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Maternal Posture
1038 CONCLUSION
Much interest is being shown in the problems of old people but vague statements of good intent are insufficient. We need to agree on objectives, and on indicators that can be used to monitor progress. Furthermore, we need to express our indicators not simply as numbers but as rates, just as we use rates (vaccination rates, infant mortality rates) to improve child health. Finally, it is not enough for any health authority to consider its own rates in isolation. To monitor progress over a period of time is useful, but more telling is a comparison of progress with that in other areas and other countries. The 1981 Census gives people working in the United Kingdom an accurate denominator on which to calculate rates; let us use it to set a baseline, agree on objectives, and audit our services for elderly people as a means of improving effectiveness and efficiency and, most important of all, the quality of life of older people.
birth. Mounting evidence that lying supine to give birth-the "stranded beetle" position-may be more painful and dangerous than delivery in any position by the woman was offered by all the speakers. The manifestoofthe movement states the superiority of squatting, kneeling, and standing positions, where the body works in harmony with the force of gravity, the pelvis is fully mobilised, and there is no compression on blood vessels. When birth is active, the authors believe, uterine contractions are stronger, more regular, and more frequent; dilatation of the cervix is enhanced; the first and second stages of labour are shorter; and the condition of the newborn is improved. The conference, as a whole, was a celebration of faith in the joyous nature of birth, and a gesture of solidarity among women deeply dissatisfied with present maternity services. The movement has gained momentum in the U.K. and it is affecting present obstetric practice. The latest recommendations2 from the Royal College of Obstetricians and Gynaecologists clearly reflect a desire to restore the woman’s freedom of choice in having her baby.
chosen
REFERENCES 1. World Health Organisation. A global strategy for health for all. Geneva: W.H.O, 1981. 2. World Health Organisation. A basis for health policy on ageing. Report from the World Health Organisation Regional Office for Europe. Commun Med 1982; 4: 125-28. 3. Kaprio LA. Primary health care in Europe (EURO Rep Studies no. 14). Copenhagen: W.H.O., 1979. 4. World Health Organisation. Alma-Ata primary health care. Geneva: W.H.O., 1978. 5. World Health Organisation. Preventing disability in the elderly. Report on a W.H.O. Working Group (EURO Rep Studies no. 65). Copenhagen: W.H.O., 1982. 6. World Health Organisation. International classification of impairments, disabilities and handicaps. Geneva: W.H.O., 1980. 7. Svanborg A, Bergstrom G, Mellstrom D. Epidemiological studies on social and medical conditions of the elderly. (EURO Rep Studies no. 62). Copenhagen: W.H.O., 1982. 8. Knox EG. Epidemiology in health care planning. A handbook sponsored by the I.E.A. and W.H.O. Oxford: Oxford University Press, 1979. 9. World Health Organisation. Development of indicators for monitoring progress towards health for all by the year 2000. Geneva: W.H.O. 1981. 10. Hunt A. The elderly at home: a study of people aged sixty-five and over living in the community in England in 1976. H.M. Stationery Office, 1978.
Conference Maternal Posture 2750 people, over half of them midwives, and the rest mostly parents, attended the International Conference on Active Birth, held in London last Saturday, to hear the exponents propound their philosophy and watch reels of film of babies emerging into the world. An extract from one film, Birth with R. D. Laing, restated Leboyer’s theories with disturbing force: being born in a routine obstetric ward under the glare of lights and accompanied by the smell of disinfectant and the feel of rubber, must, from the point of view of the infant, be hideously traumatic; from the point of view of the mother, the event is a surgical one, where she is the passive locus for an extraction procedure. Dr Laing then spoke with his customary rhetoric of the politics of birth, portraying the hospital delivery as a practice derived directly from surgery, with all the accoutrements of drugs and instruments. Dr Michel Odent presented his case for instinctive birth with the personal charm and impeccable obstetric record that have caused pregnant women to travel miles to his Pithiviers clinic to give birth. The film of his work showed women in labour clinging to his neck or being supported by him from behind as they delivered their babies (including breech deliveries) without drugs or intervention, unless strictly necessary. The expressions on the faces of women in the final stage of labour and their descriptions of the experience seemed in many cases to bear out Dr Odent’s words that giving birth was the ultimate sexual event, that the last contractions were like the ecstatic waves of an orgasm. He also voiced a more obscure idea, echoing Laing: children born under technology and drugs might, in some fundamental way, be different from children born actively. These were the august speakers. More matter-of-fact information was offered by the founder members of the Active Birth Movement, Sheila Kitzinger and Janet Balaskas, who outlined the decisions to be made by the woman during pregnancy, delivery, and after giving
Medicine and the Law Procedure for Erasure from medical Register A doctor was charged before the Professional Conduct Committee of the General Medical Council with having been convicted of a criminal offence. The doctor admitted committing the offence. On March 8, 1982, in accordance with rule 36 of the General Medical Council Preliminary Proceedings Committee and Professional Conduct Committee (Procedure) Rules 1980, the chairman announced that the doctor, by reason of the conviction proved against him, and having regard to his previous record, should have his name erased from the Register. The doctor appealed from that decision on the grounds that the chairman ought to have announced each of the stages by which the committee had arrived at that final result under the terms of rule 34, which sets out in detail the steps by which the committee must
proceed by obliging them to consider possible penalties in ascending order of gravity. It finally provides that, the committee not having determined to impose any of the lesser penalties, the automatic result is that they must direct that the name of the practitioner be erased from the Register. Lord FRASER OF TuLLYBELTON gave the judgment of the Privy Council. He said: "Looking at the matter from a practical point of view, the answer of the Council is that all rule 36 requires is that the chairman shall announce the effective or operative decision of the committee and that the chairman is not bound to announce publicly the various steps by which the Committee has reached that decision. The only practical reason in favour of requiring the chairman to announce each step would be to ensure, and to enable the doctor in this case to be sure, that the committee had proceeded properly in their deliberations, but their Lordships are of the opinion that is not what the rule requires. All that it requires ... is that the chairman shall announce the decision of the committee. Anything else would require the chairman to go through what might be a comparatively lengthy narrative ... finishing up with the result that they had directed the erasure of the practitioner’s name from the register... that would be a formal and not useful proceeding to be gone through and that is not what the rule requires." Lord Fraser continued: ".. even if the matter were reviewed more precisely on the exact words of rules 34 and 36 together, the rather semantic argument open to the doctor would not succeed." The appeal was dismissed with costs. Deb Narayan v General Medical Council. Privy Council Appeal: Lord Fraser of Tullybelton, Lord Keith of Kinkel and Lord Brightman. Judgment date: June 16, 1982. DIANA BRAHAMS Barrister-at-Law
By Arthur and Janet Balaskas. Available, £1, from the Active Cholmeley Crescent, London N6 5JR. New dimensions in obstetric audit. Lancet Oct 16, 1982, p. 857.
1. Active Birth Manifesto. Birth Movement, 32
2. Editorial:
Much interest is being shown in the problems of old people but vague statements of good intent are insufficient. We need to agree on objectives, and on indicators that can be used to monitor progress. Furthermore, we need to express our indicators not simply as numbers but as rates, just as we use rates (vaccination rates, infant mortality rates) to improve child health. Finally, it is not enough for any health authority to consider its own rates in isolation. To monitor progress over a period of time is useful, but more telling is a comparison of progress with that in other areas and other countries. The 1981 Census gives people working in the United Kingdom an accurate denominator on which to calculate rates; let us use it to set a baseline, agree on objectives, and audit our services for elderly people as a means of improving effectiveness and efficiency and, most important of all, the quality of life of older people.
birth. Mounting evidence that lying supine to give birth-the "stranded beetle" position-may be more painful and dangerous than delivery in any position by the woman was offered by all the speakers. The manifestoofthe movement states the superiority of squatting, kneeling, and standing positions, where the body works in harmony with the force of gravity, the pelvis is fully mobilised, and there is no compression on blood vessels. When birth is active, the authors believe, uterine contractions are stronger, more regular, and more frequent; dilatation of the cervix is enhanced; the first and second stages of labour are shorter; and the condition of the newborn is improved. The conference, as a whole, was a celebration of faith in the joyous nature of birth, and a gesture of solidarity among women deeply dissatisfied with present maternity services. The movement has gained momentum in the U.K. and it is affecting present obstetric practice. The latest recommendations2 from the Royal College of Obstetricians and Gynaecologists clearly reflect a desire to restore the woman’s freedom of choice in having her baby.
chosen
REFERENCES 1. World Health Organisation. A global strategy for health for all. Geneva: W.H.O, 1981. 2. World Health Organisation. A basis for health policy on ageing. Report from the World Health Organisation Regional Office for Europe. Commun Med 1982; 4: 125-28. 3. Kaprio LA. Primary health care in Europe (EURO Rep Studies no. 14). Copenhagen: W.H.O., 1979. 4. World Health Organisation. Alma-Ata primary health care. Geneva: W.H.O., 1978. 5. World Health Organisation. Preventing disability in the elderly. Report on a W.H.O. Working Group (EURO Rep Studies no. 65). Copenhagen: W.H.O., 1982. 6. World Health Organisation. International classification of impairments, disabilities and handicaps. Geneva: W.H.O., 1980. 7. Svanborg A, Bergstrom G, Mellstrom D. Epidemiological studies on social and medical conditions of the elderly. (EURO Rep Studies no. 62). Copenhagen: W.H.O., 1982. 8. Knox EG. Epidemiology in health care planning. A handbook sponsored by the I.E.A. and W.H.O. Oxford: Oxford University Press, 1979. 9. World Health Organisation. Development of indicators for monitoring progress towards health for all by the year 2000. Geneva: W.H.O. 1981. 10. Hunt A. The elderly at home: a study of people aged sixty-five and over living in the community in England in 1976. H.M. Stationery Office, 1978.
Conference Maternal Posture 2750 people, over half of them midwives, and the rest mostly parents, attended the International Conference on Active Birth, held in London last Saturday, to hear the exponents propound their philosophy and watch reels of film of babies emerging into the world. An extract from one film, Birth with R. D. Laing, restated Leboyer’s theories with disturbing force: being born in a routine obstetric ward under the glare of lights and accompanied by the smell of disinfectant and the feel of rubber, must, from the point of view of the infant, be hideously traumatic; from the point of view of the mother, the event is a surgical one, where she is the passive locus for an extraction procedure. Dr Laing then spoke with his customary rhetoric of the politics of birth, portraying the hospital delivery as a practice derived directly from surgery, with all the accoutrements of drugs and instruments. Dr Michel Odent presented his case for instinctive birth with the personal charm and impeccable obstetric record that have caused pregnant women to travel miles to his Pithiviers clinic to give birth. The film of his work showed women in labour clinging to his neck or being supported by him from behind as they delivered their babies (including breech deliveries) without drugs or intervention, unless strictly necessary. The expressions on the faces of women in the final stage of labour and their descriptions of the experience seemed in many cases to bear out Dr Odent’s words that giving birth was the ultimate sexual event, that the last contractions were like the ecstatic waves of an orgasm. He also voiced a more obscure idea, echoing Laing: children born under technology and drugs might, in some fundamental way, be different from children born actively. These were the august speakers. More matter-of-fact information was offered by the founder members of the Active Birth Movement, Sheila Kitzinger and Janet Balaskas, who outlined the decisions to be made by the woman during pregnancy, delivery, and after giving
Medicine and the Law Procedure for Erasure from medical Register A doctor was charged before the Professional Conduct Committee of the General Medical Council with having been convicted of a criminal offence. The doctor admitted committing the offence. On March 8, 1982, in accordance with rule 36 of the General Medical Council Preliminary Proceedings Committee and Professional Conduct Committee (Procedure) Rules 1980, the chairman announced that the doctor, by reason of the conviction proved against him, and having regard to his previous record, should have his name erased from the Register. The doctor appealed from that decision on the grounds that the chairman ought to have announced each of the stages by which the committee had arrived at that final result under the terms of rule 34, which sets out in detail the steps by which the committee must
proceed by obliging them to consider possible penalties in ascending order of gravity. It finally provides that, the committee not having determined to impose any of the lesser penalties, the automatic result is that they must direct that the name of the practitioner be erased from the Register. Lord FRASER OF TuLLYBELTON gave the judgment of the Privy Council. He said: "Looking at the matter from a practical point of view, the answer of the Council is that all rule 36 requires is that the chairman shall announce the effective or operative decision of the committee and that the chairman is not bound to announce publicly the various steps by which the Committee has reached that decision. The only practical reason in favour of requiring the chairman to announce each step would be to ensure, and to enable the doctor in this case to be sure, that the committee had proceeded properly in their deliberations, but their Lordships are of the opinion that is not what the rule requires. All that it requires ... is that the chairman shall announce the decision of the committee. Anything else would require the chairman to go through what might be a comparatively lengthy narrative ... finishing up with the result that they had directed the erasure of the practitioner’s name from the register... that would be a formal and not useful proceeding to be gone through and that is not what the rule requires." Lord Fraser continued: ".. even if the matter were reviewed more precisely on the exact words of rules 34 and 36 together, the rather semantic argument open to the doctor would not succeed." The appeal was dismissed with costs. Deb Narayan v General Medical Council. Privy Council Appeal: Lord Fraser of Tullybelton, Lord Keith of Kinkel and Lord Brightman. Judgment date: June 16, 1982. DIANA BRAHAMS Barrister-at-Law
By Arthur and Janet Balaskas. Available, £1, from the Active Cholmeley Crescent, London N6 5JR. New dimensions in obstetric audit. Lancet Oct 16, 1982, p. 857.
1. Active Birth Manifesto. Birth Movement, 32
2. Editorial: