Articles by Month: November 2003

Projects

It has been a busy week - where do the days disappear to?

In some ways it has been frustrating too - I have a number of major projects on my desk (and in my head) that need urgent attention, yet there are just not enough hours in the day to work on them.

Top of my list is finalising the last details of the exciting “Midwifery Intensives” program that will launch with the ‘Keeping Birth Normal’ tour in April/May next year. We’ve been planning this for some months, the idea crystallising when I toured the UK with Lynne Staff in June. The feedback we received from participants in those workshops encouraged me to formulate a practical, hands-on event that would be skills based and topical. The full details will be on our web site next week (just as soon as I receive the last photo from our speakers!).

This week I’ve had to decline an invitation to work with MIDIRS on a resource package for young teenagers in South Wales. This Young Persons Project will be a multimedia effort, combining workbooks, activities and a dedicated website and will provide those working in this field with much needed resources. I was delighted to be asked to prepare the practical educational content for the classes etc, but I just don’t have the time available (given their very tight deadlines) to do it justice. I am sure they can find someone in the UK who will be able to contribute appropriate material.

I am also immersed in the final proof reading of the new edition of The Midwife Companion, which will be available early next year. One of the joys of self-publishing is that we can move very fast when it comes to production, avoiding the long delays, often well over a year, that are encountered by authors using regular book publishing companies. I like the fact I can write a foreword dated October and have the book in readers hands 3 months later!

I have started my next book as well. This one has been germinating for a while now, but the time is right to get on with it. I can see some furious writing over the next months as I get all my ideas down on paper. This will be a completely new topic - and unique in its content. I am not giving any more away.... you’ll have to wait and see!

Posted by andrea at 03:48 PM | Comments (1)

Breech birth options

There was an interesting phone call today, from a woman expecting her fourth baby. All her babies had been big (over 10 lbs or 4 kg) and all had been born very easily. In fact numbers 2 and 3 had been unplanned homebirths due to very rapid labours.

This pregnancy (she was 34 weeks) was turning out a little differently. The baby had decided to adopt a breech position, although it had turned to vertex for a while before again resuming its head up posture. The woman had been under pressure from 20 weeks to be induced (“you have such quick labour, come in and we will induce you so you don’t have to worry about getting to the hospital in time”) which she had already dismissed as nonsense. Another unplanned home birth was not going to be a problem for her, and in fact she quite liked the idea, because of its convenience.

With the baby being breech, things had changed. She was now told it would have to be a caesarean, and she was adamant about not wanting surgery. As she pointed out, she could manage 4 children under 6 years as long as her health was OK, and she could see it would be very difficult, if not impossible, to care for her family if she was recovering from surgery. In desperation she was calling anyone she could find for ideas on how to turn the baby, but had been receiving no help at all. Finally, the local Childbirth Education Association gave her my number and suggested she call me.

We talked for a long time and I was impressed with her clear grasp of the situation, her insight into her own body and baby and her common sense attitude. She knew about the various kinds of breech presentations and felt that this baby was in a footling position (although she was reluctant to have this confirmed with ultrasound because of the pressure she would again be under). She knew that there was a good chance this baby would be bigger than the last one, possibly over 11 lbs. Even given these facts, she still didn’t want any surgery, so we talked about ways of getting the baby to turn, including moxibustion and external cephalic version. We also talked about waiting until labour started if she did reluctantly accept a caesarean, to avoid prematurity for the baby.

I was surprised that no mention of ECV had been made at the public hospital she is attending. At the last consultation in the clinic, the doctor, who had confirmed the baby’s breech position, dismissed her questions with a pat on the knee and the comment “you’ll be OK”. This was not helpful for a woman who already was being treated for a raised blood pressure and was anxious to know as much as she could. I felt it was disgraceful treatment from this Registrar, who should have had more sensitivity and concern for her emotional state as well as physical state.

I am hoping that she will contact me again. I gave her the website address for the moxibustion treatment details, and she was keen to hunt down the moxa sticks (trawling through the Yellow Pages for a herbal remedy or Chinese medicine retailer was to be her next step) and I offered to find a practitioner who could perform ECV at term if she needed one. With a baby due over the New Year period, she will be under a lot of pressure to be induced.

Women with such clear visions and insight need support and encouragement, not doubt, doom and gloom. Talking to her was refreshing and uplifting for me and she was grateful to be able to talk to someone who had a positive approach. She has promised to let me know how it goes and I hope she calls after the holidays with the news that either the baby turned and was born (as usual) at home quite spontaneously, or that she got to the hospital so late in the labour that her breech baby was born vaginally. Either way she will be happy.

Posted by andrea at 07:43 AM | Comments (1)

Breech birth options

There was an interesting phone call today, from a woman expecting her fourth baby. All her babies had been big (over 10 lbs or 4 kg) and all had been born very easily. In fact numbers 2 and 3 had been unplanned homebirths due to very rapid labours.

This pregnancy (she was 34 weeks) was turning out a little differently. The baby had decided to adopt a breech position, although it had turned to vertex for a while before again resuming its head up posture. The woman had been under pressure from 20 weeks to be induced (“you have such quick labour, come in and we will induce you so you don’t have to worry about getting to the hospital in time”) which she had already dismissed as nonsense. Another unplanned home birth was not going to be a problem for her, and in fact she quite liked the idea, because of its convenience.

With the baby being breech, things had changed. She was now told it would have to be a caesarean, and she was adamant about not wanting surgery. As she pointed out, she could manage 4 children under 6 years as long as her health was OK, and she could see it would be very difficult, if not impossible, to care for her family if she was recovering from surgery. In desperation she was calling anyone she could find for ideas on how to turn the baby, but had been receiving no help at all. Finally, the local Childbirth Education Association gave her my number and suggested she call me.

We talked for a long time and I was impressed with her clear grasp of the situation, her insight into her own body and baby and her common sense attitude. She knew about the various kinds of breech presentations and felt that this baby was in a footling position (although she was reluctant to have this confirmed with ultrasound because of the pressure she would again be under). She knew that there was a good chance this baby would be bigger than the last one, possibly over 11 lbs. Even given these facts, she still didn’t want any surgery, so we talked about ways of getting the baby to turn, including moxibustion and external cephalic version. We also talked about waiting until labour started if she did reluctantly accept a caesarean, to avoid prematurity for the baby.

I was surprised that no mention of ECV had been made at the public hospital she is attending. At the last consultation in the clinic, the doctor, who had confirmed the baby’s breech position, dismissed her questions with a pat on the knee and the comment “you’ll be OK”. This was not helpful for a woman who already was being treated for a raised blood pressure and was anxious to know as much as she could. I felt it was disgraceful treatment from this Registrar, who should have had more sensitivity and concern for her emotional state as well as physical state.

I am hoping that she will contact me again. I gave her the website address for the moxibustion treatment details, and she was keen to hunt down the moxa sticks (trawling through the Yellow Pages for a herbal remedy or Chinese medicine retailer was to be her next step) and I offered to find a practitioner who could perform ECV at term if she needed one. With a baby due over the New Year period, she will be under a lot of pressure to be induced.

Women with such clear visions and insight need support and encouragement, not doubt, doom and gloom. Talking to her was refreshing and uplifting for me and she was grateful to be able to talk to someone who had a positive approach. She has promised to let me know how it goes and I hope she calls after the holidays with the news that either the baby turned and was born (as usual) at home quite spontaneously, or that she got to the hospital so late in the labour that her breech baby was born vaginally. Either way she will be happy.

Posted by andrea at 07:34 AM | Comments (2)

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 09:23 AM | Comments (1)

Another workshop is completed

The Six Day workshop has closed after a hectic week of effort all round. The last day was spent on presentations - a task that the students always find stressful. They are given some days to prepare a topic they have drawn from a hat. All the topics are related to a segment they will eventually include in their prenatal program, so working on the outline, their aims, the learner objectives and devising an appropriate teaching strategy gives them good practice for later.

We have also begun videotaping some of the presentations as well - again students names are drawn from a hat. At first they feel nervous about being taped, but quickly see that it is a great way of receiving feedback and checking how they are doing for themselves. The camera is silent and is not intrusive at all. Once a gain, this is a good rehearsal for their supervised teaching which will commence next year. All assessment of their classes is now done via videotape and we have found it to be very effective.

All I have to do now is prepare the student’s workshop assessments - we offer feedback on their participation in the program and pointers that we hope will be useful when they are working on their own classes. An honest appraisal now may save anguish and concern later when their supervisor is evaluating their tapes class series.

There is no doubt in my mind that those who complete our Course are outstanding educators with the necessary skills to facilitate effective parenting education. I just wish that all expectant parents could have the kind of educational experience that our graduates offer - they would be so much better prepared for birth and parenting than happens for many of them now.

Posted by andrea at 04:10 PM | Comments (1)

New models of midwifery care at last!

The moves to get new models of midwifery care established in New South Wales are gathering pace. Since the launch of the National Midwifery Action Plan, various projects have been developed and at last some are starting to come to fruition. It all takes a lot of time, but the end product will be very worthwhile.

Two major initiatives in Sydney look particularly promising. At Ryde Hospital, the closure of the hospital was averted and in a bold move, management overruled the objections of the private obstetricians to support a plan to turn the unit into a midwifery model of care, that will offer women a real alternative to the obstetrics that has been the norm in this area for many years. Ryde is in the same Area Health Service as Manly Hospital, and, inspired by the moves at Ryde, it now looks as though Manly will follow the lead and that they will become a Midwifery unit as well.

Considering that both of these smaller hospitals were due to close their birth services, this is a major coup. The North Shore area of Sydney (the up-market end of town) has always lagged behind the rest of the city in providing alternatives to obstetrics. Their hospitals have regularly topped the charts on the levels of interventions they inflict on the wealthy women they attract. Theirs is the last Area Health Service in the Sydney Metropolitan region to open a Birth Centre, which is appalling, given that Birth Centres have been in operation at other city hospitals for around 20 years. The first Birth Centre in this Northern region opened in August 2003 - at last.

Meanwhile, on the other side of the city, an exciting plan is about to be launched that will make home births available for women as part of the public health care system. Until now, home births have only been available in NSW if a woman could find an independent midwife and afford to pay her fee. Whilst this is still an important options for women who want to move right away from the health cares system, there is a shortage of midwives willing and able to offer this kind of service, because of the lack of professional indemnity insurance and the necessity of being continuously on call (often with little back up). There are few midwives in a position to work this way because of family commitments and burn out can be a reality.

The proposed service that will operate in the South Eastern Sydney Area Health Service will be based around the Birth Centres and utilise a more midwife-friendly service that will hopefully reduce the risk of burnout and encourage more midwives to try this way of working. For the women, they will be able to have a home birth on the public purse, making this option available to more women, not just those who can afford it.

Some concerns have been raised around the restrictions that may be placed on midwives who are recruited to facilitate these home births. No doubt there will be strict guidelines about which women will be cleared for a home birth, and given that there is no legislation that protects midwives who stay with women in the home when a transfer has been advised (as they have in the UK) this seems very sensible, if midwives are to avoid litigation. Recent history underscored these risks when a midwife in Sydney was de-registered for what was seen as the unprofessional conduct of a number of high risk births in home settings. We can’t afford to lose experienced home birth midwives in this way, so some guidelines that will give them protection and strengthen their position seems only common sense.

I well remember when the first Birth Centres were opened all those years ago. The list of exclusion criteria was pages long and women were routinely transferred for the slightest deviation from “normal”. While it could be argued that the transfer rate from some Birth Centres is still too high, the list of exclusion criteria has been relaxed and now, in some units, VBAC births are encouraged, for example, a situation that would have been unthinkable even a few years ago.

No doubt as home births become more mainstream and accepted within the community (and there is a long way to go here) the guidelines that govern their availability will be relaxed as well. The important thing is to have this option established, so that women (and midwives) can experience the joys and benefits of home birth. There seems little benefit in holding out for a more “purist” approach that revolves around independent midwifery alone, at least until the insurance situation is resolved and there are more midwives willing to offer this kind of dedicated community service. If there is one thing we can learn from the way home births are managed in other countries such as the UK, The Netherlands and New Zealand, it is that midwife as well as women friendly services are the only ones that will stand the test of time. Australia might be lagging behind in the provision of a home birth option as part of our regular national health service, but at least we can use this delay to learn from others who have more experience than ourselves, and hopefully develop a sustainable, viable and effective alternative that will give all women real choice.

Posted by andrea at 06:39 AM | Comments (1)

A meeting of like minds

This weekend we are hosting a meeting of the faculty for the Graduate Diploma. Supervisors and assessors have come from as far away as Cairns to spend a weekend together updating, sharing and conferring over details of the Course.

Students enrolling for next year will find there are there are a few changes. The Study Program has been re-organised into 5 modules of equal length and the timetable has been altered to allow appropriate time for completion of the study units. Today we will discuss some other possible changes, in light of our plan to offer a number of accredited stand alone modules from the Australian Vocational Education Training system - these may be dovetailed into the Six Day workshop, for example, to offer more flexibility for students.

This group of women are inspiring and visionary. They have a clearly defined view of the importance and relevance of quality prenatal education programs and the skills needed to facilitate them effectively. They are committed to doing their best for the students in our Course and all are having an impact in their own workplaces. There is a high degree of trust and concern for each other, the students, the Course and Birth International and I am very proud of them and enormously buoyed by their support.

We all reaffirmed our commitment to the Mission Statement for the Course and shared many useful ideas and feelings. Today we will be tackling the nitty gritty details of some student’s work and forging some plans for future developments. We’ve already agreed that these gatherings are very worthwhile and next year we hope that our Supervisors from Malaysia, the UK and Thailand will be able to join us.

Posted by andrea at 07:06 AM | Comments (1)

Six Day Workshop

The first three days of the Six-day Workshop of the Graduate Diploma in Childbirth Education are over. The group of students (15 in all) come from all over: every State in Australia except Tasmania and we have three overseas students: one each from Wales and Scotland, and one from Saudi Arabia.

There are all sorts of skills and talents in the group and for such a diverse bunch they are working very well together. I am sure they are looking forward to a break over the weekend before we tackle the next three days, starting Monday.

The participants from Saudi was particularly impressed by the Thursday program. She is a clinical educator in her hospital and was required to take a year-long course in adult education as part of that role. She said she learned more during that one day with us than she had learned in the year of studies she had undertaken before!

The week starts with considering the big picture of prenatal education (overall aims, the role of the educator, ethics, legalities etc), then moves on through the practicalities of working with adults and presentation methods, gradually becoming more specific as the program builds on what has gone before. By the end of the week, the students will be making their own presentations, utilising all the skills they have developed during the entire week.

These programs are a challenge for everyone - for us (Cassandra, the other presenters and myself) as presenters/tutors, our challenge is to get everything in, and for the group members it is to absorb a lot in a small space of time. Watching the students grasp the various principles of working with adults and observing them applying them to the various tasks they are set during the week is not only interesting but very rewarding. I am looking forward to next week with great anticipation!

Posted by andrea at 04:22 PM | Comments (1)

New midwifery unit for Ryde

Barbara Vernon, the EO of the Australian College of Midwives called today and we were able to discuss the developments within midwifery in Australia. The push for implementing caseload models of midwifery care and midwifery only units is gathering pace and some exciting projects are almost ready for launch.

In the Northern Sydney Area Health Service, one of the smaller hospitals, which was due to close, will be re-launched as a stand alone midwifery service in February. There will be no on-site anaesthetic service nor resident doctors available at all times. Midwives will offer all the care, referring complications and difficulties to doctors at the nearby Royal North Shore Hospital, which is a major tertiary care centre.

It has taken a huge effort to convince the management at Ryde of the safety and practicality of operating the hospital in this new way. The evidence is so strong, and has been so ably collated and presented by Sally Tracy that they have realised how sensible and effective the service will be.

Naturally, the obstetricians who had private practices at the Hospital were not happy about the proposed changes and they threatened to withdraw their services if the project went ahead. At an apparently stormy meeting, they blustered that they would walk out if the hospital management did not put a stop to the changes. The managers (I am told) stood an opened the door!

Underpinning the success of this project has been the establishment of a set of guidelines for the consultation procedures that will govern the way the midwives and doctors work together around the referral of women from midwifery to medical care, when necessary. The Ontario guidelines were used as the basis for drawing up a consultation document with input from New Zealand and the UK. In addition, the proposed guidelines were widely discussed with salaried obstetricians who work within the public sector for their professional input.

The final consultation document is almost ready for printing. It will be published by the ACMI and made available in all states, in an effort to get standardisation across State borders and provide a unified approach to the provision of midwifery care. It will be an invaluable resource for the midwives in other States who are also working hard on developing new models of care.

Barbara Vernon is spearheading a wonderful revolution within the ACMI. Her energy, vision, skills and passion are just what the College needs right now. She is committed to establishing a transparent, vibrant organisation that will take midwifery forward in new and exciting ways. We are lucky to have her at the helm!

Posted by andrea at 11:19 AM | Comments (1)

The Royal Hospital for Women, Randwick

These last two days have been spent facilitating a workshop for midwives from the South Eastern Sydney Area Health Service in Sydney. There are three maternity hospitals in this region: The Royal Hospital for Women at Randwick; St George Hospital at Kogarah; and The Sutherland Hospital in Caringbah.

This program was the first of three that I have been asked to present - one at each campus. This Area Health Service is arguably the most progressive in NSW and they are actively pursuing a number of major midwifery initiatives, including making homebirths an option for women choosing to give birth with midwives employed by the hospitals. This will be a first for NSW and many on the group I worked with today are eagerly awaiting the start of this exciting program.

This workshop was at Randwick, and next month I will be at Sutherland Hospital. I was disappointed that so few of the Royal’s midwives chose to attend - I wonder why they chose not to come? In this hospital rotation through the whole maternity unit is not compulsory and there are some midwives who have worked in one area (post natal or “delivery suite”) for many years. I believe that this is a poor policy for a number of reasons: it encourages stagnation and entrenched attitudes and practices; it de-skills midwives at a time when flexibility in the workforce is of paramount importance and it may breed an arrogance that is dangerous - “we are experts at what we do and don’t need to update/revise/review”.

A midwife who is only competent in one area of her practice is a liability to an organisation and runs a severe risk of being supplanted by a person with better skills and is cheaper to employ. For example, a midwife who just works in post natal wards could be replaced by a lactation consultant and an enrolled nurse (or other less expensive personnel). However, if she has skills in labour ward, the prenatal clinic, early discharge program, birth centre and team midwifery she is an asset that is very valuable in these days when the need to staff all areas is essential.

I have also heard that some of the obstetricians that work at the Royal are difficult, wanting control over what is said in prenatal classes, the number of epidurals they can order and insisting on dictating some aspects of the midwives work practices. Perhaps this is the reason that midwives are unwilling/unable to remind themselves of what normal birth is all about?

Posted by andrea at 06:01 PM | Comments (5)

Workshops for 2004

It been a “catch up” week for me - checking through the in-tray after my time away from the office and getting started on some tasks I had left for my return.

Finalising all the venue details for the series of Managing and Leading Change workshops for February was the first priority - this program will take the place of our popular Managing Midwifery workshop that we have run in Sydney for the past 3 years. Next year we are offering a program that builds on the feedback we received from this year’s event, and will be presenting it in three locations: Adelaide, Melbourne and Sydney. The full details will be in the post for those of you on our mailing list, and for the rest of you, the registration form will be on the web site very soon.

I have also been finalising the details of the next exciting tour event - “Keeping birth normal - strategies that work”, which will be offered around the country in April/May next year. This is an intensive one-day workshop designed to up-skill midwives with practical ideas for reducing interventions (and the appallingly high caesarean rate) when the baby is in an OP position, is breech or the woman has had a previous caesarean birth. It will be facilitated by three experienced midwives, Maggie Banks, Lynne Staff and Vicki Chan, and promises to be an event of great practical importance to midwives and students. Again, details on the web site very soon and in the next catalogue mailing in January..

I have also been scheduling the various Active Birth workshops for Australia - finding a slot for them was quite hard, as they have to fit in between the trips to the UK in March and June. < In April I have accepted an invitation to present two workshops in Israel on the theme of Active Birth. Over the past 18 months there have been a number of Israeli midwives in my London programs and to spread the word about natural birth faster they have asked me to come to their country next year. I am regarding this trip as my contribution to world peace - as Michel Odent points out in his books, the way a baby is born has a significant influence over that child’s capacity to love in later life, and that is something that seem to be in short supply in the Middle East at the present time.

Posted by andrea at 11:41 AM | Comments (3)

New training packages for educators

One of my major concerns over many years has been the quality of the training that childbirth educators undertake before launching into the field of parent education. Many are just “thrown in” and find themselves in front of a group, terrified at the prospect of interacting with adult learners and feeling less than competent to facilitate an effective educational opportunity for them.

Birth International has been investigating how we can provide shorter courses, apart from our Graduate Diploma in Childbirth Education, that would enable more educators to update or expand their skills in parenting education.

Today we had a very productive meeting with the Sydney CEO of Community Services and Health Training Australia (CSHTA), with a view to expanding the range of training courses that we offer. There are a number of training packages that already exist within CSHTA that will be of interest to those working in the field of childbirth education (and other health and related fields) that we are now considering adding to the portfolio of accredited Courses available through Birth International. As a Registered Training Organisation we are authorised to issue Statements of Attainment for training packages that we have registered to provide.

The beauty of these modules is that they are generic in nature, that is the competencies they measure can be applied in any appropriate field. Foe example, the “Run Small Groups” module of the Certificate IV in Workplace Training and Assessment that we will offer could be undertaken by anyone who will be facilitating small group work. This, of course, is immediately applicable to childbirth educators, but could be used by those working in other fields, even outside the health sector.

The modules we will offer will also articulate into the Graduate Diploma, so that a pathway of gradual study can be undertaken by those who don’t have the time for the concentrated effort required of a Graduate Diploma. Having completed a number of smaller modules, exemptions will be possible from some of the units of study in the Graduate Diploma, making it easier to complete the full Course over a longer period of time than is now possible.

Look for details in the New Year (one the website and in our next January catalogue) of the modules that will be offering. Most will be available as distance learning packs and some will have workshop content. All will have inbuilt assessment tasks that will enable competencies to be proven, leading to the issuing of the appropriate Statement of Attainment.

These are exciting developments and we will be working on them over the coming weeks. Look for announcements in the New Year - there is bound to be a training module amongst our collection that will be useful for you to undertake, to gain further accredited qualifications and to improve your skills in the workplace.

Posted by andrea at 04:00 PM | Comments (1)

Mining the archives

I’ve been re-organising files today (the last vestiges of our office move) and have come across some artwork and overheads from many years ago. There were some useful graphics that can be utilised in the forthcoming Managing and Leading Change programs we have scheduled for February and some overheads on marketing and promoting prenatal programs that we can use in our Graduate Diploma Six Day workshop, which begins next week.

Reviewing the contents of filing cabinets reveals just how many workshops we’ve been involved with at Birth International and how many different types of programs I have presented myself. Of course these days we have access to much better technology such as computers and Powerpoint and the days of hand written overheads have been left behind. The content is much the same, however, so I was pleased to discover some long forgotten notes that are just as relevant today and will save me re-inventing the wheel for events I have in the pipeline. Archives are a wonderfully useful resource!

Posted by andrea at 06:46 AM | Comments (1)

Routine prenatal care

There was a lot of discussion in the media during my last weeks in London about the UK Government’s decision to cut back the number of antenatal checks from 14 to 10 for first time mothers and to 7 for subsequent pregnancies. Ultrasound scans will be scheduled to take the place of some visits for all women and will be the main reference point for the due date.

The aim is to enable doctors to spend more time with women who are sick rather than seeing healthy women who are busy and not in need of special care. In general, these guidelines follow the evidence that was available some time ago in the Cochrane Library, and are a logical outcome of accepting that pregnancy is a well-ness not an illness condition.

I was amused therefore, to learn from Susanna Houd that in Denmark they have cut the number of visit required to three with the woman able to request more if she feels the need or if her condition suggests additional care is necessary. Susanna’s view was that women are healthy on the whole and everyone (midwives and women) gets sick of routine visits that achieve very little. There is also the understanding that if a woman is concerned she will seek a consultation with her caregiver - in other words, women are credited with being able to take responsibility for their own health (and that of their baby). What a refreshing attitude!

Posted by andrea at 04:25 PM | Comments (1)

Reflections on another European tour

Another tour of the UK and Europe is coming to an end. It has been a journey through several contrasting worlds of maternity care, from the re-awakening of midwives in Northern Ireland (and their commendable efforts to establish free standing Community Midwifery Units), the incredible subjugation of women giving birth in Spain, the cosy fiefdom of the private obstetricians in Guernsey, the idiosyncratic mix of Italian birth practices to the very predictable British birth scene.

I have been honoured to meet many midwives who are trying to make a difference for women and their own colleagues. There have been opportunities to catch up with old friends such as Michel Odent and Marsden Wagner and to meet Susanna Houd, whom I feel I have known for years even though we had never met until last week.

Once more I am impressed by the world wide movement towards humanising birth and feel proud to be part of that effort. These past few days in Florence have given me a chance to step back from the actual work and let my mind roam free around the global scene and what it will take to make cultural change a reality.

It was a comment made by Sylvia (from Argentina) at the Water birth Conference in Carrera (that I was able to roughly translate from the Italian) that really sparked my imagination. She pointed out that epidurals, far from freeing women from the pain of labour, actually did the opposite, rendering them completely submissive to the medical model. The picture of a woman strapped down and restrained by an epidural sprang into my mind and it occurred to me that this was a form of ritualised rape, and one that should be completely abhorrent to the modern woman. That so many women have been seduced into embracing epidurals by the hype around labour pain and the slick advertising of the anaesthetists speaks volumes to me. We need a whole new way of looking at birth, and some major shifts on women’s thinking.

This will be my next major project. Already the ideas are fermenting in my mind ......

Posted by andrea at 01:03 PM | Comments (1)