Tuesday, May 26, 2009

VBAC in South Africa

Thanks to the wonderful Lia, women of South Africa now have access to help, support and advice on how to have a VBAC!



Friday, May 22, 2009

C-sections 'a rational choice'

First read (by clicking the link) -

"Women are often urged to opt for a "natural" birth - such as having a baby at home - wherever possible.

But in this week's Scrubbing Up health column, Philip Steer, emeritus professor of obstetrics and gynaecology at Imperial College, London, says rejecting Caesareans is like rejecting technological advances in transport or energy generation."

This argument is so severely flawed in so many ways its hilarious. If he wants to use the example of "modern technology" we could also take a look at how the result of modern technology has given us a plethora of problems that only years and years down the line have we come to fully comprehend. Lets use the example of antibiotics - great invention that has saved countless lives, but it's overuse (and misuse) has resulted in mutations of diseases that are now resistant to them.

C-sections are also wonderful and *do* save lives in many instances but it is unbelievably foolish for this man to be suggesting that it is now the answer even over a natural birth in an uncomplicated pregnancy. We don't yet have a generation of children born primarily by c-section that have reached old age and I'm almost certain we will see some serious effects that c-section birth causes in the long term.

If modern technology has taught us anything it's that we should not plunge straight in, but use it in appropriate ways until we fully understand the effects it will have. Someone might like to remind our well-learned friend that a vast number of people are embracing older forms of housing construction (cob houses etc), solar and wind power, non-plastic items, and other forms of older or more natural ways in place of technology, due to the damage certain modern technology has caused the environment.

He also fails to mention that part of what causes the higher mortality rates in Africa and India has a lot to do with things like nutrition, education and the introduction of basic hygiene practices - as if the *only* reason they have "saved" the poor Africans is by using his great, amazing "modern technology".

Given the choice between having this man deliver my baby through surgery or going to an African community and being looked after by the women there while I squat and push my baby out - I take African village any day! I'm a young, healthy, strong woman who is having a baby, not a sick patient who needs a clever doctor to come in and save the day! And pass on the plastic surgery as well - even if it's one of those tummy tucks they do during a c-section. My stretch marks and various other things pregnancy has done to my body are beautiful reminders to me (and others) of how I did the most amazing thing ever - I made, and grew a beautiful healthy little boy in there! I would also like to mention that have a friend(a proud HBACer) who took up belly dancing post-babys!

"but many women see childbirth as an essential "rite of passage" and exhort others of their gender to eschew technological assistance"

Now that sentence really made me see red! The implication here is that he feels it is not a rite of passage. Perhaps in his view it is just another day, no big deal in the grand scheme of things. No longer should women be interested in "giving birth" to their child, but should embrace cold, unemotional modern technology and allow a qualified surgeon to surgically removed a parasitic growth from her abdomen?!

Yes, I may be overreacting here, but seriously, how callous is he being by even implying this? What is wrong with wanting to give a beautiful birth to the child you have carried in your belly? For nine months the woman has worked hard at eating correctly, exercising correctly and doing all that she can to help nurture her growing child. For many women to take an active role in finally bringing their child into this world is a very important rite of passage.

Half of what is wrong with the world today is our complete dismissal of important life events that help prepare us psychologically for a new phase in our lives. He is also effectively demonstrating a fundamental flaw of modern western medicine that totally forgets the human being in its entirety. He simply sees this as a fetus, a womb and that one must now exit the other. There is a complete dismissal of the spiritual, emotional and psychological parts of the whole picture. I might mention to him here that in Africa and India, this is one thing they get right!

I wish there was a way that people like him could stop for a moment and think. Better yet - LISTEN! Listen to what women are saying to him. He has been given a very privileged position when a woman entrusts him to assist her in the safe delivery of her child. It's time he realised that!

Wednesday, May 6, 2009

Men and Women in Midwifery

I found this blog on men in midwifery very interesting -

Men and Women in Midwifery

Sunday, April 19, 2009

Childbirth PSA

I've been doing a lot of thinking about the Public Service Announcement we have to do as a project for college. Obviously I'm very keen on making a PSA that involves childbirth in some way.

The best PSA's always use a metaphor to make a simple statement of fact. But how do you do this with childbirth.

I've heard the metaphor used which likens labour to a butterfly emerging from a chrysalis. If you pull a butterfly out of it's chrysalis it will die as it needs that struggle to emerge in order to live. This metaphor has been used to promote natural childbirth (in low-risk pregnancy's obviously) but I don't feel happy with this. Although c-sections have their side effects, many baby's have no immediate adverse side-effects from it. Perhaps one day in the future when we have generations of c-sction baby's reaching old age we will discover what the true side-effects are, but right now they aren't immediately life threatening for a great number of people born this way.
So what is the message I really want to get across:

Make an Informed Choice.

When a woman is pregnant she can often be overwhelmed by all the information she receives, and often it's even worse when so much of what she hears is conflicting information! This can actually make it harder to make a truly informed choice because how is she to know what is correct and what is not.

One might think that listening to your doctor and taking his/her word on things is the best solution. But what about when a doctor says something like "Once a C-section, Always a C-section" or "You pelvis is too small" or "Your shoe size is smaller than a size 4 so you won't be able to give birth to your baby vaginally" (last one is something a doctor actually said to someone I know).

Disagreeing with your doctor is a very scary position to be in, and women who do often get flack not only from medical staff but from friends and family as well because of societies belief that "Doctor knows best".

There are more and more times that it has been shown that questioning your doctor is not only good, but a necessity. Most recent example I can think of is a friend who was worried about a lump and was told it was nothing by more than one doctor. Finally a doctor was found who investigated it properly and the diagnosis was inoperable cancer.

But back to childbirth! The survey's I did only showed a very clear feeling among the women who took it that doctors were pushing women into interventions that probably had more to do with being convenient for the doctor than being for the good of mother and baby.

But in South Africa we also have some important things to take into consideration:

  • There are many, many women reliant on government health services to care for their pregnancy, and that in itself gives them very little choice
  • Government Hospitals are direly understaffed
  • Government Hospitals have no money and lack many basic facilities
Method of childbirth is so far removed from the realities of many pregnant women in this country, so why should we bother focusing on that?

My conclusion was that we shouldn't - we should focus on something far more important and very needed in government hospitals as well. It's one word that represents so much:


Already these women do so much in the government maternity wards - providing the much needed care that overworked, underpaid nursing staff just don't have the time or energy to give. In some cases doula's have been the one's delivering the babies because there was just no one else!

For women who have more money (and they aren't necessarily rich) they can afford more choice by opting for private healthcare. However, in private healthcare the c-section rate is a staggering 80% (approximately) and so the Doula has a very different role to play.

In government hospitals they perform a very practical service, helping nursing staff and offering support and company to women who almost always come to give birth completely alone. In the private sector they offer much wider form of care, through information during pregnancy, physical and emotional support through pregnancy and birth, and even being an advocate for a woman when she is in a vunerable position.

I feel this is the best focus for a PSA. To bring attention to what at Doula is and what she does.

Government should pay women to be birth doulas in Government Hospitals and medical aids should cover their cost as an important part of the team caring for women in private facilities.

But how on earth does one say this in metaphor?!

It's easy to come up with one's for woman in private care (eg. doctors pushing unncessary interventions, overuse of technology), but it's almost impossible to think of a single one that would cover the important role in both government and in private care.

Here are some ideas I've got so far:

  • Old wives tales, medical myths, and random strangers - all giving advice to a pregnant woman. Who can help her know the truth? A doula.
  • A woman goes to reverse her car out of her driveway. Suddenly a variety of experts (eg civil engineers, builders) come to measure, calculate and give advice. The woman is overwhelmed when they say they're just going to go ahead and lift the car out of her driveway with a crane. [NB this is the only one that is actually a metaphor]

So far the best idea is:

  • A serious of childbirth related problems (such as mentioned above, women giving birth alone in govt hospitals etc) are shown but a fairy godmother character appears and waves a magic wand and the scene is "fixed". It could end with a voice over saying something like "You might think such a magical creature doesn't exist, but the birth fairy is real. She's called a Doula - and every woman deserves one!" and then give information as to where someone could find out more about this.
Please feel free to post comments directly here or email me directly.

Thursday, April 16, 2009

Homebirth as safe as in hospital

The largest study of its kind has found that for low-risk women, giving birth at home is as safe as doing so in hospital with a midwife.

Research from the Netherlands - which has a high rate of home births - found no difference in death rates of either mothers or babies in 530,000 births.

Home births have long been debated amid concerns about their safety.

UK obstetricians welcomed the study - published in the journal BJOG - but said it may not apply universally.


Tuesday, April 14, 2009

The case AGAINST breastfeeding

Obviously the title of this article is highly evocative. One quote which was rather infuriating was the following:

"The debate about breast-feeding takes place without any reference to its actual context in women’s lives. Breast-feeding exclusively is not like taking a prenatal vitamin. It is a serious time commitment that pretty much guarantees that you will not work in any meaningful way. Let’s say a baby feeds seven times a day and then a couple more times at night. That’s nine times for about a half hour each, which adds up to more than half of a working day, every day, for at least six months. This is why, when people say that breast-feeding is “free,” I want to hit them with a two-by-four. It’s only free if a woman’s time is worth nothing."

I am definitely pro-breastfeeding but I know what it's like to struggle. Breastfeed if you can, but don't feel guilty about bottle feeding if it makes your experience of motherhood more pleasant. A happy attentive mother is what a baby needs most!

Another ironic aspect is that in South Africa breastfeeding is the lowest in wealthy and well educated mothers. Those that do are seen as a uncouth at best, and somewhat peculiar at worst. This is the complete opposite in the US - so I wonder what a study here would uncover about breastfeeding?

It's an interesting bit of writing overall, but I really take objection to women who choose to breastfeed somehow being less feminist (or whatever she's trying to say) by doing so. It's like the same bad rap women get for choosing to be stay at home mothers! Somehow being liberated means all women must work, and must not stay home and raise breastfed children.

Personally I always thought it was about having the choice to do either - but obviously I've missed something!



Sunday, April 12, 2009

VBAC SouthAfrica

VBACSA is a South African site offering compassionate understanding
to women who have had a caesarean and nurturing support to women in
their journey towards a vaginal birth after Caesarean birth.

To subscribe please send an email
to VBACSA-subscribe@yahoogroups.com

Who can subscribe: women who have had a caesarean or repeat
caesareans, Women who have had a VBAC or attempted a VBAC, Doulas
that are supporting women in their VBAC journeys or caesarean births.

There are multiple links and files to add to your resources. The
group is also working towards increasing awareness about VBA2C and
doctors around South Africa that are supportive.
For further information please email rosalia@birthing.co.za