Adelaide Conference: Australian College of Midwives 16th National Conference

It’s been a while since I last blogged, and why? that's easy to answer, too much to do and caught up with Facebook & Facebook games.. Yes unfortunately I am guilty of mindless games.... I do find it helps me relax... however it was taking up too much time. You know the old saying...."everything in moderation".. Well almost everything.



The Adelaide Conference "Midwives & Women: A brilliant Blend" was excellent. The good thing about attending conferences is not only hearing the keynote speakers, presenters and looking at the trade / exhibition displays but the social networking with like minded people. Other midwives you've read about, wanted to meet, old friends, acquaintances and conference junkies, the ones you see at every conference. It's great...... you get to meet other midwives, students and in fact each new city you go to you increase your chances of meeting complete strangers... and strike up new liaisons. What a great opportunity we have as midwives to increase our profiles. It was good to meet up with Sarah Stewart and Lisa Barrett whom I met initially blogging, now we meet also at conferences. The break times was an ideal time for networking over a coffee or tea. Meetings took place anywhere people could find a comfortable spot. The food over the four days was splendid, great choices and enough for everyone.






Highlights of the conference for me: Welcome reception - renew old acquaintances and meet new contacts: The opening- Welcome to Country was performed by three Aboriginal males... was superb: Pat Brodie outgoing National President of the ACM, together with Dr Barb Vernon Executive Office ACM, are always inspirational. Hon. Sandra Kanck former Parliamentary leader of the Democrats (SA) her tenacity in politics did well for women and midwives of SA, she was memorable. Cheryl Boles, Midwife, Anangu Bibi Birthing Program...again inspirational.





As with all programs when it comes to the concurrent sessions its hard to choose which one you want to go to...and often there are two at the same time you want to attend, its times like this you wish you were Hermione Granger from the Hogwarts School of Witchcraft and Wizardry - Harry Potter movies and had a time piece so you could alter the time to attend everything you wanted- ah life in the movies.



Several concurrent sessions spring to mind: Angela Kellock Midwife her presentation on waterbirth had a very catchy title; "Swim with the Sharks" brilliant how appropriate. Amber Janowicz, a brave mother, her story reduces you to tears, and makes you remember why you became a midwife. Hannah Dahlen midwife, Homebirth and the National Maternity Review: Too hot to handle? politically motivates you and makes you realise how far we have come and how far we have to go... no rest for the wicked. Finally Devon Plumbley Midwife sang "We Dreamed of You" a song written and composed by Devon when she was a student midwife. The song is about grief and loss, the journey of bereaved families’ experiences. Devon has a truly remarkable voice a very talented young woman. All the concurrent sessions I attended were of an excellent standard and memorable.





This conference was different for me because I achieved two personal goals; that was to present a concurrent session and do a poster presentation, of which I did both. I was extremely nervous for my presentation; the room was full, standing room only. There were friends, peers, strangers, all come to hear what I had to say - however all like minded people thirsting for information and the sharing of ideas. After the initial nervousness I went into full swing and pretended they were all my family, relaxed and gave my talk. I felt it went well and would do it again.




On Wednesday night I was fortunate to be invited to the Fellows Oration... anyone that knows me, knows that I like a bit of pomp and ceremony...I am a bit of a Royalist have been to the Garden Party at Buckingham Place, so I was delighted to be going to the Fellows Oration. My friend and colleague was being made a "Fellow" of the Australian College of Midwives... what an honour, not sure what you have to do when you are a Fellow, I am guessing more work for nothing. No I shouldn't say that it was tongue in cheek... it is for the profession of Midwifery. Anyway it was pomp and ceremony, champagne flowing. Chris Cornwell Vice President SA ACM gave a brilliant oration - now I am really going to show my ignorance by saying I didn't know what an oration was until then "a formal public speech - a sacred story" Chris did a magnificent job, I was truly inspired by it and in awe of her ability to present it so well.





It was a busy four days, however we did have a fantastic dinner on Thursday night at The Pavilion Adelaide Oval Function Centre.... it was a sea of purple, pink and blue, the food was fabulous the wine flowed freely, good company, relaxing, dancing a good time was had by all. There was many a tale to tell the next morning... and I was one of them... and that’s all I'm going to say on the subject... except to say! You never know when you are going to meet someone, who knows someone you know.... in a strange city. Remember there is only 6 degrees of separation.....

This duck posed for my picture!


This shop has the best chilli hot chocolate I've ever tasted...worth a try.

Next ACM Conference: 2011 NSW

Just don't hand your body over to medicine!

Hi blogers, yes I have been away, busy working and having a holiday. It was Ian's 60th birthday, so I just had to take him away to Malaysia for a golfing holiday. We had a restful time, I will do a blog on it as we did have some fun and I managed a par! yeah!

The semester is well underway now and the new students have began. It is always exciting. I am looking forward to "Women & Midwives - A Brilliant Blend" the Australian College of Midwives 16th Biennial Conference: in Adelaide 22 - 25 September, however lots of work has to be done before then.

I came across this trailer for orgasmic birth - have a look its great!

http://www.youtube.com/watch?v=zG_6IVmXvr0

Midwives are shown to have best outcomes for women.

It is really great to see a positive story about midwives in the press: I came across this story in the Sydney morning Herald. It is nothing any midwife does not already know, but it is good to see in print and raises our profile.
The story talks about midwives being the best option in terms of midwifery led care for women during pregnancy.
Kate Benson writes

Women who are cared for by midwives rather than GPs or obstetricians are less likely to lose their babies within the first six months of their pregnancies, an international review of maternity services has found. Researchers gave no reasons for the shock finding, taken from an analysis of 11 trials involving more than 12,200 women in four countries, but a spokeswoman for the Australian College of Midwives, Hannah Dahlen, said women who were seen by the same midwife during pregnancy, labour and birth usually felt more supported and less anxious, leading to reduced risk of miscarriage.

What a surprise to see that the Australian and New Zealand College of Obstetricians and Gynaecologists, are not happy with these findings. It is a shame that collaboration is not the focus.

The analysis, which is the largest undertaken in the world, also found that women in midwife-led models of care were less likely to be admitted to hospital during pregnancy, have instrumental deliveries, episiotomies or require analgesia and were more likely to have spontaneous vaginal births, feel in control during labour and better able to initiate breastfeeding.

The Australian college of Midwives spokes person Dr Dahlen said

the analysis, published by the Cochrane collaboration, considered the gold standard of assessing medical evidence, proved that midwife-led models of care had no adverse outcomes and many benefits.
"If this was a tablet, it would be mandatory that all women have it, but instead we have to deal with all this shroud waving by obstetricians. Now we know the evidence for their claims just isn't there,"

What a good analogy from Hannah Dahlen. Off course this is nothing new for midwives, we have always argued that midwifery-led care offers more for women and would reduce the Cesarean rate which is currently at 31%.
Our government needs to work towards more midwifery-led models of care and obstetricians need to start collaborating with midwives rather than always opposing us, after all we all want the same thing, informed choice for women and safe birthing options.

We need to listen to what women want, and stop being paternalistic.



Reference: Sydney Herald: http://www.smh.com.au/news/lifeandstyle/parenting/midwives-found-to-aid-babies-survival/2008/10/09/1223145589248.html

Is our Maternity system failing? A Freebirth gone wrong.

In NSW a newborn baby dies, after the mother birthed at home with her husband and no health professional, a freebirth. The woman attended a hospital three days prior to the birth and was told the baby was fine however that she was at high risk of complications, including the rupture of a scar from previous caesarean. They wanted to induce her labour immediately. The woman refused and return to her home in the Blue Mountains where she gave birth to a stillborn baby several days later.

Two doulas, who are not medically trained but provide emotional support for women before and during childbirth, and a qualified independent midwife were called but arrived too late.

The baby's father told The Sun-Herald the doulas had told him the baby was stillborn due to an infection contracted inside the womb.

This tragedy confirms the fears of maternity experts who are alarmed at the growing trend of women evading the health system in favour of unsupervised home births.
This begs the questions, what information did the hospital doctors give this woman to scare her away and make the decision she did? Why do women make these choices? Was this woman suspicious that she may be coerced into something she did not want, and made a hasty decision? did she feel she had "no choice"
The Australian College of Midwives supports homebirth for low risk women. Midwives are trained in the 'normal' and can recognise the 'abnormal' therefore refer when necessary to an obstetrician. However the College does not support "freebirthing" its too risky.

Associate professor Dahlen said in this case the woman had been traumatised by a previous hospital experience and fears she might be forced into induction or a caesarean. Against medical advice, she made a last-minute decision to leave the hospital and go home and soon after the baby died in the womb.

If we fix the system we won't have women resorting to a last-minute panicked decision like this......... The increase in women freebirthing is a symptom of a system that does not give women choice. We're seeing more and more of these concerning incidents in the last two years. It has to be addressed, and urgently.

The NSW Health Department spokesman said;

Patients have the right to decline medical intervention or treatment, as as the freedom to choose where, when and from whom they will receive medical advice and assistance

It is suspected that this baby died of Group B streptococcus, not as a result of the homebirth. This case is currently with the coroner, so watch this space........

As a midwife I have to say, that there are enormous risks associated with 'freebirthing' and it is not advisable. I am an advocate for homebirth in low risk women, that is with no risk factors. However it is important to talk about your concerns and collaboration is the key. I urge any woman considering the option of Freebirth to seek advice, from your doctor, midwife, someone who can give you appropriate advice.

Look at all your options carefully, be fully informed in the risks associated with your condition and your babies condition before you make a decision. Write the risk and benefits down so that the facts are clear and there can be no mistakes, get a health professional to read your list so you have a balanced view and you have not left something out, then make a decision.

Remember to act on the FACTS not the EMOTION, after all it is your life, dreams and aspirations that your are considering. Take the time to make that decision, there are always consequences to actions.

Ref: http://www.smh.com.au/articles/2008/09/13/1220857899000.html?feed=fairfaxdigitalxml

Role of the midwife

As I was reading the West Australian paper today I came across a headline which read:

“Baby boom brings new role for midwives”, I thought great, what’s this about? And proceeded to read it and was surprised for two reasons; the first being;
“Midwives would get doctor-style responsibilities such as ordering diagnostic tests and the ability to prescribe drugs under proposals the Federal Government is considering”

– I thought, what a new role? Well, as I did my midwifery in the UK, and worked as a community midwife, this is something that I already use to do and was stripped of this right once I began working in WA as midwives do not work in this capacity here. There are several other countries that also work in this capacity where midwives have diagnostic responsibilities, these are New Zealand and off course Britain.

This is the role a midwife is supposed to have, this is the role midwives are educated for, to provide continuity of care, one on one care, know and recognise the normal and then recognise the abnormal, order diagnostic tests and then refer to the obstetrician when the situation becomes abnormal. The midwife is the expert in the normal pregnancy and birth, the obstetrician in the abnormal.

I am delighted for the profession of midwifery and for the women of this State that we are finally letting midwives work to their fullest capacity.

Secondly I am also delighted that the Health Minister Nicola Roxon has bought this issue to the forefront and is open to dialogue and discussion regarding the prospect of midwives working to their fullest capacity and also considering the option of Medicare provider numbers for midwives and looking at the issue of indemnity insurance.
This is a result of a comprehensive review of maternity services throughout Australia which says “that there is no Medicare benefit payable to midwives for management of labour and delivery and private health insurers offer only limited support for midwifery services”.

It was no surprise to read that the “Australian Medical Association” will oppose this proposal. We should be working in collaboration with each other, midwives and obstetricians, rather than this constant power play, using ‘fear tactics’ and patient/client safety to keep women and midwives in line.

Let the dialogue and discussions begin.

Ref: West Australian 10 September 2008 p12

Limited choice for rural areas - Homebirth refused

A NSW hospital refused a woman the right to have a homebirth, despite the local obstetrician agreeing to the woman's request. The obstetrician was willing to send a hospital midwife to the homebirth, however the request was rejected by the hospital.
The woman only found out by chance that her request was rejected - she states

They knew that at 37 weeks you can't fight,"Ms Caines said.

This woman who has been a maternity advocate in the region for eight years, said she was upset that women in the Upper Hunter were given fewer choices when it came to delivering their babies than elsewhere in the region.

she said.

"As a leading advocate I hold dear the fact that there needs to be benchmark of safety and quality,"

It's birth by postcode

The outcome is that this woman has now employed a private midwife for the birth, but not all women have have this option or resources to do this.
The reason the hospital gave for not allowing the homebirth was

...did not meet the criteria for a home birth because she did not have a GP who would support her and she needed to have a midwife from the Upper Hunter area.

There was no medical reason stated for the refusal of this woman's request, in fact she did have the support of an obstetrician and it made no difference to her case. This is a tragedy for women's choice.

Ref: http://www.theherald.com.au/news/local/news/general/muswellbrook-hospital-rejects-home-birth/1251837.aspx

The questions I am posing is; do our hospitals have the right to do this? and as a result of this, will the hospitals be forcing our women to "freebirth" or birth in a way that may not be safe and go it alone?

Would it not be better to find a compromise to suite all parties rather than a straight out "no"? do they think in doing this they can control women?

If we constantly refuse women their choices, women will find a way to do it? where does this leave us as a society and our duty of care?

What happened to informed choice and women taking responsibility for their own choices?
Why do we not allow women to make these choices? or are we just a paternalistic society?

Paternalism manifests in the making of decisions on behalf of clients/patients, where doctor knows best - that is the culture of our health care system - a culture which is hard to change.

My experience of an unplanned homebirth – Mother, Nanna, Midwife

The birth of Isabella Rose, my granddaughter 19/07/08

If you are following my blog you will be aware that my daughter Faye was due in July. Faye was now 5 days over her due date, she was drinking raspberry leaf tea three times a day, eating curry, walking and trying various other methods of trying to get into labour, which will not mention on my blog.
It was Friday evening I was going over to see how Faye was, it was a real winters evening, dreadful, cold and wet. I got to Faye’s to find her upset, very emotional, teary. Brendon (her husband) had been outside in the dark, wet night trying to fix the shed roof, as it had blown off in the storm. Little Dylan was pestering mummy to go outside and help daddy; it was all a bit much for Faye, she was much stressed and rightly so. Brendon came in and decided that the shed could wait, Faye went off for a long hot shower, I started dinner, Brendon finished it and Dylan was playing in the lounge, the house was back to normal.
We had a lovely dinner, settled in and watch some telly. I had a listen to the baby with my Doppler, her head was well down, and it would not be long now. I went home about 1030pm. I had a sixth sense Faye would go into labour, I stayed up on my computer till about 0130ish and gave up on the idea of a birth and went to bed.
The phone rang at 0300, it was Faye saying “mum my contractions have started, can you come over”. I jumped out of bed, woke the rest of the house up, my husband Ian and step daughter Kirsten (18yr) and we all went off in the car. It took us about 20mins at that time of the morning to get to Faye’s house.
When I got there Faye had just got into the bath, she had woken up with contractions at 0245hrs, and had two really strong contractions when she had called me, and up until then she had been asleep.
I added several drops of Clary sage to the bath water to assist with the contractions. Faye was contracting about 2:3:10, they were irregular in strength she was complaining her back was exceptionally painful. On palpation the baby was LOA, head well down, fetal heart was within the normal range, membranes were intact, and all was well, progressing normally. Dylan was asleep, Brendon was getting drinks for everyone and Ian was watching the golf. I had briefed Kirsten that she would be my record keeper.
As I was watching and talking to Faye I noticed her contractions although irregular were very intense and I got the sense that things were progressing quickly, it was now 0345 and she was contracting 4: 10, still in the bath, the water was very therapeutic for Faye it helped her back pain enormously. The fetal heart was 140bpm before, during and after the contractions. Then there was a spontaneous push, Brendon asked was it time to ring the birth centre? Faye got out the bath, and walked around, and with every third contraction Faye spontaneously pushed. Brendon rang the birth centre to advise them Faye was contracting, however I told him I didn’t think we would make the birth centre as I thought Faye was fully dilated. As Brendon was talking on the phone, Faye’s water broke at 0430, it was clear liquor, I then examined her to confirm she was fully dilated head was plus 3 spines. We were going to birth at home. Brendon told the birth centre and then called an ambulance so that I could have some back up if required for the baby. I also got Kirsten to call my friend Lorraine (who is also a midwife) who came to back me up, and Faye & Brendon know Lorraine so they were also happy. Kirsten stripped the bed, Brendon put towels on the heater, and we were just waiting for the baby to arrive. Faye was doing so well, fetal heart was good throughout. The ambulance crew arrived, and asked how long it would be? I said about half and hour at the most, they did not know about birthing and were very happy for me to continue, they put some blueys on the bed, bought in the delivery pack and then went to talk to my husband, whilst Brendon, Kirsten (who was doing the record keeping) Lorraine and I supported Faye. We were all in the en-suite of the bedroom, Faye was leaning over the sink, contracting, irregularly, every second contraction was strong, Faye pushed very well, the vertex (head) was advancing well, she crowned at 0450, head was then born, Brendon said “the baby is trying to breathe is that OK?” next push the body was out, Isabella cried as soon as she was born & did a poo (passed meconium), at 0455, I passed the baby to Brendon, he caught his daughter, we turned Faye around and she walked into the bedroom and climbed up on the bed, we were waiting for the third stage, the placenta, Faye was cuddling her baby, Isabella was crying she did not want to come out, she rooted to find the breast, it was beautiful to watch. The placenta was delivered, Faye had started bleeding, and her uterus was boggy, so I rubbed up a contraction until it was firm, we put the baby on the breast to encourage her uterus to contract, Faye’s uterus relaxed again, so I rubbed up another contraction. I asked the ambulance crew if they had oxytocics and they said they don’t carry them. We made the decision to transfer into the Birth Centre (FBC) as Faye needed the oxytocics to help contract her uterus. Faye had a small labial tear that was not bleeding and she had passed urine not long before the birth. So we put the baby, skin to skin with mum, and warming blankets on top, I kept rubbing up for contractions, and encouraged the baby to breast feed.



Once we arrived at the FBC Faye received the oxytocics and her uterus contracted well, and she went home again in 5 hours. All was well.

Birth is not an emergency: it is simply an emergence
Jeannine Parvati Baker

On refection, it was a 2 hour labour; Faye said once she had the first two contractions she thought this would go quickly & thought she would not have time to go to the FBC. Brendon was not phased as he and I were with Faye for Dylan’s birth and Brendon felt it was all under control, Kirsten felt traumatised as she had not experienced a birth before, (good contraception for her) however she did think it was great birth. Ian (pops) enjoyed watching the golf.
I was surprised the ambulance crew do not carry oxytocics. I am very proud to have helped Faye again birth her baby and at home, even though it was an unplanned home birth. I would like to have had an oxytocic at home to give to Faye, then she could of stayed at home, but then it would be a planned homebirth and I would have to be an independent midwife. This then raises the question of indemnity insurance or lack of it for independant midwives and I could not work with out insurance.
Thank you Faye & Brendon for sharing and allowing me to support you during this very intimate time, it has truly been a pleasure and a real honour. I am humbled by the experience. The highlight of my career is to assist my family through labour to achieve the birth they want.
“

If mothers have an instinct to give birth, midwives have the impulse to assist them” Jeannine Parvati Baker

Dylan with his baby sister Isabella 2hrs after the birth.

Reflections of an unplanned Homebirth:

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

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

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

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

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

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



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