I tried to find your response on Andrea's website Karen and couldn't, please direct me. marilyn ----- Original Message ----- From: "Karen Arthur" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Thursday, September 05, 2002 11:40 PM Subject: RE: [ozmidwifery] Hello - Brasil here...
Marilyn I agree with you 100%. I've posted a response to Andrea's article on her website for anyone interested in this subject. Kind regards Karen Arthur -----Original Message----- From: Marilyn Kleidon [mailto:[EMAIL PROTECTED]] Sent: Saturday, 7 September 2002 6:34 AM To: [EMAIL PROTECTED] Subject: Re: [ozmidwifery] Hello - Brasil here... Hi Andrea: I am going to bight on your controversy re doulas. I totally understand your apprehension to yet another American phenonmenon and your inference that it is just another way to make money. Though I have just returned from the USA after almost a quarter century, I am hardly an advocate for the prevaling free market capitalist culture that is so valued there. I really hope it isn't further exported here (as it already has been in the privatisation of so many public utilities, but that is another and not midwifery debate). From what I have seen it is market based economics (a USA import I think) is driving the health care system here. That is why is many hospital systems, unless it is a slow shift most women in a birthing suite wont get one to one midwifery care. Not enough midwives are being employed to give quality care to women. Enter the family and friends. Even if friends and family are available to give support, and even if, as you assert (from the Klaus and Klaus articles) there is no difference in outcomes between trained and untrained support people not everyone has good familial relationships so not everyone will use their family or friends for support. Also, because it has been several generations that women have been birthing in hospitals, many mothers do not want to accompany their daughters in birth, they don't want to relive their birth experiences and are more than happy to show up once the baby is "delivered". Similarly with family and friend support for breastfeeding. I continue to be amazed at women my own age who tell me adamantly that the hospitals encouraged formula feeding 25 to 30 years ago and that is why they didn't breastfeed. It wasn't my experience but neverthless they feel helpless when it comes to supporting their daughters with breastfeeding. Doulas are not pretending to be midwives or lactation consultants they just represent the informed supporter, and sometimes they are paid. I don't think any doula would place herself in the birthing room at the expense of a family member and I haven't been in a birthing room in either the USA or Australia where family members were not welcomed. Doulas can also help with discouraging (gently) the exaggerated breathing techniques that some of us used 20 or 30 years ago that well meaning aunties or mums may inflict on the labouring mum. If the mom does have a c/s the doula is never in the OR in place of a relative unless of course the mom/partner requested it. Doula services do provide support to women who are removed from their families for whatever reason. They provide supplementary support to partners and they provide the woman with a knowledgable woman to just talk to. Some women have had traumatic birth experiences, feel their partners or family just did not have enough knowledge to explain to them what was happening and hire a doula to fill this gap. Some hire doulas to be advocates for them: this can be controversial. Obviously this is a gap in either midwifery or obstetric care, the cold fact is it exists here as well as there. Most women are not personal friends with either midwives or childbirth educators and so do not have these people to call on. I personally do not know of any wealthy doulas. I do know people who earn a modest living supporting women in birth. The schools that offer doula training offer them, surprisingly, much cheaper that the trainings are here, and they are much briefer. Experience as a doula is often a prerequisite for direct entry midwifery education in the USA. At this point I just want to offer some info on the obstetric nurse versus midwifve. USA trained obstetric nurses are not required to be educated/trained as midwives, they are nurses with experience in labor and delivery, they are usually extremely well trained/educated and I wouldn't be without one in an obstetric emergency in a US hospital. It is not in their job description to either birth/deliver babies, however they do everything else including calling the doctor or midwife when the baby is on view. Many are also great supporters and/or advocates for the mum (mom), however they work in a hospital environment governed by protocols, guidelines, and procedures. They are also incredibly understaffed and again while they will do their best to provide one to one care during labor and birth if it is busy the care will be less than supportive though competent. There are midwives in the USA both nurse midwives and DEM's (of which I am one). Nurse midwives (if working as a nurse midwife and not a L& D nurse) have their own clients. They either have their own clinic, usually part of a group practice of other CNM's and sometimes OB's and GP's or they are part of a hospital clinic where they work similarly to team/group midwives at hospital antenatal clinics here. Nurse midwives may also work independently doing home and free-standing birth center births. They have usually had to have 1 to 2 yrs experience as a labour and delivery (obstetric) nurse in a hospital delivery suite before being accepted to nurse midwifery school. There are some 8,000 CNM's in the USA. Direct Entry Midwives may or may not be also nurses, usually have their own clinics and attend births at home or free-standing birth centers, some also have hospital privileges which means they continue to attend their women as their care giver if there is a hospital transfer and also that they can attend women who for personal or insurance reasons require a hospital birth, they will be assisted at the hospital birth by the obsteric/labor and delivery nurse. In a perfect midwifery world there would be no need for doulas or should I say professional doulas, however it is not a perfect world and most likely wont be for a while. The big down side that I see to the doula movement is that hospital administrations may come to depend on them, and so pass the cost of hiring extra nurses (in the USA) or midwives (Australia, UK etc) onto clients/consumers of whom a certain percentage may be counted on (by the admin)to hire their own private doula. So, I don't think we should be antagonistic to doulas but maybe cautious. I had better finish before I write a paper. regards marilyn ----- Original Message ----- From: "Andrea Robertson" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Thursday, September 05, 2002 4:00 PM Subject: Re: [ozmidwifery] Hello - Brasil here... Hello Ricardo, Terrific to hear from you and to have you on the list. I hope you'll find the midwifery scene in Austrlaia interesting to read about. As you know, I've been able to have a first hand look at what is happening in Brasil and I am very excited about the work of REHUNA. Can I just say that I think REHUNA should be careful of the "doula" phenomenon? Rather than spending time on training a new team of people as doulas, why not put your energies into re-shaping the thinking and up-skilling the nurses you already have working in maternity and at the same time, open your labour wards to family and friends of the labouring woman? The work of Klaus and Kennell in the 1980's showed that in order to improve outcomes for labouring women all that was needed was to provide a companion for her, and one with no training was just as good as one with training. I've looked at birth in other parts of the world similar to yours and still think that the first and easiest step to take is to find a way to enable the woman to have her sister/mother/best friend with her during labour and birth. This is cheap, easy, woman friendly and easy to implement. I hope to be able to get back to Brasil to do some more workshops for your nurses on the basics of being "with women". In the meantime, I have written a Diary entry http://www.birthinternational.com/diary/index.html on doulas that you might like to read. A bit controversial but I think these things need to be said. Look forward to seeing you again! Andrea At 04:29 6/09/2002, Ricardo Herbert Jones wrote: >Hello everybody: > >My name is Ricardo Herbert Jones >I am an obstetrician from Brasil, and had the pleasure of meeting Andrea >Robertson this year in a Congress about Humanization of Childbirth in São >Paulo, Brasil. >As an obstetrician I would like to share experiences with midwives and >doulas all around the world, because I think that humanization of birth is >an issue that has to do with every single person in this planet. Even thou >only women deliver babies (yet - who knows where the tecnocratic paradygm >will takes us?) all of us were once born, and lived during a limited time >in a womanīs womb. Were we rescued from there by doctors and eletronic >devices or were we cherished by momīs tender body till we entered this >world? These are different ways of looking to the same event. As I grew >old (I am 43 now, and work with births from 20 years) I learned that women >shall be treated with caress and gentleness. Birth in our tecnocratic >society is seen as a mechanic phenomenon, and doctors usually see their >patients as objects, and not as persons and subjects. Thatīs a terrible >thing, because itīs a humanīs right problem. >I am one of the leaders of Rehuna (Humanization of Childbirth Network - >Brasil) and our struggle now is to empower women in their decisions about >chilbirth and force the government area to humanize the assistance to >women in the public hospitals. The first step is a doula project, called >"Friends in Light", to graduate doulas and doula trainners in Rio de Janeiro. >Ok, as u can see my english is not quite well, and I love to talk too much... >Hope I can get good advices from you all. > >Ricardo Herbert Jones >Ob/Gyn and Homeopath >Porto Alegre - Brasil > >__________________________________________________________________ >Ricardo Herbert Jones >Ric >ICQ#: 1640612 >Current ICQ status: 249cee.jpg >( Home Tel#: 55 51 9981 0445 >( Work Tel#: 55 51 9981 0445 >7 Fax#: Ask me >+ <http://wwp.icq.com/1640612>More ways to contact me >i <http://web.icq.com/whitepages/about_me?Uin=1640612>See more about me: >__________________________________________________________________ > ---------------------------------------------------------------------------- ---- > > ----- > Andrea Robertson > Birth International * ACE Graphics * Associates in Childbirth Education > > e-mail: [EMAIL PROTECTED] > web: www.birthinternational.com > -- This mailing list is sponsored by ACE Graphics. 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