The promotion of normal birth, within a framework of watchful readiness to intervene if needed, is a fundamental duty of care of all midwives. The Definition of the midwife, a core document of the International Confederation of Midwives, states that the midwife's care "includes preventative measures, the promotion of normal birth, the detection of complications ..." (ICM 2005, emphasis added)
In this respect, a midwife is not free to support the 'every woman, every choice' slogan of our leading consumer and midwife advocacy organisation, Maternity Coalition. Every 'choice' includes caesarean, induction, epidural ... the works ... on demand. The midwife who is practising authentic midwifery will act in such a way that enables a woman to accept and embrace her birthing strength, rather than cower and demand that her body be numbed and her baby removed like an unwanted growth.
Wishy-washy notions of choice in maternity care abound in our society. Paradoxically the one choice that is difficult to access in the developed world, including our land of Oz, is normal birth. I think there are many reasons for this, including de-skilling of the midwifery workforce, medical control of the birthing continuum, and medical oversight of all things maternity. It is unusual today to find a midwife in mainstream care, or medical practitioner who has a commitment to promoting normal birth, coupled with the skill to work in harmony with hormonally mediated natural processes. Instead, the reliance is on machines, drugs, and surgery.
A woman phoned me the other day to talk about engaging a midwife who would accompany her for birth in a private hospital.
well prepared as far as all the standard childbirth education classes are concerned,
and pretty excited about having a baby.
BTW, hubby is petrified! Not likely to be much support ...
I willingly launched into an explanation of what I or another independent midwife could offer in such a situation. I explained why it's important to trust your baby and your body ... and why we encourage women to use water and position and massage ... in learning to work with the pain of labour.
"I'm not really concerned about drugs. But a friend of mine had a baby recently and her doctor put her legs in stirrups, and I would prefer not to have that. I want someone who can tell me I don't need to have stirrups."
[OK! How to answer that one? Stirrups may have been a good idea in that particular birth.]
But, if you have the drugs, you may not be able to be active. You know narcotics are dangerous drugs, don't you? You know epidural anaesthesia is a pretty major medical procedure, with real risks, don't you? And the narcotics and anaesthetics pass to your baby ...
I do hope this woman has found someone who will help her to avoid the indignity of stirrups - to have the birth of her choosing. I don't think she is looking for a midwife.