Monthly Archives: January 2013

Birth keeper or Baby catcher?

I felt compelled to comment on a great blog my the brilliant Rebecca Wright today. It can be seen here entitled “Are you a birthkeeper? Then don’t catch babies.” She was commenting upon the language used by birth workers in a facebook post which said “because maternity care providers are not serving mothers’ needs, more doulas and non-medically trained supporters being called on to catch babies.” She made great comment about mothers being the ones who should catch their own babies and why.

I’d like to elaborate further on my comments here, as this is an interesting subject, and I didn’t want to fill Rebecca’s site with my ramblings.

I was privvy to a conversation last year about the midwife’s role, brought about by the looming end to legal independent midwifery care. One party said when Independent midwifery becomes illegal we will be doing what doulas do anyway. The other camp were vehermently defending the title of midwife and not wanting to be compared to the service a doula provides. The arguement got heated (as is the way with passionate women!), and it was mentioned that women dissatisfied with their maternity care were indeed employing doulas to attend their births. Further heated discussion about the legality of this followed.

This got me thinking about what Independent or Authentic midwives do at a birth. I’ve been very honest over the past few years, telling my clients that I won’t actually be delivering their baby, they will. In fact most of my time (between the nurturing/ loving type of things) is taken up writing notes and drinking tea. I need women to realise that its not like on telly where the doctor heroically swoops in at the last moment to pull the baby out. It is the woman’s body, love, sweat and pure determination which get the baby born.

Several years ago I noticed that some women reach down to receive their own babies at the point of birth, but some are ashamed to touch themselves “down there,” especially if they are being watched! As a student midwife I recall watching my mentor move a woman’s hand away so she herself could ‘do’ the “delivery”. I’ve never been very directive myself, and have learnt the most by observing what women do naturally. Some women need to be informed that catching their own baby is possible as the power has so often been taken away from them. Professionals sometimes forget that they are there to serve the needs of the mother and baby – and not tell her what to do! (another post brewing on the balance of power). I remember telling a friend pregnant with her second child that I thought she could catch her own baby, for a number of reasons. I had seen many women slow down the birth of their baby if it was coming quickly and others who protect their own body in this way, giving tissues time to stretch (after practicing 11+ years I have never seen anything worse than a second degree tear). My friend did catch her own baby and tells all her friends that they can too!

empowered birthI’ve been mulling over what it means to be a midwife, what Independent midwives can call themselves, and how they can still serve women after October this year. I’ve also been thinking about what difference there would be between what a doula or I could legally do at a birth. There is potential for several posts on this, so I’ll try to stick to the current theme.

As a midwife I know it is the woman’s baby and not mine. I’m sure he prefers his mothers touch to mine, and encourage women to receive their own babies. I’ve shied away from unessesary internal examinations, and refrain from telling women how, or when to push, because I have attended many births where the mother does something totally unexpected and it turns out brilliantly. I remember being present at a birth centre birth where I was the second midwife. The woman was in advanced labour and spontaneously pushing with her first baby . We were prevented from being nosey, birth coach midwives, as visibility in the room was poor. The lights were dimmed and the water was a little cloudy, so our torch light couldn’t penetrate the water. Despite our efforts with torch and mirrror we could see nothing. I was concerned that I wouldnt be able to help her prevent a tear if I couldnt see when to tell her to pant, or give smaller pushes. As she pushed she spontaneously reached down and told us that she could feel the baby advancing, and before long told us baby was emerging. She lifted the baby triumphantly to the surface knowing she had done it all herself! We examined her perineum a while later and she had no tears. I told myself that women can obvoiusly prevent tears better than I can with all my experience.

I cannot bear midwives or doulas who brag about their ‘catches’ or how many deliveries they’ve done. I’ve no idea how many births I’ve attended (although it must be several hundred by now), and feel that keeping numbers makes it into some unsavoury sort of competition (like notches on a bedpost), rather than a unique event in someone’s life! Its a shame this bad habit starts in midwifery training where students have to get 40 deliveries to qualify as a midwife. Its not about numbers, its about people. I fail to see what student midwives learn when they are shoved into rooms to deliver a baby at the last minute, without knowing the woman, just to get their numbers. It can’t be nice for the mother either.

Being an authentic midwife means having the wisdom to not do everything you’ve been taught to do. The past 10 years of practice have been about unlearning the medical model, and learning from women. I like to think of it as a reverse Ina May Gaskin midwifery journey. A journey back to basic loving care, and being a birth keeper for the women and babies I serve.

Last word from Rebecca Wright: “Not all doulas or midwives are birthkeepers, of course, but the essence to me of this concept is exactly what you express here: service to mothers and to birth. Birthkeeping (and authentic midwifery) to me is about holding mothers and babies at the centre of their own experience, bringing with us whatever skills or talents we possess that are needed in that space, but always with humility and discernment.”

Thank you Rebecca for fueling my fire. xx

 

2013 A New Era in Midwifery or Withdrawal of Women’s Childbirth Choices?

I original wrote this at the beginning of 2013 when Independent Midwifery was seriously under threat of becoming illegal if they failed to obtain professional indemnity insurance (PII) before 25th October 2013. At the 11th hour we have a glimmer of hope due to the hard work of Independent Midwives UK (IM UK). These dedicated midwives have failed to give up, and have found a workable insurance product. Whilst having compulsory insurance was not welcomed by every member of IM UK, it will soon be the only way of legally continuing to work as a midwife in the UK.

For the majority of women the loss of independent midwifery will make no difference to them as they’ve never even heard of Independent Midwives. Many are happy doing what everyone else does, not questioning their care providers, assuming health professionals will care for them when their time comes to give birth. Some may have a rude awakening as they find themselves in hospitals which are short staffed and therefore ill-equipped to care as well as they’d like. When women are denied their choice of birth at home due to staff shortages, or are not supported in their choices they may seek out an alternative. Birth trauma and caesarean rates rise each year, and women deserve choice in care provider and alternatives to the NHS model if needed .

Independent Midwives are fully qualified, Registered Midwives who have chosen to work outside the NHS to fully practice their midwifery skills. They are regulated like any other midwife, and provide one to one care for women during pregnancy, birth and up to 28 days postnatally. Unlike midwives that are employed by the NHS, Independent Midwives have not been able to purchase Professional Indenity Insurance (PII) since 1994. Since then Independent Midwives have practiced without insurance which means we are personally liable for any clinical negligence claim against us. This has not discouraged women from hiring Independent Midwives as they value the benefits of individualised care.

Independent Midwives provide one to one care for women. This type of working relationship allows women to get to know and trust the person who will be present at the birth of their child. Women really value this professional relationship, and midwives get a great deal of job satisfaction from working this way.

So why are they under threat of becoming illegal? Because a European directive has been passed which makes it compulsory for professionals allied to medicine (which includes osteopaths, chiropractors, midwives etc.) to have Professional Indemnity Insurance (PII). Our government decided to implement this in England this year, despite being informed that Independent Midwives cannot obtain PII due to being self employed. A deadline to have insurance was initially set for October 2013, but this has now been moved to February 2014. Nursing and midwifery council published this statement at the beginning of October. Without professional indemnity insurance Independent Midwives will not be legally be able to care for women in labour, although some may be able to provide antenatal and postnatal care. Independent Midwives will lose their livelihood and women will have less choice in childbirth.

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This is a human rights issue, as women will no longer be able to choose who cares for them throughout pregnancy and childbirth. Unlike other areas of healthcare, women will be denied the option of privately employing a health professional of their choice. This doesn’t sound too important for the majority of women, but it is very important for the women who do not have good NHS midwifery services in their area. Some women who’ve had previous caesareans would like to give birth at home, women who’s baby is in the breech position often have difficulty finding a midwife skilled in breech birth, women who’ve been scared or scarred by previous NHS experiences may like an alternative, some want to know there will be a midwife available for their homebirth, or just to know the midwife who will be caring for her. These women will be denied choice.

IM UK have been liaising with the government to implement our insurance but they are slow coming to our aid. See more about the campaign, donate or find out how you can help here.

So what choice will women have after February 2014 if the government does not help us implement our insurance? Women would then have the choice of NHS midwifery care, or no midwifery care. This worries many midwives, as although childbirth is normally a straightforward biological function, it can be advantageous to have a midwife present at times when a rare complication occurs. Of course women have the right to take responsibility for their birth and give birth unassisted, but this should be an informed descision, and not one made through lack of choice or fear of NHS care. But why should women have to give birth alone to guarantee a peaceful, uninterfered-with birth?

There is hope that women will demand one to one midwifery care be available to all, on the NHS. It worked in New Zealand so could it work here? There are small pockets of case loading midwives appearing such as one to one and neighbourhood midwives but not enough to care for all women who need them. If women are denied the choice of nothing other than NHS care there would be a possibility of an underground movement of illegal midwives, or unqualified birth attendants, called to attend birthing women. There are similar situations in parts of America where women seek alternatives to institutionalised care, and again I don’t condemn this if it is what women want. Would women be able to discern if an illegal midwife has been previously trained and qualified as a midwife, or if she is a doula? Would it matter to most women who opt out of NHS care? My fear is, that like other parts of the world, those who continue to answer women’s calls to be cared for in this way will be penalised for doing so. It may come in the form of fines, bad publicity, or as in Hungary, the imprisonment of midwives. But also that women may not know if they have fully qualified caring for them if they are deemed illegal.

Taking away women’s choice of legal birth carer will not stop women making choices, it will only encourage women to make alternative and possibly illegal choices.

 

For further information on Independent Midwives see Independent Midwives UK

For Information on childbirth rights and choices see the Association for the Improvement in Maternity Services (AIMS)