Birth Action

Support Home Birth in Hungary

18th October 2001
In Hungary Obstetrician Dr Agnes Gereb and paediatrician Dr Györgi Büki have been suspended by the Chamber of Physicians for attending home births. The Board of Obstetricians states that any professional care giver who supports planned home-birth is acting contrary not only to current guidelines and protocols, but also to his or her professional oath.

An international petition is being organised called "Giving Birth in Freedom, Being Born to Freedom." To learn more about this email Nick.Thorpe@bbc.co.uk

Supporting bereaved women in New York after 9/11

September 2001
The Metropolitan Doulas were faced with the challenge of giving support to women before, during and after childbirth whose partners or other loved ones were killed in the tragedy at the World Trade Center. Ilana Stein, their Director, said, 'Most of us are feeling very lost in the face of the enormity of what we have experienced here.'

They let all the hospitals know that they would be with any woman, free of charge, who wanted a doula.
They set up a free phone service for women who wanted the opportunity to talk with a doula.
They are notifed trauma centers, the Red Cross and the press, and posted flyers at memorial sites and Union Square, offering these services.

The New York doulas asked for guidance in giving emotional support to these women in their grief.
You can contact them at www.nydoula.com

Evidence based guidelines for midwifery led care in labour

Congratulations to the midwives of St. Richard's Hospital,Chichester, on their Guidelines (2000). This is a brilliant booklet produced by the Guidelines and Protocols (GAP) group they set up, and is a model for every other hospital. This publication was itself inspired by two previous guidelines produced by the midwives of the Leicester Royal Infirmary and the Central Sheffield University Hospitals. Ventures like these are huge steps forward in midwifery, and for women.

On support in labour, for example, the Chichester midwives state in a beautifully concise way:

Continuous support is associated with:

º less pharmacological analgesia
º fewer instrumental deliveries
º fewer caesarean sections
º more five minute Apgar scores greater than 7
º women thought labour was better than expected
º labour seen as more positive experience overall by women
º less perineal trauma women more likely to be breastfeeding at six weeks
º less maternal depression less difficulty in mothering.

On care of the perineum, they quote Enkin et al in A Guide to Effective Care in Pregnancy and Childbirth: 'Touch may be a disruptive distraction and potentially causes trauma'.

Recommendations include: There is no justification for 'hands-on management during second stage of labour to prevent perineal trauma... (They are critical of the HOOP trial, which revealed that after midwives were 'hands on' at delivery fewer women had pain 10 days after birth, since every woman who participated in the trial was 'managed' and had to assume a semi-recumbent or sitting position for the second stage.)

The recommendations continue: 'Episiotomy is the most common operation in obstetrics and is associated with complications such as increased blood loss, infection, and prolonged sexual problems. The use of routine episiotomy should be abandoned. Specific informed consent should be obtained prior to performing an episiotomy.
They conclude: 'Rather than seeking the perfect technique to save the perineum, perhaps we should make extra efforts to enhance women's natural birthing capabilities.'

The Caesarean section rate is rising

Sheila is on the Maternity Care Working Party that is addressing the issue of a rising Caesarean rate in the UK. This is a multi-disciplinary group set up by the National Childbirth Trust.
The recommendations they make include:
All maternity units should audit their Caesarean births
Local data on Caesarean rates should be published
Obstetricians, who perform Caesareans have a responsibility to justify that in each case the benefits outweigh the hazards.

The Independent 27th August 2001
'Unnecessary Caeareans' on older women by Kim Sengupta
Older mothers are being subjected to scans, Caesarean sections and aided deliveries even when these procedures are unnecessary.
A study of close on 30,000 births at the Aberdeen Maternity Hospital published in The British Journal of Obstetrics and Gynaecology at the end of August reveals that primigravidae over the age of 40 are 14 times more likely to have an elective Caesarean than those under 30. They are more likely to have 2 scans or more, and a hospital stay lasting 5 days. They are more likely to be separated from their babies, who are sent to the neonatal unit. It seems that the term 'elderly primigravida' in the maternity records sends a subliminal message to obstetricians and midwives that they should intervene. In fact, unless pregnancy has shown that a woman is at increased risk, birth is as safe as it is for younger women.

Independent Midwives produce a Manifesto on Human Rights and Birth and Women's Rights to Midwifery Care

9 October 2000
The first conference of independent midwives in Europe held in Aachen in September 2000 has produced a manifesto on human rights and birth and women’s rights to midwifery care.

The Aachen Declaration on Midwifery For All states:

Maternity care policies should henceforth form an integral part of all public health policies, at local, national and European levels.
Such policies should recognise midwifery as a distinct and separate profession from nursing, and from obstetrics.
Autonomous nature EU Member States should introduce legislation strengthening the separate and of midwifery as a profession.
Continuity of care from a domiciliary midwife at primary health care level from conception through to six weeks after the birth should be recognised as the single most important strategy in the promotion of maternal and child health in the European Region of WHO.
EU Member States should introduce changes in national health and insurance systems privileging midwifery care.
EU Member States should introduce legislation giving midwives powers and responsibilities in the provision of maternity care services at community level equal to those currently held by general medical practitioners.
EU Member States should introduce legislation giving midwives prescribing rights in the matter of drugs and other requisites necessary for the practise of their profession; referral rights; hospital admission, practising and discharge rights; and certification rights in the matter of unfitness to work in pregnancy, and in relation to birth, and perinatal death.
EU Member States should ensure that national health and insurance systems give midwives equal remuneration with general medical practitioners and with obstetrician/gynaecologists for the provision of services to women for normal birth.
EU Member States should introduce legislation mandating the collection and publication of statistics in maternity care, measuring perinatal and maternal outcomes by care provider, and obliging maternity hospitals to collect and publish annual statistics on medical interventions, such as Caesarean section.
A charter of rights for women in childbirth, which recognises the right of all women to continuous, one-to-one care from the midwife of their choice, should be drawn up.
Equality of midwifery representation with nursing and medical representation should be recognised as a gender mainstreaming measure in maternity care and related services, and in maternity care policy-making structures at local, national and international levels.
The European Union should fund the establishment of a European Institute of Midwifery, to provide for the educational, research and training needs of midwives.

Midwives are under attack in many different countries.

They often feel very isolated and have no political support groups. Sometimes their colleagues have been cowed by years of institutional bullying and feel unable to offer support. Many midwives are concerned with using their skills to serve mothers and babies but are not interested in the politics of midwifery.
Prosecutions often concern midwives who do not tow the line and who assist at home birth and try to help women give birth physiologically. It looks as if independent midwives who challenge the medical establishment are at risk.
What are the implications of these cases for midwifery and for women's experiences of birth? Midwives are at risk of losing self-confidence when they work independently or take professional initiative. At worst, they will only be safe when they function within an institutional bureaucratic system, keep their place in the hierarchy, and cover themselves legally every step of the way. They will be under pressure to do all investigations possible, intervene early, and let obstetricians make the major decisions. Then they cannot be found responsible. They will warn women that home birth is dangerous and refuse to attend those who do not come into the hospital.
If midwives start to work in this way midwifery will be destroyed. In its place we shall have obstetric nurses. The painful conflict that has continued for so long in North America has now come to Europe. In spite of all the rhetoric of Changing Childbirth and talk about woman-centered care we are faced with a challenge to midwifery and also to women's right to give birth in their own way, in their own time, and in their own place.

Consumer guide to Services in Ireland

Jan 2000
Research organisations in a range of countries are contacting Sheila because they wish to publish information from women about their experiences of giving birth in hospitals, together with hospital protocols and statistics. Sheila' s 1979 & 1984 Good Birth Guides to maternity units in the UK (now out of print) were forerunners of this.
A superb example just published:
Preparing Together For Birth And Beyond - A Consumer Guide to the Maternity Services in Ireland
Cuidiú
Irish Childbirth Trust
Carmichael Centre
North Brunswick Street
Dublin 7
Tel: (01) 872 4501