Monday, July 07, 2008

Expecting better days

Tonight I am feeling weary from a night out for a birth last night, but very hopeful that there is a trend towards better days for homebirth mothers and their families.

A couple of weeks ago a young woman and her man came to see me, and asked me to accept a booking for homebirth, and the baby was due any day. This woman had not had any prenatal care, and did not know her blood group, or any of the other basic screening results that are usually done. There was no local GP who she could ask to do this work, and expect anything other than rejection.

I spoke to the clinical midwife specialist at the local hospital, Sunshine. The midwife was happy to support this woman, and guided her through making a booking at the hospital. The blood tests were done without any fuss. The blood group was Rh Negative, so the midwife prepared request slips and tubes. The baby was born beautifully, at home, last night. An hour after the birth I collected blood from the large venous sinuses on the fetal side of the placenta - the homebirth 'alternative' to cutting the cord immediately after birth to collect cord blood. [I must remember to write a blog on the undisturbed third stage of labour.] The hospital pathology department processed the blood samples, and the midwife organised the Anti-d immunoglobulin and paperwork for me to collect.

Any midwife reading this may wonder what's so special about all that? That's what is supposed to happen.

What we have experienced in this case is a seamless interface between independent midwifery practice and a public hospital. I am blogging because I am so pleased that it has happened this way.

We talk about 'woman centred' care; we talk about 'collaboration'; we talk about 'partnership' between the woman and the midwife. This care was 'woman centred' in that each time a decision point was reached and a need was identified it was simply and efficiently met. The care was collaborative - the hospital midwife and I collaborated in accessing a service that was appropriate, and that neither of us could provide independently. The care respected the partnership between my client and me, which was a new and fragile relationship, not the usual trust that is established during months of traveling together through the unpredictable terrain of pregnancy.

I have no idea if anyone who knows about Sunshine hospital will read this blog. It's a sprawling public hospital situated to the West of Melbourne, and it's not the maternity fashion centre. Yet Sunshine is a leader in offering midwives a new respect for our skill, and moving ahead with caseload midwifery practice. It's not a big step for the hospital to move a little further and offer homebirth.

In May I wrote a blog 'Waiting patiently', about a twin birth at the Royal Women's Hospital. This was another instance of cooperation and collaboration that I have experienced with a senior midwife employed by a large public hospital. I don't think I am wearing rose-tinted glasses. I think there is evidence of change, and I am expecting better days.


Lisa Barrett said...

Hi, I must the the WCH are excellent in this state for helping with anti D. I am always helped even when the client has no booking. I have also taken blood there when the client was booked at a different hospital and they were fine. I too think these are good signs that there is a spark of something better. It's just these small things that make the life of a homebirth midwife a little smoother.

Joy Johnston said...

Thanks for your comments Lisa (in South Australia). In Melbourne we usually arrange blood tests and anti-D through the local doctors. The public hospitals used to provide such support, but some years ago there were complaints to the public hospitals from GPs that they were losing business, so midwives were told we needed to ask women to go to GPs to organise the blood tests and anti-d. Some women are happy to do this and have good relationships with local doctors, while others have no local doctor, and this becomes another hurdle for them to negotiate.