Thursday, January 28, 2010

Meeting Kevin Rudd - The Hon Prime Minister of Australia

not a good photo of me....but it had to go on the blog.....

Yes it was good to be invited to the Australia Day Celebrations at the Town Hall on Thursday 21st January. I bought a great pair of new high heel red shoes to wear for the occasion...together with my pearls, I was set to go... by the end of the evening my feet where killing me as we had been standing for several hours....

Over 400 hundred guests were present, there was a welcome to country and the Prime Ministers speech.....the guests included members of parliament, multi denominational religious dignitaries, associations, unions, volunteers, hospital and health officials....... too many for me to mention, however a mixture of peoples. We were greeted at the door by the Hon Kevin Rudd, he held out his hand and said “hello I’m Kevin”...... not what I was expecting and on his right was the Hon Colin Barnett. It was all so surreal, the hall was very hot, the drinks were flowing freely and people mingling and talking, it was great....

We met the Federal Member for Hasluck Ms Sharryn Jackson MP, I had recently sent Ms Jackson an email, asking her what her position was on Homebirth, MBS, PBS and Midwifery models of care.

We were also fortunate to meet the Hon Nicola Roxon, the Minister for Health and Aging, what a delight Nicola is.... we spent quite some time discussing the issues surrounding midwives and midwifery... the take home message for midwives: was to work together, all come from the same page and support each other, which also means supporting the Australian College of Midwives who is actively fighting for the rights of the midwife in Australia.

I enjoyed the evening particularly networking and spreading the word about midwives, midwifery and all facets of our wonderful some people who did not know what it is we do....I feel it is on these occasions we are able to spread the word and hopefully make a difference.....

Wednesday, January 27, 2010

Fetal monitoring (CTG) made easy for the pregnant woman.........

A few basics about fetal monitoring, cardiotocograph (CTG).... what every woman needs to know about CTG; you only need to be monitored if you have a problem, there needs to be a medical reason for you to be monitored. Normal healthy low risk women do not need continous monitoring.

What is monitoring...well it is listening to the babys heart rate, that is having a CTG attached, this entails a toco to measure uterine contractions and a transducer to pick up the fetal heart beat. No admission CTG needs to be conducted unless there is a medical reason for doing so. You can have intermittent monitoring, where the midwife will listen with a Doppler and or pinnard, however the guidelines do say if you use a pinnard to use a Doppler as well so that the woman can also hear the baby's heart rate... it is reassuring for her.
What are some of the reasons to be monitored: breech presentation, antepartum bleeding, diabetes, prolonged rupture of membranes, pregnancy greater than 42 weeks, big or small baby, polyhydramnios (too much liquor/water) - oligohydramnios,(not enough liquor/water) multiple pregnancy, previous cesarean, pre-eclampsia, reduced fetal movements,changes in labour, or some medical condition in labour....

Before the CTG is commenced it is important for the midwife to take your pulse rate to compare it to the babys baseline to ensure they are not the same. Also your blood pressure needs to be recorded...

What the midwives are looking and listening for is that the baby's heart rate is between 110 - 160bpm and that the heart rate does not go below 110bpm... if it goes below 110bpm it is called a deceleration and we do not like to see this happen, it is not considered normal.
As the baby moves in utero the baby's heart rate will go up, due to his/her movements and it shows normal oxygen levels this is considered normal, this is called an acceleration.

The other consideration of a CTG is the variability, this is the most important factor, in simple terms variability is the saw tooth looking part of the trace if it is between 5-25bpm the baby is well oxygenated and you don't have anything to worry about. However baby's can sleep for 20-90mins whilst being monitored and the variability will be reduced that is less than 5bpm, so the trace will not look like a saw tooth... it will be flatter, if this lasts longer than 90mins then it needs to be investigated further... flat lines on a CTG are never good... and needs immediate intervention especially if there are decelerations as well.

Lets revise some facts: normal baseline 110-160bpm
The time to be concerned is when you have reduced variability, decelerations, and long decelerations....
accelerations are usually good... when you are in labour you do not need to see accelerations but should have good variability.

Continous fetal monitoring is not required for 'low risk women' however it is important to assess how well the baby is doing through labour. This can be done by intermittent monitoring.....pinnard and or Doppler every 15-30 mins once you are in established labour and every 5 mins in second stage of labour.....

Point to remember if you are ever concerned about the CTG speak to your midwife and ask her to explain what is happening..... always ask the question.

RANZCOG guidelines for fetal surveillance

The normal CTG has the following features:
• Baseline rate 110-160.
• Baseline variability of 5-25 bpm.
• Accelerations 15bpm for 15 seconds.
• No decelerations

The following features are unlikely to be associated with significant
fetal compromise when occurring in isolation:(RANZCOG)
• Baseline rate 100-109.
• Absence of accelerations.
• Early decelerations.
• Variable decelerations without complicating features.

The following features may be associated with significant fetal compromise
and require further action (RANZCOG)
• Fetal tachycardia. (fast heart rate over 160 bpm)
• Reduced baseline variability.
• Complicated variable decelerations.
• Late decelerations.(after the contraction)
• Prolonged decelerations.(greater than 3-5 mins)

The following features are very likely to be associated with significant fetal
compromise and require immediate management, which may include
urgent delivery (RANZCOG)

• Prolonged bradycardia (<100 bpm for >5 minutes)(RANZCOG)
• Absent baseline variability.(flat line)
• Sinusoidal pattern.(wave like pattern)
• Complicated variable decelerations with reduced


Tuesday, January 26, 2010

CTG - Case study what would you do?

A gravida 2 para 1, 22 years old, uneventful pregnancy however in the last week developed high blood pressure: today not feeling well, visual disturbances and 1+protein in her urine, PE bloods taken, waiting results:
For Induction of Labour (IOL)@ 40 weeks.
Last baby spontaneous vaginal birth after an 8 hour labour, perineum intact.

admitted to ward at 1400hrs pre prostin CTG, normal reactive trace.

CTG recommenced post prostin 2mg @ 1600 hours..... describe the CTG and what action would you take...... what are your options and the womans options?

Tuesday, January 19, 2010

Homebirth Study: creates furore in the press

The Maternity Services Review has sparked a debate about Homebirth and independent midwives or private practice midwives. By refusing to indemnify this group of health professionals and which virtually outlaws homebirth.
Instead of bringing the obstetricians and midwives together the decision by the Government not to indemnify private practice midwives has created a war between the AMA and Midwifery Profession.

The newspapers are all sprouting the new SA Homebirth study "New Study Confirms High Risks Of Home Births" which is not supportive of Homebirth, however skewed the study may be... here are a few headline examples as a result of the study: Tightening Of Homebirth Laws Recommended: and

Women warn they'll risk birth without midwives
MANY future mothers say they will give birth at home without any medical assistance if proposed changes to maternity services proceed.

It is interesting that Dr Pesce quotes
"But, given the accumulated evidence from Australia spanning 30 years, facilitating and funding home birth in an autonomous setting would be contrary to the principles of evidence based health administration".

Now that is a farce......this study clearly is not accurate, there is no evidence that these planned homebirths were under the care of a registered midwife between 1991-2006 (fifteen years) and it is a retrospective population based study, that is low evidence. Why is it that evidence is not used by our learned colleagues in relation to our high cesarean section rate.... or why has the AMA not taken any notice or even commented on this newspaper article "Cesarean births risk mums' lives"
maybe it has something to do with the fact midwives have nothing to do with the increase in the cesarean section rate and we are not threatening their income in this instance...... however it is a different matter when it comes to homebirth even though less than 1% of the population have a homebirth.
It is rather funny that this evidence is being manipulated to suit the AMA......

At the end of the day it comes down to power and living in a patriarchal society. It is every woman's right to choose where and how to birth her baby, given informed choice and free from coercion.

Is this the future for Australian women......Why did hospital send the police to my door? The hospital wanted this woman to be induced....she was not quite sure and not ready so she missed her appointment...the woman was being cared for by a private practice midwife and was a planned homebirth.... so the hospital sent the police to ensure she was safe and not birthing at home......what is happening to Australian women's autonomy?

Here is a story of a "Freebirth" I found on mystic wick forum, if you don't think Freebirth happens read this story....And this is the birth story of Marley, born Feb this year
There are many stories like this one, the Australian Maternity system is letting women down, it needs to change......

Homebirth is not a crime, it is a choice!

Friday, January 15, 2010

Being a Midwife, two very different cases:

Its days like today you remember why you are a midwife. I had the pleasure and privilege to support a couple at birth with a great team of midwives who all in their own way added to the wonderful experience for the couple during the day. As I walked in the room the woman had an epidural in and was kneeling on all fours there was an air of serenity, peacefulness and expectation. This was the couples fourth child, they were so in love you would think this was their first baby. The woman was tall very attractive quiet and confident. The husband was short, ordinary in appearance quietly spoken, at first glance you might wonder what attracted the pair to each other they seemed so different. Yet it would only take a few moments to see why this was such a dynamic couple, they were so in tune to each other, a mutual respect, he was devoted to his wife and she was listening intently to her body.... it was beautiful to observe, it wasn’t so much what they were saying it was how they were with each other, the unspoken word..... The touch, the silence, the unity, the support from just being there from the husband without saying a word.... and the inward journey the woman took to be able to gently push her baby out and without tearing. It was a superb birth of a gorgeous 10.11 lb (4855gm) baby girl, who cried as soon as she was born. The parents were delighted with their prize baby and mum was very pleased with how her labour and birth went, she was beaming from ear to ear.... she looked beautiful as she cuddled her baby against her skin. It was no surprise when the family came to visit that the children were delightful, they came in with flowers excited they could hardly contain themselves, yet they did, they were so caring towards their mother, smiling constantly and in total ore of their new baby sister, they all sat around their mum and talked about the birth and dad hovered around busy taking photos as mum breast fed the baby...... I was truly touched by their closeness, unity and obvious love for each other.

My second case was a 16 year old at 38 weeks feeling unwell with symptoms of pre-eclampsia. Some 16 year olds are just too young to have babies, they are babies themselves, they can be challenging and this one was. I wonder if not enough education about what is actually happening to them in pregnancy is part of the problem or if when they do get the education they are not listening and don’t take it all in. However in my experience this age group can be difficult in any health setting. The girl was also needle phobic and was promised numbing cream....She was supported by some friends and her mum was en route...... and she wanted her mum understandably however I did ask the question did she want her mum there at conception... this did raise a smile and said no...her admission CTG was reactive (meaning normal) and she was maybe having some tightening, her blood pressure was boarder line.... and she was sent to walk around to see if that would encourage some contractions whilst awaiting blood results. The decision based on the blood results was to have an induction of labour, so after explaining the process to her...... the course of action was set...... a vaginal examination, prostin gel 2mg and CTG for 30mins, then wait for labour to commence, reassess in 6 hours, more prostin or Artificial Rupture Membranes. There were times I felt that this young woman did not understand some of the issues discussed, and this was confirmed when I helped her to the toilet and she asked me to explain again what the doctor had said.....which I did and hoped she had a better understanding of the issues. Seems straight forward, however nothing goes according to plan...... 5 mins after putting on the CTG post insertion of the prostin, she started to have decelerations, one after the other....I called for help....there were no obvious contractions.... the doctors were in attendance....we attempted to wash the prostin out using a saline wash, which did improve the trace, however we ended up going to theatre for an emergency Cesarean section approximately 15 mins later. It took some convincing to put the IV cannula in... due to the needle phobia.... but there was success...This is the first time in my years of midwifery that I have seen such a reaction to prostin gel.......yes it can happen sometimes the baby just does not take well to these things. The end result was a beautiful baby girl weighting 2710gm, mother and baby well, and her mother made it to support her in theatre and help with the baby..... This young girl has a lot of growing up to do, I am sure she is still in shock and the reality will hit in a few days. it is a shame to have very little understanding of the process of birth.....I am pleased that she will have time to adjust and will have help with mother crafting before she goes home, it is fortunate she has a very supportive mother and I suspect that the mother will be doing a lot of the caring of the was nice to see the family together.... mother, baby and grandmother.....
All’s well that ends well...... thank God.....


Wednesday, January 13, 2010

Seeing Red - the use of the word "midwife"

Now I have seen & heard it all.... This is an interesting concept, a "Postpartum Doula", I am not sure this is the most apt title for them.

what infuriates me more is to see the words midwife and doula interchanged - yes I know this is an American article and YouTube..... but its time to be weary....when you see this sort of article.....
"Doulas can be two types, the mid-wife who assists the birth of your baby and the doula who assists with all the non-midwifery work"

What does this say?
It makes no difference if the word mid-wife is hyphenated or not... it still intimates a 'midwife' which indicates a professional status, a level of education and qualification, which the doula does not have in terms of midwifery or as "midwife". In Australia it is against the law to use the term 'midwife' if you are not a qualified 'midwife'.

The word doula comes from Ancient Greek δούλη (doulē), and refers to a woman of service as a slave.My understanding of a Doula is an assistant, someone who provides non-midwifery, non-medical support to a pregnant woman more physical and emotional support. They may begin in the antenatal phase through labour and in the postnatal period. the postnatal period would be as support, errands, housekeeping, cooking and childcare.... but no medical or midwifery input.

The 'midwife' is still responsible for the woman for up to 6 weeks postpartum. Yes i think that the "postpartum doula' has a place in society but use a different title because if you are working beyond the 6 week period.... you are assisting with newborn care and parenting issues or the transition to parenthood... this then becomes the early childhood period...

The roles of a Doula need to be clearly defined and the consumer/woman needs to fully understand the difference between the roles of a doula and a Midwife.

Definition of midwifery from Wikipedia: Midwifery is a health care profession in which providers give prenatal care to expecting mothers, attend the birth of the infant, and provide postpartum care to the mother and her infant including breastfeeding.

International Confederation of Midwives definition of a Midwife:
A midwife is a person who, having been regularly admitted to a midwifery educational programme, duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practise midwifery.
The midwife is recognised as a responsible and accountable professional who works in
partnership with women to give the necessary support, care and advice during pregnancy,labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.
A midwife may practise in any setting including the home, community, hospitals, clinics or health units.

Sunday, January 10, 2010

another post relating to Freebirth......

I am wondering is the rise of Freebirthing or unattended childbirth two fold... one women are not being heard... and secondly they are taking matters into their own hands, that is making their own decisions... without medical advice. This may be because once they seek medical advice they are bullied or made to feel guilty that they choose to do it alone.....
Unfortunately it is when things go wrong that everyone sits up and takes notice..... I can blog till the cows come home as to how unsafe Freebirthing or unattended childbirth is.... but until something goes wrong... no one is really going to listen or do anything.... and that is the tragedy....every thing seems easy and 90% of the time it is.....however life is not that clear or easy....

I have to agree with Regina's post on The Fun Times Guide Pregnancy site.... where she intimates the Freebirth figures are pretty scary.

No one has answered my question as to how do we fix the problem? is there a solution? or do we wait for infant and maternal mortality to rise first then act?

Thursday, January 7, 2010

This is inspiring...... Randy Pausch "The last Lecture"

I have watched the You Tube video and read the book.... and I have found it sad and inspiring so much so that I thought I would share it.... I also show my students this clip and when i feel that life is not going to plan, or I get despondent, I play it again to remember what my dreams and passions are so that I can continue and achieve them.
Randy Pausch Last Lecture: Achieving Your Childhood Dreams

Tuesday, January 5, 2010

An interesting perspective on Freebirth:

Basil from my garden:

Surfing the net as I do, I often come across some very interesting stories...this one made me think more about how some women feel about Freebirth...(birthing without any health professional present) however even though I can understand the choice these women have made... I still can not comprehend the fact that women will choose to birth without a midwife.

this quote was taken from: Women giving birth at home without midwives
When Jennifer Margulis went into labor with her fourth child, she sent her husband off to take the kids to school, then waited at home for her body to do what she felt confident it had evolved over millions of years to do on its own.
There was no rushing to the hospital, no midwife, no EMTs. Just Jennifer and her husband, home alone, giving birth.
"I think a lot of people think a woman who would want to have an unassisted birth would be a little bit crazy," said Margulis, who holds a Ph.D. in literature, and is a contributing editor for Mothering Magazine. "I think I may have had that reaction as well. I am definitely not a crazy person. I am a very educated, thoughtful and caring person. I am not a person who takes a lot of unnecessary risks. The whole point is it is not risky if you do your homework."

I would really like to know what 'homework is done' I am sure that there is a lot of information.... but if it takes a Bachelor of Midwifery student 3 years to learn how to be a competent Midwife and a Registered Nurse a further 12 months as a post graduate course or 18 months if in Europe to be a competent midwife - how is it that women think all it takes is a bit of homework to be able to recognise when things are going wrong with a birth where medical intervention may be required for both the woman and baby......

I appreciate that many women may have fallen foul of medical intervention which has scared them.....however I firmly believe that Freebirthing is not the answer.... a more collaborative approach is required with more flexibility from our health professionals and hospital system.... rather than a fear factor or paternalistic approach.

I would like introduced into Australian legislation the clause that is in British legislation which makes it illegal for a midwife to refuse to care for a women who choose to have a homebirth and they may be considered "high risk" are supported by a midwife... and the midwife is protected by the legislation and has support from her supervisor of midwives ( we would have to introduce a similar system here) and all care is clearly documented if required for legal reasons, therefore protecting the woman, baby and midwife...

I have been practicing midwifery for many years... and I have to say that every birth is unique, special and at times unpredictable.... however I am so acutely aware of what is normal that when things begin to become abnormal it is like a sixth sense for me.... how do women who are freebirthing understand this or even begin to think they know when often times it can be a total surprise.... the difference being that if recognised early enough help can be close at hand....Yes I also am a firm believer of a woman's body knows what to do and how to do it.... but as we all know this doesn't always go the way it is meant to do... years ago we had a much higher childbirth morbidity and mortality rate and why was that, in a nutshell, women hemorrhaged and infection was high on the list. This has been reduced why, because we are better educated, we know more (through research) and have better treatments. This brings with it higher expecations.... that everything will be normal.... and yes 90% of the time it is.... but I would not want to be in that 10%.

A sad reflection is that Freebirth is on the increase, although it is difficult to prove this fact. This therefore means as health professionals we are failing women and not respecting their choice, we need to re think this whole position....

Please help me understand why some women think it is best to have a freebirth...

New website for Nurses & Midwives to navigate: Changes for 2010

The year has began and for me it is going to be a very busy year with all the expected legislative changes affecting Nursing and Midwifery for Australia with National Registration being one of them.

The Australian Health Practitioner Regulation Agency Website:

This will be the website for updated information relating to National Registration for July 2010.

Here are some key points from Louise Morauta Project Director:for the full report see Australian Health Ministers’ Advisory Council
National Registration and Accreditation Implementation Project

The national law has now been passed in Queensland and adopted in New South Wales and Victoria. The adopting legislation has also been introduced but not yet passed in Tasmania, ACT, and NT. What is happening to WA? we have to wait until Parliament re commences for the New Year. The expectation is that the legislation will be passed in all jurisdictions in time for commencement day on 1 July 2010.

The boards commenced work with their first meeting on 20 September 2009.
Work commenced in November on the data migration project which transfers information from the existing boards to the new national boards.
The Agency announced Martin Fletcher as its inaugural CEO on 18 September 2009.
Martin commences on 21 December 2009.

Nursing and Midwifery Board of Australia

From 1 July 2010 Nurses and Midwives across Australia will have to meet the same requirements to be registered and their registration will be recognised in all States and Territories. Wow I have been waiting for this for about 20 years... that's a long time for change to occur......these things move very slowly and this just proves it.

The Board was established under the Health Practitioner Regulation (administrative arrangements) Act, 2009. From 1 July 2010 the Board will operate with its full range of functions under the Health Practitioner Regulation National Law (the national law) where adopted in a jurisdiction.

Members of the inaugural Nursing and Midwifery Board of Australia were appointed by the Australian Health Workforce Ministerial Council for a period of three years on 31 August 2009 and here they are if you don't already know.

Ms Gillie Anderson - Appointed as a community member
Ms Angela Brannelly - Appointed as a practitioner member (registered nurse and midwife) from the Northern Territory
Professor Elizabeth (Mary) Chiarella - Appointed as a practitioner member (registered nurse) from New South Wales
Ms Anne Copeland - Appointed as Chair and a practitioner member (registered nurse and midwife) from Queensland
Dr Lynette Cusack - Appointed as a practitioner member (registered nurse) from South Australia
Professor Denise Fassett - Appointed as a practitioner member (registered nurse) from Tasmania
Mrs Lynne Geri - Appointed as a practitioner member (enrolled nurse) from Victoria
Ms Louise Horgan - Appointed as a practitioner member (registered nurse) from Western Australia
Ms Mary Kirk - Appointed as a practitioner member (registered nurse and midwife) from the ACT
Dr Christine Murphy - Appointed as a community member
Ms Heather Sjoberg - Appointed as a community member
Ms Margaret Winn - Appointed as a community member

There are some familiar names here for me and I even know a few....don't know what that says about me....for that's enough information.... keep watching for more...

Friday, January 1, 2010

My year according to the horoscope: Leo

This year has started well.... a great clinical shift today lots to reflect on but will save that for another day.... however as I was browsing the Newspaper on my break this evening I pondered on my horoscope according to Tanya Obreza in the West Australian star was split into three categories, soul purpose, overview and love and went something like this?
Soul Purpose for 2010: leadership;

After years of hard work...the planets are aligned and you are now happy...and they are planing big things for you;.. you are a 'go and get it kinda person' just as well as there are a number of projects on the horizon for you... you have leadership qualities and you will lead by example and be recognised for your work... the most interesting bit was the love and sex....Jupiter plans a year long stay in my sector of sexuality...whatever that means...but sounds exciting...not sure where I will get the time from though... Pluto sends a romantic tremble through the work place... these plants are all rather busy... some foreign involvement...oh I almost forgot the 'treat yourself to something naughty but nice' em wonder what that might be....any clues?
I did then go on to read Ian's and his was exciting too....
It was a pleasant tea break wondering how many other Leo's have read this horoscope and feel excited about the coming year....emm now how many Leo people would this apply too.... is it possible that they will all achieve this sort of year... maybe now I am being the sceptic.... it is all in good fun and if it encourages some enthusiasm then i am all for it... it made light reading for my break and I felt good....I was excited about the year before I read the stars but this confirms my thoughts..... its going to be a good year....

ref picture:

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