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.

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