Thursday, April 25, 2013

Making the bed

I drove through crisp Autumn air, under blue sky, to visit the mother and her baby boy who was just 24 hours old.

Within minutes of laying eyes on them, and without touching either, I was satisfied that all was as it should be.  With early morning light filtering onto the bed, I noticed that the baby was sleeping quietly in his mother's arms; that his skin was a healthy pink; that his mother had a confident, oxytocin-induced smile.  A few questions confirmed my assessment: mother's blood loss was minimal; she was eating and drinking well; passing urine without difficulty; she had slept a little, and her baby was eagerly taking the breast.

It's difficult to describe the deep thankfulness that I feel as I witness the normality of birth.  Much of the preparation and discussion prior to the birth focus on what would happen if complications or difficulties arise in labour, or if the baby's condition at birth is not good.  The equipment and supplies I bring to the birth require skill and competence in assessment, resuscitation, and midwifery management of sometimes unpredictable, rare events.

Although the assessment was made with the confidence that comes from years of professional learning, at this postnatal visit I did not need to take any professional action.  I asked the mother if she had had breakfast yet, would she like a cup of tea?  Yes.  So the midwifery student went to the kitchen to prepare it.  We reflected on the exhaustion a mother feels after even an 'uneventful' spontaneous birth.  We laughed at the though that the father is often more spent!  We pondered the help given by the warm water in the birth pool; that the softness of the pool's inflated sides gave the mother a lovely soft surface upon which to drape her upper body in the most demanding part of the labour.  We chatted about the responses of the baby's brother and sister, building up a set of unique and very personal memories of this unique and very personal event.

I had noticed a small splatter of blood on the bed sheet.  "Would you like us to make the bed for you, with clean sheets?" I asked.

And while mother ate her toast and drank the hot herbal brew, we changed the sheets.

Making beds happens each morning in hospital, and it's not something that I would write about in a midwifery context.  Yet as we went away from this beautiful homeborn baby and his beautiful mother, I thought that making the bed was the main professional act that we had accomplished in that visit.

Sunday, April 21, 2013

Informed decision making

As I take a few moments to reflect on the past couple of weeks, I am trying to pull together the issues in the world of maternity, and highlight anything that needs critical comment from yours truly. 
no explanation required!

The AMA's new Position Statement on Maternal Decision-Making is worth focusing on for a few moments.  My initial comments are at the MidwivesVictoria blog.

The topic of  'decision-making' in situations of known risk - particularly breech and twin births - is being discussed constantly by mothers, via social media.  One group, linked to BBANZ, that I belong to, often has messages from women who are torn between options that appear to be poles apart - the elective caesarean, or the unpredictable, un-knowable journey of spontaneous natural birth.  Another option comes up from time to time, especially for women who have financial reserves + private health insurance and can access a private maternity hospital and a sympathetic obstetrician (that's a big IF), that the doctor sets out the 'rules'.

"OK, here's the plan.  You come to hospital as soon as your labour starts and ..."

These few obstetricians, well known for pushing boundaries, set down what they believe is the safest course of action in the given situation.  They (understandably) want good outcomes, as do the women in their care.   They are able to achieve good outcomes if they recognise the time when it is best to depart from the spontaneous natural process, and take decisive action without delay.  This may mean delivering a baby with forceps or ventouse, or moving to the operating theatre for caesarean surgery.  The women understand the rules, as they have been discussed, and are expected to submit to them.

In many cases, this is an acceptable, and successful exchange.  Yet it is medical dominance, with a touch of class, Melbourne style. 

When the doctor enunciates the plan, and receives a compliant nod from the woman, there is a big exchange of trust.  There is not likely to be any subsequent *informed* decision-making by the woman, because she has entered a 'plan' with her doctor.

This phenomenon disturbs me as much as any other form of medical dominance, whether it is carried out in a private arrangement, or in the less refined tactics that we often experience in public hospitals.  The woman's ability to bear and nurture her child is a basic ability that requires huge respect.  I would like to suggest that the AMA position on maternal decision-making is not worth the paper it is written on, unless the protection of the woman's own natural processes in childbearing, including spontaneous onset of labour, giving birth, and breastfeeding, are held in high priority, and not by-passed without a valid reason.

Saturday, April 06, 2013

Welcoming the newest member of the family

Thanks to Bec and Al for this picture

In the past few weeks, in writing this blog, I have delved into personal memories and thoughts, preparing for and anticipating a particular birth.   I expect this fact has been clear to many of my readers; many being women with whom I have shared that deep and wonderous journey.  Although I usually write in an impersonal way of 'the woman' and 'the midwife', so much of my knowledge of midwifery is inextricably linked to my own experiences in childbearing and mothering - intensely personal.  In many ways, I am the woman; I am the midwife; I am even the child.

Tonight as I sit at my computer, thinking of how I can express the wonder that is welling up in my heart, I hear the brief small cry of the wee one in another room of our home.  I know she will soon be transported back into that milky dream world, her little body being nourished by the abundant supply that is freely given.

I treasure the memory of the first view of her beautiful face, and the ecstatic glow on her mother's face, as we three - mother, child, and midwife - three generations of a family - shared in the moment of birth.  I look at her, and wonder what her life will bring.  I practice using her name.  This is a new name; a new person who I will treasure and pray for, for the rest of my days.  I look at her features; the colour of her hair, the exquisite tone of her skin, the wonderfully made body.  I observe the deep bond that is apparent in her mother, her father, and her 'big' brother; instinctive and intentional behaviours that protect the new child within a family unit.  I have so much to be thankful for.

Yet even as I am awash in the joy and newness of new birth, I know there are times when even our best is insufficient.  Times when a baby cries with tummy ache, or when a mother is overwhelmed with tiredness.  Times when the needs of other children must be attended to.  Times when we seek medical expertise for health problems that can sap us of energy.  Times when our best is simply not good enough.

An abiding lesson that I have learnt from my contact over the years with newly born babies; my own children, the children of my friends and clients, and my grand-children, is the picture of the baby's craving for mother's milk.  This analogy was drawn by Peter: "Like newborn infants, long for the pure, spiritual milk, so that by it you may grow."  (1Peter 2:2) 

In the same way as the newborn infant craves her mother's milk, and cannot be satisfied without it, the skill of the midwife is to work in harmony with this primal natural process.