Medical establishment prevents nurses from assuming new roles

Physicians still retain the bulk of decision-making power over nurses in Quebec - a situation that's detrimental to evolving nursing roles. According to a new study by Université de Montréal researchers, published in Recherches Sociographiques, nursing functions are still very much assigned by physicians who often oversee family medicine groups (FMGs), specialized nurse practitioners (SNP) and oncology nurse navigators (ONN).

Medical establishment prevents nurses from assuming new roles

Georgianne Nienaber: Congo: Midwives Transform Trash Into Hope

"The midwives who fight to preserve new life as babies struggle to enter the world in the Mugunga camps and in the villages are tired, but their courage overcomes discouragement. When we visited with them in January of this year, their requests were simple. "Do not forget us." "We have no means to feed our own families." "Some cloth for the babies would be nice."

Georgianne Nienaber: Congo: Midwives Transform Trash Into Hope

"I swore never to be silent whenever and wherever human beings endure
suffering and humiliation. We must always take sides. Neutrality helps the
oppressor, never the victim. Silence encourages the tormentor, never the
tormented". Elie Wiesel

Doctors to gain veto powers over midwives and birth choices

Maternity Coalition sent out a press release which explains the current legislation changes very clearly.

Doctors to gain veto powers over midwives and birth choices

On 5 November the Government announced that the “Medicare for midwives” Bills
would be amended to require midwives to have “collaborative arrangements” with
“medical practitioners” before being eligible for professional indemnity insurance or Medicare rebates:
*before the midwife can access professional indemnity insurance, and
*before women can claim a Medicare rebate for midwifery services.
Doctors must approve each midwifeʼs entry to private practice:
*Midwives will be required by Commonwealth law to have “collaborative arrangements” with
“one or more medical practitioners” before being eligible for Commonwealth-subsidised professional indemnity insurance (PII).
*PII will be a prerequisite for a midwife to enter private practice, under new national registration laws, being enacted state by state.
*Doctors will be able to unilaterally withdrawal from collaborative agreements with a midwife, rendering her uninsured, and legally unable to practice in a private professional capacity.
*This legally mandates medical control over midwives’ ability to register and work in private practice.
*This will be set in Commonwealth law, which can only be changed by Commonwealth
Parliament.
*These provisions are contained in the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009.
Doctors must approve womenʼs access to Medicare rebates for midwifery care:
*Midwives will also be be required by Commonwealth law to have “collaborative arrangements” with “one or more medical practitioners” before their services are eligible for Medicare rebates.
*This puts women’s access to private midwifery care under medical control.

This is potentially defacto “parallel regulation” of the midwifery profession:
*Medical practitioners will control the registration status of midwives, despite their being a discrete, separately regulated profession.
*Medical professional organisations could set guidelines for collaborative arrangements,potentially forming defacto regulatory standards for midwifery endorsement and practice.

This gives doctors right of veto over womenʼs choices in birth care:
*Any birth care choice using private practice midwives, or developed under the
Commonwealth’s new arrangements, will be subject to medical control or veto.
*This gives medical practitioners unprecedented control over women’s choices and access to care.

“Collaborative arrangements” may be legally restricted to privately practicing doctors
*The amendments do not specifically include hospitals as able to form collaborative
arrangements with midwives. They require medical practitioners to be “of a kind or kinds specified in the regulations”.
*It is unclear whether a hospital, health service district or authority may be included within the definition of “one or more medical practitioners”.
*Doctors who are employees of public hospitals can’t make “collaborative arrangements” as employees of the hospital they work for. They work for the hospital, attend their workplace when rostered on and collaborate in line with hospital policies.
*A range of very serious consequences would flow if these arrangements were restricted to privately practicing doctors. Consequences could include:
o No new midwifery models in public hospitals.
o No private midwifery practice.
o No homebirth care from midwives in private practice.
o Practice midwives in private obstetricians rooms could be the only viable model of private practice or Medicare-funded midwifery.
This brief represents the best information available to Maternity Coalition on 8 November 2009. We are actively seeking ongoing clarification and dialogue with Government in order to ensure women and families have access to accurate information.

For full text of amendments go to:
http://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;adv=yes;db=;group=;holdingType=;id=;orderBy=priority,title;page=7;query=Dat
aset%3AbillsCurBef%20Dataset_Phrase%3A%22amend%22;querytype=Dataset_Phrase%3Aamend;rec=11;resCount=Default

For more information contact: Bruce Teakle 07 3289 0231, teakle@maternitycoalition.org.au

Julia Gillard's 2005 speech about the importance of choice for childbearing women

In 2005, Julia Gillard was the Shadow Minister of Health, Manager of Opposition business in the House of Representatives. Ms Gillard spoke at the following conference: 

Midwifery By The Sea - Riding The Waves Of Change

Speech - ANNUAL CONFERENCE OF NSWMA

20th October 2005 
Following are excerpts from Ms Gillard's speech

"Thank you very much for your invitation to join you here today at your annual state conference by the sea.

The best start in life

It will not surprise this audience - I'm sure you will all agree - if I now say that I see the pregnant woman as the best focus for early intervention.

Between us we could draw up an impressive list of perinatal programs that would boost the health of the mother and her baby, and improve outcomes, and give all our kids the best start in life. 

Obstetric services and workforce shortages

In the middle of this is the big event - the birth.

I know that midwives - as a group and individually - have strong ideas about what should be provided in terms of birthing services. 

But shockingly, it is increasingly the case that for some women the idea of having a choice of birthing services and having continuity of care throughout their pregnancy, the birth and in the post-natal period is an impossible luxury - not just unaffordable, but unobtainable in their local area.

The shortage of midwives is also a problem. The Australian Health Workforce Advisory Committee estimates a current national shortage of 1850 midwives, and this is expected to increase over the remainder of the decade.

Midwives face additional concerns about the lack of professional recognition as well as limited opportunities to practise as primary carers and provide continuity of care to women. 

The need for a concerted approach 

Clearly this is no time for turf warfare between doctors and midwives, but it is time for all health care professionals involved in delivering obstetrics care to mount a combined attack on the Howard Government to force them into action to address this situation.

Unless and until the Government is shocked and shamed into realising that Australian women are now scrambling to find the birthing centre of their choice, and in some cases scrambling to find any professional who will deliver their child, the situation will not improve. 

It seems to me that we need a variety of solutions to fit all the circumstances that arise.  There is no 'one size fits all' way to solve the problems that present so differently in metropolitan Sydney, the isolated community of Wilcannia, the growing town of Byron Bay and the multicultural suburbs of Western Sydney.  The one common factor is the pregnant woman and her child - they must be at the centre of the solution.

… I believe that midwives … are key heath care professionals whose role in the care of women and their babies has yet to be fully realised in the Australian health care system.

We need to realise that potential so that mothers have real choice in their birthing experience, and their babies have the best start in life".  

Beautiful and true words. However, now we are finding that it is no longer the Howard government standing in the way of women's choice, it is now the Labor Government.  Right now, Nicola Roxon  is seeking to abort women's choice in birth place and birth attendant.  Ms Gillard, you need to ensure that your words in 2005 were not empty rhetoric and politically driven spin to win brownie points in opposition. 

The time for action on your words is now. 

1. Ensure the needs and choices of all childbearing women are at the centre of any  goverrnment, health /maternity  service or policy action. 

2. Ensure that midwives are able to work unhampered by politics in the way that the World Health Organisation recommends.  

3. Provide a level playing field for health care providers (midwives , lactation consultants (IBCLC) and doctors) who work with childbearing women (access to Medicare, insurance and PBS)

4. Remove professional silos and institute true dialogic conversations and interactions for those situations when childbearing women require a multidisciplinary approach for their situation).

 

Facebook | RALLY FOR BIRTH CHOICES - SYDNEY

The proposed amendment to the nurses and midwives legislation is contained in the Federal Minister of Health's press release below.

As Jo Hunter, convenor of Homebirth Australia explains:

"The point that will redefine the fundamental nature of midwifery and certainly homebirth midwifery in Australia is that “collaborative arrangements with medical practitioners will be required to access the new arrangements”. In short this amendment will require midwives to work with GP obstetricians and private obstetricians and have a “collaborative arrangement” in place at all times.

This is NOT acceptable. How will it be possible for a midwife who attends homebirths and for women wishing to birth at home to gain the support of a GP ob or private obstetrician when their own college statement does not support homebirth?

RANZCOG statement reads -

“The College does not support Home Birth or ‘Free-standing’ Birth Centres

(without adjacent obstetric and neonatal facilities) as appropriate Health Care

Settings. The College acknowledges that a very small minority of women will

choose to birth in these centres, even if appropriately informed of the

consequences”

In solidarity with our northern and southern sisters (who will be rallying outside Kevin Rudd’s Brisbane office and Julia Gaillard’s Vic office) please come and rally outside the Minister for the status of women, Tanya Plibersek’s office in Sydney".

Facebook | RALLY FOR BIRTH CHOICES - SYDNEY

THE HON NICOLA ROXON MP
MINISTER FOR HEALTH AND AGEING

MEDIA STATEMENT – 5 NOVEMBER 2009

Midwives/ Nurse Practitioner Amendment

The Minister for Health and Ageing, Nicola Roxon has today circulated an amendment the Government intends to introduce into the Health Legislation (Midwives and Nurse Practitioners) Bill and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill.

This amendment makes clear in the legislation something that was articulated both on introduction of the Bill to parliament and in the explanatory material tabled at that time.

Following requests for clarification, this amendment will simply clarify in legislation that collaborative arrangements with medical practitioners will be required to access the new arrangements.

The details of these requirements will be specified in subordinate legislation following the ongoing consultation with the professional groups.

These bills are a key plank of the Government’s 2009/10 Budget commitments which recognises for the first time the role of appropriately qualified and experienced midwives and nurse practitioners in our health system.

The Minister for Health and Ageing said today “I thank the doctors, nurses and midwives for their constructive engagement to date to ensure these new opportunities for nurses and midwives are implemented in an integrated fashion for the benefit of patients.”

For more information contact the Minister’s office on 02 6277 7220

Wining and dining doctors a $60 million a year industry / Current news / The University of Newcastle, Australia

Transparency is important. Where funding comes from and goes to, what makes the cost of pharmaceuticals so high are financial and health related issues that the government and the general population need to know more about.

The Baby Friendly Hospital Initiative has sought to keep maternity services free from the wining and dining, 'gift' freebee culture of formula makers that creates dependency and a sense of 'owing one' to the generous one. If anyone wonders if it is necessary to keep midwifery free of funding by vested interests of formula makers and the like, wonder no more.

Wining and dining doctors a $60 million a year industry / Current news / The University of Newcastle, Australia

YouTube - Monty Python - Hospital Sketch

The best social commentary on how the medical model (the Emperor has no clothes model) treats women and birth. This clip is from the Monty Python movie "The Meaning of Life". These people are/were geniuses. Although this movie was made in 1983, it is still relevant over thirty years later.

YouTube - Monty Python - Hospital Sketch

The food-energy cellular connection revealed

This article helps us understand why shift workers are more at risk of a raft of diseases. Night duty workers are more at risk of breast cancer. More reasons why changing the way that midwives work leads to better outcomes. This time it's midwives who benefit by coming off shift work and working one to one or in caseload models with childbearing women. Maternity service managers please take note.

"Shift workers face a 100 percent increase in the risk for obesity and its consequences, such as high blood pressure, insulin resistance and an increased risk of heart attacks," says Howard Hughes Medical Investigator Ronald M. Evans, Ph.D., a professor in the Salk Institute's Gene Expression Laboratory.

The researchers' findings, which are published in the Oct. 16, 2009, issue of Science, could have far-reaching implications, from providing a better understanding how nutrition and gene expression are linked, to creating new ways to treat obesity, diabetes and other related diseases. "It is estimated that the activity of up to 15 percent of our genes is under the direct control of biological clocks," says Evans. "Our work provides a conceptual way to link nutrition and energy regulation to the genome."

The food-energy cellular connection revealed

Shared via AddThis

Bullying and harrasment of Doctors who support women's choices

Welcome to my blog. Thank you for your support!

Please take a moment to read Dr Fischbein's blog. He is a medical doctor who supports women's right to autonomy and informed choice.

Language and Paradox in Childbearing

I was reading a piece of work which commented that a woman had an 'uneventful pregnancy'. That word 'uneventful' appears to be innocent at first glance. What 'uneventful' means in the context of maternity care is that there are no problems with the pregnancy. Labeling the life changing transformative experience of a normal healthy pregnancy as 'uneventful' belies the importance of a pregnancy to a woman, her family and society. That word 'uneventful'diminishes the power and magnificence of what is happening within a woman's body and psyche when she is pregnant.

Being pregnant would have to rate up there as one of the most momentous of events in a woman's life. I was thinking about language and words have so much power and convey so much meaning. The use of the word 'uneventful' together with healthy pregnancy creates a paradox. This paradox is not immediately recognised. The paradox may never actually be recognised by the speaker. With one word the wonder of pregnancy is relegated to the status of an unremarkable and therefore somehow meaningless reality. I wonder if the mindset that word 'uneventful' creates is one of the reasons why our maternity services make pregnant women wait for hours in cattleyard-like antenatal clinics?


Carmel Niland said in 1992 in her Anne Conlon Memorial Lecture “Women, Power and the Political Process” to the NSW Women’s Advisory Council “Words are seeds. Whole worlds lie curled in them. Three words like ‘women’, ‘power’ and ‘politics’ have a universe in ideas curled in them”.

The way we speak, what we say and how we say it is culturally and politically determined and reflects our belief structures, perspectives, values and biases. Language also defines structure, creates thought and gives thought form. It not only embodies our history and culture, it reinforces our values and beliefs in a self perpetuating system of meaning making. Words are carriers for cultural ideology. We see the world through the lenses of our values and belief systems. Spoken language is a major form of interpersonal communication. The words used in oral communication demonstrate power structures and positions of those communicating within those power structures. As Sheila Rowbotham (in Waring 1990:18) comments,
“language … is one of the instruments of domination... expresses a reality experienced by the oppressors. It speaks only for their world, their view.”

Changing our language to ensure what we say truly reflects the magnificence of pregnancy, birth and breastfeeding is vital if we want to change maternity services and what happens to women.

Waring, M. If Women Counted: A new feminist economics Harper Collins New York.

Australian Private Midwives Association - Home

Australian Private Midwives Association - Home

Pregnant women's rights US style

Three years ago, a pregnant woman who refused a continuous monitor when she was in labour and refused a caesarian section was given two psychiatrist consultations and found to be behaving 'erratically'. The woman gave birth normally to a healthy baby during the second psychiatric consultation. Because of her non-compliance, the woman was diagnosed as 'paranoid schizophrenic'.

The hospital in question has a caesarian section rate of nearly 50%. 'They' decided, because the woman was not 'cooperative' that the woman and her partner were not fit to care for their child and they took the baby away from her at birth.

Her baby was never returned to her.

That 'stolen child' situation has recently come to media attention

http://www.huffingtonpost.com/louise-marie-roth/is-a-woman-in-labor-a-per_b_242307.html

Some facts:

The baby was born normally and well
The woman had a history of abuse
The woman had a history of depression (pronounced well in 2005 and no longer requiring medication)
The hospital had a caesarean section rate of nearly 50%
The court decided the woman's refusal to have a caesarean indicated child abuse of an unborn child, even though the fetus has no legal rights
The court decided the woman did not have the right to make an informed choice

The court decision cites hospital records that describe the mother, V.M., as "combative," "uncooperative," "erratic," "noncompliant," "irrational" and "inappropriate."

Sounds like normal labour behaviour of many women to me, especially women who have been sexually abused as children and who have not had the opportunity to work things through with their midwife.

The judge was overheard telling V in one of her hearings that he felt she would be 'too argumentative and that would wind up hurting her child. For instance, she would argue with teachers and receptionists at the dentist office.'

Hmmm, anyone else ever argued with someone about something to do with your child? Anyone else ever argued with a teacher?

Henci Goer, the medical writer, joined several doctors and birth/women/rights related organisations and they together filed an amicus curiae (friend of the court) brief to support the appeal that was filed by the parents.

They lost. A supreme court appeal is likely.

In Australia, we all have to be very clear that women are autononous; that women have the right to decide what they will do or not do; that women have sovereignty over their own selves and their pregnancies. Women have the right to give birth where and with whom they choose. Full stop.

The situation that has happened to V could happen here.

Come to Canberra 7th September 2009 and make your presence felt. Write letters, see your local member. Help them understand what normal labour is like and what women need. Our future as a sane and just society depends upon it.

This is where Nicola Roxon was clear about not funding women's choice to birth at home with a private midwife

parlinfo.aph.gov.au

Women's rights further eroded - Homebirth denied

Today our health minister, Nicola Roxon introduced two Bills to Parliament. One of these bills eroded women's rights to choose to birth at home with the midwife of her choice. This is unacceptable.

It is not acceptable to treat women this way. Every woman deserves to have the choice to employ her own midwife or to access the health service offerings, to choose her place of birth and to be supported in her choice.

Women are citizens of Australia. We are thinking, autonomous beings and want sovereignty over our bodies.

Who got to Nicola? Who over-rode her innate understanding of women's rights?

What do we need to do differently to get this to change?

Homebirth Rally at Parliament House Monday September 7th 1130am

Put this date in your diary and come with us! This is a critically important rally. The changes in Medicare rebates and the fine print is pointing to the demise of private midwifery and women's choices for birthing at home. For everyone who cares about women's rights to birth where they want and with whom they want, this rally is a must attend. We must show the politicians and the people of Australia that women matter, birth matters and choice is imperative.

The following message is from Justine Caines, an awesome woman and mother who has campaigned tirelessly for women's choices in birth.

HOME - EVERY WOMAN’S BIRTH RIGHT – RALLY FOR HOMEBIRTH – MONDAY SEPTEMBER 7 2009, PARLIAMENT HOUSE CANBERRA

Homebirth Australia is hosting a MAJOR rally in Canberra (outside Parliament House) on Monday September 7 from 11.30am.

There has been much discussion about the potential outlawing of homebirth and the continued lack of equity for women choosing homebirth.

We need this to be BIG. When I met with the federal department of Health they commented on the huge number of submissions (900 of which over half came from homebirth consumers). Sadly I said if you outlaw homebirth I will lead 9000 angry women and babies to Canberra!

Now 9000 may be a tall order but we need thousands.

For all the women and midwives that have contacted and said this issue matters please put it in your diary.

There is lots to organise and we look forward to many providing ideas and support.

The states close to Canberra will be called on to provide as many as possible to attend.

It would be great to have at least a few from every state and territory.

Please forward this meeting far and wide.

Details will soon be on the HBA website.

www.homebirthaustralia.org

For any other info please email justine.caines@bigpond.com

Improving Maternity Services Package Budget 2009

Improving Maternity Services Package

The following paragraphs are from the federal budget released on the 12th May 09. I've been reading it, seeking to understand what it all really means. I'm not really any closer to finding out. What I do know is that the 'system' is not working well. Women centred care is still a pipe dream in many places. Stories student midwives tell are threaded with examples of bullying and coercion of women to fit in with the policy driven, factory style approach to the birthing process. There is still lots of work to do to create maternity services which are women centred, aware of women's individuality, private, kind and respectful. Is the budget offering a good move?

"The Government will provide $120.5 million over four years for the introduction of Medicare‑supported midwifery services to provide greater choice for women during pregnancy, birthing and postnatal maternity care. This measure includes $3.1 million in capital funding in 2009‑10 for Medicare Australia.

The new arrangements will allow midwives to work as private practitioners, provide services subsidised by the Medical Benefits Schedule and prescribe medications subsidised under the Pharmaceutical Benefits Schedule. The Government will also provide subsidised medical indemnity for eligible midwives working in collaborative arrangements in hospitals and healthcare settings. To ensure that Australia maintains its strong record of safety and quality in maternity care, a safety and quality framework, including professional guidance and an advanced midwifery credentialing framework, will be developed. A new 24‑hour, seven‑days‑a‑week helpline will also be established to provide antenatal, birthing and postnatal maternity advice and information to women, partners and families during the ante‑natal period and up to 12 months following the birth of a child.

The measure will also assist women in rural and remote areas by expanding the Medical Specialist Outreach Assistance Program to provide integrated outreach maternity service teams for women in under serviced areas. The expanded teams will include midwives, obstetricians, general practitioners and other health professionals, such as paediatricians and Aboriginal health workers. Additionally, funding will be provided for the professional development of midwives and for general practitioners to undertake additional training to become GP obstetricians or GP anaesthetists. The package will be implemented progressively from 1 July 2009".

Garling Report

That fact that the NSW Health System is in crisis led to the appointment of Mr Peter Garling SC to conduct a review of the acute health care services in NSW in January 2008.

On 27th November, 2008, Mr Garling released his report. Terms of Reference and the report is available here:

http://www.lawlink.nsw.gov.au/lawlink/Special_Projects/ll_splprojects.nsf/pages/acsi_index

The report makes sobering and fascinating reading as Mr Garling outlines the problems which are troubling our health care system, for example, problems such as increased numbers of people accessing health care facilities. Mr Garling praised the skill, competence and dedication of the health care staff, but outlines many changes which need to occur for the health care system to improve. A particularly important point that Garling makes is that "Furthermore, the rigid demarcation between what a doctor’s job is, and what a nurse’s job is, needs to be consigned to history. Once the concept of teamwork is accepted as the norm in treating a patient, it is easier to see why a qualified nurse practitioner should be able to do many jobs once reserved for doctors".

These comments by Garling demonstrate his deep recognition of the power dynamics which are keeping the health care system stuck in its medieval origins and which mitigate against true efficiency and effectiveness for patients well being. Even though Garling only mentions nurse-doctor working relations, his comments are very applicable to the power dynamics which trouble maternity services. His words echo the conclusions of my study into midwife-doctor interactions in the care of birthing women.

thesis available on line here: http://ogma.newcastle.edu.au:8080/vital/access/manager/Repository/uon:2509

The NSW Government is wanting feedback on the Garling Report. You can give feedback here:

http://healthactionplan.nsw.gov.au/provide-feedback.php

Please take a moment to give feedback on this important report. In my feedback I've talked about how birth is normal and that we are seeing iatrogenic outcomes because birth has been treated as an illness. I've argued for an expansion of 1-2-1 midwifery services and talked about how mothers and babies are safer when women feel valued, listen to, respected and given information and then able to make choices which are actioned.

Imagine if we all gave this feedback?

Garling Report

Adverse publicity ensured the shortcomings of the NSW Health System were spotlighted and it was widely recognised that acute care services were in crisis. On the 29th January 2008, the NSW Governor appointed Mr Peter Garling SC to inquire into and report upon matters falling within the Terms of Reference (link available below).

On the 27th November, 2008, the Final Report of the Special Commission of Inquiry Acute Care Services in NSW Public Hospitals Overview was presented to the NSW Government and released to the public.

The report is available here:

http://www.lawlink.nsw.gov.au/lawlink/Special_Projects/ll_splprojects.nsf/vwFiles/E_Overview.pdf/$file/E_Overview.pdf

The report makes sobering and fascinating reading as Mr Garling highlights the troubled aspects of our health care system. Garling is impressed by the skill, dedication and competence of health care service staff but notes that many things need to change so that staff can work more effectively. Of particular importance, Garling notes:

"Furthermore, the rigid demarcation between what a doctor’s job is, and what a nurse’s job is, needs to be consigned to history. Once the concept of teamwork is accepted as the norm in treating a patient, it is easier to see why a qualified nurse practitioner should be able to do many jobs once reserved for doctors".

This is a very positive comment and fits with the thesis of my research into midwives and doctors interactions in the care of birthing women. I know Garling only mentions nursing staff in this statement, but it is equally applicable to maternity care issues, if not even more so, given that childbirth is, above all else, a healthy process suffering from iatrogenic outcomes.

You can access the terms of reference here:

Terms of reference

http://www.lawlink.nsw.gov.au/lawlink/special_projects/ll_splprojects.nsf/pages/acsi_terms

The Garling Report is available for comment and the link to the comment pages is here:


Feedback on Garling Report

http://healthactionplan.nsw.gov.au/provide-feedback.php

Please have your say and make the point that maternity services need to be focussed on what keeps women and babies safe. Women and babies are safer when the services which are being provided are women centered, that is respectful of and listening to women's concerns, questions,ideas and choices and ensuring that women's choices are implemented. It is also about ensuring that the profession that is expert in working with women to keep birth normal, that is midwives, are primary care givers.

My thesis on line

Hi everyone, here is the link to my thesis "Putting women first: Interprofessional Integrative Power"

You can download it here:

http://ogma.newcastle.edu.au:8080/vital/access/manager/Repository/uon:2509

I'm interested in your comments.

Carolyn

Women rallying across Australia for 1-2-1 midwifery care and The Age misses the point!

Women rallied across Australia today in support of 1-2-1 midwifery care in the wake of the close of submissions to the National Maternity Services Review.

The Age newspaper runs a story with the headline "Huge rise in obese mums-to-be"
Jill Stark November 16, 2008

The article says

"A RISE in the number of obese women becoming pregnant has sparked calls for more vigilant monitoring and weighing of expectant mothers, amid fears babies' lives are being put at risk.

Specialists at leading Melbourne hospitals have told The Sunday Age that women with pre-pregnancy weights of 150 kilograms or more are increasingly common, with some then adding up to 30 kilograms before giving birth — around three times the recommended weight gain of 7 kilograms to 12 kilograms.

The mothers' excess fat is posing serious challenges for medical staff, who are struggling to detect babies on ultrasound machines and monitor their heart rates. Many of the women suffer obesity-related diabetes and high blood pressure, with their size tripling their babies' risk of sudden death or birth defects.

Pregnancies for very large women are considered so risky that most hospitals are turning away expectant mothers with a body mass index higher than 35 or 40. A healthy BMI is 20 to 25."

That's all true of course and worthy of concern. However, two things are of interest here. One is that this story was run when, on the same day, there was a women led rally for better maternity care options. This article could be seen as an effort to keep women in their place and interestingly, the article was written by a woman!

The other interesting and not mentioned fact is that circulating and unremitting levels of stress hormones are part of the problem in the obesity epidemic. Stress hormones interfere with healthy physiology and disrupt growth and repair mechanisms. This means that women are more likely to become fatter as high stress hormone levels interfere with glucose and insulin pathways.

Pregnant women and their babies are vulnerable to the stress caused by ever increasing social pressures. When childbearing women feel loved and cared for, and are able to talk with their midwife about the things that are bothering them, their stress hormones are lower, they feel more in control with what happens to them and their clinical outcomes are improved.

One to one midwifery care, where the focus is on the woman and her needs and wants, has far ranging health and wellbeing benefits for mothers and babies.

Thank goodness Nicola Roxon appears to be listening to good science, rather than scare mongering, power plays and sensationalism.