Inspiration and technology: Alison Baum blending the two!

I have been observing Alison Baum's phenomenal achievements for many years, and have been captivated by her passion, energy and charisma. Alison is the CEO of the charity Best Beginnings, and there's more about the brilliant work the organisation does in this post. After becoming increasingly involved in Alison's latest project, the Baby Buddy App I wanted to interview her, to find out a little more about the inspiration behind her successes. In particular, I wanted to know more about this app, and why she was driven to make it happen!

Alison, Hi! Can you tell me what the Baby Buddy phone app is?

Baby Buddy is a personal baby expert that guides mums through their pregnancy and the first six months of their baby’s life. It has been designed to help mums give their baby the best start in life and support their health and wellbeing. The app is free to download, and it allows you to create your own personalised avatar (your “Buddy”) and has lots of lovely features, including useful “daily information”, some great videos, a cool goal setting function called “You can do it,” a “What does it mean” feature where you can find out what words means, and a very helpful “Appointments” feature. Baby Buddy focuses on empowering young mothers, as well as increasing their knowledge, improving confidence, enhancing bonding and attachment and reinforcing the importance of accessing health services.

What is the inspiration behind the creation of the app?

Our charity Best Beginnings is all about ending child health inequalities in the UK. This means giving every baby the best possible start in life. Our vision is a future in which all children in the UK enjoy excellent care from the very beginning. My own personal experience has been a major influence on what we are trying to achieve. My first son David was born with a cleft palate as well as breathing and feeding problems. My second son Joshua was also born with a cleft palate and developed viral meningitis at 8 days old. My nephew Joe has a condition called Tuberous Sclerosis, he has multiple and complex healthcare needs, including severe learning difficulties, autism and epilepsy. Sometimes things go wrong, and some health problems are unavoidable, and we all do what we can to make the best of a situation. But as I became more and more aware of the shocking child health inequalities that exist in the UK, I realised some things are avoidable. For example, it’s totally unacceptable that a baby born in Bradford is six times more likely to die in infancy than a baby born in Tunbridge Wells. For the most part these inequalities are avoidable and that is what I decided to focus my energies on. Best Beginnings was set up in 2006 and the Baby Buddy app is an important part of that vision as it is designed to support parents-to-be and new parents in the social, emotional and physical transition to parenthood, and in giving their baby the best start in life. Baby Buddy focuses particularly on engaging young parents, who based on the evidence, are more likely to find the transition to parenthood harder and their babies are more likely to have poorer health outcomes. We as a society have failed to give them information in a way that works for them. Young parents want to give their babies the best possible start and we’ve created this app as a way to help them do just that.

How is it different to all those other parenting apps on the market?

Some apps are offered at a cost but Baby Buddy is free to all. Another important thing is it contains content that can be trusted. Everything in the app has been approved and endorsed by organisations including the Royal College of Midwives and the Royal College of Paediatrics and Child Health. Pregnancy or parenting apps give daily information based on the mother’s pregnancy stage or the baby’s age. No other app straddles pregnancy and birth with content which covers the emotional as well as the physical, which mentions the mother, baby and partner by name which is different content whether or not the mother has a partner and/or is or isn’t breastfeeding, all of which has been endorsed by many key maternal and child health organisations. This means the user gets the right information at the right time. We’ve had a huge amount of input from parents and professionals too. Through this, and with a clear vision of what is possible, we’ve created something that has never been done before. Baby Buddy is unique in its combination of endorsed content, friendly chatty style, its practical and interactive features, and in the ways it is being used. Baby Buddy has also been designed to be used as a tool by healthcare professionals to both support and complement their work. We have been working with local areas to actively embed the app into care pathways.

Is it easy to use?

Yes, installing the app on to your phone could not be easier and only takes a few minutes. Anyone can access it – mums or dads, health or social care professionals, peer supporters and other charity workers – as long as you have either an Android phone – in which case visit this, or an iPhone – in which case visit this link. Everyone who registers gets access to all the app's features. We ask that people please register as who they really are not as who they are imagining being. We are (as an anonymised dataset) keeping track of who is using Baby Buddy, where in the country users are and (if they complete the in-app questionnaires at 7 and 8 weeks) what they think of it. For example, we are keen to see how many midwives, health-visitors, paediatricians, obstetricians, psychologists etc are using it in different parts of the country. So, tempting as it may be to go in as a 19 year old pregnant woman when you are an interested professional, please register with your real age and profession. Once you are registered you'll end up having exactly the same experience as the 19 year old pregnant women you have in mind when testing the app. The in-app data will help us get the app ever better. We've only released the 1.0 version and this will be a multi-year project informed by in-app and site-based evaluations. Our web page has it all spelled out here. The app itself is very visual, and uses lots of images and video clips. Many mums who have been giving us feedback tell us how much fun it is to use the avatar, which can be customised. There are well over a million different avatar Buddies you can create, each with their unique combination of body shape, skin tone, eye shape and colour, nose, lip shape and colour, outfit and hairstyle, and if the user chooses, virtual earrings, necklace and sunglasses.

Why do mothers need an app when we have so much information on the web available?

Very few young parents with babies are far from their smart phones these days and it makes sense to deliver key messages and support to them in this way. Mums have been telling us that, frankly, they are overwhelmed by the amount of information out there and searching the web for an answer is a minefield when you don’t know if the source can be trusted or not. Baby Buddy has a fantastic Ask Me function that gives them answers to all their questions on pregnancy, birth and parenting, as well as a “what does it mean?” feature. But Baby Buddy does more than give information, it is also highly interactive. This means as well as sending regular messages with timely reminders, daily alerts and video advice, it also enables the parent to set goals, manage health appointments and find local groups and resources via a map. A phone app is a great way to reach out to younger mums, who as a group are among the highest users of smartphones. Younger mums may not always be accessing health services in the same way as older mums, so it provides a way to connect them to a resource that maintains regular contact and alerts.

When will it be ready to install on my phone?

Right now! Version 1.0 is available to install. Visit the web page now to install it. I would actively encourage everyone to download and use it. We are seeking feedback from parents and health and social care professionals ahead of the official launch in mid-November 2014 to make the app even better. When you install it you’ll be asked to give feedback in the app and you can also email us directly. We are particularly keen for multi-disciplinary healthcare professionals to understand its functionality and content, so they can recommend it to the families they support, and use it in appointments. When you register as a user, just choose the options that fit you best.  This way we can separate out feedback from parents and professionals. I really would be delighted to hear any suggestions anyone has for additional content for example new FAQs for the “Ask me” function via: hpapps@bestbeginnings.org.uk. Midwives may even want to rate it and write a review of it on Google Play or iTunes App Store. The more reviews there are for parents-to-be and new parents looking for help, the easier it is for them to decide if Baby Buddy is worth downloading. So if you’re readers, (after using the Baby Buddy app), want to take a few minutes to write a review that would be wonderful.

How are parents going to hear about the app?

Well, there are lots of ways and your readers can play a big part in this, if they wish!

1. Special posters and postcards are available to display in areas where pregnant and new mums visit, and they can be downloaded or ordered free of charge here!  Some areas are putting the leaflets in pregnancy booking appointment letters and other maternity services are working with us to develop ideas on integrating the app into local maternity and children's care pathways.

2. We have a social media campaign building on Twitter using @babybuddyapp @BestBeginnings and @AlisonBaum and we are very keen for you to get involved. We are a growing 'family' and would love you to be part of it! See the video below...

3.  We are planning a press launch on November 19th 2014 - so please do join in the Twitter and Facebook chat, and let us know if you would like your local area to be part of the press launch. Email us at hpapps@bestbeginnings.org.uk

Is the app complete?

No not at all, we are very much at the beginning of a multi-year journey.

We have an abundance of helpful content in the app, but we are constantly looking for more Questions and Answers for the "Ask Me" function and I am always keen for suggestions, all of which have to be endorsed by our team of experts before inclusion. We are also in the process of making more than 100 new films to go into the app which will include everything from young mothers preparing simple healthy meals, to mums at antenatal classes talking about what they get out of them, films about creating wellbeing plans, creating birth plans, films about active labour, about baby communication, spotting a sick child and much much more. We are actively recruiting young pregnant women and young mothers from across the country who are happy to be filmed during their pregnancy and/or their baby's first months. We are also keen to recruit and film mothers with older children who experienced mild, moderate or severe mental health problems to tell their story retrospectively, with the purpose of raising awareness, destigmatising and informing app users about mental health and wellbeing.  For more information please see the dedicated webpage on our website. We'd be delighted to hear from healthcare professionals working with young parents or from parents themselves.

In addition to new content coming on board, we are also adding in new features to Baby Buddy. Within the next few weeks three long-awaited features will go “live”:

Bump Around/Baby Around: this new feature helps users of the Baby Buddy app to find local services and classes based on their locality, using a map. The aim of this feature is to use technology to increase social capital by supporting more young mothers to attend classes and use local services.

Bump Book/Baby Book: this new feature allows users to keep their own private diary with photos, thoughts and reflections. Users can, if they choose, share individual daily entries with friends and family and their wider network). In creating this feature we have created a reflective space within the app to support mind-mindedness and the emotional transition to parenthood. Our aim, in the future, is to create a way for users to easily make a hard-copy version of their Bump or Baby Book if they choose.

Text to voice: that users will be able to tap a button and their Buddy will speak her message to them

Here is a special message from me about how you can play a key role in this project and make a difference to babies' lives in the UK. Thank you!

Here is a special message from me about how you can play a key role in this project and make a difference to babies’ lives in the UK. http://vimeo.com/101627566 Together we can make a difference for future generations. Thank you! PS: If you want to find out more about the dad’s app I mention in my special message click here.

The right to choose home birth: a debate in the UK

I am always alarmed, though not surprised, to see press articles such as this questioning the ‘rights’ of women requesting a home birth.  Over a period of 35 years as a midwife, I have cared for scores women who have given birth at home, and those occasions have been some of the most rewarding moments in my career.  We now have clear evidence that home birth is cost effective and safe.

My district nursing sister (who had her babies at home) tells me that when loved ones wish to die at home, the request is always respected. Services are mobilised to ensure those precious end of life moments are as comfortable as possible. To me, this is fundamental stuff, and choice at the beginning and end of life should have equal priority.  Yet in the above article, lawyer Barbara Hewson is quoted as stating that ‘mother’s don’t have a right to choose a home birth’.

I noticed that the Royal College of Midwives is debating this very issue at their forthcoming conference in November.

I was surprised that an obstetrician is speaking on the topic, and we are to hear perspectives from a panel made up of a lawyer, an obstetrician and a journalist. But where’s the midwife? Isn’t the midwife the one who facilitates home birth?

So I thought I would ask some questions to a similar panel, but to include a midwife, to get a debate going…please add your comments and experiences at the end of the post, and add to the conversation.

 The panel:

Professor Soo Downe OBE (Midwife)

Elizabeth Prochaska (Lawyer-Public Law and Human Rights)

Milli Hill (Journalist-Mother-Doula)

First of all, what do you think about the newspaper article, and Barbara Hewson’s stance on the matter?

SD: I was rather surprised to see the statement that women don’t have a right to a home birth in the UK. As far as I understand it, the Midwives Act 1902 gives women this right, by virtue of the fact that the midwife must attend a woman in labour if called. So, at the extreme, whatever clinical or social situation she is in, a woman in labour at home can call a midwife to her. Obviously, it is much better if this doesn’t happen at the last minute, and if this right to be attended in labour is translated into a an obligation for the maternity services to provide good antenatal care and planned support for the labour, the home birth right-or-not debate becomes a red herring.

The debate also sets up women in opposition to the fetus, and the midwife as having more obligations to her employer than to her Code of Practice and professional moral standards. Both of these developments are very sinister, and both should be resisted.

MH: Although my first reaction to the newspaper article was negative, on reflection I think the article is interesting.  To me it looks like an editor has given it a very attention seeking headline and chosen a particularly provocative sub heading (sometimes called the ‘sell’), which sadly complies to the popular notion that home birth is dangerous and probably shouldn’t be allowed.

However, the article is not really saying that birth is dangerous – Barbara Hewson balances this statement with the fact that birth can equally go wrong in hospital and that the litigation culture is probably causing unnecessary interventions. Nor is Hewson saying that ‘mothers don’t have the right to a home birth’ – although she is unpicking from the legal angle the question ‘what are mother’s rights when it comes to home birth’ – a subtle difference that the editor perhaps ignored in their search for traffic.

As a mother who has birthed at home twice (once last month!), the article made me very uneasy. When you put it alongside the current situation in Ireland highlighted by the recent case of Aja Teehan – and the current situation for Independent Midwives in the UK – and a similar struggle to save home birth in France - which I understand is also happening in South Africa… and then read details of the RCM conference debate - it really starts to feel almost like a backlash against the movement to reclaim birth.

Home birth – for me – was the place where I felt safest from unnecessary intervention – and I speak as someone who experienced an episiotomy and forceps delivery in hospital for my first birth, purely because the clock dictated I could not have any more time, although myself and baby were well.

In my two home births I have experienced how birth proceeds so normally in a safe and loving environment, and how wonderfully empowering it can be to birth your baby yourself, with nobody taking control or telling you what to do. I wonder why there is such an energy across the western world that seems determined to prevent women birthing like this? Is it really all about safety?

EP: Lawyers often have different views on the right interpretation of the law and there are rarely clear-cut answers to legal questions, especially when the question hasn’t been considered by a court. Nevertheless, when a lawyer purports to explain the law (rather than give their own opinion about it), it is incumbent on them to give a clear and balanced account. It is a shame that the headline to the article suggested that there is no ‘right’ to home birth, as this is not an accurate reflection of the law, and did not reflect the nuance of the article.

What are the mother’s legal rights to a have a home birth, and does it make a difference ‘if things go wrong?’

SD: Even in the very rare situations where the choice a woman makes for place of birth might lead to a very real risk to the baby, there is still no legal grounds for denying her her autonomy, as far as I’m aware. Consider, for example, the case of two identical twins. One is terminally ill with kidney failure, and his twin is the only possible donor match. However, for reasons best known to himself, the healthy twin refuses to donate his kidney to save his brother. Is there any conceivable situation when it would be legally and morally acceptable for the healthy brother to be taken against his will to hospital, subjected to necessary drug treatment to prepare him for surgery, be operated on against his will, and have his kidney removed, for the sake of the brother, however much we may struggle to understand the rationale for his refusal?

Why is it different for women who are refusing to go to hospital for the sake of their baby?

MH: Since learning about the case of Ternovsky vs Hungary at the European Court of Human Rights, I have been under the impression that women have a human right to give birth wherever they wish.

What Barbara Hewson seems to be saying is worrying – essentially that, although women may have the ‘right’ to give birth where they like, the state does not have an obligation to provide them with care in any setting, if this is not practical or they deem the birth to be too risky. This is exactly what has just happened to Aja Teehan, and it seems we are only a whisker away from a similar situation in the UK – the whisker being, as Hewson points out, that the NMC states that midwives have a duty of care to attend a woman no matter what.

Some women who are aware of this will currently insist on attendance by a midwife at home even if their local hospital states that they do not have enough staff to provide one.

But it would only take a small change – an insurance issue, for example – for us to be in a situation where it was impractical or even illegal for a midwife to attend a woman at home regardless of their employer’s wishes.

‘Things going wrong’, insurance, and the desire to minimize or even eliminate risk seem to be at the heart of the issue. Having had two ‘uninsured’ home births with Independent Midwives, I think it’s worth reminding ourselves that insurance only pays out in the case of negligence, and that ‘things going wrong’ in birth does not necessarily mean someone was to blame or that we would have been safer in hospital. I also feel that myself and my partner were capable of assessing any risks involved in home birth – exercising our autonomy as we did so, and being prepared to take responsibility for our decision no matter what happened.

Perhaps the most controversial aspect of Hewson’s piece is that she implies that mothers (and fathers) of unborn children may not be the best people to decide where their baby is born. She talks about births at home against medical advice that had tragic consequences. And she finishes by saying that insisting on having a midwife attend you at home against their employer’s wishes may not be ‘wise’.

This, too, is at the crux of the debate – who should decide where a baby is born? Of course, my view is that it should always be the mother, and that she can absolutely be trusted to make the right decision about this. However, this view is not shared by everybody – many still subscribe to a ‘doctor knows best’ attitude and are reluctant to examine the actual facts and figures that underpin medical advice and decisions. As Labour party Counsellor Ronan McManus tweeted in response to AIMS Ireland, “allowing someone untrained and emotionally involved to interpret the evidence is a dangerous trend.”

This breathtakingly misogynistic view sums up the problem that many people have with home birth – it puts the power and autonomy back into the hands of the mother, which is ‘dangerous’.

The voice of a home birth mother – or any mother – also seems conspicuous by its absence at the RCM debate?

Again I’m wondering – is the current backlash against home birth part of a drive towards safer births and better outcomes? Or does it contain an undercurrent of an age-old desire to limit or destroy the power of the birthing woman?

EP: We need to start from the basic premise that women are the best and only judge of where they give birth. If we start to question their capacity to make that decision, we undermine centuries of hard-won legal autonomy and we wouldn’t be far from advocating forced c-sections, which Barbara Hewson was instrumental in prohibiting in the 1990s.

The simple legal answer to the question whether a woman has a right to give birth at home is: yes, of course. She has a right to make choices about the circumstances in which she gives birth, including where the birth takes place. This is uncontroversial as a matter of English common law (which respects autonomous decision-making) and under Article 8 of the European Convention on Human Rights (which protects the right to private life and associated right to physical integrity).

A woman cannot be compelled to accept hospital services and she may give birth where she chooses. The real issue is whether this ‘negative’ right translates into a positive right to midwifery assistance at home. The European Court has recognised that the state is required to take steps to enable this positive right, but there will be acceptable limitations that can be placed on it. Barbara Hewson’s article dealt with those potential limitations. She suggested that staffing shortages might be one such limitation. In the absence of a case determining this point, we can only say that there may well be circumstances in which staffing issues would justify a limited service and cases when they would not. There isn’t a blanket rule when it comes to factual conditions that justify limitations on rights. Certainly, government and NMC policy mandating attendance of midwives at home would inform the court’s assessment of hospital decision-making about home birth.

You can read more about the debate on the Birthrights website: www.birthrights.org.uk

How can we ensure that the balance is right, with respect of what the woman wants, and what the care-giver wants and is able to provide, ensuring safe, high quality care?

 EP: The question of service-provision isn’t really about balance, it’s more about what women can reasonably expect from their maternity services. Clinical Commissioning Groups (CCG's) in England and Health Boards in Scotland and Wales are under an obligation to provide services to meet local needs. Women invariably need to be provided with a variety of options for maternity services, including home birth. CCGs and Health Boards are also under an obligation to have regard to government policy on maternity choices, which requires them to make home birth available as a choice in all areas. In essence, women can expect to be provided with home birth services and should hold their local decision-makers to account if they are not provided, or are unreliable.

Do you think the issue of choice in place of birth influences the relationship between mother and midwife, and if so, why?

SD: Good maternity services = skilled and compassionate care in an authentic relationship with the woman. And this includes a stop to the quibbling about facilitating home birth for women, especially when the evidence says it is the most economic and safest place for most low risk women and babies to be;  and a turn towards providing the best possible care for women and babies in the place that suits them best.

EP: All the evidence suggests that choice of place of birth can have a profound effect on women’s experience of their birth experience, measured not only in improved clinical outcomes (and consequent public health savings) but also in terms of long-term emotional consequences for the mother and child. Continuity of carer, generally only achieved when the mother chooses a home birth, has a particularly positive effect for women, presumably because women build a trusting relationship with their midwife that enables better care and support. It is no surprise that the Department of Health seeks to promote home birth as a result.

If you have anything else to add….

MH: I don’t think the question should ever be asked, “Do mothers have the right to give birth at home?”, or, “Do women have the right to give birth where, how and with whom they choose?”. A woman’s right to have her baby where and how she chooses seems so fundamental to me and it feels wrong and dangerous to even question that basic right.

However, there are questions about the practicality of home birth in such times of midwife shortages, insurance issues etc, that are worth asking. Why are the RCM, for example, not debating ‘How can we encourage home birth to increase and flourish in the current climate?’, that would seem to make more sense.

We would like to know your thoughts, to start the debate...

More about the contributors

Milli Hill:

Founder Positive Birth Movement Twitter: ‪@birthpositive

Editor Water Birth: stories to inspire and inform Twitter ‪@waterbirthbook

Birth Columnist for Best Mag Daily ‪@BestMagDaily

Blog: the-mule.com Twitter @Millihill

Elizabeth Prochaska:   

Lawyer, Matrix Chambers 

Founder: Birthrights Twitter @birthrightsorg

Professor Soo Downe OBE

Professor of Midwifery University of Central Lancashire 

Previous post interviewing Soo Downe

Three babies and a party!

It’s been a busy and exciting couple of weeks. It started with the birth of our sixth grandchild on the 11^th of July, which was our other granddaughter’s Betsy’s 1^st birthday.  Then it’s been babies all the way.

Our youngest daughter Olivia gave birth to her second baby, Myla, after several weeks of being unwell. We heaved an audible sigh of sheer relief, as well as tears of joy, as we cast eyes on a beautiful and tiny angel face.  As Myla was born early by Caesarean section, she could've been fragile.  Instead she was alert and responsive, and healthy. Olivia had amazing maternity care, and we are incredibly lucky. Tender, compassionate midwives and a trusted, expert obstetrician Liz Martindale ensured that our girl and her baby were happy and safe. So many heartfelt and everlasting thanks to you all.

Then Prince George made his grand entrance, with such little fuss! As a midwife of more than 3 decades, I was delighted to see an unruffled, beautiful Duchess emerge from the Lindo Wing doors, hours after giving birth. Like many other midwives and birth supporters, the speculation on HOW baby George was born has been phenomenal. And of course it was speculation until today, when it emerged that Kate was attended by midwives, who facilitated the birth. And one of those midwives is an old friend of mine, and featured in my book, Catching Babies! I am so delighted that Kate had the normal, positive childbirth experience that she wanted.

And on the same day, Sonny Ray was born in water at Blackburn Birth Centre. There was a double significance to Sonny's birth, as I was the midwife who helped Amy (Sonny’s mummy) into the world 26 years previously, at a nearby birth centre (Bramley Meade). As Amy, Alex and Sonny are propelled to fame due to Royal 'links', I revel on how the world moves in mysterious ways, and the synergies and connections between people make life so intriguing and very wonderful.

My reflections of the three births in a nutshell:

Olivia needed medical assistance for her pregnancy and birth, and it was available, thank God. Although her choices were limited, she was able to make some, and therefore she had a wonderfully positive experience. I am so proud of her.

Amy was born into my hands, and 26 years later gave birth in a birth centre that I helped to develop. Amy didn’t need medical help, and whilst she had many choices, she believed in her body’s ability and made the perfect decision for her, her partner, and her baby.

And Kate chose (or did she?) to have her baby in hospital, with medical support on hand even though she didn’t need it, yet the Queen had her four children at home.

So, Myla, Sonny and George have one thing in common. They were born in the same month, and their parents are happy and healthy. I wonder what their lives will bring?

PS And lastly, I was at a very successful launch of the parent led 'Birth in East Lancs' website on Thursday evening…you can read about it here!

Home Birth in the Netherlands......back to the future?

Attending the second day of the Human Rights in Childbirth Conference  in the Hague on the 2nd June was a revelation, and a remarkable opportunity. I was unable to be part of the first day, as I was travelling by car to the Netherlands for a two week stay to see our brilliant Dutch grandchildren. When I wrote about the conference previously, I didn't think I would be able to attend at all.

It was Hermine Hayes-Klein, an American Lawyer, who developed the idea for a conference with others after researching the politics of birth in the Netherlands and USA following the birth of her two children. Women's right and authority to choose the place of birth for their baby, and to be supported in her choice was the key driver for Hermine.

The first day of the event aimed to bring attention to and focus on the issues surrounding the Ternovszky v. Hungary case. Although I thought I knew a fair deal about the horrific plight of Agnes Gereb, I learnt so much more as I absorbed the text within the conference's detailed publication.

The implications of the Ternovsky case are apparent in other countries other than Hungary, and the holding of the case offers a potential solution globally. Experts from around the world were carefully chosen and they gathered willingly to debate human rights and childbirth and explore a way forward.

Day two was of particular interest to me because of my family link with Holland, and as an advocate of home birth, midwifery and maternity care in the Netherlands has always caught my attention.

It was utterly incredible to be in Den Haag and to listen to the debate surrounding birth in this small country. I found Dr Raymond De Vries's keynote address inspirational, and I couldn't get enough of it. From Dr De Vries and then the panel of experts I heard an array of perspectives about the controversy surrounding the perinatal mortality rate in Holland, how it is higher than other European countries and proposed as one of the factors that is influencing women's decisions on where to give birth. I heard how these statistics are being challenged, and how health professionals are exploring every opportunity to understand the situation.

Another issue raised was the Dutch maternity guideline, Verloskundige IndicatieLijst (VIL) and the restrictions it increasingly imposes on women's choice to birth their baby at home. The introduction of market forces within Dutch health services and changes to how maternity services are funded is also believed to be a factor in the decline in home birth. And some suggest that some women in Holland have different priorities and are preferring to give birth in hospital...although others contest this claim.

I was particularly moved by Rebekka Visser  and  Marjolein Faber's address to the conference, they received standing ovations from the delegates and they gave the impression that they are forces to be reckoned with.

So what did I learn?

1. A country that has been the shining light for birth practice globally for decades is potentially under threat, and that is a travesty. I desperately hope the Netherlands doesn't follow other countries in their quest to improve.

2. I realised that during my career as a midwife in East Lancashire in the UK I experienced something special. Because...

During her address Rebekka Visser said:

To me it's of great importance to really listen to the woman - and to the way she assesses risk for herself. To guarantee absolute trust that she is the one in charge. To provide her with all the information she asks for. To be open about this towards other people.. My dream is to be able to do my work as a midwife in close cooperation with gynecologist and hospital, thus creating a network where women can be respected and supported in their choices.

I was able to provide such care. Obstetricians working closely with midwives to facilitate woman centred care collaboratively meant (and still means) that women do have a choice in home birth, birth centre birth and hospital birth...and their choice is respected and supported even if their individual needs and requests do not 'fit' a guideline.

3. That women in Holland using maternity services now and in the future need to ensure their voice is heard and maintain momentum from the conference. It is crucial.

I feel privileged to have been part of what I consider to be the cusp of a birth revolution. If you would like to learn more  you can visit the conference website and consider subscribing to the webinar.

You may also wish to read comments on Twitter from the two days, and pursue the various links from the posts.

Many thanks to Simone Valk and all the conference organisers for welcoming me on the 2nd.

Other blogs about the Conference:

Rebecca Schiller-The Hackney Doula

Dr Amali Lokugamage 

Oxytocin, childbirth and Troon

For the past three days I have been at the MAMA conference in Troon, Scotland surrounded by women (and a few men) who are totally dedicated to making birth better, for many reasons. Some of the comments and activity were shared via Twitter

The atmosphere in the Marine Hotel’s conference rooms felt like a full and busy bee hive, buzzing and happy! The positivity and energy was palpable. I attend many conferences on childbirth, and this one was exceptional.

I met so many people I immediately connected with, I learned lots, and I laughed and cried. The emotion at times was overwhelming as I listened to how childbirth was being marginalized, even though I knew it already. One of the wonderful doulas I met, the lovely Mars Lord (she helped me deliver a Twitter lesson!) has written a fabulous reflective blog of the event, and has summarised it beautifully.

During the two day event the most profound words for me came from Michel Odent and Kerstin Uvnas Moberg 

http://www.youtube.com/watch?v=pcEmuUrdMGU&feature=related

They really made me think.

Since time began women (and mammals) have relied on the efficient release of natural oxytocin to give birth and to breast feed their babies. Oxytocin is also released by men (and women) during sex and is described by Michel as the ‘hormone of love’.  Both Michel and Kerstin have studied the positive effects of oxytocin and it’s crucial role in our existence. Kerstin states that oxytocin can reduce pain, lower blood pressure and reduce stress. They clearly raise concern that as birth is increasingly disturbed by intervention in labour, pharmacological drugs and unnecessary Caesarean section  the production of natural oxytocin is weakened.  One of the consequences of this Michel says is that women are becoming less able to birth their babies. He warns that globally we are at the ‘bottom of the abyss’, in other words we are as bad as we can get. The authors also claim that as oxytocin is necessary for bonding and attachment of mother and infant, this is affected too.

It certainly makes sense to me. Fear and loss of control were the main reasons women came to me during my time working as a consultant midwife, and I hear it constantly from the young women I talk to.    Sadly, our society increasingly believes that childbirth is laden with risk, and as a hospital procedure. This is a worrying trend, and the reasons are complex and too many to write here. I will say though that I am not alone in being convinced that TV programmes such as One Born Every Minute aired in the UK and USA are contributing to the situation. For anyone interested, there is a Facebook page dedicated to the highlighting the issues.

This is a great pity.

I certainly will be taking the oxytocin message with me when I talk to midwives, doulas and doctors, for the sake of love, of positive childbirth, of parenting and of basic human existence. And I need to pursue the opportunity to increase awareness among the women and men I communicate with. We can’t stay at the bottom of the abyss.

Oh, and I met the midwife who influenced my career from the early 1980s, Ina May Gaskin. Ina May is a one off, and it was an honour to be in her company for several meals and chat to her and her husband Steve. Ina May is a world class midwifery leader, and her predicted inspirational talk at the end of the conference provided further confirmation that birth really matters, and there is much to be done. As a real 'groupie' of Ina May and the proud owner of her first book Spiritual Midwifery (and perhaps the first edition!), I was blown away when she turned to me on the last day and quietly said 'can I have a signed copy of your book Catching Babies?' Wow. What do you think about that? #neverthoughtitwouldhappen

Photgraph courtesy of Severns Jones Photography