November 24, 2003

Birth reform for Taiwan

It has been another busy weekend - this time an Active Birth workshop in Melbourne. The usual mixed group of midwives, some B Mid students and one of our own Graduate Diploma in Childbirth Education students, who had travelled from Taiwan.

Chia Wen told me that in Taiwan birth is a very medicalised affair, based on the American style of birth, and almost all women end up with an episiotomy, drip and lithotomy position for the birth. Caesarean rates are also very high. Chia Wen is a medical epidemiologist and she and a group of feminist friends are working to change the culture around birth in Taiwan. I guess this a theme that could be repeated anywhere in the world, but it sounds as though she has some strong opposition to contend with. There are no midwives as such, just obstetric nurses, and although there is a growing movement to establish midwifery as a separate entity from nursing this will take time. The doctors are fighting these moves, because midwifery is seen as competition to their lucrative private practices.

The doctors are willing to accept doulas at births and there are moves to get doula training underway (again based on the American model). As I pointed out to Chia Wen, doulas are no substitute for midwifery care and will muddy the waters in the overall campaign for better alternatives to medicalised birth. Doulas are popular with the doctors because they can be bossed around - a doula has no legal status and insufficient training and knowledge to be anything more than a provider of comfort for a labouring woman. This is fine as far as it goes, especially for those women who have no other source of support. They will not, however, impact on the outcome of the birth, which will still be governed by the attitudes and practices of the primary caregiver (the doctor in this case).

Chia Wen is collecting policies and guidelines about the practice of midwifery in various countries. She and her group will use these as background evidence to put pressure on health care providers to look at establishing midwifery services to offer real choice for women. It will be an uphill battle, but one I have the impression, that Chia Wen is very keen to take on.

Posted by andrea at November 24, 2003 09:23 AM

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