We are delighted to be sharing with you our edited book about spirituality in and around the start of life. The chapters highlight aspects of birth we often take for granted, qualities often ignored or left silenced and questions the art of birth and the meanings ascribed. The voices you hear in this book are from international practitioners, educators and researchers as well as those of women and those who care for them and are present at the birth of a new life. Spirituality means different things to different people yet what consistently is shown is that spirituality is concerned with meaning and purpose and each chapter draws our attention to new dimensions of understanding of what it means to be human in and around childbirth. The premise of our work is that spirituality at this stage of a life span has been ignored for too long. Though discussed and raised as significant and important at the end of life, at the start it has been hidden. We are honoured that Lesley Page has written the forward for the book and recognises the significance of the content. There are many contexts that are explored throughout the chapters, ranging from straightforward births to those that are complex or challenging; from the mother to the practitioners; to the unborn and born baby. This book raises many questions and suggests some practical suggestions to take this forward. We hope that this book will provoke discussion and debate over a topic that has long been subdued. We welcome you on this journey with us and look forward to engaging further.
Today we want to Shine the Light on Dr Roa Altaweli – an inspirational midwife from Saudi Arabia. Although Roa is well known to many, we wanted to tell the rest of the world about her amazing career, her creativity and her leadership. If you want to be inspired….then read on!
‘I love being a midwife and would like others to love this profession as much as I do’.
Dr Roa Altaweli is the first midwife from Saudi Arabia to obtain a PhD. Roa was born in Jeddah, she is a registered nurse and midwife, and has worked as a midwife at National Guard Hospital in Jeddah and as a teaching assistant at Dar Al Hekma University.
Roa decided to pursue a academic career and obtained a Postgraduate Certificate in Advanced Practice of Midwifery from King’s College London and then a Masters and PhD in Midwifery at City University, London.
Roa now works as a Clinical Director of Nursing at East Jeddah Hospital, Saudi Arabia. She is. a founding Board Member and Vice-Chairperson of the Saudi Midwifery Group and a member of a Saudi Ministry of Health initiative called the Optimizing Maternal Mortality and Healthcare Advisory Team.
I hope that midwifery education in Saudi Arabia can be as strong as in the UK
Roa says. “I love being a midwife and would like others to love this profession as much as I do. My aim is to empower women to have natural childbirth in Saudi Arabia and help in the development of direct-entry midwifery courses that prepare competent, qualified midwives.”
And Roa certainly takes ’empowering women’ seriously, by keeping connected to women and childbirth.
‘Due to the limited and trusted Arabic resources about natural childbirth I created ‘Rahmah Birth’ in April 2016 to increase the awareness of natural birth, for women in Saudi Arabia and around the world. Rahmah (my mother’s name who passed away January 2014) means Mercy in English. My mother always believed in natural childbirth and gave birth at home to my older brother Khalid who passed away in November, 2016. I dedicate this work to her and my brother.
We are beginning a series of ‘Shining the light on…’ blog posts, a space for YOU to share your work or ideas, to tell others about your innovations in midwifery or maternity care.
Please let us know if you would like to be next! We’re waiting….
TODAY THE LIGHT IS SHINING ON … LAURA GODFREY-ISAACS!
We are delighted to share Laura’s work and interests with you, and information of an exciting event that will be well worth attending!
Laura is an artist, midwife and feminist academic and activist. She spent over twenty years in the arts, as a visual arts, feminist academic and creative producer. In 2016 she graduated as a midwife from King’s College London, and now works at King’s College Hospital, London.
‘I’m really excited to tell you about this up and coming event. I’m delighted too, as I am involved as an artist/midwifery advisor and speaker. Oxytocin – Birthing the World takes place at The Royal College of Art, and is organised by Procreate Project in collaboration with The Museum of Motherhood USA This is an international research and community event designed to encourage conversations and exchange between medical, midwifery, academic and art sectors with the aim of facilitating collaborations between them and increasing awareness of women’s rights, and their emotional, physical and cultural needs during pregnancy, labour and the postnatal period.
‘Becoming MILF’ Madison Young 2014
Before qualifying as a midwife in 2016, I spent over twenty years in the arts, as a visual artist, feminist academic and creative producer, and projects like this are enabling me to bring these different aspects of my life together. What excites me is the potential for the arts to inform and enrich midwifery – through an analysis of social constructs around women’s bodies, femininity and birth, by creating images and projects which can illuminate and extend representations and understandings of birth and as a tool for midwives to explore their own creativity and reflection.
‘Lactation Station’ Jess Dobkin 2006
The panel Midwifery, Art & Culture will include a group of midwives who represent some of the ways in which these issue are being explored as they all have a different connection, through their practice, with art and culture, which will be articulated through presentations and discussion. It’s great to be able to provide a platform to discuss a range of artistic and cultural strategies in midwifery with Ellie Durrant – Midwife Diaries & Secret Community of Midwives in the Making, Emily Maclean – midwife, journalist and social media editor, Nabila Fowles-Gutierrez – midwife, activist, mother of 3, female entrepreneur & musician and Claire Harbottle – Independent midwife, artist and director of Nativity Hub Leeds.
My introduction to the panel will build on recent conference presentations I have given at The Normal Labour & Birth Conference in Sydney 2016, MaMa Conference 2017, VIDM 2017 and the RCM Annual Conference, which look at depictions of ‘Birth in the media’ and representations of breasts and breastfeeding including brelfies (selflies of women breastfeeding). By looking at work about birth and breastfeeding, by artists and birth activists, in relation to depictions in the media and the wider culture it is possible to chart dominant cultural constructs which often limit and constrain women’s understanding of birth, and offer wider, more complex representations that open up meaning and connection and encourage women’s autonomy and agency in birth.
This event will be a fascinating interdisciplinary event, which I hope will encourage more cross-over between midwifery, art and culture and ultimately benefit those working to enhance and improve maternal experience: artists, midwives, birth workers and activists.
Details of Oxytocin – Birthing the World
Saturday 3rd June, 9.30am – 5.30pm, Royal College of Art Battersea, 1 Hester Road, SW11 4AN
Indie’s message to the world, for International Day of the Midwife 2017
Indie Kaur is a consultant midwife at the Royal London Hospital, and is currently on sabbatical working in Hyderabad, India, at the Fernandez Hospital. This hospital is owned by the inspirational obstetrician, Evita Fernandez, who is working tirelessly to develop professional midwifery programmes in her region. More about Evita, and her campaign, below!
We keep in touch with Indie, and recently saw this post on Facebook. We asked her if I could repost an adapted version of her words here, as we are in awe of the work she is doing, and the ground-breaking progress taking place in India.
It is now April in India.
I have been here for 3 months now. I must admit I love the sunshine despite this intense heat. All this sun, yet Indian mothers seem to be vitamin D deficient. The weather fluctuates between 33 to 42 C. I am on a journey, which is exciting, as I believe it will be a slice towards influencing professional midwifery services in India. But it is also frustrating. I am a professional midwife with over two decades of experience. However, I am unable to practice in this country due to the complexities and bureaucracy within the government, which by the way does not accept midwifery as a separate unique profession. Accountability within one’s sphere of practice therefore, is not accomplished.
It was the 1902 Midwives Act, which introduced training and supervision for midwives in England and Wales, outlawing uncertified and untrained (bona fide) midwives. However this legislation didn’t eliminate traditional birth attendants, as fewer midwives were available in rural areas. After 1910, all women were expected to have a qualified medical practitioner in attendance at the birth of their baby. Uncertified midwives were forbidden to attend women in childbirth without the direction/supervision of a medical practitioner. The newly registered midwives were initially required to have a 3 months training, which increased to six months in 1916 and a year in 1926, with the model of calling the doctor in difficult cases. The proportion of births attended by qualified midwives increased steadily and by 1930’s is almost all practicing midwives had received training and continues to have legislation changed. Today in the UK direct entry midwifery is a three year programme, and for registered general nurses it’s eighteen months.
Human rights violations
There are some similarities in India today to the 1920’s in the U.K. There are traditional birth attendants in rural India, and no professional midwives based on the International Confederation of Midwives (ICM) core standards. In the public institutions where the majority of women give birth, there are masses of vulnerable women, birthing in appalling desensitized environments. There is lack of dignity, respect and there are violations of basic human rights like privacy. They are cared for by health care professionals who are a mix of nurses, unskilled birth attendants (dais) and auxiliary nurses (erroneously called midwives) who lack the knowledge and training. The challenge lies in India urgently recognizing the need for professional midwives.
Evidence and choice
The place in which majority of women give birth in the UK has changed considerably over 100 years; following the Peel Report in 1970 birth went from home, to maternity institutions – hospitals. The Changing Childbirth Report in 1993 suggested that women should have a range of options of place of birth. The philosophy behind birth centres in the U.K is the provision of a safe environment for healthy women to give birth in outside the hospital, where the medical interventionist model dominates. The Birthplace Study in England clearly highlighted that healthy women, who gave birth in a midwifery led unit (MLU) had significantly fewer interventions, including substantially fewer intrapartum caesarean sections. The study also demonstrated that for healthy women, giving birth in a midwifery unit was as safe as hospital, for her and her baby. This gives women choice in place of birth, and allows doctors to focus on medical complications.
In the UK, MLUs (also called birth centres) continue to be sustained because there is a midwifery profession which is autonomous and accountable, and has been embedded into the healthcare system for more than a hundred years. However, in India, there are some birth centres run by midwives certified from overseas to help a rising tide of women demanding midwifery led support during their birth. Would it not benefit all childbearing women in India, to have a baseline cadre of professional midwives? Why does the government and the Indian Nursing Council not accept midwifery as a separate autonomous profession?
I am working in a tertiary referral perinatal center, with over 8000 deliveries per annum, providing clinical leadership to our midwives in the antenatal and intrapartum areas of care. I am lucky to work with a visionary leader Evita Fernandez an obstetrician, who understands the value of professional midwifery and how it can influence maternity care including reducing the mortality and morbidity rates in India. She launched an in-house professional midwifery education and training (PMET) programme in August 2011. Had she waited for bureaucratic approval, we would not have the rich data we have collated over the years of the impact of professional midwifery support on birthing experiences and outcomes.
Our professional midwives in Fernandez following our ‘train the trainer workshop’ conducted last year have recently trained health care professionals in the rural districts. We travelled to Nandyal (300 km) in April and four of our midwives trained health care professionals in obstetric emergencies drills of shoulder dystocia, pre-eclampsia, postpartum haemorrhage and neonatal resuscitation. The workshops were well received and the positive feedback from the participants was very encouraging. The medical director of the hospital that hosted this workshop, that very night, had a case of eclampsia, which was dealt with efficiently by the nursing team who had attended the workshop. A mother’s life was saved and long-term morbidity averted.
My friends – this is going to change outcomes and indirectly save lives of mothers in India.
Unlearning poor practice
Recently in Fernandez, the midwives experienced a Lotus Birth, as one of the mothers opted for this experience. The concept of listening to mothers and supporting them through their birth choices was strongly demonstrated with this mother’s request. The mother experienced lots of telephone calls from her family and friends constantly asking if she had had her baby. I was her point of contact and she felt assured with a daily phone conversation. When she came in spontaneous labor the midwife who had helped her birth her first baby was also available. This made the woman more happy and added to her comfort and feeling of safety. The midwives in Fernandez are learning to understand women and “unlearning” the need for repeated vaginal examinations. They are discovering the value of spending time with women, watching and listening while they understand the signs of progress of labour, without a vaginal examination. The mother raised the question of having a vaginal examination. She was comfortable and relaxed when we said ‘No’ and encouraged her to mobilize. She was relieved and had planned a water birth. The lights were dimmed and the clock on the wall turned off. When she relaxed, her contractions picked up after she had her supper and her older child slept. Her waters broke spontaneously, the intensity of her contractions increased, and she was ready to use the birthing pool. The cephalic pole was 2/5th’s palpable on abdominal palpation. She was four cms dilated with a thin well-applied cervix. She entered the pool and as she submerged into the water, she sighed with relief. The room was silent and her husband supported her with fluids. The midwife listened to the fetal heart and was completely in awe. This was a first water birth experience for her and the mother.
The environment was surreal and she chanted her mantra, adding a spiritual dimension to her labour. She birthed her baby in water just after midnight. The baby was brought up to her, took his first breath and cuddled up to his mother. Her placenta soon birthed and we kept it with her in a bag rubbed with rock salt and ”tulsi” which is an Indian herb with medicinal effect. This was also very rewarding for me. In my role as a consultant midwife in London, I have been steered into a managerial role. This “hands-on” clinical exposure filled me with deep satisfaction. I realized then how much I missed the clinical involvement and the rapport midwives develop with the women they help birth.
Midwife Jyothi Rapelli showing positions in labour to a mother
On the road!
The road trips in India are exciting. One encounters a variety of challenges- from a mix of good and bad roads, with cows and goats crossing over. Evita and I travelled 575 kms to The Krishna Institute in Karad, Maharashtra. I contributed to the driving under Evita’s beady eye, who in the passenger seat (obviously NOT her favourite position) ensured I learnt the rules of driving in India! I had to endure comments such as “This is India where majority of drivers do not stay in their lanes and do not warn you either when they cross. So watch out and yes- please hoot” The horn was used often enough to warn the driver ahead that I was going to overtake him….and yes, I was also reminded – ”You do not overtake two vehicles at a go”. Despite this, we survived the drive and arrived in the small university town. The hosting team was amazed and impressed that two women drove all the way themselves. We were treated as minor celebrities! On our arrival, we visited the labour and delivery wards. We were impressed with the efforts the team was trying to make, to improve the environment of birth. The workshop on Respectful Maternity Care was initiated under the Safe Motherhood Initiative, a programme spearheaded by the Dean of Nursing Studies. The next day, was spent in a think tank session to discuss practical action plans with time lines. Evita presented on birth experience and Human Rights in Childbirth, which is an urgent need for India. I highlighted the role of a professional midwife and her impact in supporting mothers, advocating and evidence behind positions in labour.
Evita Fernandez speaking to the trainee midwives
The success of this workshop lies with the conviction of Evita as an obstetrician endorsing the need for professional midwifery in India. We complimented each other’s roles. I shared my experience as a professional midwife in the UK, and now in Fernandez working under my sphere of professional accountability. We emphasized the strict need to adhere to the core clinical competencies as endorsed by the ICM. We both shared the challenges of working with a multi-disciplinary team and how it was worth every effort to work with protocols. We emphasized the need for drills and for doctors and nurses to work with respect for each other’s professional roles. All of this is needed if we wish to offer woman centered care in a high volume setting, such as their hospital, which has a 350 delivery rate every month.
I am now back in Hyderabad and attended my first Indian wedding. I was fortunate to have a personal dresser within our team with her immaculate dress sense, draped me in my sari. I felt elegant, sophisticated and stood tall at the reception. The hospitality and rich culture is amazing and the work reaps rewards. I can see the change evolving with the team. It is an ongoing journey and the decision to be a role model in India for a year has been the right path for me.
I shall keep you posted soon.
PLEASE READ ON…..
Dr Evita Fernandez campaign for professional midwives can be found here Professional Midwifery Services PROMISE – please donate to the cause if you feel able. Below is a link to an article by Evita, and an award winning video explaining more about the need for professional midwives.