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Real Midwives

June 15, 2014

I woke up this morning and began Tweeting. I usually casually scroll through what has been happening whilst I have been away from the site or asleep.

I came across celebrations for senior midwives who have now received great honours in the UK. Well done!

I found a flag to a website in Australia about I quote “10 “homebirth” tips that can help to empower your hospital birth”. http://www.knowyourmidwife.com.au/birth/ten-home-birth-tips-hospital-birth/

I then had a little spat about “risk” with my good friend in Leicestershire about Michel Odent.

I then found that I was angry.  When I am angry these days I am forced to write, which is much better than how I used to react and far more constructive, thus the following blog.

 

Real Midwives

These are the thousands of women and men who staff the delivery units, birth centres or are at home births across the globe. They deliver millions of babies safely and often save women and babies lives.

Most work in a hospital based context.  Most are bound by organisational constraints and philosophies that restrict the way, a lot of them, would like to care.

I read constantly about natural birth, home birth, water birth on Twitter and I sense a great animosity towards intervention in pregnancy and birth.

I agree with this animosity to a point and I will do all I can to ensure that we prevent unnecessary interventions in pregnancy and birth.  However , the choice of when it was necessary and unnecessary is often done in hindsight. It is my opinion and strong belief that the midwives and medical staff currently working within maternity care are doing what they believe is best for that woman and her baby at that particular time.

The challenge is to educate and share current best knowledge at the very highest level in hospitals in order to then have an impact at the clinical floor.  But we have to be careful so as to not to undermined the midwives and medical staff currently working there and to make women scared of what will happen to  them at the point of birth.

 

I have tried to illustrate this in following table.  I am going to attempt to compare the ideas offered on the Australian website(Apologies but it offered a good approach); with possible reactions of hospital based midwives and the woman herself.

She is being induced(IOL) slightly early 36wks, because of hypertension and diagnosed pre-eclampsia. Her baby appears small on scan.

 

10 Home Birth Tips for a hospital Birth Lady being induced/ Midwife
Get a midwife I feel undermined. I am very capable of caring and supporting the woman and her family in this hospital setting They must not have staff at the hospital that will care for me. It is going to be a battle to get what I want. I am scared.
Prepare for your birth I agree all women should do this but this lady was preparing for a “normal birth” without IOL now she has to change tack quickly with advice and reassurance why IOL might prevent maternal and fetal morbidity.I was thinking all would be well but now it is all going wrong. I am sad that I am not going to have the birth I wanted.  I was very focussed on natural birth.
Read all you can about normal birth I have been reading but a lot is very biased against IOL. I am scared these people might not be providing the right care for me.Preparing for birth is very important but knowing the points where we have to step in to save lives is also important. She has found very biased writing about IOL, so she is now unsure whether this is right for her. The midwives and medical staff are finding it hard to explain, how important it is for her and her baby at this time.
Stay at home in early labour If she was at home and she did this she would be not be able to access monitoring and care that might save her and her baby’s life.The staff at the hospital have advised that I should stay in but this literature suggests otherwise to get the best outcI don’t know what to do.
Use the shower or bath as much as possible during labour Induction of labour involves being attached to an infusion – difficult to go for a shower but I will care for her and assist her to the bathroom as needed. This is not appropriate for me now.  I have missed out.
Plan for the unexpected How can she do this, if the main literature is very biased against IOL and interventions, as if we want to do things to women for no reason.  This woman and her baby need it.I have failed because it is all not happening naturally. I want my “natural birth”.
Enjoy you birth“Who is the enemy in the birthing room?” I feel undermined.  I will do all I can to ensure this woman’s birth experience is the best it can be in the circumstances. There will be people around me who will do things to me that are unnecessary and will stop me having my “natural birth”. I am afraid.

 

 

I know that this website and organisations like it in the UK and elsewhere are positively promoting natural birth.  This has to be applauded, but we have to live in the real world.  We have to work with midwifery as it is and where it is, changing it gently and gradually from the bottom up in the context that it currently is happening. Acknowledging and working with women the many reasons why for example; a water birth might not be right for them.

Motivated midwives, need strong support to challenge unnecessary interventions and birth practices that are outdated and not supported by evidence.

I re-iterate please support the majority of midwives where they are. Do not undermine them and make women scared of giving birth and having care in hospital.

 

 

Postscript

I just need to add something here.  Many women are pregnant and still do not access enough education and support. In the UK many enter birth with no idea of what it might be like beyond watching the odd episode of One born every minute. (Channel 4 Series UK)

The midwifery challenge here is to identify these women antenataly and provide the advice and care necessary, which might help a safe physiological birth. For women with problems in their pregnancies this has proven invaluable time and time again to ensure better outcomes.

My opinion: sometimes I think we spend too much time, writing and blog space on women who really have no problems at all.  I think the term in an illness context is the “worried well”.

My opinion: the staffing levels in British and Australian hospitals are deemed fantastic to the woman delivering alone in the Cambodian bush.

 

 

 

 

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