A practice of decolonisation

He uri mokopuna tenei no Te Whānau a Apanui, Ngāti Porou, me Waikato-Tainui hoki. Ko Teah Carlson toku ingoa.

Initially home birth was not my first choice; I wanted to give birth in a birthing centre. I did not want the mess at home, worry about cleaning my whare, having to cook my own kai. I wanted to be looked after, thought of, wanted my baby and I to be safe. These ideas were understandable, as my preconception of home birth was narrow, told in stories of old, of woman having to, of woman that were strong, and had a community of supportive people – this was not me.

Through a friend’s recommendation I met with Claire, a gentle, humble, but I would soon learn, a very wise woman. She was my light, the pathway to a home birth.  At first, I said that I wanted to give birth at a birthing centre and she was open to that, but shared that she mostly supported home births. No that’s not for me. This was an important moment as she could have said, that’s okay, may be you would be best suited to another midwife, but instead she was gentle and patient.

On our first visit, she gave me a book to read and when I was ready for another, she had plenty more. She also invited me to attend pregnancy yoga and a home birth antenatal weekend. All of these valuable resources and actions slowly informed me, at my pace, to the possibility of home birth, to a community where home birth was the first and safest choice.

As a practitioner, Claire had a wealth of knowledge she drew on from all disciplines, bio-medical, alternative medicines, rongoa, acupuncture and aromatherapy to name a few. When we would met, she would draw on these knowledge systems and inform me of the options I could follow. I never received such care from a health practitioner, it was an empowering experience. Empowering because healthcare was provided in a way that was holistic, informative and allowed me to understand that carrying my baby was the most important and grounding experience I could have as a woman, that I did not have to handover to the public health system. I was no consumer, I was hauora.

To me home birth is a philosophy, not confined to the walls and roof of a whare but much more, it is a way of being that frees you from the confines of a Western society. A society consumed by materialism, outcomes, statistics, risk and fear-based views, that tells woman what to do, how to be, told your body is not your own, birth is a medical process and babies are extensions of those views.  Home birth is a philosophy, because you don’t have to give birth at home to have a home birth, it is a practice that is holistic, culturally safe, strength-based, whānanu capacity building, grounded in practices of whanaungatanga (reciprocal, responsive and responsible relationships).

My two tamariki where born at home, into the hands of their pāpā’s. I had no mess, very little blood, my whānau where there to clean up, cook for me, I was looked after, thought of and my baby and I were safe.

No reira,
Tuia ki te rangi
Tuia ki te moana
Tuia ki te whenua
E rongo te po
E rongo te Ao
Tihei mauri ora

Place of Birth – How much choice do we have?

We are a fly on the wall at the first appointment a pregnant mother is having with their midwife or obstetrician, their LMC (Lead Maternity Carer). Among other things, we watch the expectant mother given a pamphlet or other information that explains her three main choices for the place they would like to give birth, to take away and consider. We hear the LMC explaining that they can choose between birthing at home, in a primary birthing unit, or in a hospital, an overview of the pros and cons of each location. We hear the LMC recommend that they take some time to think about the different options, perhaps do some research of their own, and to come back and ask any questions they need to to clarify things. And we hear the mother told that when they reach 28 weeks, they can let the LMC know their preference, but that they are free to change their mind anytime before baby actually arrives.

If you have already become a mother, did it happen that way for you? If you can ask other mothers you know, was that their experience? Or did you, and they, walk away from the first appointment with the forms already filled in for a hospital? Were you told that this is the hospital that your LMC works out of, and it’s easier to get the paperwork out of the way right from the start so we don’t have to worry about it later? Do you live in an area with more than one hospital option, like Auckland, and so it was more a comment like “I work out of either Auckland or North Shore, which would you prefer?”

Let me ask you another question: If you were a mother told at your first appointment “I work out of either Auckland or North Shore, which would you prefer?”, what does that leave you concluding? A number of women would hear that and conclude that those are her ONLY two options, Hospital A or Hospital B, and that that was it. Others would hear that and conclude that they must need medical support if that’s their only two choices, so their pregnancy must have some difficulties ahead that the midwife isn’t telling her about yet. Or for a one hospital location, how many people would have filled in the forms and taken that to mean that they were now booked into the hospital, and that was that? How many people would hear what the should have heard, that if a hospital is required, then this LMC can come with them to this hospital or these hospitals, but that these forms are only a precaution. How many expectant mothers hear that they can choose to birth at home, or in a birthing unit and quite likely never need to go anywhere near a hospital….? And while we are at it, how many people are getting the feeling that they NEED to be pre-booked into a hospital? As if hospitals would turn you away if you hadn’t already sent in the appropriate forms…

The HDC Code of Rights* actually requires that we are given full, unbiased information before we make our own decisions. (It also says that we aren’t required to give any reasons to anyone for what we choose to do, which some medical professionals seem to forget if they don’t like your decision.) And informed consent actually requires ALL the options clearly explained to you, with the pros and cons given so that you are in possession of all the facts, and then you are given time to digest and consider and come to your own decision without any pressure (or manipulation) by the medical professionals involved with your care. Think back to the last few times you were being helped by a medical professional, particularly in a hospital setting, but also at your GP’s office. Were you given choices, or were you just told the course of action your health professional had chosen for you? Did you get the pros and cons explained to you? Did you hear what possible side effects were known for this treatment plan? Were you given information about what was the expected outcome if nothing was done? And were you then left alone to take time to choose, with no pressure or coercion, and then your decision accepted with no issues whatsoever?  Hmmmmm…..

Back to our focus for this article, a pregnant mother and their decision where to birth their baby. This falls squarely under the Code’s Right 7: It’s Your Decision. This means a) It is up to you to decide; and b) You can say no or change your mind at any time. And it dovetails nicely with Right 6: Information. This means a) You have the right to have your condition explained and to be told what your choices are. This includes likely benefits and side effects; and b) You can ask any questions to help you to be fully informed. Our opening paragraph illustrated this happening perfectly, however for the majority of expectant mothers in Aotearoa New Zealand, what they get is not even close. More often than not, mothers receive something along the lines of the second example, the one where the filling out of hospital paperwork is often interpreted by the mother as the only option they have available to them. LMCs may feel that they are offering their new clients full choice, but their actions and words, or lack of them, are giving their clients a message of little or no choice on their place of birth options. Other LMCs are actually actively ensuring their clients will birth in hospital by not explaining the three key options, only discussing the option or options that the LMC prefers. And still others do offer all three choices, but sabotage their client’s choice by finding a reason (consciously or subconsciously) later in the pregnancy that “requires” a hospital setting. So the client feels that they did get to choose, but that the choice later was no longer available to them. Which might or might not actually have been the case. And while in some cases the hospital setting and medical support is 100% necessary, what is very worrying is the fact that too often those reasons given by the midwife or obstetrician for needing a hospital actually do not NEED a hospital at all. They are things that are still within the scope of a physiological birth outside of a hospital if any LMC who has the skills, knowledge and the confidence in their skills and abilities to provide that assistance (Note: Right Four is about Proper Standards – You have the right to be treated with care and skill, and to receive services that reflect your needs, and all those involved in your care should work together for you. So a midwife or obstetrician that is not up to scratch with supporting physiological birth, without the need for the back up of a bunch of interventions and a building full of medical professionals just outside the door, actually isn’t holding up to their side of the Code of Rights requirements. Just sayin’).

So why is this happening? Why are pregnant mothers often encouraged, passively or actively, into going to birth in hospital? All LMCs are supposed to be able to support normal birth in low risk pregnancies (and the majority of pregnancies ARE low risk). And we have New Zealand research using New Zealand data showing that your chances of interventions and issues for mother and baby are significantly increased if a low risk mother births their baby in a hospital. Hospitals are emergency care facilities, and do that wonderfully well. But this does not transfer to non-emergency situations. Hospital staff are trained to look for problems, and as well, have time pressures on their resources. Also, they are used to using interventions, and often having forgotten what a normal, physiological birth looks like, and how best to support that. Which most of the time is very little to nothing. Sitting back and doing nothing, and waiting for as long as mother and baby need, is difficult to achieve in a hospital setting. Hospital staff are used to taking action, doing things, and clearing beds as soon as possible for the next intake. A clash of cultures, so to speak. We even see the caesarean section rates increase when the staffing numbers go down, as that is the quicker option. So when extra medical support is required, transferring into hospital is a fabulous facility to have, but labouring and birthing in a hospital if you aren’t requiring medical support is actually increasing your risks of problems occurring. Seems counter-intuitive, but it’s true.

So why are LMCs taking their clients to hospitals to deliver? Surely it’s because they, in their professional judgement, feel that that’s the best place for that client to deliver? This is the widely held assumption the general public makes, but actually there are usually a number of factors that trump what’s best for mother and baby. I can’t speak for every LMC and every situation, but here are a number of issues that can often be part of the mix, most particularly for independent midwives:

  • Confidence – in a hospital, outside that door is a collection of experts and equipment, to consult or to hand responsibility over to. A midwife can rely more on the skills and opinions of others, and needs less to rely on their own skills or those of their back up midwife.
  • Protection – if there are any unexpected, traumatic outcomes, then blame is less likely to fall on the golden institution of a hospital, and if it does, it can be shifted to guidelines and protocols and not the individuals involved. The media spotlight is less likely to fall, rightly or wrongly, on the health professional concerned and their career is less likely to be put on hold (or destroyed) while enquiries take place into whether they did everything right or not. Even midwives that have carried out their duties perfectly can have their reputation damaged by the media before the details are available, however once their exemplary care has been confirmed by the enquiry, there is no public confirmation or celebration of how well they had performed by the same media who did the damage. The media have a lot to answer for…
  • Convenience – in a hospital, the LMC does not need to have a second midwife arranged and available to provide back up, whereas in a home birth they have to arrange that themselves. Also, if two mothers are labouring at the same time, in the same hospital, the LMC can bounce back and forward between the two, with the hospital midwives covering the gaps. If this was a home situation, the houses could be quite far apart, plus there is no automatic extra back up. The LMC would probably only be able to be there for one birth, and not the other. And so they will be paid less for the work they have done with this client… which leads onto the next point.
  • Finances – Are there any other professions where the ONLY way to make more money is to take on more clients? Usually we can also choose to raise our prices or go for a promotion. LMCs can not do either of those things. The payment plan is set by the government, and if a client changes to another midwife, or if something occurs and the LMC is not present at the birth, they lose income. This can mean that LMCs often have to accept a caseload that is too large to give the quality and amount of care they would like to, or that is recommended, for each client. And they have to because they can’t pay their mortgage if they cap their numbers at the level that would be best for all concerned. So one way to help support a larger number of clients is to have them all birthing at the same hospital, so the LMC can work between several clients who are labouring or recovering from giving birth in the same building. And as we said above, with the hospital midwives filling in the gaps. Also, this can mean that LMCs can be quite aggressive in either obtaining clients, or in trying to discouraging them from leaving for another LMC. One tactic I have heard of a number of times is an LMC telling a new client that they definitely support a home birth, but as the time approaches, reasons are found to “prevent” home being a safe choice according to the LMC and so another hospital birth ensues. Sometimes an LMC who lists home as one of the locations they support hasn’t actually been present at a home birth in several years, and their physiological skills are out of practice.

Sounds bleak, doesn’t it? It doesn’t have to be. You as a consumer, if you understand the situation, understand your choices, and vote with your feet, you can help yourself and your baby by finding midwives who are amazing at what they do, and support both your choices and your right to choose. You can ask the right questions of LMCs, and then explain to those that don’t fit your needs, gently and respectfully, what you were needing that took you elsewhere. If it is a reason that they would do better to address, then perhaps hearing it voiced as an issue might give them reason to consider looking at how they currently practice….

But there is more you can do that will benefit midwives, all of them.

  • Talk about the great experiences you have had, wherever they were. Share how valuable the skills and services are that a midwife provides. Those who have never experienced the services of a good midwife or any midwife have no idea how important it is, and that it’s more than just catching the baby.
  • Don’t put up with poor service. Write a letter to someone, or contact your local support services, and find someone that will help you pass on your concerns in an anonymous way if that feels more comfortable for you. If people don’t know there’s a problem, they won’t know they need to change. And the more people speak up, the more impact it will make. You don’t just speak up for yourself, but you also speak up to make it better for others who come after you….
  • Speak up for midwives’ pay conditions, any chance you get. If you know anyone in a position of influence, don’t be afraid to say that midwives can’t do their job well because the pay is woefully inadequate, and that consequently we haven’t enough midwives across the country… and that has to change. Mothers suffer because of this… babies suffer because of this…..
  • Don’t encourage media witch hunts of anybody, health professionals or otherwise. Media continue to have that power because we click on that story that sounds juicy about someone. Often those stories are part fact and part speculation and all it does is damage good people. And definitely don’t share or talk more about those stories. Let the proper processes work it all out, as they are supposed to.
  • If you feel that “normal”, physiological birth is something that appeals to you, do something to help you learn more, and to help others learn more. Find great resources to read or watch, check out your local home birth or positive birth organisations, and be part of what they do. You will also find you help strengthen your own knowledge, help others find out more, and you usually get to make great friends among like-minded people. And you do not have to have had a home birth yourself or even be pregnant to be involved. Myself, I am very involved in my local home birth group, and have made some amazing friends among the people there, but not only have I never had a home birth or will never have one (no more children in our future), my personal experience was an induction-caesarean in hospital. All I have is an interest in what could be, should be normal birth, and a wish for more people to understand their choices and options better than they do now. And for people to choose what they know is the birth they want, wherever that is, rather than go along with whatever their LMC says, or what they see everyone else do, or what happens on TV…..

I hope that this article has given you some things to think about, and that it helps you to make a decision that you feel confident in. That’s the best outcome for everyone.

– SANDY MCGIVERN-BUTLER, Chairperson, Auckland HomeBirth Community

 

HDC Code of Rights Red PosterThe Health and Disabilities Commission’s Code of Rights is actually a legal document correctly called The HDC Code of Health and Disability Services Consumers’ Rights Regulation 1996. If you are interested, the full document is a 4 page pdf that clearly explains what the Ten Rights mean in actual practice, which is interesting reading. It’s available here. There’s also a summary available on the website here, a leaflet that explains all the ten rights, available to download here, a prettier, easy read brochure that summarises the ten rights and what to do if you have problems, which you can download from here in English or in a multitude of other languages from this web page plus there’s a lovely red poster (left) that you should see in every clinic, waiting room, hospital room, etc that can be downloaded from here, plus a poster in sign language you can access here.

If you are curious now, these are your ten rights under the HDC Code:

 

  • Right 1: the right to be treated with respect
  • Right 2: the right to freedom from discrimination, coercion, harassment, and exploitation
  • Right 3: the right to dignity and independence
  • Right 4: the right to services of an appropriate standard
  • Right 5: the right to effective communication
  • Right 6: the right to be fully informed
  • Right 7: the right to make an informed choice and give informed consent
  • Right 8: the right to support
  • Right 9: rights in respect of teaching or research
  • Right 10: the right to complain

What you need for home water birth

What you may need:

  • The pool itself – you may like to partially inflate or set up the pool, and then finish it off once labour has commenced Some have suggested having a nice throw over to hide the birth pool if you think you’re going to have a week’s worth of prodromal labour or you’ll be wanting to jump on it and pop holes in it by about day three! You may like to have the pool in the garage or a spare room to keep it out of the way too.
  • You can put pillows or soft mats underneath or around the pool, under waterproof layers, for extra softness and padding
  • You may like to have other materials for waterproofing floor and furniture, such as more tarpaulins, drop sheets, shower curtains, etc.
  • You may choose to hire a califont for instant hot water, or:
  • A spare electric jug – handy to have 2 on the go for topping up pool or for hot towels. You may consider running these from different circuits to avoid an electrical overload.
  • Clothing: bra, T-shirt, bikini top, sarong, or something you find comfortable to wear in the pool if you don’t want to be naked.
  • Lots of old towels. Old woolen blankets are good as they are very absorbent
  • Sieve or net or similar for collecting floating poo from the pool
  • A water thermometer to check the pool heat is optimal
  • An insulated cover for the pool will help keep in warm when not in use
  • A small mirror if you want to see crowning
  • A small torch if lighting is low

Considerations

  • You may need to turn off your smoke alarms if there is a lot of steam
  • Check the strength of the floor where you plan to locate the pool. Ground floor rooms are more likely to be strong, as are corners, in a bay window, or above a supporting wall. A full pool with a labouring woman is no heavier than 10-12 adults. If you would have a gathering in the room, you can probably rest assured about having a birth pool in the room.
  • Think about how you plan to empty and fill the pool, so you aren’t worrying about it at the time.
  • If you are planning to take photos, consider what these will look like in relation to the colour/patterns on the pool. An alternative liner or sheet can be used to customise the pool for your labour and birth pictures.

Home birth supplies

'Birth Basket' containing supplies for during labour and birth and just after birth.

Basic must haves

  • A waterproof mat – this can be a blanket over the top of tarpaulin or a plastic drop cloth, a waterproof backed picnic blanket, a birth mat (instructions on how to make one here), etc.
  • Two buckets – one lined with a plastic bag for rubbish and one in case you need to vomit.
  • A laundry basket lined with a plastic bag or similar to put soiled/wet laundry into.
  • Old towels.
  • A container for the placenta.
  • A cord tie, muka or items for lotus birth/umbilical non-severance.
  • Baby blankets.
  • Comfortable clothing such as a towel robe.
  • Healthy snacks
  • Drinks such as water, coconut water, red raspberry leaf tea (can also be pre-frozen into ice cubes to suck), etc.
  • A source of heat if it’s cold.
  • Support people who love you.

Optional extras you may want to consider

  • Birth space set up (just in case)
    Birth space set up

    Waterproof absorbent pads (get before labour from midwife).

  • Torch
  • Mirror
  • A method for warming hot towels, such as a slow cooker/crock pot, boiling water and container, etc. and thick rubber gloves to handle them. Alternately hot water bottles or wheat packs.
  • A container with cold or frozen face cloths
  • Decorations such as affirmations, photos of loved ones and special memories, fairy lights, candles, birth flags/pennants, birth beads, etc.
  • Music
  • Hand held fan
  • Acupressure items including acupressure point info,  a comb to squeeze during contractions (acupressure points).
  • A TENS machine
  • Homoeopathic remedies such as arnica or a homoeopathic birth kit.
  • Flower essences such as Rescue Remedy or Stress Med Spray
  • Essential oils such as Tea tree oil, a birth mix and carrier oils (if not premixed) and/or an oil burner.
  • Camera, charger, spare batteries, memory space, etc. or a birth photographer.

After the birth

  • Baby blankets, wraps and optionally baby clothes.
  • Nappies or EC (Elimination Communication) potty and clothing.
  • Comfortable underwear and clothing for yourself.
  • Maternity pads and/or disposable underwear such as Tena for the first day or two (usually bottom shelf of the sanitary goods aisle in the supermarket).
  • Perineum healing mix/spray.
  • Homoeopathic remedies such as Arnica, Weleda Chamomilla/Nicotiana Comp (for afterpains), etc.
  • Fresh made bed for sinking into with baby – nice fresh sheets and comfortable protective underlayer and everything you need nearby (e.g. lamp/ torch, water, snacks, nappies/potty, wipes, wraps, etc.).
  • A message on your answering machine asking people to call back later/leave a message/send a text or email instead.
  • A list on the fridge of things visitors can do when they ask “what can I do to help?” Ideas include: laundry, vacuuming, dishes, reading stories to children, taking the dog for a walk, taking out the compost, etc. It can be hard to ask for help, or hard to think of what needs to be done. If people can choose a task they will probably enjoy it more, and everyone likes to help.
  • A sign for the door or gate to say mum and baby are sleeping, or express your wishes around visiting for friends and family calling by.
  • Lots of easy-to-make frozen meals in the freezer or organise friends and family to make meals each night for a week or two.

Waterbirth items

Further Reading

Save

Save

Save