Saturday, February 23, 2008

[Photo: My niece Laura and her baby Elie, my husband Noel, and me, Joy]


Today I am being very practical, thinking about the weariness I feel after being out all night. This old grey 'mere' (French for 'mother') used to work night shifts in a hospital - nowadays she likes to spend the whole night in bed. And when in bed she prefers to sleep - something else that has become more elusive with the progressive whitening of the hair.

The other day I received a call at midnight, and headed out to the home in the hills. Jane (not her real name) was very pleased to be in labour, and was walking around and enjoying her early labour. After a while I lay down, but did not sleep. Labour became stronger from about four, and Jane gave birth to a beautiful healthy boy at about 6.30 in the morning. I went home and spent a few hours in bed before getting on with what I could of the day's work.

Was I really stronger 20 years ago, was it really any easier then, or am I just more willing to be honest about how I feel now? I have a memory of those night shifts in the maternity wards at the Women's and St George's Hospital in the 80s and 90s: fighting off sleep in the wee hours; the horrible exhaustion that I often felt as I collapsed into bed in the morning; the legs and feet that stayed cold for what seemed like hours. The interruption to the body's usual diurnal processes brought on jet lag for a few days every week.

Working through the night is never easy, yet it was a choice I made while our children were growing up. It gave me the option of being at home when they returned from school, and it seemed the best option at the time. I enjoyed the uncomplicated quietness of hospital life in the night. The only people there were those who needed to be there. There were no 'politics'. Everyone had a job to do, and got on with that job. Over time I developed confidence in working with the natural processes in birth, and as I learnt to be 'with woman' I became assured of my midwife identity.

Since I have been working independently I have truly appreciated the fact that I am no longer working night shifts. Even if every woman booked were to call me out at night it would only be a few nights in the month. I know that night is a time when many women labour spontaneously, and I accept the need to be called out at night.

I believe that the best way midwives can provide appropriate primary maternity care is to take caseloads - to enable women to face childbirth in partnership with a known and trusted midwife. There is no easy way around the issue of sleepless nights on the job - each midwife needs to find the best and most sustainable way she can do it. The world of managed care in obstetrics, in which labours are induced at a time that is considered convenient is not in the best interests of mother or baby. There is no safer way for most women than to labour spontaneously.

I do not ask women to delay calling me so that I can get more sleep. My commitment to each woman means that she is the one who determines the best time to invite me to be with her. I like to have a chat with women in the days before they labour, so that they are confident in their knowledge of their bodies, and confident in their relationship with me.

In recognising the importance of a one-to-one midwifery partnership, I need to balance that with the woman's need to be sure that her midwife can be replaced if that becomes necessary. It's a fine balance - one that midwives are addressing in group practices and specific backup arrangements.

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