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The search for “Normality”

March 10, 2013

I have worked in the Community at home births. I have worked in Midwifery led Birth Centers too. I have worked in medium-sized Delivery units where they try to offer  Low risk Care alongside High Risk Obstetric care. I have also worked in massive Obstetric Led units where the number of women to care for and the number and type of staff available has dictated the care they received.

How you provide care that is appropriate for individual women; at the time that they need it; with the correct staffing, time, equipment and environment that is required, is the dilemma and challenge of modern maternity services.

One to one midwifery care in labour is the gold standard that is possible at home births and many units now achieve. But for others it is impossible. Some women need more than one midwife because of what is happening at that time, in their particular labour.  How can one midwife support the woman, give aromatherapy massage, monitor the baby, move on and help the anaesthetist to site the epidural, site infusions and commence drug therapy, respond to the needs of the obstetrician, take account of the partners and keep contemporaneous notes!  What we often ask of midwives is clearly stressful and near impossible?   But it is asked and asked daily within the British NHS.

Maybe it is time to take a step back and look at modern midwifery practice .  The role of the midwife and her undoubted beneficial influence on the outcome of pregnancies has been proven and proven again. They are tremendously cost-effective to the health service, if able to give the time and energy to the care of women.  Maybe it is time to stop midwives being used as ‘all encompassing’ practitioners who step from room to room.  We as practitioners must accept that we cannot be specialist in everything and at the same time put the woman and her baby’s needs first.

I am very supportive of the fact that high risk women need midwives too.  Many women who are severely ill or with special needs have been helped to achieve excellent birth outcomes by the care and attention of supportive, educated and experienced midwives. There will always be midwives who prefer to work in a non-intervention environment and those who enjoy giving care to women who need the care of obstetric, anaesthetic and other practitioners too.  But this is not the time for a war between the two camps just a real recognition that the needs of those women and those midwives are different.  It is also time to accept that if you constantly work with women requiring lots of support and intervention it is rare that the same midwife will also be able to work and choose to work in low tech areas with the same confidence. Visa versa the low tech midwife will not find it easy to jump back into a room with syntocinon in progress and the woman requiring an epidural.

Midwives need to regain trust in the birth process. That it can happen without intervention and medication. Medical staff, also need to get on board and accept the overwhelming evidence that this is the case.  They need to support the idea, that a women might choose to give birth without access to an epidural or continuous fetal monitoring and not be ridiculed for doing so especially if this woman requires their services later because of clinical need.

The challenge in 2013 is to give the right care to the right woman, with the right personnel with the right attitude.  Us, the staff and women, need to be open to the challenge that presents itself to us because of changing clinical circumstances.  Whatever women’s dreams of the ideal birth may not be what may actually be possible due to pregnancy or labour events. It is about working together to achieve what is safe and satisfying for all concerned. It is I believe a time to work together not set women against their carers when trust is such a big part of the experience of childbirth.

I have been thinking back to the people (role models) and books that have been my bedrock of knowledge and development of my own philosophy of care.

Ina May Gaskin, of Spiritual Midwifery fame. I read her works avidly and always wished to go to the ‘farm’ to work. Idealistic holistic midwifery that is sadly rare. I had the great pleasure of receiving a hug from this very special midwife at a workshop.  http://www.inamay.com

Caroline Flint – Spiritual Midwifery.  This also influenced me to always work with the woman in mind but I did not share some of the more ‘touchy – feely’ approaches that I knew some women would not accept.  I learned that just because if feels right for the midwife it is not necessarily right for the woman.

Mavis Kirkham – I saw her speak many times and I read many papers and finally she became my professor. I was so proud of her Northern-ness and her ability to say it like it is – like it truly is. I too share that approach but continue to learn when and where this directness has its uses.

Denis Walsh – worked with him and watched him develop into the ambassador for normal birth that he now is.  Concerned he is now seen as being on one side of the argument when I am aware he sees the whole picture and challenge. His workshops have changed many a midwife.

Marsden Wagner Pursuing the Birth Machine 1994 –  A scary book that all modern midwives should read.

Michel Odent – I heard him speak several times.  He is a very rare Obstetrician, who really believes in women and their ability to birth.  Birth without violence – says it all really. http://www.waysofthewisewoman.com

Andrea Robertson and Janet Balaskas for ‘Active Birth’  grounding that I use every day in practice.

I had a very “normal” oriented training in Stockport UK and lots of “normal” birth experiences including twins and breech.  I did not enjoy my training I was always a challenger of the status quo, it made for a difficult ride.  I dislike the “because we have always done it that way” response.  It does not make it right.   The internet; modern communication devices; social expectation; and growing public accountability, make midwifery a very difficult profession but it is a rare and extraordinarily rewarding one.

I have a strong belief that women can birth with minimal help, but it is also the case that a growing number of others do require lots of support, skills , experience and intervention to achieve the best possible birth for them.  Birth is a scary time and modern society requires more of women now than just producing babies. Our changing times require midwives and medical men who can adapt to that change. I hope to help midwives to do just that in my later midwifery years.

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