Protecting, supporting and promoting normal birth in New Zealand

In New Zealand we have a National Strategic Plan of Action for Breastfeeding. At the same time intervention rates in birth are skyrocketing, as they are internationally. Breastfeeding is an important health issue for women and their babies, and it is right that we should do all in our power to support breastfeeding in our communities. There is however general lack of acknowledgement of the health risks of birth intervention to women and their babies. Caesarean section is accompanied by significant morbidity to women and to neonates. It also siginificantly increases risks for future pregnancies. This is an issue of concern for me, as it is for many midwives.

I have taken the first couple of pages of the Action Plan for breastfeeding and have substituted Normal Birth for the word breastfeeding. One or two sentences needed to be removed as they were not relevant to normal birth. I would be interested to know what you think of this. If only we could inspire a movement to protect, promote and support normal birth. Is there any way that you think that we could make this happen?

So read on::
The vision for the National Strategic Plan of Action for Normal Birth

Aotearoa New Zealand is a country in which Normal Birth is valued, protected, promoted and supported by the whole of society.
The statements on this page set out the achievements that will show that the vision has been realised in New Zealand.

Women and their wha¯nau/family have the information they need to make confident and informed decisions about Normal Birth, and live and work in an environment that enables and supports their decisions. Women and families have access to support to help them gain, practise and pass on knowledge of Normal Birth to family, friends, and successive generations. Communities, along with health and social services, provide accessible, consistent and knowledgeable support to women and families who need it. Normal Birth rates show a significant improvement across all population groups, and there are no longer any significant differences between the Normal Birth rates of different ethnic, socioeconomic or geographic communities. There are accessible and appropriate Normal Birth education and support services for all eligible women, fathers/partners, families and wha¯nau from all cultural and ethnic groups, and for migrant communities, low-income families and young mothers. Government planning, policy and service delivery decisions are thought through with a view to actively protecting, promoting and supporting Normal Birth. This occurs across all relevant government agencies in ways that fully involve and respond to communities. Where it is necessary, legislation actively and explicitly protects, promotes and supports Normal Birth.
1.1 Priority areas for action for the short term: 2008–2010
The Committee has identified a group of issues that need to be addressed in order to make demonstrable progress in improving Normal Birth rates in New Zealand. The priority areas are listed below:
Government
• Objective 1.1(a): The Ministry of Health provides the leadership for Normal Birth strategy and policy.
• Objective 1.2(a): The Ministry of Health continues to strengthen the accuracy and completeness of the existing dataset on Normal Birth.
• Objective 1.3(a): Identification of New Zealand-specific Normal Birth research needs.
• Objective 1.4(b) The Ministry of Health supports a programme of research into intervention in the normal birth process. National Strategic Plan of Action for Normal Birth 2008–2012 page


Family and community
• Objective 2.1(b): The Ministry of Health works with District Health Boards (DHBs) to assess and plan for improving access to ante-natal education.
• Objective 2.2(b): Communities work with DHBs and other providers to establish new or support existing peer support programmes for Normal Birth.
• Objective 2.3(a): the second phase of the national Normal Birth social marketing campaign promotes positive attitudes to Normal Birth in the community and public places.

Health services
• Objective 3.1(a): All DHBs achieve and maintain Normal Birth Friendly Hospital accreditation.
• Objective 3.2(b): DHBs are aware of and act on the Normal Birth support needs of their Māori, Pacific and other ethnic communities.

Workplace childcare and early childhood education
• Objective 4.1(a): The Ministry of Health continues to link with other agencies (for example the Families Commission, Department of Labour) to support the development of a policy framework for options for extending current paid parental leave entitlements.

1.2 The need for the National Strategic Plan of Action on Normal Birth
Normal Birth is important for the physical, social, emotional and mental health and wellbeing of infants, mothers, fathers/partners and families. There are risks identified with intervention in birth. Normal Birth is important to the health of individuals and communities. [We] now require[s] DHBs to actively work towards improving Normal Birth rates as one way of improving the health status of communities. Concern over declining Normal Birth rates is not unique to New Zealand.

For all you new midwives learning about labour and birth

Here is a really lovely story in video and pictures for you

Many thanks to rachlezucker and family.

Routine epidural denied. Is this a problem?

A news item today discusses women in the UK being denied epidurals because of a lack of anaesthetists. Epidurals are a local anaesthetic injected into the epidural space in the spine near to the spinal cord, which provides numbing and therefore relief of pain in labour. This emotive article quotes the Vice President of the Royal college of Obstetricians saying that epidurals should be routine in birth.

There are clear associations between epidural anaesthetic and the need for other interventions in labour, such as instrumental birth with forceps or ventouse(suction cap applied to the babies head)or caesarean section.

The article sites the Cumberland Royal Infirmary as being particularly affected by this inability to provide epidural. It is not so strange then that the Cumberland Royal Infirmary has a lower level of intervention in childbirth compared with other local hospitals. Cumberland Infirmary has a 50% normal vaginal birth rate, Cresswell maternity has a 30.8% normal birth rate and Furness has a 44.4% normal birth rate. Normal vaginal birth leads to lower incidence of complications in the postnatal period for both mother and child. There are also fewer complications with following pregnancies. Do women want pain free birth at this price? What do women think about 'routine' epidural? How do staff support women to birth normally and without intervention if they expect every woman to have a epidural? How do they walk alongside women through the triumphant process of normal and natural labour and birth?

Do you have any thoughts or comments about this? Are women told enough about what to expect in childbirth and the effects of interventions such as Epidural?

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?

Two very different birth videos

In this post I want to highlight the very different experiences women can have with what might be called a 'normal vaginal birth'.

In this first video a young woman gives birth to her child in water. In contrast to the video posted on my friend Sarah's blog, this baby is taken from the water quite quickly. I wonder if, given a little more time, the mother might have reached down and picked up the baby herself. Obviously all the labour has gone before this and this is just the birth of the baby. It appears a relaxed and loving birth experience. Both mother and child seem to take a moment or two to realise what has just happened.



In this second video a young woman is giving birth in a hospital. We do not see the whole birth. She is fully draped in sterile drapes, with many gowned and masked health professionals and others buzzing around. The doctor at the foot of the bed is ready to catch the baby. He does not seem to be using any instruments so it would seem safe to assume that this is a 'normal vaginal birth'. A friend or family member is taking this video. The language used is Spanish I think, but the body language clearly indicates that the doctor is not pleased to be videoed. I wonder why? The doctor does not seem to engage with the woman at all. His focus is entirely on the woman's vulva. A shame we do not see the rest of this video.


I welcome your thoughts on the contrast between these two birth experiences. All over the world, and I think New Zealand is no exception to this, women can experience birth in the way these two young women do, and many variations in between.

How might these different birth experiences affect women as they start on their journey of motherhood?

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.

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?

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.