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I along with my fellow lincolm midwives attended your workshop in warwick. It has revolutionised our midwifery practise
and tomorrow we have our own active birth workshop for our fellow midwives. Wish us luck. If we are half as inspirational
as you it will be good! These days i can't wait to get to work. thank you andrea
I attended Andreas workshop last weekend in Warwick with Even the doubting thomases have had to admit there must be something in it with the increase in either reduced analgesia or drug-free normal births many amongst primips. You can almost feel the excitement and eagerness in the air. I am currently the leader on a 6 month project to take forward normality and felt that the workshop would be a turning point. Thank you Andrea for relighting our passion and belief in midwifery and the wonder of pregnancy and birth. Jane Kania, Midwife The following review of this workshop appeared in the Practicing Midwife Journal, May 1998 Vol 1 No 5: Andrea Robertson, an internationally-known childbirth educator and author from Australia has been running Active Birth Workshops in the UK for a number of years. We invited her to the Leicester Royal Infirmary NHS Trust Maternity Unit in 1997 and again this year and subsidised local midwives to attend. So far 40 midwives have attended the two-day event and the feedback has been very positive, both from sceptics and enthusiasts of active birth. One message seemed clear --- be prepared to be challenged! The first day focuses on the physiology of birth. Andrea works with a doll and pelvis to review the pathway of the baby during childbirth. She speaks in jargon-free language, a legacy of many years of prenatal education to prospective parents, and affirms the inherent ability of a woman's body to birth her baby. She stresses the role of the hormones oxytocin and endorphins in assisting the events and the need to keep the flight and fight hormone, adrenaline, in balance with these. She vividly illustrated how hospital birth may undermine this balance by raising anxiety levels to the point where labour becomes dysfunctional i.e. excessively painful or inhibited. She is particularly challenging about the dangers of hospital birth for the vast majority of women whose labour will be natural. Her starting point here is that childbirth is primarily a psycho-social event and that these dimensions need protecting and enhancing if the physiology is to work. Andrea opened our eyes to the level of interference we impose on women, not just through monitoring techniques but through the environment in which we place them and the power relationship we form with them. These tend to affirm our knowledge and skill and undermine theirs. The second day was very practical, working with a partner through a variety of postures and positions to assist labour and birth and the use of massage and hot towels to bring comfort. She also showed a number of videos of natural births that reinforced the active birth message. These videos successfully conveyed the sense of awe, almost reverence, at the wonder of birth and many of the participants were moved by them. The course was philosophically very challenging and this is a great strength, as active birth is much more than a series of techniques. The effective application of the skills taught requires a positive and enabling attitude to childbirth. Andrea's style is informal and upbeat. Although very committed, she's not a crusader who is defensive and intense about her work. She relaxed us and I think all of us caught her infectious enthusiasm for natural childbirth. It was also very practical, giving many ideas that require a minimum of props to implement immediately. In a unit of over 200 midwives, it is often difficult to change practice when you are in a minority. After the 1997 workshop, there was little change in birth practice regarding positions. Andrea says that units can reach a critical mass level when a large minority of midwives who have attended the workshop begin to affect the culture of practice. We have seen some encouraging signs following the 1998 workshop and intend to invite Andrea back in 1999. Denis Walsh
Postscript: In 1998, a clinical audit was carried out by Denis Walsh in his unit to assess the degree of change that occurred following this workshop. The subject was the practice of encouraging women to take up alternative positions for birth, and remarkable results have been achieved in the 18 months over which the study was conducted. There was a change from 18% of alternative positions used in "no intervention NSD (normal, spontaneous delivery)" to 46% in the first 3 months of 1998. "No intervention NSD" is defined as all the normal vaginal births excluding epidural, continuous fetal heart monitoring and syntocinon augmentation. The birth positions used included: kneeling 29%, all-fours 28%, left lateral 23%, standing 9%, pool 7%, and squatting 4%. This contrasts to the recent Audit Commission Report which gives 10% of women in the UK adopting alternative positions, a figure that included forceps/ventouse births. The results at the LRI may well be the best figure in the UK, especially among consultant units of comparable size (5,600 births per year), and has been achieved in a relatively short space of time. For full details of this study, see The Practising Midwife, June, 1998, Vol 1 No 6. The tutor is so informatove, intersting and knowledgeable an knew her subject and audience so well. She is an excellent communicator. Wouldliek to spend at least one month listening and working with Andrea dealing with her clients. Wouldlike to see all midwives in Ireland and this hospital attending her workshop. Looking forward to reading her books and spreading the "Gospel of Andrea" everywhere I go.
Andrea was an excellent Course Leader. Both days were refreshing and stimulating, they put my chosen career of midwifery back in perspective, reminding me of my student days just 2 1/2 years ago. With my colleagues we learned with passion all about the wonderful process of birthing. Unfortuantely, it didn't take long for me to realise that reality was far from the ideal situation in which I would like to care for women. Since qualifying I have worked in an institution that imposes policies and rules on midwives, thus disempowering them and making it hard for them to be enabled to empower the women for whom they care. Its easy to lose sight of goals under the heap of rules, regulations and the politics surrounding birth, all to the detriment of being an advocate for women. I feel listening to Andrea speaking so convincingly was just what I needed to put me back on track. To honestly be "with women" is a mammoth challenge for midwives working under present constraints and pressures. But I shall quietly get on with it, behind closed doors. I would like to see people like Andrea infiltrating our Schools and Colleges of Education inspiring the new blood that is coming into the profession and empowering student midwives who are firstly women/mothers and secondly midwives. There is great value in preaching to the converted but power in preaching to those that need to be converted for the philosophy of active birth. Andrea, I want to thank you very much for a wonderful few days. Congratulations on your wonderful work and all the very best for the future. Hope to see you again soon.
I asked a colleague what Andrea's sessions were like and her reply was "be prepared to be blown away". She was right! I will endeavour to carry on her philosophies as will my colleagues.
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