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.

Saturday, August 2, 2008

Reflections of an unplanned Homebirth:

Jodie is a 32yr old woman in a stable relationship, and she is my daughter-in-law. She is intelligent, street wise, determined and very much the feminist. Jodie had read and watched everything possible about pregnancy and birth to be well prepared and make informed choices about what she wanted for her birth. I remember talking about a homebirth for her first pregnancy, but being a first baby you are always a little cautious and opt for what is perceived as the safest option. The next best thing then is a Family Birth Centre, home away from home. Jasmine was born after labouring at home (shower) and going into the Birth Centre at 7cm, a beautiful vaginal birth and perineum intact, no complications, baby breast feeding. Mother and baby where home again within 24hrs. Three years later along came Talia. This time things were more relaxed, everyone knows what is going to happen, not sure what happened to the idea of a homebirth it was floating around but never eventuated. Again Jodie laboured at home (shower/bath) and we went into the Birth Centre at 8cm, very much the same birth as previously. After this pregnancy it was decided that this was it, no more. If I had a dollar for every time I’ve heard that before I wouldn’t have to work.
Needless to say Jodie was pregnant with no 3: and Talia was 4mths old. Did they have their work cut out for them!
Jodie contemplated a homebirth but it was all too hard to organise, she was tired of being pregnant, didn’t want to be pregnant again, busy running after two children, so organising a homebirth just did not happen. Also the thought of having to pay $3000.00 when you have reverted to a single income family was a serious consideration, as balancing finances is difficult. By now Jodie was very familiar with the process of childbirth; she was comfortable with her body and knew it intimately she had every faith the baby would come and everything would be fine. They booked into the Family Birth Centre and the pregnancy progressed normally. We had planned our long awaited holiday which coincided with the birth of two of our grandchildren. We asked them to wait for us rather selfishly really, but what the heck, you can only ask. Jodie’s babies always came a little earlier, so I was not surprised she birthed before we came home.

When we came home, Jodie told me her story, this is
The Birth of Samuel James:
Jodie had felt pressure for a couple of days and she knew she was ready, contractions were on and off. Jodie had sent a text message to us in York UK to say she thought that labour was beginning: from that text I was on tender hooks, I called her and she said “the contractions were irregular, but it was beginning” and so it did. Jodie felt the labour “started and stopped, started & stopped”, she could eat her dinner through the contractions. She decided to go to bed to try and get some sleep, she dosed but was uncomfortable.
The contractions were irregular up until about 20 minutes before Samuel was born. The last contraction that she timed was 13 minutes apart, before that one, it was 5 minutes, and before that 10 minutes. Then the contractions were overwhelmingly close together, one after the other with barely any break. Jodie woke Danny up, asked him to call her Mum (Nat) to come over to look after the girls. Danny went to put their bags in the car and move it. Jodie knew it was going to be a rush to get to the birth centre when she asked him to call her Mum. Jodie was sitting on the edge of the bed; “I thought, God I can’t get up, I need to push” She got up and walked into the bathroom. Danny came back inside, she told him to call the birth centre and she remembers saying, “tell her he will probably be born in the car, no, no don’t tell her that”. The Birth Centre midwife talked to Jodie for a while on the phone, this really did not reassure her. Jodie now felt the urge to push and told Danny to phone an ambulance and at this point opened the door for his mother-in-law. First push the waters went, Jodie sat down and pushed, the head crowned. Nat went straight into the bathroom, to find Jodie on the floor pushing, the head was crowing – Nat helped to make Jodie more comfortable. Jodie describes it as “first push the waters broke, second push half the head out knickers off, third push whole head out, fourth push body out then, he (the baby) peed and cried straight away” four contractions in a row, that was it!
Jodie, “I lifted him onto my chest, waited a few minutes to catch my breath” “I asked mum to hold him, as I moved upwards to get more comfortable, we both moved in different directions. The cord snapped like an elastic band, blood squirted in my face, when I realised what happened, I called out the cord and grabbed his end between my fingers, there was about 4 inches left, at no point did I think about the other end of the cord. I will never forget that sound - ping”
The ambulance crew had now arrived; Jodie felt they did not look at any blood loss. The placenta was still in “I could feel myself oozing blood”.
Jodie and the baby were then transferred to hospital.
Jodie says “I was surprised at my own reaction, Samuel, born in the bathroom, and that’s that”.
A rather nonchalant attitude of a woman who knew birthing is a normal process.

I asked Danny how he felt, “It scared the shit out of me” “I was disbelieving of the event, this can not be happening to me” “Pauline the only birth there is no midwife in attendance the whole time and we have him in the bathroom” Danny did say that he was “pleased how it turned out, spun out that Samuel was not intended to be born (as he was not planned), so it was apt that he was to be born at home”

I also spoke to Jodie’s mum Nat, about how she felt about the sequence of events, and on reflection Nat said “it takes 12 minutes from my house to Jodie’s, I thought, Ok, I just have to be around, I can do that” “I wish I had more time to prepare, blankets, towels, etc for the baby, it all happened to quickly, I didn’t even have enough time to take my coat off”. “Jodie was wonderful”, when I think about it now, I can smile, but at the time I just couldn’t believe it”. “It was good to have a glass of red and collect my thoughts after they had all gone to the Birth Centre” “thank goodness the girls slept through it all”.

Jodie’s birth reminds us of how important mental attitude is to the birthing experience. When women trust their bodies and the natural process of birth they are intuitive and sensitive to the process of birth. Women intuitively squat, or lie down in a quiet place and spontaneously push. Jodie believes that the birthing process is normal and that all will be well.

Congratulations Jodie for allowing Samuel to be born in the way he wanted to be born.

“Just as a woman’s heart knows how and when to pump her lungs to inhale and her hand to pull back from fire, so she knows when and how to give birth” Virginia Di Orio

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