Wednesday, December 31, 2008

The end of 2008 – A time to reflect

As nurses and midwives we are use to the word reflect. To reflect according to the Collins thesaurus means to; consider, think, contemplate, deliberate, muse, ponder, meditate, mull over, ruminate, wonder and cogitate. Of these words, I will contemplate the year just ending and ponder the one we are just about to embark upon.
I will start with Christmas, I love Christmas. There was a time when I lost the Christmas spirit and that was once my children were grown up, it is just not the same, without small children and that’s where the grandchildren come to mind. To me Christmas is about a spiritual essence, it’s about children, making wishes come true, believing in make believe and Santa Clause. It’s about families, cooking, eating, drinking, sharing and yes the occasional disagreement. It stands to reason when you get a large group together, someone is going to fall out even if only for a moment, this is human nature; the trick is not to let it get to you and move on. I get tremendous joy out of preparing the Christmas feast and then watching everyone enjoy the gourmet delight.
A famous chef wrote “the peak is neither eating nor cooking, but the giving and sharing of food. Great food should never be taken alone. What pleasure can a man take in fine cuisine unless he invites cherished friends, counts the days until the banquet, and composes an anticipatory poem for his letter of invitation?” – Laing Wei. The Last Chinese Chef, Peking, 1925.

I have touched on some of the issues of this year in my previous blog – for me this has been a year of tremendous workload both professionally and on the home front. Therefore some decisions had to be made to reduce the workload and have more of a work-life-balance. Secondly we, that is my husband and myself have to concentrate on a healthier lifestyle, as Ian’s health is of some concern, that means we have to find 30 minutes a day for walking. Once you begin to reflect on the year it becomes clearer which direction you need to take and then you are able to outline clear objectives for the coming year. I have been on holidays since the 19 December and my main objectives for this time was to do those mundane jobs around the house that were beginning to really irritate me that were not being done, like – clean the venetian blinds, sort and paint the pantry, re organise and paint the laundry. I know they sound as if they are not important, but this goes to show you that importance is only measured by the need of the person wanting to do the chore? I am relieved now when I look out my bedroom window that the blinds are clean, and when I open the pantry door that everything is in the right place, this may sound anally retentive but to me it is important, therefore I have to find the time to fit it in. My home runs so much smoother now for me. However, I was tempted to spend this time updating a program for next semester but I chose not too as my home needed the attention more. The work will always be there, but my home is my place of refuge so it needs to be in order for me to be comfortable. It’s all about choices!
I have not fully decided on my objectives for next year yet, my first thoughts are to concentrate on a healthier lifestyle, that is, reduce my stress levels, 30 minutes of exercise a day and smaller meal sizes. I want to spend quality time with the family especially the grandchildren. I will be publishing several articles this year and picking up my PhD. As for the rest time will tell.

What do you have planned for 2009?
Do you find reflecting on the previous year helps you determine your objectives for the coming year?

Wednesday, December 24, 2008

I’m back, the marking is complete, the semester is over.

I am back blogging; I have been so busy with clinical work, marking papers and off course fitting in the family social life. November and December has been consumed with marking and at last it is all completed, hence the blog.

I have also had to make some changes to my working life, a decision had to be made as my work load was too great and I was finding I had very little work life balance.
I have decided to move totally to university life and maintain possibly one clinical shift a week or fortnight. This had been a difficult decision to make, however to maintain my sanity and family life something had to give. Maintaining two high level positions within different intuitions’ is difficult, it is a balancing act and 0.5 in each place equates to 1.5 in the real world. I am hoping now that I will have more time to devote to one place and more time to promote midwifery.

This has been a challenging year in more ways than one. We had our major trip to Europe which incorporated the ICM conference a fantastic experience for all of us. I also went to Singapore teaching again.
Our family has grown this year with three more delightful grandchildren and our youngest daughter has finished her first year of University and is starting her first real relationship – all big steps, oh I remember it well, oh so long ago!
We now have 7 grandchildren (ranging from 8 weeks to 4yrs old), believe me it keeps us on our toes.

I also feel have achieved much this year in both work places. In my clinical area we have introduced the self directed fetal monitoring package which I feel will enhance the midwives knowledge should she/he need to use a CTG and it will be a way of maintaining knowledge if you require it.
Through the Australian College of Midwives (WA Branch) we have disseminated information relating to the ANMC updated Codes, also keeping members updated on information relating to National Registration and we have conducted several seminars throughout the year.
My university work has progressed in leaps and bounds this year, I have updated my unit and have had raving reviews from my students regarding this, which is always good. At the end of each year I have a look at how to move forward in the New Year.... I will soon have to make a decision relating to my PhD as it is on hold until May 2009.....
I am pleased with my blogging; however, I have found it difficult to maintain the pace over the last two months as my work load has been so great. I will have to review how I proceed with my blog in the next few weeks.

I am enjoying my break now (hence the blog) and looking forward to Christmas and reading a couple of novels.

I will take this opportunity to thank all my readers for your support and wish you all a very happy, safe Festive Season and the very best of health & happiness for 2009.

Tuesday, November 4, 2008

RANZCOG - the need to support Midwifery- Led Care - give women informed choice!

It is the 21st century and whenever we discuss midwifery, nursing and medicine it is usually in relation to evidenced based practice - the latest research - how to move forward within the professions looking at the research. I do find it ironic that when Obstetricians have good evidence to show that homebirths have a place in Maternity Care they fail to acknowledge this.

I came across this site called 6 - and there was an article written by Michael Woodhead - click on the link to find the full article.

Doctors 'in denial' about safe home births The medical profession has been accused of encouraging the trend for dangerous unattended ‘freebirths’ by failing to support safe homebirths.

Obstetricians and state bureaucracies are reluctant to acknowledge that there is good evidence to support the safety of planned attended homebirths for low risk women, says a public health researcher and member of the Australian Maternity Coalition.

.... in this month’s Australia and New Zealand Journal of Obstetrics and Gynaecology (48: 450-52) she says the Royal Australian and New Zealand College of Obstetrics and Gynaecology opposes home birth, even though the balance of evidence shows that planned home births for low risk women have no greater mortality or morbidity than hospital births if attended by a qualified health professional.

This is a tragedy for women and midwives: why are obstetricians so opposed to midwifery led care? in the face of good evidence. One has to ask, what is the point of research if we do not use it?
In recent years there appears to have been an increase in popularity in freebirth, I wonder why?

The professions need to be working in collaboration with each other, respecting the knowledge, skills and ability to care for women and refer to obstetricians when we need to. Let midwives look after low risk women, that is what we do best.

Monday, November 3, 2008

Soooo busy marking papers! no time for blogging!

I am so busy marking papers I can not see the forest for the trees. I am dreaming case studies, law and ethics. Marking is fun when your students are getting it right - however marking is so much harder when they get it wrong, there has got to be a better way of testing knowledge. The biggest issue I am facing is incorrect referencing, paraphrasing or incorrect paraphrasing and PLAGIARISM, role on next semester when I will use a computer system that detects plagiarism for you. I am sure that will make both the students life and mine easier. I found this great site that helps you understand referencing, paraphrasing and plagiarism - have a look and pass it on to others who may be interested it is called The Owl at Purdue:
Must go, marking calls, the joys of lecturing/teaching.....................

Wednesday, October 29, 2008

Cyber Talk and Midwives

Tonight I presented a lecture about Cyber talk: The presentation was a brief introduction to the Internet, focusing mainly on blogging. The aim of the presentation was to raise the awareness of midwives about the internet, who blogs and why, also to highlight the legal and professional responsibility of cyber mediums such as Facebook, MySpace, Skype, YouTube, Twitter and blogging. Currently there are approximately 22million blogs online. Blogs are becoming one of the fastest growing mediums for discussions relating to marketing, legal issues, health, political activism and social change.1

So, what is a blog? It’s a journal, reflection, diary, newsreel or a newsletter. However you describe it, it is something you write that is personal and informal for the world to read. Blogs are designed for the public forum – they can be updated daily, weekly, monthly or whenever the writer chooses. Blogs are very easy to set up – any of the major search engines will direct you to a site of your choice and you simply follow the instructions. 2

Major legal issues surrounding publishing on the Internet relate to: defamation, copyright, trademarks, moral rights and confidentiality. I am sure there are more but for now I will concentrate on these relating to midwifery.

All Midwives be they; community, independant, hospital based are bound by legislation such as the Nurses and Midwives Act. Within this framework we are regulated by the ANMC Code of Conduct (2008),
Code of Ethics(2008) &
The Competency Standards for the Registered Midwife (2006). If midwives fail to meet the required standards of these Codes, then they can face disciplinary action as stated within the legislation. Therefore midwives need to know and understand what the Codes mean and how they work. It is important to remember when you are blogging to be professional at all times, being mindful not to bring our profession into disrepute. Once something is published on the web it is very hard to delete, it is passed around the cyber world like lightening creating lots of threads and being saved in different places.

There are many health professionals blogging, sharing stories, practices, education and reflecting care given. This increases the risk of breaking patient/client confidentiality due to the blogger or authors sharing too much information, such as subspecialties, names, places and content.

The Journal of General Internal Medicine published an article titled “STUDY HIGHLIGHTS RISK OF BREAKING CONFIDENTIALITY IN BLOGS” this was a study that examined 271 medical blogs and found that 56% of the blogs contained enough information to reveal the author’s identity. 3 The study found that blogging was a great way to reach both patients and health professionals so long as people were responsible about it. However “blogging does pose serious concerns about confidentiality and bringing the profession into disrepute. 3”

Defamation occurs when one person communicates material that damages the reputation of another. This can be verbal, written or pictures and the publication must reach someone else other than the person being defamed. However there are several defences to defamation such as: is it a ‘fair comment’ on a matter of public interest or was it simply an opinion, was it an honest opinion of the author 3.

ANMC Professional conduct refers to the manner in which a person behaves while acting in a professional capacity. It is generally accepted that when performing their duties and conducting their affairs professionals will uphold exemplary standards of conduct, commonly taken to mean standards not generally expected of lay people or the ‘ordinary person in the street’.

The moral from this evening's presentation is to know your ANMC Codes inside out, they provide you with a tremendous framework. As for my presentation, I must remember to have my cheat sheet with me, because once I start talking lots of new ideas come through and I forget the ones I was going to focus on. This is such a massive topic that I really just tipped the iceberg.

Happy Blogging - 'have blog will travel'

1. Sylvia Mercado-Kierkegaard, Blogs, lies and the doocing: The next hotbed of litigation? Science Direct.
3. BMJ 2008;337:a1043; Study highlights risk of breaking patient confidentiality in blogs.

Monday, October 27, 2008

A vaginal Birth with an epidural. It is all about informed choice!

Birth of Logan Mark

This birth story has been written with the permission of Nikki & Scott. Thank you.

Firstly I will congratulate my son Scott and his fiancé Nikki on the birth of their son on the 19th October at 0115, weighing in at 3420gm. Nikki has always wanted an epidural, with the birth of Jessica (8hr labour) their first child, she also had an epidural which was not very effective and Nikki ended up with an episiotomy and Neville Barnes forceps – not very nice. Why do some women want an epidural? – Well that is simple, as Nikki would say “I don’t do pain” and “I am the biggest sook”. Now I don’t agree with Nikki’s choice of terminology, because pain is whatever the woman/client says it is and epidurals have a place in childbirth, because it is all about informed choice. The aim is to achieve a safe spontaneous vaginal delivery (SVD) or birth. As midwives our role is to inform women of their options and assist them to achieve the birth they choose. Nikki wanted a normal birth without an episiotomy and that was pain free. The only way to have a pain free birth is by having an epidural, all other forms of pain relief do not take the pain away completely they just knock the top off the mountain. In saying all this, epidurals are not completely foolproof; sometimes they do not work or only partially work as Nikki found out. Full credit to the excellent midwife who was looking after Nikki, who did everything possible to make sure that Nikki’s epidural was working effectively, finally after all possible top-ups etc Nikki was comfortable, now we could concentrate on getting more effective contractions.

Nikki called me at about 3pm not sure if her waters had broken, I was on my way to see my friend and decided to call in a see how Nikki was going – sure enough there was a wet patch on the bed, and most women hate the thought that they may have wet the bed, heaven knows why, you have a baby constantly pushing on your bladder, it would not be surprising at 38+5 days. Anyway after resting on the bed with a pad on for 20 minutes the pad was wet, had a sweet odour and was clear. The baby was moving nicely, the head was engaged, and there was a good fetal heart. There were no apparent contractions and Nikki described having a cramping feeling, so we decided to keep her walking around the house. I decided to go home, which is only 10 minutes away, and finish cooking my dinner and we would share it. Scott’s sister Faye and Brendon & their children would come over and we would pass some time – Nikki reminded me that she still wanted an epidural and not to leave it too late, I also said to Nikki that it would be beneficial if she was in established labour before she had the epidural to ensure an vaginal birth and she was agreeable.

About 6:30 Nikki’s pad changed colour, it was meconium stained (the baby has done a poo in-utero), lightly stained meconium. Nikki was still not contracting regularly or strongly, we rang the hospital, and were advised to make our way in. There was mild disappointment in the air, meconium stained liquor, and this changes things now.

We arrived at the Labour and Birth suite at about 1945hrs – Scott was dropping off Jess and would meet us there shortly. Nikki was great, we had a good talk in the car about expectations, epidurals and how to push effectively when you have an epidural in place so as to avoid having an episiotomy. Nikki laughed at my analogy – as you can’t feel anything, close your eyes and imagine that you are totally constipated and you have to push the biggest shit out – that’s what you have to do.
No sooner were we there when Nikki was assessed, hooked up to the CTG, examined – it was good to see that she was 4cm dilated, however the head was -3. IV inserted and bloods taken. Nikki was happy to stand next to the bed whilst being monitored; it was now meconium 2, which meant continuous fetal monitoring. Her contractions were still not strong, getting more uncomfortable for Nikki, so the epidural was arranged. The CTG had good variability however a couple of late decelerations – the decision about using an oxytocics was made, to increase the strength and frequency of the contractions, due to the meconium and late decelerations. Nikki was happy to get things going, anything to make it work rather than having a caesarean section. Nikki was coping really well, now comfortable with her epidural almost working effectively – it was denser block on one side, her left leg was numb and difficult to move.

Scott was like a cat on a hot tin roof – he had his own expectations, and did not share them. He is 6’+ and seems like a gentle giant and he felt out of place in the delivery suite, although he very much wanted to be there. Like most men he was busy comparing the CTG machine to the equipment he used when working out in the bush with the geologist comparing it to the seismograph. This did make me smile; he was constantly eating, lollies, biscuits, fruit and pacing the floor.

The baby was difficult to monitor, and I really could not understand why, as Nikki is tall and fairly slim – certainly not obese – therefore theoretically should be easy to monitor, however the “little fella” was playing possum with us. The CTG baseline rate was about 145bpm, variability was good however we were getting complicated variable decelerations. The pressure was on; “I don’t want a caesarean section” was Nikki’s lament. It was time to reassess due to the complicated variables, at approximately 1130pm Nikki was still 4cm, head 2-, so the head had come down, it was really no surprise that the cervix was still 4cm as the contractions really were not yet effective or strong enough. The decision was made to continue and reassess in 30 minutes. We changed positions, left lateral, right lateral, then upright to try and improve the trace. Another top-up as well as self administered top-ups were given, Nikki still has an uneven block, however she was more comfortable now. The syntocinon was titrated upwards as per the protocol and Nikki’s contractions finally kicked in, 4:10 strongly, however with this came more complicated variable decelerations, the registrar decided to tickle the baby’s head, to ascertain if the baby’s heart rate would accelerate which would be equivalent to a 7.25 pH and therefore the baby is not hypoxic. Hooray! The little fella’s heart rate went up to 165bpm, which bought us some more time.

At 0100hrs the midwife decided to put a scalp electrode on the baby’s head, so it would be easier to monitor him – and to her/our surprise Nikki was fully dilated – fantastic – that is an efficient uterus - she did a test push, Nikki was fantastic, she visualised and pushed well. It was time to birth, Nikki, Scott and the midwife were happy for me to catch – as was discussed earlier.

It was a wonderful vaginal birth, intacted perineum – little Logan Mark was born at 0115hrs weighting 3420gms.

On reflection talking to Nikki and Scott a few days later – Nikki found the birth easier than Jessica’s birth and was grateful to have the midwife and myself present, “everything was easy, casual and relaxed – it was awesome!” Nikki said that she had back pain for at 5 days post the epidural.
Scott reflected that he thought that there would be more blood and gore! He cut the cord which gave him a sense of fatherhood. However, Scott did say that he felt superfluous through the whole process. I wonder when women have an epidural does it change the focus for men, as the level of support may change due to the level of pain being different. I did notice that both Nikki and Scott watched TV and debated which movies to watch.

As for me...............This was as always a memorable experience. It is a privilege to help birth your grandchildren, to support the women of your family and share your knowledge, expertise, love, warmth, caring, just being there. It is truly a magnificent moment – a true reminder of the miracle of birth and the power of a woman’s body, truly spectacular.

It’s all about what the woman wants!

Interesting comments by Louise Sliverton

I was browsing the net, as you do on a Sunday night after a very busy weekend (withdraws from the Internet) I came across this story from the 'Fear of pain' causes big rise in cesareans, written by Denise Cambell.
I thought what a "surprise" there's nothing new! the difference is that a Midwife has made the comments - and who is the midwife - Louise Silverton.

Now one of Britain's leading midwives has reignited the debate about cesareans. In an interview with The Observer, Louise Silverton, deputy general-secretary of the Royal College of Midwives, has controversially claimed that an increasing number of women under 40 are less prepared to undergo the physical trauma of childbirth than their predecessors, a trend that is pushing up the rate of surgical deliveries.

I have had the pleasure of meeting Louise on several occasions. It is always nice to meet the author of books you have read. I also think it is time that midwives became more vocal, it does raise our profile.
The article goes on to talk about current trends in the perception of pain in today's society, which is very interesting. I do tend to agree with Louise when she argues that people today do not want to deal with any sort of pain, the answer is take a pill, however I am not sure that is is contributing to the increase in the cesarean section rate. These comments have created debate from all angles, to the point of blaming the shortage of midwives to the raising cesarean rate. I also found it interesting that the cesarean section rate is lower in the UK than in WA which is currently at 30%. I think that people forget that a cesarean is major abdominal surgery, as it is never portrayed in this way.
'Currently, the Cesarean rate [in England] is 24.3 per cent. Therefore one has to question whether the women of this country are physiologically incapable of having normal births, and I don't think they are,' said Silverton, a midwife for 30 years. She wants Britain's rate brought closer to the 15 per cent recommended by the World Health Organisation and fears cesareans 'have been normalised in the minds not just of women but also midwives and obstetricians'.

If you have time click on the link and read the comments by women relating to their experiences of birth.

We all know that 'fear' plays a big part in the birth experience, so if you feel as if this is stopping you or you want to debrief seek some counselling, talk it through.
The best way to deal with 'fear' as Susan Jeffery's would say is "feel the fear and do it anyway"

Friday, October 17, 2008

Best poem nominated by United Nations in 2006

I have to share this poem that was passed to me at work today:

This poem was nominated by UN as the best poem of 2006, Written by an African.

The poem is called


When I born, I black
When I grow up, I black
When I go in Sun, I black
When I scared, I black
When I sick, I black
And when I die, I still black
And you white fellow
When you born, you pink
When you grow up, you white
When you go in sun, you red
When you cold, you blue
When you scared, you yellow
When you sick, you green
And when you die, you gray
And you calling me colored?

Sunday, October 12, 2008

Writing a joint article using the internet - Perth WA - Dunedin NZ

I have been wanting to publish an article about the growing trend and use of the Internet. It always astonishes me how much information is out there and how many women seek out this information or use the Internet to spread information about pregnancy, childbirth, freebirth, unattended birth, medicalised care, good & poor care received from midwives. I am also perplexed or surprised at how many midwives still do not utilise this resource or are afraid of it - 'the Internet' or cyber world as I like to call it.

It seemed a logical step to take when I asked Sarah Stewart to co-publish with me, Sarah has been a great support to me since I began blogging in January of 2008. Today I contacted Sarah via Skype to discuss the next step, which has been to create a document using google docs,(you do need to have a current google account) by which we can both write and edit our article, it is so great, I can't believe it is so easy, off course once you know how! It was so amazing to talk to Sarah after blogging for 10 months we have finally spoken. I find it unbelievable that technology takes us this far, here I am in Perth WA and Sarah is in Dunedin NZ, five hours of time between us and we spoke and saw each other as if we were face to face - it is really amazing.

My first task is to brainstorm all the things I'm interested in, as I have already mentioned some of them, Sarah did point out to me that we could write several papers and culling will be very important.
This is a familiar problem for me - too many ideas, that's where Sarah will keep me focused.

Watch this space to see how we go ..............

Joint Media Statement From NZCOM And RANZCOG

This is a Joint Media Statement from New Zealand College of Midwives and the Royal Australian New Zealand College of Obstetricians and Gynaecologists.

see full statement: Joint Media Statement From NZCOM And RANZOG

"The NZCOM and RANZCOG have recently signed a memorandum of understanding between their respective organisations and are already committed to enhancing the relationship between obstetricians and midwives so that our combined workforce provides a seamless and responsive maternity service," say Ian Page, spokesperson for RANZCOG, and Karen Guilliland, spokesperson for NZCOM

congratulations, we are watching you lead the way............

Prenatal Company: Midwife goes to top executives office for antenatal care

What a tremendous story this is, check it out in the Evening Standard
Midwives are providing highflying City women with pregnancy care at their desks, it was revealed today.

The 24-hour working culture means many female executives find it impossible to juggle hospital check-ups with meetings.

But a London midwife has now launched the first ante-natal service tailored for women who want to combine motherhood with a high-profile career.

Lexie Minter, 29, set up The Prenatal Company after identifying a gap in the market for a service for women in the workplace.

A typical consultation lasts from half an hour to an hour and is arranged to fit round the client's work schedule.

The cost of the service, which provides support throughout pregnancy, is £5,000.

This includes blood tests, work check-ups and advice on the best place to give birth and exercise tips during pregnancy.

What a fantastic idea, I can see how it would work in London, shame in Australia midwives do not have the same impact on care. I think this is two fold, one is, our health care system is funded differently for pregnancy and secondly, we have a higher uptake of private insurance, which means, more women opt for private health care (specialist obstetricians) thinking they are getting the best care, which is always not the case.

Very interesting!

Saturday, October 11, 2008

Midwives are shown to have best outcomes for women.

It is really great to see a positive story about midwives in the press: I came across this story in the Sydney morning Herald. It is nothing any midwife does not already know, but it is good to see in print and raises our profile.
The story talks about midwives being the best option in terms of midwifery led care for women during pregnancy.
Kate Benson writes
Women who are cared for by midwives rather than GPs or obstetricians are less likely to lose their babies within the first six months of their pregnancies, an international review of maternity services has found. Researchers gave no reasons for the shock finding, taken from an analysis of 11 trials involving more than 12,200 women in four countries, but a spokeswoman for the Australian College of Midwives, Hannah Dahlen, said women who were seen by the same midwife during pregnancy, labour and birth usually felt more supported and less anxious, leading to reduced risk of miscarriage.

What a surprise to see that the Australian and New Zealand College of Obstetricians and Gynaecologists, are not happy with these findings. It is a shame that collaboration is not the focus.
The analysis, which is the largest undertaken in the world, also found that women in midwife-led models of care were less likely to be admitted to hospital during pregnancy, have instrumental deliveries, episiotomies or require analgesia and were more likely to have spontaneous vaginal births, feel in control during labour and better able to initiate breastfeeding.

The Australian college of Midwives spokes person Dr Dahlen said
the analysis, published by the Cochrane collaboration, considered the gold standard of assessing medical evidence, proved that midwife-led models of care had no adverse outcomes and many benefits.
"If this was a tablet, it would be mandatory that all women have it, but instead we have to deal with all this shroud waving by obstetricians. Now we know the evidence for their claims just isn't there,"

What a good analogy from Hannah Dahlen. Off course this is nothing new for midwives, we have always argued that midwifery-led care offers more for women and would reduce the Cesarean rate which is currently at 31%.
Our government needs to work towards more midwifery-led models of care and obstetricians need to start collaborating with midwives rather than always opposing us, after all we all want the same thing, informed choice for women and safe birthing options.

We need to listen to what women want, and stop being paternalistic.

Reference: Sydney Herald:

Thursday, October 9, 2008

All Australian legislation makes reference to Indemnity Insurance for (independent) midwives:

South Australia currently has the Nurses and Midwives Bill 2008 going through parliament (As laid on the table and read a first time, 23 September 2008) – what is good about this legislation is that the definition of
midwifery means any treatment, care or advice provided by a person to — (a) a woman in relation to her pregnancy; woman or child in relation to the birth of the child, (whether such treatment, care or advice is provided)
‘midwifery’ ( is much more defined in the SA Bill than the Nurses & Midwives Act 2006 WA ('midwifery' means the practice of assisting a woman in childbirth) our definition of 'midwifery' is very broad– however definitions aside, both legislations puts restrictions on midwives when it comes to indemnity insurance.

This is the South Australia Nurses & Midwives Bill 2008 section 41 page 27 states:
“41—Services providers to be indemnified against loss
1) A services provider must not, unless exempted by the Board, provide nursing or midwifery care through the instrumentality of a nurse or midwife unless insured or
15 indemnified in a manner and to an extent approved by the Board against civil
liabilities that might be incurred by the nurse or midwife or services provider in
connection with the provision of such care.
Maximum penalty: $10 000.
(2) The Board may, subject to such conditions as it thinks fit, exempt a services provider,
20 or a class of services provider, from the requirements of this section and may, whenever it thinks fit, revoke an exemption or revoke or vary the conditions under which an exemption operates.”

(This is very similar to the West Australian Nurses & Midwives Act 2006: Section 32 Professional indemnity insurance page 24 states.....2 “(a) that – (i) the nurse or midwife must hold professional indemnity insurance: (ii) the professional care provided by the nurse or midwife must be covered by professional indemnity insurance. (iii) the nurse or midwife must be specified or referred to in professional indemnity insurance......(b) that the professional indemnity insurance must meet the minimum terms and conditions approved by the Board.” 4. The Board may, on its own motion or on the application of a person the subject of a condition imposed under this section, on reasonable grounds, revoke or vary the condition.”

What does this all mean: the bottom line is the word “MAY” it is very open and powerful. This is the word that is detrimental for independent midwives. It means that The Board can insist that before you can register as a midwife you have to have indemnity insurance.

I know the Australian College of Midwives is actively trying to find and insurer before National Registration comes in, we have to work together to resolve this issue. This is a worldwide problem, not just synonamous to Australia.


Tuesday, October 7, 2008

National Registration for Nurses and Midwives in Australia: - Have your say!

At the end of September I went to a meeting to discuss the National Registration and Accreditation Scheme, being proposed for Australia. I must say it is long overdue that we as health professionals should be able to work in any State or Territory in Australia without having to pay different fees and register in within each State or Territory we choose to work in. At some point of my career I have registered and worked within four of our States, it will be nice to know that by July 2010 I will be able to register nationally and be able to work anywhere in Australia, this seems to make more sense. Consequently this will change the way our current Nurses & Midwives Boards will be governed.

The council of Australian Governments (COAG) in March this year signed an agreement on the health workforce. This agreement was the first step in creating a single national registration and accreditation system for nine health professions: nurses & midwives, medical practitioners; pharmacists; physiotherapists; psychologists; osteopaths; chiropractors; optometrists and dentists. This means less red tape and a more flexible workforce, greater safe guards for the public and will stop banned practitioners from registering in another State.

However with such a system comes consultation and changes; so, what are the changes and how does it affect us as nurses and midwives: I suspect for nurses there will not be a great deal of change however for midwives it will mean that all independent midwives will need indemnity insurance to be able to register. This is a huge problem for us. I know that the Australian College of Midwives is working to secure indemnity insurance for our midwives; however this is proving to be a mammoth task. The other issue that will prove to be difficult will be the complaints and review process, there are current discussions happening to resolve some of these issues.

I urge all of you to read the consultation document as submissions close on the 29 October, so have your say.


Sunday, October 5, 2008

Stealing a long weekend away

We have been back from our overseas holiday just over 2 months and our feet have not touched the ground with work, family & new grandchildren. We are waiting for our latest grandchild to be born, due in about 3 weeks or so, that will be the last one for this year. Currently this little one is still breech, here’s hoping he will turn in the next few weeks. So Ian thought this would be an opportune time to steal a long weekend away, or so he thought. Ian did not count on me having approximately 50 analytical essays to finish marking, so he booked a romantic weekend away, also forgetting he was on call. Great stuff, typically male, don’t you just love them. I will say in his defence, I would always have a reason not to go away due to work commitments, he did well.

So away we go to Basildene Manor in Margaret River, a beautiful spot set in our wine making district, with my papers, laptop in toe and Ian with his mobile phone and his laptop. Wow I can see this is going to go well. I did not take much notice of the scenery on the way down to Margaret River; I took this time to continue marking papers. I get great satisfaction from marking a paper that has everything you anticipated it would have in it, one that follows the marking guide and the student endeavours to get it all right, and then I feel I got the message across. Conversely, it is the opposite when the student gets it all wrong, and then there is the student that is right on the line, 50%. I am not sure if that equally means I have not done my job well? I have yet to make a decision on this.

Margaret River is one of our favourite places and we try to stay somewhere different each time we come to this region, we also endeavour to try several different vineyards, of course. Basildene Manor is an old manor which was built around 1902 and owned by the Willmott family. This is a grand venue, set on 14 acres and has enchanting gardens, luxurious rooms, our room has a king size bed and a spar, sheer bliss for us, mixed with elegance and a taste of old world charm. Breakfast was set in the conservatory overlooking the 14 acres of enchanting gardens watching the exotic birds playing in the trees; it really was peaceful and relaxing. We would stroll around the grounds each morning enjoying the surroundings and thankful we live in such a beautiful country.

Cape Lavender holds a special place for us; we just adore the spot and love the wine, hence why we bought two cases– we indulged in afternoon tea – that is lavender tea, lavender scones & cream, sheer decadence and see it was tea we enjoyed, it goes to prove we do drink tea.

Dinner Saturday night was at Leeuwin Estate – what can I say except to say “exquisite” we went back the next day to see the grounds in the daytime to also enjoy the gardens. It is my aim to get to a Leeuwin concert...........

Redgate – wine tasting, you just have to try the white port it is very special, especially with lots of ice and a slice of lemon – it is to die for!

The Knights Inn –was one of the local pubs where we had dinner Sunday night – nothing beats a pub dinner watching the English football - Portsmouth vs Tottenham was playing so my hubby was in his element and I did not mind either, we had a table in front of the wood fire and the big screen what more could you ask for?
Only 20 papers left, the students are doing to badly, it does make a change to sit out in the gardens marking it gives you a different perspective.

Our last day – we visited the Voyager winery, this place has to be seen to be believed, it is just an unbelievable spot. We had lunch there and it was “outstanding”

Now it is time to go home, we feel refreshed the battery is recharged and ready to start again, until the next time, ciao from Margaret River.

Wednesday, September 17, 2008

UK concern over 'Freebirth'

Following on from my earlier blog....Freebirth seems to be reaching epidemic concern - this article "Pregnant women are opting for risky 'freebirths' in the UK Telegraph states that
Advocates of the freebirth approach claim that it is "more natural" than giving birth surrounded by midwives and doctors. It would usually take place at home.

Freebirth involves giving birth without medical assistance, which has led to concerns that women could find themselves in dangerous situations if something goes wrong.
The Royal College of Midwives suggest that
Mothers-to-be are making the radical choice because ministers have failed to deliver their pledge to let them have their babies where they want.
Some women aren't certain about homebirths and others want them but the service can't provide..... "The worry is that women will do it themselves. If you're not offering women choice then that is the danger."

I have noticed over the last 6 months that the topic of Freebirth has become more topical and anecdoteally there have been a number of women choosing this option.

Freebirthing is a trend that is becoming increasingly popular in America. It is not known how many freebirths take place in Britain or Australia, however it is becoming of concern. Off course America's Medical Association (AMA)adopted a resolution at its annual meeting last weekend (June 08) to introduce legislation outlawing home birth -

"It's unclear what penalties the AMA will seek to impose on women who choose to give birth at home, either for religious, cultural or financial reasons-or just because they didn't make it to the hospital in time," said Susan Jenkins, Legal Counsel for The Big Push for Midwives 2008 campaign. "What we do know, however, is that any state that enacts such a law will immediately find itself in court, since a law dictating where a woman must give birth would be a clear violation of fundamental rights to privacy and other freedoms currently protected by the U.S. Constitution."
This is an interesting concept happening in America, apparently this motion is a swipe at Ricki Lakes documentary The Business of being Born on homebirth - The Big Push for Midwives are an organisation of midwives fighting for the rights of midwives and women. "Our goals are to fully integrate the Midwives Model of Care into the health care systems of our states, to highlight the importance of family health care choices and to defend the ability of CPMs to provide legal and safe prenatal, birth and postpartum care to families in every state".

It does seem to be a worldwide trend that midwives and women are constantly fighting for the right to choose the model of care and birth they want. Why is this so difficult? This is the 21st century, we as women have the right to autonomy, the right to choose whatever model of care we desire.
It is interesting to note that America is pro-fetus, Britain pro-woman, Australia & New Zealand have not had many test cases, but tends to follow the UK, however can be swayed by the USA.
I am so pleased I do not live in America.

If you know any freebirth stories please share them.

Is our Maternity system failing? A Freebirth gone wrong.

In NSW a newborn baby dies, after the mother birthed at home with her husband and no health professional, a freebirth. The woman attended a hospital three days prior to the birth and was told the baby was fine however that she was at high risk of complications, including the rupture of a scar from previous caesarean. They wanted to induce her labour immediately. The woman refused and return to her home in the Blue Mountains where she gave birth to a stillborn baby several days later.
Two doulas, who are not medically trained but provide emotional support for women before and during childbirth, and a qualified independent midwife were called but arrived too late.

The baby's father told The Sun-Herald the doulas had told him the baby was stillborn due to an infection contracted inside the womb.

This tragedy confirms the fears of maternity experts who are alarmed at the growing trend of women evading the health system in favour of unsupervised home births.
This begs the questions, what information did the hospital doctors give this woman to scare her away and make the decision she did? Why do women make these choices? Was this woman suspicious that she may be coerced into something she did not want, and made a hasty decision? did she feel she had "no choice"
The Australian College of Midwives supports homebirth for low risk women. Midwives are trained in the 'normal' and can recognise the 'abnormal' therefore refer when necessary to an obstetrician. However the College does not support "freebirthing" its too risky.
Associate professor Dahlen said in this case the woman had been traumatised by a previous hospital experience and fears she might be forced into induction or a caesarean. Against medical advice, she made a last-minute decision to leave the hospital and go home and soon after the baby died in the womb.

If we fix the system we won't have women resorting to a last-minute panicked decision like this......... The increase in women freebirthing is a symptom of a system that does not give women choice. We're seeing more and more of these concerning incidents in the last two years. It has to be addressed, and urgently.

The NSW Health Department spokesman said;
Patients have the right to decline medical intervention or treatment, as as the freedom to choose where, when and from whom they will receive medical advice and assistance

It is suspected that this baby died of Group B streptococcus, not as a result of the homebirth. This case is currently with the coroner, so watch this space........

As a midwife I have to say, that there are enormous risks associated with 'freebirthing' and it is not advisable. I am an advocate for homebirth in low risk women, that is with no risk factors. However it is important to talk about your concerns and collaboration is the key. I urge any woman considering the option of Freebirth to seek advice, from your doctor, midwife, someone who can give you appropriate advice.

Look at all your options carefully, be fully informed in the risks associated with your condition and your babies condition before you make a decision. Write the risk and benefits down so that the facts are clear and there can be no mistakes, get a health professional to read your list so you have a balanced view and you have not left something out, then make a decision.

Remember to act on the FACTS not the EMOTION, after all it is your life, dreams and aspirations that your are considering. Take the time to make that decision, there are always consequences to actions.


Thursday, September 11, 2008

Teaching in Singapore

I have just recently come back from teaching in Singapore; it is always a pleasure to teach there. People always say when you are passionate about something you do it well, that is me with teaching Professional Issues. My aim is that nurses and midwives have a good understanding about their legal responsibilities, that is, a good understanding of the legislation and professional codes that govern their practice. The university staff and students are very welcoming and the students are keen to learn, they are quite shy to start with then after a warm up session they are sharing experiences and answering questions.
On my trips to Singapore I usually spend 12 hours teaching and like to incorporate a few days off to do some sightseeing.
Singapore is an interesting country it is has a population of approximately 4.6 million and there are four main languages spoken, Chinese, Indian, Malay and English.

Singapore has a controlled democracy; this is the first time I had heard of this notion, not a bad idea really. Speakers corner is where people can express freedom of speech to a degree - you have to submit your speech and have police approval before you can deliver your speech = off course you can not talk about religion, race, politics or the government, controlled democracy.
It is a tropical island and has a humidity rating of 70-90%, this is the only thing I don’t like about Singapore is the humidity, especially for a menopausal woman, I have taken to carry a travel towel and mini fan to try and stem the flood of perspiration that often ensues after venturing outside for a walk or shopping, the only consolation is that the taxis are fabulous and have fantastic air conditioners’ it’s like going into an icebox.
I must say I don’t like travelling alone and do miss my husband when I’m away, however there are some benefits to being on your own; you can do exactly what you want when you want. I particularly like book shops and enjoy spending time in Borders and Kinokuniya – they are both fantastic shops, Kinokuniya has a much bigger reference section than Borders. My most recent acquisition apart from medico-legal books was the ‘Seven daughters of Eve” which I have not had a chance to start yet.
The other thing I enjoyed this trip was visiting about 4 or 5 temples/churches. What an array of religions there are in Singapore, I wouldn’t like to guess at the number of different ones in case I was to leave one out. However I did visit Kwan Im Thong Hood Cho Temple- the Chinese Goddess of Mercy, also believed to be a manifestation of the Boddhisattva Avlokitesyara.

Also the Chinese biggest Temple with the biggest Buddha. The Hindu temple Sri Krishana. The Relic Temple and museum of the hundred Buddhas. The Muslim temple and the Catholic Church St Joseph. Wow that’s a lot of temples in one day – it was an interesting day -

– I had an unusual experience outside a Chinese Temple, a Sikh man approached me, said hello and simultaneously reached for my hand and talked into me incessantly, he was hard to understand, however, when he said ‘I was spiritual but lazy with it’ I laughed and then the penny dropped that he was telling me my fortune and giving me a personality reading – I was astounded, I had never know Sikh people to be fortune tellers, so I was taken by surprised, I was also outside a temple a spiritual place so did not expect to be ripped off. He then held my hand and asked for paper money, when I gave him some he asked for more. Now I thought I was a fairly strong woman, but on this occasion I was weak, I was taken aback by this man and also felt I should give him more money as he still had hold of my hand and that I would not have any bad karma, more fool me, a valuable lesson learnt.

On my other free day I took a round island tour – this was an interesting day, I travelled with a multicultural group of people, German, American, British, Scottish, two I don’t knows, and myself. The tour guide was a retired engineer Singapore Chinese man ‘Abdul’ he was absolutely fantastic he had lived in Europe for 17 yrs and could speak several different languages. Abdul gave a little of Singaporean history and commentary on most places we went to. The Tiger Balm Park was interesting, showing a little of Chinese cultural background. I do find some of the festivals intriguing ‘the festival of the Hungry Ghost’. We had lunch at the Orchid Country Club; Ian would have loved to have a game of golf here, it was very colonial. The most thought provoking place we visited was the Changi Chapel and museum – this was a very sad place and it certainly made you reflect. The other place that had the same effect was the war cemetery for Singapore, Australia, New Zealand, India and UK.

I relished walking through the markets and just watching people, I enjoyed the best cup of ginger tea watching workers as they rolled and cooked pastries with such precision and wishing I could try them, but after watching them being cooked I thought twice about it, my arteries and waist line were saying ‘no don’t do it’ so I took a photo instead. It just was not the same.

I look forward to my next trip.

Role of the midwife

As I was reading the West Australian paper today I came across a headline which read:

“Baby boom brings new role for midwives”, I thought great, what’s this about? And proceeded to read it and was surprised for two reasons; the first being;
“Midwives would get doctor-style responsibilities such as ordering diagnostic tests and the ability to prescribe drugs under proposals the Federal Government is considering”

– I thought, what a new role? Well, as I did my midwifery in the UK, and worked as a community midwife, this is something that I already use to do and was stripped of this right once I began working in WA as midwives do not work in this capacity here. There are several other countries that also work in this capacity where midwives have diagnostic responsibilities, these are New Zealand and off course Britain.

This is the role a midwife is supposed to have, this is the role midwives are educated for, to provide continuity of care, one on one care, know and recognise the normal and then recognise the abnormal, order diagnostic tests and then refer to the obstetrician when the situation becomes abnormal. The midwife is the expert in the normal pregnancy and birth, the obstetrician in the abnormal.

I am delighted for the profession of midwifery and for the women of this State that we are finally letting midwives work to their fullest capacity.

Secondly I am also delighted that the Health Minister Nicola Roxon has bought this issue to the forefront and is open to dialogue and discussion regarding the prospect of midwives working to their fullest capacity and also considering the option of Medicare provider numbers for midwives and looking at the issue of indemnity insurance.
This is a result of a comprehensive review of maternity services throughout Australia which says “that there is no Medicare benefit payable to midwives for management of labour and delivery and private health insurers offer only limited support for midwifery services”.

It was no surprise to read that the “Australian Medical Association” will oppose this proposal. We should be working in collaboration with each other, midwives and obstetricians, rather than this constant power play, using ‘fear tactics’ and patient/client safety to keep women and midwives in line.

Let the dialogue and discussions begin.

Ref: West Australian 10 September 2008 p12

Monday, September 8, 2008

Poor Record Keeping has Midwife Cautioned

An experienced midwife was cautioned by the NMC for failing to maintain accurate records and then falsified records once she realised she had made an error. The midwife failed to maintain appropriate records which lead to a patient being given the contraceptive drug Depo-Provera while the woman was pregnant. When the midwife realised her mistake and that the patient was pregnant, she falsified the previous entry by adding the words "last menstrual period - first day 11.5.2005" and two weeks later made a further entry - "remembered conversation with patient".

This raises the question of lying to save yourself, however, the fundamental behavior of our nurses and midwives is that of “trustworthiness” that honesty is the best policy – to be dishonest brings our profession into disrepute. Our Codes of Conduct clearly give us guidelines of how to behave and what the expected standards are, this is clearly a breach of these standards.

The ANC did take into account the midwives good record, and that her actions did not result in direct or indirect harm to the patient and the subsequent outcome for the patient was not as a result of her actions. However the committee did find that the inaccuracy of recording and the incidents of falsifying records were not of the standard required of a registered nurse/midwife and resulted in misconduct.

"Nurses are required to adhere to their Code of conduct which says that they should act in a way to uphold the reputation of the profession. The panel considered her behaviour to be unprofessional and dishonest and outside of the NMC's guidelines on record keeping which say that "records should be written in such a manner that any alterations or submissions are dated, timed and signed in such a way that the original entry can still be read clearly".

The midwife had produced good testimonials and that this behaviour was out of character, also the midwife had been dedicated to the profession of nursing and contributed to academic teaching and nurse training.
The report also stated that “last year nearly 10% of the cases that went to a full hearing were to do with poor record keeping”.

Nurses and Midwives need to remember that accurate record keeping is a fundamental part of their practice. Poor sloppy documentation (record keeping) equals a non professional attitude.

Remember if it is not written it is not done!


National Caesarean Awareness Day (NCAD)

"Getting clear about fear"

I attended the NCAD conference yesterday and what a sensational day it was. It never ceases to amaze me the endurance of women. I was fortunate to meet many amazing women but in particular a women who had dreamed of having a vaginal birth, but unfortunately had quite the opposite. Amber shared her journey of first the joy of being pregnant then the horrendous pain of being rail-roaded into a caesarean, not once but twice and why, for the perceived ‘risk’. Amber for her third pregnancy employed an independent midwife to achieve the dream she wanted. ‘
This begs me to ask the question?
Why is our medical system failing these women?
This has been the theme of a few of my recent blogs and I have come to the sad conclusion that Obstetricians have what they perceive as the women’s best interest in mind, historically this comes from the Hippocratic Oath, however, they fail to hear or listen to what women want. They hide behind the fear of litigation and work in a defensive manner (consent forms for vaginal birth, refusal of epidurals etc).This also is a result of a perceived loss of medical power, in times gone by it was always ‘doctor knows best’ however now with ready technology and ‘google’ the consumer, woman is armed with information and therefore asking more questions. We fear risks that are hard to understand: doctors find it hard to understand why women make the choices they do. This then leads to the power struggle and the ‘fear’ tactic to regain the power and so the cycle continues. If the medical model continues to not listen to women, instead of women caving in to the ‘fear’ or the doctors pressure, they will seek help from other sources, be it, independent midwives or freebirth, they will do it alone.

Approximately 77 people attended the conference, what was exciting to see was women breastfeeding their young babies. It was sad to see that there were no Obstetricians at the NCAD conference, last year there were several and it made for good conversation and debate. Why did the doctors not attend? They would benefit from hearing Ambers story!
The word ‘RISK’ is communicated in many different ways and changes the birth plan enormously if communication is not a two way street. Maybe a solution is that we need to start at medical school to change the mindset of doctors, have consumer groups talk to medical students, about listening and informed choice.
Doctors are forgetting that most women are well informed and make choices. Autonomy is the single most denied option given to women who are pregnant. Women have the right to choose the care that they desire, despite the doctor not agreeing with them, as long as the women are fully aware of the implications of their actions. It is important to let go of control, develop a trust relationship and do not manipulate. “Listen more & insist less”.
I have to acknowledge the great presenters of the conference, Amber her story, The VBAC Dilemma: What the Evidence Tells Us - Henci Goer; Risk and Fear: The Best of Friends - Heather Hancock, Birth Beyond Fear - Lorraine Hale, Next Birth after Caesarean - Tracy Martin, Moving on after a challenging Birth - Lynne Staff and Initiating Change in the Operating Theatre – Caroline Dufton & Sara Bayes.

NCAD have achieved many things over the last year, more awareness regarding the rising rate of caesarean sections, the enormous help they provide to traumatised women resulting in caesarean section. Government recognition of the caesarean rate and the need to reduce this rate (through lobbying), advice on the National Maternity Plan, also the assistance with NVBAC (Next Vaginal Birth After Caesarean) clinic at a major tertiary hospital, and too much more to mention here.

This is only the tip of the iceberg; Birthrites do a fantastic job and continue to do so. They are a group of dedicated people who work very hard, a job well done.
If you require any further information regarding Vaginal Birth after Caesarean section: visit Birthrites - Healing After Caesarean Section

The planing committee: Congratulations an Excellent program and day.

Saturday, August 30, 2008

Who will be the next American President? My view!

BBC World news
Democratic convention - Denver
Whilst away in Singapore teaching I happened to be watching the BBC World news, as you do when in a hotel room and listened to a speech delivered by Mr Bill Clinton, he received an overwhelming standing ovation. I know you might think that is sad, however I do think it is important for the world to know what is happening in America and the world can certainly do without another George Bush. I found Bill Clinton to be charismatic and interesting to listen to. He was a diplomat and inspiring. Clinton suggested that “America needs to be strong at home before strong within the world” – how true is this, you have to love yourself before you can love someone else.
I think Clinton is an easy man to look at, not a hair out of place, he presents very well – despite his admission of his indiscretions, I think he still does a good job and goes to show that we are all human and make mistakes. The other way to look at this is off course, is that I am being pulled into a false sense of security and falling for his charm and really he is a womaniser, I will reserve my judgement. However I do think that a President should be above reproach. He paid tribute to his wife Hilary Clinton, who I am disappointed is still not in the running; however I can see why Hilary could not be Obama’s right hand person. I do like both the Clinton’s and see why they have made a good team. However I have never understood why Hilary remained by her man, unless it was a pact, so that she could achieve her dream, only time will tell. Bill’s speech was directed at Hilary’s followers and other democrats to support Barack Obama, saying, he is ready to be President:– well by the time he finished his speech I was ready to agree with him, not because he said so, because his speech outlined all aspects/issues of what is required of the next American president: global warming, health care for the poor, poverty, military, rising costs of gasoline, food, utilities – equal opportunities for women etc; I am not sure if Barack Obama can achieve all this but he seems to me a better option than McCain and Palin.
I was disappointed that I did not get to listen to Obama’s speech as I had teaching commitments, but it did get good reviews. Barack Obama accepted the Democratic Party presidential nomination, declaring that the “American dream has been threatened” by rule under President George Bush and the McCain represented a continuation of policies that undermined the nation’s economy and devalued it standing around the world.
How cleaver of the Republicans, to choose a woman as second in command, but then, how, appropriate to be behind the man. Now let’s look at Sarah Palin, normally I would be supportive of a woman in this position, but Sarah Palin is pro-life, pro guns, pro war, her son is just off to Iran to war, but I guess it depends on what side of the fence you sit on, this is certainly not my choice. I think that this is a step backwards for women in terms of pro-life issues. America under the current Presidency has put the women’s movement in America backwards by giving the fetus more rights than the women that carry the fetus.
This will be a closer race than first anticipated now that McCain has a woman at his side; it will be very interesting to watch. Whichever way this election goes, history is in the making, the first black American to be President, or the first woman to be Vice President.

ref picture: Alan Davidson: Daily Mail:

Wednesday, August 27, 2008

Limited choice for rural areas - Homebirth refused

A NSW hospital refused a woman the right to have a homebirth, despite the local obstetrician agreeing to the woman's request. The obstetrician was willing to send a hospital midwife to the homebirth, however the request was rejected by the hospital.
The woman only found out by chance that her request was rejected - she states
They knew that at 37 weeks you can't fight,"Ms Caines said.

This woman who has been a maternity advocate in the region for eight years, said she was upset that women in the Upper Hunter were given fewer choices when it came to delivering their babies than elsewhere in the region.

she said.
"As a leading advocate I hold dear the fact that there needs to be benchmark of safety and quality,"

It's birth by postcode

The outcome is that this woman has now employed a private midwife for the birth, but not all women have have this option or resources to do this.
The reason the hospital gave for not allowing the homebirth was
...did not meet the criteria for a home birth because she did not have a GP who would support her and she needed to have a midwife from the Upper Hunter area.

There was no medical reason stated for the refusal of this woman's request, in fact she did have the support of an obstetrician and it made no difference to her case. This is a tragedy for women's choice.


The questions I am posing is; do our hospitals have the right to do this? and as a result of this, will the hospitals be forcing our women to "freebirth" or birth in a way that may not be safe and go it alone?

Would it not be better to find a compromise to suite all parties rather than a straight out "no"? do they think in doing this they can control women?

If we constantly refuse women their choices, women will find a way to do it? where does this leave us as a society and our duty of care?

What happened to informed choice and women taking responsibility for their own choices?
Why do we not allow women to make these choices? or are we just a paternalistic society?

Paternalism manifests in the making of decisions on behalf of clients/patients, where doctor knows best - that is the culture of our health care system - a culture which is hard to change.

Saturday, August 23, 2008

e-learning: Introducing the K2ms fetal monitoring (CTG) teaching package.

e-learning is this the way of the future? Yes, is the answer, the question is, how do we balance the present with the future? Our institution has introduced the K2ms (medical system) Fetal Monitoring ( self directed learning package. Personally I think this is a great package, it is systematic and clear, you can work at your own pace. You can repeat sections until you are satisfied that you understand the concepts being taught and you can move ahead quickly if you need to. The instructions are reasonable to follow. The program provides case studies for you to work through, it is the fun bit like a virtual game, however providing good learning examples. However I am very familiar with computers and make sure that I keep up with current trends. This program may not be so easy for someone who is not use to learning in this way.
There are some aspects of the computer world I find quite frustrating, such as, trying to add new features to my blog. Working with computer programs can be very frustrating and time consuming, and at times even a waist of time. So how does someone cope who has never used a computer?

Yes all our students now currently use computers, however if the average age of a midwife is 45yrs old - it would stand to reason that there are some midwives that will find it very challenging to move to a e-learning framework.

Do all health professionals have a personal computer? do they like using a computer, do they all use email? do they know about Facebook, myspace, Internet banking, eBay etc...... there are so many areas in life that are influenced by technology, yet e-learning is very challenging. Is this because there are issues that may influence this such as: eye strain, concentration of looking at computer screen, do they actually learn in this way if they do not like this method. For some people interaction in its self enhances the learning experience.

We have many e-learning packages, such as: Breastfeeding modules, manual handling package, emergency preparedness and the list goes on.

Are we losing the face to face teaching? is there room for both methods? do we need to ensure that both methods of teaching are still available for our health professionals?

What are some of your experiences regarding e-learning?

How can we make the transition smoother for our less technologically minded colleagues?

Wednesday, August 20, 2008

What is Free birthing? please help answer the question!

In recent months I have heard this term used more frequently. This is a new phenomena for me, "Free birth" or "Free birthing". I am guessing it is the same as an unattended birth, meaning that there is no health professional present. Is this a correct assumption?

These are open questions in an effort to get some answers from the women who choose this option so that i can understand what freebirthing is, you don't know if you don't ask.

What is freebirthing?

What makes women decide to have a freebirth?

How common is freebirthing? Is it becoming a more favourable choice for women?

Are our midwives and obstetricians not meeting the needs of women?

How many women do you know who have had a free birth? or contemplating a free birth?

If anyone knows the answers to these questions, please feel free to comment.

Friday, August 15, 2008

Client Confidentiality: Is it time to use PDA's

A UK community midwife lost her diary that contained 350 names and details of all her clientele. As you are aware this could be catastrophic for some of these women. The hospital wrote to all the women apologising for the mishap and assured the women it was not their records however acknowledged how serious this incident was in terms of breaching client confidentiality. You might be asking is this easy to do? I can think of several high profile cases lately of leaked/lost information for example; what about the AFL footballers whose medical records were allegedly found in a public place, and politicians who have misplaced sensitive information/documents on the train. I am sure you will be able to think of many more examples.
We all acknowledge that confidentially is the corner stone of our Code of Ethics and we do our up most to protect patient/client confidentiality within the scope of our practice. No part of any patient/client records can be photocopied or taken home by nursing/midwifery staff. However community and independent midwives have a different set of rules, also in this category are Nurse Practitioners and Remote Area Nurses.

May be we need to embrace the technological age and we should be using PDA's (personal data assistants or organisers) - you can have it password protected and synchronised with your computer, personal and hospital. There are many different types and prices on the market, off course it means the hospital has to invest in the package deal for all computers/systems. The question is will they?

I know that Silver Chain Nurses use PDA's very effectively and to my knowledge have not had breaches with confidentiality and if you do misplace your organiser it is backed up to the main computer and password protected. I have also noticed more and more restaurants use them as well to improve communication and legibility for their staff.

I personally use a HP iPAQ 112 and find it brilliant, you can get all sorts of programs to upload, for example; due date and pregnancy progress; dictionaries, you can upload policies and have them at your finger tips etc. I also believe this is the way of the future, yes I know that there are very clever hackers out there but for the most part they are not interested in our health details, I hope this is not a naive view.

1. Let me know if your area uses a PDA?
2. What do you think about using a PDA?

Sunday, August 10, 2008

An Amazing Nurse

On the weekend my husband again became unwell - Metaphorically speaking Ian has an enormous heart and he has the constitution of an Ox. What Ian has to remember is that he does not have the strength of an Ox and physically he has a weak heart. It amazes me at the total lack of insight some men have and how quickly they forget how sick they once were. Also how they ignore the signs their body gives them, they just do not want to bother any one and feel like a fraud. Needless to say Ian was not in a good way. After being admitted and treated on the weekend he is again on the road to recovery and his heart is ticking over nicely. Now again we contemplate the life style changes we have to make.
I will take this opportunity to say that Ian received wonderful care by all the nurses that attended to him. However this blog is about an amazing nurse I met during this time. My first impression of this nurse was "gosh you look a bit old to be working in coronary care" it just goes to show you that first impressions are not always the best, it is better to reserve your judgement. As my husband was showering I had the opportunity to talk to this nurse, her name is "Mary" (a pseudonym) she is 67 years old, at a guess I would have put her at 60. Mary is small, trim, sprightly she has auburn coloured hair, not one grey hair and she is amazing. Mary was forthcoming with information and enjoyed talking about her life. When I asked Mary why she was still working she said "I am working to help pay my grandchildren’s HECS fees, and I love the social interaction". Her husband died 20 years ago, and her life is dedicated to her family and work. Mary admits that she would not physically be able to work in elderly care or surgical/medical wards as it would be to physically difficult. Mary says this job is perfect; I am mentally very alert which I need to be for this position however it is not to physically demanding. Mary works full time for 6 months of the year and then for the next 6 months (unpaid leave) she does volunteer work for Médecins Sans Frontières (Doctors Without Borders) working in war torn countries (MSF). This work has taken her to many countries, such as, Uganda, Congo, Tanzania, Ethiopia, China, Afghanistan. India, Sri Lanka and a few more I cannot remember. The few stories she shared with me were heart wrenching, such us the women from Afghanistan live a life of hell, the immense poverty in China, and the thousands of children that suffer in all these countries, and that is why she goes back to make a difference to these children’s lives. Providing basic nursing care, immunisation programs, health education and setting up AIDS clinics. Mary said “it is amazing what you remember when you have to, about your nursing training, every day presents a new challenge and there is certainly not as much paper work”. “It is always good to come home to Australia, I am glad I live here it is the land of opportunities”.
I was truly impressed by this woman’s endurance, and passion for her work. I found her an inspiring woman.

If you want to know more about about volunteer work follow the link below.

Tuesday, August 5, 2008

My experience of an unplanned homebirth – Mother, Nanna, Midwife

The birth of Isabella Rose, my granddaughter 19/07/08

If you are following my blog you will be aware that my daughter Faye was due in July. Faye was now 5 days over her due date, she was drinking raspberry leaf tea three times a day, eating curry, walking and trying various other methods of trying to get into labour, which will not mention on my blog.
It was Friday evening I was going over to see how Faye was, it was a real winters evening, dreadful, cold and wet. I got to Faye’s to find her upset, very emotional, teary. Brendon (her husband) had been outside in the dark, wet night trying to fix the shed roof, as it had blown off in the storm. Little Dylan was pestering mummy to go outside and help daddy; it was all a bit much for Faye, she was much stressed and rightly so. Brendon came in and decided that the shed could wait, Faye went off for a long hot shower, I started dinner, Brendon finished it and Dylan was playing in the lounge, the house was back to normal.
We had a lovely dinner, settled in and watch some telly. I had a listen to the baby with my Doppler, her head was well down, and it would not be long now. I went home about 1030pm. I had a sixth sense Faye would go into labour, I stayed up on my computer till about 0130ish and gave up on the idea of a birth and went to bed.
The phone rang at 0300, it was Faye saying “mum my contractions have started, can you come over”. I jumped out of bed, woke the rest of the house up, my husband Ian and step daughter Kirsten (18yr) and we all went off in the car. It took us about 20mins at that time of the morning to get to Faye’s house.
When I got there Faye had just got into the bath, she had woken up with contractions at 0245hrs, and had two really strong contractions when she had called me, and up until then she had been asleep.
I added several drops of Clary sage to the bath water to assist with the contractions. Faye was contracting about 2:3:10, they were irregular in strength she was complaining her back was exceptionally painful. On palpation the baby was LOA, head well down, fetal heart was within the normal range, membranes were intact, and all was well, progressing normally. Dylan was asleep, Brendon was getting drinks for everyone and Ian was watching the golf. I had briefed Kirsten that she would be my record keeper.
As I was watching and talking to Faye I noticed her contractions although irregular were very intense and I got the sense that things were progressing quickly, it was now 0345 and she was contracting 4: 10, still in the bath, the water was very therapeutic for Faye it helped her back pain enormously. The fetal heart was 140bpm before, during and after the contractions. Then there was a spontaneous push, Brendon asked was it time to ring the birth centre? Faye got out the bath, and walked around, and with every third contraction Faye spontaneously pushed. Brendon rang the birth centre to advise them Faye was contracting, however I told him I didn’t think we would make the birth centre as I thought Faye was fully dilated. As Brendon was talking on the phone, Faye’s water broke at 0430, it was clear liquor, I then examined her to confirm she was fully dilated head was plus 3 spines. We were going to birth at home. Brendon told the birth centre and then called an ambulance so that I could have some back up if required for the baby. I also got Kirsten to call my friend Lorraine (who is also a midwife) who came to back me up, and Faye & Brendon know Lorraine so they were also happy. Kirsten stripped the bed, Brendon put towels on the heater, and we were just waiting for the baby to arrive. Faye was doing so well, fetal heart was good throughout. The ambulance crew arrived, and asked how long it would be? I said about half and hour at the most, they did not know about birthing and were very happy for me to continue, they put some blueys on the bed, bought in the delivery pack and then went to talk to my husband, whilst Brendon, Kirsten (who was doing the record keeping) Lorraine and I supported Faye. We were all in the en-suite of the bedroom, Faye was leaning over the sink, contracting, irregularly, every second contraction was strong, Faye pushed very well, the vertex (head) was advancing well, she crowned at 0450, head was then born, Brendon said “the baby is trying to breathe is that OK?” next push the body was out, Isabella cried as soon as she was born & did a poo (passed meconium), at 0455, I passed the baby to Brendon, he caught his daughter, we turned Faye around and she walked into the bedroom and climbed up on the bed, we were waiting for the third stage, the placenta, Faye was cuddling her baby, Isabella was crying she did not want to come out, she rooted to find the breast, it was beautiful to watch. The placenta was delivered, Faye had started bleeding, and her uterus was boggy, so I rubbed up a contraction until it was firm, we put the baby on the breast to encourage her uterus to contract, Faye’s uterus relaxed again, so I rubbed up another contraction. I asked the ambulance crew if they had oxytocics and they said they don’t carry them. We made the decision to transfer into the Birth Centre (FBC) as Faye needed the oxytocics to help contract her uterus. Faye had a small labial tear that was not bleeding and she had passed urine not long before the birth. So we put the baby, skin to skin with mum, and warming blankets on top, I kept rubbing up for contractions, and encouraged the baby to breast feed.

Once we arrived at the FBC Faye received the oxytocics and her uterus contracted well, and she went home again in 5 hours. All was well.
Birth is not an emergency: it is simply an emergence
Jeannine Parvati Baker

On refection, it was a 2 hour labour; Faye said once she had the first two contractions she thought this would go quickly & thought she would not have time to go to the FBC. Brendon was not phased as he and I were with Faye for Dylan’s birth and Brendon felt it was all under control, Kirsten felt traumatised as she had not experienced a birth before, (good contraception for her) however she did think it was great birth. Ian (pops) enjoyed watching the golf.
I was surprised the ambulance crew do not carry oxytocics. I am very proud to have helped Faye again birth her baby and at home, even though it was an unplanned home birth. I would like to have had an oxytocic at home to give to Faye, then she could of stayed at home, but then it would be a planned homebirth and I would have to be an independent midwife. This then raises the question of indemnity insurance or lack of it for independant midwives and I could not work with out insurance.
Thank you Faye & Brendon for sharing and allowing me to support you during this very intimate time, it has truly been a pleasure and a real honour. I am humbled by the experience. The highlight of my career is to assist my family through labour to achieve the birth they want.
If mothers have an instinct to give birth, midwives have the impulse to assist them” Jeannine Parvati Baker

Dylan with his baby sister Isabella 2hrs after the birth.

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