[Pil-pc-oceania] Womens' PDC's: Homebirth network says yes to PDC's

Tue Apr 8 18:03:24 EST 2008

Wow Deb, Wow.

I suppose I need to pull my finger out, get over the fear and start canvassing for a location. I was hoping somewhere close to me at least for the first one, at least in Victoria, but who knows? I am from SA, so I would feel comfortable organising stuff there. If you are elsewhere, I could probably do that too.

My friends are happy for us to hold the PDC at their "cottage" but it really isn't very inspiring, a bit desolate, really. And it would be good to have it at an established system rather than the stark naked bones. More inspirational, really.

My place is too small for women plus kids plus teachers plus helpers. Any suggestions welcome.

From: bocor at bigbutton.com.au
To: pil-pc-oceania at lists.permacultureinternational.org
Date: Tue, 8 Apr 2008 14:49:54 +0930
Subject: [Pil-pc-oceania] Womens' PDC's: Homebirth network says yes to PDC's

Hi all,

I have had several positive responses from midwives 
around Australia in reply to my request for assistance in teachingh natural 
birth in the context of PDC's.

Also, this response from the homebirth network has 
arrived in response to asking them if they could contribute to teaching about 
natural birth in the context of permaculture design courses (for women as well 
as generally):

"Joyous Birth would LOVE to help out and we have women all over 
Australia
available.  Let me know how we can help.

Cheers,

Janet"

Janet Fraser
National Convenor, Joyous 
Birth
Australian homebirth network.
http://www.joyousbirth.info/
In a 
world where homebirth is an act of civil disobedience - 
2008 - year of 
homebirth awareness!

-----Original Message-----
From: Deb 
Guildner [mailto:] 
Sent: Tuesday, 8 April 2008 7:31 AM
To: ozmidwifery at birthinternational.com
Subject: 
[ozmidwifery] Childbirth education via permaculture design courses

Hi 
all,

I just posted a piece from the website (birth Int: re Maggie Banks 
book) to 
the International Permaculture mailing list.

Have just 
received some very positive feedback about including segments 
about natural 
birthing into future Permaculture Design Courses (PDC's). 
PDC's are run in 
many countries all over the world, and in many parts of 
Australia. Many 
thousands of students have graduated from these courses 
since the first 
Permaculture book was published 30 years ago in 1978.

PDC's specifically 
designed for women have been held on and off since 1985, 
and some people are 
suggesting that specific segments of special relevance 
to women should be 
added on to the general curriculum; some think these 
should be included in 
all courses, given the current state of childbirth in 

Australia.

Midwives are a very busy professional group, but is there 
anyone around the 
country who would be prepared to spend even a morning or 
an afternoon 
explaining the pros and cons of natural birth and the midwifery 
one-on-one 
care model?

PDC's run for 72 hours over 2 weeks =a 72 hour 
intensive introductory 
course.  There are also advanced courses. Given 
the nature of the midwife's 
workload, there would naturally be some 
flexibility afforded with times and 
schedules etc. A modest renumeration 
would be available, as teachers are 
paid via course fees 
charged..

Has anyone any other ideas about what should be included in 
courses for 
women? Or help with an outline for a segment on natural birth? 
Any 
contributions would be greatly appreciated.

Natural health care 
is a given....as, of course is designing all those 
lovely organic food 
gardens and orchards.

I am contributing a paper tabling the highest 
antioxidant and vitamin-rich 
foods.

Permaculture is a sustainability 
model of culture and agriculture. Its basic ethos is: care for people, care for 
the earth.

Cheers
Deb
----- Original Message ----- 

  From: 
  Deb 
  Guildner 
  To: permacultue 
  discussion list 
  Sent: Monday, April 07, 2008 8:18 
AM
  Subject: [Pil-pc-oceania] Womens' 
  PDC's

  Hi 
  all,
  Contrast the information in the article (below) with the alarming 
  statistics regarding birthing in Australia and intervention rates.
  It is now the norm at private hospitals here in SA (where overservicing in 
  maternity "care" is common) to have a 52% caesarian rate. 
  There is a much higher risk to mother and baby from C/S births (double the 
  mortality rate), where the mother is deemed low-risk from a normal birth.
  Cheers
  Deb
  Reclaiming Midwifery Care as a Foundation for Promoting 'Normal' 
  Birth 
  by New Zealand's Maggie Banks
  *  Maggie 
  is a home birth midwife, researcher and writer living in the Waikato, New 
  Zealand. Her first book "Breech Birth Woman Wise" was published in 1998 and 
  her second "Home Birth Bound: Mending the Broken Weave" in 2000. She is a 
  founding member of the New Zealand College of Midwives and established the 
  Midwifery Standards Review process in the Waikato.
  .......................................................................................
  from: Birth International website:  http://www.acegraphics.com.au/articles/maggie01.html
  This paper identifies some essentials of midwifery practice and looks at 
  how the woman who may have additional care needs receives woman-centred care. 
  Breech presentation will be used by way of example to demonstrate the latter. 

  Childbirth is neither 'normal' nor 'abnormal'. It is, quite simply, a 
  childbirth journey - a unique experience for each individual woman. The 
  recognition of each woman as distinctly individual is fundamental to midwifery 
  philosophy and the provision of woman-centred care.[1]  
  Without such recognition, maternity care is practitioner- or institution- 
  centred. 
  It is frequently cited that eighty-five percent of women can give birth to 
  their babies without interventions or problems. Yet maternal and perinatal 
  morbidity reflect a different reality. The 'norm' of childbirth has shifted 
  and the usual does not reflect the childbearing woman's true capacity to give 
  birth. Instead the norm is reflective of the aberration of medicalised 
  childbirth and the many unnecessary interventions that are performed on women. 

  Suzanne Arms calls this new norm 'typical' birthing. In her video, Giving 
  Birth: Challenges and Choices, Arms lists withholding of food; artificial 
  rupture of membranes; medical induction or augmentation of labour; intravenous 
  fluid administration; epidural anaesthesia and perineal suturing amongst an 
  extensive list of typical birthing interventions in America. She draws 
  attention to the fact that there are few births that occur without at least 
  five of these interventions. 
  As medicalised childbirth has become entrenched the healthy process of 
  giving birth has become more illusive and is seldom attainable for women in 
  the readily available maternity service. The 1999 report of births in Victoria 
  during 1988 and 1989, the Australian Senate's Rocking the Cradle, states "only 
  11% [of women] had a spontaneous labour and a spontaneous delivery without an 
  epidural or a tear requiring stitches".[2]  The New 
  Zealand figures are less explicit only because data is not kept that 
  specifically identify the number of women who give birth without any 
  interventions. However the New Zealand Ministry of Health reports 
  approximately sixty-seven percent of women did not have operative deliveries 
  or Caesarian sections in the 1996/97 twelve month period. There were over 
  60,000 procedures performed during the births of just over 57,000 live born 
  babies.[3]  Clearly, New Zealand and Australia share a 
  childbirth picture in common - interventions in childbirth are occurring when 
  they are unnecessary and a medical model of birth is dominant. 
  Given these statistics it is fair to say that if well women with well 
  babies are unable to birth without unnecessary intervention and trauma with 
  usual maternity services, it is highly unlikely that women with additional 
  health care needs will be able to do so. Whenever women are allocated a risk 
  label there will be an accompanying pathology that is anticipated. Care will 
  be organized around the 'risk factor'. All the woman's uniqueness will merge 
  into the background as her care centers around the fear entrenched and 
  litigation driven principle of 'just in case'. 
  The only way to ensure that care remains specific to the individual woman 
  is to encompass the foundations of woman- centred care which have been 
  identified as essential, some of which are as follows: 
  Continuity of care & caregiver
  Women wish to have continuity of care from a known and trusted caregiver 
  throughout the entire pregnancy, labour and birth and postpartum period. Women 
  do not want fragmented care from multiple caregivers who provide inconsistent 
  and conflicting information.[4]  This continuity of care 
  encompasses: 

    Pre-conceptual care

    Pregnancy testing

    Antenatal health care

    Preparation for birthing and parenting

    Care during labour, including the facilitation of birth

    Management of any necessary emergency measures until appropriate medical 
    assistance is available

    Support and facilitation of breastfeeding

    Postnatal care for mother and baby for four to six weeks after 
    birth

    Contraceptive/family planning care and education

    Transfer to ongoing well child services (as appropriate) following 
    completion of the childbirth continuum

    Consultation or referral to the medical specialists if additional health 
    care needs necessitate their input at any stage in the continuum This may 
    include a haematologist, cardiologist, endocrinologist, obstetrician, 
    paediatrician and so on. 
  The appropriate caregiver
  The most appropriate health professional to provide continuity of care in 
  the healthy childbearing experience is the midwife. It is the midwife who has 
  the complete range of skills necessary to provide the total maternity service 
  for well women and their babies. The midwife is the only health professional 
  specifically educated for this purpose and the only one who can organise her 
  practice structure accordingly. While midwives can and do provide this whole 
  service without obstetricians and/or general practitioners, these latter 
  practitioners cannot, and do not, provide a total maternity service without 
  midwives. 
  When obstetricians are involved in birthing, women are more likely to 
  experience the births of their babies as operative or surgical procedures. In 
  1996 the New Zealand College of Midwives undertook a study of 2,212 births to 
  examine outcomes of the different maternity care providers. The study grouped 
  women into the following: 

    Those who chose full midwifery care and

    Those who had shared-care between: 

      A midwife and a general practitioner or 
      A midwife and an obstetrician. 
  The women studied were very similar to the usual childbearing population in 
  age; number of children; socio-economic background and pregnancy related 
  alerting factors, commonly called 'risk factors'. Thus the study population 
  was not selected on of the presence or absence of a 'pregnancy condition'. 

  There were more normal births; fewer Caesarian sections; fewer vacuum 
  extractions and fewer forceps deliveries with sole midwifery care than in any 
  shared-care type. Breastfeeding rates at six weeks were also highest and the 
  perinatal mortality rate was lowest.[5]  
  The care of the obstetrician is appropriate to provide 'advice, support and 
  expertise' to those women who have additional health care 
  needs.[6]  
  Informed choice and informed consent
  To make informed choices and give informed consent a woman requires 
  necessary and individually appropriate information to be given to her. This 
  information needs to be based on unbiased evidence and to be given in a manner 
  and at a time when she is able to consider and question its 
  implications.[7]  The most appropriate time for this 
  process of exploration is the antenatal period when time is most available to 
  repeat, interpret and expand on information. It is a major component of the 
  antenatal midwifery process and fundamental to effective birth planning and 
  the empowerment of women in childbirth. 
  Whether a birthing experience has culminated in a natural birth at home or 
  a Caesarian section in hospital, the woman who has had the opportunity and 
  been supported to make her own decisions, is more likely to have felt in 
  control of her birthing experience and to be in a position to start her 
  mothering well. 
  Appropriate care
  The World Health Organisation in its 1996 document, Care in Normal Birth: A 
  practical guide, draws attention to a woman's 'birthing potential', that is, 
  the realm of possibilities that could eventuate given a woman's individual 
  circumstances. This birthing potential is dependant and interlinked with 
  social, environmental and cultural factors as well as the physical 
  characteristics of health. It notes that all valuable health care results from 
  being guided by 'alerting factors' - things which may pose a problem for a 
  woman and baby but which may not eventuate. [8]  Thus it 
  is possible to get past thinking of 'risk management' and the practice of 
  subjecting a woman to unnecessary interventions that are performed 'just in 
  case' there is a problem. 
  Evidenced-based practice
  All maternity care needs to reflect 'best practice' principles. Evidence 
  drawn from across the disciplines that shows a particular form of care has 
  proven to be beneficial needs to be incorporated into practice. That which has 
  proven to be unbeneficial should be discarded. However this still leaves a 
  very large proportion of maternity care which, when one searches the 
  authoritative sources of literature such as the Cochrane Collaboration, 
  frequently states 'there is not enough evidence to evaluate the effects of 
  ...'. 
  Midwives working in continuity of care are well placed to take an in depth 
  look at the implications of care for the individual woman. We are also well 
  placed to employ the use of 'thoughtful exchange' to reflect on and critique 
  appropriate care for women and their babies based on our 
  experience.[9]  It is this thoughtful exchange that, in 
  the absence of definitive answers, is most likely to ensure care is 
  beneficial. 
  We need to inform women of any lack of definitive answers. There is an 
  expectation that there are guarantees of perfect outcomes with childbirth. 
  Maternity care providers have fostered the notion that 'doing something is 
  better than doing nothing' since the introduction of a high tech approach to 
  birth. It has lulled women and health professionals alike into a false sense 
  of security that by providing the very best of appropriate care we can always 
  avoid an unexpected outcome. It is this fallacy of guarantees and the unreal 
  expectation of perfection in a process ultimately beyond our control that has 
  fuelled the litigation apparent in maternity services today. 
  Woman-centred care and potential for additional health care needs
  When one considers these tenets of midwifery care mentioned above, the 
  presence of any alerting factor does not alter the integrity of woman-centred 
  care. Considerations remain individually determined. To illustrate how this 
  occurs aspects of the label associated with a breech baby will be examined. 
  Rather than being subjected to a highly interventionist birth - an elective 
  (but mandatory) Caesarian section - simply because her baby is presenting 
  breech, woman-centred care exposes the flaws in such an approach. A picture 
  can be build up that helps to differentiate between potential for an 
  individual baby and woman and 'risk' for all breech babies, as follows: 
  The 'evidence'
  The Toronto Term Breech Trial, a multinational trial studying outcomes for 
  mother and baby, ended in April of last year. The study compared perinatal and 
  maternal morbidity and mortality differences between planned vaginal 
  deliveries and planned Caesarian sections when the baby was in a flexed or 
  extended legs breech presentation at term. The findings were as follows: 

      "Planned [C}aesarean section is better than planned vaginal birth 
        for the term f[o]etus in the breech presentation; serious maternal 
        complications are similar between the groups." [10] 

  Publication of results with a commentary[11]  urging 
  quick dissemination of findings will certainly be effective in shutting down 
  women's options to give birth naturally to their breech babies. 
  Mandatory Caesarian section
  To give a blanket statement that all breech babies should be born by 
  Caesarian section is very problematic. It will result in a great deal of fear 
  for those women (approximately a quarter of all breech 
  presentations[12]) whose babies are not diagnosed as breech 
  presentations until labour, a good proportion of whom will go on to rapidly 
  give birth. Within the study 9.6 percent of babies were born vaginally despite 
  their allocation to the Caesarian section group. 
  This is unlikely to change therefore vaginal breech births will continue to 
  occur - not only accidentally but, as experience shows, because of women's 
  choice. The skills to assist women giving birth to their breech babies remain 
  essential. 
  Randomized controlled trials
  As with all randomized controlled trials both the study and control groups 
  of the Term Breech Trial did not have a "strong management 
  preference".[13]  The act of giving birth in highly 
  interventionist childbirth cultures will automatically see those women who 
  wish to achieve natural childbirth exclude themselves from randomization. As 
  this self-excluding group was not studied it is unknown whether the results 
  are generalizable to those women who have a strong preference for natural 
  breech birth. 
  Considering how intervention can cause the problem
  It is commonly acknowledged that cord prolapse is a concern specific to the 
  breech baby. Cord prolapse is more specific to pre term babies who are less 
  likely to have a good sized buttocks to cover the cervical opening. It is also 
  these pre term babies who are more likely to present as footling breeches - 
  again a factor that predisposes to cord prolapse.[14]  

  Obstetric interventions can turn a potential risk into an actual 
  complication. A recent study[15]  reported in the American 
  Journal of Perinatology examined the circumstances surrounding umbilical cord 
  prolapse for eighty-seven women. It was found that in forty-one cases 
  (forty-seven percent of the study group) obstetric practices - including 
  breaking of waters; application of 'scalp' electrodes and intrauterine 
  pressure catheter insertion - preceded umbilical cord prolapse. 
  Rather than pointing to evidence that therefore all breech babies should be 
  born by Caesarian section to avoid cord prolapse, how to avoid the problem 
  becomes highlighted. The most appropriate form of monitoring with a breech 
  baby is the non-invasive Pinard stethoscope or other external forms of 
  monitoring so the membranes are left intact to provide the cushioning pool of 
  waters. 
  Midwifery practice
  A spontaneous onset of labour; upright and woman-led positions; normal 
  healthy muscle tone that has not been decreased by epidural anaesthesia; a 
  baby who is not debilitated by sedation and epidural anaesthesia optimize the 
  likelihood of healthy birthing. These are all strategies to the midwifery 
  model of care. The Term Breech Trial did not embrace the distinct and separate 
  style of care that the midwife provides when facilitating the act of giving 
  birth. Instead this evidence is only cognizant of medical management of 
  vaginal breech birth. Seen in this light of medicalised birth, the study gives 
  a well-rounded overview of the perinatal morbidity and mortality with such 
  management. However, it remains of dubious relevance to woman-centred care and 
  midwives need to consider the relevance of the findings to their practice. 

  Conclusion
  As mentioned previously, medicalised birth has colonized the act of healthy 
  birthing for women and babies who have no additional health care needs. When 
  one is seeing monthly Caesarian section rates of between thirty-one and 
  thirty- three percent at a tertiary obstetric and neonatal facility catering 
  for approximately two hundred and fifty births a month along with a ten to 
  twelve percent instrumental delivery rate, this means just over half of births 
  in that same facility will be experienced as 'normal' 
  births.[16]  These so-called normal births are vaginal 
  births without the use of forceps or vacuum extraction. The women may still 
  have had inductions or augmentation of labour; narcotics; epidurals; 
  episiotomies; sutured lacerations; post partum haemorrhages; intravenous 
  fluids or blood replacements; manual removals and so on. If the knowledge and 
  practice of supporting well women to give birth to well babies has been lost 
  to such a degree, there is minimal likelihood that the woman or baby needing 
  additional expertise will be able to access it. 
  Women who have extra considerations in their pregnancies can be overwhelmed 
  with the negative view that health professionals have about their pregnancy. 
  Even women who are very knowledgeable and assertive can feel intimidated by 
  the barrage of pathology that is aimed at them and their unborn babies. Our 
  focus on every woman receiving woman- centred care, irrespective of additional 
  heath care needs, must be maintained. It is every childbearing woman's 
  birthright to be supported as a unique individual throughout the childbirth 
  continuum. 
  The politics of birthing have divided maternity services into those things 
  that a midwife 'can and cannot' do. To contemplate where we stand in relation 
  to supporting women in their informed choices in childbirth is to contemplate 
  the very essence of midwifery. We must never forget that midwifery is about 
  being 'with woman'. 
  Providing woman-centred care is not without its own challenges. It upsets 
  the dominant players (medicalised practitioners) and the way obstetric 
  services are currently ordered, that is, with institutional expedience in 
  mind. It is my experience and that of other midwives who practice the 
  woman-centered way of midwifery that the road is not easy. However, no midwife 
  can afford to take a position of distance and aloofness from the woman, 
  isolating her in her journey. The consequences for the woman of losing her 
  midwife's knowledgeable companionship are too great and there is too much at 
  stake - a healthy and uninjured mother and baby who are well placed to start 
  mothering and maturing - the next step in the continuum of childbearing. 
  References

    New Zealand College of Midwives. (1993) Midwives Handbook For Practice. 
    Author: New Zealand. P. 48.

    Senate Community Affairs Reference Committee (1999, December) Rocking 
    the Cradle: A Report into Childbirth Procedures. Australia. P. 109.

    Cited in Banks, M. (2000) Home Birth Bound: Mending the broken weave. 
    Hamilton: Birthspirit Books. Pp. 30-33.

    National Health Committee. (1999) Review of Maternity Services in New 
    Zealand. Author: Wellington.

    Guilliland, K. (1998, July) "Midwives and Midwifery - Leaders in Safe 
    Maternity Care." New Zealand College of Midwives National Newsletter. Pp. 
    1-3.

    H.M.S.O. (1993) Changing Childbirth. Part 1: Report of the Expert 
    Maternity Group. London: Author. P. 41.

    Ibid. P. 10.

    World Health Organization. (1996) Care in Normal Birth: A practical 
    guide. Maternal & Newborn. Health/Safe Motherhood Unit. Geneva. 
    P.2.

    "The Canadian Consensus on Breech Management at Term.", retrieved 8 
    February 1998.

    Hannah, M.A.; Hannah, W.J.; Hewson, S.A.; Hodnett, E.D.; Saigal, S.; 
    Willan, A.R. (2000, October 21) "Planned caesarian section versus planned 
    vaginal birth for breech presentation at term: a randomized multicentre 
    trial." The Lancet. Vol. 356. Issue 9239. Pp. 1375-1383.

    Lumley, J. (2000, October 21) "Any room left for disagreement about 
    assisting breech births at term?" The Lancet. Vol. 356. Issue 9239. Pp. 1368 
    -1369.

    Nwosu, E.C.; Walkinshaw, S.; Chia, P.; Manasse, P.R. & Atlay, R.D. 
    (1993, June) Undiagnosed breech. British Journal of Obstetrics & 
    Gynaecology. Vol. 100. Pp. 531-535.

    Term Breech Trial Newsletter. Vol. 4. Issue 6. June 30, 1998.

    Banks, M. (1998) Breech Birth Woman-Wise. Hamilton: Birthspirit Books. 
    Pp. 22-23.

    Usta IM, Mercer BM & Sibai BM. (1999) "Current obstetrical practice 
    and umbilical cord prolapse." American Journal of Perinatology. Vol 16. No 
    9. Pp. 479-484.

    Macfarlane, M. (2000, 7 November) Child & Women's Health Maternity 
    Statistics. Health Waikato Ltd PIMS data.

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