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.

"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."

Judging Right and Wrong?

Great changes are happening to midwifery and women's birth choices in Australia. The government has passed legislation that on the one hand gives more autonomy and a wider scope of practice to midwives working in the public health system and on the other hand, restricts the services able to be offered by midwives in private practice. More women will be able to have their babies at home as more public hospital homebirth services are being offered. However women will have less ability to choose their own midwife. In accessing publicly funded services, women will have to, in the main, take 'pot luck' with their midwives. Women who have 'criteria' also known as risk factors will be denied a choice of birth venue, even though many of the risk factors are poor predictors of outcomes. With good midwifery care, these women birth  well.

I have had an email from someone recently who is absolutely distraught because her local hospital staff are bullying her into having another caesarean. The maddening thing is that the woman has given birth normally both before and after the caesarean birth. The hospital where the woman lives has a 'once a caesarean always a caesarean' policy and does not take into account the individual and her circumstances . The woman is unable to pay a private midwife and any other options are non existent.

Just yesterday, a woman who was booked to have a homebirth with a publicly funded service, was explaining to some midwifery students how she found out that her allocated midwife was off when she went into labour. She rang the phone number and got a midwife on the other end who she felt was not the least bit interested in her. The woman told the students how uncomfortable she felt and how she had to ring someone in charge and get another midwife allocated to care for her. She was finally allocated two midwives she felt good with. Once that arrangement was settled, she was able to focus on her baby and her labour. She went on to have a her baby at home.

I've found the various perspectives on the current changes polarised and distressing for many people. I can understand the distress. Change is always challenging. Many people feel we are losing too much. I believe that we have to stay focused on what we want and how we want maternity services to be. Focusing on the problem only adds energy to the problem. Looking clearly at what is going on and then choosing our path and taking action is a much better way.

I truly want everything - I want women led maternity services.  I want women and their babies to be safe and given the care they want so that their physiology works well and their safety is optimised. I want publicly funded birthing services, including venue of choice to be freely available.  I want midwives in private practice able to work to the full scope of their practice. I want 'no fault' compensation for women and their families when babies have problems as they occasionally do regardless of birth venue.  I want women, midwives and doctors to work together and with other health care providers as needed for any particular woman's circumstances.  I believe we can achieve these changes.

Imagine my delight when I found this email newsletter in my inbox from a wonderful man, Charlie Badenhop, this evening talking about right and wrong. Charlie is a fourth degree black belt and certified instructor of Aikido in Japan, and a certified trainer in NLP and Ericksonian Hypnosis. He is also a long term practitioner of various forms of bodywork, Self-relations therapy, the Japanese healing arts of sei tai and seiki jutsu, and Yoga.

I have found Charlie well worth listening to as he always has something interesting and appropriate to say. As I read the newsletter, I thought how pertinent Charlie's writing is to our circumstances. I wrote to Charlie and asked if I could share the newsletter. He readily agreed and to my surprise, told me that at one stage he had thought about becoming a midwife but ended up in Japan instead.

Enjoy!  If you like what Charlie has to say, you can subscribe to his newsletters down the bottom of the blog post.

"Pure Heart, Simple Mind"(tm) is the Seishindo newsletter written and edited by Charlie Badenhop (c).

Punishment, and the concept of "right or wrong"

"A lot of the best learning I received as an Aikido student came when we were outside of the dojo with sensei. We could be having a cup of coffee, or occasionally having a drink, and at some point it would become clear sensei had a message to deliver.

Once we were sitting in a coffee shop waiting for a train in the countryside.
Seemingly out of nowhere, sensei said, "I think there are many people in the world who act in a confrontational manner, and thus I wish more people understood the Aikido principle of non-dissension."

"Instead of spending so much time and so many human lives quarreling over who is right and who is wrong, I think the world would be a better place if we spent more time exploring how both sides are both right and wrong."


Myself, and the other two students sat there and said very little, knowing sensei was just beginning to get warmed up.

"You see," sensei said, "In Aikido we learn to refrain from engaging in confrontation, but that does not mean we shy away from protecting ourselves. It always intrigues me when new students attend a class and ask, ‘How can Aikido really be a martial art if you don't attack or retaliate against your opponents.' By this time the three of you have heard my reply many times over. In Aikido we have no attack form because we have no desire or intention to harm our adversaries. Instead we strive to bring hostilities to a conclusion that is respectful of all involved."

"If my opponent has never harmed me, never struck me, never hurt me, then why would I want to hurt or punish him? Do I want to punish him simply because he has thought about hurting me, or because he has made a weak effort that was easily rebuffed? You see, even in a court of law, you can't charge someone with murder simply because they thought about murdering someone. Attempted murder and actual murder are two very different crimes. When I am relaxed, aware, and fully present in the moment, then my adversary will have little opportunity to successfully attack me. Since he hasn't hurt me, since he hasn't truly threatened me, I have little desire to punish him in any way. His own thoughts, and the negative results he achieves in the world will be punishment enough."

"Related to punishing someone, is the idea of someone or something being either right or wrong. In Aikido, we learn to refrain from believing one path, or one way of thinking, is inherently superior to another. We also learn to refrain from engaging in thinking that any one point of view is the opposite of others."

"When we think in terms of opposites and disagree with someone else's opinion, we begin to oppose the other person's point of view. And this is exactly the kind of thinking that leads to resisting, combat, antagonism, and an overall disrespect for our perceived adversary."

"In Aikido, we do not attack, but we also do not concede or give up. In every day life the same can be true. Without attacking the viewpoint of others, without conceding or giving up our own viewpoint, we can still maintain ourselves, and continue to act in a way that is consistent with our beliefs."

"Keep that in mind," sensei said as he looked across the table. "More than once I've heard you arguing with other students, trying to prove your viewpoint was more correct than theirs. When you act like that, not only will you fail to convince them that you are right, and they are wrong, you'll also wind up losing them as friends and allies."

"Pure Heart, Simple Mind"(tm) is the Seishindo newsletter written and edited by Charlie Badenhop (c). All rights reserved. Click if you would like to subscribe.

Flu vaccination ban goes national after fever, convulsions in children

More than 60 children around WA have had adverse reactions to the flu vaccine, Fluvax. This vaccine contains three different flu components, including swine flu. If a child has already been exposed to swine flu, experts suggest that some children may be reacting badly to receiving a second exposure. Reactions have included febrile convulsions leaving one child in a critical condition. Doctors have been advised by the department of health to stop giving the vaccine to children under five years of age.

Photo from WA News 23rd April 2010

The official response to the adverse reactions has been remarkably slow.

Chris Thompson reported in WA News that

"WA's chief public health officer Tarun Weeramanthri has defended the response time in closing down the state's juvenile flu vaccine program amid revelations that children were presenting with convulsions more than two weeks ago".

The ABC said on Friday, 23rd April, 2010, that authorities in SA and Queensland have also acknowledged a number of adverse reactions to the vaccine in young children. The AMA have agreed with the ban on Fluvax to young children, however they caution parents not to lose confidence in immunisation.

In the ABC news story on Friday, Professor Peter Collignon, from the Australian National University, whose expertise is in infectious diseases, voiced concern about wide scale vaccination with Fluvax. Professory Collignon doesn't think that we have enough data to roll out a population wide vaccination program because it might cause more harm that good.

I'm wondering if the delayed reaction to the widespread reaction to the Fluvax is the result of an inability to truly perceive what was happening because the phenomenon is so outside the belief system that has been created about vaccination.

While the authorities claim they were monitoring the situation, the reality appears otherwise. They appear to have been rationalising.

The pro- vaccination lobby has been virulent in the way that open debate and discussion about the value of vaccination has been squashed until now. Dissent has been forbidden, thought patterns about vaccination have been dictated. I was told at an immunisation nurses' update session to leave the room if I didn't agree with newborn babies being given Hep B immunisation. I was seeking honest, open discussion and information. I was told "you have to believe!!" in very strong tones. Well, I don't agree to 'just believe' I want to keep my thinking open, curious and able to critique events if and when they occur.

The cult like behaviour that accompanies the pro-vaccination stance reminds me of fundamentalism.

Fundamentalism in any context is dangerous. Slavish following of 'science' is no different to slavish following of 'religion'. Slavishness removes the ability to discern, debate and think clearly.

The delayed response to the childrens' vaccine reactions can be seen as a symptom of a fundamentalist, non thinking bio-behavioural state.

The Term Breech Trial and Catholic Priests paedophilia are both examples of slavishness; also recognised as cult like behaviour - (no independent thinking encouraged or allowed) with dreadful sequelae that continues to reverberate.

Programming the future

My friend came back from England yesterday.  I picked up her daughter in the early hours and we drove to the airport together to meet her mum. Her daughter is in year 12. Studying is her major activity. The sunrise was stunning. Intensely pink and orange light filled the sky over Sydney as we made our way towards the airport. We chatted about her studies and what she hoped to do in the future. I was impressed with her clarity and vision.

Next week, as part of her family and children studies, all her group are being given a 'baby' to take home. The students all have to pretend it is a real baby and do all the things that mothers do when they have a new baby.  As many new mothers have never even held  a baby until they give birth to their own, this initiative is an effective way to help address that deficit in embodied knowledge.

I asked about feeding the baby. "oh, I have to give it a bottle and make up the formula" was the answer.

The conversation that followed explored the damaging message that this very creative and innovative exercise was unwittingly sending about how babies are fed.

The well intentioned, but ill advised, baby care education promotes bottle feeding as 'normal'. Young girls get that message early, for example, when given a baby doll complete with bottle as a gift for their birthday or Christmas. Have you noticed how those dolls all have bottles?

I went to the NSW Department of Education's website and looked up the curriculum for the "Exploring Early Childhood" program. 

The syllabus is very comprehensive.

Infant feeding, including a thorough section on breastfeeding is there, but no mention about how these subjects are taught. The practical application of knowledge to behaviour by providing a baby model for each student to take care of and feed is excellent. However, teachers need to ensure that students are able to 'breastfeed' the 'baby' as a matter of course.

Then young adults will get the right message: that breastfeeding is 'normal'.

As we pulled into the airport car park, my friend's daughter said she was grateful for the conversation, because she 'hadn't thought of it like that'. 

Neither would she.

Why would she? 

People don't know something until they know there is something to know!  When all society's clues and subliminal messages point to bottle feeding as 'normal', for a counter truth to have traction, you need other experiences or input, perhaps from a breastfeeding aunt, friend, neighbour or mother to enable you to think differently to the crowd, to be able to challenge the 'status quo'.

 La Leche Materna

After the event is a terrible time to learn the truth about what you can do to give your baby the optimal start in life. 

Caesarean vs VBAC a dramatic difference

This is a very inspirational and moving video by Alexandra Orchard about her birth experiences.


Cesarean vs. VBAC:  A Dramatic Difference from Alexandra Orchard on Vimeo.


There are some very interesting comments on Alexandra's page. Click this link or cut and paste into your browser.

http://vimeo.com/5648654

Government sold out to the AMA

 "The new regulatory framework includes a request for midwives to form a collaborative relationship with doctors, requiring their sign-off to access Medicare insurance and pharmaceutical benefits"

This bit of legislation has put midwifery under the control of doctors and sold out women's choice to birth at home with her own midwife

 

and is it no wonder when our prime minister, the honourable kevin rudd, at the AMA's union dinner says:

"In particular, tonight I want to acknowledge the hard work of Andrew Pesce as President of the AMA. I've appreciated Andrew's input and his engagement with
the health reform agenda in the meetings that we have had together in recent weeks.

The Government and the AMA are both committed to tackling the long-term challenge of health reform, and we are both committed on the direction we need to take to tackle this challenge - in particular, on the need for stronger clinician leadership within our health system.

In July last year, the AMA told us about the sorts of things that they would like to see in health reform....

Andrew, we heard you."

Date: 10 March 2010
News Type: Speech
Title: Speech to the 2010 AMA Parliamentary Dinner


Senate passes controversial birth bill | Herald Sun

Private practice midwifery

I've been quiet on my blog for a couple of weeks. I've been thinking a lot.

Over the last two weeks, I have been contacted by more and more women wanting one to one midwifery care.

The  women who have contacted me include:
1. Women who live outside the boundary set by publicly funded homebirth services
2. Women who prefer to know their midwife and have one to one care, rather than take 'pot luck' on which midwife will be there at the birth
3. A woman having twins who is apprehensive about all the negativity around having twins and being 'routinely' done to -  you know, induction, epidural... etc. She wants a midwife to go to hospital with her because she doesn't trust the 'system'.
4. A woman who has had three births via caesarean and wants to birth normally.
5. A woman who has had two births via caesarean and wants to birth normally.

To me, this signifies a problem with the 'system' of maternity care in this country. Women's rights are still being ignored. The importance of birth and freedom of choice is still being ignored.

The mountain of research which demonstrates that pregnant women's emotional as well as physical needs must be met to enable optimal health and wellbeing of the mother and her baby is being ignored.

Now is the time to write to the government, the opposition and all your local members talking about these human rights issues. Write your letter. Send it by snail mail. I've been told that a letter from any person is seen as representative of 100 members of the community.  Google the various political parties and all the politicians and their addresses are easily found. Our lives are being over regulated and under serviced. Time for a change. Please make your voice heard.

YouTube - Our bodies rally.wmv

On the 18th February, 2010 in 14 locations across Australia, 1000's of people rallied to register their protest at the Rudd Government policies that threaten to restrict options for women.

Jane Palmer's wonderful video montage of the rallies for women's right to choose what happens to their bodies in childbirth

And some media on the 'issue'


The Sunrise piece that seems to have stirred up the Government

http://au.tv.yahoo.com/sunrise/video/play/-/6819641/

a TV piece from Chan 7 yesterday

http://www.youtube.com/watch?v=LvZFZ0gd-Zw

http://www.facebook.com/l/64996;www.mybirth.com.au/19-02-2010/women-rally-at

Nicola Roxon's response to collaboration agreements.

http://www.abc.net.au/news/stories/2010/02/19/2824133.htm

Roxon says: "I'm unapologetically on the record as saying let's encourage people across the health services spectrum to work together and make sure that women can safely choose options that are good for them and suit them.." 

That's great in theory and obviously something that sounds very reasonable. 

The question then has to be asked: So why not restrict doctors work unless they collaborate - they are the ones who make things difficult! 

In reality, Roxon's 'encouragement' is only fueling the power imbalances and women are caught in the 'rip'.

 

 

 

Birth: a woman's right to decide?

A sobering article on Essential Baby site

What Women Want's Founder Justine Caines shares her views on the proposed maternity reforms.
Soon after the 2007 election, Nicola Roxon announced maternity reform that would enable women to choose a midwife to care for them for their pregnancy, labour, birth and for up to six weeks postnatally. This was to be funded under Medicare. The fantastic part was that it would be one midwife, enabling a woman to form a relationship, knowing who would share her birth experience with her and also provide home based post-natal care. Maternity reform advocates were excited and heralded this as a landmark.

Over the last year, however, we've seen intense lobbying from the Australian Medical Association (AMA). Late last year, the proposed reform was altered. Medicare funded midwifery would not go ahead unless a doctor 'signed off' the practices of the midwife, giving an individual doctor veto power over a midwife's practice and woman's decision making.

Read the rest of the article by clicking this link
Birth: a woman's right to decide?

Ethics, AMA and that South Australian Homebirth 'study'

Barbara Katz Rothman, Ph.D,  Professor Department of Sociology,  City University of New York, is the author of fabulous books such as The Tentative Pregnancy and In Labour: Women and Power in the Birthplace. W.W. Norton and Company, 1982, now updated as Laboring On: Birth in Transition in the United States, With Wendy Simonds and Bari Meltzer Norman. Routledge, 2007.

Professor Katz Rothman famously said "Birth is not only about making babies. Birth is about making mothers - strong, competent, capable mothers who trust themselves and know their inner strength".

Barbara Katz Rothman made another great comment about how whenever there is a move to return power to women, patriarchal interests rise up in protest to reclaim their position. I haven't got the exact quote, but something along that line.

What is particularly interesting right now is that the negative voice of reproductive medicine headed by their president, is growing louder and louder, warning everyone that birth is dangerous!  The voice is getting louder, telling women and the community that birth at  home is dangerous, just as the Federal Government begins to move to increase women's birth choices and position midwifery as the health care profession most suitable and appropriate to provide primary health care for childbearing women.

Coincidentally, a report on homebirth in South Australia was published recently in the AMA medical journal.

Medical Journal of Australia article on SA homebirth

The president of the AMA Dr Andrew Pesce, wrote the editorial of the issue of the AMJ which published the 'study'. He listed his competing interests this way

"I am President of the Australian Medical Association, which is opposed to home birth in Australia".

The title of Dr Pesce's editorial is "Planned home birth in Australia: politics or science?"

Dr Andrew Pesce (Dr 3am)'s Editorial in the MJA

Good question, Dr Pesche, all looks good and transparent on the surface so far!

Dr Pesche discussed the controversy surrounding homebirth and midwifery practice and quoted the following 'facts' from the 'study' of SA homebirth statistics:

"planned home birth was associated with a sevenfold increase in risk of intrapartum perinatal mortality compared with planned hospital birth, and a 27-fold higher risk of death due to intrapartum asphyxia.6 These differences were significant despite a sample size of only 1141 home births. Overall perinatal mortality standardised for gestation and birthweight was more than double that of planned hospital births, but because of low numbers these differences were not statistically significant. Of course, not all severe adverse perinatal outcomes in labour can be avoided, but they are better avoided, statistically speaking, when birth is planned to take place in a hospital birth unit".

Deeper analysis of the 'data' reveals the statistics are somewhat skewed. I have written else where about the results of this 'study'.  As the old truism goes there are 'lies, damned lies and statistics' - it requires enormous rigor and willingness to look at one's blind spots when interpreting statisics.  One of the ways to assist with blind spot removal is to have independant reviewers go over the results of data interpretation. Everyone would presume the AMJ would do that to maintain credibility and transparency. A reasonable assumption given that the Journal’s website links to the World Association of Medical Editors Position Statement on “Conflict of Interest in Peer-Reviewed Medical Journals”: http://www.wame.org/conflict-of-interest-in-peer-reviewed-medical-journals

However, following various online articles debunking the analysis of the statistics, including an article by Melissa Sweet at Crikey.com  Don't believe the homebirth horror headlines galvanised Dr Pesche and the AMA to seek a right of reply.

In his reply to the criticism of both the article and his editorial, Dr Pesce said

"My editorial was primarily about the politics of home birth.  Most neutral commentators have commended me on the balance of the editorial".

As Croakey comments "Dr Andrew Pesce, for those who haven’t been following the story thus far, is the president of the AMA (which opposes homebirth), an obestetrician and gynaecologist, one of the reviewers of the new study, and also the author of the MJA editorial on the study".

Now wait a minute! Dr Pesce was one of the reviewers of the new study? Hmmmm  and wasn't Dr Mark Keirse, an obstetrician,  one of the authors of the discredited Bastion study also cited by Pesce as evidence of the dangerous nature of birth at home?

Uh oh.  Excuse me,  the bias is showing.

I'd love to know who the 'neutral commentators' were!

Using 'science' to back up biased opinions is hardly new or unique to this particular study and the rhetoric which surrounds it.  However, frightening childbearing women and the community about the safety of birth in any context is unethical, given what we know about the way that the hormones of fear impact upon both the fetus and the woman.

Dr Pesce also asks the reader

"...to be fair, my editorial did mention the lower intervention rates, the similar rate of post partum haemorrhage and other favourable outcomes of home births found in the study".

Dr Pesce needs to listen to the despairing voices of midwives and student midwives who struggle daily with the way that medicine interferes, disrupts and pushes the birthing process into places that women are not ready to go with disabling consequences.

for example

"So, after watching BOBB (The Business of Being Born) and doing my current reading about the history of midwifery/hospitals/medicine, my eyes have been opened, yet again (still!) as to how harmful the hospital environment can be towards childbirth and women.

Yes, hospitals, medicine and nursing care can save lives. However, ever notice the trickle down effect of us *causing* some of the problems in the first place?"

Some self loathing, some guilt, and a whole lot of venting

It's time Dr Pesce to stand back and look at who's interests are being served in this 'debate' and controversy?  This 'shroud waving' and 'spin doctoring' of facts is an 'emperor has no clothes' kind of situation. What do we make of it in light of the fact that over $2.11 million dollars of tax payer's 'safety net' money has been siphoned off into the pockets of some doctors?

Changes to obstetric safety net are fair, despite foul cries – Croakey

The big question is how do we get to work together so that the woman is in control of her body and reproductive process and we as health care professionals are there to support and encourage every woman to feel safe in her own body and respected for her evidence informed choices?  There are some great doctors who really respect women and believe that the natural brilliance of the birth process works well when women are informed and supported to labour and birth undisturbed in the place of her choosing. These doctors are there, respectfully supportive for the rare occasion when some kind of intervention is warranted.


Birth is as safe as life gets Dr Pesce.  The therapeutic use of self as a health care practitioner is what makes both life and birth safer. As Barbara Katz Rothman says "birth is about making strong and capable mothers". Time to stop pulling the rug from under women's sense of self with all this 'turf war' rhetoric!

Birth at home Safer than at Hospital: eMJA: Planned home birth in Australia: politics or science?

Good news from the latest review of homebirth statistics. Despite the fact that the AMA can't read research, and then go on to make gooses out of themselves by quoting incorrect statistics to frighten people about birth, the news for women who want to have their babies at home is very good.

The correct information is this:

1. The rate of perinatal mortality for the period under examination (1991-2006) was 8.2 per 1000 births for planned hospital births; for infants born at home 2.5 per 1000 births.

According to the reviewers, one of the two infants who died after being born at home

"had congenital anomalies suspected on ultrasound; the parents declined further investigation, and the infant had palliative care and died from lethal anomalies. The other was a fresh stillbirth from a water birth. Although birth under water was thought not to have contributed to the death, closer monitoring during labour may have changed the outcome.

The evidence clearly shows that birth at home is safer than birth in hospital!

Image from Wikipedia

The reviewers said:

Although it is not anticipated that large numbers of women will opt for home birth, women’s autonomy in choosing reproductive behaviour is a fundamental human right enshrined in Australian law.4 Respecting their choices and achieving the best outcome for all concerned is likely to remain a challenge that will require more light and less heat than it has received thus far.

A pity that the AMA has chosen the route of "Lies, damned lies and statistics" to further their 'shroud waving' agenda to frighten women and their families about birth.

Image from http://www.mothersbliss.com/nine/birth/hospital.asp

eMJA: Planned home birth in Australia: politics or science?

The really important point amidst all this stupid shroud waving and fear mongering on behalf of the AMA is that women do best where they feel safest. Our jobs as health professionals is to be supportive of women's choices and provide an environment where women feel supported and cared about and to intervene appropriately. That's it.

Sadly, the AMA has forgotten about the therapeutic use of self. Using fear to coerce women into submission to fit the 9-5 agenda is not kind, good or ethical.

YouTube - (Baby's perspective) barnets perspektiv!

Ever wondered what it is like to be baby looking out at the world from inside a pram? Wondered what it is like to be a baby being carried? This short video demonstrates the difference. The language is not English, but for those English speakers, the visual portrays the message brilliantly.



YouTube - Barnets perspektiv!

t r u t h o u t | Rethinking Education as the Practice of Freedom: Paulo Freire and the Promise of Critical Pedagogy

Paulo Freire has been an inspiration to me and his theory has underpinned and informed my work in my roles as educator and midwife ever since I first read his book "Pedagogy of the Oppressed". This respectful, thought provoking, beautifully written article "Rethinking Education as the Practice of Freedom: Paulo Freire and the Promise of Critical Pedagogy" by Henry A. Giroux, provides an inspiring lens on the most amazing educational theorist ever to grace this earth.

Giroux says, about Freire:

Occupying the often difficult space between existing politics and the as yet possible, Paulo Freire spent most of his life working in the belief that the radical elements of democracy are worth struggling for, that critical education is a basic element of social change and that how we think about politics is inseparable from how we come to understand the world, power and the moral life we aspire to lead. In many ways, Paulo embodied the important but often problematic relationship between the personal and the political. His own life was a testimonial not only to his belief in democracy, but also to the notion that one's life had to come as close as possible to modeling the social relations and experiences that spoke to a more humane and democratic future. At the same time, Paulo never moralized about politics, never employed the discourse of shame or collapsed the political into the personal when talking about social issues. For him, private problems had to be understood in relation to larger public issues. Everything about him suggested that the first order of politics was humility, compassion and a willingness to fight against human injustices.

For anyone who cares about education, liberation and personal mastery, this article is a must read.

t r u t h o u t | Rethinking Education as the Practice of Freedom: Paulo Freire and the Promise of Critical Pedagogy

Mothers' views of maternity: interventions

Mothers' views of maternity: interventions
January 2, 2010 -The Age newspaper

The president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Dr Ted Weaver, said while a fear of litigation arising from complications of vaginal births had partly driven intervention rates in recent years, more women were also asking for them than before.

He said this trend meant many private obstetricians felt they should agree to interventions if their patients had been properly counselled on the pros and cons of the procedures.

''In private, most doctors will do [elective caesareans] because they think if I don't do it, someone else will do it. It's about consumer demand,'' he said.

Mothers' views of maternity: interventions

Now we are blaming women for asking for interventions after years of scaring women about birth! You will note it is still about money.

"If I don't do it someone else will".

Wouldn't you love to be a fly on the wall to hear the 'proper counsel on the pros and cons of the procedures'? This statement reminds me of a great cartoon some time back in MIDIRS, the English publication on all matters to do with childbearing. The cartoon had a doctor, complete with stethoscope around the neck and white coat, sitting talking to an anxious looking pregnant woman sitting on the edge of her chair. The first frame showed the doctor saying "of course I believe in choice". The second frame had the doctor waving his hand expansively saying "you can bleed to death at home or have your baby safely in hospital!!"

I would encourage you all to obtain Labouring Under an Illusion. Have a look at my entry on 22nd December Social construction of Childbirth - how the media works for details and the trailer for the movie.

Mother, baby revived after 'dying' in labor - Heart health- msnbc.com

What a blessing that this young mother and her baby revived and survived.

Mother, baby revived after 'dying' in labor - Heart health- msnbc.com

What I found particularly interesting is that the woman had an epidural minutes before the circulatory collapse. Her husband noticed her colour was blue and when the nurses checked her, she had no pulse.

The fact that an epidural had been administered had not made it into any of the news reports that heralded the story about the miracle of this woman and her baby's survival.

The doctors are at a loss to explain what happened to this young woman.

Yet, there are several possible explanations with the administration of an epidural in labour:

1. The anaesthetic agent could have been inserted into a vein by mistake causing cardiogenic shock
2. The epidural block may have been too high, causing paralysis of the intercostal muscles and respiratory arrest and then cardiac arrest
3. Allergic reaction to the anaesthetic agent

None of these possibilities have been explored in the news. What this story does of course is add to the general fear cascade around 'birth' in western culture. The 'problem' in this story is not with labour, it is with the intervention, the epidural administration. The problem needs to be attributed to where it rightfully belongs. Where most of the problems with birth lie is with the interventions that are 'done to' birthing women. Instead of providing every childbearing woman with one to one midwifery care that enables a woman to feel valued and cared about, work through her feelings about becoming a mother and then supported to give birth in her unique way, according to her own body biorythms, women are fed a steady diet of fear and problems, anaesthetised, poked, prodded and pushed. The way that the normal natural process of birth is tampered with is what leads to the problems that women experience.

Fear is a powerful force for shaping women's experiences of birth. The trouble lies in our cultural conditioning and media portrayals of birth. Fear makes us compliant and anxious. Instead of women perceiving the birth of their babies as something special and transformational, they are encouraged to rush to take 'whatever' modern medicine provides for deadening the feelings associated with the experience.

Unfortunately the 'cure' can often be far worse than the experience itself.

This story should have read " Mother, baby revived after 'dying' post epidural"

Home-birth boost for expectant mothers

Hospital provided homebirth pilot project

JULIA MEDEW

December 23, 2009

VICTORIAN women will be able to give birth at home - with hospital back-up for the first time - under a pilot project starting at three hospitals next year.
Health Minister Daniel Andrews said yesterday that the State Government had allocated $400,000 for midwife-led home births through Casey Hospital in Berwick and Sunshine Hospital in Melbourne's west. A regional health service will also participate, but the Government has yet to decide which one.

The provision of state funded homebirth services is a welcome sign of change in attitude towards the normality of birth, at least in the eyes of politicians and health care service bureaucrats. However, this pilot scheme is funded for one year. What happens after that is anyone's guess. The skeptic in me is suspicious that this 'offer' is to mollify the insurgents and designed to keep people quiet. Given the groundswell of support from the community for privately practising midwives to provide homebirth services for women who want to birth at home, that is a reasonable suspicion.

Those of you old enough to remember will remember the fanfare and Commonwealth money dished out to fund midwifery model of care pilot programs following the Shearman report in the late 80's. Many programs were funded in the early 90's. As soon as the money ran out, however, those models fell over and childbearing women across the country were left high and dry, with no midwifery service. The only model to survive those halcyon days was the Community Midwifery practice in Perth, Western Australia. The only reason that model continued was because the state government at the time agreed to fund it.

Time will tell if this is a Wizard of Oz or Emperor's New Clothes situation or not. The government may be sincere in wanting women to have true choice, however true choice means equity for all health professionals, not just those with the most money and the most power. 

A disturbing aspect to this pilot project is that the government is hoping that private midwives will want to work in the program and become state funded employees. While that sounds good on the surface, the reality is that along with state funding comes state rules and regulations which is where the problems start for some people. Midwives who work privately do so because they want to work in their full scope of practice and be 'there' for those women who request their services. That means being on call for those women. With state run services there are rules about how many days you can work, how many hours you can work, who you can work with and how you do your work. Depending upon how the project is structured, women may or may not know who will attend them for their birth; they may not know the midwife on the other end of the phone when they ring in labour. Those rules and regulations are designed to protect the institution. Because the rules and regulations are designed for institutional needs, not the birthing woman's needs, they end up creating a 'cookie cutter' approach to maternity care work. A birthing woman does not necessarily fit neatly into a proscribed pattern of care provision. Privately practising midwives I know choose to work as a contracted employee of the woman, within their scope of practice and according to their professional requirements, not contracted by the state to have their working schedule dictated by rules and regulations for government purposes. Private midwives primary focus is on the woman and what her needs and desires for the birth of her baby were. Serving two masters never works.

An article which explored the ethics of caring for nurses in the health care system identified three ways that nurses align themselves. The first way is aligned with the institution, the second, aligned with doctors and the third, aligned with 'patients'. Midwifery ethics, as described by Fay Thompson, are clearly 'with woman'. While some privately practising midwives may be interested in working in state run institutions, others are not going to be interested in working for the state.

Apart from the right to work in way that is aligned with one's ethical and professional values, our profession needs privately practising midwives. Midwives in private practice demonstrate what midwifery care is at its essence and provides an inspirational role model for future midwives. Midwifery knowledge and wisdom, which has, in institutionalised maternity care, been subsumed under the technocratic approach to childbirth of the medical model, is held and passed on by privately practising midwives.

To sum up, this pilot study is welcomed, but this year long program, even if it continues, does not take the place of ensuring there are robust structures in place for the continuation and support of private midwifery and a woman's choice to birth with someone she knows and trusts.

Home-birth boost for expectant mothers

Social construction of Childbirth - how the media works

A new film called "Labouring under an Illusion"  shows the way that childbirth is portrayed in the media. The film makers juxapose the often comical, always fear inducing media perspective with normal, healthy, calm birth footage. The presentation of the two points of view provides an excellent reality check.

Here's the trailer for the video

Vicki Elson, a childbirth educator, explains her motivation for making the film during an interview with

Amie Newman  http://www.rhrealitycheck.org/blog/2009/12/14/laboring-under-an-illusion-rh-reality-check-talks-filmmaker-vicki-elson

"I was doing a workshop for nurse-midwives at a local hospital when a particularly ghastly and unrealistic (and Emmy-winning) episode of “E.R.” came out. The midwives said their phones were ringing off the hooks because moms were scared that they could die like the lady on TV. Meanwhile, Murphy Brown was America’s liberated TV mom who could anchor the news and stand up to Dan Quayle. But in labor, she was wilted and powerless, except when she was strangling men by their neckties. I wanted my kids and their friends to grow up with realistic, nourishing imagery about the power of their bodies to do normal things like have babies. I was working with midwives Rahima Baldwin Dancy and Catherine Stone on a workshop called “Empowering Women in the Childbearing Year,” and we started collecting clips to show childbirth educators what they were up against from the culture. It’s still a struggle to compete with compelling but unrealistic imagery that sticks in people’s minds. I expanded on that project to write my master’s thesis 10 years ago, and when the kids grew up I finally got around to updating the project and putting it on DVD so it’s more useful and accessible.”

Well done Vicki!  Resources like this are essential to counter the negative publicity that childbirth is subject to. For more information on the video or to order a copy, visit Birth-Media.com.

Amy Romano on Science and Sensibility blog has an excellent post on Childbirth Literacy that includes this video trailer and information. http://www.scienceandsensibility.org/

Midwifery takes a northern look: UofA program supports Nunavit women to birth at home

U of A program supports Nunavit women to birth at home

By Jodie Sinnema, Edmonton Journal December 18, 2009

"A healthy community has to be one where women can give birth," said O'Brien, who has been travelling to Nunavut for three years to speak with traditional midwives, most in their 80s. They share stories of feeding the best cut of meats to expectant mothers and delivering babies in ice houses, or tents made of furs. That history is informing the new midwifery program"

The aim of the program is to train midwives locally so more Nunavut mothers can give birth in their home communities.

Kango, a traditional midwife who learned her skills from her mother-in-law, sister-in-law and other northern elders, is now sharing her knowledge through Nunavut's first midwifery training program.
"Before colonization", Kango said "there were no doctors or nurses in Nunavut, so men and women stepped forward to be midwives. But in the 1960s and '70s, when western medicine arrived full force, mothers had to leave their homes, husbands and children six to seven months before their delivery to give birth in distant hospitals".
"With this kind of method of hospitals to send the mother out without husband or parents to attend, it was hard for the mother," Kango said. "With increased stressed, they would smoke more, lose their appetite and lose interest in looking after themselves. Oftentimes, health professionals couldn't speak any Inuit languages, leaving the women isolated in pain".
Midwifery takes a northern look

More women choose do-it-yourself births - Pregnancy- msnbc.com

By Linda Carroll

msnbc.com contributor

updated 1:05 p.m. ET Dec. 6, 2009

"Jennifer Margulis thinks birth should be a private party — no doctors or midwives invited. So when her daughter Leone Francesca was born at home last month, only Margulis and her husband, James, were in attendance.

“My husband and I were the only ones there when she was conceived,” says the 40-year-old writer from Ashland, Ore. “I thought we should be the only ones there when she was born.”

Margulis is part of a very small but growing number of women who are choosing to deliver their babies at home without the presence of health professionals. Some choose to have a husband or another family member help, while others opt to deliver their babies completely on their own."

Jennifer Margulis, 40, of Ashland, Ore., gave birth to her daughter Leone Francesca at home Nov. 4 without medical or midwifery help.

I can understand why women would choose to birth on their own or with their loved ones in this modern climate around birth. These women are telling us in the health care industry that they are not happy with what we are doing. If we want to have a place at birth with intelligent, self aware women who understand the process and feel comfortable with their bodies then we have to pay attention to what they want.

I personally love it when I am redundant at birth. When the women are fully present and aware and confident. They manage their labours beautifully, they breathe their babies and their placentas out easily; they and their babies are well and healthy. When I've sat on my hands and enjoyed the process and the woman's sense of self mastery, that's my idea of a good days/nights' work.

Unattended births can be problematic, that's true. So can attended births.  The issue, no matter where or with whom women chose to give birth,  is how does the woman feel, what does she know, is she well nourished, does she love her partner and how is their relationship, how confident is she in herself and what else is going on?

For women in developing countries it is often a very different situation. The problems for birthing women in developing countries are multifactorial.  These women are usually anaemic, have no birth control and therefore too many babies already, they are tired and poorly nourished. They usually work too hard and don't have any support of any kind. These women often don't have the stamina and energetic resources to stay mindful and present to the birthing process to keep safe.

Let's listen to women, find out what they want. Rather than seeking to undermine their confidence to get compliance with our agendas, let's listen and change what we are doing to be more likely to be invited to be part of the most amazing experience on earth. 


More women choose do-it-yourself births - Pregnancy- msnbc.com