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What is a Doula? A Doula provides emotional and physical support to mothers and families during their pregnancy and birth journey. A Dou...

Thursday, 20 October 2016

DOULAS ARE NOT MIDWIVES IN EMBRYO

THE ROLE OF A DOULA IN A HEALTH PROMOTION CONTEXT




Last week Christa presented a beautiful poster about the role of a doula to a crowd of around 500 birth professionals, most of whom were midwives. Like a boss. 

Christa Buckland: Doula Extraordinaire

Why did she choose to present to this audience?

Doulas know how important their role is. Their clients know how important the Doula is. Yet somehow, many midwives and doctors have become cautious in recommending or even accepting doulas into their practise.

"I wanted to help midwives and medical care providers understand that our role as Doulas is not treading on their toes and that we really do make a difference with the support we provide. Additionally, we are peers with the women we serve so we are not a threat to care providers in any way."- Christa Buckland

What's the deal with that? 
Christa speculates that some of the problems arise from confusion over what a doula actually does and whether or not it's helpful. I would go further to suggest that often the focus of a doula's role is shifted onto what they do not do, rather than the amazing things they do.

Doulas viewed in a Health Promotion context. 
She describes doulas as a grassroots health promotion strategy born from community need. The women who have chosen to become doulas have seen the need, created and filled the role to serve pregnant women.

"In a health promotion context, this comes under the banner of "community action and participation" so in this sense we are utilising a very effective strategy to improve health outcomes for women, babies and families."  -Christa Buckland

See that tail coming out of the sperm??? I know you do.
That's the doulas!!


Doulas as Community Action:


"This closely resembles a peer support or community-based model (HealthConnect One, 2014). This perspective may help to diffuse the tension between care providers and doulas, as it views doulas as part of the community, rather than part of the 'medical team'."  - Christa Buckland

See that lady wearing a cape there? ^ She's a Doula!
She is an allied health professional and community member. 


Alrightio, so how can a doula help?

With fractionated and unpersonalised maternity systems often the doula provides the only continuity of care received by childbearing women.

Which leads to the amazing conclusion that...
Doulas are amaaaazing!!

"Doulas are not 'intruders' in the birth room. Rather, they represent an excellent example of community action and empowerment." - Christa Buckland


Christa is a passionate doula, childbirth educator and health promotion graduate. She has a Bachelor of Health Science (Health Promotion) from Western Sydney University and is now embarking on postgraduate research studies. Christa is the President and Co-Founder of Doula Network Australia Inc 

Find out more: www.naturalbirthconnection.com



Brochure accompanying poster presentation:





Wednesday, 19 October 2016

DAY 3- OF THE 11TH INTERNATIONAL NORMAL BIRTH AND LABOUR CONFERENCE 2016

Normal Labour and Birth Conference 2016


This final day of the conference was filled with joy and sadness. Pretty much in that order as it started with keynote addresses on oxytocin and moved onto the deeper and darker side of maternity, coming to a head with Bashi Hazard's speech about human rights in childbirth. Keep reading to find out how that all went down!

Professor Kerstin Uvnas Moberg- 'The Oxytocin Factor'


This Professor knows oxytocin. And she wasn't shying away from putting it aaaall out there, good and bad. 

I'll start with a quote from her which brings everything she said in wonderful detail into a single point. 

"Normality in birth is usually best because everything was thought of when these systems were created." - Professor Kerstin Uvnas Moberg



Professor Kerstin Uvnas Moberg keeping it real.

So then what does she have to say? Here are the main points (I tried to condense for you)

1. Oxytocin is more than a hormone, it is a complex system. 

It has the same effect on all mammals, you can even give it to sandworms and they will lay eggs... the relevance of this information evaded me, but I thoroughly enjoyed it none-the-less and hope you do too. 

2. It's a long point but good- it was new to me and may be to you too so hang in there. I believe in you. 

There are two nerves that interact with the uterus (the new exciting thing is the nerves- hopefully the italics helped you with that). One is tapped into fight-or-flight system, the other waves the flag for rest-and-digest. (In labour, women have faster labours with less pain when they are channelling the rest and digest system). Synthetic oxytocin basically switches of the rest-and-digest nerve, and leaves the ugly cousin fight-or-flight nerve in control of the uterus. This gets messy because it means a reduced blood flow to the uterus and placenta- which is bad. It also causes unnaturally long contractions which the Professor speculates may then impact the baby because of the physical force- also bad. 

3. Epidurals may also impact these nerves, as the anaesthetic is given very close to where they are. Also the probability of needing synthetic oxytocin increases with an epidural. She really makes her point by adding that women describe epidurals as having reduced pain, however, do not describe their births as being more pleasant than physiological birth. 

I told you she wasn't shying away from telling it how it is. She uses the research she undertaken to illustrate her points. I think some of those points got a little bit pointy for some of the audience, but 'truth will out' right? She then goes on to describe unnecessary intervention as:

"Cutting off the roots of a positive, self supportive system" - Professor Kerstin Uvnas Moberg.

She said a lot more but that was the final cut. 


I probably needed a brain break at that point but onwards and upwards we went to Professor Maralyn Fourer's 'How birth space can influence normal birth". 


This talk was interesting, and began with the speculation that moving women from birthing at home to in the hospital was one on the most "amazing uncontrolled experiments ever". She then went on to examine how neuroscience is connected to architecture. Who would have thought.  

Professor Maralyn Fourer- setting the scene before talking about setting the scene. 

Quick facts:

1. Worldwide all hospital birth rooms have the same four features: Bed, Monitors, Neonatal Rhesus Bed and Bright lights. Pretty sexy. The bed is the biggest and most central feature of the room. 

2. Optimal birth space influences the brain to produce optimal oxytocin levels, increasing the probability of normal birth. This is because the fear of something going wrong increases adrenaline, decreases oxytocin and therefore it makes the chances of something actually going wrong much higher. 


3. There are some really cool birth rooms- my favourite was one with a projection of nature scenes onto the wall. Just showing this on the screen for 10 seconds was calming as a member of the audience, I can only imagine how effective it would be in a birth space. Excitedly (but under her breath) the midwife next to me commented that there are lots of white walls in hospitals. 

Dr Rachel Reed from Midwife Thinking is a passionate advocator for women in the arena of traumatic childbirth. She presented 'Traumatic childbirth: Women's descriptions of care provider actions and interactions'. 



I already loved her blog. Now I love her. #notweirdiswear


So what did she have to say?

1. Care providers are prioritising their own agenda over the birthing women they are serving. 

2. Rachel ran a survey, and of all birth trauma described by women 2/3 described care provider interactions as the traumatising event of birth (1/3 described physical trauma).

3. Women are left feeling violated, disregarded, coerced, judged, lied to, many reported screaming 'no' to their care provider, some said they felt as though they "were treated like a piece of meat". It's so so bad. 

4. Institutions are risk averse, with many unnecessary procedures being forced on women in the name of risk. However, in Australia, the leading cause of maternal death is suicide. That's a risk. 

5. Rachel noted that there are mandated workshops for healthcare workers in many areas, such as personal protective equipment and she suggests that mandated workshops on promoting wellbeing may be part of a solution to this insidious issue. 

It wasn't a feel good presentation. It was a get off your butt and do something presentation. If you have unresolved feelings about your birth please seek help. Birth Talk is a foundation dedicated to helping women with birth trauma, or you may benefit from professional birth debriefing, visiting a counsellor or psychologist. You are not alone.

Then, as though they knew we needed a big dose of cuteness, these lovely geese and their little goslings decided to give us a show. 


Our new friends sensed the oxytocin in the air!

Bashi Hazard 'Human Rights in Childbirth' - The last session of the conference did not disappoint. 



What an amazing woman. Here are some highlights from her talk:


1. Midwives have been persecuted in the past and continue to be in their current work, particularly home birth midwives, for example Agnes Gereb. 

2. We are fostering a system where women are being forced to choose between their mental health and their physical health. 

3. In countries such as India and South America, governments are getting rid of traditional midwives (often the only accessible form of maternity care in rural areas) and pushing women into institutions where they are abused and disrespected. This is called obstetric violence and is pervasive. 


Slide displayed by Bashi Hazard during presentation. Bam. 


I could say so much more I had such an amazing time!! Feel free to ask any questions. 


THANKS FOR READING! 

Comment below <3 




Wednesday, 12 October 2016

DAY 2- OF THE 11TH INTERNATIONAL NORMAL BIRTH AND LABOUR CONFERENCE 2016

NORMAL BIRTH AND LABOUR CONFERENCE 2016



The second day of the conference was just as engaging as the first. I'll start from the very beginning because I hear it's a very good place to start.

Keynote Address by Professor Sally Tracy and Professor Alec Welsh

Holy schamoley- these two trailblazers basically introduced a whole new model of care in their Tertiary Hospital's maternity unit. Just casually of course. 

They used a woman-centered midwifery group practice model for both 'high' and 'low' risk women. The Obstetricians, Registrars (fresh doctors) and midwives had meetings weekly to ensure quality care.  This model exemplified continuity of care, which is essential for good outcomes. You go guys. 

Bonus quote: "Let's do what we can together to keep birth normal" - Alec Welsh

Yessir.


Professor Alec Welsh and Professor Sally Tracy 

And then Dr Andrew Bisits wooed the audience with his presentation on 'Can breech birth normal?'... hot tip. The answer is yes. 

He basically addressed 500 women who either were already in love with him, or are now. 


Fun facts from his talk: 

1. Birth workers can use every breech birth as an opportunity to learn about and therefore normalise breech birth. His groovy example was that even during a cesarean he lifts the baby from the womb in such a way as to show his Registrars how a breech would naturally arrive. 

2. He suggested that women were just as, if not more interested in how the baby manoeuvres during a breech birth than the statistics surrounding the decision making process. 

This is where it gets really good. 

A lovely Keynote speaker in the Audience, Bashi Hazard (who we hear from tomorrow... exciting!) asked Dr Bisits to explain to her, as though she were the mother, how the breech baby was born. 

He may as well have sung us all a breech lullaby. 

By the time he finished everyone was deadly quiet, as they had been hanging onto his every word. 

In the spirit of education I'll attempt to replicate what he said below... if you want the real deal I highly recommend seeing him at any future conferences/ chances you get. 


The Baby Women Whisperer


How does a breech baby come out? A Dr Bisits Breech Lullaby: abridged version. 

Everything moves down as a unit
Baby's bottom presses on the cervix, replicating the head
Cervix dilates at the same rate as head first
Once the Cervix is fully dilated and baby reaches mothers pelvic floor
One of the baby's hips move into the mother's pelvis
Mother gets a strong urge to push that hip under pubis bone
Then the baby comes down hip first, two steps forward one step back 
Get to point where it's two steps forward no steps back
That is bottom almost out
Which is good because babies' hips are same width as their head, you know baby won't get stuck if their head is tucked in
Once bottom is out, baby turns
-At this point bottom, body and arms are out
Then the woman feels a strong urge to push- even through contractions
This pushing is encouraged as this last stage should only last 3-4 minutes. 
Baby's head comes out 
Voila 
Baby is born. 


Dr Bisits went on to describe breech birth competence as a "fundamental and nonnegotiable item for midwives and obstetricians".  

It was all too much! We cheered. Then got tea. 

Rhea Dempsey wrote the book on pain dynamics in birth. I know, because I bought it today. 



Just hanging out with Rhea Dempsey. Everything is normal. 


Rhea's session on Pain Dynamics and Physiological birth had so many layers and so much truth to it. Like a truth cake... or truth haircut. Anyway- here are the quick highlights of what I took away: 

1. There are many different mindsets of women regarding their perception of pain during labour. At one end of the spectrum are women who do not want to experience it at all (orders the epidural before labour),  at the other are women who are keen to embrace the pain and arrange their birth environment and support people around that preference (home birth, birth centre). The majority of women are in between these two options. 

2. There are primarily two mindsets of labour ward midwives. They are either a working with pain midwife or a medicate pain midwife. This creates a problem for the majority of birthing women in the middle, as they don't know which midwife they will get. This can be seen in the woman who, during labour, decided that she really wanted an epidural but the midwife talked her out of it and as a result she was devastated; and the woman who had an epidural but didn't really want it, but had asked for it and then felt guilty about her decision. 

It's basically a communication breakdown which is leading to neither party knowing the mindset of the other, creating a difficult scenario when women reach their "crisis of confidence" points in their labour- wherever that may be. 


Here she is again. Because two pictures is better than one


The final keynote address of the day didn't leave a dry eye in the house. Or in my row of seats at least. Professor Sue Kildea and Leona McGrath's combined presentation addressed 'Birthing on Country, from Policy to Practice' and an 'Aboriginal Midwives perspective'. They also introduced us to Ranae Coleman, an Indigenous student midwife. 


L-R: Renae Coleman, Professor Sue Kildea, Leona McGrath.
A quick overview: 

1. They opened with a series of sobering statistics about maternal and infant mortality and morbidity for Indigenous compared to non-Indigenous Australians. Basically every statistic that I would hope would be the same, was twice as high, if not higher. 

2. They implored that culturally safe care is vital. 

3. Ranae Spoke about her journey to becoming an Indigenous student midwife, the difficulties she encountered and overcame along the way. **insert tears**

4. The importance of developing culturally safe stand alone birth centres in rural Indigenous communities was raised with the aim of improving cost effectiveness, health outcomes and provide spiritually safe care. However, at this point in time this seems like a pipe dream, as funding has not been granted- Professor Sue Kildea speculates that public involvement may amend this. 

Rally anyone?


Please take time to read the quote that Renae read to us.


"When you tell me ‘you don’t look Aboriginal’, you are denying that I am Aboriginal. To deny that I am Aboriginal is to deny that my grandmother was taken by welfare because she was Aboriginal, by the dictates of past government policies. To deny that she was taken because she was Aboriginal is to deny that past policies attempted genocide of Aboriginal people. To deny that the government’s objective was genocide is to deny that the government is responsible for the widespread decimation of Aboriginal language, traditions, land rights and intact family trees today. To deny that there is no widespread crises of identity within Aboriginal individuals, families, communities – and indeed our entire country – is to deny our lived reality. And when you deny our reality, you deny us our humanity. And so when you tell me ‘you don’t look Aboriginal’, it goes much further than just skin-deep." - Mykaela Saunders

The full article can be found here.



Thanks for reading you gorgeous thing! 



xxxxxx



Comment below if it pleases you. 







Tuesday, 11 October 2016

DAY 1- OF THE 11TH INTERNATIONAL NORMAL BIRTH AND LABOUR CONFERENCE 2016

NORMAL BIRTH AND LABOUR CONFERENCE 2016



O.K. Today was a special day! The first day of a three day international conference (held in Sydney this year woooooh) exploring normal birth.

Here is the highlight reel for those of you playing along at home.

This guy... Professor Eugine Declercq

 

It doesn't look like it here.. but this guy had a room full of sleep-deprived birth workers giggling.

Somehow Professor Eugine Declercq managed to make statistics fun and informative... what kind of magic is this?

One highlight from Professor Declercq was:


1. Women are being told that their babies are too big... but babies aren't getting bigger. Interesting. 



Check out some fun data at the Birth by the Numbers website he recommended.


The next exciting development of the day.... got me all sweaty and nervous! 

 

As fate would have it I got to sit next to my doula crush Sarah Buckley! She wrote the first book that I ever read which got me questioning how we do birth in this country. *birthy swooooon*

 
Me and Sarah Buckley. I'm definitely not pooping my pants...
 my face just looks like that.

 

As if that wasn't enough... I then got to listen to a room full of amazing midwives talking about the third stage of labour!  

 

All the funs.

After a fun history lesson where I learned that apparently the drug Ergometrine originally came from a fungus that grows on rye (Delish!) then all the midwives were on the placenta train. Listening to their experiences was so incredible. I. can't. even. 

So three fun facts from this session:

1. Many midwives primarily practise managed third stage... some have never seen a physiological third stage- even at the normal labour and birth conference. 

2. Language is important. It's "placental birth"opposed to third stage. Instead of Delayed Cord Clamping they are labeling it Physiological and Early Cord Clamping should be used for anything other than Physiological.

3. Increased management of the third stage has not decreased post-partum hemorrhage rates. In fact they are increasing. 

And a bonus one for funsies

With delayed cord clamping placental blood transfusion to the baby can be anywhere from 50mls to 150mls. My good mate (who I said an entire two sentences to) Sarah Buckley brought this up, the hypothesis is that the baby can regulate the amount of blood he/she receives when optimal cord clamping is used. Clever things. 

If this area interests you check out my post 10 Things To Do With Your Placenta



Then I went to Bernadette Leiser's Session about acupressure for the perinatal period. 

 

I'm not sure what drew me to this one in the first place, but I do feel more confident in using the tools they showed us for women during labour. 

Things I learned:

1. There is a bucketful and a half of studies showing that acupressure is effective- including randomised control trials. 

2. There is a woman called Deborah Betts who is super passionate about this all and has lots of info for parents on her website. Check it out here.

3. There is an acupressure point that stimulates your bowel. Interesting right? 


*Then I had a lovely doula catch-up lunch where talking about placentas over pasta was acceptable* 

 


Next keynote speaker was Caroline Homer, the President of the Australian College of Midwives. 

 

Holy mackerel.

This woman is clever. And I mean clever. She pretty much blew everyone away with her address. It was centered around the inequalities that women face in low income countries.

Taking into account all of the places she has visited, papers she has worked on and things she has done, I have deduced that she is at least 130 years old.
Things I took away from her talk: 

1. Developing countries have incredibly low cesarean rates (sometimes as low as 0.25% in poor rural areas) and women and children are dying because of it. This is due to many factors; primarily access, funding and education.

2. Where women in low income countries do have access to a cesarean birth, they may have many complications as a result- including approximately 20% of all women developing birth fistulas as a result of the operation. Further concern surrounds future birth for these women who may not be able to access healthcare again from small villages.

3. If local women in developing countries could be trained adequately as midwives, many of the inequalities surrounding birth could be addressed- the money doesn't need to go into fancy machines.

The take away message was that globally our healthcare system is in desperate need of balance.



THANKS FOR READING YOU LOVELY PERSON YOU!!! 

 

 

Please feel free to comment below! xx