Thursday 21 April 2011

Symbols, power and woman's place in the world

I always enjoy Maria Popover's links and articles. Her Blog has fascinating and often obscure articles which are relevant to my interests. I follow Maria on Twitter  - her twitter name is @brainpicker

So it was with great interest that I followed this link
 

to YouTube to see
Symmetry, a short vimeo film by Radiolab that Maria said "explores the dualities of human existence, best short film you'll see all week".
 
The film is very clever - it juxaposes images concerning the dualities of existence to explore

"What the origin of the universe has to do with gender identity, binary parallels and anatomy"
I felt disturbed by the juxtaposition of hot chips and tomato sauce, pepsi and coke, popcorn and movies as typical of life on this beautiful planet of ours, but this following image really bothered me



Why does that bother me?

Positioning these images as the gender divide and to represent masculinity and feminity bothers me because of the inclusion of the disabled sign with the woman figure.

Maria says that:
"Symmetry is a mesmerizing split-screen short film exploring the poetic parallels and contrasts of our world — birth and death, heart and brain, masculinity and femininity, all many more of humanity’s fundamental dualities. It’s the best thing you’ll watch all week, we promise"
Given the producers and Maria are cluey in regards to the messages we receive from the visual stimuli around us, it is hard to believe that they didn’t recognise the way this image can subliminally erode women’s sense of self and personal power. Perhaps they didn’t ‘see’ the message the film is sending because that view of women is 'normal' and that makes it all the more fascinating and concerning.

Maria explains that:
"The film was inspired by Radiolab’s Desperately Seeking Symmetry episode, which examines how symmetry and its pursuit shape the core of our existence, from the origins of the universe to what we see when we look in the mirror"
Is that how you see yourself when you look in the mirror?

Here's the film so you can  make up your own mind

Read more: http://www.brainpickings.org/index.php/2011/04/20/radiolab-symmetry/#ixzz1K7q855ff

Symmetry from Everynone on Vimeo.


Those of us who are birth workers are very aware of the way that in western culture at least, women are being progressively disabled to birth normally. Women are embodying the messages that birth is something to be medicated... avoided... that being delivered surgically is preferable and 'safer for the baby' even though it is certainly not.

Our connection to 'nature' is eroding and our birth DNA, our wild side, is getting switched off and put under the lock and key of medicalisation.

The grunting, groaning, sweating, swearing, movement and effort associated with giving birth is increasingly perceived as unbefitting modern women. Birth is now sanitised with pretty delivery room decorations and epidurals on demand. I've noticed many partners and other family members feel relieved when the woman is neatly in bed, unable to move and 'painfree' for labour. The fact that they can't push or move and end up with baby extractions either with abdominal or perineal cuts doesn't seem to be an issue. The disablity accompanying the pain and difficulty moving for some time after the baby extraction doesn't seem a problem for anyone either. '

We have to ask what it is about the birth process that causes all this angst about 'pain' in labour. That's probably a topic for another time.

Back to the images in this short film and what they represent.  My perception is that the unconscious coupling of a woman with the disabled sign positioned as symmetrical with the male symbol is a striking indicator of how women are culturally constructed as disabled in our world. 

The fact that the message is subliminal and that neither the producers, nor those who understand subliminal marketing and neuroscience recognised the message makes it even more powerful and dangerous to women's sense of self, power and place in the world.

And then there is the message about what it means to be female in western society fostered by the likes of  the ubiquitous Child Beauty Pageants.  As  Heidi Davoren, in her column Dirty Laundry for Life & Style section of the Brisbane Times wrote:

"Shame on us as a society that our daughters are groomed into submission, objectification and sexualisation at such a tender age, in the name of entertainment. In fact, in the name of ‘building self-esteem’."

The rampant sexualisation of girls is another powerful and dangerous threat to women's sense of self, power and place in the world.





Tuesday 19 April 2011

Raising birthing consciousness: moving beyond cruelty to women and babies

I met a friend for breakfast this morning at a lovely little cafe on the shores of a local lake.  My friend is a Calmbirth practitioner and I have had 30 years in private midwifery practice. We are both passionate about sharing information and exploring ideas about birth and parenting with couples.  Our conversation involved a lot of animated discussion on the subjects dear to our hearts, including why women chose the care they do.

How women and their partners think about the birth of their babies and choose their care provider and their birth place is intriguing.  Women who sought out my midwifery care wanted to know who was going to be with them during their labour and birth, so building trust and understanding during pregnancy was an integral part of their plan. They wanted to ensure privacy and be in control of what happened to them and their baby.  They wanted continuity of care into the postnatal period for support. How their baby was born was something they considered deeply; they wanted their babies to be born gently, into a loving environment and for themselves to be as involved as possible.  These parents desired to be the first to touch their babies; they sought minimal intervention and to discover the sex of their children themselves.  They were fully aware that their baby was a conscious being who participated fully in the labour and birth experience.

According to my friend,  women who access her services don't realise there is any other choice but private or public medical care. They didn't consider public maternity care and didn't generally know about midwifery models of care. As they are generally privately insured, they want to "get their monies worth" by employing an obstetrician and having a private room in the hospital.  We discussed the way that employing a surgeon usually means you will end up with interventions and surgery.


I told my friend about a video on birth trauma that Gloria Lemay had shared on Facebook (see below) and a post Birth Abuse by Navel Gazing midwife.  Routine obstetric management of birth is shown in the video. The video is a compilation of clips are from women's own birth videos collected by a chiropractor and made into this short film. For those not habituated to medical care at birth, these scenes may be distressing, so please take care of yourself when watching this information.
 
Warning: If you are pregnant, it may be best to give this video a miss as you are better off watching beautiful birth films that inspire and support your birth vision.



Birth Trauma from Centre Quiropràctic Molins on Vimeo.


Both those items and the accompanying comments have really troubled me. That women still emerge from their birthing experiences feeling like they have been abused is a dreadful and indefensible underbelly of maternity care. I left the public system thirty years ago to go into private midwifery practice because of the abuse I'd observed. I've written about that in my master's dissertation.
 
My friend told me she had been very roughly examined vaginally during the birth of her first baby and how devasted she had felt after that experience.  She told me that she felt it was the beginning of her slide into severe postnatal depression with that child and the source of the tremendous fear that she felt with her second pregnancy.  My friend said that she didn't stand up for herself at the time and as she was a midwife she 'should have'.  Then she said something that really illuminated the whole issue of birth trauma and abuse for me. She said "I should have stood up for myself, but I didn't have the words to do it..."
 
I thought about the way that women trust their health care practitioner to do the right thing by them and believe their practitioner has their best interests at heart.  Obviously, when the practitioner is rough, or behaves differently to what the woman expects, the woman goes into a shock-like biobehavioural state and has a cognitive dissonance experience. Cognitive dissonance experiences are usually difficult to put into words at the time.

A comment on Navel Gazing midwife's blog explored the Roots of birth abuse. The comment sheds some light on the reasons why birth abuse occurs.  The big question is how do people (partners, family members, midwives, obstetric nurses, doulas, registrars, paediatricians etc) accept these atrocities committed in the name of obstetric 'care'? Mind you, there is conversation in the various tea rooms across the land that revolves around these issues and I know many doulas lament what they observe in labour wards.

Perhaps in the main, the focus of wanting the baby 'out' and 'alive' means the 'how' and the 'why' pales into insignificance until we 'wake up' to the actual brutality of what is accepted as routine obstetrical management. Until we wake up, we are blind to that reality. Blindness to anything other than that which the person is focused on is called 'inattentional blindness'.  An explanation for inattentional blindness can be found in the latest research on how certain neurons actively suppress visual data streaming into the brain. This research informs us that we are only aware of approximately 1% of what's going on around us.


My friend and I discussed ways to provide information to women and men about birth options and ways to raise consciousness about birth choices and effects. How do we help this generation of parents to understand that abdominal birth and vaginal birth are not equal; that the choices they make for their care will have profound effects on the outcomes and their experiences?  How do we create a culture where violence against women and babies, even that form of violence couched in terms of 'obstetric care' is unacceptable? How do we lay the foundation of kind, respectful woman centred care in maternity services? How women are treated in their most vulnerable state during childbearing provides a template for how society treats women generally. How do we help parents recognise and engage with the spirit and consciousness of the child that is embodying and being born?

Thursday 14 April 2011

Senate Inquiry re: complaints about midwives

The Australian Senate Finance and Public Administration Committees are holding an Inquiry into the administration of health practitioner registration by the Australian Health Practitioner Regulation Agency (AHPRA). On 23 March 2011 the Senate referred the following matter to the Senate Finance and Public Administration Committees for inquiry and report.
Inquiry into the administration of health practitioner registration by the Australian Health Practitioner Regulation Agency (AHPRA). Submissions should be received by 14 April 2011. The reporting date is 13 May 2011.

The Committee is seeking written submissions from interested individuals and organisations preferably in electronic form submitted online or sent by email to fpa.sen@aph.gov.au as an attached Adobe PDF or MS Word format document. The email must include full postal address and contact details.

I have just sent my submission to this inquiry.

The situation as it stands is like this report from Kelly at the Belly Belly site:

"There is currently a major problem occurring with the process of complaints about midwives.

Several midwives around the country have had conditions placed on their registration due to complaints. These complaints are mostly from hospital staff when a labouring woman and her partner are transferring from a homebirth. Most of these restrictions demand that the independent midwife can only practice midwifery within a hospital birthing unit. This brings their homebirth practice to a screaming holt, leaving their women without a care provider and the midwife without an income!

The process as it currently stands is this:

The hospital staff or anyone put in a complaint to the Nursing and Midwifery Board (NMB) about a midwife. The Board meet monthly and decide whether the complaint needs to go to investigation or not. In some cases they’ll decide it doesn’t need an investigation and the conditions will automatically go onto the midwives registration.

If they decide it needs investigating they slap ‘interim conditions’ on the midwives registration. In the case of homebirth midwives the conditions are “Must work only in a hospital and under supervision”.

The investigation then goes to the HCCC and the conditions remain on the midwives registration until the investigation is complete.

Basically, it is a matter of midwives being found guilty until proven innocent.

Investigations can take a year or more. This is leaving many women without a midwife (some are 39 weeks pregnant) and leaving midwives without income – and for some it could be a matter of losing their home, as they cannot pay their mortgage etc".


Given that the Collaborative Arrangements Inquiry had thousands of submissions which the committee dutifully ignored, it will be interesting to see what they do with the submissions for this one.
 
We live in hope that sanity and a 'fair go' for women and midwives will prevail in Australia.

Thursday 7 April 2011

A coroner's perspective on the death of a baby

The coroner, in his report released today on the intrapartum death of a baby girl at a private hospital in Queensland, was critical of both the midwife and the obstetrician involved in the labour and birth care of the mother.

The care was found to be substandard by the coroner on many levels.  The midwife was found to have altered the woman's medical records after the event; did not follow hospital protocols regarding monitoring and documentation and did not refer to an obstetrician in a timely manner. The coroner will be reporting the midwife to the Director for Public Prosecutions.

The coroner found the doctor's response to the clinical situation to be ''inadequate" and recommended that he be reported to the hospital board.  I wonder why the coroner is not reporting the doctor to the Director of Public Prosecutions too?

The coroner made 21 recommendations from the content of antenatal education and the way they are formatted to the essential nature of good collaborative care for safe care of mothers and their babies.

The president of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), Dr Rupert Sherwood commented that this case highlighted the reasons why the college "has always insisted on collaborative arrangements between doctors and midwives".  He further claimed that there were two aspects of good collaborative care: adherence to protocols and timely referral. Those aspects, while very important, are not the key to what constitutes either collaboration or safe maternity care.

There is no doubt that collaborative maternity care is the safest for both mothers and babies. I have had the supreme good fortune of working collaboratively with a number of skilled, compassionate and insightful obstetricians. I have sadly, had the misfortune of working with the others too. The key to collaborative maternity care provision is the way the organisation is structured. There are two aspects to that positioning. One, that the organisation overtly recognises that birth is a normal natural event which sometimes needs expert and timely intervention. The other, fundamentally crucial aspect is the acceptance and promotion of the woman's right to self determination, evidenced by the woman being treated as an equal partner in the care planning and giving. A woman centred maternity service, where both obstetrics and midwifery AND the organisation has the woman, her wellbeing, her desires, needs & requirements at the centre of their practice leads to the leveling of hierarchies and the destruction of professional 'silos' which engenders an atmosphere of trust with optimal communication.  I found in my research that without that organisational structure creating the culture of collaboration, with warm, trusting relationships of mutual respect and woman centred practice, both doctors and midwives lose their emotional and social competence, they act stereotypically, the turf war is in full swing and mothers and their babies suffer.

The loss of this little baby Samara is a tragedy for all concerned.  The fact that with good collaborative care, this baby's death could most likely have been avoided is heart wrenchingly tragic.

This coroner's report is a must read for everyone associated with maternity services, from caregivers to managers as it contains important directions and information regarding staffing, culture and practice.