Microbirth Premier film screening in Glastonbury

The Premier screening of Toni Harman’s new film will be shown globally on 20th September 2014.
Following the successful screening of her previous film “Freedom for Birth” last year, I am pleased to be able to share her new film in Glastonbury.

“Microbirth” is a new feature-length documentary looking at birth in a whole new way; through the lens of a microscope. Investigating the latest scientific research, the film reveals how we give birth impacts the lifelong health of our children and potentially could even affect the future of humanity.

View a trailer here: http://microbirth.com

Recent population studies have shown babies born by Caesarean have approximately a 20% increased risk of developing asthma, 20% increased risk of developing type 1 diabetes, a similar risk with obesity and slightly smaller increases in gastro-intestinal conditions like Crohn’s disease or celiac disease. All of these conditions are linked to the immune system.

“Microbirth” explores several possible plausible explanations. One hypothesis is that if normal vaginal birth is interfered with or bypassed completely because of Caesarean birth, this could alter the “seeding of the baby’s microbiome”, the critical transfer of bacteria from mother to baby at birth. Scientists suggest this could lead to the baby’s immune system not developing to its full potential. Another hypothesis is the actual process of vaginal birth, including the cocktail of hormones produced during labour, could profoundly affect the baby’s immune regulation and metabolism.

The film’s co-director Toni Harman says, “Caesarean Sections are essential and often are life-saving. However, up until now, no-one has really looked into the long-term impact. This emerging research is painting an alarming picture in terms of future health across populations. There may even be repercussions for the future of humanity. And yet, up until now, I don’t hear any alarm bells ringing.”

Join us on 20th September 2014

In Glastonbury Town Hall , Magdalene street, Glastonbury, BA6 9EL

From  7pm to 9pm for the film premier, followed by after film discussion.

Tickets £5. All proceeds will be donated to Towards tomorrow Together  Registered charity number 1151022.

Parking close by. Disabled access. Refreshments available.

Contact me for further details on 0799247462 or email joy@birthjoy.co.uk


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Radical Midwifery on the Road

?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????According to the Association of Radical Midwives (ARM)  “In the mid 70s, the majority of pregnant women in UK had labour induced by artificial rupture of membranes (ARM) around the date they were “due”. These initials were used when the group needed a name, using the dictionary definition of “radical”, (roots, origins, basics, etc.) which aptly described the basic midwifery skills which they hoped to revive.”

In this spirit I offer a grass roots midwifery information service to women. I am an Independent Midwife, and as such I provide total midwifery care for women and their families, but the numbers I care for are small, and every woman needs good information. I’ve always served women by giving free information by telephone, and running a local ARM group, but again the numbers are limited, and so is my time. But I feel a huge need to pass on my knowledge of maternity rights and choices to women who may not even know that they have a choice.

Am I saying that the NHS is not giving women enough information or choice? No.

Am I saying women are unable to find out this information for themselves?  Certainly not.

Pregnant women just don’t know what they don’t know. First – time mums may, or may not have read widely, they may, or may not have a relationship with a known NHS midwife, and the midwife may be too short of time, experience or knowledge herself to be able to help each individual.  Without adequate information about choices in pregnancy the woman may feel she has no choice, and if things don’t go to plan, she may feel things were done to her without her fully informed consent. Feeling disempowered or not understanding why things were done to you in childbirth, can contribute to postnatal depression. After a poor experience women often look for further information and support to prevent the same happening in subsequent pregnancies.

2541987300_7cf0e2543a_mAs an Independent midwife many of my clients come seeking truly unbiased midwifery information, so they can feel empowered in their current pregnancy. Some have suffered previous birth trauma and wish to avoid similar happening again. But why wait until the second or subsequent pregnancy to get a positive birth experience? The first experience of birth is likely to be the most challenging, so it is important that we as midwives know how to serve you best. Unless you tell us what would help, or hinder you in labour, we will not know. Unless you know your rights and the choices available to you, you will not be able to instruct us in providing the right kind of care for you.

This is where writing birth preferences comes in useful. As an NHS midwife I would meet someone (often for the first time) in labour, and have to discuss all the pros and cons of different birth choices. I  don’t mind explaining at all, but Labour is not the right time to be engaging the thinking part of a woman’s brain!

  • Educate yourselves, know your rights and choices before labour starts.
  • Write your birth preferences down. Discuss them with your birth supporters before labour, and share them with your midwife when labour is underway.
  • If you don’t know why a course of treatment or an intervention is being suggested then please ask.
  • If you don’t understand or don’t like the answer then ask someone else.

The Association for the Improvement in Maternity Services (AIMS) are a great resource for anyone having difficulty getting support for their birth choices. AIMS have a booklet entitled “Am I Allowed?” and all over it’s cover it has the word YES. Nothing can be done to you without your informed consent. If it has not been explained to you fully, you cannot make an informed choice. Please buy this book if nothing else (order from website, under “publications”).

Read also Mary Cronk’s assertiveness phrases and practice them in front of a mirror.

Birth Rights is a new organisation founded by a human rights lawyer. The website contains useful fact sheets on rights in childbirth.

The birth bus
The birth bus

 

If you live local to me then find out when I am next holding a midwifery clinic in my Birth Bus (campervan). I park at various locations locally, to give information and answer queries about rights and choices. Just text or email me for dates and venues. These do vary according to my midwifery caseload.

Remember that knowledge is power, and you don’t know what you don’t know- BUT you can always find out and ask WHY?

 

 

 

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Please Help Save Independent Midwifery by commenting on the Professional Indemnity insurance consultation document

A public consultation is now open to the public until the 17th May 2013. It is your chance to say why professional Indemnity Insurance should not be linked to Midwives registration. This will have far-reaching implications after 25th October when it will become law – unless we can convince the powers that be to not implement it. This is where you can help by commenting on the consultation document. It is a long and wordy process and the issue is hard to get your head around unless you know the history so read a short version here at Birthrights

Question 6 is the most important one, but answer as many questions as you can.  Below are some of my comments. Please feel free to use any part of this to help you phrase your own answers:
“Linking Professional Indemnity Insurance (PII) to midwifery registration will discriminate against Independent midwives. Independent Midwives will be unable to purchace professional indemnity insurance as they are self employed. They are not part of, and most do not want to be part, of a corporate structure. They have chosen to work independently of the NHS to provide a better quality of service to women. As individuals it is impossible to purchase PII.
It suits many Independent midwives to be self-employed for many reasons. Continuity of carer provides better outcomes, and working this way means being on call for all the births on your caseload. The commitment to attend every booked birth requires the ability to re-scedule planned appointments on a daily basis. Many independent midwives also have young children/ elderly parents to care for, and working independently gives a greater flexibilty to their working day. Working for the NHS doesn’t offer this provision.
Women choose Independent Midwives for many reasons, but the majority have found their needs are not met by NHS care. Another group have had bad experiences with the NHS in previous births and need an alternative. The restrictions that insurance companies place on care is the reason many women opt out of NHS care. These same restrictions will apply to the care independent midwives can provide if indemnity insurance becomes compulsory. Just because something is high risk doesnt mean women should not have the right to do it.
The court of human rights have ruled that women are able to choose the circumstances of their birth including where, and with whom they choose to give birth. Making it impossible for midwives to practice independently without insurance is removing women’s human rights!
And what about the rights of Independent Midwives to work and provide for their families? is that not a human right too? Hundreds of Independent midwives will lose their livlihoods, thousands of women will be denied individual choice in pregnancy and birth if it becomes illegal to practice without insurance.
Independent Midwives are highly skilled in facilitating normal birth, including breech birth, and physiological third stage. These skills are in short supply in the NHS leading to an ever increasing caesarean section rate. Caesarean surgery carries serious risks and makes subsequent births high risk – costing the NHS extra time and resourses used, and in compensation claims. Wouldn’t it make sense for the NHS to save money by government supporting the contribution Independent midwives make to the normal birth rate?
I’m afraid that independent Midwives will not simply join the ranks of their NHS colleagues, they will leave the profession. One colleague recently told me she would rather die than return to NHS hospital midwifery. I know that sounds over dramatic but it’s not. Having worked as an Independent midwife for 7 years I understand how the same level of Midwifery care is impossible to achieve on the NHS. Independent Midwives pride themself on their professionalism and high standards – and to some, returning to NHS work would mean lowering those standards. It is impossible for many independent midwives to contemplate returning to giving piecemeal care, on under-staffed wards, with not enough time to provide quality care. It would break many midwives hearts to have to work this way, seeing the daily distress of women uninformed in pregnancy, left alone in labour and unsupported in their attempts to breastfeed.
Without an option to NHS midwifery care women will look for alternatives. I have already heard of the growing movement of unassisted births and women giving birth with doulas, are we to add qualified but illegal and unregistered midwives to the list of choices?
  Many independent midwives want women to be financially compensated for negligent care but fear the restrictions insurance companies will put on the type of care given. Is there any way a no-fault compensation scheme could be provided for these families? I understand there is such a system in New Zealand.
I am truly saddened to think that when my daughter gives birth she will only have the option of NHS midwifery care or illegal birth attendants.
PLEASE DO NOT LET THIS HAPPEN!”

In response to the question on cost I wrote:

“I do not have the necessary monetary cost data to hand, as I’ve been a caring, professional midwife for 12 years, not a politician, statistician or… research fellow.
The important costs that I’ve witnessed are not just of monitary value, so may not be viewed as valuable to this consultation, but they are of paramount importance to women and their families! Women and their experiences should be at the centre of this consultation rather than how much the monitary costs to the NHS will be.
I care for women. I care about what quality of life they have as a consequence of the maternity care they’ve received. I care about the unseen cost of dammaged women and how that impacts on their children, relationships, and our society in general. What cost is there to the traumatised woman who sees herself as dammaged, and unable to realise her own potential as a result of her birth trauma. What cost in terms of postnatal depression, child neglect and abuse, the need for foster care and the potential for future criminal behavour, maternal self harm and even suicide. Suicide is a leading cause of death for women in the period around childbirth. What cost to the children who have lost mothers and partners who’ve lost the love of their life? Do these costs count for anything under our current government?
If you’d like to hear about direct financial costs I’d like you to consider the additional future costs to the NHS of caring for  thousands of women previously cared for by independent midwives. These are often women with complex physical and/or psychological needs, requiring specialised one to one care, to ensure optimum outcomes. Without this specialised care, women have the potential to be further traumatised, with the consequenses already mentioned above. Lack of compassionate, one to one care for vulnerable groups also holds the potential for women who’s needs are not fully met, to sue for negligent care – costing the NHS millions in payouts and increased insurance premiums.
And what about other specialised groups such as those wishing for a peaceful breech birth, or vaginal birth after caesarean? Breech birth skills are woefully lacking in the NHS, and women are informed (often because there is no one knowledgeable or skilled to help with breech birth) that they have no alternative but to undergo abdominal surgery (with all the known risks) to deliver their baby. Independent Midwives are highly skilled in caring for women choosing these types of births. It is well known that surgical birth costs more than straightforward vaginal, midwife-led birth. The complications associated with caesarean surgery cost the NHS much more than normal birth, and the longer term costs of such complications are far reaching. The short term costs of preventing and treating wound infections, and giving blood transfusions are well documented. The longer term costs of caesarean surgery may not be as easy to cost. Treating subsequent postnatal depression (and the future cost implications for the child), further surgery to divide adhesions and the increased risks (and associated costs) on future pregnancies also need to be costed in. A broader view also needs to be taken of the cost implications of women who’ve had a caesarean being less likely to breastfeed. Children who are not breastfed are prone to many more health problems, at huge financial cost to the NHS!
Independent Midwives are highly skilled in facilitating normal birth so wouldn’t it make sense for the NHS to save money by government supporting the contribution Independent midwives make to the normal birth rate?”

I don’t have the comments I wrote on whether this will discriminate against anyone as I was so mad at this point to remeber to copy it. Needless to say it was a lengthy post.

Please, Please comment and ask as many people as you can to do likewise. The more people who bother to add their comments, the more potential we have to halt this requirement to link PII to registration before it becomes law. Respond to the government ‘consultation’ with your views http://consultations.dh.gov.uk/professional-standards/indemnity_for_regulated_healthcare_professionals 

OTHER WAYS TO HELP INCLUDE:

Join the Facebook group: https://www.facebook.com/pages/Choose-your-Midwife-Choose-your-Birth/223503274456877 it doesnt take long and you’ll receive up to date information as it happens.

Email your MP now, find who your MP is here:  http://findyourmp.parliament.uk/

Sign the petition http://epetitions.direct.gov.uk/petitions/44382 this takes just seconds to do.

Ask the Royal College of Midwives union to support us https://www.facebook.com/MidwivesRCM

March with us on the 25th March in London. It will be a peaceful protest to highlight our campaign. The more people attend the more the Government may take us seriously. More information here: https://www.facebook.com/events/337186596400907/

See what this type of care means to women;

here in this Independent article written by a woman who’s given birth with independent midwives twice.

and here on you tube where a woman discusses the importance independent midwifery made to her when her baby was born breech.

There is also a plea from a well respected obstetrician to leave Independent Midwives alone.
 

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Choose your midwife choose your birth campaign 2013

As mentioned in my previous post Independent midwives will be unable to work without professional indemnity insurance after October 2013 and there is no affordable insurance available to them. After this date Independent Midwives will not be able to remain on the midwifery register, and therefore will be unable to provide midwifery care legally. This may not be a problem for every woman, but a significant number of Independent Midwives and the women they care for will be affected. Nhs midwives will also be affected although many are unaware how. Worse still it signals a reduction in choices available to pregnant women which has far reaching consequences.

A wonderful student who is supporting the Choose your Midwife, Choose your Birth campaign created the document below, on what linking PII to registration really means. Please share with all Midwifery colleagues and women.

1. It will cost you MONEY.

Every time a new midwife finishes her training or an NHS midwife moves job, takes a break between jobs or goes onto maternity leave she will have to be either added, removed or amended on the NMC register. There are over 38,000 midwives on the register moving around every week. The NMC will have to administer this scheme. That’s the NMC that is “failing at every level” and has just increased its’ registration fees by 32%. So where will the money come from to fund this extra work? Exactly. YOU.

 2. It will take away your AUTONOMY.

If you have to be insured to be a midwife from October then it follows that you have to comply with any stipulations that the insurers make to be a midwife from October. So if the NHS insurance underwriters decide one day after a nasty lawsuit that homebirth/VBAC/Whatever is too risky for them they might say you can no longer do these things in practice. And you’ll have to obey, else you won’t be insured which means you’re breaking the law. Making a link between registration and insurance puts policy decisions in insurer’s hands, not midwives. Bye-bye autonomy. And talking of breaking the law… 

3. You may be PRACTISING ILLEGALLY without even thinking about it.

Shift running over but still caring for a woman? Stopped in the street to answer a question for a woman or friend? Want to care for your friend in labour who lives outside of your Trust area? Covering a shift for someone else in a different area? Supposed to be on annual leave but offered to cover? Better be checking the terms of your NHS insurance policy to make sure you’re covered, or you’ll be practising illegally. 

4. It will take away CHOICE from women.

Not everyone wants to birth within the NHS. That doesn’t mean the NHS is bad, it isn’t. But some women just don’t want to go into hospital or for whatever reason, they can’t get the birth they want on the NHS. Taking away more choices from women about ANYTHING (but especially about birth) is a bad thing and will lead to…

 5. It will HARM women and babies.

With no alternatives to NHS care, scared women may decide to go it alone. This could have truly devastating consequences for mothers and their babies. 

6. Your WORKLOAD will increase.

Women who would otherwise be cared for by independents may now turn to the NHS. This will further increase the NHS workload and birth rate at a time when resources are already stretched and the birth rate is off the chart. All of this further contributes to burned out midwives and unsafe practice. 

7. Midwifery will LOSE fundamental skills.

Vaginal breech birth, homebirth of twins, homebirth after caesarean section, routine physiological 3rd stage; these are a dying breed in some parts of the NHS. Independent midwifery keeps many of these skills alive in our communities, these are skills that we need to see as thriving and routine if we are to keep from being turned into obstetric nurses. 

8. It will change the perception and future of YOUR profession.

Insurance does NOT keep women safe. One-to-one care from a known skilled midwife keeps women safe. Forcing Independent Midwifery underground due to lack of insurance could bring your profession into disrepute and result in qualified midwives facing criminal charges for delivering care to women who would not otherwise be supported in their choices.

 9. Because our DAUGHTERS and GRANDDAUGHTERS deserve more.

They do. They deserve more than to have their maternity care dictated to them by insurance companies. Insurance does NOT keep women safe. One-to-one care from a known skilled midwife keeps women safe. THIS HAS TO BE STOPPED.

see the original document here: 9 reasons why PII and registration should not be linked

 

WAYS TO HELP INCLUDE:

Join the Facebook group: https://www.facebook.com/pages/Choose-your-Midwife-Choose-your-Birth/223503274456877 it doesnt take long and you’ll receive up to date information as it happens.

Email your MP now, find who your MP is here:  http://findyourmp.parliament.uk/

Sign the petition http://epetitions.direct.gov.uk/petitions/44382 this takes just seconds to do.

Respond to the government ‘consultation’ with your views http://consultations.dh.gov.uk/professional-standards/indemnity_for_regulated_healthcare_professionals This takes a bit longet but is very important. See my response to some of the consultation questions here. Please feel free to use any part of it in your answers.

Ask the Royal College of Midwives union to support us https://www.facebook.com/MidwivesRCM

March with us on the 25th March in London. It will be a peaceful protest to highlight our campaign. The more people attend the more the Government may take us seriously. More information here: https://www.facebook.com/events/337186596400907/

See what this type of care means to women;

here in this Independent article written by a woman who’s given birth with independent midwives twice.

and here on you tube where a woman discusses the importance independent midwifery made to her when her baby was born breech.

There is also a plea from a well respected obstetrician to leave Independent Midwives alone.

Please do whatever you can to ensure women retain choice and midwives are enable to support women in their choices. Please share as widely as possible. x

 

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Mary Cronk’s Assertiveness Phrases

Following on from my “Am I Allowed post” I phoned my dear friend and former colleague Mary Cronk. As well as a good chat with each other, I obtained her permission to post her assertiveness phrases. She re-quoted the phrases that I know by heart, and have recommended to many women. I had the pleasure of working with Mary Cronk for 5 years as an Independent Midwife, and a further 2 as co-teacher of “Once More Unto The Breech” workshops. She is a true Midwife and has spent her life helping women achieve positive birth experiences.

joy and mary307710_251788671525311_932911360_nMary Cronk is an expert in breech birth who has shared the skills of breech birth with midwives and doctors across the United kingdom. She was awarded a MBE for her services to women.

See Mary in action here: Mary

You may find these phrases useful, particularly if told that you are “not allowed” to have your baby at home, or you “have to” be induced, etc.

“I am sure that many others will explain your absolute right to refuse any procedure for any or no reason. The law, and good practice is quite clear. A sensible person will listen carefully to any explanations to why a procedure is proposed, and then should she choose not to have XY or Z she just says no or no thank you. The “allowing” is done by YOU. An asssertive approach is worth cultivating. You may care to commit the following phrases to memory and practice them frequently in front of a mirror. Continue reading

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Birth keeper or Baby catcher?

I felt compelled to comment on a great blog my the brilliant Rebecca Wright today. It can be seen here entitled “Are you a birthkeeper? Then don’t catch babies.” She was commenting upon the language used by birth workers in a facebook post which said “because maternity care providers are not serving mothers’ needs, more doulas and non-medically trained supporters being called on to catch babies.” She made great comment about mothers being the ones who should catch their own babies and why.

I’d like to elaborate further on my comments here, as this is an interesting subject, and I didn’t want to fill Rebecca’s site with my ramblings.

I was privvy to a conversation last year about the midwife’s role, brought about by the looming end to legal independent midwifery care. One party said when Independent midwifery becomes illegal we will be doing what doulas do anyway. The other camp were vehermently defending the title of midwife and not wanting to be compared to the service a doula provides. The arguement got heated (as is the way with passionate women!), and it was mentioned that women dissatisfied with their maternity care were indeed employing doulas to attend their births. Further heated discussion about the legality of this followed.

This got me thinking about what Independent or Authentic midwives do at a birth. I’ve been very honest over the past few years, telling my clients that I won’t actually be delivering their baby, they will. In fact most of my time (between the nurturing/ loving type of things) is taken up writing notes and drinking tea. I need women to realise that its not like on telly where the doctor heroically swoops in at the last moment to pull the baby out. It is the woman’s body, love, sweat and pure determination which get the baby born.

Several years ago I noticed that some women reach down to receive their own babies at the point of birth, but some are ashamed to touch themselves “down there,” especially if they are being watched! As a student midwife I recall watching my mentor move a woman’s hand away so she herself could ‘do’ the “delivery”. I’ve never been very directive myself, and have learnt the most by observing what women do naturally. Some women need to be informed that catching their own baby is possible as the power has so often been taken away from them. Professionals sometimes forget that they are there to serve the needs of the mother and baby – and not tell her what to do! (another post brewing on the balance of power). I remember telling a friend pregnant with her second child that I thought she could catch her own baby, for a number of reasons. I had seen many women slow down the birth of their baby if it was coming quickly and others who protect their own body in this way, giving tissues time to stretch (after practicing 11+ years I have never seen anything worse than a second degree tear). My friend did catch her own baby and tells all her friends that they can too!

empowered birthI’ve been mulling over what it means to be a midwife, what Independent midwives can call themselves, and how they can still serve women after October this year. I’ve also been thinking about what difference there would be between what a doula or I could legally do at a birth. There is potential for several posts on this, so I’ll try to stick to the current theme.

As a midwife I know it is the woman’s baby and not mine. I’m sure he prefers his mothers touch to mine, and encourage women to receive their own babies. I’ve shied away from unessesary internal examinations, and refrain from telling women how, or when to push, because I have attended many births where the mother does something totally unexpected and it turns out brilliantly. I remember being present at a birth centre birth where I was the second midwife. The woman was in advanced labour and spontaneously pushing with her first baby . We were prevented from being nosey, birth coach midwives, as visibility in the room was poor. The lights were dimmed and the water was a little cloudy, so our torch light couldn’t penetrate the water. Despite our efforts with torch and mirrror we could see nothing. I was concerned that I wouldnt be able to help her prevent a tear if I couldnt see when to tell her to pant, or give smaller pushes. As she pushed she spontaneously reached down and told us that she could feel the baby advancing, and before long told us baby was emerging. She lifted the baby triumphantly to the surface knowing she had done it all herself! We examined her perineum a while later and she had no tears. I told myself that women can obvoiusly prevent tears better than I can with all my experience.

I cannot bear midwives or doulas who brag about their ‘catches’ or how many deliveries they’ve done. I’ve no idea how many births I’ve attended (although it must be several hundred by now), and feel that keeping numbers makes it into some unsavoury sort of competition (like notches on a bedpost), rather than a unique event in someone’s life! Its a shame this bad habit starts in midwifery training where students have to get 40 deliveries to qualify as a midwife. Its not about numbers, its about people. I fail to see what student midwives learn when they are shoved into rooms to deliver a baby at the last minute, without knowing the woman, just to get their numbers. It can’t be nice for the mother either.

Being an authentic midwife means having the wisdom to not do everything you’ve been taught to do. The past 10 years of practice have been about unlearning the medical model, and learning from women. I like to think of it as a reverse Ina May Gaskin midwifery journey. A journey back to basic loving care, and being a birth keeper for the women and babies I serve.

Last word from Rebecca Wright: “Not all doulas or midwives are birthkeepers, of course, but the essence to me of this concept is exactly what you express here: service to mothers and to birth. Birthkeeping (and authentic midwifery) to me is about holding mothers and babies at the centre of their own experience, bringing with us whatever skills or talents we possess that are needed in that space, but always with humility and discernment.”

Thank you Rebecca for fueling my fire. xx

 

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2013 A New Era in Midwifery or Withdrawal of Women’s Childbirth Choices?

I original wrote this at the beginning of 2013 when Independent Midwifery was seriously under threat of becoming illegal if they failed to obtain professional indemnity insurance (PII) before 25th October 2013. At the 11th hour we have a glimmer of hope due to the hard work of Independent Midwives UK (IM UK). These dedicated midwives have failed to give up, and have found a workable insurance product. Whilst having compulsory insurance was not welcomed by every member of IM UK, it will soon be the only way of legally continuing to work as a midwife in the UK.

For the majority of women the loss of independent midwifery will make no difference to them as they’ve never even heard of Independent Midwives. Many are happy doing what everyone else does, not questioning their care providers, assuming health professionals will care for them when their time comes to give birth. Some may have a rude awakening as they find themselves in hospitals which are short staffed and therefore ill-equipped to care as well as they’d like. When women are denied their choice of birth at home due to staff shortages, or are not supported in their choices they may seek out an alternative. Birth trauma and caesarean rates rise each year, and women deserve choice in care provider and alternatives to the NHS model if needed .

Independent Midwives are fully qualified, Registered Midwives who have chosen to work outside the NHS to fully practice their midwifery skills. They are regulated like any other midwife, and provide one to one care for women during pregnancy, birth and up to 28 days postnatally. Unlike midwives that are employed by the NHS, Independent Midwives have not been able to purchase Professional Indenity Insurance (PII) since 1994. Since then Independent Midwives have practiced without insurance which means we are personally liable for any clinical negligence claim against us. This has not discouraged women from hiring Independent Midwives as they value the benefits of individualised care.

Independent Midwives provide one to one care for women. This type of working relationship allows women to get to know and trust the person who will be present at the birth of their child. Women really value this professional relationship, and midwives get a great deal of job satisfaction from working this way.

So why are they under threat of becoming illegal? Because a European directive has been passed which makes it compulsory for professionals allied to medicine (which includes osteopaths, chiropractors, midwives etc.) to have Professional Indemnity Insurance (PII). Our government decided to implement this in England this year, despite being informed that Independent Midwives cannot obtain PII due to being self employed. A deadline to have insurance was initially set for October 2013, but this has now been moved to February 2014. Nursing and midwifery council published this statement at the beginning of October. Without professional indemnity insurance Independent Midwives will not be legally be able to care for women in labour, although some may be able to provide antenatal and postnatal care. Independent Midwives will lose their livelihood and women will have less choice in childbirth.

Picture-014.jpg

This is a human rights issue, as women will no longer be able to choose who cares for them throughout pregnancy and childbirth. Unlike other areas of healthcare, women will be denied the option of privately employing a health professional of their choice. This doesn’t sound too important for the majority of women, but it is very important for the women who do not have good NHS midwifery services in their area. Some women who’ve had previous caesareans would like to give birth at home, women who’s baby is in the breech position often have difficulty finding a midwife skilled in breech birth, women who’ve been scared or scarred by previous NHS experiences may like an alternative, some want to know there will be a midwife available for their homebirth, or just to know the midwife who will be caring for her. These women will be denied choice.

IM UK have been liaising with the government to implement our insurance but they are slow coming to our aid. See more about the campaign, donate or find out how you can help here.

So what choice will women have after February 2014 if the government does not help us implement our insurance? Women would then have the choice of NHS midwifery care, or no midwifery care. This worries many midwives, as although childbirth is normally a straightforward biological function, it can be advantageous to have a midwife present at times when a rare complication occurs. Of course women have the right to take responsibility for their birth and give birth unassisted, but this should be an informed descision, and not one made through lack of choice or fear of NHS care. But why should women have to give birth alone to guarantee a peaceful, uninterfered-with birth?

There is hope that women will demand one to one midwifery care be available to all, on the NHS. It worked in New Zealand so could it work here? There are small pockets of case loading midwives appearing such as one to one and neighbourhood midwives but not enough to care for all women who need them. If women are denied the choice of nothing other than NHS care there would be a possibility of an underground movement of illegal midwives, or unqualified birth attendants, called to attend birthing women. There are similar situations in parts of America where women seek alternatives to institutionalised care, and again I don’t condemn this if it is what women want. Would women be able to discern if an illegal midwife has been previously trained and qualified as a midwife, or if she is a doula? Would it matter to most women who opt out of NHS care? My fear is, that like other parts of the world, those who continue to answer women’s calls to be cared for in this way will be penalised for doing so. It may come in the form of fines, bad publicity, or as in Hungary, the imprisonment of midwives. But also that women may not know if they have fully qualified caring for them if they are deemed illegal.

Taking away women’s choice of legal birth carer will not stop women making choices, it will only encourage women to make alternative and possibly illegal choices.

 

For further information on Independent Midwives see Independent Midwives UK

For Information on childbirth rights and choices see the Association for the Improvement in Maternity Services (AIMS)

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The Third International Breech Birth Conference. Washington DC November 2012

Robin Guy

Heads Up breech birth conference

I was lucky enough to be invited to lead a workshop at this years International Breech birth conference.

My qualifications are that I have been lucky to work with Breech birth expert Mary Cronk MBE as an Independent midwife. We attended several breech births together and thus I started to learn breech birth skills. Our midwifery clients alowed us to take photos of their births for teaching purposes, and these have further added to our knowledge as we studied the many and varied ways breech babies are born.

My workshop was entitled “Arse Backwards” as my journey to learning breech birth skills started with the most unusual births. A double footling, a foot then knee, a foot and extended leg, VBAC breech birth - all at home, were marvelous to attend and record, to share with other health professionals and women expecting breech presenting babies. Unfortunately I do not have permission to share these photos on-line which is why Mary Cronk and I travel the country (and abroad) sharing the stories and skills of breech birth.

My presentation told the story of how I learnt breechbirth skills, and how important it is to share these skills with others, to give women the option of skilled birth attendants at their breech birth. I took along video footage of Mary Cronk sharing her wisdom which was very well received.

I also learnt a tremendous amount at this conference which will aid me in the future care of women planning spontaneous breech birth.

I hope to have time to write up the highlights, but until then check out the brilliant Rixa Freeze’s blog

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Association of Radical Midwives monthly discussion group.

This is a local group for the support of peaceful pregnancy, birth and parenting. Hosted by Joy Horner, radical midwife, mum, lecturer and some day writer. Inspired by the Freedom For Birth film I am determined to impart information about human rights in childbirth, facilitate discussions, and to support women on their journeys to parenthood. You don’t have to be a midwife, a radical, or a female to attend. All those with an interested in women’s rights and experiences in pregnancy and childbirth are welcomed. These stimulating monthly discussion groups are designed to encourage experience sharing and debate, accompanied by tea and cake. All welcome. Donations for refreshments welcomed as 50% given to local charity Towards Tomorrow Together.

2013 Meetings at my house 7:30pm-9:30pm:

Thursday 8th August - Birth rights and choices.

Tuessday 3rd September - Waterbirth evening.

Thursday 3rd October Postponed due to midwifery commitments.

Thursday 7th November - Am I allowed? how to get the best from your pregnancy, birth and postnatal care experiences.

Thursday 5th December - Blissful, ecstatic or orgasmic birth?

Please phone or text 07939247462 prior to attending the meeting to confirm date and location details. I am a practicing midwife so there is a chance I would have to reschedule a meeting if attending a birth.

Please note that although children are welcome they are your responsibility at all times, as I do have free-roaming teenagers, lurcher and elderly cats.

The Association of Radical Midwives are midwives, student midwives and others in the UK committed to improving the maternity care provided by the NHS. We strongly believe that all women have the right to a service tailored more closely to their needs, and a sympathetic attitude on the part of their professional attendants.

We are primarily a support group for people having difficulty in getting or giving  sympathetic, personalised midwifery care, and those who wish to provide good care. A few of us are working independently outside the NHS, in order to offer a more woman-centred,one-to-one, style of practice, which at present is not widely available within NHS maternity services.

In the mid 70s, the majority of pregnant women in UK had labour induced by artificial rupture of membranes (ARM) around the date they were “due”. These initials were used when the group needed a name, using the dictionary definition of “radical”, (roots, origins, basics, etc.) which aptly described the basic midwifery skills which they hoped to revive.

Held in our homes in Somerset, the group meet monthly to share skills and knowlege to empower women to have the best possible maternity care experience. Phone me or e-mail me at joy@birthjoy.co.uk for details of the next meeting.

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Taunton Birth Forum 4th September 2012

I was delighted to have made it to The Taunton Birth Forum this month as I have had such a busy Summer I have missed a few. It is always a pleasure to See Eleanor Copp and her husband Simon and learn from the speakers she invites along.

This month was a real treat with speaker Katherine Ukleja teaching about the embryonic face. katherine is a Cranio Sacral Therapist, teacher and lecturer. She has also undergone prenatal and birth training with Ray Castellino.

Katherine started off explaining how human babies are born immature compared to other species, and how this means we are dependent on our parents for our basic needs (warmth food etc). Babies are reliant on face to face contact which enables their brain to develop. The baby’s “social nervous system” allows babies to pick out a human face and mimic facial expressions (such as sticking their tongue out) within minutes of birth. This allows baby to engage with parents and communicate it’s needs, as it is helpless otherwise. Through this social engagement and play the baby’s nerves learn to “self regulate”. The baby’s face is a major form of communication, and the helpless baby relies on parents being able to read it’s facial expressions.

Now the technical part

The embryonic stage of development lasts until 8 weeks. during this time all body structures are present and just develop further beyond that point. At 3-5 weeks of development the baby’s face begins to develop. It develops between the brain and the heart in a series of folds that used to be called gills, as they resembled those of fish.

The face is where the internal and external world meet. the outer world covered by the skin of the face, and the inner world of the body, with entrances at the mouth and nose. Exteroception being the sensitivity to stimuli originating outside the body and  interoception being sensitivity to stimuli originating within the body.

The structures of the face and head develop in the mesoderm (the middle germ layer of an animal embryo, giving rise to muscle, blood, bone, connective tissue, etc).  when the mesoderm is compressed it forms cartillage and when it is stretched it becomes membrane. Bone then develops from the cartillage. The base of the skull is formed from cartillage and are less moveable than the upper cranium. The cranial nerves develop in the folds of the embryonic face and make up what is known as “the social nervous system”. The cranial nerves supply the facial muscles, help babies orientate their heads towards their parents, and alow them to identify the human voice over background noise. The nerves that control expression are very important to humans. As adults we read facial expressions to tell if another human is safe to approach.

One branch of the cranial nerves, the vagus nerve, supplies the heart and lungs. it modulates the heartrate, enabling enough blood to supply the brain. It also allows baby to coordinate sucking, breathing and communicating. The cranial nerves exit the head at the base of the skull.

Because of our large brains our babies need to be born relatively immature. To enable passage through their mother’s pelvis the upper bones of the skull develop seperately and can move over each other (moulding) during the birth process to navigate through the pelvis.

 

As baby travels through the pelvis it moves under it’s mother’s pubic arch, and at this point there is potential for the nerves to be compressed or overstretched. This is more likely in instrumental births like forceps, ventouse and caesareans where traction is applied to the head to pull the baby out. There is also a possibility of this if the baby is pulled out by the head during a so called normal birth. (Note from Joy: in the normal birth process there should be no pulling on the baby’s head!).

If these nerves are dammaged the baby can suffer feeding problems, pain from the injury, impaired hearing and facial expressions. Cranial nerve injury can also affect arousal of the vagus nerve with increased heartrate, inability to sleep and colic. All of these injuries affect the baby’s ability to communicate with it’s parents, and their empathy with their baby. A traumatised newborn baby feeling fear cannot use the “fight or flight” mechanism, so develops a self preservation behaviour of freezing or playing possum. This makes communication even more difficult.

Babies need to communicate face to face from birth as eye contact and empathy encourage brain development. Playing with babies and sharing joy increases dopamine and oxytocin production in the baby, which increase brain growth. In babies the right half of the brain develops first. This ensures emotional strength develops before intelligence. The stimulation of the right half of the brain is important in the first year after birth, as without stimulation these areas can atrophy. A well developed brain leads to empathetic behaviours in the child rather than antisocial ones.

It is a survival mechanism for babies to be able to communicate. Babies read the emotional tone of their carers. If parents are unhappy then the baby will be unhappy.

What I’d like to share from what I learnt is that:

  • Babies are born very immature and depend on us for their survival.
  • Babies are ready to communicate with their parents from the moment of birth.
  • The birth needs to be gentle to avoid dammage to the cranial nerves.
  • No pulling babies out by their heads!
  • If a baby’s nerves have been dammaged he may be less able to feed or communicate his needs.
  • These injuries can heal with time but craniosacral therapy can help.

Thank you for sharing your wisdom Katherine. xx

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