Articles by Category: politics

Promoting breastfeeding in Thailand

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

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

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

Posted by andrea at 02:31 PM

What women want

The formation of a political party to focus on specific issues relating to childbirth is a momentous event. The coming Federal election in Australia (due in October or November 2007) has been the catalyst for Justine Caines, former national President of the Maternity Coalition to launch a campaign that will put midwifery care into the spotlight.

What Women Want is the new force on the block - dedicated primarily to getting Medicare rebates for midwifery services in Australia. In this country, midwives are the only group of recognised health professionals that are not included in the Medicare system, and this situation has reduced choices for women across the country, escalated the cost of maternity care enormously and contributed to the shocking rates of intervention in childbirth that are occurring.

Despite many reports in maternity services (almost 40 Government and industry enquiries have investigated maternity services in Australia in the last 30 years) recommending that midwives be given a greater role in the provision of care, the medical lobby has worked hard to maintain their monopoly on birth services. Several landmark population based studies have proven that reliance on obstetricians as the primary care professionals for pregnancy and birth has given us poor outcomes (amongst the worst birth results in the western world), cost us millions of unnecessary dollars and reduced options for women.

The new political party will be highlighting these issues, amongst others, during the coming election campaign. They are actively recruiting members at present, prior to registering the party and planning the details of their policies. I encourage everyone in Australia who wants to see better births, more equitable and sustainable maternity services and long overdue recognition of midwifery to get involved. Their website outlined their aims and plans - check it out for more information and join up today.

Posted by andrea at 08:43 AM

The sick NHS in Britain

I’ve heard a string of stories today from midwives in the Huddersfield/Halifax area that illustrate the terrible state of the NHS in the UK.

Despite the Government’s many initiatives, policies, legislation and regulations that support midwifery across the UK, the enormous hole in the budgets in many NHS Trusts has meant that many programs are being cut or scaled back and restrictions on staffing are putting labouring women and their midwives at risk.

One of the midwives in my group ducked into the Labour Ward at the first break to grab a cup of coffee and discovered that the Manager was frantically phoning around trying to find some staff for the night shift this evening. The midwife was made to feel that she should be on duty or else her colleagues would be struggling and working under duress. She had to leave the workshop so she could get sleep and organise her child care in preparation for turning up for the night shift.

This was described as a typical problem in this area (and I suspect, many others). A full complement of staff cannot be found for many shifts and those on duty find they are having to work in conditions that are clearly unsafe for women. It was suggested that several incidents (one that ended in tragedy) were exacerbated by the extreme stress of midwives who were doing their best, but working way under safe working conditions.

Several midwives mentioned that even basic equipment, such as Sonicaids, was in short supply and that even CTG machines, often vital when a baby is in trouble during labour, were sometimes hard to find. There is a new Birth Centre being constructed in this area, but there is concern that its facilities and equipment may be limited by the stringent budgets in place.

The midwives in this group are committed and dedicated, wanting to practice their skills as they know how. Many are totally frustrated and angry with the way the NHS is taking advantage of their willingness to do the best for the women in their care. One wonders how much worse it will all get before improvements finally arrive.

I hope tomorrow to give them practical measures they can implement within their own scope of practice. When things are bad within the system at large, perhaps this is the time to think local rather than global: working with each women, one at a time, and making her experience the best it can be, so a midwife can gain some personal rewards for her work.

Addressing the issues at the broader level will take group action, commitment, and strong political action. The midwives here have good leaders, willing to support and encourage change so I hope they see the potential of a collective approach and work as a unified group to achieve what they want as midwives.

Posted by andrea at 05:33 AM

Double dipping

This morning I heard a report on the radio that the Australian Competition and Consumer Commission had set up a new code of conduct to oversee the relationship between drug companies and doctors, in particular the way the companies offer freebies and kick backs (my words) as part of their advertising campaigns. The Government feels that this widespread practice needs to be made more transparent, so that patients are aware of what is going on and why certain drugs may be promoted by their doctors over other alternatives.

The schmoozing and massage of the doctors by drug companies (and no doubt equipment manufacturers as well) is outrageous. Incentives to attend conferences, free samples, free publications etc are all widely offered and received. The doctors need to keep up to date with rapidly changing developments in the medical field, which may not be so easy in a busy professional life. However, the requirement to keep updated comes with the territory and is a requirement for maintaining registration.

In addition, subscriptions to professional journals, registration fees for Conferences and seminars and other strategies that can be proven to be important for the maintenance of professional competence are all tax deductable. Doctors earn huge amounts of money (despite their protestations, no-one has ever met an impoverished doctor in Australia) and I would have thought that a few handy tax deductions might be useful.

At a recent workshop I presented, the midwives’ attendance was subsidised by the taxpayers, through a special purpose grant. Midwives earn very modest salaries and often get no help with seminar or Conference fees, and have to fund their registration, travel and accommodation from their own pockets. However, the doctors (GPs) who attended this workshop were paid to attend, the princely sum of $1500 for each day. The cost of the workshop to the taxpayers would have worked out at around $100 per day for each of the midwives, so the doctors did very well. In addition, two of them didn’t stay the whole time, dashing in and out to attend patients, for whom they would have received payment as well. Not bad - being paid handsomely to be in two places at once!

Knowing about this rort of the system left me feeling less than charitable (hence this whinge) when I also heard a comment from the Australian Medical Association spokesperson, in response to the report on the radio, that any changes made to the current system, “were unnecessary”, and might discourage drug companies from telling doctors about new treatments. Perhaps he was thinking about the added costs to his own pocket if all the freebies dry up.

You can read more about this interesting development on the ABC’s Newsradio website.

Posted by andrea at 11:53 AM

Home birth gets the official nod in NSW

It was heartening to read the latest News Release from the Australian College of Midwives announcing that the NSW Department of Health has released a Policy Directive that supports and encourages the setting up of home birth services through the State’s Area Health Services.

Politicians often pay lip service to programs they think will win them friends and votes, yet often fail to follow up with appropriate legislation or regulations that enable services to be set up. In the case of home birth, the midwives and women of NSW have been lobbying hard for many years at both the national and State level to have home births made available on our national health service (Medicare). Privately, the NSW Department of Health has been muttering encouragingly, and now finally they have issued a directive that is binding on all Area Health Services in NSW. The full text is available on their website, but here is an excerpt:

Date of Publication 29 June 2006

Summary

This Policy Directive has been developed to reflect current evidence about the provision of homebirth. Area Health Services (AHSs), when providing public homebirth services, must comply with the standards set out in this document. Clinicians providing public homebirth services must be employees of, or have clinical privileges with, AHSs.

This document applies to: Area Health Services/Chief Executive Governed Statutory Health Corporation, Board Governed Statutory Health Corporations, Affiliated Health Organisations, Divisions of General Practice, Government Medical Officers, NSW Ambulance Service, Public Health Units, Public Hospitals.

Now that this Policy Directive is in place, it will be easier for Area Health services to set up appropriate home birth services for women. The South Eastern Sydney Area Health Service already offers home births as an extension of their Birth Centre Program at both St George Hospital and the Royal Hospital for Women, Randwick. It is hoped that home births will soon be available through Camden and Belmont Hospitals to extend theircurrent caseload midwifery services.

Although a welcome development, the Policy Directive does not help independent midwives, as it does not address their lack of professional indemnity insurance. As the Directive states, midwives offering home birth will have to be employed by or have been granted visiting rights at the AHS. This means that independent midwives are still excluded as they had their visiting rights at hospitals withdrawn when their indemnity insurance was withdrawn some years ago. This is a critical issue that still needs urgent resolution. Until a means is found to resolve the insurance issue, independent midwives will be reluctant to offer their services and women will be denied access to their care. This situation is discriminatory both for pregnant women and also independent midwives.

The Policy Directive is a good start. How many Area Health Services will heed this policy and set up a service for homebirths? That will be the final proof that home birth is on the map.

Posted by andrea at 01:06 AM

Home birth guidelines

The BBC News this morning had considerable coverage of the latest National Institutes of Clinical Excellence (NICE) draft guidelines regarding home births. NICE is the advisory body that establishes “best practice” guidelines for the NHS and they have made a number of recommendations regarding aspects of childbirth and its management.

In their view, women should have more choice regarding the place of birth and home births should be more widely supported. Although Government policy supports home birth, only 2% of women in the UK choose this option, although this figure varies widely across the country - some areas have 12% and there are pockets where 20% choose birth at home.

Beverley Beech, Chair of AIMS was interviewed and stated that choice was a myth and that women were often unable to get a home birth due to local hospital policy. She also said that the practice of sending two midwives to a home birth was unnecessary and not supported by research. She claimed that this practice had been established when it was discovered that home births were cheaper than hospital births, so two midwives were to attend at home to keep the costs artificially high. This was something I had not heard before - I have often questioned the necessity for two midwives at a home birth as it certainly adds to the costs.

The shortage of midwives was raised with the Obstetrician and NICE representative who were interviewed, as well as the old hoary arguments about safety of home births. The Obstetrician was from University College Hospital said he thought that their “home from home” centre was the best compromise (but women who want a home birth want to be at home, not in a birth centre).

Whilst stating that birth at home resulted in less intervention in birth, the safety issue is still unresolved, according to the NICE spokesperson, and they will be “keeping an eye on it”. Given the massive shortage of midwives and the chronic low morale in the UK maternity services, it will take more than these new draft guidelines to turn things around. Even with the very public support for home birth at all levels of Government, they still can’t get their rates up, possibly because of the fear factor in both women and midwives. Women in the country have simply been scared off.

If you want to read about these draft NICE guidelines, which will be finalised next year, you can view them here.

Posted by andrea at 05:43 PM

How to increase the birth rate

I am back in the UK at present, with several workshops planned for this short trip. Just before I left Australia there was quite a bit of discussion about the rapid rise in our birthrate and also the timing of many of these births.

For some years now, Australia has been doing very well economically. Very low inflation, low unemployment, affluent lifestyles and high levels of education have encouraged many women to work on their careers and as a result many are delaying having babies until they are in their 30s (other western countries have similar trends). Our relatively low birthrate has also been flagged as a possible problem for the future – who will support the ageing population in years to come?

Our Treasurer came up with a plan to solve this problem. The Government brought in a “baby bonus” of $3,000 that was to be paid for every baby born after June 1, 2004. The Treasurer then began exhorting women to have three babies – “one for you, one for your partner and one for the country”. The incentive of a cash payment, no strings attached, seems to have done the trick and we are experiencing a large jump in the birth rate – another baby boom.

Interestingly, a new report has revealed that in order to be eligible for this “baby bonus” many women delayed the births of their babies by two or more weeks. Holding off until after June 1, 2004 was a good move worth money to many families. Most of these women were planning caesareans or else were refusing inductions before their due dates. There was a suggestion from the Australian Medical Association that some women might have delayed too long and put their babies’ lives at risk!

On July1 this year, the baby bonus will be increasing to $4,000 per birth. The question being asked this week is, how many women this time around are going to put of their caesarean or induction in order to make more money? July 1 also falls on a Saturday in 2006, a traditional day for obstetricians to be playing golf (or whatever) but this year might see them hard at work in the operating theatres, valiantly supervising births that have been delayed an extra week or two. I wonder if they will charge extra for this “after hours” service and if this will be paid for out of the extra baby bonus?

Posted by andrea at 11:22 PM

Camden Birth Centre

Another busy week draws to a close - where does the time go?

The workshop at Campbelltown on Monday and Tuesday gave me the chance to catch up with developments in that area. The Hospital at Campbelltown and the Birth Centre at Camden (about 17 kms away) are part of the same Area Health Service. This AHS has been under a cloud due to many problems, and some deaths, which have been attributed to a number of factors. Some administrators have gone, some staff have left and the situation is improving, however, it has left moral amongst staff at a low point and a degree of suspicion and distrust as well.

Camden has a lovely Birth Centre, which is currently closed. The obstetricians in the area have refused to cover for births at Camden, forcing women to travel and give birth in the larger Hospital at Campbelltown. When the Birth Centre was closed, there were two very noisy protest marches of mothers and babies which received extensive media coverage and as a result, the State Government, under a lot of pressure to provide better services in the area, has promised Camden will re-open as a midwifery only unit. For the women of the area this is good news, but many have heard it all before, and are sceptical that it will ever happen.

Into this scene has come two top midwifery administrators to sort out the mess, clear away the blocks and get the service running. A caseload model is the preferred option, and is close to being implemented, once the annualised salary issues are resolved. The midwives in the area who have been patiently waiting for 5 years, are close to giving up and are beginning to doubt the promises. While their frustrations are understandable, this is the very time that a final concerted effort (push?) is needed to get this baby born.

Until Camden Birth Centre re-opens, the midwives from that Unit will be providing pre and post natal care on that site and bringing the women to Campbelltown for the births. This is far from ideal, but at least does offer the midwives in Campbelltown the chance to witness the working of this model and to learn from some very experienced midwives. Eventually it is to be hoped that the midwifery services across both hospitals will be similar so that women can be assured of having midwifery style (not obstetrically influenced) care wherever they choose to give birth.

Managing major changes of this nature are hard on everyone. Improvements and new developments never happen fast enough and usually take longer to negotiate than planned. An additional pressure comes from the fact that these new midwifery-only hospitals are a new concept that is being gradually introduced, amid a flurry of angst from the doctors and considerable political pressure from various stakeholders. The midwives in these new units must feel they are being watched like fish in a tank, with hungry predators waiting to pounce!

The medical model of obstetric care is a robust and almost unshakable system that is very hard to shift. However, the realities of high costs, over-servicing (30% caesarean rates), unjustifiable restrictions on women and lack of choice are forcing a re-think of the way birth is managed in this State. Camden could be one of the leading lights in this process and given a chance, I feel sure that it will succeed, just as other midwifery unit have done in the recent past.

Posted by andrea at 11:16 AM

More on doulas

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

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

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

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

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

Posted by andrea at 08:25 PM

Fathers at caesarean births

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

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

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

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

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

Posted by andrea at 08:16 PM

Midwifery legislation in South Australia

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

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

Wednesday 14th September 2005

OF MIDWIFE BORN

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

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

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

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

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

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

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

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

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

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

Posted by andrea at 04:56 PM

Midwives and obstetricians at loggerheads again in Queensland

Over the past two weeks there has been an amazing media stoush between Dr Molloy, the past President of the Queensland State Branch of the Australian Medical Association and midwives, primarily those working in the Birth Centre at the Royal Brisbane Women’s Hospital. Dr Molloy is known as the most vocal Australian proponent of caesarean births for all women and reportedly has a 100% caesarean section rate in his private practice.

A bit of background - this is the only Birth Centre in Brisbane, Queensland, the last state to get such a unit. The local obstetricians have fought the development of midwifery services in this State over many years and have waged an active campaign to discredit midwives, especially those who have offered home birth services. This “witch hunt” has been well documented and has given rise to many clashes in the media and some colourful public protests, such as the time a washing line of baby’s clothes was strung across the front of the Government House as part of a protest march.

Recently, Dr Molloy issued a statement that the Birth Centre at the RBHW was a “killing field” and the centre was being very poorly run, placing mothers and babies at risk. This was hotly refuted, and after pressure was applied (no doubt by his colleagues) he retracted the statement, saying that he was “just repeating what others were saying”.

Eventually, a Press Release came out from the State Branch of the Australian College of Midwives, following the release of a report into the running of the Birth Centre. It is worth reproducing the Press Release here, as it highlights very clearly the antics that go on behind the scenes when the medical establishment and hospitals collude to restrict options for birthing women. Jenny Gamble is a midwife (with a PhD), and is State President of ACMI in Queensland.

The report highlights “That there were widespread system issues and a culture that is actively unsupportive of a midwife-led service that meets consumer expectations and demands”. This has been occurring despite there being significant unmet consumer demand for continuity of care by midwives with 3 times as many women being turned away from the Birth Centre than are accepted.

Problems highlighted by the report include inadequate allocation of resources to the Birth Centre, lack of support by management for evidence based clinical guidelines and policies, and lack of commitment within the wider hospital to the collaborative approach necessary to ensure the Birth Centre is able to provide the best possible care to all women.

“Birth Centre Midwives have been alerting management for years to the lack of collegiality and respect from some obstetricians and trainees towards Birth Centre midwives and the women they care for” Dr Gamble said. “The College understands that formal complaints about some obstetricians refusing to treat a labouring woman referred to them by Birth Centre midwives have never been responded to.”

“We call on Queensland Health to ensure the recommendations are fully implemented” Dr Gamble said, “Midwives at the Birth Centre have been calling for many of the recommendations to be implemented for many years, but have been repeatedly ignored” “For example, midwives have been keen to provide care to women from early in pregnancy until a month after the baby is born as the Report recommends, but have been prevented from doing so.” said Dr Gamble. ”Midwives have also been urging management to adopt evidence based policies and guidelines, like national referral guidelines, without success.”

Lack of management transparency is another problem flagged in the report. “At the moment it looks like implementation of the recommendations will be managed unaccountably by RBWH Executive, when it is on their watch that these problems have persisted” Dr Gamble said.

“Only with a transparent and consultative process for implementation, that includes representatives of consumers, Birth Centre midwives, obstetricians and Department of Health officials--not just senior RBWH management--will the public be able to have confidence that we’re not just in for more of the same” Dr Gamble said. “The Report has confirmed that the service at the Birth Centre is safe, cost effective and popular with women.”

“In line with Dr Cherrell Hirst’s recent recommendations for state-wide maternity services [the recently released State Government Enquiry into Obstetric Services in Queensland- ed], it’s time the Birth Centre at the Royal was properly resourced, supported and respected so that women who seek continuity of care from midwife can be confident of the highest standards of care whether or not they experience a straight forward labour and birth” Dr Gamble said.

The battle goes on.....

Posted by andrea at 06:24 PM

Mareeba Hospital's maternity unit

News this morning that another small maternity unit, this time in Mareeba, Queensland, is to close because the only obstetrician in town has decided to turn to private obstetrics and won’t now support the public hospital maternity service.

Mareeba, which is in far north Queensland, just inland from the very popular tourist spot of Cairns, has had an excellent maternity unit for many years, offering very woman centred care, excellent outcomes and a wonderful midwifery philosophy. The obstetrician has been very supportive of the model of care they have developed over time and is very midwife-friendly in the past. Although the midwives have been told they can continue to offer pre and post natal care at the Hospital, this is not satisfactory. Women will be forced to drive down from the tablelands when they are in labour to give birth at the Cairns Base Hospital, which is already struggling to meet demand from surrounding areas. The chances of babies being born on the side of the road is very real.

Th sudden announcement to suspend birth services at Mareeba, made with no warning and no consultation, does offer a great opportunity. This may be the catalyst for the opening of the first midwifery maternity service in Queensland, along the lines of the very successful Ryde Hospital service in Sydney. I understand that the lobbying and politicking has already begun and no doubt there will be much activity both locally and across the State, supported by evidence gathered from other parts of Australia.

The report of the Queensland Government enquiry into Maternity Services has not yet been tabled in Parliament. It is hoped that this enquiry will have exposed the lack of options for women giving birth in Queensland and provide the impetus for the development of more woman and midwifery-friendly services across the State. This debacle in Mareeba may be the tipping point for better birth options in a State that has, for years, lagged behind the rest of the country in terms of birthing services.

The developments in Mareeba will be watched with great interest by everyone.

Posted by andrea at 11:09 AM

Obstetricians - where to next?

Contrasts in obstetric care are in my thoughts this morning, as I head to Heathrow for the long trip home to Sydney today.

First I have been in Ireland, where obstetricians rule the roost and women clamour for private consultant care so they can get their private room in a hospital for three days following the birth. Irish women seem quite happy to accept the high levels of birth intervention they and their babies will suffer during labour, the added costs they must pay, and the potential for long term health problems (of which they have probably been told nothing) just as long as they can be moved into a private room in the crowded maternity hospitals for a few days of “hospital pampering”. Private health insurance is a status symbol and women talk proudly of “their consultant”.

Next, I read in the Sydney Morning Herald (which I access online each day) of the problems facing pregnant women in rural NSW. As a result of the close down of small rural maternity units due to the reluctant of doctors to attend births, women in labour are being forced to drive hundreds of kilometres to the nearest regional centre. A recent report of a baby being born outside a pub with the aid of a publican’s wife (an Irish nurse, as it happens!) during a drive of over 150 kms to get to hospital has raised the issue.

Meanwhile, the Australian Government has decided to try and curb the excessive amounts of money being spent through Medicare on IVF as a way to ease the blow-out in the safety net funding arrangements. This has caused a stir because some women feel they have the right to IVF so they can have a baby, and that this should be funded by the public purse. The fact that the obstetricians charge so much for the procedure, knowing that us taxpayers will pick up the tab is not openly acknowledged, but is the root cause of the high price of IVF.

Here is London, obstetricians are apparently diversifying. Not content with the huge boom in caesareans and IVF, they are now adding colo-rectal surgery to the services they are offering. Using the ploy of encouraging women to get “their private parts tidied up” up after giving birth, some are now offering to re-fashion perineums and vaginas so that the “body beautiful” can be preserved. It won’t be long before the need to preserve the “honeymoon vagina” creeps up the list of reasons for caesarean birth in Britain, as it has in places like Brazil, where obstetricians routinely perform this surgery and are proud of their 100% caesarean rates.

Not that Brazil is alone in having obstetricians who boast of their surgical skills. In Brisbane, Queensland, there are at least two obstetricians who will only perform caesarean sections and they too have 100% surgical birth rates. One of these is a staunch and vocal supporter of private obstetric care and is scathing in his criticism of midwives and normal birth. As a spokesperson for the Australian Medical Association he gets lots of publicity and he is no doubt one reason why people are coming to regard some doctors, and especially some obstetricians, as money hungry self publicists.

I wonder what exploitation of women’s bodies obstetricians will come up with next, to maintain their bank balances?

Posted by andrea at 06:01 PM

Reactions in Ireland

The feedback from my last Diary entries about the workshop in Dublin has been interesting. I gather that there has been some discussion on the Irish Midwifery Egroup discussion list (G’day all my Irish readers!) and that I have raised the ire of some midwives.

If people are talking about the issues I have raised then that is terrific. My intention is not to irritate or annoy people, but to raise awareness and encourage action to improve the maternity services in Ireland. It would be easy for me to walk away, shaking my head and full of pity for the women who must suffer under this system (women and midwives). Shooting the messenger is also a very easy game for people to play and neatly avoids facing the problem or tackling the issues. The fact is, I care about the women here and am willing to do my bit to bring about a change I know that many people in Ireland want, but feel powerless to influence.

For those who want to consider these issues further, I would urge you to read these articles, to print them off and to circulate to colleagues, friends and anyone else you think would benefit:

Fish can't see the water

The Active Management of Labour

I will be writing more on maternity care in Ireland after I complete the workshop today in Limerick.

Posted by andrea at 06:31 PM

Obstetricians rort the "safety net"

As we toured around Australia recently with the Future Birth program, the subject of the huge cost of obstetric care to the Australian public came up several times. Apart from the 30% subsidy that all taxpayers give to those who choose to take out private health care (which I consider to be a gross misuse of my money), the Federal Government has established a “safety net” designed to ensure that no-one is disadvantaged by being unable to afford the high cost of medical care (with both GP and specialists) when fees are charged over the basic scheduled Medicare rates that cover all Australians

The “safety net” was part of the Federal Governments platform for re-election last year. Those with private health cover are also included in this safety net, because private insurance cover does not cover all additional medical expenses and people find themselves paying for the extra charges, on top of their insurance premiums.

The obstetricians have been the big winners from this arrangement. They charge way above the scheduled fees for their services, and insurance cover still leaves a large gap to be funded by expectant parents. A neat story in the latest edition of “Birth Maters”, the journal of the Maternity Coalition, illustrates this well:

A Melbourne woman who was considering making a booking with a private obstetrician phoned his office to ask for the details of his charges, and exactly what the safety net covers. This is what she was told:

“ I pay him $3600.00 and the safety net picks up $1600. Apparently the safety net picks up 80% of out of pocket expenses which are incurred over $700.00 in any one year.”

Here is a simple calculation: If 30% of all women giving birth in one year (250,000 x 30% = 75,000) give birth in private hospitals, under the care of obstetricians, who each charge $3,600 for their services, Medicare is rebating $1600.00 x 75,000 = $120,000,000 via the safety net alone. There is also the ordinary Medicate rebate”.

No wonder this marvellous safety net scheme is so loved by the doctors. It is already known that the blow out in the funding for the scheme is hundreds of millions of dollars (and we haven’t yet reached the end of the first year of operation) and it seems that the obstetricians may be the main cause of this. Rumour has it that the Australian Medical Association (AMA) is aware of the way the obstetricians are using this scheme to make money for themselves and can see that this rorting of the system is giving doctors as a whole a bad image. It will be interesting to see if the AMA decides to take action internally to rectify this, or whether the obstetricians (who have a long history of going it alone within the medical fraternity) decide to tough it out with their colleagues until they are forced to change their ways by the Government.

Meanwhile, us poor taxpayers are again footing the bill for those extra little luxuries enjoyed by the obstetricians.

Posted by andrea at 06:52 AM

Dodgy sponsorship of midwifery events

The issue of what is appropriate sponsorship for events has come up, in relation to a group seeking help to fund an event I may be involved with. I asked this group if they would be careful when seeking funding and advised that I would not be prepared to attend any event where baby formula (or its gadgetry) would be advertised.

Some years ago now, I was caught out on this issue in the UK. A Branch of the Royal College of Midwives had arranged an Active Birth study day and when I arrived, I found to my horror, that beside the registration desk was a large display and handouts about a specific brand of baby formula. There were similar tables of advertising material from other companies in the entrance area as well.

I took the organiser aside and explained my dilemma: although I had come a long way to present the program, and the participants were similarly well travelled, I would never have been involved at all had I known that such sponsorship would be used to underwrite the event. The organiser was very surprised. She explained the RCM often used such companies to help defray costs and this was an “acceptable practice” as far as she knew.

She was a midwife herself, but was not familiar with the WHO Code. When I pointed out that it was the bottle feeding women who ultimately would be paying for the company’s largesse and the midwives’ refreshments, she said that she had never thought about this bigger picture, and was surprised by it.

On that occasion there was little I could do but compromise. I stated to the group that I did not support the products being advertised, nor the position of the RCM in inviting such involvement from these companies. I also stayed well away from their tables, but made sure that they heard the conversation that I had with the organiser.

I suspect that the midwives in the group were not bothered - breastfeeding rates in the UK are the worst in Europe and I think the group members were just happy to have had a cheaper program and free refreshments. The bigger picture and the motivations of multinational corporations in co-opting health professionals is an issue that is often overlooked as a matter of expediency.

Posted by andrea at 06:46 AM

Blocking comments

Over these past weeks the amount of spam that I receive each day has grown to unmanageable proportions and it is taking me up to 30 minutes each day to delete it from my Diary entries. The spam comes in via the “Add Comment” option that I have available for those who wish to add their thoughts on a subject.

Reluctantly, I am going to have to turn off this facility in the short term, until I can find a way to delete all span from the site. This may be possible with later versions of the software that I am using, but there are issues with installing this and migrating the current Diary entries over, so until I can be assured that none of the current entries will be lost in the update, I will stay with the current software.

The time I need to delete the spam is time I usually devote to writing the Diary entries, so I have decided that these are more useful than the comments. I will be arranging for this option to be turned off in the coming days.

If anyone wants to give me feedback directly, I am always available by email and I can include comments sent in this manner in new Diary entries. My email address is: andrea@birthinternational.com.

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

The doula issue

The Childbirth Educators of New Zealand (CENZ) have asked me to write an article for their next newsletter on the relationship between doulas and midwives. As soon as the word “doula” pops up, my mind goes into overdrive and so I have just spent the last hour and a half furiously writing down my initial thoughts on this very contentious subject.

Whenever I write about doulas I get considerable response. Their arrival on the birth scene in a fairly recent phenomena - originally the term “doula” was coined by anthropologist Dana Raphael in her book “The Tender Gift - Breastfeeding” published in 1973, to describe the a supporter (usually a friend or family member) who cared for a women post-natally during the “lying-in” period. Over the past few years, the emphasis has shifted and now doulas see themselves a primarily birth supporters and prenatal educators, leaving the daily visiting and care of women after the birth to others.

The concept of the doula would probably not have appeared on Australian radar if it had not been the organisation and promotion of doulas in the US. American ideas always seem to be exported, even if they may be inappropriate in other cultures. In the US, there are doula training courses, special doula organisations and many private businesses offering doula services to pregnant women. All this may be necessary in a society of fractured family groups, individualised and isolated lifestyles and where the health care system provides no mainstream midwifery options.

In our country with its different cultural patterns, better health care systems and universal midwifery care in maternity units, I believe that doulas, especially as a paid up member of the health care team, are not necessary. Women should be encouraged to have close friends, family or significant others at the birth of their babies. Paid for social support services have the potential to undermine the community values we have always valued in Australian society - of helping each other out in times of need has been an underpinning fiundation of the Australian way of life.

Yes, I know that midwives in hospitals are stretched and often under great pressure, and that in this situation a some extra helpers for the labouring woman might be useful Yes, I know that we have a shortage of midwives. Yes, I recognise that not all women have someone close they can ask to help out during labour (although I find this very hard to believe). Yes, I know that some midwives will welcome a doula because it mean less work for themselves, work they perhaps are unwilling to be involved in. I also know that there is a risk that hospitals could see doulas (especially one paid for by the parents) as a “free staff members”, useful when midwives are scarce on the unit.

I would prefer that we look for ways to increase the numbers of midwives so they can provide better midwifery care for all women. I also want women to encourage their close friends and family to help out during birth, just as they traditionally have done. Perhaps all the doulas could consider enrolling in the direct entry midwifery programs that are now available so they can take on a recognised professional role and help fill the gaps in hospital staffing levels. Alternatively, they could focus their energies on becoming childbirth educators, with recognised qualifications.

At the moment the role of the doula is blurred and complex. No doubt there will be many responses to my comments here, as there usually are when I raise this thorny issue. Meanwhile, when I have the article written and published in the CENZ newsletter I will post it on the web site so you can read my full opinion on this issue.

Posted by andrea at 02:33 PM | Comments (0)

Should access to epidurals be a "right"?

Today I found the reactions of the Belfast midwives I am currently working with a bit depressing. Although they are very keen to explore the concepts of Active Birth and half of their staff complement are in this group, I was left with a distinct feeling that many of them felt the ideas could not be implemented “with their kind of client”.

The hospital is located in the north of the city, in an area that is socioeconomically disadvantaged, withe the highest rate of teenage pregnancy and unmarried mothers in the UK. The welfare state provides well for young mothers and provides some incentive to have babies when young, and this has become a tradition in many families. I was also told that contraception can still be hard to obtain, as even though doctors may write prescriptions for the pill, many chemists will not stock them for religious reasons. Many teenage women make great mothers and I am not being critical of their decision to have babies, if this is what they want to do.

The welfare mentality can prove problematic and this was raised in another context by midwives in the group. Everyone in the UK contributes to the health care system through their taxes, and in return they expect access to all available health services throughout their life. This was the promise made in 1948 when the National Health Service was introduced - that with a universal health care service, paid for by all taxpayers, no-one would be denied health care whenever they needed it.

These days this promise has created problems of its own. Women are arriving into labour wards expecting that they can have an epidural on demand and maybe even a caesarean section if they desire. Women are not seeking full information about these options and it is convenient for the system to encourage their use as it makes for better control over births in busy hospitals. The lack of informed consent is a potential time bomb, which could also prove expensive if women decide to take action over outcomes they didn’t expect.

Here in Belfast, I think the high caesarean rate (29%) may be due, in a large part, to the high rate of epidurals and inductions. I got the strong feeling that many midwives were willing to offer epidurals because they believed that women should get what they are entitled to, and of course they have little else to offer (warm water, positions, hot packs etc). I hope to shift some of their thinking on these issues today and give them some alternatives they can try instead of just offering the menu of drugs. Few of these midwives have any experience of home births and some seemed uncomfortable with normal physiological labour. Their reactions to the noises of normal births (as shown in the film “Inner Strength”) indicated that they were personally unsettled, dismissing the messages of the film as “impossible with our women”.

It is a very conservative area, that was made clear, yet some are open to new ideas and the fact they so many are attending this program is a positive indication of interest in new ways of working. We will see how we go today.....

Posted by andrea at 06:15 PM | Comments (0)

Midwifery loses out again in Australia

I must admit that today I am depressed. I had hoped that in today’s general election in Australia, we would get a Government that is supportive (or at least leaning in that direction) of midwifery and that we would have the hope of support, at long last, for independent midwifery and community based midwifery programs.

Alas, it is not to be. Instead, we will have “more of the same” - support for the obstetricians, a blind eye turned towards their blatant ripping off of the Medicare system and conservative voices extolling the benefits of “fee for service” that has bedevilled our attempts to get a more equitable health care system for all. I can’t believe that Australians have not seen through the lies and deceptions of this Government, yet they have. The fact that in Australia voting is compulsory only makes it worse - in counties like Britain and the US where voting is not mandatory, it must be possible to blame those few who do take the trouble to vote for the ailments of their electoral system. In OZ, this excuse doesn’t hold water, and I must accept that the cunning and wiliness of a conservative old-timer has once again appealed to the lowest common denominator and won office by appealing to their hip pocket nerves rather than the collective good.

What a shame. One big loser will be midwifery, which needs far-sighted and broad minded political leaders who are prepared to tackle the medical lobby so that ordinary women get some decent choice in how they give birth. We were making some headway with the Opposition party and the major alternative political groupings and some valuable concessions and commitments had been wrung from them in the heat of the political battle. It is hard to imagine any of these pipe dreams coming to fruition now, or at least, not until we can change this Federal Government and its allies.

Not all is lost, however. The various States are all still in the hands of the socialists, so it is to them that we must now turn our attention. Each State has a major role in the way that health funding is distributed, so there is still the possibility that they will see the light and make the necessary arrangements that will enable midwives and midwifery to flourish. It would have been so much easier if our central Government was supportive as well. The battle goes on, and we are a resilient, resourceful lot. After time to lick our wounds after this furious election round, no doubt we will rally and take the fight for choices for women to another political battlefields.

I was sorry that the election was called for a date when I would not be in Sydney, but now perhaps I am glad that I am not there to feel more directly, the pain of the reformers and innovators whose dreams have been dashed again.

Posted by andrea at 06:18 AM | Comments (0)

A last word on Italy

A last comment on my recent weekend in Italy. My program was sponsored by MIPA (Movimento Internazionale Parto Attivo - International Movement for Active Birth) who offer a whole range of programs and services for midwives and women in Italy. They are about to celebrate their 20 th year of operation, and they have been central to the raising of consciousness about humanized birth, water birth and home birth in Italy. Piera Maghella, the founder of MIPA, is a passionate woman who has lead many campaigns for better birth services and I enjoyed working with her on this workshop project.

She explained that recent changes announced by the Italian Government will have far reaching effects for the education of health professionals. From now on, all educational and in-service programs for health workers are to be provided by staff within the hospitals themselves - no outside consultants, educationalists or experts are to be used unless they can provide programs at a cheaper cost to the system than internally funded programs. This is a disastrous move and one that is likely to lead to the perpetuation of hospital practises and increased rigidity within hospital services. Such an approach risks the institutionalisation of practises that may be outdated and inappropriate. It is vital that hospital based workers be exposed to fresh and new ideas by outside speakers, leaders in their fields and experts with specialised knowledge. The reasoning of the Italian Government is to save money by not having to pay realistic rates for quality education, but what about the cost to the standards of medical and nursing care?

MIPA has also been hit by new regulations that require organisations to separate their commercial and educational functions: if a group offers training it cannot sell products and vice versa. This will hit many groups hard because selling appropriate products and services that back educational programs is often vital to these groups financial survival. Piera expects that her group will have to undergo some major restructuring in the coming months and it is to be hoped that they can continue their important work in a financial viable way. Italy certainly needs people with a passion for birth reform to keep prodding at its medicalised birth systems.

Posted by andrea at 02:06 AM | Comments (0)

Bumper stickers

With the Federal election campaign underway in Australia, it seemed a good time to get some bumper stickers prepared, to help sell midwifery and get it into the consciousness of our aspiring politicians. Everyone has an election in their area at some time, so get yourself prepared with some useful ammunition!

We’ve got two stickers available, which can be ordered through our website.

Midwives - The Safe Birth People

for normal birth, vote 1 midwifery

Check them out!

Posted by andrea at 06:21 PM | Comments (0)

Bumper stickers

We’ve got two stickers available, which can be ordered through our website.

"Midwives - the safe birth people"

" for normal birth, vote 1 midwifery"

Check them out!

Posted by andrea at 06:08 PM | Comments (0)

Pushing politicians to take action on birth

I am supposed to be on holidays at the moment but sometimes it is important to take time out to stay involved. Although the next Federal election date has not been announced, we are in full electioneering mode, with all politicians jockeying for position on policies and making announcements designed to win friends and influence the people.

Midwives and consumers have decided that enough is enough in regards to the dreadful rising intervention rates in birth and that we must sieze this opportunity of an election to put pressure on the Government to recognise midwifery and provide family friendly birth options. Everyone is being encouraged to write letters to a number of political leaders and to gain as much publicity as they can for this cause.

I've done my bit and sent off the following letters to all the political leaders (the first one to our current Prime Minister):

The Hon. John Howard
Prime Minister
House of Representatives
Parliament House
Canberra ACT 2600

Dear Mr Howard,

RE: WOMEN’S RIGHT TO CHOICE FOR BIRTH SERVICES

Australia has one of the highest caesarean section rates in the developed world, and rates of intervention in birth that continue to rise each year. These figures, compiled each year by the National Perinatal Statistics Unit, cannot be justified on any grounds and cannot be tolerated any longer. The impact on Australian families, through poorer health outcmes, added costs and overuse of unnecessary medical services is a position that must be addressed by Governments, both Federal and State. Other countries, notably the UK and the US, have reacted strongly to similar situations by introducing a range of policies and programs that are now lowering intervention rates across the board. Australian Governments must follow their example so that our women are not unnecessarily disadvantaged.

The simplest measure that would have the most immediate impact would be the expansion of midwifery care, through supporting independent practitioners and the expansion of community midwifery programs. The Federal Government bailed out the obstetricians by subsidising their professional indemnity insurance, and altered the Medicare arrangements to enable them to shift costs for private maternity care from families to taxpayers. As a result, intervention rates are rising further, at the expense of women’s and baby’s health and well being and considerable unaccounted financial burdens to taxpayers.

The Federal Government is already in receipt of many Governments reports clearly showing than an expansion of midwifery services will lower health costs, improve birth outcomes and provide freedom of choice in birth care for families. The current arrangements are discriminatory against midwives, who are professionals in their own right, anti-competitive and completely unsupported by evidence and extensive research.

It is time for the Government to show leadership in this matter and to resist the strong obstetric medical lobby, who are unwilling to provide transparency and accountability to support their abuse of the Medicare and private health care system that has produced the current situation.

Birth is not an illness and should not be treated as such. Midwifery care deserves your support, through legislation that extends to midwives the professional indemnity insurance currently provided to obstetricians and through the provision of Medicare provider numbers to independently practising midwives.

I urge you to consider these issues and to take the appropriate action to change this shameful treatment of Australia’s women and babies. Women make up half of your voters, and are entitled to equality, equity and fairness when accessing services for childbirth. I look forward to hearing of your plans in this regard.

Yours sincerely,
Andrea Robertson
Director, Birth International
Honorary Fellow, the Australian College of Midwives

I hope that we can have an effect on these politicians and that some sensible policies will be announced. The first political party to take these issues on will certainly get my vote!

Posted by andrea at 10:14 AM | Comments (0)

Breastfeeding and world peace

Several months ago, I was asked by a Brazilian friend if I would help with the English translation for a video they were making to promote breastfeeding. The project was a joint effort between various Government Departments and support organisations and they had recruited a number of women, including some well-known personalities to convey the benefits of breastfeeding.

Having sent off the prepared script, I was keen to see the finished product, since I had no idea of the visuals that went with the story. In due course the video arrived and I have now had a moment to play it. It is a delightful film, full of babies nursing contentedly while their mothers explain their reasons for breastfeeding and the benefit it bestows on themselves and their children. I was particularly taken by the message, delivered unequivocally in a gentle, caring manner, that breastfeeding babies contributes to world peace, through helping babies experience a loving, nurturing relationship at the beginning of their lives.

This thought, of the link between early mothering and calmer, more peaceful adults is not new (Michel Odent has spoken of this in his many books) but it is the first time I have seen it used to underline the benefits of breastfeeding. Perhaps some film makers don’t want to “tread on any toes” of the bottle feeding mothers, or perhaps we just don’t think about the longer term benefits of the close intimate relationship that is an essential and automatic ingredient of the mother/baby nursing couple.

It is great that the Brazilians have tacked this one - perhaps we should take a leaf from their book and move away from all the daunting, technical “you must get the baby latched correctly” breastfeeding videos and instead look towards motivating mothers through exploring the wider implications of this gift to their babies.

Posted by andrea at 10:06 AM | Comments (0)

Silly rules and regulations

Once again, during my travels in Ireland these past few days, the ridiculous rules imposed by the Occupational Health and Safety police surfaced. No-one disputes the necessity for making workplaces safe, but their over enthusiastic approach has, in some instances, become absurd.

There was the story of one hospital where someone had an accident with the kettle, resulting in a blanket ban on the use of electric jugs by visitors (read: fathers) to the labour ward. In another unit, a hot pack was overheated by someone unfamiliar with the microwave, so all hot packs were banned forthwith.

I have heard of midwives being told that if they don’t wear uniforms, they will not have any insurance (unbelievable!) and long hair and false fingernails being outlawed because of concerns about possible infection.

All of these measures and wonderful examples of the “nanny state” where people are not expected to take any responsibility for themselves and instead and shepherded from cradle to grave by “caring” authorities. Rules like these almost encourage dissent, because they are so patently over the top. If we treat adults like children then they will behave that way.....

If fathers can’t be trusted to boil a kettle then what is the world coming to? If the microwave is some fancy model that needs instruction in its use, then why not provide some basic hints and then let then get on with it?

I am going to start making a list of all the silly rules and regulations being imposed on midwives and expectant parents in an effort to keep them in line. They will make good reading in a future Diary entry. Let me know of you have some good example to share.

Posted by andrea at 06:57 PM | Comments (1)

Feedback for VETAB

The Certificate that verifies our status as a Registered Training Organisation arrived today. It has been nine months since we formally applied for re-registration. There was a delay of 6 months before the Vocational Education and Training Accreditation Board (VETAB) even began assessing our application but once it was handed to the independent auditor, everything went smoothly.

The audit that she undertook showed we were performing well and the only major sticking point was the obtaining of professional indemnity insurance for our trainers. This we have now achieved - even though we felt it was an unnecessary impost. It has meant an increase in fees for our students however, which is a shame.

Now that we have achieved both re-registration and re-accreditation (what a year that was!!) we decided to write to VETAB and offer them some feedback about the process we had to undergo. Given that we had to go through a number of hoops we felt they would benefit from some constructive feedback about their performance, especially given that the requirements for re-accreditation of all courses are being beefed up at the present time. I hope they will take some of our suggestions on board and I look forward to receiving a response from them.

Posted by andrea at 03:49 PM | Comments (0)

The state of private obstetrics in Australia

As the pressure builds to reform maternity services in Australia, there seem to be an increasing number of media stories that try to paint the obstetricians as the victims of fickle women and unsympathetic Governments. Their lobbyists have always had good access to the media, and whenever a question is raised or a report released that challenges, even gently, the status quo, the media trot out a “poor me” story about some struggling obstetrician who is just “trying to save babies” in the face of hostility and political ill-will.

Of course, what is really going on is that the doctors are starting to feel the blow-torch of public scrutiny over their management styles which invariably result in over-servicing of pregnant women and high rates of intervention in birth. The reports that have been released in recent years and the excellent research that has revealed the truth have made this abundantly clear.

In today’s major Australian weekend newspaper, the Sydney Morning Herald, is yet another such media beat up. This story, once again about doctors leaving the private health care system, places the blame on long hours and being on-call 24 hours each day. Whilst this is a genuine concern for many obstetricians, especially the women who have chosen this profession, the regular complaints about insurance are once again cited as a reason. The most interesting part of the report are the figures, which must be read in the contact of an annual birthrate in Australia of 250,000 babies:

'Almost half the country's obstetricians are planning to abandon private practice in the next five years, affecting the delivery of up to 17,000 babies by 2008. Some will enter the public hospital system and others will practise gynaecology and related specialties.

Doctors are also warning that the public hospital system will be increasingly struggling to meet the demand created by the exodus of private obstetricians.

"If we get another 16,800 babies in the public hospital system, which is the amount of births we would expect to handle in the next few years, there will be strain," Dr Child said.

Specialist obstetricians are also quitting public hospitals. The survey found 100 intended to quit the system in the next five years. Of the 1162 specialists practising obstetrics and gynaecology around the country, less than half practise obstetrics and only 300 are in private practice only. Already, 150 specialists have quit private practice in the past three years, and 55 said they intended to stop private practice in 2003, the survey found. Over the next five years, another 150 will cease practice.

While medical indemnity was not nominated as the main reason for leaving the profession, 10 per cent of those surveyed reported paying premiums of more than $98,000 in 2001-02.

"One issue is the affordability, but there is also the ogre of this hanging around in the background, whatever you do," Dr Child said. Ultimately, it meant it was increasingly difficult to get a private practitioner, with rural areas suffering most, he said.'

I feel sure our public health care system can easily cope with another 16,800 babies being born in our public hospitals. With a change in Government policy these women’s maternity needs could easily be catered for by independent midwives!

I have always believed that the obstetricians would eventually price themselves out of private obstetric practice one way or another. Despite their protestations of other reasons, I think this si starting to happen, and rather more quickly than many of us had hoped.

Posted by andrea at 09:31 AM | Comments (1)

Are poor birth outcomes linked to falling birth rates?

From time to time, the Australian Government spouts platitudes about putting "families first" and encouraging women to have babies. There is concern that the birth rate is falling and this has many negative effects on a country's economy and big implications for the community as a whole.

I've been thinking about possible links between the way birth is managed and its impact on women, and wondering if these form part of the story. In Australia the birth rate is about 1.7 children per family and it is about the same in the UK. Ireland and Italy are lower and Spain is 1.2. The average age of women in western countries having their first baby is now 30 years, which means that half of first time mothers are over this age.

Given that research has shown that when birth is traumatic for a woman, she waits for an average of four years before having another child, this fact, in combination with the high average age of first time mothers, may be significant. For example, if a woman was to have her first baby at age 32 years and the birth was traumatic ( a strong chance given that better educated "career" women are more likely to choose obstetric care, with its well documented risks) she may need four or more years to recover to the point where she will consider another pregnancy. A woman's fertility is falling as she ages, so that may then impact on her ability to conceive in her late 30s. If this does take time, she may then decide to give up and leave her family at one child.

Women who have good births are often keen to have more children. This may be anecdotal evidence, I know, but seems logical to me. Perhaps if research could be undertaken that explores the links between poor birth outcomes, delayed conception, reduced fertility and resultant smaller families, we might have strong evidence from a different to convince Governments that ways must be found to reduce birth interventions. Every little bit helps to promote midwifery.....

Posted by andrea at 03:23 PM | Comments (1)

Breastfeeding in Parliament

I’ve been off the air for a few days while I have been travelling, first to Bangkok and then on to London. There’s also been some problems with email access which I have now sorted out as well - I feel completely lost these days when cut off from my email!

Over the past week there has been quite a lot of comment on the ozmidwifery list about Kirsty Marshall and her attempts to breastfeed her 11 day old baby during her first Question Time session in the Victorian Parliament, to which she has just been elected. She was asked to leave because “no strangers” are allowed in the House during Question Time, and there is also a “no eating or drinking” policy in place as well. The media when wild with this story, and the Speaker of the House ( a woman) said that Standing Orders were being revised, no doubt to ensure that they are not discriminatory.

I am amused to see a report that Breastfeeding is not allowed in the House of Commons in the UK (report from an NCT Newsletter). The Chamber, the Committees and the Public Gallery are all off limits to the breastfed baby. A challenge to this ruling has resulted in better facilities being provided for women else where in the building, but they are not budging on their ruling. It seems that while anti-discrimination laws that protect breastfeeding in public may be in place for the community generally, can be readily overlooked by those who make the laws themselves!

Posted by andrea at 10:51 PM | Comments (2)

War and peace

This weekend has seen huge numbers of people massing to protest the war that seems to be inevitable. As I write this, hundreds of thousands of Sydneysiders are massing in the city to vent their anger and frustration with our Prime Minister who seems to be hell bent of supporting the American President, ahead of his own people. Australia is a peaceful and peace loving place, with tolerance and the concept of “a fair go” firmly embedded in our national psyche. The idea of fighting someone else’s war, on the other side of the world, at the behest of a deeply suspicious, belligerent, right-wing cowboy is anathema to me and millions of my compatriots. There are other ways to deal with tyrants apart from dropping bombs on them. Perhaps the American President will find himself subjected to some of these measures in the end, because people perceive his bellicose and posturing behaviour as tyrannical as well.

The NSW Midwives Association is marching in today’s protest and had I been in better health, I would have joined them. My heart is with these women, who, as midwives, know that the way one begins life can have a profound impact on the mental and emotional (as well as physical) health of people. We must humanise birth if we are to produce reasonable human beings.

I wonder how George W Bush was born? Was he “untimely ripped” from his mother’s womb, or dosed with drugs that have impacted on his capacity for love and respect? I have always believed that the babies born today will be making the decisions that affect us all in the future and that we should therefore recognise the impact of our actions on these sensitive beings in the precious and important hours around birth. We need our children imprinted with love and sensitivity, not aggression or survival anxieties.

It may be too late to save the American President. However, there are good and rational people in the world and with luck they will prevail over the war mongers and blinkered egomaniacs that seem to be leading us at present.

We may feel helpless and sometimes hopeless when viewing the antics that are leading us down self-destructive paths. Even if we can’t do much to impact the bigger picture, we can influence the smaller picture, in the hope that the future will provide a safer and more respectful, tolerant home for us all. The next time you are journeying towards birth with a labouring woman, remember that her child may hold your future in his/her hands. Be gentle, be kind, be patient and loving. These are lessons we can pass on to the next generations through our direct action and heartfelt example.

Peace be with us.......

Posted by andrea at 11:56 AM | Comments (2)

Campaign for maternity reform tastes success

I have just heard that things are hotting up in NSW regarding the reform of maternity services. Having ti face the electorate in 7 weeks focuses the Government and its Ministers very clearly and Craig Knowles has had some shocking experiences with irate women demanding better maternity care in recent rallies in Bulli and Camden. He seems to be developing a phobia about strollers containing babies!

I am told that NSW Health will implement the NMAP in the Hunter and Illawarra Area Health Services as the starting point. This will mean that women in those areas will be able to access midwifery care and give birth where they choose - hospital or home and funded directly by the Health Service. Central Sydney Area Health Service (Royal Prince Alfred Hospital is its flagship maternity hospital) was to be included but was dropped when they excluded home births from their proposed service.

This is a major breakthrough and one that has come about through intense and clever lobbying by the consumers and midwives involved in The Maternity Coalition. They have put together such a strong case for reform that to ignore it would be foolhardy, as the political parties are beginning to discover.

There will be more news soon, but the revolution is certainly underway. It is just like the “olden days” when we were struggling to get rooming in and father at births - it has taken a long time to get consumers on the march again but they are falling into step right now!

Posted by andrea at 03:56 PM | Comments (2)

Independent midwifery

Had dinner last night with two good friends who are independent midwives. The conversation roamed around births (as you would expect!) and eventually we came to the hassles that they encountered when transferring women to hospital. So often independent midwives are met with hostility and suspicion when they need to transfer a woman during a birth, sometimes in ways that could jeopardise the labouring woman (for example, when the receiving midwife or doctor disputes the diagnosis made by the independent midwife, resulting in unnecessary delay).

I guess many of us feel a bit intimidated when we are confronted by a professional who is obviously competent, in charge of the situation and willing to take responsibility, especially if we are feeling a bit unsure of our own skills in some way. Many of the attempts to restrict the scope of practice of these midwives probably stems from feelings of inadequacy by those who feel they should be in control, or who feel that their territory is being threatened by an “interloper”.

If the NSW Government grasps the nettle and decides to introduce models of midwifery care that will enable and support home birth options (amongst other innovative schemes), they will need willing midwives to take up the challenges of providing the necessary services. If these new schemes come at a price of curtailing the autonomous practice that has been the hallmark of the independent midwives, then I think few will want to be a part of the new ways of working, and may leave the field rather than subject themselves to restrictions on their work. My friends were certainly of this view. If anyone tried to impose guidelines or limits on the services they could offer women, they would rather leave midwifery than submit. This is even if the Government offers to cover their professional indemnity insurance as part of the bargain.

I hope that some equitable system can be hammered out that leaves everyone a winner. Many women want to do their own thing with birth and engaging an independent midwife is the only possible way of achieving this without hassles. Hospital based midwives need the strong example of home births to remind them of the beauty of birth as well as its normality. Fear and vested interests are again likely to prevail when it comes to Government decision making - unless we can be sensible about this there is a risk that we will lose some of our best examples of midwifery practice in this country. This must not happen!

Posted by andrea at 03:48 PM | Comments (3)

WHO, Safe Motherhood and human rights

Provision of appropriate maternity care tailored to the needs of the individual woman should be a basic human right. Of course, it is hard to achieve this when a health care system is trying to manage a multitude of women utilising their services at any one time. This is where the routines and protocols come in as a way of attempting to get some kind of order into what could become chaos, especially in hospitals where women must be cared for by staff they have never met and in conditions that are far from personal, let alone intimate.

The World Health Organisation has a useful free publication that explores the issues of human rights in the context of the necessity for health systems to operate with some degree of efficiency and safety. Called “Advancing Safe Motherhood through Human Rights” it has been produced with “the intention .... to facilitate initiatives by governmental agencies, non-governmental groups and, for instance, international organizations to foster compliance with human rights in order to protect, respect and fulfil women’s rights to safe motherhood.

Well worth a read.

Posted by andrea at 03:28 PM | Comments (2)

Insurance rebates for home births

Some really interesting news to hand today - one of the largest private health insurance companies in Australia (Medical Benefit Fund - MBF) has agreed to offer a refund for midwifery services for homebirth of up to $3000.00, provided “that no obstetrician is consulted”.

This is good news indeed. Some of the smaller health funds are already giving rebates for midwifery care, but getting these big players to recognise the benefits of midwifery is a bonus. It has to have a financial benefit for them - their profits are already under pressure and the obstetricians are doing more and more caesareans mainly for their private (and insured) clients.

Perhaps it will be the health insurance industry that pulls these doctors into line - there seems little political will to make them behave more appropriately towards healthy labouring women and our community is bearing the costs of their rampant excesses in a number of ways.

Next year is shaping up as a watershed year for midwifery, and 2003 is not that far away now!

Posted by andrea at 03:50 PM | Comments (4)

Saving ourselves from meddlesome men

A couple of weeks ago, a male hypnobirther contributed to the discussion on the ozmidwifery list about giving birth in water. He stated that this was “the stupidist idea he has ever heard of” and that women should “get out of the water and onto a chair where you belong”. This naturally led to more discussion during which he said that pain in labour is wrong and that it doesn’t have to hurt - if it does this is just women’s minds at work, expecting pain which they then experience.

These comments really stirred things up. I was very proud of my fellow Aussies that he wasn’t flamed for his assertions and outrageous remarks and that several women tried to gently open his eyes to the realities of birth. His male views and his self-righteous tone didn’t cut any ice with the women on the list but we tried to give him some insights.

Anyway, soon after I was taken to task by the anaesthetists who want to tell women in prenatal classes that their particular form of “rescue” will also save them from the pain of labour. No need to suffer if we place our faith and trust in their particular form of magic.

It all reminds me of the snake oil merchants who used to go around convincing people that their remedies would cure all manner of ills, with no scientific foundation whatsoever. They played on peoples fears and harnessed the power of the mind plus the placebo effect to sell their products (and make a lot of money in the process).

Many men seem incapable of accepting that women are able to be supremely creative and produce a baby without their input (apart from starting it off). It makes me mad when I hear a man tell me that he knows better than I do what my body is capable of when it gives birth. Men have no idea what it feels like to even have a vaginal examination, let alone push a baby out into the world - how dare they presume to know better than me what I need in order to birth a baby successfully and safely? Of course, I am far past childbearing age, but you know what I am getting at....!

Being able to give birth without the meddlesome antics of medical men (or pseudo clinicians) is, for me, the most basic feminist issue. Sure, we need their help sometimes, and be thankful for it, but until we call them in, please leave us alone! Don’t presume to know better than we do what is required. Abandon the arrogant stance of trying to better nature when it comes to perpetuate the species in the safest and most efficient way possible. There are plenty of things you can get your teeth into, like protecting us from unnecessary wars and saving the planet from environmental catastrophe. You work on those bigger issues and leave us to having the babies...... that way there will be plenty of happy healthy children to inherit a beautiful and peaceful world.

Time to get off my soapbox now!

Posted by andrea at 06:51 AM | Comments (2)

A Conference on NMAP?

The National Maternity Action Plan (NMAP) is still very much on the agenda and a lot of “behind the scenes” meetings etc are taking place to ensure that it is on the political agenda. The future is looking hopeful, but not assured and there is a huge need to keep pushing the central issues of reform and freedom in the maternity services in Australia so that the grand plan can come to fruition.

It has been suggested that a national conference be staged, to bring together those who will need to be influenced to accept NMAP and have it implemented. The Maternity Coalition would be the main sponsoring body and I have offered the services of Birth International to provide the organisational expertise and necessary infrastructure. It will probably be in about 12 months (early 2004, is a likely timing) and we will have to get cracking to get the basics in place.

This could be a most exciting event, that could attract a huge amount of publicity and exposure for midwifery in Australia. Already ideas are forming in my mind of the main thrusts of the program and who we will invite to speak. I look forward to hearing from the others who will be working with us on this project.

As this event takes shape, I will keep my Diary readers informed.

Posted by andrea at 06:55 AM | Comments (2)

Putting maternity reform on the political agenda

Now that I am back in Sydney, I am catching up with the very exciting developments that are happening around midwifery in New South Wales. There is much going on!

The Maternity Coalition have compiled a wonderful document that outlines how autonomous midwifery can be implemented in NSW within 3 years. It forms a companion piece to the National Maternity Action Plan (NMAP) that was launched in September and is designed to show that they have not just come up with a great idea, but also have worked out the means to implement it (an essential strategy if NMAP is to succeed, because if left to the politicians/bureaucrats to implement we would be waiting forever).

There will be an election in NSW before the end of March 2003, so the time is right for getting maternity services reform onto the political agenda. The Greens and Democrats have already endorsed NMAP and will incorporate it into their election platform, so the pressure is already starting to mount on Labour, who have been in power for many years and are due for a shake up.

Premier Bob Carr was effectively ambushed at the recent opening of a new hospital in Camden where the media chose to focus not on the new hospital, but on the brand spanking new Birth Centre that was not allowed to have any births because the obstetricians would not co-operate. The very vocal and colourful collection of mothers and babies demanding better services were a heady mix for the media. Apart from putting the Health Minister, Craig Knowles, firmly on the spot for this silly bureaucratic bungle, it also highlighted the general dissatisfaction at the lack on consultation with maternity care users over the broader plans for hospital closures and reorganisations across Sydney. The moves to close several smaller maternity units were immediately scrapped and the Health Minister who has been reluctant to consider midwifery up until now, is about to consult with the Maternity Coalition about their implementation plan for comprehensive one-to-one midwifery across the whole State.

Justine Caines, Sally Tracey, Denise Hynd, Barb Vernon, Jan Robinson and a host of others have all contributed mightily to this effort. They are amazing women and they have every right to expect that their efforts will succeed. Hats off to them!

Posted by andrea at 02:27 PM | Comments (3)

Private insurance for caesarean births

It has just been reported on the BBC evening News that the AXA Insurance company is to stop paying out for caesareans carried out privately for those people who have private health cover with their company. The reason given is that they cannot tell which caesareans are being undertaken for genuine medical reasons and which are being done as “lifestyle choices”. As a result they will pay our for none.

This may be the breakthrough we need to get the caesarean section rate down. AXA are a huge international company and offer health cover in a number of countries. If we can pressure them to make the same decision in Australia, then other insurance companies may follow suit. Wouldn’t that put the cat among the pigeons?

I will try and follow this up and see what is in the newspapers in the morning. This news has really made my day!

Posted by andrea at 03:40 AM | Comments (6)

Using consumer power!

Reading about the various launching events for the NMAP on the ozmid list today has once again illustrated for me that consumers of maternity services have very powerful voices when it comes to achieving change. Of course, I have "come up through the ranks" of consumers myself and now work with maternity care providers, so I have a foot in both camps, so to speak.

When midwives complain that they having trouble getting a policy changed, or some new equipment, or even saving their unit from being closed down, I always ask if they have contacted the women whom they serve and asked them for help. There are many ways that consumers can challenge the system and get changes made from the outside that would be impossible for midwives to undertake from the inside.

Consumers these days also bring a number of potentially useful skills to their cause. With the average age of women having first baby now standing at just under 30 years, it means that these women have more education and life skills, and are also better equipped (i.e. experienced) at tackling authority figures, speaking in public, getting organised, finding resources etc.

Of course, many women don't know the problems being faced by midwives. Therefore, if you need help you will have to ask and provide background details before they can take up your cause. Multips are often the best bet - they are at home with children and are used to juggling a number of tasks at once. They are often keen to take on an interest outside their homes and they know the importance of good births from their own experiences. Check through the birth register at your hospital - find out who has writing skills, is a journalist, can manage statistics, prepare budgets, lobby politicians, has access to potential funding sources or whatever it is that you need. Make a personal call and ask for their help - very few will refuse and most will be delighted to be asked.

Following a suitable background briefing, you can then let the consumers get on with fighting the cause. Keep in close contact and praise their efforts. You'll be surprised at the energy they can create and the wonderful supportive atmosphere that develops between women and midwives.

This is how it always was - women needing their midwife for the birth, then the midwife needing the woman for support to enable her to do her job most effectively. These relationships need rediscovering and nurturing. BTW - does any have a better word we can use to replace "consumer" in this context? I have tried out just calling these women "users" of maternity services but that doesn't seem quite right either. Ideas anyone?

Posted by andrea at 02:52 PM | Comments (4)

NMAP takes off

Well, NMAP is off the launching pad! Here in Sydney we had a good day - first there was the Press Conference which was reasonably well attended by the major TV channels and some other print media. Nicole Christianson ("Keep Birthing in the Mountains", Fiona Tito (of the famous Tito Report on Professional Indemnity), Lee Rhiannon (NSW Greens) and Arthur Chesterfield-Evans (Democrats) all spoke in support. The hazard of choosing Parliament House was that the press conference would be hijacked by media intent on grabbing a politician for a quote on anything that was breaking news and that did happen in the question time. Chesterfield-Evans was aksed about some corrupt politician's antics that had hit the headlines earlier that morning, so we were left feeling a little silly while he had his say. However, he thought we went well - and we are hopeful that it will make the local news bulletins this evening.

The Launch event followed and lasted an hour. The speakers were Jo Westley (spearheading the campaign to save Camden Hospital Birth Centre), Hannah Dahlen (NSW Midwives Association), Fiona Tito and Mark Tracy (Father, husband of Sally and Neonatologist). All covered aspects of NMAP and provided great background information. Copies of the report were on hand, other material relating to the NSW Government's Greater Metropolitan Transition Taskforce's idiotic plans about rationalising materntiy services in Sydney were given out and various health policy makers and politicians ( a few - most had Caucus meetings to attend) heard more about NMAP.

We heard that Craig Knowles' (NSW Minister for Health) advisor was to issue the considered response at 3.30 p.m. and Denise Hynd was to wait and see what it contained.

We did manage to doorstop Bob Carr (Premier) and to give him a quick message about NMAP and a copy of the report. He wanted to know about how much it would cost, and when told it would save him money, said he "would look into it". We were most impressed by his wonderful tan and impeccable suit and decided that he either must have been wearing make-up or else spent a lot of time in a solarium!

An interesting day. It will be great to hear how the launches went in other capitals and how the meetings in Canberra with Meg Lees (Independent) and Helen Coonan (Deputy Treasurer) went.

This is the start - we still have a long way to go. As Fiona Tito said to me over lunch - "why does this stuff have to be so hard? We keep giving them the data and the cost savings and telling them what we want and they just find ways to ignore it". If she is having difficulty, then we have our work cut out. We won't let them stop us - our time as mothers and midwives has come.

Posted by andrea at 04:47 PM | Comments (4)

NMAP Launch

It's been an exciting few days. Over the weekend I have been in Queanbeyan (right next to Canberra) presenting a workshop for the Southern Area Health Service, and it gave me the opportunity to catch up with Barb Vernon and Justine Caines from the Maternity Coalition. We talked about the last minute plans for the launch of NMAP tomorrow and the meetings with the politicians planned for the rest of the week. What a dynamic duo these two are!

The launch is on final countdown and the excitement is building. I'll be back to you later with some feedback on what could easily be the watershed event for maternity care in this country!

Posted by andrea at 02:51 PM | Comments (2)

More on Doulas

I am really glad that so many poeple have responded to my comments on doulas. I was going to add some feedback to the comments already posted, but since there are a number of things I wanted to say, I will put them in this new Diary entry.

Karen, Pip and Jaqueline - thank you for your thoughts. I agree that we are all striving for the same things, I guess my concern is how we go about it. See my comments below.

Tina, yes, we need to be careful that lactation consultants and childbirth educators are also not co-opted into the system. The place and role of lactation consultants is another interesting development and I will write about it another day. It seems these specialities develop in medical systems that are dehumanised and social systems that are fractured...... but more about this later.

Childbirth educators have a different function, as I see it, and that is to provide social settings in which parents can explore their experiences together. I ahve always seen this facilitation role as the most important reason for prenatal groups of all kinds. The giving of information is of secondary importance to my mind. Again, when health professionals (e.g. midwives employed by a hospital) take on this role, they are often coming from a different angle and see the information they give as the primary function of their programs. As a result, parents end up in huge classes with didactic teaching that revolves around the theme of "what will happen when you come in to have your baby in our unit". Choice is explained as "the services we offer (tolerate) here. I could go on, but let's leave this to another day as well.

Marilyn, thank you for your insights, especially about the system in the US, where my experience has been limited to facilitating workshops for a mixtureof midwives/nurses. I agree that if the system was perfect we wouldn't need doulas because there would be enough sensitive midwives (as opposed to burnt out or frustrated midwives) who could fulfil that role. Several years ago I was the keynote speaker at the Midwives Alliance of North America (MANA) Conference, whose theme was "Midwifery in the Mainstream". My message was to take the skills that the participants at this conference clearly had (most work in either independent practice or in birth centres) and get them into hospitals, so that the vast majority of women, and not just the priviledged few, could get better births. I was astounded to discover that in reality, MANA members didn't want to have anything to do with hospitals and that instead of being "mainstream" they wanted to stay on the fringes. I am not blaming them for taking that position, because they've been hounded by the system as it is, but I was surprised that they didn't see that this stance was elitist and that all women should have the right to midwifery care. They didn't know what to make of me - for a start I was wearing my "corporate type clothes" even though I sounded like one of them!

Beth, I think you have misunderstood me (or perhaps I haven't made my self clear). I would never question that women want to be suported by women at birth, it is very defintiely "women's business". If you have read what I have written in my books, you would know that most of what I know about birth has come from labouring women, those I have been honoured to support as a companion. Some of these were friends but most were women I met though my prenatal sessions and that I had come to know. I think there is an "art" to being a good support person - and that revolves around being invisible. The woman should not be aware of your presence and at the end of the day believes she did it all by herself. I am concerned that some women may choose to be a doula because it gives them a profile and they "need to be needed" - that's why I say you have to look at your own motives and innermost feelings before you take this role on.

In summary, I would say I have these major concerns about doulas:

1. The potential for undermining midwifery and midwives, especially when the system is under stress.

2. The commercialisation of social support. This is something you do because you care and not because you will be paid.

3. Friends and family should always be invited first, and openly, into the labour wards. We've been doing this readily in Australia for 20 years as part of our Active Birth approach and thus I question the need for an organised system of doulas.

4. Claims are being made for the necessity/usefulness of doulas on the basis of questionable research, sometimes as part of selling training courses etc.

Being present at the birth of another woman's baby is the most special thing in the world and something anyone would do, if asked, without hesitation. Let's keep it at the level of community service and not turn it into another business or allow it to be cooted by the health care system.

Posted by andrea at 06:08 PM | Comments (5)

Laptop-less in Wagga Wagga

It’s been a frustrating couple of days. I went to Wagga Wagga to facilitate a workshop and found that I had left my laptop power cable behind, so I was unable to do much except answer a few emails, and hence, no Diary entries for a few days. It is amazing how dependent we