Showing posts with label midwifery. Show all posts
Showing posts with label midwifery. Show all posts

Thursday, 3 June 2021

How to Make Birth (a Homebirth) Long and Difficult

 My Midwifery Today newsletter arrived in my email inbox this evening. 

This 2001 article by Michel Odent, one of my many heroes in the birthing arena, was reproduced in the newsletter and I thought it was so apt.  I had to share it here. 

Michel's title is How to make a homebirth long and difficult.  However, it fits for birth in hospital too.  

by Michel Odent

From Having a Baby Today, 2001

Editor’s Note: Even though this article is from 20 years ago, it is still fitting today.

  1. As soon as you think that you are in labor, call some friends and invite them to join you.
  2. Choose a talkative midwife who will constantly keep you informed about the progress of labor (why not a pair of midwives?).
  3. Stay in the largest and the coldest room you have at your disposal.
  4. Make sure that there is at least one man around, preferably a doctor.
  5. Make sure that a camera is available.
  6. During the day, have the curtains open. At night, switch on the lights.
  7. Never spend a long time in the bathroom by yourself with the door closed.
  8. If, in spite of doing all of the above, you can reach complete dilation, try to remember what you learned from books or from classes about pushing.

Michel Odent, MD, founded the Primal Health Research Centre in London and developed the maternity unit in Pithiviers, France. A contributing editor to Midwifery Today, he is the author of ten books published in nineteen languages.

Here's another way: 

Push: A satire short film (2021)





Friday, 24 January 2020

Maternity Care: Building Relationships Really Does Save Lives - free online course



Griffith University is again providing its highly acclaimed online MOOC


The life-saving, life-enhancing, powerful course was developed by the fabulous Professor Jenny Gamble, Professor of Midwifery and wonderful Associate Professor Mary Sidebotham from Griffith University, Australia in partnership with the brilliant soul-sister midwife, Leanne Schwartz, Director of Deepening the Journey, retreats for midwives and birthkeepers.

Learn how quality relationships between mothers, midwives and other health professionals transform maternity care and save lives.

This next course starts 27 January 2020. It runs for 3 weeks and the volume of learning takes about takes about 3 hours a week.

Research unequivocally shows that providing a woman with the same midwife before, during and after birth, results in less preterm birth, fetal death and other complications.

This course explains why we need relationship-based care in maternity services. You’ll discover how to create successful relationships, and how this produces better outcomes for the mother, baby and midwife.

You’ll learn about organisational healthcare models, and what you and your local community can do to contribute to the transformation of maternity care globally
Professor Jenny Gamble writes: 
If you think that what happens during pregnancy and birth matters. If you're interested in relationship-based maternity care, or if you just want to have the evidence readily accessible: please sign up and join our global movement!
The course is free. If you want a certificate for your records, then you can pay to upgrade your enrolment.

It's a fabulous learning opportunity - with this course, you will get the science behind the facts!

Here's the link Maternity Care: Building Relationships Really Does Save Lives

Monday, 23 September 2019

Handmaidens of the hospital birth machine - No More


The emotional work of being with women is immense and what we see and come to embody is that birth is now a battle ground, leaving bruised, battered and traumatised women in its wake, with many midwives the witness or the handmaids of the hospital birth machine
Click on the link to read the full post

I walk into the Panopticon, affectionally known as the fishbowl, the central area in the birthing unit where a bank of monitors line the walls, each one displaying a fetal heart rate and her/his mother's contractions as part of the fetal surveillance tactics of modern obstetric care. Despite the evidence that these tracings called CTG's - cardiotocographs - don't change fetal/newborn outcomes; lead to more and more interventions and harpoon women to beds, restricting their movements and compromising their ability to find comfort, every woman in the place is hooked up to one of these 'machines that go ping'.


I could be in any birthing unit in a tertiary referral hospital in the country and what I've described above is what I'd see.

Birthing is not a relaxed, happy event in a medically dominated, fragmented care system.

I was wondering 'was it ever?'

The correct answer is probably not. Certainly not in major teaching hospitals. Perhaps yes in small country hospitals, where everyone knew everyone. Many of these small hospitals have been closed over the last ten to twenty years.

Birthing women have been ignored, dismissed, controlled and managed ever since hospitals became the norm.  There is something very weird about healthy women bringing babies into the world in places where sick people go to be cared for and healed or die. Intervention in the birthing process has been accelerating in the last few decades.  More and more women are emerging from their childbearing experiences shocked and traumatised.

That's one hell of a start to mothering a defenceless, needy brand new human!

The identification of unexpected and preventable events that influence mortality is a key indicator of the safety of health care for those who access the services. When interventions to reduce these events are not utilised, or health providers don't have the skills to use them, it's called 'failure to rescue'.  'Failure to rescue' as an outcome indicator identifies hospital characteristics as a potent contributor to adverse outcomes. What does 'failure to rescue' mean for midwifery care and maternity services?   Marie Hastings-Tolsma and Anna Nolte have written an excellent paper, reconceptualising 'failure to rescue' in midwifery. In considering the importance of protecting labouring women from encountering an adverse event, the authors ask "What processes are in place to prevent unnecessary interventions for low-risk women and thus, promote normal birth processes?"  

The authors continue: 
The ability to provide ‘watchful waiting’ is typically eroded by the culture of the hospital setting. Such restriction contributes to failing to rescue where women seek care which promotes normal childbirth.

None of us are prepared to put up with this situation any longer. Things have to change.

What's different now is that we are more aware, we are more educated and we have more knowledge abour our physiology and what conditions help physiology to work in an optimal way.  We expect to be treated with respect and care to be given with our best interests at heart.

We also have the evidence.

The evidence says that relationship based care is the best; that knowing your midwife reduces complications, increases the normal birth rate and supports successful breastfeeding.

At the ICM ICM Africa Regional Conference ICM President@FrankaCadee left us with a strong parting message in her welcome address that “the hand that rock the cradle should also rock the boat.” The time is now for midwives, we cannot keep silent and ‘behave’! 

No more tinkering with and disrupting women's physiology!

Women don't have their brains bathed with natural oxytocin 'the love hormone' during labour and birth when they're being induced with artificial hormones


Women birthing in hospitals don't get pronurturance - care at birth associated with lowered rates of postpartum haemorrhage and improved rates of succcessful breastfeeding and more settled, happier babies - hospital protocols get in the way!

Midwives are stressed, burnt out and depressed by their sense of powerlessness and what they see happening to women on a daily basis in the health care system.

Dr Liz Newnham says the Time for Midwifery is Now and provides the following suggestions:
  • The truth is out there
  • Call out obstetric discourse
  • Speak truth to power
  • Refuse to participate
  • Support birth physiology
  • Prioritise relationship
  • Association #Strongertogether

    And our ICM President has the last word ....



Friday, 10 October 2014

Should Midwifery have its own National Board?

A massive change in the way health professions, including midwifery, are regulated

Four years ago Australia underwent a huge change in the regulatory system that oversees health professions. A National Registration and Accreditation Scheme (NRAS) was created.  This change saw the consolidation of 75 Acts of Parliament and 97 separate health profession boards across eight States and Territories into a single National Scheme. The National Scheme sets a minimum standard for safe practice by health professionals. This minimum standard can be and is, augmented by states, professions and institutions. 

The National Scheme is overseen by the Australian Health Practitioner Regulation Agency (AHPRA); each profession regulated by the National Scheme has its own board apart from nursing and midwifery who have the one board. The Nursing and Midwifery Board is responsible for the regulation of midwives which involves setting midwifery policy, standards and guidelines; managing midwifery registration; dealing with complaints against midwives; and assessing overseas midwives.



Midwifery coming of age as a profession


Whilst for many decades midwifery was seen as a nursing speciality, there has been an increasing recognition of the differences between nursing and midwifery. Australian maternity services and the way midwives are being educated have been changing dramatically in the past two decades in response to consumer demand and an increasing body of national and international evidence on the importance of midwifery models of care in meeting women's needs and resulting in cost effective, best outcomes for childbearing women and their infants (Barclay et al. 2003; McLachlan et al. 2012; Renfrew et al. 2014; Sandall et al. 2013; Tracy et al. 2013). There has also been increasing recognition of the necessity for midwifery to be developed as a separate profession. 



The National Registration and Accreditation Scheme (NRAS) is under review


The review is being led by Mr Kim Snowball, and the public consultation closes today, on the 10th October 2014.  Our Australian College of Midwives has submitted a proposal for a separate Midwives Board to the review: 



Why we need a Midwifery Board!

The ACM has provided a list of concerns about the current combination of both nursing and midwifery professions under the current board in their document above.  They also identify that midwifery must be regulated by midwives in the form of a Midwifery Board, in order to ensure that:
  • Midwifery practice issues are assessed and regulated by a full Board who are both credible and cognisant of the issues in the provision of contemporary, safe maternity care
  • Issues associated with privately practising midwives and eligible midwives would receive attention from individuals who are appropriately qualified and experienced
  • Complaints are managed in an appropriate and timely manner which includes the application of the principle of natural justice i.e. to be judged by peers who are competent to make a judgement
  • Protection of the public is increased through the nimbleness of a midwifery focussed Board thus improving responsiveness to emerging issues associated with rapid escalation
  • There is an increased understanding of the regulatory context for midwives in private practice providing a fee-for-service model
  • Community representatives who are aware of the relevant issues for childbearing women and families are recruited to the Board thereby ensuring accurate assessment of practice-related issues for midwives
  • Cost effectiveness is achieved by appropriate regulation and protection of the public
  • Data collection about practising midwives is improved, which will improve workforce planning
  • The issue of midwifery invisibility in the legislation, and its consequences, would cease 
  • The Nursing Board would be free of the time consuming complexities of midwifery issues and able to concentrate fully on the important issues for nursing.

Do you support an Australian Midwifery Board? 


If you do agree that midwives should be regulated by midwives, please make your voice  heard by writing to Mr Snowball by close of business today, the 10th October and attach the ACM submission:


or write a letter outlining why you think midwives should have our own Board and email to: nras.review@health.vic.gov.au

Share the ACM submission with colleagues, even if they are not ACM members, and encourage them to make their own submission.


Any questions about the NRAS Review or the ACM submission, please contact Sarah Stewart, ACM Professional Officer: sarah.stewart@midwives.org.au or phone (02) 6230 7333.  

Friday, 21 February 2014

Midwifery voices needed on WHO draft of Every Newborn Action Plan

Calling all midwives: Please read this request from the International Confederation of Midwives and ensure the midwifery perspective is included in this important plan to save newborn lives.

Your voice is urgently needed: The WHO together with partners have drafted an action plan to end preventable newborn deaths (Every Newborn Action Plan). The draft is now online for a public consultation process with the deadline on the 28th of February. It is crucial that midwives have an input as the plan will affect midwives in their work and midwifery on a global level. Strong indications from midwives are needed that this Action Plan is about high quality midwifery, normal birth and normal care of healthy babies (as well as the complications and treatments highlighted in the document).

Feedback is coming in to WHO, but sadly not (yet!) from midwives. The voices of midwives are urgently needed!

Thank you to those who have responded. For those who have not yet, kindly take some time from your busy schedule and provide feedback to this important document

Don’t miss this opportunity to make your voice heard and make sure the midwife perspective is included in the plan! Click on the link to comment: http://www.who.int/maternal_child_adolescent/topics/newborn/enap_consultation/en/ 

The deadline is FEBRUARY 28th and unfortunately cannot be extended.

Thank you for the time and effort.

Kind regards

Charlotte Renard
International Confederation of Midwives

Sunday, 12 August 2012

Australian Government acts to give women greater access to midwives and improve care!

An important update on the outcome of the Standing Committee on Health in regards to midwifery care.  So exciting to see this sensible development.  I know many people have been working tirelessly on getting the government to understand the issues.  My deepest gratitude to you all.

MEDIA RELEASE: 11 August 2012
Contact: Liz Wilkes 0423 580 585

Standing Committee on Health Decision will give women greater access to Midwives and improve Care.

Today’s decision by the Standing Committee on Health to enable midwives to collaborate with hospitals rather than individual doctors provides a welcome relief to Medicare provider midwives struggling to provide Medicare funded care to women.

“Until now government policy designed to provide women with Medicare access to private midwifery care has been to date severely restricted by obstetricians not wanting to be involved” said Liz Wilkes President of Midwives Australia.

“The recognition from every Health Minister across the country that midwives work collaboratively with doctors in hospitals and do not need individual doctor sign off is entirely appropriate. We applaud the sense they have shown” said Ms Wilkes

Midwives Australia has seen the legislation requiring midwives to collaborate with individual doctors has created unnecessary administrative burden and has created opportunity for medical veto over women’s access to Medicare rebates.

“What we are seeing here is the opportunity for midwives to develop license agreements and contracts with hospitals which enable true collaborative practice to continue”

“The whole hospital system relies on obstetricians being in the right place to deal with referrals of women. It is not a change in safe practice.”

“Midwifery care should not and does not require the presence of an individual doctor at a tertiary hospital when many other doctors are on staff, what matters is that there is a doctor present who is able to accept referral and transfer as doctors are employed to do this on a daily basis.”

“This week a Melbourne study found the care of a known midwife reduced the need for a caesarean section and actually improved outcomes. It is comforting to know that all Health Ministers agree on the need to make the care of a known midwife more accessible to Australian women.” said Ms Wilkes.

 We hope you will find it informative.

Best regards,
Midwives Australia

Thanks Liz Wilkes for this update! 

Saturday, 11 August 2012

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.



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'.



Sunday, 27 May 2012

"midwives' views" etc have NO place in our literature. Bugger their views!”


The other evening I posted this article to twitter.

“Women who plan to birth at home with midwives are more likely to receive Evidence-based Care http://fb.me/1puDpq2un

The article described research that found that first-time mothers who chose to give birth at home were not only more likely to give birth with no intervention but were also more likely to receive evidence-based care that women who gave birth in hospital despite care by the same midwives. (BIRTH 39:2 June 2012)

There was an immediate reply tweet from a female obstetrician who has the twitter name @obgynkenobi


Obygnkenobi  tweeted:  “primips should not then home birth according to recent bmj RCT. This article is level 9 evidence. Sorry.” 

I responded:  er no, that's not what that study showed at all

Obygnkenobi  tweeted: “p0s [nulliparas]: increased risk of adverse outcomes if home birth. Please don't make me get out of bed to get the ref. it's cold.”  

I responded: "the BMJ study showed a miniscule increase risk to the neonate with a primigravid woman birthing at home"

Obygnkenobi  tweeted: “let's not just pick and choose which evidence suits us”.  

I replied:  “birthing at home is still far safer than driving with your child in the car or having a swimming pool in one's back yard”

Obygnkenobi tweeted:  "I'm not debating the safety. I'm debating the article that stated that homebirth midwives were more likely to use EBM [evidence based medicine]” And further “Yes, the absolute risk is low but if EBM is the master we all serve, primips should not home"

I wrote back:actually, the researchers said that people needed to be aware of the risks, not that they shouldn't”

Obygnkenobi tweeted: “because clearly, "some" midwives choose whichever evidence is more appropriate to their aims”  

I asked "clearly"? why clearly?"

Obygnkenobi replied:  "b/c some mws (and drs) don't practice EBM. Interpreting evidence based on proving a point"

That comment reminded me of the way people responded to a very poor study that changed practice overnight, so I repliedHmmm, I guess the Term Breech Trial is a good example of your point. So many so quick to jump based on such flawed research” 

Obygnkenobi responded: “probably true to a degree. However I know many skilled docs who won't touch a breech” 

To that I commented: “then they're not skilled with breech; over decades I've seen many breech births & brilliant doctors & midwives; now fear rules”

Obygnkenobi  tweeted: “It's not just the medicolegal aspect but the trial confirmed what they had always thought”. 

I was confused by that statement, so replied: “sorry, you've lost me here” and when I thought more about what she said, I asked: “so you think they stopped doing breeches because the skewed trial confirmed what obstetricians thought all along?”

Obygnkenobi responded: “no but it probably was one of the factors #beforemytime"

I was confused by this comment too, because surely, understanding why we do what we do involves knowing one’s history and ensuring that what we are doing is evidence based. I am also aware of how one’s own cognitive bias leads us to perceive and interpret things from our own viewpoint, which is what happened with the Term Breech Trial. Cognitive bias was also happening in response to the BMJ article, so I tweeted in response “the biggest issue is ensuring the evidence is robust and real - we know how easy it is to find what you are looking for”

Obygnkenobi  tweeted: “So there IS a role for using our brain!! Who'd thought!”

I didn’t recognise this at the time as sarcasm, but I did feel confused so said: “and I'm not sure what this was in relation to either?? erk - I've missed something :( and I was enjoying this conversation”

Obygnkenobi replied:  “EBM raises a difficulty: either use our brains or use evidence. It's ok to use either but don't dress it up as EBM if it's not”

I fully agreed with that statement about evidence based [medicine] care being a difficulty, I was experiencing that in this conversation and replied: “very much so!”

Obygnkenobi  then tweeted: “precisely. And that's why the article with "midwives' views" etc have NO place in our literature. Bugger their views!” (my emphasis)

I was surprised and disheartened by that comment and replied: “I find that comment depressing :( “

Obygnkenobi responded:  ok. How about: ebm and individuals views should not coexist in the same article. Better?” and then “individuals views are ok, so long as they're not gusseyed up to look like evidence. It's all good really.”

I didn’t respond to those two statements as it was 1230am and I was not wanting to say anything that could be misconstrued or appear rude.

The next day I tweeted:  @obgynkenobi I'm curious to know if you read the actual paper?

I haven’t received any response to my query. 

This morning I tweeted: @obgynkenobi “did you see this? Term Breech Trial 10 years on” 

That article is worth reading as it revisits the criticisms of the Term Breech Trial and highlights the fact that there has been an increase in maternal deaths with the rise of caesarean section surgery for breech presentations following that study. 
The abstract states:
Abstract:  In 2000, the Term Breech Trial was published, and its authors recommended cesarean section as the safest mode of delivery for breech-presenting babies. Criticisms of the trial were raised at the time, which the authors dismissed. Since then, maternal deaths have been recorded among women undergoing cesarean sections for breech presentations. Accordingly, those initial criticisms deserve to be revisited. (BIRTH 39:1 March 2012)
Not only did the BMJ article that Obgynkenobi had referred to earlier in our twitter conversation Perinatal and MaternalOutcomes Perinatal and maternal outcomes by planned place of birth for healthywomen with low risk pregnancies: the Birthplace in England national prospectivecohort study   not say women having their first baby should not give birth at home, they concluded: 
“Our results support a policy of offering healthy nulliparous and multiparous women with low risk pregnancies a choice of birth setting. Adverse perinatal outcomes are uncommon in all settings, while interventions during labour and birth are much less common for births planned in non-obstetric unit settings. For nulliparous women, there is some evidence that planning birth at home is associated with a higher risk of an adverse perinatal outcome. A substantial proportion of women having their first baby who plan to give birth in a non-obstetric unit setting are transferred to an obstetric unit.
These results will enable women and their partners to have informed discussions with health professionals in relation to clinical outcomes and planned place of birth. For policy makers, the results are important to inform decisions about service provision and commissioning. The relative cost effectiveness of the different birth settings will also be of interest to policy makers and is being compared in another component of the Birthplace Research Programme.
Further research is needed into the avoidability of adverse perinatal outcomes, the effect of staffing and service configuration on outcomes, and more detailed analyses of transfers from non-obstetric unit settings. It is unfortunate that routine maternity information systems are not currently of a sufficiently high quality to enable the analyses presented here to be repeated without carrying out another large prospective cohort study.”
I also retweeted the article that sparked the twitter conversation:

I tweeted: @obgynkenobi in terms of evidence based practice, did you actually read the article about midwives use of evidence and place of birth? 

There is still no response, but it is Sunday!   

I would like to think that we can have good, intelligent conversations about evidence and practice without denigration and dismissive behaviour.  

Interprofessional collaboration in Delivery Suite was the subject of a research project I did in 2008. Attitudes like those displayed here by this obstetrician fit the model of Negative Interprofessional Interactions and stereotypical behaviour. This model is linked to low social and emotional intelligence of the midwives and obstetricians together with adverse outcomes for women and their babies.  Obstetricians and midwives don't feel good about these negative interactions either. I certainly feel very disconcerted with the attitude of this doctor towards midwives and our practice and the misinterpretation of these three studies.