Is a 37% Induction rate for healthy women normal?

Induction of Labour Audit, Power Point Presentation 2011  
Airedale Maternity Services did an audit on various aspects of their Induction of Labour practice and presented it to the local MSLC.  Key statistics included:

Parity 24% nul par, 19% 1 par ( the majority of women induced are first time mums, or with one previous pregnancy that was 'viable' whether or not the baby lived beyond 20 weeks gestation).

45% of those induced are 41 weeks gestation and 37% of the women induced are for postdates only.  This means that nearly half the women are being induced within the recognised normal range for gestation, and

37% of those induced are entirely healthy and normal, the arbitary line of induction policy is the only reason for this intervention.

The other shocking thing is that in this Trust 73% of women induced are put on Electronic Foetal Monitoring, not intermittent auscultation. The reasons we were told are 'historical' ie not evidence based.

Comment: As women and midwves we need to ask whether we have got our sums right on length of pregnancy if 37% of healthy women need to be induced for postdates alone. A Stats textbook called Supercrunchers by Ian Ayres demonstrates how our clinicians have got their sums WRONG in calculating the length of preganncy.  Also check out Ann Frye' fantastic textbook of Holistic Midwifery.  She quotes Professor Carol Woods method of calculating length of pregnancy - based on research into the actual lengths of pregnancy groups of women have.  We should not accept high induction rates of health women for postdates as normal and acceptable maternity care.

I sparkle like a diamond

Once upon a time a long time ago yesterday, there was a young woman who sat on her bed looking very sad :

She was so sad her hair was lank and grey, her face was grey, her clothes were grey.  She was sad and grey.

She was so sad and grey that her bed was grey, her bedroom walls were grey, and as she looked at the people around her they were drab and grey.

In the morning she went into her workplace and it was grey and sad and unappealing.

So she went out into the garden.  And there she found a rose, beautiful and crimson.  She said to the rose, "Why have you so much beauty and colour when I am so sad and grey?  The rose replied, "I am being just who I am."

She came to some phlox standing tall and white and full of scent. "Why are are you so white and beautiful, when I am so grey?"  the girl asked the flowers.  "Because we are being just who we are."  Came the reply.

Then she came across a cluster of sweet peas.  They were lilac, and blue and purple, swaying in the breeze. "Why have you so much colour when I am so grey?"  she asked the Sweet Peas.  "We are just being who we are."  The Sweet Peas responded.

The girl walked on and came to a Hawthorn tree where she sat down and began to think.  And she reached down inside herself and brought out a beautiful sapphire, sparkling and glittering in the sunlight and in its prisms she saw pinks and blues, purples and greens, yellows and golds.  The world was filled with colour and so was she, the girl was no longer grey but sparkled with colour and life.

The girl held the prism for a while and laughter sparkled on her lips: she was being just who she was.  She placed the sapphire carefully back in her soul and continued on her way sparkling like a diamond, full of colour and life.

Radical mother, cake maker, born stroppy I was tired and worn out, discouraged and depressed. Today I told myself this story and remembered who I was.

Carrying the Courage of Conviction

"We do not have to take our troubles lying down – the most effective way of birthing new life as we all know is standing up!"

This begins as a report on the opening of ABL’s Carlisle Business Centre Conference Suite on Wednesday 30th June 2011- but Oh there is always more to it than that . . .

Steve Wyler OBE was the ketnote speaker.  He is a Big cheese in the new organisation Locality which is an amalgamation of the Development Trust Association with Settlements and Social Action Centres. 

Steve commended the courage of ABL to take risks to invest in the local community in the middle of a recession and talked about the commitment of ABL and other development trusts to enABLing their communities.

He then went on to talk about the bigger strategy which he and his colleagues at national level are working on, to support the courage and commitment of local communites like Manningham seeking to invest in their people.  This is what we are asking for, he said – and sometimes getting: 

1. Asking for a pause in the ‘slash and burn’ cuts which fall most heavily on the poorest communities.  Giving time for communities to  co-design local alternatives, taking the chance to do things a different way.  They have got 3 months moratorium to do this.

2. Community Right to Buy – this is now in the Localism bill but there is opposition from the Lords and from landowners who see that they may lose out.  In Scotland there is a stronger law which has enabled the inhabitants of many of the Western Isles to own the land they live on.

3. Community Allowance – to enable people on benefits to do short terms sessional paid work for community organisations without effecting their benefits.

4. Community Rights Act.  This puts a requirement on banks to be transparent about lending activities in poor communities;  where they are found to be wanting it puts a requirement on them to put remedial measures in place ( eg supporting local business, partnership/support for credit unions etc).  This law is effective in the US and communties are using it.  Steve said: “We think it is a scandal not to have this here.”

5. To have a large team of Communtiy Organisers working within communities.  They will listen to people, find out what they want and see if they can come together to effect change – often this is about taking down the barriers those in  power have put up preventing people helping themselves – positive solutions run on our terms not yours.  The Government is up for this.

Steve said that: We are about working to do thing differently, working with local people’s hopes and dreams and helping to make them happen.

Here clearly was a can do man in a can do organisation where poor local communties are able to build and invest in their own future.  This takes courage and conviction.

Mothers and Midwives let us carry that courage and conviction to build birth care and communities on our human terms, let us start challenging the barriers to us claiming our birthrites -  and those who put them there.  Let us invest in our children and in our futures together.

In the evening it was my local church’s Church Meeting: a difficult one as the financial situation is bad – but it comes down to the same issues of courage and conviction: who we are, why we are here, what are we going to do with the resources we have to fulfil our aims and why we are here?  And in partnership with fantastic organisations like Locality we can turn around whole communities not just individual churches.

Who has the courage and the conviction? We do not have to take our troubles lying down – the most effective way of birthing new life as we all know is standing up!

The Mother magazine: Around the campfire

The Mother magazine: Around the campfire

Of Birthdays and Government White Papers

This is an odd day.  My eldest child is 16 today, and it is therefore, the sixteenth anniversary of becoming a mother to a term baby: bittersweet memories vie with the present day realities leaving me feeling somewhat disorientated and bewildered.

At 8.20 16 years ago after 24 hours labour, being transferred into hospital, having labour augmented, suffering agonies without anaesthesia with those synthetic contractions, giving birthing yelling in animal agony as I birthed my baby in fear and pain facing a blank hospital wall and a drip machine because I was not important enough to be faced.  That memory haunted me for many years and my body remembers even if the joys of subsequent births have healed the wounds.

And yet despite this my baby was born miraculously calm and cheerful, she fed right away and easily and we both took to breastfeeding as ducks to water.  This was the joy of motherhood for me, and it continues to be. 

And then the weeks of challenge, nursing a baby learning the art of motherhood alone with a husband working away, building a new life outside of employment which had been the centre of my life up until then.

And as winter turned to spring and then to summer, I would sit in our tiny garden overlooking the park, with my tiny daughter playing at my feet, and as she grew older how I loved to sing and to read to her.

These memories partially suppressed bubbled to the surface through this day 16 years on.  Sixteen years old, my child was woken by her four siblings, being sixteen years old she curled her lip at our practical present, being sixteen she had already got her birthday money out of us some days earlier, being sixteen she wanted to spend her birthday not with us but with her friends at a sleepover.  And I realised I was clinging to a daughter I no longer had.

“How do you mother a teenager?” I ask the memory of a mother struggling to come to terms with her new role 16 years earlier.

And today I went to a meeting where CS rates were discussed and professionals talked of women as ‘them’ as opposed to ‘us’ the professionals.  I thought this does not feel right – ‘should it not just be ‘us’?’  Was this the attitude underyling my experience of becoming an object in the hospital system 16 years ago?

And this afternoon, in another meeting I learnt that the Government has changed its mind and Maternity Services will be commissioned by GP’s.  And I wanted to cry with frustration and fear.  16 years ago I had to change GPs twice to find a GP who would cover my homebirth (despite the evidence even then that supported my choice). Dr Eisner (now retired) and her practice were the only ones to really specialise in maternity care in the area.  Certainly Dr Eisner was the only GP who ever turned up to one of my births – and 16 years ago she turned out at 4am and stayed with me until her surgery began – so just missing the triumph over adversity which was my first birth.

I so fear  GP’s who have no interest and no committment for good birth, whose knowledge is limited and partial, taking control of the budgets and purse strings, using their power to stop the progressive investment in normality, not understanding the importance of ensuring a good start to motherhood and a good start to those little lives.  GPs who care but don’t understand because in the last 20 years they have progressively handed over all the work and knowledge and experience to midwives and centralised maternity services based in hospitals.

I was so looking forward to midwives as independent professionals in partnership with their medical colleagues and service users having the chance to be part of the commissioning of the care they see as necessary for the wellbeing of women, and now we have GPs – General Practitioners being given the role – who asked for that?

I feel tonight that if we all pull together, work hard and campaign well, we might just stave off the worst  - but that is no where near good enough!  I want the best, the best for my daughter  - my daughter who is sixteen today - not the make-do, not the maybe if we have enough staff, but the world class services that have been abolished in the new terminology of the new Government.  I want my daughter to have world class midwifery and maternity care – because she deserves it and so do I!

And so today past and present collide. The personal is so painfully the political.  And with bitter sweet memories, and anger borne of experience and determination borne of love, I pull on my boots, roll up my sleeves, paint my placard and light my candle in the dark.

Sisters I hope you may join me, I cannot do this alone. And tonight I feel as alone as I did all those years ago staring into the abyss of a blank hospital wall.

Sir Ken Morrison, former chairman of the Morrison's supermarket chain and native of my adpted city Bradford.  He started with a market stall and ended his working life with anational supermarket chain.  He is now developing his interest in farming.

I found this little bit of advice in an article I found today.  I think it is worth keeping these thoughts in your head whatever you want to succeed in - from supermarkets to birth resource centres to any social enterprise or project.  It takes and heart and soul to achieve anything worht achieving.  Heart and soul.



Over to you Ken:

1. Have confidence in what you do

2. Do your research

3. Respect your competitors

4. Expect to work hard

5. Expect to work continuously

5. No one person has all the good ideas, there are still plenty of good ideas around

6. You can learn from others - seek them out

7. Look at other industries for tips that could help your business

8. There are no short cuts

9. Application, dedication and hard work – no substitutes

10. Success is hard won

Kes: a metaphor for an ambition

We went to watch Kes at the Oldham Coliseum on Friday night. It was a fabulous production and it has disturbed and gripped me ever since.


Kes, the feral boy. Father left home when he was six, neglected by mother, bullied by big brother. The food he eats is largely stolen from others. Picked on by anyone who feels like it. In trouble with the police.

And then he finds a baby Kestrel and becomes absorbed in training the bird. It takes patience and skill. A boy who never reads, reads voraciously in order to learn.

A teacher is able to pull this out of him and he is transformed into a lad full of enthusiasm, respect and joy as he talks about his Kes. A person with purpose.

But the story is a tragedy. Because in revenge for not putting a bet on a winning horse (Billy spent it on chips for himself) and he because he could not find and beat him up his bullying brother kills the bird.

All this was played out on stage and in my soul. The playright Lawrance Till says: “The bird is a metaphor of his ambition – what he delights in, what he is reaching for, what he runs towards.” The tragedy is the destruction of a young boys ambition, which with life so stacked against him, was as fragile and as vulnerable as himself - and as beautiful.

Lawrence continues: “We may not have the extreme events happen to us as happen to Billy Casper, but we all have ambitions, we all have passion, invest in something and, unless we are very lucky, we all have a sense of loss in our lives – divorced parents or the loss of a pet or maybe something more tragic than that.”

What are my dreams, my ambitions, what do I run towards, what do I invest so much of myself in? Do not allow the bully destructiveness of the bullying big brother to kill it, nurture and protect it – do not show the indifference and neglect of this story’s mother. Be the English teacher, empowering, enabling, interested, mentoring, listening respecting – so that your dream might with patience be tamed and trained and one day take flight but always come back to you.

For it occurred to me last night that each character in this story could be an aspect of oneself – if the kestrel was a metaphor for a boy’s ambition then the mother should have been nurturing it.

And I wonder, for myself and others whether if we treat our own ambitions with such violence. If we do, then whether we also treat the dreams, ambitions, delights of others with similar violence - even without realising it.

And it reminded me of growing up in a Lancashire industrial town in the 1980ies with the miners strike, the decimation of manufacturing industry in the area.  The state, Government and policy of the time did not care how this crushed and destroyed the communities, the families, and above all the kids of our town - the kids I went to school with. Let us never forget the Billy’s of this nation when we make policy and investment, when we make swinging cuts and take austerity measures. Let us not be a state that kills Billy’s Kes.