[Pil-pc-oceania] Womens' PDC's
Tamara Griffiths
scarletwoman at hotmail.com
Wed Apr 9 15:09:47 EST 2008
Hi Deb,
David mentioned Anne Marie to me specifically after we talked about the women's PDC to the group.
What do the other women out there think about Gawler?
I like it. Right in my comfort zone!
Love T
From: bocor at bigbutton.com.au
To: scarletwoman at hotmail.com
Subject: Re: [Pil-pc-oceania] Womens' PDC's: Homebirth network says yes to PDC's
Date: Tue, 8 Apr 2008 19:45:25 +0930
I feel a convergence coming on......om.....
The Food Forest is 30 kilometres north of CBD of
Adelaide!!
What do you think, should we ask Anne marie about a
womens' PDC?
It would be a good starting place...all set up, so we'd
only have to concentrate on our curriculum......all female teachers for this
one? I can do a bit..
Give me time to dust off my old notes...from PDC with
Frances Lang.
Cheers
\
Deb
----- Original Message -----
From:
Tamara Griffiths
To: permacultue
discussion list
Sent: Tuesday, April 08, 2008 5:33
PM
Subject: Re: [Pil-pc-oceania] Womens'
PDC's: Homebirth network says yes to PDC's
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 & caregiverWomen 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 caregiverThe 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 consentTo 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 careThe 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 practiceAll 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
needsWhen 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 sectionTo 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 trialsAs 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 problemIt 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 practiceA 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.
ConclusionAs 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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