Midwifery is catching

- I’m on placement at the moment. 3 weeks of fun, and then 2 weeks of holidays, and then 3 more weeks of placement. Yeesh it’s hard (read: expensive, and fuel-consuming) work and a lot of challenges for me with a dodgy shoulder and lo! a lovely dose of bronchitis. I’ll debrief about it when I’m a little further through… I’ve got placement in an antenatal clinic, a women’s health clinic at a hospital, an abortion clinic, a country hospital and a large-ish hospital that I’ve not worked at before. Should be interesting. And 6 weeks of trying to not go bankrupt in the process.

- Last week at school I had a study day that covered pharmaceuticals in pregnancy (nothing I didn’t already know, thankyouverymuch to reading a lot about it, and having a Bachelor of Science and Bacherlor of Technology!), ultrasound (didn’t change my mind about it, did get me thinking more about it but generally frustrating in the way that many of the fellow students believed everything that was said), quit smoking campaigns (important message but really, what smoker thinks that smoking is safe and healthy and smart, and what woman isn’t adult enough to work out herself that it’s not a fabulous idea to do when pregnant?) and then a CTG workshop which was really interesting and I loved that feeling of "more more more fill my brain up" that I get with truly learning.

- Scary scary new device on the market: The underlying concept behind BirthTrack is the use of ultrasound technology to calculate the distance between sensors. BirthTrack system monitors cervical dilatation by transmitting ultrasonic waves from transducers (placed on the abdomen) to receivers affixed safely and painlessly to the mother’s cervix. Thus cervical dilatation is monitored continuously and automatically with a high degree of accuracy, reducing the need for manual examinations.

- New ticker to count down until I finish school.

Registration will come in 2010 so I’m not thinking that far ahead at this point. Plans post-uni are a little up in the air at the moment. I have the chance to work as an assistant in midwifery next year and I’m considering doing that instead of working in retail still. When I register, I have to do "something" to pay the bills, so I’m thinking either going the New Zealand for a year or more experience (woo logistics of all that!) or else working somewhere in a graduate position for a while. Do I have to make these decisions now - yes, and no. I have to make some plans in the next few months I guess (must update the resume in preparation for this!) to be able to step into 3rd year with confidence.

- Hopefully I’ll have some more babies in the next few weeks. I’m missing out on the babies and the new mothers and fathers thing at the moment. I attended a c-section recently and that’s about it - and not a lot of midwifery that I could do as it was at a small private hospital that I’d not worked at before so I did the "with woman" thing incredibly well and babbled about things that came to mind.

*sigh*

What an exciting day for maternity care in Australia! We stand on the threshold of change and the possibilities are endless.

Hang on - haven’t we been here before? Why do I get a sense of de ja vu? Well, we have had a large number of these in the past with no change whatsoever, so I’m not holding my breath.

Details and ways to make submisions are here on the Department of Health and Ageing’s website. Submissions close end of October, with the review to be released next year.

What I’m worried about is that it will become a turf war between doctors and midwives, between doctors and hospitals and midwives, between women and insurers and generally everyone who has something to say about it. We don’t need a turf war - that’s already been had, and the women lost (I’ll leave debates as to who won up to other people, because I don’t actually care beyond that one statement).

There is a need for reform because women only get choice and continuity of care and carer when they pay for it out of pocket, and even then it’s sometimes a figment of someone else’s imagination that continuity is what they get… but when women will settle for their ob being there for 15 minutes for the arrival bit of their birth, or the 1/2 hour it takes to do a c-section, thinking that that’s good service because they know who he is, then there is something screwy with the system. Same with settling for having a complete stranger of a midwife because yours has "timed out" for that day or week.

The focus needs to be on what women want and need. This is a spectrum of things, from "unassisted birth with an easy path to registering their child" through midwife-attended or -assisted homebirths, into small hospitals, through to tertiary hospitals and then out  the other side into private hospitals and private obstetricians. To name just a few of the options.

I’d like to see something like New Zealand has, where the money follows the woman around. This could mean that obstetricians earn less and midwives earn more. It could mean that homebirth numbers rise because it is a SAFE option for birth, and possibly the safest but not the most socially acceptable still (I’m working on that). It should mean that more women have the chance to get to know their caregivers, and have them attend their birth, if that’s what they want. Lots of women don’t know anything different from the fragmented care system that exists and is delivered to the masses. Education as to their options, beyond this, need to be supported by the money.

Women can want all they like in the direction of a private midwife and a homebirth, but when their private obstetrician and a 6 day stay in hospital is "free" under private health insurance and Medicare, and a private midwife and homebirth is $3000+, and a public hospital birth is free, it can be a hard decision to make. Families make the decision to homebirth regardless of the cost only when they see the benefits and for a lot of people, there aren’t any because they can’t see them (fish, water, same analogy…). Same with birthing with an epidural or not - some would say they’d never go to a dentist without anaesthetic and others would say it’s a huge interference in the natural order of things.

Way off track from saying - go forth and read and respond, for tomorrow or next year or next decade, it may be you or someone you love or someone you know who’s making these choices.

I’ve been wondering about a few things recently.

• The purple line and its relation to dilation - meaning that lots of VEs were done on women as they progressed through labour to see whether there was a correlation. 
• Why we wait until 10cm to be convinced that a woman is dilated.
• Where the 10cm rule came from.

"There is a rule of labor that forbids a woman to push with contractions until her cervix is completely dilated to 10 cm. Women are warned that to push before this doorway is completely open and out of the way will result in a swollen and/or torn cervix."

I’m curious to hear more on this topic and when I’m done with my current paper, I’ll look into it some more.

I’m developing a style of practice that is being hands off and observational, which is often in conflict with the hospital system that I am learning in. I get that I am a student and that I have to learn before I can be. I also get that I am the midwife I will be in the future; it’s in the heart and soul, not in the textbooks, but I need the knowledge and skills to catch up to that passion. But wow it’s hard going to be trained in The System when I don’t agree with so much of what I have to do.

Parents on run, refuse son’s vaccination
August 23, 2008, 5:56 am

A Sydney couple are in hiding after the Department of Community Services (DoCS) took out a court order to have their three-day-old boy vaccinated against hepatitis B. The parents, from Croydon Park, fled their home on Thursday to avoid police and DoCS officers after refusing to have their son vaccinated at Royal Prince Alfred Hospital. They told Fairfax newspapers they believe aluminium in the vaccine can cause him more damage than contracting the disease.

The infant’s mother, who is from China, was diagnosed with hepatitis B several years ago, but both parents believe the illness, which can cause liver cancer and cirrhosis, can be managed more effectively than any potential neurological damage from the vaccine. Vaccinations are not compulsory in Australia but it is NSW Health policy that babies born to hepatitis-B mothers are given the immunoglobulin within 12 hours of birth. The treatment is followed up with four more doses of the vaccine over six months. The father, a financial adviser, is seeking an injunction against the court order. He told Fairfax doctors and midwives on the post-natal ward told him he and his wife would be arrested and they would lose custody of their child if he left the hospital without being vaccinated.

The Supreme Court order, obtained by DoCS, states the baby must be vaccinated by midnight on Thursday but the father is adamant they will stay on the run indefinitely. The case will be back in court on Monday, Fairfax reports.

There are only two developed countries that don’t have paid maternity leave - and Australia is one of them. This even leaves us lagging behind Tanzania, Iran, Burma and Djibouti.

Paid parental leave is not just about valuing the well-being and development of children; there is also an economic benefit in retaining people in the workforce and safeguarding the nation’s future prosperity. Isn’t it time Australia caught up?

Well this is the chance we have long been waiting for - the Productivity Commission is finally looking into the issue. Click here to sign the petition calling for a minimum of six months paid parental leave - and we’ll deliver it direct to the Commission and the Government:

www.getup.org.au/campaign/AllTheOtherKidsAreDoingIt

If almost every other nation on earth can see the benefit - even the very poorest - then surely it’s time for Australia to start looking after families. Australia currently leaves it up to the individual employer to decide - and those in the retail and service industries have almost no access to paid parental leave.

That’s why a joint statement was signed yesterday by more than a dozen prominent Australian organisations advocating a minimum of six months paid parental leave. You can join us in the push for paid parental leave by clicking here:

www.getup.org.au/campaign/AllTheOtherKidsAreDoingIt

Change only happens in society if we can demonstrate enough of us demand the government get with the times. You can help make this change by signing the petition today. If all the other kids are doing it, why can’t we?

Thanks for being a part of the solution!