A presentation to assist women in considering birthing options and choices that suit themselves and make them feel they have an active choice, role in their birthing options
2. Navigating Birth Choices
What I wont be telling you is which way is best for you! I
will be talking about best practice, evidence and how to
decide how you will navigate negotiate and demand for
yourself so your choices are your own
During this workshop I will be asking you to be engaged
and ask questions make sure you get what you need
from today
3. Birth is not only about making babies.
Birth is about making mothers ~ strong,
competent, capable mothers who trust
themselves and know their inner strength.
Barbara Katz Rothman
4. If only there was a list of options!
Menu
Mains
Medical clinic
Midwives clinic
Midwifery led care
GP shared care
Private obstetrician
Private midwife
Side order
Water birth
Epidural
Cesarean
Home
Hospital
Drugs
Massage
hypnotherapy
5. Are women making choices?
Are they informed by what ? who ? When?
Where ?
11. Is there a choice?
What are we talking about today?
Medical model midwifery model birth
centre, labour ward delivery suit private
public homebirth drugs no drugs pain
relief no pain relief partner mother
father mother in law arghhhhhhhhh
29. Special interest groups i.e. Australian
College of Midwives, Maternity Coalition,
Baby Friendly health Initiative, Homebirth
Australia, Australian Private Practice
Midwives Association, Midwives Australia,
Australian Breastfeeding Association,
Cesarean Awareness Resource and
Education (CARES).
30. Midwives
Doctors
Hospitals
Networks
Other women
Surf the net!
31. How to handle the net!!!!!
What information is good quality
What is opinion
When to stop!
32. So how to be flexible but not
compliant?
know what you prefer/want
Understand your options
Make sure the people around you
understand your preferences and WILL
support them
Remember partners and support people
can be scared too
35. remember
Childbirth doesnt have to be a drama
even though it sometimes is
Avoid interventions unless you are
comfortable with why you need them
36. Last thought
There is nothing
better in this world
than the smell of your
own newborn baby
Editor's Notes
#3: The following presentation will discuss the myriad of choices and options available to women when considering antenatal, birth and postnatal care, in or out of hospital facilities. There is a lot more to choice than simple making a choice based on evidence or information. Women, partners and families need skills to help them manage and navigate the choices they make within evolving, emotive and contentious beliefs about women, birth and babies.
#6: It would appear that women in Australia can make many choices and that maternity care provision has a sound basis in evidence and research. However with soaring cesarean sections rates coupled with rising associated morbidities and postnatal stress disorders it would seem that effectively navigating choices is problematic. I will present some of the various ways that women can make informed decisions based on choices that suit their own needs and desires, but also within the dominance of medicine and the hospitalisation of maternity care. This aims to be meaningful to all women regardless of the options of care they choose, because ultimately individual choice based on sound evidence and having support therein is what matters.
#10: Pleaswe excuse the sexist nature of male doctor and female midwife but statistically I am not far wrong
#12: Lupton (1993) describes risk as being ideologically loaded and discursively constructed to produce control over the social and personal body.
#13: Choosing one does not exclude the other. There is always a midwife at every birth. There is always a doctor available if you require medical attention
We are not aliens
#14: Is it just health mother healthy baby
What is health
Australian women are experiencing an obstetric cascade starting with overuse of drugs for induction and augmentation leading to the excessive use of epidural block inevitably resulting in the extreme rates of forceps and vacuum extraction found in Australia---the highest rates recorded anywhere in the world. How can it be that a third of babies born in Australia must be pulled out of their mothers? Such aggressive extraction results in damage to the neonate including swelling and bruises of the head. Using a surgical instrument also means frequent episiotomy and all these invasive surgical procedures on the woman results in damage to the woman still evident six months postpartum including 54% with perineal pain, 18% with urinary incontinence, 19% with bowel problems, 36% with haemmorrhoids and 39% with sexual problems. This is why it is appropriate to define rates of episiotomy over 20 % as female genital mutilation.
First, there can no longer be any doubt that midwives are the safest birth attendant for low risk birth. One meta-analysis of 15 studies comparing midwife-attended birth with physician attended birth found no difference in outcomes for women or babies except for fewer low birth weight babies with midwives.[23] Two randomized controlled trials (RCT) in Scotland[24,25] and 6 RCTs in the US all found no increase in adverse outcomes with midwife attended birth.[13]
Qld stats as of 2008
34% not augmented
93.9% cephalic presentation
56.9% nvb
35.8% no drugs
50% no analgesia for birth
20.5% non induced augmented vbac
68% re section rate
24% precipitate labour
42.8 not continuously monitored
23.4% episi
3.4% episi and laceration
#15: Is it a choice when it is based on fear or misinformation
Medical intervention in childbirth is fine when it is needed. There's no doubt it can save the lives of some mothers and babies. But we now have way too much of a 'good thing'.
There is risk with CS --- maternal mortality even for elective (non-emergency) caesarian section is 2.84 fold or nearly three times higher than for vaginal birth.[3] For fifty years the maternal mortality ratio came down. Then in the 1980's the maternal mortality ratio began to rise and, according to the US Centers for Disease Control and Prevention, it rose from 7.2 in 1987 to 10.0 in 1990.[4] While this ratio continued to decline in other industrialized countries, in the US the maternal death rate continued a slow but steady rise through the 1990s and according to the World Health Organization is now higher than at least twenty other highly industrialized countries.[5]
#16: it is estimated that less than 25% of women do not have some form of pharmaceutic intervention and Australia wide 57.9 women birth without instrumental intervention what is normal anymore?
Vaginal birth is normal birth for the majority of women. However not normal doesnt necessarily mean bad! This is key to our language and framework for the value of women's experiences and women must take ownership of their choices. An elective cesarean is not normal birth but for a woman that may not be bad as such. A normal birth in hospital or at home is one more normal than the other?
#17: The big one
Yes birth is painful and no birth isnt painful
Birth pain is both pain and not pain
It is most importantly normal physiological work the body does and fear is the key factor as to how you responds to approach and make choice for birth care
This doesnt mean that its your fault that you fear therefore experience pain it means that overwhelmingly we have one language for pain in labour.
We could say pain is a very strong sensation that you have to work very hard on. It could be that it is excruciatingly horrendous. Which way makes you approach it more positively. Language is powerful
My experience
#18: Options are vast
What do you feel do you like alternate therapies, water, heat, smells
Movement
Support
being known
Touch
environemnt