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!


I

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