Sunday, 14 November 2010

21 strategies to help keep birth normal

NSW Health has released a policy aimed to help with increasing the rates of normal birth and decreasing surgical births. Called Towards Normal Birth, the policy "provides direction to NSW maternity services regarding actions"  to achieve those aims.

At a recent conference with about 100 midwives looking at why and how to "keep birth normal' and what we as midwives need to do, a brainstorming session produced the following list.  These strategies run from the big ticket culture change items to the seemingly small, but profoundly effective 'watch our language' individual action.

The list:
1. Avert the medical 'gaze'
2. Be powerful and able to negotiate as equals to doctors
3.  Establish a "round table culture'
4. Dispel 'urban myths' about birth
5. Support women to choose upright positions in labour
6. Educate teenagers
7. Promote the use of positive images of birth
8. Look at system issues: promote and change to woman centred midwifery models
9. Discuss what normal birth means to us and ensure we are talking about the same things
10. Listen to women with respect - what does the woman want?
11. Encourage women in labour to stay home as long as possible
12. Establish and provide support structures to help women stay at home in early labour
13.Establish and provide support structures so women can choose to stay home to give birth if desired
14. Examine our own attitudes to 'being with woman' in pain and uncertainty
15. Seek to establish a relationship with each woman
16. Allay fear: let woman know what birth is really about
17. Address anxiety of support people and other health professionals
18. Pay attention to the language we use
19. Have confidence in women's ability to give birth
20. Pay attention to our body language as body language conveys meaning: what are we saying?
21. Set up birth space intentionally - find out what makes each woman feel safe and do that.

Each of these strategies could be a blog post on its own!  What do you think? What else can we do? How do we put these strategies into practice?


Julieanne Hensby said...

Hi Carolyn - Wonderful info - and not before time! I will 'share' as much as possible.
Warm Regards, Julieanne

InfoMidwife said...

thanks Carolyn, you really are an inspiration... I will put this up on the WA Blog and share to all.... I think I will even print and laminate your 21 strategies to keep focused.....and keep others on track....

Anonymous said...

An excellent article.
I am happy to say that Mareeba does virtually all of it.

Carolyn Hastie said...

Thanks for your comments Julieanne, Pauline and Judy. Glad to hear that Mareeba has that sorted Judy and of course, your statistics show that to be true! Pauline, producing the strategies as a laminated list is a great idea. Thanks too for sharing the ideas Julieanne and Pauline, I appreciate that very much. The more we can share ideas and think about how our services can be better, the better it will be for women and their babies (and for midwifery). warmly, Carolyn

WiseWoman said...

The first strategy would be: STOP INDUCING THE BIRTH PROCESS IN ANY WAY. When the birth starts on its own time, the scales tip dramatically in favour of, at least, a vaginal birth.

I hate to see "as long as possible" as the guideline for how long to stay at home. Most people think that means 5 minute apart sensations which, in reality, gets them tracking back and forth and exhausting themselves with worry, travel and dealing with strangers.
It needs to be more specific. i.e. stay home until the top shoulder is born.

Sarah Stewart said...

Here is the RCM's 10 top tips for normal birth:

Carolyn Hastie said...

Thanks Sarah, the more tips the better! You are funny Gloria - I agree and wish all women could feel safe in their own bodies and choose to stay home to give birth. An apt observation is that the first intervention in a woman's labour and birth is when she leaves her home.

Anonymous said...

How refreshing to see something like this coming from the medical fraternity. I think the more midwives we can get thinking along these lines, the better the health system will be for everyone. Nothing worse than going into a birthing situation and have your midwife tell you to stand up to the doctor and then meakly agree with everything they say!!!

Carolyn Hastie said...

Hi Anonymous, I'm a midwife, not the medical fraternity. Your comment that nothing worse than midwives who go along with what the doctors say is troubling. Sounds like you have had that happen to you. I'm sorry if that's been your experience. What would you have liked to happen?

Joy Johnston said...

Thanks for this information Carolyn. I have blogges it at the Australian Private Midwives Assn blog

Carolyn Hastie said...

Thank you Joy. The death of the woman from uncontrolled bleeding with placenta accreta written about in this post:

shows clearly the need to do everything we can to provide the right environment to keep birth normal.