Midwifery

Midwifery in Australia is poised for a numnber of exciting developments, after years of struggle for recognition.  Birth International has sponsored many visits to Australia by overseas speakers, all of whom have been instrumental in achieving change in their own countries so that women and babies have better birth experiences and the midwifery profession gains its rightful place in the health services.Their insights have provided direction and ideas for midwives in Australia, who have adapted and developed the new systems that will come into operation in 2010.

The following articles chart the progress of midwifery  in a number of countries and also offer insights into midwifery practise and its impact on birth outcomes. A number of these articles were presented at an important series of seminars with the overall title of "Future Birth" that were sponsored by Birth International every two years from 1992 until 2009.

Maintaining comfort and progress in labour

Penny Simkin

Penny Simkin has been working with pregnant and birthing women for 42 years. On her recent tour in Australia she offered participants in her workshop a wealth of experience, stemming from her background in childbirth education and practical support as a doula for over 1000 labouring women.

As a passionate supporter of evidence based care, Penny provided a comprehensive reference list and several articles that explained her approach and detailed her ideas. These will be available on our website until December 22 as downloadable PDF files:

Non-pharmacological approaches to management of labor pain

Safe positions for the mother with an epidural

Supportive care during labour – a guide for busy nurses

Read more: Maintaining comfort and progress in labour

   

Nitrous oxide - no laughing matter

by Andrea Robertson

Nitrous oxide (often called 'laughing gas'), in combination with oxygen (50% of each gas), has been in use for two centuries
as a simple anaesthetic agent, and in obstetric care since the 1930s. It is the most popular form of anaesthesia in UK labour
wards, where it is available in 99% of consultant units (Chamberlain et al, 1993), as well as in birth centres and for home births.

Read more: Nitrous oxide - no laughing matter

   

Midwife Power

by Nicky Leap

If you look up the word "power" in the dictionary, you'll come across some definitions that fit well within the concept of the "skilled companion" described by Professor Lesley Page and other midwives who expound a "woman-centred", "woman-led", "with woman" approach to midwifery.

You will also find definitions of the word "power" that are more in keeping with the authoritarian approach to midwifery. Such definitions of "power" will trigger different reactions in all of us. Today I shall be attempting to look at different concepts and uses of power in relation to midwifery, paying particular attention to how we, as midwives, move forward in building woman-led services.

Read more: Midwife Power

   

On her own responsibility

The struggle for independent midwifery in the United States

by Elizabeth Davis

Abstract
The United States is the only country in the world that virtually eliminated the practice of midwifery. This took place around the turn of the century, when obstetrics became a profit-generating and male-dominated profession. Women could not acquire the requisite credentials because they were denied access to university education, and traditional midwives fell victim to a campaign organized by physicians to discredit their work.

Read more: On her own responsibility

   

The Re-emergence of Canadian Midwifery

A New Profession Dedicated to Normal Birth

by Holliday Tyson

The Destruction of Canadian Midwifery during the 20th Century

Throughout most of the 20th century, Canada was the only western industrialized country with no legal provisions for the practice and the profession of midwifery. Prior to the Second World War, many births were attended by lay midwives; Canada's indigenous peoples had a strong tradition of midwifery and there were thousands of trained midwives from other countries living in Canada. Nonetheless, Canada and the United States developed a medical monopoly of childbirth early in the century which was enforced fiercely. In both countries, midwives were discussed by the medical profession, government and media as "the midwife problem", and endured the non-recognition of their profession, humiliation, harassment, legal action, and imprisonment. In the United States, certified nurse midwives were permitted to practice in very limited settings, serving about 4% of the population throughout this century. In Canada, the profession and practice of midwifery was eliminated as medicine claimed sole professional rights to provide primary maternity care.

Read more: The Re-emergence of Canadian Midwifery

   

No Gain Without Pain!

by Nicky Leap

Why study pain?

The pain of labour is a constant feature of the discussion in unstructured antenatal groups (Leap 1992) and women have highlighted the fact that the attitudes of midwives have a profound effect on their experience of giving birth (Kitzinger 1988; Oakley 1981; Philips et al 1984; Leap & Hunter 1993; McCrea et al 1998). This understanding motivated me to explore midwives' ideas and understandings regarding pain in labour.

Read more: No Gain Without Pain!

   

Managing Change In Midwifery Practice

by Pat Brodie

This paper will describe the process of improving maternity care through an innovative program, based at St George Hospital, that enabled the introduction of a community based 'continuity of midwifery care' model incorporating collaboration between midwives and obstetricians. This model of care was initially based on evidence and experiences gained elsewhere, such as that from the team midwifery models at John Hunter Hospital, Newcastle NSW and Westmead Hospital in Sydney.

Read more: Managing Change In Midwifery Practice

   

Enriching Care The Selangor Maternity Centre Experience

by Lynne Staff

This paper was presented at the Enriching Midwifery Conference, Australia, March 2000 for Birth International.

What we did/do at Selangor

Live the philosophy, breathe it and believe in it -- we don't just pay lip service to it.

Read more: Enriching Care The Selangor Maternity Centre Experience

   

Reclaiming Midwifery Care as a Foundation for Promoting 'Normal' Birth

by Maggie Banks

This paper identifies some essentials of midwifery practice and looks at how the woman who may have additional care needs receives woman-centred care. Breech presentation will be used by way of example to demonstrate the latter.

Read more: Reclaiming Midwifery Care as a Foundation for Promoting 'Normal' Birth

   

Horizontal violence in the workplace

by Carolyn Hastie

Definition of horizontal violence

Horizontal violence is hostile and aggressive behaviour by individual or group members towards another member or groups of members of the larger group. This has been described as inter-group conflict. ( Duffy 1995).

Horizontal violence is endemic in the workplace culture and it is an unacceptable and destructive phenomenon. All members of every workplace are urged to work together to address the issues of oppression and eliminate this unhealthy behaviour from the workplace.

Read more: Horizontal violence in the workplace

   

The Power of One

by Sandy Kirkman

When health professionals find themselves working in situations that seem, to them, to be wrong, it is easy to become discouraged. It is true that one single individual may have little impact on a well-entrenched system, but this presentation aims to explore how some such lone individuals have changed the world of childbearing women in the past, both recent and distant.

Read more: The Power of One

   

The outcome of perinatal care in Inukjuak, Nunavik, Canada 1998-2002

by Susanne Houd

Abstract

Introduction. From the 1950s women in Nunavik were transferred to South Quebec to give birth. Since 1986 women have had the opportunity to give birth in Povungnituk, Nunavik, and the education of community midwives began. Inukjuak, a small community in Nunavik, was included in the project in 1998. There is no possibility for caesarean section or transfer during birth, in any of the places. Women can be transferred in pregnancy or post partum to the small hospital in Povungnituk or to a specialist obstetrical unit in Montreal. Study design. A5-year retrospective survey of the perinatal care in Inukjuak. Method. Data were collected from 1. Birth registrations. 2. Antenatal records in Inukjuak. 3. Records and follow-up of medical evacuations to either Povungnituk or Montreal. Results. Of the 182 women from Inukjuak who gave birth, 72.5% of the women gave birth in their own community. 4.5% women or/and newborn was evacuated for reasons related to birth. The rate of premature birth is 3.3% of all pregnant women from Inukjuak. The PMR is 0.5% of all babies born by women from Inukjuak and 0.7% of all babies born in Inukjuak. Conclusion. Three out of four women can stay in Inukjuak and give birth with a PMR of 0.7%

Read more: The outcome of perinatal care in Inukjuak, Nunavik, Canada 1998-2002

   

Midwifery care for every woman, everywhere.

by Susanne Houd

To be born with a home

Women in Nunavik, Eritrea and Greenland want to give birth where they live, with midwives that understand their language and culture and at the same time, who have the knowledge of today’s midwifery care. They want their babies to be born with a home – this means to be born in your own culture, assisted by midwives from your own culture who understand the language, the food habits, and the words to be said or not to be said.

Read more: Midwifery care for every woman, everywhere.

   

It's happening - midwifery led maternity services at last!

by Sally Tracy

In this update on our progress towards a National Maternity Action Plan, the new midwifery services are described - the battles, the strategies and the results so far. Together we can reverse the trends of over-medicalised birth in this country. The first part of my presentation will be based on the results of research that will be extremely important for midwives and women in Australia to argue the safety of small maternity units.

Read more: It's happening - midwifery led maternity services at last!

   

Highlights: First 100 Babies Report

The Ryde Group Midwifery Practice

Ryde Midwifery Group Practice was launched on 15th March 2004. A six months transition period followed. This is a report card of the first 100 intended bookings at Ryde.

Read more: Highlights: First 100 Babies Report

   

Midwifery in North Korea

by Jill Moloney

Project 1: Concern Worldwide, July 2004 to April 2005

As part of the first health project (July 2004 to April 2005), I spent 3 months last year observing various outpatient and home-visit consultations in a county of South Pyongan province ­ a 2 hour mountainous drive north of Pyongyang. The Project has been supporting 3 Industrial Hospitals (located in mining towns), 5 'Ri Hospitals' (located in ri's ­ farming communes) and 12 'Ri Clinics' (also located in farming communes, but don't have inpatient services). I was able to attend 102 consultations, 49 of which were perinatal, and a further 10 'women's health' appointments. Of course these observations were very interesting, but the discussions I had with the health staff were even more enlightening.

Read more: Midwifery in North Korea

   

The Place of Birth: The Dutch Midwifery System

by Beatrijs Smulders

Dutch midwifery care is unique in the world. Our country has a totally different culture and system that allows Dutch midwives to work as they do and this is not because our midwives or obstetricians are very different from elsewhere but because our approach enables women to get the best of both worlds. The system prevents midwives and obstetricians from behaving in ways that are bad for women and demands the best from all of us.

In Holland, midwives are totally autonomous. How have we achieved this status? What are the problems we have faced and what of the future?

Read more: The Place of Birth: The Dutch Midwifery System

   

Midwifery in New Zealand

by Karen Guililland

Social change of the magnitude experienced by the New Zealand Maternity Service over the last eight years has not been without difficulties. The changes have challenged individual women and their families, midwives, general practitioners, obstetricians, politicians and institutions. Such challenges attract considerable excitement and enthusiasm but they also attract resistance and hostility. Now, some years down the track, New Zealand is starting to accrue some evidence on the effect of these changes on maternity services and overall health goals.

Read more: Midwifery in New Zealand

   

The pain of labour - a feminist issue

by Andrea Robertson

Pain in labour is universal: it hurts to give birth. Since this is such a common experience it could be seen as comforting, a bond among women, a fundamental truth that confirms our special biological role and affirms the importance of our contribution to society. More often, however, it is seen as a blight, an unnecessary imposition, an affliction we must bear as the price for bearing children. This view, bolstered by the perception that pain is a symptom of disease and illness, has enabled medical men to convince us that pain is dispensable during birth, and is of no value, an evil to be cured with modern treatments and technology.

Read more: The pain of labour - a feminist issue

   

If your baby is breech

by Andrea Robertson

Most breech babies will turn naturally before labour. You will probably be referred to an obstetrician as these days few midwives will undertake a breech birth, even though in the past most midwives considered this within their scope of practice. There are still some midwives who are happy to assist with this variation of a normal birth, so it may be worthwhile asking around in your local community to see if you can find a willing midwife.

Recent research, an internationally conducted randomised controlled trial, concluded that caesarean section was the preferred birth option, but this study has been heavily criticised because it has given conflicting results.

Read more: If your baby is breech

   

Pain in labour - your hormones are your helpers

by Dr Sarah Buckley

Imagine this. Your cat is pregnant, due to give birth around the same time as you are. You have your bags packed for hospital, and are awaiting the first signs of labour with excitement and a little nervousness.

Meanwhile your cat has been hunting for an out-of-the way place - your socks drawer or laundry basket - where she in unlikely to be disturbed. When you notice, you open the wardrobe door, but she moves again. Intrigued, you notice that your observation - even your presence - seems to disturb the whole process. And, wish as you might to get a glimpse into the mysteries of birth before it is your turn, you wake up the next morning to find her washing her four newborn kittens in the linen cupboard.

Why does birth seem so easy to our animal friends when it is so difficult for us?

Read more: Pain in labour - your hormones are your helpers

   

Unexpected outcomes - mentioning the unmentionable

by Andrea Robertson

One of the most fascinating aspects of birth is its total unpredictability. No-one knows what will happen and how those involved will fare, and no amount of preparation will ensure a given result. It's this uncertainty that makes giving birth both exciting and frightening!

Every pregnant woman has her moments of doubt about the health of her baby. Fears about death and handicap are common. These are the worst case scenarios and are often sources of great anxiety as the pregnancy rolls on. Talking about them can help and even though it is impossible to allay all fears, sharing concerns with others puts problems into perspective.

Read more: Unexpected outcomes - mentioning the unmentionable

   

Are midwives a dying breed?

Andrea Robertson

Enabling a woman to give birth physiologically must surely be every midwife's aim. The whole philosophy of midwifery rests on the knowledge that birth is a normal bodily function for a woman that requires a conducive environment and an experienced companion to watch for problems that may occasionally develop. This "experienced companion" has traditionally been the midwife.

The encroachments of the medical model in the birth process have de-skilled many midwives and led to many becoming "obstetric nurses" who watch over the technical equipment and carry out the doctor's instructions (i.e. the protocols).

Read more: Are midwives a dying breed?