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The midwife you meet is not your enemy – Title proposed by @BirthSalford on Twitter

June 17, 2014

I recently wrote a post that really set off a lot of traffic, both here and on Twitter. Real Midwives http://wp.me/p2bPtK-4n

I wanted it to, but there were some misunderstandings about the piece. I felt I should write again today as obviously I was not very clear in my approach. I am still learning. Bear with me.

I used the Australian website, only because of the layout of the chart in the leaflet.  http://www.knowyourmidwife.com.au/birth/ten-home-birth-tips-hospital-birth/

It seemed to lend itself  to explain what I needed to explain. The first column in the table “get a midwife” was confusing I believe in a UK context.

In Australia a lot of midwives are independent, so “get a midwife” would be the first appropriate step.  But as I was once  successful in applying for a job in Sydney I also know British midwives work in those hospitals. I was trying to write a wider world piece, not just UK.  The idea was that we should respect the work of the hospital staff and not think women need an ‘ally’ to take in with them,  to defend them from the ‘system’.

The first statement “get a midwife” is a bit like the current surge in the UK in the maternity press to “get a doula”.  You may think if you are a midwife – why does the woman need a doula.  if you are a midwife who feels she can work with the woman, support her in her wishes and help her achieve a beautiful birth why does the woman need anyone else. Doula’s are ‘with woman’. I have met some great ones. But isn’t that the midwife’s role?

It feels like midwives are not enough anymore. It feels like an insult, as if the woman should be “afraid” of the  midwife who might care for them. Believe me there are millions of women in the world who would be happy with a midwife, any midwife. I feel we are making birth more complicated than it needs to be here in the west.

 

The point I was really trying to make and I hope I make it clearer today, is that sometimes we go on so much about “normal” birth on blogs, on twitter etc, that women who are pregnant with problems that require intervention are seen as second class. Not only that, but the midwives caring for them in hospital are sometimes seen as “not as good” as the midwives who help women birth at home or in birth centers. The hospital midwives may ‘intervene’ but this is often as a solution to a problem.

I just think we have to be careful and think about trying to support all woman to achieve their best pregnancy and birth whatever support or intervention they may or may not need in the place of birth that is right for them.

 

I do believe that  the current NICE publication, supporting more births at home or in birth centres, is marvelous. I do think that this change will save a lot of women, with “normal” pregnancies, interventions they did not need.

But giving birth in hospital is often as good as birth at home if that is where you need to be.  The midwives who care for women there are marvelous.  But they are often restricted by peer pressure, local philosophy, and uninformed leadership.  Please don’t blame them themselves, blame the leadership. Please don’t frighten women from going into hospital thinking they will have to “fight” for their rights.

It is all about communication as people have said on Twitter. It is all about being kind to all sides of the pregnancy story. My colleagues and I, both midwifery and medical are listening to women.

Someone said on Twitter that we should move care out into the community and their should be more continuity. I totally agree and this has been supported by lots of research that even in the most complicated of pregnancies, continuity by the midwife has led to better outcomes. But, and this is a big BUT, some midwives don’t want to work in this way.

For my Masters thesis 1994/1995  I went around the country doing focus groups with midwives after the publication of Changing Childbirth 1993. A lot of units had tried to implement caseload type midwifery as the report suggested.  I met midwives who were totally burnt out, who felt that too much was being asked of them. Sadly I never got around to publishing but really wish I had.

Not everyone wants to be “on call” twenty four hours a day.  I  know this report was a long time ago, but I talk to midwives now and many of them feel the same.  This is why I suspect more continuity/caseload projects have not got off the ground.   It has been a 20 years since the Cumberlege Report.

Many midwives are wives and mothers themselves and have full lives outside of their profession. They dont want to be doing midwifery all the time.  Working the shifts in the hospital suits them.  This does not lessen them as midwifery practitioners.

It is a challenge, but we have to accept that we will not change all current midwives into the type who wants to be supporting mothers in natural childbirth at home.  Not all midwives need to be like that. I know that the midwifery education programmes have changed to support caseloading midwifery but when these midwives  qualify they often want to do work that fits in with their lives.

Many midwives are expert in the care of women with pre-eclampsia. Expert at preventing and dealing with postpartum haemorrhage. Expert at dealing with the shoulder dystocia and the suturing of second degree tears.Expert at supporting women through caesarean section and fetal loss. They are all present in hospitals. There are a growing number, expert in the field of obesity and pregnancy, substance use in pregnancy etc.

If there are individuals who are not good at their job as midwives or doctors, then they must be dealt with on an individual basis, not a whole group of hospital based midwives created into the ‘enemy’.  You are right @Birthing4Blokes, it is “about the midwife in front of the woman”.

I do think we are also ignoring the rise in women who will have problems during pregnancy.  Not all will be suitable for the water birth at home. I know some out there might say I have no right to say what is suitable for the woman, but I have enough experience to know that some women and their babies might not fair well in those circumstances. Am I really to stand by and not give my opinion.  Happy to support her if that is what she chooses. But please read my blog about midwives and medics being put in a very difficult position at a birth.  http://wp.me/p2bPtK-3h

 

I feel forced to repeat my postscript from the previous blog and add one more

My opinion: sometimes I think we spend too much time, writing and using 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.

My opinion: we have to stop demonising hospital care and stop scaring women, some women need it. The birth they have is their birth and should not be compared to anyone else’s.

 

Looking forward to more traffic

 

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