 section and I'm very excited to be here today. So this presentation is showing my the preliminary findings for my PhD research which I'm doing through the Australian Catholic University in Australia. My research team includes my three wonderful supervisors, Shala Media, Sarah Bays and Valerie Wilson and I really thank them for all the support they've given me through this. Okay next slide. Thank you and I'm sharing this with you today from Naurah in New South Wales Australia and I'm on the lands of the durable Aboriginal people of the UN nation and I acknowledge that that is where I'm sharing from and of the people who have been on this land and birthing babies for a very long time. I also want to acknowledge that not all of the women who are in this so not all birthing people identify as women or mothers and this study presents finding for those who do call themselves women. Thank you. So this was the problem separating mothers from their baby at Caesarean section birth without medical need and this is what I was saying within my clinical workers electation consultant in my local health district women coming back to see me for the next baby because of breastfeeding problems but also describing the trauma that they had experienced being separated from their baby at birth. Thank you. So what do we already know? So we know women do not want to be separated from their baby at Caesarean section birth and they really want to see and to hold and to feed their baby as they start to become a mother and get to know their baby and skin to skin contact between a well woman and her baby at Caesarean section helps keep the mother and baby together so it's like the vehicle for keeping them in the one room attached to each other and it means that both mother and baby get their wants and their needs met and it's very simple it's safe and it protects their future physical and emotional well-being and skin to skin is it helps ensure a positive birth experience and a sense of control which impacts birth experience and you can read more about that in the paper that I released my literature of you which was released in 2021. Linda you should have control to progress to the next slide by yourself. Yeah beautiful thank you. So if we think women are going to remember and be impacted by their birth experience for the rest of their lives and for those of you who have had children I know this will resonate really strongly with you so you remember what has happened who was there with you what they said to you and how you were feeling and skin to skin at Caesarean section isn't anything new so it was first described in 2008 by Smith et al. Just calling it a natural Caesarean that we've been doing skin to skin at the vaginal births for a long time and we know there's so much evidence that shows how good this is. So just from this first description here that was 15 years which I think fits really well with VRDM because it's the same time that they've been around as well but we're still missing this link and it's not happening consistently with mothers and babies and keeping them together. So this is the study design and analysis so it was a feminist phenomenological framework and feminist because the phenomenology so that human experience is very much not a gender neutral experience and women are having babies. Participants were sought through social media in Australia and there was an overwhelming response. So this was put out into a consumer advocacy group and within 24 hours there was a huge number of responses that got shared widely and these women that chose to wanted to be involved they were doing it for altruistic reasons. It was very purpose of sampling as well because we wanted women who had experienced separation from their baby non-medically so there wasn't no mothers were sick, no babies were sick. So 15 women who had experienced this separation from their baby were included and then interviewed so anywhere between five months and 10 years previously the interviews took one to two hours and were very emotional interviews. Data was analysed using a modified van cam approached and that is when you group the data, reduce it, theme it, validate it and then describe it and it was viewed through two feminist birthing experience theories one by Fay and Parrot which is birth territory and the other by Rachel Reed, childbirth as a rite of passage. So the participants aged in range between 23 and 38 for the birth of separation they were all married or in a relationship and well educated. The Caesarean section with separation had happened between that five months and 10 years prior to being interviewed. 14 out of 15 were primates at the time of their first separation and two experienced a repeated birth with a separation so there were 17 total birth experiences. 12 of those were emergency procedures and in pregnancy all of these women planned and engaged with healthcare providers they look for people who are going to help them achieve their goals. So they chose people who they felt aligned with their own ideas. So two of them had planned home births. One was going through a birthing centre. Seven chose private obstetricians and this is because they thought that they would get continuity of care which they may not get in the public health system and two of them had dollars. All of these women birthed in Australia. So looking at the findings and what the people were saying, where's my baby was a common theme and which is why it's the title. So women were saying that they wanted to know where their baby was. The overarching sort of themes that were coming out of this like the first thing they were unable to hold their baby so they didn't get to see their baby or hold their baby. They were separated from their baby. There wasn't skin to skin but it was more than just the separation of the mother and baby. So it was very hard to just to pull that tiny little piece out of their entire birth experience. So covering their pregnancy right through to postpartum and birthday briefing afterwards as well. There was you know that really the physical hormonal response to having a baby and many of these women had been laboring prior to the birth by caesarean section. That whole experience and each one impacting the other. There was general disregard for women which is where that feminist notion really comes into it and there was obstetric violence and neglect and that was very obvious in the stories that the women were told and we don't think of that often in my country in Australia that there is violence involved with this. Now I'd like to share with you some of the stories from the women. So some really lovely quotes that they had to say. Well they're not always lovely about each of these themes. So really wanting but unable to hold their baby and the women were asking to hold their baby. These weren't women who were lying there benignly. They were saying they wanted to hold their baby but they were not supported to do so. Participant one said I want to see my baby. I want him brought to me now but that didn't happen. And participant 12 said I was just like please please let me see my baby. And these women are physically unable to hold their baby to do it themselves. They're very vulnerable so we give them a spinal anesthetic so they can't get up. We then put blood pressure cuffs. We put IV cannulas. We put clothing like gowns. We tuck them in with blankets so we make it really hard. They can't do it themselves. Participant 12 said my hands were down so because they had cannulas in so I couldn't actually touch her but my husband held her to my cheek and I was able to cuddle into her for a little bit which was beautiful. So even that tiny little touch that she got was important for that woman. Participant 10 said that she wanted to do something so that I could hold him a bit more like there was a lot in the way. The participants all talked as well about their babies being rubbed and wiped and cleaned and weighed. Cords were cut and wrapped. They're often unable to see their baby and unsure if they're even well or alive. Just when you think about the design of if you think about the design of the room sorry that was my thing. If you think about just the design of this the theatre rooms and often the trolleys for that we resuscitate babies or take babies to even when they don't need resuscitating on the other side of the room. Participant 15 said the whole time that I was that the caesarean was occurring I thought he was dead and that woman had been coerced into having a caesarean section by being told that her baby was going to die if she didn't have it and he didn't cry when he was first born. He was well had apgas of nine and 10 but he didn't cry so she still thought he was dead and she couldn't see him. Participant 11 said they were crowding her a lot so I couldn't really see her that much and participant 2 said they're cleaning every sign of me from her and then the women were unsure whether they were allowed to ask for their baby and I know all the midwives that are listening to this will all be cringing at that word allowed because it's a word that we tend to not like very much isn't it. But this is what women are expecting that they will somebody let me do something will they allow me to do something and participant 10 said I was sort of hoping he would come to me but we really didn't voice that very clearly in the theatre and I think it's sad that women feel that they need to advocate themselves when they're in a position of such vulnerability. So no skin to skin there were two participants who were given very brief skin to skin while they were in the operating theatre but it didn't continue out into recovery. So thinking about skin to skin what the recommendations are what we're assessed for when you think of baby friendly health initiative so it's at least one hour of uninterrupted immediate skin to skin. In theatre you know they class this once they get out to recoveries you know when we're having a BFHI assessment but this wasn't happening for these women. One participant one said my midwife kind of grabbed him off the page and kind of got him to me and open my gown and tried to rip the blankets off him and get him onto my chest. So there was a lot happening for this woman but she still had a midwife who was trying to do the best that she could but that healthcare provider advocacy was quite rare didn't happen very often. Participant four said she literally went against everything that had been organised so no delay called clamping or skin to skin and participant six said I was told I was not allowed to do that because of infection control and then healthcare provider and I'm not just talking about midwives here this is all of the people that are involved with the birth of these babies obstruction was also unfortunately quite common. Participant 13 said they didn't talk about skin to skin or anything like that so it was just slice cut over to the table do all the things weigh wrap her up and then bring it to me or wrapped up. The women's choices were completely disregarded and the focus was really on the staff not on the women and this participant four said you know having mum and bub together and in skin to skin contact costs the hospital nothing and I think we know this and you know there might be arguments about the time that midwives may have to spend doing skin to skin but there's already midwives there there are very few births at least within Australia where there isn't a midwife there with the mother while she's having her baby and then the period of actual separation so just as a general thing women didn't understand why they were separated from their baby they understood that if one of them was sick that that would happen but these were well mothers well babies. Participant six said she was just confused as to why I couldn't have my baby. Participant nine said I kept on asking and asking and they just didn't. Participant 13 said it felt like forever and 14 said they took him I didn't hold him for two hours she was crying as she explained this I didn't know what had happened to him and then participant two said she was taken I don't see her face they take her away these were really emotional responses when women were talking about this there was lots of crying. They also didn't think that the staff understood the the importance of this they just thought it as very much being a clinical medical procedure not a birth. Participant nine said I just didn't feel like they really understood the urgency of it how important it was to me. I was sent to recovery for five hours she was deliberately keeping me there to keep me separated from my baby that was participant four and participant three said but I guess they didn't see it as being important and I think as we're listening to this we do see the value in this and this probably grates on many of you as you're listening to these stories. There was a lot of emotional turmoil and as I said lots of people crying there was people very angry when they were recounting their birth stories you know there were feelings of fear and trauma during that actual period of birth and that separation made way to those that they were angry they were sad they were guilty because they couldn't fix things and those feelings were still very strong in the present at the time that they were sharing them as well. Relationships were impacted particularly with their partners and participant one said the damage that it does first hand on you know not just with breastfeeding relationships but entire family units can suffer because of this so this is relationships with you know their families and it's ongoing it doesn't just stop it when the baby's been born. Participant two said I was a very sexual person we had a very healthy nice sexual life before and I cannot even have effing sex with my husband now he was the only person who could have said stop but he was silent and calm it was one way of siding with the hospital and then the connection with babies as well and this is why we really really want mothers and babies to stay together at birth is so that we they look after and love and care and feed and their babies form from birth onwards. Participant 15 said to be honest I didn't feel very connected to him I didn't feel that bond with him for a good couple of months. Participant 12 said at first I was jealous because he loved everyone but me and participant two said I have a good relationship with her but a lot of it it's out of duty I know how I have to behave but it's not this natural overjoyed burst of emotion and that mum's child was heading up to two years old and then participant five said I didn't feel connected to her but I think it was just it still felt theoretical you know there was something that was just off and it just took time. This is just looking at you know some of the words and the frequency of the words that were used and you know the immediate responses were often numbness weirdness it felt very clinical they felt like they didn't have any control in that early period but then looking back at the birth is this retrospective feeling so you know anger frustration these people were unhappy they were confused they were powerless these people these were really strong emotions that they still had many years after the birth for some of them. So looking at with this study looking at the perspective through a feminist theory just explaining what the two theories were so birth territory by Fay and Parrott so it's really understanding that maternal experience of birth by the environment that the woman is birthing in and who has power and control within that space so the terrain and the jurisdiction and if you think about the terrain of a caesarean section it's very clinical monitored unfamiliar it's termed the surveillance room and it's got that potential for emotional distressed and reduced physical functioning and in a vaginal birth this means women don't birth you know they don't continue to contract and things like that but for a mother birthing in a caesarean section this means that she also has lots of emotional responses that continue on beyond the birth but we can challenge that the people that are in the room if you have shared goals you're maintaining safety for the woman and respectful protection of the woman and giving her the sense of choice and control so letting her have a say in what is happening to her can really change her experience and midwives we're the people in that room that can make a difference so we're there to we can advocate for keeping mothers and babies together and in skin to skin contact and the birth territory describes this as midwifery guardianship and it's a form of integrative power so returning power to the woman the opposite of that is midwifery domination and that's disintegrative power and it's more often seen in that place that women are birthing with caesarean sections so that patriarchal medical system so women are expected to behave if they don't behave if they decline treatment refuse care you just imagine the documentation I know all of you are thinking about things that you've seen in patients notes you know that people refusing to do what they've been told because they're expected to be good they're disciplined for non-compliance and there's often very subtle and coercive reactions to that as well and then childbirth is a rite of passage this is Rachel Reed's work and it's understanding the phases of birth and that's from pregnancy right through to the postpartum period that her whole journey takes with a non and it includes a non- physiological or surgical environment and it talks about both the rights of passage for the woman and also rights of protection which are more important when a woman is having a birth such as a caesarean section and again the midwife is really central to both of those the birth phases that were talked about in in this theory is preparation and that's you know the woman where she gets to develop trust in herself this is her birth and she writes birth plan she anticipates the baby coming you don't want her to be feeling anxious in this time but she does feel a bit anxious because it's unpredictable and many women including the participants had planned for unexpected they knew that caesarean section may happen in their future but let them meet the team you know so and support them as they're making those birth plans the separation period is a time when they're getting ready for birth and this for a caesarean section the women coming into the hospital meeting the staff as they come in because today is the day their baby has come introducing them to people who are in the room is really important minimizing distractions let them know what's going on and what you say and do at that point is really important for their birth experience liminality is also a phrase that's called the betwixt in between which is probably more obvious that vaginal births so women really head into another place as they prepare to push their babies out but there are still a lot of endorphins and you know altered states of consciousness in that time they're often very open to suggestion from authority figures and a lot of the women in these stories were already laboring before the caesarean section so being told that their baby was going to die was an incentive to go and have a caesarean section even if it wasn't realistic so for us remaining with women advocating supporting and then with emergence this is the birth we often you know call this emergency rather than emergence as well when someone's having a caesarean but thinking about the woman's preferences still providing respect for care for her does she want the drapes lowered does she want somebody in particular to announce the sex of the baby or to see that themselves and then integration which is really the focus of this study which is when the mother and baby are first meeting so not separating them skin to skin this is all about also about the time where women talk their birth stories get debriefed about their birth and thinking about birth debrief is not just a clinical trying to stop somebody getting sued but you know which is often what was happening you know there's a lot of women's experiences were just completely disregarded in the clinical debriefs complaint processes that were done read says a positive and empowering birth is more strongly related to how a woman is treated by care providers than how she gives birth and i think that's really important so those rights of protection are what we need to be supporting as midwives and giving the woman back the power and there was so much more than just that separation so yes taking babies from their mothers not giving them skin to skin not letting them hold and feed their babies straight away is all really important but it's a part of a bigger picture and that overall birth experience was really negatively associated with separation but how she felt in that time you know there's a lot of expected physical and hormonal responses to labor and stress i think you better all those catecholamines like adrenaline noradrenaline and cortisol and they cause physical responses in women shaking memory loss change to memories things like that and that further impacted the women in these this study of the moments of meeting their babies and what they remembered and some women didn't remember things one participant seven said it took about five minutes for them to do all of their checks and whatever they're doing they brought him back but i had really bad shaking and then participant twelve said they kept saying you can't go up until you stop shaking that was she wanted to go back to her baby and i'm like i can't stop shaking and some memories of the time as well so i'm being aware of what the time is there's often not a clock that women can look at either and you know time can be very warped some women were able to track time because of things that were happening so they knew that the time that their husband left or when i was taken to the ward but some people use time stamps on their phone and participant seven said that she said i'm not sure who had my phone somebody was taking photos so i can actually track the time of like how long did it take to do stuff but participant nine who didn't have photos said they checked him then he was on me but it wasn't for very long and participant eight when asked how long had she been separated for she said i have zero memory of it my memory is of zero time participant fourteen said we're not the priority at all we're just a cog in the hospital machine just getting churned out like a sausage and participant fifteen really described the cold hostility from her doctor because she didn't agree to his timing of the caesarean section she said i feel like the system fails women and i feel if men give birth the system would really really support them but i think the birthing system is not supportive of women because it's women that give birth like and i have never known such inequality as i do now and i think this is really looking at that patriarchal medical system that midwives were in that system we can make changes so we are the key and that art and science midwifery really shows that we are best placed to create a protective and supportive environment and improve that birthing experience we can return that power and control back to the woman by letting her choose what happens to her body and her baby and that helps we can help that by keeping mothers and babies together and birthing women shouldn't be expected to advocate for themselves and nor should their partners we can prime up the partners to be doing this but i think it was very evident with these women as well that the partners were often very vulnerable as well so again it comes back to midwives we really do hold the key in this and this is yes definitely watch this space this is my twitter handle at linda day so as new papers come out over this year you'll see some more come through and you'll see more of these findings coming out so hopefully you'll look out for those and there my references there thank you thank you so much linda i'm just having a look at the chat um uh lisa says i think as midwives we have to be prepared to rock the boat janine just says thank you great job there's no other questions so um thank you so much linda for participating in the virtual international day the midwife