Saturday, April 02, 2011

Midwifery knowledge

click to enlarge

One of my current projects is to lead the review of the Maternity Coalition INFOSHEETs - see the APMA blog for more detail. I also headed the previous working group which put together these information sheets in about 2006. Our aim was, and is, to provide reliable information that supports informed decision making for women and midwives who seek to promote normal physiological birthing, and to work in harmony with the natural processes in pregnancy, birth the perinatal period.

It's a big project, and the working group is asked to consider current evidence and practice, and check the information provided on the INFOSHEET. Recently we completed the first to be reviewed, A Baby's Transition From the Womb to the Outside World, (see jpeg file above) and are now working on The Third Stage of labour. Unfortunately I do not know how to link a .pdf file to this blog, so if you would like a copy of the revised document emailed, please send a request to me joy[at]aitex.com.au

A midwife commented to me that "what we need to say loud and clear is that we use Midwifery Knowledge which is very different and definitely not less than obstetric and surgical belief."

Yes, I (sort of) agree – but remember that ‘midwifery knowledge’ is not well defined, as is also the case with some 'medical' practices, or 'alternative health' knowledge. If our knowledge embraces truth, it's true regardless of whose it is. Midwifery knowledge should not belong to midwives only - it should be common knowledge.

If 'midwifery knowledge' is to be accepted as reliable it has to be well articulated and put out to scrutiny. I believe that’s what these infosheets are trying to do.

Management (or non-management) of the Third Stage (S3) and the time interval from birth to clamping of the umbilical cord are two examples of what I would call 'midwifery knowledge', compared with rituals that have been widely accepted by modern obstetrics and midwifery, without any evidence to support them.

I am excited to see changes in the mainstream maternity attitudes to time of clamping the cord, and protocols for active management of S3. This has been in response to evidence, just as the virtual mandating of active management of S3 in hospitals was in response to flawed evidence.

We must continually engage in critical review of all that we do. Many hospital ‘guidelines’ require [that’s an oxymoron I know] immediate clamping of the cord, and none of them that I have seen have a reference linked to it.

Watch the APMA blog in the coming weeks for developments in the revision of this INFOSHEET. This is all voluntary work, and it is put out in the public domain to encourage involvement of anyone who is interested.

Today’s Age newspaper has an article about a research program for which ethics approval is being sought for a cord blood trial, and the relationship between a baby receiving its own placental transfusion and cerebral palsy. There are many questions that this research, if well done, may begin to provide answers to. The proliferation of private facilities that collect and store cord blood, without any reliable evidence that the baby will benefit from it - and without any evidence that the baby has not been harmed by the withholding of that placental blood at the time of birth - is evidence that many parents have taken a punt on this issue.

Your comments are welcome.

No comments: