If Mum Can't Choose....?

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Caesearean? Unnecesarean?

The World Health Organisation declares a caesarean rate above 15% in any one region unjustifiable (Fortaleza Declaration - Summary Report). The national rate of caesareans in Australia is 30.8%, making over half of all caesareans in Australia unnecessary. Each State and Territory in Australia has a caesarean rate above 25%, the highest being 34% (Queensland) (Perinatal Statistics -Queensland 2006). Worse still are the rates of individual hospitals. In one Victorian hospital 50% of all primiparae (first time) births were caesarean sections. (Victorian Maternity Performance Indicators 2006-2007) The most shocking statistic, however, was Western Australia's 87.3% repeat caesarean rate! (Perinatal Statistics in Western Australia, 2007). With rates as out of control as these you can understand why I raise an eyebrow when I hear the words "had to have a caesarean."

In the last four years there have been many articles in Australia's newspapers asking the question "what is driving the national caesarean rate up?" Usually birthing women are blamed. Women are accussed of being "too posh to push", or being too career oriented and making our lives comform to scheduals that suit our busy selfish lifestyles. We are also accused of being too under-prepared and too scared to give birth normally. It is the standard blame-the-victims of the system approach to the discourse and it works well at disguising what is really responsible for rising rates of unnecesareans.

There are of course cases when caesarean surgery is necessary. But with statistics like those already mentioned it is clear that a lot of caesareans are being performed without medical justification. According to the International Caesarean Awareness Network (ICAN) a caesarean is a necessary surgical intervention in cases of:

• Complete placenta previa at term
• Transverse lie at complete dilation
• Prolapsed cord
• Abrupted placenta
• Eclampsia or HELLP with failed induction of labor
• Large uterine tumor that blocks the cervix at complete dilation (Most fibroids will move upwards as the cervix opens, moving it out of baby’s path.)
• True fetal distress confirmed with a fetal scalp sampling or biophysical profile
• True absolute cephalopelvic disproportion or CPD (baby too large for pelvis). This is extremely rare and only associated with a pelvic deformity (or an incorrectly healed pelvic break). Fetal positioning during labour and maternal positioning during second stage, most notably when women are in a semi-sitting position, cause most CPD diagnosed in current obstetrics.
• Initial outbreak of active herpes at the onset of labor
• Uterine rupture

(Emphasis added).

Despite this caesareans are commonly recommended to pregnant and birthing women in cases of:

Twins or more in one pregnancy

Breech presentation

Grades other than "complete" of placenta previa at term

Previous caesarean surgery

Fake foetal distress and foetal distressed caused by active management of labour

Eclampsia during pregnancy (ie. no labour permitted)

Size of mother's feet

Size of mother's pelvis

Size of mother's hips

Overall size of mother (deemed too thin or too fat, at doctor's discretion)

Maternal age (deemed too young or too old, at doctor's discretion)

Shape of uterus

"Competence" of cervix

Size of baby (deemed too big or too small, at doctor's discretion)

Possibility of baby having abnormality

Possibility of baby having issues with umbilical cord

Sugar levels

Blood pressure

Baby heart tones

Possibility that baby's shoulders might get stuck

Baby's head might not mold

Maternal contractions are "ineffective"

Maternal contractions are too strong

The baby hasn't dropped/engaged

Too much amniotic fluid

Not enough amniotic fluid

Labour not spontaneously beginning by a date specified by doctor

Labour continuing past an hour specified by doctor

Previous neonatal death

History of infertility

(list adapted from list provided at Joyous Birth and Birth International).

In short, there are ten legitimate medical justifications for performing a caesarean section instead of enabling a normal physiological birth, but there are at least thirty-five lies pregnant and birthing women are told to convince them they need a caesarean.

Why Would Anyone Want A Woman To Have An Unnecesarean?

Surely if surgery isn't medically justifiable no one would want to convince a woman she should have it, right? In an ideal world, yes, but in our current maternity system, sadly the answer is no. There are six major factors which contribute to rising rates of unnecesareans, these are; ignorance, fear, control, litigation, convenience and money (Ruzek 1991; Goer 1995, 25; Wagner 2000a).

Lack of Knowledge
For a supposedly enlightenened and developed civilisation the industrliased West is rather ignorant when it comes to childbirth. Our obstetricians are trained to attend births with rare complications rather than to attend birth as it normally is. Likewise the majority of midwives in the industrialised West are little more than obstetric nurses trained to do as the doctor says and follow hospital protocols (and these too are based on the assumption that every birth will present a rare complication in need of medical management). Despite this 99% of Westerners give birth in hospitals! It is very rare that any of these people (the women experiencing birth themselves too) actually see, attent, or give a normal birth (see The Business of Being Born).

Marsden Wagner writes:

"It is no coincidence that in the US, Canada and urban Brazil, where obstetricians attend the majority of normal births and there are few midwives attending few births, the highest CS rates in the world are found. Having a highly trained gynecological surgeon attend a normal birth is analogous to having a pediatric surgeon baby-sit a normal two-year old child. It would be a waste of the pediatric surgeon's time and skills and, when the young child gets tired and fussy, the surgeon might be tempted inappropriately to use drugs, where a properly trained baby-sitter would soothe the baby with a variety of non-medical techniques---the medicalisation of normal childhood similar to the medicalisation of normal birth. High CS rates are a symbol of the lack of humanization of birth." (Wagner 2000b)

To understand how these strange facts came to be you would have to take a look at the history of midwifery and the formation of the obstetric profession (see here). To learn about what normal, everyday, average and boring ole physiological birth you have to seek out the radical fringes of society critiquing the current maternity system and calling for reform (such as natural birth activists, homebirth advocates, independent midwives who facilitate homebirth, unassisted birthers, and the odd lone voice of reason in the medical world).

Fear & Control
Due to widespread ignorance about birth in our industrialised world many women fear childbirth long before having experienced it for themselves. Raised on a diet of "horror" birth stories, a social obsession with the pain of labour and countless television and film misrepresentations of birth as both dramatic and dangerous, it is little wonder that many women fear what might happen to them during birth.

At the same time as receiving social messages that normal birth is unsafe, women receive social messages that surgery is safe. They watch any number of television programs, real or fictional which portray surgeries and surgeons as life-saving and trustworthy. Based on these poorly informed assumptions some women reach a point where they think opting for a caesarean is the better option.

Part of some women's fear of birth is the fear of the unknown. For some of these women the surgical option gives them a false sense of control over birth and makes it seem more knowable. This is the same for care-providers. Their poorly informed understanding of birth (by which I am referring to their entire focus being on rare complications) can leave care-providers with a fear of unmanaged birth. For these obstetricians performing caesarean sections gives them the greatest form of direct control they can possibly have over birth.

Litigation
Within medical circles there is the opinion that a caesarean indicates the obstetrician did everything in his power to create a good outcome. This is fed by the backwards (at birth) notion that doing, rather than sitting on ones' hands, is the best thing a birth attendant can do (Wagner 2000a). Marsden Wagner states:

"The most common reason given by doctors for the excessively high rates of CS is “defensive obstetrics”--- a CS is performed as a defense against litigation. In a recent survey 82% of physicians employed such defensive approaches to avoid negligence claims. (13) Presently, with a bad birth outcome doctors are sued and during the trial find themselves criticized for not performing interventions such as CS. There are few or no cases of litigation in which doctors are criticized for performing unnecessary interventions. As a result, doctors take a risk doing fewer interventions and gain insurance against litigation doing more interventions, including CS." (Wagner 2000)

Convenience
Caesarean section are just one of the interventions routinely used in birth today which is motivated by convenience. It is convenient for women to schedule the birth of their babies into their lives at a time that suits them, however this is hardly the main reason women have unnecesareans. Convenience for care-providers on the other hand has been linked to the rising rate of unnecesareans (Goer 1995, 24-5; 29; 31).

Friday afternoons are a popular time for unnecesareans because it is convenient for obstetricians to remove the baby from the mother's body during business hours than have to come back into work after 5pm when the baby is ready to be born (Wagner 2000a; see also Business of Being Born). Anecdotally I have heard of many women who were advised by their obstetricians to have inductions or caesareans at certain times during their pregnancies because their obstetrician was planning a holiday around the baby's estimated due date.

Cascade of Intervention
Some unnecaesareans may at the time of birth have been necessary, but only because of earlier interventions unnecessarily administered to the woman during labour.

Cascade of Intervention Flow Chart from Birth International

The following clip explains the cascade of intervention leading specifically to unnecaesareans:

The baby was put in distress by interventions that weren't necessarily required earlier in labour and then caesarean surgery was presented as the medical solution to a complication with the birth. This is called "iatrogenic disease" where the medical problem was created by medical personnel and/or procedures.

Money

It costs billions of dollars to have the resources necessary to intervene in birth ready and waiting for a complication. To justify this spending hospitals need to use the equipment. As OBGYN Abbe Wain said in The Business Of Being Born: "Technology is technology, it's not stopping, this is what life is all about, so if you're gonna have good stuff, you might as well use it."

It is also worth noting that when an obstetrician performs a caesarean section he gets paid. He gets paid significantly more than if the birthing woman has a normal physiological birth because to perform a caesarean he needs to be more active in the process and he needs to use the hospital's expensive surgical equipment and he needs an operating theatre full of helpful staff who also need to be paid for their work. In 2005 in The United States an uncomplicated caesarean section operation cost $12 544us compared to $6 973us for an uncomplicated vaginal birth (Birth Charges). Please note that the cost of a homebirth midwife is approximately $3000 for total care throughout pregnancy, birth and the postpartum period (C-Sections And Insurance) and yet homebirth midwives are not publically funded.

In her comprehensivie text Obstetric Myths Versus Research Realities, Henci Goer acknowledged the financial incentives for hospitals to perform caesareans:"When Myers and Gleicher reduced the cesarean rate from 17.5% to 11.5% over two years, the hospital lost $1million in revenue" (Goer, 1995, 24). She quotes one obstetrician who stated:

"I beleive that the trend in obstetrics will continue toward managed labor because traditional care for the normal woman in labor is no longer cost-effective. It is no longer feasible for individual physicians who have invested 12 years in training at a cost of hundreds of thousands of dollars to dedicate extended periods to observing one normal woman in labor ."(in Goer, 1995, 24)).

Risks of Caesarean

No discussion about surgical birth is complete without considering the weighty risks associated with it. It would be irresponsible not to include this information. The risks of caesarean include:

• Infection
• Blood loss and hemorrhage
• Hysterectomy
• Transfusions
• Bladder and bowel injury
• Incisional endometriosis
• Heart and lung complications
• Blood clotting
• Anesthesia complications
• Decreased bowel function for days after the procedure, which can lead to distention, bloating and discomfort
• Rehospitalisation due to surgical complications. Twice as many women who have caesareans require rehospitalisation than women who birth vaginally.
• Rate of establishment and ongoing breastfeeding is reduced, thus children born via caesarean face a greater risk of exposure to artificial milk which greatly compromises their health and well-being
• Psychological well-being compromised and increased rate emotional trauma. Especially with unplanned cesarean section, women are more likely to experience negative emotions,including lower self-esteem, a sense of failure, loss of control, and disappointment. They may developpostpartum depression or post-traumatic stress syndrome. Some mothers express dominantfeelings of fear and anxiety about their cesarean as long as five years later
• Pelvic pain
• Pain during sexual intercourse
• Scar tissue makes subsequent cesareans more difficult to perform
• Increasing the risk of injury to other organs Up to 40% of women experience uterine, wound, or urine infections post-operatively
• One-half of all women who have undergone a cesarean section suffer complications
• Women face a much higher chance of dying during caesarean than vaginal birth
• Each successive cesarean greatly increases the risk of developing placenta previa, placenta accreta and placental abruption in subsequent pregnancies. These complications pose life-threatening risks to mother and baby
• Increased odds of secondary infertility in subsequent pregnancies
  
• Increased odds of miscarriage in subsequent pregnancies
• Increased odds of ectopic pregnancy in subsequent pregnancies
• Baby being born with respiratory distress syndrome
• Iatrogenic prematurity (when surgery is performed because of an error in determining the due date)
• Persistent pulmonary hypertension (PPH) in baby
• Surgery-related foetal injuries such as lacerations (1 in 2 babies are cut during caesarean surgery)
• Elective cesarean significantly increases the risk to the infant of premature birth and respiratory distress syndrome, both of which are associated with multiple complications, and intensive care.
• Babies born via caesarean are five times more likely to require admittance to intensive care
• Even with mature babies, the absence of labor increases the risk of breathing problems and other complications
• Premature and at risk babies born by cesarean fare worse than those born vaginally
• Cesareans can delay the opportunity for early mother-newborn interaction, breastfeeding, and the establishment of family bonds. Mother's are more likely to have difficulty forming bonds with their children if born by caesarean
• One in ten women report difficulties with normal activities two months after the birth,23 and one infour report pain at the incision site as a major problem. One in fourteen still report incisional pain sixmonths or more after delivery.

(List from Buckley 2005, 221; Childbirth.org; Goer 1995, 21-7; ICAN; Mother Friendly; Wagner)

How To Avoid An Unnecesarean

Choose Your Care Provider Wisely

Birth activist and radical feminist, Janet Fraser said it best when she said "if you hire a surgeon you can expect surgery." Obstetricians are surgeons, surgery is what they do, it's what they know best and are most comfortable with. Robbie Floyd-Davis states "Because Obstetricians are socialised to see pathology they often see pathology where it doesn't exist. They find pathology because then they have something to do" (in The Business of Being Born). When in doubt they're going to go with what they know. By not hiring a surgeon you dramatically decrease your risk of getting unnecessary surgery (or surgery at all).

Choose Your Place of Birth Wisely

If you have a medical condition requiring that you give birth in a hospital be sure to research the hospital extensively before booking your birth there. Find out what their caesarean rates are, find out what their protocols are regarding how much time and freedom they allow birthing women and families to birth their way.

If you are considering a birth centre be sure to check their transfer to hospital rates, you may be surprised by how quickly some centres pass their consumers on to the hospitals. Find out their protocols regarding time and freedom they allow birthing women and families to birth their way. You may be surprised to discover that some birth centres are bound by the exact same protocols as hospitals.

Caesarean & Birth After Caesarean Resources Online

Caesarean Awareness Network Australia

International Caesarean Awareness Network

Birthrites - Healing from a Caesarean

List of Resources Provided by Joyous Birth

The Risks of Cesarean Delivery to Mother and Baby

VBAC.com

Childbirth.org

Gentle Birth.org

Cesarean Section: What You Need To Know

Cesareans: Are Cesareans Really A Safe Option

Vaginal Birth After Cesarean: The Facts

VBAC Safety: A Closer Look At The 2002 JAMA Study

Rebuttal to Rationales For Denial of VBAC

Choosing Caesarean Section - Wagner 2000

Pushed Birth

Cesarean Booklet

Birth International

Cascade of Interventions Diagram

Technology in Birth: First Do No Harm - Wagner 2000a

Firsh Can't See Water: The Need To Humanize Birth - Wagner 2000b

In Books

The Thinking Woman's Guide To a Better Birth

Obstetric Myths and Research Realities - Goer 1995

Gentle Birth, Gentle Mothering

The Politics of Birth

Persuing The Birth Machine

Journal Article:
Ruzek, Sheryl, (1991) "Women's Reproductive Rights: the impact of technology," in Judith Rodin and Aila Collins eds Women and New Reproductive Technologies: Medical, Psychosocial, Legal, and Ethical Dilemmas, New Jersey, Hove and London: Lawrence Erlbaum Associates.

Statistics used for this blog post were obtained from:

Victorian Maternity Performance Indicators, Complete Set 2006-2007

Perinatal Statistics in Western Australia, 2007

Perinatal Satistics - Queensland 2006

See also

http://www.independentweekly.com.au/news/national/national/general/public-hospitals-versus-private-the-painful-truth-about-childbirth/1399037.aspx

http://www.health.vic.gov.au/perinatal/stats/birthsvic07.htm#t5

United We Homebirthers Stand, Divided We Fall

***Update 1/7/09. Since this post was written Home Birth Australia have removed the press release in question and replaced it with the following, far more inclusive press release:

Health Minister Denies Women their basic rights

NEWS RELEASE
Wednesday June 24 2009

Contact: Justine Caines 0408 210 273



Homebirth Australia today slammed the exclusion of homebirth from insurance schemes for midwives announced by the Health Minister Nicola Roxon in parliament today.

“Effectively two pieces of legislation will outlaw midwives providing homebirth care from July 2010” said Justine Caines, mother of seven and secretary of Homebirth Australia.

“Women will continue to homebirth, but will now be forced to do so without the assistance of a qualified professional.” said Ms Caines.

“It is unacceptable and unsafe to force a woman into a choice that is not optimal for her, whether that is a hospital birth or a birth at home without midwifery support. It is absolutely impossible to understand the government’s position on this, other than to say that they have bowed to political pressure from medical lobby groups.”

The National Maternity Service Review received submissions from hundreds of women wanting access to homebirth services. The vast majority of homebirth services are provided by private practice midwives. Removing this option is likely to end access for most women to homebirth.

Ms Caines called on all ALP members to declare their view on a woman’s right to self determination of her health care needs. “If the ALP is so hell bent on preventing women from accessing homebirth as an option I ask all ALP members to publically state their position on this.

It appears that having a Health Minister who is a woman, a recent mother, and a lawyer understanding consumers’ rights, is not proving to be an advantage for women. Removing women’s rights to the point where we are back providing care in dark alleys or in back rooms is ridiculous in 2009.”

Thank-you Home Birth Australia for listening to the concerns of your sisters. It is comforting to know that at least homebirthers are listening to each other. ***

Original post from 25/6/09:

Yesterday Homebirth Australia issued the following press release:

"Deaths will increase with new announcements

NEWS RELEASE
Wednesday June 24 2009


Homebirth Australia today slammed the exclusion of homebirth from insurance schemes for midwives announced by the Health Minister Nicola Roxon in parliament today.

“Effectively two pieces of legislation will outlaw midwives providing homebirth care from July 2010” said Justine Caines, mother of seven and secretary of Homebirth Australia.



“Women will continue to homebirth, but will now do so without the assistance of a qualified professional.” said Ms Caines. “The result will be an increase in deaths for mothers and babies, this is certain. It is absolutely impossible to understand the government’s position on this, other than to say that they have bowed to political pressure from medical lobby groups.”

The National Maternity Service Review received submissions from hundreds of women wanting access to homebirth services. The vast majority of homebirth services are provided by private practice midwives. Removing this option is likely to end access for most women to homebirth.

Ms Caines called on all ALP members to declare their view on a woman’s right to self determination of her health care needs. “If the ALP is so hell bent on preventing women from accessing homebirth as an option I ask all ALP members to publically state their position on this. It appears that having a Health Minister who is a woman, a recent mother, and a lawyer understanding consumers’ rights, as a health minister is not proving to be an advantage for women. Removing women’s rights to the point where we are back providing care in dark alleys or in back rooms is ridiculous in 2009.”

I was disappointed with the tactics used in this press release to further the cause of saving private midwifery. In particular I was unimpressed with how the release claims that birth is inherently dangerous unless a care-provider is present and the marginalisation of freebirthers within Homebirth Australia (they may be freebirthers but they're homebirthers too!). A dear friend of mine, a fellow birth activist and homebirther, Jessica Pritchard wrote a response to this press release which outlines my concerns more clearly and succinctly than I could. She has given me permission to share her response here:

"It is disturbing to witness the slander of birth that is in the media at the moment. I really believe to label the "freebirth or purebirth movement" as dangerous is irresponsible and just another way of disempowering and dividing an already small community.

While I understand the sentiment behind the claims - unassisted birth should not be the only choice beside hospital birth - this is very different to actually naming the freebirth movement. There are many women who are choosing to birth on their own, or with non-medical assistance for very different reasons - the least of which is money or political. These women will continue to birth this way whether or not these recommendations become law. For you to say that women and babies will die as a result just solidifies the uninformed notion that birth is innately dangerous. It saddens me that as a homebirth advocate you would have so little regard for the process of birth and of women.

If you don't trust birth (or the women who birth) you have no business being it that space.

Divide and conquer - its what 'they' want. Please don't continue to alienate some of the very few allies you have with propaganda and slander. By doing that you are guilty of what Obstetricians do to you - label and shame.

UNITED WE STAND - a homebirth is a homebirth no matter who you have there."

We understand that women being left with a "choice" between homebirthing unassisted or hospital birth could lead to women "choosing" freebirth who aren't really prepared or ready for the responsibility that brings and this could lead to dangerous outcomes. But, as Jess said in her letter, alienating some of their allies does not serve the greater good, it divides an already small community of women (for more on that see my early post "Divide and Concquer Pitting Homebirthers Against Freebirthers")

Save Homebirth Rally September 7

Readers are probably aware of the crimes against women, babies and birth the Australian government is in the process of committing (see Maternity Services Review blog posts). Midwives Victoria have succinctly outlined the measures the government has taken which will effectively make homebirth with a midwife illegal on their blog:

"Clauses from the draft legislation Health Practitioner Regulation Law 2009 below have been identified by Justine as being very problematic to homebirth practice.

69 Eligibility for general registration

(1) An individual is eligible for general registration in a health profession
if:
(a) the individual is qualified for registration in the health profession,
and
(b) the individual has successfully completed:
(i) any period of supervised practice in the health profession required by the National Board established for the health profession, or
(ii) any examination or assessment required by the Board to assess the individual’s ability to competently and safely practise the profession, and
(c) the individual is a suitable person to be registered in the profession, and
(d) there is, or will be, in force in relation to the individual appropriate professional indemnity insurance arrangements, including a policy held, or arrangements made, by the
individual’s employer that will cover the individual

101 Conditions of registration

(1) If a National Board decides to register a person in the health profession for which the Board is established, the registration is subject to the following conditions:
(a) for a registered health practitioner other than a health practitioner who holds non-practising registration:
(i) that the registered health practitioner must complete the continuing professional development program required by the National Board, and
(ii) that the registered health practitioner must not practise the health profession unless professional indemnity insurance arrangements are in force in relation to the practitioner’s
practice of the profession,
(b) for a registered health practitioner who holds non-practising registration, that the person must not practise the health Profession,

Note. A failure by a registered health practitioner to comply with a condition of
the practitioner’s registration does not constitute an offence but may constitute behaviour for which disciplinary action may be taken." (Read full blog post here).

One birth activist; Justine Cairnes has organised for anyone who is outraged with these actions to gather in Canberra on September 7 to protest.

The following is from Justine's Save Homebirth website:

Homebirth Rights Rally - Canberra September 7 2009

HOME - EVERY WOMAN’S BIRTH RIGHT – RALLY FOR HOMEBIRTH – MONDAY SEPTEMBER 7 2009, PARLIAMENT HOUSE CANBERRA

Homebirth Australia is hosting a MAJOR rally in Canberra (outside Parliament House) on Monday September 7 from 11.30am.

There has been much discussion about the potential outlawing of homebirth and the continued lack of equity for women choosing homebirth.

We need this to be BIG. When I met with the federal department of Health they commented on the huge number of submissions (900 of which over half came from homebirth consumers). Sadly I said if you outlaw homebirth I will lead 9000 angry women and babies to Canberra!

Now 9000 may be a tall order but we need thousands.

For all the women and midwives that have contacted and said this issue matters please put it in your diary.

There is lots to organise and we look forward to many providing ideas and support.

The states close to Canberra will be called on to provide as many as possible to attend.

It would be great to have at least a few from every state and territory.

Please forward this meeting far and wide.

Details will soon be on the HBA website.

They ignored our stories and our letters during the review, let's hope we can cause enough of a ruckus that they cannot ignore our voices when we take to the streets. And how utterly depressing that whenever women have a great need like control over their bodies at birth or the right to vote we have to go to such lengths to get powerholders to give a shit.

Hopefully I'll see you all in Canberra in September!

Congratulations Sarah & Steven!

In a shower at quarter past ten last night a baby girl emerged from her mother's body to the soothing sounds of her mama calling "it's alright bubby girl" (for she instinctively knew her child's sex without having found out from scans).

Welcome earthside Eloise Jane!

Congratulations Sarah & Steven! And what a surprise Iris will get in the morning when she wakes to discover she is a big sister!

Thank-you, beautiful family, for your friendship each day and especially for the wonderful blessing of being invited to be a part of such a special time in your lives. It was humbling to serve you last night, and before xoxo

Blog Awarded

Ilithyia Inspired has been given the following award by the ever inspiring Michelle of The Living Temple.

Michelle says:

It is an award for bloggers who distinguish themselves for showing cultural values, ethics, great and fun writing skills, as well as individual values, through their creative writing...Here are the award rules: To accept and show the distinct image. Show the link to the blog from which you were given the award. Choose 15 blogs to give the award to.

Thank-you Michelle, your appreciation of my blog and your respect for my values and writing is both humbling and encouraging.

The 15 blogs I would like to pass this award on to are (in no particular order)

1. Water & Spirit. The blog of a doula in Fiji.
2. Rachael Austin. The blog of an Australian Midwife working in a rural area.
3. Majikfaerie. The blog of a lay midwife who is a citizen of the world, living a rainbow life.
4. The Living Temple. I return the award to Michelle, the freebirthing, raw foodie, BirthKeeper being the change we want to see in the world.
5. Homebirth: a midwife mutiny. The blog of Adelaide's with-woman, packed with valuable birth information, her breech articles are a must read!
   
6. Gloria Lemay. The blog of Canadian birth attendant Gloria Lemay.
7. Jodi Cleghorn. An Australian writer who shares her fiction along with her nonfiction and co-editor of the Sex After Childbirth e-book.
8. One of Those Women. A great breastfeeding focused blog that always makes me feel a little less alone in my lactivism.
9. Empowering Birth Blog. The blog of a midwifery student who has discovered that birth can be empowering after homebirthing after caesarean.
10. Stand and Deliver. Dr Rixa Freeze's blog, the woman who wrote a PhD about unassisted childbirth in North America.
11. Letters from Laura. The blog of Laura Shanley, author of "Unassisted Childbirth" and creator of the Born Free website.
12. Homebirth For Dads. The blog of a Dad preparing, with his partner, for the homebirth of his child.
13. Hoyden About Town. A great Australian feminist blog with multiple contributors. Check out the work of Lauredhel in particular!
    
14. The Well-Rounded Mama. A really insightful blog that takes a look at pregnancy, birth and plus size women.
15. Kate Harding's Shapely Prose. A terrific resource for anyone interested in fat acceptance and the reality that you can be healthy at any size.
    

Enjoy checking out those 15 engaging blogs!

Birth Week Round Up

I spent May 27-31 staying in Kallista, Victoria for Birth Week. Birth Week is a five day long festival in which women come together for seminars, workshops, film screenings, artwork, and information about pregnancy and birth. It's a fabulous opportunity for birth workers and anyone with a love of birth to network with like minded women and men.

Of the 16 sessions offered over the course of the week I attended 6. All sessions were held in Kallista Mechanics Hall:

The Birth Week organisers had decorated the inside of the hall with lots of beautiful pregnancy and birth inspired artwork including photographs, sculptures, paintings and installations:

This plaster belly cast is painted in placental blood

I have learned that this painting and the sculpture below are the work of Gabby Willmott. You can see more of her work at The Breastfeeding Centre in Dandenong.

There was also a display table with items for purchase, free brochures, pamphlets and business cards from a variety of different people; yoga instructors, doulas, midwives, toy makers etc.

The first session I attended was run by three local midwives who work together in private practice. Eastside Midwives; Andrea Bilcliff, Helen Barrington and Karen Heyword spoke about "Birth Choices". To illustrate the importance of taking time to make informed birth choices the midwives told the hypothetical tale of a fictional mother-to-be they named "Mavis".

Mavis found out she was pregnant after missing a period, taking a home pregnancy test and then going to her GP for confirmation. Her GP then asked her where she would have they baby; "in a public or private hospital?". She had multiple ultrasound scans throughout pregnancy despite her health and her low risk categorisation because they were recommended by her care provider, she was told they were completely safe for her and the baby. When the time came to birth she relied on the information her care provider gave her, and every step of the way the risks of interventions were not mentioned and Mavis was told that most patients her care provider looked after did what he suggested.

The birth of her first child was a typical cascade of interventions story that began with a medical induction and ended with a caesarean. At the end of it she and her partner were grateful that they she had birthed in hospital with a surgeon for a care provider.

The Eastside midwives then spoke briefly about how the interventions Mavis endured during birth could have been avoided had she had a different care provider from the beginning. To demonstrate this they went on to tell the hypothetical tale of Mavis's vaginal homebirth after caesarean.

The main point of the session was the relevance of choices made early in the birth journey to the outcomes and experience of birth months later. This opened up a discussion about choosing homebirth, the services independent midwives provide and the dangers of some medical procedures (of which induction was the focus).

The Eastside Midwives also spoke briefly about the Maternity Services Review and the Budget announcement that midwives will be receiving medicare numbers and what these things meant for women and for homebirth.

While I enjoyed their talk and really enjoyed catching up with the midwives themselves, I wish there had have been more discussion about how our society, our medical care providers and our government control and limit birth choices. I feel there was a little too much focus on how the woman makes her own bed and lies in it when the sad fact is that she doesn't have a say in what linen, mattress or bed frame she has to work with. There was great discussion about; "this is how the system is" with a very lite discussion of "how to change the system" and no discussion of "why the system is the way it is". Of course it's clear that the midwives target audience was pregnant mothers for whom these topics are very new, and for them I'm sure it would have been a really useful and informative session.

Morning tea was had between this session and second session "Birth Work" which was facilitated by another midwife; Fiona Hallinan.

Fiona Hallinan's session was entitled "Birth Work" and it was fabulously educational for all the mothers and birth workers present. Fiona spoke about the importance of learning from traditional midwives and cultures where the practices of traditional midwives continue to prosper. In relation to this she said of western midwifery training that it is "watered down medicine" and therefore western midwives really need to go in search of further knowledge from traditional midwives.

Fiona herself has learned from Mexican midwives and during her session taught everyone in the room a technique she learned from them called "rebozo". Rebozo is a method of relaxing the mother during pregnancy and birth and moving the baby in utero using a shawl. Fiona demonstrated how to use rebozo to relax a mother and ease any discomfort she has in pregnancy or birth when you have only one birth servant:

And then she enlisted the help of another midwife to demonstrate how to do it with the aid of someone else:

She mentioned that if the baby was lying in a posterior position she would not recommend using rebozo with the mother lying on her back. Instead she said it is good for the mother of a posterior bub to get on her hands and knees and for her birth servants to use rebozo by wrapping the shall around her backside and rocking her from side to side:

Fiona shared some stories about the wonderful help rebozo had been to the women she had served as well as some general insights about birth work including; "if birth is like taking drive it doesn't matter who is in the car with the mother so long as she is always in the drivers seat".

She also spoke at length about a woman's pelvis, busting common myths about the pelvis and tips on how to work with your pelvis during birth. She said that indeed some women do have small gaps through which their babies need to come through but that this didn't mean they were unable to birth. She spoke about the importance of knowing your equipment/familiarising yourself with your body before birth. For example, she said a woman with a small opening could use her time during pregnancy to learn about movements to help her open up as much as possible and facilitate her baby's descent into the vagina.

While I found Fiona's talk to be incredibly educational and by far my favourite workshop for the week, there were parts of it where I wondered "does this come from trust in birth? Or fear of it?". For me I'd rather not spend pregnancy learning optimal positions to birth in and instead see what movements come naturally to me when the time comes. I trust that my instincts will guide me to adopt the positions that will best facilitate birth without me needing to understand them intellectually beforehand.

Having said that, I do understand that I am a small minority and have the advantage of birthing in a space where I am free to move as I see fit. For most Australian women they are birthing in an institution where their movements are restricted, often so restricted that they are kept on their backs in bed. For these women it is important to hear the teachings of women like Fiona Hallinan, but I wonder how many of them would attend such a seminar or even know about it.

In any case Fiona Hallinan strikes me as a gifted and valuable birth servant to Melbourne women and I look forward to learning more from her in the future and taking one or more of her workshops.

I did not attend any of the sessions on day two as I needed to head back home to attend a 36 week meet with the woman whom I'm currently serving and the rest of her support team.

On day three I had the pleasure of meeting Dr Sarah J. Buckley. I attended the afternoon session "Gentle Birth and Gentle Mothering" in which Sarah covered a range of topics including pregnancy, birth, breastfeeding and cosleeping (to name a few). It was basically her book Gentle Birth, Gentle Mothering squeezed into a three hour discussion.

What I enjoyed in particular about Sarah's talk was what she had to say about evolution. She spoke about the fact that human beings have evolved in such a way that it is natural, normal and necessary for them to parent in certain ways, which is often referred to as "attachment parenting" in today's western society. Our species owes its survival to women, the pregnancy and birth processes, breastfeeding, cosleeping and babywearing.

After the session she sold and signed copies of her second edition of Gentle Birth, Gentle Mothering and chatted to the women in attendance.

On day four Rhea Dempsey gave two talks. Rhea has been a birth attendant for over 30 years who now runs a birth attendant training course and provides cousenlling to families before and after birth, as well as couples counselling. In the morning Rhea spoke about "Ego and Birthing".

During the "Ego and Birthing" session Rhea spoke about attachment psychology and how our experiences as children and how we are parented shape how we relate to others later in life. She then linked this to women's birth choices. She focused on "anxious attachment", (brought about by inconsistent responses to the persons needs) "avoidance attachment" (brought about by the consistent refusual to respond to the persons needs) and "secure attachment" (brought about by consistent meeting of the persons needs).

Rhea suggested that an individuals' attachment psychology shaped her expectations regarding birth care providers and the birth process and in particular their tendency to trust. She spoke about the spectrum of trust in birth and how at one end there are women who have little trust in the natural process of birth and a lot of trust in birth interventions, and at the other end are the woman who have a lot of trust in the birthing process and little trust in care providers and interventions.

Her afternoon talk was about "Sex and Parenting". To start with she got the room to shout out motivations for having sex and pointed out that there are a lot of different reasons someone might want sex. The first half of this seminar was very similar to the morning session, going over attachment psychology, but with a focus on how this plays out in adult couple relationships as opposed to birth choices. She then spoke about biological drive and sex and how men and women are different.

In the middle of her session she got everyone to get up and dance around to Flight of The Concords "Business Time" and then spoke briefly about how the lyrics to the song give us a light hearted look into how two people's understanding of what is happening regarding sex can be completely different.

Sadly I missed the second half of her talk which I am sure was the really useful and interesting stuff to do with parenting and sex because my toddler really had had enough of being in the room so I took her for a play outside. My friend who attended the whole talk told me afterwards that Rhea had said that for six months after birth it is normal for a woman not to feel like sex but she claimed that it was a myth that breastfeeding hormones decrease a woman's libido for longer than six months, which shocked me. She also said, according to my friend, that the longer a woman goes without sex the less she wants it or feels she need it. It's hard to comment on any of this as I was not present and I daresay what Rhea actually said was far more complex than this (as was her ego and birthing talk which I have not done justice in this reflection).

On the last day of Birth Week I attended the morning discussion about lotus birth. This session was ideal for pregnant women considering lotus birth, with lots of information about the benefits of lotus birth, how to care for the placenta, ideas for what to do with the placenta after birth, photos of lotus births and placenta bags for parents to look at.

A number of people present shared their lotus birth stories, including my partner and I. I was able to share some information about creating placenta artwork. There was discussion about the practical elements of lotus birth such as; keeping visitors at bay, preventing the baby from being passed around to all and sundry, and encouraging mothers to take it easy and spend their first week in bed snuggled up with her baby. As the session was concluding one of the two facilitators mentioned that for her family lotus birth was the natural conclusion to an intervention free birth experience & a process of honouring the final stages of birth without rushing.

Thus concludes my report on the six sessions I was able to attend during Birth Week. I thoroughly enjoyed the festival and connecting with so many birth-loving women and men. Kallista is a beautiful place, surrounded by tall trees, which makes Birth Week all the more enjoyable. If you do get a chance to attend one of the future Birth Weeks I strongly recommend you do (you'll most likely see me there, for one!).

For those who were unable to attend you can still become a member of the Birth Week association and the benefit of this is you receive their Birth Stories journal. The journal features really gorgeous front cover artwork and cover to cover birth stories written by the birthing women themselves. Find out more here.

My daughter and I with another birth servant I studied with.