Wednesday, February 29, 2012
Fear of Home Birth in Doctors and Obstetric Iatrogenesis
LINK Fear of Home Birth in Doctors and Obstetric Iatrogenesis
Author: Lokugamage, Amali
Source: International Journal of Childbirth, Volume 1, Number 4, 2011 , pp. 263-272(10)
Abstract:
Home births are physiological births and form part of the social model of birth. Doctors, traditionally, have been very fearful of out-of-hospital birth, and physiological births happen less frequently in obstetric units. Normal/physiological birth contributes to improving public health, and doctors are often not aware of the extent of this benefit. Normal birth leads to adaptive physiological function in the baby (endocrine, immune system, thyroid function, respiration, neurology, temperature regulation), more mother and baby bonding, and promotes higher breastfeeding rates, which in turn lead to better lifelong emotional and physical health in babies. Normal birth affirms health, promotes empowerment in mothers, and is a societal event that has been linked to promoting positive emotional qualities in society via the birthing hormone, oxytocin. Training within the medical model constrains doctors' appreciation of normal birth. Experience of complications, a lack of awareness of the evidence surrounding home birth, compounded by failure to understand the concept of iatrogenesis, perpetuates fear of home birth among doctors.
http://www.ingentaconnect.com/content/springer/ijc/2011/00000001/00000004/art00007
www.theheartinthewomb.com
Thankyou for your comments
Tuesday, February 21, 2012
"MIDWIVES SAVE LIVES" webinar 5 May
Message from Sarah Stewart
Just a quick note to tell you about this year's Annual Virtual International Day of the Midwife (VIDM). We are now accepting EOI for presenters so please let us know if you'd like to be involved.
The Virtual International Day of the Midwife (VIDM) celebrates the International Day of the Midwife by bringing midwives and others from across the globe together using online electronic media (http://internationaldayofthemidwife.wikispaces.com).
A variety of live online events are presented every hour for 24 hours on the 5th of May 2012 starting at 10am New Zealand time via web-conferencing facilities. These may include presentations about latest research or practice issues, informal discussions, panel discussions, meetings or story-telling.
The organising committee are now calling for Expressions of Interest (EOI) to present at the VIDM eVent. This year's theme is MIDWIVES SAVE LIVES. However, we will consider any topic as long as it is of interest to midwives and people interested in childbirth.
While the EOI must be in English, we welcome presentations on the day in other languages. We also welcome EOI from non-midwives and midwifery students. Presenters need not be experienced in using electronic media - members of the organising committee will be able to give support. Please provide a short paragraph (no more than 150 words) describing your presentation and the form it will take (for example, you may wish to use a PowerPoint presentation).
Please also include your status (eg midwife, non-midwife, midwifery student), country of origin and language of presentation. Your presentation or session should:
• Have a clear aim or purpose
• Focus on maternity care or midwifery
• Be of interest to an international audience
• Be appropriate for web conferencing
If you would like to give a presentation, please indicate what country and time zone you are available in your EOI.
Please note: We will be using the web-conferencing platform Adobe Connect. All sessions will be facilitated by an experienced online facilitator so you will be supported at every stage.
Please submit your EOI by 10th March 2012 by one of these methods:
• Email to Sarah Stewart sarahstewart07@gmail.com
• Add it to the VIDM wiki
• Add to the VIDM Facebook page
• Via Twitter
Just a quick note to tell you about this year's Annual Virtual International Day of the Midwife (VIDM). We are now accepting EOI for presenters so please let us know if you'd like to be involved.
The Virtual International Day of the Midwife (VIDM) celebrates the International Day of the Midwife by bringing midwives and others from across the globe together using online electronic media (http://internationaldayofthemidwife.wikispaces.com).
A variety of live online events are presented every hour for 24 hours on the 5th of May 2012 starting at 10am New Zealand time via web-conferencing facilities. These may include presentations about latest research or practice issues, informal discussions, panel discussions, meetings or story-telling.
The organising committee are now calling for Expressions of Interest (EOI) to present at the VIDM eVent. This year's theme is MIDWIVES SAVE LIVES. However, we will consider any topic as long as it is of interest to midwives and people interested in childbirth.
While the EOI must be in English, we welcome presentations on the day in other languages. We also welcome EOI from non-midwives and midwifery students. Presenters need not be experienced in using electronic media - members of the organising committee will be able to give support. Please provide a short paragraph (no more than 150 words) describing your presentation and the form it will take (for example, you may wish to use a PowerPoint presentation).
Please also include your status (eg midwife, non-midwife, midwifery student), country of origin and language of presentation. Your presentation or session should:
• Have a clear aim or purpose
• Focus on maternity care or midwifery
• Be of interest to an international audience
• Be appropriate for web conferencing
If you would like to give a presentation, please indicate what country and time zone you are available in your EOI.
Please note: We will be using the web-conferencing platform Adobe Connect. All sessions will be facilitated by an experienced online facilitator so you will be supported at every stage.
Please submit your EOI by 10th March 2012 by one of these methods:
• Email to Sarah Stewart sarahstewart07@gmail.com
• Add it to the VIDM wiki
• Add to the VIDM Facebook page
• Via Twitter
Saturday, February 4, 2012
making birth safer
... for the mother and her baby.
All maternity professionals are expected to act in a way that protects the wellbeing and safety of mother and baby. That's a reasonable expectation of any society. Midwives have guidelines and codes of practice and decision-making frameworks that are all structured around principles of safety and quality.
The tragic death of a woman, Caroline Lovell, after giving birth at home in a Melbourne suburb, has thrust homebirth midwifery into the media spotlight. I have written about the breaking news at the MIPP blog. One comment summed up the situation,
I am hoping that whatever tests are done, the autopsy, coroner's inquiry and report, and the investigations by the Nursing and Midwifery Board of Australia will satisfy my need, as a member of this community, to be confident that in this case, there was no professional negligence or unprofessional conduct. I would have this expectation regardless of where the death occurred.
Many women have contacted their midwives with messages of love and support. Women have also told their midwives that they are being questioned by concerned family members about their plan for homebirth.
The decision to give birth at home is made by the mother, with professional advice from her midwife. If the labour is not progressing well, it's crucial that decisions about transferring care to hospital are made in a timely fashion. This is the midwife's responsibility - not the woman's choice. A labouring woman cannot be expected to monitor her own progress. A mother and baby have limited reserves. When the demands of the birthing process become more than the mother or baby can be reasonably expected to cope with under natural situations, the best option is to transfer care to a hospital which provides emergency obstetric care. There can be no guarantees of particular outcomes.
Dear reader, I have only touched on these deep and potentially unsettling issues. The intense media interest in this case passed quickly. However, midwives who are ready to learn from each situation will not forget.
The reports by Coroners are placed on the public record. For example, a baby death in hospital from perinatal asphyxia.
Thankyou for your comments
All maternity professionals are expected to act in a way that protects the wellbeing and safety of mother and baby. That's a reasonable expectation of any society. Midwives have guidelines and codes of practice and decision-making frameworks that are all structured around principles of safety and quality.
The tragic death of a woman, Caroline Lovell, after giving birth at home in a Melbourne suburb, has thrust homebirth midwifery into the media spotlight. I have written about the breaking news at the MIPP blog. One comment summed up the situation,
"A tragic event is made sadder by the tendency of traditional media to suggest a causal link between the setting for this birth and the poor mother's passing before the facts have come to light."I do not have information about the facts of this case, and I therefore cannot form an opinion. I have heard the TV reports, read the newspaper reports and online commentators, and had conversations with other midwives and members of the community who have heard rumors. A TV reporter who spoke to me before recording an interview told me that a leading legal person in Victoria had commented that she considered homebirth midwives to be "cultish". I reject this notion. There is nothing at all cultish in professional midwifery as described in international and Australian definitions and standards: the standards against which all midwives are judged.
I am hoping that whatever tests are done, the autopsy, coroner's inquiry and report, and the investigations by the Nursing and Midwifery Board of Australia will satisfy my need, as a member of this community, to be confident that in this case, there was no professional negligence or unprofessional conduct. I would have this expectation regardless of where the death occurred.
Many women have contacted their midwives with messages of love and support. Women have also told their midwives that they are being questioned by concerned family members about their plan for homebirth.
The decision to give birth at home is made by the mother, with professional advice from her midwife. If the labour is not progressing well, it's crucial that decisions about transferring care to hospital are made in a timely fashion. This is the midwife's responsibility - not the woman's choice. A labouring woman cannot be expected to monitor her own progress. A mother and baby have limited reserves. When the demands of the birthing process become more than the mother or baby can be reasonably expected to cope with under natural situations, the best option is to transfer care to a hospital which provides emergency obstetric care. There can be no guarantees of particular outcomes.
Dear reader, I have only touched on these deep and potentially unsettling issues. The intense media interest in this case passed quickly. However, midwives who are ready to learn from each situation will not forget.
The reports by Coroners are placed on the public record. For example, a baby death in hospital from perinatal asphyxia.
Thankyou for your comments
Wednesday, February 1, 2012
'Coming out' of the hospital
A colleague who is in the process of establishing a private midwifery practice wrote:
"I am feeling very disillusioned with the whole hospital system at the moment. ... Women do not have choice in hospitals."
My colleague went on to describe a couple of instances in which women who she accompanied to hospital experienced intimidation and bullying which led them to accepting interferences that they did not want, and were, understandably, unhappy with their experiences.
This midwife is a skilled, competent midwife with years of experience in hospital-based midwifery. She asked me if I think the solution to her dilemmas is to guide women into planning homebirth. I said no, I don't think that's the answer,
Understanding normal physiological birth (Plan A) from the woman's and baby's perspective is, I believe, the key to working as a midwife, 'with woman', and without fear of the hospital. I'm not suggesting that an experienced midwife does not understand normal birth, but what I am saying is that having become acclimatised to hospital processes and rituals can diminish the midwife's focus on the woman, as she has always previously been required to work according to the service's guidelines and protocols. As the midwife 'comes out' of the hospital, and shifts her focus from the service to the woman who knows and trusts her individually, she will become strong in her identity as a professional midwife.
Whether it's a first baby, third baby, or a vaginal birth after caesarean (VBAC), or any other situation in which the woman intends to labour spontaneously, once everyone accepts the process of spontaneous onset of labour and getting established in labour, not interfering without a valid reason, it’s usually not difficult to go to hospital and complete the birthing there. Plan A all the way, if that's possible at the time.
I recently wrote about vbac at the mipp blog so won’t repeat that here. Many midwives feel disillusioned with the hospital system, and they have experienced no alternative so they quickly start to feel trapped. I think the thinking of the disillusioned midwife (or student) may be too much in the framework of being part of the system in the way they want the doctors and the other midwives to work with them, such as in respecting women's 'choice'.
'Choice' is a concept that is misunderstood in maternity care. Midwives talk about 'informed choice', and become frustrated when a woman who wants spontaneous unmedicated birth is quickly put on the managed care conveyor belt, and ends up with augmentation, epidural, 'and the lot'.
A midwife who has become independent of the system, and independent in her thought processes actually has a new way of looking critically at birth and learning how to adapt her knowledge to suit the individual woman in her care. The focus of the midwife changes subtly, and she learns how to work effectively so that the wellbeing of mother and child is always first in her mind, at the same time as she uses knowledge and skill to work in harmony with, and protect, delicate natural processes. The private midwife's role takes into account the standard responses that are part of mainstream obstetric managed care, and the midwife expertly protects and guides the woman to understand how she can accept what she needs and decline, without becoming anxious or defensive, what she doesn’t.
For example, I spoke Linda (not her real name) who had achieved vbac for her last baby by just refusing everything and I mean everything – she is very (wonderfully) stubborn! Understandably Linda wants to have an unmedicated spontaneous birth for this baby too. I spoke to Linda about the various interventions that are considered standard practice in the hospital for vbac, and asked her to tell me how she felt about each one.
When we got to having intravenous (IV) access, Linda could only think about it getting in the way and being annoyingly painful when she moved her hand. Linda was interested that the IV cannula could be sited at her wrist, and she could have full movement of her hand. She came around to an understanding that it could be to her advantage, if "they" were happy for her to get on with her labour. She knows that her veins are difficult to access at the best of times, and siting the IV cannula might be something that can be taken care of in early labour rather than being a major source of interruption in the most demanding time.
Does Linda have choice in hospital? Yes. She can choose to refuse the intervention. Or, she can make an informed decision to accept an IV cannula that is positioned carefully so as not to impede her activity or movement.
This is a very simple example of how a midwife and woman work in partnership. The midwife knows and understands the system, and at strategic points gives the woman guidance that assists her in making informed decisions, and feeling she has authority for her natural birthing process. The midwife has 'come out' of the system/hospital and is learning how to use the system to benefit her client.
Thankyou for your comments
My colleague went on to describe a couple of instances in which women who she accompanied to hospital experienced intimidation and bullying which led them to accepting interferences that they did not want, and were, understandably, unhappy with their experiences.
This midwife is a skilled, competent midwife with years of experience in hospital-based midwifery. She asked me if I think the solution to her dilemmas is to guide women into planning homebirth. I said no, I don't think that's the answer,
Understanding normal physiological birth (Plan A) from the woman's and baby's perspective is, I believe, the key to working as a midwife, 'with woman', and without fear of the hospital. I'm not suggesting that an experienced midwife does not understand normal birth, but what I am saying is that having become acclimatised to hospital processes and rituals can diminish the midwife's focus on the woman, as she has always previously been required to work according to the service's guidelines and protocols. As the midwife 'comes out' of the hospital, and shifts her focus from the service to the woman who knows and trusts her individually, she will become strong in her identity as a professional midwife.
Whether it's a first baby, third baby, or a vaginal birth after caesarean (VBAC), or any other situation in which the woman intends to labour spontaneously, once everyone accepts the process of spontaneous onset of labour and getting established in labour, not interfering without a valid reason, it’s usually not difficult to go to hospital and complete the birthing there. Plan A all the way, if that's possible at the time.
I recently wrote about vbac at the mipp blog so won’t repeat that here. Many midwives feel disillusioned with the hospital system, and they have experienced no alternative so they quickly start to feel trapped. I think the thinking of the disillusioned midwife (or student) may be too much in the framework of being part of the system in the way they want the doctors and the other midwives to work with them, such as in respecting women's 'choice'.
'Choice' is a concept that is misunderstood in maternity care. Midwives talk about 'informed choice', and become frustrated when a woman who wants spontaneous unmedicated birth is quickly put on the managed care conveyor belt, and ends up with augmentation, epidural, 'and the lot'.
A midwife who has become independent of the system, and independent in her thought processes actually has a new way of looking critically at birth and learning how to adapt her knowledge to suit the individual woman in her care. The focus of the midwife changes subtly, and she learns how to work effectively so that the wellbeing of mother and child is always first in her mind, at the same time as she uses knowledge and skill to work in harmony with, and protect, delicate natural processes. The private midwife's role takes into account the standard responses that are part of mainstream obstetric managed care, and the midwife expertly protects and guides the woman to understand how she can accept what she needs and decline, without becoming anxious or defensive, what she doesn’t.
For example, I spoke Linda (not her real name) who had achieved vbac for her last baby by just refusing everything and I mean everything – she is very (wonderfully) stubborn! Understandably Linda wants to have an unmedicated spontaneous birth for this baby too. I spoke to Linda about the various interventions that are considered standard practice in the hospital for vbac, and asked her to tell me how she felt about each one.
When we got to having intravenous (IV) access, Linda could only think about it getting in the way and being annoyingly painful when she moved her hand. Linda was interested that the IV cannula could be sited at her wrist, and she could have full movement of her hand. She came around to an understanding that it could be to her advantage, if "they" were happy for her to get on with her labour. She knows that her veins are difficult to access at the best of times, and siting the IV cannula might be something that can be taken care of in early labour rather than being a major source of interruption in the most demanding time.
Does Linda have choice in hospital? Yes. She can choose to refuse the intervention. Or, she can make an informed decision to accept an IV cannula that is positioned carefully so as not to impede her activity or movement.
This is a very simple example of how a midwife and woman work in partnership. The midwife knows and understands the system, and at strategic points gives the woman guidance that assists her in making informed decisions, and feeling she has authority for her natural birthing process. The midwife has 'come out' of the system/hospital and is learning how to use the system to benefit her client.
Thankyou for your comments
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