The business of being born in Dunedin

At last, after a long wait, I have finally had the opportunity to see this documentary.

On the worst night of the year, wintery showers of sleet and hail we went to Logan Park High school to view this film. There was a fairly small group of us, not surprising due to the weather. None the less enough hardy souls made the effort to cover the costs for the Otago region of the College of Midwives. It was a mixed group with good number of student midwives and midwives from Queen Mary maternity center. A few independent midwives and sprinkling of consumers.

I had a fairly good idea of what to expect from the online discussion that has been generated. I will not go into the details of the film, others have done that much better than I could. I have to say it is very similar to "Giving birth: Challenges and choices" produced by Suzanne Arms in 1998. Marsden Wagner features in both of these films with a very similar message. This new film is longer and more in depth, it is also significantly longer at 1 hour 30 mins as opposed to 35 mins for the Suzanne Arms film. It has more births and stronger historical overview of how America lost midwifery in the first place. Overall the material and the information was not something that is new to me. The benefits of being upright and mobile in labour were highlighted. The importance for no restriction on the pelvic joints was mentioned and the ability of the woman to move through out the birth. The benefit of water was highlighted.

Overall it is a good film but I think for those, like me, who have been involved in the business of birth for a while the information was not new. It has been around for a long time. I think that obstetricians and midwives have heard this all before and they either agree or disagree with the arguments. None the less it is a good to reiterate, and clearly in America the message desperately needs to be heard. The real value in this film is to women who are thinking about birth. It is a shame therefore that there were not more consumers in the audience. It would have been good to have some sort of debate scheduled for the completion of the film to allow us to talk about how this might impact on us and our situation in Dunedin. To talk about what, if any, relevance it had for us. It is also a shame that the film is not more available so that midwives could show it to women. The arguments are valid and well presented, why is it so protected? I understand that the marketing of the film has stimulated interested and created a whole culture around it which I beleive has been having an impact in America, which is great.

The question that remains to be asked is how does this apply for us in New Zealand. We have the most supportive legislation for midwifery care in the world. All women can choose midwifery care for normal birth. One would think that all choices should be available to all women. Any woman should be able to birth at home if she wishes. The benefits of birthing outside of the hospital should be explained to women. All women should be able to birth in water. The benefits of birthing in water should be explained to them. All women should be able to decline obstetric intervention in the absence of clear and apparent medical risks. Most women should be able to birth in the care of a midwife without ever having to see a doctor. If this is the case why is our caesarean section rate so appallingly high, 22.7% in 2002
, (the last available statistic) and would appear to be much higher than this now. What do others think about this. As reported by Paul Kruger in response to the screening of this video in Sydney Australia "The Royal Australian and New Zealand College of Obstetricians and Gynaecologists says there are a range of complex factors to explain the high caesarean rate, including the older age at which women are giving birth, and litigation against doctors". What do you think about this? Does this video have any relevance for us? Or is it only important for women in America?

Charlie Parr 1922: That vodaphone ad

Does anyone else love that vodaphone ad? If so here is a video of the man himself singing his song. I think I'll need to get some more of this man's music, ain't that the way it is?

Tittle tattle in the corridors: confidentiality and all that::-

This post discusses the issues of confidentiality particularly in relation to blogging.

I am back on board having had a wonderful, much needed, break. It was great to be involved in my first ICM. Although there were some organisational hiccups it was a great experience. Now back to reality and there is plenty to do so not much time for blogging at present. There is an issue I do feel a great need to address however and this is about confidentiality and midwifery practice. This is of course an issue for all health professionals not just midwives. The other issue is around how shared experience contributes to learning within the profession and the value of blogs in facilitating this. I do not pretend to have the answers to how these contradictory issues can be managed but feel that this discussion needs to take place. As bloggers we need to develop some sort of best practice guidance around how to blog about professional issues. My friend and colleague Sarah Stewart has also been blogging about this issues recently.

Confidentiality
When we enter the midwifery profession we all sign a confidentiality agreement. We will only share information if it is necessary for the health and wellbeing of the woman or her baby and only to other health professionals involved in their care. This meets the requirements of the Privacy Act 1993. For student midwives to learn from the practice experiences they are having it is necessary that to share and reflect with lecturers. Women who have students working with them are made aware that this may happen. Students in our school have small tutorial groups where they can share their experiences, reflect together and promote safe practice and shared learning.

Despite these safeguards issues around confidentiality arise from time to time. During my career, from time to time, I have heard people talking in the corridors about something that has happened, I may well have been guilty of this myself. Sometimes a complaint is made because someone heard something in the supermarket, or the bank, or wherever about a patient. Blogging takes this illicit sharing of information to a whole new level. No longer is it a whisper in the corridor, it is a trumpet blast to the world. We always should have been aware of how we can properly share information to promote learning without compromising confidentiality but now it is urgent that we get on board with this. We need to be able to share and learn, we also need to protect confidentiality.

As midwives we are involved in the most intimate experiences of a persons life. We need to be trustworthy. We might know things about the woman the no one else knows. I might know the sex of her baby from scan, I might know that she is unsure of the paternity of her child, I might know that she cursed and swore through labour when normally she would never utter these words. Women need to trust us not to share this information with anyone. When other health professionals need to be involved in a woman's care we can share information which is relevant to this situation and only that.

So where does that leave us when we are blogging? How can we share experiences so that we can promote learning? To whom does the experience we are sharing belong? Is it ours to share? What about the other health professionals who may feature in our tales? How do they feel about having their practice exposed in this most public of forums?

I welcome your thoughts on this.



Image: Whispering, Saams photos on flickr.com

Carolyn's ICM presentation

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A very quick post from me. Doug and I are having a great time being together with my family in the UK. We have had a family Christening in Ireland and a family wedding celebration in Buckinghamshire. We had a lovely cruise up the Thames for this party. Have had very little time to blog about anything to this point. Leaving for a few days in Thailand soon before heading back to NZ. We also had a day in Paris after a big walk around old haunts in London - poor old feet - ouch!
I have just put my ICM presentation on slide-share and I am posting here. I will try to add the audio track I recorded during the presentation later, when I get my head around this technology.

A taste of ICM

If you would like a wee taste of ICM and you were not able to attend here is a link to a webcast that has been posted by ICM. Several symposia were videoed so perhaps in time there will be more of these webcasts available. This one is the first Place of Birth symposium chaired by Sue Bree, from New Zealand. speakers are Edwin Van Tijlingen from Scotland, Marijke Hendrix from the Netherlands and Oda von Rahden and Petra Kolip from Germany.

Glasgow ICM conference

I am at conference in Glasgow at the moment. There have been some great moments and it has been fantastic to be with so many midwives and hear midwives speaking about their research work which I have previously read. What a buzz that is. I was particularly pleased to be present at the presentation given by Jaki Lambert (Scotland), Gisela Becker (Canada) and Sally-anne Brown (Australia).

Jaki spoke about supporting and strengthening midwifery in rural and remote parts of Scotland. She described and initiative which has seen continuing professional development for and by rural and remote rural midwives to meet the needs they have identified. This has created improved confidence and self esteem with these midwives and has seen an increase in women being able to birth locally, with skilled and competent local carers. I am very interested in this initiative as my research also identified that rural midwives in New Zealand wanted more locally delivered and context specific professional development activities. The similarity in circumstances for rural and remote rural midwives is amazing the sense of identity and difference acknowledged by rural and remote rural midwives seems to be felt across international boundaries. I believe that this is bond that we could build on to support each other in our practice.

Gisella described the development of a local birthing service for women in a remote rural community in the northern territory of Canada. Once again the issues for women and midwives share many similarities with remote rural communties in other countries.

Sally Anne spoke of a rural community in Australia reclaiming local birthing and re-establishing a local birthing service after it had been lost. This too was a thought provoking and inspiring presentation.

Yesterday I gave my presentation and this was well received. I recorded this and hope to save it online and link it here. I was thrilled to meet Pauline Costins [see the photo and top of this page] and have a chat face to face.

I will try to write more soon.