Helping Babies Breathe
Helping Babies Breathe (HBB) is an initiative of the American Academy of Paediatrics and the World Health Organisation. It is a programme that has been implemented to ensure that every birth attendant is skilled in the basics of neonatal resuscitation as part of one of the five 2015 Millennium Goals (to reduce infant mortality). Apparently, in Countries where this programme has been implemented, governments have found a decrease of up to 25% in neonatal deaths. Helping Babies Breathe is a neonatal resuscitation curriculum for resource-limited circumstances. It was developed on the premise that assessment at birth and simple newborn care are things that every baby deserves. The initial steps taught in HBB can save lives and give a much better start to many babies who struggle to breathe at birth. The focus is to meet the needs of every baby born. Helping Babies Breathe emphasises skilled attendants at birth, assessment of every baby, skin to skin contact with mother, delayed cord clamping, temperature support, stimulation to breathe, and assisted ventilation as needed, all within “The Golden Minute” after birth. Midwife Marianne Littlejohn and myself are trained as teachers and trainers of HBB and volunteer for Operation Smile and have thus far taught midwives, doctors, NICU staff, nurses, doulas, birth attendants, mothers, fathers, and interested people these basic but life saving skills. We have been privileged to teach all over South Africa, as well as in Malawi and Kenya. Plans are also afoot for us to teach in the DRC and Lesotho, as well as continuing to teach in South Africa. This last week I taught the skills to a group of peers, WOMBS doulas and CPM Mandi Busson at friend and colleague Lana Petersen‘s home. I must admit to feeling slightly intimidated, teaching friends and colleagues but this fell away very quickly as stories were shared and we acted out various scenarios from precipitous unplanned home births to water births. What I love about the HBB programme is its emphasis on normal birth – that it reiterates that approximately 90% of all births are straightforward and that it teaches as its introduction how to facilitate that: Skin to skin, delayed cord clamping, breastfeeding, etc and that even when a baby needs help to breathe, that every step is take to ensure that that mother and baby bond and cycle is not broken. Here are some pictures from this week’s course. We had so much fun acting out the various scenarios that plans are afoot for some fun birth theatre sports, possibly to be presented at this year’s Cape Town Midwifery and Birth Conference. If you would like to host or attend a Helping Babies Breathe course, please contact...
Read MoreWhat is it About Birth?
What is it about birth? It is as though time suspends itself and something unique unfolds from within the labouring woman. She has purred, sighed, breathed, whimpered, cried her way through her contractions, these life giving pains which make her rock her hips, make her moan and groan, make her eyes roll back in her head, make her sweat, make her hate, make her angry, make her one, make her have to give in, give up, surrender. And as she surrenders something primal is unlocked and this, this essence, this power takes over, her body is no longer her own. She sits on the loo, or she squats, or she kneels, or she lies on her side.She grunts and moans, red slime drips down her thighs, she feels overwhelmed. She may stand up, she may look up, she may feel with her hand as the head of the baby slowly stretches her perineum. She seems more alert now. There. Present. She may crouch down, or breathe, or gasp, or moan, or scream as her baby’s head emerges, not quite believing the sensation of this slimy little head stretching stretching stretching her wide open. The head emerges and hangs, almost lifeless. The world holds its breath. Then a splutter, or a crackle, or a bubble of spittle and a grimace. Then slowly, slowly, the baby’s head turns – as though ready to face the world and with a newfound power, the little body ejects itself, swimming forth in a gush of blood and water and shit. Again, it is as though time has suspended itself as the baby, still aquatic in its features and colour, begins to move, sometimes throwing its arms back and stretching its back like a ballet dancer, and sometimes uncurling slowly slowly slowly as though waking from a deep sleep. A gurgle, a crackle, a soft cry. Slippery body, oily white vernix, blinking eyes, stretching fingers and toes. Cord pulsating. Body breathing. Mother touching. Stroking. Smelling. Kissing. Whispering. Crying. Laughing. Grateful. Astonished. Astounded. Holding. Loving. Ecstatic. Triumphant. Perfect. Beautiful. Primal. Sublime. What is it about birth?...
Read MoreAre We Creating an Epidemic of High-Risk Women?
Two weeks ago I wrote about the first unnecessary caesar I attended. It was the first but it was also not the last. It did prompt me to do my homework and to really make sure that the women I was attending as a doula were well informed. One of the things I did was call up all the maternity wards of all the private hospitals here in Cape Town and ask them directly what their their caesarean section rates were. I knew from discussions with other doulas and midwives that many caesars were taking place but I did not have clear numbers. The conversations went something like this: “Hi…I am a doula supporting mothers wanting to birth vaginally in private hospitals here in Cape Town and I would just like to know what your caesarean rates are so that they can make an informed decision about where the best possible place to birth is.” Or something along those lines. Responses were everything from helpful and obliging to irritated, rude and irate: “Oh one doctor here has about a 60% caesar rate…he really tries, but the others are definitely around 80 – 90%” “About 65% but I think it is the private midwives that do deliveries here that bring the rates down…the doctors have much higher rates than that.” “Between 60 and 90%.” “I don’t see why we should divulge this sort of information, I don’t see how a high caesarean rate can make a difference to a woman’s chances to birth naturally!” “It is definitely upward of 80% but I am not telling you how much higher – I don’t think it is any of your business!” So in private hospitals in Cape Town, we are looking at a caesarean rate of 60 – 90%. And from my experience in two of the major government hospitals in Cape Town, it seems to be around 50% in the public sector. The World Health Organisation recommended a caesar rate of between 10 – 15% as being healthy, so WHY is our caesarean section rate so high? And why is it not my business to find out the caesarean rate of a hospital that is often promising to be supportive of women’s wishes to birth as they wished? And why is it suddenly okay to slice open perfectly healthy women and change their obstetric history forever? (I need to stress that I am not anti caesarean. I am eternally grateful for the operation that saves the lives of mothers and babies. I am not putting down this very necessary intervention and the skilled people who can perform it.) Since then I have worked within home birth midwifery practices and met midwives from all over the world who maintain a caesarean rate of between 2 and 20 %. Why do they get it right and the hospitals do not? I think the saddest and hardest thing for me is meeting the women who have undergone these unnecessary caesars. Who come with their stories. And who really want to give birth vaginally this time around, sometimes after one, sometimes after two, sometimes after more caesareans… I was induced at 38 weeks and didn’t progress so I had to have a caesar. The doctor said my baby was getting to big and I would never be able to birth her – but then she was an average size! I had a supportive doctor but she was on holiday when I went into labour and I got the doctor with the highest caesar rate in the hospital. The environment was too clinical for me, the beeping machines,...
Read MoreBirth : A Poem
Birth: What is birth? Birth is the emergence of a new individual from the body of it’s mother. The emergence of that new individual, is the emergence of a new life. Birth is completely normal yet unbelievably profound. As that baby emerges, everyone holds their breath….. Where do we give birth? We choose to have our babies in various settings: At home In hospital In a theatre And sometimes these are not choices but necessities. Sometimes we plan to give birth in one way but then something completely different may happen. Sometimes babies are born in trees, or on trains or by the roadside. Sometimes babies choose for themselves where they want to be born. Where and how we give birth affects who we are. It affects how we are as parents. We need to feel safe. We need to feel confident. And we need to feel in control, so that later we can lose control. If a woman feels cared for and nurtured, she is more likely to love and care for her baby. When we feel safe where we give birth, we give birth more easily. If we feel frightened or vulnerable, we may feel traumatised and incapable of loving our babies. If we are made to believe that we are incapable, we may hand over the power to someone else. There is a hidden secret in our culture: ‘It is not that birth is painful It is that women are...
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