Friday, October 2, 2009
Monday, September 14, 2009
Don't Let Litigation Rule Birth Choices
There has been a lot of media lately about “bad home birth outcomes” – both here in Aus as well as in America, and it has been distressing to say the least. These stories are inevitably extremely biased towards a medical view – that hospital is the only safe place to birth – without any fair representation of the truth. Both of the most recent stories discuss the death of a baby at home and neither story mentions that babies die in hospitals too. Neither story mentions the studies that repeatedly show that home birth is as safe as hospital birth with far fewer injuries, traumatic outcomes and higher breast feeding rates. Far happier mums and bubs all around. But it does not surprise me – I have lost all faith in the media and our legal and political systems, and I do not have much hope left for our medical system.
Let me be very clear – care in a hospital is NOT about what is in the best interests of mothers and babies. The doctors and midwives on the coal face may have very good motives, but the policy makers – those that dictate how a labour and birth will be “managed” are purely trying to protect themselves from litigation – regardless of whether it is good care or not. So long as it seems as if all technology was applied, then there is no case to answer. But there are some glimmers of hope for the medical profession – not all it seems have sold their souls and can see the dark path that birthing in Australia is descending. I would like to finish my little rant tonight (sorry, it’s late and I’ve got an early start) by quoting an Australian Obstetrician who is distressed by where things are heading. Insurance for midwives is NOT the answer – we CANNOT let litigation rule birth choices. Australian women – you need to stand up and reclaim the power of birth – YOUR BODY, YOUR BABY, YOUR BIRTH – YOUR CHOICE.
“- - - I agree with you that at the end of it all women are the "victims" of our medico legal system, when it is supposed to be helping them. [Local hospital] midwives have just been forced into doing mandatory admission CTG's in the interests of the hospitals lawyers. We argued until we were blue in the face that it won't improve outcomes for women and babies, or even reduce the litigation, but after a recent $14 mill payout they are only worried about their bottom line. - - - It is getting harder and harder to practice GOOD obstetrics and midwifery in Australian hospitals. Which is why HB midwives becoming insured is such a double edged sword. I'll bet a million bucks that any insurance company that takes on insurance for home birth midwives will have a long list of do's and don'ts for their "customers", which will reduce home birth to hospital birth in the home. And if the midwives refuse to do it they will be uninsured and de-registered and we are back where we started.”
Let me be very clear – care in a hospital is NOT about what is in the best interests of mothers and babies. The doctors and midwives on the coal face may have very good motives, but the policy makers – those that dictate how a labour and birth will be “managed” are purely trying to protect themselves from litigation – regardless of whether it is good care or not. So long as it seems as if all technology was applied, then there is no case to answer. But there are some glimmers of hope for the medical profession – not all it seems have sold their souls and can see the dark path that birthing in Australia is descending. I would like to finish my little rant tonight (sorry, it’s late and I’ve got an early start) by quoting an Australian Obstetrician who is distressed by where things are heading. Insurance for midwives is NOT the answer – we CANNOT let litigation rule birth choices. Australian women – you need to stand up and reclaim the power of birth – YOUR BODY, YOUR BABY, YOUR BIRTH – YOUR CHOICE.
“- - - I agree with you that at the end of it all women are the "victims" of our medico legal system, when it is supposed to be helping them. [Local hospital] midwives have just been forced into doing mandatory admission CTG's in the interests of the hospitals lawyers. We argued until we were blue in the face that it won't improve outcomes for women and babies, or even reduce the litigation, but after a recent $14 mill payout they are only worried about their bottom line. - - - It is getting harder and harder to practice GOOD obstetrics and midwifery in Australian hospitals. Which is why HB midwives becoming insured is such a double edged sword. I'll bet a million bucks that any insurance company that takes on insurance for home birth midwives will have a long list of do's and don'ts for their "customers", which will reduce home birth to hospital birth in the home. And if the midwives refuse to do it they will be uninsured and de-registered and we are back where we started.”
Saturday, September 5, 2009
People power or political blindside?
Driving home from a long day of antenatal visits yesterday afternoon, I was listening to ABC News Radio when I hear that our friend Nicola had done a “back down” on the “making homebirth illegal issue”. The volume was instantly turned up as I listened to her say that she didn’t want to “make illegal” a current practice that was at present legal, and so had agreed with the State Health Ministers to give a 2 year exemption from the law to home birth Midwives.
“Wow” I thought.
YEH FOR PEOPLE POWER - OUR LETTERS AND PROTESTS HAVE BEEN HEARD. Or had they?
And then I thought “How come I am not excited by this news? Am I so totally cynical and jaded that I am disappointed the fight is over?”
And then I heard her say something along the lines that midwives would be able to continue to practice in jurisdictions where it was allowed. Hmmm. What did that mean? What other hidden catches were there? I couldn’t wait to get home to get onto the net and discover the goss.
“Additional requirements to access the exemption will include;- A requirement to provide full disclosure and informed consent thatthey do not have professional indemnity insurance.- Reporting each homebirth- Participating in a quality and safety framework which will bedeveloped after consultation led by Victoria through the finalisation of the registration and accreditation process.These provisions will only apply to midwives working in jurisdictions which do not prohibit such practice as at the date of the implementation of the scheme.”
And why will it be led by Victoria? I’d like to quote from Home Birth Australia - - -
"We have been told by Nicola Roxon's office that this is due to Victoria leading the National Registration and Accreditation Scheme. However, we have concerns that Victoria may also lead the development of a framework within which private practice midwives will have to work, in order to be eligible for an exemption. Some members of Maternity Coalition and Australian Private Midwives Association recently attended a meeting with the Victorian Health Minister Daniel Andrews and they reported back that "The Minister summarized the implications that the current Bills before parliament will have for women and midwives. He stated that midwives cannot continue uninsured as they are and that if they wanted to work it would need to be as part of a team at a public hospital providing homebirth". He was asked whether he recognized the right of women to choose place of birth and what they would do in the instance of July 2010 if the issue is not resolved, "Well they will be faced with the difficult choice of choosing from what is available". We have grave concerns that this will be the beginning of the end for private practice homebirth midwifery.” http://www.homebirthaustralia.org/
So in reality, the fan fare that Nicola has made on Friday is all show and no substance – a political blind side designed and timed specifically to take momentum out of the rally at Canberra on Monday.
DON’T BE FOOLED BY SUCH POLITICAL TRICKS.
Political agendas should have NO SAY over a woman’s body and birthing decisions and I urge you to support the rally in Canberra with an even louder voice. If you can’t attend, it is too late to purchase a virtual rally ticket (this has taken a huge amount of work and co-ordination and I thank the organisers for this possibility) – you can still make your opinion count. Tell your relatives and friends to watch for it on the news. Tell them to write letters to the paper and Federal Labour MP’s as a result. We do not want to descend back into the dark ages and we do not want women’s rights violated, and we do NOT want to have to go through all this again in 2 years when the medical lobby will have enough time to spearhead an even more detailed and deadly attack.
I also urge you to remember this is not about homebirth verses hospital birth.
This is not about midwife versus doctor.
This is about women and their right to make their own decisions regarding their own births and what happens to their bodies.
This is about how your daughter will birth –please fight for her autonomy and freedom.
This is not about midwife versus doctor.
This is about women and their right to make their own decisions regarding their own births and what happens to their bodies.
This is about how your daughter will birth –please fight for her autonomy and freedom.
Wednesday, September 2, 2009
antenatal care vs nurture
Well, according to RANZCOG – antenatal care is important – even vital – for the health and well being of women. In fact, so important that a woman I helped last year, who had to transfer into hospital for complications during the birth, was punished for having “no antenatal care”. Her baby was isolated from her, (he was separated from her for an ENTIRE night – despite his normal newborn behaviour for most of that night), checked, poked, prodded and tested all because of “NO ANTENATAL CARE”. That is what is actually written in capital letters in her baby’s chart as his number one problem. Hmmmm. I have two issues with this assertion – the first is that standard “antenatal care” actually promotes wellness in baby and mother or even that it actually prevents complications; and the second is that because this woman chose not to partake in the “antenatal care” on offer at this particular institution than it amounted to “no antenatal care”. Apart from seeing me, a privately hired registered midwife 5 times (for a minimum of 2 hours each time), her local GP 3 times, and a midwife that was employed by her doctor’s surgery 3 times, an ultrasound at 22 weeks, and complete antenatal blood screen work up at the beginning of her pregnancy, this woman apparently had NO antenatal “care” and thus “endangered” her baby. Please someone hold me back while I scream!! HOW DARE THEY IMPUNE THIS WOMAN’S CHARACTER like they have? I personally know her to be acutely aware of her own responsibility and how her own actions will affect her baby’s health and well being. She and SHE ALONE knows the best for herself and for her baby. We are currently composing letters of formal complaint about the treatment this woman received at the hands of the hospital concerned, so I have to be careful about what I say and cannot give you details of her abominable and illegal treatment. So I will rave about “antenatal care”.
“Care”?? Since when can the standard antenatal service provided by hospitals and many private obstetricians be described as “care”? In a previous blog I discussed a woman who at 36 weeks was given her first bit of dietary advice when they discovered that she was carrying a large baby. True “care” would ensure that these issues would be discussed in depth at the very first meeting. But that is not the focus of standard antenatal care - visits usually involve examining how big the mother’s uterus is growing, where the baby is positioned (ie head down or up) and listening to the baby’s heart tones. It also consists of many screening tests that women are given little if any information on the consequences of submitting to. Women are certainly not encouraged to research all that is available and consent to what they feel they need to – incompliance with any of these tests is seen as dangerous and risky behaviour and women are treated accordingly.
“Care”?? Since when can the standard antenatal service provided by hospitals and many private obstetricians be described as “care”? In a previous blog I discussed a woman who at 36 weeks was given her first bit of dietary advice when they discovered that she was carrying a large baby. True “care” would ensure that these issues would be discussed in depth at the very first meeting. But that is not the focus of standard antenatal care - visits usually involve examining how big the mother’s uterus is growing, where the baby is positioned (ie head down or up) and listening to the baby’s heart tones. It also consists of many screening tests that women are given little if any information on the consequences of submitting to. Women are certainly not encouraged to research all that is available and consent to what they feel they need to – incompliance with any of these tests is seen as dangerous and risky behaviour and women are treated accordingly.
No, it is not ‘antenatal care’ that the medical profession seek to give women, but ANTENATAL COMPLIANCE that they seek from them - - - “You must have ALL tests that we say you should, and you need to comply with ALL protocol that we say you should, because we say so, and not because there is good evidence for it, and certainly against your own better judgement and researched opinion.”
The 3rd edition of the Collins Dictionary lists “care” with 13 different meanings or contexts in which the word can be used. Those applicable to our topic today are the following - - -
1. To have regard or consideration
2. To provide physical needs, help or comfort
3. Careful or serious attention
4. Protective or supervisory control
Now let’s see. When a woman enters the care of a GP, private obstetrician or hospital antenatal clinic does she receive numbers 1 or 2? No she receives number 4 as a priority and maybe in some circumstances number 3. The medical profession is "big brother" - monitoring size and supervising screening compliance. Standard maternity “care” is basically set up to make sure a woman has the proper screening procedures – to make sure it is a “normal” pregnancy (can’t have congenital abnormalities mucking up our peri natal statistics now can we?) as well as comply with standard protocols that have been designed for the organisations benefit – not for the benefit of the individual woman. Antenatal visits are brief – lucky to be 15 minutes long, and NO information is given in adequate amounts so that a woman can make up her own mind about anything. No care or nurture is given about a woman’s individual circumstances, and only information that is deemed “acceptable standard practice” is ever presented to women. Most women DO NOT KNOW that they HAVE a choice about the course of their “care”. I once had a doctor actually say to me in private conversation that “informed consent” with pregnant women was “impossible”. Why? Well due to the fact that pregnant women were hormonal and their perceptions were altered about what is best for their baby, “how on earth COULD they make rational decisions based on the facts” when “they were ruled by emotions”? Excuse me? Who on THIS EARTH has a bigger stake in the welfare of baby and mother than a pregnant woman and her partner????? Since WHEN does the medical profession care about the outcome of a birth MORE than a mother and father??
My aim during pregnancy is to “nurture” the women that come to me to assist them achieve their desire for a natural birth. The definition of “nurture” is as follows
1. The act or process of promoting the development of someone
2. Something that nourishes - to feed or support, educate or train
Pregnancy is a wonderful time of exploration - emotionally, spiritually and pysically. Women transform during their pregnancies and it is always amazing to watch. They carry a very deep power if it is nutured and encouraged to develop - and this changes not only their birth experience but their experience of motherhood. I do not use the terminology “antenatal visits/care” – not because there is anything wrong with the meaning of the words themselves, it has just come to imply an authoritarian/subject; supervisor/supervised relationship. The connotations these words bring up is of long waiting times, brief visits, reams of paperwork and test after test – and compliance with the system. I believe pregnant women need nurture – they need to feel cherished and important. They need individualised nurture - someone to met them where they are and walk alongside them in their journey. They also need someone with accurate information and statistics that they can discuss things with to help them come to a decision about what they do or do not think is important for themselves in this pregnancy. They need to develop a relationship with the person that they have asked to be at their birth – what will ultimately be their most powerful yet most intimate moment. They need to be assured that both they and their baby will be respected at all stages along the way. They need to feel safe. So I have “pregnancy visits” and I aim to “nurture”.
The 3rd edition of the Collins Dictionary lists “care” with 13 different meanings or contexts in which the word can be used. Those applicable to our topic today are the following - - -
1. To have regard or consideration
2. To provide physical needs, help or comfort
3. Careful or serious attention
4. Protective or supervisory control
Now let’s see. When a woman enters the care of a GP, private obstetrician or hospital antenatal clinic does she receive numbers 1 or 2? No she receives number 4 as a priority and maybe in some circumstances number 3. The medical profession is "big brother" - monitoring size and supervising screening compliance. Standard maternity “care” is basically set up to make sure a woman has the proper screening procedures – to make sure it is a “normal” pregnancy (can’t have congenital abnormalities mucking up our peri natal statistics now can we?) as well as comply with standard protocols that have been designed for the organisations benefit – not for the benefit of the individual woman. Antenatal visits are brief – lucky to be 15 minutes long, and NO information is given in adequate amounts so that a woman can make up her own mind about anything. No care or nurture is given about a woman’s individual circumstances, and only information that is deemed “acceptable standard practice” is ever presented to women. Most women DO NOT KNOW that they HAVE a choice about the course of their “care”. I once had a doctor actually say to me in private conversation that “informed consent” with pregnant women was “impossible”. Why? Well due to the fact that pregnant women were hormonal and their perceptions were altered about what is best for their baby, “how on earth COULD they make rational decisions based on the facts” when “they were ruled by emotions”? Excuse me? Who on THIS EARTH has a bigger stake in the welfare of baby and mother than a pregnant woman and her partner????? Since WHEN does the medical profession care about the outcome of a birth MORE than a mother and father??
My aim during pregnancy is to “nurture” the women that come to me to assist them achieve their desire for a natural birth. The definition of “nurture” is as follows
1. The act or process of promoting the development of someone
2. Something that nourishes - to feed or support, educate or train
Pregnancy is a wonderful time of exploration - emotionally, spiritually and pysically. Women transform during their pregnancies and it is always amazing to watch. They carry a very deep power if it is nutured and encouraged to develop - and this changes not only their birth experience but their experience of motherhood. I do not use the terminology “antenatal visits/care” – not because there is anything wrong with the meaning of the words themselves, it has just come to imply an authoritarian/subject; supervisor/supervised relationship. The connotations these words bring up is of long waiting times, brief visits, reams of paperwork and test after test – and compliance with the system. I believe pregnant women need nurture – they need to feel cherished and important. They need individualised nurture - someone to met them where they are and walk alongside them in their journey. They also need someone with accurate information and statistics that they can discuss things with to help them come to a decision about what they do or do not think is important for themselves in this pregnancy. They need to develop a relationship with the person that they have asked to be at their birth – what will ultimately be their most powerful yet most intimate moment. They need to be assured that both they and their baby will be respected at all stages along the way. They need to feel safe. So I have “pregnancy visits” and I aim to “nurture”.
Just last week a precious mum was at the end of her pregnancy and "totally over it". She needed friendship, nurture, love and a change of scenery. So we packed the children up, got together with two other mums and went to the beach. During the hour drive there and back, we had plenty of time to discuss her upcoming birth and all that was on her mind. We swam and played and laughed and ate some yummy food. Oops - I didn't check the baby's heart tones - guess it wasn't "antenatal care" after all!
Saturday, August 29, 2009
Midwifery' s Renaissance
I found this article a great read and a good explaination of the difference between midwifery and obstetric care. A midwife is focused on the woman and what is best for her individually - she is an expert in normal birth. An obstetrician is focused on what the scientific research says and what course of action brings the least risk of beign sued. He/she is an expert in what is NOT normal - the few percent of women that need obstetric help.
Midwifery' s Renaissance
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Midwifery' s Renaissance
Shared via AddThis
Tuesday, August 25, 2009
Crime and punishment
I am so sick and tired of helping women deal with medical misinformation. Don’t get me wrong – I’ll never tire of helping women, I am just so sick of deliberate weighting of evidence or only giving one side of the story or even downright lies and deceit. I should probably wait until I calm down a little before I blog about this, but I just seem to get angrier every time I think about it. There seems to be a habit among some health professionals of punishing women who decline their interventions during pregnancy and/or labour and birth. Don’t get me wrong – I know there are “good” staff out there – I am friends with some – but I have witnessed this sort of thing too frequently.
Some of you may remember my reference to Sally in my previous post (http://charisbirthsupport.blogspot.com/ ) – well once again the treatment this lady has received at the hands of the medical profession has inspired this “blog of disgust”. It seems the hospital staff couldn’t let Sally enjoy her “babymoon” without scaring her silly about the consequences of her labour choices on the health of her baby. (Despite her labour choices resulting in an empowering natural birth of a healthy baby weighing just over 4.5kg) I would hate to think anyone’s reasoning would be so petty, but it seemed as if they were punishing her for being “uncompliant during labour.”
Sally’s crime number one: Not attending the hospital when her waters broke, and then not accepting IV antibiotics when she did so. Sally stayed at home for nearly 2 days, monitoring her loss for smell and change of colour, monitoring her temperature and how she felt. Baby was moving and she felt fine with no signs of infection so Sally made the informed decision to wait for true labour to kick in. I believe she took vitamin C every 3-4 hours to help her body keep any infection at bay.
Punishment: The staff thought that Sally’s amniotic fluid smelled “off”. Sally and her 2 support people hadn’t noticed any change in odour over the 48 hours her waters had been broken, nor at this time. The baby had blood drawn to test for infection (though showing no signs of distress or illness and had breastfed beautifully). The staff acted as if they expected the baby to be infected and not simply monitor her as a precaution. They also cultured the placenta (which eventually came back negative). When the blood results on the baby came back fine – the staff were still reluctant to empower Sally to make her own decisions about how to mother her precious baby, and told her that the presence of the fine hair on her baby’s ears was a possible sign of infection so they had to keep a close eye on her. ???? What was the motive for this statement? A bold lie to get Sally to do what they wanted?? An ignorant statement that was just something to say?? ALL babies have hair on their bodies – called lanugo – and it starts to disappear in the last few weeks before birth. The last place it disappears is the ears and the back. If Sally’s bub was born just under the 38 week mark, it makes even MORE sense that the baby would have hair on her ears. (Though I have seen this on some babies that are over 40 weeks). Since when does a body grow hair on the ears as a response to infection? How dare they tell a mother that a normal occurrence in a baby is a sign of infection! What the staff were trying to do – consciously or unconsciously – is to keep the balance of power on their side. We are the professionals with the knowledge – you are the mother who did not follow our advice now suffer the consequences – your baby is sick.
Sally’s crime number two: Having a baby over 4.5kg.
Punishment: The baby was subjected to frequent routine BSL checks as per policy in every hospital (pricking the baby’s heel to get a drop of blood and testing the blood sugar level). Sally was not “allowed” to co-sleep (as per hospital policy) and was not allowed to breast feed on demand . Yes – in spite of all the research that indicates frequent breast feeding the most effective way of treating things like low blood sugars and preventing/treating jaundice, the staff demanded the baby be schedule fed – FOURTH HOURLY !! Sally was told that she “must sleep” and that her baby needed to develop a “healthy feeding pattern and learn to regulate her blood sugars.” And just how was the baby going to do that when she wasn’t allowed to feed? If the baby had of been allowed in bed with her Sally could have rested and fed at the same time. I find it amazing that at the same time they were limiting how much she fed, they told her they were worried about the baby’s blood sugar levels and “if they did not come up” would have to “give her formula”. Hello!!!! Let her feed form the breast whenever she wants to and her blood sugar levels would regulate themselves!!.
After this piece of advice, Sally was given another gem – she was told that because her baby was big that she wouldn’t have enough milk for her, and rather than get sore nipples, she should consider giving formula to supplement. After all, you couldn’t have the baby “sucking all the time”. I thought that it was COMMON KNOWLEDGE that the more a baby sucked, the more she stimulated her mother’s milk supply. I thought it was COMMON KNOWLEDGE that supplementing a baby with ONE bottle of formula put the baby at risk for an allergic response to milk as well as disrupt the colonisation of the baby’s bowel with good bacteria and well as have the effect of DECREASING the mother’s milk supply and make breast feeding failure more likely? Apparently it is not common knowledge and ignorance in the medical midwifery world is alive and well. Apparently, it is especially true with large babies that you need to “get them into a routine from the beginning”. Too bad if little baby was hungry and wanted to feed from her mother – sorry, the staff member says you have to wait another 2 hours! Oh dear – a low urine output and low blood sugar levels? It’s just as well you are in hospital my dear because we can tell you that your baby needs formula and you don’t have enough milk!! I am absolutely disgusted and angry – but I know this happens to women all the time. NO mother instinctively denies her baby be fed when she is asking to be fed – that only comes when people in authority demand it and how dare they.
All of this ignorance brings to mind another case where a home birth transfer was punished for planning a home birth in the first place. When the mother declined a vitamin K shot for her baby, the medical staff threatened to “keep the baby for observation” for 3 days, but if she consented she could go home. Informed consent? Or illegal abuse – even assault and battery?
How are the medical/midwifery profession ever going to achieve any level of respect among thinking women when they act like this? Is this the sort of “collaborative practice” that home birth midwives will be forced into if by some miracle amendments are made to the coming law to allow them to continue to practice? I absolutely stand against the idea that current practice or medical opinion is the ultimate authority in the health of mother and baby. The medical profession – and hospitals – are there to provide a service – not be the final authority over a woman’s body and her baby. If we start thinking of them in this way, when they say to us “no you can’t feed your baby” we can tell them politely and calmly that we can and we will and that they cannot stop us. Women – claim your birthing power and your mothering power!!
Some of you may remember my reference to Sally in my previous post (http://charisbirthsupport.blogspot.com/ ) – well once again the treatment this lady has received at the hands of the medical profession has inspired this “blog of disgust”. It seems the hospital staff couldn’t let Sally enjoy her “babymoon” without scaring her silly about the consequences of her labour choices on the health of her baby. (Despite her labour choices resulting in an empowering natural birth of a healthy baby weighing just over 4.5kg) I would hate to think anyone’s reasoning would be so petty, but it seemed as if they were punishing her for being “uncompliant during labour.”
Sally’s crime number one: Not attending the hospital when her waters broke, and then not accepting IV antibiotics when she did so. Sally stayed at home for nearly 2 days, monitoring her loss for smell and change of colour, monitoring her temperature and how she felt. Baby was moving and she felt fine with no signs of infection so Sally made the informed decision to wait for true labour to kick in. I believe she took vitamin C every 3-4 hours to help her body keep any infection at bay.
Punishment: The staff thought that Sally’s amniotic fluid smelled “off”. Sally and her 2 support people hadn’t noticed any change in odour over the 48 hours her waters had been broken, nor at this time. The baby had blood drawn to test for infection (though showing no signs of distress or illness and had breastfed beautifully). The staff acted as if they expected the baby to be infected and not simply monitor her as a precaution. They also cultured the placenta (which eventually came back negative). When the blood results on the baby came back fine – the staff were still reluctant to empower Sally to make her own decisions about how to mother her precious baby, and told her that the presence of the fine hair on her baby’s ears was a possible sign of infection so they had to keep a close eye on her. ???? What was the motive for this statement? A bold lie to get Sally to do what they wanted?? An ignorant statement that was just something to say?? ALL babies have hair on their bodies – called lanugo – and it starts to disappear in the last few weeks before birth. The last place it disappears is the ears and the back. If Sally’s bub was born just under the 38 week mark, it makes even MORE sense that the baby would have hair on her ears. (Though I have seen this on some babies that are over 40 weeks). Since when does a body grow hair on the ears as a response to infection? How dare they tell a mother that a normal occurrence in a baby is a sign of infection! What the staff were trying to do – consciously or unconsciously – is to keep the balance of power on their side. We are the professionals with the knowledge – you are the mother who did not follow our advice now suffer the consequences – your baby is sick.
Sally’s crime number two: Having a baby over 4.5kg.
Punishment: The baby was subjected to frequent routine BSL checks as per policy in every hospital (pricking the baby’s heel to get a drop of blood and testing the blood sugar level). Sally was not “allowed” to co-sleep (as per hospital policy) and was not allowed to breast feed on demand . Yes – in spite of all the research that indicates frequent breast feeding the most effective way of treating things like low blood sugars and preventing/treating jaundice, the staff demanded the baby be schedule fed – FOURTH HOURLY !! Sally was told that she “must sleep” and that her baby needed to develop a “healthy feeding pattern and learn to regulate her blood sugars.” And just how was the baby going to do that when she wasn’t allowed to feed? If the baby had of been allowed in bed with her Sally could have rested and fed at the same time. I find it amazing that at the same time they were limiting how much she fed, they told her they were worried about the baby’s blood sugar levels and “if they did not come up” would have to “give her formula”. Hello!!!! Let her feed form the breast whenever she wants to and her blood sugar levels would regulate themselves!!.
After this piece of advice, Sally was given another gem – she was told that because her baby was big that she wouldn’t have enough milk for her, and rather than get sore nipples, she should consider giving formula to supplement. After all, you couldn’t have the baby “sucking all the time”. I thought that it was COMMON KNOWLEDGE that the more a baby sucked, the more she stimulated her mother’s milk supply. I thought it was COMMON KNOWLEDGE that supplementing a baby with ONE bottle of formula put the baby at risk for an allergic response to milk as well as disrupt the colonisation of the baby’s bowel with good bacteria and well as have the effect of DECREASING the mother’s milk supply and make breast feeding failure more likely? Apparently it is not common knowledge and ignorance in the medical midwifery world is alive and well. Apparently, it is especially true with large babies that you need to “get them into a routine from the beginning”. Too bad if little baby was hungry and wanted to feed from her mother – sorry, the staff member says you have to wait another 2 hours! Oh dear – a low urine output and low blood sugar levels? It’s just as well you are in hospital my dear because we can tell you that your baby needs formula and you don’t have enough milk!! I am absolutely disgusted and angry – but I know this happens to women all the time. NO mother instinctively denies her baby be fed when she is asking to be fed – that only comes when people in authority demand it and how dare they.
All of this ignorance brings to mind another case where a home birth transfer was punished for planning a home birth in the first place. When the mother declined a vitamin K shot for her baby, the medical staff threatened to “keep the baby for observation” for 3 days, but if she consented she could go home. Informed consent? Or illegal abuse – even assault and battery?
How are the medical/midwifery profession ever going to achieve any level of respect among thinking women when they act like this? Is this the sort of “collaborative practice” that home birth midwives will be forced into if by some miracle amendments are made to the coming law to allow them to continue to practice? I absolutely stand against the idea that current practice or medical opinion is the ultimate authority in the health of mother and baby. The medical profession – and hospitals – are there to provide a service – not be the final authority over a woman’s body and her baby. If we start thinking of them in this way, when they say to us “no you can’t feed your baby” we can tell them politely and calmly that we can and we will and that they cannot stop us. Women – claim your birthing power and your mothering power!!
Wednesday, August 19, 2009
“I’M SORRY DEAR BUT YOUR BABY IS TOO BIG”
As a home birth midwife, I often help women cope with the after effects of a previously traumatic birth. Among them are women who have had previous caesarean sections because their baby was “too big” to fit through their pelvis, or had caesarean sections because of a failed induction at 38 weeks to “prevent” their baby “getting too big to birth”. Other women tell tales of hours of pushing and several attempts at a vacuum extraction where the doctor has placed his foot on the end of the bed to gain more traction. After their episiotomy tears and extends down into their anus, the doctor says to them that obviously their pelvis was “too small” and with such extensive damage to their soft tissues that they would be “better to have a caesarean next time.” Without exception, every woman I have counselled in this area has so far achieved a very empowering birth, many of them with babies that were bigger than their first. I often wonder at the logic of an obstetric system that continually denies women their power. In the current political climate where women face the likely event of a reduction in their birth choices (and therefore a reduction in their choices for healing) I feel that women are being corralled into an authoritarian and patronising system where their voices are seldom heard. Wouldn’t it be better to empower women to birth powerfully? Wouldn’t it result in better health for mum and bub? Better families? Better society?
As I write this I await news of Sally, who is in early labour with her third child. She is just over 37 weeks. Her first two children were just under and just over 4.5kg (10lb). She was not working with me towards her birth, but was planning on attending her local hospital. A friend of hers had birthed with me, and she had read some of the articles from my book. I received an email after she had just returned from a routine 36week antenatal visit, and left very upset - convinced that there was something wrong with her baby. Apparently her baby was “macrosomic” and that the only option for a safe birth for her was a caesarean section. It seems the Dr had felt a very large tummy and sent her for an ultrasound and the ultrasound had told her that her baby was “already” 4kg. Returning to the doctor she was informed that ultrasounds were 70% accurate in estimating fetal weight and that if she persisted in her push for a natural birth then she would endanger her baby. While probably not exactly what the doctor said, this lady left the office with the impression that they would have to break her baby’s collar bone or arm during the birth because it would get stuck. Two separate doctors on two different days scared this woman silly about the “risks” of a large baby without ever communicating to her things that increased her risk or things that would decrease it. Birthing options such as positions were never discussed. They also left her with the impression that she would experience the complication of her baby getting stuck and that her baby would be temporarily or permanently injured form the experience, and not that she had x% chance of such an occurrence. They certainly did not tell her that it is generally accepted that elective caesarean sections to prevent shoulder dystocia are not proven to be effective.
“In fact, most past studies have found that neither macrosomia nor shoulder dystocia can be reliably predicted in the babies of diabetic mothers.... The bottom line: Predicting macrosomia and shoulder dystocia in diabetic mothers has been as difficult as predicting these factors in the nondiabetic population.” [Lerner, H. (MD); 2006; “Shoulder Dystocia – Facts Evidence and Conclusions” http://www.shoulderdystociainfo.com/index.htm ]
“Babies who are very large (macrosomic - over 4500 g) can sometimes have difficult and, occasionally, traumatic births. One suggestion to try to reduce this trauma and to reduce operative births has been to induce labour before the baby grows too big. However, the estimation of the baby's weight in utero is difficult and not very accurate. Clinical estimations are based on feeling the uterus and measuring the height of the fundus of the uterus, and both are subject to considerable variation. Ultrasound scanning is also not accurate. Induction, if undertaken too early, can lead to babies being born prematurely and with immature organs. The review of trials, assessing induction of women when it was suspected that their baby was above 4 kg, found three trials involving 372 women, none of them with diabetes. There was no evidence of any benefit in terms of caesarean section or instrumental births, or in outcomes for the baby. However, these studies were too small to be sure of the outcomes. Further research is in progress.” [ Irion, O.; Boulvain, M.; “Induction of labour for suspected fetal macrosomia”; Cochrane Database of Systematic Reviews 2007, Issue 3. Art.No.:CD000938.DOI:.1002/14651858. http://www.cochrane.org/reviews/en/ab000938.html ]
Results from large cohort and case-control studies reveal that it is safe to allow a trial of labor for estimated fetal weight of more than 4,000 g. Nonetheless, the results of these reports, along with published cost-effectiveness data, do not support prophylactic caesarean delivery for suspected fetal macrosomia with estimated weights of less than 5,000 g (11 lb), although some authors agree that caesarean delivery in these situations should be considered.” [Taken from the ACOG Guidelines on Fetal Macrosomia . Chatfield, J.; “Practice Guidelines - ACOG Issues Guidelines on Fetal Macrosomia”; 2001; American Family Physician; http://www.aafp.org/afp/20010701/practice.html]
Only now at 36 weeks did this lady receive any nutritional advice during her pregnancy and only because she returned a high blood sugar level reading. While making dietary changes at 36 weeks may have some effect – the time to make these changes and receive this advice is at the beginning of pregnancy where they can have the biggest chance of having an effect on the outcome of her pregnancy and birth – NOT at the end when it is more like shutting the gate after the horse has bolted.
For a detailed article on the BIG BABIE ISSUE – go to
As I write this I await news of Sally, who is in early labour with her third child. She is just over 37 weeks. Her first two children were just under and just over 4.5kg (10lb). She was not working with me towards her birth, but was planning on attending her local hospital. A friend of hers had birthed with me, and she had read some of the articles from my book. I received an email after she had just returned from a routine 36week antenatal visit, and left very upset - convinced that there was something wrong with her baby. Apparently her baby was “macrosomic” and that the only option for a safe birth for her was a caesarean section. It seems the Dr had felt a very large tummy and sent her for an ultrasound and the ultrasound had told her that her baby was “already” 4kg. Returning to the doctor she was informed that ultrasounds were 70% accurate in estimating fetal weight and that if she persisted in her push for a natural birth then she would endanger her baby. While probably not exactly what the doctor said, this lady left the office with the impression that they would have to break her baby’s collar bone or arm during the birth because it would get stuck. Two separate doctors on two different days scared this woman silly about the “risks” of a large baby without ever communicating to her things that increased her risk or things that would decrease it. Birthing options such as positions were never discussed. They also left her with the impression that she would experience the complication of her baby getting stuck and that her baby would be temporarily or permanently injured form the experience, and not that she had x% chance of such an occurrence. They certainly did not tell her that it is generally accepted that elective caesarean sections to prevent shoulder dystocia are not proven to be effective.
“In fact, most past studies have found that neither macrosomia nor shoulder dystocia can be reliably predicted in the babies of diabetic mothers.... The bottom line: Predicting macrosomia and shoulder dystocia in diabetic mothers has been as difficult as predicting these factors in the nondiabetic population.” [Lerner, H. (MD); 2006; “Shoulder Dystocia – Facts Evidence and Conclusions” http://www.shoulderdystociainfo.com/index.htm ]
“Babies who are very large (macrosomic - over 4500 g) can sometimes have difficult and, occasionally, traumatic births. One suggestion to try to reduce this trauma and to reduce operative births has been to induce labour before the baby grows too big. However, the estimation of the baby's weight in utero is difficult and not very accurate. Clinical estimations are based on feeling the uterus and measuring the height of the fundus of the uterus, and both are subject to considerable variation. Ultrasound scanning is also not accurate. Induction, if undertaken too early, can lead to babies being born prematurely and with immature organs. The review of trials, assessing induction of women when it was suspected that their baby was above 4 kg, found three trials involving 372 women, none of them with diabetes. There was no evidence of any benefit in terms of caesarean section or instrumental births, or in outcomes for the baby. However, these studies were too small to be sure of the outcomes. Further research is in progress.” [ Irion, O.; Boulvain, M.; “Induction of labour for suspected fetal macrosomia”; Cochrane Database of Systematic Reviews 2007, Issue 3. Art.No.:CD000938.DOI:.1002/14651858. http://www.cochrane.org/reviews/en/ab000938.html ]
Results from large cohort and case-control studies reveal that it is safe to allow a trial of labor for estimated fetal weight of more than 4,000 g. Nonetheless, the results of these reports, along with published cost-effectiveness data, do not support prophylactic caesarean delivery for suspected fetal macrosomia with estimated weights of less than 5,000 g (11 lb), although some authors agree that caesarean delivery in these situations should be considered.” [Taken from the ACOG Guidelines on Fetal Macrosomia . Chatfield, J.; “Practice Guidelines - ACOG Issues Guidelines on Fetal Macrosomia”; 2001; American Family Physician; http://www.aafp.org/afp/20010701/practice.html]
Only now at 36 weeks did this lady receive any nutritional advice during her pregnancy and only because she returned a high blood sugar level reading. While making dietary changes at 36 weeks may have some effect – the time to make these changes and receive this advice is at the beginning of pregnancy where they can have the biggest chance of having an effect on the outcome of her pregnancy and birth – NOT at the end when it is more like shutting the gate after the horse has bolted.
For a detailed article on the BIG BABIE ISSUE – go to
As women are reduced to walking “risk factors”, medical analytical thinking poses a real threat to the normality of birth. This fact becomes obviously clear when dealing with certain issues in particular around birth. One of these issues is your baby going past his/her “due date”; one is birthing vaginally after a previous caesarean section; and another obvious candidate is “large babies”. Despite there being a lack of evidence that having a large baby is a “risk factor” for shoulder dystocia (the baby’s shoulders getting stuck during the birth) it seems it has become a mandate for the medical profession to scare women silly about how large their baby is. After 15 years working with birth I have come to the conclusion that the medical understanding of the physiology of birth (what happens naturally) is just plain wrong – they only know how to manage. (When you need their “management” it is lifesaving – but most labours don’t need management, just support). They simply don’t get how birth works. I have seen women’s uteri, pelvii and fanny’s do some AMAZING things. Just a couple of months ago a lady had a 4.8kg baby who was in a direct posterior position. Her labour was 2 ½ hours long and she received NO perineal trauma. I have assisted a lady birth naturally a baby who was 5kg – a 40 cm head – with NO perineal trauma. Just this morning I returned from a birth where the woman was having her fourth baby. (I have only had one hour sleep since yesterday morning so I do hope I am making sense with my ramblings). All three previous babies had got a little stuck in her pelvis where the midwife had to help them out. Last night she did it all herself – she was amazing as her baby slid out and she picked her up from the water and said “I did it! I did it! I did it!!!” All three of us were crying (mum, dad and midwife). Bub was quietly looking around the dimed room.
LADIES – CLAIM YOUR BIRTHING POWER!!!!!!!!!
LADIES – CLAIM YOUR BIRTHING POWER!!!!!!!!!
Monday, August 10, 2009
"Its midwifery Jim, but not as we know it - - -"
The Australian maternity system is in crisis. Everybody is aware of the looming “illegality” of Registered Midwives attending home births, and many families have been stirred into action. New blogs (such as my own), websites, protests, visits to politicians, submissions to parliament, press releases and news articles. It has been wonderful to see the response from the general public to this travesty – to this blatant disregard for basic human rights, and I thank every person who has written letters and attended or will attend rallies. What has upset me most about the protest is the focus being on the Midwife and not the woman and her right to choose what she feels is the safest birth for her. Don’t get me wrong, my midwife heart is devastated – but somehow the main protests seem to miss the point entirely.
This is all about a medical dominion over childbirth and therefore over women. One particular philosophy (and not necessarily the philosophy with the scientific evidence to back up its claims, just the most common) has reached out its tentacles to once and for all crush all opposing philosophies. (“Our way or the wrong way!”) For the majority of women, going along with the medical system is almost a part of our genetics – but for some – free thinking is important. And what these women discover is that there is a better way for them – a way more aligned with their own philosophy. A way with more compassion, more heart, more power, more truth, more comfort and respect: and because of these things – more safety. By calling for the government to pay for home birth, to fund it through Medicare, it has brought national political attention to a quiet yet growing group of informed women who choose to do things a different way to medical dogma. The flow on from this has served to shine a light on the powerful medical lobby who is calling for the severe restriction and regulation of Midwife practice, and to remove certain choices that women have previously had about their own births. And they have succeeded.
Now, some very positive things have been happening on the political scene. Senator Fielding has come out in support of Registered Midwives being able to continue to attend home births and so have the Greens Party – and the latest news is that discussion with the Senate has been positive .
For a look at the recent rally go to -http://www.youtube.com/watch?v=OhfSJlWbMaU&feature=PlayList&p=CC6EA57B9C8EDDB1&playnext=1&playnext_from=PL&index=1
To see the Greens Media Release about their position on home births go to - http://greens.org.au/node/5013
Maybe a way will be found for Registered Midwives to continue to legally practice in women’s homes. But if home birth Midwifery does remain legal, in some respects it is too late. Midwifery as we know it has changed forever – regardless of what happens now. Some regard this as a good thing – I am heartbroken. Home birth Midwives who have been practicing for years will not automatically be able to continue with their practice – they will need “further education” to ensure that they conduct themselves more in line with medical line of thought and ‘professional standards’. Women will be “allowed” to birth at home only under certain circumstances (and the guidelines will be strict) and will not be free to determine their own situation and evaluate their own risk according to their own individual situation. Home births will only be “allowed” when the woman and midwife work in “collaborative practice” with a willing doctor. I wish to be very clear – all women and all midwives should seek a good working relationship with the medical community – true collaboration is essential for the ultimate care for women. Some women will very much need the skills of obstetricians during the course of their pregnancy and birth. But for the majority – this care is unneeded and unwelcome and should not be forced upon a woman who is experiencing a normal pregnancy and birth. The bottom line of this collaborative practice that the government wants to implement means supervision and ensuring the woman complies with all medical protocol – that is if a woman can find a doctor willing to work in this way in the first place. The medical regulation of midwifery practice is not of any advantage to the woman who chooses not to follow the standard recommendations of medical protocol. Women have a right to good information about the pros and cons of all aspects of their care– something they DO NOT get from the medical profession. The standard approach is “we have examined everything scientifically for you because it is too complicated for you to understand without a medical degree, and we have come to the conclusion that this is the best course of action. Trust us.” Women also have the right to choose a different course of action – a right that is rapidly being denied her. A Midwife’s role is to assist the woman in gathering information that will help her make a decision, help her apply it to her own individual situation, provide an open and honest support system for the woman to fully explore the consequences of her decision, and then to support the woman (and facilitate) her choice. The heart of midwifery – that of being with women and supporting and enabling her decisions will be lost under protocol and bureaucracy. It is still called ‘Midwifery’ – but it will not resemble anything that truly represents the heart and essence of a Midwife.
This is all about a medical dominion over childbirth and therefore over women. One particular philosophy (and not necessarily the philosophy with the scientific evidence to back up its claims, just the most common) has reached out its tentacles to once and for all crush all opposing philosophies. (“Our way or the wrong way!”) For the majority of women, going along with the medical system is almost a part of our genetics – but for some – free thinking is important. And what these women discover is that there is a better way for them – a way more aligned with their own philosophy. A way with more compassion, more heart, more power, more truth, more comfort and respect: and because of these things – more safety. By calling for the government to pay for home birth, to fund it through Medicare, it has brought national political attention to a quiet yet growing group of informed women who choose to do things a different way to medical dogma. The flow on from this has served to shine a light on the powerful medical lobby who is calling for the severe restriction and regulation of Midwife practice, and to remove certain choices that women have previously had about their own births. And they have succeeded.
Now, some very positive things have been happening on the political scene. Senator Fielding has come out in support of Registered Midwives being able to continue to attend home births and so have the Greens Party – and the latest news is that discussion with the Senate has been positive .
For a look at the recent rally go to -http://www.youtube.com/watch?v=OhfSJlWbMaU&feature=PlayList&p=CC6EA57B9C8EDDB1&playnext=1&playnext_from=PL&index=1
To see the Greens Media Release about their position on home births go to - http://greens.org.au/node/5013
Maybe a way will be found for Registered Midwives to continue to legally practice in women’s homes. But if home birth Midwifery does remain legal, in some respects it is too late. Midwifery as we know it has changed forever – regardless of what happens now. Some regard this as a good thing – I am heartbroken. Home birth Midwives who have been practicing for years will not automatically be able to continue with their practice – they will need “further education” to ensure that they conduct themselves more in line with medical line of thought and ‘professional standards’. Women will be “allowed” to birth at home only under certain circumstances (and the guidelines will be strict) and will not be free to determine their own situation and evaluate their own risk according to their own individual situation. Home births will only be “allowed” when the woman and midwife work in “collaborative practice” with a willing doctor. I wish to be very clear – all women and all midwives should seek a good working relationship with the medical community – true collaboration is essential for the ultimate care for women. Some women will very much need the skills of obstetricians during the course of their pregnancy and birth. But for the majority – this care is unneeded and unwelcome and should not be forced upon a woman who is experiencing a normal pregnancy and birth. The bottom line of this collaborative practice that the government wants to implement means supervision and ensuring the woman complies with all medical protocol – that is if a woman can find a doctor willing to work in this way in the first place. The medical regulation of midwifery practice is not of any advantage to the woman who chooses not to follow the standard recommendations of medical protocol. Women have a right to good information about the pros and cons of all aspects of their care– something they DO NOT get from the medical profession. The standard approach is “we have examined everything scientifically for you because it is too complicated for you to understand without a medical degree, and we have come to the conclusion that this is the best course of action. Trust us.” Women also have the right to choose a different course of action – a right that is rapidly being denied her. A Midwife’s role is to assist the woman in gathering information that will help her make a decision, help her apply it to her own individual situation, provide an open and honest support system for the woman to fully explore the consequences of her decision, and then to support the woman (and facilitate) her choice. The heart of midwifery – that of being with women and supporting and enabling her decisions will be lost under protocol and bureaucracy. It is still called ‘Midwifery’ – but it will not resemble anything that truly represents the heart and essence of a Midwife.
Sunday, August 9, 2009
Who Is A Midwife?
The literal translation of “Midwife” is “WITH WOMAN”. ‘Women being with women’ during birth has been around in every culture for as long as women have been having babies – the tradition of midwifery is more ancient than its title, than western medical knowledge and the medical profession. By right of pre-existence, traditional midwifery should remain the defining standard. Midwifery is not a “branch of nursing”, nor did it arise out of nursing. It is unfortunate that both birthing and the traditions and knowledge of those dedicated to the care of birthing women have been so thoroughly medicalised. Midwifery is also not confined to the birthing room. The literal translation of midwife - “with woman” - implies a companionship through all of life’s journeys – the onset of menstruation, sexual health and well being, pregnancy, birthing, motherhood, menopause. It is the passing of women’s knowledge from generation to generation. It is the keeper of women’s power.
The political debate over who has the “right” to call themselves “Midwife” continues and feelings are passionate on all sides. You may have noticed that I use the term “birth worker”. I love the term midwife, and hold dear to all that it traditionally implies, but I have reluctantly changed my terminology because I disagree with the way modern midwifery is practiced, and I disagree with the educational content of midwifery courses as well as the way midwives are “trained” and regulated. Traditionally, midwives were the women in the community called to “be” with women – companions for those life-issues women faced, particularly in pregnancy, childbirth and early parenting. It is unfortunate in my opinion that the art and wisdom of midwifery has been consumed by a western medical and educational philosophy and has been moulded into something it was never traditionally known as. Midwifery has been organised into a profession, and duly regulated, controlled and managed. While there are some very good arguments for the benefits of this (such as creating consistent standards for the safety and well being of women), the end result is a profession dictated by medical, legal, and liability policy – and women’s right to accurate information and informed choice gets lost under the bureaucracy. The control of woman's choice has been lost in midwifery's professionalism. Midwifery in its traditional sense is woman centred, not midwife centered, or medical knowledge centered; and midwives that have been traditionally trained have felt themselves “out in the cold” and no longer allowed to use the term that has always described what they do – ‘midwife’. I have had the privilege of knowing and learning from some extremely gifted and knowledgeable traditional midwives and have a great respect for the service they provide. What gives the medical profession the right to high-jack the term that was originally applied to a traditional practice, change the practice, ridicule traditional knowledge, and then forbid “true midwives” to practice in the setting they have always practiced – the home? I’d just like to make it very clear that a medical education and registration certificate does not a midwife make (in the true traditional sense of the word). While for the moment I am still a registered midwife, this is why I call myself a “birth worker” and what I do as “birth work”.
Some feel the traditional and the medical can be blended successfully, and others believe that this is only partly true. Some believe that there can be no mixing, and that once a pregnancy/labour/birth departs from what is physiologically normal, than it transitions into needing medical help, and therefore into a differnet model of care entirely. Some home birth midwives feel that the responsibility for care is theirs, and operate according to medical guidelines (though generally with more relaxed boundaries, and certainly with more time to build a caring relationship with you). My philosophy is somewhat between the second and third philosophies - that it is my responsibility to provide “nurture” and all that you require to facilitate your own birth, sometimes my medical knowledge is helpful, but in most scenarios, if medical care is needed than it is outside my area of expertise, and enters a different model of care. I will always remain and be 'midwife' to you, your nurture is my responsiibility, but if you require medical care, than that 'care' belongs to the medical model. Some women feel they can trust a midwife who has the official education and registration more than someone who does not have these things but has dedicated their life to learning, wisdom building and being with women. When you know little about a subject, you feel someone whose practice is regulated must at least know what they are talking about. There is nothing wrong with that – it is of primary importance that you trust the person you ask to assist you during your birth. But if you take the time to learn a little about your subject, you will have the tools to be able to choose the birth worker who suits you the best – registered or not; and the freedom to be in charge of your own pregnancy and birth. It is so empowering to make your own choices and not need the ‘OK’ of a medical professional to do what you know is right and safest for your individual circumstances. My belief is that women need to take responsibility on for themselves, and commit to learn more about the process rather than rely on someone else to spoon feed them and keep them safe. Some women do not wish to take on this responsibility and it is a very wise woman who recognises what her needs are, what her beliefs are, and choose an appropriate birth worker accordingly. If you choose hospital or home, registered or unregistered, medical philosophy or natural philosophy it doesn’t really matter – the important thing is that YOU have made your choice – one that is best for YOU.
The political debate over who has the “right” to call themselves “Midwife” continues and feelings are passionate on all sides. You may have noticed that I use the term “birth worker”. I love the term midwife, and hold dear to all that it traditionally implies, but I have reluctantly changed my terminology because I disagree with the way modern midwifery is practiced, and I disagree with the educational content of midwifery courses as well as the way midwives are “trained” and regulated. Traditionally, midwives were the women in the community called to “be” with women – companions for those life-issues women faced, particularly in pregnancy, childbirth and early parenting. It is unfortunate in my opinion that the art and wisdom of midwifery has been consumed by a western medical and educational philosophy and has been moulded into something it was never traditionally known as. Midwifery has been organised into a profession, and duly regulated, controlled and managed. While there are some very good arguments for the benefits of this (such as creating consistent standards for the safety and well being of women), the end result is a profession dictated by medical, legal, and liability policy – and women’s right to accurate information and informed choice gets lost under the bureaucracy. The control of woman's choice has been lost in midwifery's professionalism. Midwifery in its traditional sense is woman centred, not midwife centered, or medical knowledge centered; and midwives that have been traditionally trained have felt themselves “out in the cold” and no longer allowed to use the term that has always described what they do – ‘midwife’. I have had the privilege of knowing and learning from some extremely gifted and knowledgeable traditional midwives and have a great respect for the service they provide. What gives the medical profession the right to high-jack the term that was originally applied to a traditional practice, change the practice, ridicule traditional knowledge, and then forbid “true midwives” to practice in the setting they have always practiced – the home? I’d just like to make it very clear that a medical education and registration certificate does not a midwife make (in the true traditional sense of the word). While for the moment I am still a registered midwife, this is why I call myself a “birth worker” and what I do as “birth work”.
Some feel the traditional and the medical can be blended successfully, and others believe that this is only partly true. Some believe that there can be no mixing, and that once a pregnancy/labour/birth departs from what is physiologically normal, than it transitions into needing medical help, and therefore into a differnet model of care entirely. Some home birth midwives feel that the responsibility for care is theirs, and operate according to medical guidelines (though generally with more relaxed boundaries, and certainly with more time to build a caring relationship with you). My philosophy is somewhat between the second and third philosophies - that it is my responsibility to provide “nurture” and all that you require to facilitate your own birth, sometimes my medical knowledge is helpful, but in most scenarios, if medical care is needed than it is outside my area of expertise, and enters a different model of care. I will always remain and be 'midwife' to you, your nurture is my responsiibility, but if you require medical care, than that 'care' belongs to the medical model. Some women feel they can trust a midwife who has the official education and registration more than someone who does not have these things but has dedicated their life to learning, wisdom building and being with women. When you know little about a subject, you feel someone whose practice is regulated must at least know what they are talking about. There is nothing wrong with that – it is of primary importance that you trust the person you ask to assist you during your birth. But if you take the time to learn a little about your subject, you will have the tools to be able to choose the birth worker who suits you the best – registered or not; and the freedom to be in charge of your own pregnancy and birth. It is so empowering to make your own choices and not need the ‘OK’ of a medical professional to do what you know is right and safest for your individual circumstances. My belief is that women need to take responsibility on for themselves, and commit to learn more about the process rather than rely on someone else to spoon feed them and keep them safe. Some women do not wish to take on this responsibility and it is a very wise woman who recognises what her needs are, what her beliefs are, and choose an appropriate birth worker accordingly. If you choose hospital or home, registered or unregistered, medical philosophy or natural philosophy it doesn’t really matter – the important thing is that YOU have made your choice – one that is best for YOU.
Is Insurance Necessary?
What I believe about this question sees me part ways rather drastically with many Midwives who are currently fighting the proposed legislation. As I could go on and on about this subject, I will endeavour to keep it to the basic minimum. Feel free to contact me if you would like more, or have questions.
the pros for insurance
We live in a litigious world. Like it or not, insurance is a necessary part of everyday life. We have insurance for our car, our house, our income, our life - - - public liability insurance, third party insurance etc. You cannot advertise a meeting in a park without making sure you have insurance to cover it first. Some see private indemnity insurance for Midwives as a woman’s right. They see that it is an important and valuable part of modern society to have the protection of this insurance. What does it protect against? Basically, it gives the woman the security of understanding that her Midwife will not operate outside of the standard guidelines of her profession, and that in the event of a tragic outcome, have a pathway for some financial recourse. Care for the chronically disabled is very expensive and can cripple some families financially. Receiving a payout from an insurance claim is the only way some families can meet those financial burdens.
the cons of insurance
The legal system as it stands is a very expensive and roundabout way of seeking financial compensation. Clogging up our legal system, it certainly keeps the pockets of lawyers nicely lined. Many cases that are brought are frivolous, and raise the cost of insurance premiums for everybody. Without insurance, nobody sues a home birth Midwife, but with insurance, the court cases will sky rocket. If you doubt my words, history proves what I say.
Asking a private Midwife to take the responsibility for the outcome of your birth is basically unfair. While parents have the right to expect that their Midwife will act responsibly, and within the bounds of her practice, her sole role is to support the woman and partner in THEIR choices. Some couples may see the risk of a breech birth for example as too high and choose medical management, but other couples may choose to proceed with a home birth. So long as the midwife fully informs them of the implications of each choice, the choice should remain the couples to make, and the responsibility of the outcome theirs. If a couple does not wish to take on the responsibility, then they need to birth within the medical system, which assumes the responsibility for keeping them safe, and has the insurance to cover it.
Along with an insurance policy, a list of ‘conditions’ will be attached to a Midwife’s practice. She will no longer be able to support parents in their choice for a breech birth at home, or a vaginal birth after a previous caesarean, or a home birth when the woman has a history of a previous haemorrhage. There will be no twin births allowed at home and probably no first time mother’s having the freedom to birth at home, or perhaps a home birth will be denied in cases where the mother declines some or all standard prenatal testing. There will be a list as long as your arm of the women who will be denied their right to choose a home birth – all in the name of insurance.
How a midwife practices will be determined not by what is right or truthful or best for the individual woman, but by her insurance policy. Planned home births will have to be cancelled when a woman goes beyond 41 weeks, women will have to be transferred in when their labour goes over a certain time limit or their placentas take a little longer to birth, vaginal examinations will be required routinely, fetal heart monitoring to the extent where it interrupts a mother’s labouring rhythm will be required - - - once again the list goes on and on.
A family who sues for financial gain (needed or not) will ruin the career of a dedicated Midwife who went out on a limb to stand up for their rights. Fault will have to be found and blame attributed for something that may not have been the Midwife’s fault. This is true now in cases where Obstetricians and hospitals are sued. The difficulty with obstetric cases is it is very difficult to know whether somebody was really at fault, or if the outcome would have been different had different action been taken. Nobody can re-wind the clock and do it a different way – it is all speculation. I have no doubt that many Obstetricians are sued because of an outcome that was not their fault. It was once thought that cerebral palsy was purely a birth injury, but now it is thought that many of these cases happen in utero pre labour, and there is no definitive way of proving when exactly the injury occurred. What has happened within the medical community is that Obstetricians and Doctors intervene in a woman’s labour when there is only a remote possibility of an injury in fear of being sued for doing nothing. This has resulted in over-intervention in birth and many traumatised women suffering at the hands of a fear based system. We should not want the practice of Midwifery to walk a similar path. For the most part, home birth Midwives work outside of the medical system and base their practice on faith and trust in birth. Insurance would completely destroy this.
In effect, insurance for private midwives will allow the complete domination of birth by a medical philosophy. Those who seek a truly natural birth will have to choose a person other than a Registered Midwife to help them achieve their desire.
is there an alternative?
As far as I can see, the only thing in favour of insurance is the availability of financial assistance for families who have to care for an injured child. I would like to see a system in place in Australia that bypasses the legal system, but provides funding for families in these situations. Not only birth injuries, but for all families who find themselves caring for a family member with special needs. This would include car accidents, spinal injuries, birth injuries, chronic diseases etc. If the Government provided more adequate care and support for these families – in practical as well as financial ways, this reason for insurance would not be valid. This would make insurance far cheaper, (and in some cases invalid) and free our court system from multiple insurance claims. Examples like the one seen on the Gold Coast several years ago would not occur. (A family was successfully sued for a substantial sum because their boundary fence had a flat top and was an “invitation” to a drunken 18 year old youth to stand on it and dive into the canal. His dive resulted in a broken neck and he became a paralysed from the neck down.)
Families would still be able to seek disciplinary action against a Midwife is she acted negligently through the appropriate channels. This would prevent a midwife from practicing if indeed she was unsafe and prevent harm to future families.
Unfortunately, such a system would involve a complete overhaul of our laws and our legal system. It would meet with much resistance – particularly from the legal profession. But still, I see this option as the most logical and fair - - - and I hope and I pray.
the pros for insurance
We live in a litigious world. Like it or not, insurance is a necessary part of everyday life. We have insurance for our car, our house, our income, our life - - - public liability insurance, third party insurance etc. You cannot advertise a meeting in a park without making sure you have insurance to cover it first. Some see private indemnity insurance for Midwives as a woman’s right. They see that it is an important and valuable part of modern society to have the protection of this insurance. What does it protect against? Basically, it gives the woman the security of understanding that her Midwife will not operate outside of the standard guidelines of her profession, and that in the event of a tragic outcome, have a pathway for some financial recourse. Care for the chronically disabled is very expensive and can cripple some families financially. Receiving a payout from an insurance claim is the only way some families can meet those financial burdens.
the cons of insurance
The legal system as it stands is a very expensive and roundabout way of seeking financial compensation. Clogging up our legal system, it certainly keeps the pockets of lawyers nicely lined. Many cases that are brought are frivolous, and raise the cost of insurance premiums for everybody. Without insurance, nobody sues a home birth Midwife, but with insurance, the court cases will sky rocket. If you doubt my words, history proves what I say.
Asking a private Midwife to take the responsibility for the outcome of your birth is basically unfair. While parents have the right to expect that their Midwife will act responsibly, and within the bounds of her practice, her sole role is to support the woman and partner in THEIR choices. Some couples may see the risk of a breech birth for example as too high and choose medical management, but other couples may choose to proceed with a home birth. So long as the midwife fully informs them of the implications of each choice, the choice should remain the couples to make, and the responsibility of the outcome theirs. If a couple does not wish to take on the responsibility, then they need to birth within the medical system, which assumes the responsibility for keeping them safe, and has the insurance to cover it.
Along with an insurance policy, a list of ‘conditions’ will be attached to a Midwife’s practice. She will no longer be able to support parents in their choice for a breech birth at home, or a vaginal birth after a previous caesarean, or a home birth when the woman has a history of a previous haemorrhage. There will be no twin births allowed at home and probably no first time mother’s having the freedom to birth at home, or perhaps a home birth will be denied in cases where the mother declines some or all standard prenatal testing. There will be a list as long as your arm of the women who will be denied their right to choose a home birth – all in the name of insurance.
How a midwife practices will be determined not by what is right or truthful or best for the individual woman, but by her insurance policy. Planned home births will have to be cancelled when a woman goes beyond 41 weeks, women will have to be transferred in when their labour goes over a certain time limit or their placentas take a little longer to birth, vaginal examinations will be required routinely, fetal heart monitoring to the extent where it interrupts a mother’s labouring rhythm will be required - - - once again the list goes on and on.
A family who sues for financial gain (needed or not) will ruin the career of a dedicated Midwife who went out on a limb to stand up for their rights. Fault will have to be found and blame attributed for something that may not have been the Midwife’s fault. This is true now in cases where Obstetricians and hospitals are sued. The difficulty with obstetric cases is it is very difficult to know whether somebody was really at fault, or if the outcome would have been different had different action been taken. Nobody can re-wind the clock and do it a different way – it is all speculation. I have no doubt that many Obstetricians are sued because of an outcome that was not their fault. It was once thought that cerebral palsy was purely a birth injury, but now it is thought that many of these cases happen in utero pre labour, and there is no definitive way of proving when exactly the injury occurred. What has happened within the medical community is that Obstetricians and Doctors intervene in a woman’s labour when there is only a remote possibility of an injury in fear of being sued for doing nothing. This has resulted in over-intervention in birth and many traumatised women suffering at the hands of a fear based system. We should not want the practice of Midwifery to walk a similar path. For the most part, home birth Midwives work outside of the medical system and base their practice on faith and trust in birth. Insurance would completely destroy this.
In effect, insurance for private midwives will allow the complete domination of birth by a medical philosophy. Those who seek a truly natural birth will have to choose a person other than a Registered Midwife to help them achieve their desire.
is there an alternative?
As far as I can see, the only thing in favour of insurance is the availability of financial assistance for families who have to care for an injured child. I would like to see a system in place in Australia that bypasses the legal system, but provides funding for families in these situations. Not only birth injuries, but for all families who find themselves caring for a family member with special needs. This would include car accidents, spinal injuries, birth injuries, chronic diseases etc. If the Government provided more adequate care and support for these families – in practical as well as financial ways, this reason for insurance would not be valid. This would make insurance far cheaper, (and in some cases invalid) and free our court system from multiple insurance claims. Examples like the one seen on the Gold Coast several years ago would not occur. (A family was successfully sued for a substantial sum because their boundary fence had a flat top and was an “invitation” to a drunken 18 year old youth to stand on it and dive into the canal. His dive resulted in a broken neck and he became a paralysed from the neck down.)
Families would still be able to seek disciplinary action against a Midwife is she acted negligently through the appropriate channels. This would prevent a midwife from practicing if indeed she was unsafe and prevent harm to future families.
Unfortunately, such a system would involve a complete overhaul of our laws and our legal system. It would meet with much resistance – particularly from the legal profession. But still, I see this option as the most logical and fair - - - and I hope and I pray.
Midwife's Insurance Crisis
Home births in Australia have almost always been provided without indemnity insurance, even for Registered Midwives. For a brief period in history, registered Midwives were provided with indemnity insurance through Guild Insurance. This changed in 2001 when after a landmark obstetric birth injury case proving a payout of $11 million, Guild Insurance withdrew their cover for private Registered Midwives (despite this birth injury case being brought against an obstetrician and involved the administration of the synthetic labour hormone – syntocinon). This was purely an economic decision on the part of Guild Insurance – there simply wasn’t a big enough pool of private Midwives (less than 200) to pay premiums that would cover such a large payout should one of them be sued. This withdrawal of indemnity insurance saw many Registered Midwives in the home birth scene hang up their stethoscopes and cease practicing home births. There were several brave Midwives who soldiered on regardless and provided care to women who sought it. While Midwives were left without insurance, the Federal Government stepped in and funded insurance for obstetricians and other medical practitioners (which continues today with over $900 million of tax-payers money being spent to date). What has changed now, is that if the proposed new laws come into effect in July 2010, it will be illegal for a Registered Midwife to attend a home birth without insurance. Practically, for women seeking home birth, this means that their choice of how to achieve their desire has been severely restricted. It is a violation of a woman’s basic right to birth where she chooses and with whom she chooses. At the present, a woman seeking a home birth has 3 choices – to have a free birth (no professional birth worker); a birth with a traditional birth attendant/Midwife/Birth Worker; or to choose a Registered Midwife to help her achieve her desire for a home birth. As of July 2010, her choice will be restricted to the first two. For many women it will not be an issue until the Government turns its attention to hunting traditional Birth Workers. And it will – do not think that if the Government gets away with outlawing Registered Midwives attending home births that their attention will stop there. Soon a woman’s choice will be restricted to only the first option. And then they will start prosecuting parents for child abuse for choosing a free birth.
The new laws are also a violation of a Registered Midwives right to practice their profession in the speciality they have chosen. Many Midwives – some with more than 25 years experience providing home births – have been told that their profession is soon to become illegal, and they are simply meant to stop. This is an extremely bitter pill to swallow, seeing as many of these Midwives view the hospital system as wholly inadequate to provide quality care for birthing women. The distress that they suffered while witnessing the abuse of many women within the system was what drove them to practice outside of the system and in the home in the first place. Whichever way you view the new legislation – it is a violation of basic human rights – a violation of WOMEN’S RIGHTS – and I wonder at the conscious of Nicola Roxon – a woman – blatantly denying women their rights. This view is shared by Homebirth Australia who see this as a breach of basic human rights and possibly a contravention of Convention of the Elimination of Discrimination Against Women (CEDAW). Regardless of whether you would or would not have a home birth, and regardless of whether you would choose a Registered Midwife to assist you or not, ALL women should be concerned that such serious and discriminatory laws could be passed in 2010. Please let your voice be heard
Websites with more information
http://www.savehomebirth.com.au
http://www.joyousbirth.info
www.homebirthaustralia.org
www.maternitycoalition.org.au
Things you can do
Below is a standard list of the action being taken by women right around Australia. Before you visit the sites and write your letters, I ask that you read what I have to say in “is insurance necessary?” the letters I have submitted do not ask for insurance to be provided for home birth midwives, but for home birth midwives to be exempt from the law requiring insurance for practice. Please be careful what you ask for in your submissions, and please do not denigrate other women’s choices (such as free birth) and the wonderful work of traditional Midwives who are not registered. Remember what we are fighting for here – a woman’s right to choose where she births and whom she asks to be her support team. We are not fighting for Registered Midwives to be the only legal option for a woman who chooses to home birth. (Which is what will happen if the government acts on what many submissions are saying – and that is ‘birth is unsafe without a Registered Midwife’.) We are fighting for birth with a Registered Midwife to remain an option. I say this because much media attention has been given to the angle that “women and babies will die without the presence of a Registered Midwife.” This is not only untrue, it is an insult to traditional Midwives and those informed women who choose to freebirth. Let’s fight, let’s stick together, but let’s also be careful of what we are saying.
Write a letter to your local State MP. Your letter can be short –a couple of paragraphs would be fine. Please attach Maternity Coalition’s brief on homebirth. Email saranest@maternitycoalition.org.au for a copy.
In your letter you might like to say whether you’ve birthed at home or not, and why you are concerned about women losing the option of birthing at home with a qualified midwife. Ask them directly what they will do to protect mums and their babies. Also ask them for a meeting.
Please write and say that they need to find a way for midwives to be able to provide homebirth care after the new regulation system starts on 1 July 2010. You don't need to sound like an expert, just tell them that it matters to you.
MPs who are members of Cabinet are particularly important. Maternity Coalition would like for every single Cabinet member to receive our brief on the issue of national registration (homebirth).
Write to your Federal MP and Senators find out who your Federal MP is here https://oevf.aec.gov.au/
You could probably send the same letter (remember to change the names though!) to both your State and Federal MP. Again, please attach Maternity Coalition’s brief and ask them directly what they will do to protect mothers and babies.
Three Bills have been introduced to Commonwealth Parliament to implement the Government's maternity reform agenda. These Bills give Medicare and subsidised insurance to eligible midwives - a huge breakthrough for Australian women. The problem is that the Government doesn't intend the insurance to cover homebirths, at this stage.
Because some politicians are worried about this homebirth insurance issue, a Senate Committee is investigating. This Committee needs to hear it loud and clear that homebirth matters as a choice for Australian women.
Please write to our Senators and tell them how much women's right to choose homebirth matters to you.
Attend the rally in front of Parliament House in Canberra on 7 September. Homebirth Australia needs at least a couple of thousand people to attend to make an impact on the politicians. This means YOU need to get there. If you cannot physically get there, your virtual presence will speak volumes. Check out their website for more details http://www.homebirthaustralia.org
The new laws are also a violation of a Registered Midwives right to practice their profession in the speciality they have chosen. Many Midwives – some with more than 25 years experience providing home births – have been told that their profession is soon to become illegal, and they are simply meant to stop. This is an extremely bitter pill to swallow, seeing as many of these Midwives view the hospital system as wholly inadequate to provide quality care for birthing women. The distress that they suffered while witnessing the abuse of many women within the system was what drove them to practice outside of the system and in the home in the first place. Whichever way you view the new legislation – it is a violation of basic human rights – a violation of WOMEN’S RIGHTS – and I wonder at the conscious of Nicola Roxon – a woman – blatantly denying women their rights. This view is shared by Homebirth Australia who see this as a breach of basic human rights and possibly a contravention of Convention of the Elimination of Discrimination Against Women (CEDAW). Regardless of whether you would or would not have a home birth, and regardless of whether you would choose a Registered Midwife to assist you or not, ALL women should be concerned that such serious and discriminatory laws could be passed in 2010. Please let your voice be heard
Websites with more information
http://www.savehomebirth.com.au
http://www.joyousbirth.info
www.homebirthaustralia.org
www.maternitycoalition.org.au
Things you can do
Below is a standard list of the action being taken by women right around Australia. Before you visit the sites and write your letters, I ask that you read what I have to say in “is insurance necessary?” the letters I have submitted do not ask for insurance to be provided for home birth midwives, but for home birth midwives to be exempt from the law requiring insurance for practice. Please be careful what you ask for in your submissions, and please do not denigrate other women’s choices (such as free birth) and the wonderful work of traditional Midwives who are not registered. Remember what we are fighting for here – a woman’s right to choose where she births and whom she asks to be her support team. We are not fighting for Registered Midwives to be the only legal option for a woman who chooses to home birth. (Which is what will happen if the government acts on what many submissions are saying – and that is ‘birth is unsafe without a Registered Midwife’.) We are fighting for birth with a Registered Midwife to remain an option. I say this because much media attention has been given to the angle that “women and babies will die without the presence of a Registered Midwife.” This is not only untrue, it is an insult to traditional Midwives and those informed women who choose to freebirth. Let’s fight, let’s stick together, but let’s also be careful of what we are saying.
Write a letter to your local State MP. Your letter can be short –a couple of paragraphs would be fine. Please attach Maternity Coalition’s brief on homebirth. Email saranest@maternitycoalition.org.au for a copy.
In your letter you might like to say whether you’ve birthed at home or not, and why you are concerned about women losing the option of birthing at home with a qualified midwife. Ask them directly what they will do to protect mums and their babies. Also ask them for a meeting.
Please write and say that they need to find a way for midwives to be able to provide homebirth care after the new regulation system starts on 1 July 2010. You don't need to sound like an expert, just tell them that it matters to you.
MPs who are members of Cabinet are particularly important. Maternity Coalition would like for every single Cabinet member to receive our brief on the issue of national registration (homebirth).
Write to your Federal MP and Senators find out who your Federal MP is here https://oevf.aec.gov.au/
You could probably send the same letter (remember to change the names though!) to both your State and Federal MP. Again, please attach Maternity Coalition’s brief and ask them directly what they will do to protect mothers and babies.
Three Bills have been introduced to Commonwealth Parliament to implement the Government's maternity reform agenda. These Bills give Medicare and subsidised insurance to eligible midwives - a huge breakthrough for Australian women. The problem is that the Government doesn't intend the insurance to cover homebirths, at this stage.
Because some politicians are worried about this homebirth insurance issue, a Senate Committee is investigating. This Committee needs to hear it loud and clear that homebirth matters as a choice for Australian women.
Please write to our Senators and tell them how much women's right to choose homebirth matters to you.
Attend the rally in front of Parliament House in Canberra on 7 September. Homebirth Australia needs at least a couple of thousand people to attend to make an impact on the politicians. This means YOU need to get there. If you cannot physically get there, your virtual presence will speak volumes. Check out their website for more details http://www.homebirthaustralia.org
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