Wednesday, October 29, 2008

NORMAL BIRTH: The bare necessities


Understanding
that physiologically normal birth is a quintessential female act
• only women can give birth
• other people can greatly influence a woman’s ability to work in harmony with her natural processes. Each woman chooses her professional care provider(s)as well as her own trusted support team, which may include
• Partner
• Family members
• Friends
• Other supporters such as lay birth helper (doula)


Recognising the importance in physiologically normal birth that a mother is able to
• feel safe, personally respected, in a personal, intimate space
• be flexible – the mother can change what she wants/ doesn’t want
• move out of her thinking mind, and work in harmony with her intuitive brain
The mother who is able to take control of her environment, the space in which she labours, or the amount of light in the room, or personal touches such as her own music, or essential oils, can minimise feelings of alienation in labour, and enable her body to work effectively.

Minimising sensory stimulation in labour protects normal birth. Interference from anxiety, fear, higher brain activity, such as thinking about
• time between contractions,
• amount of dilatation, and other calculations that are in fact indicators of progress, which may inhibit normal birth
A woman may also be inhibited by the feeling of being observed, through photography, or strangers entering her labouring/birthing space. Any sensory stimulation may be unwelcome, and many mothers ask midwives to please refrain from using perfumes when attending births.

Being well. Healthy women usually give birth to healthy babies. Healthy diet, exercise, no exposure to smoking or other harmful substances in the environment, good social/emotional support in pregnancy and after the birth, access to professional care (eg dentist, physiotherapist, GP) as needed support wellness in pregnancy and birthing.

Knowing and trusting the midwife who can act with authority and take professional responsibility for primary maternity care. Being attended by a known midwife helps a woman to
• understand choices and make informed decisions
• have confidence in the knowledge base of her care provider
• be realistic about expectations

If decision is made to accept medical intervention, the change of plan is made from the physiologically normal birth, to the best birth that can be achieved with the collaborative efforts of the maternity care providers in that situation.

[Readers are encouraged to add any other 'bare necessities' for normal birth in the Comments section.] Joy Johnston

Monday, October 27, 2008

BaBs submission to the Maternity Services Review

• Q: What, if any, are key support services, including peer support which warrant national coverage?
In addressing this question, we wish to comment specifically on peer support in local communities, as we believe peer support in local communities is a key support service that is not currently available for most pregnant women and new mothers. BaBs, Birthing and Babies Support, provides such support. BaBs is a model of community based peer support that is specific to women’s maternity experiences. We recommend to the Review that the BaBs model be made available to all women, as part of a package of reforms that have been foreshadowed in the Maternity Services Review.

One of BaBs’ stated goals is “to expand opportunities for women and their families to find peer support, information and education regarding pregnancy, birth and parenting.” BaBs seeks to achieve this goal by establishing local peer group support as a forum to share information and knowledge of mothers, midwives, educators and researchers in the area of childbirth and early parenting. We work to support women and their families make informed choices and take action about pregnancy, birth and early parenting and to feel empowered and confident in their choices to improve their parenting experiences, health and life skills.


Topics covered in BaBs group meetings include:
• adjusting to mothering
• breastfeeding
• preparing for labour and birth
• birth after caesarean
• prenatal screening
• gentle parenting
• nappies and potty training
• consumerism
• and sleep issue for mothers and babies.

BaBs groups use reflection on experience, and group discussion, which are ‘maieutic’ forms of learning, rather than the ‘didactic’ or lecture/text book styles.

We recognise and value other support services which are available to women and their families around the time of pregnancy and birth, such as the Australian Breastfeeding Association, PANDA, CASA, SIDS, multiple birth association, and the like. These organisations target specific needs that apply to some women, addressing either social or health issues.

Local maternal and child health (MCH) services in Victoria provide a form of peer support for new mothers, in that they organise Mothers Groups for first-time mothers who give birth at approximately the same time. These new mothers’ groups are highly significant, and valued by many women. However they are accessible to only first-time mothers. Our members report that they find the peer support in BaBs, provided voluntarily by various women with children of different ages, and midwives, to be very important as local BaBs groups are responsive to their personal needs than the more structured Mothers Groups.

In this submission, in addition to our responses to questions posed by the Review, we are presenting brief case studies which are based on the experiences of mothers who have been attending BaBs groups, to illustrate the way BaBs is providing peer support. We propose that the Review provide support for the BaBs group concept, by means of recommendation to the Health Minister, that this model be developed and supported in communities nationally.

We have not responded in detail to questions about rural maternity care, as the peer support structures established within the local BaBs groups are possible in any community, rural or metropolitan. As the focus of BaBs is health promotion, enabling pregnant women and new mothers to increase control over, and to improve, their health in pregnancy and birthing, and in the nurture of their babies, we seek evidence based programs in pregnancy, birth, and early parenting, that are likely to improve health. We support the reforms to maternity services, as outlined in the review’s Discussion Paper, by which women themselves become the centre of the care, rather than the condition or the care provider. We look forward to the day when all women will be able to access quality maternity care by a known midwife who is their primary care provider throughout the episode of maternity care, and who works collaboratively with specialist health services when required. We refer particularly to the Cochrane Review of Midwife-led versus other models of care for childbearing women (Hatem et al 2008), and its authors’ conclusion “All women should be offered midwife-led models of care and women should be encouraged to ask for this option.”

Promotion of normal birth, and minimising unwarranted medicalisation through interventions into the natural processes in birth and establishment of breastfeeding and mother-baby bonding, are health promotion activities that will be supported by the reform of maternity services in line with clear evidence.

Tuesday, October 21, 2008

Macedon Ranges BaBs - the Great Nappy Debate...

This coming Monday we will be discussing all things nappy related in "the great nappy debate - cloth v's disposable" and opting for neither...there is an alternative.

It is interesting debate - in the current climate of water shortage and restrictions are cloth nappies an environmentally friendly choice?? Then again, the contribution of disposable nappies to landfill is staggering ...and what of the toxins used in manufacture and released on disposal??

Lets face it, cloth nappies are expensive to buy and there are so many 'modern' varieties to choose from - what is a good investment and will they last? Are eco-friendly disposables really living up to that claim given most are imported - besides who can afford them???

So, what is the alternative??

Come along and join in the discussion - BRING ALONG YOUR NAPPY OF CHOICE OR SIMPLY BE INFORMED ABOUT THE CHOICES - thats what BaBs is all about!

Monday 27th October 9:30-11:30am
Gisborne Community Health Centre - 5 Neal St (conference room)

We look forward to your support.

Tanya
PS - We will be at the Childrens Week Expo at Kyneton this Thursday - see www.macedon-ranges.vic.gov.au for more information!!

Wednesday, October 15, 2008

"From the beginning in Babs club I felt very welcome and supported. "

Sabina Aliyeva
Doncaster East
I am Azerbaijani and live in Australia for more than 8 years. Being a well educated business woman, I always loved to learn from books. In the beginning of my pregnancy I read a lot about pregnancy and motherhood. In fact, “Borders” was the place where I was discovering more and more about my body changes.

I found a pamphlet about BaBs at Box Hill Hospital, and was so pleased to find this information. I started to come to BaBs since I was 7 months pregnant. My daughter is now 22 months old.

From the beginning in Babs club I felt very welcome and supported. It was and it is very important for me to be surrounded by people who’s not indifferent to my worries or concerns. No way you can find in any book what every women was sharing about their pregnancies and labour there. Plus in the group we have professional midwife who could and can explain what really happening to you. Having a midwife at BaBs with many years of experiences has been very important to me. So, before my labour I had discovered through BaBs group discussions and advices of some principles (tips) that became very important to me in giving birth. I learnt about the importance of being active, and using gravity to help my baby progress. Few weeks before labour I had a birth plan ready which the midwife in the hospital respected. My labour was painful, but I didn’t let to give me any pain killers (as I was concern about baby’s well-being after) and lasted for 16.5 hours, but I am proud that I managed to give birth myself. I did not want an episiotomy to be cut, as at BaBs we had talked about avoiding episiotomy if possible. My tears healed well in 40 days.

In the hospital I was in a room with three other mothers. Their babies had all been delivered by caesarean. Their babies cried all the time; my baby was happy. I felt sorry for them.

I have no family support in Australia. A social worker at the hospital helped me and write a letter to present to the Immigration Department, and my mother was able to come here to help me.

My mama, whose name is Rafiga, arrived during the last month of my pregnancy, and stayed for 6 months. I brought my mama to BaBs. Mama was so impressed over how everyone was so warm, and really appreciated each other’s company. Although they were not family, they cared about each other. Mama really loved BaBs. She does not speak much English, but that did not seem to matter. She was loved and easy could communicated with my friends.

As my baby grew I had encouragement from BaBs, helping me know it was OK. I was worried about breastfeeding, settling, introducing solids. I learnt from other mothers’ parenting experiences.

Now we have new and healthy “branches” of Babs – our Playgroup! We all came to Babs during pregnancy and as our babies grew up we - Mums become friends and our little one’s not only recognise each other but also love to meet every time when they have a chance – Once a week so far!

Saturday, October 11, 2008

"I came to the conclusion that I didn't need a specialist surgeon to go about natural pregnancy and childbirth"

Submission to the Maternity Services Review from Kiera Perrott

Dear Ms Bryant

I am writing to express my support for expanding women's access to midwifery care in Australia.

I recently had my first child in Box Hill, Victoria, and was unable to access the kind of care I wanted within the public system or private obstetrics route and instead chose to engage an independent midwife and birth at home at my own expense (my health insurance didn't cover these services either). I'd like to share with you some of my pregnancy, birth and postnatal story to let you know how I feel the system could be improved so that all women have the options I was fortunate enough to be able to access.


Once I had successfully conceived I went to my GP to discuss my options. My GP referred me to an obstetrician on the basis that I had private health insurance and that he was a great surgeon who would be useful if I needed a caesarean. This seems to be a common experience among my friends, but being fit, healthy, young women, the odds of us needing caesareans are low. The medical evidence suggests that care by a known midwife leads to the best outcome for mother and baby so it seems to me it would be better if GPs were referring women to the available midwifery services, which in my case includes a Know Your Midwife program at Birralee Maternity Service, Box Hill Hospital.


I made an appointment with the recommended obstetrician, but luckily his bedside manner was so poor that I came to the conclusion that I didn't need a specialist surgeon to go about natural pregnancy and childbirth. Unfortunately by the time I rang to try and get a booking with the Know Your Midwife program I was 17th on the waiting list. I made a booking with Birralee instead, but I was disappointed at the tour to discover water birth would not be an option, despite the great bathtubs, because not all midwives had the expertise and the hospital didn't have a policy supporting water birth. I was also concerned at the thought of birthing my baby aided by a midwife I might never have met before.

From my reading I was starting to realise that the best way to ensure that I could have a normal, physiological birth was to do it at home, with the support of an independent midwife who would care for me and my baby before, during and after the birth. At about 24 weeks pregnant I engaged an independent midwife and began to plan for homebirth. Fortunately my midwife was able to provide Shared Care with Birralee, so I maintained my Birralee booking in case I needed to transfer to hospital from home.


At the hospital I was offered the 20 week ultrasound but declined it because of the unknown effects ultrasound poses to an unborn baby and the cascade of interventions that can occur if something unexpected is detected. Doctors claim ultrasound is safe but there is no research that really proves this. Studies also show that despite the cascade of interventions that can occur, the outcome for the baby is often the same either way. It's staggering to consider that despite the conclusion of the Cochrane Collaboration that "no clear benefit in terms of substantive outcome measures like perinatal mortality can yet be discerned to result from routine use of ultrasound", in 1997 the Australian Federal Government paid out $39 million to subsidise pregnancy scans, compared to spending $54 million for all other Medicare obstetric costs (Buckley, S, Gentle Birth, Gentle Mothering).


I also declined Doppler ultrasound heartbeat checks. My independent midwife used a Pinard's stethoscope. While there was a Pinard on the shelf in the hospital consulting room, the hospital midwife said she didn't know how to use it, and said if I could feel the baby moving then it must have a heartbeat anyway. I also declined the Group B Strep swab, despite the hospital doctor muttering something into his desk about how sorry I'd be if my baby died.

My baby was only exposed to Doppler ultrasound during labour, when I agreed it was important to monitor my baby for fetal distress during contractions. I also avoided being offered unnecessary antibiotics by birthing at home, given that my waters broke 14 hours before the birth (the hospital apparently likes to give them after 6 hours).

At home in a space I could relax in, without unnecessary interruptions, and the aid of my midwife and a birth pool, I was able to give birth to my baby and her placenta without any need for pain relief drugs, ensuring the best start for me and my baby in terms of bonding and breastfeeding. My midwife also provided five postnatal visits over the week after the birth to ensure my baby and I were doing well, providing advice and reassurance, and saw us again at 6 weeks. Birthing at home with a known midwife who also provides follow-up care should be available to all women through the public health system.

Friday, October 10, 2008

"BaBs has given me a sense of belonging"

Petra Hoffmann

I am a recent immigrant to Australia, having moved here with my Australian husband and 9 weeks old first born son Cian. I had no connection with Australian maternity services at the time of our landing, and was unsure of how I would fit into the system. I had had a home birth with an independent midwife in the UK and was somewhat concerned that the main stream medical child health system in Australia would not best serve my needs.
An incredibly lucky coincidence resolved my concerns within the first months of our arrival in Australia. While my husband and I browsed a clothes store in Melbourne, with our son carried in a sling, we started to talk to another mother who also carried her infant in one. She invited us to a BaBs meeting in Box Hill, and Cian and I have been going to the meetings ever since. Even my husband attended a few times before he found a job here.
I found the mix of mothers of different backgrounds, some with one, some with six children from newborn (some still pregnant) to toddlers extremely stimulating. I was delighted to find women who shared my passion for breast feeding and natural parenting methods. The presence of midwives I frankly took as a luxury. In all, this meant that I could ask virtually any question and raise any concern surrounding pregnancy, birth and parenting in Australia. From finding a GP that shared our philosophies via borrowing strollers to arranging baby swimming lessons, I had a question for almost every meeting, and always found help.
But this only describes the practical side of BaBs. In moments when being an immigrant and first time mother, living crammed into the guest room in her mother-in-law's house, and with her relatives on the other side of the globe became tough, the value of the emotional support I experienced during the BaBs meetings was and is inestimable. We share worries and high points, and I have found much comfort and understanding there. I feel that I can always pick up the phone or email fellow BaBsers and help is just a couple of suburbs away. Sometimes it even extends across the network of the different Melbourne BaBs groups. In the six months that we have lived in Australia I have formed several friendships that extend well beyond the weekly BaBs meetings.
In both its "practical" and the "emotional" function, BaBs has given me a sense of belonging. We are seriously considering a second baby now. I hope I will then be one of the pregnant mothers with a toddler running around the room, welcoming new first timers into the group.

Tuesday, October 7, 2008

submission to maternity services review

We are working on the BaBs submission to this review. The questions that we would like to address are:

· What, if any, are key support services, including peer support which warrant national coverage?

· What is required to ensure the quality and consistency of key support services?

We wish to comment specifically on peer support in local communities, as we believe this is a key support service that is not currently available for most pregnant women and new mothers, and that this service deserves the support of government to enable national coverage.

We are asking mothers who have been involved in local BaBs groups to write a couple of paragraphs for our submission. Please tell the story (being honest) of who you are, why you went to babs, what babs provided for you, why you have continued involvement, why you think it would be good to have this model available in communities across Australia.

Your contributions can be emailed to joy@aitex.com.au, or info@babs.org.au