Tag Archives: respect

Radical Midwifery on the Road

?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????According to the Association of Radical Midwives (ARM)  “In the mid 70s, the majority of pregnant women in UK had labour induced by artificial rupture of membranes (ARM) around the date they were “due”. These initials were used when the group needed a name, using the dictionary definition of “radical”, (roots, origins, basics, etc.) which aptly described the basic midwifery skills which they hoped to revive.”

In this spirit I offer a grass roots midwifery information service to women. I am an Independent Midwife, and as such I provide total midwifery care for women and their families, but the numbers I care for are small, and every woman needs good information. I’ve always served women by giving free information by telephone, and running a local ARM group, but again the numbers are limited, and so is my time. But I feel a huge need to pass on my knowledge of maternity rights and choices to women who may not even know that they have a choice.

Am I saying that the NHS is not giving women enough information or choice? No.

Am I saying women are unable to find out this information for themselves?  Certainly not.

Pregnant women just don’t know what they don’t know. First – time mums may, or may not have read widely, they may, or may not have a relationship with a known NHS midwife, and the midwife may be too short of time, experience or knowledge herself to be able to help each individual.  Without adequate information about choices in pregnancy the woman may feel she has no choice, and if things don’t go to plan, she may feel things were done to her without her fully informed consent. Feeling disempowered or not understanding why things were done to you in childbirth, can contribute to postnatal depression. After a poor experience women often look for further information and support to prevent the same happening in subsequent pregnancies.

2541987300_7cf0e2543a_mAs an Independent midwife many of my clients come seeking truly unbiased midwifery information, so they can feel empowered in their current pregnancy. Some have suffered previous birth trauma and wish to avoid similar happening again. But why wait until the second or subsequent pregnancy to get a positive birth experience? The first experience of birth is likely to be the most challenging, so it is important that we as midwives know how to serve you best. Unless you tell us what would help, or hinder you in labour, we will not know. Unless you know your rights and the choices available to you, you will not be able to instruct us in providing the right kind of care for you.

This is where writing birth preferences comes in useful. As an NHS midwife I would meet someone (often for the first time) in labour, and have to discuss all the pros and cons of different birth choices. I  don’t mind explaining at all, but Labour is not the right time to be engaging the thinking part of a woman’s brain!

  • Educate yourselves, know your rights and choices before labour starts.
  • Write your birth preferences down. Discuss them with your birth supporters before labour, and share them with your midwife when labour is underway.
  • If you don’t know why a course of treatment or an intervention is being suggested then please ask.
  • If you don’t understand or don’t like the answer then ask someone else.

The Association for the Improvement in Maternity Services (AIMS) are a great resource for anyone having difficulty getting support for their birth choices. AIMS have a booklet entitled “Am I Allowed?” and all over it’s cover it has the word YES. Nothing can be done to you without your informed consent. If it has not been explained to you fully, you cannot make an informed choice. Please buy this book if nothing else (order from website, under “publications”).

Read also Mary Cronk’s assertiveness phrases and practice them in front of a mirror.

Birth Rights is a new organisation founded by a human rights lawyer. The website contains useful fact sheets on rights in childbirth.

The birth bus
The birth bus

 

If you live local to me then find out when I am next holding a midwifery clinic in my Birth Bus (campervan). I park at various locations locally, to give information and answer queries about rights and choices. Just text or email me for dates and venues. These do vary according to my midwifery caseload.

Remember that knowledge is power, and you don’t know what you don’t know- BUT you can always find out and ask WHY?

 

 

 

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

 

Copyright and the sharing of information

After an awkward issue arose between some midwifery colleagues over use of each other’s materials without consent I was prompted to write this page.

I believe all information is knowledge, knowledge is power and therefore should be shared to empower women. All information contained in this blog is my original work, from knowledge amassed throughout my midwifery career. I have worked very hard and am proud of the work I have done, so have marked photos, artwork and text as copyright Birth Joy Ltd(c). When I have used someone else’s material I will credit them in the text. I respectfully request that you do likewise. Please pass on information from my website but please remember to quote the origins of your information out of respect.

Photos are copyright to the photographer. I am very lucky that when I’ve taken birth photos, some women have given me permission to use these for teaching purposes, others have let me use their photos on my website. Some have allowed me to share with other midwives and one allowed publication in a midwifery text book. Many women have not, and I respect their right to do so.

For more information on copyright see this useful website.

“Am I allowed?”

A woman this week asked me one of the things that make me want to get on my soapbox about assertiveness and women’s rights.  What she said was “are you allowed to give birth to a breech baby?” My response, as ever, to this type of question is “it you who allows or disallows your care providers to do anything to you or your baby. Nothing can be done to you or your baby at home or in a hospital setting, without your consent. You are a mentally competent adult making rational decisions about your care, and you, more than anyone, has the best interests of your baby at the foremost in your mind”.

The Nursing and Midwifery Council (NMC), that govern all practicing midwives, provide information to midwives and nurses on the issue of consent:

“Legally, a competent adult can either give or refuse consent to treatment, even if that refusal may result in harm or death to him or herself. Nurses and midwives must respect their refusal just as much as they would their consent”.

The problem may lie with the allocation of power and responsibility in maternity care. Midwives and doctors are in a uniquely privileged position to be able to serve women at such a vulnerable time in their lives. We train long and hard to amass knowledge to help those we care for, but we should not use this to control or coerce women into what we think they should do. We are after all “Professional Servants” (Mary Cronk). We are there to serve the families we care for, but it is also our professional duty to inform them of any risks associated with their choices. The Nursing and Midwifery council (which regulates all midwives and nurses) has rules and codes of conduct advising us how to support our clients such as:

1. You must treat people as individuals and respect their dignity

2. You must not discriminate in any way against those in your care

3. You must treat people kindly and considerately

4. You must act as an advocate for those in your care, helping them to access relevant health and social care, information and support

5. You must respect people’s right to confidentiality.

6. You must ensure people are informed about how and why information is shared by those who will be providing their care.

7. You must disclose information if you believe someone may be at risk of harm, in line with the law of the country in which you are practising.

8. You must listen to the people in your care and respond to their concerns and preferences.

9. You must support people in caring for themselves to improve and maintain their health

10. You must recognise and respect the contribution that people make to their own care and wellbeing.

11. You must make arrangements to meet people’s language and communication needs.

12. You must share with people, in a way they can understand, the information they want or need to know about their health.

Point number 2 was obviously not read or understood by midwives who attended a woman’s home birth. The woman was from a particular religious group and her partner was from a different ethnic group. The woman phoned me as a result of midwife harassment in her current pregnancy, and in telling me her previous birth experiences said the midwives at one of her previous births had made racist remarks! I was livid and asked if she had complained – no she hadn’t! this is so wrong on so many levels I don’t know where to start! Harassing heavily pregnant women, and going against their wishes in labour is not acceptable but racism from a so called professional is a disciplinary offence. I gave the woman information and advice to make written complaints about current and previous problems, and gave her AIMS contact details.

Another part of our rules concerns consent:

13. You must ensure that you gain consent before you begin any treatment or care.

14. You must respect and support people’s rights to accept or decline treatment and care.

15. You must uphold people’s rights to be fully involved in decisions about their care. 

16. You must be aware of the legislation regarding mental capacity, ensuring that people who lack capacity remain at the centre of decision making and are fully safeguarded.

17. You must be able to demonstrate that you have acted in someone’s best interests if you have provided care in an emergency.

Whether your care provider will like or dislike your choices should be no concern of yours. I personally don’t like junk food, but understand that some people know the risks of consuming it, and still chose to do so. I may offer education about the risks, but wouldn’t dream of telling people not to do it just because I don’t like it myself. This applies to many areas of midwifery care, for example if you are told you are not allowed to give birth at home it would be good to ask if there are specific risks you need to be aware of, before thanking your health professional for their opinion, informing them that you will consider what they’ve said very carefully and let them know you will let them know your decision in due course (Taken from Mary Cronk’s assertiveness phrases). Consider how your care provider would actually be able to force you to do anything against your will (sadly, women have informed me of social services being used as a threat in some circumstances!).

REMEMBER: You do not have to ask permission to do anything which concerns your own body or your baby. Politely question your caregivers, do your own research then take responsibility for your choices! Your body, your baby, your choice!

See also:

Mary Cronk’s assertiveness comments on Angela Horn’s great homebirth website

AIMS the Association for the Improvement in Marternity Services has a great website and provides telephone support for anyone having trouble finding good maternity care. Please consider becoming a member or making a donation to their good work. x

All rights reserved. Copyright Birth Joy 2011 (C)


Breech Birth

Breech birthBreech birth is a very complex subject which needs in depth discussion with your care provider. I am lucky to have worked with one of the UK’s most experienced breech birth midwives, Mary Cronk, learning what I can about these unusual, but not abnormal  presentations. I have attended several breech births and taught alongside Mary Cronk, and Shawn Walker. I am happy to provide information and birth support for those carrying a breech presenting baby.

The Breech Birth Network run study days for health professionals and others wishing to learn more about spontaneous breech birth. This is a different set of skills to those needed to “Deliver” a breech baby which is a hands-on medical technique. Spontaneous breech birth is a hands off birth which can be facilitated by experienced midwives. The Royal College of Midwives consider this a normal type of birth.

Although breech is a normal presentation it carries additional risks compared with a head down birth. Breech babies are often born swiftly and spontaneously, but sometimes manouvers or surgery are needed to ensure baby is born safely. For this reason I recommend hospital birth with experienced care providers for breech presenting babies.

There are many things you can do to encourage a breech baby to turn see the brilliant spinning babies  website or the very funny pregnant chicken blog. The majority of babies who present as breech in pregnancy will turn head down by 36/37 weeks. If baby has not turned by 36/37 weeks of pregnancy you may be offered an External Cephalic Version (ECV) in hospital.

This ECV video  shows the technique used. The success rates (aprox 50%) vary with practitioner, whether it is your first baby, type of breech, how much fluid, size of baby etc. There is a small risk (1 in 200) of the baby becoming distressed during the procedure and needing immediate delivery by caesarean. More information is available here.

Breech babies can of course be born vaginally, but some doctors recommend caesarean surgery to deliver breech babies. Those doctors are probably basing their recommendation on the flawed Hannah trial (also called the Term Breech Trial or TBT) results. The TBT study seemed to indicate that babies born vaginally had worse outcomes than those born by caesarean, but when the outcomes were looked at 2 years later there were no differences in outcomes for the babies, but there are differences for the mother recovering from abdominal surgery. There have been many studies since, such as the PREMODA study (reported on at the 2012 breech birth conference) which show no differences in outcomes for breech babies born vaginally or by caesarean section. It is very important that you have a skilled midwife or doctor caring for you whichever type of birth you have.

The information and criteria which doctors use to determine who is a good candidate for sucessful vaginal birth can be found here. Please bear in mind that this green top guideline was published in 2006 and there has been lots of research done since then! I attended the International Breech Birth Conference in Washington DC in November 2012 and am eagerly awaiting the data soon to be published by Dr Frank Louven and his team in Frankfurt. See more information from the conference in Dr Rixa Freeze’s fantastic blog here.

See beautiful breech birth videos here:

A first baby born Frank Breech at home. Attended by a gentle doctor, this is a good illustration of spontaneous breech birth. The doctor does use a manouvre to help the baby’s head be born, and the baby doesn’t breathe immediately (this is fairly typical of breech born babies). You will notice how the doctor wisely does not cut the umbilical cord and how baby just requires stimulation to start breathing within a minute. Click here

A wonderful video of breech birth at home in water. It is the woman’s 4th baby and I can’t help wondering if baby would have got herself out sooner if the mother was in the supine position so buoyancy would have lifted baby’s body? The reverse of dry land breech birth, when the mother is on all fours and the baby descends aided by gravity. Anyway it’s a beautiful birth and a lesson to midwives that babies play an active part in the birth process.  You tube beautiful breech waterbirth

Another you tube film of planned breech birth at home clearly illustrating baby lifting her legs to flex her head (necessary for birth of the aftercoming head). It also shows how quickly breech babies can be born (this is the woman’s third baby), the midwife makes a very good catch of this little one! click on link Breech homebirth

There is also a lovely DVD you can buy which tells one woman’s story of deciding which birth was right for her and her baby. its called A Breech in The System. See the trailer here  and order your copy here

Of course I’m not saying all babies can, or should be born vaginally, but many can, and women should be given balanced information so they can make informed decisions about their care.

Delayed cord clamping is a much kinder transition for the newborn baby

Cutting the baby’s umbilical cord is a ritual repeated unthinkingly by many doctors and midwives every day. Please educate yourself about the potential harm that could be caused for the baby by doing this.

In the 1980’s I was taught to feel for the umbilical cord around the baby’s neck, once the head was born, and to cut it if it was tight to facilitate delivery. I realise there were so many things wrong with this practice now. What if we cut a cord and then have a shoulder dystocia? We have effectively cut the baby’s lifeline. I don’t think many practitioners do this now. I certainly do not feel for nuchal cords as babies can be born, even when the cord is tight. The somersault manouver  can be used to keep baby close to the mother whilst the cord is untangled.

The brilliant midwife thinking blog highlights the dangers of premature cord clamping if a baby needs help to start breathing. Basically when the baby is born a significant amount of his blood is still in the placenta. After birth that blood is needed to perfuse the baby’s respiritory system, enabling him to transition to breathing air for the first time. If a baby is slow to breathe but has a good heatbeat he is still receiving oxygenated blood through his cord if it remains intact.

Some women like to keep the cord intact in the form of a lotus birth. Aida’s birth and lotus birth was filmed, and illustrates how not cutting the baby’s cord helps when her baby needs help to start breathing.

Here is a 7 minute film with good, common sense advice about not cutting baby’s cord immediately after birth. This film has brief images of a woman’s breast and nipple as she is with her newborn baby as his cord is cut and as he crawls to the breast to self-attachment. This process, called Self-Attachment and/or Breast Crawl is becoming known now as a very critical part of human development that has been disrupted by modern, medicalized birth. Click to view: We can be much kinder

Penny Simkin gives a visual aid teaching session on the subject of how much of baby’s blood is still in the placenta if we cut the cord too soon after birth. here

Robim Lim explains the importance of not clamping or cutting a newborn’s umbilical cord here:
https://www.youtube.com/watch?v=SwvRUrn0p90&feature=player_embedded