Fads, birth and safety

A 'prominent' Perth obstetrician and president of the Australian Medical Association (WA) Dr Michael Gannon, was reported as saying that "an “obsession” with skin-to-skin contact between mothers and babies after birth is a fad that is putting newborns at risk of death and serious injury".  His comment appeared in the article 'Skin-to-skin' fad blamed for deaths of babies published in The West Australian online newspaper 5 March 2016.

The coroner is investigating the death of a newborn at the Fiona Stanley Hospital. The article suggested that the baby is thought to have died 'after the mother fell asleep while holding or breastfeeding the baby'.

The AMA president rightly raised concerns about drug affected, exhausted women:

"New mothers are often exhausted by a long day in labour and there are the side effects of opioid drugs, epidurals or c-section"

 Photo from Midwifery Today site

However, he also criticises what he calls a

" new obsession amongst mothers and midwives with immediate skin-to-skin contact after birth ... which "stemmed from taking whatever possible measures that might lead to small increases in the number of women who breastfeed"

Far from a fad, skin-to-skin contact for women and their newborns at birth and beyond is a well-researched instinctive behaviour. This instinctive behaviour has been shown to not only improve breastfeeding success, but also, combined with breastfeeding attempts, reduce the rate of primary PPH, along with enhancing the sense of safety and attachment for the newborn and her mother. There are implications for the newborn's microbiome and there is some evidence that skin-to-skin experience reduces mothers' stress levels.

The doctor is reported to have said, in response to the claims for skin-to-skin, that:

 “I think that gets over-interpreted. Babies, instead of being in a safe environment like a warming crib, are being left on their mother’s chest”

Now the attitude that a newborn is better off in a warming crib than with its mother is the nub of medicalisation of the childbearing process and the disconnect between the use of technology and our humanity.

The medicalisation of childbirth is a done deal. Whilst physiological birth is appealing from both an evolutionary and capacity building perspective, the reality is the majority of women in the western world, are already heavily socialised into accepting and wanting medicalisation. Whilst choosing and embracing medicalisation and interventions, women are drawn to the idea of having their newborns with them skin-to-skin from birth and in the main, to breastfeed them. There is even a push (excuse the pun) for 'natural' and 'self-assisted' surgical births. Midwives are drawn to 'keeping things normal' and whilst supporting women in their choices; they are also drawn to facilitating skin-to-skin for the woman and her newborn at birth.

There is no doubt that 'drug affected, exhausted women' are vulnerable, as are their newborns, to the creation of potentially asphyxiating situations. A review of Apparent Life-Threatening Events in Presumably Healthy Newborns During Early Skin-to-Skin Contact  highlighted the issues for six babies left prone, unsupervised by a midwife or other health professional, on their mothers' abdomens. 

The reality is that midwives are increasingly having to care for postnatal women who are 'drug affected and exhausted'. The current staffing levels are woefully inadequate to care properly for these 'drug affected and exhausted women' together with their newborns.  Some people suggest recruiting partners or other family members to observe the newborn who is skin-to-skin with its mother, but that's a cop-out. 

Daily Mail

Often partners and others don't know what to look for and the bottom line is, the woman and infant's well-being is the responsibility of the institution that provides the 'care'. 

Whilst a decrease in medicalisation of birth would be ideal, that ideal will need a revolution in society's attitudes. In the meantime, what the good doctor and the AMA should be arguing and agitating for is not a separation of a mother and her infant, but for women and their infants to be treated with the profound respect they deserve and adequate midwifery staffing levels so that women and their infants can benefit from best practice and have the support and expertise of the midwife's presence to ensure that experience is a safe one.

Dr Gannon and the AMA need to understand that it is not skin-to-skin experience at birth that is putting newborn babies at risk.

What's putting newborns and childbearing women at risk is the rampant, unfettered medicalisation of childbearing that pervades modern maternity services coupled with ridiculously inadequate staffing levels - that situation is lethal.

The mother whose baby died at the Fiona Stanley hospital deserves our heartfelt love and support, kindness and respect - not blame for her baby having skin-to-skin and breastfeeding at birth - she was doing the very best she could for her baby.

If the little one is found to have succumbed because of airway obstruction, then our society has failed her and her family.  Our society does not value childbearing women enough to provide adequate staffing levels and midwifery expertise to be their guardians through their most vulnerable time. 

A midwife's personal journey into supporting birth honestly

Elly Copp is a guest blogger today.

 Photo: Elly Copp

Elly is a hospital midwife working in a birth centre in the south-west of the UK.  She is also an integrative therapist in private practice in Bristol and where she lives, in Somerset.  I first 'met' Elly on twitter over a year ago and liked her approach to midwifery, women and birth. I was interested in Elly's many 'hats' and how she managed to work within the system with her approach to women and their families. I invited Elly to write a piece for this blog to share her rich understanding and experience and here it is.

Enjoy!

Elly writes:

"I recently attended a conference on “Attachment, Loss and Significant Change” which taught me such rich and relevant information that I have been able to synchronise all my learning for the first time. This experience feels like a culmination of years of process which has made a direct and immediate improvement to my work as a midwife and mentor.

The two presenters, experts in their fields, shared their knowledge with us:

Sir Richard Bowlby, spoke about his father, Sir John Bowlby and his work on attachment theory. He identified the key needs we all have in order to survive our life, which begins as early as birth. By the third trimester, a baby is equipped with senses, feelings, reflexes and a personality. We are born ready to make contact with our parents. Attachment is a core need and initiates in us a sense of belonging and feeling ok in the world.

Conversely, the effects of not having our needs met in the early days and not being ‘seen’ just as we are, is likely to have long lasting effects on health and relationships. Considering the impact on a baby when she loses her mother temporarily or permanently will have us all unsettled as we don't like the idea of it or how it felt when that was our experience. As midwives we are in a prime position to assist at these moments of a person’s life: mother, father and new baby, the evidence is there and now our challenge is to bring it into our daily work. The rewards for us as individuals will fuel more courage, compassion and love we have for ourselves and the women we meet.

The second speaker, Dr Una Mccluskey, talked about the roles of care seeking and care giving and the dynamic between the two. In our world these are the roles of ‘mothers’ and ‘midwives’. Midwives with good attunement antenna will pick up the ‘state’ a mother is in and will consider the next appropriate step. Dr Mccluskey says it's what the care giver does with that knowledge which is important. In order that she does that effectively, a midwife has to be aware of her own state, her own ability to regulate her internal system. This ability to self-regulate takes attention, commitment and support.

When fear diminishes, the ability to explore and be curious expands. That is true for midwives and the women they care for.  When we model our own state we see it mirrored and replicated. In her book “Why Love Matters" Sue Gerhardt looked at effects of being and feeling loved. When young people experienced no or poor attachment the consequence on their internal regulatory system was an inability to find equilibrium and resulted in negative, anti-social behaviours. What is known is that we do not manage so well in life if we have not felt the feeling of being loved and cared for, cherished, touched and cuddled by our mother or a mother like figure, a person who will stay with us long enough to understand us and regulate our internal state, and will keep coming back to us, again and again.

Watching film clips of mothers and their babies interacting and learning the theories behind this brings to life vividly the need for a secure attachment from the start, as well as feeling empathy for the newborn, the impact of a secure attachment for the baby on lifelong health is absolutely clear.

I consider myself very lucky , because I have been involved in some very profound births .I am often moved to tears and have the sense that I have been appreciated at a very deep level of the mothers'  being. These spiritual births where I feel a connection with the mother often come after she has experienced a traumatic time in a previous labour and birth .My understanding is that these women had been holding their trauma in mind and body and are very relieved to be able to let it go and feel pleasure, happiness and wonder in a birthing environment. It is my quest to remain open, available, curious and exploratory and I offer these mothers the same, and work very hard not to move myself or be manoeuvred or coerced by others into a fear state. The ability to translate that knowledge into practice is transformational and meaningful for the mother, the father the baby, the midwife and the student midwife.

As a midwife of 20 years, I am familiar with the realm of labour and birth and work in a birth centre where the environment is spacious. I learn here, and carry that knowledge to other places I go to, such as the delivery suite or ante /post natal ward for example. Even in a different environment I bring with me the assumption that this doesn't have to change a woman’s ability to birth and bond, and the baby to attach. When the environment is out of our control, we can still make it work, as everyone needs a supportive and companionable attachment system wherever they are.

A recent birth demonstrated to me how it is possible for a mother to change her physiology and emotional state when the people she has supporting her are present, being in the now, mindful and observant. I wish to share this with the intention that midwives reading this will be motivated to make their own deliberate but subtle and invisible switch in their own understanding and response. All the names have been changed to maintain confidentiality.

As a hypnotherapist, I am familiar with the mind and how it works, the limbic system, the cognitive brain and how the two are affected by each other and the environment. Dr Stephen Porges describes the neurophysiological foundations of attachment, emotions, communication and self-regulation so well in his book “The Polyvagal Theory ". It is quite manageable to digest and process the theory, the difficulty is making theory useful practically in such a busy environment where risk is calculated and expectations and therefore stress is high.

"Help for the Helper" by Babette Rothschild discusses how roles can get confused when boundaries are not maintained, the mirror neurones in our brain mean that before we realise it, care seekers are mirroring and mimicking the care givers own state.

It is significant that working in a fear state a lot of the time is not helpful or healthy for us, and has a part to play in burnout. We have a real vested interest to self-care and ensure we regulate our systems frequently to maintain our health. This is extra difficult when we are working a shift pattern which is pre-arranged for us. Add to that the variety of work needing to be attended to, which can be acute and immediate for a short or prolonged time, plus no breaks and the situation for the midwife can become untenable.

When a midwife is in fright / flight mode herself she needs to become aware and notice it quickly so she can shift it. Her brain will prevent any connectivity or attunement as long as it it is focused on anxiety. In such a situation the midwife cannot create a safe birthing environment; instead she becomes distracted and loses focus. No one is grounded, no one is self-regulating. 

Dr Mccluskey stated that in supportive relationships, a genuine response must match the depth of the other person’s situation; Women will know it if we show mixed messages. The words need to match our actions for us to be seen and trusted by the women in our care to have faith in us She states: " we are all hard wired to care for other people, to seek care for ourselves and to pursue interests " As midwives in a work environment where the care we give is increasingly scrutinised and critiqued retrospectively, seeking care for ourselves and pursuing interests can be the aspects where we are not so successful, and therefore less able to self-care. In addition our workload becomes greater and visibility around each other is reduced.

For a mother, when the fright /flight brain is in ascendance, dissociation from the self, the body and the baby will result (as a survival technique), it will not be easy for her to experience an empowered birth. I believe that when doctors, midwives, anaesthetists and health care assistants operate collectively from this place of flight/fright, disconnect is a constant presence.

When women can be in a calm and regulated state there is sufficient capacity for them to utilise internal resources, to stay exploratory and look for ways to cope. Ultimately they give birth in an engaged and connected way.

When a midwife successfully regulates her own internal state, the woman she is with can be in touch with her own skills necessary to deal with any upset. We are facilitating an environment within which a woman can build her own competence in the world, which is what she will simultaneously be passing on to her baby. Having worked in a birth centre since 2008, I have found my own ability to problem solve and find solutions has expanded and that is apparent in the confidence I have and pass to the parents I meet.

I am also a Bowen technique practitioner (Bowen is a way of working with the fascia and muscle spindles which rebalances the body via the vestibular system). During a Bowen session, a body can restore health and vitality to the best of its ability. There are clear parallels between Bowen and birth, because the same environmental conditions are required for best outcome. Michel Odent commented " an ideal situation for a mother to birth in is where there is as little interference to the mother’s natural process as possible: speaking, feeling cold, feeling unsafe and bright lights are stimulation which is not conducive to giving birth."

What seems to be happening during a Bowen session is that the body is allowed to re-orient to a memory of a previously healthy state or an original blue print of health. Many of the moves are made on areas significant during embryological development (John Wilks, The Bowen Technique). Like the mind and its ability to move from a fear state into a calm state, the body can do too, physiological changes occur when liquid crystals in the cells which hold memory and have the capacity to register a new experience which are highly receptive to change are touched.

Sheila Kitzinger writes about birth crises and the effects on bonding with the baby as well as any future births. Where a woman has experienced a shocking birth experience and felt helpless and out of control, that memory of helplessness stays with her. If she does some work to recover from her trauma, restore her self-esteem and confidence, she can experience healing in advance of her next birth. If she's doesn't, her bonding and attachment with her next baby will be negatively affected

Sir Richard says:

“If she doesn't recognise that state and therefore remains static she cannot release the dynamic energy needed to give birth to her next baby. She becomes stuck in her thoughts and in her muscles. This is visible in the way a mother uses her body in labour, during and in-between contractions, her posture, her eye contact and how she expresses herself and receives support”.

Putting all this into practice is sometimes straight forward and sometimes very complex. The woman I met called Suzy* and her husband John* seemed initially to be quite a simple care in labour, part of my daily work, but moved into a more complicated area as she moved through her labour and some details emerged.

Two years ago. Suzy had been in labour with her first baby in the pool, and out of the blue, the midwife became worried about the baby's heart rate. Suzy was rushed and hurried along a long corridor to the obstetric theatre where her daughter Imogen was born by forceps. It happened fast. Suzy and John were handed Imogen after a while when she was dressed. There were no other concerns about her health; the perceived concerns about her wellbeing during labour had not affected her wellbeing at birth. This aspect was never discussed though, and the couple were not given any more information about what had happened.

Suzy and John decided to have another baby a year later, but Suzy was very worried about how the birth would go during the second pregnancy. She only told John about this, he was as supportive and kind as he could be. He couldn't see they had any choices.  Suzy started her labour in the early hours and they drove to the birth centre, she wanted to use the pool again but was plagued by lack of confidence, worry and fear about it. She questioned herself so much that she couldn't actually think any more. It was a busy night and the couple met 4 different midwives over 4 hours. Suzy began to panic that her contraction pattern was spacing out. She started to think that this was an impossible situation for her. She was kneeling and closing her eyes a lot of the time.

I entered the room and saw a lovely and supportive man talking gently to his wife and introduced myself and my student who is gentle and kind and softly spoken.

My colleague who was leaving thought that the birth was imminent so we waited for some signs; it was 07:30 am.

We watched and attuned to Suzy and through John we learned about their experience with Imogen. Suzy said it was awful, she had been worrying about it, she didn't want that to happen again but she was frightened it was heading the same way.

I am very careful about discussing previous births with couples because my experience is that it can detract from this baby, but on this occasion, the nature of Imogen's birth needed to be spoken about out loud because the residual fear seemed to be stopping Suzy from giving birth. It felt like an elephant in the room.

My thinking is always how do I give the woman my full and complete attention, my whole person support without judgement or a set of conditions - as well as give her free reign to find her own path to birth her baby. I wonder and worry that I may be perceived as unsupportive, disinterested or lazy. In "Birthing Normally” Gayle Petersen details birth stories where she has attuned herself to women’s fears and needs and in doing this, has enabled the mother to birth her baby herself without any interventions. Whilst Gayle knows the women she describes, I am unfamiliar with the women I meet and not knowing them I cannot know their preoccupations and concerns.

Nine o'clock now and I observe Suzy in a pickle, she is wanting it to be over, saying she can't do it and becoming increasingly negative, defeatist and a little self-centred; rejecting Johns loving support. In my calm state I am wondering how to move Suzy out of her fear state and back into exploratory without being dictatorial or overbearing.

Where is that internal space for her to connect with herself, find her resilience and prepare to meet her baby? Dr Mcclusky says we are moving inside ourselves with other people all the time, and that self-regulation goes on as background music. "We are born with the expectation of being met as a person” resonates within me, and I want that for Suzy so that her baby receives that meeting.

Meanwhile Suzy is becoming more despondent and closer to giving birth (9cm dilated). Is analgesia the right thing to offer? Is that kind and appropriate I ask myself? Maybe, but I think not is my internal answer.

After another of Suzy's desperate outbursts that "she cannot do it", I realise she is overwhelmed and I ask her 3 questions very carefully.

What does she need right now - she answers “not to feel any of this”

What does her baby need right now - “to be born quickly”

How can the two align?  A pause and then - “I had better get a grip", said with a sense of authority and humour.

John smiles at me, as if we have made a breakthrough, it feels like she has moved from her fear state to her maternal and problem solving state.

That is the moment the labour changes, because 30 minutes later and without any pushing at all her baby's head is born in the pool, the membranes are intact and still over his face when Suzy brings Harry to the surface.

We were all in tears, moved by her capacity to change and in how by releasing something negative from her past she became free to move energetically and give birth so smoothly.

A few hours later, we chatted it over and she said last time her birth had been taken away from her, she felt she had lost a part of herself which she hadn't realised until this birth. I told her what had been going through my mind about analgesia, and she agreed she had been thinking that too - I reflected how we had synchronised. She loved having so much skin to skin with her baby because that had not been included last time, and she valued us as helpers and enablers whilst we saluted her for her courage and commitment to her baby.

To conclude, I do not say that having this understanding will mean all births are going to be smooth or straightforward, but I do believe that seeing a woman for who she is gives her choices and with those choices she can make the best decisions for herself and her baby.

 

The approaches I use incorporate my knowledge of hypnosis and Bowen technique, directly and indirectly. Sometimes I use touch, and sometimes calm and reassuring suggestions. The midwifery training itself did not give me a good enough education to understand the minutiae and nuance of what birth entails. I was shocked when I was in labour with my first baby that my training had not prepared me for the realities of birth and what resources I needed. It has taken years of work and application, critique and evaluation to reflect on what holistic means and how to see women holistically. It is a journey not encouraged within the hospital system and finding my own identity has been a hard slog but one I could not avoid. My passion has stemmed from a mixture of sources and is maintained by the appreciation I receive from women and their families as well as colleagues and students. When a mentee says "all we are told about is litigation and self-protection" I worry a little bit more about the lack of self-awareness and acknowledgement these fledging midwives are being trained in.

The other motivation is personal: as a daughter, wife and mother of four, I have to keep working at all my relationships - and in trying, my efforts will be seen, and I will be met as a person. 

You can contact Elly via her email eleanorcopp@me.com and she tweets as @EleanorCopp

REFERENCES

Bowlby,EJM. (1997) Attachment: Volume 1 of the attachment and loss trilogy. (1st ed) UK:Vintage publishing. 

Gerhardt,S.(2004). Why love matters: how affection shapes a baby's brain.(1st ed.)UK:Brunner-Routledge.

Kitzinger,S.(2006). Birth Crises. (1st ed.).UK: Routledge.

McCluskey,U.(2005).To be met as a person: The dynamics of attachment in professional encounters.(1st ed) UK:Karnac. 

Peterson, G. (1984). Birthing Normally: a personal growth approach to childbirth (2nd ed.). USA: Shadow and Light.

Porges, S (2011) The Polyvagal Theory: Neurophysical foundations of emotions attachment communication self-regulation. (1st ed) USA: W.W.Norton and company.

Rothschild,B.(2006) Help for the Helper: self care strategies for managing burnout and stress.(1st ed ) USA:W.W Norton and company.

Wilks,J (2007)The Bowen Technique: The inside story (1st ed) UK:CYMA LTD.

Natural Births A Major Cause Of Post-Traumatic Stress? Wrong!

A Tel Aviv University researcher has linked natural birth with post traumatic stress disorder (PTSD).

Natural Births A Major Cause Of Post-Traumatic Stress

Interestingly, some people consider that PTSD is a very modern trauma

According to the Tel Aviv study, 1 in 3 postnatal women in their study sample showed signs of PTSD while a small percentage were severely affected.

What causes PTSD?  A posting on medical news today in 2009 states that PTSD is triggered by a traumatic event and that:

"The sufferer of PTSD may have experienced or seen an event that caused extreme fear, shock and/or a feeling of helplessness".

"a woman is four times more likely to develop PTSD than a man. Psychiatrists say this is probably because women run a higher risk of experiencing interpersonal violence, such as sexual violence"
Traumatic events that commonly trigger PTSD in women - these include rape, sexual molestation, physical attack, being threatened with a weapon, childhood physical abuse.

Given that labour and birth are innately highly emotional, vulnerable times for women - and that is to enable the liberation of the 'love hormone' oxytocin - the emotional 'fixative' for attachment, bonding and breastfeeding - the feeling is a natural 'high' - the reward for labour and birth;  care needs to be respectful, supportive, kind and competent for labour to go well.  Women need to feel in control, to have agency and feel safe during labour and birth.   Numerous studies have found that women labour and birth well when they have caregivers they know and trust.

Photo of joy filled mother with newborn

Women who have their emotional needs met in labour and birth enter motherhood feeling awesome!

Feeling good after giving birth is not about whether it was natural or not, it is not about whether you coped with the pain or not, although labour is much harder to handle when you are not in a good environment or in control of what's happening to you - it's about how you are treated, how well supported you are, how protected and private your birth territory is and how well you feel in control of what's done to you.

I think the good doctors need to investigate what is going on in their hospitals! They are 'barking up the wrong tree'.

Midwifery Care: What's in it for Women?

What is midwifery care?


The debut video for I am a Midwife, a new online series about midwives and what they do, explores just that! Eight different "real life" midwives describe the safe, satisfying and supportive care midwives in all settings provide women and their families!

From the Midwives Alliance of North America: http://mana.org/IAAM/

Giving birth is not a competition

International Women's Day has been a powerful reminder of how far we've come as a species.

IWD has also shown how far we still have to go to create a social world where the vast majority of women and many men enjoy the human rights of sovereignty and social safety to live as they desire and deserve.

From delusions of being able to create the master race to the idea that you can reduce or even eliminate risk in life, medicine and science have sought to control and dominate nature.

Nowhere is this more apparent than in the area of reproduction and in particular, for western women. Western women have come under increasing surveillance, control and criticism from medical 'experts' and the population at large during childbearing and parenting.  Conflicting advice abounds creating confusion and distress for women, all of whom want the best for their babies and want to do 'the right thing'. Women are told on the one hand that the rate of stillbirth doubles after age 40 and so induction around 37 weeks is recommended. On the other hand, other experts say that babies born early around 37 - 38 weeks with induction of labour are at risk of health problems.

What's hard to reconcile with the constant negativity with what is a very normal, human activity is that evidence shows that medical error causes more death and disability to people in hospital than motor vehicle accidents, breast cancer or AIDS. You may note that childbirth doesn't get it a look in with the comparison because the real problems with childbirth, even those caused by intervention, are so low in the western world. The other disturbing fact about hospital culture is that people are afraid to report errors because they fear recrimination. So really, we don't know what actually goes on in hospitals. Our only clue in NSW for example, is the Mothers and Babies report and that is a broad brush view.

We do not know exactly what the rate of intervention in the birthing process is doing to developing brains and human relations, but there are some signals that there are detriments.

Various individuals and groups challenge medical domination of birth and the medical profession's dismissiveness of the social aspects. There are thankfully, some enlightened doctors championing "patient" centred care and calling on clinicians to "relinquish the role as the single, paternalistic authority."

Films such as the Face of Birth, which aim to defuse the hysteria and show the social view of humanity's most primal act, have a tough gig. The media's delight in traumatic tales, coupled with 'reality TV's' depiction of birth all flavour enhanced by the medical profession's staunch opposition to birth at home and midwifery care, especially in Australia, has led to public opinion becoming increasingly hostile and disapproving of those who choose other than the 'doctor in charge' status quo. As a result, western women are becoming increasingly fearful of birth.  They are increasingly feeling under 'siege', a state of perpetual fearfulness. What is not so well known is how 'fear' affects a person's physiology.  The biochemical correlate of fear is cortisol. There is a lot of work being done on the effect of cortisol on physiological functioning and brain development for the fetus. Prenatal programming is a burgeoning field of inquiry investigating how a person's lifetime risk of disease or health is actually 'set' in the womb and dependant upon the mother's social world. We need to really wake up to what that means.

Western women are also becoming increasingly insecure about their parenting, which for heaven's sake is hard enough without the avalanche of 'advice' and disapproval from all and sundry.  I have been reading the comments under the mass media's articles on birth at home and the different perspectives are fascinating and show how we all see life through our own lenses of beliefs and experiences.  What, however is alarming, is the punitive and nasty way that some people respond to people's choices.

The scorn and criticism heaped on women who choose to do things differently, no matter what 'norm' is being touted by whichever interest group, is horrendous and needs to stop.

Where a woman gives birth and who she gives birth with is her business. For anyone to think they care more about a woman's life and baby than she does is the height of ignorance and arrogance. Our job as a society is to support women's choices because the evidence is clear that when a women feels supported and has choices her cortisol level is lower and her physiology and therefore her baby's physiology is more likely to be 'normal'.

Birth is NOT a competition.

It is about feeling safe, supported and respected.  Interestingly, the outcomes, including those of maternal satisfaction, are very very good when that is the situation. On another note, so many people downplay the need for the woman to feel good after birth - the health and wellbeing of the family are enhanced when a woman feels loved, respected and cared for, so that should be the focus of society.  We need to ask ourselves where does she feel safe and how can we, as a society support her in that?

Meanwhile, in too many countries, women are dying in childbirth.  The current estimate is that around 1000 women die every day giving birth.  That statistic is shocking and, with the right conditions, preventable.  These statistics illustrate clearly the social determinants of health and disease. Women are dying because in their cultures, they are "nothing" - they are worthless in the eyes of their culture  - they are the possessions of their partners or parents; they have no access to contraception and often have (too) many children, their nutrition is very poor, they are dreadfully anaemic, in some areas have malaria, HIV/AIDS and live with domestic violence and the threat of more of it hanging over their heads. Their living conditions are harsh. If we use Maslow's Hierarchy of Needs to think about the social determinants of health, you can readily see that these women exist without even their basic human needs being met. No wonder the challenges of reproduction are sometimes too great for them.  These women do not have the best conditions at home to give birth there - even the hospitals are poorly equipped and lacking in staff, but at least there may be someone there, with some education and training, who can support them and help them give birth safely. We know that when there is a strong and capable midwifery profession,  childbearing women and their babies do well.  Capacity building midwifery education is one of AusAid's projects to improve maternal and neonatal wellbeing and decrease mortality and morbidity rates in PNG.

People in the western world who are so concerned with what childbearing women do and where they give birth need to turn their attention to the developing world and work on making it safer for all women and their children.  We are, after all, living in a global village. What affects one, affects us all.

Instead of making birth a "who's right or wrong' competition, let's make it about cooperation, compassion and support.

If we want a peaceful society and happy mothers and babies, we would do well to ensure women felt loved and cared for, respected and nurtured, fed good food, rested, kept away from bad news and surrounded by loving family and friends and able to give birth the way they want to, with people they know and trust around them.

Creating Optimal Birth Space

The environment in which we live and move and have our being is critical to our physical, mental, spiritual and social functioning. More and more understanding is emerging about how the environment plays a pivotal role in all aspects of our lives. From mice to (wo) men, science is demonstrating that the body's neural network is "plastic", that genes are not destiny and that the "environment" is an integral part of how living creatures function and develop. Every physiological interaction and behaviour, from the way genes are expressed in the sperm and the ovum to our health and experience across the lifecycle depends upon the environment. The environnment gives feedback which will be either nourishing and provide the stimulus to function well and grow or hostile, which disrupts our functioning, leading to disease, distress and decay.

Recognition of the way the environment is integral to optimal functioning is expanding our understanding of the role of maternity care in providing optimal environments for childbearing women. The science is also demonstrating why woman centred care, facilitating the fulfilment of woman's choices and incorporating women's rights into maternity care are so much a part of optimising outcomes for women, their babies, their intimate relationships and society in general.

My friend and colleague, the wonderful Maralyn Foureur, Professor of Midwifery at the University of Technology of Sydney (UTS) presented on this topic at the recent homebirth conference in New Zealand.  Maralyn is heading up a research team exploring birth space and has attracted a highly prized NHMRC grant for this work. 

Click the link below and it will take you to the slide share of her presentation

Creating Optimal Birth Space

I think you will enjoy and get a lot out of her research.

Right Livelihood Award: Ina May Gaskin

The world's premier award for personal courage and social transformation, The Right Livelihood Award honours and supports those "offering practical and exemplary answers to the most urgent challenges facing us today".

The wonderful Ina May Gaskin, affectionately referred to as 'the mother of midwifery', was awarded the Right Livelihood Award this year for:

“… for her whole-life’s work teaching and advocating safe, woman-centred childbirth methods that best promote the physical and mental health of mother and child.“

Ina May's acceptance speech is sobering as she carefully catalogues the abuses that have been and continue to be perpetrated against women and their babies in the name of industrialised birth; inspirational as she talks about the brave and loving doctors who have acted in the face of repression and vilification from their less than women centred peers and seek to scare women into submission to the medical juggernaut...

"We must wake up to the fact that it is easy to scare women about their bodies, especially in countries in which midwives have little or no power in policy-making, relative to physicians and the influence of large corporate entities. This takes no real talent. Given such imbalance, fear, ignorance, and greed begin to reinforce each other, and rates of unnecessary intervention soar, with women and the babies suffering the consequences"

Ina May's speech is heart warming as she asks the Hungarian Goverment to release Agnes Gereb, a Hungarian doctor who supported women to birth at home and encouraging as she offers a vision of a better world through optimising midwifery care and supporting women's choices ...

Another site came across my computer screen this morning, and given the content is highly relevant to the content of Ina May's speech, I thought it was entirely appropriate to link it here.

I'm not sure why the midwife broke the sac on this breech baby as she was born, I would have thought it was better left alone to provide that lovely buffer that intact membranes offer.  Even so, I'm grateful to the woman and her family and to the midwives for sharing this delightful photo journey. The explanatory notes are very useful.

Ina May's book Spiritual Midwifery, together with Frederick Leboyer's Birth Without Violence, changed my world when they were released in 1976.  I first heard Ina May speak at a preconfernce workshop at the 1992 Homebirth Conference in Sydney.   I was so emotional on being in the presence of Ina May, that I spent most of the workshop in tears - her passion and 'right thinking' about women and birth still has that effect on me as I watch and listen to her speech accepting her Right Livelihood award.  Thank you Ina May for all you have done and are doing for Women and Birth and Midwifery.  Congratulations on receiving this prestigious award. You certainly deserve it.

What birth activists can learn from Steve Jobs

Steve Jobs, the person, will be sadly and achingly missed by his family and friends and Steve Jobs the genius, will be missed by those of us who enjoy the amazing fruits of his formidable creativity and attention to detail.

So why, on a midwifery and birth related blog am I talking about Steve Jobs?

Hugh @gapingvoid an amazing cartoonist, had an obituary for Steve Jobs on his site yesterday.  He quoted Steve Jobs in this way:

Hugh rightly said that Steve's legacy is more than the hardware, wonderful as that all is, it's what he "helped us believe about ourselves".

So important to believe we are capable, strong and courageous and that we can go beyond the boundaries and limitations imposed by upbringing, culture and the myriad other influences that seek to contain our genius and creative self expression.

Nowhere is this more important than with birth and the bringing forth of life.

Those of us who are birth activists, who care about how women are treated in the birthing world; who care about the way that babies are born and how the whole childbearing experience is constructed for women, partners/fathers and babies all over the world need to read these words of Steve Jobs and take them to heart.

We want to change the birthing world for the better and we can!

Thanks for reminding us what we are capable and who we are Steve.  RIP.

Strengthening Midwifery in PNG

Giving birth and being born is dangerous in Papua New Guinea.

According to the National Department of Health Ministerial Taskforce on Maternal Health in Papua New Guinea the staggering rate of maternal mortality in PNG is a national emergency.

Every day, at least five women die of preventable childbirth related causes. Sixty per cent of childbearing women do not have access to skilled birth attendants and because there are only 270 registered midwives in the whole country, outside of the understaffed and under resourced regional hospitals, maternity and newborn care falls on the shoulders of community health workers and nurses.

In  September 2000, Papua New Guinea committed to combat poverty, hunger, disease, illiteracy, environmental degradation and discrimination against women and signed the United Nations Millenium Declaration, along with the other 190 UN member states. Eight Millenium Development Goals  were derived from this declaaration with specific targets and indicators. The PNG National Department of Health is targetting the 4th (reduction of infant mortality) and fifth goal (reduction in maternal mortality).

Midwives are internationally recognised as the number one primary health care professional for optimal safety for mothers and babies at birth. Even though there is recogntion of the vital role of midwives in optimising maternal and infant wellbeing and thereby reducing maternal mortality and morbidity in Papua New Guinea, the capacity to produce midwives too low and the number of midwives has remained stagnant. The midwifery workforce is aging and the registered midwives, few as they are, are rapidly approaching retirement.  Over the last five years, reports on the state of Midwifery Education and Maternal Health together with the National Health Plan have all focussed on increasing the midwifery workforce with the aim of having a midwife in every health centre and a skilled birth attendant for every childbearing women.

The reality is harsh. Too many women. A failing health system. Not enough midwives.

A sobering article in the Sydney Morning Herald in 2009 captured the issues and conditions succinctly on this date two years ago. Those issues and conditions are unchanged or worse.

Against this backdrop, the National Government of Papua New Guinea has partnered with the Australian Government to strengthen midwifery and capacity build the existing educational systems. Eight midwives started a month ago to work in pairs in four university programs with the educators and students to ensure the PNG National Standards and Competencies are achieved.

I'm fortunate to be one of the midwives, based at Pacific Adventist University (PAU) and working clinically with students and educators in the women and babies wing of Port Moresby Hospital.

The midwifery facilitation team, minus one and plus two!
From right to left Sue Englend (visiting Port Moresby), Lois Berry (based at Madang) Tarryn Sharp and her daughter Willoughby (PAU), Marie Treloar (based at Goroka) Alison Moores (University of PNG at Port Moresby), Glenda Gleeson (Mandang) Annie Yates (the Kiwi: University of PNG) and yours truly (PAU).  Missing from the photo is Heather Gulliver, who is also at Goroka with Marie.

Today, there was another big step in the right direction of strengthening midwifery in PNG.

The PNG Midwifery Society had their inaugural meeting in the conference room of the women and babies wing of the Port Moresby Hospital.

Fifty one midwives, nurses with midwifery education (unregistered) and student midwives crowded into the conference room to discuss professional midwifery matters.

Student midwives from PAU.

We booked a bus to bring the students and educators from PA University (about 30 minutes away from the hospital) and take them home again after the meeting. The students loved the experience. A very new experience for everybody.

The students are great fun and keen to learn. The educators are amazing people who are very welcoming and want their programs to meet the profession's needs and the Council's regulations. The midwives are appreciative of the students' work on clinical days as the midwifery workforce is scanty and the workload is huge. There is a lot to do to get things right in PNG.

Following the business of the meeting, the buzz was electric as the society member's shared food and conversation

                                                           

As part of the Australian College of Midwives committment to supporting and strengthening midwifery in our closest neighbour nation, four members of the society, two from Port Moresby and two from Goroka have been sponsored by the College to attend the Biennial Australian College of Midwives Conference in Sydney. Another initiative in strengthening midwifery in PNG is the  International Midwives Twinning Project. Two members of the PNG society are being sponsored by the Australian College of Midwives to go to the Hague, with two Australian College members to discuss and explore professional matters at the end of the month.

We know that when there is a strong and autonomous midwifery profession, mothers and their babies do well. The PNG Midwifery Society has the potential to play an enormous role in strengthening midwifery and creating a proud and powerful professional group for midwives, which in turn, creates a safety net for the  mothers and newborns of PNG.


Judging by today's conversation and the turn out for the meeting, the Society is well and truly up for the job!

"All women have the right to dignified health care."

I'm posting this email in its entirety. There is nothing that I can add to the information in this heartfelt request. The title of the post says it all. I've donated and I hope you do too. Thank goodness for women who care like Adina and midwives like Hannah. What a blessing to the world they are!! 


Hello Carolyn,

I read your natural birth blog, and really appreciate what you stand for. I live in a developing country,  Guatemala, where women are not educated about birth choices and many times they only have one option. Due to lack of money they go to the public hospitals where there is more than 70% C-section rate. Then, confronted with birth trauma, they search for any other option possible. Many of them find my midwife with Manos Abiertas, a clinic dedicated to helping these women have a natural birth.

 In a developed country, people have the luxury of forming a self-educated opinion on their preferred manner of giving birth, thankfully, and we are working towards making that an option in Guatemala.

 The clinic that helps mostly indigenous and low income Guatemalan women works on a sliding pay scale. This often means patients visit free of charge or pay much less than their visit costs, because most can't afford the $5 for a checkup. However, as anyone involved in midwifery knows, there are always numerous costs involved.

I am asking you to help by spreading the word via an interview with one of the only licensed midwives in Guatemala who has her own birth clinic: Hannah Freiwald. She explains the situation here: http://www.all-about-guatemala.com/registered-midwife-guatemala-interview.html

You could also help by spreading the news via blog story told here: http://sagaunscripted.blogspot.com/2011/06/birthing-options-in-guatemala-city.html

If you are able to make donations, thank you. If you are not, but you can spread their story, thank you! Every little bit helps.

If you can link to us on your blog or forum, more people will see and hopefully help. I am not a midwife. I am only a citizen who supports my midwife and who sees a very great need with the women of Guatemala. If nothing else, they need the power to choose their birth. They need the right and education to know and choose what happens with their own bodies. Together, we can make this an option.

Thank you,

Adina Barnett

Manos Abiertas

"All women have the right to dignified health care."