Lovely freebirth story

There's a rather wonderful series on British TV this advent called Our Yorkshire Farm (four episodes I believe, one for each season) following the year in the life of a family who live in Upper Swaledale in Yorkshire.  In yesterday's 2nd episode (Spring), Amanda Owen tells her story of giving birth to her eighth child (the Owens have nine children) in front of the fire in the middle of the night with one of the dogs and a cup of tea for company.  She explains her how she came to her decision and evokes a sense of place, time, calm and peace.  A lovely, lovely narration and well worth a viewing (UM is fast becoming a Yorkshire Shepherdess addict):

https://netpro.website/series/356069/1/2

Amanda has her own website: https://www.yorkshireshepherdess.com/

Birth centre and home are safe for low-risk women: new systematic review.

Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: A systematic review and meta-analysis

https://www.sciencedirect.com/science/article/pii/S0266613818300974

This is a paper by Vanessa Scarfe and colleagues [Australia] looking at the combined outcomes of 28 studies involving more than half a million women across a number of countries.  It demonstrates that the evidence for the safety of home or birth centre for birth for low risk women is broad, substantial and clear.  Not that this hasn't been known and shown before, but it is good to remind the world of this at regular intervals, given the continued commitment of the anti-homebirth, anti-normal birth, anti-midwife lobby to their Project Fear agenda (for example but by no means the only example, Amy Tuteur's regular pseudo-skeptical pronouncements e.g.http://www.skepticalob.com/2014/04/just-how-dangerous-is-childbirth.html
and https://www.youtube.com/channel/UCnYRie_neROaEuTQslggVvg )


 

Why mobility in labour matters...really, really matters!

Below is a link to a blog written by birth physiology expert Margaret Jowitt.  Margaret Jowitt is also the designer of the Osborne Kneeling Chair (see earlier posts in this blog), based on her unique understanding of the anatomy and physiology of birth.  Margaret has also written a book "Dynamic Positions in Birth" which expounds her theories and is probably one of the most important books on birth physiology to have been written for at least a century.

Her insights should change the way women are cared for and the whole design of institutional labour environments across the world.  Her work also has implications for the all-too commonplace intervention of Induction of Labour and the crude manner in which this is currently carried out.  Understanding the onset of labour may lead to much better ways of inducing labour rather than the dreadful beating of the uterus with syntocinon that currently occurs (in the small minority of cases where starting labour may be helpful to mother and/or baby).

This work needs to find its way into textbooks and the teaching of midwifery and medical students.  It is really a back-to-basics where the foundation of physical care is based on an understanding of anatomy and physiology. 

https://softbirth.com/new-model-uterine-function/

https://softbirth.com/hi-lo-birth-support-birthing-chair/ 

https://www.waterstones.com/book/dynamic-positions-in-birth/margaret-jowitt/9781780661155 

New blog on birth and politics

A group of experienced birth activists, writers and campaigners have got together to write a campaigning blog focusing on threats to choice, continuity and control for women in the UK, Ireland and beyond.  This group has an impressive line-up, already has a couple of well-written posts on key issues, and you can subscribe quickly and easily. Link is also on the Useful Links facility to the right ->.

https://www.birthpracticeandpolitics.org/

Sad but truly excellent film about recent maternal deaths in Ireland and the commemorative quilt made in memory of the women who died.

Heart-wrenching but essential and inspiring viewing - well done to all involved.  It's beautiful.

https://vimeo.com/202475404

Being a bigger woman doesn't necessarily mean big birth risks.

The Birthplace Study continues to publish interesting analyses, this one about the birth risks associated with larger BMI (over 35 kg/m2).  

https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.12437

Multiparous women with BMIs over 35 appear to have a lower risk of adverse events than primiparous women with BMIs within the 18 to 25 range, and to generally have fewer problems associated with birthing their children than we may have believed.  Of course, primiparous women generally  have a lot of meddling with their labours and births and only a minority have straightforward births without interventions, so the comparison is not without its problems.  However the data does show that higher BMI in women who have given birth previously is probably being over-played as a "risk" factor.  

Perhaps consultant midwives and Birth Centre managers in the UK will be able to get the criteria for Birth Centre care altered to reflect this evidence.

While I am on the subject of bigger mothers, here is a link (will also post in useful links section) to the blog of The Well-Rounded Mama and her previous excellent website.  Lots of information here and a positive approach to birth and mothering with a well-rounded body!

https://wellroundedmama.blogspot.co.uk/p/about-this-blog.html 

http://www.plus-size-pregnancy.org/firstindex.html

The contemporary bullying and adversarial culture of UK midwifery and Jane Greaves RM

Update: Jane Greaves reinstated!!  AND the story is covered by today's Sunday Express.

https://www.express.co.uk/news/uk/946014/jane-greaves-midwife-petition-job-sacking-unfair-dismissal-wakefield 


What is going on in midwifery in the UK?  Weekly UM hears of a midwife who has been sacked or suspended, or who has been forced out of the profession.  If these were careless, uninterested, uncommitted, lazy or rude midwives, that would be one thing.  But almost without exception, the midwives involved have a long history of woman-centredness, commitment to their profession, kindness, and standing up for services and colleagues.  

The UK is chronically short of midwives but many managers show little sign of wanting to retain those they have.  Contractual hours, policies, shift times, shift lengths, lack of study opportunities, inadequate responses to legitimate concerns and complaints from staff, favoritism and the nurturing of cliques, all combine to make the lives of many midwives very difficult, and result in a huge percentage of midwives working part-time or "taking a break" from the profession.  

Many (not all) senior posts in UK midwifery are filled by those who fit the corporate blueprint, show themselves to be loyal to the business (and Foundation Trusts are businesses run by managers and accountants from non-clinical backgrounds), not rock the boat, accept cuts sorry transformation and persuade their staff to work harder sorry smarter.  If you challenge this model of healthcare organisation (e.g. want choice for women that may require more staff, reject shoestring continuity models, oppose the downgrading of a birth centre etc), then promotion will not come your way. 

Malicious or unnecessary referrals to the NMC are made to settle scores and to consolidate power.  Threats and lies are common.  One Head of Midwifery in a northern English city recently told a midwife that she might be sued, not over clinical malpractice or neglect, but because another NHS Trust was annoyed by something she had written.  As her writing expressed an honestly-held opinion and accorded with the scientific evidence, this was palpable nonsense.  So why say it, if not to instill fear and dread, in other words to bully the midwife? 

Another midwifery manager (again in a northern English Trust, but it is happening all over the country) has sacked a midwife called Jane Greaves.  Jane has an excellent track record for caring for women and defending the service, but the manager, citing her sickness record, feels the service doesn't need her, despite the midwifery shortage in the area. A petition started by a friend has attracted over 30,000 signatures in a week.  UNISON, the union involved, appears to be hanging out the Trust to dry in the local media and this is a welcome change to the Royal College of Midwives (RCM)'s common approach of stay quiet, say nothing.  

You can sign the petition for Jane Greaves' reinstatement here:
https://www.change.org/p/mid-yorkshire-nhs-trust-support-nhs-midwife

And view the local paper article here:
https://www.yorkshireeveningpost.co.uk/news/wakefield-midwife-fired-over-sickness-record-after-suffering-kidney-infection-claims-no-time-for-trips-to-loo-due-to-hospital-understaffing-1-9075856

Needless to say, the friend has come under pressure.

So why are midwifery managers so drawn to the unkind, adversarial, and punitive approach and outcome rather than one that is solution-focused, trusting, and compassionate?  UM feels it is basically an issue of skills and knowledge as well as one of misplaced loyalty and deficient understanding of the wider picture.  

Midwifery is a global profession with a history as long as the human story and its current connection with the NHS in the UK is a minuscule part of that history and this planet, and even tinier is its shackling to the pseudo-market-orientated NHS of the 2010s.  I don't think that anyone enters midwifery to be part of the latter, we become midwives to be part of the ancient and universal energy of women and birth.   The health of that connection is shown by actions not words.  Yvonne Rowlan, the Head of Midwifery who may have personally sacked or was involved in the sacking of Jane Greaves, gave this vacuous statement to the Yorkshire Evening Post:

"We are dedicated to providing excellent patient care and supporting our staff to do this.  In every aspect of our work we adhere to a set of core values which underpin not only the care we give to our patients but also the care and respect we show to each other as members of staff."   


Fine words but empty ones in the face of loss of livelihood, vocation and workplace friendships.  Empty in the face of anxiety, stress, mental ill-health, suicidal thoughts, and depression caused by heavy-handed approaches to common and manageable workplace differences and challenges.  Empty in the face of no staff loo.

are dedicated to providing excellent patient care and supporting our staff to do this.

Read more at: https://www.yorkshireeveningpost.co.uk/news/wakefield-midwife-fired-over-sickness-record-after-suffering-kidney-infection-claims-no-time-for-trips-to-loo-due-to-hospital-understaffing-1-9075856

“We are dedicated to providing excellent patient care and supporting our staff to do this. “In every aspect of our work we adhere to a set of core values which underpin not only the care we give to our patients but also the care and respect we show to each other as members of staff.

Read more at: https://www.yorkshireeveningpost.co.uk/news/wakefield-midwife-fired-over-sickness-record-after-suffering-kidney-infection-claims-no-time-for-trips-to-loo-due-to-hospital-understaffing-1-9075856

“We are dedicated to providing excellent patient care and supporting our staff to do this. “In every aspect of our work we adhere to a set of core values which underpin not only the care we give to our patients but also the care and respect we show to each other as members of staff.

Read more at: https://www.yorkshireeveningpost.co.uk/news/wakefield-midwife-fired-over-sickness-record-after-suffering-kidney-infection-claims-no-time-for-trips-to-loo-due-to-hospital-understaffing-1-9075856

Read more at: https://www.yorkshireeveningpost.co.uk/news/wakefield-midwife-fired-over-sickness-record-after-suffering-kidney-infection-claims-no-time-for-trips-to-loo-due-to-hospital-understaffing-1-9075856

The RCM is currently more part of the problem than part of the solution, having a schizoid relationship to its members: it appears to be most comfortable with those at the top of the NHS hierarchy spending time befriending, liaising with and hobnobbing with them at all sorts of dos and events, but like a rabbit caught in headlights when confronted with the multiple problems of the thousands and thousands of its members who are not senior managers, but on whom it depends for the bulk of its subscriptions.

The position of shop-floor midwives trying to get proper representation is also often invidious.  Those who become RCM workplace representatives generally have two mutually exclusive reasons for doing so:
Either they want to climb the slippery pole, get close to management, and show how compromising they can be;
Or they want to represent and serve their colleagues and challenge injustice and unfairness in the workplace.
The latter group often become subject to the same investigatory and disciplinary processes that they have helped others through.  The RCM, often as thick as thieves with midwifery managers (whom it often mistakenly refers to as "midwifery leaders"), appears uncomfortable with its dual role as a trade union, recruits full-time officers from its own stewards rather than from a TU background, and often fails to stand up for its members as strongly as it ought.  The RCM line is all too usually to advise repentance and to show remorse and accept the punishment.

UM suggests:

• If the RCM is serious about representing midwives, it has to pull its finger out and join with  those who are fighting to heal the toxic culture of contemporary midwifery in the UK.  The Caring for You Campaign is not biting deep as the RCM's own report shows (their December 2017 Evaluation of the CfY Campaign showed an increase in workplace bullying in services signed up to it).
• Midwifery managers need to stop indulging in mutual self-congratulation on their various get-togethers but get down to some serious work of self-scrutiny and objective criticism.  They need to rediscover (or discover) midwifery and public service values and kindness and solution-focused approaches to their differences with midwives. 
• There should be a complete moratorium on malicious referrals to the NMC.  
• Midwifery managers should stop threatening and bullying their staff and stop promoting their acolytes over those whom they know are the better midwives.  They need to turn their attention from those in the corporate offices to the women they serve and the midwives who care about serving them.

Postscript
Before you all go away thinking the north of England is the midwifery pits, UM would like to pay tribute to Airedale Hospital Trust and its midwifery managers for the solution-focused approach it has taken with Yorkshire Storks Midwifery Practice to address the independent midwives indemnity insurance issues. 

More reasons to be cautious about paracetamol-use during pregnancy and labour

https://www.medscape.com/viewarticle/892824?nlid=120841…t_obgy&uac=45732BX&spon=16&impID=1566858&faf=1#vp_1 24/02/2018, 08O25





In case you can't access the article I am quoting it below:

"Acetaminophen Use Alters Sex Hormones, May Cause Birth Defects?
 
Acetaminophen (paracetamol) use has been linked with a depletion of sulfated sex hormones in a large metabolomic study, and the findings suggest that fetal exposure to the drug could even be linked
with risk of male urogenital malformation at birth. Acetaminophen has been used for over 50 years, and more than half of women take it for pain relief while pregnant, but recent data, including animal-model and human-epidemiologic studies, suggest it may have some unexpected side effects.
 
"The current work identifies depletion of sulfated sex hormones as a potential mechanism" for genital malformation at birth in boys, say Isaac V Cohen, a PharmD candidate at the University California, San Diego, and who works at Human Longevity, in San Diego, California, and colleagues, in an article published online February 1 in EBioMedicine.  "The surprising thing that we observed in people who were taking acetaminophen (paracetamol) was that all of them had a peculiar profile in hormone metabolites," senior author Amalio Telenti, MD, from J Craig Venter Institute, in La Jolla, California, explained to Medscape Medical News.
 
The researchers speculated that they might find liver dysfunction with large doses of acetaminophen, "because that is normal toxicity," but surprisingly they found that acetaminophen was associated with
changes in certain hormonal metabolites.  For example, the effect of taking acetaminophen on pregnen-dioldisulfate was roughly equivalent to the effect of 35 years of aging, or the normal decrease in levels seen in menopause. However, the effect only lasts 2 days, Telenti noted. "Three days after you took the acetaminophen you would be back to your chronological age." Nevertheless, given "epidemiologists are concerned that the people with animal models are concerned, and now we have data saying [acetaminophen] does modify some of the hormones," Telenti said, "I would try to be cautious until we understand better."
 
"I'm not saying that there is a risk to taking acetaminophen because you have a headache," he said. However, "I would not like to take acetaminophen every day for 1 month during pregnancy."
 
Common OTC Painkiller, Reproductive Health Concerns
 
Even though acetaminophen is one of the most common pain medications used worldwide, there is a lack of consensus about its mechanism of action, and more recently, growing concern about possible adverse effects on reproductive health. Acetaminophen has also falsely elevated continuous glucose monitor readings by a large margin in some patients with diabetes, which is a cause for concern as these devices are increasingly being adopted.
 
In the new study, Cohen and colleagues enrolled 455 active adults age 18 years and older and performed an analysis of more than 700 metabolites in 208 participants to establish a metabolomic profile. They then tested the training model in the other 247 participants. They found that 19 of the 208 participants were likely taking acetaminophen based on the presence of acetaminophen and its
seven metabolites, and this use affected a unique subset of sulfated sex hormones. The model was validated in 1880 individuals of European ancestry in the TwinsUK cohort and 1235 individuals of African American and Hispanic ancestry from the Insulin Resistance Atherosclerosis Study. "Overall, our analysis of 3570 individuals (including training test, Europeans, African Americans, and Hispanic participants) confirm the generalizable effect of acetaminophen use on sulfated sex
hormone levels across human populations," they write.
 
The study also sheds light on how acetaminophen may ease pain.  "Individuals who took acetaminophen," they note, "had very low levels of neurosteroids such as pregnenolone sulfate and DHEAS [dehydroepiandrosterone], a mechanism that could synergize with acetaminophen's known mode of action in the central nervous system that implicates the COX [cyclooxygenase], vanilloid, and endocannabinoid systems."  Moreover, "the current work showcases the use of pharmacometabolomics to identify unexpected effects of a commonly used drug, acetaminophen, on hormone metabolism," according to the researchers. "Closer scrutiny of this commonly used medication is warranted," they add.  "These findings are significant for they showcase how the body is impacted by seemingly innocuous everyday medications like Tylenol," said Telenti in a press release by Human Longevity. "There are hundreds of other drugs that no one has done this research for. We delineate a general strategy that should be applied broadly in the study of medications in common use."
 
EBioMedicine. Published online February 1, 2018."

First rate paper exploring why Continuous Electronic Fetal Monitoring (EFM) is used despite its uselessness.

Thanks to Ruth Weston of Aquabirths for alerting me to this very interesting article exploring the widespread use of EFM (or CTG as it is more commonly known in the UK) in face of the evidence that it is not only useless but harmful.
https://mhnpjournal.biomedcentral.com/articles/10.1186/s40748-017-0060-2
The paper is not only interesting regarding EFM but also about the interfaces between health and law and ethics.  
The whole mad parallel world of Labour Ward practice is embedded in the premise on which EFM is based:  Surveillance and rapid intervention, not necessarily in that order.  The care and support of women and the safeguarding of the hormonal dance of labour plays second fiddle to that, and that is being kind about most labour wards, which are no places for birthing women.  In UM's experience and opinion.

200 women freebirth annually in London (London Evening Standard 11.1.18)

It's not often the London Evening Standard publishes anything of interest (neo-liberal, property-price obsessed, consumerist, growth-addicted rag edited by George Osborne the previous Conservative Chancellor of the Exchequer) but this week it had a headline (p.13) "Mothers shun midwives for "free births"".
https://www.standard.co.uk/news/health/mothers-shun-midwives-for-free-births-at-home-a3737396.html
None of the 170 to 200 women who had freebirthed in London last year was interviewed, so whether midwives are being shunned or whether medicalised care or lack of continuity is being shunned, we do not know.  You may be glad to hear that Kenny Gibson, NHS England's head of public health commissioning in London is "not unduly concerned".  Perhaps Kenny may like to stop being so complacent, look a little deeper and commission the sorts of services that women want, before jumping to his conclusion that freebirth is just another choice for affluent women (see article). 

With the Standard's usual lack of logic, there is alongside this "shunning" story, another titled "2000 choose private help costing up to £5000".
https://www.standard.co.uk/news/health/women-choosing-private-midwives-with-price-tag-of-5000-a3737411.html
This tells us that continuity of care is hugely important to women (both a midwife and mother appear in this article) and it is very positive about Neighbourhood Midwives, a group of independent midwives working in London and across much of south-east England, who clearly aren't being shunned by mothers at all!
http://www.neighbourhoodmidwives.org.uk/