“Birth in Focus: Stories and photos to inform, educate and inspire.”

From the soft-edge focused front cover photo to the series on the back cover, this is a book which shows through the words of mothers, their midwives and family members, as well as pictures, what is possible when experienced midwives have a philosophy centred in trust of women and their bodily knowledge, motivating and informing their practice. The pregnancy and birth experiences of this book happened as part of the Albany Midwifery Practice which “ran from 1997 to 2009 in Peckham, South East London, caring for an all-risk caseload of local women within the NHS. The unique model of midwifery care included continuity of carer with two named midwives and choice of place of birth. The midwives looked after over 2500 women with excellent outcomes, achieving a home birth rate of over 40% alongside a low perinatal mortality rate”.

In the ‘Forward’ legendary, USA midwife Ina May Gaskin encourages us all by saying that the amazing outcomes of this program can be replicated anywhere “the needs of birthing women are put before other concerns which often enter into maternity care policy-making and practice”. Ina May also challenges midwives, their educators and regulators by saying that the ‘true art of midwifery’ as shown in this book, is to reduce or eliminate fear of birth.

Author, midwife Becky Reed puts the contents of the book in the framework of her maternity history, midwifery career and history in the introduction; “Looking at birth”, as the birth of her first child is the first story of this tome. Her first child was a hospital birth in 1979, illustratings some of the changes in maternity practices since then. However, too many birthing women are still put in a semi-recumbent position despite evidence of the negative impacts on both mother and baby, as well asbeing contrary to the preferences and instincts of women to adopt a more appropriate, supported upright or kneeling position, as demonstrated in the other stories in this book .

Photos in the book were created as Albany midwives carried a camera as part of their birth kits, and women gave them back some of their birth photos to use as part of the 36 week “Birth Talk” for other women on the program. Subsequently many program women thought the use of photos as part of their ‘Birth Talk, “helped them to believe in themselves”. In addition, birth photos were a feature of the settings where the program’s women-led antenatal and post-natal gatherings were held, which often provoked questions and enhanced discussions at these events.  Positive responses to a ‘photo story’ series of articles by Becky in ‘The Practicing Midwife’ encouraged her to create this book. Becky also felt that pictures of labour and birth need to be accompanied by their stories to give them additional meaning and educative value, which is lacking in birth photographer’s web sites and You Tube uploads. Despite the constraints of non-professional photographers (midwives or family members), limited light, tight spaces and often awkward positions of the subjects the photos show the dynamic character of natural labour for each woman. Also demonstrated in these pictures are features of physiological birth rarely seen in hospital deliveries, such as a baby born in its caul, vaginal breech birth, cords left to finish pulsating and women birthing their baby’s placenta.

Currently the majority of midwives and other maternity care practitioners qualify and practice in environments which do not promote, encourage or support physiological labour or birth, and thus such maternity professionals have not seen, nor experienced enough natural labours or births to have developed the skills and confidence to ‘manage’ woman wanting a natural labour and birth, especially outside a hospital. For example, most hospital trained midwives do not feel confident assessing progress of labour through visual and auditory signs or ‘allowing’ women to push on their own initiative as in these stories, rather they rely on disturbing the woman’s rhythm to do a vaginal examination(s). Therefore this book adds to the published research which shows us that use of inappropriate birthing spaces and practices contributes to the escalating rates of childbirth interventions, particularly  for healthy women.

The stories and pictures in this book show women being cared for by midwives who encourage and support physiological birth as a normal life event in familiar, respectful and private environments; women who are trusted to make healthy choices for themselves and their babies. It shows that birth can be normal, healthy and joyous whether it happens at 36  or more than 42 weeks; whether a first or a seventh baby; a baby coming head  or bottom first, or being followed by a twin. Thus this is an essential  book for the reading lists of Child birth Educators, Schools of Midwifery, all Midwives and Obstetricians as well as women’s groups!

Addition: Finally an analysis of the outcomes of this program is available here and show that;

  • Though more than half (57%) of all women were from minority ethnic communities; one third were single and 11.4% reported being single and unsupported. 
  • Almost all women (95.5%) were cared for in labour by either their primary or secondary midwife. 
  • Resulting in high rates of spontaneous onset of labour (80.5%), spontaneous vaginal birth (79.8%), homebirth (43.5%), initiation of breastfeeding (91.5%) and breastfeeding at 28 days (74.3% exclusively and 14.8% mixed feeding). 
  • Of the 79% of women who had a physiological third stage, 5.9% had a postpartum haemorrhage. 
  • The overall rate of caesarean section was 16%. 
  • The preterm birth rate was low (5%). Ninety-five percent of babies had an Apgar score of 8 or greater at 5 minutes and 6% were admitted to a neonatal unit for more than two days. 
  • There were 15 perinatal deaths (perinatal mortality rate of 5.78 per 1000 births); two were associated with significant congenital abnormalities. 
  • There were no intrapartum intrauterine deaths.

Currently in New Zealand where more than 90% women do choose a midwife as their LMC only 3-4 % of births per annum for more than the last decade, have been at home. Meanwhile as elsewhere, rates of intervention (as below) in the labours and births of healthy women have escalated, as more and more women labour in hospitals (87% in 2014) whilst numbers who use primary units (‘birth centres’) has declined to 9% in 2014.

The NZ Ministry of Health’s definition of a Spontaneous Vagainal delivery is “any vaginal birth that does not involve Obstetric assistance or delivery’ and in 2014 did include;

  • 24.4% ARM or Artificial Rupture of Membranes, from 19.0% in 2005, though the membranes protect both mother and baby in labour,
  • 24% Induction of Labour  or IOL;  despite the risks,
  • 26% Augmentation of Labour despite lack of accuracy in assessing progress of labour
  • 27% Epidural despite the potential for care to raise beta-endorphin levels
  • 15% Episiotomy compared to other means to protect the perineum.

These statistics means  that 1 in 2 women had some form of intervention in their labours resulting in possible separation of mother and baby, especially for the 25.9% who ended their efforts with a Caesarean section . This is all despite local research which have similar outcomes as the UK Birthplace study, showing that home and birth centre births result in the healthiest outcomes for mothers and babies.

Meanwhile The Midwifery Council NZ is “The Guardian of Professional Standards” says that “The competent midwife …………………….utilises midwifery skills that facilitate the physiological processes of childbirth and balances these with the judicious use of intervention when appropriate”.

Why Not Home In New Zealand?

“Why not Home?:The surprising birth choices for doctors and nurses” is a new and beautifully produced US documentary exploring the experiences of several family nurse practitioners, obstetrically trained doctors and midwives who choose to deliver (as they call birth) their babies at home, rather than in a hospital. This film reviews the history of birth moving from home to hospital in the USA, the rising and internationally high US caesarean section rates and 2 sets of research about the safety of home birth compared to hospital delivery; all of which are some of the reasons behind these US health professionals asking “Why Not Home”. Continue reading

“Bump: How to make, grow and birth a baby” by Kate Evans

Beginning with a cheeky baby on the cover, ‘Bump’ is packed with wonderful cartoons; many laugh-out-loud funny ones, some hauntingly beautiful which accompany an at times irreverent yet sensitive, evidence based and yet visceral text; a combination which authentically depicts many of the roller-coaster rides of womanhood today. In “Functions of the Orgasms” Michel Odent said “the function of joy in pregnancy is to protect the unborn child against the effects of the harmful stress hormones”, and “to transmit from generation to generation the capacity to be joyful”, thus I recommend this book to all but especially to pregnant women. “Bump” covers the full gamut of reproduction issues; through pre-conception to trying to, or not trying to conceive, early to late pregnancy development and possible losses, preparing for the baby, birth options and rights.   Continue reading

How Birth Matters!

A midwife explains labour and birth from a baby’s perspective!

The knowledge about how to give birth is within every woman.

The knowledge about how to be born is within every baby.

Labour is an instinctive dance between mother and baby !

Birth is a ‘pas de deux’!

Connection is Everything

Growing knowledge and awareness about the physical and emotional implications of the mother-baby connection, and how our actions from conception to early childhood can help or impede this relationship, is resulting in promotion of practices which support this relationship.

In Pregnancy.

Authorities are beginning to acknowledge that parenting begins before birth, and possibly before pregnancy. There is mounting evidence from scientific experiments, and personal stories of children and adults about their experiences before birth, which makes us realise that memory, learning and communication begin in the womb; a long time before we acquire language. Babies in the womb have a fast developing sensory system which allows them to react to individual voices, stories, music, and even simple interaction games with the mother from about the second month (8 weeks) of pregnancy.Therefore the quality of the emotional, as well as the physical uterine environment is affected by the parents, their behaviours and their lives.

Most women become aware of their baby’s movements from about 16 to 22 weeks of their pregnancy, depending on various things like; is this their first baby or not, is the placenta at the front of the uterus which may also be well covered with fatty layers, both form padding which can lessen the sensation and awareness of baby’s movements. These days many women do not notice the time of the first, or subsequent movements as they are busy working long hours, this lack or late perception maybe a sign that a mother needs to slow down, rest so she can connect with and nourish her baby, to help it grow emotionally, as well as physically. Those who study stillbirth in Australia and New Zealand, encourage mothers to be mindful of their baby’s behaviours, advising that as the baby grows the number and types of movements will change depending on the mother’s activity. They also warn that “a change in the number or pattern of movements may be an early sign that the baby is unwell and should be checked” with their maternity care provider, rather than waiting for the next appointment or monitoring. Sleeping on her left side during the last weeks of pregnancy will also helps to nourish and maintain its growth by not compressing her blood vessels which give the womb and baby its blood supply. Drugs like smoking, alcohol and strong pain killers are known to alter a baby’s behaviour, and this is why we need to decrease the exposure of pregnant women to noxious substances such as car fumes and cigarette smoke. Continue reading

Giving birth in a stable might be better than a labour ward

From  on Tuesday, Dec 23 2014 with New Zealand modifications by Denise Hynd

The ‘greatest birth story ever told’ has a lot to teach 21st century policy makers, writes Milli Hill

baby with a santa hat and green background

© Getty Images

When it comes to giving birth, maybe newer, shinier and more technological isn’t necessarily better. The world was baffled recently when new UK guidelines for pregnant women stated quite clearly that hospital was the LEAST safe place to give birth – how very mysterious! Could it be that those beeping machines and vigilant docs, which we’d all been led to believe epitomised progress and were so very essential to our labours, were actually making things worse?!

It seems like the world is finally waking up to the fact that birth is something so fundamentally human – like eating, sleeping, making love – that it does not benefit from the interference of modern technology. With birth, we need to go back to basics, and to allow ourselves to be mammals. And so, although the straw might be a little spiky on the knees, a stable might be just the place to have a baby. Here’s why: Continue reading

Microbirth

More Auckland screenings of Microbirth  will happen in 2015 -if you would like to host one please contact Denise 

“Microbirth” examines evidence which links modern delivery practices with the reduction and loss of some critical biological processes making our children more susceptible to non-infectious diseases through-out their lives. For example recent studies have shown that babies born by Caesarean have an increased risk of developing asthma, type 1 diabetes, obesity and other diseases linked to the immune system;up-to 30% higher than children born vaginally. Other research also shows that the process of vaginal birth which involves a cocktail of hormones for mother and baby in labour, sets the best beginnings for our immune system and subsequent health. International experts in the film also forecast that the current escalation of these non-communicable diseases is a potential world health catastrophe which could bankrupt many nations!

Auckland hospitals Caesarean Section rates in 2013 are; National Women’s 30%, North Shore 30%, Waitakere 24.6%, Middlemore 22% !

Further explanation of the Microbiome and its implications on pregnancy is here; Midwifethinking

Placenta Birth Choices.

The placenta and its care is a vital part of a healthy pregnancy and birth, as together with the baby’s cord, amniotic fluid and 2 membranes or sacs, it is “The Fetal Life Support System” until the baby is living outside the womb.

Each baby and its placenta, cord, amniotic fluid and membranes develop simultaneously following the union of the ovum (egg) and sperm. Placental function begins from implantation until the baby has moved to life outside the womb, if we allow it to complete its work. Continue reading

Love and Fear.

There are only two feelings: Love and Fear

There are only two languages: Love and Fear

There are only two activities: Love and Fear

There are only two  motives, two procedures,

Two frameworks, two results : Love and Fear,

Love and Fear.

Michael Leunig

 

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A loving heart is the truest wisdom. — Charles Dickens
Trust children. Nothing could be more simple, or more difficult. Difficult because to trust children we must first learn to trust ourselves and most of us were taught as children we could not be trusted. — John Holt
I can promise you that women working together - linked, informed and educated - can bring peace and prosperity to this forsaken planet. — Isabel Allende
All change is not growth, as all movement is not forward. — Ellen Glasgow
No other natural bodily function is painful and childbirth should not be an exception. — Grantly Dick-Read
We need to have their hearts before we can open their minds. — Dr Gordon Neufeld
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
Without deviation from the norm, progress is not possible. — Frank Zappa
Nothing in life is to be feared it is only to be understood. Now is the time to understand more so we can fear less. — Marie Curie
The greatest joy is to become a mother; the second greatest is to be a midwife. — Norwegian proverb