Knowing about birth and interventions: Women's role

A recent study by Klein et al, sought to discover the knowledge and attitudes of women pregnant for the first time to their own roles in their pregnancy and towards the use of technology in birth. The report was written up in the Los Angeles times as Pregnant women show an amazing lack of knowledge about childbirth options, study shows - latimes.com . You could be forgiven for thinking that modern childbearing women were obviously failing in their duty to be informed and either submissive or unintelligent.

So who were these women that Klein et al studied?

The sample of 1318 women was a convenience broad based sample of "mainly well-educated, middle-class women" whose planned place of birth

"ranged from home to hospital, and from rural centres to large city hospitals ... 13.2% of respondents were in the first trimester, 39.8% were in the second trimester, and 47.0% in the third"

A good range of sites for birth, so who was their primary care giver?

"Overall, 42.6% were under the care of an obstetrician, 29.3% a family physician, and 28.1% a registered midwife; 18% planned to engage a doula."

OK, nearly half had a private obstetrician, plus nearly 30% who had family physicians makes nearly 3/4 of the total number of women 'under' the care of a medical practitioner.

Now here is something very interesting in this study:

"Women attending obstetricians reported attitudes more favourable to the use of birth technology and less supportive of women’s roles in their own delivery, regardless of the trimester in which the survey was completed"

What do you suppose could be going on there? There is no doubt that some women access medical care because they want the assurance of the ready availability of intervention if they 'need it'. Some choose to have intervention from the start, but that number is considerably less than is touted by mainstream media or medical rhetoric. Part of that orientation however, comes from the steady undermining that goes on at every antenatal visit with many of our medical colleagues. Comments such as 'small pelvis', 'large baby', 'getting stuck', 'bleeding to death', plus the steady supply of 'horror stories' and hype about birth danger that women are regaled with by the doctors as they seek to validate their interventionist perspective are ubiquitous. The orientation that 'doctor knows best' is also very much alive in our community and the way that antenatal care is organised so that the women wait for hours and get seen for minutes feeds the belief system that doctors are 'so busy' and 'don't have time for women's petty concerns' - so women don't raise them in visits - that silence from the women aided and abetted by the 'not wanting to be a bother' stereotypical stance of many women.

Another lens on this phenomenon is provided by this study from 1995 which reported that privately insured pregnant women were more likely to experience interventions and surgical birth than comparable women in the public hospital system, but that the rate of intervention was greater for those women:

"who in late pregnancy were thinking clearly, had high self esteem, mature means of dealing with anxiety, were confident in their knowledge of childbirth procedures and in secure relationships with highly educated men"

A paper in 2000 by Roberts, Tracy and Tracy explored the differences in intervention between public and private hospitals maternity services offers some insights for the higher level of intervention for women in private medical care. Litigation fears, physician convenience factors and theatre staff availability are suggested as reasons for the increased rate of interventions and surgical birth in private hospitals. But what if there is something more 'underbelly' about the way intelligent, articulate women with supportive, educated husbands are subjected to increased rates of intervention? What if it is a situation of putting uppity self assured women in their place? Women will always preference their baby's well-being over their own, so it is easy to undermine them and when they are told that the 'fluid around the baby' is 'suspect' therefore induction is a good idea "I'll book you in for tomorrow" or "you have a placenta praevia (actually low lying) and I'll take the baby at 37 weeks because we don't want the placenta ripping and the baby being short of oxygen" how many women are going to challenge that? So many of the women who are induced for spurious reasons are told after 8 hours of desultory but painful contractions that they aren't going anywhere and may as well have the baby now rather than later when they are even more tired and the baby gets stuck  " I can just take you upstairs/downstairs/across the hall and it will be all over and you'll have your baby in your arms" - who is going to argue then? Anyone who has worked or is working at a private maternity unit can relate similar stories.

This comment is interesting:

"Women attending midwives reported attitudes less favourable to the use of technology at delivery and more supportive of women’s roles"

The fact that these women have a better understanding of women's roles in childbirth is heartening and affirming, as midwifery care is all about capacity building and information sharing. The fact that women who access midwives as primary care givers are less interested in technology comes as no surprise as that is usually one of the reasons women seek out midwifery care. Another important point is that midwives use stories too. Midwives use stories to inspire and instill confidence in a woman's sense of self and ability to birth and parent well. 

The finding that women attending family practices had opinions that "fell between the other two groups" is encouraging, but could clearly be better:

Now, this final finding that:

"For eight of the questions, “I don’t know” (IDK) responses exceeded 15%. These IDK responses were most frequent for questions regarding risks and benefits of epidural analgesia, Caesarean section, and episiotomy".

is very concerning. There is some comfort in the fact that:

"Women in the care of midwives consistently used IDK options less frequently than those cared for by physicians".

as that demonstrates that midwives role in information sharing and discussion about labour and birth is clearly occurring, even though there is scope for improvement. One of the benefits of midwifery care is the longer time for antenatal visits, where thoughts, feelings, stories and information can be shared and discussed. Perhaps the room for improvement here is with models of midwifery care that have short antenatal visit times scheduled and discussions are limited.

The conclusion of the Klein et al study that"

"women held different views across a range of childbirth issues, suggesting that the three groups of providers were caring for different populations with different attitudes and expectations"

is true in many regards, but not in all cases and not for all women. I've met many women who were privately insured and cared for by obstetricians, who were genuinely bemused and upset that they had unplanned intervention, I've seen others who argued that the doctor saved their lives (or the baby's) having (in my view based on observation and experience) created the problem in the first place.

Most people aren't that interested in finding out about pregnancy and birth until it becomes an immediate reality. School, parents and friends provide a particular perspective and background to people's information and knowledge about birth and babies, the media certainly provides another. Many women and their partners have never held a newborn baby until they hold their own. The primary care provider, be it midwife, family physician or obstetrician has a duty of care to provide opportunities to explore information, knowledge, understandings and experiences with pregnant women/couples who access their services.

To say that women are ignorant of options and interventions says volumes about their health care provider. What do you think? 

Healing from Birth Trauma

A very important post on birth trauma was posted by a guest blogger on the wonderful Rachel Reed's  Midwife Thinking blog the other day.  As I read the post and then the comments, I was taken by a young woman's story of her two births; one traumatic and one healing.  I emailed Amber and asked her if she would allow me to publish her stories on my blog because there are many powerful lessons to be learned from her experiences. Amber kindly agreed and here are her stories.  The posts are long, but well worth reading in depth to gather and savour the illuminations she gives us. For those of us who are pregnant parents and those of us who are midwives or other health care practitioners working with birthing women, her words are precious invitations into the world of birth and what women need.

The headings provide links to Amber's blog.

Tale of Two Birth Stories, Part 1

I wish to share my birth stories because becoming a mother is where this journey began. I cannot tell the one without the other—it would only be telling half the story of how I came to be the woman I am today. The birth of my son, now almost three years ago, is still very fresh and vivid in my mind…and deeply painful. I have been repeatedly reminded that I am so fortunate, a hemorrhage is such a little thing; and indeed, as I commented recently, “on paper” it looks like a wonderfully successful natural birth, but to me, it was a nightmare, and one I’ve lived repeatedly over the years. It was only recently that I realized I have truly been grieving over this birth and, allowing myself to go through that process, I believe I have finally arrived at a peace and even a gratitude for that day: for without it I would never had had the courage to take my first step into this wonderful adventure God is unfolding before me now.

I made the choice to birth in hospital as a compromise. I had wanted a homebirth from the time that I knew they were still an option—I’m an introvert and deeply sensitive when it comes to privacy—but due to fear of confrontation and concern for my mother (who is not well and unable to handle stress), I convinced myself that a CNM in hospital wouldn’t be horrible: I still had a midwife and my mom wouldn’t have to worry unduly. I had also convinced myself that Mom had to be a part of the birth of her first grandchild (how could I deny her that?) even though I knew she’s never been able to handle any situation in which I’ve been ill or in pain.

My heart screamed it was a mistake throughout all my prenatal care, but I stuck to my choice even though I was becoming increasingly unwell. Because I was perfectly healthy in all the numbers, my concerns were repeatedly ignored and downplayed as mere complaining. I was frustrated, determined, hopeful, and excited all at once. Thus sets the stage for that eventful day…

Senate Inquiry re: complaints about midwives

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

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

I have just sent my submission to this inquiry.

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

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

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

The process as it currently stands is this:

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

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

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

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

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

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

A coroner's perspective on the death of a baby

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

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

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

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

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

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

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

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

21 strategies to help keep birth normal

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

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

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

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

Wired for empathy?

Emotions are increasingly recognised as the language our bodies use to communicate. Between cells, between genes, between body processes, the chemicals of emotion trigger, calm, irritate, inflame and soothe.

John Heron, one of my heroes, was the first person I read who talked about our emotional needs. John identified that we have three core emotional needs and if these emotional needs are not met, we develop defense mechanisms.
The core emotional needs that John Heron identified are:

1. To love and be loved
2. To understand and be understood
3. To choose and be chosen.

When our emotional needs are not met, to avoid feelings of distress, we develop defense mechanisms

•      Rationalisation – judging, blaming

•      Projection – attributing one’s own faults to other people eg gossip, criticising behind backs

•      Reaction formation – overdoing the opposite of the emotion

•      Dissociation – distancing from feelings by excessive theorising, analysing, measuring

•      Substitution – carrying out activities guaranteed to succeed – focusing on minutae instead of addressing big issues (which may fail!)

•      Repression and denial of own emotions – intrinsic part of each of the previous defense mechanisms – ‘water off a duck’s back’ – ‘doesn’t bother me at all!’

The defence mechanisms can be seen as the foundations for bullying and violence generally. 

There are, according to John Heron, steps in  managing our emotions, now known as emotional and social intelligence and competence.

Emotion has the central role in determining what we perceive, experience and do (Goleman, 2006). According to the perspective taken by both Goleman and Heron, our power and ability in human affairs is a direct result of our feeling nature. Our deepest feelings are meant to guide us in how to live our lives.  Goleman suggests that the emotional life of an individual underpins their ethical and moral stance and therefore social behaviour. Obviously, if the individual's life has started in the right way, in a loving family with their emotional needs met, then they will be emotionally and socially intelligent and therefore empathetic to the needs of others.


An easy way to understand how we are wired for empathy came into my life this morning in the form of the You Tube video below.





Are we doomed if we didn't have the best start?  No, we can change. However change needs to be sought and new behaviours practiced so that our neurology and the emotional 'codes' are more in alignment with our desired way of being.  Norman Doidge has written a great book explaining how change can happen.

For John Heron, the process requires understanding the four basic skills and practising them continually to become competent.

These skills are: 

1.      Awareness – of one’s own emotions and their effect on behaviour

2.      Choice – between control and spontaneity

3.      Sharing emotions with other people as appropriate

4.      Releasing emotions cathartically (4 aspects)

    4.1 controlled letting go – aware of process and choosing time and place to do it

    4.2 letting go- allowing oneself to let go both emotionally and physically

    4.3 insights – catching intuitive and creative insights

    4.4 decision-making – after moving through emotion and intuition, use our intellect to consider the                learning and make decisions

What do you think of the video? Do you agree we are wired for empathy?  Do you think we can develop the self management skills as suggested by Heron and Goleman? The really big aspect in all of this for me is how to be self managing and stay embodied - to allow ourselves to feel the feelings and cherish the full gamut of what it means to be human.  Of course, like everything, the applications of all this for me is with our work as midwives with birthing women and their families.  Our role in facilitating the best environment so that a woman and her baby can grow well, birth well and enter the early parenting phase well and the woman feeling in control is vital to 'setting' foundational feelings of safety and love for the mother and her baby's relationship.

OB Gyn perspective on "OB Patient"

YouTube - OB patient

There is a rash of these mini movies. Clever, 'funny' (?) and short. Humour is a great way of getting a message across.



Ask yourself, what is the message that is being sent with this movie?

Here's another mini movie doing the rounds.



What is the message being promoted in this mini movie about women? What message is being sent about pregnant women?

and then, there is the anaesthetist's perspective on midwifery



I asked someone 'in the know' is that really how 'they' see us? "I'm afraid it is" was the answer.

all in good fun the film maker said. Really?

Words are powerful creators and transmitters of cultural beliefs and habits. What we see and what we hear shape and create patterns of thinking that become our perspective and our reality. These patterns and ideas take a life of their own, becoming a cultural meme and influencing every aspect of our minds, our behaviour and our culture. Emotions make those patterns deeper and stronger. Humour is a great release and can often bring the truth of a situation into a clear light. However, humour can seem benign, but is in reality, a particularly powerful pattern 'fixer' and giving more life to a meme.

I feel deep concern that childbearing women are being profiled in the way that these videos do. Yes, there are women who take advantage of systems and other people. In the main, most women want the best for their babies. Ignorance, abuse, violence and poverty are common themes in the lives of those who take drugs, avoid maternity care and lack education. Objectifying women as these videos do is unkind and leads to the adoption of a negative stereotypical view of anyone who is different and then flows on to include all those who seek choice, control and autonomy.

Maternity care is generally constructed to suit the health care institution and the doctors. For some women, their experience of maternity care is horrendous and deeply traumatising. These women can feel raped, violated and brutalized by their experience.

As Amity Reed writes "we should be striving to make all birthing environments, whether at home or in hospital, both safer and more peaceful and empowering".

Safe, peaceful, empowering birth environments for all women is a meme that is essential for our culture to adopt and create. Pregnancy and birth set the foundations for the future health and wellbeing of the baby.

We all know that anyone can change, grow and develop. Respectful, kind, supportive care that engages the heart of the woman does more to promote growth than unkind objectification and superior attitudes.

Videos like those above create a perspective that is harmful and ultimately degrading what's possible.

One born every minute: SBS documentary

SBS: Documentary

 The introduction to the US version of this 'documentary' explains:

"Every minute of every hour, a baby is born. But no birth story is ever the same. One Born Every Minute USA is an eight-part series that celebrates what it really feels like to become a parent.

Experience the high drama, humour and overwhelming emotion of child birth as new lives begin and others change forever.

This ground-breaking series observes the dramatic, emotional and often funny moments that go hand in hand with bringing a new being into the world, from the perspective of the soon-to-be parents and family, as well as the hospital staff".

In the lead photo to the US version of this series, a gloved hand, not the mother's, attempts to feed an obviously preterm infant, while the mother looks on with an intravenous line in her arm. The gloved hand is doing the important work.

The introduction for the UK version of the SBS documentary says this:

"Every minute of every day a baby is born in Britain. One Born Every Minute is an eight-part series that celebrates what it really feels like to become a parent, by taking a bustling maternity hospital and filling it with 40 cameras.

Filming from the reception desk and neo-natal ward to the operating theatre and birthing pool, this groundbreaking new series observes the dramatic, emotional and often funny moments that go hand in hand with bringing a new being into the world, from the perspective of the soon-to-be parents and family, as well as the hospital staff".

I am very bothered by both versions of this documentary. I am bothered because the lead photos (shown above and below) show a version of birth that is a complicated one.The mothers are not at the centre of care, which is where they should be.

The very pale baby being ventilated on the resuscitation trolley implies and transmits a subliminal message that birth is dangerous for babies.

That implication is wildly untrue and is a mean, cruel and dangerous association to put into the minds of people. That association undermines women's sense of self and sense of safety around birthing their babies.  I know sensationalism is what brings 'ratings' but good grief, preying on people's insecurities is despicable.

I was bothered because the assumption was and is, that the sort of maternity care that was shown in this documentary is 'normal'.

Yes, this maternity 'care' is normal if you think that women in labour should:

• be apologetic
• be treated like a nuisance
• be told how busy everyone is
• be surrounded by noise: telephones, pagers, beeping machines, talking
• be confined to the bed
• be strapped to monitors
• be left with only their partners and other support people
• have intermittent surveillance
• be attended by a technician that gives pain modifiers as requested
• be spoken to rudely
• be threatened
• be positioned in a way that ensures fetal distress
• have their babies handled roughly
• be separated from their babies

That view of normal maternity 'care' is what is at the back of the current wave of anxiety and mental health disorders in our population. How can I claim that? Our culture has been interrupting, disturbing and derailing mother-baby bonding and attachment processes for many decades now. Evidence is accumulating that early experiences shape personality, health and wellbeing.  Early emotional experiences have the most profound impact. There is nothing as emotional as birth. The corruption of the most primal and important experience in life, as evidenced in this documentary is startling in the way that such cruelty is accepted without any comment.

I have a very different view of maternity care and what is 'normal' during labour and birth.

In my world, a woman in labour is:

• continuously supported by a midwife she knows and trusts
• in an environment conducive to optimal physiological functioning - quiet, dimmed lighting, warm, private
• free to move, be mobile and adopt positions that feel right
• spoken to encouragingly
• free to focus on themselves and their babies
• supported by her partner and family as desired
• free to drink and eat as desired
• continuously monitored only if there is an indication to do so
• treated kindly and with respect
• able to expect her baby will be handled gently
• able to have the benefits of skin to skin with their babies at birth

What's your view of 'normal' maternity care?

The Look of Love: birth, mothers, babies and attachment

We humans are gifted with a prefrontal cortex, the site of our executive functioning. Our prefrontal cortex allows us to make choices, decide on different courses of action, rather than reflex, reactive behaviour.  Our prefrontal cortex enables us to evaluate different options and make a decision on what suits us best.

Sociologists contend that rather than being self determining agents with free will, we are culturally constructed, and our decision making is culturally driven and that we do not make decisions based on true free will, but based on what society has taught us is 'expected' and 'accepted' behaviour. Certainly, marketing psychology takes advantage of our tendency to buy on emotions and rationalise our purchases. We make our decisions based on emotionally based programming, we over ride our instincts and go with what is culturally predetermined as 'right'.  In the eyes of the law and culturally accepted social codes, such as avoiding fighting, stealing and self aggrandizement, that form of socially constructed behaviour is useful and makes for a safer and perhaps kinder society. However, there is a down side to over-riding innate instincts. 

Nowhere is the negative side of culturally driven behaviour more apparent than childbirth. Childbirth has been corrupted in our modern world.  In 1972, Doris Haire wrote a wonderful piece about the Cultural Warping of Childbirth, drawing attention to the way that the medicalisation of women's bodily processes at birth were causing harm. A more recent article by Estelle Cohen has drawn attention to "alarming continuing decline in the scores of high school students on the Scholastic Aptitude Tests or, "SAT's," a decline which had started with the 18-year-olds born in 1945 and thereafter. From 1963 to 1977, the score average on the verbal part of the SAT's fell 49 points. The mathematical scores declined 31 points. (1)" Estelle questions whether this decline in academic performance is linked to the way that obstetrics "manages" childbirth.

There are myriad intersecting and interconnecting influences on the personality, health, breastfeeding success, intelligence etc of any human being. However, the links between the way someone is born and their future health and wellbeing is becoming more understood. Epigenetics is one of the scientific arenas that are explaining the links. Many of the practices around the birth of a baby are pivotal and set the scene for the long term relationship of mother and baby. More and more attention is being paid to the mother baby interaction at birth, the role of being skin to skin for mother and baby on both the mother and the baby's future health.

Hospital practices have meant that entire generations of mothers and babies have been separated at birth. The consequences of that separation are only now starting to really be understood.

When my daughter was born, she was whizzed off to the resus trolley, cleaned up and wrapped, then shoved under my nose for about five seconds, then whisked off to the nursery.  I didn't see her until the next morning. About three hours after she was born, I found myself pacing the corridor of the hospital ward. I was surprised by my behaviour, but I recognise now that my body was looking for my baby, even though my conscious mind knew she was in the nursery. I did not think to question, to ask to see her; I fully accepted that she was in the nursery.


Lynne Reed, a Birth Keeper said in a recent interview that “We are the only animals on this planet where the mother will willingly give up her baby to someone else,” she says. “To me, that’s a huge indicator of how separated we are from our natural instincts, which would be so fierce to protect the baby.”

I certainly was separated from my natural instincts and days passed before I saw my daughter naked and we never had the skin to skin experience. I wonder if that is why I was so keen to go back to work and why putting her on the bottle was totally acceptable?  Research shows clearly that women who have skin to skin time at birth with their babies have all kinds of benefits and sequelae such as happier babies, self soothing babies, better breastfeeding experiences, less likely to leave their babies with others, babies smile earlier and more frequently. The list goes on and on.


A significant part of the experience seems to be the first eye to eye connection between mother and baby. Carla Hartley from Trust Birth has spoken about the smile a newborn gives her mother when she looks up at her as they connect skin to skin at birth. Carla describes that moment as 'precious' and 'sacred'. That eye to eye connection can be seen as a connection of spirits, a recognition of souls on this life journey.

For those who haven't had this connection, the gap can feel profound and deep. For example, in a Facebook conversation about this topic, Katherine Suszczewicz said " I was adopted. I hadn't realized until just now how my birth affected me today. It just occurred to me reading this that I have lived 45 years with a smothered urge to look my (birth) mother in the eye, something she didn't do when I was born. That feeling has been simmering and is quickly reaching a rolling boil. Just to look into each other's eyes, there's something there". When I asked Katharine if I could share her words she gave permission and said "whatever choices a momma makes, I think that first gaze is crucial....to begin life with the first air breath, a stare into your mother's eyes, and a feeling of love, security, to feel that someone is fiercely protecting you.....will carry you all your days on earth".

Leah Ann Sandretzky commented on Katharine's post and gave me permission to share her story. Leah said

"Katherine Suszczewicz: my heart goes out to you. ♥ my mother was and still is a recovering drug addict and alcoholic; she's looked me in the eyes many times and I have never seen that love. She says she loves me; and I know she does deep down . . . but her heart is gone from her selfishness. I was cared for by my grandparents most of my life; ...and to this day my soul longs for a Mother's love in my heart. I've taken that pain, that want, and turned it around to love my children 10x more than I think I can every day....in honor of the mother I never had. I don't know your story, your heart; but I hope that whether or not you have or will find that Mother's love in someone's eyes for you; you can go on loving like a Mother should. ♥ "

Another woman said "... the "look" I never received, I was adopted as well. My mother wasn't allowed to look, touch or hear me at birth due to the trauma of adoption on her. I was wisked away and the nurses kept me in the closet behind the nurses station so my mother or her family wasn't tempted to see me. The nurses spoiled me, I was told... and held me all the time but it just isn't the same. I hear the pain of the other women saying almost the same things. Way before reading this article I came to a conclusion during self reflection that I had a very hard time allowing anyone to get too close to me. I have attachment issues with everyone on this planet except for my children. Who I wouldn't let out of me sight when they were born. Thanks for posting this. I never put the two together about the "look" and bonding, I always assumed it was not being with my birth mom in general".

 

That look of love at birth is crucial for brain patterning and wiring a sense of self for the baby. Newborn babies are wired to look at faces and to prefer their mother's face to any other. That look of love triggers cascades of oxytocin in both mothers and babies, welding them together, spiritually, emotionally and physically. 

 

The implications for midwifery practice are clear. We are the guardians of the birth territory. We must facilitate the space so that mothers and babies can connect in this deep and profound way. The future of society and every individual's health and wellbeing depend upon us getting the beginning 'right' and providing an optimal environment, enabling a woman to respond to that innate voice and do what comes 'naturally' or rather, instinctively. 

 

 

 

Birth and Bugs

Note: for some reason the links aren't showing up in this post. Just run your cursor over the words and they will show as a purple colour. I can't fix this glitch, not sure why! Sorry.

Mumma and babe

Some interesting posts about the importance of the way babies are born and the bacteria they are exposed to through the birth process are emerging in cyberspace. The information is not only interesting, it helps to inform our practice as midwives and enables parents to understand one of the many reasons why there is a concerted move in both midwifery circles and government agencies to turn the tide more towards normal birth. Concerns are being raised that environmentally triggered changes to immune cells of babies born by caesarean section are predisposing those babies to be susceptible to immunological diseases such as diabetes and asthma in later life.

A blogger has explained the importance of our exposure to bugs at birth this way.

and a teacher of molecular biology at Princeton University, Bonnie Bassler, explains how bacteria talk to each other chemically. Bonnie informs us that we are composed of 10x more bacteria cells than human cells!

This information is a powerful addition to the accumulating evidence about normal, natural, unhindered, supported birth being best for mother and baby.

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.

BBC News - Post-natal depression in fathers 'often undiagnosed'

Modern day pressures on men have escalated in the last couple of decades as men seek to find relevance in a world that is rapidly changing their role in society and the family.

At last researchers are turning their attention to men's experiences of birth and early parenting. Researchers from the Eastern Virginia Medical School team looked at 43 studies involving 28,004 parents from 16 different countries. The countries included the UK and the US. In a news item in the BBC news, the researchers were quoted as saying:

"One in 10 new fathers may have the baby blues, US researchers believe - based on their trawl of medical literature. While this rate is lower than in new mothers, it is more than currently recognised, they told the Journal of the American Medical Association. Lack of sleep and new responsibilities, or supporting a wife with post-natal depression can be triggers, they say".

Childbearing and early parenting are stressful experiences.  New roles, new experiences and general unfamiliarity with babies provide a catalogue of changes that both women and men are having to deal with and integrate. A new reality for many along with smaller family sizes and the nuclear family phenomenon is that a vast majority of young parents have never even held a baby before they hold their own. Many men are inadequately prepared for being present at the birth of their baby and parenting.

BBC News Article

Midwives have a real role in including fathers-to-be in their work with childbearing women. Many men feel left out and sidelined during antenatal visits and during the birth process. Feedback from women on their experiences of midwifery student follow through often contain comments about how the student included their partner. The women always say how grateful they are that their partner was included and made to feel important by the student. The fact that the women feel a need to comment on this aspect of the student's involvement in their childbearing experience indicates to me that partners are not generally included in the care given by midwives and doctors.

Midwives and other health professionals have to recognise that childbearing is an emotional experience for men too. Working with women across the continuum of childbearing is enhanced when their partners are included in the woman centred focus of the midwife. Respect, kindness, inclusion and relationship building are core attributes of midwifery practice and set the foundation for women's feelings of being well cared for and valued during their experience of maternity care. Engaging fathers in the same way obviously has implications for how men emerge from their experience of maternity care too.

John Heron (born 1928) , a wonderful man who pioneered a participatory research method called cooperative inquiry, provided (for me) the first clear understanding about the importance of emotions in human interactions and wellbeing. John Heron identified three core emotional needs:

1. To love and be loved
2. To choose and be chosen
3. To understand and be understood

Heron said when these core emotional needs were not met, people develop defense mechanisms. Defense mechanisms are often counter productive to optimal relationships; optimal interactions on both cellular and social levels and overall mental and physical health and wellbeing.

If midwives and other health practitioners make a clear goal to ensure the emotional needs of women and their partners are met in their work with them through the childbearing year and beyond, many of the ills that plague new parents may be 'headed off at the pass'.

BBC News - Post-natal depression in fathers 'often undiagnosed'

Why midwives and women have to stay upbeat about birth: The wisdom of herds: How social mood moves the world - 19 May 2010 - New Scientist

In the latest New Scientist (19th May 2010), an article by John Casti, Senior Research Scholar and a futurist (castiwien@cs.com) based at the International Institute for Applied Systems Analysis in Laxenburg, Austria who is developing early-warning indicators for extreme events in society, informs us that

"No collective human activities or actions, such as globalisation or, for that matter, trends in popular culture such as fashions in films, books or haute couture, can be understood without recognising that it is how a group or population sees the future that shapes events. Feelings, not rational calculations, are what matter. To see what our world might be like tomorrow, next year or next decade, we need to spend time and money investigating "social mood". Put simply, the mood of a group - an institution, state, continent or even the world - is how that group, as a group, feels about the future".

How would we, as a group of people who care about what happens to women and babies during the childbearing year, be described as feeling about the future?

Are we optimistic or pessimistic? "

According to John Casti, how we feel and how we see the future, does much to create it. In the Selfish Gene, British scientist, Richard Dawkins coined the word 'meme' as a concept to enable discussion about these collective social, cultural moods/orientations and behaviours as evolutionary principles in explaining the spread of ideas and cultural phenomena.

What's our meme? What do we want it to be?

Casti's essay is based on his new book Mood Matters: From rising skirt lengths to the collapse of world powers.

The wisdom of herds: How social mood moves the world - 19 May 2010 - New Scientist

Where's the Placenta in Birth Films?

The placenta is an ignored organ in birth films. 


The following film is beautiful, but the cord is cut early and there is no placenta! I can't help but wonder why.



The way the woman gives birth so calmly and consciously in this video is a delight.  I love the way the tank enables the family, the midwife and the doctor to see what is happening without interfering or interrupting the woman's 'flow'. I also love the way the woman uses her hands to birth her baby's head and how she engages with the baby when the baby's head is born.  This woman was obviously well prepared for the birth of her baby.

BUT - where is the placenta???

The birth of the placenta is missing from most videos.  The fact that the placenta is missing from birth videos sends the wrong and incomplete message about birth.  Giving birth to the placenta is the third stage of labour. The third and fourth stage of labour, during which time the woman adjusts psychologically, physiologically and spiritually to the birth of the baby, are vitally important parts of the birth process. This period is a 'peak experience' time; one where women get surges of the 'love' hormone oxytocin if the environmental conditions are optimal. These surges in oxytocin are essential for optimal psychophysiological functioning for bonding with the baby, contraction of the woman's uterus, haemostasis and the initiation of lactation. 

The placenta is an awesome organ and needs to be given due respect and acknowledgment for the mighty role it plays in the beginning of life.

Many cultures have the Tree of Life symbol which is said to be a metaphor for the placenta; artworks across millenia demonstrate this potent recognition of the placenta's role in the life of a fetus and baby.  Not only is the symbolism missing in modern life, even the placenta itself is written out of the mainstream artform - that of videos.

Ignoring or dismissing the placenta comes at a cost.  Women don't know they have a placenta to birth; if they do know, they don't know the magnificence of it. What that means is they think birth is over when the baby is born. Unfortunately, thinking birth is over sends the wrong message to the neural networks and hormonal system.  Safe birth requires conscious engagement in the process.

A key lesson of modern neuroscience is that a change in the focus of our attention changes our brain firing patterns and changes the neurochemicals associated with the firing pattern. The practical application of this lesson is that our physiology responds to our thinking. The thought that birth is over when a woman doesn't realise that the birth of the placenta requires attention, especially when the feeling of relief is profound and/or the woman is disturbed/distracted from her baby and birth process can result in a blocking of the release of oxytocin.  A drop in the level of oxytocin can  predispose the woman to excessive blood loss because her uterus doesn't get the chemical messages it needs to contract well and seal off the placental site. The attentional network that I suggest is optimal in birthing the placenta and keeping safe in third and fourth stage of labour is the attentional neural network associated with fascination. When a woman is fascinated with her baby, she is safe and her physiology works as it ought. Disrupting, distracting or in any other way interrupting the fascinating network bodes trouble. Midwives have a duty of care to ensure the birth environment is conducive to women's fascination with their babies being enhanced and potentiated; a key aspect of midwifery guardianship. .

I've written a theoretical paper, with my colleague, Professor of Midwifery, Dr Kathleen Fahy,  on midwifery guardianship in the third stage of labour. You can access the abstract here. 

We also conducted a cohort study which showed that women who had active management of third stage were 7-8 times more likely to experience excessive blood loss in third and fourth stages of labour than women who were well prepared and, together with their families and midwives, had a mindful approach to the birth of the placenta.

The answer is: let's talk up the placenta, make sure women know that third and fourth stages are an integral and important part of labour and include the birth of the placenta as an integral part of any film about birth.
 
On this Mother's Day,  the recognition that knowledge is power and education about the placenta is lifesaving and helping women to stay safe in childbirth is a good thing to think about!

What you don't say can hurt you!

The vital importance of speaking up and saying how you feel to your health and wellbeing is demonstrated in a post by this young woman, Fiona Hollis.

You can visit Fiona’s website and read more about her journey here: http://www.iloveraw.co.uk/

The post was part of an email newsletter I found in my in-box this morning from The Raw Divas, one of my favourite health and wellness sites.

The Raw Divas are entertaining and informative and I always enjoy their take on life and food. Their articles are often enlightening and I have fun with their recipes. Their approach suits my interests and understanding because my move to a vegetarian way of life, as a result of being employed as a nurse in an abattoir in the early 70's, has lead to an increasing interest in the power of food, especially raw food, to function as medicine for all sorts of ailments.


Fiona writes:

"My name is Fiona, and I wanted to share with you how raw greens have helped transform my health. January was my one year anniversary of healthy thyroid function. Woohooo!

In December 2008, I was diagnosed with hyperthyroidism. To my horror, I was told by my GP that surgery would probably be needed to remove 3/4 of my thyroid gland, leaving me dependent on medication for the rest of my life. This didn’t feel like a road I wanted to go down at all".

Having a baby had been life transforming for Fiona. Her birthing experience caused her to think differently about life and health. Fiona now believes that:

"... all illness or dis-ease is caused by energy blockages within our bodies where emotions get trapped and repressed. I have not always thought this way - but since having my son my eyes have opened to the magical possibilities that are open to us if we dare to believe and see for ourselves"

She explained her belief that our bodies are able to heal themselves when they are working properly and how she:

"... knew deep down the goiter in my neck was blocked expression - clearly affecting my throat chakra. There was a key issue that had been bubbling to the surface of my mind for the last few months and the fear of expressing it to those around me was too great. I denied the need to confront it. The ‘thing’ I least wanted to say - had now backed me into a corner and was testing how much I was willing to stay in denial.

I now had no choice - and I could feel it in every painful cell. The emotions surrounding this admission were HUGE. The waves of shame, self-hatred, and despair I experienced as I spoke my truth was clearly what I had been avoiding. The day after I spoke my truth my goiter went down & I started my healing - and believe me it was the biggest thing that’s ever happened to me".

According to Fiona, her remarkable healing and overnight reduction in her goitre occurred when she 'spoke her truth' and dealt with difficulties that she had been suppressing.

Fiona's experience resonates with what happens for childbearing women having one to one midwifery care. Anyone who observes the results of one to one midwifery care for childbearing women will find that among that cohort of women, more births are normal, more women and babies are well and breastfeeding successfully, there are less occasions of preterm labour and birth, pre-eclampsia and gestational diabetes compared to what happens for women who access the standard, run of the mill maternity 'care'.   

Midwives who work in a genuine continuity, one to one, relationship based model of care provide a safe place and develop a relationship of trust with the woman within which the pregnant woman can feel heard and respected and able to discuss concerns, fears and troubles. Putting words to troublesome feelings enables emotional release. The role of unrelieved and unexpressed stress on inflammatory processes and the involvement of inflammatory processes in the aetiology of disease is becoming more widely recognised.

As stress is expressed and released, health and wellbeing go up.

Awareness is so crucial to living a full, healthy and happy life. The importance of paying attention and acknowledging how you feel cannot be overemphasised. Midwives have a real role in supporting women to become aware of and express their feelings. Asking 'how are you today' in a meaningful way and waiting for a genuine answer, being present and acknowledging any discomfort for the woman, enables her to feel heard and cared about - the ultimate stress reduction exercise.

Not saying how you feel, as Fiona's experience demonstrates, can be toxic to the bodymind.

Another important point to note in Fiona's remarkable story is that she also embraced a nutritional approach to improving her health and used raw food to suppress thyroxine release.

Happy International Midwives Day!

Happy International Midwives Day! 

All over the world, midwives and women, their partners and anyone who cares about how women are cared for during childbirth,  are celebrating midwifery today, the International Day of the Midwife. 


The 24 Hour Virtual International Day of the Midwife is an online event aimed at bringing midwives together from all over the world. The event is being facilitated by Sarah Stewart and Deborah Davis. For more info: click this link here

Remember to come and enjoy the different sessions. You can find the program here. 


A gallery of photos of Global mothers, midwives and nurses can be found here

Talking about the importance of baby's birth experiences at the Mother of all rallies, PH Canberra 2009

I happened upon this video when I was searching for some information on Google! What a rally that was. I was interviewed at the rally for the upcoming film 'Face of Birth' and this is the result of that interview:



There are other snippets of the film in the making on the site.

Carolyn Hastie - Mother of all rallies, PH Canberra 2009

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. 

Midwifery Legislation Update from Maternity Coalition

Update from Maternity Coalition about Health Care Legislation.

The Senate passed the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 on Tuesday 16 March. This legislation should give Australian women greater access to affordable, continuity of care with a known midwife.

It marks the beginning of a new era of maternity care for Australia’s maternity consumers. It is a huge achievement; and thanks to the work of generations of women and to you.

In recent months, much of our focus in the birth community has been on the aspects of the maternity reforms we are unhappy with including the collaborative arrangement and the threat to births at home. But we should remember that this legislation is a giant step forward in the right direction to woman-centred maternity care.

What this means

We don’t know how it will all work in practice yet as Health Minister Roxon still needs to make decisions on a number of things including definitions for ‘eligible midwife’ and ‘collaborative arrangement’ and details around Medicare and prescribing are still not finalised.

But what we do know is that:
• Consumers, from November 2010, will be able to choose (in theory) their own midwife for their pregnancy, birth care in a hospital and post-natal care. How intrapartum care in hospital will work still needs to be sorted with visiting/admitting rights. This care will be more affordable as they can get Medicare rebates for it. This has the potential of increasing the numbers of Australian women who can access continuity of care with a known midwife from less than 5% to a New Zealand figure of around 80% or higher.
• Midwives will have access to
o Medical Benefits Scheme
o Pharmaceutical Benefits Scheme
o Professional Indemnity Insurance (excluding birth at home) and the Government will also pay any insurance claims that exceed $1 million. Note: The need for a collaborative arrangement to be in place before a midwife could access this indemnity was dropped in the Bills.

What MC is doing?
MC is working hard. We have:
• representatives at all working groups of the Department of Health and Ageing involved in implementing these reforms.
• given evidence at two Senate enquiries.
• attended consultations and made submissions to provide the consumer perspective on maternity issues.
• engaged in strategic conversations with other stakeholders.

MC and a range of midwifery and nursing organisations have agreed on a consensus for collaborative arrangements and took this proposal to the Minister’s office. We’re feeling optimistic about this. Senator Joe Ludwig (ALP) clearly stated in the Senate it was not the Government’s intention in the legislation to give one professional group control over another. We need to keep the Government accountable to this.

What about homebirth?
There is nothing in the Bills for homebirth – the Bills neither support nor outlaw homebirth. However Health Minister Roxon has made it clear that she intends women to be able to continue to access midwifery care for homebirths. To hear it straight from the Minister, see this video:
http://www.youtube.com/watch?v=iK_Vt18eq0s

MC, along with the Australian College of Midwives, has developed an alternative proposal for the Quality and Safety Framework midwives will need to work to in order to qualify for the two year exemption from professional indemnity insurance. As the whole purpose of this exemption was to secure women’s access to homebirth care, MC expects an outcome which will work.

We have asked that this framework be finalised by 1 April 2010 giving women and midwives 3 months in which to make plans. The final version of the framework will be released in the next few days. Look to the website for a link to it shortly.


MC’s perspective of an ideal outcome for homebirth (in terms of what’s going on at the moment) is that midwives providing homebirth care will be:
• registered as a midwife and able to practice
• exempt from professional indemnity insurance for the first two years of national registration (from July 2010)
• working in much the same way they do now.

Some homebirth midwives might also choose to become an ‘eligible midwife’ with access to MBS and PBS. In which case they will need to have a collaborative arrangement in place so that their clients can receive Medicare rebates for their pregnancy and post-natal care.


What you can do right now?

• The National Health and Medical Research Council has released its draft ‘Guidance on Collaborative Maternity Care’. This is a very important document. They are asking for feedback on this document and want it by Friday 27 April. For more information go here: http://www.nhmrc.gov.au/guidelines/consult/consultations/ngcmc.htm. When you read it, ask yourself how these arrangements would work for you as a consumer. SEND YOUR COMMENTS TO l.metcalfe@tpg.com.au for incorporation into a response to the NHMRC.

• If you haven’t written/visited your Federal MP for awhile, get back in touch and tell him/her that birth and birth care really matter to women and families, and we expect governments to take responsibility for the quality of care and choices available to women [how do you see this yourself?]. Remind them that they need to find a long-term solution for indemnity for midwives providing homebirth by June 2012 and that the clock is ticking.

• Keep up your membership to Maternity Coalition and other consumer and midwifery groups. In numbers we have strength. Without you, we are nothing. To renew your membership with MC and find out when and where the next meeting is close to you, go to our website www.maternitycoalition.org.au



Lisa Metcalfe
President Maternity Coalition
Em: president@maternitycoalition.org.au
Web: www.maternitycoalition.org.au