Articles by Month: February 2005

Israel's first Birth Centre

I have just received word that the first birth centre in Israel has finally opened and that four babies have been born there in its first month. This is fantastic news and so exciting - for the first time, women in Israel will have an alternative to the regular labour ward if they want to give birth in a hospital.

The birth centre is located in the Tel Hashomer Hospital, the largest hospital and the main teaching facility in Tel Aviv. It has taken years of lobbying, organising, building, equipping and staffing to get it established, co-ordinated by a small dedicated team of very committed midwives, led by my good friends Iris and Debbie. It is a private facility, and women will have to pay to use it, but if (as I suspect) it proves its worth and there is enough demand, perhaps Israel will follow the lead of other countries and offer a birth centre as an alternative in the regular public health system.

The centre in Tel Aviv is large, thoughtfully equipped and very woman (mother and midwife) friendly. Last September when I visited Israel I saw the unit as it was nearing completion and was impressed by the facilities they has incorporated into the design.

I especially remember the large hanging rope that was positioned so women could use it in various parts of the room. Women like to grip tightly in the latter parts of labour and a rope makes an effective handhold. Today, I have been presenting the first Active Birth workshop for my year, in Gosford, just north of Sydney, and the knotted fabric “rope” shown in the video we watched (“Inner Strength”) caused one midwife to note wryly that the Infection Control people would be wanting to know how it could be disinfected between each birth! I am sure that the Israelis will keep things in proportion and not let such silly considerations affect the use of their birthing rope. The biggest source of infection in a hospital are the staff, not the furniture or equipment!

I am looking forward to visiting this latest birth centre in June, when I hope to be back in Israel for more workshops. By then they will have a wonderful string of birth stories to be told........

Posted by andrea at 08:20 PM

Educating women about caesarans

This past week has been extraordinarily busy for me and I apologies for the lack of Diary entries - it is not as though there isn’t enough to talk about!

For example, I received this note from a friend in the UK:

“One of our friends from work had her baby last week. She had a 10lb baby boy, and they gave her a Caesarean section, cutting a major artery during the operation. Apparently she nearly died and they have had to give her a hysterectomy as a result.

I just hope the Caesarean section was absolutely necessary - probably the reason given was Preparing for Birth: Mothers the size of the baby. We had given her a some time ago but I don’t think she read it. She didn't want a birth plan, was sure the hospital and midwives would know best and was happy to go along with anything (pretty much like 90% of pregnant women in the UK I think).”

This is a sad comment, but one that I fear is very true. So many women take the their health for granted and put their faith completely in the system, sometimes to their detriment. By way of contrast, there has been a huge kerfuffle in Queensland recently over a woman who wanted a vaginal birth after two previous caesareans,

This woman was receiving care through the largest Women’s hospital in Brisbane. She was advised that another caesarean would be required because of her history, even though she had stated clearly she didn’t want one and was very confident that she could achieve a VBAC (vaginal birth after caesarean). Much pressure was applied by various staff, so she sought a second opinion at another smaller hospital where she was given every support for her decision to have a vaginal birth. The first hospital got wind of this, and demanded a meeting with her. There were five staff to “interrogate” her, including a lawyer, and they asked her to sign a statement that she would undergo the surgery. She declined, saying she would take the document home to read first. When she failed to appear at the next scheduled appointment, the hospital phoned the Department of Community Services, who sent around an officer to check up on her (this is the agency that is charged with protecting children at risk). Her unborn baby had been deemed to be at serious risk, despite our laws that clearly state the unborn baby has no “rights” until it leaves the mother’s body.

In the end, the woman (very sensibly) declined to be “assisted” by this major hospital, and went on to have a perfectly straightforward vaginal birth in the smaller unit, with two lovely midwives who were delighted to be of service.

This case is still reverberating around Queensland. The fact that the Government can intrude on a woman’s rights to this extent, the lack of empathy, caring and support from the major hospital in Brisbane, the pressure from supposed health professionals, all illustrate the sad state of affairs in some areas of the maternity services. There is a Ministerial Review of Maternity Care in progress in Queensland, and it is to be hoped that it recommends sweeping changes so that women’s retain their rights and have better choices available.

There is no evidence that a woman cannot have a vaginal birth after one or more caesareans. Few studies exist, but many anecdotal stories attest to the success of VBAC, when women prepare well and have good midwifery support. This major teaching hospital was more concerned about “risk management” than following the evidence, providing individualised care and offering compassionate support for this woman’s needs. It has been a shameful episode in their history.

Meanwhile, for women who do want to know the risks of Caesarean births, a new publication from the Maternity Center Association in the US has been added it to our range, and you can check it out by clicking here.

Posted by andrea at 06:26 AM

Conferences

I have had to decline an invitation to present workshops at a conference in Barcelona in October. It is rare (in fact It’s never happened before) that I decline an invitation, because I am always keen to spread the word and do what I can to further the cause of natural birth.

In this case, I was asked to do 6 workshops of 1 ½ hours each over the course of one day, all on the same topic, with groups of up to 50 people each time. There would be two short breaks and lunch, and the day would have stretched to 12 hours of work. I have decided that this is unacceptable, for me and for those attending - no-one can be at their best when working like this. I also question whether the participants are capable of taking much in during days packed out like this. Perhaps, if the organisers change their format another time, I can contribute, which I will be very happy to do on a more professional basis.

Organising conferences is quite an art. I have done this a number of time over many years and know that they are exhausting for the participants, as well as for the organisers and speakers. I believe that a Conference presents the professional face of an organisation and that this image is important. Behind the scenes it is vital to carry this theme on - paying speakers well for their time, providing them with good audiovisual and venue support, making sure that they are comfortable, accommodated and valued. This costs money, and the expenses incurred must be covered by the costs of the event. If that means participants paying a little more, then they must realise that they are privileged to have access to so much expertise in the one place - something they could never achieve otherwise.

I’ve given years of free time to promoting better midwifery and great births for women but as I get older (sigh!) I am realising that it is time to take stock of the time I have available and to use it wisely. It is a hard juggling act - balancing community support and the need to provide viable professional services - but I am going to get plenty of practise, it seems.

Posted by andrea at 07:05 AM

Home birth rates in the UK

The statistics for home births in Britain for 2003 have been released. Britain is famous for its “post code lottery” when it comes to health care - the way health care is administered (by small local Trusts ) means that the services you are entitled to depend on where you live and what your local Trust is prepared to offer. This becomes apparent when looking at the rates for home birth across the country.

It is often thought that Britain has a high rate of home birth as it is Government policy to provide this service for women. However, in practice, many Trusts don’t encourage home births and some refuse to make it available at all. Overall, despite Government recommendations, the Winterton and Cumberlidge Reports (“Changing Childbirth”) and numerous initiatives to encourage women to consider a home birth, the overall rate has risen to just 2.18% in 2003.

In the south, there is a much better chance of giving birth at home - Devon has a rate of 5.8% (with some local Trusts with this country having rates of almost 20%) . In the north, women have far less choice: Northumberland, near the Scottish border, has a rate of 0.2%and in Merseyside (Liverpool area) the rate is 0.7%. Wales has a policy of promoting home birth very positively, and they are aiming for a 10% home birth rate - so far it is 2.7%, with Carmarthenshire topping the list at 7%. In Scotland, they have a rate of just 1.03%.

Why are these rates so low, especially when there is so much support at Governmenl levels for home birth? Some trusts claim they don’t have enough midwives to offer this service. One midwife was sacked last year for attending a home birth when his Trust had a stated policy of only providing hospital care. In his case the woman insisted and knowing that the law in Britain says a midwife must not leave a woman in labour, even if advisable, this midwife helped her birth at home, as this was her wish. The result was the midwife was sacked, despite there being no problems and he was fulfilling his legal obligations.

One reason for the shortage of midwives is the insistence that there be two midwives at every home birth - one for the mother and the other “to take the baby” (using the quaint vernacular quoted to me by midwives). This is completely unnecessary and is a waste of scarce midwifery resources. Only one midwife is needed and if there is a problem (very unlikely) there will be other responsible adults who can assist in an emergency. This is how it works in most other places in the world where homebirths are available.

Fear is another major factor. The advent of constant “risk assessment”, the overplayed threat of litigation and the general fear of pain, women’s bodies, midwifery skills and Mother Nature has compounded to a point where having a baby at all, let alone in a home setting, is seen as a risky and complicated procedure. The culture around birth in Britain is not helping and changing this around, I believe, is now almost impossible.

I remember 30 years ago when rooming in with a newborn during the postnatal stay in hospital was considered dangerous. An outbreak of Staph infection in one of our biggest teaching hospitals necessitated all babies staying with their mothers because the nursery was infected. Surprisingly, the sky did not fall when babies roomed in, and in fact, breastfeeding was easier and mothers and babies were happier. Some important lessons were learned in a hurry and centralised nurseries disappeared very quickly. Perhaps we need drastic measures of a similar kind to prove that home is a good place to give birth - perhaps some hospitals having to shut down instantly due to infection, or damage by a force of nature (wouldn’t that be a nice ironic touch?), so that midwives had to work in the community for a while. Of course, such models already exist, in New Zealand, The Netherlands and many developing countries. Perhaps we don’t have to wait for nature to step in, but just let the scales fall from our eyes and take a few bold steps. Somehow, I can’t see that happening, which is such a shame......

Posted by andrea at 07:12 AM