Follow Up With District Health Board

2 February 2008

Yesterday I posted an invitation put forward by our District Health Board ... inviting Common Knowledge Trust to be involved with the 20 year plan.

This is the email response I sent to Jennifer who is organizing the feedback from all 'stakeholders'.

Hello Jennifer:

Thank you for making contact with me as one of the trustees to Common Knowledge Trust that produces The Pink Kit Method For Birthing Better® resources.

I'll be meeting with Andrea Vincent tomorrow. She is the midwife who has collected Pink Kit statistics for the past 7 years and is speaking to the DHB on 5 Feb.

She and I have worked closely since 2000 to grow a skilled birthing population. She has done this by requiring and insisting her clients teach themselves The Pink Kit skills and come to their birth prepared to work with their baby's efforts to be born ... in whatever birth circumstances.

When I read your attachment, I was struck by the approach to maternity care ... it's all about delivery of maternity services to ...

Our Trust's approach to maternity care is about creating a societal expectation that when a woman is pregnant this is the time to learn how-to birth through preparing her body to let her baby out safely with reduced trauma to her body and baby ... and to use birth skills to work with her baby's efforts to be born.

This is equally true for expectant fathers, partners, friends or relatives who will 'support' the woman. They must move beyond 'being there' to learning how-to 'coach' (the ability to support and to help/guide/work work with the woman so that she can cope with the naturally occurring pain).

CKT sees birth as the gateway between being pregnant and becoming a parent and is an activity (even if an elective c/s). We strongly believe the 'doing' of this activity (giving birth) requires self learned skills, preparation of the pregnant/birthing body and the use of these skills during the activity of birth.

We would like to see a greater emphasis on the maternity Partnership toward growing a skilled birthing population within quality maternity services. We believe this is an educational issue (not political nor anti-medical nor toward reducing interventions nor toward increasing more 'natural birth'). Birth is birth and birth skills help families participate more in the activity of giving birth under all circumstances.

Andrea's statistics clearly show that families who teach themselves The PK skills self reduce many of the common medical interventions. However, this is a happy side effect.

Those families who require medical care still have the skills and work well with and around medical assessments, monitoring and procedures leaving them feeling equally positive about their birth experience and this extends to women who have surgical deliveries.

The true benefits of having a skilled birthing population are:

* Women feeling more in control of the process of birth
* Fathers more able to help so the couple works as a team
* Increasing the bond within the family
* Decreasing post natal anxiety because the family is ready to move into parenting without lingering emotional feelings about the birth experience.

We would like very much to participate in developing a skilled birthing population alongside a quality maternity service ... which we believe already exists. We strongly believe the perceived failure stems from a basic lack of societal expectation that learning to birth and being pregnant are essential for all families.

Recently the Government has been educating people not to drive when tired ... m/w, specialists and cbes can simply provide the message .. 'when you're pregnant you need to learn birth/coaching skills. Here are a number of resources that provide you with these skills to learn'. I know Andrea is going to recommend to the DHB that they purchase a sufficient number of Pink Kit Packages to be given to every couple coming through the hospital classes (to be returned after birth). We absolutely know that when women are giving the 'choice' they do not do the work. When they are given The Pink Kit Package and explained the importance of both themselves and their partner learning, practicing and using these skills they are more likely to take on that responsibility.

All birth providers love to see women cope with labour and fathers really help. Too many of them see women not coping and fathers not knowing how to help. This can easily be changed with a few years of an educational message and free access to The Pink Kit resource.

How is this possible? Consider driving a car for a moment. Does the Government give people the 'choice' of whether to learn good driving skills in order to drive a car or to just get in a car and go for a ride? No. The Government acknowledges that everyone who wants to drive a car must learn a set of complex skills, put those skills into use every time they get behind the wheel of a car and pass a practical driving test. People don't have to become mechanics to drive and driving instructors can't practice and apply the skills ... you have to practice, practice and practice and then perform. Birth is similar. It's an activity that requires a set of complex yet simple, common sense skills and really shouldn't be left to 'choice'. Childbirth leaves too many memories and has a huge impact on families.

There can become a high societal expectation that learning to birth and being pregnant require a level of practice, practice and practice of birth skills coupled with an expectation that the skills be encouraged during the birth process by m/w and specialists.

The PK Package is the driving instructor and the skills are best self learned. Although CKT was set up in 1996 when I immigrated to New Zealand, these skills have been used since 1970s when they developed with the families with whom I worked. They are 100% successful as the quotes below will show. They work in every single birth experience and work well with all birth providers.

These quotes would be typical Pink Kit stories. There are quite a number of PK families in Nelson who would appreciate being heard by you.

There is one dramatic difference between the PK and how you language the maternity services in NZ. The PK is about both women and men ... mothers and fathers-to-be. These skills are equal to both. The Pink Kit is not about 'women' then 'their babies' and then 'the family'.

Fathers do not fall into the last catagory. When women wanted their husbands in birth, they wanted them to do more than stand there, wipe the brow, be hung on, hold hands, rub the back or give a sip of water. Men wanted to know how to help. The PK skills are a shared set of skills that stem from our shared human body and behaviors ... equally learned by women and men.

The maternity services in NZ would do well to increase the Partnership expectation of families. Childbirth will always be an activity to be 'done' by the woman and helped by the family member she wants with her along with the care given by birth providers.

Thank you for letting me clarify our position and our goal. We look forward to working with you and we hope to get a number of Pink Kit families explaining how The PK is vital.

One other thing before the quotes. There is a woman doing her Master's (this year) and eventually her Doctorate Thesis on the PK (later) at Otago University Psychology Dept. She would like to be included somehow.

I've got a first draft of the birth story for our son. This is the quickie report. She did a little bit of
reading, watching and listening (to the CD). I went through almost all of it. With the
skills I had from the PK, we had a wonderful birth. I feel that it could have been
even better, but it went very smoothly, so there really isn't anything to complain
about. Got to the hospital on Jan 5 a bit after 9:30am, her water broke at 10:10
and I was catching my son at 11:23am. We both agree that had you and I
not met (*on a train) and we (mostly me) not had the PK skills the birth would have been
very different and much the same as her first two births. I had to play a bit more
of a director then a coach, but we worked well.

Warmth and love,

Greg
PS: we did not fail. We didn't get all we could have, but what we did was wonderful.


I am really interested in the Pink Kit. When I was pregnant with my first child, my midwife borrowed me a copy to read through. I did a little bit of it, but not enough. However I did use one technique that most definately I think prevented me from having any intervention. I went onto have a beautiful, completely natural birth with no intervention and I would like to know more and do more for subsequent pregnancies. A lot of women would not even know what the pink kit is, and I think it is really important for people to understand it. So that is where I am at in a nutshell.

Kind regards,

Wintergreen, trustee

The Pink Kit And District Health Board

1 February 2008

I met up with Andrea Vincent yesterday. She's one of the midwives who has collected The Pink Kit statistics for the past 8 years.

She's meeting with our District Health Board on 5 Feb to make a proposal. Everyone in New Zealand now acknowledges that the intervention rate in birth ... under a Midwifery Model of care ... is as high as in countries under obstetrical care. The national c/s rate is 30%.

At the present time the Government is looking to fund more Primary Birthing Centers where women don't have access to epidurals. There's no doubt if epidurals, forceps, inductions, augmentations, other types of pain relief aren't available to women they won't use them.

However, consider two factors:

1. Should the intervention come from denying women the use of modern maternity care?
2. What about women who have medical needs? Should they be denied a positive birth experience?
   

Is the goal just to reduce 'intervenitons?'

Anyway, the DHB has contacted Common Knowledge Trust to participate in setting the agenda for the next 20 years of maternity services in our area.

NOTE:

1. The proposal is ONLY about the service provided to 'women, their babies and families'. This puts fathers (men) into the last category. Bad decisions. The Pink Kit birth skills are equally for mothers and fathers-to-be because both will parent.
2. The proposal is ONLY about the service provided. The proposal mentions nothing about what a 'woman' or 'family' can do to improve their own experience. The Pink Kit is about sharing in the Partnership within the Midwifery Model. Families must come into their birth experience knowing how to work their way through the activity of labour and birth.

If YOU don't live in a country where there is a Midwifery Model, then having your own set of birth skills is even more important. YOU know you don't have continuity of care. YOU know that you'll pretty much be left alone to labour with your husband, partner, friend or relative with you. So, it's best if you have a great set of birth/coaching skills to do the work.

But back to the DHB. Andrea wants them to supply rental Pink Kit Packages to all the families coming through the hospital childbirth classes from the 1st class through birth. The cbe would then give 6 very short 10minute experience samples from each Pink Kit resource as well as educate the couples as to the importance of self-learning these skills and coming into labour prepared to use them.

We're a fairly geographically isolated community. One thousand births occur in the area/year and this would be a great place to do a 2 year study.

Here's Jennifer's letter

Planning and Funding
The Summer House
Nelson Marlborough District Health Board
PO Box 18
Nelson

January 27th 2008

Wintergreen
Motueka


Dear Wintergreen

I am writing to invite you or your organisation to participate in developing a strategic Health Service Plan for maternity services over the next 20 years for Nelson Marlborough.

The Nelson Marlborough District Health Board has identified the need to develop such a plan in order to ensure that women, their babies and their families have continued, equitable and sustainable access to well-integrated maternity services that are of a high professional standard. The vision is for a district wide service plan that has the best possible configuration of quality services responsive to the maternity service needs of women, their babies and their families.

Critical to the development of the plan are the views of women who have recently received care under the current arrangements.

We plan to have one to one or focus group meetings to ensure we include expertise and opinion from a wide range of stakeholders. An interviewer is happy to attend a regular meeting of your group. We will be asking people to tell us what they believe works well, what maybe not so well and what gaps, barriers and opportunities they perceive in current maternity services across the continuum.

Prior to the meeting we will give you the specific questions. We are keen to have a wide response field, and so if a meeting is not possible for you a written response to the questions may be posted or emailed back.

I have attached a brief summary of the project as a background for your information. Please do not hesitate to make contact if you need further information or clarification of anything I have said here.

My contact details are on this letter and I look forward to hearing in the next few days from your representative, about a suitable date before mid March, (plus time and venue) for you to contribute to this advance work.

Yours sincerely

Jennifer Lockwood
Project Manager
03 546 1783 (internal 7783)
jennifer.lockwood@nmdhb.govt.nz

Baby Shower Or Pregnancy Gift

29 January 2008

We've recently received a number of orders for The Pink Kit Package from mothers, friends AND grandparents who are purchasing The Pink Kit Package for a gift.

What a great idea. One grandmother said: 'Oh how lucky my son is to have these coaching skills. I wish his dad had them when he was born'.

A friend said: 'My best friend is having her first baby. I had such a terrible birth experience and know she and J... will do so much better than we did. I envy them'.

Then we received this from another person: 'I'm purchasing The Pink Kit Package for a couple I've been helping to relocate into A ... They are refugees and terrified of the maternity care in our country where they are alone without family. They speak english well but I just know they'll feel better about their birth experience.'

Every day we receive many emails from people who just say 'The Pink Kit Package SHOULD BE EVERYWHERE.'

Oh, yes, we do agree.

Is The Pink Kit Making A Political Statement?

27 January 2008

I am frequently asked whether The Pink Kit is making a political statement about childbirth.

I'm more frequently told that The Pink Kit MUST be about natural birth, alternative and even anti-medical and pro-home birth and midwives.

Sometimes when you have a job, your personal opinions are different from your job description. As a trustee to Common Knowledge Trust, I have to consistently and clearly give the same message about The Pink Kit Method For Birthing Better®.

However, I have to admit. I personally hold the same opinion.

So, let's get down to it. NO, emphatically, NO ... The Pink Kit is not making a political statement about birth.

However, The Pink Kit is making a SOCIAL statement and that social statement evolved along with the skills from hundreds of families in the 1970s. No, we didn't get together and brainstorm. No, we didn't take the skills from other systems.

No, there is no scientific basis:

• For knowing your body.
• Learning how to work with your baby' s efforts to be born.
• Working together in partnership with your husband, friend or relative.
• For feeling confident about how to use your skills in whatever birth you have ... because giving birth is an activity.

What stimulated this entry?

Over the years we have received information about women who work as midwives and doulas who are 'teaching' other birth professionals these skills yet are doing little or nothing to directly get the skills to expectant parents ... nor encouraging those they are teaching to also grow a skilled birthing population.

This is not a political issue. It's a social issue and tells us something about what we value and how we symbolically treat each other as women.

On 7 January I wrote an entry about a conversation I had with a woman who works as a midwife and her thoughts about becoming more skilled.

That's the story of one woman who might work with a number of families during the years she is in practice. But what about all the other expectant parents? And what does it mean if she takes the approach of being the practitioner who 'owns' these skills?

There is no doubt that the families who were the foundation of these skills fully gripped the reality and benefit of having their own set of skills. Too many birth plans changed. Too many birth providers were unexpectedly occupied elsewhere on the day of the birth. Too many medical issues prevented the preferred choices. Too many, many other issues made the 'perfect birth' improbable.

Isn't that what so many people want with their birth? A perfect birth and perfect baby.

We seemed to be screaming that we deserved, were entitled and required a perfect birth ... just like an apple with no bruises.

Then reality struck. We had to do it ourselves. If we wanted a perfect birth, we had to accept less then perfect along with our imperfect lives. If we expected others to give us a perfect experience then we were often disappointed, angry and let down.

If we believed wishful thinking would produce that rapturous experience, we were startled into reality with the first few really painful contractions.

But no matter how we viewed the whole situation around us, we were left with one stark truth. We were more responsible for ourselves than we believed possible. We believed 'they would take care of me'. We believed 'we have no choices'. We believed 'birth is unknown therefore unknowable'.

This all changed once the skills evolved into what has become The Pink Kit Method For Birthing Better®.

Then the question immediately surfaced once the Pink Kit resources became publicly available ... who should 'teach' or 'do' the skills.

From the view point of CKT this wasn't even a question or a thought. The skills come from us ... women and men who are having babies. And the skills need to remain with us.

If these skills are co-opted by birth professionals then we socially perpetuate the situation we have now ... women who don't know how to birth and fathers who don't know how to help them.

The social symbolism is profound. We either continue to reduce the role of expectant parents, keep them feeling afraid, reliant on their provider and in fact ... a child OR we socially grow a new value that equates being pregnant with learning how to birth/coach for whatever birth unfolds.

When we look at the world what do we want for ourselves? Do we want the necessary and essential skills that help us navigate through this incredible and dynamic, life transforming event ... even if the delivery is surgical OR do we want to remain passive looking for someone to save us.

Look at your own life. Do you feel more comfortable when you have skills to fulfill whatever task is facing you?

If you need a teacher of The Pink Kit then use The Pink Kit Package. It is your teacher.

If you are a birth professional who is teaching or doing the PK skills on your clients, think bigger and become conscious that you are perpetuating a type of reliance that can tire you and cause your clients to either overly admire you or be angry you didn't meet their expectations.

If you are a birth professional who is teaching other birth professionals these skills then at least get them to become wholesalers and/or affiliates of The Pink Kit and in parallel grow a skilled birthing population.

The Pink Kit skills were not developed to become midwifery or doula skills, they evolved from us ... we ... who were giving birth. Let's grow that empowerment in more of us.