responding to emails. There are a couple of writing projects that I plan to finish off as well (the article on Entonox is one) as soon as I can.

Over these next weeks, I will be moving house and trying to “get a life” beyond the birth scene. This job is so all consuming, what with the workshops, writing, managing Birth International, planning Conferences, developing new projects etc that at times it is seems to be all that I do. The next few weeks will give me the space to catch up with long lost friends, get started on some new hobbies/interests and generally re-charge my batteries.

I’ll stay in touch with you all from time to time.

Posted by andrea at 05:42 PM | Comments (0)

An election in the air

Although the next Federal election has not yet been announced officially, all the indicators are that it will occur in October, before the US Presidential election in early November. The unofficial campaigning is well underway, and the politicians are already on the hustings, promising new programs, making sudden back flips on unpopular policies and dishing out money from some bottomless pit (our taxpayer pockets).

This time there is a strong feeling in the air that the Government may change, driven by anger over our forced involvement in an unpopular war (Iraq), huge scepticism over the “honest” credentials of the current government and a feeling that it is time for a change, especially of our Prime Minister.

Australian midwives have developed a canny nose for a political opportunity, spurred on by some passionate consumers, such as Justine Caines, the President of the Maternity Coalition, and Barb Vernon, the Executive Officer of the Australian College of Midwives. Tactics have already been discussed and the campaign prepared. Senior members of both major political parties have been targeted and meetings have been set up with Ministers and Shadow Ministers, especially those with influence in health matters. Some of the minor parties, notably the Greens and the Democrats have already pledged support for better access to midwifery care for women and families. The perception that Labour offers a younger, more family orientated approach to managing health also offers hope that change may bring real results, especially as and election of a Federal Labour Government would mean all Governments in this country were of the same political persuasion.

A petition is being circulated to gather support for midwifery programs as outlined in the National Maternity Action Plan. Midwives are being encouraged to set up appointments with their local member of Parliament and to chew their ears about the need for better choices for women. There is a real feeling this election may be our best hope yet of achieving significant reform of maternity services and long-awaited recognition of midwifery care and midwives as professionals.

At Birth International, we are preparing to do out bit towards getting the message across, but more about these plans later!

Posted by andrea at 03:13 PM | Comments (0)

Have ticket, will travel

It is time for me to go home, after four weeks of hectic travel around the UK. The time seems to fly past and before I know it I am heading back down that gangway to board another Qantas flight home.

It has been the usual mix of workshops, midwives, places and faces, across a wide range of locations. Ireland was revealing and Spain was dismaying and Britain offered its usual variety, from innovative birth centres and rigid routines and protocols in busy hospital “delivery suites”.

I will be “off the air” for a few days, while I travel and then recover over the weekend. I will be keen to see what awaits in the Sydney office on Monday.....

Posted by andrea at 01:37 AM | Comments (0)

Prize winners in Hemel Hempstead

The 500th baby was born at the Hemel Birth Centre yesterday, while we were workshopping away in another part of the hospital. The unit has only been open for around 18 months, and has proven very popular - the number of women choosing it has exceeded expectations.

The midwives had organised a raffle to be drawn when this milestone was reached, so yesterday, after we finished the program, I was invited to draw the winning ticket. There were 16 prizes in all, so I took turns with Caroline Duncombe (on the left) and Nicky Wilkins (on the right) to choose the winners. The photo was taken by Jenni Farrell, the workshop organiser.

This Birth Centre is a lovely unit - as a stand alone centre it is 20 minutes from the nearest referral centre and the autonomy of practice that it offers midwives is excellent. They have a “snoozle room” too - a lovely dark room, with soft beanbags, a mattress and floor cushions, lava lamps, other mood lighting and peaceful music. Anyone in the unit is able to use it, to chill out, relax, recover or rest. Women often use it in early labour and midwives can also take time out to restore energy after a busy shift. There have been a few babies born there as well - it is a very comfy and inviting intimate space.

The statistics for the first year of operation of the Unit are being compiled now, and I have encouraged them to publish them in an appropriate midwifery journal. Successes such as these need publicity, so that others can learn how it can be done, and to strengthen the case for more of these kinds of services.

It was a terrific weekend, and a pleasure to be among a group of dedicated and enthusiastic midwives. This afternoon I am off to Nottingham for another in an ongoing series of programs fot the midwives in that area.

Posted by andrea at 09:44 PM | Comments (0)

The next UK trip

I am setting out today for the UK. This next round of workshops will take in Northern Ireland (Belfast and Derry), Hemel Hempstead (just north of London), Nottingham, Burton on Trent, and Solihull (Birmingham). There is also a week in Spain, with two workshops scheduled, one near Alicante at the Acuario Birth Centre and another in Murcia, about 2 hours further south.

In the middle, I will have a few days with my good friends the Habananandas from Thailand, who spend part of each year in Bournemouth. We will be discussing how we can set up a training program for childbirth educators in Thailand, as part of the work of the Childbirth and Breastfeeding Foundation of Thailand’s work. Birth International will be consultants for this project.

There will also be a day out with my office manager in the UK, Fran Gallwey, to inspect the proposed site for our big conference on childbirth education next year. We will be checking out the facilities at Reading University, which are looking promising. This will be a landmark event for the UK, not only for Birth International, but also for childbirth education, as no-one has offered a program such as the one we have planned, which will ensure that all participants are able to attend 6 workshop sessions on specific educational topics over the two days. There sill also be Plenary Speakers (of note!) and a video evening, where all the new releases will be shown. During my visit to the UK, we will be finalising the program and speakers, so keep an eye on our Web site for the details, which we plan to have available in July.

OK, now to finish the packing.....

Posted by andrea at 10:34 AM | Comments (0)

Office work

Another catch-up day in the UK office today. Next week we are having a trade display at a big breastfeeding conference in London, so I have been packing up stocks of books, videos and models for sale and display at that event.

I am also monitoring the situation in Israel, as I am due to travel there in a few weeks to present two Active Birth workshops. My main concern is being stranded if the airport is closed - I have a number of workshop commitments in Australia both before and after this trip, so cannot afford to experience travel delays.

Tonight I am off to Manchester, for the first of three workshops that will conclude my trip to the UK. Two of these programs are on Teaching Skills for childbirth educators and the other is an Active Birth program. It will be good to be covering some different topics with these groups, although each workshop is always unique because the groups, their needs and personalities are so different every time.

I will report from Manchester in the next day or two.

Posted by andrea at 01:46 AM | Comments (0)

Catching up in the UK office

I’ve spent today in the Birth International office in the UK. Things are busy - the latest catalogue is generating many sales that need processing as well as registrations to process for the remaining workshops in my current tour of the UK and the coming series in June.

I had a message waiting for me - would write a few words for the re-printed 3rd edition of Grantly Dick-read’s classic “Childbirth Without Fear” which is being reprinted in Britain. My copy of this classic has long gone missing (the original appeared in the 1940s), and as it has been a while since I read this book I have asked for a copy of the text so I can make an appropriate comment. There have been several editions of this work, including some that were heavily edited and revised. I will be keen to re-read his original ideas.

I have also come across advertising for Entonox - the brand name for the nitrous oxide/oxygen mix that is commonly used in Britain for easing pain during labour and birth. The manufacturers are offering information CDs and leaflets to childbirth educators, presumably as a means of promoting the use of this ubiquitous gas mixture. I will be sending off for my copy of this material and will be very interested to see what it contains. More about this issue when I get the package and have had a chance to peruse it.

The proofs for the article I have written for The Practising Midwife on ideas for changing the birth culture in Britain were also waiting for me. It is a provocative piece, designed to make people think and I am very pleased that they have given it prominence in the April issue. It will be interesting to see if there is any feedback - the 11th idea (the article gives 10 ideas) is to write to the Practising Midwife with another strategy. I wonder if there will be any suggestions?

Posted by andrea at 05:31 AM | Comments (0)

Another visit to the Irish Republic

Today I have travelled from snow and freezing winds in London to the slightly warmer Republic of Ireland. This will be my fourth visit to Drogheda and I will again be presenting an Active Birth program for the midwives in the surrounding areas.

I am keen to hear of their progress with implementing the ideas we discussed last time. I remember that in the last group we hade some midwives from Northern Ireland who worked in a wonderful midwifery led unit in Craigarvon and that their approach had been quite a revelation to many in the group. Many of the group were keen to develop their midwifery practises, especially as a real alternative to the “active management of labour” protocol that is so prevalent in Ireland and I hope to hear that they have been making good progress.

We shall see....

Posted by andrea at 03:43 AM | Comments (0)

Setting off again

Packing up today ahead of my next trip to the UK. On the way I will have two days in Bangkok where the Thai version of my booklet “Preparing for Birth: Mothers” is being launched, along with the new Birth Room at the Samitivej Hospital.

Then it will be London to begin one of my treks around the countryside: Leeds, Hexham (near Newcastle on Tyne) and Dumfries (Scotland, south of Glaasgow) in the first week. Then it will be over to Ireland, for a program in Drogheda (my fourth visit) and a workshop for the Irish Childbirth Trust in Dublin. After that comes Norfolk, a workshop in London and then the final round: Manchester, Birmingham and Bristol (Phew!). I will be back in Sydney on April 1st.

I will be facilitating a mix of Active Birth and Teaching Skills workshops, which are always in demand. There will also be a few days in our UK office to plan future events with our UK Manager, Fran Gallwey.

As I travel about, I’ll keep you updated with observations on the midwifery and birth scene in the UK. The MIDIRS Digest and The Practising Midwife journal are helpful in staying abreast of maternity issues but there is nothing like hearing what is going on from those directly involved, and these workshops are a great opportunity for sharing stories and reporting on developments.

But first, to the book launch tomorrow, in the very different birthing climate of South East Asia

Posted by andrea at 10:08 AM | Comments (1)

Spam havoc

My Diary entries have been hit by a major spammer - I estimate that there are about 250 spam comments on many of the entries - mostly for a casino website.

I apologise to my readers. Steps are being taken to stop (or at least, significantly slow) this antisocial behaviour and I hope to have a blocking mechanism in place very soon.

Meanwhile, deleting each message is a laborious process as they have to done individually. I'll do my best, but it will take time. While I am doing this, please ignore many of the comments - you'll know what I mean when you see them.

Posted by andrea at 09:19 AM | Comments (0)

The end of the week

This has been a very busy first week back after the holidays. We have finalised the new catalogue that will be published and mailed in about 2 weeks and completed the last details of the workshops we will be offering in the next six months.

This year brings two important anniversaries: it is 20 years since we began our independent consultancy in Australia and 10 years since we launched our UK company. The catalogue will contain some interesting archival photographs that plot our progress and success over these years, which have slipped by very quickly.

There are a number of interesting reports awaiting attention on my desk and one of these is the NSW Mothers and Babies Report for 2002, which contains all the data collected about birth outcomes in this State. It is always fascinating reading, and I will include some snippets in my Diary entries over the next few days.

This weekend I am presenting the first workshop of the New Year for midwives in the Illawarra Area Health Service, about an hour’s drive south of Sydney. One of their smaller regional maternity units at Shellharbour has been under threat again - its been opened and closed more times than you would think possible. I know there have been moves to establish it as a midwifery only unit so it will be good to meet with some of their staff this weekend and to find out what is happening at the present time.

Posted by andrea at 03:10 PM | Comments (0)

End-of-year wrap up

This will be my last Diary entry for the year - I am taking a three week break to rest and recuperate before launching into a very busy 200 on January 14.

It has been a very productive and busy year, with a number of stand out highlights for me: