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
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.
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
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.
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