Allowing women to make their own decisions......

Here is the follow up to the Empowering women - not as easy as you think scenario

....the woman is GBS positive with query ruptured membranes....she has commenced IV antibiotics, the advice given to her by the doctor is to be induced immediately 1700hrs....as the doctor feels she will not go into labour on her own...she is currently contracting 1:10 mildly. After being given all her options by the midwife....

The woman chooses not to be induced until the morning and goes against the medical advice given (this is all clearly documented).... she does choose to stay in hospital and wait until the morning.... her hope is to go into normal labour.... the outcome of this scenario is that the woman continued to walk around, eat, drink and no monitoring, until in established labour.... she progressed into normal labour and birthed at 0739hrs that morning....an assisted birth....

This was a good outcome by a woman who knew what she wanted and was willing to standby that decision despite the advice given by the doctor....she determined the risks and made her mind up with the information given... together with what she had anticipated for her birth (her birth plan was a natural normal birth) and an induction of labour was not in that plan (as it meant, restrictive movement, monitoring) however she made the best compromise she knew how..... to achieve what she wanted..... well done... congratulations......

Empowering women - not as easy as you think

Thoughts to ponder on!

There are times it is difficult empowering women.... there is a fine line that you walk and the only way I find to walk it is to be true to yourself, let go of your ego and just state the facts and what you see.

As any midwife knows there are always two sides to a treatment and this is where the fundamental problem arises, because you can have several responses from the woman, and you as the midwife have to know which way the woman wants to go.....and often you will sense that...

Often women only get one side of the treatment, often a paternalistic point of view. Not that a doctor consciously chooses that, it is what the doctor feels is in the best interest of the woman... now how he puts across that treatment option is often to sway or dis empower the woman to his way of thinking rather than giving the woman the complete facts and allowing her to make that decision. Now why is that?

The second option of course is that the woman does get the compete treatment option from the doctor and then says "I don't know what to do, you make the decision"? now I understand this option and I can live with this option.... it is the first option I have problems with...here is an example....

A woman comes in with a query rupture of membranes...40/40 (she is due) not a convincing history of her waters breaking...she was lying in bed, knowing she wants to go to the loo.... gets up and feels a gush of fluid but she is unsure her waters have broken.... she waits several hours.. and then calls the hospital.... she is asked to put on a sanitary pad to see if any water leaks and come in to be assessed. She arrives several hours later, her pad is slightly wet so she is asked to lay down for 20 mins to see if any water is leaking (amniotic fluid)... the woman has an assessment...the fetal position is LOA, presentation-longitudinal, position-cephalic (head down) head ?3-4/5 palpable..(a high head) and a speculum examination is performed to see if there is any water pooling.... there is none...she then has a real time scan (ultrasound) which shows reduced amniotic fluid.... and on reviewing her notes it is noted that she is GBS positive... which means she needs IV antibiotics in labour... the woman is contracting irregularly 1:10..it is now 9 hours since query rupture of membranes....and early evening... the doctor recommends induction of labour (IOL)due to GBS positive, high head, and irregular contractions..... the woman is unconvinced... but her questions are dismissed by the doctor.....when the midwife attends the woman and asks what are we doing for you this evening... the woman is hesitate about the upcoming procedure... when she is asked to explain what is going to occur...she states "the doctor wants me to have the drip"...language is very important... if you are listening to women you hear the unspoken question or the resentment....the next question needs to be... "is that what you want?" she replies " what are my options, I would prefer to wait until the morning to see if I can go into normal labour", she was asked, did you discuss this with the doctor....she said yes.... but he said this is the best option, "you will not go into labour with the baby's head so high".....I would still like to wait said the woman... the midwife discussed it with the doctor and he repeated, his reasons as already stated..... now here is where the conflict lies..... how far do you push for the woman? yes I hear you say all the way.... but how many times do you do this and then the doctor walks in and speaks to the woman and she says to him ok do it......

In this instance the midwife sat and spoke to the woman asking what did she really want and why? and gave the woman the pros and cons for having the IOL now or waiting until the morning.....presenting all the evidence including information about her GBS status & ruptured membranes including the option not to accept (refuse the treatment option) the doctors treatment option and that all this information will be documented in her progress notes. The midwife left the woman to discuss her options with her family, the woman then made the decision to wait until the morning before having the drip. The doctor was notified and the information was documented in the clients progress notes. The woman had some dinner, was happy with her decision and went walking around the hospital for the next two hours.... when she returned she was contracting every 6 minutes... and they were lasting about 45 seconds... it was great......everyone was happy..... the woman went on to labour all night and birth in the morning... it was a vacuum extraction.... there was no induction....in this instance it all worked out well.... the empowering of the woman was because she was given all the information and the woman made her own choice knowing all the risks... she just wanted to wait until the morning..... it really was not a lot to ask... she was being monitored.... that is, pulse, temperature, IV antibiotics 4/24,she did not want to go home... just wait until the morning... to have her baby the way she had planned....

Sometimes I think as a midwife you need to choose the battle.... read the woman's Birth Plan, and most importantly listen to what the woman wants......

picture ref:http://mdean.tripod.com/justice.html

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!

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?

Should health professionals who have a criminal record be allowed to continue working in the profession?

This story again highlights the importance of the trust placed with health professionals, doctors, nurses, midwives, dentist etc.... the list is extensive.

This is a particularly personal story as I worked with this doctor many many years ago and remember his colleague for being a sexual deviant... but not so much him... it does make one think... for how long do these crimes go undetected before you can conclusively convict these doctors.....as in this case. As for his colleague he was stuck off the medical register for his sexual misconduct for two years and then went back to work with restrictions.... my question is should this be allowed?

More and more doctors are misplacing or abusing the public trust, whether it is Medicare fraud to sexual assault... this latest story of Dr John Cooper 61 who has been found guilty of drugging and sexually assaulting a 24year old woman. Two years ago this doctor made a house call.... to ask the woman a favour.... I wonder what favour he needed to ask on a Sunday that required him to inject her with a drug with the intention of assaulting her.... it is truly a sad day...

Remember as Nurses and Midwives you are the clients advocate and we are compelled to report any misconduct by our health colleagues and that includes doctors.... as per ANMC Code of Ethics.... and with the new National Registration legislation... this will also be a requirement... so these issues can not stay behind closed doors.

Ethical question: should we be encouraging octuplets?

Has the idea of fertility gone mad, eight babies to a family who already have six children what is the point or have I missed something? The chances of eight babies being conceived naturally are inestimable. I thought the idea of fertility treatment was for couples who could not conceive naturally.

I would argue that the doctors concerned in this case are negligible on ethical basis, why? Because they knowingly put this woman at risk and high risk is what doctors should be avoiding.

What do you think? Do you think there is any responsible reason why octuplets should be conceived?

To read the complete story click here

Midwives opinion disregarded by doctor

Trust to pay millions after brain damaged boy's 'mismanaged birth'
This story was reported in The Independent UK, it is a sad story of a mother’s (Kristi Riches) labour & subsequent birth in 2001 that went wrong and resulted in her child (Oscar) being born with catastrophic cerebral palsy, severe cognitive deficit, impaired vision, epilepsy and painful muscle spasms. The midwives involved in the care of Kristi were very troubled and tried to influence the doctor’s course of action, to no avail.

Oscar Riches would have been unharmed and grown up to live a normal life if he had been born swiftly by emergency Caesarean, Mr Justice Holroyde heard at London's High Court.
But the delay at Eastbourne District General Hospital had left the now seven-year-old with catastrophic cerebral palsy.
Oscar's counsel, James Badenoch QC, said that East Sussex Hospitals NHS Trust had admitted liability because of the behaviour of the locum obstetric registrar - an overseas doctor who has now left the UK - who "grossly mismanaged" his birth. Mr Badenoch said that before Oscar's birth, the heart-rate trace showed that he was in great jeopardy but not yet damaged.
But the locum "inexplicably" insisted that Mrs Riches should continue in labour and then failed in a ventouse delivery. Eventually extracted by forceps, Oscar was severely asphyxiated with the umbilical cord tightly around his neck and did not breathe spontaneously for 20 minutes.

"It was effectively an admission of negligence against the doctor - it was not a system failure... and we are happy to acknowledge that the midwives were very concerned and did seek to influence the doctor to take prompt and effective action."

Mr Badenoch said that the locum refused to speak to the midwives, hummed and whistled while attending to Mrs Riches after the birth and wrongly recorded the amount of blood lost when she suffered a potentially dangerous haemorrhage.

"It was effectively an admission of negligence against the doctor - it was not a system failure... and we are happy to acknowledge that the midwives were very concerned and did seek to influence the doctor to take prompt and effective action."
Mr Badenoch said that the locum refused to speak to the midwives, hummed and whistled while attending to Mrs Riches after the birth and wrongly recorded the amount of blood lost when she suffered a potentially dangerous haemorrhage.
It was also reported that as a result of the trauma of Oscars’ birth in December 2001, Kristi (mother) suffered stress and anxiety that she could not contemplate having any more children.
It was not believed that he had worked again in this country but his present whereabouts were unknown.
Oscar is totally helpless and would require constant care long as he lived, which was likely to be into his 20s, funded by an agreed lump sum payment of £1.118m plus annual payments.

Mrs Riches who, with her husband Clive, cares devotedly for Oscar at their home in Glenleigh Park Road, Bexhill-on-Sea, East Sussex, has reached a further undisclosed settlement with the authority for her psychiatric injury.

It is interesting to see the CTG submitted as evidence relating to the fetus’ well being; however there was no mention of any fetal scalp sampling or cord bloods. Also the midwives documentation and concern were duly noted, it would be good to examine this case further to see what other options the midwives may of had in relation to the doctors who were leading this case.


Reference:Posted by The Independent
Friday, 30 January 2009 at 06:54 pm
Published: 2009-01-30 14:18:38
Author: By Jan Colley, Press Association

Rating your GP online?

Happy New Year to all - best of health, happiness and love for 2009.

I was checking and responding to blogs when I came across this article in the Mail Online (UK)
Patients will be able to rate and review performance of their GPs on new NHS website By Rebecca Camber
It's this a good idea, to be able to rate your GP online. The NHS has created a website which will be under Government control. The idea is that this will boost doctors' performance - or will it?
Off course I can see potential problems with confidentially and truthfulness - however legal action can be taken against writers for defamation if they write untruths.

The NHS already does something similar with the NHS Choices (types of treatment or hospital) website -

from this analysis of the first 6,500 comments showed, 24 per cent were positive, 27 per cent negative and the rest were balanced.

that's not bad odds!

We must remember people that who are dissatisfied will complain more, tend to be more negative and may also be more malicious.

Also website staff will be able to moderate reviews to exclude comments that could identify a GP or staff member.

What do you think? do we need to go down this road? Do you think it will make a difference?