Here’s a great idea for easing breast pain due to engorgement in those early days with breastfeeding. A simple device, but cleverly crafted for ease of use and maximum comfort, The Breast Aura offers a quick remedy that will be appreciated by new mothers everywhere.
It has other applications as well - some women suffer breast tenderness in early pregnancy, others when menstruating. The Breast Aura offers a simple solution to these problems as well.
When we exhibited the Breast Aura prototype at the International Congress of Midwives in July 2005, there was a lot of interest and we promised to let everyone know when it would be available. Production problems have caused unanticipated delays, but it is now available, exclusively through Birth International.
The inventor of this teaching tool explained that until now, doctors learning the techniques of epidural insertion had to practice using oranges or latex rubber blocks as crude substitutes for simulating the important feedback reactions of the human body as the needle is inserted into the epidural space surrounding the spinal cord. This learning method was very unsatisfactory, and usually after just a few practice runs on an orange, the doctor would resort to using human guinea pigs (women in labour?) to hone their skills. This is clearly an unacceptable situation, as inserting an epidural successfully takes a high degree of skill and accuracy if unwanted side effects are to be avoided.
All this was explained in graphic detail by the inventor of this training model. Using a combination of real time visual feedback monitoring, an appropriately constructed humanoid dummy and even audible signals (“OUCH!” if the needle was inserted incorrectly) the learner can now master the necessary techniques without ever going near a real person.
This was a fascinating segment of very popular television show. The inventor of this device was very frank and open about the side effects and possible consequences of a poorly performed epidural (he mentioned spinal headaches, and even paraplegia) while explaining the virtues of gaining the proper skills using his clever simulator.
It also highlighted that one of the major risks with an epidural is the level of skill of the anaesthetist and that this is not a procedure to be undertaken lightly. I sincerely hope that this new invention will quickly gain universal acceptance and that women in labour will no longer be used as “real time” learning tools.
Here is a wonderful piece of marketing! The Queensland State Government inAustralia has sponsored the Australian Breastfeeding Association to in a campaign of displaying large pro-breastfeeding posters in bus shelters across the State. The posters will go on display from July 24 - August 7 .
This is clever and delightful. You can download a copy of the poster for yourself here. How about printing some up and putting them up on notice boards in your local area?
Using warm water (in various forms) during labour had been around a long time and has a proven record in enabling women to manage labour pain effectively and safely. Water birth has also long been a reality, since Michel Odent first tried this technique in the early 1980's in France. Most home births these days involve water, either for easing pain or the birth itself, and many hospitals have also adopted the idea, installing baths or pools for women to use during labour if they want.
Some hospitals, however, have been reluctant to provide water options, fearing that water birth requires special training of staff and presents special risks for care givers (bad backs, infection). The reality is that water births are very easy for staff - they need to do very little during the labour and birth, apart from regularly checking the baby’s heartbeat. It is the woman who does the work and gives birth unaided, into the water. The caregiver then helps her to lift the baby to the surface.
This video adds to the growing number of films on this theme. This one, intended primarily for parents, will also be valuable for professionals who want to know more about this gentle option for birth can be implemented in their own hospitals.
The WHO Reproductive Health Library is an alternative source of information to the Cochrane Library. It focuses on all areas of reproductive health in a multimedia format, from fertility regulation, through pregnancy and childbirth, HIV/Aids, newborn care, infertility and more. The April 2006 release includes new editorials, commentaries and systematic reviews, as well as a new practical video demonstrating how to do a vaginal breech delivery (which unfortunately has the labouring woman lying on her back).
The RHL is prepared by an editorial team based in the WHO Department of Reproductive Health and Research and was established in 1997 in collaboration with other agencies worldwide.
The website is easy to use and well laid out. I think it is more user-friendly than the Cochrane Library and because it has other input apart from the randomised controlled trials, is more geared to the practical application of the research.
This is another very useful source of information for midwives, educators and others keen to see better maternity services worldwide. You will want to bookmark this site in your browser.
Women whose babies have been born by caesarean need really good information if they are to consider a vaginal birth for their next pregnancy. The research says that women have around an 80% chance of success, even after more than one caesarean, yet the figures for vaginal birth after caesarean (VBAC) are usually much lower than this, even in hospitals where VBAC is encouraged.
Obtaining the information is the hard part. Often women are given part of the story, those facts that are “convenient” for the caregivers and hospital policies. Sometimes the risks of the vaginal birth and the incidence of scar separation or rupture are over emphasised and the risks of repeat surgery are downplayed. It can be hard for women to get accurate, unbiassed details that can form the basis for making a good decision and for finding the necessary care they will need.
CARES SA has produced a booklet that is designed to bring all the facts together to enable expectant parents, and their caregivers, to make considered decisions. This 80 page booklet has been compiled using the research and feedback from women and is a very worthwhile resource. The response in Australia has been overwhelming and as a result CARES has decided to put the booklet on a CD ROM so that it can be posted more easily.
CARES is a not for profit organisation with no funding other than memberships and fundraising. Purchase of this CD will go towards providing VBAC education workshops for women.
The cost is AUD$15.00 including postage within Australia. Add AUD$10.00 for postage overseas. Personal cheques (Australian Banks are acceptable) but for those outside Australia a Bank cheque in Australian dollars will be necessary. Credit card facilities are not available. Cheque or money orders made out to CARES SA Inc.
The most popular items at the ICM were charts, videos and some of the new book titles.
In the Technical Series, we also take care to depict women in upright positions (see the Pelvic Floor Chart as an example). Almost all the other charts available from other suppliers around the world have women in recumbent, un-physiologic positions, signalling that women should be passive and compliant during birth, for the benefit of the caregivers. The “Progress in Labour” chart does not have any time indications for labour, also an important consideration.
We are working to produce these useful charts in a desk size format so use with individuals, rather than groups. We will let you know when they are available.
Amongst the books, some of the new titles sold like the proverbial hot cakes. The most popular were:
There was considerable interest in the launch of a new title at the ICM - “Midwives’ Tales”, but I will write more about this in a later entry.
Birth International has appointed a new agent to handle our products in Japan. Yumi Osako is a very well known childbirth educator in Japan, who regularly appears in magazines, on television and in the mainstream press. I first met her many years ago when I presented a training program for Japanese Childbirth Educators in Tokyo, and then again at the Birth Without Borders Conference in Chaing Mai in Thailand (1997). Yumi was also responsible for having my book Empowering Women translated into Japanese - this has become a best seller amongst the general population.
The addition of this new agency expands our local suppliers across several continents. ACE Graphics products can now be obtained locally from suppliers in New Zealand, Canada, the USA, South Africa and now Japan. The full list of their contact details is in our paper catalogue.
Readers in Japan may like to contact Yumi through her company - they have a whole range of interesting and useful information, products and services available:
Birth Sense Institute Co. Ltd
504# 1-9-16 Tomigaya Shibuya-ku
Tokyo
Japan 151-0063
TEL 813-5454-8232
FAX 813-5454-8212
Posted by andrea at 11:52 AM
An innovative website on pregnancy issues
I’ve been taking a few days of leave with some friends in Bournemouth. While I was there, I was reminded of meeting Jo Alexander, a midwifery lecturer at Bournemouth University. We were both on the program for the Conference at Ormskirk a few weeks ago.
During her presentation, Jo revealed a new website that is well worth adding to your list of favourites. It is the DIPEx site, where personal stories of health and illness can be found, together with evidence based information about the conditions being discussed. There are video clips from patients that describe their feelings, their condition (including signs and symptoms, the treatments they have undergone and their reactions and how their condition has affected heir everyday life. Written transcripts are also available, as well as question and answers, and an area where contributions from the pubic can be added.
It is an innovative site, sponsored by an Oxford-based charity and it has won an award for its outstanding presentation and content. For those who want access to information “out of hours” or to hear what others have experienced, this is a useful starting place.
Personal experiences currently included cover cancers, screening tests, heart disease, neurological conditions, mental health, sexual health and chronic illness. There also sections on pregnancy and women’s health.
Posted by andrea at 11:36 PM
Birth videos for black women
A customer in Malawi has been in touch regarding some videos that she ordered. She was happy with some, but not all of the tapes we sent her, and her main complaint was that none of the birth videos showed black women giving birth. She used one tape with a group, who quickly became bored when the film only showed white women giving birth, and she felt that this was a problem that the film makers should have addressed.
In responding to her, I explained that finding any woman who would allow a camera into the birth was a rarity, especially if the finished film was to be used for public screenings. Her assumption that a video made in Australia would contain black women because we are “pretty multi-ethnic” was perhaps reasonable, except that we have very few black people in Australia and they are very protective of their birth culture. It is completely off limits to men, and women outside their immediate family. Filming them would be impossible and inappropriate.
We are always on the lookout for products that will be of use to our clients. If anyone knows of a good birth film, that shows black women giving birth naturally, and preferably with midwives, please let me know!
In the meantime, I have assured our client in Malawi that she can return the video for a credit or refund, as is our policy. I would dearly love to be able to send her a suitable substitute......
Posted by andrea at 02:30 PM
Monologues from the Labour Room
Last year I visited Israel and met some wonderful midwives. Many had come from other countries to settle in Israel and it was a truly international group that attended the workshops that I presented.
One of the midwives, Leslie Wolff, mentioned that she had made a film about the experiences of midwives working in hospitals. She said it was a play, performed by four women and that they had presented it, to great acclaim, at the Midwifery Today Conference that had recently been held in Germany. Naturally I was curious, so she offered to send me a copy on DVD.
This arrived during my holiday break and I have now had a moment to view it. Called “Working under restraint: Monologues from the Delivery Room” it is a series of short scenes, spoken as monologues by midwives and mothers about birth in hospitals. Two of the actors are midwives and two are “real” actors, who play a variety of roles. All the familiar feelings of midwives are included: their beliefs in women; prayers for lovely natural births; desires to be able to practice true midwifery; frustrations with the system; constraints on their practice and lack of appreciation by the hospital administration. There are wonderful snatches dealing with doctors and their unreasonable demands, stifling protocols, and the dreaded epidural. Towards the end there is a wonderful birth story, acted out with a truth and honesty that will resonate with women and midwives everywhere. The segment on “Eyes” I found particularly moving - the descriptions of what can be read in the various people’s eyes around a labouring woman is revealing and full of insight.
These women tell an universal story. Midwives and women everywhere know these lines, have heard them, sometimes on a daily basis where they work. Women have been told these things in labour, in countless delivery rooms across the world.
This film will be a wonderful talking point for midwives, a great discussion starter and invaluable in preparing students for the realities of hospital life. I loved it and am delighted that we can bring it to a wider audience. It will be in the next catalogue, due out in 3 weeks. It will also be available on-line through our extensive mail-order range. I’ll keep you posted.
Posted by andrea at 12:32 PM
EPI-NO for avoiding perineal trauma
My goodness, we seem to be selling a lot of EPI-NOs these days! There must be some information about them in the Parents magazines that has generated the enquiries, and women seem to be keen on using them to prepare for birth (although they also have a role post birth as a perineal muscle exerciser). One obstetrician did call me recently to request some pamphlets about it that he could hand to his clients.
Women’s bodies are designed to stretch well during birth and if the second stage of labour is not rushed so that tissues have time to stretch naturally, and there is sensitive management (read: no handling) of the perineum as the baby emerges, there should be minimal, if any damage to the vaginal tissues. Midwives know that women value an intact perineum and most midwives try hard to maintain the integrity of muscles and skin around the vaginal opening.
Not all doctors have understood women’s sensitivity towards stitches and many lack the skills and patience to stand back an allow the baby to emerge slowly. These doctors want to stretch the tissues manually, or massage the area, or just make an episiotomy as a means of speeding up the birth process. Time is their main problem - they don’t want to wait and “do nothing”.
Women too, have lost a lot of confidence in their capacity to give birth well. In today’s technological, “quick-fix” society, the appeal of this gadget may be in its claims, backed by research, to reduce the incidence of perineal trauma. For some women, choosing an appropriate caregiver (e.g. a midwife) would be a better way of reducing the risk of tearing during birth, but many women may not be able to make such a choice, or are unaware of the significance of midwifery skills. .
The position of the woman as she gives birth is also a potential problem. In an upright position the vagina has more even pressure applied on all sides, encouraging better stretch. If the mother is recumbent, or even worse, flat on her back, there is considerable pressure on the area between the vagina and anus, and the whole perineum tends to be thinned and over- extended by the pressure of the baby’s head. This is much more likely to lead to an unnecessary episiotomy if the caregiver believes that a nice clean cut (episiotomy) is better than a tear - a situation prevalent in many hospitals where evidence based care is not the norm.
Women who use an EPI-NO are sending a signal to their caregiver that they care about intact tissues and are prepared to use this equipment during pregnancy to improve flexibility and stretchiness of their vaginas. Perhaps this is one reason why the research, especially the studies done in Israel where episiotomy is almost 100%, shows that intact perineal rates can be significantly improved when women use an EPI-NO during the last weeks of their pregnancy.
If buying and using this gadget is what it takes to avoid an episiotomy then that’s OK by me. Not all women can count on having a caring midwife to facilitate the gentle arrival of the baby and a caregiver who knows that a woman have taken a lot of trouble to avoid tearing or an episiotomy may be better prepared to wait.
Posted by andrea at 01:36 PM
Preparing for Birth
Today we took delivery of 15,000 “Preparing for Birth” books, enough to see us through the next few months. These books have been in print, in several editions, since 1987 and must be the all time most popular book on childbirth in Australia. Almost 300,000 copies have been sold.
There is still no other simple format and concise book like it on the market, as far as I know, especially at the price (cheap!). There are several imitations and many much longer books, but where they usually fall down is in the area of information on the effects of drugs and obstetric interventions on the mother and baby. Most books gloss over these, sometimes giving the impression that women should be protected from details that may make them anxious, especially if an intervention becomes necessary or medication is chosen in labour.
Preparing for Birth: Mothers takes a different approach - setting out the vital details on the impact of intervening in birth in a clear, unbiassed and simple fashion, using dot points and simple line drawings. Women will find information here on the effects on the baby, often overlooked when the comfort of the labouring woman is the chief focus of labour these days.
I have deliberately left the references for this information out of the publication, to keep it “user friendly” and uncomplicated. The educator presenting the classes should be able to provide this information, but if not, the references can be found on our website.
Everyone who registers for the forthcoming Preparing for Birth - new strategies for parent education conference in the UK will be receiving a free copy of “Preparing for Birth: Mothers and Preparing for Birth: Fathers. We hope they will find it useful for their own programs and the parents with whom they are working during pregnancy.
Posted by andrea at 06:58 AM
Happy New Year
Happy New Year!
This is my first Diary entry for 2005 and already is seems that we are off to a busy start. Our Sydney office has re-opened today after the Christmas holiday break, although our UK office has been in full swing for almost a week.
We have a large pile of orders to process today and no doubt the phone will be running hot as well. Over the break, I have taken time to undertake a number of administrative tasks in readiness for the new year, including reviewing our plans for future development and putting some new systems in place. A holiday period is a good time to do this kind of thinking - no phones, emails or other distractions to impede the thought processes!
The first priority will be to finalise the January 2005 catalogue, ready for printing and distribution. This issue will be bigger than ever, as we have a number of new and exciting products to add to our ever growing list. Twenty one new books, new charts, videos and DVDs plus some innovative teaching aids for parent educators are amongst the collection. If you don’t already receive this full colour catalogue, click here to go to the website area where you can order a paper copy. Although many people choose to view products and order on-line these days, a paper copy can be more convenient for sharing with colleagues or showing the boss.
While you are on the website, check out the big events for this year. Future Birth: With woman, with child is the major tour in Australia this year and early registrations (before January 31) are available at significant discounts.
Preparing for Birth: New strategies for parent education is the title of the major conference we are presenting in the UK in April. This innovative program features a number of international speakers and promises to be a practical, skills enhancing program for everyone who works in prenatal education. Full details can be obtained by clicking here, including the early registration special offers, which close on February 18.
We have two other exciting tours with international speakers planned for 2005 and details will be on the website soon. I will let you know when the information is available.
Posted by andrea at 06:49 AM
Vaginal Birth After Caesarean video
Another goody waiting on my desk when I returned was a VBAC (Vaginal Birth After Caesarean) video from the US. This had been sent to us with a view to including it in our catalogue.
There is certainly a need for better information for parents on the issue of VBAC. Many women are talked into an unnecessary repeat caesarean when they have a very good chance (up to 80%) of having a perfectly straightforward vaginal birth. The main obstacles to increasing the VBAC rate are the convenience factor for doctors and hospitals, lack of confidence in supporting VBACs by caregivers, and women’s not unreasonable reluctance to be branded as a “trial of labour”.
Many women have suffered deep emotional trauma as a result of unexpected caesareans, and may be grieving from the questioning of their competence to birth successfully. It is our ability to give birth that is central to female sexuality, and any doubts cast on our capacity give birth well strike at the heart of our self image as women. These feelings may not be overtly recognised, but may be very real, influencing a woman’s willingness to once again be put to the test during the next labour.
Fathers are often traumatised by an emergency caesarean as well. It is very unlikely that anyone will have helped the father to resolve his feelings and his emotional state may also put pressure on his partner to accept a scheduled caesarean birth, rather than opt for a less predictable vaginal birth.
The video explored some of these issues. Fathers were not mentioned and there were no views of a VBAC labour that could be used as a teaching tool for women. The brief views of a “normal” birth showed the woman flat on her back. The baby (with a scalp electrode in place) was man handled out by an obstetrician, sucked out vigorously, whisked away to be tidied and wrapped tightly before being presented to the mother. It was a complete contrast to the midwife led births that we aim for in Australia and the UK. There were echos of “push, push” going on in the background and a large number of family and friends urging the woman on and celebrating afterwards. It was far from the “active birth” that we aim for here.
This is one video we won’t be stocking. I am hopeful that a video in the making in Queensland will be much more useful in promoting normal birth after caesarean, and show the benefits to be gained from supportive midwifery care. I feel it will be worth waiting for!
Posted by andrea at 08:52 AM
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"Hypnobirthers" have their say
Once again I am hoeing into the debate about “hypnobirthing”. A number of comments have been posted to my previous entry on this subject (they are an organised group, these hypnobirthers!) which have been welcome.
In reading through this passionate feedback, several facts stand out. First, all these comments have come from those who have used the technique (usually referred to in these comments as a “birthing method”) and found it useful. I have not received any feedback from those who have used it and found it didn’t work, so these comments represent a biassed sample of users.
It is abundantly clear that all of these women had a deep sense of trust and faith that they could give birth without drugs etc. They may have needed the input of the “hypnobirth trainer” to be convinced of this over several sessions prenatally, or they may have used this technique to reinforce a belief they already had but which was being stifled by messages they were receiving from health professionals, the media, friends, family etc. I think it can be very hard to retain a sense of belief in one’s own birth abilities in the current climate of fear being created by the medical professional, drug companies, equipment makers and other vested interests. If “hypnobirthing” has strengthened these women’s belief in themselves and their own capacity, then great - I have no argument with it at all.
However, it seems sad that they have had to go to such lengths to discover what they had within themselves all along. The majority of the world’s women would think that having to learn how to give birth using a method of any kind is crazy - they know that you just get on with when the time comes. The women contributing to this discussion are clearly well educated and articulate and leaning about giving birth may fit comfortably with their attitudes towards learning and education in general. I would just point out that if the survival of our species relied on women learning a technique or adopting prescribed behaviours during labour and birth, we humans would have died out long ago! Women have been managing perfectly well for millions of years, long before hypnobirthing or any other method was invented.
I am amused that many of the comments being made by the “hypnobirthers” could equally be trumpeted by the women who are choosing epidurals - there seems to be a need to justify a need for something to get through labour and birth.
Many of the comments that have been made are reminiscent of the claims and endorsements made for those other great “inventions” for achieving painless labour - psychoprophylaxis and Lamaze - that were made in the 70s. I well remember the passionate statements, the training that women underwent, the almost religious fervour that was reflected in the literature and the classes. No evidence (randomised controlled trials) have been produced to show that these approaches improve birth outcomes, reduce the need for pain killing drugs or that they are even safe. Elizabeth Noble in her pioneering work “Childbirth with Insight” (published in the early 80s and now out of print) pointed out that encouraging women to breathe in any pattern other than her natural rhythm had the potential to alter blood chemistry. Reading this comment was a powerful wake up call to me at that time and was the basis for dropping all forms of “teaching about the breathing” from our educators training course and classes in 1984. My discovery, at about the same time, from observations of women labouring in their own homes, that they didn’t use any “methods” and gave birth really well, was also an important revelation. These two factors formed my underpinning faith in women and that we had the capacity for safe and effective labour all along - we had just forgotten to trust our instincts.
I must also point out that, like the Lamaze business in the USA today, many of the proponents of the hypnobirthing technique have a vested interest too (I notice they have registered it as a trademark!). They need to attract willing clients and promote success stories for their own purposes. It is notable that psychoprophylaxis (the basis of the original Lamaze training) is a very American concept - its techniques were abandoned many years ago in most other countries, if they were every adopted in the first place. Could this new phenomenon be another manifestation of the American way of birth?
In the past 20 years, western cultures seem to have strayed even further from our instinctive natures. As a result pregnant women may well be finding it difficult to find someone or something to use as a foundation to explain/validate/justify their needs and desires for natural birth. Some will choose “hypnobirthing”, others will rely on TENS, some will choose aromatherapy, reflexology, yoga - whatever. If this helps, then wonderful - at least these “birth methods” will not alter blood chemistry, fill the unborn baby with drugs, or compromise their hormonal flow during labour and birth. There is no hard evidence that they work, and if they are effective, it is probably as a placebo. What I do find sad, is that those who choose these strategies place their faith in the method when their success was most likely doe to their own body’s capacity and their natural physiological and biological functions working well.
Please don’t sell yourself short as a woman - you have what it takes to give birth well and, just as millions of women have done before you down the years, you can be successful. Find those who will support your needs and choose a safe and comfortable birthplace. Find a supportive midwife at the hospital and use her to shield you from medical intervention whilst enabling you to give birth yourself. If you can’t find a midwife in the hospital (perhaps you live in the USA) then look outside the hospital system and choose appropriate alternatives. I believe that with a caring midwife and an appropriate environment, women will discover they don’t need props and “birth methods” - they will discover their own power and pleasure in birth all by themselves.
Meanwhile, I expect there will be more comment from readers on this issue and I look forward hearing from those who have tried “hypnobirthing” and found it lacking - some balance will make the claims for this technique more believable.
Posted by andrea at 10:30 AM
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Valuing pioneering research
Recently, I was challenged about the relevance of referring to 25 year old research to support statements I was making in the Active Birth workshop - the implication being that anything that old was irrelevant and should not be used. This is an interesting topic to explore further.
The specific research being questioned was the work of Roberto Caldeyro-Barcia, who studied the effects on the fetus of prolonged breath-holding and closed glottis pushing during the second stage of labour (the so-called “cheer squad” pushing routine). He showed that this practice was dangerous because it had the potential to reduce blood flow to the placenta and to reduce the oxygen concentration of the blood that was available to the baby (both effects compounded if the woman is lying flat on her back to give birth). This pioneering work, done by an obstetrician who was, at that time, the President of the International College of Obstetricians and Gynaecologists, received widespread reporting 25 years ago, the result of his publishing in several journals and speaking at a number of Conferences. Sadly, his message does not seem to have penetrated some practitioners approach to birth, and this over zealous management of second stage still goes on.
Is a study, done so long ago, still relevant? Yes, of course it is. There seems to be a view, often drummed into midwifery students, that the only research that is relevant are studies that are less than three years old. Books and journals that are older than this are not considered appropriate and are discounted and taken off reading lists. This approach overlooks the huge body of work that was done many years ago and that does not need to be repeated: we know that it works/doesn’t work and we don’t need more funds spent on replicating this research. The Cochrane Library has a list of treatments or management strategies that are already proven beyond doubt to be either advantageous or dangerous. Interestingly, the placing of time limits on second stage (often the excuse for the “cheer squad” in the first place) is considered dangerous.
Michel Odent has written about “circular epidemiology” - the practice where the same studies keep being done because they give good results or are easy to undertake, even though the outcome is already proven. He also talks about “cul-de-sac” epidemiological studies - those that end up not being pursued further because the results might be unwelcome to practitioners. We’ve all come across yet another study on a topic that has been well proven in the past (the value of support during labour, for example). Doing further research on topics like this is a waste of precious resources and should be discouraged.
If academics and some practitioners maintain their stance that relevant evidence must be less than three years old, it leads to the conclusion that the entire body of research evidence needs to be replicated on a regular cycle - clearly impractical and wasteful. Many wonderful pioneering studies could be overlooked (the work of Caldeyro-Barcia falls into this category) and important research that need to be done could be quietly avoided (such as the effects of exposure of the unborn baby to nitrous oxide during labour - a topic that has never been investigated).
Keeping up with the research is hard work. It requires constant reading, dedication and an open mind. As we embrace the important work being published now, we must not overlook the valuable lessons from the past. Just because a reference has an “old” date on it, doesn’t mean it is worthless - many of them are in fact, priceless.
Calderyo-Barcia R. The influence of maternal bearing-down efforts during second stage on fetal well-being. Birth and the Family Journal, Vol 6:1, Spring, 1979.
Posted by andrea at 10:48 AM
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Ultrasound exposure
The issue of ultrasound exposure for the unborn baby came up in conversation last week. The woman I was talking to was around 16 weeks pregnant and had just had her dating scan, which she showed me. She said this would be the only scan she would have, as she was concerned about unnecessary exposure of her baby to ultrasound. Some of her friends had undergone multiple scans during their pregnancies, often almost as a routine, and they didn’t seem to be aware of the potential risks to their baby of this invasive procedure.
I came across this useful document recently and thought is was an excellent idea. The evidence for safety of ultrasound to the unborn baby is still not conclusive, so until we know what levels are safe it would seem sensible to at least have a record of the baby’s exposure to ultrasound, for future reference. Ultrasound machines vary in their strength and must be well maintained. Different procedures will require differing levels of exposure, so some babies will accumulate greater exposure than others. Babies with specific problems or questionable development may have the most scans of all, which may contribute to their overall problems. We just don’t know enough yet to be certain.
Download file
This document was produced by The Association for Improvements in the Maternity Services (AIMS) in the UK. It can be reproduced providing their name appears on it. It would make a good handout in prenatal clinics, prenatal classes and doctor’s waiting rooms. AIMS can be contacted by email : Chair@aims.org.uk and their web site is www.aims.org.uk
Posted by andrea at 12:46 PM
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New Aboriginal poster
We received a lovely new poster today on the theme of “Women’s Business”. It comprises a collection of wonderful photos of Aboriginal women, collected by Sue Kildea, a midwife who has been working on and researching Aboriginal health issues in the Northern Territory for some time now. It is a large poster which would grace the walls of any health centre - the full details will be in the new catalogue which will be out in January (and also on the web site at that time).
The arrival of this colourful chart started a spirited discussion about Aboriginal health issues amongst our office staff. One of the team has a friend (English) who, together with her husband, now lives in the Northern Territory as an accepted member of an Aboriginal group. She and her family live amongst the people and share their lifestyle completely - her job is teach them how to cut hair!
Another staff member recounted the story of trying to gather material for a newsletter on Aboriginal issues. When she contacted the ATSIC (Aboriginal and Torres Strait Islander Commission) to ask how she could go about including some information and news items about the Aboriginal culture she was roundly abused by the person at the end of the phone - “you people think you can take what’s ours and just use it” etc in a very belligerent tone. Thoroughly shocked by this outburst, she apologised for asking and was then told “now you want to say sorry!!” She gave up at this point and has not attempted to talk about Aboriginal issues in any way since.
Aboriginal Health is a thorny and sensitive issue in Australia. It seems the more we try to help the worse conditions get and the records sow that in this very affluent country our native people have health outcomes that are equivalent to the worst of third world countries. Midwives like Sue Kildea have been working hard over many years to make some inroads into this appalling state of affairs and this new poster celebrates some of their achievements.
Posted by andrea at 03:18 PM
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Making headway through the in-tray
Today has seen some milestones achieved.
I have had confirmation that Childbirth Graphics in the US ( the largest supplier of teaching aids and equipment for birth and health educators in America) will stock copies of my book “Preparing for Birth: Mothers” for sale through their extensive mail order catalogue. This is good news indeed as it will make this information available to parents in the US and I know there is no other publication of this quality available there now.
I have finalised the text and commissioned the new cover artwork for the next edition of “The Midwife Companion”. Finding the time to get this project completed has been a real challenge and to have it almost ready for press is great, especially before Christmas. It will be available in mid-February (might aim for a birthday present for myself!) and there will be announcements on the website about a special price for advance copies ordered on-line, so watch for those.
We’ve finalised almost all of the last requirements for our Re-registration as a Registered Training Organisation. Following our audit there were a few small items we needed to update and this has now been completed, thanks again to Cassandra, my trusty Course Co-ordinator!
The Midwifery Intensives program information is to be launched on the web site today - click on the Events listings to find the details. This will be a series of “must do” workshops, and you will want to attend one if you can. We have our usual group booking discounts and a special price for students. We have some other workshops in the pipeline as well - I will let you know when these are finalised too.
All in all, a productive day. Thank heavens that a holiday is looming - I am very ready for a break from the intensity of the last few months!
Posted by andrea at 02:56 PM
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Projects
It has been a busy week - where do the days disappear to?
In some ways it has been frustrating too - I have a number of major projects on my desk (and in my head) that need urgent attention, yet there are just not enough hours in the day to work on them.
Top of my list is finalising the last details of the exciting “Midwifery Intensives” program that will launch with the ‘Keeping Birth Normal’ tour in April/May next year. We’ve been planning this for some months, the idea crystallising when I toured the UK with Lynne Staff in June. The feedback we received from participants in those workshops encouraged me to formulate a practical, hands-on event that would be skills based and topical. The full details will be on our web site next week (just as soon as I receive the last photo from our speakers!).
This week I’ve had to decline an invitation to work with MIDIRS on a resource package for young teenagers in South Wales. This Young Persons Project will be a multimedia effort, combining workbooks, activities and a dedicated website and will provide those working in this field with much needed resources. I was delighted to be asked to prepare the practical educational content for the classes etc, but I just don’t have the time available (given their very tight deadlines) to do it justice. I am sure they can find someone in the UK who will be able to contribute appropriate material.
I am also immersed in the final proof reading of the new edition of The Midwife Companion, which will be available early next year. One of the joys of self-publishing is that we can move very fast when it comes to production, avoiding the long delays, often well over a year, that are encountered by authors using regular book publishing companies. I like the fact I can write a foreword dated October and have the book in readers hands 3 months later!
I have started my next book as well. This one has been germinating for a while now, but the time is right to get on with it. I can see some furious writing over the next months as I get all my ideas down on paper. This will be a completely new topic - and unique in its content. I am not giving any more away.... you’ll have to wait and see!
Posted by andrea at 03:48 PM
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Mining the archives
I’ve been re-organising files today (the last vestiges of our office move) and have come across some artwork and overheads from many years ago. There were some useful graphics that can be utilised in the forthcoming Managing and Leading Change programs we have scheduled for February and some overheads on marketing and promoting prenatal programs that we can use in our Graduate Diploma Six Day workshop, which begins next week.
Reviewing the contents of filing cabinets reveals just how many workshops we’ve been involved with at Birth International and how many different types of programs I have presented myself. Of course these days we have access to much better technology such as computers and Powerpoint and the days of hand written overheads have been left behind. The content is much the same, however, so I was pleased to discover some long forgotten notes that are just as relevant today and will save me re-inventing the wheel for events I have in the pipeline. Archives are a wonderfully useful resource!
Posted by andrea at 06:46 AM
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The perils of publishing
It has come to my attention that there is a mistake in our paper catalogue that is quite amusing.
I am going to give a book prize to the first 25 people who email me with the details of the error, together with their postal address.
My email address is: andrea@birthinternational.com
I await your replies...... !
Posted by andrea at 08:27 AM
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Suggestions for a pregnant mum about private health care
Had a nice time chatting to a pregnant mum today, who called looking for some books that would help her feel confident about having a natural birth in about three weeks time. We got talking (as I tend to do!) and I discovered that she is booked into a private hospital on the Gold Coast in Queensland under the care of the private obstetrician. She had attended the classes, but found that they focussed on the drugs for pain in labour (pethidine, epidurals and the gas) and when she asked questions about non-drug ways of easing pain she was apparently met with blank stares by the educator.
These days I don’t pussy-foot around with information for women who call me like this. I gave her the facts about private hospitals and obstetricians (high rates for interventions and a big risk of an unnecessary caesarean). The facts are known and the figures available, although I did point out to her that in Queensland, the Department of Health will not release the birth outcome data for private hospitals under any circumstances, even though it is obtainable in other states. In any case, if anything, the outcomes are likely to be worse in the sunny north than in NSW, given the data that has been passed on by midwives who work in these units.
We had a quick chat about her options and I pointed out that she is calling the shots here: no-one can lay a finger on her without her expressed permission and as she is paying the bills, she can tell the caregivers what she wants them to do for her. She already has a copy of Preparing for Birth: Mothers and is working on her birth plan. I pointed her in the direction of useful articles on our Essential Parent web site pages, and in particular these:
I also recommended some books that she could read to bolster her confidence:
all essential reading for women who want to avoid a medicalised birth experience.
I hope that these suggestions will help her achieve her goals. She said she was having real trouble finding information and that the prenatal classes had been of little help, beyond explaining what the hospital offered. I also strongly suggested that she enlist the help of the midwives on the staff and explain what she was trying to achieve. Many midwives in private hospitals would welcome the chance to assist at a normal birth for once and I even suggested that if all was going well, she could ask the obstetrician to stand in the corner so the midwife could continue to assist her! As long as he is present he will feel justified in charging his fee, and for many of them, that is after all, the bottom line.
Posted by andrea at 04:52 PM
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Another task completed...
Today I have put the finishing touches to the new edition of my book The Midwife Companion - the art of support during birth. It now has an extra chapter (Keeping Birth Normal), more illustrations, extra info on things like birth balls, birth stools and moxibustion and updated references and resource lists.
I hope to have it available before the end of the year - we’ll be making the appropriate announcements prior to its release via our email lists and on the web site.
Now I can get on with some other projects - new charts, videos and more content for our ever-expanding web site.....
Posted by andrea at 07:01 PM
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Internet woes
Diary entries have been a bit erratic this week - our Web site domain host experienced technical difficulties all week, perhaps as a result of the Blaster worm that is doing the rounds.
Those of us in Australia (and elsewhere) who use the ozmidwifery mailing list to stay in touch, found that our lifeline was down and for almost a week. Dozens of emails flowed in from subscribers asking where their beloved list was - it was nice to know that it was missed. This list was one of the first of this kind and has been going for over 5 years. It has an archive service too, so that people who want to check what was discussed earlier on a topic can track it down. One day it will be used for research - especially for someone who want to track the history of midwifery innovation in this country. If you are interested in joining us for a while, the instructions on joining can be found here. We have a number of international readers - the world is such a small place!
After a chaotic week with the Internet, it seems that all is back to normal. Ten years ago we hardly knew what the internet was all about and now we have come to reply on it almost completely for quick communication, information and resources. Some of us have even managed to leave technophobia behind (sometimes after a bit of a struggle)!
Posted by andrea at 09:37 AM
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Mining the Archives
In three weeks we will be relocating our office, and in preparation for the move, we are having a big clean out of old papers, files and accumulated detritus that tends to mount up in any office. It is amazing what we have kept, thinking it might be useful “one day”.
Our very first ACE Graphics catalogue came to light, revealing that some of the products we stocked in the early days are still popular. Back in 1986, the pelvis and fetal doll model were our main items. We began to add books, and early titles included Birth Reborn by Michel Odent and Active Birth by Janet Balaskas.
By 1990 we had produced our first set of “Positions for an Active Birth” charts following the success of our Anatomy and Physiology charts. The first videos in our range were “Ella’s Birthday” and “Birth of our Second Child”, and “Active Birthing”, all from New Zealand and “Under her own steam” and “With both feet on the ground” from The Netherlands. It is funny to think that the babies being born in these videos are now young adults! The Dutch videos are still available and are amongst my personal favourites - they show no sign of ageing.
In 1991 we had added the Breast Model and Knitted Uterus to the ever expanding list and had located a local manufacturer for Newborn dolls, making them cheaper than the American imports that were the only alternative.
Looking at our huge range of products now, I am proud that we have maintained our high standards whilst continuing to support our basic goals of protecting, promoting and supporting midwifery. We are aware that is what our customers expect, together with a high standard of customer service. It won’t be long until we are celebrating our 20th anniversary!
Posted by andrea at 06:01 PM
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First anniversary
It is a year since I started this Diary. Hard to believe that a full twelve months has passed but life seems to flow on so fast these days. Over this year I have posted 227 entries and 167 comments have been added by readers.
I have commented on a whole range of topics, mostly arising from things that have come to my attention each day. Travelling as I do gives me many opportunities for reflection and discussion about the midwifery and birth scene and I trust you have enjoyed exploring the world along with me. Amongst the many and varied experiences that I am fortunate to encounter, one thing is clear: the birth process remains the same all over the world but the way it is handled differs considerably from place to place. Midwifery faces the same pressures everywhere as well, yet again, the management of these stresses and strains and the solutions being found to tackle the problems varyconsiderably.
Of all my Diary entries over this past year, the entry that I wrote on Doulas has attracted the most comment. This is a heated issue, and a complex development in maternity care that has either the potential to enhance birth for women, undermine midwifery practice or create another level of health “carer” that muddies the water in terms of the overall picture. I have left all the comments that have been posted to this entry intact, even though some of them are rather impolite and certainly don’t support my ideas. I think it is important to have debate and I am pleased that my entry has stimulated much needed discussion, especially amongst Americans, who have most openly embraced the whole concept of Doulas. If you want to read more about this, the original entry, “The ‘doula’ craze” and the comments, can be found
in the entry for September 6, 2002, in the Midwifery collection.
The other issue that attracts many responses is the entry on Moxibustion to turn breech babies. There have been many requests for more information, which led me to writing a whole article on the issue with detailed instructions on the procedure, the research that supports its use and the alternatives that can also be considered. Click here if you want to go straight to this article.
I look forward to continuing to write these musings. I read recently that writing a page like this each day amounts to a whole book over a year - so now when I am asked how I manage to find time to write my books, I can now honestly say that much of the time is now taken up with writing my Diary. Writing each day is a wonderful discipline, however, and as long there are people who are willing to read them, I will continue to put fingers to keyboard to give you a daily dose of Diary. Your comments will always be welcome as well, so let’s hear from you too!
Posted by andrea at 09:50 AM
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Maggie Banks and New Zealand midwifery
There can be few doubts that midwifery as practised in New Zealand, offers the best options in the world for the care for pregnant women and midwifery practitioners. They seem to have grasped the whole philosophy of normal birth with a broad stroke of the brush and backed it up with the necessary structural services and underpinning legislation. Working as a midwife in New Zealand would b a goal of many of the midwives I meet in my travels!
A few years ago, we invited Maggie Banks to participate in one of our Future Birth tours. She was a sensational speaker, gently encouraging us to trust and believe whilst showing how breech births could be managed safely using midwifery principles. Her book Breech Birth, Woman Wise is easily the best practical manual on vaginal breech birth around, and a copy should be in every midwife's possession in readiness for the day when an undiagnosed breech birth presents itself.
We have again invited Maggie to participate in one of our programs - this time a series of workshops that will be scheduled around Australia. More about this exciting program later - it promises to be a very practical, hands on event, led by experienced midwives who want to share their know-how for the betterment of midwifery and birth for women. There will be details on our web site in the next few weeks.
Meanwhile, you may like to check out some of Maggie Banks’ work - her website has some interesting articles and her new “Intensives” will be of interest to many. They will provide a good alternative to the ALSO Courses that are very medicalised in their approach and philosophy. Maybe going to one of these courses with Maggie will provide the excuse you need to visit Kiwiland!
Posted by andrea at 09:44 AM
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Education about birth in high schools
One of the best ways we could change attitudes to birth in our community would be to improve the information about pregnancy and birth in the high school curriculums. It is a strategy that is often mentioned in my workshops, and here and there I here about midwives who have accepted invitations to speak to high school students about birth and breastfeeding.
Core of Life is a magnificent project that was started in 1999 by two midwives at Rosebud Hospital in rural Victoria. The program takes 1 ½ hours, and involves the children in an interactive, multimedia, “hands on” session that covers the topics of pregnancy, birth, breastfeeding and parenting. It aims to enable these young people to make informed choices about these issues and to take responsibility fort heir own health and well-being.
From a humble start, it has now spread to many regions of Victoria. A facilitator training package has been developed and funding has been received to enable further expansion. The evaluations o f the program and the feedback received from participants, parents and teachers have all been overwhelmingly positive, and considerable changes in knowledge and attitudes have been noted. For example, 94% of males and 89% of females completing a post-evaluation questionnaire stated that they would like their children to be breastfed in the future.
This is a wonderful program, and a great example of midwifery in action, this time as part of community education. As major suppliers of educational materials fore these programs we salute the initiative demonstrated by these dedicated midwifery leaders and look forward to continued support of their efforts in the future.
Please check out their website by clicking on their name above. Could you extends this program to the students in your area?
Posted by andrea at 05:45 PM
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Interesting book titles
One advantages of working in this office is that you get to see the new book releases before anyone else. We are constantly working with publishers and authors regarding new titles and a steady stream of books arrive for review and consideration almost every day.
We choose the books and products for our range with some care. Any textbook on midwifery will be automatically included, as will most texts on breastfeeding. Books for the Essential Parent section of our list will require careful scrutiny, because we try to provide sensible, practical, baby friendly titles, just as we look for woman friendly titles for pregnancy and birth. Some books for parents have such wacky ideas that they fail to measure up to our standards (the current fad for “controlled crying” is one notable example) and these are rejected.
Two books caught my eye today, “Fresh Milk” and “Midwives of the Black Soil Plains”. Apart from the very attractive cover, Fresh Milk takes a quirky look at all the “other” aspects of breastfeeding, apart from the purely mechanical and physiological. It is very unusual in its approach and highly entertaining. There is plenty of material here that will resonate with women who have breastfed their babies and a lot you won’t find anywhere else.
In “Midwives of the Black Soil Plains”, the stories of the pioneer midwives are retold, complete with photographs, maps, extracts from public and private records and many anecdotes. The situations in which these midwives found themselves are truly amazing, and their inventiveness, resourcefulness and determination (not to mention skill) could make working as a midwife today seem simple, by comparison. However, although some aspects may have changed for the better, conditions for midwifery are still poor, but in different ways. In bygone days, the midwife worked by herself and did what she could in often trying and even dangerous conditions. Today, many midwives would love to work by themselves, without the meddling medical strictures that so-called “progress” has forced upon them. Conditions may be less hazardous in some ways (travelling by horseback through fire and flood for example) but more so in others: the heavy threats of litigation, for example. In the early days, women were grateful for anything the midwives could do to help and were not expecting everything to be “perfect”. How things have changed today - women seem to want the midwife to do everything and threaten action if expectations are not met.
People often yearn for “the good old days” when life seemed simpler and people friendlier and less stressed. Yet life today offers so much more for woman than ever before, if we can just stand the strain of having to deal with all our options!
Posted by andrea at 04:45 PM
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Things that turn up in the post
We sometimes have a good giggle at the items that come through our book sales subsidiary, ACE Graphics. We have a very useful teaching kit for pre and post natal educators called The Contraceptive Kit, which contains samples of a whole range of contraceptive devices plus reference materials. It has proven very popular.
Recently, a customer contacted us to say that their kit was missing its "banana penis" when it arrived. We immediately offered to obtain the missing part and today it duly arrived. I wondered what on earth I was unpacking, as I helped out with the post this morning!
We have now sent of one "banana penis" to our client. Fortunately we didn't have to declare the package contents on a customs slip as this was going locally, not overseas. Not sure how customs people in some countries would regard such an item......
Wonder what will turn up next?
http://www.birthinternational.com/product/cbe/cbe004.html
Posted by andrea at 02:15 PM
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Birth International Agencies
The half-yearly Birth International catalogue is about to be released - another great effort by our dedicated team. It has the usual range of new products and details of the new edition of Preparing for Birth: Mothers. There is also a mammoth stocktake sale with some products up to 80% off - now that's a bargain!
We've also included the details of our agents in other countries as some customers may prefer to order direct from them so they can get prices in local currencies, rather than having to convert to either Sterling or Australian dollars. These agents are:
New Zealand
Birds and Bees,
PO Box 34 406, Birkenhead, Auckland
Phone: 09 480 1451
info@babyshop.co.nz
www.babyshop.co.nz
Canada
Canadian Childbirth Teaching Aids
11716 267 Street, Maple Ridge, BC V2W
Phone: 604 462 0457
ccta@childbirthedu.com
www.childbirthedu.com
South Africa
Baby Talk Consulting
PO Box 15047, Lambton, South Africa 1414
Phone: 011 827 4810
babytalk@mweb.co.za
www.babytalk.co.za
USA
Perinatal Education Associates
98 East Franklin Street, Suite B, Centerville, OH 45459
Phone: 937 312 0544
info@birthsource.com
www.birthsource.com
Posted by andrea at 04:16 PM
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Birth photographs as teaching aids
On Thursday night, I spoke at the launch of Lina Clerke’s wonderful Childbirth Fotosets. The event was organised by the Parenthood Education Department of the Royal Women’s Hospital in Melbourne and it was a fun event, with many of the families featured in the Fotosets attending to wish Lina well with this unique project.
Lina has been collecting photos of births for many years. She has now assembled this specially chosen selection, and grouped them into four sub sets, each showing women, fathers, babies and caregivers in positive, uplifting images that will be sure to inspire and reassure expectant parents. I especially like the set that shows technology being used creatively to enable women to have humanised births in difficult circumstances.
Each set of photos comes with a descriptive list explaining the images, designed to help educators make best use of the large format photos in their classes. The quality if excellent, and size perfect for group use and each set comes in a carry case for simple storage,
I am very proud to include this unique teaching aid in our extensive range of products because it reflects our philosophy of supporting normal birth and midwifery so very well. It was a privilege to be asked to launch the product and I wish Lina great success with it. I am sure that many of you reading this would find these pictures enormously helpful for your work with expectant parents as well.
Posted by andrea at 04:33 PM
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Are we overdoing pregnancy care?
For the last 10 years, Michel Odent has been publishing his excellent “Primal Health Research Newsletter”. It comes out quarterly, and each issue explores an aspect of pregnancy and birth care that has implications for the future health of babies and mothers.
The latest issue, Volume 10, No. 3 examines the advisability of routine pregnancy care for the majority of women and comments on the many studies and randomised controlled trials that have proven that routine ultrasound scans, haemoglobin testing, glucose tolerance tests and even the taking of blood pressure do nothing to improve the outcome of the pregnancy. As always, Michel raises interesting questions and propositions, and in this newsletter he suggests that the emphasis should be on preconception care rather than pregnancy care. The references that back up his assertions are included and will be useful for students and midwives interesting in providing more cost effective and beneficial pregnancy programs for women.
You can obtain the newsletter by emailing Michel Odent at Modent@aol.com. The research papers can be found on the Birthworks website, where all the data accumulated by the Primal Health Research Centre can be located.
Posted by andrea at 03:27 PM
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NSW Birth Statistics - obtaining a copy
For those of you who have been following my Diary entries about the NSW Birth Statistics, you may want to know more - these statistics are very useful to show to parents in prenatal programs, for example. The information is contained in the
NSW Public Health Bulletin Supplement
Volume 13, Number S - 4 December 2002
ISSN 1034 7674
“New South Wales Mothers and Babies 2001"
It is a free publication and can be ordered from
Centre for Epidemiology and Research
Public Health Division
NSW Department of Health
Locked Bag 961
North Sydney NSW 2059
For those of you in other States who are looking for similar information on birth outcomes in your area, you will not be so lucky. The NSW Department of Health has been producing these reports for years, but is the only State to do so. The others have much smaller reports, often just no more than a few tables (Victoria, for example) or make nothing available in print at all (Queensland). This is a very unsatisfactory state of affairs: as taxpayers propping up our health care system we have a right to know how our money is being spent; as expectant parents and families we have a right to know what is going on in our hospitals and how they are performing; as caregivers we need to know how our hospital compares with others in the region and across the State as a whole.
It would be worthwhile calling your local Department of Health and requesting the information they have. Mention the NSW Report and ask for similar information to be made available where you live. If we don’t ask for this, we will never get it!
Posted by andrea at 03:20 PM
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Birth outcome statistics for NSW - Part 3
We all know that more women today are requesting epidurals for labour pain than ever before. Therefore it has been interesting to review the percentage of women at various hospitals in NSW (for the year 2001) who are given epidurals. As expected, women choosing to use a private hospital for the birth have every likelihood of ending up with a bill from the anaesthetist for your epidural.
The highest reported rate of epidural use was at Kareena Private Hospital - 76.4%, just pipping Prince of Wales Private Hospital in Sydney which had a rate of 76%. The Mater Mothers Hospital in North Sydney had a rate of 62.7% and Hurstville Community 65.2%.
At the other end of the scale were Wyong (see my previous Diary entry) whose rate was 0.0%, Inverell Hospital with 0.8% Mudgee 2.3%, Broken Hill Base Hospital 9.6% and Armidale Hospital 4.5%. Of course, these are all country units and there is probably not an anaesthetist available to offer epidural for anything other than caesareans. Where epidurals are not on offer, pethidine or nitrous is used instead, and this is reflected in the figures: Wyong for example has a whopping number of 44% of women using nitrous and 21.9% using pethidine and only 1.6% of women giving birth in that midwifery unit escaped with no pain medication at all. Makes me wonder what has happened to the skills of those midwives working in Wyong!!
Reviewing the figures for “Nil” use of pain relieving drugs makes sorry reading. Again, the private hospitals have dismal outcomes: Kareena Private with 2.6%, The Mater Mothers in North Sydney, just 1.8%, Hurstville Community 7.25%, St George Private 4.0% and Prince of Wales Hospital 2.8%.
The hospital with the lowest rate of women labouring without drugs was Gosford (in the same area as Wyong), with a pathetic outcome of just 0.9%!. 50.2% of women there get nitrous oxide, 38.9% have pethidine and 25.3% have an epidural. They seem to have lost the plot completely.
The best hospitals could only manage rates of 28.3% (Muswellbrook), 24.7% at Inverell, 25.6% at Moree and 29.8% at Queanbeyan. Much better than most but still falling a long way short of ideal.
We have a lot of work ahead if we are to turn this around. Almost all babies born in NSW will be exposed to one or more drugs during labour and birth and will have on-going effects from this exposure for days and perhaps much longer. The work of Jacobsen suggests that it may be many years before the insidious effects show up, perhaps as drug addictions or other antisocial behaviours.
Midwives have got to ger their acts together over this. They are the ones who are offering the pethidine and nitrous oxide instead of using their skills to enable women to manage in other ways. Perhaps midwives could be counted amongst the biggest drug pushers in our State!
Posted by andrea at 03:37 PM
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Birth outcome statistics for NSW - Part 2
In reviewing the outcomes for births in NSW, it is worthwhile looking at the rates for induction, as this is a well known starting point for the cascade of intervention that often leads to either an instrumental or caesarean birth.
The rate of spontaneous onset of labour with no further intervention varies between 18.4% at Kareena Private Hospital to 66.6% at Broken Hill Base Hospital (where they have caseload midwifery). Amongst the big city teaching hospitals, the rates are 51.5% at King George V (now the Royal Prince Alfred Women and Babies Unit), 44.7% at Royal North Shore, 45.1% at The Royal Hospital for Women and 50.5% at Westmead.
Once labour starts, many women are then augmented with either ARM or oxytocics, but again there are wide variations: 13.5% augmented at King George V, 17.1% at Royal North Shore, 21% at Royal Hospital for Women and 18.7% at Westmead. Kareena Private augments 17.1% and Broken Hill Base 11.6%.
Inductions tell another story: 21% at King George V; 27.3% at Royal North Shore, 20.9% at The Royal Hospital for Women and 19.3% at Westmead. Kareena Private induces a whopping 37.8% and Broken Hill induces 14.9%.
Wyong Hospital (another with midwifery programs in place) also has interesting figures: 62.6% of women begin labour spontaneously, however 34.6% go on to be augmented. Their rate of induction is only 2.5%! It seems you won’t be prodded into labour artificially in Wyong, but once you start you’ll be expected to get on with it!
Perhaps the moderate approach found at Bankstown Hospital in Sydney is the way to go: 62.4% spontaneous labour rate, 8.9% augmentation and 19.3% inductions.
In case you are adding up these figures and are wondering why they don’t add up to 100% for each hospital - there are a percentage of women who have no labour (i.e. they have an elective caesarean) and this ranges from 13.9% at King George V, 15% at Royal North Shore, 12.9% at The Royal Hospital for Women, and 11.5% at Westmead. Kareena Private Hospital’s obstetricians are busy with 26.4% elective caesareans, and Broken Hill’s midwives have 7% of women with elective caesareans. Wyong Hospital has 0.5% elective caesarean rate!
Why I am I giving you all this detail? First, NSW is the only state that makes these statistics freely available to anyone who wants them, a proper state of affairs for taxpayers and customers (patients) alike. Second, to illustrate the fact that it is worth shopping around for maternity care as it varies considerably. Knowledge is power and we need to use these figures to argue the case for a more rational approach to maternity services, and by that I mean midwifery care not obstetric over servicing.
Next, let’s look at use of pain medication......
Posted by andrea at 08:03 AM
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Birth outcome statistics in NSW: Part 1
The NSW Mothers and Babies 2001 report has arrived on my desk. It makes fascinating, if alarming, reading as it details the birth outcomes, neonatal intensive care statistics and perinatal and maternal death statistics for the whole population of the State and for subgroups that live in out community. There is such a wealth of information here that it deserves several Diary entries which I will spread over the coming days.
The figures are compiled from the Midwives Data Collection form that is completed following every birth in the country. In 2001, there were 85,858 babies born to mothers with an average age of 29.9 years. About one in four mothers were born overseas. Over the preceding five years the number of women giving birth in birth centres fell from 4.6% to 3.4% and the number of planned home births decreased from 202 to 182 ( the number of unplanned home births was 297 in 2001).
The changing pattern of type of birth was clearly evident: in 1997 the normal vaginal birth rate was 70.4% and in 2001 it was 65.4%. Over this five year period the caesarean birth rate rose from 18.2% to 23.6% - the rate of vacuum and forceps births remained the same. For privately insured mothers the figures were worse: the normal birth rate decreased from 61% to 55.5% and the rate of caesarean birth rose from 22.2% to 28.2%. For women using the public health system the rate of normal birth fell from 75.4% to 71.8% and caesareans rose from 15.4% to 18.6%.
This increase in caesarean births is alarming. It has been climbing steadily at about .05% per year from some time but in these figures we see a sudden jump to a level that rivals the US and UK. The rate of prematurity increased as well - from 6.8% in 1997 to 7.2% and there was a slight decrease in babies born at 42 weeks or more. Only 44.4% of women in 2001 began labour spontaneously and 24.8% were induced, the remainder were either augmented (17.7%) or had elective caesareans (13%).
The disparity between private and public is also apparent when comparing other birth outcomes for the year 2000: forceps births accounted 3.6% for public patients and 6.8% for private patients; vacuum extraction was used for 5.1% of public patients and 8.9% of private patients; elective caesarean was used for 9.3% of public patients and 16.9% of private patients. Even emergency caesareans showed significant differences: 9.3% of public patients and 11.3% of private patients.
It is clear that maternity care is in chaos, starkly illustrated by these rapidly worsening outcomes for women and babies. These figures relate to the years before the Federal Government decided to encourage more Australians to use the private health system by subsidising the cost of private health insurance by 30%. It is already known that more pregnant women now use private health insurance to pay for their health care and that private hospitals are so heavily booked that some are only guaranteeing a bed if a woman is prepared to give birth on a chosen day (i.e. be induced). When the outcomes for these years are collated in the future, the writing will be very clearly on the wall: women and children are paying for the madness of the private obstetric system with its over-servicing and preference for scheduled, managed births.
As a taxpayer, I object to my taxes being used to underwrite this appalling apology for a health care system. I don’t want my money going to subsidise the rich who can afford health insurance and the private hospitals who are also allowed to dip into the public purse.
Pregnancy is the only health condition that a woman is encouraged to choose expensive specialist care as a first option. For all other health concerns, a primary care giver (GP) must be chosen first and a specialist will only be consulted if the primary care giver is unable to fix the problem. Midwives should be caring for pregnant women, as they are the appropriate primary care givers in this instance. Until this happens we will have birth outcomes that cannot be justified in any way, especially in a healthy, well fed, wealthy population such as Australia’s.
More on these statistics tomorrow.
Posted by andrea at 04:22 PM
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Pregnant Barbie!
I’ve heard that there is a new version of the Barbie Doll coming to Australia soon - the Pregnant Barbie! Apparently she has a “baby” in a tummy that is attached by a magnet - now there’s a lesson on how easy it is to give birth - just pop off the tummy and there it is!
I have heard that this doll was removed from sale in the US because it was thought that it might encourage teenage pregnancies (!). The main issue in Australia will be the bottle that is included in the kit and the feeding information that mentions bottles but not breasts. That will have to go or the product will receive very bad press from all the breastfeeding activists here.
It will be interesting to see how they plan to market it here!
Posted by andrea at 03:33 PM
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Events for 2003
It's been a catch up day today. This time of year means putting the final touches together for our program for the first 6 months of the next year and planning the broad outline of the remaining months of 2003. I keep saying that I “will cut down a bit” and “take a holiday” but it never seems to happen - there is so much to be done!
The timetable is shaping up well for the first half of the year:
January
Childbirth Education module for the Monash University Graduate Diploma in Midwifery students (and others) in Traralgon, Victoria - 5 days plus assessments
February
Active Birth workshops
NACE Conference in Sydney
March
UK visit - 10 two-day workshops in various parts of the country
April
Future Birth tour around Australia
Active Birth workshops
Managing Midwifery workshop (Sydney) - a new program for this popular event
May
Active Birth workshops around Australia
June
UK visit - 6 Active Birth workshops (including one in Spain)
Essential Midwifery tour in the UK - 6 events around the country
All this is just for starters.......
Later in the year there will be more workshops in the UK (October) another Conference presentation in Barcelona, Spain and a series of Dynamic Education workshops in Australia. We also have plans to offer the Childbirth Education elective for other University midwifery programs in several states.
All the details of these events are on our website, so have a browse around - I would love to meet you all for a catch up somewhere next year.
Posted by andrea at 03:17 PM
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The Cochrane Library
On October 18, the Australian Government has announced at that the National Institute of Clinical Studies has negotiated a license to provide free access by all Australians to the data held in the Cochrane Library. As most people working in the field of maternity will know, the Cochrane Library is THE repository of Randomised Controlled Trials concerning many aspects of health care. It began, over 20 years ago, by looking into maternity and obstetric care because this was the area of medicine least evaluated and most in need of reform. Since then it has expanded into other areas of medicine.
Although only 10% of interventions and treatments in medical care have been assessed, it is expanding quite quickly and there are currently 1,500 completed reviews and another 1,000 in progress. 60 reviews are being added to each quarterly update.
This is an initiative that will enable consumers as well as health professionals to keep as up to date as possible in terms of appropriate care. It is particularly relevant for those of us concerned with birth, because as a normal process and a wellness condition, it flourishes best when interventions are kept for those few mothers and babies who need them. The old excuses of meddling to “save the baby” and installing routine procedures without any or adequate testing should now be over. We are starting to amass the science - now all that is needed is to use it!
Posted by andrea at 04:48 AM
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The UK birth websites
If you are expecting a baby in the UK, choosing an appropriate birthplace has never been easier. The Dr Foster website (an initiative linked with Boots Chemists) has a listing of all the maternity units in the country and details about the services they offer together with their birth outcome statistics. Another website, set up by a group of childbirth educators and a statistician, has similar information. For those without internet access, The Times newspaper has published extracts - in July 2001 the whole Sunday Supplement was devoted to birth, using the Dr Foster statistics as a starting point for a series of articles about that childbirth that were extensive and useful. This year they followed up again unduly with a series of supplements in the Sunday edition over 5 weeks. These updated the information given the previous year and contained additional notes for parents on a whole range of issues associated with pregnancy, birth, breastfeeding and early parenting. A book has also been published that contains the same data as the web site.
The only potential problem for expectant parents in using these figures to choose a birth place is the difficulty in being able to access services outside the area in which you live. In the UK, health services are provided by a series of Trusts or Primary Care Groups, which handle the budget for the area nd decide which services will be provided. Their geographical area of responsibility can be quite small and larger cities will be divided up into a number of Trust areas.
In Britain, people are not able to shop around for health care as they can in other developed countries. Each person must “sign on” with a local GP, who is paid per patient to provide medical care when needed (the patient pays nothing directly to the doctor). Each GP is allowed to carry a specified caseload and this determines, to a large extent, the salary that will be earned. If your preferred GP has no vacancies on their list, you must approach another until you find one willing to take you on. If you find you don’t like the doctor, it can be very difficult to change, because you must first find another willing to accept you as a client before you can move on and “shopping around” is frowned upon.
Like all systems, it has pros and cons. For example, there is no tendency for doctors to over service their patients in order to make more money, but there is also no incentive for doctors to see you as they won’t get paid for each visit you make. People can’t visit several GPs to get extra prescriptions, for example, and costs of providing health care can be determined in advance, to a large extent. However, if your GP is against home birth, you will not get much support and you may find it daunting to find another GP who is supportive and willing to have you sign on to their list.
In a similar way, it can be hard to make use of the birth outcome statistics offered by these internet guides. If, for example, your local Trust does not have a Birth Centre (and very few do), but the one next door does, you may have difficulty in accessing it, because this will require special funding arrangements between Trusts, a procedure that is available, but discouraged. This “postcode lottery” has been often discussed in the press here and can have major implications for those who require specialised services that are only available in some centres in the entire country.
The availability of these guides to maternity care is wonderful, but it seems to me, of limited value unless women are actively encouraged to seek out the care they want. A free enterprise system would encourage this, but socialised medicine is not well set up to support the idea. Those who have money an can afford private care will be able to choose a private hospital anywhere and therefore can exercise their right to choice, but those reliant on the National Health System may have very few options.
Another example of the double standards that are so prevalent in maternity care: there are a range of choices in maternity care in this country , but make sure you choose the local hospital, whether it meets your needs or not! If you have money, however...... (the rich win again!)
Posted by andrea at 12:04 AM
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Bangkok Mothers and Babies International
The Bangkok Mothers and Babies International (BAMBI) group is celebrating its 20th birthday this week. It was established by a small group of expatriate mothers living in Bangkok who recognised the need for a place where foreign women and children could meet and support each other. These women were often wives of businessmen or diplomats who were not allowed to work themselves and many were in Thailand on contracts that would mean a temporary residence of a few years before returning home or moving on again to another city.
These women often had skilled or professional jobs in their own countries and this brought a huge range of talents to the group. Sub groups were formed to meet specific needs, for example, the BUMPS and BABIES group utilises the skills of midwives, child health nurses and breastfeeding counsellors to offer prenatal classes and post natal breastfeeding counselling. Playgroups in several areas of the city offer a chance for the children to mix and socialise and a Charities Committee collects unwanted toys, children’s clothing and equipment from those no longer needing them and distributes them to orphanages, schools and other deserving institutions around Thailand. Fundraising efforts have supported a wide variety of projects including school buildings for Thailand’s Hill Tribes in the north.
Another interesting service that BAMBI has set up is a link to the Central Blood Register. Negative blood groups don’t exist in Thailand, so anyone requiring a transfusion of negative blood could be in serious trouble. BAMBI asks all it members to be blood donors and most willingly agree - after all it could be them or their children who needed a transfusion. With the caesarean section rate quite high in Thailand there is also a potential need for blood.
The BAMBI Magazine is a very professional publication that carries articles and advertising of interest to members. Here can be found useful tips on living in Bangkok and finding the services that make adapting and settling in easier. It is also a means to welcome new members and share experiences.
A guide for nursery schools has also been produced and there is even a wonderful booklet of clothing designs for pregnant women that can be used as the basis for discussions with local dressmakers. I’ve never seen such an extensive collection of maternity dress ideas!
A new publication “Having your baby in Thailand” is about to be released and this will offer basic information about the health care system and suggestions for finding the kind of pregnancy and birth care that expatriates might want. Compiled by Mel Habanananda (see my previous entries) who, as BAMBI founder, is now the Honorary President, it contains the wisdom and insight of 20 years of living and working in Bangkok - a valuable asset for any newcomer.
Imagine that you were suddenly required to go and live in a very foreign land, with small children and perhaps pregnant again, for a period of a couple of years. BAMBI is just the kind of group you would want to know about to make your stay much more enjoyable. Some High Commissions, many businesses and companies and all the removalists now support BAMBI and make sure that new arrivals know of its existence. It is not only a support group for a section of the Bangkok community but a generous supporter of Thailand in a wider sense.
For more information, check out their website: www.bambi-bangkok.org
Happy birthday BAMBI!
Posted by andrea at 12:31 PM
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The Childbirth and Breastfeeding Foundation of Thailand
The Childbirth and Breastfeeding Foundation of Thailand (CBFT) is the brainchild of Mel and Tanit Habanananda (see my previous Diary entry). Having spent 20 years working, largely on their own, to get some better birth practices into Thailand they wanted to find away to keep the work going when they decide to retire, probably to their wonderful property outside Chiang Mai in the north. They also wanted to involve the Thais themselves in taking the work forwards, because this is really about cultural change and setting in place programs and visions that will benefit the Thai people at large. A very successful Conference had been held in Chiang Mai in 1997 (“Birth without Borders”) and it was clear from the enthusiasm of the participants from allover the South-East Asian region that change was much needed and leadership would be required.
After much soul searching (and some prodding from me, I have to admit) they decided to form a non-profit Foundation with a Board representing stakeholders in the Thai maternity system. Establishing a Foundation is no easy task and it took some years. Everyone involved had to be scrutinised by the Government and the police to check their backgrounds, worthiness and suitability and an elaborate process for registration exists, ensuring that very few proposed Foundations manage to jump all the hurdles. It took some years, but finally the deed was done and the Foundation began work in 1998.
This is the Mission statement of the Foundation:
“The CBFT is a non-profit networking and resource centre dedicated to ensuring the best possible start in life for our babies. We believe that this can best be achieved through:
Encouraging the appropriate use of technology and medication for all births
Promoting breastfeeding for every mother and baby in the community
Providing information and training to health professionals involved in maternity care
Supporting parents through pregnancy, birth and postnatal period."
The Foundation has begun its first projects and to establish its credentials. Workshops have been held in a number of hospitals and a tour of major centres with Marsden Wagner, Gabrielle Palmer (author of The Politics of Breastfeeding) and myself as speakers took place in 1999. Links have been forged with UNICEF and the Department of Health and various publications are in the pipeline. As an Advisor to CBFT, I have given then permission to translate Preparing for Birth as a basic manual for parents and a means of raising funds through sales, and this is about to be printed.
Getting things done in Thailand takes time. The Thais are lovely, gentle, warm people with a very proud background and a strong sense of self as a nation. Their ways of doing things are unique, and at times very frustrating. They are known for their smiles, but these can hide a range of emotions making it impossible to “read” their reactions. Their concept of time and deadlines is very relaxed and causes angst for those used to westernised time-driven ways of working and getting things done.
I know that the Foundation is very much needed here and holds the promise of improved birth and parenting for the Thai people. I also see the effect that lack of action and slow progress is having on my dear friends and I hope they can hang in there to see their dream emerge and develop.
More about Thailand tomorrow.
Posted by andrea at 12:13 PM
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Making pelvis models
Things have been a bit quiet on the Diary entries from me in the last couple of days. Next week I am going back to the UK for a series of workshops and Conference appearances and so I have been working madly trying to make as many pelves as possible before I leave.
Yes, that’s right - making pelves. Most people don’t know that this is what I do in my “spare time”, butl those pelvis models you see in our catalogue are all made by my hands, in the good old “garden shed” equivalent at our office.
It all started 15 years ago, when I was looking for a pelvis to use in my own classes. All the ones I could find has bolts and wingnuts holding them together and I thought they were insulting to women and very distasteful. What do do about it? The answer was - design and make your own.
It was quite a saga. First I had to find someone who could make the moulds (three) and this was surprisingly hard until I discovered a wonderful sculptor who found no difficulty dealing with the complex shape of bones when making the fibreglass cradles and silastic rubber inserts. The task of getting the right polyurethane mix for the casts was a lot of drama as well but eventually the best combination of ingredients was worked out after a lot of trial and error and help from a surf board manufacturer. I wanted just enough “give“ to make it possible to show how the joints move, but enough rigidity so that the model was easy to work with. Then there was the glue problem! Polyurethane is notoriously hard to stick together and I still sometimes have trouble with breakages, which I am always happy to fix.
Anyway, thousands of pelves later (I’ve given up counting) I am still at it on a regular basis. As a best selling item, I must make sure that there are enough on hand to supply customers when I am away for extended periods, so for the last three days I have been slaving away getting them done.
You didn’t know that I was so multi-skilled did you? Amazing what a bit of passion will drive you to create!
Posted by andrea at 02:56 PM
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