Can midwives STOP shouting at other midwives

July 5, 2014

This is my response to a blog by @Birthing4Blokes  3/07/2014

I felt compelled to write as a list was put forward to “Stop” midwives saying certain things, I believe some of those things on the list can be seen in an alternative light. I felt it important that the other point of view be put out into the ether. I have taken each point in turn.

Number 1: ‘MY ‘ladies’.
I really am not sure why this one is regarded as being so bad. Yes, I can see that it is a little paternalistic but I do know lots of women who have been cared for a particular midwife, have enjoyed being part of that particular midwives group of women.
They liked that she thought of them as “her” ladies. It invokes a caring response, a notion of the fact that she would be there for them and on their side. Midwives on every shift on a birthing centre or labour ward will talk about “my lady”. I think it comes from wanted to do the best for their particular women they are caring for. I believe it to be a kinder saying that is portrayed.

Number 2: ‘you might ‘be ALLOWED’ to have a home birth’…insert anything in for home birth. The language of permission is missing the point.
Yes, I agree that the term being “allowed” to do something by any other person would get people’s backs up. But where has this come from? The verb “to allow” means according to Oxford English dictionary – to permit, to let (thing) happen. Yes, there is the idea of one group with power “allowing” another to do what they want. But in the end they are “letting” it happen. So the person is getting their way. You are not being disallowed or prevented from doing what you want to do. The woman is actually getting her way. Just a thought.

Number 3: ‘I just catch babies’!Aghhh as most midwives offer support based on reflected upon experience.
I really can’t get why this is an issue either. Some midwives do think that they help mothers birth and just at the end “catch” the baby. They don’t make women do things that are not required during labour or make women have interventions they don’t need. They support women through the labour and delivery the woman wants and just “catch “ the baby at the end to assist onto his/her mother’s abdomen/into her arms. Surely this kind of midwife is what a lot of women want. Not to take over just to be there. Is there not a well known book called “Catching Babies – a Midwives Tale” by Sheena Byrom.

Number 4: ‘if you don’t push better than this I’m going to get the doctors’.
Well threatening things may not be regarded as the best way of practising, but I would be surprised if it quiet came out as depicted above.
Midwives sometimes need to explain to women that even though they are pushing well, actually because of time or fetal issues medical staff are likely to be needed soon. Do not blame the midwife who is working often in a difficult space driven by guidelines and often hovering medical staff. I have personally seen women respond to this albeit strong encouragement. Especially if you go on to say you believe in them and know they can do it without help. This gives them confidence and around the bend the baby comes. I am not sure it is quite the severe threat that the inverted comma’s say.

Number 5: Stop any references to ‘stages’ of ‘labour’ that suggests that they actually exist! Remember, we MADE them UP! Useful guide? Maybe? Maybe not.
The stages of labour have been a tool for assessing labour and birth for centuries. Maybe recently we have begun looking at loosening that strict adherence to ha ha “allow” physiological birth to happen. But the current references available to women on the internet, in books etc. are still using this terminology. You have to use what is out there. To ignore these terms that have been there for years would be silly in my opinion. You work with what is, not pretend you can wave a magic wand and all will be immediately the dream garden of maternity care. It is currently a messy but good intentioned space.

Number 6: ‘They’ are not all the SAME, your experience is useful BUT not absolute, always ‘bow the knee’ to a woman’s sublime uniqueness.
Midwives are taught in universities now, before then it was often on the wards and in the community with short burst of classroom teaching. In order to get to grips with midwifery you have to learn what “usually” happens in order to identify when things are not following a normal physiological event. I agree all women are different in how they respond to pain and the experience of birth, but you do have to have some standard with which to measure their behaviour against. You need to know when to act. You might need it to save a life.

Number 7: Any use of the words ‘they’ or ‘them’ when speaking about pregnant women.
So who are the “they” and “them” saying all these bad things then. Please do not group midwives the way you apparently don’t want women to be referred to.

Number 8: ‘pethidine will work well for you.
Again are we to stop offering all the methods of pain relief that is out there for women. Are midwives only to offer the care that they the particular midwife and their philosophy of care. Is that not just as bad as what was offered above? In the past there may have been circumstances where the sentence above was true. I really doubt that it is said often now, as we are moving to different forms of pain relief. Please stop scaring women.

Number 9: ‘you must get on the bed for me to examine you’.
Sometimes it is difficult to do a vaginal examination. In years prior to my training nearly thirty years ago most examinations were actually done per rectum.
Most midwives in modern days are taught to do them whilst the woman is on the bed. It is a technique that is difficult to get experience of. Sometimes midwives do struggle to ascertain dilatation, descent, presenting part etc. where the woman is
It would therefore be deemed professionally responsible and appropriate to ask the mother to get into a position where it is more likely a successful assessment of progress would take place. This is better for the woman in the long term. If she does not wish to be assessed, that is her choice. But most women want to know what is happening. It is how you explain that to the woman at the time.
Confidence and competence in this examination comes over time. Yes, midwives should learn how to examine wherever the woman is, but don’t interfere in a professional opinion of what is best at the time. The ongoing care of the woman is at the point of this.

Number 10: ‘it’s too late for an epidural’.
Head on view about to be born It is clearly “too late” for an epidural”. Do you really think that midwives withhold epidurals? We live in a litigious area of medicine. No way these days do midwives do this. They might have tried to persuade the mother that they can do it without, as they have faith in the woman giving birth without and all the signs are there that she is progressing well.
I myself have assisted an epidural being put in at the nth hour and then the woman giving two pushes and out came the baby before the anaesthetic had time to take. She said afterwards “I should have listened to you shouldn’t I”. Mmmmmm can midwives not have an opinion any more. Can we not work with the woman to try and not have an intervention sometimes?

Number 11: ‘we are going to let the epidural wear of so you can feel when to push’. NO NO NO!
Now this one I totally agree with. There is enough evidence out there now that really has put this one to bed. There is no way if you have got the woman to a reasonably pain free labour that you make her have acute pain at the end. It is barbaric. I totally agree. But I also think the likelihood of this is less than it used to be. So scaring women that this may happen is not useful.

Number 12: ‘if we put your legs into lithotomy you will be able to push better’.
You see this comment is so totally low risk, home birth biased it makes me mad. I don’t like women’s legs being put into lithotomy either. I personally think it predisposes to shoulders being pulled down through perineums. I am working hard to encourage midwives, if they do use this position, and at the end of the day that is all it is, they only use it for a short time to help move the baby a bit then change to another.
We have all used the toilet at home deliveries, the child’s plastic stool, stairs, etc. In the olden days many a midwife’s shoulder or hip was utilised to support a leg. Thank God we have stopped doing that. But we all know that a change of position often does the trick. Releases that child from where he she has got stuck along the passage and then enabled he/she to be born. Lithotomy is just one of those positions. Yes, I have seen it work really well and NO, I would not advocate it as a first response but it is just a tool. Maybe overused in America, so women will see it on TV but a midwife should have all the tools in his or her armoury to assist the woman. Especially if by doing so she avoids an instrumental delivery.

Number 13: ‘If you think this is painful (a comment on so called latent phase of labour), just wait until ‘labour’ starts.
I agree this appears like a sad comment for a professional to make, but the purpose I am sure was to try and help the woman understand a little that she may have a long way to go. The conversation should have continued as to how to help her in her current state of pain, to acknowledge this point in order to assist her to move on to the next. Often midwives who have gone through labour themselves say these things, like the woman’s friends or her mother might in a kind of camaraderie. Yes, it might not be the most professional thing to say.

Number 14: ‘it’s too early for gas an air’.
Again I find the presence of this comment in your list very strange. You appear from the writings in your blog and on twitter to come from a standpoint of low tech, low intervention midwifery yet you challenge a midwife for saying “it’s too early for gas and air”. Surely you should be applauding her for trying to assist a woman to have a birth without medication if at all possible if that is what the woman has stated she wants.
Are you really saying that a woman should have what she wants whenever she wants it, that the professional has no place to have an opinion as to why that may or may not be a good idea at that time.
Why on earth have we been trained to such a high level if we just say of course yes I will go and get it. See epidural section. I think women want us to have an opinion. They want to trust their carer to work with them for the best outcome. I think your list is again just scaring women. Take it from me if you really want your gas and air you will get it.

Number 15: with fingers in the woman’s Vagina: ‘RELAX’!
Now again. After nearly thirty years as a midwife I understand having a vaginal examination is sometimes very difficult for the woman to have performed on them. I can honestly say from both sides of the fence it is not the easiest procedure. You try and explain what you are doing, you help the woman breathe beforehand, but sometimes you achieve a slight entry and then she has vaginismus. Her vagina clamps down on your fingers and it is difficult for all concerned.
At this point if you don’t say “relax” neither you nor she will escape unscathed. This is sometimes a word that is needed to be said. This is an example of a midwife working with the woman not against her. To withdraw and then insert again would for me to be more traumatic.

Number 16: ‘just pop on the bed, I’m going to examine you ‘down there’. Think this is really a repeat of apparent issues in 9 and 15. Please read my responses.

Number 17: ‘chin on your chest, hold your breath and with the next contraction…PUUUUUUSH’! This should STOP now.
You are correct the evidence is plain for all to see and has been there over for ten years that this type of pushing as a routine should be outlawed. Encouraging the woman to push as her body is telling her to, is the way to go.
But again I say the midwife has to have all the tools at her disposal and if the mother has pushed in every which way but loose, sometimes, just sometimes, advocating this for a short time can focus the mother on the job in hand and the baby will be born.
Like a lot of things I am not advocating it’s routine use, but something that might be appropriate for that particular woman, in particular circumstances at that particular time. If you have no emergency team at your disposal you need all the tools in your box. Personally – alone at a home confinement with a fetal heart failing I used this to good effect to focus the mother on the emergency task in hand and the baby was born. No one is going to take this tool out of my personal midwifery box of delivery tricks to be used when appropriate.

@Biirthing4Blokes has said he is not going to enter a debate about the above. I accept and respect that but I just wanted to put another opinion out there. I welcome others thoughts and opinions.

But can we not work with mothers and midwives towards better physiological birth without pulling midwives and how they may practice apart. Except to say that all views are just views, yours (the reader) is the only one that really matters.


3 Responses to “Can midwives STOP shouting at other midwives”

  1. Hello again, just discovered your blog and may now have to read it all, really interesting!

    I have a question about point 11- how long ago was this stopped? Are there any papers research papers about it? I had the epidural turned off before pushing with my first (a while ago now) I was very happy with this as I wanted to be able to move around and feel what was going on. I was fine with the return of the pain initially but once it became apparent things weren’t going to plan and I was going to have a c section it became mind bendingly unbearable. I’ve always found this very interesting, it seems that I could cope with the pain while I thought it was useful but as soon I realised it was all pointless my perception of it completely changed.

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