Born Alive Rule - is it time to rethink

A few seconds after birth:

There is much debate over recent months regarding this issue; traditionally in Australia and some other countries a fetus has no rights until “Born Alive”, otherwise considered the “Born Alive Rule”. This rule has been around since the 17th century, at this time viability was considered when the woman could feel the fetus this was generally known as “the quickening”. It is now the 21st century technology is advancing at great speed, ultrasound is very definitive, there is no question now about the viability of a term fetus, is it time to reconsider the rights of the term fetus. An embryo is usually from fertilization, early stages of growth and then a fetus from 12 weeks of pregnancy; The definition of a term fetus is when it is considered that the fetus can survive outside the uterus without any assistance this happens from 37 weeks - 40 weeks. Once born most people refer to the infant as a baby.


When considering the question of fetal rights it is important to consider what is considered a human being? Is the fetus a human being? What or who is a person? Can the fetus survive outside the woman’s body? These questions raise many ethical questions: My masters 10yrs ago was, is it time to re think fetal rights, and I concluded then that a woman’s autonomy was sacrosanct. 10 yrs on I think it is time to open Pandora’s box and debate the issue again.

The born alive rule can be viewed from several perspectives; women - pregnancy – domestic violence – violence against pregnant women – criminal responsibility. I am going to view several circumstances; This blog is not a judgement of anyone, I am expressing a point of view to illicit debate on the issue of does a ‘term fetus’ need rights:

A recent case in WA, Matthew Silvestro who had a history of domestic violence was found guilty of causing grievous bodily harm when he drove his car into another car, causing his pregnant partner Vanessa De Bari serious harm (she spent 8mths in hospital recovering from injuries) including the death of her 8 month fetus. His sentence was a two year driving suspension and $8000.00 fine to which he pleaded he was unemployed and unable to pay this fine he ordered to pay costs of $119.20

South Australia’s coroner has been conducting an inquest into several homebirth deaths of term fetus’s. The issue of “sign of life” and the “Born Alive Rule” has been bought into question and debated. Another issue that has been debated during the SA coronal inquiry is the decision to have a home birth, particularly because it involved twins a higher risk – and that no backup plan was made. One twin was born alive at home and the second suffered brain damage and died later. This is not a judgement, this is about questioning what is a human life? And does a fetus have a right to life? Do we have the right to dictate by our actions whether a term fetus lives or dies? It is time to debate this question further.
Dr McCaul said at the SA coronial inquiry:

"I had a strong sinking feeling because I felt she strongly still wanted to go ahead with a home birth," she said.
"I don't think it's safe to deliver twins at home. I think the risk of complications is high.
"She listened to what I had to say but I didn't feel that it was influencing her. I don't know that frustrated was the right word. I felt a bit powerless I think."

Another case from SA that has a questionable ruling that of Tate Spencer-Koch case in which the coroner states

“Tate had been a perfectly viable fetus until the time of her delivery........the PEA (Pulseless Electrical Activity) that excited in Tate after her birth, acknowledging as I do that it was slow and could not support a mechanical heart beat, and could not be reversed, is to be regarded as the last vestige of her human existence. This last vestige existed at a time after she had been fully delivered. As such it was a sign of life that existed after she had been fully delivered. (1.27)
.......the PEA of 15 beats per minute that was detected in Tate approximately 10 minutes after she was fully delivered was a sign of life for the purposes of the law......all facts of the born alive rule have been satisfied in this case and I find Tate was a person in the eyes of the law and for the purposes of the jurisdictional requirements of the Coroners Act 2003”.(1.28)

This case will change the course of history if this definition of a sign of life remains......it is my opinion that PEA is not a sign of life and that is because at this stage there is no cardiac output, you are essentially dead....there is only an electrical current that runs through your body as the last automatic process of the body....it does not mean you are alive.... It is however interesting to read the process and see how the coroner has come to his conclusions, it is all about words and how they are used and what they mean.

Interestingly in the case of R v Iby a case of an assault that caused the subsequent death of a fetus/child. This case heard that the presence of a heart beat was sufficient to satisfy the born alive rule. It was also found that there was no ‘common law definition of what constitutes ‘life’ for the purposes of the born alive rule (248).

WHO defines live birth as

Live birth refers to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life - e.g. beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles - whether or not the umbilical cord has been cut or the placenta is attached. Each product of such a birth is considered live born

.

Fetal rights is a real dichotomy the right of a woman to her own autonomy and her body v the right of a fully formed term fetus who would live if able to be born..... what is the answer...In my mind there is no question that a term fetus is a human being: What is required is that there is community support / structures for midwives who choose to support women who make these choices; one thing is for sure, women have the right to choose where and how to birth – what is required is for hospitals and health professionals to be more flexible.

In 1999 Regina McKnight the first woman in South Carolina was convicted of homicide by child abuse in 2001 after a jury bought scientifically unsupported arguments that her cocaine use caused the stillbirth. Regina suffered the charge for suffering an unintentional stillbirth after having used cocaine during her pregnancy.

McKnight unsuccessfully appealed her conviction in 2002, challenging the constitutionality of using murder statutes to prosecute women who experience stillbirths. But in a split decision, the state Supreme Court upheld her conviction, offering a novel interpretation of the state's homicide laws. The court held that any woman who unintentionally heightens the risk of a stillbirth could be found guilty of homicide with "extreme indifference to human life." Under this doctrine, the court held, any pregnant woman who engages in activity "potentially fatal" to her fetus could be charged with murder.

In 2008, the Supreme Court ruled that McKnight had an unfair trial... McKnight argues that counsel was ineffective in her preparation of her defense through expert testimony and cross-examination...and the court also found that the information given to the jury about the supposed link between McKnight's cocaine use and her stillbirth was not scientifically supported. More importantly this ruling sends a clear message to lawyers as it was found that current research simply does not support the assumption that antenatal exposure to cocaine results in harm to the fetus, and the opinion makes clear that it is certainly ‘no more harmful to a fetus than nicotine use, poor nutrition, lack of antenatal care, or other conditions commonly associated with the lower socio economic group. This ruling will send a clear message to lawyers to get the facts right and not be misguided by medical misinformation.

It is a travesty that Regina McKnight spent 9 years in prison for a crime she did not commit and in South Carolina 90 women have been convicted of drug use during pregnancy, this is not the answer to the problem.

As a midwife sometimes this issue creates a dilemma for me as I firmly believe in the woman’s right to choose what happens to her body. That is under no circumstances should she be forced to accept any treatment she does not want. How do we balance the need to protect the term fetus that is a fully formed human life, but for the fact it has not been born alive it has no rights.... one minute in utero it has no rights, however once born and shows a sign of life you cannot kill it..... this just does not make sense to me........

I do think a term fetus should be afforded some right to life.....but I'm not sure how we can do this without impinging on women's right to autonomy, which must take precedence.


References:
CORONERS ACT, 2003 SOUTH AUSTRALIA RULING OF CORONER
http://www.courts.sa.gov.au/courts/coroner/findings/findings_2010/Spencer-Koch_Tate.pdf
R v Iby (2005) 63 NSWLR 278, 248
http://stopthedrugwar.org/chronicle/2008/may/16/pregnancy_south_carolina_supreme
26484 - McKnight v. State; http://www.sccourts.org/opinions/displayOpinion.cfm?caseNo=26484National Advocates for Pregnant Women: http://www.advocatesforpregnantwomen.org/
Doctor says mother ignored homebirth warning:
http://www.abc.net.au/news/2011-11-17/home-birth-twins-death-coroner/3677156
Pic ref: http://www.solarnavigator.net/animal_kingdom/humans/babies.htm

Writing My Memoir Journey:

Ian and I have come down to Margaret River for a well earned break just for a few days; as usual we spent some time in the Margaret River bookshop...and I spotted this book “write your memoir – the soul work for telling your story” by Dr Allan G Hunter....what attracted me to this particular book is that it refers to your writing as your soul work, that resonated with me, because I think that when you write your life story you have to also be thinking at a deeper level and this may also bring about change...so I had to have it...my wonderful husband Ian bought it for me.


Ian is such a patient man, he supports all that I do, he must think there she goes again...another project started. In his wisdom, he said ok, this is a great place for you to start writing, and he is correct it is tranquil, nature surrounds, the birds, butterflies and flies for company and the occasional truck or car that flies along the road, just to remind you that life goes on. I start to type away on my computer under the grand Oak tree that has its own stories to tell, I can at least say the memoir has begun.

I have wanted to write my story for many years it is something I want to do for myself and I did begin several years ago compiling a timeline of events to keep me on track, I will have to put it together with this work and keep writing. This off course is a long term goal, so I will chip away at it slowly. We have decided that it would be good to book a regular yearly holiday to Basildene Manor to keep the project going.... and Ian well he is sitting beside me listening to his ipod story..... enjoying the same wonderful peace and quiet.....


Busselton Jetty:

My plans for 2011

It would not be a New Year without setting some goals, writing them on your blog makes it harder to break and you are more accountable.... I find it very useful each year to reflect on the year gone by and plan for the following year... some of my goals are as a result of reflecting the year gone bye..... one decision I have come to as a result of my trip to Tanzania is to spend more time on my spirituality. Equally importantly I need to reduce my stress levels.

Spirituality: - Dharmapala Buddhist Centre – starting January 2nd with a week guided meditations – I am committing to the first week four sessions a day for the first two days.... and then two evening session for the rest of the week... then I will do the evening sessions... My aim is to meditate each day and go at least once or twice a week to a group mediation to keep me focused.

Study – Must complete my assignments on time.... devote more time to my study and learn to say “No” to anything that interferes with it......

CeMGP – Centred Midwifery Group Practice – much is required this year, I am so excited about the success of this practice...continuity of care is the focus... advertising, clientele, staff..... I am really excited about this business and its growth.... the website and blog is coming by the end of January.

Work – I have reduced my teaching hours.... starting a new curriculum therefore much work is required for my units.... Singapore is exciting and challenging...and I am not ready to give this up... I am looking forward to meditating in the temples when I next visit.

Clinical Practice – I will be signing up for casual midwifery work...the decision is which hospital and probably a shift or two a week...

It is an exciting year and I am really focused this year on getting my spirituality & study on track then every else will fall into place.

6 Key points to keep in mind this year;
Spend less, watch my weight, be less wasteful, exercise 5 out of 7 days, meditate everyday, keep a work life balance.

I am determined and dedicated as always to put women and midwifery first for greater choices for childbirth.

An extraordinary year:

As the end of the year sets and the New Year dawns we often think of the year gone by…at least I do…it seems to me that the years are getting busier and time is flying bye…this could be a reflection that I am getting older however I don’t feel older, but sure as hell my body keeps reminding that I am….

As this has been a humongous year in line with my recent trip to Tanzania I am going to list the 10 highs and lows of the year: it is so handy having a blog to look back on to jog the memory when so much happens in a year.

Top 15 highlights for 2010 – the order is not significant

Meeting the Prime Minister (K Rudd) & Health Minister
Listening to proceedings in Parliament and hearing the words 'midwife' 'midwifery' continuity of care' spoken so many times and in a positive light
Teaching in Singapore / Meeting up with friends in Sydney
Putting in Submissions / politically lobbying
24hr Virtual IMD Celebrations (Sarah Stewart)
Linda’s Holiday – Perth to Carnarvon – (being a Skype Midwife)
Sitting on Uluru….breathing in the atmosphere
Making a decision about my study – starting a new degree
News of a new Grandchild (April 2011)
Medicare Provider Number for Midwives
Gaining Eligibility
Starting Centred Midwifery Group Practice Inc (CeMGP)
My Tanzanian experience
Family, friends & some great work colleagues

The Grandchildren

Jasmine started Yr 1, Dylan Pre-Primary, Jessica Kindy
Talia coming into her own, starting to stand up for herself,
Sam, Isabella and Logan all going through the terrible two’s

Top 11 Disappointments:

The division over collaborative arrangements and the Determination 2010
Homebirth debate / Insurance issues
Miscarriage in the family
Election dirty politics
Factions within Midwifery
Lack of team work and loss of integrity from esteemed colleagues
Bullying issues
Muffin passed away
A better disciplinary process (Hospital) for midwives using their piers
son-in-law having a back operation
Seeking & acting on legal advice for defamation

As you can see the highs thankfully outweigh the disappointments….and my lists are not exactly 10…. See you have to be adaptable in life…best laid plans of mice and men...lol.
Wishing everyone that reads my blog a happy, peaceful, safe and successful 2011:

Dreams; Dreaming:

Last night I dreamt that I was swimming in the ocean, it was a beautiful clear ocean, I love the sea.....my husband was standing on the shore as he normally does..... I was a little afraid a healthy respect of the ocean, it was a nice sunny day and I just love to swim in the ocean, so continued to swim. I then noticed some fish middle size fish... this frightened me a bit more but they seemed non threatening..... so I continued to swim...... more and more fish came.... they seemed to have their mouths open and looked half out of the water.... I was starting to panic the more fish that I sore... and then there seemed to be snakes and eels in the water, now I was terrified and swam for the shore completely panicked...... I woke in a sweat.... afraid there were just too many fish and eels in the water.......I was out of breath and afraid..... I looked around and thought “thank God I am in my bed, it was a dream”.......



In trying to make sense of my dream, I thought is must be that I have been a busy the few months, in fact an extremely busy year; certainly ending in a big way, in many ways very difficult I have to say I am tired, and sadden by many great women being wounded and continue to be wounded all in "the best interest" of midwifery, women, life, work.....I have to ask the question is it worth it? But deep down I know it is for the sake of all women and midwives, not just one or two groups... the one’s who shout the loudest.....and care the lest for all women and midwives.

The poverty and lack of resources in most parts of Africa - the uncaring of our fellow man/woman/child......it leaves me feeling completely drained...however hopeful of progress with help and resources.... I enjoyed teaching in Singapore.... it is was worlds apart shopping on Orchard Road v Dar Es Salaam .........it really is food for thought!



A dear friend of ours, not so close these days but from the past, well thought of & loved, lost their son of 34yrs (Peter); our boys all use to play soccer together: Peter was larger than life, enjoyed life to the fullest; listening to his eulogy it was a full life packed into 34yrs, but oh so young to die & so suddenly: the memorial service was packed and there was not a dry eye, men, women and children all crying........as we sat in the Limerick Bar at Rosie O'Grady's celebrating Peter’s life " I pondered as you do on your own life" what would they say about me? I have so much more to do.... so much more to give.... so much to share.... the energy spent on nonsense is a tragedy.... I want to yell from the highest mountain...pull your heads in......get on the same page!!!!!!!


The Kids putting up the Xmas tree....

Family is most important.... letting them know how much I love and am proud of them, watching the grandchildren grow up and being able to influence that growth....sharing the passion of life...teaching them to reach for their dreams and passions......everything is possible.....not to get bogged in the minutia of bullshit......listen to your inner voice and you will know what are the correct things to do in life.... that is really one of the most important lessons..... That is to trust your own judgement...... listen to and trust your inner judgement..... then follow that ...... you can’t go wrong........



It is times like these I like to go back to a favourite poem of mine Desiderata:

Go placidly amid the noise and the haste,
and remember what peace there may be in silence. .......... Avoid loud and aggressive persons;
they are vexatious to the spirit.......... Exercise caution in your business affairs,
for the world is full of trickery....... Take kindly the counsel of the years,
gracefully surrendering the things of youth.
Nurture strength of spirit to shield you in sudden misfortune.
But do not distress yourself with dark imaginings.
Many fears are born of fatigue and loneliness.......... Beyond a wholesome discipline,
be gentle with yourself.
You are a child of the universe
no less than the trees and the stars;
you have a right to be here.
And whether or not it is clear to you,
no doubt the universe is unfolding as it should.
Therefore be at peace with God,
whatever you conceive Him to be.
And whatever your labors and aspirations,
in the noisy confusion of life,
keep peace in your soul.
With all its sham, drudgery, and broken dreams,
it is still a beautiful world.
Be cheerful. Strive to be happy

Singapore 2010

Nursing in Tanzania:

The airport:

It is hard to know where to start with this blog... as there is so much to tell, therefore I think there will be several blogs relating to Tanzania; The main focus of the trip was to take 20 nursing students from five different universities to experience nursing in Tanzania. My first impressions were biased with a preconception of what things would be like, having already lived in Africa, however some things still were confronting and the total lack of resources, water, infra-structure (in rural areas) and medication still came as a surprise:


The process through customs, immigration is the usual for any African airport, slow, hot and humid, confusion as to which forms to fill out, eventually we all got through.... the main currency for Tanzania is shillings..... 1000.00 approx for each $1.00.... we changed some currency and got some local sim cards for our phones, we were met at the airport which was fantastic.... we were all bundled into cars and buses, with our luggage perched preciously at the back of the bus. Our hotel was about 35 mins from the airport, the first thing that struck me was the amount of cars on the road.... it did not take long to realise that they all drive like lunatics.... it was equal to Egypt which I thought have the worst driving in the world. There were hundreds of people milling around, over crowed buses and many street markets......


Health care in Tanzania is dependent on social status and level of income is the most predominant social determinant of health for people. This means access to clean water, sufficient food and reasonable health care. Health care access is further compromised due to issues of geographical location and distance to services as well as lack of resources and technology. It was interesting to note that everyone has access to mobile phones even when electricity was not available.


Our Hotel:

We arrived at our hotel ...... pleasant, clean, small, friendly staff.... the first thing I noticed was there was no bar fridge.... now I know what you are thinking....no not for alcohol... I wanted a cold drink of water.... alas this was to be one of my biggest complaints.... a must in a hot humid country....the availability of cold water and tea and coffee making facility.... minor things really, just shows how spoilt I am. Every day began at 0530... the bus collected us at 0645 to get us to both hospitals..... we would split into two groups, two supervisors and 10 students in each hospital: one to a private hospital and a government hospital.... then the following week we would swap. Mine was the government hospital first.... this was a baptism by fire.... it was a culture shock for all, I was a acutely aware of how the students would be coping, sights, smells, queue’s of people, sad hollow eyes watching our every move....we stood out like beacons in our stark white uniforms; at times I felt like the fish in the fish bowl..... Intruding into the lives of people I could not really make a huge difference to....We would attend the hospital handover, all given in English we would then go to our allocated wards.


I had to focus on the task at hand..... once orientated to the ward we would begin to assess the situation and decide how to move forward.... each ward had a notice board which listed the 10 most common disease and drugs used, together with the tasks for the day: There was no surprise to find No 1 condition in the medical ward was HIV (there are medications and treatments for HIV which was good to see), I learned about the finger test for HIV.... great idea quick and efficient, next condition was Malaria, hypertension, anaemia and diabetes: each ward (medical & surgical male and female) consisted of approx 30 beds, sparse furniture, a single sheet on the beds and some ceiling fans, however the wards were stifling hot.........patients bought in their own food and water; sometimes it was hard to know where to start.... so often I would get students to take vital signs, as this was something I knew they could do well and would start the two way conversation... however our Swahili consisted of “Jambo” – Hello, or “ Hujambo” – how do you do, “Jina langu ni......Pauline – my name is....


The nurses work very hard and are short staffed, often 1 RN to a ward, a couple of student nurses and nurse assistants; doctors milling around, completing ward rounds, barking orders, nursing assistants scurrying around to get tasks completed. There was often only one oxygen cylinder and the ethical decision would be who needed it the most... and sometimes someone would come urgently from another ward requiring the oxygen cylinder ..... what do you do?


The sister's desk:

The drug cupboard was sparse, patients are ordered medications and it is a pay as you get service.....the students coped remarkably well.... all equipment used for patients are paid for by the patient, such as IV cannula’s, drips, catheters, tests etc, everything we take for granted here.... it really makes you appreciate the excellent health care service we have.


We witnessed some interesting procedures and dressings, at times did some teaching as well as sharing experiences and ideas.... it was an interesting journey: documentation, nursing notes, filing cabinets, policies were all nonexistent in the literal sense.... there were two cardboard boxes... marked “discharge notes” a stark reminder of where we were....... Pain seemed second nature to patients....as well as lack of dignity and privacy due to overcrowding and lack of resources..... the hard working underpaid nursing staff and health workers, were not well respected......they do the best they can in these harsh conditions, always with a resolve that things would get better. Also acutely aware of how the situation must look to us the ‘foreign nurses’ apologising for the bad conditions and stating they just do not have enough staff or resources to treat all these patients.


I was amazed at how long people wait to see a doctor or nurse; they have walked for hours and sit patiently in the sun until they are seen, with not a word of complaint.... just happy to be seeing someone and getting some treatments. Our challenge was often to think of cheaper effective ways of treatments, dressings etc choices of medications were limited to bare essentials.......families assisted with patient care, feeding and bathing.......traditional medicines were popular and the stigma of HIV was an issue: I was surprised to see that bowel obstruction was very common – top 10 surgical conditions were: Intestinal obstruction, peptic ulcer, pyomyocties (infection of the muscle), hernia, haemorrhoid, hydrocele, osteomylitis, burns, diabetic wounds, and motor vehicle accidents (no surprise there with the driving we witnessed).

The nursing system is three tiered; enrolled nurses (2yrs training nurse/midwife), registered nurse/midwife (degree course 3yrs), diploma registered nurse/midwife (3yrs or 1yr after EN course): nursing assistant (2yrs – can go on and do diploma RN 3yrs); a diploma RN/M can go on and complete the degree course 3yrs – equal to 6yrs: Their scope of practice is wide and varied........the medical system is equally complicated: from medical assistants to degree MD’s. The graduation I attended had only 10 degree RN/M’s, 20 diploma RN/M’s and 40 Doctors graduating....... nursing is not considered a prestigious career, parents try to discourage their daughters from doing nursing if they are going to do a degree.......nursing assistants and diploma nurses usually complete form 1V (equivalent to year 10).


discharge notes:

The question I ask is how do we make a difference? Some of the students who travelled will travel again, they have all be touched by the experience, maybe two or three will go back to Africa and help make a difference; I think you need to stay in one area for a two – six month placement and introduce structures for change; working alongside our fellow nurses exchanging ideas and promoting change: providing mentorship, support for the new students, therefore providing for the future..... Fundraising for essential equipment (gloves, alcohol gel, fob watches, thermometers etc); now that this will be an ongoing project I am hopeful that we will be able to make a difference in some small way:


On our last day we met four first year nursing students, all straight from school, they were so young, full of enthusiasm, our students took them under their wing and taught them vital signs, it was delightful to see, gave them some text books, our equipment, stethoscopes, thermometers etc... and we wished them well. I have promised to keep in touch with one student and provide some mentorship from a distance. If I am to return I will ensure to follow her up.........This has been an incredible journey for me and I will be forever touched by the courage of the patients I have met and for some of the brave nurses I worked with....... I am eternally humbled from the experience.......I have met some fantastic students who are know RN’s and also have made special friends with the other supervisors from our trip........partners in crime.......next blog..... Midwifery!


Good luck to all my students (now RN's)as well as the new students starting....life is a continuous journey which we are all learning.....

Back to my roots Africa:

We have been in Africa Tanzania for a week now…. I will be blogging about the clinical experiences soon but just had to share this wonderful weekend with my friends and the world. Despite all the hardships that can clearly be seen in parts of Africa the country and its wildlife are absolutely magnificent….Africa is rich with warm friendly people, diverse cultures and stunning wildlife. I began to feel as if my soul had returned home once I got off the aeroplane. The steamy airport….. crowds of people a disorganized chaos was all reminiscence of my times spent in Zimbabwe.



Our weekend was spent at Mikumi National Park: the park is in Morogoro Region, in the southern tourist circuit of Tanzania. This is the nearest park to the commercial capital of Tanzania, Dar Es Salam. It is about 288 km west of the city and takes about 5 hrs by car. We travelled in convoy in land cruiser troopies 8 to each vehicle that includes the driver (who is a local). The road is bitumenised all the way to the park. The park gets its name from the spindle – shaped borassus palm trees which are typical of the area. Mikumi National Park with an area of 3230sq.km is the fifth largest park. It lies between the villages of Doma and Mikumi on the Dar Es Salaam-Tunduma road. The Mkata River-flood plain, with its hardpan, ridges, swamps and black-clay grassland, the miombo woodlands on the hill to the east and west, and the rivers with their fringe of tall trees and dense thickets. Often it looked like it was going to rain…. Thankfully it didn’t; the short rains usually fall during November and December. Long rains are from March to May.



Everyone relaxed and really enjoyed the weekend, it was just not long enough…..being with the students all week, it was great to see them relax as well as us (the supervisors). We were warned that the animals wander around the grounds and to walk together and be watchful. As we sat drinking; me with a gin and tonic and as we had lunch we watched the animals arrive at the waterhole; zebra, warthog (pumba) and her babies and a small family of elephants…. It was brilliant to watch the elephants drinking and having a mud bath…..the giraffe were ambling in the background grazing on the leaves ….. what a wonderful world we live in….it was a time to reflect, re-energize and rejuvenate.



We stayed in small lodges made from mud….self contained double rooms. The windows were open spaces covered by a wired mesh similar to fly wire. We were all sharing; I was sharing with two other fantastic women…. We chose our beds unpacked our bags then out for our first adventure in the land cruisers. The usual application of sunscreen and insect repellent…. Excitement in the air…..a beautiful sunny day….the African air. It was not long before we came across our first elephants, then impala, lots of impala they are almost like our kangaroo’s…. we were all glued to the scenery trying to spot the next animal…when I called out “there’s a Kangaroo” ……on our way back to the village we came across a group of Giraffe, they are so spectacular to watch…. elegant and graceful. Alas still no Lions: The African sunset was spectacular as expected….. got back to the village…. Had a double gin and fanta as there was no tonic….tasted great… a fabulous dinner….beef stew and veg whilst watching animals at the waterhole….. later that evening the lions came to visit…some of the students were disturbed and frightened, the park employees escorted everyone back to their rooms….. it was a hot night…the electricity went off at 11pm so no more fans….. we slept under mosquito nets…it was a hot sticky night….as for me I had tooth ache so took a bucket load of pills and could feel my tooth throbbing…..but did manage to get to sleep…..



Up on Sunday morning at 0600hrs out to go for the morning safari drive; wonderful morning… a bit cloudy…weather great…cool; spotting animals… we came across a herd of elephants…. Unbelievable…the female leads the herd and the rest follow there were two calves in the herd… we spent quite a while admiring them it was so quiet you could hear them walking, they came very close to us…. Fantastic pictures…..we drove for an hour watching…. I was standing feeling the wind on my face…….feeling very much at home in one with the land…..the driver got a phone call and then began driving very fast…., we knew there was something to be seen…. We finally caught up with the other group to find a pride of lions who had very recently killed a buffalo, it was disemboweled…. There was a lioness close by well camouflaged, we all were excited and scrambled to get pictures…the safari was complete now that we had seen lions in the day….it was back for breakfast then the homeward journey back to the hotel (5hrs).



It was fantastic to see large herds of buffalo, wandering groups of elephant, wildebeast, zebra, impala, baboon, warthog, jackal and giraffe. Most spectacular was the sight of a fresh kill of a Buffalo by a pride of lions…… wow… just amazing.
Giraffes are the tallest of all living land mammals. The animal’s typical gait is rather slow, deliberate and remarkably graceful, almost as if the actions were filmed in slow motion.

Elephants have a gestation of 24months and live to about 60yrs, they weigh 3-4 tons and they eat 375kg of food….wow

I have to mention that the traffic (in Dar Es Salam) and the cars / buses are just diabolical – they are crazy drivers; how there are not more accidents I do not know…. We cringed more than a few times on our journey….. overtaking… causing the oncoming traffic to take responsibility to move out the way…..our drivers were excellent: There was a small gift shop on sight which I bought some material for the girls (Kanga) a traditional piece of cloth used for clothes: Now it is back to reality we have another week left….

spot the lion: sitting watching her kill...the pride was further back under a tree too far to take pictures:




I have written this blog on the homeward journey on the bus, as we are often stuck in traffic and hopefully I can upload it when I get back to the hotel, if the wireless is working....Watch this space for further tails and I have many…… photos will be coming soon.. it has taken me over an hour to upload these few.....it is back to work tomorrow...

I'm feeling very relieved and excited:

I am so grateful my life is filled with love, passion, abundance and excitement;
I was so relieved that my exams are over for this semester, I had forgotten how you stress when you feel under pressure to perform in examinations... I do wonder the value of examinations.... for two hours I regurgitated information, not necessarily in a organised fashioned, everything I knew relating to the topic I just vomited it onto the paper, so much so that my hand was sore from all that writing.... you know we are just not use to that type of writing any more...why don't they move with the times....we should have computers....automatic spell check, legible writing.... I did think the faster I was writing to get the information down before my time was up...my writing was getting worse... and was thankful I was not marking these papers...now that would be a nightmare....the topics were broad and I should think hard not to be subjective when marking..... Well enough about that it is finished and forgotten until I get my results;

Marking is all done....and most of the students did well.....just amazing how much you can fit into a day.....

Tomorrow I am off to Tanzania...the spare bed is full of what should be going into my suitcase....with the uniforms....nice starch white tops...and navy blue three quarter pants....emmmmm..... aprons, gowns, gloves, etc etc etc....oh and all the books we are donating to the midwifery library.....I have been reading up on all sorts of exciting treatments.... and life in Tanzania.... bought my US dollars...not that there will be much time for any shopping....and got the first aide kit.

We are going on a Safari ...the middle weekend we are there.... I am waiting in anticipation of all that we will see and experience over the next two weeks... I am sure that I will experience many things... and be ever grateful for the wonderful country we live in.... Australia....watch this space for updates.... or the report when I get back....i guess it depends on several factors...internet....and time. take care until next time;


ref pic; http://trekkertime.com/index.php/Site/Tanzania

Being a student again: a humbling experience:

As a lecturer myself I consider that I am a considerate fair and equitable person when I am dealing with students, in fact it applies to all aspects of my life ; one thing I really don’t appreciate is being taken for a ride.... in other words when students “take the piss” then I come down like a ton of bricks;
As some of you are aware I have commenced another course reaching for new heights..... My aim is still woman and birthing focused..... equality, autonomy and right to refuse treatment; the right for women to choose where to birth and with a midwife.
Being a student in a completely new discipline has been daunting....going from experienced to something completely different, a whole new style and way of thinking....it really is letting go and learning new ways of being....I still have not mastered this... I guess it will take some time; patience is the lesson I need to master;
As I reach the end of the semester (13 weeks) and start to cram for exams, which incidentally I think is the worst way to learn anything.....I really appreciate the way that I interact with the students whom I have been privileged to teach. Most of the lecturers I have encountered over the past 13 weeks have all been inspiring, articulate and passionate, exactly how it should be; however there is always one.....that is challenging. This one is a male.... he takes a tutorial group... he walked into the class.... or I should say he strutted in and said “hello I am Fred and I Fucking swear.... and if you fucking don’t like, there is the fucking door” well I was flabbergasted my jaw hit the floor.... there were students squirming in their seats...myself included. Here is a man who is presumably highly intelligent.... or so I thought, holds down a very important job and I am sure he would not swear in a court room...so I wonder why he would do so in class.....Our assignment was a case study that we would work on and discuss in a tutorial group, this is nothing new similar way of teaching that I have adopted.... I did notice that I used to say to my students “now this is easy, just follow the model as I go through it” of course it seemed so easy to me, as I teach it week in and week out.... with enthusiasm I might add.....when my tutor went through the case study at 100 miles an hour, telling me how easy it was..... the penny dropped for me.... this is exactly what I said to my students.... “I felt like saying of course its “Fucking” easy you teach it week in and week out and you know it, but alas I did not, I sat quietly and decided I would never tell my students how easy something was.... because it’s not me doing it” lesson learned;
The other valuable lesson I have learned is how vulnerable you can feel as a student: I mean I know that this is possible but as a student you want to pass, so therefore you do not want to be to argumentative as marking is so subjective a terrible way to feel and you don’t want a personality clash; if your tutor does not like you, would it affect your mark, theoretically no.... I felt several times when I questioned the tutor’s methods I was quickly reminded who was the student and who was the teacher....how could I forget this? I decided it would be best to grin and bear it.... until the unit was over... then I could have my say! Now we are at week 14 he has become nicer....more considerate for the first year students.... even thoughtful.... it must be the semester is nearly over..... and all I can say is thank God for both of us; this experience has made me reflect more on my own teaching methods and I am ensuring that I am always fair and equitable.

Time, Love, Passion and Life: Children:

Time is of the essence; My mother use to say "Pauline there is only time for the quick and the dead" I wish I had Hermione Granger, time watch... that alters time so you can fit it all in...from the Harry Potter movies. There is no doubt that I am a work-a-holic... I have been very well trained for this...again mother use to say "don't sleep your life away, get up and do something".

Over the years I have learned to relax and wind down... I love spending time with Ian on our spontaneous outings...or our occasional golf game.... and the day trips with the Grandchildren are a genuine treat..this is what memories are made of.....even the sitting and watching a Disney cartoon with them is delightful.... Finding the balance with 7 soon to be 8 grandchildren, and a passion for my work can be difficult....but I think the time spent with the children make it more special for both of us....if I was to ask the grandchildren what are their favourite moments with me, it will have something to do with going out on one of Nana's trips...



I have collected a few sayings that really sum up what I think about time.....that relates to family, work and life..... can you guess which one I like most?

Time is making fools of us again. ~J.K. Rowling

Time is the coin of your life. It is the only coin you have, and only you can determine how it will be spent. Be careful lest you let other people spend it for you. ~Carl Sandburg

If you want work well done, select a busy man - the other kind has no time. ~Elbert Hubbard

"Time is a great healer, but a poor beautician." - Lucille S. Harper

"Dost thou love life? Then do not squander time, for that's the stuff that life is made of." - Benjamin Franklin

"The bad news is time flies. The good news is you're the pilot." - Michael Altshuler

"All the flowers of all of the tomorrows are in the seeds of today."- Chinese Proverb

"I am only one, but still I am one. I cannot do everything, but still I can do something. I will not refuse to do the something I can do." - Helen Keller

Love makes the world go round.....I think of love and remember the first movie I saw about love.....yes the classic "Love Story" with Ryan O'Neil & All McGraw:

"Where do I begin (Andy Williams)
To tell the story of how great a love can be
The sweet love story that is older than the sea
The simple truth about the love she brings to me
Where do I start

The other great movie that I watch when i just want to switch off or feeling low...that gives me a lift is the wonderful "Sound of Music" I love the scene when Christopher Plumber kisses Julie Andrews for the first time... on the garden bench....it is just such a romantic moment...I know it's sad... but I love it...



love is what makes life worthwhile, I could not be me without my family and friends; the profound love that you have for your children is for some reason multiplied with your grandchildren.... and I think this is because you are wiser, less strict, you can see the error of your ways as you get older.... or you become a soft touch for those beguiling eyes...they are just so beautiful....

It's kind of fun to do the impossible. Walt Disney

If you want to make enemies, try to change something. Woodrow Wilson (1856-1924)

Life is short and we have never too much time for gladdening the hearts of those who are traveling the dark journey with us. Oh, be swift to love, make haste to be kind. Henri Frédéric Amiel

When we are motivated by goals that have deep meaning, by dreams that need completion, by pure love that needs expressing, then we truly live life. Greg Anderson

Teach only love for that is what you are.
A Course In Miracles

I love life, my family and I am passionate about women, midwifery, midwives, law, ethics, fairness & equality and having fun with my children..... but most of all I want to achieve my dreams and vision...and teach the grandchildren about being passionate and following dreams.....for this I need the love and support from my family.....because this is who I am and what is most important next to them.....time is of the essence:





ref for picture;http://www.flickr.com/photos/shewatchedthesky/2835193235/
Passion: http://www.art.com/products/p10345310-sa-i1058105/paula-scaletta-passion.htm

It is time to be thankful......

In this political climate when everyone has a different opinion I thought I would remind everyone to be kind and gentle with each other..... there are feelings around:

It is central to remember the most important things are kindness, empathy and we do respect each others point of view even though it is different. It does not mean that we are not nice people....so remember when making comments and sending emails, not to be unkind rude and personal..... I came across these pictures and thought I would share it..... as a reminder to us all... that life is short, and there is time to be thankful for the wonderful things we have in life and how lucky we truly are:

Taking a day to smell the roses....or look at the spring flowers

life has been so hectic lately i have not had time to scratch myself and sometimes have been quiet disillusioned by it all...which way do you go....so it came as no surprise when I became unwell....late nights...etc.. and to make matters worse I have had the worst flu ever...which left me with bilateral Otitis Media (middle ear infections. My head felt like it was going to explode with the pressure.... I really empathise with those poor little babies and toddlers that get recurrent ear infections no wonder they are so miserable.....poor babies.



Finally the antibiotics have kicked in and relief is finally here... my husband baned me from the computer and mobile phone and took me out for the day to smell the roses....a delightful spring day... it was so refreshing...just what the doctor ordered.... we took a lovely country drive from Perth, Northam to York.... and there were some lovely flowers along the way....



We came upon an unusual couch...made from bricks.... very clever... as my husband was a brickie in his past life I received a lecture about how difficult it would be to make....he was intrigued by this icon...as he referred to it... I tried as I might to be rivetingly excited by it all but alas.... unless it has something to do with birthing and women my passion was just not evident....poor darling...we then went for a walk in the bush and admired the wonderful display of spring flowers..something we both really enjoyed......life is truly wonderful.



We also came across this great little bookshop called "the book lady" in one of the country towns...always a great little find.... we sat for ages looking at books...just delightful.. I picked up one called "letters from a Fainthearted Feminist" by Jill Tweede. I opened the book at page 71

"I've been brooding about those fairy tales where Snow White, Sleeping Beauty the Ice Queen, the Little Mermaid and other happily resting ladies get woken from their snoozes by a peck from Prince Right on the old liperoos..Male fantasies about arousing female virgins, What?....But did anyone inform the ladies in question that once they're awakened passions - ie a permanently insomniac infant - all they will desire in life is to return from whence they came"

how true is that..... you see I could not leave the little book behind... I will be sure to read it to my grand-daughters....

Coping with stress..... for Women

Life is forever busy.... and we fit so much into it, everyone I know is busier than ever, no matter who I am talking to the general conversation is that life is busy. When I was at a meeting during the week, three of my colleagues put their hand up to take on more work...because there was no one else to do it...now these people are already overworked or very busy...so why do we do it? why do we say YES when really it should be saying NO.
Taking time out is not as easy as you think, as there is no one to do your job, workloads are high....and there is so much to do within every aspect of life...family, friends, and self.

Yes we all need a degree of stress in our lives, it helps us learn and grow, however as I get older I am finding that I seem less able to handle as much stress and my body is now giving me physical signs of stress.... so lets look at what stress is and the symptoms ....
Stress is a normal fact of life, stress releases powerful neurochemicals and hormones that prepare us for action (to fight or flee). However it is how we manage it...
Because of the overabundance of stress in our modern lives, we usually think of stress as a negative experience, but from a biological point of view, stress can be a neutral, negative, or positive experience. In general, stress is related to both external and internal factors. External factors include your job, physical environment, relationships with others, home life, and any other situations, challenges, snags, and your own expectations you're faced with on a daily basis. Internal factors determine your body's ability to respond to, and deal with, the external stress-inducing factors. Internal factors which influence your ability to handle stress include the way you eat, so nutrition, overall health and fitness, your emotional well-being, and the amount of sleep and rest you get. For me sleep and rest are the last things on my list, followed closely by exercise..... I seem to be a night owl. Diet I try to do the right thing...however eating out and late are aspects that could be reviewed. As for work this is one of the biggest stressors...

The degree of stress in our lives depends upon individual factors such as our physical health, the quality of our interpersonal relationships, the number of commitments and responsibilities we carry, the degree of others' dependence upon us, expectations of us, the amount of support we receive from others, and the number of changes or traumatic events that have recently occurred in our lives.
There is now evidence that points to abnormal stress,responses as causing various diseases or conditions such as: migraine headaches, asthma, diabetes, fluctuating blood sugar levels, clinical depression,chronic anxiety states, high blood pressure, heart disease, and addictive disorders. I wonder if sex addiction comes in this category.....? A very important point is that stress can begin in the womb and recur throughout life....

When women experience stress, their behavior sometimes changes. Examples; of behavioral symptoms of stress in women: overeating or eating less, over sleeping or sleeping less, procrastinating, isolating one's self, increased use of alcohol and cigarettes, drug use, cynicism and or bitterness. One of the most common behaviour symptoms is irritability, followed by anger, mood swings, and weeping. Constant worrying is also shown by women under stress.


Relaxation:

So how do we manage stress; there are the standard strategies:look around to see what you can change and don't sweat the small stuff.....some tips:
avoid stressful situations, change how you react to stress, set priorities and goals, change how you see the situation, find relaxation techniques, find out what is most important to you, Relaxation Techniques, exercise, healthy diet....

Are you at risk of Burnout...do this simple Burnout self-test....my score was 46 which is "I am at risk if I am not careful"..... now there is a surprise..... It is hard to change the way you are used to working but when the warnings are present...it is time to sit up and take note.... so for me the first step is to hit the pavement and doing some walking..... second get some more sleep.... and third.... relaxation.... that's my first three steps...lets see how I go..

This website has some great ideas and strategies...Stress Management MindTools: have a look its worth a visit..

Valentines Day.......

February 14 Valentines Day....Wikipedia defines St Valentin's day as a day of celebrating affection between lovers....often with flowers, chocolate and cards...

What does this mean...for me its a day of celebration of love...not just couple love but family love....as a romantic at heart I love Valentines Day... we do not go overboard...usually a small gift..sometimes I get flowers...or I may send Ian a noisy animal that sings to his office.... and yes we do a romantic dinner...although this year I am so busy I didn't think we would be going for dinner...but as usual Ian came through and booked us a romantic dinner....so what happens if we have an argument...several choices.. cancel dinner... go and not talk or bite the bullet and make up and enjoy the evening...sometimes when life is so busy you just have to make the time to keep your relationship going otherwise you drift apart....and that's another reason to set the dinner date for this day...any excuse... for a good time with the person you love.

"Roses are red, my love.
Violets are blue.
Sugar is sweet, my love.
But not as sweet as you."

Here is one of our favourite songs Hold me thrill me kiss me" Gloria Estefan

Happy Valentines Day everyone..........

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