Midwifery as the basis for peace

Mindy Levy is a remarkable midwife in Israel, who has established a birth centre in the north of the country near Nazareth, and who also offers a home birth service. She was one of the driving forces behind both of my visits to Israel. On my last visit, she offered to arrange a workshop for Palestinian midwives, which took place in East Jerusalem in June 2005. This was a wonderful event, if somewhat disjointed due to the langauge difficultlies and the haphazard arrival of midwives due to the onerous checkpoint formalities at the border of the West Bank. The midwives from Gaza had been unable to attend because the border has been closed completely for 4 days by the Israelis.

However, we had an interesting day and Mindy said she would like to follow up wirh another meeting between Israeli and Palestinian midwives. Today I received the following email from her - she has achieved her goals at last.

Dear All,

The last 2 days were big ones- the culmination of months of work and years of planning and dreaming. Sponsored by COHI, nine Israeli midwives and nine Palestinian midwives spent 2 days together at my birth center in Beit Lechem Haglilit talking about women, babies, birth, midwifery and mothering in the Middle East.

It was a party. The atmosphere was festive, loving, hopeful, and professional. We learned much about midwifery on "the other side" and had many opportunitied to explore the differences and similarities, the strengths and weaknesses of each health system.

We understood very quickly that midwives are midwives, regardless of their religion and nationality. Our passion about our profession is universal as are the warmth and love that eminate from our bodies and souls. Midwives are midwives are midwives.

We fell in love with each other instantly. We forgot that there had been a time when we were wary about this first meeting, when we felt fearful of meeting the "enemy" and encountering our own prejudices. There was no fear. There was trust, openness to reveal weaknesses and difficulties, a lot of curiosity, and a great willingness to share and to listen.

We are now planning the continuation of this connection and the sky seems to be the limit. When we parted ways this afternoon, we spoke of when we will meet again, not IF we will meet again.

I feel as if I had given birth- happy, exhausted and overwhelmed. And indeed a birth has occurred- the birth of this incredible project. Now we need to hold it, get to know it, nurture it and some day teach it to walk.

When the birth center emptied I could still feel the energy buzzing in the building- the presence of these midwives was a true blessing for the birth center. I am thankful that I had the honor to host this birth.

In the concluding circle one of the midwives raised the possibility that the end to the violence in our region could be begin by eliminating violence in birth. We all agreed that we really do have the power to change the world, one birth at a time. This might sound a bit much to the non-midwives among you, but this is one of the things that gets us through the pain, blood, sweat and guts of birth, knowing that what we do does makes a difference. Birth is important for both women and babies.

Anyone who feels motivated to support this project financially is encouraged to do so through the COHI website or directly to me.

Mindy

Posted by andrea at 11:36 AM

Promoting breastfeeding in Thailand

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

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

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

Posted by andrea at 02:31 PM

Midwifery education in Thailand

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

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

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

Posted by andrea at 02:23 PM

Childbirth options in Thailand

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

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

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

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

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

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

Posted by andrea at 02:10 PM

Midwifery in the UK

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

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

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

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

Posted by andrea at 06:52 PM