Series Of Homebirth Protests Across Australia This Monday

The struggle for birth rights in Australia continues. This week the health minister announced an amendment to the Midwives/Nurse Practitioners Bill which clarifies the government's understanding of "collaboration": an obstetric monopoly over maternity care. Protest rallies have been swiftly organised for a number of Australia's capital cities, including demonstrations out the front of the offices of federal members of parliament:

Brisbanites
Monday 9 November 2009
10:30am-11:30am
Kevin Rudd's electoral office, 630 Wynnum rod, Morningside, Brisbane

See facebook event page here

Melbournians
Monday 9 November 2009
10:30am-12:30pm
Julia Gillard's Werribee Office, Shop 2, 36 Synnot st, Werribee, Victoria

See facebook even page here

Perthers
Monday 9 November 2009
11:10am-1:10pm
Outside Stephen Smith's Office, 953A Beaufort Street Inglewood WA 6932
See facebook event page here

Sydney siders
Monday 9 November 2009
10:30am
111-117 Devonshire Street, Surry Hills NSW
See facebook event page here

For more see:
Midwives/Nurse Practitioner Amendmant
The Final Cut
Thing are looking grim for midwives
Mum's the word on home births
Doctors gain veto powers over midwives and birth choices

That Infamous Birth Hating Sign

I know I am very slow to get to this and readers have most likely already come across the above photo on one of the many quality birth blogs inhabiting cyberspace. So, in short: an Obstetrician's office featured the above sign stating that doulas and birth plans are not allowed in his (or her) establishment. Obviously this is an issue of control. This obstetrician doesn't even want to let his (or her) patients get any funny ideas about who is in charge at birth. Birthing woman = passive recipient of whatever the Ob deems necessary. Don't bother wasting your time on a birth plan or bringing along someone to support you in being an active participant!

It's sickening to think that so-called care providers can be so blatantly anti-birth and anti-woman. But at the same time, at least this guy (or gal) is up-front about their hatred. I daresay there are thousands of Obs who feel the same but they humour their patients: "suuure, you can try for a VBAC..." (the ellipses contains the unspoken "but you 'aint gonna get it if I have anything to do with it!").

To see what others have had to say about the sign you can check out the following links:

Dou-La-La
Instinctual Birth

Organic Birth
Radical Doula
The Unnecsarean
Wonderfully Made Bellies & Babies

Jill at The Unnecesarean has taken critique of the sign to a whole new level and given us all a much needed laugh at the issue by running a photoshop competition. Some entries are already up and are well worth a look (her own entry is my favourite). The competition is still on so head over there and participate:

http://www.theunnecesarean.com/blog/2009/11/4/photoshop-contest-the-anti-doula-sign-in-the-utah-obstetrici.html

And here are some of my own re-interpretations of the sign:

And BTW how freakin' '80s is the clock they got in that obs office?!
Time to redecorate Aspen Women's Centre!

You Have a Choice Documentary

The following documentary was made by Birth Matters Virginia. It is 7 minutes duration and includes a nurse sharing what a typical day at work for her is in the maternity ward of a hospital, as well as mothers and fathers talking about their experiences of giving birth or being present at different kinds of births:

You Have a Choice (A Short Birth Documentary) from Goodrich Creative on Vimeo.

For more on choices for childbirth: http://www.ilithyiainspired.com/2008/05/childbirth-your-options.html

Marsden Wagner M.D. M.S. on Australia's Maternity Services Review

When I was working on my PhD and my passion for unhindered birth was just beginning to blossom I read the work of Marsden Wagner M.D. M.S. Wagner was one of the first people to convince me that birth was safe and women's bodies work perfectly during birth! Who is Marsden Wagner? I refer to his webpage:

Marsden Wagner, born in San Francisco, his education at University of California at Los Angeles (UCLA) included an M.D., clinical specialty training in pediatrics, then in perinatology (neonatology and obstetrics) followed by two years post-graduate study with an advanced scientific degree in perinatal science. Following several years of full time clinical practice and some years as a full time faculty member at UCLA, he was a Director of Maternal and Child Health for the California State Health Department. After six years as Director of the University of Copenhagen-UCLA Health Research Center, he was for 15 years Director of Womens and Childrens Health for the World Health Organization. He is now an independent consultant.

With extensive experience in maternity care in industrialized countries, including midwifery and the appropriate use of technology during pregnancy and birth, he has consulted and lectured in over 50 countries and given testimony before the US Congress, British Parliament, French National Assembly, Italian Parliament, Russian Parliament and others. His publications, in 11 different languages, include 131 scientific papers, 20 book chapters and 14 books.

When the results of Australia's latest Maternity Services Review were published and the Australian government's discrimination against homebirth and midwives in private practice became ever clear I contacted Dr Wagner and asked him if he would be interested in writing a letter to the relevant power-holders in Australia. Within 24 hours I received the following letter along with his permission to forward it to "all those in Australia who need to see it" and to publish it here:

To all those in Australia concerned with maternity services:

Childbirth is not a medical procedure, it is a normal part of the life cycle and belongs to women and their families, not to doctors nor hospitals nor the government. There is overwhelming scientific evidence that planned out-of-hospital birth attended by a midwife is an absolutely safe choice for all low-risk pregnant women---women without any serious medical problems. To in any way limit or forbid the choice of out-of-hospital birth or the training and ability to practice of midwives willing to attend out-of-hospital births is to deny Australians the freedom to control their own lives and is to fail to honor the central importance of family values in Australia.

In the 1980’s the German organization of obstetricians and gynecologists tried to get a national law forbidding planned out-of-hospital birth. The German women rose up and fought against it, there was an international outcry and the effort of the doctors failed and since then there has been a vast effort to promote out-of-hospital birth centers, increasing from one to the present over 100 such centers, all using midwives.

In the 1990’s the Hungarian organization of obstetricians and gynecologists tried to get their government to forbid planned out-of-hospital birth. The Hungarian women rose up and there was an international outcry and the effort of the doctors failed.

In the last decade, the government of Brazil tried to lower their very high caesarean section rate through working with the doctors and hospitals. When this did not succeed, the government of Brazil started up a national network of out-of-hospital birth centers staffed by midwives which are very popular and have quite reasonable caesarean section rates.

Efforts by doctors in Australia to prevent or limit in any way the option of planned home birth attended by midwives by completely falsely claiming, without any scientific evidence, that planned out-of-hospital is unsafe, will ultimately fail as the people of Australia cannot be fooled all the time and value their freedom too highly and Australia does not want an international outcry against them and to be seen as unable to prevent unjustified medical dominance of normal family life.

Marsden Wagner, M.D., M.S., for 15 years a Director of Women’s and Children’s Health, World Health Organization.

In such dark times for women and for birth it is reassuring to know there is at least one medical expert in our corner.

To read some of Wagner's well-researched articles about birth take a look at these:

Fish Can't See Water - The Need to Humanize Birth

Marsden Wagner explores the rates of technological intervention in birth and the treatment of women during birth arguing that birth has been dehumanised. He notes that many people within the medical model of birth are so used to this model that they cannot see how inhumane the treatment of birth can be - just as a fish doesn't see the water he or she is immersed in.

Technology in Birth - First Do No Harm

Marsden Wagner offers a timely reminder that just because we have the technology doesn't mean we need to use it, and that just because technology is said to help birthing women doesn't mean it is without risks. The best way to stay unharmed in birth, argues Wagner, is to be informed.

The Active Management of Labour
Marsden Wagner critiques the pathologising of birth. He looks at the issues of control and arrogance within the maternity system, the lack of medical evidence to suggest the benefits of the active management of labour outweigh the risks, and how birthing women are kept in the dark about those risks.

Choosing Caesarean Section
Marsden Wagner takes a look at the arguments in favour of women's freedom to choose to have their babies surgically removed instead of born normally.

Australian Government , Violating The Fortelesa Declaration

The Australian Government is in the process of violating the human rights of Australian women. They are doing this through the latest Maternity Services Review which stands to extensively restrict the choices women have with regard to where they give birth and who they can hire to be their medical care provider. The recommendations of the Maternity Services Review stand in violation of The World Health Organisation's Fortelesa Declaration. In particular, article one which states:

1. The whole community should be informed about the various procedures in birth care, to enable each woman to choose the type of birth care she prefers.

And the opening statement of the delcaration which states:

Birth Is Not An Illness

These 16 recommendations are based on the principle that each woman has a fundamental right to receive proper prenatal care: that the woman has a central role in all aspects of this care, including participation in the planning, carrying out and evaluation of the care: and that social, emotional and psychological factors are decisive in the understanding and implementation of proper prenatal care.

The latest Maternity Services Review in Australia is removing the rights of Australian women by refusing to publically fund home births, thus restricting the availability of home birth to many Australian families. And forcing independent midwives to be part of a national registration scheme. This registration will include mandatory professional indemnity insurance for all midwives, the alternative is to practice midwifery unlawfully.

In order for midwives to access professional indemnity insurance they must work within a "collaborative team", however no definition of "collaborative team" has been provided. It is possible that "collaborative team" could mean not working independently (as many homebirth midwives do) in which case insurance would not be available to these midwives and their decision to attend homebirths could lead to prosecution and incaceration.

The Materntiy Services Review clearly states that these decisions were based on presumptions of risk for homebirth. No medical evidence was consulted regarding homebirth and the review goes as far as to make the outlandish claim that there is no medical evidence which they could base their judgments on.

Ultimately The Australian Government has furthered obstetricians' monopoly over maternity care and has prioritised the medical model of maternity care over the midwifery model, despite the fact that the midwifery model is the safer model for the majority of women. By further empowering the already powerful players in Australia's maternity system, The Australian Government has aggressively restricted the rights and freedoms of birthing women. Perplexing behaviour for a government committed to raising the national birth rate!

For Those Of You Who Don't Homebirth

At this time I refer to the author of Empowering Birth Blog's reinterpretation of "First They Came For The Jews":

"First they came for the unassisted birthers,
but I did not speak out, because I do not free-birth.
Then they came for those who birth at home with lay midwives,
but I would would not speak out, because I would not have a home-birth with a lay midwife.
Then they came for those who birthed with Certified Professional Midwives,
and I would not speak out, because I would not have a home-birth with a CPM.
And then they came for those who birthed in birth centers and with Certified Nurse Midwives,
but I would not speak out because I would not have a birth in a birth center or with a CNM.
And then they came for me,
and there was no one left to speak for me."

When one woman's human rights are attacked, all human rights are attacked! No one is safe when a government takes to such heavy regulation of the choices women make with regard to their bodies, their babies and their birth experiences!

What Can You Do?

You can send your letters of disgust and demand to The Department of Health and Aging:

Central Office postal address
GPO Box 9848,
Canberra ACT 2601, Australia

And your feedback to Maternity.Services.Review@health.gov.au

And The Office For Women:

Australian Government Office for Women
Department of Families, Housing, Community Services and Indigenous Affairs
PO Box 7576
Canberra Business Centre
ACT 2610

Telephone 1300 653 227
Facsimile +61 6212 9572
Email women@fahcsia.gov.au

You can also send them to the parties in opposition to the current government as well:

The Liberal Party

The Greens

The Democrats

Family First

What Women Want

(I do not endorse any of these parties. I provide links to them so that readers have access to the information required to contact political power holders in Australia in order to apply pressure to these groups and individuals to do something to change this unacceptable position Australian women and indpendent midwives find themselves in).

Join the Facebook group "Home Birth should NOT be illegal in Australia" and find out more ideas for how to help!

Sign Homebirth Australia's online petition to Save Private Midwifery and Homebirth Choices!

Watch this space for more ideas and for information about various protests and talks you can support.

Australian Maternity Servies Review: Maintaining the Status Quo & Then Some!

The results of Australia's latest Maternity Services Review are in and sadly it is doom and gloom for those of us who care about the health and safety of low risk mothers and babies. Giant steps backwards have been taken for homebirth in Australia and midwives in private practice have been put in an unnecessarily difficult position. In short; obstetricians' medical monopoly over birth has been further solidified thanks to this latest review of maternity services.

The following is an analysis of the review from a dear friend of mine who has graciously permitted me to share it here:

There were over 900 submissions to the review committee. 407 of them were the personal stories of women, and 53% of those were from women who'd had homebirths. In other words, over 20% of the submissions to this review were from homebirthing women, despite the fact that only about 0.26% of all births in Australia are homebirths. (I daresay there was a significant number of women who haven't had a homebirth who also made submissions in favour of homebirth. I did.)

Of the 886 planned homebirths in Australia in 2006, "only" 706 actually occurred at home. An 80% success rate. Of the 9368 planned birth centre births in Australia in 2006, only 5460 births actually occurred in a birth centre. A 58% success rate...[note from sarah@ilithyiainspired; this means that actual home birth settings have greater success than so-called home-like birth settings].

As of the 1st of July, 2010, it will effectively be made illegal to practice as an independent midwife in Australia. This is because national registration requirements for all midwives will include having professional indemnity insurance, and this is not available to independent midwives. (It used to be, until 2001 when the AMA and RANZCOG lobbied hard enough to have it removed.) Because, basically, homebirth is perceived to be so dangerous. What were those stats I just quoted you?

The politics of birthwork have never been so obvious for all to see. But they're just statistics. I would like to highlight a few extracts from the review concerning homebirth, which struck me. These come directly from the review and do not leave much to the imagination with regard to the politics at play against homebirth and midwives in private practice:

1. "No adequate and reliable data is available to develop an accurate risk profile for privately practising midwives who provide birthing services".
This is incorrect. There are many studies attesting to the safety of homebirth attended by midwives in private practice, one of them was published in The British Journal of Medicine in 2005. This shows that those who made the final decisions on the review are not properly educated or familiar with the medical evidence concerning birth. This is very troubling considering they hold the power in making decisions regarding birth choices in Australia.

2. "It is difficult for insurers to come up with a suitable premium for midwives because the provision of birthing services by privately practising midwives is perceived to be a high-risk activity" (emphasis added).
This demonstrates that the power holders on this review committee based their decisions regarding homebirth on nothing more than their uneducated opinions. Rather than researching the medical literature on homebirth, they decided to accept the perception that homebirth is risky.

3. "The Review concluded that, while homebirth is the preferred choice for some women, they represent a very small proportion of the total."
One of the reasons homebirth rates are so low in Australia is a lack of government funding for homebirth, a lack of accurate information of homebith being readily available to Australian families and the misconception that homebirth is more dangerous than hospital birth, which is owed to cultural propaganda. The review chose to base it's recommendations concerning homebirth on this propaganda and essentially make the review itself another piece of propaganda.

4. "Lack of professional indemnity cover for midwives is a barrier to the development of collaborative models of maternity care involving privately practising midwives...while a risk profile for midwife professional indemnity insurance premiums is being developed, consideration be given to Commonwealth support to ensure that suitable professional indemnity insurance is available for appropriately qualified and skilled midwives operating in collaborative team-based models."
Midwives in private practice can't work with obstetricians because they can't get insurance for their work and they can't get insurance for their work because they can't work with obstetricians. Midwives in private practice in Australia are damned if they do and damned if they don't. Ultimately obstetricians don't want them working at all and this services review has given them the solution; rendering independent midwifery illegal in the near future.

5. "Currently, privately practising midwives who provide birthing services independently of a medical practitioner."
This illustrates that the review does not recognise midwives in private practice as medical practitioners, despite the fact that midwives are the medical experts on normal physiological birth!

6. "The Review also considers that moving prematurely to a mainstream private model of care incorporating homebirthing risks polarising the professions rather than allowing the expansion of collaborative approaches to improving choice and services for Australian women and their babies."
Basically, homebirth is serviced by professionals who aren't obstetricians and by giving independent midwives government support it would enable Australian women to more easily access homebirth and therefore take away business from obstetricians. Ultimately pleasing the obstetricians and maintaing the status quo is of more importance to the maternity services reviewers than meeting the needs of birthing women and giving them choice and control over their own bodies at birth.

Finally, I would like to return to my friend's analysis of the review because she summarises the situation so aptly:

"The Australian Medical Association and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists are a filthy stinking lot of evil, power and money hungry parasites intent on making their near-monopoly on birth in Australia complete...Let's just get this in perspective. Homebirths with independent midwives represent ZERO POINT TWO SIX PER CENT of ALL births in Australia. Why are these doctors running so scared? Because homebirth is actually SAFE. Because if homebirth was government funded, if independent midwives weren't having to operate with nooses around their necks, and if more women caught on that homebirth is the best option, that it has the best outcomes, is the easiest and most convenient option and has the priceless, invaluable advantage of EMPOWERING WOMEN TO TAKE BACK SOME CONTROL OVER THEIR LIVES and BOOSTING THEIR CONFIDENCE AS MOTHERS, well! More women would go for it! Maybe even LOTS of women would go for it -- eventually, anyway. Now THAT is a worry for the surgeons and other powers that be who run birth (and health) in Australia, isn't it?

...So here's the state of affairs: You can have a free and unnecessary C-section in a public hospital which costs the public $8000 and the government and everybody else claps and cheers and tells you not to worry because at least you got a healthy baby. About 20% of births in Australia occur like this (the C-section rate is 31% but let's be generous and say 11% of them are actually necessary)[note from sarah@ilithyiainspired: the world health organization recommends that anything above 10-15% of caesareans in any one region is medially unjustifiable, so approximately half of all caesareans performed in Australia are unnecessary] . Or you can have a beautiful, empowering homebirth with a midwife risking her integrity, livelihood and possibly even freedom to attend you, which costs you somewhere between $2500 and $4000 and everyone tells you you're a crazy risk-taker endangering the life of yourself and your baby and if you get up someone powerful's nose they might even get the Department of Child Services onto you."

See also:
Australian Government, Violating The Fortelesa Declaraion

More on this
Homebirth Underground
Maternity Review part one
Maternity Review there's more
Homebirth Ban
Medicare payments to OBs up from $77m to $211m...

Join the Facebook group "Home Birth should NOT be illegal in Australia" and find out more ideas for how to help!

Sign Homebirth Australia's online Petition to Save Private Midwifery & Homebirth Choices!

Why is the Health of Babies Less Important?

After an unfriendly encounter with an artificial breastmilk (also known as formula) pusher in a department store it occured to me that the health of babies simply does not rate as important as the health of adults and older children. I have no doubt everyone in this society would deny such a claim, but when we consider social attitudes and behaviour concerning health issues such as breastfeeding and birth it is undeniable.

Yesterday I discovered a local store had two large promotional displays of artificial breast milk (ABM) assembeled in their baby section. This is a violation of the World Health Organisation's code about advertising ABM. The World Health Organisation is very clear on the improtance of breastfeeding to the health of all babies (See "The World Health Organisation Says" section in the right hand sidebar of this site). In addition to WHOs 'stance, many scientific studies attest to the superiority of breast milk compared to ABM, and indeed give cause for great concern about the dangers ABM poses to the health and well being of babies (in the short and long term).

I gave the store the benefit of the doubt and assumed that the store manager was not aware of the violation or of their responsibility to promote good health for babies. I politely approached her about the issue to let her know. She was immediately rude and defensive and wanted to argue with me and make the issue personal. And I learned that I was wrong to give her the benefit of the doubt because she told me I was not the first to inform her of the code and recommend removing the promotional display. She simply chose advertising a product that promotes poor health and disregarded the concerns of educated consumers.

She implied that I was a breastfeeding mother intent on forcing my choices on others, she argued "some women just don't want to breastfeed and they have a choice and I'm allowed to advertise what I want in my store, except for cigarettes". I informed her that this is not a matter of choice it is a matter of health. Furthermore the danger ABM poses to the health is comparable to the danger cigarettes pose to health. But babies don't smoke, adults do. Adults don't drink ABM.

Moreover, I question how much the store manager turly values so-called choice, given that she had two large displays promoting feeding babies an inferior man-made artificial and dead substance and yet no equivalent promotion of feeding babies the superior, normal, natural, organic, living milk of mothers' breasts. Well, it hardly takes a genius to figure out why that is the case; breastfeeding doesn't make the store manager money!

Attitudes towards birth provide another example of how little this society values the importance of infant health. Scientifically we know that giving birth under the influence of narcotics, such as pethidine, compromises the health of unborn and newborn babies. Medical evidence supports the safety of homebirth and the danger of caesarean sections. Yet, almost 100% of Australian babies are born in hospitals where only 1-5% of babies escape these interventions (and more). And educated folks who share this information with others are accused of not respecting the choices of women who prefer to make birth choices which compromise the health of their babies and themselves.

Of course another glaringly obvious way our society refuses to acknowledge the humanity of babies is male infant genital mutilation. Our society refers to this abhorrent abuse of human rights politely as "circumscision". It is in fact the unnecessary and permenant mutilation of a baby boy's penis which poses health risks to him for life, including the potential for castration. Some people may point out that such a risk is low, but when you take into account that in this age; with awareness about hygeine, where there is rarely to never a medical justification for genital mutilation, and is almost always carried out for cosmetic reasons, facing such a risk, no matter how low, is ridiculous and sickening.

Just like birth and breastfeeding, the concept of choice gets thrown around when it comes to chopping up baby boy's penises. It's a parents' choice to mutilate their son's penis. It's a parents 'choice to give their babies a drugged start to life or increase their babies risk of death three fold by surgically removing baby from mother's womb. It's a parents' choice to compromise their babies immune systems, digestive systems, increase their risk of malnutrition, contimination and obesity in future life (to name just a few health consequences of ABM). Where, in all this, is the baby's choice?

Babies are people too. It is dispicable that so many babies are artificially fed, and almost 100% of those babies do not need ABM to survive. It is because ABM companies and stores profit from the sale of artificial infant milk that feeding a baby normal milk (which is their birthrite) has become one of two "choices". It is this easy access and insidious advertising of ABM that undermines a mother's breastfeeding journey and makes it easy for parents to deny their children breast milk.

Furthermore artificial infant formual does not need advertising! If a baby has a genuine medical need to eat something other than breast milk, then his or her parents can go in search of such a product (I was going to write "just as parents of a child with a gluten or lactose intolerance search for gluten and lactose free foods for their children", but that is an unfair comparison given that it is much harder to find gluten and lactose free products than it is to find artificial infant milk and yet there is a legitimate and widespread need for easy access to gluten and lactose free foods!). Promoting artificial feeding is more aptly compared to promoting artificial breathing products - IT DOESN'T NEED PROMOTING! We know it's needed in dire circumstances, and we'll get back to you if we suddenly struggle to breathe!

Breastfeeding is not a parent's choice! Breastfeeding is a baby's health requirement!



For information about the importance of breastfeeding and dangers of artificial breast milk read:

101 Reasons to Breastfeed Your Child

Artificial Feeding – Nothing To Do With Breastfeeding

Consumer Research on Infant Formual and Infant Feeding

Formula for Disaster

Genetic Engineering and Infant Foods

Hot Milk - The Unbottled Truth About Formula

IBFAN

International Breastfeeding Journal

Just One Bottle

Misinformation: Redefining Baby Feeding

Myths

Suck on This

Toxic Phthalates in Infant Formulas

The Case of The Virgin Gut

The Language of Breastfeeding

The Risks of Infant Formula Feeding

What Should I Know About Infant Formula

Yes! Just One Bottle Will Hurt!


For related articles at Ilithyia Inspired:

Those Not Breastfeeding Yet, Need Breastfeeding Support

The Personal is Political For Everyone But Me

Uncovering What Lies Behind Lactophobia

Breastfeeding Beyond Two Years

Trust Birth, Prepare For The Staff

The Age, a Melbourne newspaper, published an insightful opinion piece concerning birth preparation titled "Homework is the mother of prevention". The author, Monica Dux, discusses an issue that sparked my interest in the politics of birth when I was working on my PhD:

"There seems to be a widespread culture of passivity when it comes to labour. Many expecting mothers do dedicate an enormous amount of time and effort to preparation, yet, in my experience, there are just as many who refuse to do adequate homework, preferring to sit back and see how things develop. It's not that these women are unsure about what sort of labour they'd like to have (almost always an uncomplicated vaginal delivery). They've simply decided that "waiting and seeing" is the only realistic approach. Why bother committing to a detailed birth plan when it will probably go wrong anyway? Perhaps other wait-and-seers are simply in denial, preferring not to think about an experience that is understandably terrifying. The end result is that they approach the business of labour with less preparation than they would bring to buying a new car."

I have often thought how ridiculous it is that so many women put little thought or preparation into the birth that lays ahead of them. But then again birth is a normal physiological function, and we don't write ourselves poo plans before going to the toilet. The reality is that during birth a woman is more vulnerable than when she is on the toilet, and as a society men and women are granted privacy and assumed to be capable of going to the toilet without assistance. Society does not extend this trust to birth. Sadly most women have more trust in their medical care providers than they do in their bodies to birth safely and efficiently. This is problematic, as Dux notes:

"Medical experts bring their own subjective values to the decisions they make and the advice they give, and these may not be the same as those of the patient. Similarly, it is naive to discount the vagaries of the contemporary hospital environment. Most of us are suspicious of large institutions such as banks and government departments because we know they are not set up in a way that always serves the best interests of individual clients. Why would hospitals be any different, particularly when so many of them are over-stretched and under-resourced?

Despite all the rhetoric about the importance of consent and respecting the patient's wishes, my experience of giving birth in a big hospital is that women are encouraged to take a passive role, to defer to both their doctor's opinion and to the institutional imperatives. If you argue, you are often told "that's just the way we do things."

Dux concludes that "To just "wait and see" when the stakes are so high is simply negligent — both for the mother's health and for her baby." And she is right. When working on my PhD I collected a number of birth stories from women who had had their trust betrayed during birth. The effects of these betrayls lasted long after the baby was born and included the breakdown of a marriage, many cases of post traumatic stress disorder, breastfeeding problems and challenges to the motherbaby bond.

It is my wish that all women were aware of these issues and possibilities before giving birth for the first time. Dux has done a great job of raising awareness. You can read the full article here.




My own writings on this and related topics:

A Matter of Trust

Doulas: Mortal Ilithyiai

Your Childbirth Options

BirthKeeper

The term doula means "handmaiden" and as such I prefer the term birth servant to doula because technically a doula could be an attendant for anything. "Birth servant" more accurately sums up what it is I see as my role as a doula: to serve women at birth, families who are preparing for a birth, and families in the period after birth. Recently I also find myself more and more drawn to the term "birthkeeper".

Initially I was not a fan of the term "birthkeeper" because it made me imagine birth being put in a cage and guarded by some self-appointed authority. But I misunderstood what it meant. A birth keeper does not cage or tame birth, rather she protects normal birth from adversaries and attackers.

Jeannine Parvati Baker coined the term "birthkeeper", which was a marriage between the terms "birth" and "earth keeper". She wrote:

EarthKeeper is a Native American word for Eco-activists as well as holders of the sacred Earth-based wisdoms. Midwives can be the same, yet the term "Midwife" has been usurped by MEDwives and other medically-based perinatal professionals. At this point in time on Turtle Island, midwifery is an endangered species. Too many midwives have identified with the oppressor, learned to speak the conquerers language, and otherwise been vanquished to emerge as obstetrically-trained "Medwives". In other words, many Midwives have given up being guardians and keepers of natural birth at home, in order to survive as professionals.

...BIRTHKEEPER...

Healing Birth is Healing the Earth. (Parvati Baker)

Like Parvati Baker, I see honouring birth in its most pure, unhindered and natural state (and working to protect birth from intervention and interruption) as a very important part of the birth servant's role. I believe that in serving, honouring and protecting birth in this way, birthkeepers serve womankind by assisting them to realise their innate strength and power. They do this by nurturing the mother through the intensity of labour and providing her with the encouragement she might need if she begins to doubt herself.

There are doulas who rather than using their role to serve birth, enable the current anti-birth maternity system. These doulas understand their role to be supporting pregnant and birthing women's choices, regardless of what those choices might mean for birth, women, and babies. If this is what the world thinks a doula is: an enabler of any and every choice, then I am no doula, nor shall I ever be one. I don't believe all choices are equal, or that all choices are deserving of respect. I didn't go down this path out of a love for choice, rather a love for birth, women, and more specifically women's power in birth.

I don't believe that kind of "support all choices" doula is necessary at birth. Women have their friends, families and care providers to support them in making popular choices. What is lacking is a voice for normal birth and someone in the birth space never wavering in their faith in the birthing woman's body! What is needed now more than ever, with such high rates of unnecessary intervention in birth, is someone willing to "hold the space" - that is, give birth the time and the space to be whatever she needs to be, free from intervention and interruption, and someone to give the mother freedom to get on with the business of labour rather than having to negotiate with or rage against a system unwilling to sit on its hands.

It's quite common these days for people to confuse respect for a person with respect for a choice that person made. They are not the same thing. I believe it is thanks to our capitalist society that many people have grown so attached to the concept of "choice", indeed it is often worshiped. Those of us willing to dig a little deeper and critique choice are often received with a hostility that brings to mind the fury of another time, when someone dared to say the world was round.

Simply because someone chooses a certain choice does not mean they're choice is above critique. Making a choice does not equal being empowered, for example an individual can be held at gunpoint and told to choose between handing over their possessions or being murdered. They may make a choice, but it's hardly an empowered one! Likewise pregnant and birthing women make choices left, right and centre. But whether those choices are based on accurate information and for the right reasons depends on her preparation and the quality of care providers she has surrounded herself with (eg. making a choice out of fear or because someone else made that choice are not good reasons to committ to a particular birth option!).

I have no interest in supporting choices. I wish to support women, and that means assisting them in becoming informed and subsequently empowered. "Supporting" a woman in making choices based on fear and a lack of information or handing her power over to someone else is not supportive in my view! It is dishonest and patronising.

Protecting and serving normal unhindered birth protects and serves birthing women. A normal unhindered birth means mother and baby are safe from the risks and consequences of interventions that are not necessary 90% of the time and gives the mother the oppotunity to see and feel the great depths of her strength! This means that she begins mothering a new child filled with self-respect and confidence.

Related Pages:

Personal is Political

What Does "Support" Mean?

Interview with Birth Activist Janet Fraser

The Wisdom of Ani DiFranco

Your Childbirth Options


This post was a long time coming, initially inspired by the thoughts of Michelle The Herbwyfe. Upon first reading Michelle's thoughts on identifying as a birth keeper rather than a doula I really didn't understand where she was coming from. I couldn't see how the term "doula" was lacking but having more exposure to the western world's maternity systems I now see more clearly..

What Does "Support" Mean?

This year's World Breastfeeding Week theme is supporting mothers, which begs the question what is support? I have noticed two major understandings of what it means to be supportive. The first is the belief that to be supportive of a mother we must agree with her, nod and smile, and bite our tongues if we have information that contradicts the information she bases her choice on. The second understanding of support involves recognising that knowledge is power and that a mother cannot truly make a choice unless she knows what she is really choosing and what the alternatives are.

The biggest difference between these two schools of thought is that those who subscribe to the smile and nod approach believe that all choices are equal. In this school both breastfeeding and formula feeding are seen as valid "choices" and regardless of which a mother chooses, and the motivations behind such a choice, she deserves to be patted on the back and told she made the right choice. In these people's view it is unsupportive to tell a formula feeding mother the facts about breast milk's superiority to artificial milk, or even to question her about what led her to make such a choice.

Those who take the second view of support don't believe that respecting all choices as equal is supportive. Not only is it not supportive, it is insulting to mothers. For example, deciding not to share the facts about breastfeeding to formula feeding mothers out of a desire not to upset them assumes that formula feeding mothers are too precious to process information and need to be protected from the truth.

Another key difference between the two understandings of support is what the goal of offering support is in each. In the first (soft) approach the aim of support is to comfort or make the mother feel good about herself and her choices. Contrastingly, the goal of support in the second understanding is empowerment.

I am of the opinion that supporting mothers involves being honest with them, even if the truth might hurt. Sometimes when we are honest about breastfeedings' superiority over formula feeding, mothers become defensive and perceive our honesty as a personal attack. That is the risk we face in attempting to truly support mothers. But even if they are not ready to accept the facts, we have planted a seed of information that will stay with those mothers, and maybe in the future we (or someone else) can nurture that seed in the mother and watch as it grows and she blossoms into a more informed individual. Having said that, there are of course ways to be honest with mothers without being cruel.

Many choices and opinions based on a lack of knowledge are based on fear itself or fear of the unknown. Breastfeeding is not seen as normal in our society (by which I mean it is considered a choice mothers have to make, rather than something they automatically do). This means that before women reach the point at which they must make the decision to breastfeed, they already have years of impressions, opinions, prejudices and fears about breastfeeding to confront, as well as years worth of formula advertisements. Thus access to information is of paramount importance. Your decision to either smile and nod or share the facts with a mother could make the difference between whether her children get the health and well-being they deserve, or man-made powder from a can.

The smile and nod approach to support is not only a dead-end in terms of mothers becoming empowered through knowledge, it assists formula companies in upholding the belief that formula is just another valid form of feeding a child, and it is not! Formula is an absolute last resort for the mother who has tried everything but still can't feed her child breast milk (hers or anyone else's).

So how can you support a mother or mother-to-be?

• Buy her a membership to the Australian Breastfeeding Association (or your nation's equivalent group).

• Provide her with information from the World Health Organisation about the importance of breastfeeding

• Provide her with information from other trustworthy sources about the importance of breastfeeding and the risks of formula feeding (such as the kellymom website, see Ilithyia Inspired breastfeeding articles and brestfeeding websites for more).
  

• If a woman tells you she couldn't breastfeed tell her how sorry you are for her. Ask her what she tried and what kind of support she got? Eg. did she sleep with her baby, express, refuse to supplement with formula, enlist the help of the ABA and lactation consultants or other lactating mums who could donate their milk? Remember that the actual number of women who cannot breastfeed or produce enough milk to feed their babies is minute. Be an outlet for her grief, because it is there, it is just not often given the space to be expressed in a society where breastfeeding is not considered normal.
  

• Find a struggling mother a lactation consultant.

• If you're lactating offer your milk if she needs it, even if it's just for a couple of days or weeks as she learns how to do it herself. She will get it.

• Remind her that many people start off struggling, there is a period of adjustment and learning, and that's normal and it's okay, and it doesn't mean she won't get to a place of ease and enjoyment.

• Don't give up on her even if she wants to give up on herself.
  

• Share your own breastfeeding story to give her inspiration and hope, or provide her with with the inspirational stories of others (to see a list of breastfeeding stories click here).

• If you know she is being provided with incorrect information correct it immediately. Even if it is a health professional giving her this wrong information, you need to give her access to the facts, and remember that doctors, nurses and midwives don't necessarily know the facts about breastfeeding, and some of them even receive promotional information from formula companies.
  
  
• Don't be afraid to get topless and nurse in front of your friends, family, other mothers, mothers-to-be, the world! If we are to normalise breastfeeding it has to be seen and accepted, and how is a woman supposed to suddenly know how to breastfeed if she hasn't even seen it done before her time comes?

• Challenge the assumption that many women can't breastfeed or don't produce enough milk. How insulting this incorrect assumption is to women! Our bodies were made to breastfeed. If so many women can't breastfeed, women would not have breasts! If you know a mother who is concerned about her supply give her the information which will set her mind at ease (eg. how breast milk production works, and what she can do to increase her supply in the unlikely event that she needs to do something to help build her supply).
  

• Encourage mothers to disregard the "advice" of their mothers who formula fed. Sadly our mothers generation had even less support and access to information than we have today, and many of them believed they had no choice but to use formula, and believed that formula was just as good as breast milk. Some of these women find it hard (or refuse) to accept that they got it wrong or were lied to, and to reassure themselves they like other women to do the same as they once did. Your support can be as simple as saying "aren't we fortunate that we have better information and support than our mothers ever did?"

• Share you experience. Don't be afraid to tell other mothers how much breastfeeding means to you and your children, and all that you've gained from it in addition to increased health. If someone tries to silence you because they think your breastfeeding joy is offensive to mothers who don't breastfeed pull them up on this, you can say "that has nothing to do with my story", ask them why they don't value your experience as much as those mothers experiences? If you're feeling really brave you can ask them why they feel threatened by your breastfeeding joy?