Our Editorial

1 REFLECTIONS Our Editorial. By Sian Hannagan Jun 2014 Birth in New Zealand has come a long way due to the efforts of the women and midwives before us. Since the Nurses Amendment Act was instated in 1990, women got a real choice in their place of birth. Annette King in her address at the 100 th anniversary of Midwifery in NZ in 2004, said “Although the amendment to the Nurses Act was minor, the consequences for midwifery were significant. The most important outcome of that piece of legislation for midwifery was that it permitted midwives to operate as fully independent providers of pregnancy and childbirth services without reference to or supervision by medical practitioners.“ This amendment signalled a huge change in the birth culture of New Zealand. Prior to this change, birth looked very different. I remember talking to my mother in law about her births. When she was birthing my husband, she was told by the nurses to “hold on” and “keep her legs crossed” so that the Doctor had time to arrive and deliver her baby. He turned up, just in the nick of time, and smoked a cigarette while he watched her birth her baby and left shortly thereafter. He got paid a tidy sum for his attentive care. With the nurses amendment act, medical practitioners lost their monopoly on funding, causing the power balance to shift, the result being more choice for women. However, as we enter the 21 st century, while the same law is in place, we still have to overcome obstacles when it comes to our view of birth. A culture of fear has permeated our birthing milieu. From alarmist reporting, 2 to emergency birth shows such as ‘One Born Every Minute’ and the activism of certain social interest groups there has been a shift in the language and the way we frame birth. Women are often defined by what they are ‘allowed’ and ‘not allowed’ to do during birth. These social signals, directly and indirectly, erode our birth choices, if not by law, by social pressure. Women choosing to birth at home are often subjected to professional and peer pressure, sometimes even pressure from their spouse to birth in a hospital environment. New Zealand is often held up to other countries as an example of good midwifery based birth-care, and we do have a great system. But if we aren’t aware of it and if we don’t utilise it, then is this enough alone? Given that many health and social services have changed significantly since the nursing amendment act. It is sometimes a surprise that our birth care has remained mostly unchanged. But can we rely on this to continue? The global culture of birth has become the forefront of feminist discussion. More and more we see women being treated as secondary to the infant when it comes to pregnancy and birth, more often than not, a mothers needs and an infants needs are pitted against one another as if they are mutually exclusive. This cultural and medical myth allows women to be marginalised in birth. The truth is that in birth, the mother and baby do not have greatly differing needs. By serving the mother, you serve the baby. Birth violence, for many women, has become the norm, so much so that women who have had traumatic experiences don’t speak out, or feel unable to speak out. It it seems that informed consen t matters less for women giving birth than people receiving other hospital care. Many women experience coercion, and if they speak to this experience, they are silenced with phrases such as “Well, as long as baby is okay then there is no problem” and “you should be happy you’re alive and your baby is alive” sometimes these statements echo the statements made against feminists when they question patriarchy. As we might hear “not all men” we hear “not all birth professionals”, which while being ultimately true, does not undo the trauma experienced by women at the hands of some birth professionals, it is however an effective silencer. It ensures that women and their experiences do not get heard. Landmark law suits such as the Ternovsky vs Hungary case, are framing birth as a human rights issue. Is this what we need to do to ensure we 3 continue to be able to choose our place of birth? Take a legal stance? Things have not reached that level in New Zealand, but in our close neighbours Australia and further overseas in America, this is often the only recourse for women being denied their basic human rights when it comes to birth. More than ever we need the voices of our birth luminaries to continue to speak for the birthing mother as too often her voice is talked over by a culture of fear. It is now that we feel the loss of Marsden Wagner, a perinatologist and perinatal epidemiologist who served as a Director of Maternal and Child Health for the California State Health Department and was also the Director of the University of Copenhagen-UCLA Health Research Center, and Director of Women’s and Children’s Health for the World Health Organization . Wagner’s work supporting midwifery and birth rights was invaluable. He spoke of the movement against homebirth as a ‘global witch hunt’ and wrote a number of books that pulled apart our commercial birth model. He chaired three W.H.O consensus meetings, where the appropriate use of technology during birth was discussed. His mark on the birth world is indelible, and we are better for it. Another voice in birth that has recently left us is David Chamberlain, psychologist, author, and editor who has lectured on birth psychology in 20 countries. His work in exploring and resolving birth trauma experienced by the infant was landmark, and paved the way for our understanding that experiences of birth affect not just the mother, but the baby too. These are two great voices in the world of birth rights that have now fallen silent. Closer to home we remember Joan Donley, author of ‘Save the Midwife’. Joan Donley was a key visionary when it came to birth and midwifery in New Zealand in the 80’s and 90’s. Her tireless work led in no small part to the system we have now. Previous to the nursing amendment act, Joan felt that the role of the midwife had been undermined and could vanish altogether if not protected, in 1985 she published Save the Midwife (New Women’s Press), which charted the history of the profession and placed midwifery in New Zealand within the political sphere. Joan was also a founding member of the NZ Homebirth Association and in 1989 she played a key role in the establishment of the New Zealand College of Midwives. In the same year she was made an OBE in for her work in birth advocacy and midwifery. Her work placed New Zealand midwifery in a 4 position to be a world leading system. These successes were a result of tireless work and lobbying. As we reflect on these past challenges, we also need to look forwards. With the rights of women being challenged globally, it is not time to be complacent. Have vocal birth activists had their time?, or do we need them now more than ever? In his interview with Home Birth Aotearoa Michel Odent noted that it was a paradox that Countries like New Zealand had a strong natural birth movement, but that Caesarian rates were on the rise, have we made the best use of your resources and energy to drive change? What is the future of Home Birth in New Zealand? Sian Hannagan our Interim Editor A letter on Joan Donley ––– by Margo Townsend My first experience with Joan was at a tutorial at the Auckland Midwifery School in 1991. She was a guest speaker. I remember she covered many topics, not the least being the importance of “getting out of the hospital setting and into the community” where she felt was where Midwifery Skills and Confidence could be gained. Remember I am talking 1991 most of my class were looking towards hospital setting placements, thinking that was where we would get the experience we would need to become confident. Joan challenged that notion and suggested that by working outside the hospital setting we would discover our strengths and also would more readily be in a good position to support women in their choices around birth. She offered to take a student under her wing to experience the Home Birth scene. I was the very lucky student Midwife who got to go with Joan those were some of the best weeks of my life in midwifery. Joan was fearless in the protection of normal birth and women centred care. She often said things that were quiet deliberately challenging of the system of the day. She called obstetricians “the boys” said with humour, 5 not I feel in a disrespectful way, but rather in a frustrated way about some of the institution driven protocols that prevailed within the hospital setting. She enabled me and many others, midwives and women alike, to see that there were options outside of hospital and indeed even inside the hospital setting. She subscribed to the notion that women, given the chance, and support could (and did) birth naturally. She empowered me to be a midwife who held women central to the pregnancy and birth journey. She really made me think about being with and alongside women, at the same time she was mindful that I was a student and she made sure that I was exposed to as many experiences as possible: including making soup and scones and taking that meal along to a post natal visit.

Load more