Name: Keys to healthy childbirth and preventing obstetric risks
Uploaded: 2023-08-13T10:46:49.100Z
Duration: 312.67
Description: Hear from experienced Obstetrician Jenny Dowd, as she explores the key risks in labour and childbirth and how Obstetricians and Midwives can prevent them. Jenny explores how patient and clinician perspectives can interpret risk differently and how it's important to ensure both are on the same page.

Jenny Dowd.mp4

Jenny Dowd v2.vtt

Jenny Dowd

{{00:00:13}}
I think that question could
be answered in two ways.

{{00:00:15}}
You either answer it as a
practitioner, a doctoral midwife

{{00:00:19}}
who sees what the real risks are.

{{00:00:21}}
For example, life-threatening
risks like obstetric hemorrhage,

{{00:00:24}}
severe infection, severe high blood
pressure, preeclampsia, eclampsia.

{{00:00:28}}
There's those sort of things
that we consider risks.

{{00:00:30}}
But I'm beginning to realize that from
a patient's perspective or a family's

{{00:00:34}}
perspective, they think other things
as risks, which I wouldn't really

{{00:00:38}}
consider as a risk such as having
an epidural, having an instrumental

{{00:00:42}}
delivery, having a long, painful labour.

{{00:00:45}}
They see those, they see those things
as risks, whereas to me, they're

{{00:00:50}}
just a part of what may happen.

{{00:00:51}}
So I think we also need to look
at the way we use language.

{{00:00:56}}
So instead of talking about risks, we talk
about the chance of something happening.

{{00:01:00}}
So if we know that in the private sphere,
50% of babies are born by caesarean

{{00:01:05}}
and in the public sphere, it's about a
third of babies are born by caesarean.

{{00:01:08}}
So we don't talk about the risk of having
a caesarean birth, it's really the chance.

{{00:01:13}}
Because that is a safe healthy
way to have a  successful outcome

{{00:01:16}}
to a pregnancy these days.

{{00:01:25}}
I think to prevent risks is to
understand what can happen during

{{00:01:30}}
pregnancy and during labour.

{{00:01:32}}
So there's sometimes a mismatch
between the reality and the

{{00:01:35}}
expectations of patients these days.

{{00:01:37}}
I think social media perhaps is a lot to
blame and the sites that people go to.

{{00:01:42}}
Individuals might have opinions
about things, but if you look at

{{00:01:46}}
the actual, as I mentioned before,
the statistics of outcomes of birth,

{{00:01:50}}
which is often a good outcome.

{{00:01:51}}
If you have a healthy mum and a healthy
baby, then we look at the experience

{{00:01:55}}
of the mother and I think the way to
decrease what some people think of as

{{00:02:01}}
risks is to inform people beforehand
what the likelihood is of certain

{{00:02:06}}
things happening so that they're
fully prepared and they're not asking

{{00:02:09}}
questions in the heat of the moment.

{{00:02:10}}
If we explain that they might need an
instrumental delivery or a caesarean for

{{00:02:14}}
example, they've already got a bit of an
understanding of what that's about and

{{00:02:17}}
we just have to explain at the time why
we think that's the best thing and allow

{{00:02:21}}
them to ask questions going on what's
happening to them at the time, not what

{{00:02:24}}
is a caesarean or what is an epidural.

{{00:02:26}}
That should have all
been covered antenatally.

{{00:02:36}}
Yeah, I've been doing this for
a long time and mainly dealing

{{00:02:39}}
with private patients now.

{{00:02:41}}
I feel I've got the luxury of getting
to know people and having time to

{{00:02:44}}
explore all these issues antenatally.

{{00:02:47}}
So recently it was a bit of a
surprise when someone had read

{{00:02:50}}
all of our literature, had a
chance to discuss all her issues.

{{00:02:53}}
When she came into labour she, I
would say decline, she would refuse,

{{00:02:58}}
she would say decline to have
what we thought was routine care.

{{00:03:01}}
It was confronting for both myself
and the midwife and the person

{{00:03:05}}
herself, because she didn't feel she
could have a conversation with me.

{{00:03:09}}
She put her headphones on and I had to
talk through the doula, who then talked

{{00:03:13}}
to her partner, who then would decide if
I could discuss things with her during

{{00:03:17}}
what turned out to be a fairly complicated
labour because she had some risk factors

{{00:03:21}}
from her previous birth in the United
States that we discussed antenatally.

{{00:03:25}}
And there were things we could do
to make sure this was a safe birth,

{{00:03:28}}
but she wasn't keen once we got
into labour to allow me to undertake

{{00:03:33}}
those things that we had discussed.

{{00:03:34}}
So it was really almost withdrawing
consent in the heat of the

{{00:03:37}}
moment, which I find difficult.

{{00:03:39}}
In the end, she had a successful birth.

{{00:03:41}}
The baby did get stuck.

{{00:03:42}}
She did have shoulder dystocia
and I had to use my skills

{{00:03:44}}
to safely deliver the baby.

{{00:03:46}}
But that was a good outcome eventually.

{{00:03:49}}
Although she mightn't have thought it was.

{{00:03:52}}
Staying up to date's important.

{{00:04:00}}
And I think these days we don't go
back to reading a lot of journals

{{00:04:03}}
as we perhaps did years ago.

{{00:04:06}}
There are good journal
services that summarize things.

{{00:04:09}}
There are academic institutions,
hospitals, colleges that run

{{00:04:14}}
up-to-date courses, which is important.

{{00:04:16}}
So we keep abreast of the latest
publications that way, going to morbidity

{{00:04:21}}
mortality meetings, m and m meetings,
case presentations within your hospital.

{{00:04:25}}
And I think that's one of the
benefits since COVID that we're

{{00:04:27}}
also used to Zooming into things.

{{00:04:30}}
Previously, particularly I think with
a lot of women doing obstetrics now,

{{00:04:33}}
both ends of the day with childcare and
responsibilities means you can't always

{{00:04:36}}
go to a meeting at 7:00 AM or 5:00
PM but you might be able to Zoom in.

{{00:04:41}}
And so we keep up to date listening
to each other's presentations and have

{{00:04:45}}
formal and informal discussions, about
new concepts, new ways of doing things.

{{00:04:51}}
Going to conferences is important and even
keeping up to date with companies that are

{{00:04:56}}
coming up with new devices or new drugs.

{{00:04:58}}
We have, perhaps a little bit of
skepticism with something that's

{{00:05:02}}
very new, but we'd like to keep
abreast of what's happening and

{{00:05:04}}
see how it might be implemented.

I think that question could
be answered in two ways.

You either answer it as a
practitioner, a doctoral midwife

For example, life-threatening
risks like obstetric hemorrhage,

severe infection, severe high blood
pressure, preeclampsia, eclampsia.

There's those sort of things
that we consider risks.

But I'm beginning to realize that from
a patient's perspective or a family's

perspective, they think other things
as risks, which I wouldn't really

consider as a risk such as having
an epidural, having an instrumental

They see those, they see those things
as risks, whereas to me, they're

So I think we also need to look
at the way we use language.

So instead of talking about risks, we talk
about the chance of something happening.

So if we know that in the private sphere,
50% of babies are born by caesarean

and in the public sphere, it's about a
third of babies are born by caesarean.

So we don't talk about the risk of having
a caesarean birth, it's really the chance.

Because that is a safe healthy
way to have a  successful outcome

I think to prevent risks is to
understand what can happen during

So there's sometimes a mismatch
between the reality and the

I think social media perhaps is a lot to
blame and the sites that people go to.

Individuals might have opinions
about things, but if you look at

the actual, as I mentioned before,
the statistics of outcomes of birth,

If you have a healthy mum and a healthy
baby, then we look at the experience

of the mother and I think the way to
decrease what some people think of as

risks is to inform people beforehand
what the likelihood is of certain

things happening so that they're
fully prepared and they're not asking

If we explain that they might need an
instrumental delivery or a caesarean for

example, they've already got a bit of an
understanding of what that's about and

we just have to explain at the time why
we think that's the best thing and allow

them to ask questions going on what's
happening to them at the time, not what

That should have all
been covered antenatally.

Yeah, I've been doing this for
a long time and mainly dealing

I feel I've got the luxury of getting
to know people and having time to

So recently it was a bit of a
surprise when someone had read

all of our literature, had a
chance to discuss all her issues.

When she came into labour she, I
would say decline, she would refuse,

she would say decline to have
what we thought was routine care.

It was confronting for both myself
and the midwife and the person

herself, because she didn't feel she
could have a conversation with me.

She put her headphones on and I had to
talk through the doula, who then talked

to her partner, who then would decide if
I could discuss things with her during

what turned out to be a fairly complicated
labour because she had some risk factors

from her previous birth in the United
States that we discussed antenatally.

And there were things we could do
to make sure this was a safe birth,

but she wasn't keen once we got
into labour to allow me to undertake

So it was really almost withdrawing
consent in the heat of the

She did have shoulder dystocia
and I had to use my skills

Although she mightn't have thought it was.

And I think these days we don't go
back to reading a lot of journals

There are good journal
services that summarize things.

There are academic institutions,
hospitals, colleges that run

So we keep abreast of the latest
publications that way, going to morbidity

mortality meetings, m and m meetings,
case presentations within your hospital.

And I think that's one of the
benefits since COVID that we're

Previously, particularly I think with
a lot of women doing obstetrics now,

both ends of the day with childcare and
responsibilities means you can't always

go to a meeting at 7:00 AM or 5:00
PM but you might be able to Zoom in.

And so we keep up to date listening
to each other's presentations and have

formal and informal discussions, about
new concepts, new ways of doing things.

Going to conferences is important and even
keeping up to date with companies that are

We have, perhaps a little bit of
skepticism with something that's

very new, but we'd like to keep
abreast of what's happening and

Expert Insight

Hear from experienced Obstetrician Jenny Dowd, as she explores the key risks in labour and childbirth and how Obstetricians and Midwives can prevent them. Jenny explores how patient and clinician perspectives can interpret risk differently and how it's important to ensure both are on the same page.