I Believe |
the maternity phase in a family's life is one of the most important in the foundation for that family. This first experience will inform the ones coming after it.
that Pregnancy, Childbirth and the postnatal period are part of a natural or normal physiological process of the human body and these processes need to be protected and promoted before the use of any intervention. in Continuity of Care for every Mother and each family during pregnancy, childbirth and postnatally and I believe that that care is best delivered in a relationship-based model. Fully qualified and educated Midwife/s who are specialist Maternity Care providers are best suited to deliver care in the health paradigm, with additional care providers as needed. that individuals must be fully informed and engaged in their healthcare for it to be meaningful and successful and I believe that health care is best delivered in a consumer-centric model. |
Childbirth - a Normal Physiologic/al Process of a Human Body
There should be no doubt that living organisms have many normalised physiological processes, chief among these is the process of bringing about new life. Survival, is, after all, our chief concern. Due to many contributing aspects
A normal physiologic labor and birth is one that is powered by the innate human capacity of the woman and fetus. This birth is more likely to be safe and healthy because there is no unnecessary intervention that disrupts normal physiologic processes.17 Some women and/or fetuses will develop complications that warrant medical attention to assure safe and healthy outcomes. However, supporting the normal physiologic processes of labor and birth, even in the presence of such complications, has the potential to enhance best outcomes for the mother and infant.
Childbirth. There are consequences to Intervention.
Developmental Origins of Disease Paradigm: A Mechanistic and Evolutionary Perspective
https://www.nature.com/articles/pr2004210
https://www.nature.com/articles/pr2004210
"Moreover, it lends to the growing understanding of the remarkable dynamic nature of our metagenome and its role in vertical transmission of the microbiota through subsequent generations."
Our Microbial 'heritage' is impacted, to what degree we are yet to find out, but we know there is an impact. The Human Microbiome differs with pregnant and non-pregnant individuals, distinctively.
Drawing on their extensive research for Microbirth, authors Toni Harman and Alex Wakeford reveal a fascinating new view of childbirth and how microscopic events during pregnancy, birth and breastfeeding can have lifelong consequences not only for ourselves and our children, but also for the species as a whole.
Microbirth film, book, research and education series
Drawing on their extensive research for Microbirth, authors Toni Harman and Alex Wakeford reveal a fascinating new view of childbirth and how microscopic events during pregnancy, birth and breastfeeding can have lifelong consequences not only for ourselves and our children, but also for the species as a whole.
Microbirth film, book, research and education series
Childbirth as an experiment.
Most Women and families are exposed to a maternity healthcare system based in a disease management paradigm. Women's first encounter, often when they find out they are pregnant, is marred by the medical lens which is dictated by strict constraints and does not take into account the whole person in the context of their family and community.
Health Paradigm vs Disease Management Paradigm
Health Paradigm vs Disease Management Paradigm
Even though many vertical programmes have become more “diagonal” by incorporation of an element of health system strengthening, we are still toiling within the same paradigm as before. To make real progress on global health inequities we must break free from the traditional biomedical model.
It is debatable whether planned home birth or planned hospital birth should be considered the experimental intervention. In line with Archie Cochrane we will consider planned hospital birth as the experimental intervention. Hospital practices vary a lot (EURO‐PERISTAT 2008) and in many places there is a high intervention rate (Sakala 2008). Home birth practices also vary, but it is a common feature that only very few interventions can be carried out without transfer to hospital. Home birth is not only a birth that takes place in a specific place, it is also as a way to perform birth, as a range of childbirth practices (Mansfield 2008). “[...] the act of giving birth to a child is never simply a physiological act, but rather a performance defined by and enacted within a cultural context” (Jordan 1997; Romalis 1981). Thus both the planned hospital and the planned home birth options cover a broad range of actual practices.
Childbirth is a Psycho-Spiritual experience
belonging to the MotherBaby dyad
where Medicine has the Privilege to Interact with and,
a Responsibility to uphold the Integrity of.
belonging to the MotherBaby dyad
where Medicine has the Privilege to Interact with and,
a Responsibility to uphold the Integrity of.
Holding the Family Unit in Reverence
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The Seed of A CommunityThe Family Unit is a Seed in a wider Community. Seeing maternity care within this context we realise the wider implications our decisions have on the future.
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We Need To Get Talking
The need for Alliancing has never been more apparent. Fragmented care is leaving innumerable families in disillusion and long-lasting consequences.
+ We also need to talk about about experiences in a meaningful way.
Sensationalisation of singular cases promotes a fear-based culture driven by an often mis-guided perceived risk.
+ The health of mother and baby are inextricably linked
The Stakeholders in Maternity
write intro
Who are the stakeholders in maternity care?
Why is the consumer the main stakeholder in maternity care?
The Consumer is the main stakeholder. Without the consumer there is no care needed and we have no services to supply. The consumer is the person that pays, whether through taxes or direct pit of pocket expenses. It is often misunderstood that healthcare is meant to be consumer-centric and elements that are not consumer0centric are allowed to steer the narrative and impact quality care.
Which elements impact on the delivery and reception of maternity care?
How do we improve maternity healthcare on an individual basis and at a systems level?
1. Start by listening
2. Get connected! Form Alliances
3.
- The Consumer is the main stakeholder
- The community in which consumers live, work and raise their children, this includes local councils
- Policy makers directly impacting families
- Academia who teach maternity care
- Researchers
- Providers of healthcare and clinicians
- Government, specifically Health
Why is the consumer the main stakeholder in maternity care?
The Consumer is the main stakeholder. Without the consumer there is no care needed and we have no services to supply. The consumer is the person that pays, whether through taxes or direct pit of pocket expenses. It is often misunderstood that healthcare is meant to be consumer-centric and elements that are not consumer0centric are allowed to steer the narrative and impact quality care.
Which elements impact on the delivery and reception of maternity care?
- Existing culture surrounding maternity care and childbirth
- Mixed messages in agenda-based research
- Hospital policies
- Clinicians unions, governing and representative bodies
- Insurance products for health care providers, clinicians and healthcare groups
- Legal aspects, specifically the Medico-legal framework in which providers and clinicians operate and the regulatory framework within which clinical services are delivered. At any rate, the constraints this lens applies to every single clinician in all medical settings without exception.
- Fragmented care and varying degrees of healthcare quality on offer throughout a community, state or country
- Stressful and conflicting working conditions for clinicians
How do we improve maternity healthcare on an individual basis and at a systems level?
1. Start by listening
2. Get connected! Form Alliances
3.
Midwives Matter
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What Matters Most |
Openness Matters
Truth matters
Show the AMA example, show the review example.
How do we het to truth? We start getting honest.
How do we het to truth? We start getting honest.
Honesty matters
Mothers full stories about their full experiences matter. We cannot cherry pick what serves us to explain what is going on. We need to look at the whole picture and this includes being honest about the history and success of specific models of care. It also includes the very real fact that for both consumer and clinician, the experience of childbirth is qualialistic in nature. Subjective to their own experiences in and of life.
Education Matters
There are several aspects of education that impact maternity and the maternity care a woman and her family have access to. One of these is the level of education provided to various clinicians who may end up with the title midwives. The other very important ascot is that the current education system pits various models of care against each other and polarises the environment in which maternity care is delivered, rather than encourage them (or even make them) communicate and collaborate effectively. For many OB's midwives act in a subservient role to them and even junior doctors in training. In New Zealand, a Midwife is considered a Maternity Specialist and able to lead care for a woman and her family through pregnancy, childbirth and postnatally.
Relationships matters
Continuity delivered within a relationship based model
Stakeholders matter
Acknowledgement of all parties involved in maternity care, chiefly among these the consumer of the care is imperative If we want to truly understand and reform maternity care.
Mothers, Matter.
the quality and depth of information that you are exposed to is in direct relation to your beliefs, and, the ideas you are open to - your willingness to Listen.
Research, Resources and the Bottom Line.
Below you will find a list of the latest in quality evidence-based research relevant to maternity care.
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A Normal Physiologic Process
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Cascade of Hormones during Childbirth
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The Cascade of Intervention
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The relevance of Midwifery in delivering excellent maternity care - Lancet
The Lancet Series on Midwifery
Source: The Lancet
Executive Summery: The essential needs of childbearing women in all countries, and of their babies and families, are the focus of this thought-provoking series of international studies on midwifery. Many of those needs are still not being met, decades after they have been recognized. New solutions are required. The Series provides a framework for quality maternal and newborn care (QMNC) that firmly places the needs of women and their newborn infants at its centre. It is based on a definition of midwifery that takes account of skills, attitudes and behaviours rather than specific professional roles. The findings of this Series support a shift from fragmented maternal and newborn care provision that is focussed on identification and treatment of pathology to a whole-system approach that provides skilled care for all.
2 of the Key Messages (see link for the whole summery in pdf.):
Source: The Lancet
Executive Summery: The essential needs of childbearing women in all countries, and of their babies and families, are the focus of this thought-provoking series of international studies on midwifery. Many of those needs are still not being met, decades after they have been recognized. New solutions are required. The Series provides a framework for quality maternal and newborn care (QMNC) that firmly places the needs of women and their newborn infants at its centre. It is based on a definition of midwifery that takes account of skills, attitudes and behaviours rather than specific professional roles. The findings of this Series support a shift from fragmented maternal and newborn care provision that is focussed on identification and treatment of pathology to a whole-system approach that provides skilled care for all.
2 of the Key Messages (see link for the whole summery in pdf.):
- These findings support a system-level shift, from maternal and newborn care focusedon identification and treatment of pathology, to a system of skilled care for all, with multidisciplinary teamwork and integration across hospital and community settings. Midwifery is pivotal to this approach.
- Midwifery is associated with more efficient use of resources and improved outcomeswhen provided by midwives who are educated, trained, licensed, and regulated, and midwives are only effective when integrated into the health system in the context ofeffective teamwork and referral mechanisms and sufficient resources.
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Continuity of Care
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Informed Consent and Decision Making
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Human Rights in Childbirth
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A comparison of maternity models of care - Cochrane
Midwife-led continuity models of care compared with other models of care for women during pregnancy, birth and early parenting
Source: Cochrane Cochrane Database of Systematic Reviews 2016
Authors: Sandall J, Soltani H, Gates S, Shennan A, Devane D
Published: 28 April 2016
Summery: The main benefits were that women who received midwife-led continuity of care were less likely to have an epidural. In addition, fewer women had episiotomies or instrumental births. Women’s chances of a spontaneous vaginal birth were also increased and there was no difference in the number of caesarean births. Women were less likely to experience preterm birth, and they were also at a lower risk of losing their babies. In addition, women were more likely to be cared for in labour by midwives they already knew. The review identified no adverse effects compared with other models.
Source: Cochrane Cochrane Database of Systematic Reviews 2016
Authors: Sandall J, Soltani H, Gates S, Shennan A, Devane D
Published: 28 April 2016
Summery: The main benefits were that women who received midwife-led continuity of care were less likely to have an epidural. In addition, fewer women had episiotomies or instrumental births. Women’s chances of a spontaneous vaginal birth were also increased and there was no difference in the number of caesarean births. Women were less likely to experience preterm birth, and they were also at a lower risk of losing their babies. In addition, women were more likely to be cared for in labour by midwives they already knew. The review identified no adverse effects compared with other models.
The World Health Organisation position on maternity care
WHO recommendation on midwife-led continuity of care during pregnancy
Source: WHO - the World Health Organisation
Published: 1 November 2016
Methods: The quality of the scientific evidence underpinning the recommendations was graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) (5) and Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) (6) approaches, for quantitative and qualitative evidence, respectively. Up-to-date systematic reviews were used to prepare evidence profiles for priority questions.
Recommendation: Midwife-led continuity-of-care models, in which a known midwife or small group of known midwives supports a woman throughout the antenatal, intrapartum and postnatal continuum, are recommended for pregnant women in settings with well functioning midwifery programmes.
Source: WHO - the World Health Organisation
Published: 1 November 2016
Methods: The quality of the scientific evidence underpinning the recommendations was graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) (5) and Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) (6) approaches, for quantitative and qualitative evidence, respectively. Up-to-date systematic reviews were used to prepare evidence profiles for priority questions.
Recommendation: Midwife-led continuity-of-care models, in which a known midwife or small group of known midwives supports a woman throughout the antenatal, intrapartum and postnatal continuum, are recommended for pregnant women in settings with well functioning midwifery programmes.
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Baby Friendly Health Initiative
The Baby Friendly Health Initiative (BFHI) is a joint UNICEF and the World Health Organization (WHO) project that aims to give every baby the best start in life by creating health care environments where breastfeeding is the norm and practices known to promote the health and wellbeing of all women and babies are followed. ‘Baby Friendly’ accreditation is a quality assurance measure that demonstrates a commitment by the facility to offer the highest standard of maternity care.
The Baby Friendly Initiative in Australia Q: Is your hospital a Baby Friendly Hospital? |
The Role of Microbes in Childbirth
Q: is your care provider up to speed on the role microbes play in short and long-term health and what are the policies they have in place to support optimal ... and least intervention..
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The First Hour Post Birth
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Due Date Concerns
There is no such thing as a 'due date'. The term due date is misleading and unfortunately it has become the norm to use, even amongst practitioners and clinicians. The correct medical term for defining a term in which a baby may be born, is 'estimated date of confinement', sometimes referred to 'estimated date of delivery'.
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Induction of Labour
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Pain during labour
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The medico-legal framework - know what your healthcare teams are up against and why they may not be able to provide consumer-centric care
Know your healthcare provider.
The quality and depth of information that you are exposed to is in direct relation to your beliefs, and, the ideas you are open to - your willingness to Listen. This applies to your healthcare provider too. Oftentimes, beliefs are based on values and truth is subjective. What line of treatment is best for each patient varies widely depending on the clinician addressing that patient. Assuming your provider is basing their decisions on evidence and best practice is naive and as the consumer it is important that you take measures to ensure you are fully informed and engaged in the delivery of your healthcare.
The quality and depth of information that you are exposed to is in direct relation to your beliefs, and, the ideas you are open to - your willingness to Listen. This applies to your healthcare provider too. Oftentimes, beliefs are based on values and truth is subjective. What line of treatment is best for each patient varies widely depending on the clinician addressing that patient. Assuming your provider is basing their decisions on evidence and best practice is naive and as the consumer it is important that you take measures to ensure you are fully informed and engaged in the delivery of your healthcare.
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Quality of Research
Not all research is quality research! A bit like the commercial white bread variety vs the quality, hand-made by an experienced baker sourdough variety, research has varying degrees of quality.
When considering research, look out for qualitative and qualitative. |
Dissemination of Research
The 17 year gap
How Research is communicated can be damaging. When research is sensationalised by healthcare professionals, providers and the media we put women and families at greater risk than necessary. Medical risk needs to be seen in perspective within a big-picture framework. There is an undeniable link between sensationalism and |
Consumer engagement
In Australia, standard two.....
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Overdiagnosis
In Australia, overdiagnosis is being taken seriously, yet we are still to see this attention carried over into maternity care.
Overdiagnosis is comprised of a trifecta of situations: Overdetection, Overdefinition and Overselling. Overdetection refers to the identification of abnormalities that were never going to cause harm, abnormalities that do not progress, that progress too slowly to cause symptoms or harm during a person’s remaining lifetime, or that resolve spontaneously. In Pregnancy and Labour and in Labour in particular these are al relevant, in particular, there are many aspects of the natural physiological process the body conducts while delivering a baby from the womb, that can and do resolve spontaneously.
Overdiagnosis is comprised of a trifecta of situations: Overdetection, Overdefinition and Overselling. Overdetection refers to the identification of abnormalities that were never going to cause harm, abnormalities that do not progress, that progress too slowly to cause symptoms or harm during a person’s remaining lifetime, or that resolve spontaneously. In Pregnancy and Labour and in Labour in particular these are al relevant, in particular, there are many aspects of the natural physiological process the body conducts while delivering a baby from the womb, that can and do resolve spontaneously.
Bio Individuality and the Bottom Line.
Taking into account all the above research, at the end of the day each individual is of unique bio-individual - constitution and condition - make up and has specific circumstances both of nature and nurture in origin, that determine, what is best for that particular individual. No amount of research, quality or not, can be substituted for the need for individualised and relationship based-care that is consumer or patient-centric.
Childbirth. Inextricably linked to Women's Rights.
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Not all people that give birth or for that matter, become pregnant, identify as a woman. However, the overwhelming majority of people that do become pregnant, are, women. I therefor tread with the utmost respect for women, their history and their human rights when I say that Childbirth and its sphere are inextricably linked to women's rights and furthermore, lie at the centre of women's most important issues. Childbirth and what happens to women during the time in which they give birth and the time that follows, is often left out of the debate over reproductive rights. Why? Because women are afraid to face their greatest violations alone.
How you experience childbirth is directly related to you being a woman. Why you may have an aversion to call an issue a woman's issue, is directly related to how women have been treated over the course of history. Specifically around maternity care, women and their carers have faced discrimination, criminalisation and violence in enough an amount to leave a daring scar on our genetic, cellular and cultural memory. Being a woman is dangerous and supporting women during maternity is very dangerous. We perpetuate this trauma over and over again in an involuntary act. The systems created around us, do the same. We are all, unwittingly, caught up in the never-to-be-won game - let's control life. I truly believe, our chief subconscious tactic to perpetuate this fallacy is by trying to control life becoming - or the place where it all starts - in a woman's womb. How, as women and feminist, we have "missed" this link, is not beyond me. But there is no doubt we overlook it all the time and it is detrimental to us, our children and families and this unique planet we live on.
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Your tools |
Ask Questions! -
Listen and Tune in -
Get Involved -
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