Birth: the forgotten feminist issue

Dr Heather Mattner, psychologist and midwife, joins me to discuss birth trauma. Studies suggest one third of women experience birth trauma. In the current maternity system, she believes 100% of birthing women are experiencing birth trauma. We discuss symptoms, prevention, the overall maternity system, previous trauma's impact on birth trauma and what women and the system can do to reduce birth trauma. Heather says: Birth trauma is preventable harm. And, birth trauma does not favour/disfavour any women regardless of age, culture, spirituality, religion, parity, gestation, intellectualism, status etc etc. That in itself is probably evidence enough to say it is a systemic issue against women - all gestational women. Dr Heather Matter's qualifications:  Perinatal Health Psychologist  PANDA Clinical Champion Honorary Clinical Senior Lecturer (Psychology) The University of Adelaide heather.mattner@adelaide.edu.au

In this episode, Dr Rachel Reed and I, discuss the all too common "diagnosis" of Gestational Diabetes, and how this affects a woman's treatment pathway, often leading to induction, women being treated as a source of risk for their baby, and the cascade of intervention. Rachel explains how so many women have come to be diagnosed with Gestational Diabetes, why else we're seeing so many women having an induction of labour, medical risk, and birth trauma. We discuss the ceremonial practice of birth, the "identity crisis" midwives are currently going through, and why birth is the forgotten feminist issue.  You can read more from Rachel at her blog midwifethinking: MidwifeThinking Her recent books are: Why Induction Matters and Reclaiming Childbirth as a Rite of Passage She also co-hosts the podcast The Midwives' Cauldron  You can see Dr Rachel Reed formerly from USC’s School of Nursing and Midwifery was interviewed for Birth Time: The Documentary. She states: “In Australia we have a heavily medicalised maternity system that leads to a lot of interventions for women, many of whom do not particularly want or need them,” said the Senior Lecturer in Midwifery. “There have been reports of coercion and manipulation. Often, it’s not done intentionally – rather more as an attempt to mitigate medical risk. But what is not counted is the emotional risks facing women if they experience disrespectful care. “Birth trauma is not about how a woman births. It’s about how she was treated during birth. There’s more to trauma than a physically traumatic experience.”

Midwife and researcher, Nigel Lee, joins me to talk about the Perineal Tear Bundle (bungle?!) that was rolled out in Australian hospitals a few years ago, in a feeble attempt to reduce the incidence of 3rd and 4th degree perineal tears. It consisted of 5 different practices applied to women during birth, in an attempt to reduce 3rd of 4th degree tears. These tears extend to include the muscles around the anus (3rd degree) or into the anal passage (4th degree). We discuss what the evidence says, the issues with most of the elements of the bundle, consent, the rise of episiotomy, what his own research found when interviewing midwives about the Perineal Tear Bundle, what other parts of the world are doing to reduce 3rd and 4th degree tears, and what Australia needs to do in order to improve outcomes.  Link to Nigel's research: 2021 Allen, J., Small, K., Lee, N. How a perineal care bundle impacts midwifery practice in Australian maternity hospitals: A critical, reflexive thematic analysis. Women and Birth. In press https://doi.org/10.1016/j.wombi.2021.01.012 2018 Lee, N, Gao, Y, Lotz, L and Kildea, S . Maternal and neonatal outcomes from a comparison of spontaneous and directed pushing in second stage. Women and Birth. 32(4), e433-e440.https://doi.org/10.1016/j.wombi.2018.10.005 https://doi.org/10.1016/j.wombi.2018.10.005 2018 Lee, N., Firmin, M., Gao, Y., & Kildea, S. . Perineal injury associated with hands on/hands poised and directed/undirected pushing: A retrospective cross-sectional study of non-operative vaginal births, 2011–2016. International journal of nursing studies, 83, 11-17. DOI: 10.1016/j.ijnurstu.2018.04.002  More on the Perineal Tear Bundle and midwifery practice here: Bundles for perineal care: the impact on midwifery practice - Transforming Maternity Care Collaborative

Jolene specialises in trauma as an Accredited Mental Health Social Worker. She shares how trauma effects our body, and how previous trauma can impact birth. Various studies over the years have shown how women who've experienced trauma are more likely to experience birth trauma, but it's never been described in detail; how trauma impacts the body and our births. I invited Jolene on to explain why this link occurs, how a part of the brain called the Amygdala overrides the prefrontal cortex (logical part of our brain) to ensure we survive. Jolene describes how trauma isn't stored in our mind in a narrative memory sense, but felt-senses and patterns of behaviour in certain situations, which can included fight, flight or freeze response. We discuss how women can understand how their trauma can impact their births, how birth companions and care providers can identify and help women during birth who've experienced birth trauma.    In this episode, I share my childhood trauma with having my own mum suffer from Bipolar, Borderline Personality Disorder and multiple suicide attempts. As a child, I learnt that in order to survive, I needed my mum to survive, and a strong sense of self-reliance in order to not "be let down". I describe how this impacted my birth through my need to "control" the situations in order to feel safe and secure.  You can find Jolene here: Child and Family Therapist | Jolene Hutchings | Bli Bli A recommended reading resource we spoke of is: The Body keeps the Score by Bessel van der Kolk

Although Rachael and I have never spoken on the phone or via Zoom before, we worked closely together during the 2018-2020 Bush Baby Media Campaign. It was the largest maternity campaign the country has ever seen- at least 8 Front Page stories, National morning TV, nightly news, The Project and international interest. It was an national award-nominated media campaign. As a result of this campaign, Queensland created a Rural Maternity Taskforce and subsequent report to ensure some sustainability of our rural maternity services. In this episode, we discuss what the evidence says for rural births, what were the results of the Bush Baby Campaign, the service capabilities of hospital maternity units and some tips on running a good media campaign to lobby for maternity services. 

Jodie shares her journey to receiving care in a Birth Centre in Brisbane, her journey into advocacy and some of the amazing campaigns she helped create to improve access to the Birth Centre. We also discuss the obstetric lobbying, including the label "the killing fields" the Birth Center was known as by the obstetricians opposed to it. You can find Jodie's book here: What Does It Feel Like Being Born? by Jodie Miller. 

Catherine Bell is the creator of the Birth Map, author of the book THE BIRTH MAP: Boldly Going Where No Birth Plan Has Gone Before  takes you through the Informed Birth Preparation process leaving you Informed, Prepared and Confident.  THE BIRTH MAP covers risk assessment and informed decision making, what to expect during labour and birth, and then takes you into The Beyond.  We discuss the difference between the Birth Map and birth plans/preferences, making informed decisions within the maternity system and taking responsibility for our decision making process. Find Catherine's book, training and other resources here: https://birthmap.life 

Julie Bell is a well-known herbalist, doula and advocate in the birth world. Her early career as a nurse, time spent as an obstetric nurse, and her own mother being a midwife has given Julie an amazing insight into the maternity system. She shares her own powerful journey to birth outside the system, the changes she saw in the New Zealand system, the oppressive systems that dominate Australia's birthing landscape, and birth through a feminist lense. You can find Julie at: https://www.blissfulherbs.com.au.

Liz Wilkes is Australia's first private midwife to have access to Medicare. Prior to this, she worked in private practice in Toowoomba, Queensland. She now has several private midwifery practices under the My Midwives brand.  In this episode we have quite nuanced discussions about private midwifery, what medicare has meant for women and midwives, the obstacles and requirements of private midwives including visiting access and collaborative arrangements. We discuss how all of this impacts women and ways forward to ensure care remains woman-centered. 

Obstetrician and Gynaecologist, Dr Kirsten Small's PhD research was on CTG (formerly described as EFM- electronic fetal monitoring). In this episode we discuss what her research found and despite CTG not having the outcomes intended when it was 1st used to monitor women in labour, it is still routinely used in institutions. We discuss the history of obstetrics and the silence by her colleagues around this research. You can find Dr Small's research and referenced reading during the podcast here: Small, K. A., Sidebotham, M., Fenwick, J., & Gamble, J. (2021). Midwives must, obstetricians may: An ethnographic exploration of how policy documents organise intrapartum fetal monitoring practice. Women and Birth, in press. https://doi.org/10.1016/j.wombi.2021.05.001  Small, K. A., Sidebotham, M., Fenwick, J., & Gamble, J. (2020, Sept). Intrapartum cardiotocograph monitoring and perinatal outcomes for women at risk: Literature review. Women and Birth, 33(5), 411-418. https://doi.org/10.1016/j.wombi.2019.10.002  Murphy-Lawless, J. (1998). Reading birth and death. Cork University Press.

Dr Hazel Keedle is a VBAC (vaginal birth after cesarean) woman, midwife, researcher and is very passionate about research in the space of women's experience of birth. She helped design and publish the Birth Experience Study (BESt) in collaboration with the Birth Time documentary. This survey currently has over 6050 submissions- Australia's biggest birth experience survey. We discuss the results of her research survey of VBAC women and the 4 areas women "scored" their experiences by. We also discuss the trends of the current survey AND the much needed funding required to ensure our most vulnerable groups are heard (need translations). More info on the survey here: https://surveyswesternsydney.au1.qualtrics.com/jfe/form/SV_d7lb1dyOczveOxw and the Go Fund me page: https://gofund.me/59d153df

Bruce spent 17 years lobbying for maternity improvements. He was involved in the National Maternity Action Plan- a plan involving partnership between consumers and midwives to lobby for change including more access to continuity of midwifery carer in a woman's place of choice. He is a past President of Maternity Coalition- both nationally and in the state of Queensland. Bruce lives at Mount Glorious near Brisbane. Link to the National Maternity Action Plan: https://en.wikipedia.org/wiki/National_Maternity_Action_Plan and here: https://web.archive.org/web/20070329214948/http://www.birthinternational.com/nmap/index.html

Dr Robyn Thompson has a midwifery career of over 50 years. She foundered The Thompson Method breastfeeding support for women. In her extensive career, both in hospital and at home she discusses the institutionalisation and mechanicalisation of pregnancy, birth and breastfeeding.

Associate Professor Emily Callander speaks about the high cost of the maternity system, and how the activity based funding and segregation of funding continues to ignore what women need and addressing inequities in the maternity system.  More information about Emily here: https://research.monash.edu/en/persons/emily-callander Some of her research:  https://www.womenandbirth.org/article/S1871-5192(19)30696-1/abstract https://www.publish.csiro.au/ah/Fulltext/ah18209

This is part 2 of my birth stories. Ep. 16 covers my 1st and 2nd birth. The last 3 births were birth centre and homebirths. All with private midwives. Birth 3 and 4 were unassisted births due to precipitous labours.

My own birth journeys set me on a new direction- advocacy and childbirth education. In this episode I retell my birth journeys for my first and second.

Lizzie Carroll is one of Australia's most well-known VBAC mentors. She is a doula, childbirth educator, admin of the VBAC Support Group and personal VBAC mentor for women all over the country. http://www.lizziecarroll.com.au/musings--more https://www.facebook.com/groups/342851302473349/?ref=share

Professor Nicky Leap is currently the Adjunct Professor of Midwifery, Faculty of Nursing Midwifery and Health UTS Visiting Professor, Florence Nightingale School of Nursing and Midwifery, Kings College, London 2010-2012 International Francine Gooris Chair for Midwifery, University College Arteveldehoge school, Ghent, Belgium.    Nicky went into midwifery as she saw it as a ultimate feminist issue. We discuss midwives role in ensuring birth isn't the forgotten feminist issue.  For over twenty-five years, Nicky has worked across midwifery research, education and practice in both the UK and Australia. She was integrally involved in the development and implementation of the Australian Bachelor of Midwifery programs in South Australia and at UTS and has had a leadership role in developing national standards for midwifery education and practice in Australia. Nicky has played a pivotal role in both Australia and the UK in the development and evaluation of midwifery continuity of care models, including the implementation of NSW's first publicly funded homebirth program.   Nicky led a two year pilot study to develop, implement and test Centering Pregnancy, an innovative program combining antenatal care, education and support for pregnant women in small groups. Nicky was the Professor of Midwifery Practice Development and Research for South East Sydney and Illawarra Area Health Service from 2006 - 2010 (Director of Midwifery Practice 2002 - 2006 in the same area health service)Nicky completed her Professional Doctorate in Midwifery at UTS, her dissertation examining the role and culture of rhetorical innovations and intentional strategies in the development of Australian midwifery. Nicky has held a visiting researcher position at Kings College London since 2005. Some of Nicky's published work: https://opus.lib.uts.edu.au/handle/10453/17562 https://opus.lib.uts.edu.au/handle/10453/127727

Bashi Hazard is an Australian lawyer and the principal of B W Law, a legal practice established to support and assist women and children, and the Legal Director of the ANZ arm of the Human Rights in Childbirth (HRiC) International Lawyers Network. Bashi’s background is in competition and consumer law, and litigation, developed while working for several years with Allens in Sydney, immediately after graduating with first class honours in Law and Economics from the University of Sydney. She has co-authored the book Canary in the Coal Mine- birthing outside the system. This book investigates why women choose ‘birth outside the system’ and makes connections between women’s right to choose where they birth and violations of human rights within maternity care systems.  https://www.routledge.com/Birthing-Outside-the-System-The-Canary-in-the-Coal-Mine/Dahlen-Kumar-Hazard-Schmied/p/book/9781138592704 Bashi is on the board of Human Rights in Childbirth: https://humanrightsinchildbirth.org/index.php/who-we-are/

Carolyn is a mother, grandmother and midwife with qualifications in adult education, counselling, lactation, primary health care, reproductive and sexual health. She has been at the leading edge of midwifery practice and education for four decades. Now a midwifery lecturer at Griffith, having wide-ranging national and international experience in diverse settings, including commissioning and managing a quality award-winning stand-alone midwifery service in NSW, her work is well known. Her passion is strengthening midwifery and improving care for childbearing women, partners and babies; her focus is on the neurophysiological intersection of growth, development and relationships. Areas of interest include neuroscience, epigenetics, the Polyvagal Theory, Barker’s Theory, teamwork, social, emotional and spiritual intelligence, labour, birth, breastfeeding and attachment. She has researched, taught and written extensively on midwifery related subjects. A core aspect of Carolyn’s work is finding ways to optimise students' teamwork skills so midwives, women and families can thrive. Some of her published research:  https://www.academia.edu/675921/Midwifery_women_history_and_politics?fbclid=IwAR2lJ6D7C3xrvLxgUonSx2OmkTVZiWmu8GcQdEF3zHXnemWs0okbvhf7suM https://www.academia.edu/5124477/The_Birthing_Environment_A_sustainable_approach?fbclid=IwAR3cyRMhml7n9sQ_YF-MWdI3rbdBmMYMBAozsDBFfHDATHZGkncpvzLR3pk https://www.academia.edu/21765916/The_spiritual_and_emotional_territory_of_the_unborn_and_newborn_baby_NOVA_The_University_of_Newcastles_Digital_Repository?fbclid=IwAR3I4YoqceMeJINmRYLOMr-jA-uMk35g-WHE3s-392e1KDtnNF5nl2gzwlM https://www.academia.edu/7281520/Language_how_understanding_semantics_helps_us_be_with_women?fbclid=IwAR0G24SI3EjuTqkUs6Tro2D4TPGvS5RkJHNYipFPbvwev5IHmLdXfQnMJfA