How to create a youtube account

Next year I may be asking students to upload a video to youtube. This is a video which explains how to create a youtube account and how to upload a video.

Sally Tracy on the cascade of intervention

The wonderful Sally Tracy talking about the cascade of intervention which happens in birth


And what happens with the baby after all of this

Primary birthing and National standards for maternity care.

I was just reading the New Zealand Maternity Standards document from the Ministry of Health. Standard three states "All women have access to a nationally consistent, comprehensive range of maternity services that are funded and provided appropriately to ensure there are no financial barriers to access for eligible women."

There is however no primary birthing facility option for women birthing in Dunedin. There is no national consistency in the provision of primary birthing facilities for women. This is a matter that needs to be addressed if we are to support women to birth without medical intervention.

At last: Making a change, promoting normal birth.

The momentum seems to be building to raise public awareness about the dangers of ever increasing intervention in childbirth.
In new Zealand we have the Maternity Manifesto. This initiative is raising public awareness in New Zealand and lobbying government to:
◦Become informed about the impact of maternity services on the welfare of women, their babies, whanau and our communities
◦Set a comprehensive definition for ‘normal birth’ consistent with international standards
◦Develop an accessible, practical NZ campaign to increase the understanding of ‘Normal Birth’ and how this can best be facilitated
◦Publicly acknowledge positive maternity care outcomes.

And now, on the 1st of September, a new project is about to be launched raising awareness and initiating change around the world. Here is the video which launches this project. Lets get behind these initiatives and start to make a difference. The time is right! For all the women children and families we work with we need to get behind these initiatives and do what we can to raise awareness and support normal birth.

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Updating midwifery pages on WikiEducator

I have just been updating the Midwifery pages on WikiEducator. These are free resources on midwifery education, with many links to other useful online material, for student midwives and those with an interest in midwifery education. Anyone can edit these pages and add content which may be useful. I check it fairly regularly and so far no one else has added any content. If you feel that there is something you think might be useful, which is not included there, please feel free to add it. Or you could let me know here and I will add it for you.

My wee game has gone :(

I am sad to say I have just discovered that the wee game I had linked on my blog has gone! Sorry to all the many fans of that wee game who came here solely to play it.

Pelvic floor muscles

Necessity is the mother of invention so they say. Well this week I have been proving that statement to be correct. I have been at home with flu but had to meet with my lovely Invercargill group of students on Wednesday. We were to cover pelvic floor muscles and I had no model of these available without travelling through to Polytech so I decided to make a model to fit with the wonderful wee pelvis model I had sourced earlier in the year for the students from the Hesperian foundation.

I used photographs of the models which we use with our regular sized pelvis models, which I had available to me and developed the model to be constructed out of paper or card or any other medium you might wish.
Here is the pattern
Pattern, Small Pelvic Floor Muscle Model

And the instructions
Instructions for Making the Model of Pelvic Floor Muscles

Please note that you will need to download these before you can print them off and use them properly.

E portfolio from the BMJ

I just discovered that the BMJ have started a free eportfolio service. Ihttp://www.blogger.com/img/blank.gif can register for free and when I logged in I see that access is provided by the NZ Ministry of health. I am not sure how useful this will be. I think if you do any continuing online education through the BMJ it is automatically recoreded on the portfolio. I thought this was interesting and others might also find it interesting. Here is a screen shot of the my portfolio. There is no data entered there yet.

Disturbing story of birth in Africa and developing countries

I watched this video which discusses some of the issues for women birthing in Africa. I am disturbed and concerned that many women in Africa and in some developing countries do not have access to the health care they need to support them to birth safely. The video starts by showing a baby being held upside down and slapped and suggests that this is the type of care that is lacking. Now I know that the health of women and babies in these societies is often compromised. They often begin labour in a state of anaemia and may be malnourished and have many health issues but I am disturbed as much by what is suggested as good care for them. The video says many women choose to stay at home, well so would I if that was the type of care I could expect to receive in a hospital.

I have worked with many mothers who have emigrated to New Zealand from the Philippines. Many of these women have already had babies in the the Philippines and just about all of these women who have birthed in the Philippines have had a caesarean birth. Most tell stories of not having wanted a caesarean but having been told that the baby will die if they do not with little or no reason for why this may be. These are not the poorest of Philippine women who would not be given a caesarean because they could not afford it, but are women who will struggle to pay for this care. They are then sliced from umbilicus to pubis instead of the accepted low line incision that is common practice in most developed countries. This leaves them with an enormous, ugly and uncomfortable scar.
This is not the care that these women need. Yes women need to have care during pregnancy, yes they need advice on how they can best care for themselves. Yes women's place in society needs to be valued much higher so that they can get the care they need. They need and deserve the best of care. They do not need to be coerced into birthing in dirty disgusting institutions where they and their babies will be subjected to care which is known to be harmful. Practices such as dangling a baby by its feet and slapping it are of no benefit and are known to be harmful.
I wonder how others feel about this.
I feel distressed that women do not get the care they need. I do not believe that any support is better than no support. I believe that we can do more harm than good by interfering when it is not required. I believe that what the world needs now is many well trained midwives and a reasonable number of excellent obstetricians, who support midwifery care, and provide necessary medical care when it is indicated that it is required. I believe that this is what all women need and deserve no matter where they live. It is what society needs as women are the mothers of the next generation.
We have a serious problem in most developed countries where women are experiencing far too much unnecessary intervention. In developing countries women cannot get the intervention they require. We need to start getting this balance right for goodness sake.

A politician with passion and evidence supporting homebirth

This man would definitely get my vote.

Another jump in caesarean section rates

Recently the Otago Daily times published and article which reported that the caesarean section rate in Dunedin hospital had reached the rate of 42.6% in the month of February 2011. I was moved to post this on my facebook page and this resulted in conversation some of which I wish to share here. The reason for this post is to try to stimulate a wider discussion.
What do you think about this rate of intervention in what, for most women and babies, should be a normal and natural process?
Is there anything you think that midwives can do to help turn this around?

Here are some of the comments I placed on my facebook page.

I am greatly worried but these statistics. Jenny says that when the decision is scrutinised there is a reason for that particular caesarean. However the reasons for performing caesarean seem to grow all the time. How do so many women get to this point where they are being advised to have a caesarean?

It is an enormously complex issue. There isn't one group who are more accountable for these statistics than another, one group cannot change this. For years now we (well midwives at least) have been gasping in horror at ever rising caesarean rates.I think, as more and more women birth by caesarean it (CS) becomes less feared. While more and more women are afraid to birth away from secondary care services because they might need to have a caesarean or other intervention. We shouldn't ...forget that caesarean is not the only intervention in the birth process. Every birth then virtually becomes a "trial of labour". I do think as midwives we have a responsibility to help women and those close to them to understand that the best way, for the 80% of women who can anticipate having natural, uncomplicated birth to achieve that, is to choose to birth away from secondary care services.
I think it is a society issue and until society are shocked and horrified and choose to do something about it there is little else that we can do. Many midwives too are frightened to take that step to experience birth away from secondary ca...re services. As a midwifery educator this is something I struggle with every day. How do I play my part in trying to help midwives see what is happening and find the way to support the women they work with to birth away from secondary care services, whether that is at home or in a primary unit? Without blame we need to look at every birth and try to see the decision points which led to intervention in the normal process, assess where this could have been changed and how this might impact on the outcome.

Working in Lumsden, a rural maternity unit

For the last 18 months, as well as teaching at Otago Polytechnic I have also been working as a midwife in a lovely wee rural maternity centre in Northern Southland. It is a lovely part of the world. Lumsden itself is a junction town but the surrounding countryside is lovely. The community here are mainly involved in farming and rural service industries. As dairying has expanded in this area the ethnicity of the childbearing population has changed too with quite a number of asian dairy farm workers. A number of women from the Kingston and Queenstown areas also birth here and these are often professional women or women involved in the tourist industry.
I have really enjoyed working here and would recommend it as a place where midwives can practice midwifery care autonomously in a supportive small team of experienced rural midwives. It takes time to find new staff in an area such as this and I am hoping that a midwife may see this and think this would be a good place to work. If you want to know more they have a website which tells you a bit about the facility. They also have a page on facebook where you could communicate with them. If you have any questions about working here I would be happy to try to answer them.

Midwifery Students learning palpation

Those who read this blog will know that I am lecturer at Otago Polytechnic School of Midwifery. I mostly work with students in the first year of the three year direct entry degree programme. On the Wednesday the 16th of March 2011 our students are going to be learning about abdominal palpation. We need women from the community to be available to help our students with this learning. We need women who are pregnant and are 30 weeks or more gestation. This will be the first time most students have ever had the opportunity to feel a baby during pregnancy and to listen to a babies heart beat. It is very exciting for them and this is usually exciting for the women who come forward and offer to help our students learn this technique.
We have students based in the lower North Island in Whangarei, Palmerston North and throughout the Wellington area. We have students in Central Otago, Southland and throughout Dunedin.
If you are pregnant and feel that you would be able to help us with this please contact Carolyn McIntosh, freephone 0800800583. If I do not answer leave full details on my answerphone and I will get back to you. BTW we do offer a small gift of a book token to women who agree to help us in this way, it is not much but it is a wee something to say thank you.

Taking blood pressure

One of the assessments midwives perform every day, numerous times a day is blood pressure recording. It is one of those things that we quickly gain expertise with and feel that we know very well how it should be done. Since I started teaching undergraduate midwifery students I have become aware of many aspects of my practice that are not necessarily best practice.

I gained my first midwifery qualification in 1975 at Cresswell Maternity in Dumfries. It was a separate hospital in those days but is now part of the general hospital, a common trend nowadays. I learned to take blood pressures much earlier when I was a student nurse at the old D&GRI, not this new one which opened in 1975. The claim to fame of the D&GRI is the first use of anaesthetic ether in 1846 for surgical operations.Suffice to say I had many years to get sloppy in my practice, feeling I knew very well how to take a blood pressure, before I started teaching students and had to look at this again.

I try now to take blood pressures according to best practice however I do admit to not always doing this, old habits die hard. When I was looking for learning resources for my students I came across the British Hypertensive Society. They explain the process of recording blood pressure and provide clear rationale for why it should be done this way. One of the resources on this web site is an interactive learning resource, excellent for anyone wanting to know how to take blood pressure properly or learning this skill for the first time. I recommend this highly to my students.

Here are some other learning resources related to blood pressure.
For those interested here are a couple of videos about the physiology of blood pressure and hypertension by John Campbell, a UK nursing lecturer.
Video one
And Video two