Midwifery expert Dr Lesley Kuliukas shares surprising statistics on giving birth today and what could change in the future.
Ninety-seven per cent of pregnant Australian women give birth in a hospital environment. It is considered the safest option for both mother and child, with medical staff and equipment on hand to promptly manage any complications.
However, studies have shown that stark, clinical hospital surroundings can hinder the natural birthing process, and have a detrimental effect on psychological, social and physical health of both mother and child.
Dr Lesley Kuliukas, a midwifery lecturer at Curtin University has more than 35 years’ experience in maternity settings (hospitals, birth centres and in the community) and in education. She won the Excellence in Midwifery Education award in 2018.
In this episode, Dr Kuliukas discusses the range of women’s birth options, different ways in which women can achieve a more positive birth experience and how giving birth with the support of a midwife and new technology, can be a safe and peaceful experience.
Email thefutureof@curtin.edu.au.
Curtin University supports academic freedom of speech. The views expressed in The Future Of podcast may not reflect those of the university.
Music: OKAY by 13ounce Creative Commons — Attribution-ShareAlike 3.0 Unported — CC BY-SA 3.0 Music promoted by Audio Library
You can read the full transcript for the episode here.
Intro: 00:01 This is the future of, where experts share their vision of the future and how their work is helping shape it for the better.
David: 00:10 I'm David Blayney. Giving birth to a baby is a milestone in one's life, but while this momentous occasion is most often experienced in a hospital environment, studies have shown that stark clinical surroundings might not always be the ideal setting for a mother to give birth. With us today to discuss this topic is Dr Lesley Kuliukas - a midwifery researcher at Curtin university with more than 35 years of experience working in the maternity sector and in education. Thank you very much for joining us, Lesley.
Dr Lesley Kuliukas: 00:41 You're very welcome.
David: 00:43 Where are women giving birth? What does the research have to say?
Dr Lesley Kuliukas: 00:47 Well, the women are giving birth mainly in hospital. This is in Australia, now around the world, things are different. So for instance, in Holland, a much greater percentage of women give birth at home because that is expected, that's the norm. So it all depends on what women are enculturated into. What they see their friends, their mothers, their sisters do. That's the thing that women generally do. And the thing in Australia is that when a woman finds out she's pregnant, the first thing she does is go to her GP. And the first question that the GP asks is, do you have private health insurance? And that will then determine her path for her pregnancy journey. Now what really should happen when the woman first discovers she's pregnant is - ideally - she should see a midwife because the midwife is then will then give her all of the options available to her, which aren't dependent on whether she has private insurance.
Dr Lesley Kuliukas: 01:47 So for instance, I'm actually an endorsed midwife and I run a clinic on a Thursday evening out of a GP surgery in Bentley. And so women are referred to me very early on in pregnancy. And I saw a woman in my clinic last night. We spoke about what her options would be and we didn't even mention private health insurance. But I said to her, 'you know, in WA, you're really lucky because you have some very good choices'. We have something that isn't available in the rest of the country. So the first thing we have is a home birth service, which is covered by Medicare. So if we want to have their baby at home, they can then be followed by a midwife through their anti-natal labour and postnatal care, have the same midwife right the way through and then have their baby at home. Now if something changes and it doesn't look like it's the best place for them to be, then they can transfer into the hospital with the midwife and carry on and have their baby there.
Dr Lesley Kuliukas: 02:44 So that's the first option that we can give to women. And all of the research demonstrates that it is a safe option for women because the role of the midwife is to monitor the pregnancy, monitor the labour, monitor the postnatal period, and if any problems do occur then she's going to change the plan to make sure that it remains safe. So if a woman chooses a home birth and then during the pregnancy the midwife realises that perhaps the baby isn't growing as it should or anything else, then she will refer care and change the model so the woman doesn't end up having her baby at home. The same when she's looking after her in labour. It's very rare that you get a big drama at the last minute. It usually builds up to a problem. And so the midwife will be monitoring the woman monitoring the baby, and if she suspects there's any problems she'll transferring the woman's sooner rather than later and erring on the side of caution.
David: 03:39 So it's not sort of this, this complication sneaking up on you and having to - having a quick rush to the nearest hospital - the warning signs are quite early onset.
Dr Lesley Kuliukas: 03:52 Yeah, that's right. I mean, obviously emergencies do occur, just as they do in hospital, and emergencies can occur in hospital where there isn't a fantastic outcome, just the same as sometimes they do at home. But the midwives who look after women at home have the same skillset as the midwives looking after the women in the hospital. So if for instance, sometimes the baby during birth takes a little bit longer to come out, the midwife has the same skillset to help manipulate the shoulders to help the baby come out just the same as they do in the hospital.
Dr Lesley Kuliukas: 04:26 So she has, she uses her same skills. If the baby needs a little bit of help after it's born, then she has the same skillset to help to resuscitate the baby. So yeah, but yeah, generally you do pick up the problems sooner rather than later. Another option for women is to go with a group practice. So if she chooses to birth in a birth centre, for instance, she'll be cared for by a midwife in a group practice. So again, it's the same midwives caring her for her right the way through. Birth in the birth centre, there are two birth centres in Perth now. One at King Edward hospital - the family birth centre - and a new one that's opened at Fiona Stanley hospital. And they're both beautiful birth centres, which are set up for this continuity of care model. But again, if any problems occur, the woman can be transferred to the labour ward in the main hospital within a few minutes. So for some women that's a great option because it's the best of both worlds. They're getting a very lovely environment to birth the baby.
Dr Lesley Kuliukas: 05:29 And earlier you mentioned about how important environment is. Yes, it's absolutely crucial to how labour progresses. If you imagine an animal going into labour, an animal finds itself in a warm, dark, secure, comfortable place. It labours really efficiently and really well because its hormones are allowed to work. Now, if it's endangered in any way, if a predator comes, if a loud noise happens, then physiologically the labour stops just like that. If you speak to a vet, that's what they'll tell you. It stops and it doesn't restart until they find themselves back in that safe, warm, secure place. And then off they go and they birth their offspring. We're animals too. The same is clearly true for us.
Dr Lesley Kuliukas: 06:16 So we've got to find ourselves in a similar environment to allow our own hormones to work just as efficiently as they do for animals. Now in labour wards today, there are loud noises cluttering and banging going on, instruments, bright lights, strangers coming in and out of the room that the woman has never met before. Of course, that's going to affect her hormones. Of course, that's going to slow down the labour. Its going to have a huge impact and yes, we can get around that - we can put a drip up and put a hormone in it that forces the uterus to contract - but that then increases the pain threshold. It doesn't allow her own natural endorphins to gradually increase during the course of her labour, so she's much more likely to need pharmacological pain relief, which then has its own implications to the outcome of the birth.
Dr Lesley Kuliukas: 07:04 So why not allow the woman to birth in an environment that will allow her body to work the way that nature intended and such environment - the best one, of course - is at home where she's comfortable, familiar. It's her own smells. It's her own toilet. It's her own food. It's her own partner and everyone else is familiar to her. That's the thing that works best, but it won't work best if the woman's anxious about it. The woman has to think, this is where I want to have my baby. This is safe for me. If she's a little bit worried and think, I'm not sure, I don't, I don't really believe in home birth, then perhaps the birth centre would be better for her because she still has all of the environment around her and she can have the low lights, she can move around. There's, you know, really lovely equipment in there.
Dr Lesley Kuliukas: 07:52 She can take in her own pillow and things that smell of her to affect the environment. And so a birth centre is a really good place for women to consider having their babies. On the other hand, there are some women who think, well, I've, I'm a real wimp. I know I'm not going to cope with this. I've talked to my friends and I don't like the sound of what goes on. I'm absolutely certain I'm going to want an epidural. The epidural is the injection that goes into the back and it gets rid of all sensation really from the waist down. And so, for some women, that's the option for them. They think that's what I want to do. Okay. It might mean I end up with a forceps birth or a vacuum birth, that's fine by me.
David: 08:34 And that can only be administered in a hospital.
Dr Lesley Kuliukas: 08:36 Absolutely. Yeah. So she would not be able to have her baby in a birth centre if she was in labour and then she thought, I thought this was all going to go well, but in fact this labour is taking longer than I thought and it's more intense than I was considering. She could say at that point, let's go over to the hospital, actually I think I want an epidural. So it's not like you have to make the big decision up front. Everything's very fluid and flexible along the way. And with continuity of care by a midwife, the midwife gets to know the woman early on and has all of these in depth discussions to find out exactly what she wants. And if this happens, what will we do then? If this happens, what will we do then? And so it offers the opportunity to actually change the scenario as it unfolds rather than have something set in stone right from the very beginning.
David: 09:28 Is home birthing an option that's readily available? You mentioned that we have a home birthing program in WA. On a national level, there has been some issue with, for example, the professional indemnity insurance that midwives have to have. Is this an option that is as readily available as it should be?
Dr Lesley Kuliukas: 09:50 No, unfortunately it's not. There aren't many, um government supported home birth programs, so a lot of women rely on privately practising midwives. Now privately practising midwives and midwives that have done exactly the same training and have the same qualification as everyone else. But they are midwives who are frustrated with the system and they want to offer true, woman-centered continuity of care to women to allow them to have the birth they wanted. And a lot of women that go to privately practising midwives are women that have had previous birth trauma.
Dr Lesley Kuliukas: 10:27 So something has happened to them in their last labour and birth that may have given them post traumatic stress disorder. It can be that severe. And so when they have their next baby, they really want to find something that will focus on them and we'll offer them the path that they really want rather than having to go back to the same environment that caused them that trauma and anxiety in the beginning. So nationwide, privately practising midwives are able to offer care over the continuum and very often, these midwives are on call 24 hours a day, seven days a week. So they really are very dedicated to giving the best care to women. A lot of them might work for 10 months of the year and then have their holiday all in one go. So they're not on call for a couple of months at the end of the year. But during that time they are available to women all of the time.
Dr Lesley Kuliukas: 11:19 Now these midwives - on the whole - the vast majority of them - have done an extra qualification, which allows them to prescribe and order screening and diagnostics. So it means that they can actually offer women any pharmacological requirements such as antibiotics or anything else that's needed. As you mentioned, the problem that they have is with indemnity insurance. When a midwife works at a hospital, the hospital covers her. When she's through a government organisation that covers her. So the home birth midwives in WA, they're covered. The family birth centre midwives, they're all covered. But a privately practising midwife has to cover herself. Now for me in my clinic, I get indemnity insurance for antenatal care and postnatal care because I don't offer care to women in labour. Our insurance company doesn't offer care, doesn't offer cover for labour. And so what it means is for that period of time that women are in labour, there's no insurance available for them.
David: 12:20 And that's the critical point.
Dr Lesley Kuliukas: 12:21 And that is the critical point.
David: 12:23 That's when you're most likely to need that insurance.
Dr Lesley Kuliukas: 12:27 Absolutely. And so what it means is that the midwives have to talk to the women when they book them and say, look, I have to tell you that if something happens during labour and there's an outcome that would require funding for the rest of you or your child's life, I don't have anything. I don't have insurance to cover that. Now the women who choose privately practising midwives say on the whole, they say, that's okay. I was so traumatised by my previous birth. I'm prepared to take that risk. All I want to know is that I'm going to be a safe environment with a person that I know who's going to be following my wishes for my labour. And so most of the women that employ a privately practising midwife will be aware that there's no insurance and it doesn't matter to them enough to actually change their minds. Now, the government have been looking to try and change this for about the last eight years now.
David: 13:24 Because there's only one insurance company that covers home birth.
Dr Lesley Kuliukas: 13:27 MIGA. That's right. No, no, no. They don't cover home birth. No. They cover privately practising midwives. Yes. So they cover privately practising midwives for antenatal and postnatal care. There's no cover for labour and birth unless it takes place in a hospital. What the government has done because it's one of the requirements of a midwife to have insurance in order to be able to practice. It's a requirement of the regulatory body. But the government has given a waiver to say, in this situation, for that particular part of the childbirth journey, midwives don't need to have insurance. And the waiver is being extended and extended, I think three times now it's been extended, because no alternative has been put forward.
David: 14:17 Unless we go down the New Zealand route where we have a, an accident compensation corporation or something like that. There's no, there's no real sort of longterm solution.
Dr Lesley Kuliukas: 14:27 No, it really needs to be something like what New Zealand do. New Zealand did change their whole process probably about 20 years ago now. Before then, it was pretty similar to Australia and the then health minister became prime minister and she was very pro-midwifery care and she could see the advantages of it. And so she then changed the system so that when women became pregnant, they could choose their primary maternity carer. It could be a midwife, it could be a GP obstetrician or an obstetrician. And so what they found was within, I think it was in within three years, about 80% of women chose a midwife.
Dr Lesley Kuliukas: 15:10 So the system completely flipped over the space of that time because the difference is, in my clinic, you know, Medicare covers me to see a woman for 40 minute appointment, 40 minutes. Now imagine what we can talk about in 40 minutes. We talk about lots other than their physical health. So their emotional health, their plans for the birth, their birth, you know, make it actually making a birth plan, talking about all of the options that are available for them. If a woman sees an obstetrician is completely different because a, a midwife, a privately practising midwife will look after four women a month. On average, an obstetrician will look after up to 30 women a month. So, of course they're gonna try and make their lives a little bit easier by reducing the length of time of appointments by not being there for the whole labour and birth like a midwife is. So there is a big difference between the different types of care.
David: 16:10 You mentioned at the very beginning you mentioned that the first question that that a mother will be asked is do you have private health insurance? I'll take a stab in the dark and I'll guess that everyone in this room has private health insurance. Daniel, you've probably got it. I'm on my parents' health insurance and you've probably got it as well. What is the difference in the journey that you take as a mother if you have private health insurance or if you are just covered by Medicare?
Dr Lesley Kuliukas: 16:38 Well, you've got to look at the statistics and the best thing for women to do is to look at the statistics of the obstetrician that they're interested in going to. What are their induction rates? What are their caesarean section rates? What are their instrumental vaginal birth rates? Those the kinds of things that women need to be asking. And if they look, they'll find that for the vast majority of obstetricians, they do have a high induction rate and the highest caesarean section rate. Why? Because they're looking after 30 women a month. So you know if it comes to four o'clock on a Friday afternoon and the woman's still in labour, then it's a little bit more convenient for the woman to have a caesarean section.
David: 17:18 So a bit of a timing thing.
Dr Lesley Kuliukas: 17:20 Yeah, yeah, absolutely. So if a woman's induced, then she's induced in the morning and then at four o'clock in the afternoon, how's her labour going? Well, for a midwife, she's progressing, she's having a normal labour. The labour might take 24 hours. For an obstetrician who's got another woman lined up for tomorrow, he's thinking, well, I'm not going to get home before midnight. Perhaps let's say, things are a bit slow, perhaps the baby is a bit big, perhaps we should think about having a caesarean section. Now. I'm not just saying this off the top of my head. The student midwives in the program that I'm the course coordinator for, they follow women through a continuity of care experience, which means that they recruit women very early on in the pregnancy. They follow them through their antenatal care, labour and birth and postnatal care and build up a really good relationship. So every week in class, we have a bit of a debrief at the beginning of the class to talk about what experiences they've had this week and almost universally, the experience that they talk about, that the women have with private obstetricians, are the opposite end of the spectrum to the experiences that women have with midwives.
Dr Lesley Kuliukas: 18:34 I'm a midwife. Of course, I'm biased with this, but again, you've got to go back to the stats. Look at the caesarean section rates of private hospitals. They don't compare and the World Health Organisation says really, a woman's caesarean section rate risk worldwide is about 12%. 12% of women actually need to have a caesarean section. Some of the caesarean section rates in private hospitals are up to 70% so clearly something's going wrong there. Why, why do these women need caesarean sections? The answer is, they don't. That's the problem. And so the other thing, the other thing my students tell me is that an antenatal appointment with a private obstetrician, and I'm being very generalistic here because I do know of some private obstetricians who were fantastic, okay. So I'm talking about the majority according to feedback from my students. Their appointment time is much less, it's five minutes, 10 minutes if they're lucky and they don't discuss options like they might do in a longer appointment. A midwife will talk about whether the woman wants to have a physiological third stage or delay cord clamping. And obstetrician would never talk about that. Very, very rarely. And so it's a choice that the woman has taken away from her. And that's just one example of many, many things that need to be discussed during the course of her antenatal care in order for her to start labour being fully informed.
David: 20:05 So that's going down the private route. How does it ... how do things stack up when you go down the public route?
Dr Lesley Kuliukas: 20:12 Well, again, it depends on where the woman's going to go. So again, it's very worthwhile her go onto the website and looking at options in WA and looking at the different statistics in different areas.
David: 20:23 Which website is it?
Dr Lesley Kuliukas: 20:25 Um well if you just - I can't remember what it's called now - but Birth WA - if she types Birth WA into Google, she will find, if you have a look now, you're going to have a look now? Yeah, good idea.
David: 20:44 First result is births, deaths and marriages, of course. I'm assuming it's Healthy WA or something or something like that?
Dr Lesley Kuliukas: 20:54 Yeah, that's right. But there is a website and it just go through all of the different options for her. There are two types of hospital in WA. There's the tertiary referral center and the secondary hospital. And you find the tertiary referral center, generally, they have a much - King Edward, for instance - has a much narrower boundary geographically that women can access it if they live within the vicinity. Whereas Bentley, they have a wide geographical area. Women, you know, who live quite far away can still go to Bentley. Whereas King Edward is very narrow because they have to take all of the complications. So anything that's referred will go to King Edward so they can't take too many of the, in inverted commas, 'normal' women who live locally.
David: 21:40 Well, I had to go to King Edward, cause I was, I was flown in from Geraldton to go to King Edward. So they had to have room for me.
Dr Lesley Kuliukas: 21:45 Yes, exactly. And that's the thing, King Edward can't close its doors, whereas all of the other hospitals can say, we're too busy, we're too full, we're closing our doors, we're on bypass. So women who think they're going to have their baby at Fiona Stanley actually end up being in Rockingham. That's right. Or King Edward. So if a hospital has to close its doors, then the woman goes to another hospital that she's not actually familiar with. But at King Edward, they can never close their doors. So they would be accepting everyone all of the time, which makes them a very busy unit and they've got a caesarean section rate of about, I think it's 33, 35%, which is acceptable for tertiary referral centre that has all of the complications going there. It's not acceptable for a lower ...
David: 22:32 That's quite remarkable considering that there'd obviously be a bit of selection bias considering it is King Edward.
Dr Lesley Kuliukas: 22:41 Yeah, absolutely. No King Edward again, the, the public hospitals in WA do a fantastic job. Their guidelines are evidence-based. Women can go and have a look at the hospitals beforehand. They understand what, you know, what's going to happen. So yeah, I would say they're good choices.
David: 23:02 Where do you see birthing going in 10, 20, 50 years from now?
Dr Lesley Kuliukas: 23:09 Uh well, a lot of what's happened in the last five years is completely dependent on the national maternity services plan, which was a document brought out by the government after very thorough research from consumers, women, midwives, obstetricians, everyone across the maternity journey. And what they found that women wanted was to have continuity of care. And so as a consequence of that, a lot of the public health hospitals started midwifery group practices offering women continuity of care.
Dr Lesley Kuliukas: 23:46 So now, Since that document was released, there's, I don't know how many exactly, but I think there's about five group practices at King Edward, the new birth centre at Fiona Stanley is a group practice. There's about three at Armadale, there's several down in Bunbury even, and I know they're growing in other places as well, so women now have this choice of having a named midwife that will see her through her pregnancy, labour and birth journey and this is what women want. Now, this option of care, not only is it giving women greater satisfaction, but it also reduces the cost because all of the research - and you can, you know, search constitutes you care by a midwife -and you'll find that the outcomes are that first of all, women are less likely to have interventions, so they're less likely to need epidurals. They're less likely to end up with the forceps or a vacuum birth. They're less likely to end up with a caesarean section. But the outcome for the baby is just as good. And the other thing that's recently come to light is continuity of care by a midwife also reduces the incidence of preterm birth. So all these extra things which we're finding out really make a difference. And so it's cheaper because all of these interventions are now reduced and it's cheaper because midwifery care is cheaper than obstetric care. And so if a midwife could look after a woman through the whole journey and doesn't need to refer to an obstetrician for any reason, then it's going to be a cheaper option.
David: 25:22 And looking even further into the future, do you see, do you envisage a future of, of artificial wombs, of us not ... of birth being completely different to how it is today?
Dr Lesley Kuliukas: 25:35 Well I would hate to think that there would ever be an artificial womb because I think the woman's body is designed perfectly to have babies and she can do so in a remarkable way. And every woman that does is such a, you know, a strong, amazing, powerful woman. And when she's done it, you can see that she knows that herself. You can see it in her face. This is an incredible thing that I've done. Look at me. How fantastic is that? So the thought of having that taken away would be really sad. Now I can't really see how it could happen outside of the body, but I could see that like for a man to get pregnant, for instance, there is, there is something that happens very, very rarely - and it's not an ideal situation - where the baby - the conceptor - so the first few cells - don't remain in the uterus or they were conceived outside of the uterus and they never got into the fallopian tube.
Dr Lesley Kuliukas: 26:33 And so the baby embeds itself into one of the abdominal organs and it can grow. So it's known as an abdominal pregnancy. And the placenta adheres to the bowel or some other abdominal organ instead of within the uterus. So it can happen that a man could become pregnant if an embryo was injected into his abdominal cavity, that could happen. But it's not an ideal situation because after the baby is born, which clearly has to be through abdominal surgery, the placenta is left behind and you can't take the placenta away because the organs that it's attached to will bleed profusely. So you have to leave it there and hope that gradually it gets reabsorbed. So not an ideal situation. As for something outside of the body, well who knows, you know, anything's possible. They're developing all sorts of organs from generated tissue now. So who knows, something might be possible in the long term and it would be great if there was something available for women who were unable to have children themselves.
David: 27:38 And how was the profession itself? How is midwifery going to change and how is it changing so far?
Dr Lesley Kuliukas: 27:44 Well, it's changing, as I said in the last five years because of the resurgence of continuity of care and midwives really embracing that. They can see the value of it because not only is it a, does it improve satisfaction for women, it improves job satisfaction for midwives. You can imagine if you've got, you know, you're seeing the same women through the whole journey, get to know them really well, see the outcome, get excited with them. You're there afterwards to help them breastfeed their baby and care for their baby. It's an absolutely amazing journey. So for midwives to have that job satisfaction, that's really good.
Dr Lesley Kuliukas: 28:18 So for midwives' future, I hope that that will continue and the number of group practices will continue to grow and it would be absolutely perfect if every single woman in WA was introduced to a group practice at the beginning of her pregnancy. And it might be a special group practice for women that have had this caesarean section before. It might be for adolescents, it might be for women with drug and alcohol problems. It might be for women with mental health issues, but each little niche should have its own midwifery group practice that follow the women right the way through. So they get that satisfaction from both sides and improved outcomes as we know from the research. So that would be great if that was the way that future midwifery education went as well. More of allocation to continuity of care.
David: 29:09 And Leslie, before we go, do you have anything else you'd like to add?
Dr Lesley Kuliukas: 29:14 Well my biggest bugbear really is the fact that women enter pregnancy and they don't really know about the choices available to them. And then if they don't get offered those choices right at the beginning, then it means they're really railroaded into one option or another. Women really need to try and discover for themselves the options available and we need to get the message out to them that you don't need, you don't need to do what your sister, your friend, your mother has done. You need to find the options for yourself and see what is now available. Open your eyes and be aware of all of the different options out there. Find out about them and choose them because you'll see the advantages are great.
David: 29:55 So how are things trending in terms of birthing centres? Are we going to be getting more of them the future?
Dr Lesley Kuliukas: 30:00 Well, I'm really excited about Fiona Stanley's new birth centre. It's such a brilliant thing and I've been to visit it. I've, I actually worked at the King Edward birth centre for 10 years, so I knew that one very well and I loved that birth centre. To me it was like home. So I was very interested to go and have a look at Fiona Stanley's. And it is, it looks wonderful. It's very well kitted out, it's beautifully done and I hope it will be an example for other hospitals to do the same thing. Standalone birth centres are really good, but this one is incorporated into another area of the hospital. So it's not part of the labour birth suite - it's actually adjacent or a little bit round the corner. So it gives the option, the women the option, of being a little bit apart from the labour and birth suite, but they still have the advantage of being close to it if they need to be transferred for any reason. Now, I'd love to see that happening in all of the hospitals, around WA so that it's an option for women to be able to birth in an environment where their hormones are able to work the way that nature intended.
David: 31:05 We've had some, some great advances in technology over the years. IVF for example. What are some of the newer technologies that are available to women now that weren't available a couple of decades ago?
Dr Lesley Kuliukas: 31:18 Well, I have to say, you mentioned IVF and yes, IVF has been around for 30 years, but it's definitely improved. And a lot of women that I've recently looked after, they're on their first IVF attempt and pregnant. Whereas in the past, I remember one woman was on her 16th, 17th attempt. So I would say the success of IVF has really improved. So that's a really good one. Another thing that's improved is fetal monitoring during labour. So this is, this is actually still evolving, but research tells us that you don't need to monitor a baby continually during labour. There's a lot of evidence behind that. In fact, what it does is increase intervention. In a case of where there's no complications, the midwife listening to the baby every 15 minutes has the same outcome as the baby being continually monitored. So that's fine.
Dr Lesley Kuliukas: 32:16 But when a woman does need to be continually monitored for whatever reason, the monitors aren't fantastic. So trying to keep the heart rate trace going for the whole labour sometimes means you've got a student sitting on the monitor holding it, adjusting it, trying to get the heart rate coming through ideally right the way through. Now, very recently, some new monitors have been developed and they, instead of having a band around a woman's abdomen and having to hold the transducer in place, they have a little stick spot that gets stuck onto the woman's abdomen and picks up the fetal heart rate really well. Not only does it mean she can move around more easily and we can pick up the heart rate more easily, but it means she can go in the shower and the bath, so she can actually have a water birth as she wants to while she's being continually monitored, whereas before that was out of the question with the old fashioned monitors where she was likely to get a big shock if she got into the bath with that one attached!
Dr Lesley Kuliukas: 33:15 And a lot of women these days are moving to water for their comfort during labour and birth because it does have a big impact on how she's comfortable, she's more relaxed, the endorphins are working better. And when women, you know - I don't know how you feel at the end of a hard day - you might not even have a bath at home - end of a hard day, to step into a bath feels like, whoa. A lovely feeling.
David: 33:40 Oh, even a good shower.
Dr Lesley Kuliukas: 33:41 Yeah.
David: 33:41 I don't have a bath at home
Dr Lesley Kuliukas: 33:43 Okay. So a jacuzzi or, or spa, something like that. It's a lovely feeling to step into one.
David: 33:48 Oh wait I do have a bath at home actually, I just never use it.
Dr Lesley Kuliukas: 33:52 A lot of people are like that.
David: 33:53 And so this technology is in development right now. When's it going to hit - not shop shelves, but I guess - hospital shelves.
Dr Lesley Kuliukas: 34:01 It has! Yes, I recently went to a conference the national Australian College of Midwives Conference, which was in Canberra, and there were stalls there showing this new device and some of the midwives there told me, yes, their hospital is using it at the moment. So it's definitely out there. It's definitely being used and it is spreading. So I know that King Edward uses it for instance, so it will spread to the other hospitals as well.
David: 34:31 Okay. I think we'll leave it there. Thank you very much, Lesley, for sharing your knowledge on this topic and for coming in.
Dr Lesley Kuliukas: 34:36 Thank you very much.
David: 34:37 There will be some links in the show notes if you're interested in learning some more about this. So yes, thank you very much for listening and we'll see you next time.