Feminism is for everybody

An article in the Lancet earlier this month explained how Feminism is for everybody

The article quoted bell hooks, who said “to be ‘feminist’ in any authentic sense of the term is to want for all people, female and male, liberation from sexist role patterns, domination, and oppression.”

Women and men are held in a negative pattern of behaviour by the dominant paradigm of patriarchy. That pattern of behaviour is so normal, people can't perceive it until they become more mindful and aware. Even then, it is easy to slip back into unconsciousness and the same pattern of behaviour. There is a concept that 'fish can't see water' and that applies to us humans too and the dominant patriarchal paradigm. Not only is it hard to perceive without education and questionning, some people will argue for their limitations and to maintain their inability to perceive the socially transmitted invisible structures that contain and shape us.  Neither women nor men can truly be all they are capable of being until they throw off the shackles of sexist role patterns and become aware of the subliminal messages that support and cultivate the behaviours that enable dominantion and suppression.

This video, shared on Twitter this morning, has been watched by 4.48 million people across the world and demonstrates all too clearly how 'normal' violence against women is. The comments are enlightening. I encourage you to read them and think about why bell hooks wrote about feminism in the way she did and how it essential for everybody.

Childbirth is an area where women are even more vulnerable than usual. In pregnancy, women need to be cared for and supported as their mind/bodies are fully engaged in growing the next generation. Women need a safe environment for their bodies to work well.  However, pregnancy is a time when domestic violence can erupt for the first time or worsen. Not only are women damaged and murdered by violence in the home, living with violence irreparably damages children. The immediate and long-term consequences on children of living  with violence is becoming more understood and increasingly talked about in the media.

There is also recognition that too many women's wants, needs and desires for birthing their babies are ignored and dismissed by the people working in the system.  More and more women are emerging from childbirth shattered, their belief in themselves torn to shreds. A term used to describe this phenomenon is 'obstetric violence'.  Many health care professionals are horrified by that term, claiming that they care about women and their babies and their work is designed to keep the woman and her baby safe. The fact that so many women feel damaged by the very system that has been created to keep them safe means we have a problem - the question is, has the disrespect and invisible negative pattern of behaviour that signals the patriarchal paradigm caused a blindspot in the health sytem's perspective?  Women want to birth normally and need to have the support to do it.  WHO is recommending that labour,if everyone is well  and healthy, to be enabled to progress at it's own pace. Despite this call for change, intervention rates are increasing. A new book by a gastroenterologist from Cork provides a scathing attack on modern medicine, calling it “an industrialised culture of excess” and a threat to health". Certainly, along with the way women feel following childbirth, the distress and rate of death by suicide in the medical profession indicates that things need to change. Some are calling for a Royal Commission into Obsetric Care in Australia - perhaps the time has come to look deeply, with fresh eyes, at what we are doing to women and babies during childbearing.

After 68 women were murdered last year in Australia, the majority murdered by someone they loved, a northern rivers' musician, Ilona Harker, herself a survior of domestic violence experienced as a child, gathered other musicians from around the area to create a moving tribute to the women who had been murdered and to end violence against women, using Valentine's Day as the framework.

Ilona called to all of us to make a difference:

 "I would also like people to feel compelled to speak up when they see micro-aggression acts or anyone who has any hate speech towards women or children.

"And I'd really like men to stand up because without men we're not going to change this."

It's time for a new normal. As bell hooks wrote so compellingly, if we "want for all people, female and male, liberation from sexist role patterns, domination, and oppression.”  then feminism is for everybody.


https://twitter.com/JIMINSPROMlSE/status/1096449763111854080

An update on the National Strategic Approach to Maternity Services

As I wrote on this blog in June last year, there has been a consultation process to develop a National Strategic Approach to Maternity Services in Australia.  You can read that post here.

I attended one of the community consultations held in Brisbane and was disturbed by the way the event was orchestrated - the agenda was preset and restricted. Any voice which sought to talk about continuity of midwifery care was shut down.  I wrote to my local member, Justine Elliot MP about my concerns.

Dear Justine Elliot MP,

Please support our call for all women to have access to continuity of Midwifery care. We are fortunate in the Tweed to have three Midwifery Group Practices, but too many women are missing out on that excellent and safer care. Only one group offers birth at home.

Women want access to a known midwife for their antenatal, postnatal and birth care. The current developing national maternity plan (National Strategic Approach to Maternity Services, NSAMS "Towards Woman-Centred Care") has omitted midwifery-led continuity of care as a preferred model of care. 
This omission is disgraceful.
Despite high quality evidence, exemplary models around the world and mothers demanding access to continuity of midwifery carer (a known midwife) via:
- every state and national review of maternity services
- 540 recent survey responses from public consultation of the new national maternity plan
- representation on the Expert Advisory Group for the national maternity plan
- public face to face consultations around the country Our voices have continued to be ignored.

Only 8% of women can access this model, yet demand across the country far exceeds this. Our new national plan is an opportunity for women to access their preferred model of care, which results in better outcomes and is far more cost effective (approx. savings of $500/birth).

I want continuity of midwifery care to be accessible for every Australian woman who wants access to it. The national maternity plan (NSAMS) is an opportunity to lead the way to truly be working "Towards Woman-Centred Care", if it incorporated the masses of feedback from mums across Australia.

Please lobby for the women across Australia and in our own area who are unable to access this care.

Yours sincerely,
Carolyn Hastie
Murwillumbah, New South Wales, 2484, Australia

 
I received a letter this afternoon from the health minister, Greg Hunt MP. 

Good afternoon

Thank you for taking the time to email me on this important issue.

I can assure you that your views are being heard and I can guarantee that the role of midwives will be recognised and included in maternity care.

It was at the request of midwives and consumers, that I intervened, after concerns were raised when the process was being led by Queensland.  We have instead taken the lead to develop a National Strategic Approach to Maternity Services (NSAMS) on behalf of the Australian Health Ministers Advisory Council.

The aim of this process is to provide choice of access which includes all models of care, including midwives.

During October – November 2018 consultations were undertaken on the draft NSAMS. 480 health professionals, service providers and consumers attended workshops, conference presentations and webinars. Over 200 individuals and 25 organisations made online submissions and completed an online survey. A report of the online survey and copies of the submissions are available on the Department of Health website.

The resulting DRAFT document Towards woman-centred care - Strategic directions for Australian maternity services is structured around the four values of respect, access, choice and safety which underpin twelve principles for woman-centred maternity care that apply to all health professionals providing maternity services. They are aligned with the Respectful Maternity Care Charter: The Universal Rights of Childbearing Women. Together, the values and principles offer an enduring framework for high quality maternity care in Australia.

Feedback in the consultations has been supportive of continuity of care meaning that there should be a shared understanding of care pathways by all health professionals involved in a woman’s care, with the aim of reducing fragmented care and conflicting advice.

The NSAMS must also be considered by all the State and Territory Health Ministers before it is finalised.

You may also be aware that there is a separate process underway examining the Medicare Benefits Schedule relating to maternity care.  The draft report has now been released. http://www.health.gov.au/internet/main/publishing.nsf/Content/MBSR-pcrg-consult.

Both of these reports are draft and I will consider them carefully and how they interact.

I care deeply for the health of pregnant women and their babies and recognise the important role of midwifery continuity of care.

Best wishes,

The Hon Greg Hunt MP
Minister for Health Minister.Hunt@health.gov.au

I just replied to Minister Hunt's email tonight as below::

Dear Minister Hunt,

Thank you for your email.

I'm disappointed to note that your response has not taken into account what women are asking for and what is meant by continuity of Midwifery care. Continuity of care relates to the current model of GP/Hospital shared care models and private obstetric care.  The evidence shows that outcomes between continuity of care and continuity of midwifery care are chalk and cheese - very different.  Continuity of Midwifery Care and Continuity of Care are not terms which can be used as meaning the same thing, because they don't.  This confusion of terms and what they mean is unfortunately widespread in some circles.

The following figures demonstrate the differences in outcomes between the two models.  With Continuity of MIdwifery Care, there is a 24% reduction in preterm birth; 16% less neonatal loss and all fetal loss before and after 24 weeks; less surgical birth (caesarean), greater satisfaction for women, increased long term breastfeeding rates and reduced cost to the taxpayer.  There are other benefits, including lower rates of postnatal depression and improved mother/father-infant bonding, along with long term health of the newborn individual. Obstetric care, however, has seen a steady rise in surgical birth for the last few decades and is currently around 40% plus and much higher in some private hospitals.  Surgical births, whilst required for approximately 16 - 20% of the childbearing population, and expensive, but safe for the first surgical birth, comes with risks, those risks increasing with each subsequent surgical birth.

Please see the link to an overview of  The Lancet Maternal Health Series: Drives of Maternity Care in High Income Countries https://www.mhtf.org/2016/11/14/the-lancet-maternal-health-series-drivers-of-maternity-care-in-high-income-countries/on the Maternal Health Task Force at the Harvard T.H. Chan School of Public Health which provides information that will be of use in understanding the evidence regarding the benefits of Continuity of Midwifery Care.

The original article is available here https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31527-6/fulltext

The effort to develop a National Strategic Approach to Maternity Services (NSAMS) is crucial.  However, the draft, Towards woman-centred care - Strategic directions for Australian maternity services misses the point. Women don't want a document that is aiming 'towards' what they want in practice.  Women want and deserve a National Strategy that has Continuity of Midwifery Care as the central strategy and with universal access for all women, including rural and remote women. Continuity of Midwifery Care in Aboriginal communities would help Close the Gap in Maternal and Infant Health outcomes.

You mentioned the consultation process for the Strategy. I attended the meeting in Brisbane and it was a sham.  The facilitator was controlling and ensured that the conversation was limited to a preset and limited agenda.  I do not believe the consultation process can be trusted to provide a true reflection of the wider community's response and interest in the way maternity services are formulated.

I would appreciate an opportunity to meet with you to discuss the evidence for Continuity of Midwifery Care and the ways a well researched and formulated National Approach to Maternity Services can ensure that the health of the Australian Community is improved, one woman, one family, one birth, one baby at a time. The health care dollar will be better utilised by implementing universal continuity of midwifery care and the cost to the taxpayer will be greatly reduced.

Sincerely,

Carolyn

Carolyn Hastie

Midwife, PhD student

Phone: 0418428430 

Strength is not about overwhelming or overpowering - it is the subtle power of inner perseverance and kindness for others when faced with trials and hardships - Audrey Hepburn

I acknowledge the traditional custodians of the land on which I work and live and pay my respect to the Elders past and present. I acknowledge the loss of lands, cultures and treasures that have had immense consequences for people, communities and nations

 Please let Minister Hunt know your thoughts.  You can email Minister Greg Hunt here Minister.Hunt@health.gov.au

Awake to the mystery, power and magic of birth

There are many aspects of childbearing that are mysterious. Those of us who live, work and breathe in the childbearing space are often in awe of the beauty, power and magic that is a woman birthing her precious baby. This post by midwife Pat Schwaiger from Mountain Midwives in Montana USA appeared on Facebook a few days ago.  I got goosebumps while reading it as Pat articulates beautifully what many of us midwives have experienced.  I wrote about 'calling the baby in' at birth in another post on this blog and I'm thrilled to have Pat's permission to share her story about this phenomenon here with you. For those of you who want to explore the spiritual aspect of childbearing further, I'm happy to tell you that a new book on the topic has recently been published. It's a cracking read and the stories in it, and other stories such as Pat's below, gives us to pause to contemplate what we are doing to this most wondrous process with the purely medical approach of the dominant 'mainstream' western health systems. Could the medicalisation of childbirth be another 'flat earth' belief system to overcome?  Read on and enjoy this most interesting and awe-inspiring story.

IT HAPPENED LAST NIGHT, IN LAUREL, MONTANA
by Pat Schwaiger, RN, CPM, Mountain Midwives, Billings, MT (artwork by Catie Atkinson)

I hesitate to write about some of the more mysterious aspects of birth. I cringe when other midwives publicly speak of birth as “sacred”. I hate it when well-meaning friends introduce me as the “magical midwife”. I prefer a more professional reputation.

You see, for centuries, midwives have been judged and jailed and even burned at the stake, for their involvement in things that could not be explained (mostly childbirth), and even today, the medical mainstream accuses midwives of practicing less-than-scientific methods of care. Because of this, we midwives have perhaps over-compensated in defending our truly professional and educated selves, relying on evidence-based research to support every move we make.

But if a midwife does this work for very long, she will indeed see things happen that surpass all science and statistics, things that reach far beyond her wildest imagination. And if she witnesses these things with openness and a humble heart, she will eventually come to understand … that she really DOESN’T understand birth at all. Nobody does.

Still, she must be careful describing these experiences, lest she be labeled a quack or accused of telling tales. We don’t get burned at the stake anymore, but we get burned in other ways.
So, with a half dozen credentials in my pocket and 36 years of midwifery practice under my belt, I’m stepping out on a limb here, to tell you one of those amazing birth tales.

It happened last night, in Laurel, Montana.
Having attended several previous births for these folks, I’m practically one of the family by now. I’m comfortable in their home, and their kids know me well. Yesterday evening, I arrived to find the mother soaking in her bathtub, with contractions coming on strong. (She loves water birth). Her dilation was seven centimeters, and fetal heart tones were good. I set up for a delivery, and left her and her husband alone, because this is how they like to have their babies.

I was right outside the door, listening and charting and waiting for them to say my name. That moment came, and I stepped into their space and knelt at the side of the tub, ready to catch. Baby’s head immerged. The cord was around the neck, and I slipped it off quickly and asked the mother to push again. A beautiful black-haired boy came out into the water, and I lifted him into his mother’s arms. There was no cry, but his movements were lively and his color was good. He kept his eyes shut. With my stethoscope, I listened to his breath sounds and his heart beat. Everything checked out fine.
As his little knees moved outward, we saw that this was a boy. The other children were waiting in the next room, and when the dad announced the gender, a giant whoop and holler filled their whole house with joy. I was observing the baby closely then. He didn’t respond to all the hullabaloo. Still in his mother’s arms, with his mother still in the tub, his little feet made ripples in the water as we waited for the cord to stop pulsating. It had been a beautiful birth.

I stood back, watching the parents adore their child, teary-eyed and tired. We would cut the cord soon and help the mom get into bed. I kept my eye on the baby too. Although all things measurable were totally perfect, he seemed to still be in another world. I’m not sure what that means exactly, but there must be some other realm where babies live before they live here. Perhaps it is just the womb. Or perhaps it is some other un-mapped reality. But when people move from that reality into our own world, it’s a conscious move, and they each do it at their own pace. Now, I’m not talking about APGAR scoring or length of second stage. No. Those things are measurable, and this kid was doing fine in those categories. But he wasn’t quite here yet. Other midwives have seen this, I’m sure, but we don’t talk about it very much.

Last night’s baby was hanging out in the other world. There was a blue-ish distance behind the tiny slits that were his eyes. His little lips were pressed shut and he was silent. He appeared closed off, somehow. It was like he was way inside of himself … or maybe somewhere way out in the Cosmos. Yet everything I could assess was totally functional. He was here. But he was somewhere else.

I’ve only said this a few times before, but last night I heard myself saying, “Come be with us, little one. It’s a good place here”. Technically, he was several minutes old by then, so it seemed an odd thing for a midwife to say.

That’s when two of his sisters, ages five and six, quietly slipped into the room. I think they knew. They stood near the tub and one of them reached forward to hold the newborn’s tiny hand. She said softly, “I love you, baby”. The other one leaned over and kissed the infant and told him “We waited so long for you”.

IMMEDIATELY, there was a spark! The baby began to wiggle like most babies do. His eyes opened wide and focused, absolutely beaming at those two little girls. Then he moved his head to look around the room and he let out a cry. It was a powerful cry, as if to say, “OK! I’m here now. I’m home. Hello everybody! It’s me!”

We already knew he was healthy and whole. I’d officially assessed everything about him, and even written it down in the chart. Obviously, we all loved this baby boy. But it took those two little girls to convince him to actually come into our world, to join us here, and to become one of us.
So … what was their magic?

Love. Spoken without fear. Spoken out loud. Pure, innocent, unscientific Love. That’s what lit the spark.

OK. Try analyzing THAT. Try identifying the evidence. Try even talking about it without losing some credibility as a professional. You won’t find this stuff in the text books or on Youtube. But it’s all true. Sometimes Love is what brings babies around. Sometimes Love is what brings all of us around. Love is mysterious and sacred and effective.

Now, I need to say that this doesn’t happen at every birth. In fact, I’ve only seen it a few times. But it does happen. I’ve never been bold enough - or silly enough - to write about it before. But today, it seems like a worthy birth tale to tell, because it all happened last night, before my very own eyes.
Go ahead. Burn me at the stake.

Birthing Normally: What are the factors that facilitate normal birth?

Nearly 6000 women in Queensland Australia responded to an invitation to complete a questionnaire about their preferences for and experiences of pregnancy, labour, birth, and postnatal care. From the self-reported data, the study aimed to discover the modifiable and non-modifiable factors related to the potential for women to give birth normally.  A normal birth is defined as one "without induction of labour, epidural/spinal/general anaesthesia, episiotomy, forceps/vacuum, or caesarean section".

In their analysis of the women's responses to the questionnaire (2018), the researchers found that women were more likely "to have a normal birth if:

• they lived outside major metropolitan areas
• did not receive private obstetric care
• had freedom of movement throughout labour
• were not continually monitored by machine in labour
• received continuity of care in labour and birth
• did not have an augmented labour (waters were left alone, labour was not 'sped up' with artificial hormone)
• gave birth in a non-supine position (were not lying flat in a bed)

Harpers Bazaar Empowered birth project

                                     
 The researchers found that "less than half of women birthing vaginally (44.3%) and less than one-third of all birthing women (28.7%) experienced a normal birth" despite only 13.8% of women world wide expressing a preference for caesarean birth over vaginal birth.”

The study concluded: 

"Despite increasing interest in normal birth, actual rates remain low and research for how to facilitate this is minimal. Models of care with a more natural philosophy of birth, not limiting women’s freedom of movement and position during labour and birth, and continuity of care provider throughout labour and birth are shown to increase the likelihood of achieving a normal birth. To support the desired promotion of normal birth, care providers and women must be made aware of existing evidence for how care and treatment related factors influence normal birth outcomes. Pragmatic evaluation research is needed for how policies that relate to facilitating factors affect women’s experience of normal birth."

Childbearing women and their partners need to be aware of this information.  Knowing the factors that facilitate normal birth will assist women with choosing the care they want and how their babies are born. 

Reference

Prosser, S.J., Barnett, A.G., Miller, Y.D., 2018. Factors promoting or inhibiting normal birth. BMC Pregnancy Childbirth 18, 241. doi:10.1186/s12884-018-1871-5

Note: You can find some beautiful birth art on the artist Amanda Greavette's site

Freebirthing - seeking sovereignty?

At the Oslo ICM conference (1996), a German historian, Barbara Duden said that that 'modern health care was disabling women for normal birth'. Her book, 'Disembodying Women' explained how the proliferation of specialities in maternity care was constructing the 'fetus as an endangered species and the woman's uterus as a faulty ecosystem' and modern healthcare as the rescuer of that fetus from the dangerous womb.  I was deeply affected by Barbara Duden's presentation and immediately bought her book and read it avidly cover to cover.  Her words resonated with me and as a midwife, I wondered where all this measuring, surveillance and intervention in the childbearing process was going.  

                Photo from freebirthing article - look at that vernix! 

An article on Freebirthing, published in September 23, 2016, by Claire Feeley, midwife and PhD researcher from the University of Central Lancashire, stated that women were getting fed up with the fear and risk-obsessed maternity care system and were taking their autonomy and control back.  Claire's research findings suggest that the rise in freebirthing is because women perceive that doctors and midwives are not listening to women and ignoring their needs.  I have been hearing even more about freebirthing recently; more women are taking control over their bodies into their own hands, believing that the lack of respect and kindness coupled with the proliferation of interventions assocated with mainstream maternity care to be more dangerous than giving birth without midwifery or medical support. Midwives are finding their practice increasingly bound by rules, guidelines, protocols and the threat and/or reality of being reported to the regulating body, whose processes are ponderous and have been experienced as soul destroying and emotionally damaging for many.  Is this another reason why women are bypassing midwives for their care? 

As those of us who've been around for a while know, risk status is a poor predictor of outcome.  Women designated with high risk pregnancies by the system often birth well; occasionally, women designated as having 'low risk' pregnancies can end up with all sorts of misadventures. When I was in private practice, women who were labelled 'too fat' or 'too old' by the system and therefore didn't fit birth centre guidelines would find their way to me for their maternity care. Those women would birth well and easily; their sense of self and their capacity to birth their babies unimpeded by their size or age. 

The one truism that is still evident today is that when women feel strong, centred and confident, they invariably birth well. We also know that where there is a strong, autonomous midwifery profession, birthing women do well. A skilled and competent midwife, who recognises the DNA mediated intelligence of the birthing process and women's capacity/ability to birth, is alert to deviations from normal and refers appropriately. Such a midwife can be just what a woman needs as she provides information and discussion and supports that woman to find and embrace her sense of self and self-empowerment, enabling that woman to birth her baby well in her own unique way.  Is it time that midwives were fully supported to practice in a way that enables women to be informed, autonous and self-directing in their pregnancies?  Absolutely. It's a human rights issue. A fully informed and supported woman makes the right decisions in the right way, at the right time for her own and her baby's needs.

Music, Pain and Labour

I came across the video of Ed Sheeran and Andrea Bocelli singing 'Perfect Symphony' - if you haven't experienced this visual and auditory delight, take five minutes and watch it now.  I bet you'll be glad you did :)

I found myself enraptured with the video, the sounds and the sights gave me goosebumps. Time stood still.  I hit play again and again - I then shared it on Twitter and Facebook asking if anyone else was loving this video as much as I did. As I listened to this song, I felt happy and my whole body felt warm and tingly, especially when Andrea's voice soared.

We know that music moves our body, soul and spirit - I've been at music events and couldn't sit still, I had to dance. Women often dance in labour, finding the movement and the music helpful. A midwife friend, Dr Robyn Thompson, a rock and roll aficionado and Elvis fan, told me that in her homebirth practice she found women loved to dance - swing and bop in labour.

Even doctors get into the act! Dancing doc Fernando Guedes da Cunha in Brazil dances with labouring women to funky music!  Camila, the woman in the video, asked for the music and they choreographed the moves together. Looks like they are having lots of fun! Pain takes a hike when we are having fun, laughing and generally enjoying what we are doing. Camila thanked her doctor for making her birth experience so memorable.

 Music started making its way into the Australian labour wards, along with women's partners, in the 70's and early 80's.  Couples were encouraged to make their music compilations and bring their tapes and tape players with them.  The idea behind it was to make the environment more homelike and comfortable. Along with more benign choices, we had birds whistling, Enya, whales sounding and sometimes heavy metal as our background ambience while women laboured.  In the early 80's, as Brereton announced the 'beds to west' policy and the building of Westmead Hospital, I  had the immense pleasure of working in the Crown Street Women's Hospital Birth Centre before it was closed, as part of the 'beds to the west' move, and the building made into apartments. The birth centre was established in 1976 and was the first public hospital birth centre in Australia. Crown Street had wonderful management, both medical and midwifery, an unusual combination. It was an amazing hospital for many reasons, including the way the women who flooded in to Sydney from war torn Vietnam were cared for - but that's another story for another time.

The birth centre was downstairs from the labour ward and had three birth rooms.  When the birth centre was empty, I worked in the labour ward under the watchful and supportive eye of one of the grand old labour ward managers, Sister Pat Sparrow.

I came to work on a morning shift and the three birth rooms were full.  In one room, the couple were Hare Krishna followers. The prospective father had a guitar and, as he played, the couple were chanting Om Namah Shivaya (“I bow to the inner Self”).   In that room I was required to be quiet and not disturb the couple. In the next room were a talkative pair - country and western was their choice and it was Johnny Cash up loud! In the third room were self-identified hippies - they had whale songs playing and brought their own bean bags. Each couple had decorative items from home in their birth rooms, items such as photos, wall hangings, blankets, floor coverings, cushions etc that reflected their belief systems and music choices.  As I went from room to room, taking observations, observing progress, encouraging water intake, suggesting the woman went to the toilet etc, I stood at each  doorway, taking three deep breaths because I had to change my 'state' to enter each room, as each couple needed completely different behaviour from me, along with my midwifery care.  Each woman  coped well with labour and birthed well, their attentive partners fully involved in the birth of their babies.

Over the last few decades, birth centres and labour wards (now called delivery suites - a term I find obnoxious - birth centre is much more appropriate, but birth centre implies the woman has agency, so isn't popular with the power brokers), have CD and IPod players; tapes have given way to CD's and digital music, but women still collate the music of their choice for their labour and birth. Interestingly, sometimes the music/sounds they've thought they wanted, they don't want in labour. They choose something else or sometimes silence. One woman, after several hours of bird calls as her background music yelled out 'turn those f'king BIRDS OFF!' I turned them off happily - they'd started to wear me down too.  Other women sing.  One particularly memorable experience was a woman singing 'Everything's alright' from the musical, Jesus Christ Superstar.  Her volume increased as the contraction peaked.

She sounded a lot like the woman in this 1970 version of the song from the musical. She birthed beautifully (of course!).

Did the music make a difference?

Midwives have long observed the difference music and other sensory cues have on women's ability to labour and birth well. The evidence is increasing that an enviroment that feels safe is crucial to a woman's ability to relax and enable her physiology to function well. Music is part of that environment and according to a recent systematic review of  the literature, 'Music is an effective intervention for the management of pain'. Good to see evidence validating the art and science of midwifery knowledge and practice.

Reference

Martin-Saavedra, J. S., et al. (2018). "Music is an effective intervention for the management of pain: An umbrella review." Complementary Therapies in Clinical Practice 32: 103-114.

Have your Say! National Strategic Approach to Maternity Services Consultation Closes 20 November 2018

In Australia, there is a National Strategic Approach to Maternity Services being developed.

Round One consultation process was completed in May 2018. You can read the current draft document on the Government related page discussing the project here.

The working party is now undertaking Round Two.  A series of workshops is being undertaken. Written submissions are also being requested.

Submissions for Round Two (the final round) are being called for now.  Submissions close 20 November 2018

Please write and give your opinion on the provision of optimal care for childbearing women and their families. You can find the draft plan, information about submissions and workshops here. 

 I'm delighted to see the number of people who have read and cited this chapter:

Fahy, K., Parratt, J., Foureur, M., & Hastie, C. (2011). Birth Territory: A Theory for Midwifery Practice. In R. Bryar & M. Sinclair (Eds.),Theory forMidwifery Practice (2nd ed., pp. 215-240). Palgrave: Basingstoke

Available from: https://www.researchgate.net/publication/254663867_Birth_territory_and_midwifery_guardianship_a_theory_for_midwifery_practice [accessed Jun 17 2018].

The authors' fervent desire is that the information in this chapter (and the book) provides the impetus for positive change in the way that childbearing women and their partners are cared for in the healthcare system.  We want health care planners, governments and policy makers to value women, to value the childbearing process and provide maternity services that meet women's needs.

From Planning a Pregnancy to one to one midwifery support in midwifery-led environments, we know that there is 'compelling evidence that investment in midwifery is a cost-effective way to improve sexual, reproductive, maternal and newborn health (SRMNH) outcomes'. One to one midwifery care has also been associated with a reduction in all complications. Too many women suffer severe complications of childbearing and we should be doing everything in our power to change that dreadful reality. All women deserve optimum care.

According to evidence, and that evidence is strong, optimal care in childbearing is one to one midwifery care with seamless collaboration with medical care as required by any individual woman.

Whatever perspective we take, no matter what our experiences, we all can come together and improve the way women are cared for during the most important social, cultural and physically significant experience of birthing the new generation. We are, as Professor Susan Crowther reminds us, united "around the humanness that lies at the heart of each birth.”

What can you do to make a difference to maternity care in your area?

To begin with, you could write to the Federal and State/Territory Ministers of Health; the hospital managers and the newspapers/magazines demanding optimum care for women and their families.

You can write a submission for Round Two of the Consultation Process - your submission need only be something like "all women need a competent, kind midwife, only some women need an obstetrician too"

Submissions close 20 November - Have your say!


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A fundamental paradox at the heart of modern maternity care

“Our research identified a fundamental paradox at the heart of modern maternity care. Practices that fit within the medical paradigm, such as epidural use or induction of labour, are pronounced safe even though they might, in fact, carry some risk, while practices that support physiological birth, such as water immersion and mobilisation, which have minimal side-effects, are treated as either inherently risky or somewhat ridiculous.”

An article in the Irish Times on the study 'Towards the Humanisation of Birth: A study of epidural analgesia and hospital birth culture.'

Why do you think this paradox exists?

'Continuity of carer undoubtedly improves care for women’

The Better Births National Maternity Review for England and The Best Start review in Scotland recommend that continuity of carer be used as the central model of care in both countries.

How wonderful that the UK recognises the value and importance of midwifery care for the health and wellbeing of all childbearing women and their infants.

Photo sourced from generationsmidwifery.ca

In response, the Royal College of Midwives have developed an online module designed to help midwives and maternity support workers "develop a better understanding about continuity of carer in midwifery.


Questions explored in the RCM’s new i-learn module of midwifery continuity of carer include;

• What is the evidence that continuity improves outcomes?
• What is the proposed model of care?
• What would the working week of a continuity midwife look like?
•  What do we need to have in place to make continuity work for midwives and women?

In addition to this introductory online learning resource the RCM is currently hosting a series of ‘continuity of carer’ workshops across the UK and  another online learning resource is in development which  will focus on practical strategies for scale up and roll out later in the year."

I feel excited and inspired to see this recognition of midwifery in the UK.  We need to work together to ensure all women and their families have relationship-based continuity of midwifery care as the 'norm' - the bedrock of their maternity care.  The evidence is clear that when women have continuity of midwifery care, along with appropriate medical care as required by any associated medical condition and whatever their risk status, their satisfaction with their birth experience goes up, premature birth rates go down, breastfeeding rates go up, intervention rates go down and women and their infants emerge from the childbearing experience healthier, happier and more connected; women feel more in control, are informed and know what to expect with parenting their newborn/s.

Way to go UK!

This blog post has been reposted from Olvindablog - on postmodern midwifery and women

It's a brilliant post about normal birth and why it is important and how to support it.

Let's facilitate physiology and each woman's Unique Normality (quotes below from the blogpost by Oli).

"Unique Normality “takes account of each woman’s labour in the context of her pregnancy, her family clinical, psychosocial and emotional history and the story of her life. It sees birth as an ‘ordinary drama’ — not as a crisis, and not as a routine event, but as a one-off exciting event, full of possibility. In this approach, the task of the midwife is to maximize the possibility of normal birth, accepting that it will not always happen. Maximizing the possibility means opening up options to women, rather than closing down their expectations, and working with colleagues including peers, [supervisors of midwives], risk managers, obstetricians, neonatologists, and anaesthetists to see each labour as an opportunity for personal growth and development rather than a threat of complaint and litigation.” (Downe, 2006)"

"Evidence demonstrates that public health measures to address health inequalities, and more women choosing to access midwife-led care, with continuity of carer, are key to a safer system with better outcomes for women and babies (Sandall et al, 2016; Guardian, 2015)."

The post was written by Oli, a UK midwife, in response to:

"a deluge of disinformation and inflammatory, inaccurate and non-evidence-based reporting on the ‘dangers of normal birth’, from which women need protecting, and the so-called ‘cult’ and ‘overpursuit’ of normality. Midwives were supposedly backpedaling and backing down on normal birth".

The link to the full post is here:

Come back, Ten Top Tips! Normal birth needs you

 Well done Oli! 

Motherhood as a Rite of Passage

This fascinating topic was posted on the Perceptions of Pregnancy Blog today - follow the link in the title below to read it on that site. I'm interested in your thoughts about this idea - you can also leave your thoughts on the Perception of Pregnancy Blog, I'm sure they'd love to hear from you.

via Motherhood as rite of passage

"Liminality “refers to the transitional space in between well defined structures” and is a process people pass through to achieve a new status (Boland & Griffin 2015, p. 39) (1). Victor Turner describes how “liminal entities are neither here nor there; they are betwixt and between (…)” (1969, p. 359) (2). This caused me to think about women as, traditionally, childbirth has been regarded as the full achievement of womanhood (Russo 1979), and is still acknowledged as a key life event (3). While this growth is available to women who become mothers, what happens to women who, by choice or circumstances, do not do so? Is it possible to have other liminal experiences or are they stuck due to the lack of legitimized alternatives?"

 

Such important questions raised by this author.  What do you think?

Birth on My Terms Project - Invitation to Contribute

This post is on behalf of Theresa Morris, lead researcher for the Birth on My Terms Project

Were you coerced, forced or pressured to have a procedure(s) during labor and birth?

Such procedures may include: epidural, episiotomy, induction of labor, augmentation of contractions, IV medication or fluids, cesarean section, Pitocin, antibiotics or other medications, electronic monitoring, movement or lack of movement, or pushing position.

If so, we would be interested in learning about your experience.

We are conducting a study that examines the experiences of women who have been forced or coerced to have a procedure, including cesarean sections, during labor or birth. 

If you have had such an experience and are willing to share your experience, please click on the link at the bottom of this post. You will be directed to our secure and confidential survey site. 

The survey will include questions about you, your reproductive history and questions about the pregnancy, labor, and birth that involved a forced or coerced procedure(s). Participants will also be asked about any consequences of having the forced or coerced procedure. 

Completion of the survey is expected to take about 30 minutes. 

Participants names will not be used in any publication of results. 

For more information, contact Theresa Morris, Associate Professor of Sociology, (979) 862-3193; BirthOnMyTerms@gmail.com
www.facebook.com/BirthOnMyTerms
http://sociology.tamu.edu/morris-theresa/

IRB NUMBER: IRB2016-0084D; IRB EXPIRATION DATE: 12/01/2017.

Survey Link: https://tamu.qualtrics.com/jfe/form/SV_0HeWuF8x3FLKX41