Tuesday, December 25, 2007
VBAC homebirth
This is a wonderful story of a woman who had two previous hospital births resulting in caesarean birth who chose to birth at home for her third child. She tells her story very eloquently in this video. She understands that she needed to be upright and mobile and to have faith in her own bodies ability and in the care and support of her midwife. This is the story of her personal journey.
If you are considering a VBAC it is important that you understand why you needed a caesarean previously. You need to be well informed of the risks of all your birth options before you decide what is best for you and your baby. You might need to talk to more than one care giver before you can truly make an informed decision. Check out the Childbirth Connections information about the risks associated with various birth options.
Saturday, December 22, 2007
Celebrating 2000 hits on my blog
I am celebrating having had 2000 hits on my blog. Not bad since I just started this in September.
Thanks to everyone who has visited my site. Thanks especially to those who have left comments. I hope you have found something that has been helpful to you. If you have a different opinion, or if you want to agree and add something to what I have said, please leave a comment. Also if you have a question, I will respond and will answer if I can.
You will see a stat counter at the bottom of this page. It tells me how many hits I have had. I can also find out how long people look at my blog and if they have come back more than once. What I particularly enjoy about collecting these statistics is finding out where people have come from. It gives me quite a buzz to see that I have had visitors from all over the world. It would be really great to have a conversation about midwifery and childbirth with you so please comment. I would love to know how things are in your country. We can learn so much from each other and perhaps make a difference to how women experience the wonderful life changing event of childbirth.
Merry Christmas (or whatever festivity you celebrate)and Happy New Year to everyone
Thursday, December 20, 2007
Information for mothers and would be mothers
Are you worried and confused about birth? The Childbirth Connection web site offers really good unbiased evidence based information to help you to get a better understanding of some of the things that might be confusing you. They have produced a booklet, which is free online entitled "What every woman needs to know about cesarean section". You have to register with the site to be able to download but registration does not cost you anything and does not seem to come with any extras that you might not want. Well worth having a look. Whether you are planning to have a cesarean section or not this is important information that you do need to know.
Homebirth video
I have just read a posting and watched a video of this midwife's own birth. Rather than putting the video in here I am posting a link to the entry in her blog. It is her story and her video and needs to be seen as such. Please go and look and read.
She talks of the birth as a difficult struggle. I doubt that it would have been less of a struggle in a hospital setting and may not have ended as happily. She is a brave woman to share her true feelings about this birth and I applaud her for doing so. Do you want to share your thoughts about this?
She talks of the birth as a difficult struggle. I doubt that it would have been less of a struggle in a hospital setting and may not have ended as happily. She is a brave woman to share her true feelings about this birth and I applaud her for doing so. Do you want to share your thoughts about this?
Wednesday, December 19, 2007
Midwives Rock
Although this an advertisement for Texas midwives I just love it and had to put it on here. Midwives Rock!!!
Sustaining rural midwifery practice
When considering the issues of sustainability my colleague Sarah Stewart has been blogging about issues for midwives in sustaining practice. She has identified discontent amongst some midwives about the annual recertification process in New Zealand which has only been in place for the last three years. She also questions how midwives are supported and sees mentoring, particularly E-mentoring as a possible support for midwives to help to sustain them and enable them to continue in practice. She also mentions communities of practice as a possible support for midwives.
I was a rural Lead Maternity Care (LMC) midwife for around 15 years, from the start of our modern midwifery autonomy in New Zealand until I changed direction a little and ventured into the education field around 4 years ago. I still do a little rural LMC midwifery as a rural locum. I provide holiday relief or backup to several rural practices in my region and nearby. I have just completed my Master in Midwifery degree and my research looked at how midwives informed practice, finding that communities of practice had a strong influence on information sharing and supporting rural midwifery practice.
During my 15 years as a rural LMC I never had regular days off. I took days off when I had a quiet day but was still on call. I had holidays when I could and some years did not have a holiday at all. When I did take a holiday it was always for at least one month. I found it took me at leas two weeks to get my head out of the job and relax and probably took me at least twice as long as that to settle back into the job when I came back. This was during the years that my children were growing up and at times it was probably pretty tough on them and on my husband. None the less I loved the job and still do. It is my love of midwifery that sustains me most I think.
What I did not love was the continual battle that I felt I was fighting. When I worked with colleagues who shared my beliefs about childbirth I felt much more supported in my practice. Too often I felt that I continually had to justify my profession and myself with the world. With GPs who stated that homebirth was unsafe, with facility management who, rather than supporting often seemed to be trying to undermine what I was trying to achieve. With the media and public, whenever something happened in childbirth somewhere in the country and every midwife seemed to be blamed and had to justify there existence. This was not my usual experience but when it did happen it was very tiring and took most of my energy and enthusiasm for the job.
So my thoughts on how to sustain midwifery practice would be to make sure that you work with other midwives who share your beliefs about birth and work in a similar way to you. Let go and don’t believe you have to be all things to all people. It is women who are having babies not us. We should be able to prepare women so that they can do the job with or without us, as long as we know that our colleagues will support them as we would. Make sure you make the connections with other midwives who can sustain you and will share their knowledge with you as you will with them. Try to establish links with other midwives who can provide a locum service for you to have a break when you need it. If you do not have colleagues like this in close proximity to you then use online sources such as this to make connections with them and communicate regularly. Never lose that belief that this is a really important, satisfying, wonderful job that you do.
I am truly interested in what others think about this. How can we sustain midwives in practice? Our communities need midwives, how can we fill that need when it is not there or support midwives to continue in practice when it is there?
I was a rural Lead Maternity Care (LMC) midwife for around 15 years, from the start of our modern midwifery autonomy in New Zealand until I changed direction a little and ventured into the education field around 4 years ago. I still do a little rural LMC midwifery as a rural locum. I provide holiday relief or backup to several rural practices in my region and nearby. I have just completed my Master in Midwifery degree and my research looked at how midwives informed practice, finding that communities of practice had a strong influence on information sharing and supporting rural midwifery practice.
During my 15 years as a rural LMC I never had regular days off. I took days off when I had a quiet day but was still on call. I had holidays when I could and some years did not have a holiday at all. When I did take a holiday it was always for at least one month. I found it took me at leas two weeks to get my head out of the job and relax and probably took me at least twice as long as that to settle back into the job when I came back. This was during the years that my children were growing up and at times it was probably pretty tough on them and on my husband. None the less I loved the job and still do. It is my love of midwifery that sustains me most I think.
What I did not love was the continual battle that I felt I was fighting. When I worked with colleagues who shared my beliefs about childbirth I felt much more supported in my practice. Too often I felt that I continually had to justify my profession and myself with the world. With GPs who stated that homebirth was unsafe, with facility management who, rather than supporting often seemed to be trying to undermine what I was trying to achieve. With the media and public, whenever something happened in childbirth somewhere in the country and every midwife seemed to be blamed and had to justify there existence. This was not my usual experience but when it did happen it was very tiring and took most of my energy and enthusiasm for the job.
So my thoughts on how to sustain midwifery practice would be to make sure that you work with other midwives who share your beliefs about birth and work in a similar way to you. Let go and don’t believe you have to be all things to all people. It is women who are having babies not us. We should be able to prepare women so that they can do the job with or without us, as long as we know that our colleagues will support them as we would. Make sure you make the connections with other midwives who can sustain you and will share their knowledge with you as you will with them. Try to establish links with other midwives who can provide a locum service for you to have a break when you need it. If you do not have colleagues like this in close proximity to you then use online sources such as this to make connections with them and communicate regularly. Never lose that belief that this is a really important, satisfying, wonderful job that you do.
I am truly interested in what others think about this. How can we sustain midwives in practice? Our communities need midwives, how can we fill that need when it is not there or support midwives to continue in practice when it is there?
Sunday, December 16, 2007
Sarah Buckley on gentle birth and birth hormones
Dr Sarah Buckley from Australia has also investigated and written extensively on the influence of birth hormones. This is an open source article "Pain in labour" from the Birth International Website which explains the influence of birth hormones also discussed by Michel Odent in my previous posting.
Michel Odent on gentle birth and birth hormones
These three videos follow on from each other and well worth watching right through if you can You will need to concentrate but well worth it.
Saturday, December 15, 2007
elective caesarean increases breathing difficulties for babies
A recent TV One Health news item speaks of the increased risks of breathing difficulties for babies with elective caesarean sections. Particularly when these are performed early, that is before 39 weeks.
This is information gathered from a large Danish study. They found a nearly fourfold increased risk of breathing difficulties in caesarean babies delivered at 37 weeks, a threefold increase at 38 weeks and a doubled risk at 39 weeks. Babies who have breathing difficulties usually need to be transferred to a special baby unit and are monitored in incubators with oxygen provided. This is another risk which has been identified for women who are choosing or being advised to have an elective caesarean section.
A French study published recently "Postpartum Maternal Mortality and Cesarean Delivery" reported that caesarean section increased the risk of the mother dying after having a baby more than threefold.
This growing evidence of the increased risks to mother and child of having a caesarean section as opposed to a vaginal birth are very concerning as rates of caesarean section continue to rise. Recently published figures from the United States report a 30% national rate of caesarean births. The most recently published national rate in New Zealand was 27% but it is very likely that it too is now 30% or higher.
Can we as a society afford this level of intervention in childbirth.Is this an issue for sustainability? Think of the resources that are involved in this level of intervention/
I am not suggesting that any mother or child be put at risk by withholding necessary medical care and intervention, but where does it stop. Clearly we are not reducing risks for women and children by increasing medical intervention. Instead we are raising risks to the health and wellbeing of the mother and her child.
Can we turn this around? Midwives we need to help and support women to have confidence in their bodies and ability to birth. We need to provide sensitive caring support and information to women. We need to have faith ourselves in the process of birth and to share our faith with women and those who will be supporting them during the birth of the child.
This is information gathered from a large Danish study. They found a nearly fourfold increased risk of breathing difficulties in caesarean babies delivered at 37 weeks, a threefold increase at 38 weeks and a doubled risk at 39 weeks. Babies who have breathing difficulties usually need to be transferred to a special baby unit and are monitored in incubators with oxygen provided. This is another risk which has been identified for women who are choosing or being advised to have an elective caesarean section.
A French study published recently "Postpartum Maternal Mortality and Cesarean Delivery" reported that caesarean section increased the risk of the mother dying after having a baby more than threefold.
This growing evidence of the increased risks to mother and child of having a caesarean section as opposed to a vaginal birth are very concerning as rates of caesarean section continue to rise. Recently published figures from the United States report a 30% national rate of caesarean births. The most recently published national rate in New Zealand was 27% but it is very likely that it too is now 30% or higher.
Can we as a society afford this level of intervention in childbirth.Is this an issue for sustainability? Think of the resources that are involved in this level of intervention/
I am not suggesting that any mother or child be put at risk by withholding necessary medical care and intervention, but where does it stop. Clearly we are not reducing risks for women and children by increasing medical intervention. Instead we are raising risks to the health and wellbeing of the mother and her child.
Can we turn this around? Midwives we need to help and support women to have confidence in their bodies and ability to birth. We need to provide sensitive caring support and information to women. We need to have faith ourselves in the process of birth and to share our faith with women and those who will be supporting them during the birth of the child.
Sustainable babies
Photo from http://www.flickr.com/photos/worldofoddy/1171997881/
There are times in our lives when everyone wants to give a present to celebrate a special event. Times such as birthday's, Christmas, engagement, wedding and a baby's birth. We search around for an appropriate something to send to the important person. How many of these gifts then end up gathering dust in cupboards, advertised on "Trade Me" or "E-bay" or dumped in the rubbish? How many of these gifts are useful or good for any purpose?
I want to talk a little about gifts which are given for babies, but first I would like to share an old tradition that used to occur in Scotland when I was growing up in the 1950s.
I grew up in Scotland and life was full of superstitions and old traditions, for example when a bride left for the church she threw pennies out of the window of her vehicle for the local children. Everyone gathered around in anticipation and scurried to get their share. I think this was something to do with guaranteeing fertility in the marriage.
On first seeing a newborn baby it was necessary to cross the baby's palm with silver. When a new mother took her baby out in the pram for the first time people would come up and greet her and slip a coin or two into the pram. Those old Silver Cross Prams had a deep well which soon started to rattle with the money gathering in the bottom of the pram. This was often use to start a savings account for the new baby. When a new baby was expected family and friends started knitting or sewing however these arts are less common now.
Nowadays people often buy new babies a basket of goodies, full of lotions and powders and creams and shampoos. The manufacturers of these products outline how they benefit the babies skin and produce research to support their claims. We need to remember that they are trying to sell their product and the research has been conducted with this goal in mind. New born babies do not get dirty. They do not need all these lotions and potions. In my experience babies need, and love, to have a bath. All they need is warm water. After the bath a gentle massage with some pure almond oil, without any additives is relaxing and calming for the baby and is a nice way to care for the babies skin. Other oils such as olive oil can also be used but almond oil is less greasy. It is best to avoid using peanut oil because of the potential for allergy to this product.
Nappy wipes are a relatively recent addition to list of must haves for a new baby. Originally introduced as a handy way to clean the babies skin when out and about they now seem to be used universally at every nappy change. This is neither good nor necessary. A damp cloth with plain water will clean the babies nappy area just as effectively, reduces the babies exposure to chemicals and reduces waste in the environment. Women used to cut up old soft nappies or use muslin squares for this purpose.
The debate about cloth versus disposable nappies still seems to rage on. I think this is something that future generations will find very hard to understand. How could we possibly think it is OK to create this mountain of garbage so unnecessarily. What do you think about this? Why do so many parents feel that they have to use disposable nappies? Why not give a gift of cloth nappies, or maybe give a gift of an offer of help with washing these? If you are thinking about cloth nappies this is a lovely very simple little pattern for woolen overnaps. They need to be made out of pure wool but can be machine washed. The more felted the wool becomes the more waterproof the overnap is so old woolen overnaps are really desirable. Using these allows the babies skin to breath while still providing some protection from dampness. Babies nappies should be changed regularly as contact with ammonia from stale urine and bacteria from babies stools is a cause of nappy rash.
Baby Pilchers knitting pattern
Size 10 or 12 needles depending on your knitting
One ball double knitting wool does one pair, (large ball does two pairs)
Hank of natural does 3 pairs
Cast on 80 stitches
10 rows ribbing (holes half way)
(for larger size cast on 85-90 stitches).
Continue in plain knitting.
Knit two together on each plain row until one remains
Fold over band at top leaving space for cord
Sew up point in the middle leaving space for baby’s legs depending on the size of baby.
And then there is the gift of babies bottles, and sterilizers and formula. For a very few parents these might well be necessary. For most, help and support and positive encouragement to breast feed are better and healthier for the baby, and definitely better for the environment. Providing a meal or two for the new family, offers of help with shopping or housework might be much more useful gifts.
All about stuff. by Annie Leonard
This is a very well put together animated documentary about consumerism and sustainability. It has really made me think about my own life and what a true consumer I have become. It is a timely message too when we are entering the time of the year when consumerism reaches its zenith.
This video is quite large and can take a long time to load. If you have trouble you can follow this link and open it in different chapters
Saturday, December 8, 2007
Tuesday, December 4, 2007
Where to birth and how long to wait before going home.
Where to birth? At home, in a primary birthing unit or in a hospital this is a question that many women have to consider during pregnancy. If choosing to birth in a facility, primary birthing unit or hospital, how long can they or should they stay before going home?
Photo from Sadalit's photostream http://www.flickr.com/photos/sadalit/123737076/
Research does little to help women decide when it is best to go home from a facility after birth. There has been quite a bit of research into early discharge, but the problem is that definition for early discharge varies so much. For some it means 2-3 hours after the birth of the baby and for others it means 1 or 2 days after birth of the baby. A Cochrane review of this topic found that the evidence was inconclusive but found that there was no evidence of adverse outcomes for the mother or baby with early discharge from a facility (Brown, Small, Faber, Krastev & Davis, 2002). If considering a home birth again the Cochrane review of this topic was inconclusive although they could find no evidence to state whether home or hospital was better for low risk women (Olsen & Jewell, 2007). A large American study found that there was less intervention when women planned to birth at home without any increased risks to the mother or her baby (Johnson & Daviss, 2005).
So what does this mean for women? If they have no health issues during pregnancy then women are less likely to have interference in the birth process if they plan to birth at home. Women have expressed increased satisfaction with birth when there is no intervention so it would tend to follow that satisfaction would also be greater with homebirth. The same is true if they birth in a unit which deals only with low risk births, (a primary birthing unit0. Of course if any problems arose then the woman would need to go to the hospital. Discharging from the hospital within hours of the birth also does not increase problems for women or their babies who are otherwise well.
There are two main issues here. One is being prepared for being at home, either early discharge or homebirth and the other is having the necessary support to be able to achieve this. One of the advantages of planning to birth at home is getting the support you will need prepared beforehand for this event. This might mean preparing meals before the baby is born so that there is no need to cook after or it might mean that a relative moves in with the new family. The woman will have prepared herself for early baby care, her midwife will cover the knowledge the woman and her partner need for those early days well before the baby is born. The home is ready for the new baby.
With hospital birth women often plan to stay in hospital for two or three days to learn how to care for baby and then go home. Many women seem to think that they will then pick up life as it was before, but this is not the case. They still need support as they learn how to become mothers and care for the new baby. It is not an instant process. We need to think of the first month after the baby is born as a continuation of the pregnancy-labour-birth process. It is a time when the woman's body is making enormous changes as well as the psychological adaption to new motherhood. The baby too is adapting to life outside the uterus and needs loving attention during this time. For the mother to be able to provide this to her baby she needs to be cared for and supported herself. Enormous changes and adaption occurs in the first month but there are those who would say that this continues, to a lesser degree, for at least first three months of the babies life. As a society we need to embrace the concept of mothering the new mother as she takes on her new role. It is an enormous life changing event and women need to be supported and nurtured as they adapt to this new identity.
Brown S, Small R, Faber B, Krastev A, Davis P. Early postnatal discharge from hospital for healthy mothers and term infants. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD002958. DOI: 10.1002/14651858.CD002958
Johnson KC. Daviss B. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 2005 Jun 18; 330(7505): 1416-9.
Olsen O. Jewell MD. Home versus hospital birth. [Journal Article, Research, Systematic Review] Cochrane Database of Systematic Reviews. 2007;(4): (CD000352)
Photo from Sadalit's photostream http://www.flickr.com/photos/sadalit/123737076/
Research does little to help women decide when it is best to go home from a facility after birth. There has been quite a bit of research into early discharge, but the problem is that definition for early discharge varies so much. For some it means 2-3 hours after the birth of the baby and for others it means 1 or 2 days after birth of the baby. A Cochrane review of this topic found that the evidence was inconclusive but found that there was no evidence of adverse outcomes for the mother or baby with early discharge from a facility (Brown, Small, Faber, Krastev & Davis, 2002). If considering a home birth again the Cochrane review of this topic was inconclusive although they could find no evidence to state whether home or hospital was better for low risk women (Olsen & Jewell, 2007). A large American study found that there was less intervention when women planned to birth at home without any increased risks to the mother or her baby (Johnson & Daviss, 2005).
So what does this mean for women? If they have no health issues during pregnancy then women are less likely to have interference in the birth process if they plan to birth at home. Women have expressed increased satisfaction with birth when there is no intervention so it would tend to follow that satisfaction would also be greater with homebirth. The same is true if they birth in a unit which deals only with low risk births, (a primary birthing unit0. Of course if any problems arose then the woman would need to go to the hospital. Discharging from the hospital within hours of the birth also does not increase problems for women or their babies who are otherwise well.
There are two main issues here. One is being prepared for being at home, either early discharge or homebirth and the other is having the necessary support to be able to achieve this. One of the advantages of planning to birth at home is getting the support you will need prepared beforehand for this event. This might mean preparing meals before the baby is born so that there is no need to cook after or it might mean that a relative moves in with the new family. The woman will have prepared herself for early baby care, her midwife will cover the knowledge the woman and her partner need for those early days well before the baby is born. The home is ready for the new baby.
With hospital birth women often plan to stay in hospital for two or three days to learn how to care for baby and then go home. Many women seem to think that they will then pick up life as it was before, but this is not the case. They still need support as they learn how to become mothers and care for the new baby. It is not an instant process. We need to think of the first month after the baby is born as a continuation of the pregnancy-labour-birth process. It is a time when the woman's body is making enormous changes as well as the psychological adaption to new motherhood. The baby too is adapting to life outside the uterus and needs loving attention during this time. For the mother to be able to provide this to her baby she needs to be cared for and supported herself. Enormous changes and adaption occurs in the first month but there are those who would say that this continues, to a lesser degree, for at least first three months of the babies life. As a society we need to embrace the concept of mothering the new mother as she takes on her new role. It is an enormous life changing event and women need to be supported and nurtured as they adapt to this new identity.
Brown S, Small R, Faber B, Krastev A, Davis P. Early postnatal discharge from hospital for healthy mothers and term infants. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD002958. DOI: 10.1002/14651858.CD002958
Johnson KC. Daviss B. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 2005 Jun 18; 330(7505): 1416-9.
Olsen O. Jewell MD. Home versus hospital birth. [Journal Article, Research, Systematic Review] Cochrane Database of Systematic Reviews. 2007;(4): (CD000352)
A baby dies and change is sought.
My heart goes out to the couple in Wellington whose baby daughter died around 24 hours after she was born after Mum and baby had gone home 5 hours after their baby was born. This has been a frontline news item in New Zealand for the last 24 hours and it must be so hard for these parents who have not yet buried their baby. I hope that they are getting the support they so badly need at this time.
There has been strong criticism of Capital Coast DHB and its policy on early discharge as a possible contributing factor to this tragedy. Our new Health Minister, David Cunliffe, is demonstrating his vigor by suggesting that he may intervene in the management of Capital Coast Health. One network news discussed this tragedy in a very well balanced and thoughtful segment last night with Lorelei Mason providing a segment considering the lack of a primary birthing unit in Wellington and also in Dunedin. Norma Campbell the midwifery adviser from NZCOM explained that women no longer stay in facilities for 2 weeks after babies are born and this has not been the case for a considerable time. How long should women stay in a facility after birth? I am going to discuss this further in another post and would welcome your discussion on this point.
I am pleased that this debate has been opened up and the issue of primary birthing units is being highlighted. This may bring some long awaited action for both Wellington and Dunedin. It was also heartening to hear Lorlei describe the difference between a primary birthing unit which is situated within a secondary care facility and a stand alone primary birthing unit.
None the less we should not forget that this has come to the fore through one family’s personal tragedy. All who have been associated with this baby’s birth and death are suffering now, the friends and family of the couple and the midwife who provided their care. We all need to be aware that this is a far from normal situation, babies do not die because they go home within hours of birth. Before we start blaming we need to know what happened and why and we will not know this for some time yet. In the meantime I am thinking of this midwife and this family and hoping you all have strength and compassion for each other at this time.
There has been strong criticism of Capital Coast DHB and its policy on early discharge as a possible contributing factor to this tragedy. Our new Health Minister, David Cunliffe, is demonstrating his vigor by suggesting that he may intervene in the management of Capital Coast Health. One network news discussed this tragedy in a very well balanced and thoughtful segment last night with Lorelei Mason providing a segment considering the lack of a primary birthing unit in Wellington and also in Dunedin. Norma Campbell the midwifery adviser from NZCOM explained that women no longer stay in facilities for 2 weeks after babies are born and this has not been the case for a considerable time. How long should women stay in a facility after birth? I am going to discuss this further in another post and would welcome your discussion on this point.
I am pleased that this debate has been opened up and the issue of primary birthing units is being highlighted. This may bring some long awaited action for both Wellington and Dunedin. It was also heartening to hear Lorlei describe the difference between a primary birthing unit which is situated within a secondary care facility and a stand alone primary birthing unit.
None the less we should not forget that this has come to the fore through one family’s personal tragedy. All who have been associated with this baby’s birth and death are suffering now, the friends and family of the couple and the midwife who provided their care. We all need to be aware that this is a far from normal situation, babies do not die because they go home within hours of birth. Before we start blaming we need to know what happened and why and we will not know this for some time yet. In the meantime I am thinking of this midwife and this family and hoping you all have strength and compassion for each other at this time.
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